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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..a1fecdd --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #64237 (https://www.gutenberg.org/ebooks/64237) 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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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 <a href="https://www.gutenberg.org">www.gutenberg.org</a>. 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. -</div> - -<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Title: Old Age Deferred</div> - -<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>The causes of old age and its postponement by hygienic and therapeutic measures</div> - -<div style='display:block; margin-top:1em; margin-bottom:1em; margin-left:2em; text-indent:-2em'>Author: Arnold Lorand</div> - -<div style='display:block; margin:1em 0'>Release Date: January 08, 2021 [eBook #64237]</div> - -<div style='display:block; margin:1em 0'>Language: English</div> - -<div style='display:block; margin:1em 0'>Character set encoding: UTF-8</div> - -<div style='display:block; margin-left:2em; text-indent:-2em'>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)</div> - -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK OLD AGE DEFERRED ***</div> - -<div class='figcenter id001'> -<img src='images/cover.jpg' alt='' class='ig001' /> -<div class='ic001'> -<p><span class='small'>The cover image was created by the transcriber and is placed in the public domain.</span></p> -</div> -</div> -<div class='pbb'> - <hr class='pb c000' /> -</div> -<div> - <span class='pageno' id='Page_I'>I</span> - <h1 class='c001'>Old Age Deferred<br /> <br /><span class='large'>THE CAUSES OF OLD AGE AND ITS POSTPONEMENT BY HYGIENIC AND THERAPEUTIC MEASURES</span></h1> -</div> -<div class='lg-container-r c002'> - <div class='linegroup'> - <div class='group'> - <div class='line'><span class='small'>Man does not die,</span></div> - <div class='line'><span class='small'>he kills himself.</span></div> - <div class='line'><span class='small'>—<i>Seneca</i></span></div> - </div> - </div> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='small'><span class='sc'>By</span></span></div> - <div><em class='gesperrt'><span class='large'>ARNOLD LORAND, M.D.</span></em></div> - <div class='c004'><em class='gesperrt'>FIFTH EDITION</em></div> - <div class='c000'>Translated, with additions, by the Author</div> - <div>from the Third German Edition</div> - </div> -</div> - -<p class='c005'> </p> -<div class='figcenter id002'> -<img src='images/publogo.jpg' alt='' class='ig001' /> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c004'> - <div>PHILADELPHIA</div> - <div>F. A. DAVIS COMPANY, <span class='sc'>Publishers</span></div> - <div>1920</div> - </div> -</div> - -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div><span class='pageno' id='Page_II'>II</span></div> -<div class='fs80'> - -<div class='nf-center-c0'> -<div class='nf-center c004'> - <div>──────────</div> - <div>COPYRIGHT, 1910</div> - <div>COPYRIGHT, 1916</div> - <div><span class='small'>BY</span></div> - <div>F. A. DAVIS COMPANY</div> - <div>───</div> - <div>Copyright, Great Britain. All Rights Reserved</div> - <div>──────────</div> - </div> -</div> - -<p class='c005'>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.</p> -<div class='lg-container-r c002'> - <div class='linegroup'> - <div class='group'> - <div class='line'>───────────</div> - <div class='line'>PRESS OF</div> - <div class='line'>F. A. DAVIS COMPANY</div> - <div class='line'>PHILADELPHIA, U.S.A.</div> - <div class='line'>───────────</div> - </div> - </div> -</div> - -</div> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_iii'>iii</span> - <h2 class='c006'>PREFACE TO NEW REVISED EDITION.</h2> -</div> -<p class='drop-capa0_25_0_7 c007'>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.</p> -<div class='c008'><span class='sc'>Dr. Arnold Lorand.</span></div> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_v'>v</span> - <h2 class='c006'>PREFACE.<br />──</h2> -</div> -<p class='c009'><span class='sc'>Whoever</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_vi'>vi</span>degeneration is amenable to treatment, just as are chronic diseases -in general.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Every one will admit that the subject treated in this work is -not an easy one. It might be urged also that its presentation -<span class='pageno' id='Page_vii'>vii</span>here is based on entirely novel lines, scientific literature on old -age being very scarce.</p> - -<p class='c010'>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.</p> -<div class='c011'><span class='sc'>Dr. Arnold Lorand.</span></div> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_ix'>ix</span> - <h2 class='c006'>CONTENTS.<br />───</h2> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER I.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'> </td> - <td class='c013'><span class='small'>PAGE</span></td> - </tr> - <tr> - <td class='c012'><span class='sc'>On the Appearance of Symptoms of Old Age in Young Persons</span></td> - <td class='c013'><a href='#ch01'>1</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER II.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Agencies which Govern our External Appearance and the Nutrition of the Tissues</span></td> - <td class='c013'><a href='#ch02'>11</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER III.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Agencies which Govern Immunity Against Infections and Intoxications—The Origin of Fever</span></td> - <td class='c013'><a href='#ch03'>21</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER IV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Agencies that Govern the Condition of the Nervous System and Mentality</span></td> - <td class='c013'><a href='#ch04'>35</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER V.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Influence of the Sexual Glands upon Vitality and Long Life</span></td> - <td class='c013'><a href='#ch05'>45</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER VI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Heredity and Longevity</span></td> - <td class='c013'><a href='#ch06'>55</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER VII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Means which can Help us to Determine the Probable Duration of Life</span></td> - <td class='c013'><a href='#ch07'>64</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER VIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Causation of Old Age</span></td> - <td class='c013'><a href='#ch08'>90</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER IX.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>The Rational Prevention of Premature Old Age and the Treatment of Old Age</span></td> - <td class='c013'><a href='#ch09'>114</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='pageno' id='Page_x'>x</span>CHAPTER X.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>The Destruction and Elimination of Toxic Products from the Body and Hygienic Measures for the Improvement of these Functions</span></td> - <td class='c013'><a href='#ch10'>134</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Destruction of Poisonous Products Through the Thyroid and Parathyroid Glands</span></td> - <td class='c013'><a href='#ch11'>138</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Thyroid Gland</span></td> - <td class='c013'><a href='#ch12'>145</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>The Destruction of Toxic Products by the Liver and the Improvement of its Protective Functions</span></td> - <td class='c013'><a href='#ch13'>149</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XIV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>The Hygiene of the Liver</span></td> - <td class='c013'><a href='#ch14'>155</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Destruction of Toxic Products by the Adrenals</span></td> - <td class='c013'><a href='#ch15'>159</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XVI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Adrenals and of the Circulatory System—A Few Remarks on the Cause, Prevention, and Treatment of Arteriosclerosis</span></td> - <td class='c013'><a href='#ch16'>164</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XVII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>The Elimination of Toxic Products Through the Intestines and the Improvement of This Function</span></td> - <td class='c013'><a href='#ch17'>170</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XVIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Prevention and Treatment of Habitual Constipation</span></td> - <td class='c013'><a href='#ch18'>175</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XIX.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Intestines</span></td> - <td class='c013'><a href='#ch19'>182</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XX.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Intestines—A Few Remarks on the Cause and Prevention of Appendicitis</span></td> - <td class='c013'><a href='#ch20'>192</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Elimination of Toxic Products Through the Kidneys</span></td> - <td class='c013'><a href='#ch21'>197</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='pageno' id='Page_xi'>xi</span>CHAPTER XXII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Kidneys, and the Prevention of Renal Disease</span></td> - <td class='c013'><a href='#ch22'>203</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Elimination of Toxic Products Through the Skin</span></td> - <td class='c013'><a href='#ch23'>209</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXIV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>The Hygiene of the Skin—Air Baths</span></td> - <td class='c013'><a href='#ch24'>215</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Rational Clothing</span></td> - <td class='c013'><a href='#ch25'>219</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXVI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Improved Hygiene of the Skin and Kidneys through Bathing—Foot-baths</span></td> - <td class='c013'><a href='#ch26'>231</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXVII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Skin and Kidneys by Means of Perspiration</span></td> - <td class='c013'><a href='#ch27'>237</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXVIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Exercise, Swedish Gymnastics—Massage—Sport, and Walking and Running Exercise</span></td> - <td class='c013'><a href='#ch28'>244</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXIX.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>A Few Remarks on Cold Feet—Their Cause and Treatment</span></td> - <td class='c013'><a href='#ch29'>252</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXX.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Benefits of Sunlight</span></td> - <td class='c013'><a href='#ch30'>255</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXXI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Advantages of an Open Air Life and of Breathing Exercises</span></td> - <td class='c013'><a href='#ch31'>262</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXXII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Dangers of Living in Confined and Ill-Ventilated Quarters</span></td> - <td class='c013'><a href='#ch32'>271</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXXIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of Artificial Heating—the Dangers of Heat by Steam and a Few Hints about their Prevention</span></td> - <td class='c013'><a href='#ch33'>275</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXXIV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Food Hygiene—General Remarks</span></td> - <td class='c013'><a href='#ch34'>280</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='pageno' id='Page_xii'>xii</span>CHAPTER XXXV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Proteid Food, Animal Food, Meat, Fish, Eggs, Milk, etc.</span></td> - <td class='c013'><a href='#ch35'>294</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXXVI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Carbohydrates and Fats, and the Great Advantages of Vegetables and Fruit</span></td> - <td class='c013'><a href='#ch36'>301</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXXVII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Advantages and Disadvantages of a Vegetarian Diet</span></td> - <td class='c013'><a href='#ch37'>309</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXXVIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Dangers of a Too Abundant Meat Diet—A Few Hints on the Dietetics of Meat</span></td> - <td class='c013'><a href='#ch38'>317</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XXXIX.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Great Advantages of Much Milk in the Diet for the Prevention and Treatment of Old Age</span></td> - <td class='c013'><a href='#ch39'>325</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XL.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Blood as an Article of Food Containing Iron and Animal Extracts—Sausages and Blood Puddings</span></td> - <td class='c013'><a href='#ch40'>333</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XLI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Some Remarks on the Hygiene of Eating—How to Obtain an Appetite—On Mastication</span></td> - <td class='c013'><a href='#ch41'>339</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XLII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Uses of Small Doses, and the Deleterious Action of Large Quantities of Alcohol</span></td> - <td class='c013'><a href='#ch42'>347</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XLIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Some Remarks on the Causes and Prevention of the Alcohol Habit</span></td> - <td class='c013'><a href='#ch43'>356</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XLIV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Other Stimulants—Tea, Coffee, Cocoa, Tobacco: Their Merits and Disadvantages</span></td> - <td class='c013'><a href='#ch44'>362</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XLV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Sleep, and Its Importance in Ridding the Body of Toxic Products</span></td> - <td class='c013'><a href='#ch45'>368</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='pageno' id='Page_xiii'>xiii</span>CHAPTER XLVI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Causation of Sleep, Sleepiness, and Insomnia</span></td> - <td class='c013'><a href='#ch46'>372</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XLVII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of Sleep—Prevention of Insomnia</span></td> - <td class='c013'><a href='#ch47'>377</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XLVIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>The Treatment of Sleepiness and Insomnia</span></td> - <td class='c013'><a href='#ch48'>383</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER XLIX.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Sexual Glands—the Dangers of Sexual Overactivity and of Total Sexual Abstinence</span></td> - <td class='c013'><a href='#ch49'>389</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER L.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On Married Life as an Important Means for Prolonging Life</span></td> - <td class='c013'><a href='#ch50'>400</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER LI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Mind—Emotions and Worry as Causes of Old Age</span></td> - <td class='c013'><a href='#ch51'>404</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER LII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Mind—Religious Belief as a Means of Prolonging Life</span></td> - <td class='c013'><a href='#ch52'>414</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER LIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Disease Considered as a Self-defence of Nature</span></td> - <td class='c013'><a href='#ch53'>419</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER LIV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>Hygiene of the Mind—Advice to Brain Workers</span></td> - <td class='c013'><a href='#ch54'>423</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER LV.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Prevention of Premature Old Age, and the Treatment of Old Age, through Certain Drugs: Arsenic, Iron, and Iodides</span></td> - <td class='c013'><a href='#ch55'>426</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER LVI.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>On the Prevention of Premature Old Age and on the Treatment of Old Age by Animal Extracts</span></td> - <td class='c013'><a href='#ch56'>434</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='pageno' id='Page_xiv'>xiv</span>CHAPTER LVII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>A Few Hints on Youthful Appearance</span></td> - <td class='c013'><a href='#ch57'>449</a></td> - </tr> -</table> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>CHAPTER LVIII.</div> - </div> -</div> - -<table class='table0' summary=''> -<colgroup> -<col width='89%' /> -<col width='10%' /> -</colgroup> - <tr> - <td class='c012'><span class='sc'>The “Twelve Commandments” for the Preservation of Youth, and the Attainment of a Green Old Age</span></td> - <td class='c013'><a href='#ch58'>455</a></td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c012'><span class='sc'>Glossary</span></td> - <td class='c013'><a href='#glo'>459</a></td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c012'><span class='sc'>Index</span></td> - <td class='c013'><a href='#idx'>467</a></td> - </tr> - <tr><td> </td></tr> - <tr> - <td class='c012'><span class='sc'>Footnotes</span></td> - <td class='c013'><a href='#fns'>494</a></td> - </tr> -</table> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_xv'>xv</span> - <h2 class='c006'>SPECIAL ANNOUNCEMENT<br /> <br /><span class='sc'>To the Readers of “Old Age Deferred.”</span></h2> -</div> -<p class='drop-capa0_2_0_65 c007'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='c008'><span class='sc'>The Publishers.</span></div> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_xvii'>xvii</span> - <h2 class='c006'>PREMATURE OLD LOOKS:<br /> <br /><span class='sc'>Their Prevention and Treatment.</span><br /> <br />────</h2> -</div> -<p class='drop-capa0_2_0_65 c007'>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 -<span class='pageno' id='Page_xviii'>xviii</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_xix'>xix</span>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.</p> - -<p class='c010'>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 <i>vitamines</i>, 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 -<span class='pageno' id='Page_xx'>xx</span>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.</p> - -<p class='c010'>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.</p> -<h3 class='c001'><span class='sc'>The Dangers of Smoking in Women.</span></h3> - -<p class='c014'>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 -<span class='pageno' id='Page_xxi'>xxi</span>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.</p> - -<p class='c010'>I am not prepared to maintain that, <i>after the dinner</i>, -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 -<span class='pageno' id='Page_xxii'>xxii</span>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.</p> -<h3 class='c001'><span class='sc'>A Few Cosmetic Hints for the Remedying of Old Looks.</span></h3> - -<p class='c014'>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).</p> - -<p class='c010'>In persons of certain age and also in younger -persons with a fading expression of the face and beginning -<span class='pageno' id='Page_xxiii'>xxiii</span>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_xxiv'>xxiv</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_xxv'>xxv</span>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>i.e.</i>, of arteriosclerosis, -or hardening of the arteries.</p> -<h3 class='c001'><span class='sc'>Rapid and Early Death Through Arteriosclerosis and its Prevention.</span></h3> - -<p class='c014'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Such long survivals constitute, however, a great -exception in arteriosclerosis, and it usually happens -<span class='pageno' id='Page_xxvi'>xxvi</span>only in cases where there are no symptoms of -that most dreaded form of arteriosclerosis, <i>i.e.</i>, 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 <i>genuine</i> 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 -<span class='pageno' id='Page_xxvii'>xxvii</span>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 (<i>hill -climbing</i>), 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 -<span class='pageno' id='Page_xxviii'>xxviii</span>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_xxix'>xxix</span>blood-pressure, but which, if persistent, may indicate -a beginning arteriosclerosis.</p> -<h3 class='c001'><span class='sc'>The Prevention and Treatment of High Blood-pressure and the Prevention of Apoplexy.</span></h3> - -<p class='c014'>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 -<span class='pageno' id='Page_xxx'>xxx</span>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 -<span class='pageno' id='Page_xxxi'>xxxi</span>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_xxxii'>xxxii</span>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).</p> - -<p class='c010'>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 -<span class='pageno' id='Page_xxxiii'>xxxiii</span>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, -<span class='pageno' id='Page_xxxiv'>xxxiv</span>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.</p> -<div> - <span class='pageno' id='Page_xxxv'>xxxv</span> - <h3 class='c001'><span class='sc'>The Best Food for a Failing Heart.</span></h3> -</div> - -<p class='c014'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_xxxvi'>xxxvi</span>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).</p> - -<p class='c010'>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. -<span class='pageno' id='Page_xxxvii'>xxxvii</span>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 -<span class='pageno' id='Page_xxxviii'>xxxviii</span>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, <i>Journal of Hygienics</i>, -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. -<span class='pageno' id='Page_xxxix'>xxxix</span>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_1'>1</span> - <h2 id='ch01' class='c006'>CHAPTER I.<br /> <br /><span class='sc'>On the Appearance of Symptoms of Old Age in Young Persons.</span></h2> -</div> -<p class='c009'><span class='sc'>As</span> 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,<a id='r1' /><a href='#f1' class='c015'><sup>[1]</sup></a> 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.</p> - -<p class='c010'>On examination of the state of nutrition in these persons, -<span class='pageno' id='Page_2'>2</span>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.</p> - -<p class='c010'>The question now arises: In which category of diseases is -this condition to be classified?</p> - -<p class='c010'>In typical cases of this class there is a diminution of -metabolism, <i>i.e.</i>, 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.</p> - -<p class='c010'>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,<a id='r2' /><a href='#f2' class='c015'><sup>[2]</sup></a> 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<a id='r3' /><a href='#f3' class='c015'><sup>[3]</sup></a> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_3'>3</span>processes of oxidation does not take place to the same extent as in -complete myxœdema.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r4' /><a href='#f4' class='c015'><sup>[4]</sup></a> Ewald,<a id='r5' /><a href='#f5' class='c015'><sup>[5]</sup></a> -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.</p> - -<p class='c010'><span class='pageno' id='Page_4'>4</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It must be remembered that all the glands with internal -secretions, according to Pineles,<a id='r6' /><a href='#f6' class='c015'><sup>[6]</sup></a> Sajous,<a id='r7' /><a href='#f7' class='c015'><sup>[7]</sup></a> 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,<a id='r8' /><a href='#f8' class='c015'><sup>[8]</sup></a> -Stieda,<a id='r9' /><a href='#f9' class='c015'><sup>[9]</sup></a> Rogowitsch,<a id='r10' /><a href='#f10' class='c015'><sup>[10]</sup></a> Benda, and many others. Degeneration -of the pituitary is followed by a similar lesion in the thyroid.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_5'>5</span>artificially, as shown by Josué,<a id='r11' /><a href='#f11' class='c015'><sup>[11]</sup></a> by injecting adrenal extract -into rabbits.</p> - -<p class='c010'>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<a id='r12' /><a href='#f12' class='c015'><sup>[12]</sup></a>), and the thyroid diminishes it. It is -an interesting fact, demonstrated by Professor Eiselsberg<a id='r13' /><a href='#f13' class='c015'><sup>[13]</sup></a> 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,<a id='r14' /><a href='#f14' class='c015'><sup>[14]</sup></a>, -Blum,<a id='r15' /><a href='#f15' class='c015'><sup>[15]</sup></a> Lorand<a id='r16' /><a href='#f16' class='c015'><sup>[16]</sup></a>), alcohol (Hertoghe and de Quervain<a id='r17' /><a href='#f17' class='c015'><sup>[17]</sup></a>), -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).</p> - -<p class='c010'>Infectious diseases also induce changes in the adrenals, as -shown by many authors (see <a href='#ch03'>Chapter III</a>).</p> - -<p class='c010'>Various toxic products, such as lead, alcohol, and tobacco, -which are considered causes of arteriosclerosis, are also able to -produce hypertrophy of the adrenals.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_6'>6</span>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.</p> - -<p class='c010'>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, <i>e.g.</i>, 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.</p> - -<p class='c010'>In diabetes, which disease, according to our investigations, -is often caused by changes in the thyroid,<a id='r18' /><a href='#f18' class='c015'><sup>[18]</sup></a> and subsequently -in the pancreas, or <i>vice versâ</i>, amenorrhea or impotency is -frequently met with.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_7'>7</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r19' /><a href='#f19' class='c015'><sup>[19]</sup></a> has found through the -examination in St. Petersburg of 150 very young prostitutes.</p> - -<p class='c010'>We shall show in the next chapter that obesity, which has -nothing to do with overfeeding, can be caused by like agencies.</p> - -<p class='c010'><span class='pageno' id='Page_8'>8</span>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.”</p> - -<p class='c010'>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.</p> - -<p class='c010'>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—<i>e.g.</i>, 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.</p> - -<p class='c010'>The condition termed auto-intoxication may be induced by -many different factors, among which may be mentioned the -products of intestinal putrefaction (Senator<a id='r20' /><a href='#f20' class='c015'><sup>[20]</sup></a>) 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r21' /><a href='#f21' class='c015'><sup>[21]</sup></a> E. Meyer,<a id='r22' /><a href='#f22' class='c015'><sup>[22]</sup></a> and clinical -observations of Senator<a id='r23' /><a href='#f23' class='c015'><sup>[23]</sup></a> and H. Strauss.</p> - -<p class='c010'>The liver, which, according to Gilbert, H. Strauss,<a id='r24' /><a href='#f24' class='c015'><sup>[24]</sup></a> and -others, is also a gland with an internal secretion, is strongly antagonistic -to intestinal poisons. It destroys toxic products -<span class='pageno' id='Page_9'>9</span>brought to it from the intestine through the portal vein, and several -authors, Professor Adami, Sir Lauder Brunton and Bokenham,<a id='r25' /><a href='#f25' class='c015'><sup>[25]</sup></a> -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.</p> - -<p class='c010'>The third important toxin-destroying organ is the thyroid -gland, which, as shown by the experiments of Dr. Leo Breisacher,<a id='r26' /><a href='#f26' class='c015'><sup>[26]</sup></a> -of Detroit, formerly assistant to Professor Munk, of -Berlin, and of Dr. F. Blum,<a id='r27' /><a href='#f27' class='c015'><sup>[27]</sup></a> of Frankfort, as well as Dr. -Chalmers Watson,<a id='r28' /><a href='#f28' class='c015'><sup>[28]</sup></a> 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.”</p> - -<p class='c010'>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.</p> - -<p class='c010'>Accordingly we may expect that, when the thyroid undergoes -a process of degeneration, such an event may also take place -<span class='pageno' id='Page_10'>10</span>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.</p> - -<p class='c010'>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,<a id='r29' /><a href='#f29' class='c015'><sup>[29]</sup></a> 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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_11'>11</span> - <h2 id='ch02' class='c006'>CHAPTER II.<br /> <br /><span class='sc'>On the Agencies which Govern our External Appearance and the Nutrition of the Tissues.</span></h2> -</div> -<p class='c009'><span class='sc'>As</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>With the onset of puberty there is seen, also, a change in -the external appearance of the individual and the attributes of -virility—<i>e.g.</i>, 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_12'>12</span>a tendency to develop a moustache and hair on their face in -places, corresponding to the male beard.</p> - -<p class='c010'>This we can also observe in women whose ovaries have been -altered by disease or by sexual excesses.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>As Poncet<a id='r30' /><a href='#f30' class='c015'><sup>[30]</sup></a> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_13'>13</span>is often diminished, as we will show later on, and they are -usually anæmic.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.”</p> - -<p class='c010'>The influence of the thyroid upon the skeleton and size of -the body is easily shown by simple observations.</p> - -<p class='c010'>Children of parents with cachectic diseases like chronic tuberculosis, -syphilis, alcoholism, etc., in which the thyroid gland is, -as a rule, found degenerated (Gamier,<a id='r31' /><a href='#f31' class='c015'><sup>[31]</sup></a> Hertoghe<a id='r32' /><a href='#f32' class='c015'><sup>[32]</sup></a>), are (as -shown by Prof. Perrando<a id='r33' /><a href='#f33' class='c015'><sup>[33]</sup></a> and Garnier) born with a congenital -atrophy of the thyroid. Just as young animals with an extirpated -<span class='pageno' id='Page_14'>14</span>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.</p> - -<p class='c010'>The influence of the thyroid upon the skeleton is also shown -by the fact, established by Gauthier,<a id='r34' /><a href='#f34' class='c015'><sup>[34]</sup></a> 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.</p> - -<p class='c010'>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<a id='r35' /><a href='#f35' class='c015'><sup>[35]</sup></a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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</p> - -<p class='c010'><span class='pageno' id='Page_15'>15</span>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_16'>16</span>clear by Sajous’s demonstration that these glands collectively -govern the activity of general oxidation, that is to say the vital -process itself.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r36' /><a href='#f36' class='c015'><sup>[36]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>There are, however, still more facts which show the great -influence of the thyroid upon the metabolism of fat. Thus we -<span class='pageno' id='Page_17'>17</span>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,<a id='r37' /><a href='#f37' class='c015'><sup>[37]</sup></a> -of Berlin, and many others.</p> - -<p class='c010'>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. <i>Exogenous obesity</i>—<i>i.e.</i>, arising by -agencies coming from without by the food we introduce into -our body. 2. <i>Endogenous obesity</i>, having its origin within our -economy, and depending on changes in certain glands which -govern the processes of oxidation—<i>e.g.</i>, 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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_18'>18</span>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—<i>e.g.</i>, the mammary -glands or hips.</p> - -<p class='c010'>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,<a id='r38' /><a href='#f38' class='c015'><sup>[38]</sup></a> 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.</p> - -<p class='c010'>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,<a id='r39' /><a href='#f39' class='c015'><sup>[39]</sup></a> Berger,<a id='r40' /><a href='#f40' class='c015'><sup>[40]</sup></a> -<span class='pageno' id='Page_19'>19</span>and Erdheim<a id='r41' /><a href='#f41' class='c015'><sup>[41]</sup></a>) 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<a id='r42' /><a href='#f42' class='c015'><sup>[42]</sup></a> -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<a id='r43' /><a href='#f43' class='c015'><sup>[43]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_20'>20</span>as a rule, characterized by loss of weight and the production of -emaciation often to an astonishing degree—<i>i.e.</i>, diabetes.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 (<i>e.g.</i>, 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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_21'>21</span> - <h2 id='ch03' class='c006'>CHAPTER III.<br /> <br /><span class='sc'>On the Agencies which Govern Immunity Against Infections and Intoxications—The Origin of Fever.</span></h2> -</div> -<p class='c009'><span class='sc'>From</span> 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,<a id='r44' /><a href='#f44' class='c015'><sup>[44]</sup></a> of Paris, showed several years ago -how readily dogs that have lost their thyroid succumb to all -possible infections. Professor W. S. Greenfield,<a id='r45' /><a href='#f45' class='c015'><sup>[45]</sup></a> of Edinburgh, -has found that persons suffering from myxœdema (athyroidia) -very often die from tuberculosis, and Professor Pel,<a id='r46' /><a href='#f46' class='c015'><sup>[46]</sup></a> of Amsterdam, -found a great frequency of tuberculosis in the families of -myxœdematous persons. This coincides with the conclusions -of Prof. G. R. Murray,<a id='r47' /><a href='#f47' class='c015'><sup>[47]</sup></a> 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.</p> - -<p class='c010'>As we showed at the last Congress of Tuberculosis in Paris, -<span class='pageno' id='Page_22'>22</span>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.</p> - -<p class='c010'>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,<a id='r48' /><a href='#f48' class='c015'><sup>[48]</sup></a> formerly assistant of the late Professor Munk, of Berlin, -and from those of Dr. Blum,<a id='r49' /><a href='#f49' class='c015'><sup>[49]</sup></a> of Frankfort. The experimental -results of Dr. Chalmers Watson,<a id='r50' /><a href='#f50' class='c015'><sup>[50]</sup></a> showing alteration -of the thyroid in certain animals after an exclusive diet of raw -meat, and those of Dr. D. Forsyth<a id='r51' /><a href='#f51' class='c015'><sup>[51]</sup></a> 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,<a id='r52' /><a href='#f52' class='c015'><sup>[52]</sup></a> in 1897, have also shown -that the products of decomposition of meat produce an increase -of the colloid substance of the thyroid.</p> - -<p class='c010'>The antitoxic properties of the thyroid against different -products is also shown by the observations of Lanz<a id='r53' /><a href='#f53' class='c015'><sup>[53]</sup></a> and Walter -Edmunds,<a id='r54' /><a href='#f54' class='c015'><sup>[54]</sup></a> who have found that animals without thyroid resist -<span class='pageno' id='Page_23'>23</span>narcosis badly; and, as we have shown in a communication to -the Paris Biological Society,<a id='r55' /><a href='#f55' class='c015'><sup>[55]</sup></a> 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.</p> - -<p class='c010'>It has been shown recently by Hunt<a id='r56' /><a href='#f56' class='c015'><sup>[56]</sup></a> that the thyroid protects -us against poisons like acetonitril, and that iodine acts -through the thyroid. Garnier,<a id='r57' /><a href='#f57' class='c015'><sup>[57]</sup></a> 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,<a id='r58' /><a href='#f58' class='c015'><sup>[58]</sup></a> Crispin,<a id='r59' /><a href='#f59' class='c015'><sup>[59]</sup></a> Torre,<a id='r60' /><a href='#f60' class='c015'><sup>[60]</sup></a> Bayon,<a id='r61' /><a href='#f61' class='c015'><sup>[61]</sup></a> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_24'>24</span>must necessarily be similar to those found in another condition -of hyperactivity of the thyroid gland—<i>i.e.</i>, 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<a id='r62' /><a href='#f62' class='c015'><sup>[62]</sup></a>), -and can also be produced by thyroid feeding (Lanz,<a id='r63' /><a href='#f63' class='c015'><sup>[63]</sup></a> Georgiewski,<a id='r64' /><a href='#f64' class='c015'><sup>[64]</sup></a> -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 -<span class='pageno' id='Page_25'>25</span>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,<a id='r65' /><a href='#f65' class='c015'><sup>[65]</sup></a> 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.</p> - -<p class='c010'>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,<a id='r66' /><a href='#f66' class='c015'><sup>[66]</sup></a> 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.</p> - -<p class='c010'>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,<a id='r67' /><a href='#f67' class='c015'><sup>[67]</sup></a> 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,<a id='r68' /><a href='#f68' class='c015'><sup>[68]</sup></a> and -others. Sajous in his work on the “Internal Secretions,” urges -<span class='pageno' id='Page_26'>26</span>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,<a id='r69' /><a href='#f69' class='c015'><sup>[69]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_27'>27</span>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<a id='r70' /><a href='#f70' class='c015'><sup>[70]</sup></a> -produced regular fever in their animals; Easterbrook<a id='r71' /><a href='#f71' class='c015'><sup>[71]</sup></a> -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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_28'>28</span>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<a id='r72' /><a href='#f72' class='c015'><sup>[72]</sup></a>, 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 <i>The Lancet</i> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_29'>29</span>the aforesaid observations, is very probably a thyroid hyperactivity. -The <i>modus operandi</i> of all these agents is well studied -in Sajous’s work, to which the reader is referred.</p> - -<p class='c010'>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>i.e.</i>, 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.</p> - -<p class='c010'>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. -<span class='pageno' id='Page_30'>30</span>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,—<i>e.g.</i> -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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_31'>31</span>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,<a id='r73' /><a href='#f73' class='c015'><sup>[73]</sup></a> Guerrini,<a id='r74' /><a href='#f74' class='c015'><sup>[74]</sup></a> 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,<a id='r75' /><a href='#f75' class='c015'><sup>[75]</sup></a> 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<a id='r76' /><a href='#f76' class='c015'><sup>[76]</sup></a> 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,<a id='r77' /><a href='#f77' class='c015'><sup>[77]</sup></a> 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.</p> - -<p class='c010'><span class='pageno' id='Page_32'>32</span>It is also very interesting that Renon, with his assistants, -Delille and Azam,<a id='r78' /><a href='#f78' class='c015'><sup>[78]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r79' /><a href='#f79' class='c015'><sup>[79]</sup></a> has insisted upon the important rôle -of the adrenals in the production of fever.</p> - -<p class='c010'>The co-operation of the sexual glands in protecting the -body from infectious disease can be shown by the fact found -by Professor Cornil,<a id='r80' /><a href='#f80' class='c015'><sup>[80]</sup></a> 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.</p> - -<p class='c010'>Metschnikoff<a id='r81' /><a href='#f81' class='c015'><sup>[81]</sup></a> 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<a id='r82' /><a href='#f82' class='c015'><sup>[82]</sup></a> 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.<a id='r83' /><a href='#f83' class='c015'><sup>[83]</sup></a></p> - -<p class='c010'><span class='pageno' id='Page_33'>33</span>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.<a id='r84' /><a href='#f84' class='c015'><sup>[84]</sup></a></p> - -<p class='c010'>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<a id='r85' /><a href='#f85' class='c015'><sup>[85]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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. -<span class='pageno' id='Page_34'>34</span>Weljaminoff found the same also in man. Krüger found that -this applied also to ether narcosis.</p> - -<p class='c010'>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 -<a href='#ch10'>Chapter X</a>). 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.</p> - -<p class='c010'>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.<a id='r86' /><a href='#f86' class='c015'><sup>[86]</sup></a> 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.”</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_35'>35</span> - <h2 id='ch04' class='c006'>CHAPTER IV.<br /> <br /><span class='sc'>On the Agencies that Govern the Condition of the Nervous System and Mentality.</span></h2> -</div> -<p class='c009'><span class='sc'>By</span> 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.</p> - -<p class='c010'>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<a id='r87' /><a href='#f87' class='c015'><sup>[87]</sup></a> -Blum,<a id='r88' /><a href='#f88' class='c015'><sup>[88]</sup></a> Walter Edmund,<a id='r89' /><a href='#f89' class='c015'><sup>[89]</sup></a> and others. These consisted of the -destruction of nervous cells and nervous processes, chromatolysis, -<span class='pageno' id='Page_36'>36</span>and also the augmentation of the neuroglia, which increases -in the same way as the connective tissue in all other organs and -tissues.</p> - -<p class='c010'>These changes have been found by Whitwell<a id='r90' /><a href='#f90' class='c015'><sup>[90]</sup></a> 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<a id='r91' /><a href='#f91' class='c015'><sup>[91]</sup></a> 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 <a href='#ch53'>Chapter LIII</a>), -<span class='pageno' id='Page_37'>37</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r92' /><a href='#f92' class='c015'><sup>[92]</sup></a> 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, -<span class='pageno' id='Page_38'>38</span>and incapability of thinking, so that he had to suspend the treatment. -These symptoms continued for fourteen days after the -treatment had been discontinued.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_39'>39</span>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_40'>40</span>abstinence, present alterations in the epithelia of the sexual -glands (see <a href='#ch47'>Chapter XLVII</a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>As, however, in these days of scepticism we do not believe -<span class='pageno' id='Page_41'>41</span>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>i.e.</i>, -on the nervous system and mentality—by experiment, and we -believe we have sufficient facts at hand to do so.</p> - -<p class='c010'>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<a id='r93' /><a href='#f93' class='c015'><sup>[93]</sup></a>—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.</p> - -<p class='c010'>It has been found by numerous authorities that the skull -and brain of castrated animals and persons is smaller than the -normal. Gall<a id='r94' /><a href='#f94' class='c015'><sup>[94]</sup></a> noted this fact, and after him Vimont,<a id='r95' /><a href='#f95' class='c015'><sup>[95]</sup></a> from -experiments on animals; and, according to the latter observer -castration of both sides produces a considerable diminution of -the cerebellum. Leuret and Hoffmann<a id='r96' /><a href='#f96' class='c015'><sup>[96]</sup></a> 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.</p> - -<p class='c010'>As we have pointed out above, any alteration of the testicles -<span class='pageno' id='Page_42'>42</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_43'>43</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_44'>44</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r97' /><a href='#f97' class='c015'><sup>[97]</sup></a> 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.</p> - -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_45'>45</span> - <h2 id='ch05' class='c006'>CHAPTER V.<br /> <br /><span class='sc'>On the Influence of the Sexual Glands upon Vitality and Long Life.</span></h2> -</div> -<p class='c009'><span class='sc'>When</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Matthew Paris,<a id='r98' /><a href='#f98' class='c015'><sup>[98]</sup></a> 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<a id='r99' /><a href='#f99' class='c015'><sup>[99]</sup></a> also mentions that the whole community of -castrated Skopze in Russia, has a withered aspect; and in his -<span class='pageno' id='Page_46'>46</span>book Merschejewski relates that their skin is withered and -wrinkled, and that they look worn out, aged, and senile.</p> - -<p class='c010'>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<a id='r100' /><a href='#f100' class='c015'><sup>[100]</sup></a> also noted tachycardia -in such conditions. Professor Landau<a id='r101' /><a href='#f101' class='c015'><sup>[101]</sup></a> 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.</p> - -<p class='c010'>It has been shown by experiments that there is a close -relation between the condition of the ovaries and the heart. -Professor Hegar<a id='r102' /><a href='#f102' class='c015'><sup>[102]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_47'>47</span>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> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r103' /><a href='#f103' class='c015'><sup>[103]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_48'>48</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_49'>49</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_50'>50</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>We have quoted these instances of longevity from Hufeland,<a id='r104' /><a href='#f104' class='c015'><sup>[104]</sup></a> -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<a id='r105' /><a href='#f105' class='c015'><sup>[105]</sup></a>: “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 -<span class='pageno' id='Page_51'>51</span>of John Bayley, of Northampton, who died 130 years old, Dr. -James Keill<a id='r106' /><a href='#f106' class='c015'><sup>[106]</sup></a> found his testes of large size.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r107' /><a href='#f107' class='c015'><sup>[107]</sup></a> Saverio Spangaro,<a id='r108' /><a href='#f108' class='c015'><sup>[108]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_52'>52</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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”).</p> - -<p class='c010'>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.</p> - -<p class='c010'>A prominent member of the aristocracy of one of the northern -countries of Europe, who is at present 90 years old, having -<span class='pageno' id='Page_53'>53</span>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.</p> - -<p class='c010'>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.<a id='r109' /><a href='#f109' class='c015'><sup>[109]</sup></a> 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. -<span class='pageno' id='Page_54'>54</span>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!”<a id='r110' /><a href='#f110' class='c015'><sup>[110]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r111' /><a href='#f111' class='c015'><sup>[111]</sup></a> 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.</p> - -<p class='c010'>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 <a href='#ch49'>Chapter XLIX</a>).</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_55'>55</span> - <h2 id='ch06' class='c006'>CHAPTER VI.<br /> <br /><span class='sc'>On Heredity and Longevity.</span></h2> -</div> -<p class='c009'><span class='sc'>We</span> 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.</p> - -<p class='c010'><span class='pageno' id='Page_56'>56</span>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<a id='r112' /><a href='#f112' class='c015'><sup>[112]</sup></a> found 9 cases of exophthalmic -goiter in one family. The frequent instances of heredity in -Graves’s disease are insisted upon by Brouwer<a id='r113' /><a href='#f113' class='c015'><sup>[113]</sup></a> and other authors.</p> - -<p class='c010'>Degenerative changes of the pituitary body may also be -inherited. Thus Bonardi and Schwoner and others also showed -cases of acromegaly of hereditary origin.</p> - -<p class='c010'>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 -<i>Practitioner</i>, of London, in October, 1903, that the children of -diabetic persons have an inherited tendency to alimentary glycosuria, -which occurs very frequently among them.</p> - -<p class='c010'><span class='pageno' id='Page_57'>57</span>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>Evidence founded on experiments is at our disposal to -prove our assertion that irregularities of the thyroid are inherited -by offspring. Professor Lanz,<a id='r114' /><a href='#f114' class='c015'><sup>[114]</sup></a> 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.</p> - -<p class='c010'><span class='pageno' id='Page_58'>58</span>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.</p> - -<p class='c010'>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<a id='r115' /><a href='#f115' class='c015'><sup>[115]</sup></a> and Perrando<a id='r116' /><a href='#f116' class='c015'><sup>[116]</sup></a>). 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.<a id='r117' /><a href='#f117' class='c015'><sup>[117]</sup></a> He diagnosed a case -of syphilis in the father, myxœdema in the daughter and -acromegaly in the son.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_59'>59</span>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>i.e.</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>But if a long life be dependent on a good state of the ductless -<span class='pageno' id='Page_60'>60</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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!</p> - -<p class='c010'>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.</p> - -<p class='c010'>Jean Thuret was a soldier, and in spite of having been -wounded in several battles, he lived beyond the age of 104. -<span class='pageno' id='Page_61'>61</span>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.<a id='r118' /><a href='#f118' class='c015'><sup>[118]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_62'>62</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_63'>63</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, <i>viz.</i>, 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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_64'>64</span> - <h2 id='ch07' class='c006'>CHAPTER VII.<br /> <br /><span class='sc'>On Means which can Help us to Determine the Probable Duration of Life.</span></h2> -</div> -<p class='c009'><span class='sc'>We</span> 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.</p> - -<p class='c010'><span class='pageno' id='Page_65'>65</span>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 -(<i>e.g.</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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; <i>e.g.</i>, 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.</p> - -<p class='c010'>Before entering upon the examination of these glands we -must first ascertain whether our patient comes of a long-lived -<span class='pageno' id='Page_66'>66</span>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: <i>e.g.</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_67'>67</span>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.</p> - -<p class='c010'>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,<a id='r119' /><a href='#f119' class='c015'><sup>[119]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Thus, we must examine the skin and note whether it is dry -or moist, and whether the sweat glands are acting normally. -<span class='pageno' id='Page_68'>68</span>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>i.e.</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r120' /><a href='#f120' class='c015'><sup>[120]</sup></a> 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.</p> - -<p class='c010'>In examining the circulatory system we must bear in mind -<span class='pageno' id='Page_69'>69</span>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 <a href='#ch03'>Chapter III</a>). 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.</p> - -<p class='c010'>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. -<span class='pageno' id='Page_70'>70</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_71'>71</span>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,<a id='r121' /><a href='#f121' class='c015'><sup>[121]</sup></a> 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.</p> - -<p class='c010'>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 <a href='#ch03'>Chapters III</a> and -<a href='#ch50'>L</a>). 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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_72'>72</span>maintenance of life (see <a href='#ch05'>Chapter V</a>). 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<a id='r122' /><a href='#f122' class='c015'><sup>[122]</sup></a> 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.</p> - -<p class='c010'>Direct examination of the sexual glands can be more easily -carried out in men than in women.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Inquiring for gonorrhœa in the past, we must find out -<span class='pageno' id='Page_73'>73</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_74'>74</span>internal secretion. Thus, we need merely observe whether the -external sexual characteristics (<i>e.g.</i>, breasts, hips, etc.) are well -developed, since these are under the direct influence of the -internal secretion of the ovaries.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_75'>75</span>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<a id='r123' /><a href='#f123' class='c015'><sup>[123]</sup></a> which, as -shown previously, flourish on the soil prepared for them by -hereditary syphilis.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_76'>76</span>between the large flabby breasts and the firm tissue of a young -girl leading a moral life. According to our observations we -have described<a id='r124' /><a href='#f124' class='c015'><sup>[124]</sup></a> 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.</p> - -<p class='c010'>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 <i>sella turcica</i>, 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 <i>fossa canina</i> -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.</p> - -<p class='c010'>A history of headache, especially nocturnal, of mental -change, <i>e.g.</i>, 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_77'>77</span>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.</p> - -<p class='c010'>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.<a id='r125' /><a href='#f125' class='c015'><sup>[125]</sup></a></p> - -<p class='c010'>As Mering and Minkowski<a id='r126' /><a href='#f126' class='c015'><sup>[126]</sup></a> 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,<a id='r127' /><a href='#f127' class='c015'><sup>[127]</sup></a> 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,<a id='r128' /><a href='#f128' class='c015'><sup>[128]</sup></a> Weichselbaum<a id='r129' /><a href='#f129' class='c015'><sup>[129]</sup></a> -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.</p> - -<p class='c010'><span class='pageno' id='Page_78'>78</span>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.</p> - -<p class='c010'>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 <i>ex amylo</i>) may be brought into connection with -changes in the pancreas; for Wille<a id='r130' /><a href='#f130' class='c015'><sup>[130]</sup></a> 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.</p> - -<p class='c010'>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,<a id='r131' /><a href='#f131' class='c015'><sup>[131]</sup></a> 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, -<span class='pageno' id='Page_79'>79</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r132' /><a href='#f132' class='c015'><sup>[132]</sup></a> 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.</p> - -<p class='c010'>Patients with mild diabetes often have a fresh look and a -<span class='pageno' id='Page_80'>80</span>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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).<a id='r133' /><a href='#f133' class='c015'><sup>[133]</sup></a></p> - -<p class='c010'>It was also of great interest, that each diabetic dog ceased -to eliminate sugar two days after extirpation of the thyroid.</p> - -<p class='c010'>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,<a id='r134' /><a href='#f134' class='c015'><sup>[134]</sup></a> 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 -<span class='pageno' id='Page_81'>81</span>we have found in nearly every case and even when the -patients were not suffering from pancreatic or hepatic disease. -(See also <a href='#ch54'>Chapter LIV</a>.)</p> - -<p class='c010'>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 -<a href='#ch13'>Chapter XIII</a>.)</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_82'>82</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>On examining the liver we must not forget the sclerotics, -and must note whether, on looking upward, there is any yellow -discoloration.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_83'>83</span>women, in whom gall-stones are particularly common. In -fact, they occur so frequently that Halck<a id='r135' /><a href='#f135' class='c015'><sup>[135]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>As shown by Morat and Doyon,<a id='r136' /><a href='#f136' class='c015'><sup>[136]</sup></a> 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 -<span class='pageno' id='Page_84'>84</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r137' /><a href='#f137' class='c015'><sup>[137]</sup></a> on the origin of gall-stone disease -following changes in certain ductless glands. Considerable, -<span class='pageno' id='Page_85'>85</span>sometimes enormous, loss of weight is a very frequent symptom -of gall-stone disease, and is probably due to pancreatic -alterations.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r138' /><a href='#f138' class='c015'><sup>[138]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_86'>86</span>thyroid causes a diminution in the activity of the kidneys. As -we have shown in a communication to the Paris Biological -Society,<a id='r139' /><a href='#f139' class='c015'><sup>[139]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r140' /><a href='#f140' class='c015'><sup>[140]</sup></a> 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 -<span class='pageno' id='Page_87'>87</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_88'>88</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The chances of a bachelor or spinster for a long life are -always less than those of a married person. Single people are -<span class='pageno' id='Page_89'>89</span>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_90'>90</span> - <h2 id='ch08' class='c006'>CHAPTER VIII.<br /> <br /><span class='sc'>On the Causation of Old Age.</span></h2> -</div> -<p class='c009'><span class='sc'>We</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Let us now see if there is any evidence in support of such -a statement.</p> - -<p class='c010'><span class='pageno' id='Page_91'>91</span>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.</p> - -<p class='c010'>Sir Victor Horsley<a id='r141' /><a href='#f141' class='c015'><sup>[141]</sup></a> 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<a id='r142' /><a href='#f142' class='c015'><sup>[142]</sup></a> 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.</p> - -<p class='c010'>The thyroid, together with the parathyroids, have been -found degenerated in old age by Erdheim.<a id='r143' /><a href='#f143' class='c015'><sup>[143]</sup></a> Bauman found -only very little iodine in the thyroid of aged persons.</p> - -<p class='c010'>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,<a id='r144' /><a href='#f144' class='c015'><sup>[144]</sup></a> in Zurich, that the -<span class='pageno' id='Page_92'>92</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The parathyroid glands, which are in relation with the thyroid, -and changes in which may produce cramps, as shown by -Jeandelize,<a id='r145' /><a href='#f145' class='c015'><sup>[145]</sup></a> Pineles,<a id='r146' /><a href='#f146' class='c015'><sup>[146]</sup></a> etc., also present an increase of connective -tissue, with fatty degeneration of the epithelium, in old age, as -was shown by Erdheim,<a id='r147' /><a href='#f147' class='c015'><sup>[147]</sup></a> of the Vienna Pathological Institute.</p> - -<p class='c010'>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,<a id='r148' /><a href='#f148' class='c015'><sup>[148]</sup></a> but there are many -exceptions, as shown by S. Spangaro.<a id='r149' /><a href='#f149' class='c015'><sup>[149]</sup></a></p> - -<p class='c010'>As Sajous<a id='r150' /><a href='#f150' class='c015'><sup>[150]</sup></a> and we<a id='r151' /><a href='#f151' class='c015'><sup>[151]</sup></a> 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 -<span class='pageno' id='Page_93'>93</span>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.</p> - -<p class='c010'>The adrenals of old people have been examined by Minervini,<a id='r152' /><a href='#f152' class='c015'><sup>[152]</sup></a> -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<a id='r153' /><a href='#f153' class='c015'><sup>[153]</sup></a> found a hypertrophic -condition of this gland in old age.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r154' /><a href='#f154' class='c015'><sup>[154]</sup></a> and Ewald.<a id='r155' /><a href='#f155' class='c015'><sup>[155]</sup></a> 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:—</p> - -<p class='c010'>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.</p> - -<p class='c010'>With advancing age, obesity is often the first symptom, -<span class='pageno' id='Page_94'>94</span>just as in myxœdema, and, as we have said above, obesity can -be caused by degeneration of the thyroid and sexual glands.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_95'>95</span>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 <i>vice versa</i>. 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_96'>96</span>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,<a id='r156' /><a href='#f156' class='c015'><sup>[156]</sup></a> of -Vienna, who found atheromatosis of the aorta and other blood-vessels -in dogs whose thyroids he had removed.</p> - -<p class='c010'>This increase in connective tissue has been found in various -viscera after removal of the thyroid; thus it was found by -Kishi<a id='r157' /><a href='#f157' class='c015'><sup>[157]</sup></a> in the liver of one hundred and fifty dogs and monkeys. -Rosenblatt and Jeandelize<a id='r158' /><a href='#f158' class='c015'><sup>[158]</sup></a> also described an interstitial hepatitis -in similar cases.</p> - -<p class='c010'>The same change has also been noted in the kidneys after -extirpation of the thyroid (<i>e.g.</i>, Blum<a id='r159' /><a href='#f159' class='c015'><sup>[159]</sup></a> found an interstitial -nephritis), and in the brain an increase of neuroglia occurs, as -observed by Blum, Walter Edmunds, and others.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_97'>97</span>As mentioned in Chapter II, Loewy and Richter,<a id='r160' /><a href='#f160' class='c015'><sup>[160]</sup></a> of Berlin, -observed that removal of the sexual glands always produced -a diminution of the oxidation processes.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_98'>98</span>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.)</p> - -<p class='c010'>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.</p> - -<p class='c010'>The pituitary gland is also altered in infections, as shown -in the same chapter.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>In every severe infectious disease the liver shows great -change in its parenchymatous tissue, with a subsequent increase -of connective tissue.</p> - -<p class='c010'>The increase of connective tissue in various organs, and -<span class='pageno' id='Page_99'>99</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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>i.e.</i>, the ductless glands.</p> - -<p class='c010'>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, <i>e.g.</i>, 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,<a id='r161' /><a href='#f161' class='c015'><sup>[161]</sup></a> 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 -<span class='pageno' id='Page_100'>100</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_101'>101</span>Yvette Guilbert, in her novel the “Demi-vieilles,”<a id='r162' /><a href='#f162' class='c015'><sup>[162]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_102'>102</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r163' /><a href='#f163' class='c015'><sup>[163]</sup></a> -says, with reference to this exhaustion of the thyroid by pregnancies, -“each child demands one tooth.”</p> - -<p class='c010'>According to Hertoghe, pregnancies are especially apt to -produce degenerated conditions of the thyroid gland.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_103'>103</span>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—<i>viz.</i>, 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.</p> - -<p class='c010'>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 -<a href='#ch49'>“Hygiene of the Sexual Glands”</a> on this subject, in which we -show by experimental evidence the dangers of the total suppression -of sexual activity.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_104'>104</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It is a well-known fact that exophthalmic goiter can be -improved by ovarian extracts, as Latzko, of Vienna, and others, -have shown.</p> - -<p class='c010'>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.</p> - -<p class='c010'>In partial cases of myxœdema metrorrhagia is frequent. -By giving thyroid extracts these uterine hæmorrhages may be -stopped.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_105'>105</span>tonic doses excites the activity of the splanchnic nerves, and so -may produce an increased flow of adrenalin and a higher blood-pressure -(see <a href='#ch15'>Chapter XV</a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <i>Daily Mail</i> 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.</p> - -<p class='c010'>A strong point against the anti-alcohol faddists is the case -of Brown,<a id='r164' /><a href='#f164' class='c015'><sup>[164]</sup></a> an Irish peasant, who, after many years of heavy -beer-drinking, attained the age of 120. His tombstone exhibits -the following epitaph:—</p> - -<p class='c010'>“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, -<span class='pageno' id='Page_106'>106</span>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.)</p> - -<p class='c010'>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”).</p> - -<p class='c010'>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.</p> - -<p class='c010'>As a rule, celibatarians show symptoms of old age much -sooner than married persons.</p> - -<p class='c010'>If among those addicted to drink there are many instances -of long life, among smokers such instances are much fewer.</p> - -<p class='c010'>As Professor Pel says, there was only one man among -many, of those over 100, who was a smoker (see <a href='#ch42'>Chapter XLII</a>).</p> - -<p class='c010'>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 <a href='#ch05'>Chapter V</a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_107'>107</span>Tobacco, according to clinical observations (Huchard), is -apt to cause arteriosclerosis, just as alcohol in large doses; and -this is also proved by experiments—<i>e.g.</i>, those of Isaac Adler and -Hensel—which show that atheroma of blood-vessels can be produced -in animals, experimentally, by nicotine.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Plutarch, in his “De educatione puerorum,” mentions that -<span class='pageno' id='Page_108'>108</span>a certain amount of work improves the mind, but excess of work -is prejudicial.</p> - -<p class='c010'>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?</p> - -<p class='c010'>Some of the most powerful agencies in producing old age -are frequent mental emotions, especially sorrow and grief.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <i>sensorium commune</i>, <i>i.e.</i>, the center which receives -all shocks, the governing center of the ductless glands, located in -the pituitary body.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_109'>109</span>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.</p> - -<p class='c010'>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 -(<i>e.g.</i>, 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.</p> - -<p class='c010'>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>i.e.</i>, -infectious diseases, exhaustion of the ovaries after pregnancies -or sexual excesses, mental emotions, etc.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_110'>110</span>Therefore we are justified in assuming that old age will -show the same clinical symptoms as myxœdema.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r165' /><a href='#f165' class='c015'><sup>[165]</sup></a> -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.</p> - -<p class='c010'>To recapitulate, we may state that old age is caused by -<span class='pageno' id='Page_111'>111</span>degeneration of the ductless glands, and that there exists a condition -of auto-intoxication in old age.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Thus Campbell, in July, 1905, published a short note in the -<i>Lancet</i>, attributing old age to degeneration of the ductless glands, -overlooking our previous communication to the Paris Biological -Society.</p> - -<p class='c010'>Two years afterward Pineles, in an article published in the -<i>Wiener klin. Wochenschrift</i>, comparing the origin of diabetes, -tetany, and old age, came to the conclusion that old age was -caused by the same agency (<i>i.e.</i>, alteration of the ductless glands) -as the other conditions mentioned.</p> - -<p class='c010'>Sir Herman Weber, in his interesting work on the prolongation -<span class='pageno' id='Page_112'>112</span>of life, also attaches great importance to degeneration of -the ductless glands as a cause of old age.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_113'>113</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.”</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_114'>114</span> - <h2 id='ch09' class='c006'>CHAPTER IX.<br /> <br /><span class='sc'>The Rational Prevention of Premature Old Age and the Treatment of Old Age.</span></h2> -</div> -<h3 class='c001'><i>General Remarks.</i></h3> - -<p class='c014'><span class='sc'>We</span> 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.</p> - -<p class='c010'>This disease is caused by the degeneration of the glands with -internal secretion, especially the thyroid, ovaries, testicles, liver, -and kidneys.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Let us consider the means by which we can prevent this -<span class='pageno' id='Page_115'>115</span>disease, for “prevention is better than cure,” says the English -proverb.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_116'>116</span>etc., and thus could not produce anti-bodies to counteract -the infection.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It has been shown by statistics<a id='r166' /><a href='#f166' class='c015'><sup>[166]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_117'>117</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The Bible is literally true when it says that the sins of the -fathers are visited even unto the third generation.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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>i.e.</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The infant is practically helpless against infections, for its -<span class='pageno' id='Page_118'>118</span>thyroid contains scarcely any colloid substance, sometimes none; -and it also contains no iodine,<a id='r167' /><a href='#f167' class='c015'><sup>[167]</sup></a> 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.</p> - -<p class='c010'>All the internal secretions will, therefore, come to the children -from the mother or wet nurse.</p> - -<p class='c010'>The above fact also explains why infectious diseases are so -very frequent among infants, and also among children before the -years of puberty.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <a href='#ch39'>“Milk Diet”</a>).</p> - -<p class='c010'><span class='pageno' id='Page_119'>119</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It is sad to reflect that, in some countries, alcohol is given to -children, who are even far more helpless against it than adults.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_120'>120</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Alcohol, coffee, and tea are especially injurious to children. -The celebrated German clinician, Strümpell, writes as follows in -the <i>Pædagogical Pathology</i>: “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.</p> - -<p class='c010'>Dr. F. Heyn, in a statistical contribution on “Idiocy,” that -appeared recently in the <i>Psychiatrisch Neurologische Wochenschrift</i>, -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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_121'>121</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_122'>122</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>These great advantages of marriage can, however, exist -only in cases where the two halves make one whole—<i>i.e.</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_123'>123</span>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.</p> - -<p class='c010'>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, <i>omne -quod est nimium vertitur in vitima</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_124'>124</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Still, even after a woman has passed the climacteric, -everything is not lost if only she be a clever member of her sex. -<span class='pageno' id='Page_125'>125</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Unhappily, as human nature is prone to attack every innovation -or to ridicule it, in spite of the great reputation of this -<span class='pageno' id='Page_126'>126</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <a href='#ch53'>Chapter LIII</a>). 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.</p> - -<p class='c010'>Besides the thyroid gland, the extracts of the sexual glands -can also be used; thus, ovarian extracts for women, and testicular -extracts for men.</p> - -<p class='c010'><span class='pageno' id='Page_127'>127</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>These three organs are in close relation to each other, for -when one is threatened the others come to its assistance and -<span class='pageno' id='Page_128'>128</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_129'>129</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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?</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_130'>130</span>on the Continent, and becomes prevalent only as Anglo-Saxon -customs are diffused abroad.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_131'>131</span>and not “bolted”; digestion, in reality, beginning in the -mouth.</p> - -<p class='c010'>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 -<a href='#ch16'>XVI</a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>Spices should be avoided as much as possible, especially -<span class='pageno' id='Page_132'>132</span>sharp, irritating condiments, which are so freely taken, particularly -in America.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_133'>133</span>which should be smothered at their very inception in the child.</p> - -<p class='c010'>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!</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_134'>134</span> - <h2 id='ch10' class='c006'>CHAPTER X.<br /> <br /><span class='sc'>The Destruction and Elimination of Toxic Products from the Body and Hygienic Measures for the Improvement of these Functions.</span></h2> -</div> -<p class='c009'><span class='sc'>There</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The lymphatic glands play an important rôle, not only as the -birthplace of leucocytes, but also in that they are able to arrest -<span class='pageno' id='Page_135'>135</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,—<i>e.g.</i>, congenital -myxœdema. Adenoid vegetations are always accompanied -by chronic pharyngitis and tonsillitis, which bring about -<span class='pageno' id='Page_136'>136</span>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.</p> - -<p class='c010'>As I have already shown in a previous communication,<a id='r168' /><a href='#f168' class='c015'><sup>[168]</sup></a> -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<a id='r169' /><a href='#f169' class='c015'><sup>[169]</sup></a> (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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_137'>137</span>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_138'>138</span> - <h2 id='ch11' class='c006'>CHAPTER XI.<br /> <br /><span class='sc'>On the Destruction of Poisonous Products Through the Thyroid and Parathyroid Glands.</span></h2> -</div> -<p class='c009'><span class='sc'>The</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_139'>139</span>to the fact that the extracts of meat having a toxic action are -soluble in water.</p> - -<p class='c010'>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.<a id='r170' /><a href='#f170' class='c015'><sup>[170]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r171' /><a href='#f171' class='c015'><sup>[171]</sup></a></p> - -<p class='c010'><span class='pageno' id='Page_140'>140</span>The Japanese authority, Kishi, also arrived at the same -conclusion, after having removed the thyroid gland from 150 -monkeys, dogs, and other animals.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_141'>141</span>often present serious phenomena after an operation under anesthesia, -including coma and even death.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_142'>142</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>We have also shown, as already mentioned (Chapter <a href='#ch05'>V</a>), -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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_143'>143</span>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>When the thyroid is removed from an animal, but the parathyroids -<span class='pageno' id='Page_144'>144</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_145'>145</span> - <h2 id='ch12' class='c006'>CHAPTER XII.<br /> <br /><span class='sc'>Hygiene of the Thyroid Gland.</span></h2> -</div> -<p class='c009'><span class='sc'>The</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_146'>146</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It is easy to see that a tight collar offers difficulty to the -<span class='pageno' id='Page_147'>147</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_148'>148</span>We must, however, caution patients against ever taking -these extracts <i>save under medical advice</i>, since otherwise dangerous -results may be and have been produced, as will be shown -elsewhere.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_149'>149</span> - <h2 id='ch13' class='c006'>CHAPTER XIII.<br /> <br /><span class='sc'>The Destruction of Toxic Products by the Liver and the Improvement of its Protective Functions.</span></h2> -</div> -<p class='c009'><span class='sc'>The</span> 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<a id='r172' /><a href='#f172' class='c015'><sup>[172]</sup></a>: “Like unto Minos in Dante, the liver tests the -conscience of those that want to enter, and knows their sins.”</p> - -<p class='c010'>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,<a id='r173' /><a href='#f173' class='c015'><sup>[173]</sup></a> of Brussels -University, who demonstrated by experiments that nicotin -<span class='pageno' id='Page_150'>150</span>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<a id='r174' /><a href='#f174' class='c015'><sup>[174]</sup></a>), hyoscyamine (Heger and Buys<a id='r175' /><a href='#f175' class='c015'><sup>[175]</sup></a>), quinine, -morphia, curare (Lussana). According to Schiff, and Lautenbach, -alkaloids undergo a chemical change under the influence of -the liver. As Slowzoff<a id='r176' /><a href='#f176' class='c015'><sup>[176]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Yet other authors have shown that the liver probably has -an antitoxic action against bacteria and their toxins. Thus, Professor -Adami, of Montreal,<a id='r177' /><a href='#f177' class='c015'><sup>[177]</sup></a> by experiments with a minute -diplococcus similar to that which is found in Pictou’s cattle -disease, and Sir Lauder Brunton, and Dr. Bokenham,<a id='r178' /><a href='#f178' class='c015'><sup>[178]</sup></a> 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.</p> - -<p class='c010'>It has been shown that the liver excretes into the bile poisons -which it arrests during their circulation through the portal -<span class='pageno' id='Page_151'>151</span>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.<a id='r179' /><a href='#f179' class='c015'><sup>[179]</sup></a></p> - -<p class='c010'>Dr. Fraser<a id='r180' /><a href='#f180' class='c015'><sup>[180]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_152'>152</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,—<i>e.g.</i>, -subcutaneously.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_153'>153</span>Bouchard found an enlargement of the liver in 23 per cent. -of all his cases of dilatation of the stomach.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>That in diseases of the liver toxic products are formed -and eliminated by the urine in increased amounts, has been shown -by Professors Bouchard<a id='r181' /><a href='#f181' class='c015'><sup>[181]</sup></a> and Roger. They found that the -urine of patients suffering from diseases of the liver is more toxic -than that of normal persons.</p> - -<p class='c010'>That the normal urine is toxic has been proved by Séglas -and Vauquelin,<a id='r182' /><a href='#f182' class='c015'><sup>[182]</sup></a> and also by Bocci.<a id='r183' /><a href='#f183' class='c015'><sup>[183]</sup></a> 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.</p> - -<p class='c010'><span class='pageno' id='Page_154'>154</span>All these calculations of Bouchard have had no great success, -however, for many authorities, as Gumprecht,<a id='r184' /><a href='#f184' class='c015'><sup>[184]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r185' /><a href='#f185' class='c015'><sup>[185]</sup></a> They have ascertained that privation, bad nutrition, -etc., can also lower the vitality of the liver and diminish its antitoxic -properties.</p> - -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_155'>155</span> - <h2 id='ch14' class='c006'>CHAPTER XIV.<br /> <br /><span class='sc'>The Hygiene of the Liver.</span></h2> -</div> -<p class='c009'><span class='sc'>We</span> 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.</p> - -<p class='c010'>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 -<a href='#ch39'>XXXIX</a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_156'>156</span>liver either by the blood or the bile, and thus provoke very important -changes in the liver-tissue. Professor Adami,<a id='r186' /><a href='#f186' class='c015'><sup>[186]</sup></a> of Montreal, -found colon bacilli in a cirrhotic liver.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r187' /><a href='#f187' class='c015'><sup>[187]</sup></a> 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.</p> - -<p class='c010'>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,<a id='r188' /><a href='#f188' class='c015'><sup>[188]</sup></a> in his investigation -<span class='pageno' id='Page_157'>157</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r189' /><a href='#f189' class='c015'><sup>[189]</sup></a> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_158'>158</span>the cause of such a condition in Europeans residing in tropical -climates.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Here, as always, let us follow the wise precept: “Prevention -is better than cure.”</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_159'>159</span> - <h2 id='ch15' class='c006'>CHAPTER XV.<br /> <br /><span class='sc'>On the Destruction of Toxic Products by the Adrenals.</span></h2> -</div> -<p class='c009'><span class='sc'>There</span> 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.</p> - -<p class='c010'>Langlois and Abelous<a id='r190' /><a href='#f190' class='c015'><sup>[190]</sup></a> 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<a id='r191' /><a href='#f191' class='c015'><sup>[191]</sup></a> 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.</p> - -<p class='c010'>The fact, observed by all these authorities, that when one -<span class='pageno' id='Page_160'>160</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It has thus been proved by a succession of authors: Charrin,<a id='r192' /><a href='#f192' class='c015'><sup>[192]</sup></a> -Langlois, Roux, Yersin, Professor Roger, and more recently -by Oppenheim and Loeper,<a id='r193' /><a href='#f193' class='c015'><sup>[193]</sup></a> that in experimental or in spontaneous -infectious diseases the adrenals present important alterations -as a result of the reaction against infection.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Very important are the conclusions of Oppenheim,<a id='r194' /><a href='#f194' class='c015'><sup>[194]</sup></a> 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 -<span class='pageno' id='Page_161'>161</span>to which have been administered the same toxic products, but -without adrenal extracts.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Moschini, Nicholas, and Bonnamour have also found histological -evidences in the adrenals in infectious diseases indicating -a hyperactivity of these glands.</p> - -<p class='c010'>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 <a href='#ch03'>Chapter III</a>).</p> - -<p class='c010'>It was found by Aubertin<a id='r195' /><a href='#f195' class='c015'><sup>[195]</sup></a> 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 -<span class='pageno' id='Page_162'>162</span>mercury, arsenic, lead, etc. As shown by Professor Sajous,<a id='r196' /><a href='#f196' class='c015'><sup>[196]</sup></a> -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.</p> - -<p class='c010'>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<a id='r197' /><a href='#f197' class='c015'><sup>[197]</sup></a> 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,<a id='r198' /><a href='#f198' class='c015'><sup>[198]</sup></a> 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.</p> - -<p class='c010'>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,<a id='r199' /><a href='#f199' class='c015'><sup>[199]</sup></a> 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).</p> - -<p class='c010'>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 -<span class='pageno' id='Page_163'>163</span>of atheroma by Joshua, in three of which a hyperplastic condition -of the adrenals was found.</p> - -<p class='c010'>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.</p> - -<p class='c010'>We will deal further with the latter points in the following -chapter.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_164'>164</span> - <h2 id='ch16' class='c006'>CHAPTER XVI.<br /> <br /><span class='sc'>Hygiene of the Adrenals and of the Circulatory System—A Few Remarks on the Cause, Prevention, and Treatment of Arteriosclerosis.</span></h2> -</div> -<p class='c009'><span class='sc'>In</span> 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<a id='r200' /><a href='#f200' class='c015'><sup>[200]</sup></a> in the laboratories of the Johns -Hopkins University.</p> - -<p class='c010'>We must especially insist on the fact that high blood-pressure -is not a condition essential to arteriosclerosis. It has been -shown by Sawada,<a id='r201' /><a href='#f201' class='c015'><sup>[201]</sup></a> Groedel,<a id='r202' /><a href='#f202' class='c015'><sup>[202]</sup></a> and Ferranini,<a id='r203' /><a href='#f203' class='c015'><sup>[203]</sup></a> through measuring -<span class='pageno' id='Page_165'>165</span>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,<a id='r204' /><a href='#f204' class='c015'><sup>[204]</sup></a> 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,<a id='r205' /><a href='#f205' class='c015'><sup>[205]</sup></a> -Lemaire, and in four cases of Troin and Rivet.<a id='r206' /><a href='#f206' class='c015'><sup>[206]</sup></a> 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.</p> - -<p class='c010'>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,<a id='r207' /><a href='#f207' class='c015'><sup>[207]</sup></a> 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, -<span class='pageno' id='Page_166'>166</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_167'>167</span>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.</p> - -<p class='c010'>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.<a id='r208' /><a href='#f208' class='c015'><sup>[208]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_168'>168</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r209' /><a href='#f209' class='c015'><sup>[209]</sup></a> found the -same in the lower extremities of peasant women who walked a -great deal.</p> - -<p class='c010'>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.<a id='r210' /><a href='#f210' class='c015'><sup>[210]</sup></a> 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<a id='r211' /><a href='#f211' class='c015'><sup>[211]</sup></a> 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, -<span class='pageno' id='Page_169'>169</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_170'>170</span> - <h2 id='ch17' class='c006'>CHAPTER XVII.<br /> <br /><span class='sc'>The Elimination of Toxic Products Through the Intestines and the Improvement of This Function.</span></h2> -</div> -<p class='c009'><span class='sc'>The</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_171'>171</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_172'>172</span>medical practice not infrequently cases are observed where the -retention of all these products together results in very grave -conditions. Thus Ewald<a id='r212' /><a href='#f212' class='c015'><sup>[212]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_173'>173</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>But when food contains no irritating substances and is easily -assimilated without forming <i>residues</i>, 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.</p> - -<p class='c010'>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; -<span class='pageno' id='Page_174'>174</span>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_175'>175</span> - <h2 id='ch18' class='c006'>CHAPTER XVIII.<br /> <br /><span class='sc'>On the Prevention and Treatment of Habitual Constipation.</span></h2> -</div> -<p class='c009'><span class='sc'>We</span> 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 <i>extraneous</i> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_176'>176</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_177'>177</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <i>au naturel</i> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Orange and grape-fruit, taken on an empty stomach in the -<span class='pageno' id='Page_178'>178</span>morning, may also have a laxative effect, due probably to the -quantity of fruit acids they contain.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>We are confident, from experience gained with our own -patients, that people who follow such a regimen will have an easy -<span class='pageno' id='Page_179'>179</span>bowel movement daily, and will thus avoid those dangers which -are connected with the habitual use of laxative drugs.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Electricity may be applied by either galvanic or faradic -current, both of which give excellent results.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <a href='#ch20'>hygiene of the intestines</a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_180'>180</span>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_181'>181</span>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 <a href='#ch19'>Chapter XIX</a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_182'>182</span> - <h2 id='ch19' class='c006'>CHAPTER XIX.<br /> <br /><span class='sc'>Hygiene of the Intestines.</span></h2> -</div> -<p class='c009'><span class='sc'>As</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The integrity of the functions of the intestines is of supreme -importance, for it is here that absorption and assimilation of most -<span class='pageno' id='Page_183'>183</span>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 -<span class='pageno' id='Page_184'>184</span>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.</p> - -<p class='c010'>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 <i>Bacillus maya</i>.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Such poisonous microbes thrive and multiply very well in -the alkaline contents of the intestines, but the growth of such -<span class='pageno' id='Page_185'>185</span>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,<a id='r213' /><a href='#f213' class='c015'><sup>[213]</sup></a> Schmitz,<a id='r214' /><a href='#f214' class='c015'><sup>[214]</sup></a> -and Singer,<a id='r215' /><a href='#f215' class='c015'><sup>[215]</sup></a> that lactic acid decreases intestinal putrefaction, -and also the conjugated ether sulphates in the urine.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The action of the lactic bacilli has been proved by the experiments -of Dr. Herter, of New York,<a id='r216' /><a href='#f216' class='c015'><sup>[216]</sup></a> who discovered that by the -introduction of large quantities of these bacilli into animals their -intestinal putrefaction was diminished.</p> - -<p class='c010'>Dr. Michel Cohendy<a id='r217' /><a href='#f217' class='c015'><sup>[217]</sup></a> 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 -<span class='pageno' id='Page_186'>186</span>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.</p> - -<p class='c010'>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.<a id='r218' /><a href='#f218' class='c015'><sup>[218]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_187'>187</span>that it is unsuitable in those cases in which the intestines are not -in thorough order.</p> - -<p class='c010'>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 <a href='#ch34'>the hygiene of food</a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_188'>188</span>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_189'>189</span>condition of certain glands which influence these nerves: the -sexual organs and the thyroid.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_190'>190</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_191'>191</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_192'>192</span> - <h2 id='ch20' class='c006'>CHAPTER XX.<br /> <br /><span class='sc'>Hygiene of the Intestines—A Few Remarks on the Cause and Prevention of Appendicitis.</span></h2> -</div> -<p class='c009'><span class='sc'>Appendicitis</span>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r219' /><a href='#f219' class='c015'><sup>[219]</sup></a> (a surgeon in the Hague Hospital) -to be the case in 62 per cent. of normal men.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_193'>193</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_194'>194</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Having made the diagnosis in the above-mentioned way, -<span class='pageno' id='Page_195'>195</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_196'>196</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <i>vice versâ</i>, although we cannot deny the fact -that in children with thyroid insufficiency adenoid vegetations -are frequent.</p> - -<p class='c010'>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.</p> - -<p class='c010'>By a slight operation life is often saved. The pity is that -such aid is often invoked too late.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_197'>197</span> - <h2 id='ch21' class='c006'>CHAPTER XXI.<br /> <br /><span class='sc'>On the Elimination of Toxic Products Through the Kidneys.</span></h2> -</div> -<p class='c009'><span class='sc'>In</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It is furthermore important to consider the kidneys because -they are also glands with internal secretion. This is evident from -<span class='pageno' id='Page_198'>198</span>the fact that uræmia is a condition which is dependent upon the -absence of such a secretion.<a id='r220' /><a href='#f220' class='c015'><sup>[220]</sup></a> 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.</p> - -<p class='c010'>That the kidneys are glands with internal secretion has -been proved already by Brown-Séquard,<a id='r221' /><a href='#f221' class='c015'><sup>[221]</sup></a> Meyer,<a id='r222' /><a href='#f222' class='c015'><sup>[222]</sup></a> and other -authors, among whom we will mention as two of the last authorities -on this question, Professor Senator and Professor Hermann -Strauss.</p> - -<p class='c010'>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 <i>vice versâ</i>. -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 -<span class='pageno' id='Page_199'>199</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_200'>200</span>place in the body, showing that the poisonous products of these -processes have passed through the kidneys and been eliminated.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_201'>201</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_202'>202</span>Similarly English<a id='r223' /><a href='#f223' class='c015'><sup>[223]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r224' /><a href='#f224' class='c015'><sup>[224]</sup></a></p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_203'>203</span> - <h2 id='ch22' class='c006'>CHAPTER XXII.<br /> <br /><span class='sc'>Hygiene of the Kidneys, and the Prevention of Renal Disease.</span></h2> -</div> -<p class='c009'><span class='sc'>The</span> 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.</p> - -<p class='c010'>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<a id='r225' /><a href='#f225' class='c015'><sup>[225]</sup></a> 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 -<span class='pageno' id='Page_204'>204</span>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.</p> - -<p class='c010'>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,<a id='r226' /><a href='#f226' class='c015'><sup>[226]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>According to Bunge, we take decidedly too much salt every -day, and in this way we injure our kidneys considerably. -Achard,<a id='r227' /><a href='#f227' class='c015'><sup>[227]</sup></a> Strauss,<a id='r228' /><a href='#f228' class='c015'><sup>[228]</sup></a> Vidal and Javal,<a id='r229' /><a href='#f229' class='c015'><sup>[229]</sup></a> and simultaneously H. -Strauss, have found that diseased kidneys (especially in acute -or chronic parenchymatous inflammations) are unable to eliminate -<span class='pageno' id='Page_205'>205</span>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.</p> - -<p class='c010'>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,<a id='r230' /><a href='#f230' class='c015'><sup>[230]</sup></a> made in Bunge’s laboratory, -the alcohol habit leads to an immoderate use of salt with -its deleterious effects upon the kidneys.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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: <a href='#ch44'>coffee, tea, tobacco, etc.</a>).</p> - -<p class='c010'>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 -<span class='pageno' id='Page_206'>206</span>their delicate structure and hasten the development of the senile -kidneys, with interstitial nephritis.</p> - -<p class='c010'>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<a id='r231' /><a href='#f231' class='c015'><sup>[231]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_207'>207</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_208'>208</span>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_209'>209</span> - <h2 id='ch23' class='c006'>CHAPTER XXIII.<br /> <br /><span class='sc'>On the Elimination of Toxic Products Through the Skin.</span></h2> -</div> -<p class='c009'><span class='sc'>There</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r232' /><a href='#f232' class='c015'><sup>[232]</sup></a> 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 -<span class='pageno' id='Page_210'>210</span>the accumulation of harmful products of perspiration through the -skin, the particular nature of which has not been determined -as yet.</p> - -<p class='c010'>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.<a id='r233' /><a href='#f233' class='c015'><sup>[233]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_211'>211</span>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<a id='r234' /><a href='#f234' class='c015'><sup>[234]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_212'>212</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>For the subject now under consideration the second cause is -<span class='pageno' id='Page_213'>213</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_214'>214</span>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_215'>215</span> - <h2 id='ch24' class='c006'>CHAPTER XXIV.<br /> <br /><span class='sc'>The Hygiene of the Skin—Air Baths.</span></h2> -</div> -<p class='c009'><span class='sc'>In</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_216'>216</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_217'>217</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_218'>218</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_219'>219</span> - <h2 id='ch25' class='c006'>CHAPTER XXV.<br /> <br /><span class='sc'>On Rational Clothing.</span></h2> -</div> -<p class='c009'><span class='sc'>The</span> 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.</p> - -<p class='c010'>First, we will discuss the question as to the nature of the -underwear which is most appropriate for keeping ourselves -in a healthy condition.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_220'>220</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>From the foregoing it follows that socks which do not fit -<span class='pageno' id='Page_221'>221</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Ramie is a material made from a tropical plant, the <i>Bæhmeria -Nivea</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The greatest advantage, however, of cotton over all other -kinds of material (except perhaps ramie) for underwear is its -<span class='pageno' id='Page_222'>222</span>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.</p> - -<p class='c010'>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>i.e.</i>, 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 <i>quality</i> and the -manner in which it is manufactured.</p> - -<p class='c010'>According to the researches of Sir William Thompson<a id='r235' /><a href='#f235' class='c015'><sup>[235]</sup></a> -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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_223'>223</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_224'>224</span>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_225'>225</span><i>horribile dictu!</i> even rubbers, very often, on these important -organs.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_226'>226</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_227'>227</span>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.</p> - -<p class='c010'>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?<a id='r236' /><a href='#f236' class='c015'><sup>[236]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_228'>228</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Rubbers are unquestionably unhealthy things to wear, and -to many will cause a disagreeable sensation owing to the hindrance -to foot perspiration.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_229'>229</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_230'>230</span>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_231'>231</span> - <h2 id='ch26' class='c006'>CHAPTER XXVI.<br /> <br /><span class='sc'>Improved Hygiene of the Skin and Kidneys through Bathing—Foot-baths.</span></h2> -</div> -<p class='c009'><span class='sc'>Every</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_232'>232</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It has recently been shown by experiments conducted by -Strasser and Blumenkranz<a id='r237' /><a href='#f237' class='c015'><sup>[237]</sup></a> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_233'>233</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<i>vice versa</i>. Decidedly the best preventative to catching cold is -to get the skin accustomed to fresh air and cold water.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_234'>234</span>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_235'>235</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_236'>236</span>the toxic products of metabolism, but <i>it is an essential condition -that the heart and blood-vessels be in good condition</i>. The -Japanese are in the habit of taking such hot baths at an enormously -high temperature, and they feel the better for it.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_237'>237</span> - <h2 id='ch27' class='c006'>CHAPTER XXVII.<br /> <br /><span class='sc'>Hygiene of the Skin and Kidneys by Means of Perspiration.</span></h2> -</div> -<p class='c009'><span class='sc'>Under</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_238'>238</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>We can cause abundant perspiration by all the various -means by which the temperature of the body is raised. In such -<span class='pageno' id='Page_239'>239</span>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.</p> - -<p class='c010'>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 <a href='#ch30'>advantages of sunshine</a>) 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, -<span class='pageno' id='Page_240'>240</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_241'>241</span>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.</p> - -<p class='c010'>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<a id='r238' /><a href='#f238' class='c015'><sup>[238]</sup></a> 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.</p> - -<p class='c010'>Of nitrogenous bodies, according to Strauss, about 2 -grammes can be removed through the skin daily, and according to -Professor von Noorden<a id='r239' /><a href='#f239' class='c015'><sup>[239]</sup></a> 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 -<span class='pageno' id='Page_242'>242</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>There can be no doubt that sweating processes are of great -<span class='pageno' id='Page_243'>243</span>benefit, not only to the kidneys, but also to the other organs, -such as the liver.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_244'>244</span> - <h2 id='ch28' class='c006'>CHAPTER XXVIII.<br /> <br /><span class='sc'>On Exercise, Swedish Gymnastics—Massage—Sport, and Walking and Running Exercise.</span></h2> -</div> -<p class='c009'><span class='sc'>All</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_245'>245</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r240' /><a href='#f240' class='c015'><sup>[240]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>It has been shown by the experiments of Sir Lauder Brunton -and Tunnicliffe that kneading the muscles increases circulation -<span class='pageno' id='Page_246'>246</span>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>The Nauheim treatment affords good results in mild cases -of arteriosclerosis, dilatation of the heart, and various other -forms of heart disease.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_247'>247</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_248'>248</span>will, as is only natural, lose their elasticity, in which case degeneration -of the arteries and development of arteriosclerosis may -follow.</p> - -<p class='c010'>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?</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_249'>249</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_250'>250</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Climbing high mountains should be strictly forbidden persons -<span class='pageno' id='Page_251'>251</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_252'>252</span> - <h2 id='ch29' class='c006'>CHAPTER XXIX.<br /> <br /><span class='sc'>A Few Remarks on Cold Feet—Their Cause and Treatment.</span></h2> -</div> -<p class='c009'><span class='sc'>It</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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?</p> - -<p class='c010'><span class='pageno' id='Page_253'>253</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Rubbing and massage of the feet will produce results -similar to those obtained by exercise, and are still more effective -if supplemented by walking.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_254'>254</span>carriage, and not confine herself to merely walking from one -room to another.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_255'>255</span> - <h2 id='ch30' class='c006'>CHAPTER XXX.<br /> <br /><span class='sc'>On the Benefits of Sunlight.</span></h2> -</div> -<p class='c009'><span class='sc'>It</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_256'>256</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Very important was the discovery of Arloing,<a id='r241' /><a href='#f241' class='c015'><sup>[241]</sup></a> and also of -Duclaux,<a id='r242' /><a href='#f242' class='c015'><sup>[242]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_257'>257</span>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,<a id='r243' /><a href='#f243' class='c015'><sup>[243]</sup></a> 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.</p> - -<p class='c010'>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,<a id='r244' /><a href='#f244' class='c015'><sup>[244]</sup></a> 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<a id='r245' /><a href='#f245' class='c015'><sup>[245]</sup></a> 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 -<span class='pageno' id='Page_258'>258</span>diminished in such animals, but become augmented when they -are again exposed for a time to the sunshine.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r246' /><a href='#f246' class='c015'><sup>[246]</sup></a> 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.”</p> - -<p class='c010'>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.<a id='r247' /><a href='#f247' class='c015'><sup>[247]</sup></a> Not only on the blood, but -also on the nerves, they exercise a tonic action. As Niels Finsen -<span class='pageno' id='Page_259'>259</span>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<a id='r248' /><a href='#f248' class='c015'><sup>[248]</sup></a> and -Mintz.<a id='r249' /><a href='#f249' class='c015'><sup>[249]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_260'>260</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The wonderful effects of sunshine are illustrated by an interesting -experiment of Benjamin Franklin. According to Hufeland<a id='r250' /><a href='#f250' class='c015'><sup>[250]</sup></a> -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. -<span class='pageno' id='Page_261'>261</span>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.</p> - -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_262'>262</span> - <h2 id='ch31' class='c006'>CHAPTER XXXI.<br /> <br /><span class='sc'>On the Advantages of an Open Air Life and of Breathing Exercises.</span></h2> -</div> -<p class='c009'><span class='sc'>When</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_263'>263</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The more fresh air, <i>i.e.</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_264'>264</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_265'>265</span>When standing at the window inhale the fresh air deeply -several times and retain it as long as possible before exhaling it.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.”</p> - -<p class='c010'>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 -<span class='pageno' id='Page_266'>266</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>As found by A. and Y. Loewy and Luntz,<a id='r251' /><a href='#f251' class='c015'><sup>[251]</sup></a> 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 -<span class='pageno' id='Page_267'>267</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_268'>268</span>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.<a id='r252' /><a href='#f252' class='c015'><sup>[252]</sup></a> -But before him, Hamel and Harry Campbell<a id='r253' /><a href='#f253' class='c015'><sup>[253]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>These respiratory exercises can also be performed in a -sitting or horizontal position.</p> - -<p class='c010'>According to Sir Lauder Brunton, the deep respiratory -movements act as a kind of massage to the lungs, thoracic -walls, pericardium, and heart.</p> - -<p class='c010'>Sir Herman Weber mentions that he has seen persons who -<span class='pageno' id='Page_269'>269</span>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.</p> - -<p class='c010'>In certain heart troubles—for example, dilatation of the -heart—these movements are contraindicated.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_270'>270</span>of healthy cows or goats, and many eggs, sausages and puddings -made of the blood of pigs (see <a href='#ch39'>Chapter XXXIX</a>), but also of -regular deep breathing, thereby permitting of the entry of oxygen -to all parts of the lungs.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_271'>271</span> - <h2 id='ch32' class='c006'>CHAPTER XXXII.<br /> <br /><span class='sc'>On the Dangers of Living in Confined and Ill Ventilated Quarters.</span></h2> -</div> -<p class='c009'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_272'>272</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_273'>273</span>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 <a href='#ch41'>hygiene of eating—how to obtain an appetite</a>) 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.).</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_274'>274</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_275'>275</span> - <h2 id='ch33' class='c006'>CHAPTER XXXIII.<br /> <br /><span class='sc'>Hygiene of Artificial Heating—the Dangers of Heat by Steam and a Few Hints about their Prevention.</span></h2> -</div> -<p class='c009'><span class='sc'>Old</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_276'>276</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_277'>277</span>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.</p> - -<p class='c010'>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!</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <a href='#ch41'>appetite</a>), exposing themselves to -digestive troubles in consequence. Their need for food will be -less, and a bad condition of health will follow.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_278'>278</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_279'>279</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Hot-water heating is superior to steam heating.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_280'>280</span> - <h2 id='ch34' class='c006'>CHAPTER XXXIV.<br /> <br /><span class='sc'>Food Hygiene—General Remarks.</span></h2> -</div> -<p class='c009'><span class='sc'>The</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_281'>281</span>The Romans had a very appropriate proverb which ran: -“Omne quod est nimium, vertitur in vitium,” “Everything in -excess becomes a vice.”</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>All articles of diet can be classified into three principal -groups: proteids, carbohydrates, and fats. According to the -above-named authorities one gramme<a id='r254' /><a href='#f254' class='c015'><sup>[254]</sup></a> 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>i.e.</i>, 9.3 -calories.</p> - -<p class='c010'><span class='pageno' id='Page_282'>282</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>As shown by Professor Noorden,<a id='r255' /><a href='#f255' class='c015'><sup>[255]</sup></a> 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.</p> - -<p class='c010'>By a series of experiments on a number of healthy American -soldiers, continued for a long time, Chittenden<a id='r256' /><a href='#f256' class='c015'><sup>[256]</sup></a> and Horace -Fletcher<a id='r257' /><a href='#f257' class='c015'><sup>[257]</sup></a> found that these men could do very hard work with -<span class='pageno' id='Page_283'>283</span>an average of only 55 grammes albumin and 2700 calories; and, -what is more interesting, their muscular power was doubled.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_284'>284</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>According to Rubner<a id='r258' /><a href='#f258' class='c015'><sup>[258]</sup></a> the following number of calories are -indicated daily:—</p> -<div class='fs90'> - -<table class='table1' summary=''> -<colgroup> -<col width='69%' /> -<col width='7%' /> -<col width='7%' /> -<col width='7%' /> -<col width='7%' /> -</colgroup> - <tr> - <th class='c016'></th> - <th class='c017'>Albu-<br />min</th> - <th class='c018'><br />Fat</th> - <th class='c017'>Carbo-<br />hydrates</th> - <th class='c013'><br />Calories</th> - </tr> - <tr> - <td class='c016'>For an adult of 50 kilos (doing light work)</td> - <td class='c018'>90</td> - <td class='c018'>37</td> - <td class='c018'>262</td> - <td class='c013'>2102</td> - </tr> - <tr> - <td class='c016'>For an adult of 70 kilos (doing light work)</td> - <td class='c018'>123</td> - <td class='c018'>46</td> - <td class='c018'>317</td> - <td class='c013'>2631</td> - </tr> - <tr> - <td class='c016'>For an adult of 50 kilos (doing heavy work)</td> - <td class='c018'>96</td> - <td class='c018'>44</td> - <td class='c018'>404</td> - <td class='c013'>2472</td> - </tr> - <tr> - <td class='c016'>For an adult of 70 kilos (doing heavy work)</td> - <td class='c018'>118</td> - <td class='c018'>56</td> - <td class='c018'>500</td> - <td class='c013'>3094</td> - </tr> - <tr> - <td class='c016'> </td> - <td class='c018'>91</td> - <td class='c018'>45</td> - <td class='c018'>322</td> - <td class='c013'>2111</td> - </tr> -</table> - -</div> - -<p class='c010'>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.</p> - -<p class='c010'>Accordingly, persons who are growing will need more albumin -in order to produce body tissues; and albuminous food will -<span class='pageno' id='Page_285'>285</span>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 (<i>e.g.</i>, after sexual excesses) -albuminous food will be indicated.</p> - -<p class='c010'>Such a food is also necessary for women during pregnancies, -and especially during lactation.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Besides the three principal groups of food there are certain -other kinds which are almost as indispensable, <i>e.g.</i>, mineral matter -and water, without which no animal or man could live, and vegetable -acids and cellulose.</p> - -<p class='c010'>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, <i>e.g.</i>, 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.</p> - -<p class='c010'><span class='pageno' id='Page_286'>286</span>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.</p> - -<p class='c010'>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,<a id='r259' /><a href='#f259' class='c015'><sup>[259]</sup></a> Strauss,<a id='r260' /><a href='#f260' class='c015'><sup>[260]</sup></a> Vidal and Javal,<a id='r261' /><a href='#f261' class='c015'><sup>[261]</sup></a> and others. We -have enlarged upon this in our chapters on the functions of the -kidneys and their hygiene.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_287'>287</span>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.</p> - -<p class='c010'>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, <i>e.g.</i>, 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:—</p> -<div class='fs90'> - -<table class='table2' summary=''> -<colgroup> -<col width='33%' /> -<col width='22%' /> -<col width='22%' /> -<col width='22%' /> -</colgroup> - <tr> - <th class='c016'></th> - <th class='c016'>Alcohol</th> - <th class='c016'>Albumin</th> - <th class='c019'>Extracts</th> - </tr> - <tr> - <td class='c016'>Bavarian beer</td> - <td class='c016'>3.45</td> - <td class='c016'>0.61</td> - <td class='c019'>5.3</td> - </tr> - <tr> - <td class='c016'>Pilsner</td> - <td class='c016'>3.46</td> - <td class='c016'>0.4</td> - <td class='c019'>5.0</td> - </tr> -</table> - -</div> -<p class='c009'><span class='pageno' id='Page_288'>288</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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:—</p> -<div class='fs90'> - -<table class='table3' summary=''> -<colgroup> -<col width='71%' /> -<col width='28%' /> -</colgroup> - <tr> - <th class='c016'></th> - <th class='c019'>per<br />cent.</th> - </tr> - <tr> - <td class='c016'>Tyrolean wines</td> - <td class='c019'>8.3</td> - </tr> - <tr> - <td class='c016'>French red wine</td> - <td class='c019'>9.4</td> - </tr> - <tr> - <td class='c016'>Rhine wines</td> - <td class='c019'>11.1</td> - </tr> - <tr> - <td class='c016'>Palatial (Pfalz) wines</td> - <td class='c019'>11.5</td> - </tr> - <tr> - <td class='c016'>Mosel</td> - <td class='c019'>12.1</td> - </tr> -</table> - -</div> -<p class='c009'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_289'>289</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The more food also the more exercise should be taken, and -the more we work the more food should we take.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_290'>290</span>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.</p> - -<p class='c010'>We add here a table after Professor Ewald, of Berlin, on -the digestibility of the various kinds of food:—</p> -<div class='fs90'> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='sc'>Table Indicating the Digestibility of Different Kinds of Food.</span></div> - <div class='c000'>The following food leaves the stomach in 1 to 2 hours:—</div> - </div> -</div> - -<div class='lg-container-l c020'> - <div class='linegroup'> - <div class='group'> - <div class='line'>100 to 200 gr. of pure water.</div> - <div class='line'>220 gr. aërated water.</div> - <div class='line'>200 gr. tea.</div> - <div class='line'>200 gr. coffee.</div> - <div class='line'>200 gr. beer.</div> - <div class='line'>200 gr. light wine.</div> - <div class='line'>100 to 200 gr. milk.</div> - <div class='line'>200 gr. bouillon.</div> - <div class='line'>100 gr. eggs (soft boiled).</div> - </div> - </div> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>A longer time, 2 to 3 hours, is required for the digestion of the following food:—</div> - </div> -</div> - -<div class='lg-container-l c020'> - <div class='linegroup'> - <div class='group'> - <div class='line'>200 gr. coffee with cream.</div> - <div class='line'>200 gr. cocoa with milk.</div> - <div class='line'>300 to 500 gr. water.</div> - <div class='line'>300 to 500 gr. beer.</div> - <div class='line'>300 to 500 gr. milk.</div> - <div class='line'>100 gr. raw eggs, hard boiled eggs, or omelette.</div> - <div class='line'>250 gr. sweetbread, boiled.</div> - <div class='line'>200 gr. dried cod, boiled.</div> - <div class='line'>150 gr. asparagus, boiled.</div> - <div class='line'>150 gr. potatoes, boiled.</div> - <div class='line'>150 gr. potatoes, mashed.</div> - <div class='line'>150 gr. cherries, a compôte.</div> - <div class='line'>150 gr. cherries, raw.</div> - <div class='line in1'>70 gr. white bread, new or stale, dry or with tea.</div> - <div class='line in1'><span class='pageno' id='Page_291'>291</span>72 gr. fresh oysters, boiled.</div> - <div class='line'>200 gr. carp, boiled.</div> - <div class='line'>200 gr. pike, boiled.</div> - <div class='line'>200 gr. haddock.</div> - <div class='line in1'>70 gr. biscuit, fresh or stale, dry or with tea.</div> - <div class='line in1'>50 gr. Albert biscuits.</div> - </div> - </div> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>A still longer time, 3 to 4 hours, is required by:—</div> - </div> -</div> - -<div class='lg-container-l c020'> - <div class='linegroup'> - <div class='group'> - <div class='line'>230 gr. young chickens, boiled.</div> - <div class='line'>230 gr. partridges.</div> - <div class='line'>220 to 260 gr. pigeons.</div> - <div class='line'>195 gr. pigeon, roast or broiled.</div> - <div class='line'>250 gr. beef, boiled.</div> - <div class='line'>160 gr. ham, raw or boiled.</div> - <div class='line'>100 gr. roast veal, hot or cold.</div> - <div class='line'>100 gr. beefsteak, roasted.</div> - <div class='line'>100 gr. sirloin of beef.</div> - <div class='line'>200 gr. salmon, boiled.</div> - <div class='line in1'>72 gr. caviar, salted.</div> - <div class='line'>150 gr. dark bread.</div> - <div class='line'>150 gr. brown bread.</div> - <div class='line'>150 gr. white bread.</div> - <div class='line'>100 to 150 gr. Albert biscuits.</div> - <div class='line'>150 gr. potatoes.</div> - <div class='line'>150 gr. kohlrabs, boiled.</div> - <div class='line'>150 gr. carrots.</div> - <div class='line'>150 gr. spinach.</div> - <div class='line'>150 gr. cucumber salads.</div> - <div class='line in1'>50 gr. apples.</div> - </div> - </div> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>The following food demands the longest time for its digestion:—</div> - </div> -</div> - -<div class='lg-container-l c020'> - <div class='linegroup'> - <div class='group'> - <div class='line'>210 gr. pigeons, roasted.</div> - <div class='line'>250 gr. filet of beef, roasted.</div> - <div class='line'>250 gr. beef steak, roasted.</div> - <div class='line'>250 gr. tongue, smoked.</div> - <div class='line'>200 gr. hare, roasted.</div> - <div class='line'>240 gr. partridges, roasted.</div> - <div class='line'>250 gr. goose, roasted.</div> - <div class='line'>250 gr. duck, roasted.</div> - <div class='line'>200 gr. herring, salad.</div> - <div class='line'>150 gr. lentils, mashed.</div> - <div class='line'>200 gr. peas, mashed.</div> - <div class='line'>150 gr. green beans, boiled.</div> - </div> - </div> -</div> - -</div> -<p class='c009'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_292'>292</span>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.</p> - -<p class='c010'>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,<a id='r262' /><a href='#f262' class='c015'><sup>[262]</sup></a> 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.</p> - -<p class='c010'>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:—</p> -<h3 class='c001'>BREAKFAST.</h3> - -<p class='c014'>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.</p> -<h3 class='c001'>DINNER.</h3> - -<p class='c014'>Soup, fish or meat, vegetables, stewed fruit, fresh fruit, -white or brown bread.</p> -<div> - <span class='pageno' id='Page_293'>293</span> - <h3 class='c001'>SUPPER.</h3> -</div> - -<p class='c014'>Like breakfast: one pint of milk, or half a pint of sour milk, -kefir, or koumiss. Also, if liked, sour milk during the day.</p> - -<p class='c010'>In the above diet list we have a variety of foods, which -variety is of great importance.</p> - -<p class='c010'>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.</p> - -<p class='c010'>When no meat is eaten, then at least 1½ to 2 liters of rich -milk should be taken, and some cream cheese.</p> - -<p class='c010'>After these general remarks on food we will treat of the -merits and drawbacks of the various kinds of food.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_294'>294</span> - <h2 id='ch35' class='c006'>CHAPTER XXXV.<br /> <br /><span class='sc'>On Proteid Food, Animal Food, Meat, Fish, Eggs, Milk, etc.</span></h2> -</div> -<p class='c009'><span class='sc'>Meat</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r263' /><a href='#f263' class='c015'><sup>[263]</sup></a> each 100 parts -contain:—</p> -<div class='fs90'> - -<table class='table4' summary=''> -<colgroup> -<col width='31%' /> -<col width='26%' /> -<col width='15%' /> -<col width='26%' /> -</colgroup> - <tr> - <th class='btt bbt c021'>Food.</th> - <th class='btt bbt blt c022'>Albumin.</th> - <th class='btt bbt blt c022'>Fat.</th> - <th class='btt bbt blt c022'>Calories.</th> - </tr> - <tr> - <td class='c021'>Lean beef</td> - <td class='blt c022'>20.6</td> - <td class='blt c022'>1.5</td> - <td class='blt c022'>98</td> - </tr> - <tr> - <td class='c021'>Fat beef</td> - <td class='blt c022'>16.9</td> - <td class='blt c022'>27.2</td> - <td class='blt c022'>327</td> - </tr> - <tr> - <td class='c021'>Fat pork</td> - <td class='blt c022'>14.5</td> - <td class='blt c022'>37.3</td> - <td class='blt c022'>406</td> - </tr> - <tr> - <td class='c021'>Lean pork</td> - <td class='blt c022'>19.9</td> - <td class='blt c022'>6.8</td> - <td class='blt c022'>145</td> - </tr> - <tr> - <td class='c021'>Lean veal</td> - <td class='blt c022'>19.8</td> - <td class='blt c022'>0.8</td> - <td class='blt c022'>89</td> - </tr> - <tr> - <td class='c021'>Fat veal</td> - <td class='blt c022'>18.9</td> - <td class='blt c022'>7.4</td> - <td class='blt c022'>146</td> - </tr> - <tr> - <td class='c021'>Fat chicken</td> - <td class='blt c022'>18.5</td> - <td class='blt c022'>9.3</td> - <td class='blt c022'>162</td> - </tr> - <tr> - <td class='c021'>Hare</td> - <td class='blt c022'>23.3</td> - <td class='blt c022'>1.1</td> - <td class='blt c022'>106</td> - </tr> - <tr> - <td class='c021'>Herring</td> - <td class='blt c022'>10.1</td> - <td class='blt c022'>7.1</td> - <td class='blt c022'>107</td> - </tr> - <tr> - <td class='bbt c021'>Bacon</td> - <td class='bbt blt c022'> </td> - <td class='bbt blt c022'>95.3</td> - <td class='bbt blt c022'>886</td> - </tr> -</table> - -</div> - -<p class='c009'><span class='pageno' id='Page_295'>295</span>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>i.e.</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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. -<span class='pageno' id='Page_296'>296</span>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.</p> - -<p class='c010'>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:—</p> -<div class='fs90'> - -<table class='table4' summary=''> -<colgroup> -<col width='31%' /> -<col width='26%' /> -<col width='15%' /> -<col width='26%' /> -</colgroup> - <tr> - <th class='btt bbt c021'></th> - <th class='btt bbt blt c022'>Albumin.</th> - <th class='btt bbt blt c022'>Fat.</th> - <th class='btt bbt blt c022'>Calories.</th> - </tr> - <tr> - <td class='c021'>Herring (Rubner)</td> - <td class='blt c022'>10.1</td> - <td class='blt c022'>7.1</td> - <td class='blt c022'>107</td> - </tr> - <tr> - <td class='c021'>Haddock (Rubner)</td> - <td class='blt c022'>17.1</td> - <td class='blt c022'>0.3</td> - <td class='blt c022'>73</td> - </tr> - <tr> - <td class='c021'>Salmon (Pavy)</td> - <td class='blt c022'>16.10</td> - <td class='blt c022'>5.50</td> - <td class='blt c022'>110</td> - </tr> - <tr> - <td class='c021'>Eel (Rubner)</td> - <td class='blt c022'>17.8</td> - <td class='blt c022'>28.4</td> - <td class='blt c022'>317</td> - </tr> - <tr> - <td class='bbt c021'>White fish (Pavy)</td> - <td class='bbt blt c022'>18.10</td> - <td class='bbt blt c022'>2.90</td> - <td class='bbt blt c022'>102</td> - </tr> -</table> - -</div> -<p class='c009'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_297'>297</span>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 <a href='#ch38'>Chapter XXXVIII</a>).</p> - -<p class='c010'>According to Professor Rubner milk and the various products -of milk contain the three main elements of food, in each 100 -parts, as follows:—</p> -<div class='fs90'> - -<table class='table5' summary=''> -<colgroup> -<col width='25%' /> -<col width='20%' /> -<col width='12%' /> -<col width='20%' /> -<col width='20%' /> -</colgroup> - <tr> - <th class='btt bbt c021'></th> - <th class='btt bbt blt c022'>Albumin.</th> - <th class='btt bbt blt c022'>Fat.</th> - <th class='btt bbt blt c022'>Carbo-<br />hydrates.</th> - <th class='btt bbt blt c022'>Calories.</th> - </tr> - <tr> - <td class='c021'>Cows’ milk</td> - <td class='blt c022'>3.4</td> - <td class='blt c022'>3.6</td> - <td class='blt c022'>4.8</td> - <td class='blt c022'>67</td> - </tr> - <tr> - <td class='c021'>Cream</td> - <td class='blt c022'>3.7</td> - <td class='blt c022'>25.7</td> - <td class='blt c022'>3.5</td> - <td class='blt c022'>268</td> - </tr> - <tr> - <td class='c021'>Buttermilk</td> - <td class='blt c022'>3.8</td> - <td class='blt c022'>1.2</td> - <td class='blt c022'>4.6</td> - <td class='blt c022'>41</td> - </tr> - <tr> - <td class='c021'>Whey</td> - <td class='blt c022'>0.8</td> - <td class='blt c022'>0.2</td> - <td class='blt c022'>3.4</td> - <td class='blt c022'>24</td> - </tr> - <tr> - <td class='c021'>Butter</td> - <td class='blt c022'>0.9</td> - <td class='blt c022'>83.1</td> - <td class='blt c022'>0.5</td> - <td class='blt c022'>404</td> - </tr> - <tr> - <td class='bbt c021'>Cream cheese</td> - <td class='bbt blt c022'>27.2</td> - <td class='bbt blt c022'>30.4</td> - <td class='bbt blt c022'>2.5</td> - <td class='bbt blt c022'>779</td> - </tr> -</table> - -</div> - -<p class='c009'>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:—</p> -<div class='fs90'> - -<table class='table5' summary=''> -<colgroup> -<col width='25%' /> -<col width='20%' /> -<col width='12%' /> -<col width='20%' /> -<col width='20%' /> -</colgroup> - <tr> - <th class='btt bbt c021'></th> - <th class='btt bbt blt c022'>Casein.</th> - <th class='btt bbt blt c022'>Albumin.</th> - <th class='btt bbt blt c022'>Fat.</th> - <th class='btt bbt blt c022'>Sugar.</th> - </tr> - <tr> - <td class='c021'> </td> - <td class='blt c022'> </td> - <td class='blt c022'> </td> - <td class='blt c022'>{ 3.1 }</td> - <td class='blt c022'>{ 5.9 }</td> - </tr> - <tr> - <td class='c021'>Woman</td> - <td class='blt c022'>1.2</td> - <td class='blt c022'>0.5</td> - <td class='blt c022'>{ 3.3 }</td> - <td class='blt c022'>{ to }</td> - </tr> - <tr> - <td class='c021'> </td> - <td class='blt c022'> </td> - <td class='blt c022'> </td> - <td class='blt c022'>{ 3.8 }</td> - <td class='blt c022'>{ 6.5 }</td> - </tr> - <tr> - <td class='c021'>Cow</td> - <td class='blt c022'>3.0</td> - <td class='blt c022'>0.5</td> - <td class='blt c022'>3.7</td> - <td class='blt c022'>4.9</td> - </tr> - <tr> - <td class='c021'>Horse</td> - <td class='blt c022'>1.2</td> - <td class='blt c022'>0.8</td> - <td class='blt c022'>1.2</td> - <td class='blt c022'>5.7</td> - </tr> - <tr> - <td class='c021'>Ass</td> - <td class='blt c022'>0.7</td> - <td class='blt c022'>1.6</td> - <td class='blt c022'>1.6</td> - <td class='blt c022'>6.0</td> - </tr> - <tr> - <td class='bbt c021'>Goat</td> - <td class='bbt blt c022'>2.4</td> - <td class='bbt blt c022'>0.8</td> - <td class='bbt blt c022'>4.3</td> - <td class='bbt blt c022'>3.6</td> - </tr> -</table> - -</div> -<p class='c009'>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 -<span class='pageno' id='Page_298'>298</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_299'>299</span>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.</p> - -<p class='c010'>Dr. Haig<a id='r264' /><a href='#f264' class='c015'><sup>[264]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r265' /><a href='#f265' class='c015'><sup>[265]</sup></a> 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.</p> - -<p class='c010'><span class='pageno' id='Page_300'>300</span>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_301'>301</span> - <h2 id='ch36' class='c006'>CHAPTER XXXVI.<br /> <br /><span class='sc'>On Carbohydrates and Fats, and the Great Advantages of Vegetables and Fruit.</span></h2> -</div> -<p class='c009'><span class='sc'>Speaking</span> 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.</p> - -<p class='c010'>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:—</p> -<div class='fs90'> - -<table class='table6' summary=''> -<colgroup> -<col width='28%' /> -<col width='15%' /> -<col width='10%' /> -<col width='16%' /> -<col width='15%' /> -<col width='15%' /> -</colgroup> - <tr> - <td class='btt bbt c021'>Food.</td> - <td class='btt bbt blt c022'>Albumin.</td> - <td class='btt bbt blt c022'>Fat.</td> - <td class='btt bbt blt c022'>Carbo-<br />hydrates.</td> - <td class='btt bbt blt c022'>Cellu-<br />lose.</td> - <td class='btt bbt blt c022'>Calories.</td> - </tr> - <tr> - <td class='c021'>Flour of peas</td> - <td class='blt c022'>25.7</td> - <td class='blt c022'>1.8</td> - <td class='blt c022'>57.2</td> - <td class='blt c022'>1.3</td> - <td class='blt c022'>362</td> - </tr> - <tr> - <td class='c021'>Flour of beans</td> - <td class='blt c022'>23.2</td> - <td class='blt c022'>2.1</td> - <td class='blt c022'>58.9</td> - <td class='blt c022'>1.8</td> - <td class='blt c022'>363</td> - </tr> - <tr> - <td class='c021'>Flour of lentils</td> - <td class='blt c022'>25.7</td> - <td class='blt c022'>1.9</td> - <td class='blt c022'>56.8</td> - <td class='blt c022'>2.1</td> - <td class='blt c022'>364</td> - </tr> - <tr> - <td class='c021'>Flour of rice</td> - <td class='blt c022'>6.9</td> - <td class='blt c022'>0.5</td> - <td class='blt c022'>77.6</td> - <td class='blt c022'>0.1</td> - <td class='blt c022'>351</td> - </tr> - <tr> - <td class='c021'>Flour of Indian corn</td> - <td class='blt c022'>14.0</td> - <td class='blt c022'>3.8</td> - <td class='blt c022'>67.6</td> - <td class='blt c022'>3.1</td> - <td class='blt c022'>382</td> - </tr> - <tr> - <td class='c021'>Flour of wheat</td> - <td class='blt c022'>10.2</td> - <td class='blt c022'>0.9</td> - <td class='blt c022'>74.7</td> - <td class='blt c022'>0.3</td> - <td class='blt c022'>357</td> - </tr> - <tr> - <td class='c021'>Flour of rye</td> - <td class='blt c022'>10.9</td> - <td class='blt c022'>4.8</td> - <td class='blt c022'>70.5</td> - <td class='blt c022'>1.2</td> - <td class='blt c022'>383</td> - </tr> - <tr> - <td class='c021'>Wheat bread</td> - <td class='blt c022'>6.8</td> - <td class='blt c022'>0.8</td> - <td class='blt c022'>57.4</td> - <td class='blt c022'>0.4</td> - <td class='blt c022'>252</td> - </tr> - <tr> - <td class='c021'>Rye bread</td> - <td class='blt c022'>6.0</td> - <td class='blt c022'>0.5</td> - <td class='blt c022'>47.8</td> - <td class='blt c022'>0.3</td> - <td class='blt c022'>226</td> - </tr> - <tr> - <td class='c021'>Potatoes</td> - <td class='blt c022'>2.1</td> - <td class='blt c022'>0.1</td> - <td class='blt c022'>21.0</td> - <td class='blt c022'>0.7</td> - <td class='blt c022'>98</td> - </tr> - <tr> - <td class='bbt c021'>Carrots</td> - <td class='bbt blt c022'>1.0</td> - <td class='bbt blt c022'>0.2</td> - <td class='bbt blt c022'>4.4</td> - <td class='bbt blt c022'>1.4</td> - <td class='bbt blt c022'>50</td> - </tr> -</table> - -</div> -<p class='c009'>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.</p> - -<p class='c010'><span class='pageno' id='Page_302'>302</span>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.</p> - -<p class='c010'>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<a id='r266' /><a href='#f266' class='c015'><sup>[266]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Rice must be a most excellent food, for the natives of -<span class='pageno' id='Page_303'>303</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_304'>304</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_305'>305</span>made by Lunin<a id='r267' /><a href='#f267' class='c015'><sup>[267]</sup></a> in Bunge’s laboratory, and by Förster,<a id='r268' /><a href='#f268' class='c015'><sup>[268]</sup></a> -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.</p> - -<p class='c010'>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:—</p> -<div class='fs90'> - -<table class='table7' summary=''> -<colgroup> -<col width='66%' /> -<col width='33%' /> -</colgroup> - <tr> - <td class='c016'>Cows’ milk</td> - <td class='c013'>1510</td> - </tr> - <tr> - <td class='c016'>Human milk</td> - <td class='c013'>243</td> - </tr> - <tr> - <td class='c016'>Strawberries</td> - <td class='c013'>483</td> - </tr> - <tr> - <td class='c016'>Figs</td> - <td class='c013'>400</td> - </tr> - <tr> - <td class='c016'>Yolk of eggs</td> - <td class='c013'>380</td> - </tr> - <tr> - <td class='c016'>Prunes</td> - <td class='c013'>160</td> - </tr> - <tr> - <td class='c016'>Peas</td> - <td class='c013'>137</td> - </tr> - <tr> - <td class='c016'>Dates</td> - <td class='c013'>108</td> - </tr> - <tr> - <td class='c016'>White of egg</td> - <td class='c013'>130</td> - </tr> - <tr> - <td class='c016'>Potatoes</td> - <td class='c013'>100</td> - </tr> - <tr> - <td class='c016'>Pears</td> - <td class='c013'>95</td> - </tr> - <tr> - <td class='c016'>Malaga grapes</td> - <td class='c013'>60</td> - </tr> - <tr> - <td class='c016'>Graham bread</td> - <td class='c013'>77</td> - </tr> - <tr> - <td class='c016'>But beef, only</td> - <td class='c013'>24</td> - </tr> -</table> - -</div> -<p class='c009'>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,<a id='r269' /><a href='#f269' class='c015'><sup>[269]</sup></a> 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 -<span class='pageno' id='Page_306'>306</span>of the urine; and, as Lehmann, Posner, and v. Noorden have -shown, the carbonate of lime dissolves uric acid.</p> - -<p class='c010'>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,<a id='r270' /><a href='#f270' class='c015'><sup>[270]</sup></a> 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.</p> - -<p class='c010'>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</p> - -<p class='c010'>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:—</p> -<div class='fs90'> - -<table class='table8' summary=''> -<colgroup> -<col width='70%' /> -<col width='29%' /> -</colgroup> - <tr> - <td class='c016'>Pig’s blood</td> - <td class='c013'>226</td> - </tr> - <tr> - <td class='c016'>Spinach</td> - <td class='c013'>33 to 39</td> - </tr> - <tr> - <td class='c016'>Asparagus</td> - <td class='c013'>20</td> - </tr> - <tr> - <td class='c016'>Yolk of eggs</td> - <td class='c013'>10 to 24</td> - </tr> - <tr> - <td class='c016'>Beef</td> - <td class='c013'>17</td> - </tr> - <tr> - <td class='c016'>Cabbage, green leaves</td> - <td class='c013'>17</td> - </tr> - <tr> - <td class='c016'>Apples</td> - <td class='c013'>13</td> - </tr> - <tr> - <td class='c016'>Red cherries</td> - <td class='c013'>10</td> - </tr> - <tr> - <td class='c016'>Almonds</td> - <td class='c013'>9.5</td> - </tr> - <tr> - <td class='c016'>Lentils</td> - <td class='c013'>9.5</td> - </tr> - <tr> - <td class='c016'>Strawberries</td> - <td class='c013'>8.6 to 9.3</td> - </tr> - <tr> - <td class='c016'>Carrots</td> - <td class='c013'>8.6</td> - </tr> - <tr> - <td class='c016'>White beans</td> - <td class='c013'>6.2 to 6.6</td> - </tr> - <tr> - <td class='c016'>Black cherries</td> - <td class='c013'>7.2</td> - </tr> - <tr> - <td class='c016'>Peas</td> - <td class='c013'>6.2 to 6.6</td> - </tr> - <tr> - <td class='c016'>Potatoes</td> - <td class='c013'>6.4</td> - </tr> - <tr> - <td class='c016'>Huckleberries</td> - <td class='c013'>5.7</td> - </tr> - <tr> - <td class='c016'>Grapes</td> - <td class='c013'>5.6</td> - </tr> - <tr> - <td class='c016'>Wheat</td> - <td class='c013'>5.5</td> - </tr> - <tr> - <td class='c016'>Rye</td> - <td class='c013'>4.9</td> - </tr> - <tr> - <td class='c016'>Barley</td> - <td class='c013'>4.5</td> - </tr> - <tr> - <td class='c016'>Raspberries</td> - <td class='c013'>3.9</td> - </tr> - <tr> - <td class='c016'>Figs</td> - <td class='c013'>3.7</td> - </tr> - <tr> - <td class='c016'>Human milk</td> - <td class='c013'>2.3 to 3.1</td> - </tr> - <tr> - <td class='c016'>Cows’ milk</td> - <td class='c013'>2.3</td> - </tr> - <tr> - <td class='c016'>Dates</td> - <td class='c013'>2.1</td> - </tr> - <tr> - <td class='c016'>Pears</td> - <td class='c013'>2.0</td> - </tr> - <tr> - <td class='c016'>But rice, only</td> - <td class='c013'>1.0 to 2.0</td> - </tr> -</table> - -</div> -<p class='c009'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>As it is very probable that organic iron is more easily -assimilated than inorganic, it would be advisable in those cases -<span class='pageno' id='Page_307'>307</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r271' /><a href='#f271' class='c015'><sup>[271]</sup></a> -made in Bunge’s laboratory. We also used grapes in large -quantities, besides the above-named fruits.</p> - -<p class='c010'>In case of gravel, also, where the concrements consist of -uric acid, the administering of such fruit can give beneficial -results.</p> - -<p class='c010'><span class='pageno' id='Page_308'>308</span>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,<a id='r272' /><a href='#f272' class='c015'><sup>[272]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_309'>309</span> - <h2 id='ch37' class='c006'>CHAPTER XXXVII.<br /> <br /><span class='sc'>On the Advantages and Disadvantages of a Vegetarian Diet.</span></h2> -</div> -<p class='c009'><span class='sc'>Owing</span> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_310'>310</span>body. This experience we have also gained and confirmed by -personal test.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Thus with vegetarian diet we can avoid, in great probability, -those diseases which arise from an excessive formation -of uric acid. As Professor Dettweiler,<a id='r273' /><a href='#f273' class='c015'><sup>[273]</sup></a> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_311'>311</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>But the greatest advantages of a vegetarian diet are seen -in the prevention of the ravages of old age by this means. By the -<span class='pageno' id='Page_312'>312</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_313'>313</span>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.</p> - -<p class='c010'>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 <i>under</i>-nutrition, and in consequence -the imminent danger of bacterial infection.</p> - -<p class='c010'>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<a id='r274' /><a href='#f274' class='c015'><sup>[274]</sup></a> 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 -<span class='pageno' id='Page_314'>314</span>products or secretions of which take an active part in the destruction -of bacteria and their toxins.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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?</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_315'>315</span>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.</p> - -<p class='c010'>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,<a id='r275' /><a href='#f275' class='c015'><sup>[275]</sup></a> 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.</p> - -<p class='c010'><span class='pageno' id='Page_316'>316</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_317'>317</span> - <h2 id='ch38' class='c006'>CHAPTER XXXVIII.<br /> <br /><span class='sc'>On the Dangers of a Too Abundant Meat Diet—A Few Hints on the Dietetics of Meat.</span></h2> -</div> -<p class='c009'><span class='sc'>Most</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It is noticeable in a marked degree in Graves’s disease, and -also in myxœdema, that patients suffering from them will not -<span class='pageno' id='Page_318'>318</span>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<a id='r276' /><a href='#f276' class='c015'><sup>[276]</sup></a> found also -an enlargement of the follicles of the pituitary body in birds of -prey, and Houssaye<a id='r277' /><a href='#f277' class='c015'><sup>[277]</sup></a> found that chickens lost their fertility after -such a diet, which affected their ovaries.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_319'>319</span>we desire to retain our vitality for a long time, it is best for us -not to take too much meat.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_320'>320</span>fact we have already published. Diabetes may not only be due to -the changes in the pancreas, but also as we have shown<a id='r278' /><a href='#f278' class='c015'><sup>[278]</sup></a> to those -in the thyroid gland, consequent upon such nourishment.</p> - -<p class='c010'>It is a very important fact that much meat can become most -injurious to diabetic patients, and, as v. Noorden<a id='r279' /><a href='#f279' class='c015'><sup>[279]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r280' /><a href='#f280' class='c015'><sup>[280]</sup></a> 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.</p> - -<p class='c010'><span class='pageno' id='Page_321'>321</span>These conditions can, however, be improved if the meat -be suppressed and replaced by a vegetarian diet.</p> - -<p class='c010'>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.</p> - -<p class='c010'>We think we should be guilty of fanatical prejudice if, -because of the above accounts of the dangerous consequences -ensuing on an unlimited <i>abuse</i> of meat, we should discard meat -entirely, even in small quantities. Such a course is, indeed, -strongly advocated by Haig,<a id='r281' /><a href='#f281' class='c015'><sup>[281]</sup></a> but we cannot follow him so far.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <i>im</i>moderate use -of meat that is to be condemned, and not its use in small quantities. -<span class='pageno' id='Page_322'>322</span>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.</p> - -<p class='c010'>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<a id='r282' /><a href='#f282' class='c015'><sup>[282]</sup></a> 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.<a id='r283' /><a href='#f283' class='c015'><sup>[283]</sup></a> 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 -<span class='pageno' id='Page_323'>323</span>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.</p> - -<p class='c010'>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,<a id='r284' /><a href='#f284' class='c015'><sup>[284]</sup></a> Charrin,<a id='r285' /><a href='#f285' class='c015'><sup>[285]</sup></a> Lafayette -Mendel,<a id='r286' /><a href='#f286' class='c015'><sup>[286]</sup></a> and others, the thyroid of infants contains no -iodine; after the first year there is some, but even then very -little. Baumann and Jollin<a id='r287' /><a href='#f287' class='c015'><sup>[287]</sup></a> 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.</p> - -<p class='c010'>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<a id='r288' /><a href='#f288' class='c015'><sup>[288]</sup></a> -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.</p> - -<p class='c010'>There are certain precautionary measures that, perhaps, can -mitigate such dangers; thus, by the daily use of water in proportion -<span class='pageno' id='Page_324'>324</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r289' /><a href='#f289' class='c015'><sup>[289]</sup></a></p> - -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_325'>325</span> - <h2 id='ch39' class='c006'>CHAPTER XXXIX.<br /> <br /><span class='sc'>On the Great Advantages of Much Milk in the Diet for the Prevention and Treatment of Old Age.</span></h2> -</div> -<p class='c009'><span class='sc'>We</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It has been shown by Bang,<a id='r290' /><a href='#f290' class='c015'><sup>[290]</sup></a> Mossé,<a id='r291' /><a href='#f291' class='c015'><sup>[291]</sup></a> 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 -<span class='pageno' id='Page_326'>326</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r292' /><a href='#f292' class='c015'><sup>[292]</sup></a> 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.</p> - -<p class='c010'><span class='pageno' id='Page_327'>327</span>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,<a id='r293' /><a href='#f293' class='c015'><sup>[293]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_328'>328</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Those who do not like milk in large quantity may add a -<span class='pageno' id='Page_329'>329</span>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.</p> - -<p class='c010'>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, <a href='#ch19'>Chapters XIX</a> and <a href='#ch20'>XX</a>).</p> - -<p class='c010'>It is a very interesting fact that in countries where much of -a certain kind of acid milk is used (<i>e.g.</i>, Bulgarian “yogurth,” -prepared with the aid of the Maya bacillus), there are many -persons who live to be more than 100 (see Chapters <a href='#ch06'>VI</a> and -<a href='#ch19'>XIX</a>). 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.</p> - -<p class='c010'>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,<a id='r294' /><a href='#f294' class='c015'><sup>[294]</sup></a> Blum.<a id='r295' /><a href='#f295' class='c015'><sup>[295]</sup></a>) This shows that when the -<span class='pageno' id='Page_330'>330</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r296' /><a href='#f296' class='c015'><sup>[296]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r297' /><a href='#f297' class='c015'><sup>[297]</sup></a> and of Forsyth<a id='r298' /><a href='#f298' class='c015'><sup>[298]</sup></a> speak volumes on -this point.</p> - -<p class='c010'><span class='pageno' id='Page_331'>331</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_332'>332</span>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_333'>333</span> - <h2 id='ch40' class='c006'>CHAPTER XL.<br /> <br /><span class='sc'>On Blood as an Article of Food Containing Iron and Animal Extracts—Sausages and Blood Puddings.</span></h2> -</div> -<p class='c009'><span class='sc'>Iron</span> 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>i.e.</i>, 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>i.e.</i>, iron as it occurs in various articles of food, and especially -in the blood.</p> - -<p class='c010'>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<a id='r299' /><a href='#f299' class='c015'><sup>[299]</sup></a> 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.</p> - -<p class='c010'>Professor Bunge, and also his pupils Abderhalden and -Haüsermann, found that all animals which received food containing -but little iron, became anæmic, <i>e.g.</i>, 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.</p> - -<p class='c010'>Anæmia of slight degree is very frequent in women, especially -<span class='pageno' id='Page_334'>334</span>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<a id='r300' /><a href='#f300' class='c015'><sup>[300]</sup></a> 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,<a id='r301' /><a href='#f301' class='c015'><sup>[301]</sup></a> 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 -<span class='pageno' id='Page_335'>335</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_336'>336</span>ferments. Likewise it contains important immunizing -substances, opsonins, alexins, etc.</p> - -<p class='c010'>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,<a id='r302' /><a href='#f302' class='c015'><sup>[302]</sup></a> -the composition of pigs’ blood and of ox blood in respect -to their nourishing qualities and different mineral contents.</p> - -<div class='fs90'> - -<table class='table9' summary=''> -<colgroup> -<col width='67%' /> -<col width='16%' /> -<col width='16%' /> -</colgroup> - <tr> - <th class='c012'></th> - <th class='c017'><span class='sc'>Pigs’ Blood</span><br />per cent.</th> - <th class='c023'><span class='sc'>Ox Blood</span><br />per cent.</th> - </tr> - <tr> - <td class='c012'>Water</td> - <td class='c018'>71.6</td> - <td class='c013'>80.89</td> - </tr> - <tr> - <td class='c012'>Hæmoglobin</td> - <td class='c018'>14.22</td> - <td class='c013'>10.31</td> - </tr> - <tr> - <td class='c012'>Albumin</td> - <td class='c018'>4.66</td> - <td class='c013'>6.98</td> - </tr> - <tr> - <td class='c012'>Fat</td> - <td class='c018'>0.11</td> - <td class='c013'>0.052</td> - </tr> - <tr> - <td class='c012'>Fatty Acids</td> - <td class='c018'>0.04</td> - <td class='c013'> </td> - </tr> - <tr> - <td class='c012'>Sugar</td> - <td class='c018'>0.069</td> - <td class='c013'>0.02</td> - </tr> - <tr> - <td class='c012'>Cholesterin</td> - <td class='c018'>0.044</td> - <td class='c013'>0.199</td> - </tr> - <tr> - <td class='c012'>Lecithin</td> - <td class='c018'>0.231</td> - <td class='c013'>0.135</td> - </tr> - <tr> - <td class='c012'>Phosphoric Acid w. Nuclein</td> - <td class='c018'>0.006</td> - <td class='c013'>0.003</td> - </tr> - <tr> - <td class='c012'>Oxide of Iron</td> - <td class='c018'>0.696</td> - <td class='c013'>0.054</td> - </tr> - <tr> - <td class='c012'>Calcium</td> - <td class='c018'>0.068</td> - <td class='c013'>0.007</td> - </tr> - <tr> - <td class='c012'>Magnesium</td> - <td class='c018'>0.089</td> - <td class='c013'>0.004</td> - </tr> - <tr> - <td class='c012'>Potassium</td> - <td class='c018'>0.2303</td> - <td class='c013'>0.004</td> - </tr> - <tr> - <td class='c012'>Sodium</td> - <td class='c018'>0.2406</td> - <td class='c013'>0.0364</td> - </tr> - <tr> - <td class='c012'>Entire Phosphoric Acid</td> - <td class='c018'>0.1002</td> - <td class='c013'>0.0040</td> - </tr> - <tr> - <td class='c012'>Anorg. Phosphoric Acid</td> - <td class='c018'>0.749</td> - <td class='c013'>0.017</td> - </tr> - <tr> - <td class='c012'>Chlorides</td> - <td class='c018'>0.2690</td> - <td class='c013'> </td> - </tr> -</table> - -</div> -<p class='c009'>According to the researches of T. König,<a id='r303' /><a href='#f303' class='c015'><sup>[303]</sup></a> Farwick and C. -Kraut blood sausages have the following composition:—</p> -<div class='fs90'> - -<table class='table6' summary=''> -<colgroup> -<col width='12%' /> -<col width='12%' /> -<col width='12%' /> -<col width='12%' /> -<col width='12%' /> -<col width='12%' /> -<col width='12%' /> -<col width='12%' /> -</colgroup> - <tr> - <th class='btt bbt c022' colspan='4'><span class='sc'>In the Natural Substance</span></th> - <th class='btt bbt blm c022' colspan='4'><span class='sc'>Dry Substance</span></th> - </tr> - <tr> - <td class='c022'> </td> - <td class='blt c022'> </td> - <td class='blt c022'> </td> - <td class='blt c022'>Nitrogen</td> - <td class='blm c022'> </td> - <td class='blt c022'> </td> - <td class='blt c022'> </td> - <td class='blt c022'> </td> - </tr> - <tr> - <td class='c022'> </td> - <td class='blt c022'>Nitro-</td> - <td class='blt c022'> </td> - <td class='blt c022'>Free</td> - <td class='blm c022'> </td> - <td class='blt c022'>Nitro-</td> - <td class='blt c022'> </td> - <td class='blt c022'>Nitrogen</td> - </tr> - <tr> - <td class='c022'>Water</td> - <td class='blt c022'>genous</td> - <td class='blt c022'>Fat</td> - <td class='blt c022'>Extract</td> - <td class='blm c022'>Ashes</td> - <td class='blt c022'>genous</td> - <td class='blt c022'>Fat</td> - <td class='blt c022'>and Dry</td> - </tr> - <tr> - <td class='bbt c022'> </td> - <td class='bbt blt c022'>Substance</td> - <td class='bbt blt c022'> </td> - <td class='bbt blt c022'>Matters</td> - <td class='bbt blm c022'> </td> - <td class='bbt blt c022'>Substance</td> - <td class='bbt blt c022'> </td> - <td class='bbt blt c022'>Substance</td> - </tr> - <tr> - <td class='bbt c022'>49.93%</td> - <td class='bbt blt c022'>11.81%</td> - <td class='bbt blt c022'>11.48%</td> - <td class='bbt blt c022'>25.09%</td> - <td class='bbt blm c022'>1.64</td> - <td class='bbt blt c022'>23.59%</td> - <td class='bbt blt c022'>22.90%</td> - <td class='bbt blt c022'>3.77%</td> - </tr> -</table> - -</div> - -<p class='c009'><span class='pageno' id='Page_337'>337</span>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,<a id='r304' /><a href='#f304' class='c015'><sup>[304]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>For this purpose also pigs should not be too fat. As we -learned from observations in the slaughter houses, a fat pig of -<span class='pageno' id='Page_338'>338</span>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_339'>339</span> - <h2 id='ch41' class='c006'>CHAPTER XLI.<br /> <br /><span class='sc'>Some Remarks on the Hygiene of Eating—How to Obtain an Appetite—On Mastication.</span></h2> -</div> -<p class='c009'><span class='sc'>If</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>In addition to sight, smell produces similar results. Professor -Bickel,<a id='r305' /><a href='#f305' class='c015'><sup>[305]</sup></a> of Berlin, has experimented on a girl of 23, who, -after an injury from caustic potash, had to have a fistulous opening -<span class='pageno' id='Page_340'>340</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>But it is a different thing with ladies who sit all day long in -<span class='pageno' id='Page_341'>341</span>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.</p> - -<p class='c010'>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 <i>hors d’œuvres</i> -or delicacies, like the Zakuski in Russia, or the smörgasbord in -Sweden, which certainly serve to enhance the appetite.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_342'>342</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_343'>343</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The great advantage of methodical long mastication has -been shown by Harry Campbell,<a id='r306' /><a href='#f306' class='c015'><sup>[306]</sup></a> Horace Fletcher,<a id='r307' /><a href='#f307' class='c015'><sup>[307]</sup></a> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_344'>344</span>better, their food leaves less residue, and they profit more -by what they eat than do fast eaters and bad masticators.</p> - -<p class='c010'>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.<a id='r308' /><a href='#f308' class='c015'><sup>[308]</sup></a> -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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_345'>345</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Besides meat, cereals, such as are taken in America at breakfast, -especially when finely ground and taken in the form of -<span class='pageno' id='Page_346'>346</span>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_347'>347</span> - <h2 id='ch42' class='c006'>CHAPTER XLII.<br /> <br /><span class='sc'>On the Uses of Small Doses, and the Deleterious Action of Large Quantities of Alcohol.</span></h2> -</div> -<p class='c009'><span class='sc'>In</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_348'>348</span>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.</p> - -<p class='c010'>The truth is, as shown by many physiologists, such as -Atwater and Benedict, and also by Professor Tigersted,<a id='r309' /><a href='#f309' class='c015'><sup>[309]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Beer is more nourishing than wine, but has a more sluggish -effect. English and some kinds of American beer often contain -<span class='pageno' id='Page_349'>349</span>nearly as much alcohol as some kinds of wine, sometimes more -than light Tyrolean or Italian wines.</p> - -<p class='c010'>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”).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Brandy is the most dangerous form of alcohol,<a id='r310' /><a href='#f310' class='c015'><sup>[310]</sup></a> 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.</p> - -<p class='c010'>That wine may be taken without harm, even to considerable -old age, can be illustrated by a series of examples, of which we -<span class='pageno' id='Page_350'>350</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_351'>351</span>alcoholics. Out of 579 lunatics of the Provincial Insane Asylum, -in Vienna, in 1899, there were 40 per cent. alcoholics.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r311' /><a href='#f311' class='c015'><sup>[311]</sup></a></p> - -<p class='c010'>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 -<span class='pageno' id='Page_352'>352</span>acquainted; and the constant occurrence of cirrhosis of the liver -and interstitial nephritis in alcoholics plainly show this.</p> - -<p class='c010'>A matter of grave importance to us is also the degeneration -of the thyroid in alcoholics, as found by the researches of de -Quervain<a id='r312' /><a href='#f312' class='c015'><sup>[312]</sup></a> and Sarbach<a id='r313' /><a href='#f313' class='c015'><sup>[313]</sup></a> and the clinical observations of -Hertoghe.<a id='r314' /><a href='#f314' class='c015'><sup>[314]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_353'>353</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Some experiments in this direction have been made by -Laitinen,<a id='r315' /><a href='#f315' class='c015'><sup>[315]</sup></a> 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 -<span class='pageno' id='Page_354'>354</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_355'>355</span>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!</p> - -<p class='c010'>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.<a id='r316' /><a href='#f316' class='c015'><sup>[316]</sup></a> -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.</p> - -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_356'>356</span> - <h2 id='ch43' class='c006'>CHAPTER XLIII.<br /> <br /><span class='sc'>Some Remarks on the Causes and Prevention of the Alcohol Habit.</span></h2> -</div> -<p class='c009'><span class='sc'>It</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>That this is really so cannot be denied, <i>a priori</i>, 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 -<span class='pageno' id='Page_357'>357</span>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<a id='r317' /><a href='#f317' class='c015'><sup>[317]</sup></a> 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>i.e.</i>, in toxic, quantity, this having produced such a condition.</p> - -<p class='c010'>According to several authors, whom we have already quoted -(de Quervain,<a id='r318' /><a href='#f318' class='c015'><sup>[318]</sup></a> Hertoghe<a id='r319' /><a href='#f319' class='c015'><sup>[319]</sup></a>), alcohol has a great influence on the -thyroid, and in chronic alcoholism the thyroid is found to be degenerated.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_358'>358</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_359'>359</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>During treatment with thyroid tablets alcohol is not well -borne, according to our observations.</p> - -<p class='c010'>It is probable that the sexual glands have also something -<span class='pageno' id='Page_360'>360</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_361'>361</span>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_362'>362</span> - <h2 id='ch44' class='c006'>CHAPTER XLIV.<br /> <br /><span class='sc'>On Other Stimulants—Tea, Coffee, Cocoa, Tobacco: Their Merits and Disadvantages.</span></h2> -</div> -<p class='c009'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_363'>363</span>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.</p> - -<p class='c010'>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,<a id='r320' /><a href='#f320' class='c015'><sup>[320]</sup></a> 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).</p> - -<p class='c010'>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,<a id='r321' /><a href='#f321' class='c015'><sup>[321]</sup></a> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_364'>364</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_365'>365</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Chocolate is composed of cocoa and a large quantity of -sugar, and is quite a pleasant sugar food, which doubtless can -<span class='pageno' id='Page_366'>366</span>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.</p> - -<p class='c010'>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—<i>e.g.</i>, Prof. Isaac Adler, of New York—that tobacco -produces effects similar to adrenalin.</p> - -<p class='c010'>According to Sir Lauder Brunton<a id='r322' /><a href='#f322' class='c015'><sup>[322]</sup></a> and others, tobacco -raises the blood-pressure, sometimes enormously. As Brunton -says: “I do not know that there is anything that causes such -<span class='pageno' id='Page_367'>367</span>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.”</p> - -<p class='c010'>It has also been shown by Esser<a id='r323' /><a href='#f323' class='c015'><sup>[323]</sup></a> 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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_368'>368</span> - <h2 id='ch45' class='c006'>CHAPTER XLV.<br /> <br /><span class='sc'>On Sleep, and Its Importance in Ridding the Body of Toxic Products.</span></h2> -</div> -<p class='c009'><span class='sc'>Sleep</span> is one of the most important functions of the body. -As the physiologist, Bunge,<a id='r324' /><a href='#f324' class='c015'><sup>[324]</sup></a> remarks, “a man can live for a -month without food, but he must succumb after only a few days -if he fails to sleep.”</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r325' /><a href='#f325' class='c015'><sup>[325]</sup></a> 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.</p> - -<p class='c010'>Similar conditions prevail in human beings to a greater -or less degree. According to Prof. Obersteiner, of Vienna, -<span class='pageno' id='Page_369'>369</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r326' /><a href='#f326' class='c015'><sup>[326]</sup></a> 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.</p> - -<p class='c010'>There has been a dispute on this question, whether it is -hyperæmia of the brain, or its anæmic condition, which induces -sleep.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_370'>370</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Very interesting experiments have been carried out by -<span class='pageno' id='Page_371'>371</span>Christern,<a id='r327' /><a href='#f327' class='c015'><sup>[327]</sup></a> 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.</p> - -<p class='c010'>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<a id='r328' /><a href='#f328' class='c015'><sup>[328]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_372'>372</span> - <h2 id='ch46' class='c006'>CHAPTER XLVI.<br /> <br /><span class='sc'>On the Causation of Sleep, Sleepiness, and Insomnia.</span></h2> -</div> -<p class='c009'><span class='sc'>When</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The pathological and anatomical changes in patients suffering -<span class='pageno' id='Page_373'>373</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_374'>374</span>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,<a id='r329' /><a href='#f329' class='c015'><sup>[329]</sup></a> Stieda,<a id='r330' /><a href='#f330' class='c015'><sup>[330]</sup></a> Sajous,<a id='r331' /><a href='#f331' class='c015'><sup>[331]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r332' /><a href='#f332' class='c015'><sup>[332]</sup></a> of Berlin, Thiele, Nehring, -<span class='pageno' id='Page_375'>375</span>etc., and also by my own works. The fat-reducing action of -thyroid extracts confirms this clearly.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_376'>376</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, <i>without any knowledge of my communication</i>, -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.</p> - -<p class='c010'>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<a id='r333' /><a href='#f333' class='c015'><sup>[333]</sup></a> 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.</p> - -<p class='c010'>From the above observations therapeutic conclusions may -also be deduced, as we will show in the chapter on the treatment -of sleepiness and sleeplessness.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_377'>377</span> - <h2 id='ch47' class='c006'>CHAPTER XLVII.<br /> <br /><span class='sc'>Hygiene of Sleep—Prevention of Insomnia.</span></h2> -</div> -<p class='c009'><span class='sc'>We</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>From the foregoing it follows logically that in order to sleep -soundly it is best to exclude everything that can arouse the -<span class='pageno' id='Page_378'>378</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_379'>379</span>will be sent to the brain. The same occurs when the intestines -are filled with gases.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_380'>380</span>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.</p> - -<p class='c010'>In women, when menstruation comes on, there is also disturbed -sleep very frequently; and many unmarried women suffer -from insomnia.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>We must now answer the question: How many hours’ sleep -shall we indulge in?</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_381'>381</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Granted the great importance of sleep as a function of -ridding the body of toxic products and of replacing spent energy, -<span class='pageno' id='Page_382'>382</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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:—</p> - -<div class='lg-container-b c024'> - <div class='linegroup'> - <div class='group'> - <div class='line'>“Early to bed, and early to rise,</div> - <div class='line in1'>Makes a man healthy, wealthy, and wise.”</div> - </div> - </div> -</div> - -<p class='c025'>Franklin lived to be 85 years old.</p> -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_383'>383</span> - <h2 id='ch48' class='c006'>CHAPTER XLVIII.<br /> <br /><span class='sc'>The Treatment of Sleepiness and Insomnia.</span></h2> -</div> -<p class='c009'><span class='sc'>We</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_384'>384</span>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_385'>385</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_386'>386</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_387'>387</span>ourselves or tried on patients in cases of necessity, as all such -remedies may be injurious to the brain if taken often.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r334' /><a href='#f334' class='c015'><sup>[334]</sup></a></p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_388'>388</span>patients a soothing result has been obtained from 20 grains -three times a day.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r335' /><a href='#f335' class='c015'><sup>[335]</sup></a> 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.</p> - -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_389'>389</span> - <h2 id='ch49' class='c006'>CHAPTER XLIX.<br /> <br /><span class='sc'>Hygiene of the Sexual Glands—the Dangers of Sexual Overactivity and of Total Sexual Abstinence.</span></h2> -</div> -<p class='c009'><span class='sc'>We</span> 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 -<a href='#ch05'>V</a>); 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_390'>390</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Moderation, therefore, must be strictly observed.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_391'>391</span>Claude Bernard and Brown-Séquard the Hindoos already appreciated -the great importance of the internal secretions.</p> - -<p class='c010'>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,<a id='r336' /><a href='#f336' class='c015'><sup>[336]</sup></a> 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.<a id='r337' /><a href='#f337' class='c015'><sup>[337]</sup></a></p> - -<p class='c010'><span class='pageno' id='Page_392'>392</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>According to Professor Kish such preventive coition (<i>congressus -interruptus</i>) 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>We have referred to the dangers of sexual overactivity, and -<span class='pageno' id='Page_393'>393</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.<a id='r338' /><a href='#f338' class='c015'><sup>[338]</sup></a> 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.</p> - -<p class='c010'>Regaud<a id='r339' /><a href='#f339' class='c015'><sup>[339]</sup></a> 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 -<span class='pageno' id='Page_394'>394</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>According to Mingazzini,<a id='r340' /><a href='#f340' class='c015'><sup>[340]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>There are, however, important clinical facts which support -<span class='pageno' id='Page_395'>395</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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. -<span class='pageno' id='Page_396'>396</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.”</p> - -<p class='c010'>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 -<span class='pageno' id='Page_397'>397</span>been traced to the conflict between the demands of nature and -a too rigorous sexual repression, through fear, disgust, shame, etc.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_398'>398</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The best safeguard against sexual desires is an active busy -life, which affords no opportunity for idle thoughts.</p> - -<p class='c010'><span class='pageno' id='Page_399'>399</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <a href='#ch50'>Chapter L</a>, on the hygiene of the brain worker).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_400'>400</span> - <h2 id='ch50' class='c006'>CHAPTER L.<br /> <br /><span class='sc'>On Married Life as an Important Means for Prolonging Life.</span></h2> -</div> -<p class='c009'><span class='sc'>Opinions</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_401'>401</span>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 <i>vice versâ</i>, with equal -benefit to both. Thus the uniting of the woman to the man is -most desirable, if only for this reason.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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. -<span class='pageno' id='Page_402'>402</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_403'>403</span>time, who still follow the religion of Zoroaster, regard celibacy -as a deadly sin. According to Tsen-ki-tong,<a id='r341' /><a href='#f341' class='c015'><sup>[341]</sup></a> an old maid is a -phenomenal rarity in China.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_404'>404</span> - <h2 id='ch51' class='c006'>CHAPTER LI.<br /> <br /><span class='sc'>Hygiene of the Mind—Emotions and Worry as Causes of Old Age.</span></h2> -</div> -<p class='c009'><span class='sc'>When</span> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_405'>405</span>war of 1870, many cases of diabetes developed in consequence -of the fear and anxiety brought about by it.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <a href='#ch16'>Chapter XVI</a>).</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 <i>sensorium commune</i>, <i>i.e.</i>, the central organ upon -which all severe emotions react.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_406'>406</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r342' /><a href='#f342' class='c015'><sup>[342]</sup></a> strong, mental -emotions play an important part in the origin in many cases of -interstitial nephritis.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_407'>407</span>premature old age is probably brought about more frequently -by the above agencies than by any of the other contributory -causes.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It would lead us too far to enter into particulars as to how -the various organs, even the stomach, can possibly, even in a -<span class='pageno' id='Page_408'>408</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_409'>409</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_410'>410</span>and frequently also to want of perseverance, the consequence -of defective will-power.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It has been shown by the celebrated physiologist, Brown-Séquard,<a id='r343' /><a href='#f343' class='c015'><sup>[343]</sup></a> -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.</p> - -<p class='c010'><span class='pageno' id='Page_411'>411</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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; -<span class='pageno' id='Page_412'>412</span>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.</p> - -<p class='c010'>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?</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_413'>413</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_414'>414</span> - <h2 id='ch52' class='c006'>CHAPTER LII.<br /> <br /><span class='sc'>Hygiene of the Mind—Religious Belief as a Means of Prolonging Life.</span></h2> -</div> -<p class='c009'><span class='sc'>A religious</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_415'>415</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The influence of the mind over the body was recognized -hundreds of years ago by all great physicians. The great philosopher, -Kant,<a id='r344' /><a href='#f344' class='c015'><sup>[344]</sup></a> 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.</p> - -<p class='c010'>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!</p> - -<p class='c010'>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 -<span class='pageno' id='Page_416'>416</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_417'>417</span>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?</p> - -<p class='c010'>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 -<span class='pageno' id='Page_418'>418</span>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_419'>419</span> - <h2 id='ch53' class='c006'>CHAPTER LIII.<br /> <br /><span class='sc'>Disease Considered as a Self-defence of Nature.</span></h2> -</div> -<p class='c009'><span class='sc'>Many</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_420'>420</span>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.”</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_421'>421</span>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!</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_422'>422</span>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.</p> - -<p class='c010'>In view of the above deductions, it is not unjustifiable to -believe that the symptoms of disease, <i>i.e.</i>, what we designate as -disease, together with many other supposed ills, in reality contribute -toward the preservation of mankind.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_423'>423</span> - <h2 id='ch54' class='c006'>CHAPTER LIV.<br /> <br /><span class='sc'>Hygiene of the Mind—Advice to Brain Workers.</span></h2> -</div> -<p class='c009'><span class='sc'>Scholars</span>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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. -<span class='pageno' id='Page_424'>424</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_425'>425</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_426'>426</span> - <h2 id='ch55' class='c006'>CHAPTER LV.<br /> <br /><span class='sc'>On the Prevention of Premature Old Age, and the Treatment of Old Age, through Certain Drugs: Arsenic, Iron, and Iodides.</span></h2> -</div> -<p class='c009'><span class='sc'>It</span> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It is equally well known that animals obtain a glossy and -sleek coat through the administration of arsenic in small quantities.</p> - -<p class='c010'><span class='pageno' id='Page_427'>427</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>As, according to Gauthier<a id='r345' /><a href='#f345' class='c015'><sup>[345]</sup></a> and Bertrand, the thyroid gland -contains arsenic, we are thus administering an important element -of this gland. The observation of Dr. Sajous<a id='r346' /><a href='#f346' class='c015'><sup>[346]</sup></a> 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 -<span class='pageno' id='Page_428'>428</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>The best results can be observed in women between 30 and -60, even though they sometimes have no previous anæmia, who -<span class='pageno' id='Page_429'>429</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>According to Professor von Noorden<a id='r347' /><a href='#f347' class='c015'><sup>[347]</sup></a> 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<a id='r348' /><a href='#f348' class='c015'><sup>[348]</sup></a> 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.<a id='r349' /><a href='#f349' class='c015'><sup>[349]</sup></a> 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,<a id='r350' /><a href='#f350' class='c015'><sup>[350]</sup></a> 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.</p> - -<p class='c010'>As well known to urologists, the general condition in cases -of chronic posterior gonorrhœa, and in prostate troubles from -<span class='pageno' id='Page_430'>430</span>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.</p> - -<p class='c010'>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>i.e.</i>, 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>i.e.</i>, the thyroid and the -ovaries,—are degenerated in old age. Iron acts upon the bone -marrow through the intermediate agency of these glandular -structures.</p> - -<p class='c010'>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 -<a href='#ch40'>the blood as an article of iron-containing food</a>.) 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>When mud baths are used simultaneously, it will be advisable -<span class='pageno' id='Page_431'>431</span>not to take thyroid extracts also; but to await doing so till -after the course of baths is finished.</p> - -<p class='c010'>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,<a id='r351' /><a href='#f351' class='c015'><sup>[351]</sup></a> iodides can combat connective tissue hypertrophy by -rendering the vessel walls more permeable. They also increase -the activity of the leucocytes.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_432'>432</span>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>Such treatment should be undertaken only when a thorough -knowledge is possessed of the physiology and pathology -of the thyroid gland.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_433'>433</span>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_434'>434</span> - <h2 id='ch56' class='c006'>CHAPTER LVI.<br /> <br /><span class='sc'>On the Prevention of Premature Old Age and on theTreatment of Old Age by Animal Extracts.</span></h2> -</div> -<p class='c009'><span class='sc'>When</span>, 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.</p> - -<p class='c010'>It has been noticed by all the leading investigators on the -effects of thyroid extracts, such as G. Murray,<a id='r352' /><a href='#f352' class='c015'><sup>[352]</sup></a> Hector Mackenzie,<a id='r353' /><a href='#f353' class='c015'><sup>[353]</sup></a> -Hertoghe,<a id='r354' /><a href='#f354' class='c015'><sup>[354]</sup></a> 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,<a id='r355' /><a href='#f355' class='c015'><sup>[355]</sup></a> Oppenheim,<a id='r356' /><a href='#f356' class='c015'><sup>[356]</sup></a> -Ewald,<a id='r357' /><a href='#f357' class='c015'><sup>[357]</sup></a> 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<a id='r358' /><a href='#f358' class='c015'><sup>[358]</sup></a> -<span class='pageno' id='Page_435'>435</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_436'>436</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>By the amelioration of the functions of the skin, kidneys, -and intestines, which functions are, as a rule, impaired in old -<span class='pageno' id='Page_437'>437</span>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, <i>prima -facie</i>, 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 <i>de novo</i>. We must -bear in mind that the effects of the thyroid gland may be -cumulative.</p> - -<p class='c010'>From observations on ourselves and on patients we recommend -for such as are not advanced in age, say, below 40 or 45, -<span class='pageno' id='Page_438'>438</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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,<a id='r359' /><a href='#f359' class='c015'><sup>[359]</sup></a> -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.</p> - -<p class='c010'><span class='pageno' id='Page_439'>439</span>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—<i>e.g.</i>, -a rapid heart action, etc.; but we must rather try to improve only -a <i>deficient</i> 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.</p> - -<p class='c010'>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, -<span class='pageno' id='Page_440'>440</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>A very interesting case is mentioned by Burghart<a id='r360' /><a href='#f360' class='c015'><sup>[360]</sup></a> 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.</p> - -<p class='c010'><span class='pageno' id='Page_441'>441</span>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<a id='r361' /><a href='#f361' class='c015'><sup>[361]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_442'>442</span>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,<a id='r362' /><a href='#f362' class='c015'><sup>[362]</sup></a> 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;”<a id='r363' /><a href='#f363' class='c015'><sup>[363]</sup></a> 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<a id='r364' /><a href='#f364' class='c015'><sup>[364]</sup></a>).</p> - -<p class='c010'>That testicular extracts are able to improve the symptoms -of senility has been shown by the celebrated physiologist, Brown-Séquard,<a id='r365' /><a href='#f365' class='c015'><sup>[365]</sup></a> -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 -<span class='pageno' id='Page_443'>443</span>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.</p> - -<p class='c010'>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,<a id='r366' /><a href='#f366' class='c015'><sup>[366]</sup></a> 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.</p> - -<p class='c010'>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,<a id='r367' /><a href='#f367' class='c015'><sup>[367]</sup></a> of St. Petersburg, and has been commented upon -<span class='pageno' id='Page_444'>444</span>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,<a id='r368' /><a href='#f368' class='c015'><sup>[368]</sup></a> 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,<a id='r369' /><a href='#f369' class='c015'><sup>[369]</sup></a> 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<a id='r370' /><a href='#f370' class='c015'><sup>[370]</sup></a> has -successfully treated Asiatic cholera with them.</p> - -<p class='c010'>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).</p> - -<p class='c010'>As found by Bukojemsky,<a id='r371' /><a href='#f371' class='c015'><sup>[371]</sup></a> 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.<a id='r372' /><a href='#f372' class='c015'><sup>[372]</sup></a> 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.</p> - -<p class='c010'>Spermin is contained in different organs, especially in the -<span class='pageno' id='Page_445'>445</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>It is important to note that in his article on old age in Dr. -Stedman’s well-known work, Boy-Teissier<a id='r373' /><a href='#f373' class='c015'><sup>[373]</sup></a> relates that he obtained -very good results from Brown-Séquard’s testicular extracts -in the treatment of old age.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_446'>446</span>It has been found by many authorities, of whom we especially -mention Gilbert and Carnot,<a id='r374' /><a href='#f374' class='c015'><sup>[374]</sup></a> Obolenski,<a id='r375' /><a href='#f375' class='c015'><sup>[375]</sup></a> Dubois,<a id='r376' /><a href='#f376' class='c015'><sup>[376]</sup></a> -Renaut,<a id='r377' /><a href='#f377' class='c015'><sup>[377]</sup></a> and Teissier,<a id='r378' /><a href='#f378' class='c015'><sup>[378]</sup></a> 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Good effects, and probably to a greater degree, may be -observed also after the use of pancreatic extracts. Their use in -<span class='pageno' id='Page_447'>447</span>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.</p> - -<p class='c010'>According to the observations of many authorities, among -them Abelmann,<a id='r379' /><a href='#f379' class='c015'><sup>[379]</sup></a> H. Salomon,<a id='r380' /><a href='#f380' class='c015'><sup>[380]</sup></a> and E. Meyer,<a id='r381' /><a href='#f381' class='c015'><sup>[381]</sup></a> 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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_448'>448</span>to three of these pancreatic tablets. Especially have they proved -useful after late dinners in preventing a disturbance of the sleep.</p> - -<p class='c010'>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_449'>449</span> - <h2 id='ch57' class='c006'>CHAPTER LVII.<br /> <br /><span class='sc'>A Few Hints on Youthful Appearance.</span></h2> -</div> -<p class='c009'><span class='sc'>The</span> 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.</p> - -<p class='c010'>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, <i>e.g.</i>, 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 -<span class='pageno' id='Page_450'>450</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_451'>451</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='pageno' id='Page_452'>452</span>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>i.e.</i>, 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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>Youthful looks also very much depend upon the condition -of the hair. When the hair is scarce and what there is left is gray -<span class='pageno' id='Page_453'>453</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_454'>454</span>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.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_455'>455</span> - <h2 id='ch58' class='c006'>CHAPTER LVIII.<br /> <br /><span class='sc'>The “Twelve Commandments” for the Preservation of Youth, and the Attainment of a Green Old Age.</span></h2> -</div> -<p class='c009'><span class='sc'>In</span> 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.”</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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 -<span class='pageno' id='Page_456'>456</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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<a id='r382' /><a href='#f382' class='c015'><sup>[382]</sup></a> and Pel,<a id='r383' /><a href='#f383' class='c015'><sup>[383]</sup></a> 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.</p> - -<p class='c010'>We fully acknowledge the value of descent from long-lived -<span class='pageno' id='Page_457'>457</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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:—</p> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>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).</p> - -<p class='c010'>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.</p> - -<p class='c010'>5. To wear very porous underwear, preferably cotton; -porous clothing, loose collars, light hat (if any), and low shoes.</p> - -<p class='c010'>6. To go to bed early, and to rise early.</p> - -<p class='c010'>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.</p> - -<p class='c010'>8. To have one complete day’s rest in each week, without -even reading or writing.</p> - -<p class='c010'>9. To avoid mental emotions, and also worries about things -<span class='pageno' id='Page_458'>458</span>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'>11. To be temperate in the use of alcohol and tobacco, and -also in the use of coffee or tea.</p> - -<p class='c010'>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 <i>under the strict supervision -of medical men</i> who are thoroughly familiar with the functions -of the ductless glands.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_459'>459</span> - <h2 id='glo' class='c006'>GLOSSARY.</h2> -</div> -<p class='c026'><b>Acetone, Acetonum.</b> 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.</p> - -<p class='c027'><b>Acetonitrile.</b> Methyl cyanide. A colorless volatile liquid.</p> - -<p class='c027'><b>Acetonuria.</b> The presence of an abnormal amount of acetone in the urine.</p> - -<p class='c027'><b>Acromegalia, Acromegaly.</b> 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.</p> - -<p class='c027'><b>Adenoid.</b> Resembling a gland. Name given to masses of hypertrophied -glands normally present in the nasopharynx.</p> - -<p class='c027'><b>Adolescence.</b> Youth: the period between puberty and full development.</p> - -<p class='c027'><b>Adrenal.</b> Situated near the kidney. The suprarenal capsule.</p> - -<p class='c027'><b>Agglutinin.</b> 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.</p> - -<p class='c027'><b>Alexin.</b> 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.</p> - -<p class='c027'><b>Alkalimetry.</b> The process of determining the amount of free alkali in -various substances.</p> - -<p class='c027'><b>Alveolar.</b> Belonging to the alveoli.</p> - -<p class='c027'><b>Alveoli.</b> (<i>a</i>) Bony socket of a tooth; (<i>b</i>) an -air-cell of the lung; (<i>c</i>) a cavity, pit, or recess.</p> - -<p class='c027'><b>Amenorrhea.</b> Absence or stoppage of the menstrual discharge, normal -during pregnancy.</p> - -<p class='c027'><b>Amphibia.</b> 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.</p> - -<p class='c027'><b>Amyl Nitrite.</b> A drug which produces vasodilation—opening of the -blood-paths. Formerly used in trigeminal neuralgia and malaria.</p> - -<p class='c027'><b>Amylaceous.</b> Composed of starch: starch-like.</p> - -<p class='c027'><b>Amylolytic.</b> Tending to dissolve starch, and thus to favor its conversion -into sugar: sometimes applied to the saliva.</p> - -<p class='c027'><b>Analogous Tissue.</b> A diseased tissue resembling a normal elementary -tissue of the body.</p> - -<p class='c027'><b>Anemia.</b> Deficiency of the blood in quantity or quality, either general -or local.</p> - -<p class='c027'><b>Anomaly.</b> Irregularity: deviation from rule.</p> - -<p class='c027'><b>Antipyretic.</b> A remedy to lower temperature.</p> - -<p class='c027'><b>Antipyrin.</b> 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.</p> - -<p class='c027'><b>Antitoxic.</b> The quality of counteracting poisons: overcoming toxic -influences.</p> - -<p class='c027'><b>Antivenin, Antivenomous Serum.</b> A polyvalent blood-serum prepared -from animals rendered immune to snake-venom.</p> - -<p class='c027'><span class='pageno' id='Page_460'>460</span><b>Aorta.</b> 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.</p> - -<p class='c027'><b>Arborization.</b> A branching distribution of veinlets or of nerve-filaments, -especially the branched terminal ramifications of a nerve-axon.</p> - -<p class='c027'><b>Arteriosclerosis.</b> Sclerosis or hardening of the walls of an artery, especially -of the inner coats.</p> - -<p class='c027'><b>Atheroma.</b> A form of fatty degeneration of the coats of the arteries in -arteriosclerosis, producing patches of induration or of softening.</p> - -<p class='c027'><b>Athyroidia.</b> A condition caused by an insufficiency of thyroid secretion.</p> - -<p class='c027'><b>Atrophy.</b> 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.</p> - -<p class='c027'><b>Attenuated.</b> Drawn out thin. The lessening of weight, as by dietetic -and medicinal treatment.</p> - -<p class='c027'><b>Auto-intoxication.</b> Poisoning with toxic products elaborated within the -body. Self-infection from self-formed poisons.</p> - -<p class='c027'><b>Axilla.</b> The armpit.</p> - -<p class='c027'><b>Bacteria.</b> 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.</p> - -<p class='c027'><b>Butyric.</b> Relating to or derived from butter.</p> - -<p class='c027'><b>Cachexia.</b> A depraved condition or habit of body or nutrition.</p> - -<p class='c027'><b>Calcium Carbonate.</b> A soft, white, inodorous substance. <b>Chalk.</b> It -occurs in shells, bones, and marble.</p> - -<p class='c027'><b>Callus.</b> 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.</p> - -<p class='c027'><b>Calorie.</b> The unit of heat, or the quantity of heat required to raise 1 -gram of water 1 degree centigrade.</p> - -<p class='c027'><b>Carbohydrate.</b> 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.</p> - -<p class='c027'><b>Catabolism.</b> 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.</p> - -<p class='c027'><b>Catalysis.</b> In chemistry a reaction that appears to take place owing to -the mere presence of another body that apparently undergoes no -change.</p> - -<p class='c027'><b>Catalytic.</b> Belonging to or causing catalysis.</p> - -<p class='c027'><b>Cellulose.</b> A carbohydrate forming the framework or skeleton of plants, -and the most abundant substance in the vegetable kingdom except -water.</p> - -<p class='c027'><b>Chlorotic.</b> Relating to chlorosis. A person affected with chlorosis, or -“green sickness,” a form of anemia.</p> - -<p class='c027'><b>Choledochus.</b> The common bile-duct.</p> - -<p class='c027'><b>Choline.</b> A ptomaine found in brain tissues, in the bile, in yolks of egg, -and in many decomposing animal and vegetable tissues.</p> - -<p class='c027'><b>Chromatolysis.</b> The breaking down and dissolution of the chromatin of -cell-nuclei.</p> - -<p class='c027'><b>Chromophile.</b> Stainable or easily stained, or absorbing of color.</p> - -<p class='c027'><b>Cirrhosis.</b> 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.</p> - -<p class='c027'><b>Climacteric.</b> A particular epoch of the ordinary term of life marked by -periods of seven years, at which the body is supposed to be peculiarly -<span class='pageno' id='Page_461'>461</span>affected, and to suffer considerable change. Used to indicate the -“change of life,” or cessation of menstruation in women.</p> - -<p class='c027'><b>Clinical.</b> Pertaining to the sick-bed treatment of a patient.</p> - -<p class='c027'><b>Colloid.</b> Resembling glue.</p> - -<p class='c027'><b>Connective tissue.</b> The framework tissue which supports and connects -other tissues and organs.</p> - -<p class='c027'><b>Convoluted Tubule.</b> The contorted portion of a uriniferous tubule.</p> - -<p class='c027'><b>Corpus Luteum.</b> “Yellow body,” the yellow mass in the ovary occupying -the place of a Graafian follicle which has discharged its ovum.</p> - -<p class='c027'><b>Cretinism.</b> 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.</p> - -<p class='c027'><b>Cystitis.</b> Inflammation of the urinary bladder.</p> - -<p class='c027'><b>Dementia Præcox.</b> Any form of dementia beginning at puberty and -marked by negativism, stereotypy, mannerisms, and verbigeration.</p> - -<p class='c027'><b>Desquamation.</b> A scaling off. The separation of laminæ or scales from -the skin, or from mucous or serous surfaces, or from bones.</p> - -<p class='c027'><b>Dextrin.</b> A soluble carbohydrate into which starch is converted by -action of diastase or dilute acids.</p> - -<p class='c027'><b>Diabetes Mellitus.</b> 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.</p> - -<p class='c027'><b>Diuresis.</b> Increased discharge of urine, from whatever cause.</p> - -<p class='c027'><b>Ductless Glands</b>. Glands without an excretory duct.</p> - -<p class='c027'><b>Dynamometer.</b> An instrument with which to measure the force of muscular -contraction, especially of the hand grasp.</p> - -<p class='c027'><b>Ectropion.</b> Eversion of the edge of a part, especially of the eyelid or -eyelids.</p> - -<p class='c027'><b>Edema.</b> A swelling from effusion of serous fluid into the cellular -substance.</p> - -<p class='c027'><b>Emunctory.</b> Excretory. Any excretory duct of the body.</p> - -<p class='c027'><b>Endometritis.</b> Inflammation of the inner lining membrane of the body -of the uterus.</p> - -<p class='c027'><b>Enemata.</b> Liquids or injections thrown into the rectum; clysters.</p> - -<p class='c027'><b>Enteroptosis.</b> Prolapse of the intestines.</p> - -<p class='c027'><b>Enzyme.</b> 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.</p> - -<p class='c027'><b>Epiphysial.</b> Pertaining to or of the nature of an epiphysis.</p> - -<p class='c027'><b>Epiphysis.</b> 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.</p> - -<p class='c027'><b>Epithelium, -lia.</b> Epithelial cells: cells which form the surface of the -skin, mucous membranes, and line all canals having communications -with the external air.</p> - -<p class='c027'><b>Erythematous.</b> Of the nature of erythema; redness of the skin.</p> - -<p class='c027'><b>Ethnographical.</b> Concerning the science of the characteristics of the -human family.</p> - -<p class='c027'><b>Etiology.</b> The science of the causation of disease.</p> - -<p class='c027'><span class='pageno' id='Page_462'>462</span><b>Exophthalmic Goiter.</b> Synonyms: Graves’s disease, Basedow’s disease. -A disease marked by protrusion of the eyes, enlarged thyroid gland, -anemia, and overaction of the heart.</p> - -<p class='c027'><b>Extirpation.</b> The complete removal or eradication of a part by the -knife or by caustic.</p> - -<p class='c027'><b>Faradization.</b> A method of treating disease by a localized application -of induction currents.</p> - -<p class='c027'><b>Follicle.</b> 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.</p> - -<p class='c027'><b>Follicular.</b> Resembling or belonging to a follicle.</p> - -<p class='c027'><b>Gastroptosis.</b> A downward displacement of the stomach.</p> - -<p class='c027'><b>Glomerulus.</b> (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.</p> - -<p class='c027'><b>Glycosuria.</b> The presence of sugar in the urine.</p> - -<p class='c027'><b>Graves’s Disease.</b> (See Exophthalmic Goiter.)</p> - -<p class='c027'><b>Hemianopsia.</b> Blindness in one-half of the field of vision of one or -both eyes.</p> - -<p class='c027'><b>Hemoglobin.</b> 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.</p> - -<p class='c027'><b>Histology.</b> The science of the minute structure and composition of the -different tissues of organized bodies.</p> - -<p class='c027'><b>Hyaline Cast.</b> A nearly transparent and clear urinary cast.</p> - -<p class='c027'><b>Hydrothyonuria.</b> The presence of hydrogen sulphide in the urine.</p> - -<p class='c027'><b>Hyperactivity.</b> Abnormal activity.</p> - -<p class='c027'><b>Hyperemia.</b> Excess of blood in any part due to increased influx or -obstruction of the outflow.</p> - -<p class='c027'><b>Hyperesthesia.</b> Morbid increase of the general sensibility, or of one of -the special senses.</p> - -<p class='c027'><b>Hyperleucocytosis.</b> Increase in the number of leucocytes in the blood.</p> - -<p class='c027'><b>Hyperplasia.</b> The increase of the number of the individual structural -elements of a tissue.</p> - -<p class='c027'><b>Hyperpyrexia.</b> Abnormally high fever, especially when over 42° C. -or 106° F.</p> - -<p class='c027'><b>Hypersecretion.</b> Excessive secretion.</p> - -<p class='c027'><b>Hypertrophy.</b> Enlargement of a part or an organ, especially when due -to over-nutrition.</p> - -<p class='c027'><b>Hypothyroidia.</b> Diminished function of the thyroid gland.</p> - -<p class='c027'><b>Impermeable.</b> Not permeable: not permitting a passage through.</p> - -<p class='c027'><b>Interstitial Hepatitis.</b> Inflammation of the interstitial connective tissue -of the liver.</p> - -<p class='c027'><b>Interstitial Nephritis.</b> Acute or chronic inflammation of the kidneys.</p> - -<p class='c027'><b>Lab-ferment.</b> The ferment (or enzyme) of rennet which coagulates -milk, forming curds.</p> - -<p class='c027'><b>Lactation.</b> The time or period of secreting milk.</p> - -<p class='c027'><b>Lactic.</b> Pertaining to or derived from milk.</p> - -<p class='c027'><b>Lanolin.</b> 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.</p> - -<p class='c027'><b>Lecithin.</b> A complex nitrogenous fatty substance occurring widely -spread throughout the animal body; chemically, a glycerophosphate -of neurin.</p> - -<p class='c027'><b>Leguminous.</b> Pertaining to the fruit or seed that is used as a food, -such as peas, beans, etc., rarely any esculent vegetable.</p> - -<p class='c027'><span class='pageno' id='Page_463'>463</span><b>Leucocyte.</b> A white blood-corpuscle or one of the cells resembling it.</p> - -<p class='c027'><b>Leucocytolysis.</b> The destruction of leucocytes, as by bacterial extracts.</p> - -<p class='c027'><b>Leucomaine.</b> Any of a number of basic bodies, such as ornithin, the -hexone and purin bases, etc., which are the normal products of tissue -metabolism.</p> - -<p class='c027'><b>Maceration.</b> The act of steeping a substance in hot or cold water, -usually to extract its virtues.</p> - -<p class='c027'><b>Maltose.</b> 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.</p> - -<p class='c027'><b>Menstrual.</b> Having to do with menstruation. The blood discharged in -menstruation.</p> - -<p class='c027'><b>Metabolism.</b> The process by which living cells or organisms are capable -of incorporating substances obtained from food into an integral part -of their own bodies.</p> - -<p class='c027'><b>Metrorrhagia.</b> Excessive discharge (usually hemorrhagic) from the -womb, especially when occurring at other times than during menstruation. -Uterine hemorrhage.</p> - -<p class='c027'><b>Molecular.</b> Pertaining to molecule. A very small particle of matter.</p> - -<p class='c027'><b>Muscarine.</b> A poisonous alkaloid obtained from Agaricus muscarius.</p> - -<p class='c027'><b>Mydriasis.</b> A preternatural or morbid dilatation of the pupil of the eye.</p> - -<p class='c027'><b>Myxedema.</b> The name given to a condition characterized by a hyperplastic -and modified deposit of connective tissue in all parts of the -body.</p> - -<p class='c027'><b>Narcosis.</b> 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.</p> - -<p class='c027'><b>Necrotized.</b> Lifeless.</p> - -<p class='c027'><b>Nephritis.</b> Inflammation of the kidneys, which, when acute, involves -chiefly the renal parenchyma, and, when chronic, either the parenchyma -or the connective tissue or both.</p> - -<p class='c027'><b>Neural.</b> Belonging to nerves.</p> - -<p class='c027'><b>Neurasthenia.</b> 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.</p> - -<p class='c027'><b>Neuroglia.</b> The tissue, probably of ectodermic origin, forming the basis -of the supporting framework of the nervous tissue of the cerebrospinal -axis.</p> - -<p class='c027'><b>Neuron.</b> The cerebrospinal axis.</p> - -<p class='c027'><b>Neuropathic Constitution.</b> The nervous diathesis: that constitution of -body and mind which predisposes to nervous disease.</p> - -<p class='c027'><b>Nuclein.</b> The phosphorized proteid or nitrogenous substance found in -cell-nuclei. It is believed to furnish the functional activity of the -cell.</p> - -<p class='c027'><b>Omnivorous.</b> Feeding or subsisting on food of all kinds.</p> - -<p class='c027'><b>Oöphorectomy.</b> Excision of one ovary.</p> - -<p class='c027'><b>Opsonin.</b> 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.</p> - -<p class='c027'><b>Osteomalacia.</b> 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.</p> - -<p class='c027'><b>Oxidation.</b> The combining of a certain quantity of oxygen with metals -or other substances. The formation of an oxide.</p> - -<p class='c027'><span class='pageno' id='Page_464'>464</span><b>Palpation.</b> 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.</p> - -<p class='c027'><b>Pancreas.</b> 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.</p> - -<p class='c027'><b>Parametritis.</b> Inflammation of the connective tissues in the immediate -vicinity of the uterus.</p> - -<p class='c027'><b>Parathyroid.</b> 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.</p> - -<p class='c027'><b>Parenchymatous Tissue, Pulp Tissue.</b> The tissue forming the pulp or -parenchyma of an organ.</p> - -<p class='c027'><b>Pathology.</b> 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.</p> - -<p class='c027'><b>Perchloride.</b> A chloride containing more chlorine than a protochloride.</p> - -<p class='c027'><b>Percussion.</b> The act of striking any part of the body with the fingers, -or with an instrument, to ascertain its condition by the sound -obtained.</p> - -<p class='c027'><b>Pericardium.</b> 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.</p> - -<p class='c027'><b>Peristalsis.</b> A peculiar worm-like movement of the intestines and other -tubular organs by which they gradually propel their contents -onward.</p> - -<p class='c027'><b>Pernicious.</b> Highly dangerous.</p> - -<p class='c027'><b>Phagocytosis.</b> The ingestion of foreign bodies, microbes, etc., by the -action of phagocytes (certain of the colorless blood-cells).</p> - -<p class='c027'><b>Pigmentation.</b> The coloring matter in the skin.</p> - -<p class='c027'><b>Pituitary Body.</b> The small ellipsoidal body which rests on the sella -turcica and is attached to the base of the brain by a pedicle.</p> - -<p class='c027'><b>Plethoric.</b> Fullness; a state marked by excess of blood in the vessels.</p> - -<p class='c027'><b>Plexus Myentericus.</b> Auerbach’s plexus. A plexus of sympathetic -fibers between the longitudinal and circular intestinal muscle-fibers.</p> - -<p class='c027'><b>Pneumococcus (of Friedländer).</b> The bacterium of pneumonia.</p> - -<p class='c027'><b>Polydipsia.</b> Excessive thirst.</p> - -<p class='c027'><b>Polyuria.</b> A disease characterized by thirst and by a persistently excessive -flow of watery urine.</p> - -<p class='c027'><b>Porosity.</b> The state of having pores.</p> - -<p class='c027'><b>Portal Veins.</b> The large veins entering the liver at the transverse fissure -and bringing to it the blood from the digestive tract and the spleen.</p> - -<p class='c027'><b>Prognosis.</b> The foreknowledge of the course of a disease drawn from a -consideration of its signs and symptoms.</p> - -<p class='c027'><b>Proliferation.</b> Reproduction of similar forms, both normal and morbid, -but especially applied to cell-genesis.</p> - -<p class='c027'><b>Propagation.</b> Reproduction.</p> - -<p class='c027'><b>Prophylaxis.</b> The art of guarding against disease. The observation of -the rules necessary to the preservation of health, or the prevention of -disease.</p> - -<p class='c027'><b>Proteid.</b> Any one of a class of complex, nitrogenous, levorotatory -organic compounds forming the essential part of animal and vegetable -tissues.</p> - -<p class='c027'><b>Protozoa.</b> The name for the primary type of lowest division of the -animal kingdom.</p> - -<p class='c027'><span class='pageno' id='Page_465'>465</span><b>Psoriasis.</b> 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.</p> - -<p class='c027'><b>Psychoses.</b> Disturbances of the mind.</p> - -<p class='c027'><b>Ptosis.</b> A falling, or prolapsus, especially applied to a drooping of the -upper eyelid due to paralysis of the levator palpebræ superioris -muscle.</p> - -<p class='c027'><b>Puerperium.</b> The state or period of confinement of a pregnant female.</p> - -<p class='c027'><b>Pyrexia.</b> The state of fever.</p> - -<p class='c027'><b>Radicle.</b> An ultimate division of a vessel or nerve.</p> - -<p class='c027'><b>Retrograde-metamorphosis.</b> The process by which somewhat complex -bodies are broken up into simpler ones, and in the end into waste -products.</p> - -<p class='c027'><b>Salicylate.</b> A salt of salicylic acid.</p> - -<p class='c027'><b>Sebaceous.</b> Fatty. Suety. Applied to glands which secrete an oily -matter resembling suet.</p> - -<p class='c027'><b>Segmentation.</b> The process of division by which the fertilized ovum -divides before differentiation into layers occurs.</p> - -<p class='c027'><b>Sella Turcica.</b> The depression within the three clinoid processes of the -sphenoid bone, lodging the pituitary body.</p> - -<p class='c027'><b>Senility.</b> Old age.</p> - -<p class='c027'><b>Septicemia.</b> Blood poisoning. Fever and prostration due to the entrance -of pyogenic or other micro-organisms or ptomaines into the circulation.</p> - -<p class='c027'><b>Serum.</b> The clear liquid which separates in the clotting of blood from -the clot and the corpuscles, or any clear liquid resembling it.</p> - -<p class='c027'><b>Skeletal.</b> Of or relating to a skeleton.</p> - -<p class='c027'><b>Spermatorrhea.</b> An involuntary emission of semen without copulation.</p> - -<p class='c027'><b>Spermin.</b> A preparation of the prostate gland and testicle of animals.</p> - -<p class='c027'><b>Subcutaneous.</b> Situated, introduced, or living just under the skin.</p> - -<p class='c027'><b>Sudorific.</b> Inducing or causing sweat.</p> - -<p class='c027'><b>Suppurative.</b> Producing or discharging pus.</p> - -<p class='c027'><b>Tabes Dorsalis.</b> 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.</p> - -<p class='c027'><b>Tachycardia.</b> A disturbed condition of the heart’s action in which great -acceleration of the pulse occurs.</p> - -<p class='c027'><b>Tertiary.</b> Third degree.</p> - -<p class='c027'><b>Theobromine.</b> A bitter, colorless, crystalline powder, capable of forming -salts with acids, and sparingly soluble in hot water.</p> - -<p class='c027'><b>Thymus.</b> 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.</p> - -<p class='c027'><b>Thyroid Gland.</b> 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.</p> - -<p class='c027'><b>Thyroidectomy.</b> Excision of the thyroid gland or of its cartilage.</p> - -<p class='c027'><b>Tonicity.</b> The state of normal tone or tension.</p> - -<p class='c027'><b>Tortuosity.</b> Bent or twisted irregularly.</p> - -<p class='c027'><b>Transudation.</b> The morbid passing or oozing of blood, or other fluid, -practically unaltered, through the pores of the skin or membranes.</p> - -<p class='c027'><b>Trypanosome.</b> 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.</p> - -<p class='c027'><span class='pageno' id='Page_466'>466</span><b>Trypanosomiasis.</b> A diseased condition produced by trypanosomes.</p> - -<p class='c027'><b>Trypsin.</b> A ferment of pancreatic juice which has the power of converting -proteids into peptones, best in alkaline solution, but also -active in neutral solution.</p> - -<p class='c027'><b>Unesthetic.</b> Not having lost sensation.</p> - -<p class='c027'><b>Unossified.</b> Not having formed bone.</p> - -<p class='c027'><b>Urea.</b> A white, transparent, crystallizable solid, the principal solid -constituent of urine.</p> - -<p class='c027'><b>Uric Acid.</b> A crystalline substance obtained from urine.</p> - -<p class='c027'><b>Urotoxic.</b> Relating to the poisonous elements of the urine.</p> - -<p class='c027'><b>Urticaria.</b> “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.</p> - -<p class='c027'><b>Vascularization.</b> The act or process of becoming vascular, as in neoplasms, -thrombi, etc., or furnished with new blood-vessels.</p> - -<p class='c027'><b>Vasodilatation.</b> Widening of the walls of the blood-vessels; admitting -more blood to the periphery.</p> - -<p class='c027'><b>Vermicular.</b> Worm-like.</p> - -<p class='c027'><b>Viscosity.</b> Adhesiveness.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_467'>467</span> - <h2 id='idx' class='c006'>INDEX.</h2> -</div> -<ul class='index c003'> - <li class='c028'>Abderhalden, <a href='#Page_333'>333</a>, <a href='#Page_336'>336</a>.</li> - <li class='c028'>Abelard, <a href='#Page_43'>43</a>.</li> - <li class='c028'>Abelmann, <a href='#Page_447'>447</a>.</li> - <li class='c028'>Abelous, <a href='#Page_161'>161</a>.</li> - <li class='c028'>Achard, <a href='#Page_204'>204</a>, <a href='#Page_286'>286</a>.</li> - <li class='c028'>Acne, microbes in, <a href='#Page_213'>213</a>.</li> - <li class='c028'>Acton, <a href='#Page_391'>391</a>.</li> - <li class='c028'>Adami, <a href='#Page_9'>9</a>, <a href='#Page_150'>150</a>, <a href='#Page_156'>156</a>.</li> - <li class='c028'>Adcock, Sir Hugh, <a href='#Page_43'>43</a>.</li> - <li class='c028'>Adler and Hensel, <a href='#Page_162'>162</a>.</li> - <li class='c028'>Adler, Isaac, <a href='#Page_107'>107</a>, <a href='#Page_169'>169</a>, <a href='#Page_366'>366</a>.</li> - <li class='c028'>Adler, Max, <a href='#Page_322'>322</a>.</li> - <li class='c028'>Adrenals and circulatory system, hygiene of, <a href='#Page_164'>164</a>. - <ul> - <li>adrenal hypersecretion, <a href='#Page_165'>165</a>.</li> - <li>adrenals and cardiac nerves, <a href='#Page_164'>164</a>.</li> - <li>agencies, harmful, to avoid, <a href='#Page_166'>166</a>.</li> - <li>arteriosclerosis, <a href='#Page_164'>164</a>, <a href='#Page_165'>165</a>. - <ul> - <li>causes of, <a href='#Page_165'>165</a>.</li> - <li>high blood-pressure and, <a href='#Page_164'>164</a>. - <ul> - <li>and kidney disease, <a href='#Page_165'>165</a>. - <ul> - <li>blood-test for, <a href='#Page_165'>165</a>.</li> - </ul> - </li> - </ul> - </li> - <li>preventives of, <a href='#Page_168'>168</a>.</li> - </ul> - </li> - <li>atheroma, <a href='#Page_164'>164</a>.</li> - <li>mental emotions, <a href='#Page_165'>165</a>.</li> - <li>sexual glands, <a href='#Page_165'>165</a>.</li> - <li>thyroid gland, <a href='#Page_166'>166</a>.</li> - <li>tobacco a stimulant of, <a href='#Page_427'>427</a>.</li> - </ul> - </li> - <li class='c028'>Aeschbacher, <a href='#Page_431'>431</a>.</li> - <li class='c028'>Age, old, blood-drinking for, <a href='#Page_332'>332</a>. - <ul> - <li>commandments for, <a href='#Page_455'>455</a>.</li> - <li>milk diet for. See <a href='#dietmilk'><i>Diet, milk</i></a>.</li> - <li>premature, from alcohol, <a href='#Page_352'>352</a>.</li> - <li>prevention and treatment of, - <ul> - <li>arsenic, <a href='#Page_426'>426</a>.</li> - <li>for women, <a href='#Page_427'>427</a>.</li> - <li>for sexual glands, <a href='#Page_429'>429</a>.</li> - <li>in mineral waters, <a href='#Page_428'>428</a>.</li> - </ul> - </li> - <li>gland, thyroid, <a href='#Page_434'>434</a>. - <ul> - <li>iodides for, <a href='#Page_431'>431</a>. - <ul> - <li>for arteriosclerosis, <a href='#Page_431'>431</a>.</li> - </ul> - </li> - <li>iron, <a href='#Page_429'>429</a>. - <ul> - <li>for sexual glands, <a href='#Page_429'>429</a>.</li> - </ul> - </li> - <li>kidney extracts, <a href='#Page_445'>445</a>.</li> - <li>ovarian extracts, <a href='#Page_440'>440</a>.</li> - <li>pancreatic extracts, <a href='#Page_445'>445</a>.</li> - <li>prostatic extracts, <a href='#Page_445'>445</a>.</li> - <li>spermin, <a href='#Page_444'>444</a>.</li> - <li>testicular extracts, <a href='#Page_441'>441</a>.</li> - </ul> - </li> - <li>value of vegetarian diet to prevent, <a href='#Page_311'>311</a>.</li> - </ul> - </li> - <li class='c028'>Air, close, <a href='#Page_272'>272</a>. - <ul> - <li>fresh, automobiling for, <a href='#Page_266'>266</a>. - <ul> - <li>forests, <a href='#Page_267'>267</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'><span class='pageno' id='Page_468'>468</span>Air, mountain, <a href='#Page_266'>266</a>. - <ul> - <li>indoor, results of, <a href='#Page_277'>277</a>.</li> - <li>outdoor, benefits of, <a href='#Page_277'>277</a>.</li> - <li>vitiated, <a href='#Page_264'>264</a>.</li> - </ul> - </li> - <li class='c028'>Albertoni, <a href='#Page_35'>35</a>, <a href='#Page_86'>86</a>, <a href='#Page_141'>141</a>, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Albuminuria from constipation, <a href='#Page_202'>202</a>.</li> - <li class='c028'>Alcohol habit, cause and prevention of, <a href='#Page_356'>356</a>. - <ul> - <li> - <ul> - <li>gland, thyroid, exhaustion of, as cause of drunkenness, <a href='#Page_357'>357</a>.</li> - <li>glands, sexual, and, <a href='#Page_360'>360</a>.</li> - <li>preventive, <a href='#Page_361'>361</a>.</li> - <li>treatment of, <a href='#Page_361'>361</a>. - <ul> - <li>ovarian extracts, <a href='#Page_361'>361</a>.</li> - <li>thyroid, <a href='#Page_361'>361</a>.</li> - </ul> - </li> - </ul> - </li> - <li>immunity to large doses of, <a href='#Page_356'>356</a>.</li> - <li>persons easily affected by, <a href='#Page_359'>359</a>.</li> - <li>quantities, large, effects of, <a href='#Page_350'>350</a>. - <ul> - <li>age, old, premature, <a href='#Page_352'>352</a>.</li> - <li>arteriosclerosis, <a href='#Page_350'>350</a>.</li> - <li>brain, <a href='#Page_350'>350</a>.</li> - <li>delirium tremens, <a href='#Page_353'>353</a>. - <ul> - <li>progeny of, <a href='#Page_353'>353</a>.</li> - </ul> - </li> - <li>epileptics, <a href='#Page_353'>353</a>.</li> - <li>genealogy, a terrible, <a href='#Page_353'>353</a>.</li> - <li>glands, ductless, <a href='#Page_351'>351</a>. - <ul> - <li>liver, <a href='#Page_351'>351</a>.</li> - <li>kidneys, <a href='#Page_351'>351</a>.</li> - <li>pituitary, <a href='#Page_351'>351</a>.</li> - <li>sexual, <a href='#Page_351'>351</a>.</li> - <li>thyroid, <a href='#Page_352'>352</a>.</li> - </ul> - </li> - <li>heart muscles, <a href='#Page_350'>350</a>.</li> - <li>insanity, <a href='#Page_350'>350</a>. - <ul> - <li>and crime, <a href='#Page_351'>351</a>.</li> - </ul> - </li> - <li>in tropical climates, <a href='#Page_353'>353</a>.</li> - <li>on children, <a href='#Page_354'>354</a>.</li> - <li>on thyroid gland, <a href='#Page_357'>357</a>, <a href='#Page_358'>358</a>.</li> - </ul> - </li> - <li>quantities, large, immunity to, <a href='#Page_357'>357</a>, <a href='#Page_358'>358</a>.</li> - <li>resistance, diminution, <a href='#Page_351'>351</a>. - <ul> - <li>diseases, nervous, <a href='#Page_352'>352</a>.</li> - <li>fever, yellow, <a href='#Page_352'>352</a>.</li> - <li>myxœdema, <a href='#Page_352'>352</a>.</li> - <li>of powers of, <a href='#Page_352'>352</a>.</li> - <li>pneumonia, <a href='#Page_352'>352</a>.</li> - <li>scrofulosis, <a href='#Page_352'>352</a>.</li> - <li>tuberculosis, <a href='#Page_352'>352</a>.</li> - </ul> - </li> - <li>uses of, <a href='#Page_347'>347</a>. - <ul> - <li>as a preservative of tissues, <a href='#Page_348'>348</a>.</li> - <li>as a stimulant, <a href='#Page_348'>348</a>. - <ul> - <li>circulatory apparatus, <a href='#Page_348'>348</a>, <a href='#Page_349'>349</a>.</li> - <li>nervous system, <a href='#Page_348'>348</a>.</li> - <li><span class='pageno' id='Page_469'>469</span>wine, <a href='#Page_348'>348</a>.</li> - <li>beer, <a href='#Page_348'>348</a>.</li> - <li>brandy, <a href='#Page_349'>349</a></li> - <li>disadvantage, <a href='#Page_349'>349</a>.</li> - <li>for snake poison, <a href='#Page_358'>358</a>.</li> - <li>least injurious, <a href='#Page_349'>349</a>.</li> - <li>longevity, <a href='#Page_350'>350</a>, <a href='#Page_355'>355</a>.</li> - <li>most injurious, <a href='#Page_349'>349</a>.</li> - <li>overabundance, effect of, <a href='#Page_348'>348</a>.</li> - <li>tonic, <a href='#Page_349'>349</a>.</li> - <li>whiskey, <a href='#Page_349'>349</a>.</li> - <li>wine, <a href='#Page_348'>348</a>, <a href='#Page_349'>349</a>.</li> - </ul> - </li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Allbutt, Clifford, <a href='#Page_406'>406</a>.</li> - <li class='c028'>Amato, <a href='#Page_80'>80</a>.</li> - <li class='c028'>Amberg, <a href='#Page_164'>164</a>.</li> - <li class='c028'>Anderson, Mrs., <a href='#Page_105'>105</a>.</li> - <li class='c028'>Ansele, <a href='#Page_442'>442</a>.</li> - <li class='c028'>Appearance, youthful, hints on, <a href='#Page_449'>449</a>. - <ul> - <li>baths, <a href='#Page_454'>454</a>.</li> - <li>diet, <a href='#Page_453'>453</a>.</li> - <li>disposition, cheerful, <a href='#Page_450'>450</a>.</li> - <li>drugs, <a href='#Page_451'>451</a>.</li> - <li>exercise, <a href='#Page_450'>450</a>, <a href='#Page_454'>454</a>.</li> - <li>glands, sexual, <a href='#Page_452'>452</a>.</li> - <li>hair, <a href='#Page_452'>452</a>. - <ul> - <li>and thyroid gland, <a href='#Page_453'>453</a>.</li> - </ul> - </li> - <li>skin, care of, <a href='#Page_449'>449</a>.</li> - <li>slenderness, <a href='#Page_453'>453</a>.</li> - <li>teeth, care of, <a href='#Page_451'>451</a>.</li> - </ul> - </li> - <li class='c028'>Appendicitis. See <a href='#intestines'><i>Intestines</i></a>.</li> - <li class='c028'>Arloing, <a href='#Page_212'>212</a>, <a href='#Page_256'>256</a>.</li> - <li class='c028'>Arteriosclerosis, etiology, <a href='#Page_165'>165</a>, <a href='#Page_167'>167</a>. - <ul> - <li>diet, <a href='#Page_165'>165</a>. - <ul> - <li>coffee, <a href='#Page_165'>165</a>.</li> - <li>meat, <a href='#Page_165'>165</a>.</li> - <li>tea, <a href='#Page_165'>165</a>.</li> - </ul> - </li> - <li>diseases, infectious, <a href='#Page_165'>165</a>. - <ul> - <li>syphilis, <a href='#Page_165'>165</a>.</li> - </ul> - </li> - <li>in brain workers, <a href='#Page_423'>423</a>.</li> - <li>poisons, <a href='#Page_165'>165</a>. - <ul> - <li>alcohol, <a href='#Page_165'>165</a>.</li> - <li>lead, <a href='#Page_165'>165</a>.</li> - <li>mercury, <a href='#Page_165'>165</a>.</li> - <li>tobacco, <a href='#Page_165'>165</a>.</li> - </ul> - </li> - <li>preventives of, <a href='#Page_168'>168</a>. - <ul> - <li>adrenals, reduction of activity of, <a href='#Page_168'>168</a>.</li> - <li>blood, viscosity of, <a href='#Page_168'>168</a>.</li> - <li>diet, <a href='#Page_168'>168</a>.</li> - <li>exercise, <a href='#Page_168'>168</a>.</li> - <li>thyroid, increase of activity of, <a href='#Page_168'>168</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Atwater, <a href='#Page_287'>287</a>, <a href='#Page_348'>348</a>.</li> - <li class='c028'>Aubert, <a href='#Page_209'>209</a>.</li> - <li class='c028'>Aubertin, <a href='#Page_161'>161</a>.</li> - <li class='c003'>Baelz, <a href='#Page_283'>283</a>.</li> - <li class='c028'>Baldwin, <a href='#Page_39'>39</a>, <a href='#Page_394'>394</a>.</li> - <li class='c028'>Ballet and Enriquez, <a href='#Page_27'>27</a>.</li> - <li class='c028'>Bamossi, <a href='#Page_151'>151</a>.</li> - <li class='c028'><span class='pageno' id='Page_470'>470</span>Bang, <a href='#Page_325'>325</a>.</li> - <li class='c028'>Basch, <a href='#Page_169'>169</a>.</li> - <li class='c028'>Baumann, <a href='#Page_91'>91</a>, <a href='#Page_118'>118</a>, <a href='#Page_152'>152</a>, <a href='#Page_323'>323</a>, <a href='#Page_431'>431</a>.</li> - <li class='c028'>Bayon, <a href='#Page_5'>5</a>, <a href='#Page_23'>23</a>, <a href='#Page_98'>98</a>.</li> - <li class='c028'>Beck, Charles, <a href='#Page_414'>414</a>.</li> - <li class='c028'>Bedclothing, <a href='#Page_229'>229</a>.</li> - <li class='c028'>Behring, <a href='#Page_326'>326</a>, <a href='#Page_327'>327</a>.</li> - <li class='c028'>Benda, <a href='#Page_4'>4</a>.</li> - <li class='c028'>Benedict, <a href='#Page_287'>287</a>, <a href='#Page_348'>348</a>.</li> - <li class='c028'>Berger, <a href='#Page_18'>18</a>.</li> - <li class='c028'>Bernard and Bigart, <a href='#Page_161'>161</a>.</li> - <li class='c028'>Bernard, Claude, <a href='#Page_125'>125</a>, <a href='#Page_169'>169</a>, <a href='#Page_335'>335</a>, <a href='#Page_391'>391</a>, <a href='#Page_439'>439</a>.</li> - <li class='c028'>Bertrand, <a href='#Page_427'>427</a>.</li> - <li class='c028'>Besançon, <a href='#Page_334'>334</a>.</li> - <li class='c028'>Bianchini, <a href='#Page_298'>298</a>.</li> - <li class='c028'>Bickel, <a href='#Page_339'>339</a>, <a href='#Page_340'>340</a>, <a href='#Page_341'>341</a>, <a href='#Page_344'>344</a>.</li> - <li class='c028'>Bier, <a href='#Page_337'>337</a>.</li> - <li class='c028'>Binz, <a href='#Page_369'>369</a>, <a href='#Page_371'>371</a>.</li> - <li class='c028'>Bircher, <a href='#Page_392'>392</a>.</li> - <li class='c028'><a id='blood'></a>Blood as food, <a href='#Page_333'>333</a>, <a href='#Page_337'>337</a>. - <ul> - <li>chemicals in, <a href='#Page_335'>335</a>.</li> - <li>experiments with, <a href='#Page_337'>337</a>.</li> - <li>ferments in, <a href='#Page_335'>335</a>.</li> - <li>immunizing substances in, <a href='#Page_336'>336</a>.</li> - <li>iron in, <a href='#Page_333'>333</a>. - <ul> - <li>in drugs, <a href='#Page_333'>333</a>.</li> - <li>in food, <a href='#Page_333'>333</a>.</li> - <li>lack of, in chlorosis, <a href='#Page_333'>333</a>. - <ul> - <li>in anæmia, <a href='#Page_333'>333</a>.</li> - </ul> - </li> - <li>organic and inorganic, <a href='#Page_333'>333</a>. - <ul> - <li>blood, <a href='#Page_334'>334</a>. - <ul> - <li>best, <a href='#Page_335'>335</a>.</li> - </ul> - </li> - </ul> - </li> - <li>eggs, <a href='#Page_334'>334</a>.</li> - <li>nuclein of eggs, <a href='#Page_333'>333</a>.</li> - <li>spinach, <a href='#Page_334'>334</a>.</li> - </ul> - </li> - <li>ox, <a href='#Page_336'>336</a>.</li> - <li>pigs’, <a href='#Page_335'>335</a>, <a href='#Page_336'>336</a>. - <ul> - <li>extracts in, <a href='#Page_335'>335</a>.</li> - <li>puddings, <a href='#Page_335'>335</a>.</li> - <li>sausages, <a href='#Page_335'>335</a>, <a href='#Page_336'>336</a>.</li> - </ul> - </li> - <li>transfusion, dangers of, <a href='#Page_337'>337</a>.</li> - </ul> - </li> - <li class='c028'>Blum, <a href='#Page_5'>5</a>, <a href='#Page_9'>9</a>, <a href='#Page_22'>22</a>, <a href='#Page_35'>35</a>, <a href='#Page_86'>86</a>, <a href='#Page_96'>96</a>, <a href='#Page_139'>139</a>, <a href='#Page_142'>142</a>, <a href='#Page_145'>145</a>, <a href='#Page_318'>318</a>, <a href='#Page_329'>329</a>, <a href='#Page_375'>375</a>, <a href='#Page_431'>431</a>.</li> - <li class='c028'>Blumenkranz, <a href='#Page_232'>232</a>, <a href='#Page_241'>241</a>.</li> - <li class='c028'>Blumenthal and Jacobi, <a href='#Page_83'>83</a>.</li> - <li class='c028'>Boas, <a href='#Page_202'>202</a>.</li> - <li class='c028'>Bocci, <a href='#Page_153'>153</a>.</li> - <li class='c028'>Boerhaave, <a href='#Page_425'>425</a>.</li> - <li class='c028'>Boix, <a href='#Page_153'>153</a>.</li> - <li class='c028'>Bokenham, <a href='#Page_9'>9</a>, <a href='#Page_150'>150</a>.</li> - <li class='c028'>Bonardi, <a href='#Page_56'>56</a>.</li> - <li class='c028'>Bonnamour, <a href='#Page_161'>161</a>.</li> - <li class='c028'>Bordet, <a href='#Page_134'>134</a>.</li> - <li class='c028'>Borylac, <a href='#Page_162'>162</a>.</li> - <li class='c028'>Bosse, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Böttger, <a href='#Page_364'>364</a>.</li> - <li class='c028'>Boubnoff, <a href='#Page_258'>258</a>.</li> - <li class='c028'>Bouchard, <a href='#Page_142'>142</a>, <a href='#Page_153'>153</a>, <a href='#Page_154'>154</a>, <a href='#Page_371'>371</a>.</li> - <li class='c028'>Bouchard and Hanot, <a href='#Page_156'>156</a>.</li> - <li class='c028'>Bouchut, <a href='#Page_298'>298</a>.</li> - <li class='c028'><span class='pageno' id='Page_471'>471</span>Bouin, <a href='#Page_442'>442</a>.</li> - <li class='c028'>Boverie and Loeper, <a href='#Page_162'>162</a>.</li> - <li class='c028'>Breathing, deep, <a href='#Page_267'>267</a>. - <ul> - <li>benefits of, <a href='#Page_269'>269</a>.</li> - <li>contra-indications, <a href='#Page_269'>269</a>.</li> - <li>nasal, <a href='#Page_270'>270</a>.</li> - </ul> - </li> - <li class='c028'>Breisacher, Leo, <a href='#Page_5'>5</a>, <a href='#Page_9'>9</a>, <a href='#Page_22'>22</a>, <a href='#Page_138'>138</a>, <a href='#Page_145'>145</a>, <a href='#Page_318'>318</a>, <a href='#Page_329'>329</a>.</li> - <li class='c028'>Brieger, <a href='#Page_34'>34</a>, <a href='#Page_172'>172</a>.</li> - <li class='c028'>Brissaud, <a href='#Page_311'>311</a>.</li> - <li class='c028'>Brown, <a href='#Page_105'>105</a>.</li> - <li class='c028'>Brown-Séquard, <a href='#Page_8'>8</a>, <a href='#Page_32'>32</a>, <a href='#Page_125'>125</a>, <a href='#Page_159'>159</a>, <a href='#Page_198'>198</a>, <a href='#Page_391'>391</a>, <a href='#Page_410'>410</a>, <a href='#Page_442'>442</a>, <a href='#Page_443'>443</a>, <a href='#Page_444'>444</a>, <a href='#Page_445'>445</a>.</li> - <li class='c028'>Brunton, Sir Lauder, <a href='#Page_9'>9</a>, <a href='#Page_150'>150</a>, <a href='#Page_169'>169</a>, <a href='#Page_245'>245</a>, <a href='#Page_268'>268</a>, <a href='#Page_366'>366</a>.</li> - <li class='c028'>Buchner, <a href='#Page_134'>134</a>.</li> - <li class='c028'>Buddha, <a href='#Page_396'>396</a>.</li> - <li class='c028'>Bukojemsky, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Bunge, <a href='#Page_204'>204</a>, <a href='#Page_205'>205</a>, <a href='#Page_210'>210</a>, <a href='#Page_285'>285</a>, <a href='#Page_286'>286</a>, <a href='#Page_297'>297</a>, <a href='#Page_305'>305</a>, <a href='#Page_306'>306</a>, <a href='#Page_307'>307</a>, <a href='#Page_333'>333</a>, <a href='#Page_335'>335</a>, <a href='#Page_336'>336</a>, <a href='#Page_337'>337</a>, <a href='#Page_365'>365</a>, <a href='#Page_368'>368</a>, <a href='#Page_370'>370</a>, <a href='#Page_430'>430</a>.</li> - <li class='c028'>Burghart, <a href='#Page_440'>440</a>.</li> - <li class='c003'>Camerer, <a href='#Page_238'>238</a>.</li> - <li class='c028'>Campbell, <a href='#Page_111'>111</a>.</li> - <li class='c028'>Campbell, Harry, <a href='#Page_268'>268</a>, <a href='#Page_343'>343</a>.</li> - <li class='c028'>Camus, <a href='#Page_445'>445</a>.</li> - <li class='c028'>Carrion, <a href='#Page_31'>31</a>.</li> - <li class='c028'>Casselli, <a href='#Page_31'>31</a>.</li> - <li class='c028'>Cecca, <a href='#Page_103'>103</a>.</li> - <li class='c028'>Celibacy, <a href='#Page_402'>402</a>.</li> - <li class='c028'>Celsus, <a href='#Page_256'>256</a>.</li> - <li class='c028'>Charcot, <a href='#Page_84'>84</a>, <a href='#Page_96'>96</a>, <a href='#Page_257'>257</a>, <a href='#Page_415'>415</a>.</li> - <li class='c028'>Charrin, <a href='#Page_21'>21</a>, <a href='#Page_140'>140</a>, <a href='#Page_160'>160</a>, <a href='#Page_161'>161</a>, <a href='#Page_323'>323</a>.</li> - <li class='c028'>Chittenden, <a href='#Page_282'>282</a>, <a href='#Page_283'>283</a>.</li> - <li class='c028'>Christern, <a href='#Page_371'>371</a>.</li> - <li class='c028'>Christiani, <a href='#Page_438'>438</a>.</li> - <li class='c028'>Chroback, <a href='#Page_441'>441</a>.</li> - <li class='c028'>Circulatory system and adrenals, hygiene of, <a href='#Page_164'>164</a>.</li> - <li class='c028'>Cirrhosis, hepatic, production of, <a href='#Page_153'>153</a>.</li> - <li class='c028'>Clothing, rational, <a href='#Page_219'>219</a>. - <ul> - <li>(See <i>Skin, Hygiene of</i>.)</li> - </ul> - </li> - <li class='c028'>Cohendy, Michel, <a href='#Page_185'>185</a>, <a href='#Page_186'>186</a>.</li> - <li class='c028'>Cold, to prevent, <a href='#Page_233'>233</a>, <a href='#Page_278'>278</a>. - <ul> - <li>feet. See <i>Feet</i>.</li> - </ul> - </li> - <li class='c028'>Combe, <a href='#Page_7'>7</a>, <a href='#Page_102'>102</a>, <a href='#Page_184'>184</a>, <a href='#Page_186'>186</a>.</li> - <li class='c028'>Constipation, habitual, prevention and treatment of, <a href='#Page_175'>175</a>. - <ul> - <li>conditions, associated, in women, <a href='#Page_176'>176</a>.</li> - <li>diet for, <a href='#Page_178'>178</a>.</li> - <li>drugging for, <a href='#Page_190'>190</a>.</li> - <li>emotions, effect of, <a href='#Page_175'>175</a>.</li> - <li>fermentation, <a href='#Page_188'>188</a>.</li> - <li>glands, ductless, <a href='#Page_176'>176</a>. - <ul> - <li>sexual, <a href='#Page_176'>176</a>. - <ul> - <li>hygiene of, <a href='#Page_176'>176</a>.</li> - </ul> - </li> - </ul> - </li> - <li><span class='pageno' id='Page_472'>472</span>nerves, intestinal, <a href='#Page_176'>176</a>. - <ul> - <li>splanchnics, <a href='#Page_176'>176</a>.</li> - </ul> - </li> - <li>prevention of, <a href='#Page_176'>176</a>. - <ul> - <li>diet, <a href='#Page_176'>176</a>, <a href='#Page_178'>178</a>. - <ul> - <li>cereals, <a href='#Page_176'>176</a>, <a href='#Page_177'>177</a>.</li> - <li>fruits, <a href='#Page_177'>177</a>.</li> - <li>meat, <a href='#Page_176'>176</a>.</li> - <li>milk, <a href='#Page_178'>178</a>.</li> - <li>special, <a href='#Page_178'>178</a>.</li> - <li>vegetables, <a href='#Page_177'>177</a>.</li> - </ul> - </li> - </ul> - </li> - <li>thyroid, effect of, <a href='#Page_175'>175</a>.</li> - <li>treatment, <a href='#Page_179'>179</a>. - <ul> - <li>cascara sagrada, <a href='#Page_180'>180</a>.</li> - <li>electricity, <a href='#Page_179'>179</a>.</li> - <li>enemata, <a href='#Page_179'>179</a>.</li> - <li>hydrotherapeutics, <a href='#Page_179'>179</a>.</li> - <li>laxatives, <a href='#Page_180'>180</a>.</li> - <li>massage, <a href='#Page_179'>179</a>.</li> - <li>mineral waters, <a href='#Page_180'>180</a>.</li> - <li>rectum, irrigation of, <a href='#Page_179'>179</a>.</li> - <li>rhubarb, <a href='#Page_180'>180</a>.</li> - </ul> - </li> - <li>vagus, action of, <a href='#Page_175'>175</a>.</li> - </ul> - </li> - <li class='c028'>Cornaro, <a href='#Page_292'>292</a>, <a href='#Page_401'>401</a>.</li> - <li class='c028'>Cornil, <a href='#Page_32'>32</a>, <a href='#Page_47'>47</a>.</li> - <li class='c028'>Crispino, <a href='#Page_5'>5</a>, <a href='#Page_23'>23</a>, <a href='#Page_98'>98</a>.</li> - <li class='c028'>Cunningham, <a href='#Page_51'>51</a>.</li> - <li class='c028'>Cyon, <a href='#Page_31'>31</a>.</li> - <li class='c003'>Danilewsky, <a href='#Page_281'>281</a>.</li> - <li class='c028'>Darier, <a href='#Page_165'>165</a>.</li> - <li class='c028'>Darnecy, <a href='#Page_41'>41</a>.</li> - <li class='c028'>D’Arsonval, <a href='#Page_32'>32</a>, <a href='#Page_443'>443</a>, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Delcour, <a href='#Page_135'>135</a>, <a href='#Page_136'>136</a>, <a href='#Page_196'>196</a>.</li> - <li class='c028'>De l’Enclos, Ninon, <a href='#Page_54'>54</a>.</li> - <li class='c028'>Dellamare, <a href='#Page_93'>93</a>, <a href='#Page_167'>167</a>.</li> - <li class='c028'>Demange, <a href='#Page_110'>110</a>.</li> - <li class='c028'>Demange and Oettinger, <a href='#Page_96'>96</a>.</li> - <li class='c028'>De Manasseine, Marie, <a href='#Page_368'>368</a>.</li> - <li class='c028'>Demme, <a href='#Page_353'>353</a>.</li> - <li class='c028'>Denison, Charles, <a href='#Page_260'>260</a>.</li> - <li class='c028'>De Quervain, <a href='#Page_5'>5</a>, <a href='#Page_23'>23</a>, <a href='#Page_25'>25</a>, <a href='#Page_98'>98</a>, <a href='#Page_104'>104</a>, <a href='#Page_352'>352</a>, <a href='#Page_357'>357</a>.</li> - <li class='c028'>Dercum, <a href='#Page_44'>44</a>, <a href='#Page_110'>110</a>.</li> - <li class='c028'>Determann, <a href='#Page_168'>168</a>, <a href='#Page_320'>320</a>.</li> - <li class='c028'>Dettweiler, <a href='#Page_310'>310</a>.</li> - <li class='c028'>Dever, <a href='#Page_337'>337</a>.</li> - <li class='c028'>Diabetes, opium in, <a href='#Page_356'>356</a>. - <ul> - <li>sleepiness and, <a href='#Page_376'>376</a>.</li> - </ul> - </li> - <li class='c028'>Diamare and Kuliabko, <a href='#Page_78'>78</a>.</li> - <li class='c028'><a id='diet'></a>Diet, blood. See <a href='#blood'><i>Blood</i></a>. - <ul> - <li>for habitual constipation, <a href='#Page_178'>178</a>.</li> - <li>meat, avoidance of, in aged, <a href='#Page_323'>323</a>. - <ul> - <li> - <ul> - <li>in infancy, <a href='#Page_323'>323</a>.</li> - </ul> - </li> - <li>boiled, <a href='#Page_322'>322</a>.</li> - <li>canned, <a href='#Page_322'>322</a>. - <ul> - <li>preservatives in, <a href='#Page_322'>322</a>.</li> - </ul> - </li> - <li>catharsis for, <a href='#Page_324'>324</a>.</li> - <li>dangers of, <a href='#Page_317'>317</a>. - <ul> - <li>heaviness following, <a href='#Page_317'>317</a>.</li> - <li>in disease, <a href='#Page_317'>317</a>.</li> - </ul> - </li> - <li><span class='pageno' id='Page_473'>473</span>dangers of, nervous disorders, <a href='#Page_317'>317</a>.</li> - <li>results of, <a href='#Page_317'>317</a>, <a href='#Page_324'>324</a>. - <ul> - <li>absence of, from, <a href='#Page_321'>321</a>.</li> - <li>in diabetes, <a href='#Page_320'>320</a>.</li> - <li>in gout, <a href='#Page_320'>320</a>.</li> - <li>on ductless glands, <a href='#Page_317'>317</a>.</li> - <li>on kidneys, <a href='#Page_319'>319</a>.</li> - <li>on pancreas, <a href='#Page_319'>319</a>.</li> - <li>on uric acid formation, <a href='#Page_320'>320</a>.</li> - </ul> - </li> - <li>fresh, <a href='#Page_322'>322</a>.</li> - <li>moderate, <a href='#Page_322'>322</a>.</li> - <li>on circulatory apparatus, <a href='#Page_320'>320</a>.</li> - <li>putrefaction, <a href='#Page_324'>324</a>. - <ul> - <li>acids for, <a href='#Page_324'>324</a>.</li> - </ul> - </li> - <li>roasted, <a href='#Page_322'>322</a>.</li> - <li>water and, <a href='#Page_323'>323</a>.</li> - <li>white, <a href='#Page_322'>322</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'><a id='dietmilk'></a> milk, additions to, <a href='#Page_329'>329</a>. - <ul> - <li> - <ul> - <li>advantages of, <a href='#Page_330'>330</a>. - <ul> - <li>for old age, <a href='#Page_330'>330</a>, <a href='#Page_332'>332</a>, <a href='#Page_335'>335</a>.</li> - </ul> - </li> - <li>antiseptic action of, <a href='#Page_331'>331</a>.</li> - <li>asses’, <a href='#Page_332'>332</a>.</li> - <li>boiled, <a href='#Page_327'>327</a>.</li> - <li>digestibility of, <a href='#Page_329'>329</a>. - <ul> - <li>ease of, on kidneys, <a href='#Page_330'>330</a>. - <ul> - <li>on liver, <a href='#Page_330'>330</a>.</li> - <li>on stomach, <a href='#Page_330'>330</a>.</li> - </ul> - </li> - </ul> - </li> - <li>for athyroidia, <a href='#Page_329'>329</a>.</li> - <li>goats’, <a href='#Page_332'>332</a>.</li> - <li>human, <a href='#Page_331'>331</a>.</li> - <li>ideal, <a href='#Page_328'>328</a>, <a href='#Page_331'>331</a>.</li> - <li>in childhood, <a href='#Page_330'>330</a>.</li> - <li>kefir, <a href='#Page_329'>329</a>.</li> - <li>longevity by, <a href='#Page_329'>329</a>.</li> - <li>of thyroidectomized goats, <a href='#Page_326'>326</a>.</li> - <li>raw, <a href='#Page_327'>327</a>.</li> - <li>secretions of ductless glands in, <a href='#Page_325'>325</a>.</li> - <li>substances in, <a href='#Page_325'>325</a>, <a href='#Page_326'>326</a>. - <ul> - <li>in acid fermented, <a href='#Page_328'>328</a>.</li> - </ul> - </li> - <li>suppression of myxœdema by, <a href='#Page_325'>325</a>.</li> - <li>yogurth, <a href='#Page_329'>329</a>.</li> - </ul> - </li> - <li>vegetarian, advantages of, <a href='#Page_309'>309</a>, <a href='#Page_310'>310</a>, <a href='#Page_311'>311</a>. - <ul> - <li>age, old, value to prevent, <a href='#Page_311'>311</a>, <a href='#Page_312'>312</a>.</li> - <li>conditions improved by, <a href='#Page_321'>321</a>.</li> - <li>disadvantages of, <a href='#Page_309'>309</a>, <a href='#Page_312'>312</a>, <a href='#Page_313'>313</a>, <a href='#Page_314'>314</a>. - <ul> - <li>anatomical, <a href='#Page_309'>309</a>.</li> - </ul> - </li> - <li>diseases avoided by, <a href='#Page_310'>310</a>, <a href='#Page_311'>311</a>.</li> - <li>diseases from, <a href='#Page_313'>313</a>, <a href='#Page_314'>314</a>. - <ul> - <li>condition for, <a href='#Page_314'>314</a>.</li> - <li>predisposition to, <a href='#Page_314'>314</a>.</li> - </ul> - </li> - <li>lack of obesity from, <a href='#Page_311'>311</a>.</li> - <li>results of, <a href='#Page_315'>315</a>.</li> - <li>to reduce uric acid, <a href='#Page_311'>311</a>.</li> - <li>with proteids and fats, <a href='#Page_309'>309</a>, <a href='#Page_310'>310</a>.</li> - <li><span class='pageno' id='Page_474'>474</span>Diet, vegetarian, with proteids and fats, in disease, <a href='#Page_310'>310</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Disease a self-defense, <a href='#Page_419'>419</a>. - <ul> - <li>benefits of, <a href='#Page_420'>420</a>.</li> - <li>early recognition of, <a href='#Page_421'>421</a>.</li> - <li>treatment, <a href='#Page_421'>421</a>.</li> - </ul> - </li> - <li class='c028'>Dubois, <a href='#Page_446'>446</a>.</li> - <li class='c028'>Duclaux, <a href='#Page_256'>256</a>.</li> - <li class='c028'>Du Perron, <a href='#Page_402'>402</a>.</li> - <li class='c028'>Dupuytren, <a href='#Page_42'>42</a>.</li> - <li class='c028'>Dürig, <a href='#Page_37'>37</a>.</li> - <li class='c028'>Dwellings, situations for city, <a href='#Page_264'>264</a>.</li> - <li class='c003'>Easterbrook, <a href='#Page_27'>27</a>.</li> - <li class='c028'>Eating, appetite, æsthetics for, <a href='#Page_342'>342</a>. - <ul> - <li>checking, <a href='#Page_340'>340</a>.</li> - <li>conditions producing, <a href='#Page_340'>340</a>.</li> - <li>lost, in the sedentary, <a href='#Page_340'>340</a>.</li> - <li>normal, <a href='#Page_340'>340</a>.</li> - <li>stimulation for, <a href='#Page_341'>341</a>. - <ul> - <li>bouillon, <a href='#Page_341'>341</a>.</li> - <li>exercise, <a href='#Page_342'>342</a>, <a href='#Page_344'>344</a>, <a href='#Page_345'>345</a>.</li> - <li><i>hors d’œuvres</i>, <a href='#Page_341'>341</a>.</li> - <li>smörgasbord, <a href='#Page_341'>341</a>.</li> - <li>tongue washing, <a href='#Page_341'>341</a>.</li> - <li>vinegar and water, <a href='#Page_341'>341</a>.</li> - </ul> - </li> - <li>dinner, rest before and after, <a href='#Page_341'>341</a>.</li> - <li>food, most digestible, <a href='#Page_345'>345</a>. - <ul> - <li>butter, <a href='#Page_345'>345</a>.</li> - <li>cereals, <a href='#Page_345'>345</a>.</li> - <li>fat, <a href='#Page_345'>345</a>.</li> - <li>meat, <a href='#Page_345'>345</a>.</li> - <li>vegetables, <a href='#Page_345'>345</a>.</li> - </ul> - </li> - <li>gastric juice, adequate supply of, <a href='#Page_339'>339</a>. - <ul> - <li>augmenting, <a href='#Page_339'>339</a>. - <ul> - <li>mentally, <a href='#Page_339'>339</a>, <a href='#Page_340'>340</a>. - <ul> - <li>sight, <a href='#Page_339'>339</a>.</li> - <li>smell, <a href='#Page_339'>339</a>.</li> - <li>taste, <a href='#Page_340'>340</a>.</li> - </ul> - </li> - </ul> - </li> - </ul> - </li> - <li>hygiene of, <a href='#Page_339'>339</a>. - <ul> - <li>insalivation, <a href='#Page_342'>342</a>. - <ul> - <li>advantages of, <a href='#Page_343'>343</a>.</li> - </ul> - </li> - </ul> - </li> - <li>meals, companions at, <a href='#Page_342'>342</a>. - <ul> - <li>drinking with, <a href='#Page_344'>344</a>.</li> - <li>time for, <a href='#Page_344'>344</a>.</li> - </ul> - </li> - <li>reading while eating, <a href='#Page_342'>342</a>. - <ul> - <li>exceptions, <a href='#Page_342'>342</a>.</li> - </ul> - </li> - <li>saliva, secretion of, <a href='#Page_342'>342</a>. - <ul> - <li>stimulation of, <a href='#Page_342'>342</a>. - <ul> - <li>mastication, <a href='#Page_342'>342</a>.</li> - </ul> - </li> - </ul> - </li> - <li>teeth and, <a href='#Page_344'>344</a>.</li> - </ul> - </li> - <li class='c028'>Eberson, <a href='#Page_414'>414</a>.</li> - <li class='c028'>Echlin, <a href='#Page_374'>374</a>.</li> - <li class='c028'>Eckermann, <a href='#Page_53'>53</a>.</li> - <li class='c028'>Edgreen, <a href='#Page_165'>165</a>, <a href='#Page_169'>169</a>.</li> - <li class='c028'>Edmunds, Walter, <a href='#Page_22'>22</a>, <a href='#Page_35'>35</a>, <a href='#Page_96'>96</a>, <a href='#Page_140'>140</a>, <a href='#Page_373'>373</a>, <a href='#Page_388'>388</a>, <a href='#Page_438'>438</a>.</li> - <li class='c028'>Edwards, <a href='#Page_256'>256</a>.</li> - <li class='c028'>Ehrmann, <a href='#Page_453'>453</a>.</li> - <li class='c028'>Eiselsberg, <a href='#Page_5'>5</a>, <a href='#Page_96'>96</a>, <a href='#Page_167'>167</a>.</li> - <li class='c028'><span class='pageno' id='Page_475'>475</span>Eisenheart, <a href='#Page_47'>47</a>.</li> - <li class='c028'>Elberskirchen, Johanna, <a href='#Page_397'>397</a>.</li> - <li class='c028'>Emden, <a href='#Page_152'>152</a>.</li> - <li class='c028'>English, <a href='#Page_202'>202</a>.</li> - <li class='c028'>Erb, <a href='#Page_396'>396</a>.</li> - <li class='c028'>Erdheim, <a href='#Page_19'>19</a>, <a href='#Page_91'>91</a>, <a href='#Page_92'>92</a>, <a href='#Page_144'>144</a>.</li> - <li class='c028'>Espagno, <a href='#Page_105'>105</a>.</li> - <li class='c028'>Esser, <a href='#Page_367'>367</a>.</li> - <li class='c028'>Ewald, <a href='#Page_3'>3</a>, <a href='#Page_90'>90</a>, <a href='#Page_93'>93</a>, <a href='#Page_172'>172</a>, <a href='#Page_290'>290</a>, <a href='#Page_434'>434</a>, <a href='#Page_435'>435</a>.</li> - <li class='c028'>Exercise, advantages of, <a href='#Page_251'>251</a>. - <ul> - <li>benefits of, <a href='#Page_244'>244</a>.</li> - <li>breathing, <a href='#Page_262'>262</a>.</li> - <li>effects of, <a href='#Page_244'>244</a>.</li> - <li>massage, antiquity of, <a href='#Page_245'>245</a>. - <ul> - <li>by self, <a href='#Page_247'>247</a>.</li> - <li>effects of, <a href='#Page_245'>245</a>, <a href='#Page_246'>246</a>. - <ul> - <li>on heart, <a href='#Page_246'>246</a>.</li> - <li>Harvey, <a href='#Page_245'>245</a>.</li> - </ul> - </li> - </ul> - </li> - <li>sports, <a href='#Page_247'>247</a>. - <ul> - <li>best, <a href='#Page_248'>248</a>.</li> - <li>climbing, <a href='#Page_250'>250</a>. - <ul> - <li>for heart trouble, <a href='#Page_251'>251</a>.</li> - <li>Oertel’s treatment, <a href='#Page_251'>251</a>.</li> - </ul> - </li> - <li>contra-indications, <a href='#Page_247'>247</a>.</li> - <li>cycling, <a href='#Page_249'>249</a>.</li> - <li>dilatation of heart, <a href='#Page_248'>248</a>.</li> - <li>effects of, <a href='#Page_247'>247</a>.</li> - <li>horseback riding, <a href='#Page_248'>248</a>.</li> - <li>riding, <a href='#Page_249'>249</a>.</li> - <li>running, <a href='#Page_250'>250</a>.</li> - </ul> - </li> - <li>Swedish gymnastics, <a href='#Page_245'>245</a>. - <ul> - <li>Ling, Peter, <a href='#Page_245'>245</a>.</li> - <li>Mitchell, S. Weir, <a href='#Page_245'>245</a>.</li> - </ul> - </li> - <li>to induce perspiration, <a href='#Page_239'>239</a>.</li> - <li>treatment, Nauheim, <a href='#Page_246'>246</a>.</li> - <li>walking, <a href='#Page_249'>249</a>.</li> - </ul> - </li> - <li class='c003'>Farwick, <a href='#Page_336'>336</a>.</li> - <li class='c028'>Fassin, <a href='#Page_28'>28</a>, <a href='#Page_136'>136</a>.</li> - <li class='c028'>Feet, cleanliness of, <a href='#Page_234'>234</a>. - <ul> - <li>cold, <a href='#Page_252'>252</a>. - <ul> - <li>cause, <a href='#Page_252'>252</a>. - <ul> - <li>circulation, <a href='#Page_252'>252</a>, <a href='#Page_254'>254</a>. - <ul> - <li>senile gangrene, <a href='#Page_254'>254</a>.</li> - </ul> - </li> - <li>clothing, <a href='#Page_252'>252</a>. - <ul> - <li>shoes, <a href='#Page_252'>252</a>.</li> - <li>socks, <a href='#Page_253'>253</a>.</li> - </ul> - </li> - </ul> - </li> - <li>treatment, <a href='#Page_253'>253</a>, <a href='#Page_254'>254</a>. - <ul> - <li>exercise, <a href='#Page_253'>253</a>.</li> - <li>massage, <a href='#Page_253'>253</a>.</li> - <li>rubbing, <a href='#Page_253'>253</a>.</li> - </ul> - </li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Fehling, <a href='#Page_14'>14</a>.</li> - <li class='c028'>Ferranini, <a href='#Page_164'>164</a>.</li> - <li class='c028'>Finsen, <a href='#Page_256'>256</a>, <a href='#Page_257'>257</a>, <a href='#Page_258'>258</a>, <a href='#Page_261'>261</a>.</li> - <li class='c028'>Fishel, <a href='#Page_202'>202</a>.</li> - <li class='c028'>Fisher, Emil, <a href='#Page_364'>364</a>.</li> - <li class='c028'>Flamini, Mario, <a href='#Page_325'>325</a>.</li> - <li class='c028'>Fleischer, <a href='#Page_46'>46</a>.</li> - <li class='c028'>Fletcher, Horace, <a href='#Page_282'>282</a>, <a href='#Page_292'>292</a>, <a href='#Page_343'>343</a>.</li> - <li class='c028'>Flexner, <a href='#Page_311'>311</a>.</li> - <li class='c028'>Flourens, <a href='#Page_50'>50</a>.</li> - <li class='c028'><span class='pageno' id='Page_476'>476</span><a id='food'></a>Food, blood. See <i>Blood</i>. - <ul> - <li>carbohydrates, <a href='#Page_301'>301</a>. - <ul> - <li>cellulose, <a href='#Page_308'>308</a>. - <ul> - <li>advantage of, <a href='#Page_308'>308</a>.</li> - </ul> - </li> - <li>vegetables, <a href='#Page_301'>301</a>. - <ul> - <li>diet, rational, <a href='#Page_304'>304</a>.</li> - <li>disadvantages of, <a href='#Page_302'>302</a>.</li> - <li>fats in, <a href='#Page_301'>301</a>.</li> - <li>leguminous, <a href='#Page_301'>301</a>. - <ul> - <li>albumin in, <a href='#Page_301'>301</a>.</li> - <li>butter with, <a href='#Page_304'>304</a>.</li> - <li>composition of, <a href='#Page_301'>301</a>.</li> - <li>containing iron, <a href='#Page_306'>306</a>, <a href='#Page_307'>307</a>.</li> - </ul> - </li> - <li>minerals, <a href='#Page_305'>305</a>. - <ul> - <li>lime, <a href='#Page_305'>305</a>.</li> - <li>iron, <a href='#Page_305'>305</a>.</li> - </ul> - </li> - <li>potatoes, <a href='#Page_304'>304</a>.</li> - <li>rice, value of, <a href='#Page_302'>302</a>.</li> - </ul> - </li> - </ul> - </li> - <li>digestibility, <a href='#Page_289'>289</a>, <a href='#Page_290'>290</a>, <a href='#Page_291'>291</a>. - <ul> - <li>cold, <a href='#Page_291'>291</a>.</li> - <li>hot, <a href='#Page_291'>291</a>.</li> - <li>in aged, <a href='#Page_290'>290</a>.</li> - <li>in robust, <a href='#Page_289'>289</a>.</li> - </ul> - </li> - <li>hygiene, <a href='#Page_280'>280</a>. - <ul> - <li>albumin, <a href='#Page_283'>283</a>, <a href='#Page_284'>284</a>.</li> - <li>bouillon, <a href='#Page_287'>287</a>.</li> - <li>carbohydrates, <a href='#Page_281'>281</a>, <a href='#Page_284'>284</a>.</li> - <li>condiments, <a href='#Page_286'>286</a>. - <ul> - <li>harmfulness of, <a href='#Page_286'>286</a>.</li> - <li>sauces, <a href='#Page_286'>286</a>.</li> - <li>vinegar, <a href='#Page_286'>286</a>.</li> - </ul> - </li> - <li>diet, model, <a href='#Page_292'>292</a>, <a href='#Page_293'>293</a>.</li> - <li>eating, excessive, <a href='#Page_280'>280</a>.</li> - <li>experiments, <a href='#Page_282'>282</a>, <a href='#Page_283'>283</a>.</li> - <li>fats, <a href='#Page_281'>281</a>, <a href='#Page_284'>284</a>.</li> - <li>feeding, over-, dangers of, <a href='#Page_280'>280</a>. - <ul> - <li>principle of, <a href='#Page_280'>280</a>.</li> - <li>under-, dangers of, <a href='#Page_280'>280</a>.</li> - </ul> - </li> - <li>groups of, <a href='#Page_281'>281</a>.</li> - <li>in pregnancy, <a href='#Page_285'>285</a>.</li> - <li>iron, <a href='#Page_286'>286</a>.</li> - <li>keynote, <a href='#Page_291'>291</a>.</li> - <li>minerals, <a href='#Page_285'>285</a>.</li> - <li>nutritive value of, <a href='#Page_281'>281</a>.</li> - <li>potatoes, <a href='#Page_286'>286</a>.</li> - <li>proteid, <a href='#Page_281'>281</a>, <a href='#Page_284'>284</a>.</li> - <li>rice, <a href='#Page_283'>283</a>, <a href='#Page_286'>286</a>.</li> - <li>salt, <a href='#Page_285'>285</a>. - <ul> - <li>alkali, <a href='#Page_286'>286</a>.</li> - </ul> - </li> - <li>soup, <a href='#Page_287'>287</a>.</li> - <li>stimulants, <a href='#Page_287'>287</a>. - <ul> - <li>alcohol, <a href='#Page_287'>287</a>. - <ul> - <li>beer, <a href='#Page_287'>287</a>.</li> - <li>whiskey, <a href='#Page_288'>288</a>.</li> - <li>wine, <a href='#Page_288'>288</a>.</li> - </ul> - </li> - <li>cocoa, <a href='#Page_289'>289</a>.</li> - <li>coffee, <a href='#Page_289'>289</a>.</li> - <li>tea, <a href='#Page_289'>289</a>.</li> - <li>tobacco, <a href='#Page_289'>289</a>.</li> - </ul> - </li> - <li>three kinds, uses of, <a href='#Page_284'>284</a>.</li> - <li>time for meals, <a href='#Page_292'>292</a>. - <ul> - <li><span class='pageno' id='Page_477'>477</span>Food, hygiene, water, <a href='#Page_285'>285</a>.</li> - <li>hard, <a href='#Page_287'>287</a>.</li> - <li>in foodstuffs, <a href='#Page_287'>287</a>.</li> - <li>with meals, <a href='#Page_287'>287</a>.</li> - </ul> - </li> - </ul> - </li> - <li>most digestible, <a href='#Page_345'>345</a>.</li> - <li>preparation of, <a href='#Page_289'>289</a>.</li> - <li>proteid, <a href='#Page_294'>294</a>. - <ul> - <li>albumin, <a href='#Page_294'>294</a>.</li> - <li>animals, examination of slaughtered, <a href='#Page_295'>295</a>.</li> - <li>butter, <a href='#Page_298'>298</a>, <a href='#Page_303'>303</a>.</li> - <li>cheese, <a href='#Page_298'>298</a>. - <ul> - <li>digestion of, <a href='#Page_299'>299</a>.</li> - <li>putrefaction of, <a href='#Page_299'>299</a>.</li> - </ul> - </li> - <li>eggs, <a href='#Page_299'>299</a>.</li> - <li>fish, <a href='#Page_296'>296</a>.</li> - <li>meat, <a href='#Page_294'>294</a>. - <ul> - <li>composition of, <a href='#Page_294'>294</a>.</li> - <li>cold storage, <a href='#Page_295'>295</a>.</li> - <li>extractives, <a href='#Page_295'>295</a>.</li> - </ul> - </li> - <li>milk, <a href='#Page_296'>296</a>. - <ul> - <li>composition of, <a href='#Page_296'>296</a>, <a href='#Page_297'>297</a>, <a href='#Page_298'>298</a>.</li> - </ul> - </li> - <li>most perfect, <a href='#Page_300'>300</a>.</li> - <li>oysters, <a href='#Page_295'>295</a>.</li> - </ul> - </li> - <li>quantity of, <a href='#Page_289'>289</a>.</li> - <li>sausages, <a href='#Page_296'>296</a>.</li> - <li>too rich, <a href='#Page_289'>289</a>. - <ul> - <li>diseases caused by, <a href='#Page_289'>289</a>.</li> - <li>weather requirements of, <a href='#Page_289'>289</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Fordyce, <a href='#Page_330'>330</a>.</li> - <li class='c028'>Förster, <a href='#Page_305'>305</a>.</li> - <li class='c028'>Forsyth, <a href='#Page_318'>318</a>, <a href='#Page_330'>330</a>.</li> - <li class='c028'>Forsyth, D., <a href='#Page_22'>22</a>.</li> - <li class='c028'>Franklin, Benjamin, <a href='#Page_260'>260</a>, <a href='#Page_281'>281</a>.</li> - <li class='c028'>Fraser, <a href='#Page_151'>151</a>.</li> - <li class='c028'>Frerich, <a href='#Page_83'>83</a>.</li> - <li class='c028'>Fries, <a href='#Page_167'>167</a>.</li> - <li class='c028'>Frithe, <a href='#Page_367'>367</a>.</li> - <li class='c028'>Fröhlich, <a href='#Page_18'>18</a>.</li> - <li class='c003'>Galeotti and Lindemann, <a href='#Page_22'>22</a>, <a href='#Page_140'>140</a>.</li> - <li class='c028'>Gall, <a href='#Page_41'>41</a>.</li> - <li class='c028'>Garnier, <a href='#Page_13'>13</a>, <a href='#Page_23'>23</a>, <a href='#Page_27'>27</a>, <a href='#Page_31'>31</a>, <a href='#Page_57'>57</a>, <a href='#Page_58'>58</a>, <a href='#Page_141'>141</a>, <a href='#Page_314'>314</a>, <a href='#Page_431'>431</a>, <a href='#Page_438'>438</a>.</li> - <li class='c028'>Gasne and Laude, <a href='#Page_13'>13</a>.</li> - <li class='c028'>Gassenghi, <a href='#Page_30'>30</a>.</li> - <li class='c028'>Gauthier, <a href='#Page_14'>14</a>, <a href='#Page_427'>427</a>.</li> - <li class='c028'>Geist, <a href='#Page_334'>334</a>.</li> - <li class='c028'>Generali, <a href='#Page_144'>144</a>.</li> - <li class='c028'>Georgiewski, <a href='#Page_24'>24</a>, <a href='#Page_27'>27</a>.</li> - <li class='c028'>Gibson, <a href='#Page_432'>432</a>.</li> - <li class='c028'>Gibson, G. A., <a href='#Page_4'>4</a>, <a href='#Page_435'>435</a>.</li> - <li class='c028'>Gilbert, <a href='#Page_8'>8</a>, <a href='#Page_84'>84</a>.</li> - <li class='c028'>Gilbert and Carnot, <a href='#Page_446'>446</a>.</li> - <li class='c028'>Gillet, <a href='#Page_298'>298</a>.</li> - <li class='c028'>Glaesner, <a href='#Page_152'>152</a>.</li> - <li class='c028'>Gland. See individual glands, by name. - <ul> - <li>thyroid, administration of, skin eruptions following, <a href='#Page_213'>213</a>. - <ul> - <li>a function of, <a href='#Page_139'>139</a>.</li> - <li><span class='pageno' id='Page_478'>478</span>Gland, thyroid, alcohol and chloroform on, <a href='#Page_357'>357</a>.</li> - <li>and alcohol, <a href='#Page_356'>356</a>, <a href='#Page_357'>357</a>.</li> - <li>and temperature, <a href='#Page_237'>237</a>.</li> - <li>death following extirpation of, <a href='#Page_138'>138</a>.</li> - <li>degeneration of, in alcoholics, <a href='#Page_352'>352</a>.</li> - <li>exhaustion of, <a href='#Page_357'>357</a>, <a href='#Page_358'>358</a>.</li> - <li>extirpation of, effects of, <a href='#Page_167'>167</a>.</li> - <li>hyperactivity as cause of drunkenness, <a href='#Page_357'>357</a>.</li> - <li>in infants, <a href='#Page_323'>323</a>.</li> - <li>maintaining life after extirpation of, <a href='#Page_139'>139</a>.</li> - <li>milk as stimulant of, <a href='#Page_330'>330</a>.</li> - <li>results of disease of, on other organs, <a href='#Page_141'>141</a>. - <ul> - <li>intestines, <a href='#Page_143'>143</a>.</li> - <li>kidneys, <a href='#Page_142'>142</a>, <a href='#Page_143'>143</a>.</li> - <li>liver, <a href='#Page_141'>141</a>, <a href='#Page_142'>142</a>.</li> - </ul> - </li> - <li>sleeplessness and, <a href='#Page_369'>369</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Glands, ductless, effects of meat on, <a href='#Page_317'>317</a>. - <ul> - <li>secretions of, in blood, <a href='#Page_335'>335</a>. - <ul> - <li>in milk, <a href='#Page_325'>325</a>.</li> - </ul> - </li> - <li>parathyroids, influence on convulsions, <a href='#Page_144'>144</a>.</li> - <li>sexual, abuse of, <a href='#Page_390'>390</a>, <a href='#Page_391'>391</a>, <a href='#Page_392'>392</a>. - <ul> - <li>arsenic for, <a href='#Page_429'>429</a>.</li> - <li>diseases of, <a href='#Page_389'>389</a>. - <ul> - <li>frequency of, <a href='#Page_391'>391</a>.</li> - </ul> - </li> - <li>hygiene of, <a href='#Page_389'>389</a>.</li> - <li>hyperactivity of, <a href='#Page_213'>213</a>.</li> - <li>inactivity of, <a href='#Page_393'>393</a>. - <ul> - <li>treatment of, in unmarried, <a href='#Page_398'>398</a>.</li> - </ul> - </li> - <li>intercourse, too frequent, <a href='#Page_390'>390</a>.</li> - <li>interrupted, <a href='#Page_392'>392</a>.</li> - <li>iron for, <a href='#Page_429'>429</a>.</li> - <li>marriage, age for, <a href='#Page_392'>392</a>.</li> - </ul> - </li> - <li>sudorific, <a href='#Page_215'>215</a>, <a href='#Page_226'>226</a>.</li> - <li>thyroid, destruction of poisonous products through, <a href='#Page_138'>138</a>.</li> - </ul> - </li> - <li class='c028'>Gley, <a href='#Page_3'>3</a>, <a href='#Page_142'>142</a>, <a href='#Page_144'>144</a>, <a href='#Page_374'>374</a>, <a href='#Page_445'>445</a>.</li> - <li class='c028'>Goethe, <a href='#Page_43'>43</a>, <a href='#Page_53'>53</a>.</li> - <li class='c028'>Goldscheider, <a href='#Page_212'>212</a>.</li> - <li class='c028'>Gombault, <a href='#Page_84'>84</a>.</li> - <li class='c028'>Gouget, <a href='#Page_199'>199</a>.</li> - <li class='c028'>Gout, skin diseases in, <a href='#Page_213'>213</a>.</li> - <li class='c028'>Graffenberger, <a href='#Page_257'>257</a>.</li> - <li class='c028'>Grawitz, <a href='#Page_257'>257</a>, <a href='#Page_313'>313</a>, <a href='#Page_334'>334</a>, <a href='#Page_337'>337</a>, <a href='#Page_427'>427</a>, <a href='#Page_430'>430</a>.</li> - <li class='c028'>Greenfield, W. S., <a href='#Page_21'>21</a>.</li> - <li class='c028'>Groedel, <a href='#Page_164'>164</a>.</li> - <li class='c028'>Gruber and Durham, <a href='#Page_134'>134</a>.</li> - <li class='c028'>Grundzach, <a href='#Page_185'>185</a>.</li> - <li class='c028'>Guerrini, <a href='#Page_31'>31</a>.</li> - <li class='c028'>Guieysse, <a href='#Page_99'>99</a>.</li> - <li class='c028'>Guilbert, Yvette, <a href='#Page_101'>101</a>.</li> - <li class='c028'>Gumprecht, <a href='#Page_154'>154</a>.</li> - <li class='c028'>Gunzburg, <a href='#Page_200'>200</a>.</li> - <li class='c028'><span class='pageno' id='Page_479'>479</span>Gymnastics. See <i>Exercise</i>.</li> - <li class='c003'>Haig, <a href='#Page_131'>131</a>, <a href='#Page_242'>242</a>, <a href='#Page_288'>288</a>, <a href='#Page_299'>299</a>, <a href='#Page_320'>320</a>, <a href='#Page_321'>321</a>, <a href='#Page_364'>364</a>.</li> - <li class='c028'>Halck, <a href='#Page_83'>83</a>.</li> - <li class='c028'>Hall, Walker, <a href='#Page_131'>131</a>, <a href='#Page_288'>288</a>, <a href='#Page_302'>302</a>, <a href='#Page_310'>310</a>, <a href='#Page_320'>320</a>.</li> - <li class='c028'>Hallion, <a href='#Page_31'>31</a>.</li> - <li class='c028'>Hamel, <a href='#Page_268'>268</a>.</li> - <li class='c028'>Hanot and Boit, <a href='#Page_156'>156</a>.</li> - <li class='c028'>Hanseman, <a href='#Page_77'>77</a>.</li> - <li class='c028'>Harnack, <a href='#Page_430'>430</a>.</li> - <li class='c028'>Harvey, <a href='#Page_49'>49</a>, <a href='#Page_50'>50</a>, <a href='#Page_245'>245</a>, <a href='#Page_455'>455</a>, <a href='#Page_456'>456</a>.</li> - <li class='c028'>Haüsermann, <a href='#Page_333'>333</a>.</li> - <li class='c028'>Heating, artificial, air, indoor, effects of, <a href='#Page_277'>277</a>. - <ul> - <li>air, outdoor, effects of, <a href='#Page_277'>277</a>.</li> - <li>cold, catching, avoidance of, <a href='#Page_278'>278</a>. - <ul> - <li>from warm rooms, <a href='#Page_277'>277</a>.</li> - </ul> - </li> - <li>diseases, respiratory, <a href='#Page_278'>278</a>.</li> - <li>for old people, <a href='#Page_275'>275</a>.</li> - <li>for young people, <a href='#Page_275'>275</a>.</li> - <li>hot water, <a href='#Page_279'>279</a>.</li> - <li>hygiene of, <a href='#Page_275'>275</a>.</li> - <li>method of, most rational, <a href='#Page_276'>276</a>. - <ul> - <li>fireplace, open, <a href='#Page_276'>276</a>.</li> - </ul> - </li> - <li>railways, overheated, <a href='#Page_278'>278</a>.</li> - <li>steam, injuriousness of, <a href='#Page_278'>278</a>, <a href='#Page_279'>279</a>. - <ul> - <li>effects after, <a href='#Page_279'>279</a>.</li> - <li>mitigation of, <a href='#Page_279'>279</a>.</li> - <li>radiators, dusty, <a href='#Page_279'>279</a>.</li> - <li>tonsillitis from, <a href='#Page_278'>278</a>.</li> - </ul> - </li> - <li>temperature, high, <a href='#Page_275'>275</a>. - <ul> - <li> - <ul> - <li>without ventilation, <a href='#Page_275'>275</a>.</li> - </ul> - </li> - <li>indoor, best, <a href='#Page_276'>276</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Hegar, <a href='#Page_46'>46</a>.</li> - <li class='c028'>Heger and Buys, <a href='#Page_150'>150</a>.</li> - <li class='c028'>Heger, Paul, <a href='#Page_149'>149</a>.</li> - <li class='c028'>Heinz, <a href='#Page_431'>431</a>.</li> - <li class='c028'>Hemmeter, <a href='#Page_149'>149</a>, <a href='#Page_202'>202</a>.</li> - <li class='c028'>Hemp, <a href='#Page_326'>326</a>.</li> - <li class='c028'>Hensel, <a href='#Page_107'>107</a>, <a href='#Page_169'>169</a>.</li> - <li class='c028'>Hercod, <a href='#Page_354'>354</a>.</li> - <li class='c028'>Heredity and the ductless glands, <a href='#Page_352'>352</a>.</li> - <li class='c028'>Hertoghe, <a href='#Page_5'>5</a>, <a href='#Page_12'>12</a>, <a href='#Page_13'>13</a>, <a href='#Page_14'>14</a>, <a href='#Page_15'>15</a>, <a href='#Page_25'>25</a>, <a href='#Page_29'>29</a>, <a href='#Page_37'>37</a>, <a href='#Page_58'>58</a>, <a href='#Page_68'>68</a>, <a href='#Page_83'>83</a>, <a href='#Page_95'>95</a>, <a href='#Page_102'>102</a>, <a href='#Page_104'>104</a>, <a href='#Page_126'>126</a>, <a href='#Page_352'>352</a>, <a href='#Page_357'>357</a>, <a href='#Page_434'>434</a>, <a href='#Page_440'>440</a>.</li> - <li class='c028'>Herter, <a href='#Page_185'>185</a>.</li> - <li class='c028'>Hesse, Walter, <a href='#Page_326'>326</a>.</li> - <li class='c028'>Heyn, F., <a href='#Page_120'>120</a>.</li> - <li class='c028'>Hippocrates, <a href='#Page_256'>256</a>.</li> - <li class='c028'>Hirsch, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Hirschfeld, <a href='#Page_152'>152</a>.</li> - <li class='c028'>Hochenegg, <a href='#Page_44'>44</a>.</li> - <li class='c028'>Hofmeister, <a href='#Page_4'>4</a>, <a href='#Page_104'>104</a>.</li> - <li class='c028'>Holm, <a href='#Page_259'>259</a>.</li> - <li class='c028'>Horsley, Sir Victor, <a href='#Page_3'>3</a>, <a href='#Page_90'>90</a>, <a href='#Page_91'>91</a>, <a href='#Page_93'>93</a>, <a href='#Page_435'>435</a>.</li> - <li class='c028'><span class='pageno' id='Page_480'>480</span>Houssaye, <a href='#Page_318'>318</a>.</li> - <li class='c028'>Huchard, <a href='#Page_107'>107</a>, <a href='#Page_168'>168</a>, <a href='#Page_169'>169</a>, <a href='#Page_199'>199</a>.</li> - <li class='c028'>Hueppe, <a href='#Page_353'>353</a>.</li> - <li class='c028'>Hufeland, <a href='#Page_50'>50</a>, <a href='#Page_260'>260</a>, <a href='#Page_288'>288</a>, <a href='#Page_337'>337</a>, <a href='#Page_367'>367</a>, <a href='#Page_424'>424</a>.</li> - <li class='c028'>Hugo, Victor, <a href='#Page_54'>54</a>.</li> - <li class='c028'>Huler, <a href='#Page_202'>202</a>.</li> - <li class='c028'>Humphrey, <a href='#Page_324'>324</a>, <a href='#Page_355'>355</a>.</li> - <li class='c028'>Hun, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Hunt, <a href='#Page_23'>23</a>, <a href='#Page_141'>141</a>.</li> - <li class='c028'>Hutchison, <a href='#Page_131'>131</a>, <a href='#Page_325'>325</a>.</li> - <li class='c028'>Hutchison, R., <a href='#Page_363'>363</a>, <a href='#Page_364'>364</a>.</li> - <li class='c003'>Ibsen, <a href='#Page_54'>54</a>.</li> - <li class='c028'>Inada, <a href='#Page_168'>168</a>.</li> - <li class='c028'>Indian, longevity of, <a href='#Page_265'>265</a>.</li> - <li class='c028'>Insomnia. See also <a href='#sleep'><i>Sleep</i></a>. - <ul> - <li>treatment of, <a href='#Page_384'>384</a>. - <ul> - <li>medical, <a href='#Page_386'>386</a>. - <ul> - <li>milk of thyroidectomized goats, <a href='#Page_388'>388</a>.</li> - <li>serum of thyroidectomized goats, <a href='#Page_387'>387</a>.</li> - </ul> - </li> - <li>preventive, <a href='#Page_384'>384</a>. - <ul> - <li>bath, <a href='#Page_385'>385</a>.</li> - <li>hygiene, <a href='#Page_384'>384</a>.</li> - <li>room, <a href='#Page_385'>385</a>.</li> - </ul> - </li> - </ul> - </li> - </ul> - </li> - <li class='c028'><a id='intestines'></a>Intestines, hygiene of, <a href='#Page_182'>182</a>. - <ul> - <li>acid, lactic, <a href='#Page_184'>184</a>, <a href='#Page_185'>185</a>, <a href='#Page_186'>186</a>. - <ul> - <li>bacillus maya, <a href='#Page_184'>184</a>.</li> - <li>yoghurt, <a href='#Page_184'>184</a>.</li> - </ul> - </li> - <li>albumins, prepared, <a href='#Page_183'>183</a>. - <ul> - <li>for the aged, <a href='#Page_183'>183</a>.</li> - </ul> - </li> - <li>appendicitis, <a href='#Page_192'>192</a>. - <ul> - <li>adenoids, <a href='#Page_196'>196</a>.</li> - <li>cause and prevention of, <a href='#Page_192'>192</a>.</li> - <li>causes of, <a href='#Page_194'>194</a>, <a href='#Page_195'>195</a>.</li> - <li>constipation, <a href='#Page_194'>194</a>.</li> - <li>exercise, <a href='#Page_194'>194</a>.</li> - <li>psoas, influence of, <a href='#Page_192'>192</a>.</li> - <li>test for, <a href='#Page_194'>194</a>, <a href='#Page_195'>195</a>.</li> - <li>tonsils, <a href='#Page_195'>195</a>.</li> - </ul> - </li> - <li>assimilation in the aged, <a href='#Page_183'>183</a>.</li> - <li>bowel movement, residue after, <a href='#Page_191'>191</a>.</li> - <li>constipation, 188. See <i>Constipation</i>. - <ul> - <li>and fermentation, <a href='#Page_188'>188</a>.</li> - <li>appendicitis from, <a href='#Page_191'>191</a>.</li> - <li>drugging for, <a href='#Page_190'>190</a>.</li> - </ul> - </li> - <li>corsets, effects of, <a href='#Page_190'>190</a>.</li> - <li>defense, natural, <a href='#Page_184'>184</a>. - <ul> - <li>liver, <a href='#Page_184'>184</a>.</li> - <li>thyroid, <a href='#Page_184'>184</a>.</li> - </ul> - </li> - <li>diet, <a href='#Page_186'>186</a>. - <ul> - <li>fats, <a href='#Page_186'>186</a>.</li> - <li>cheese, <a href='#Page_186'>186</a>.</li> - </ul> - </li> - <li>diseases of, coincident with stomach disorders, <a href='#Page_182'>182</a>.</li> - <li>drinks, ice-cold, <a href='#Page_187'>187</a>.</li> - <li>enemata, <a href='#Page_191'>191</a>.</li> - <li>fæcal impaction, <a href='#Page_191'>191</a>.</li> - <li><span class='pageno' id='Page_481'>481</span>Intestines, hygiene of, food, quality of, <a href='#Page_187'>187</a>.</li> - <li>foods, <a href='#Page_184'>184</a>. - <ul> - <li>injurious, <a href='#Page_187'>187</a>. - <ul> - <li>canned, <a href='#Page_187'>187</a>.</li> - <li>fish, <a href='#Page_187'>187</a>.</li> - <li>fruits, <a href='#Page_187'>187</a>.</li> - <li>meats, <a href='#Page_187'>187</a>.</li> - <li>oysters, <a href='#Page_187'>187</a>.</li> - <li>preservatives, <a href='#Page_187'>187</a>.</li> - <li>sausages, <a href='#Page_187'>187</a>.</li> - <li>unmasticated, <a href='#Page_182'>182</a>. - <ul> - <li>fermentation of, <a href='#Page_182'>182</a>.</li> - </ul> - </li> - </ul> - </li> - <li>poisonous effects, <a href='#Page_184'>184</a>.</li> - </ul> - </li> - <li>glands, sexual, <a href='#Page_189'>189</a>.</li> - <li>habits, <a href='#Page_189'>189</a>.</li> - <li>purgation, <a href='#Page_188'>188</a>.</li> - <li>putrefaction, <a href='#Page_183'>183</a>, <a href='#Page_184'>184</a>, <a href='#Page_186'>186</a>. - <ul> - <li>meat, <a href='#Page_186'>186</a>.</li> - </ul> - </li> - <li>water, lack of, <a href='#Page_191'>191</a>.</li> - </ul> - </li> - <li class='c028'>Iron. See <i>Blood, iron in</i>. - <ul> - <li>in drugs, <a href='#Page_333'>333</a>.</li> - <li>in food, <a href='#Page_333'>333</a>.</li> - <li>lack of, in anæmia, <a href='#Page_333'>333</a>. - <ul> - <li>in chlorosis, <a href='#Page_333'>333</a>.</li> - </ul> - </li> - <li>organic and inorganic, <a href='#Page_333'>333</a>.</li> - </ul> - </li> - <li class='c003'>Jaffé, <a href='#Page_202'>202</a>.</li> - <li class='c028'>Javal, <a href='#Page_286'>286</a>.</li> - <li class='c028'>Jayle, <a href='#Page_104'>104</a>.</li> - <li class='c028'>Jeandelize, <a href='#Page_13'>13</a>, <a href='#Page_92'>92</a>, <a href='#Page_141'>141</a>, <a href='#Page_142'>142</a>, <a href='#Page_144'>144</a>.</li> - <li class='c028'>Jersoni, <a href='#Page_44'>44</a>.</li> - <li class='c028'>Jollin, <a href='#Page_323'>323</a>, <a href='#Page_431'>431</a>.</li> - <li class='c028'>Josué, <a href='#Page_5'>5</a>, <a href='#Page_162'>162</a>, <a href='#Page_163'>163</a>.</li> - <li class='c003'>Kant, <a href='#Page_415'>415</a>.</li> - <li class='c028'>Keill, James, <a href='#Page_51'>51</a>.</li> - <li class='c028'>Keller, <a href='#Page_205'>205</a>.</li> - <li class='c028'>Kende, Maurice, <a href='#Page_354'>354</a>.</li> - <li class='c028'>Kidney disease, test for, <a href='#Page_165'>165</a>.</li> - <li class='c028'>Kidneys, benefits of sweating upon, <a href='#Page_242'>242</a>. - <ul> - <li>hygiene of, <a href='#Page_203'>203</a>. - <ul> - <li>alcohol, <a href='#Page_205'>205</a>.</li> - <li>casts, hyaline, <a href='#Page_203'>203</a>.</li> - <li>clothing, <a href='#Page_208'>208</a>, <a href='#Page_231'>231</a>.</li> - <li>diet, lacto-vegetarian, <a href='#Page_204'>204</a>.</li> - <li>diseases, infectious, <a href='#Page_206'>206</a>.</li> - <li>drugs, <a href='#Page_206'>206</a>.</li> - <li>importance of, <a href='#Page_215'>215</a>.</li> - <li>intestines, <a href='#Page_207'>207</a>.</li> - <li>liver, <a href='#Page_204'>204</a>.</li> - <li>meat, <a href='#Page_204'>204</a>.</li> - <li>milk, <a href='#Page_204'>204</a>.</li> - <li>rhinitis and, <a href='#Page_207'>207</a>.</li> - <li>rice, <a href='#Page_205'>205</a>.</li> - <li>salt, <a href='#Page_204'>204</a>, <a href='#Page_215'>215</a>.</li> - <li>sauces, <a href='#Page_205'>205</a>.</li> - <li>skin, <a href='#Page_207'>207</a>, <a href='#Page_215'>215</a>.</li> - <li>spices, <a href='#Page_205'>205</a>.</li> - <li>tea, <a href='#Page_205'>205</a>.</li> - <li>tonsillitis and, <a href='#Page_207'>207</a>.</li> - <li><span class='pageno' id='Page_482'>482</span>Kidneys, hygiene of, water, <a href='#Page_206'>206</a>. - <ul> - <li>mineral, <a href='#Page_206'>206</a>.</li> - </ul> - </li> - </ul> - </li> - <li>internal secretion of, <a href='#Page_198'>198</a>.</li> - <li>milk an ideal food for, <a href='#Page_331'>331</a>. - <ul> - <li>diet and, <a href='#Page_330'>330</a>, <a href='#Page_331'>331</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Kisch, <a href='#Page_46'>46</a>, <a href='#Page_391'>391</a>, <a href='#Page_392'>392</a>, <a href='#Page_395'>395</a>, <a href='#Page_398'>398</a>.</li> - <li class='c028'>Kishi, <a href='#Page_96'>96</a>, <a href='#Page_140'>140</a>, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Kitasato, <a href='#Page_34'>34</a>.</li> - <li class='c028'>Klausner, <a href='#Page_353'>353</a>.</li> - <li class='c028'>Kliffel, <a href='#Page_80'>80</a>.</li> - <li class='c028'>Kobler, <a href='#Page_202'>202</a>.</li> - <li class='c028'>Koch, <a href='#Page_151'>151</a>, <a href='#Page_373'>373</a>.</li> - <li class='c028'>Koch and Kraepelin, <a href='#Page_363'>363</a>.</li> - <li class='c028'>Kocher, Albert, <a href='#Page_24'>24</a>, <a href='#Page_431'>431</a>.</li> - <li class='c028'>König, <a href='#Page_299'>299</a>.</li> - <li class='c028'>König, T., <a href='#Page_336'>336</a>.</li> - <li class='c028'>Koranyi, Alexander, <a href='#Page_205'>205</a>.</li> - <li class='c028'>Kossel, <a href='#Page_333'>333</a>.</li> - <li class='c028'>Kovesi, <a href='#Page_205'>205</a>, <a href='#Page_241'>241</a>, <a href='#Page_242'>242</a>.</li> - <li class='c028'>Krafft-Ebing, <a href='#Page_396'>396</a>.</li> - <li class='c028'>Kraut, C., <a href='#Page_336'>336</a>.</li> - <li class='c028'>Kreis, <a href='#Page_371'>371</a>.</li> - <li class='c028'>Kretschy, <a href='#Page_46'>46</a>.</li> - <li class='c028'>Krüger, <a href='#Page_34'>34</a>.</li> - <li class='c003'>Laache, <a href='#Page_126'>126</a>, <a href='#Page_434'>434</a>.</li> - <li class='c028'>Labbé, <a href='#Page_334'>334</a>.</li> - <li class='c028'>Labbé, Marcel, <a href='#Page_311'>311</a>.</li> - <li class='c028'>Laitinen, <a href='#Page_353'>353</a>, <a href='#Page_354'>354</a>.</li> - <li class='c028'>Landau, <a href='#Page_46'>46</a>, <a href='#Page_441'>441</a>.</li> - <li class='c028'>Langhans, <a href='#Page_92'>92</a>.</li> - <li class='c028'>Langlois, <a href='#Page_159'>159</a>, <a href='#Page_160'>160</a>, <a href='#Page_161'>161</a>.</li> - <li class='c028'>Lanz, <a href='#Page_21'>21</a>, <a href='#Page_22'>22</a>, <a href='#Page_24'>24</a>, <a href='#Page_27'>27</a>, <a href='#Page_57'>57</a>, <a href='#Page_72'>72</a>, <a href='#Page_140'>140</a>, <a href='#Page_196'>196</a>, <a href='#Page_326'>326</a>, <a href='#Page_388'>388</a>, <a href='#Page_442'>442</a>, <a href='#Page_445'>445</a>.</li> - <li class='c028'>Latzko, <a href='#Page_104'>104</a>.</li> - <li class='c028'>Laulanié, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Launois, <a href='#Page_95'>95</a>, <a href='#Page_99'>99</a>, <a href='#Page_384'>384</a>.</li> - <li class='c028'>Lautenbach, <a href='#Page_150'>150</a>.</li> - <li class='c028'>Lefas, <a href='#Page_80'>80</a>.</li> - <li class='c028'>Legrain, <a href='#Page_352'>352</a>.</li> - <li class='c028'>Legry and Renault, <a href='#Page_13'>13</a>.</li> - <li class='c028'>Lehman and Strassmann, <a href='#Page_46'>46</a>.</li> - <li class='c028'>Lehmann, <a href='#Page_306'>306</a>.</li> - <li class='c028'>Leichtenstein, <a href='#Page_202'>202</a>.</li> - <li class='c028'>Lemaire, <a href='#Page_165'>165</a>.</li> - <li class='c028'>Lenkey, <a href='#Page_258'>258</a>.</li> - <li class='c028'>Leube, <a href='#Page_241'>241</a>.</li> - <li class='c028'>Leuret and Hoffmann, <a href='#Page_41'>41</a>.</li> - <li class='c028'>Levi, Leopold, <a href='#Page_408'>408</a>.</li> - <li class='c028'>Levy, Magnus, <a href='#Page_238'>238</a>, <a href='#Page_323'>323</a>, <a href='#Page_374'>374</a>.</li> - <li class='c028'>Leyden, <a href='#Page_47'>47</a>.</li> - <li class='c028'>Liebermeister, <a href='#Page_233'>233</a>.</li> - <li class='c028'>Life, indoor, <a href='#Page_262'>262</a>. - <ul> - <li> - <ul> - <li>effects of, <a href='#Page_263'>263</a>.</li> - <li>examples of, <a href='#Page_262'>262</a>.</li> - </ul> - </li> - <li>married, as a means of morality, <a href='#Page_401'>401</a>. - <ul> - <li>children in, <a href='#Page_401'>401</a>.</li> - <li>disease, venereal and, <a href='#Page_401'>401</a>.</li> - <li>happiness in, <a href='#Page_400'>400</a>.</li> - <li>longevity, <a href='#Page_403'>403</a>.</li> - <li><span class='pageno' id='Page_483'>483</span>Life, married, meals and, <a href='#Page_402'>402</a>.</li> - <li>means for prolonging life, <a href='#Page_400'>400</a>.</li> - <li>sickness and, <a href='#Page_401'>401</a>.</li> - </ul> - </li> - <li>open air, <a href='#Page_262'>262</a>. - <ul> - <li>effects of, <a href='#Page_262'>262</a>, <a href='#Page_263'>263</a>.</li> - <li>examples of, <a href='#Page_262'>262</a>, <a href='#Page_267'>267</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Ling, Peter, <a href='#Page_245'>245</a>.</li> - <li class='c028'>Lingard, <a href='#Page_32'>32</a>.</li> - <li class='c028'>Liver, hygiene of, <a href='#Page_155'>155</a>. - <ul> - <li>bathing, <a href='#Page_158'>158</a>.</li> - <li>climates, hot, <a href='#Page_157'>157</a>. - <ul> - <li>hypertrophied liver, <a href='#Page_157'>157</a>.</li> - </ul> - </li> - <li>diet, alcohol, <a href='#Page_155'>155</a>. - <ul> - <li>best, <a href='#Page_157'>157</a>, <a href='#Page_158'>158</a>.</li> - <li>condiments, <a href='#Page_155'>155</a>.</li> - <li>meat, <a href='#Page_155'>155</a>.</li> - <li>milk, <a href='#Page_155'>155</a>, <a href='#Page_157'>157</a>.</li> - <li>spices, <a href='#Page_155'>155</a>.</li> - <li>stimulants, <a href='#Page_155'>155</a>, <a href='#Page_157'>157</a>.</li> - <li>vegetable, <a href='#Page_155'>155</a>, <a href='#Page_157'>157</a>, <a href='#Page_158'>158</a>.</li> - <li>water, <a href='#Page_157'>157</a>.</li> - </ul> - </li> - <li>milk diet and, <a href='#Page_330'>330</a>, <a href='#Page_331'>331</a>.</li> - <li>other organs and, <a href='#Page_155'>155</a>. - <ul> - <li>intestines, <a href='#Page_155'>155</a>.</li> - <li>pancreas, <a href='#Page_156'>156</a>.</li> - <li>stomach, <a href='#Page_156'>156</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Livon, <a href='#Page_31'>31</a>.</li> - <li class='c028'>Loeper, <a href='#Page_286'>286</a>.</li> - <li class='c028'>Loewy, <a href='#Page_18'>18</a>, <a href='#Page_33'>33</a>, <a href='#Page_233'>233</a>, <a href='#Page_441'>441</a>, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Loewy, A. and Y., <a href='#Page_266'>266</a>.</li> - <li class='c028'>Loewy and Richter, <a href='#Page_97'>97</a>.</li> - <li class='c028'>Lohrisch, <a href='#Page_188'>188</a>.</li> - <li class='c028'>Loisel, <a href='#Page_42'>42</a>, <a href='#Page_393'>393</a>.</li> - <li class='c028'>Longevity, alcohol and, <a href='#Page_350'>350</a>. - <ul> - <li>greatest, <a href='#Page_266'>266</a>.</li> - </ul> - </li> - <li class='c028'>Longfellow, <a href='#Page_125'>125</a>.</li> - <li class='c028'>Lucas Championnière, <a href='#Page_46'>46</a>.</li> - <li class='c028'>Ludwig, <a href='#Page_244'>244</a>.</li> - <li class='c028'>Luksch, <a href='#Page_161'>161</a>.</li> - <li class='c028'>Lunin, <a href='#Page_305'>305</a>.</li> - <li class='c028'>Luntz, <a href='#Page_266'>266</a>.</li> - <li class='c028'>Lussana, <a href='#Page_150'>150</a>, <a href='#Page_151'>151</a>.</li> - <li class='c028'>Luther, <a href='#Page_391'>391</a>, <a href='#Page_396'>396</a>.</li> - <li class='c028'>Luttje, <a href='#Page_200'>200</a>.</li> - <li class='c028'>Luzatti, <a href='#Page_298'>298</a>.</li> - <li class='c003'>Macallum, <a href='#Page_144'>144</a>.</li> - <li class='c028'>Mackenzie, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Mackenzie, Hector, <a href='#Page_434'>434</a>, <a href='#Page_435'>435</a>.</li> - <li class='c028'>Mac Means, <a href='#Page_352'>352</a>.</li> - <li class='c028'>Madelung, <a href='#Page_19'>19</a>.</li> - <li class='c028'>Magnus-Levy, <a href='#Page_17'>17</a>, <a href='#Page_95'>95</a>.</li> - <li class='c028'>Mahomet, <a href='#Page_96'>96</a>.</li> - <li class='c028'>Manfur, <a href='#Page_298'>298</a>.</li> - <li class='c028'>Marbé, <a href='#Page_28'>28</a>.</li> - <li class='c028'>Mariagalli and Negri, <a href='#Page_46'>46</a>.</li> - <li class='c028'>Marriage, age for, <a href='#Page_392'>392</a>.</li> - <li class='c028'>Marti, <a href='#Page_257'>257</a>.</li> - <li class='c028'>Martin, <a href='#Page_353'>353</a>.</li> - <li class='c028'>Masey, <a href='#Page_248'>248</a>.</li> - <li class='c028'>Massage. See <i>Exercise</i>.</li> - <li class='c028'><span class='pageno' id='Page_484'>484</span>Meat. See <a href='#diet'><i>Diet</i></a>.</li> - <li class='c028'>Mendel, Lafayette, <a href='#Page_323'>323</a>.</li> - <li class='c028'>Mering and Minkowski, <a href='#Page_77'>77</a>.</li> - <li class='c028'>Merklen, <a href='#Page_298'>298</a>.</li> - <li class='c028'>Merschejewski, <a href='#Page_46'>46</a>.</li> - <li class='c028'>Metschnikoff, <a href='#Page_47'>47</a>, <a href='#Page_51'>51</a>, <a href='#Page_53'>53</a>, <a href='#Page_98'>98</a>, <a href='#Page_112'>112</a>, <a href='#Page_124'>124</a>, <a href='#Page_184'>184</a>, <a href='#Page_185'>185</a>, <a href='#Page_329'>329</a>.</li> - <li class='c028'>Metschnikoff and Matschinski, <a href='#Page_32'>32</a>.</li> - <li class='c028'>Meyer, E., <a href='#Page_8'>8</a>, <a href='#Page_198'>198</a>, <a href='#Page_447'>447</a>.</li> - <li class='c028'>Milk. See <i>Diet</i>. - <ul> - <li>of thyroidectomized goats, <a href='#Page_326'>326</a>.</li> - <li>raw, for stomach, liver, and kidneys, <a href='#Page_330'>330</a>.</li> - </ul> - </li> - <li class='c028'>Mind, hygiene of, <a href='#Page_404'>404</a>. - <ul> - <li>arteriosclerosis in, <a href='#Page_423'>423</a>.</li> - <li>brain workers, advice to, <a href='#Page_423'>423</a>. - <ul> - <li>bedtime, <a href='#Page_424'>424</a>.</li> - <li>exercise, <a href='#Page_424'>424</a>.</li> - <li>mealtime, <a href='#Page_424'>424</a>.</li> - <li>moderation, <a href='#Page_423'>423</a>, <a href='#Page_424'>424</a>.</li> - <li>outdoor life, <a href='#Page_424'>424</a>, <a href='#Page_425'>425</a>.</li> - <li>rest, <a href='#Page_423'>423</a>.</li> - </ul> - </li> - <li>diseases from, <a href='#Page_404'>404</a>. - <ul> - <li>diabetes, <a href='#Page_404'>404</a>, <a href='#Page_405'>405</a>.</li> - </ul> - </li> - <li>emotions, strong, death from, <a href='#Page_404'>404</a>, <a href='#Page_407'>407</a>. - <ul> - <li>organs affected by, <a href='#Page_405'>405</a>. - <ul> - <li>adrenals, <a href='#Page_405'>405</a>.</li> - <li>hair, <a href='#Page_406'>406</a>.</li> - <li>liver, <a href='#Page_406'>406</a>.</li> - <li>pancreas, <a href='#Page_406'>406</a>.</li> - <li>pituitary, <a href='#Page_405'>405</a>.</li> - <li>sexual glands, <a href='#Page_406'>406</a>, <a href='#Page_409'>409</a>.</li> - <li>stomach, <a href='#Page_411'>411</a>.</li> - <li>thyroid, <a href='#Page_405'>405</a>, <a href='#Page_408'>408</a>, <a href='#Page_409'>409</a>.</li> - </ul> - </li> - </ul> - </li> - <li>ideational channels, <a href='#Page_411'>411</a>. - <ul> - <li>causes of depressed, <a href='#Page_411'>411</a>, <a href='#Page_412'>412</a>.</li> - <li>enlivening, <a href='#Page_413'>413</a>.</li> - </ul> - </li> - <li>life, religious belief for prolonging, <a href='#Page_414'>414</a>. - <ul> - <li> - <ul> - <li>Cause, the great, <a href='#Page_416'>416</a>.</li> - <li>effect on anæsthesia, <a href='#Page_415'>415</a>.</li> - <li>faith, <a href='#Page_414'>414</a>.</li> - </ul> - </li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Minervini, <a href='#Page_93'>93</a>.</li> - <li class='c028'>Mingazzini, <a href='#Page_39'>39</a>, <a href='#Page_394'>394</a>.</li> - <li class='c028'>Minkowski, <a href='#Page_80'>80</a>.</li> - <li class='c028'>Minnich, <a href='#Page_167'>167</a>.</li> - <li class='c028'>Mintz, <a href='#Page_259'>259</a>.</li> - <li class='c028'>Mitchell, S. Weir, <a href='#Page_245'>245</a>.</li> - <li class='c028'>Moebius, <a href='#Page_25'>25</a>, <a href='#Page_41'>41</a>, <a href='#Page_42'>42</a>, <a href='#Page_43'>43</a>, <a href='#Page_53'>53</a>, <a href='#Page_357'>357</a>, <a href='#Page_387'>387</a>.</li> - <li class='c028'>Mohammed, <a href='#Page_391'>391</a>.</li> - <li class='c028'>Mohn, <a href='#Page_258'>258</a>.</li> - <li class='c028'>Moleschott, <a href='#Page_256'>256</a>.</li> - <li class='c028'>Molière, <a href='#Page_199'>199</a>.</li> - <li class='c028'>Morat and Doyon, <a href='#Page_83'>83</a>.</li> - <li class='c028'>Moritz, <a href='#Page_248'>248</a>.</li> - <li class='c028'>Moro, <a href='#Page_298'>298</a>.</li> - <li class='c028'>Morvan, <a href='#Page_7'>7</a>, <a href='#Page_102'>102</a>.</li> - <li class='c028'>Moschini, <a href='#Page_161'>161</a>.</li> - <li class='c028'>Moses, <a href='#Page_391'>391</a>.</li> - <li class='c028'>Mossé, <a href='#Page_304'>304</a>, <a href='#Page_325'>325</a>, <a href='#Page_370'>370</a>, <a href='#Page_391'>391</a>, <a href='#Page_443'>443</a>.</li> - <li class='c028'><span class='pageno' id='Page_485'>485</span>Müller, <a href='#Page_168'>168</a>.</li> - <li class='c028'>Müller, Friedlich, <a href='#Page_206'>206</a>.</li> - <li class='c028'>Muller, P., <a href='#Page_47'>47</a>, <a href='#Page_168'>168</a>.</li> - <li class='c028'>Murray, <a href='#Page_71'>71</a>.</li> - <li class='c028'>Murray, G., <a href='#Page_21'>21</a>, <a href='#Page_126'>126</a>, <a href='#Page_142'>142</a>, <a href='#Page_434'>434</a>.</li> - <li class='c003'>Napoleon, <a href='#Page_43'>43</a>.</li> - <li class='c028'>Narbuth, <a href='#Page_18'>18</a>.</li> - <li class='c028'>Naunyn, <a href='#Page_84'>84</a>, <a href='#Page_248'>248</a>, <a href='#Page_334'>334</a>, <a href='#Page_404'>404</a>.</li> - <li class='c028'>Nehring, <a href='#Page_95'>95</a>, <a href='#Page_374'>374</a>.</li> - <li class='c028'>Neisson, <a href='#Page_350'>350</a>.</li> - <li class='c028'>Nencky, <a href='#Page_152'>152</a>.</li> - <li class='c028'>Neugebauer, <a href='#Page_392'>392</a>.</li> - <li class='c028'>Neusser, <a href='#Page_85'>85</a>, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Nicholas, <a href='#Page_161'>161</a>.</li> - <li class='c028'>Nobecourt, <a href='#Page_298'>298</a>.</li> - <li class='c028'>Nuclein for yolk of eggs, <a href='#Page_333'>333</a>.</li> - <li class='c028'>Nuttall and Thierfelder, <a href='#Page_170'>170</a>.</li> - <li class='c003'>Obersteiner, <a href='#Page_368'>368</a>, <a href='#Page_371'>371</a>.</li> - <li class='c028'>Obolenski, <a href='#Page_446'>446</a>.</li> - <li class='c028'>Oertel, <a href='#Page_251'>251</a>.</li> - <li class='c028'>Oeruni, <a href='#Page_257'>257</a>.</li> - <li class='c028'>Oesterreicher, <a href='#Page_56'>56</a>.</li> - <li class='c028'>Offer, <a href='#Page_322'>322</a>.</li> - <li class='c028'>Offerhaus, <a href='#Page_192'>192</a>, <a href='#Page_193'>193</a>.</li> - <li class='c028'>Old age, milk diet for. See <a href='#dietmilk'><i>Diet, milk</i></a>.</li> - <li class='c028'>Oliver and Schäfer, <a href='#Page_5'>5</a>, <a href='#Page_31'>31</a>, <a href='#Page_69'>69</a>.</li> - <li class='c028'>Opie, <a href='#Page_77'>77</a>, <a href='#Page_80'>80</a>.</li> - <li class='c028'>Opium in diabetes, <a href='#Page_356'>356</a>.</li> - <li class='c028'>Oppenheim, <a href='#Page_160'>160</a>, <a href='#Page_434'>434</a>.</li> - <li class='c028'>Oppenheim and Loeper, <a href='#Page_160'>160</a>.</li> - <li class='c028'>Ord, <a href='#Page_7'>7</a>, <a href='#Page_96'>96</a>, <a href='#Page_102'>102</a>.</li> - <li class='c028'>Ortner, <a href='#Page_212'>212</a>.</li> - <li class='c028'>Oser, <a href='#Page_169'>169</a>.</li> - <li class='c028'>Oswald, <a href='#Page_91'>91</a>, <a href='#Page_325'>325</a>.</li> - <li class='c028'>Ottfried, <a href='#Page_168'>168</a>.</li> - <li class='c028'>Ouspenski, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Ovaries, influence of, on the blood, <a href='#Page_334'>334</a>.</li> - <li class='c028'>Owen, Sir Isambard, <a href='#Page_350'>350</a>.</li> - <li class='c003'>Paris, Matthew, <a href='#Page_45'>45</a>.</li> - <li class='c028'>Parr, <a href='#Page_329'>329</a>.</li> - <li class='c028'>Parr, Thomas, autopsy on, <a href='#Page_455'>455</a>.</li> - <li class='c028'>Pasha, Emin, <a href='#Page_353'>353</a>.</li> - <li class='c028'>Paterson, <a href='#Page_452'>452</a>.</li> - <li class='c028'>Paton, James, <a href='#Page_221'>221</a>.</li> - <li class='c028'>Pavy, <a href='#Page_19'>19</a>.</li> - <li class='c028'>Pawlow, <a href='#Page_69'>69</a>, <a href='#Page_77'>77</a>, <a href='#Page_339'>339</a>, <a href='#Page_340'>340</a>, <a href='#Page_344'>344</a>, <a href='#Page_406'>406</a>.</li> - <li class='c028'>Pel, <a href='#Page_21'>21</a>, <a href='#Page_58'>58</a>, <a href='#Page_105'>105</a>, <a href='#Page_106'>106</a>, <a href='#Page_405'>405</a>, <a href='#Page_456'>456</a>.</li> - <li class='c028'>Pelikan, <a href='#Page_45'>45</a>.</li> - <li class='c028'>Penzoldt, <a href='#Page_200'>200</a>.</li> - <li class='c028'>Perrando, <a href='#Page_13'>13</a>, <a href='#Page_57'>57</a>, <a href='#Page_58'>58</a>.</li> - <li class='c028'>Perrin, <a href='#Page_141'>141</a>.</li> - <li class='c028'>Pettenkoffer, <a href='#Page_209'>209</a>, <a href='#Page_221'>221</a>, <a href='#Page_263'>263</a>, <a href='#Page_273'>273</a>.</li> - <li class='c028'>Pflüger, <a href='#Page_50'>50</a>, <a href='#Page_456'>456</a>.</li> - <li class='c028'>Pigeolet, <a href='#Page_392'>392</a>.</li> - <li class='c028'>Pilcz, <a href='#Page_36'>36</a>, <a href='#Page_374'>374</a>.</li> - <li class='c028'>Pineles, <a href='#Page_4'>4</a>, <a href='#Page_92'>92</a>, <a href='#Page_111'>111</a>, <a href='#Page_144'>144</a>, <a href='#Page_167'>167</a>.</li> - <li class='c028'><span class='pageno' id='Page_486'>486</span>Plato, <a href='#Page_390'>390</a>.</li> - <li class='c028'>Plutarch, <a href='#Page_107'>107</a>.</li> - <li class='c028'>Poehl, <a href='#Page_33'>33</a>, <a href='#Page_127'>127</a>, <a href='#Page_443'>443</a>, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Poison, snake, alcohol for, <a href='#Page_358'>358</a>.</li> - <li class='c028'>Politiman, <a href='#Page_105'>105</a>.</li> - <li class='c028'>Pomeroy, <a href='#Page_391'>391</a>.</li> - <li class='c028'>Poncet, <a href='#Page_12'>12</a>.</li> - <li class='c028'>Posner, <a href='#Page_306'>306</a>.</li> - <li class='c028'>Pottenger, <a href='#Page_265'>265</a>.</li> - <li class='c028'>Pregl, <a href='#Page_443'>443</a>.</li> - <li class='c028'>Products, poisonous, destroyed through thyroid and parathyroid glands, <a href='#Page_138'>138</a>. - <ul> - <li>thyroidectomy, effects of, <a href='#Page_138'>138</a>. - <ul> - <li>on animals, meat-fed, <a href='#Page_138'>138</a>.</li> - <li>on animals on meatless diet, <a href='#Page_138'>138</a>.</li> - <li>on animals on milk diet, <a href='#Page_138'>138</a>.</li> - </ul> - </li> - <li>toxic, destruction of, by adrenals, <a href='#Page_159'>159</a>. - <ul> - <li>after adrenalectomy, <a href='#Page_159'>159</a>.</li> - <li>from muscular exercise, <a href='#Page_368'>368</a>.</li> - <li>immunizing constituent, <a href='#Page_159'>159</a>.</li> - <li>infectious diseases, <a href='#Page_160'>160</a>.</li> - <li>microbes, <a href='#Page_160'>160</a>.</li> - <li>poisons, microbic, <a href='#Page_161'>161</a>.</li> - </ul> - </li> - <li>destruction of, by the liver, <a href='#Page_149'>149</a>. - <ul> - <li>albuminoids, <a href='#Page_152'>152</a>.</li> - <li>carbohydrates, <a href='#Page_152'>152</a>.</li> - <li>enlargement of liver, <a href='#Page_153'>153</a>.</li> - <li>excretion of, <a href='#Page_150'>150</a>. - <ul> - <li>bile, <a href='#Page_150'>150</a>.</li> - <li>urine, <a href='#Page_153'>153</a>.</li> - </ul> - </li> - <li>hepatic cirrhosis, <a href='#Page_153'>153</a>.</li> - <li>reduction in liver disease, <a href='#Page_154'>154</a>.</li> - </ul> - </li> - <li>elimination of, through intestines, <a href='#Page_170'>170</a>. - <ul> - <li>constipation, <a href='#Page_172'>172</a>, <a href='#Page_202'>202</a>. - <ul> - <li>internal, <a href='#Page_173'>173</a>.</li> - </ul> - </li> - <li>fæcal intoxications, <a href='#Page_172'>172</a>.</li> - <li>intestines, microbes in, <a href='#Page_170'>170</a>. - <ul> - <li>effect on liver, <a href='#Page_170'>170</a>.</li> - </ul> - </li> - <li>purgation, regular, <a href='#Page_173'>173</a>.</li> - <li>secretions, anti-bacterial, <a href='#Page_174'>174</a>.</li> - </ul> - </li> - <li>elimination of, through kidneys, <a href='#Page_197'>197</a>. - <ul> - <li>albuminuria, <a href='#Page_199'>199</a>. - <ul> - <li>from constipation, <a href='#Page_202'>202</a>.</li> - </ul> - </li> - <li>casts, urinary, <a href='#Page_199'>199</a>.</li> - <li>chloroform, <a href='#Page_201'>201</a>.</li> - <li>drugs, poisonous, alcohol and, <a href='#Page_200'>200</a>.</li> - <li>kidneys, internal secretion of, <a href='#Page_198'>198</a>.</li> - <li>liver and, <a href='#Page_199'>199</a>.</li> - <li>mercury, <a href='#Page_201'>201</a>.</li> - <li>mustard and, <a href='#Page_200'>200</a>.</li> - <li>pepper, <a href='#Page_200'>200</a>.</li> - <li>potassium chloride, <a href='#Page_200'>200</a>.</li> - <li>radishes, <a href='#Page_200'>200</a>.</li> - <li><span class='pageno' id='Page_487'>487</span>Products, toxic, elimination of, salicylates, <a href='#Page_201'>201</a>.</li> - <li>tea, black, <a href='#Page_200'>200</a>.</li> - <li>thyroid and, <a href='#Page_198'>198</a>.</li> - </ul> - </li> - <li>elimination of, through the skin, <a href='#Page_209'>209</a>. - <ul> - <li>carbonic acid, <a href='#Page_209'>209</a>.</li> - <li>perspiration, <a href='#Page_210'>210</a>, <a href='#Page_212'>212</a>.</li> - <li>retention of, <a href='#Page_211'>211</a>.</li> - <li>skin, causes of diseases of, <a href='#Page_212'>212</a>. - <ul> - <li>burns, <a href='#Page_212'>212</a>.</li> - <li>eruptions of, <a href='#Page_213'>213</a>.</li> - <li>glands of, <a href='#Page_209'>209</a>.</li> - <li>respiration through, <a href='#Page_210'>210</a>.</li> - </ul> - </li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Prudden, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Prun-Hudden, <a href='#Page_85'>85</a>.</li> - <li class='c028'>Puddings, blood, <a href='#Page_335'>335</a>.</li> - <li class='c003'>Quarters, ill-ventilated, dangers of, <a href='#Page_271'>271</a>, <a href='#Page_272'>272</a>. - <ul> - <li>air of, <a href='#Page_272'>272</a>. - <ul> - <li>microbes in, <a href='#Page_272'>272</a>.</li> - </ul> - </li> - <li>infectious diseases from, <a href='#Page_272'>272</a>.</li> - <li>persons, sickly, <a href='#Page_271'>271</a>. - <ul> - <li>unused to, <a href='#Page_271'>271</a>.</li> - </ul> - </li> - <li>schoolrooms, <a href='#Page_273'>273</a>.</li> - <li>sleeping room, <a href='#Page_273'>273</a>. - <ul> - <li>flowers in, <a href='#Page_273'>273</a>.</li> - <li>furnishings of, <a href='#Page_273'>273</a>.</li> - <li>ventilation of, <a href='#Page_274'>274</a>.</li> - <li>windows, open, <a href='#Page_273'>273</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Queirolo, <a href='#Page_212'>212</a>.</li> - <li class='c028'>Quincke, <a href='#Page_156'>156</a>.</li> - <li class='c003'>Rechenberg, <a href='#Page_283'>283</a>.</li> - <li class='c028'>Remlinger, <a href='#Page_168'>168</a>.</li> - <li class='c028'>Renaut, <a href='#Page_446'>446</a>.</li> - <li class='c028'>Rénon, <a href='#Page_402'>402</a>.</li> - <li class='c028'>Rénon and Delille, <a href='#Page_31'>31</a>.</li> - <li class='c028'>Rénon, Delille, and Azam, <a href='#Page_32'>32</a>.</li> - <li class='c028'>Richter, P. I., <a href='#Page_18'>18</a>, <a href='#Page_33'>33</a>, <a href='#Page_205'>205</a>, <a href='#Page_441'>441</a>, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Rieger, <a href='#Page_41'>41</a>.</li> - <li class='c028'>Rigaud, <a href='#Page_39'>39</a>, <a href='#Page_393'>393</a>, <a href='#Page_394'>394</a>.</li> - <li class='c028'>Riva, <a href='#Page_337'>337</a>.</li> - <li class='c028'>Roese, <a href='#Page_287'>287</a>, <a href='#Page_305'>305</a>.</li> - <li class='c028'>Roger, <a href='#Page_150'>150</a>, <a href='#Page_153'>153</a>, <a href='#Page_160'>160</a>, <a href='#Page_314'>314</a>.</li> - <li class='c028'>Roger and Garnier, <a href='#Page_5'>5</a>, <a href='#Page_23'>23</a>, <a href='#Page_98'>98</a>, <a href='#Page_154'>154</a>.</li> - <li class='c028'>Rogowitsch, <a href='#Page_4'>4</a>, <a href='#Page_141'>141</a>, <a href='#Page_374'>374</a>.</li> - <li class='c028'>Romberg, <a href='#Page_165'>165</a>, <a href='#Page_166'>166</a>, <a href='#Page_168'>168</a>.</li> - <li class='c028'>Rooms, sleeping, <a href='#Page_264'>264</a>.</li> - <li class='c028'>Rosenblath, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Rosenblatt and Jeandelize, <a href='#Page_96'>96</a>.</li> - <li class='c028'>Rosenquist, <a href='#Page_322'>322</a>.</li> - <li class='c028'>Rothschild, Baron Henry, <a href='#Page_408'>408</a>.</li> - <li class='c028'>Roth-Schulz, <a href='#Page_205'>205</a>, <a href='#Page_241'>241</a>, <a href='#Page_242'>242</a>.</li> - <li class='c028'>Rousseau, <a href='#Page_41'>41</a>.</li> - <li class='c028'>Roux, <a href='#Page_160'>160</a>.</li> - <li class='c028'>Rovighi, <a href='#Page_149'>149</a>.</li> - <li class='c028'>Rubner, <a href='#Page_233'>233</a>, <a href='#Page_281'>281</a>, <a href='#Page_284'>284</a>, <a href='#Page_287'>287</a>, <a href='#Page_288'>288</a>, <a href='#Page_294'>294</a>, <a href='#Page_297'>297</a>, <a href='#Page_301'>301</a>, <a href='#Page_302'>302</a>, <a href='#Page_303'>303</a>.</li> - <li class='c003'><span class='pageno' id='Page_488'>488</span>Sainton, <a href='#Page_374'>374</a>.</li> - <li class='c028'>Sajous, <a href='#Page_2'>2</a>, <a href='#Page_4'>4</a>, <a href='#Page_9'>9</a>, <a href='#Page_19'>19</a>, <a href='#Page_21'>21</a>, <a href='#Page_25'>25</a>, <a href='#Page_28'>28</a>, <a href='#Page_31'>31</a>, <a href='#Page_32'>32</a>, <a href='#Page_33'>33</a>, <a href='#Page_34'>34</a>, <a href='#Page_35'>35</a>, <a href='#Page_65'>65</a>, <a href='#Page_68'>68</a>, <a href='#Page_79'>79</a>, <a href='#Page_85'>85</a>, <a href='#Page_92'>92</a>, <a href='#Page_112'>112</a>, <a href='#Page_117'>117</a>, <a href='#Page_130'>130</a>, <a href='#Page_136'>136</a>, <a href='#Page_159'>159</a>, <a href='#Page_161'>161</a>, <a href='#Page_162'>162</a>, <a href='#Page_167'>167</a>, <a href='#Page_313'>313</a>, <a href='#Page_351'>351</a>, <a href='#Page_374'>374</a>, <a href='#Page_376'>376</a>, <a href='#Page_405'>405</a>, <a href='#Page_427'>427</a>, <a href='#Page_429'>429</a>, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Salaskin and Zaleski, <a href='#Page_153'>153</a>.</li> - <li class='c028'>Salmon, <a href='#Page_374'>374</a>, <a href='#Page_376'>376</a>.</li> - <li class='c028'>Sandstrom, <a href='#Page_144'>144</a>.</li> - <li class='c028'>Sanquirico and Canales, <a href='#Page_141'>141</a>.</li> - <li class='c028'>Sarbach, <a href='#Page_352'>352</a>.</li> - <li class='c028'>Sasaki, <a href='#Page_340'>340</a>.</li> - <li class='c028'>Sauerbeck, <a href='#Page_77'>77</a>.</li> - <li class='c028'>Sausages, <a href='#Page_335'>335</a>, <a href='#Page_336'>336</a>.</li> - <li class='c028'>Savile, <a href='#Page_349'>349</a>.</li> - <li class='c028'>Sawada, <a href='#Page_164'>164</a>.</li> - <li class='c028'>Sawandowski, <a href='#Page_26'>26</a>.</li> - <li class='c028'>Scharffenberg, <a href='#Page_351'>351</a>.</li> - <li class='c028'>Schiff, <a href='#Page_138'>138</a>, <a href='#Page_150'>150</a>.</li> - <li class='c028'>Schmidt, <a href='#Page_188'>188</a>, <a href='#Page_306'>306</a>.</li> - <li class='c028'>Schmitz, <a href='#Page_185'>185</a>.</li> - <li class='c028'>Schopenhauer, <a href='#Page_124'>124</a>, <a href='#Page_403'>403</a>, <a href='#Page_413'>413</a>.</li> - <li class='c028'>Schottelius, <a href='#Page_170'>170</a>.</li> - <li class='c028'>Schur and Wiesel, <a href='#Page_165'>165</a>.</li> - <li class='c028'>Schwoner, <a href='#Page_56'>56</a>.</li> - <li class='c028'>Sciolla, <a href='#Page_141'>141</a>.</li> - <li class='c028'>Séglas and Vauquelin, <a href='#Page_153'>153</a>.</li> - <li class='c028'>Senator, Hermann, <a href='#Page_1'>1</a>, <a href='#Page_8'>8</a>, <a href='#Page_86'>86</a>, <a href='#Page_168'>168</a>, <a href='#Page_172'>172</a>, <a href='#Page_198'>198</a>, <a href='#Page_199'>199</a>, <a href='#Page_202'>202</a>, <a href='#Page_203'>203</a>, <a href='#Page_319'>319</a>, <a href='#Page_322'>322</a>, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Sexual glands, <a href='#Page_165'>165</a>, <a href='#Page_176'>176</a>, <a href='#Page_351'>351</a>, <a href='#Page_452'>452</a>. - <ul> - <li>and emotions, <a href='#Page_406'>406</a>, <a href='#Page_409'>409</a>.</li> - <li>spermin, <a href='#Page_444'>444</a>.</li> - </ul> - </li> - <li class='c028'>Shattock, <a href='#Page_442'>442</a>.</li> - <li class='c028'>Shattock and Seeligmann, <a href='#Page_442'>442</a>.</li> - <li class='c028'>Sherril, Edwin, S., <a href='#Page_38'>38</a>.</li> - <li class='c028'>Siccard, <a href='#Page_311'>311</a>.</li> - <li class='c028'>Singer, <a href='#Page_185'>185</a>.</li> - <li class='c028'>Skin and kidneys, hygiene of, bathing, <a href='#Page_231'>231</a>. - <ul> - <li>baths, carbonic acid, <a href='#Page_243'>243</a>. - <ul> - <li>foot-, <a href='#Page_234'>234</a>.</li> - <li>cold, <a href='#Page_234'>234</a>, <a href='#Page_235'>235</a>.</li> - </ul> - </li> - <li>baths, sea, <a href='#Page_235'>235</a>. - <ul> - <li>heart in, <a href='#Page_236'>236</a>.</li> - <li>hot, <a href='#Page_235'>235</a>.</li> - <li>warm, <a href='#Page_235'>235</a>.</li> - </ul> - </li> - <li>by means of perspiration, <a href='#Page_237'>237</a>. - <ul> - <li>composition of perspiration, <a href='#Page_238'>238</a>, <a href='#Page_241'>241</a>.</li> - <li>fur clothing, <a href='#Page_237'>237</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>circulation in, <a href='#Page_231'>231</a>. - <ul> - <li>massage, <a href='#Page_233'>233</a>.</li> - <li>rubbing, <a href='#Page_233'>233</a>.</li> - </ul> - </li> - <li class='c028'>diseases, etiology of, <a href='#Page_212'>212</a>.</li> - <li class='c028'>eruptions, <a href='#Page_213'>213</a>. - <ul> - <li>acne, <a href='#Page_213'>213</a>.</li> - <li>from cheese, <a href='#Page_213'>213</a>.</li> - <li>from drugs, <a href='#Page_213'>213</a>.</li> - <li>from oysters, <a href='#Page_213'>213</a>.</li> - <li><span class='pageno' id='Page_489'>489</span>Skin eruptions, in diabetes, <a href='#Page_213'>213</a>.</li> - <li>in gout, <a href='#Page_213'>213</a>.</li> - <li>in Graves’s disease, <a href='#Page_213'>213</a>.</li> - <li>in masturbation, <a href='#Page_213'>213</a>.</li> - <li>in menstruation, <a href='#Page_213'>213</a>.</li> - <li>in sexual abstinence, <a href='#Page_213'>213</a>.</li> - <li>pimples of chastity, <a href='#Page_214'>214</a>.</li> - <li>psoriasis, <a href='#Page_214'>214</a>.</li> - <li>dust, <a href='#Page_231'>231</a>.</li> - <li>elimination of toxic products through, <a href='#Page_209'>209</a>.</li> - <li>excretion by, <a href='#Page_214'>214</a>, <a href='#Page_232'>232</a>, <a href='#Page_244'>244</a>.</li> - <li>exfoliation, <a href='#Page_231'>231</a>. - <ul> - <li>pores, <a href='#Page_231'>231</a>.</li> - </ul> - </li> - <li>perspiration, abundant, <a href='#Page_238'>238</a>. - <ul> - <li>baths, <a href='#Page_240'>240</a>. - <ul> - <li>for old people, <a href='#Page_240'>240</a>.</li> - </ul> - </li> - <li>baths to induce, <a href='#Page_239'>239</a>. - <ul> - <li>electric, <a href='#Page_239'>239</a>.</li> - <li>exercise, <a href='#Page_239'>239</a>.</li> - <li>light, <a href='#Page_239'>239</a>.</li> - </ul> - </li> - <li>effect on kidneys, <a href='#Page_241'>241</a>.</li> - <li>excessive, <a href='#Page_238'>238</a>.</li> - </ul> - </li> - <li>salicylates for, <a href='#Page_239'>239</a>, <a href='#Page_243'>243</a>. - <ul> - <li>soap, <a href='#Page_231'>231</a>.</li> - <li>water, <a href='#Page_231'>231</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Skin, hygiene of, <a href='#Page_215'>215</a>. - <ul> - <li>advantages of, <a href='#Page_218'>218</a>.</li> - <li>armpits, <a href='#Page_224'>224</a>.</li> - <li>bathing, <a href='#Page_216'>216</a>, <a href='#Page_225'>225</a>, 240. (See also <a href='#ch26'><i>Skin and Kidneys, hygiene of, through bathing</i></a>.) - <ul> - <li>air, <a href='#Page_217'>217</a>, <a href='#Page_225'>225</a>.</li> - <li>cold, <a href='#Page_218'>218</a>, <a href='#Page_225'>225</a>.</li> - <li>foot-bath, <a href='#Page_228'>228</a>, <a href='#Page_234'>234</a>.</li> - <li>for old people, <a href='#Page_240'>240</a>.</li> - <li>water, <a href='#Page_216'>216</a>, <a href='#Page_225'>225</a>.</li> - </ul> - </li> - <li>clothing, blue, <a href='#Page_225'>225</a>, <a href='#Page_258'>258</a>. - <ul> - <li>bedclothing, <a href='#Page_229'>229</a>.</li> - <li>changing, <a href='#Page_224'>224</a>.</li> - <li>collar, starched, <a href='#Page_224'>224</a>, <a href='#Page_228'>228</a>. - <ul> - <li>harmfulness of, <a href='#Page_224'>224</a>.</li> - </ul> - </li> - <li>cotton, <a href='#Page_221'>221</a>. - <ul> - <li>advantages of, <a href='#Page_221'>221</a>.</li> - </ul> - </li> - <li>dry, <a href='#Page_223'>223</a>.</li> - <li>fur, <a href='#Page_237'>237</a>.</li> - <li>gray, <a href='#Page_225'>225</a>, <a href='#Page_258'>258</a>.</li> - <li>hats, <a href='#Page_226'>226</a>.</li> - <li>health, impediments to, <a href='#Page_228'>228</a>.</li> - <li>leather, <a href='#Page_224'>224</a>, <a href='#Page_227'>227</a>.</li> - <li>light, <a href='#Page_225'>225</a>. - <ul> - <li>advantages of, <a href='#Page_225'>225</a>.</li> - </ul> - </li> - <li>linen, <a href='#Page_220'>220</a>, <a href='#Page_221'>221</a>. - <ul> - <li>starched, <a href='#Page_224'>224</a>.</li> - </ul> - </li> - <li>loose, <a href='#Page_220'>220</a>, <a href='#Page_229'>229</a>.</li> - <li>night-shirt, <a href='#Page_229'>229</a>.</li> - <li>overcoat, <a href='#Page_225'>225</a>.</li> - <li>porous, <a href='#Page_219'>219</a>.</li> - <li>pumps, <a href='#Page_227'>227</a>.</li> - <li><span class='pageno' id='Page_490'>490</span>Skin, clothing, ramie, <a href='#Page_221'>221</a>.</li> - <li>rational, <a href='#Page_219'>219</a>.</li> - <li>rubbers, <a href='#Page_225'>225</a>, <a href='#Page_227'>227</a>, <a href='#Page_228'>228</a>.</li> - <li>sandals, <a href='#Page_227'>227</a>.</li> - <li>shoes, <a href='#Page_227'>227</a>. - <ul> - <li>canvas, <a href='#Page_227'>227</a>.</li> - <li>half-shoes, <a href='#Page_227'>227</a>.</li> - <li>slippers, <a href='#Page_227'>227</a>.</li> - </ul> - </li> - <li>silk, <a href='#Page_221'>221</a>.</li> - <li>trousers, <a href='#Page_229'>229</a>.</li> - <li>wool, <a href='#Page_219'>219</a>. - <ul> - <li>drawbacks to, <a href='#Page_219'>219</a>, <a href='#Page_220'>220</a>.</li> - </ul> - </li> - </ul> - </li> - <li>cold, catching, <a href='#Page_225'>225</a>.</li> - <li>glands, sudorific, <a href='#Page_215'>215</a>, <a href='#Page_226'>226</a>.</li> - <li>importance of, <a href='#Page_215'>215</a>.</li> - <li>neck, <a href='#Page_224'>224</a>.</li> - <li>scalp, <a href='#Page_226'>226</a>.</li> - <li>soles, <a href='#Page_224'>224</a>.</li> - </ul> - </li> - <li class='c028'><a id='sleep'></a>Sleep and its value, <a href='#Page_368'>368</a>. - <ul> - <li>adrenalin and, <a href='#Page_369'>369</a>, <a href='#Page_376'>376</a>.</li> - <li>after dinner, <a href='#Page_370'>370</a>.</li> - <li>alcohol, <a href='#Page_370'>370</a>.</li> - <li>brain, anæmia and, <a href='#Page_369'>369</a>. - <ul> - <li>hyperæmia and, <a href='#Page_369'>369</a>.</li> - </ul> - </li> - <li>cause of, <a href='#Page_369'>369</a>. - <ul> - <li>auto-intoxication, <a href='#Page_371'>371</a>.</li> - </ul> - </li> - <li>control of, by thyroid gland, <a href='#Page_369'>369</a>.</li> - <li>death from loss of, <a href='#Page_368'>368</a>.</li> - <li>experiment of Mosso, <a href='#Page_370'>370</a>.</li> - <li>function of, <a href='#Page_381'>381</a>.</li> - <li>hygiene of, <a href='#Page_377'>377</a>. - <ul> - <li>brain, excitation of, <a href='#Page_377'>377</a>.</li> - <li>chamber, sleeping, <a href='#Page_378'>378</a>.</li> - <li>food, <a href='#Page_378'>378</a>.</li> - <li>hours of, <a href='#Page_380'>380</a>.</li> - <li>noise, <a href='#Page_380'>380</a>.</li> - </ul> - </li> - <li>sleepiness, <a href='#Page_373'>373</a>. - <ul> - <li>gland, thyroid, <a href='#Page_374'>374</a>.</li> - </ul> - </li> - <li>sleepiness, and insomnia, cause of, <a href='#Page_372'>372</a>.</li> - <li>sleeping sickness, <a href='#Page_372'>372</a>. - <ul> - <li>cause of, trypanosomiasis, <a href='#Page_373'>373</a>.</li> - <li>changes, pathological, <a href='#Page_373'>373</a>.</li> - <li>treatment, <a href='#Page_373'>373</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Sleepiness and insomnia, treatment of, <a href='#Page_383'>383</a>. - <ul> - <li>treatment of, thyroid extract, <a href='#Page_383'>383</a>.</li> - </ul> - </li> - <li class='c028'>Sleeplessness, effects of, <a href='#Page_382'>382</a>.</li> - <li class='c028'>Slowzoff, <a href='#Page_150'>150</a>, <a href='#Page_151'>151</a>.</li> - <li class='c028'>Smith, Bellingham, <a href='#Page_442'>442</a>.</li> - <li class='c028'>Sneve, <a href='#Page_212'>212</a>.</li> - <li class='c028'>Sobolew, <a href='#Page_77'>77</a>.</li> - <li class='c028'>Socrates, <a href='#Page_391'>391</a>, <a href='#Page_424'>424</a>.</li> - <li class='c028'>Solomon, H., <a href='#Page_447'>447</a>.</li> - <li class='c028'>Solon, <a href='#Page_391'>391</a>.</li> - <li class='c028'>Sommerfeld, <a href='#Page_340'>340</a>.</li> - <li class='c028'>Spallanzani, <a href='#Page_211'>211</a>.</li> - <li class='c028'>Spangaro, Saverio, <a href='#Page_51'>51</a>, <a href='#Page_92'>92</a>, <a href='#Page_442'>442</a>.</li> - <li class='c028'>Spillman and Etienne, <a href='#Page_441'>441</a>.</li> - <li class='c028'>Spolverini, <a href='#Page_298'>298</a>.</li> - <li class='c028'>Sports. See <i>Exercise</i>.</li> - <li class='c028'><span class='pageno' id='Page_491'>491</span>Springer and Serbanesco, <a href='#Page_13'>13</a>.</li> - <li class='c028'>Stedman, <a href='#Page_445'>445</a>.</li> - <li class='c028'>Steinhaus, <a href='#Page_80'>80</a>, <a href='#Page_156'>156</a>.</li> - <li class='c028'>Stengel, <a href='#Page_77'>77</a>.</li> - <li class='c028'>Stepanoff, <a href='#Page_28'>28</a>.</li> - <li class='c028'>Stieda, <a href='#Page_4'>4</a>, <a href='#Page_374'>374</a>.</li> - <li class='c028'>Stimulants, <a href='#Page_347'>347</a>, 362. See also <a href='#food'><i>Food</i></a>. - <ul> - <li>chocolate, <a href='#Page_365'>365</a>.</li> - <li>cocoa, <a href='#Page_365'>365</a>. - <ul> - <li>advantages of, <a href='#Page_365'>365</a>.</li> - <li>theobromin, <a href='#Page_365'>365</a>.</li> - </ul> - </li> - <li>coffee, <a href='#Page_364'>364</a>. - <ul> - <li>black, <a href='#Page_362'>362</a>.</li> - <li>caffein, <a href='#Page_364'>364</a>.</li> - <li>effects of, <a href='#Page_364'>364</a>.</li> - </ul> - </li> - <li>for digestion, <a href='#Page_341'>341</a>, <a href='#Page_342'>342</a>.</li> - <li>tea, <a href='#Page_362'>362</a>. - <ul> - <li>and coffee, comparison of, <a href='#Page_363'>363</a>. - <ul> - <li>effects of, <a href='#Page_362'>362</a>.</li> - </ul> - </li> - <li>good, <a href='#Page_363'>363</a>.</li> - <li>green, <a href='#Page_362'>362</a>.</li> - <li>thein, <a href='#Page_363'>363</a>.</li> - </ul> - </li> - <li>tobacco, <a href='#Page_366'>366</a>. - <ul> - <li>nicotine, <a href='#Page_366'>366</a>.</li> - <li>effects of, <a href='#Page_366'>366</a>. - <ul> - <li>arteriosclerosis, <a href='#Page_367'>367</a>.</li> - <li>poisonous, <a href='#Page_366'>366</a>.</li> - </ul> - </li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Stohmann, <a href='#Page_281'>281</a>.</li> - <li class='c028'>Stomach, milk diet and, <a href='#Page_330'>330</a>.</li> - <li class='c028'>Strassberger, <a href='#Page_188'>188</a>.</li> - <li class='c028'>Strasser, <a href='#Page_232'>232</a>, <a href='#Page_241'>241</a>.</li> - <li class='c028'>Strauss, <a href='#Page_204'>204</a>, <a href='#Page_286'>286</a>.</li> - <li class='c028'>Strauss, H., <a href='#Page_8'>8</a>, <a href='#Page_198'>198</a>, <a href='#Page_204'>204</a>, <a href='#Page_241'>241</a>, <a href='#Page_242'>242</a>, <a href='#Page_289'>289</a>.</li> - <li class='c028'>Strümpell, <a href='#Page_120'>120</a>.</li> - <li class='c028'>Sunlight, action of, chemical, <a href='#Page_256'>256</a>, <a href='#Page_257'>257</a>. - <ul> - <li> - <ul> - <li>therapeutic, <a href='#Page_256'>256</a>.</li> - </ul> - </li> - <li>altitude, <a href='#Page_258'>258</a>.</li> - <li>bactericidal effect of, <a href='#Page_256'>256</a>.</li> - <li>benefits of, <a href='#Page_255'>255</a>, <a href='#Page_259'>259</a>, <a href='#Page_260'>260</a>.</li> - <li>cheeks, pale, <a href='#Page_257'>257</a>. - <ul> - <li>red, <a href='#Page_257'>257</a>.</li> - </ul> - </li> - <li>clothing for, <a href='#Page_258'>258</a>.</li> - <li>corpuscles, red, <a href='#Page_257'>257</a>.</li> - <li>experiments with, <a href='#Page_256'>256</a>.</li> - <li>hæmoglobin, <a href='#Page_257'>257</a>, <a href='#Page_259'>259</a>.</li> - <li>in old age, <a href='#Page_260'>260</a>.</li> - <li>in the open air, <a href='#Page_258'>258</a>.</li> - <li>mental effects of, <a href='#Page_255'>255</a>.</li> - <li>rays, chemical, and altitude, <a href='#Page_258'>258</a>. - <ul> - <li>ultra-violet, <a href='#Page_256'>256</a>, <a href='#Page_257'>257</a>.</li> - </ul> - </li> - </ul> - </li> - <li class='c028'>Svaerdrup, Captain, <a href='#Page_264'>264</a>.</li> - <li class='c028'>System, circulatory, and adrenals, hygiene of, <a href='#Page_164'>164</a>.</li> - <li class='c003'>Take, Ada, <a href='#Page_353'>353</a>.</li> - <li class='c028'>Tanberg, <a href='#Page_27'>27</a>.</li> - <li class='c028'>Tanecki, <a href='#Page_46'>46</a>.</li> - <li class='c028'>Tarchanoff, <a href='#Page_444'>444</a>.</li> - <li class='c028'>Tarchanow, <a href='#Page_33'>33</a>.</li> - <li class='c028'><span class='pageno' id='Page_492'>492</span>Tarnowska, Pauline, <a href='#Page_7'>7</a>.</li> - <li class='c028'>Tavel, <a href='#Page_196'>196</a>.</li> - <li class='c028'>Teissier, <a href='#Page_199'>199</a>, <a href='#Page_446'>446</a>.</li> - <li class='c028'>Tigersted, <a href='#Page_348'>348</a>.</li> - <li class='c028'>Tizzoni, <a href='#Page_35'>35</a>, <a href='#Page_86'>86</a>, <a href='#Page_141'>141</a>, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Thaon, <a href='#Page_31'>31</a>.</li> - <li class='c028'>Thiele, <a href='#Page_95'>95</a>, <a href='#Page_374'>374</a>.</li> - <li class='c028'>Thompson, Sir William, <a href='#Page_222'>222</a>.</li> - <li class='c028'>Thyroid gland. (See <i>Gland</i>.)</li> - <li class='c028'>Torri, <a href='#Page_5'>5</a>, <a href='#Page_23'>23</a>, <a href='#Page_31'>31</a>.</li> - <li class='c028'>Traube, <a href='#Page_169'>169</a>.</li> - <li class='c028'>Troin and Rivet, <a href='#Page_165'>165</a>.</li> - <li class='c028'>Trüper, <a href='#Page_120'>120</a>.</li> - <li class='c028'>Tsen-ki-tong, <a href='#Page_403'>403</a>.</li> - <li class='c028'>Tuberculous persons, <a href='#Page_262'>262</a>, <a href='#Page_265'>265</a>.</li> - <li class='c028'>Tunnicliffe, <a href='#Page_245'>245</a>.</li> - <li class='c028'>Twain, Mark, <a href='#Page_342'>342</a>.</li> - <li class='c028'>Tyson, James, <a href='#Page_204'>204</a>, <a href='#Page_319'>319</a>, <a href='#Page_406'>406</a>.</li> - <li class='c003'>Unna, <a href='#Page_213'>213</a>.</li> - <li class='c028'>Uspenski, <a href='#Page_32'>32</a>.</li> - <li class='c003'>Valente, <a href='#Page_392'>392</a>.</li> - <li class='c028'>Van der Bergh, Heymans, <a href='#Page_154'>154</a>.</li> - <li class='c028'>Van der Ecke, <a href='#Page_142'>142</a>.</li> - <li class='c028'>Van Sommeren, <a href='#Page_343'>343</a>.</li> - <li class='c028'>Vassale, <a href='#Page_144'>144</a>.</li> - <li class='c028'>Vaughan, <a href='#Page_299'>299</a>.</li> - <li class='c028'>Vegetables. See <i>Food</i>.</li> - <li class='c028'>Vegetarian diet. See <i>Diet</i>.</li> - <li class='c028'>Vermehren, <a href='#Page_3'>3</a>, <a href='#Page_85'>85</a>, <a href='#Page_90'>90</a>, <a href='#Page_93'>93</a>, <a href='#Page_95'>95</a>, <a href='#Page_126'>126</a>, <a href='#Page_142'>142</a>, <a href='#Page_434'>434</a>, <a href='#Page_435'>435</a>.</li> - <li class='c028'>Vesalius, <a href='#Page_404'>404</a>.</li> - <li class='c028'>Viault, <a href='#Page_259'>259</a>.</li> - <li class='c028'>Vidal, <a href='#Page_286'>286</a>.</li> - <li class='c028'>Vidal and Javal, <a href='#Page_204'>204</a>.</li> - <li class='c028'>Vimont, <a href='#Page_41'>41</a>.</li> - <li class='c028'>Voith, <a href='#Page_282'>282</a>.</li> - <li class='c028'>Von Noorden, <a href='#Page_74'>74</a>, <a href='#Page_241'>241</a>, <a href='#Page_282'>282</a>, <a href='#Page_306'>306</a>, <a href='#Page_320'>320</a>, <a href='#Page_344'>344</a>, <a href='#Page_374'>374</a>, <a href='#Page_429'>429</a>, <a href='#Page_430'>430</a>.</li> - <li class='c003'>Wagner, <a href='#Page_30'>30</a>.</li> - <li class='c028'>Waldvogel, <a href='#Page_152'>152</a>.</li> - <li class='c028'>Wallerstein, <a href='#Page_201'>201</a>.</li> - <li class='c028'>Wassermann, <a href='#Page_34'>34</a>.</li> - <li class='c028'>Water. See <i>Food</i>.</li> - <li class='c028'>Waters, mineral, arsenic in, <a href='#Page_428'>428</a>. - <ul> - <li>iron, in, <a href='#Page_430'>430</a>.</li> - </ul> - </li> - <li class='c028'>Watson, <a href='#Page_318'>318</a>.</li> - <li class='c028'>Watson, Chalmers, <a href='#Page_9'>9</a>, <a href='#Page_22'>22</a>, <a href='#Page_140'>140</a>, <a href='#Page_145'>145</a>, <a href='#Page_330'>330</a>.</li> - <li class='c028'>Weber, Parkes, <a href='#Page_165'>165</a>.</li> - <li class='c028'>Weber, Sir Herman, <a href='#Page_111'>111</a>, <a href='#Page_146'>146</a>, <a href='#Page_268'>268</a>.</li> - <li class='c028'>Weichardt, <a href='#Page_368'>368</a>.</li> - <li class='c028'>Weichselbaum, <a href='#Page_77'>77</a>.</li> - <li class='c028'>Weinberg, <a href='#Page_51'>51</a>.</li> - <li class='c028'>Weiske, <a href='#Page_308'>308</a>.</li> - <li class='c028'>Weiss, J., <a href='#Page_307'>307</a>.</li> - <li class='c028'>Weljaminoff, <a href='#Page_34'>34</a>.</li> - <li class='c028'>Westergaard, <a href='#Page_116'>116</a>.</li> - <li class='c028'>White, Hale, <a href='#Page_91'>91</a>, <a href='#Page_435'>435</a>.</li> - <li class='c028'><span class='pageno' id='Page_493'>493</span>Whitwell, <a href='#Page_36'>36</a>.</li> - <li class='c028'>Widal and Boivin, <a href='#Page_162'>162</a>.</li> - <li class='c028'>Widmark, <a href='#Page_257'>257</a>.</li> - <li class='c028'>Wiley, <a href='#Page_295'>295</a>.</li> - <li class='c028'>Wille, <a href='#Page_78'>78</a>.</li> - <li class='c028'>Willems, <a href='#Page_372'>372</a>.</li> - <li class='c028'>Winternitz, <a href='#Page_233'>233</a>.</li> - <li class='c028'>Woroschiloff, <a href='#Page_302'>302</a>.</li> - <li class='c028'>Wright, Sir Almroth, <a href='#Page_28'>28</a>, <a href='#Page_136'>136</a>.</li> - <li class='c003'>Xanthin bodies, <a href='#Page_364'>364</a>.</li> - <li class='c028'>Xanthin bodies, caffein, <a href='#Page_364'>364</a>. - <ul> - <li>theobromin, <a href='#Page_365'>365</a>.</li> - </ul> - </li> - <li class='c003'>Yersin, <a href='#Page_160'>160</a>.</li> - <li class='c003'>Zagari, <a href='#Page_150'>150</a>.</li> - <li class='c028'>Zander, <a href='#Page_247'>247</a>.</li> - <li class='c028'>Zeigan, <a href='#Page_369'>369</a>, <a href='#Page_376'>376</a>.</li> - <li class='c028'>Zoroaster, <a href='#Page_391'>391</a>, <a href='#Page_403'>403</a>.</li> - <li class='c028'>Zoth, <a href='#Page_443'>443</a>.</li> - <li class='c028'>Zunz, <a href='#Page_18'>18</a>, <a href='#Page_249'>249</a>.</li> -</ul> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<div class='chapter'> - <span class='pageno' id='Page_494'>494</span> - <h2 id='fns' class='c006'>Footnotes</h2> -</div> -<hr class='c029' /> -<div class='footnote c030' id='f1'> -<p class='c031'><span class='label'><a href='#r1'>1</a>. </span>Hermann Senator: “Die Erkrankungen der Nieren;” Nothnagel’s -“Handbuch der praktischen Medicin,” ii Auflage, 1902.</p> -</div> -<div class='footnote c030' id='f2'> -<p class='c031'><span class='label'><a href='#r2'>2</a>. </span>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.</p> -</div> -<div class='footnote c030' id='f3'> -<p class='c031'><span class='label'><a href='#r3'>3</a>. </span>Sajous: “Internal Secretions and the Principles of Medicine,” vol. i, -1903, and vol. ii, 1907, and Philadelphia Medical Journal, March 7, 1903.</p> -</div> -<div class='footnote c030' id='f4'> -<p class='c031'><span class='label'><a href='#r4'>4</a>. </span>Over Myxœdemet, Kjöbenhavn, 1895.</p> -</div> -<div class='footnote c030' id='f5'> -<p class='c031'><span class='label'><a href='#r5'>5</a>. </span>Ewald: “Die Erkrankungen der Schilddrüse,” Nothnagel’s Handbuch, -Vienna, 1896.</p> -</div> -<div class='footnote c030' id='f6'> -<p class='c031'><span class='label'><a href='#r6'>6</a>. </span>Pineles: Volkmann’s klin. Vorträge, N. 242, 1899.</p> -</div> -<div class='footnote c030' id='f7'> -<p class='c031'><span class='label'><a href='#r7'>7</a>. </span>Sajous: “Internal Secretions,” Philadelphia, vol. i, p. 140, 1903.</p> -</div> -<div class='footnote c030' id='f8'> -<p class='c031'><span class='label'><a href='#r8'>8</a>. </span>“Beiträge zur klin. Chirurgie,” 1894.</p> -</div> -<div class='footnote c030' id='f9'> -<p class='c031'><span class='label'><a href='#r9'>9</a>. </span>Ziegler’s Beiträge, Bd. vii.</p> -</div> -<div class='footnote c030' id='f10'> -<p class='c031'><span class='label'><a href='#r10'>10</a>. </span>Ziegler’s Beiträge, vol. iv, 1889.</p> -</div> -<div class='footnote c030' id='f11'> -<p class='c031'><span class='label'><a href='#r11'>11</a>. </span>Josué: C. R. Société de biologie, Nov. 14, 1903.</p> -</div> -<div class='footnote c030' id='f12'> -<p class='c031'><span class='label'><a href='#r12'>12</a>. </span>Oliver and Schäfer: Journal of Physiology, vol. xviii, 1895.</p> -</div> -<div class='footnote c030' id='f13'> -<p class='c031'><span class='label'><a href='#r13'>13</a>. </span>Eiselsberg: “Die Krankheiten der Schilddrüse,” Stuttgart, 1901.</p> -</div> -<div class='footnote c030' id='f14'> -<p class='c031'><span class='label'><a href='#r14'>14</a>. </span>Breisacher: Archiv für Anat. und Physiologie, Suppl., Bd., p. 509, 1890.</p> -</div> -<div class='footnote c030' id='f15'> -<p class='c031'><span class='label'><a href='#r15'>15</a>. </span>Blum: Virchow’s Archiv, p. 495-514, 1899.</p> -</div> -<div class='footnote c030' id='f16'> -<p class='c031'><span class='label'><a href='#r16'>16</a>. </span>Lorand: Transactions of the Path. Society of London, vol. lvii, Part. -1, 1906.</p> -</div> -<div class='footnote c030' id='f17'> -<p class='c031'><span class='label'><a href='#r17'>17</a>. </span>La Semaine Médicale, 1905.</p> -</div> -<div class='footnote c030' id='f18'> -<p class='c031'><span class='label'><a href='#r18'>18</a>. </span>Lorand: “Die Entstehung der Zuckerkrankheit und ihre Beziehungen -zu den Veränderungen der Blutgefässdrüsen,” Berlin, A. Hirschwald, 1903, and -French Translation, Maloine, Paris, 1904.</p> -</div> -<div class='footnote c030' id='f19'> -<p class='c031'><span class='label'><a href='#r19'>19</a>. </span>Tarnowska: “Etudes antropométriques sur les prostitutées et les -voleuses,” Paris, 1889.</p> -</div> -<div class='footnote c030' id='f20'> -<p class='c031'><span class='label'><a href='#r20'>20</a>. </span>Senator: Berliner klin. Wochenschrift, Nu. 24, 1868.</p> -</div> -<div class='footnote c030' id='f21'> -<p class='c031'><span class='label'><a href='#r21'>21</a>. </span>Brown-Séquard: Archives de physiologie norm. et path, p. 778, 1893.</p> -</div> -<div class='footnote c030' id='f22'> -<p class='c031'><span class='label'><a href='#r22'>22</a>. </span>E. Meyer: <i>Ibid.</i> p. 179, 1894.</p> -</div> -<div class='footnote c030' id='f23'> -<p class='c031'><span class='label'><a href='#r23'>23</a>. </span>Senator: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f24'> -<p class='c031'><span class='label'><a href='#r24'>24</a>. </span>H. Strauss, Senator: Festschrift.</p> -</div> -<div class='footnote c030' id='f25'> -<p class='c031'><span class='label'><a href='#r25'>25</a>. </span>Sir Lauder Brunton and Bokenham: The Journal of Pathology and -Bacteriology, p. 50, Nov., 1907.</p> -</div> -<div class='footnote c030' id='f26'> -<p class='c031'><span class='label'><a href='#r26'>26</a>. </span>Breisacher: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f27'> -<p class='c031'><span class='label'><a href='#r27'>27</a>. </span>Blum: Virchow’s Archiv, 1899.</p> -</div> -<div class='footnote c030' id='f28'> -<p class='c031'><span class='label'><a href='#r28'>28</a>. </span>Lancet, Feb. 11, 1905.</p> -</div> -<div class='footnote c030' id='f29'> -<p class='c031'><span class='label'><a href='#r29'>29</a>. </span>Lorand: Comptes Rendus de la Société de biologie de Paris, Février -25, 1907.</p> -</div> -<div class='footnote c030' id='f30'> -<p class='c031'><span class='label'><a href='#r30'>30</a>. </span>Poncet: C. R. de la Société de biologie de Paris, 55.</p> -</div> -<div class='footnote c030' id='f31'> -<p class='c031'><span class='label'><a href='#r31'>31</a>. </span>Garnier: “La Thyroide dans les maladies infectieuses,” Thèse de Paris, -1899.</p> -</div> -<div class='footnote c030' id='f32'> -<p class='c031'><span class='label'><a href='#r32'>32</a>. </span>Hertoghe: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f33'> -<p class='c031'><span class='label'><a href='#r33'>33</a>. </span>Perrando: “Sulla struttura della Tiroide,” Sassari, 1900.</p> -</div> -<div class='footnote c030' id='f34'> -<p class='c031'><span class='label'><a href='#r34'>34</a>. </span>Les Médications thyroidiennes, 1902.</p> -</div> -<div class='footnote c030' id='f35'> -<p class='c031'><span class='label'><a href='#r35'>35</a>. </span>Lorand: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f36'> -<p class='c031'><span class='label'><a href='#r36'>36</a>. </span>Lorand: “Die Entstehung der Zuckerkrankheit,” Berlin, 1903, and in -French translation, Paris, 1904.</p> -</div> -<div class='footnote c030' id='f37'> -<p class='c031'><span class='label'><a href='#r37'>37</a>. </span>Magnus-Lévy: “Der Stoffwechsel bei Erkrankungen einiger Drusen ohne -Ausführgang,” in v. Noorden’s “Handbuch der Pathologie des Stoffwechsels”, -vol. ii, Berlin, 1907.</p> -</div> -<div class='footnote c030' id='f38'> -<p class='c031'><span class='label'><a href='#r38'>38</a>. </span>Loewy and Richter: Archiv für Anat. u. Physiologie, Supplement, 1899, -and Berliner klin. Wochenschrift, 1899.</p> -</div> -<div class='footnote c030' id='f39'> -<p class='c031'><span class='label'><a href='#r39'>39</a>. </span>Wiener klin. Rundschau, p. 78, 1901.</p> -</div> -<div class='footnote c030' id='f40'> -<p class='c031'><span class='label'><a href='#r40'>40</a>. </span>Zeitschrift für klin. Med., liv, p. 5, 6.</p> -</div> -<div class='footnote c030' id='f41'> -<p class='c031'><span class='label'><a href='#r41'>41</a>. </span>Ziegler’s Beiträge, 1903.</p> -</div> -<div class='footnote c030' id='f42'> -<p class='c031'><span class='label'><a href='#r42'>42</a>. </span>Archiv für klin. Chirurgie, p. 1066, 1904.</p> -</div> -<div class='footnote c030' id='f43'> -<p class='c031'><span class='label'><a href='#r43'>43</a>. </span>Sajous: “Internal Secretions, etc.,” vol. ii, 1907.</p> -</div> -<div class='footnote c030' id='f44'> -<p class='c031'><span class='label'><a href='#r44'>44</a>. </span>Charrin: “Les Defenses naturelles de l’organisme,” Paris, 1898 (Masson).</p> -</div> -<div class='footnote c030' id='f45'> -<p class='c031'><span class='label'><a href='#r45'>45</a>. </span>Greenfield: Quoted after Ewald, “Die Erkrankungen der Schilddrüse,” -Nothnagel’s Handbuch, Wien. p. 159, 1896.</p> -</div> -<div class='footnote c030' id='f46'> -<p class='c031'><span class='label'><a href='#r46'>46</a>. </span>Pel: “Myxœdema,” Volkmann’s Sammlung klin. Vorträge, 1895, No. 123.</p> -</div> -<div class='footnote c030' id='f47'> -<p class='c031'><span class='label'><a href='#r47'>47</a>. </span>Murray: “Diseases of the Thyroid Gland,” Part i, London, 1901.</p> -</div> -<div class='footnote c030' id='f48'> -<p class='c031'><span class='label'><a href='#r48'>48</a>. </span>Breisacher: “Untersuchung über die Gland Thyroidea,” Archiv für -Anatomie und Physiologie, Suppl., Bd., p. 509, 1889.</p> -</div> -<div class='footnote c030' id='f49'> -<p class='c031'><span class='label'><a href='#r49'>49</a>. </span>Blum: Pflüger’s Archiv, vol. xc., p. 285, 1902; Archiv für die Gesammte -Physiologie, p. 617, 1902.</p> -</div> -<div class='footnote c030' id='f50'> -<p class='c031'><span class='label'><a href='#r50'>50</a>. </span>Chalmers Watson: The Lancet, p. 347, Feb. 11, 1905.</p> -</div> -<div class='footnote c030' id='f51'> -<p class='c031'><span class='label'><a href='#r51'>51</a>. </span>Forsyth: The Lancet, p. 154, Jan. 19, 1907.</p> -</div> -<div class='footnote c030' id='f52'> -<p class='c031'><span class='label'><a href='#r52'>52</a>. </span>Lindemann: Virchow’s Archiv, p. 202, 1897.</p> -</div> -<div class='footnote c030' id='f53'> -<p class='c031'><span class='label'><a href='#r53'>53</a>. </span>Lanz: Zur Schilddrüsenfrage, Leipzig, 1894.</p> -</div> -<div class='footnote c030' id='f54'> -<p class='c031'><span class='label'><a href='#r54'>54</a>. </span>W. Edmunds: The Lancet, May 11th, p. 1317; 18th, p. 1381; 25th, -p. 1449, 1901.</p> -</div> -<div class='footnote c030' id='f55'> -<p class='c031'><span class='label'><a href='#r55'>55</a>. </span>Lorand: C. R. de la Société de biologie, 1906.</p> -</div> -<div class='footnote c030' id='f56'> -<p class='c031'><span class='label'><a href='#r56'>56</a>. </span>Hunt: International Congress of Physiology, Heidelberg, 1907.</p> -</div> -<div class='footnote c030' id='f57'> -<p class='c031'><span class='label'><a href='#r57'>57</a>. </span>Garnier: “La Thyroide dans les maladies infectieuses,” Thèse de Paris, -1899.</p> -</div> -<div class='footnote c030' id='f58'> -<p class='c031'><span class='label'><a href='#r58'>58</a>. </span>Roger et Garnier: Presse médicale, April 19, 1899.</p> -</div> -<div class='footnote c030' id='f59'> -<p class='c031'><span class='label'><a href='#r59'>59</a>. </span>Crespin: Giornale dell’ Associazione Napolitano di Medici, xii, 3.</p> -</div> -<div class='footnote c030' id='f60'> -<p class='c031'><span class='label'><a href='#r60'>60</a>. </span>Torre: “La Tiroide nei Morbi Infettivi,” Il Policlinico, No. 6, p. 145; -No. 8, p. 226; No. 10, p. 280.</p> -</div> -<div class='footnote c030' id='f61'> -<p class='c031'><span class='label'><a href='#r61'>61</a>. </span>Bayon: Würzburger Abhandlungen, 1904.</p> -</div> -<div class='footnote c030' id='f62'> -<p class='c031'><span class='label'><a href='#r62'>62</a>. </span>A. Kocher: “Mittheilungen aus den Grenzgebeiten,” etc., 1901.</p> -</div> -<div class='footnote c030' id='f63'> -<p class='c031'><span class='label'><a href='#r63'>63</a>. </span>Lanz: Quoted after Buschau, Wein, 1895.</p> -</div> -<div class='footnote c030' id='f64'> -<p class='c031'><span class='label'><a href='#r64'>64</a>. </span>Georgiewski: Zeitschrift für klin. Medicin, Bd., xxxiii, f. 1-2, p. 153, -1897.</p> -</div> -<div class='footnote c030' id='f65'> -<p class='c031'><span class='label'><a href='#r65'>65</a>. </span>Lorand: Transactions of the Pathological Society of London, vol. lvii, -part 1, 1906.</p> -</div> -<div class='footnote c030' id='f66'> -<p class='c031'><span class='label'><a href='#r66'>66</a>. </span>Lorand: Congrès Français de Médecine, Paris, 1904.</p> -</div> -<div class='footnote c030' id='f67'> -<p class='c031'><span class='label'><a href='#r67'>67</a>. </span>Moebius: “Die Basedow’sche Krankheit,” Nothnagel’s Handbuch, -second edition.</p> -</div> -<div class='footnote c030' id='f68'> -<p class='c031'><span class='label'><a href='#r68'>68</a>. </span>Hertoghe: “Die Rolle der Schilddrüse,” etc., München, 1900; and -“Paludisme et Myxœdème,” Progrès médical Belge, No. 2, 1902.</p> -</div> -<div class='footnote c030' id='f69'> -<p class='c031'><span class='label'><a href='#r69'>69</a>. </span>Sawandowski: Centralbl. f. d. med. Wissensch. B. xxvi, S. 145, 161, -1889.</p> -</div> -<div class='footnote c030' id='f70'> -<p class='c031'><span class='label'><a href='#r70'>70</a>. </span>Ballet and Enriquez: Quoted after Buschau.</p> -</div> -<div class='footnote c030' id='f71'> -<p class='c031'><span class='label'><a href='#r71'>71</a>. </span>Easterbrook: The Lancet, p. 546, August 27, 1898.</p> -</div> -<div class='footnote c030' id='f72'> -<p class='c031'><span class='label'><a href='#r72'>72</a>. </span>Stepanoff: Comptes Rendus de la S. B. de Paris, 1908.</p> -</div> -<div class='footnote c030' id='f73'> -<p class='c031'><span class='label'><a href='#r73'>73</a>. </span>Studie anatomici e sperimentali sulla psycho-pathologia della glandula -pituitaria, Reggio Emilia, 1900.</p> -</div> -<div class='footnote c030' id='f74'> -<p class='c031'><span class='label'><a href='#r74'>74</a>. </span>Revista di Patol, nerv. e mentale, Nov., 1904; and La Sperimentale, -lviii., 1904.</p> -</div> -<div class='footnote c030' id='f75'> -<p class='c031'><span class='label'><a href='#r75'>75</a>. </span>Thèse de Paris, 1907.</p> -</div> -<div class='footnote c030' id='f76'> -<p class='c031'><span class='label'><a href='#r76'>76</a>. </span>Société de therapeutique, Jan. 22, 1902.</p> -</div> -<div class='footnote c030' id='f77'> -<p class='c031'><span class='label'><a href='#r77'>77</a>. </span>Journal of Physiology, t. xviii, 1895.</p> -</div> -<div class='footnote c030' id='f78'> -<p class='c031'><span class='label'><a href='#r78'>78</a>. </span>Azam: Thèse de Paris, 1907.</p> -</div> -<div class='footnote c030' id='f79'> -<p class='c031'><span class='label'><a href='#r79'>79</a>. </span>“Internal Secretions,” vol. i, p. 33.</p> -</div> -<div class='footnote c030' id='f80'> -<p class='c031'><span class='label'><a href='#r80'>80</a>. </span>Quoted after Loisel.</p> -</div> -<div class='footnote c030' id='f81'> -<p class='c031'><span class='label'><a href='#r81'>81</a>. </span>Metschnikoff: Annales de l’institut Pasteur, 1900.</p> -</div> -<div class='footnote c030' id='f82'> -<p class='c031'><span class='label'><a href='#r82'>82</a>. </span>Lingard: Centralblatt für Bacteriologie, vol. xxxviii, Nu. 2, p. 246.</p> -</div> -<div class='footnote c030' id='f83'> -<p class='c031'><span class='label'><a href='#r83'>83</a>. </span>Comptes Rendus de la Société de Biologie de Paris, Nov. 5, 1896.</p> -</div> -<div class='footnote c030' id='f84'> -<p class='c031'><span class='label'><a href='#r84'>84</a>. </span>Richter: Organotherapie.</p> -</div> -<div class='footnote c030' id='f85'> -<p class='c031'><span class='label'><a href='#r85'>85</a>. </span>Poehl: Organotherapie, vol. i, St. Petersburg, 1905.</p> -</div> -<div class='footnote c030' id='f86'> -<p class='c031'><span class='label'><a href='#r86'>86</a>. </span>Sajous: “Internal Secretions,” vol. i, p. 624, 1903 (see also vol. ii, p. -13, 1907).</p> -</div> -<div class='footnote c030' id='f87'> -<p class='c031'><span class='label'><a href='#r87'>87</a>. </span>Arch. per le scienze Mediche, vol. x., p. 45, 1886.</p> -</div> -<div class='footnote c030' id='f88'> -<p class='c031'><span class='label'><a href='#r88'>88</a>. </span>Blum: Virchow’s Archiv, 1899.</p> -</div> -<div class='footnote c030' id='f89'> -<p class='c031'><span class='label'><a href='#r89'>89</a>. </span>Walter Edmunds: Transact. of the Path. Soc. of London, vol. liii., Part -3, p. 343, 1902.</p> -</div> -<div class='footnote c030' id='f90'> -<p class='c031'><span class='label'><a href='#r90'>90</a>. </span>Whitwell: British Med. Journal, p. 730, Feb. 1892.</p> -</div> -<div class='footnote c030' id='f91'> -<p class='c031'><span class='label'><a href='#r91'>91</a>. </span>Quoted after Oppenheim: “Lehrbuch der Nervenkrankheiten,” p. 1383, -Berlin, 1906.</p> -</div> -<div class='footnote c030' id='f92'> -<p class='c031'><span class='label'><a href='#r92'>92</a>. </span>Dürig: Münchener Med. Woch., 1908, Nu. 18.</p> -</div> -<div class='footnote c030' id='f93'> -<p class='c031'><span class='label'><a href='#r93'>93</a>. </span>Moebius: “Die Wirkungen der Castration,” Halle, 1902.</p> -</div> -<div class='footnote c030' id='f94'> -<p class='c031'><span class='label'><a href='#r94'>94</a>. </span>Gall: “Anatomie et Physiologie du Système nerveux,” T. iii., p. 108, -Paris, 1818.</p> -</div> -<div class='footnote c030' id='f95'> -<p class='c031'><span class='label'><a href='#r95'>95</a>. </span>Vimont: “Traité de Phrenologie humaine et compareè,” two vols. et -atlas, vol. ii., p. 233, Paris, 1835.</p> -</div> -<div class='footnote c030' id='f96'> -<p class='c031'><span class='label'><a href='#r96'>96</a>. </span>Hoffmann: “Ueber die Castration der Hausthiere Schneidermühls Thier -medecin,” Vorträge ii., 12. 1892.</p> -</div> -<div class='footnote c030' id='f97'> -<p class='c031'><span class='label'><a href='#r97'>97</a>. </span>Journal of the American Med. Association, May 10, 1907.</p> -</div> -<div class='footnote c030' id='f98'> -<p class='c031'><span class='label'><a href='#r98'>98</a>. </span>Quoted after Moebius, “Die Wirkungen der Castration,” p. 43, Halle, -1907.</p> -</div> -<div class='footnote c030' id='f99'> -<p class='c031'><span class='label'><a href='#r99'>99</a>. </span>Pelikan: “Gerichlach Med. Untersuchenger über das Skopzentham in -Russland,” Giessen, 1876.</p> -</div> -<div class='footnote c030' id='f100'> -<p class='c031'><span class='label'><a href='#r100'>100</a>. </span>Kisch: “Das Geschlestrlehen der Frau,” second edition, Vienna, 1908.</p> -</div> -<div class='footnote c030' id='f101'> -<p class='c031'><span class='label'><a href='#r101'>101</a>. </span>Quoted after Kisch.</p> -</div> -<div class='footnote c030' id='f102'> -<p class='c031'><span class='label'><a href='#r102'>102</a>. </span>Quoted after Kisch; as also other authors on the relation between heart -and stomach, and the ovaries.</p> -</div> -<div class='footnote c030' id='f103'> -<p class='c031'><span class='label'><a href='#r103'>103</a>. </span>Metschnikoff: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f104'> -<p class='c031'><span class='label'><a href='#r104'>104</a>. </span>Hufeland: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f105'> -<p class='c031'><span class='label'><a href='#r105'>105</a>. </span>The works of William Harvey, M.D., edition of the Sydenham Society, -p. 590, London, 1847.</p> -</div> -<div class='footnote c030' id='f106'> -<p class='c031'><span class='label'><a href='#r106'>106</a>. </span>Philosoph. Transactions, xxv., 1706.</p> -</div> -<div class='footnote c030' id='f107'> -<p class='c031'><span class='label'><a href='#r107'>107</a>. </span>Essais optimistes, p. 47, Paris, 1907.</p> -</div> -<div class='footnote c030' id='f108'> -<p class='c031'><span class='label'><a href='#r108'>108</a>. </span>S. Spangaro: Anatomische, Hefte, Heft lx., p. 630, Wiesbaden, 1902.</p> -</div> -<div class='footnote c030' id='f109'> -<p class='c031'><span class='label'><a href='#r109'>109</a>. </span>Eckermann: Quoted after Metschnikoff.</p> -</div> -<div class='footnote c030' id='f110'> -<p class='c031'><span class='label'><a href='#r110'>110</a>. </span>Lewes: Vol. ii., p. 372; quoted from Metschnikoff.</p> -</div> -<div class='footnote c030' id='f111'> -<p class='c031'><span class='label'><a href='#r111'>111</a>. </span>Quoted from Professor Kisch.</p> -</div> -<div class='footnote c030' id='f112'> -<p class='c031'><span class='label'><a href='#r112'>112</a>. </span>Quoted after Moebius, “Die Basedow’sche Krankheit,” second edition, -1906.</p> -</div> -<div class='footnote c030' id='f113'> -<p class='c031'><span class='label'><a href='#r113'>113</a>. </span>Quoted after Oppenheim, “Lehrbuch des Nervenkrankheiten,” Berlin, -1906.</p> -</div> -<div class='footnote c030' id='f114'> -<p class='c031'><span class='label'><a href='#r114'>114</a>. </span>Beiträge zur klin. Chirurgie, xiv., p. 1, 1905.</p> -</div> -<div class='footnote c030' id='f115'> -<p class='c031'><span class='label'><a href='#r115'>115</a>. </span>Garnier: “Les maladies infectieuses,” Thèse de Paris, 1899.</p> -</div> -<div class='footnote c030' id='f116'> -<p class='c031'><span class='label'><a href='#r116'>116</a>. </span>Perrando: “Sulla struttura della Tiroide,” Sassari, 1900.</p> -</div> -<div class='footnote c030' id='f117'> -<p class='c031'><span class='label'><a href='#r117'>117</a>. </span>Pel: Berl. klin. Wochenschrift, 44<sup>a</sup>, 1905.</p> -</div> -<div class='footnote c030' id='f118'> -<p class='c031'><span class='label'><a href='#r118'>118</a>. </span>Quoted after Professor Pel.</p> -</div> -<div class='footnote c030' id='f119'> -<p class='c031'><span class='label'><a href='#r119'>119</a>. </span>Holsti: Zeitschrift für klin. Medicin, p. 272, 1892.</p> -</div> -<div class='footnote c030' id='f120'> -<p class='c031'><span class='label'><a href='#r120'>120</a>. </span>Nouvelle: Iconographie de la Salpêtrière, Juillet-Aout, 1899.</p> -</div> -<div class='footnote c030' id='f121'> -<p class='c031'><span class='label'><a href='#r121'>121</a>. </span>Murray: “Disease of the Thyroid Gland,” p. 72, London, 1901.</p> -</div> -<div class='footnote c030' id='f122'> -<p class='c031'><span class='label'><a href='#r122'>122</a>. </span>Lanz: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f123'> -<p class='c031'><span class='label'><a href='#r123'>123</a>. </span>Arnold Lorand: “Pathogeny of Crime,” Address to the Philadelphia -Med. Jurisprudence Society. Monthly Cyclopædia of Practical Medicine, 1907.</p> -</div> -<div class='footnote c030' id='f124'> -<p class='c031'><span class='label'><a href='#r124'>124</a>. </span>International Congress of Medicine, Lisbon, 1906, reported in Presse -médicale, 1907.</p> -</div> -<div class='footnote c030' id='f125'> -<p class='c031'><span class='label'><a href='#r125'>125</a>. </span>Langerhans: Thèse, Berlin, 1869; G. Lange.</p> -</div> -<div class='footnote c030' id='f126'> -<p class='c031'><span class='label'><a href='#r126'>126</a>. </span>Mering und Minkowski: Archiv für exper. Path. und Pharm., xxvi, 1889.</p> -</div> -<div class='footnote c030' id='f127'> -<p class='c031'><span class='label'><a href='#r127'>127</a>. </span>Opie: Journal of Experiment. Medicine, p. 827, 1901.</p> -</div> -<div class='footnote c030' id='f128'> -<p class='c031'><span class='label'><a href='#r128'>128</a>. </span>Virchow’s Archiv, clxviii, p. 1.</p> -</div> -<div class='footnote c030' id='f129'> -<p class='c031'><span class='label'><a href='#r129'>129</a>. </span>Wiener klin. Wochenschrift, 1901-1902.</p> -</div> -<div class='footnote c030' id='f130'> -<p class='c031'><span class='label'><a href='#r130'>130</a>. </span>Quoted after Professor Oser: Deutsche klinik., vol. v, p. 158.</p> -</div> -<div class='footnote c030' id='f131'> -<p class='c031'><span class='label'><a href='#r131'>131</a>. </span>Second edition, Berline, 1909.</p> -</div> -<div class='footnote c030' id='f132'> -<p class='c031'><span class='label'><a href='#r132'>132</a>. </span>“Die Entstehung der Zuckerkrankheit,” Berlin, 1903, and its French -translation, Maloine, Paris, 1904.</p> -</div> -<div class='footnote c030' id='f133'> -<p class='c031'><span class='label'><a href='#r133'>133</a>. </span>Comptes-Rendus de la Société de biologie, Paris, 25 Mars, 1904.</p> -</div> -<div class='footnote c030' id='f134'> -<p class='c031'><span class='label'><a href='#r134'>134</a>. </span>Revue de médecine, 23, 1903.</p> -</div> -<div class='footnote c030' id='f135'> -<p class='c031'><span class='label'><a href='#r135'>135</a>. </span>Quoted from Hoppe-Seyler in Nothnagel’s “Practice,” p. 548, 1904.</p> -</div> -<div class='footnote c030' id='f136'> -<p class='c031'><span class='label'><a href='#r136'>136</a>. </span>Traité de Physiologie.</p> -</div> -<div class='footnote c030' id='f137'> -<p class='c031'><span class='label'><a href='#r137'>137</a>. </span>Archives générales de médecine, Octobre, 1905, and Monthly Cyclopædia -of Practical Medicine, 1906.</p> -</div> -<div class='footnote c030' id='f138'> -<p class='c031'><span class='label'><a href='#r138'>138</a>. </span>Over Myxœdemet, Kjöbenhavn, 1895.</p> -</div> -<div class='footnote c030' id='f139'> -<p class='c031'><span class='label'><a href='#r139'>139</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f140'> -<p class='c031'><span class='label'><a href='#r140'>140</a>. </span>Die Erkrankungen der Nieren, second edition, Berlin, 1906.</p> -</div> -<div class='footnote c030' id='f141'> -<p class='c031'><span class='label'><a href='#r141'>141</a>. </span>“On the Thyroid and Pituitary Bodies,” British Medical Journal, 1890, -and Proceedings of the Royal Society, 1886.</p> -</div> -<div class='footnote c030' id='f142'> -<p class='c031'><span class='label'><a href='#r142'>142</a>. </span>Hale White: Med.-Chirurg. Transactions, vol. lxxi, 182.</p> -</div> -<div class='footnote c030' id='f143'> -<p class='c031'><span class='label'><a href='#r143'>143</a>. </span>Beiträge zur path. Anatomie, xxxiii, p. 158, 1903.</p> -</div> -<div class='footnote c030' id='f144'> -<p class='c031'><span class='label'><a href='#r144'>144</a>. </span>Oswald: Zeitschrift für physiolog. Chemie, 1899, and Virchow’s Archiv, -169, p. 444, 1902.</p> -</div> -<div class='footnote c030' id='f145'> -<p class='c031'><span class='label'><a href='#r145'>145</a>. </span>L’insuffisance thyroidienne et parathyroidienne, Paris, 1904.</p> -</div> -<div class='footnote c030' id='f146'> -<p class='c031'><span class='label'><a href='#r146'>146</a>. </span>Grenzgebiete f. Med. Chirurg., 1905.</p> -</div> -<div class='footnote c030' id='f147'> -<p class='c031'><span class='label'><a href='#r147'>147</a>. </span>Erdheim: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f148'> -<p class='c031'><span class='label'><a href='#r148'>148</a>. </span>Langhans: “Hoden Atrophie,” Handbuch der Deutschen Chirurgie, -Stuttgart, 1887.</p> -</div> -<div class='footnote c030' id='f149'> -<p class='c031'><span class='label'><a href='#r149'>149</a>. </span>Spangaro: Anatomische Hefte, lx, 1902.</p> -</div> -<div class='footnote c030' id='f150'> -<p class='c031'><span class='label'><a href='#r150'>150</a>. </span>Sajous: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f151'> -<p class='c031'><span class='label'><a href='#r151'>151</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f152'> -<p class='c031'><span class='label'><a href='#r152'>152</a>. </span>Minervini: Journal d’anat. et de physiol., p. 449 and p. 639, 1904.</p> -</div> -<div class='footnote c030' id='f153'> -<p class='c031'><span class='label'><a href='#r153'>153</a>. </span>Dellamare: Soc. de biologie, 17 Octobre, 1903.</p> -</div> -<div class='footnote c030' id='f154'> -<p class='c031'><span class='label'><a href='#r154'>154</a>. </span>Studier over Myxœdemet, Kjöbenhavn, 1895.</p> -</div> -<div class='footnote c030' id='f155'> -<p class='c031'><span class='label'><a href='#r155'>155</a>. </span>Ewald: “Die Erkrankungen der Schilddrüse,” Nothnagel’s Handbuch, -Vienna, 1896.</p> -</div> -<div class='footnote c030' id='f156'> -<p class='c031'><span class='label'><a href='#r156'>156</a>. </span>“Die Krankheiten der Schilddrüse,” Stuttgart, 1901.</p> -</div> -<div class='footnote c030' id='f157'> -<p class='c031'><span class='label'><a href='#r157'>157</a>. </span>Virchow’s Archiv, p. 260, 1904.</p> -</div> -<div class='footnote c030' id='f158'> -<p class='c031'><span class='label'><a href='#r158'>158</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f159'> -<p class='c031'><span class='label'><a href='#r159'>159</a>. </span>Blum: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f160'> -<p class='c031'><span class='label'><a href='#r160'>160</a>. </span>Archiv für Anat. u. Physiol., Supplement, 1899; and Ergebnisse der -Physiologie, ii, 1902.</p> -</div> -<div class='footnote c030' id='f161'> -<p class='c031'><span class='label'><a href='#r161'>161</a>. </span>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.</p> -</div> -<div class='footnote c030' id='f162'> -<p class='c031'><span class='label'><a href='#r162'>162</a>. </span>Quoted after Professor Kisch.</p> -</div> -<div class='footnote c030' id='f163'> -<p class='c031'><span class='label'><a href='#r163'>163</a>. </span>Hertoghe: “Die Erkrankungen der Schilddrüse und der chronische -gutartige Hypothyreoidismu,” München, Lehmann, 1900.</p> -</div> -<div class='footnote c030' id='f164'> -<p class='c031'><span class='label'><a href='#r164'>164</a>. </span>Quoted after Professor Pflüger.</p> -</div> -<div class='footnote c030' id='f165'> -<p class='c031'><span class='label'><a href='#r165'>165</a>. </span>Journal of the Amer. Med. Assoc., May 17, 1907.</p> -</div> -<div class='footnote c030' id='f166'> -<p class='c031'><span class='label'><a href='#r166'>166</a>. </span>Westergaard: “Die Lehre von der Mortalität u. Morbilität,” second -edition, Jena, 1901.</p> -</div> -<div class='footnote c030' id='f167'> -<p class='c031'><span class='label'><a href='#r167'>167</a>. </span>Baumann: “Zeitschrift für Physiolog. Chemie,” 21, 319, 1895; 22, 1, 1896.</p> -</div> -<div class='footnote c030' id='f168'> -<p class='c031'><span class='label'><a href='#r168'>168</a>. </span>Policlinique de Bruxelles, Avril, 1903.</p> -</div> -<div class='footnote c030' id='f169'> -<p class='c031'><span class='label'><a href='#r169'>169</a>. </span>Report in Centralblatt für Stoffwechsel, 1907.</p> -</div> -<div class='footnote c030' id='f170'> -<p class='c031'><span class='label'><a href='#r170'>170</a>. </span>“Untersuchungen über die Glandula Thyroidea,” Breisacher: Archiv -für Anatomie und Physiologie, p. 504, 1890.</p> -</div> -<div class='footnote c030' id='f171'> -<p class='c031'><span class='label'><a href='#r171'>171</a>. </span>Virchow’s Archiv für Path. Anatomie und Physiologie und klin. Medicin, -vols. 158, 162.</p> -</div> -<div class='footnote c030' id='f172'> -<p class='c031'><span class='label'><a href='#r172'>172</a>. </span>Quoted after Professor Hemmeter. Address to Sixty-first Annual Meeting -of the Ohio State Medical Association, May 9-11, Canton, Ohio.</p> -</div> -<div class='footnote c030' id='f173'> -<p class='c031'><span class='label'><a href='#r173'>173</a>. </span>Thèse de Bruxelles, 1873; Journal méd. de Bruxelles, 1877; C. R. -de l’Académie des Sciences, May, 1880.</p> -</div> -<div class='footnote c030' id='f174'> -<p class='c031'><span class='label'><a href='#r174'>174</a>. </span>Thèse de Paris, 1887.</p> -</div> -<div class='footnote c030' id='f175'> -<p class='c031'><span class='label'><a href='#r175'>175</a>. </span>Quoted from Hanot, Archives Gén. de Médecine, II, 895.</p> -</div> -<div class='footnote c030' id='f176'> -<p class='c031'><span class='label'><a href='#r176'>176</a>. </span>Slowzoff: Beitr. zur chem. Physiologie u. Path., p. 281, 1901.</p> -</div> -<div class='footnote c030' id='f177'> -<p class='c031'><span class='label'><a href='#r177'>177</a>. </span>Adami: Montreal Med. Journal, p. 485, July.</p> -</div> -<div class='footnote c030' id='f178'> -<p class='c031'><span class='label'><a href='#r178'>178</a>. </span>Sir Lauder Brunton and Bokenham: The Journal of Pathology and -Bacteriology, p. 50, Nov., 1907.</p> -</div> -<div class='footnote c030' id='f179'> -<p class='c031'><span class='label'><a href='#r179'>179</a>. </span>Quoted after Metschnikoff.</p> -</div> -<div class='footnote c030' id='f180'> -<p class='c031'><span class='label'><a href='#r180'>180</a>. </span>Fraser: British Med. Journal, vol. ii, p. 595, 1897.</p> -</div> -<div class='footnote c030' id='f181'> -<p class='c031'><span class='label'><a href='#r181'>181</a>. </span>Leçons sur les auto-intoxications dans les maladies.</p> -</div> -<div class='footnote c030' id='f182'> -<p class='c031'><span class='label'><a href='#r182'>182</a>. </span>Journal de Magendie, vol. ii, p. 357, 1822.</p> -</div> -<div class='footnote c030' id='f183'> -<p class='c031'><span class='label'><a href='#r183'>183</a>. </span>Centralbl. für med. Wiss. 51, 1882.</p> -</div> -<div class='footnote c030' id='f184'> -<p class='c031'><span class='label'><a href='#r184'>184</a>. </span>Centralbl. für Inner. Med., 24, 1897.</p> -</div> -<div class='footnote c030' id='f185'> -<p class='c031'><span class='label'><a href='#r185'>185</a>. </span>Roger et Garnier: C. R. Soc. de biol., p. 209, 1899.</p> -</div> -<div class='footnote c030' id='f186'> -<p class='c031'><span class='label'><a href='#r186'>186</a>. </span>Quoted from Quincke: “Diseases of the Liver” in Nothnagel’s “Practice.”</p> -</div> -<div class='footnote c030' id='f187'> -<p class='c031'><span class='label'><a href='#r187'>187</a>. </span>Hanot and Boit: Congresso Med. Internat. di Roma, 1894.</p> -</div> -<div class='footnote c030' id='f188'> -<p class='c031'><span class='label'><a href='#r188'>188</a>. </span>Steinhaus: Deutsches Archiv für klin. Medicin, 1902.</p> -</div> -<div class='footnote c030' id='f189'> -<p class='c031'><span class='label'><a href='#r189'>189</a>. </span>Quincke: “Diseases of the Liver,” in Nothnagel’s “Practice,” 1907.</p> -</div> -<div class='footnote c030' id='f190'> -<p class='c031'><span class='label'><a href='#r190'>190</a>. </span>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.</p> -</div> -<div class='footnote c030' id='f191'> -<p class='c031'><span class='label'><a href='#r191'>191</a>. </span>Albanese: Archiv. Ital. di Biologia, p. 338, 1892.</p> -</div> -<div class='footnote c030' id='f192'> -<p class='c031'><span class='label'><a href='#r192'>192</a>. </span>Charrin: “Les défenses naturelles de l’organisme,” Paris, 1898; C. R. -Soc. de biologie, 1892.</p> -</div> -<div class='footnote c030' id='f193'> -<p class='c031'><span class='label'><a href='#r193'>193</a>. </span>Oppenheim et Loeper: C. R. Soc. de biol., 22 mars, 1901.</p> -</div> -<div class='footnote c030' id='f194'> -<p class='c031'><span class='label'><a href='#r194'>194</a>. </span>Oppenheim: “Les capsules surrénales,” Thèse de Paris, 1902.</p> -</div> -<div class='footnote c030' id='f195'> -<p class='c031'><span class='label'><a href='#r195'>195</a>. </span>Aubertin: C. E. Soc. de biologie, 22 juillet, 1902.</p> -</div> -<div class='footnote c030' id='f196'> -<p class='c031'><span class='label'><a href='#r196'>196</a>. </span>Sajous: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f197'> -<p class='c031'><span class='label'><a href='#r197'>197</a>. </span>Société d’Anatomie, Mai 31, 1907.</p> -</div> -<div class='footnote c030' id='f198'> -<p class='c031'><span class='label'><a href='#r198'>198</a>. </span>Deutsche Med. Wochenschrift 8, 1906.</p> -</div> -<div class='footnote c030' id='f199'> -<p class='c031'><span class='label'><a href='#r199'>199</a>. </span>C. R. Soc. biologie, Nov. 14, 1893.</p> -</div> -<div class='footnote c030' id='f200'> -<p class='c031'><span class='label'><a href='#r200'>200</a>. </span>Amberg: Archives Internationales de Pharmakodynamie et Therapie, -1905.</p> -</div> -<div class='footnote c030' id='f201'> -<p class='c031'><span class='label'><a href='#r201'>201</a>. </span>Deutsche Med. Wochenschrift, No. 12, 1907.</p> -</div> -<div class='footnote c030' id='f202'> -<p class='c031'><span class='label'><a href='#r202'>202</a>. </span>Congress für Innere Medicin, 1907.</p> -</div> -<div class='footnote c030' id='f203'> -<p class='c031'><span class='label'><a href='#r203'>203</a>. </span>Grom. Int. della Soc. Med., xxvi.</p> -</div> -<div class='footnote c030' id='f204'> -<p class='c031'><span class='label'><a href='#r204'>204</a>. </span>Lehrbuch der Krankheiten destergens und der oxlutgefüre. Stuttgart, -1906.</p> -</div> -<div class='footnote c030' id='f205'> -<p class='c031'><span class='label'><a href='#r205'>205</a>. </span>Parkes Weber: Transact. Path. Society, London, lviii, 3.</p> -</div> -<div class='footnote c030' id='f206'> -<p class='c031'><span class='label'><a href='#r206'>206</a>. </span>Gazette des hôpitaux, Juin 14, 1906.</p> -</div> -<div class='footnote c030' id='f207'> -<p class='c031'><span class='label'><a href='#r207'>207</a>. </span>“Die Arteriosclerose,” Leipzig, 1898.</p> -</div> -<div class='footnote c030' id='f208'> -<p class='c031'><span class='label'><a href='#r208'>208</a>. </span>“Recherches sur la senescence des glandes surrénales,” Soc. biologie, 17 -Oct., 1903.</p> -</div> -<div class='footnote c030' id='f209'> -<p class='c031'><span class='label'><a href='#r209'>209</a>. </span>Remlinger: “Dissertation on Arteriosclérose,” Marburg, 1905.</p> -</div> -<div class='footnote c030' id='f210'> -<p class='c031'><span class='label'><a href='#r210'>210</a>. </span>Preface of Romberg: Deutsche Med. Wochenschrift, No. 78, 1904.</p> -</div> -<div class='footnote c030' id='f211'> -<p class='c031'><span class='label'><a href='#r211'>211</a>. </span>“Therapie der Gegenwart,” March, 1907.</p> -</div> -<div class='footnote c030' id='f212'> -<p class='c031'><span class='label'><a href='#r212'>212</a>. </span>Ewald: “Die auto-intoxication,” Berl. klin. Wochenschr., No. 7-8, 1900.</p> -</div> -<div class='footnote c030' id='f213'> -<p class='c031'><span class='label'><a href='#r213'>213</a>. </span>Grundzach: Zeitschrift für klin. Medicine, p. 79, 1893.</p> -</div> -<div class='footnote c030' id='f214'> -<p class='c031'><span class='label'><a href='#r214'>214</a>. </span>Schmitz: Zeitschrift für Physiologische Chemie, vol. xix, 1897.</p> -</div> -<div class='footnote c030' id='f215'> -<p class='c031'><span class='label'><a href='#r215'>215</a>. </span>Singer: Therapeutische Monatshafte, p. 441, 1901.</p> -</div> -<div class='footnote c030' id='f216'> -<p class='c031'><span class='label'><a href='#r216'>216</a>. </span>Herter: Brit. Med. Jour., p. 1898, Dec. 25, 1897.</p> -</div> -<div class='footnote c030' id='f217'> -<p class='c031'><span class='label'><a href='#r217'>217</a>. </span>Cohendy: C. R. de la Société de Biologie, Mars 17, 1906.</p> -</div> -<div class='footnote c030' id='f218'> -<p class='c031'><span class='label'><a href='#r218'>218</a>. </span>Combe: “L’Auto-intoxication intestinale,” Paris, 1906.</p> -</div> -<div class='footnote c030' id='f219'> -<p class='c031'><span class='label'><a href='#r219'>219</a>. </span>Offerhaus: Proefschrift, “Eine mechanische oorzaak voorhet ontstaan -van Appendicitis,” Leiden, 1901.</p> -</div> -<div class='footnote c030' id='f220'> -<p class='c031'><span class='label'><a href='#r220'>220</a>. </span>Senator: <i>Loc. cit.</i>, and others.</p> -</div> -<div class='footnote c030' id='f221'> -<p class='c031'><span class='label'><a href='#r221'>221</a>. </span>Brown-Séquard: Archives de physiologie norm. et path., p. 778, 1893.</p> -</div> -<div class='footnote c030' id='f222'> -<p class='c031'><span class='label'><a href='#r222'>222</a>. </span>Meyer: <i>Ibid.</i>, p. 179, 1894.</p> -</div> -<div class='footnote c030' id='f223'> -<p class='c031'><span class='label'><a href='#r223'>223</a>. </span>Oesterr. Med. Jahrbuch, No. 2, 1884.</p> -</div> -<div class='footnote c030' id='f224'> -<p class='c031'><span class='label'><a href='#r224'>224</a>. </span>Hemmeter: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f225'> -<p class='c031'><span class='label'><a href='#r225'>225</a>. </span>Senator: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f226'> -<p class='c031'><span class='label'><a href='#r226'>226</a>. </span>Tyson: A treatise on “Bright’s Disease and Diabetes,” second edition, -London, 1904.</p> -</div> -<div class='footnote c030' id='f227'> -<p class='c031'><span class='label'><a href='#r227'>227</a>. </span>Achard: Presse méd., 1901.</p> -</div> -<div class='footnote c030' id='f228'> -<p class='c031'><span class='label'><a href='#r228'>228</a>. </span>Strauss: “Die chronischen nierenentzundungen,” Berlin, 1902.</p> -</div> -<div class='footnote c030' id='f229'> -<p class='c031'><span class='label'><a href='#r229'>229</a>. </span>Vidal et Javal: Soc. Méd. des Hôpitaux, Juil. 31, 1903.</p> -</div> -<div class='footnote c030' id='f230'> -<p class='c031'><span class='label'><a href='#r230'>230</a>. </span>Keller: Zeitschrift für Physiol. Chemie, vol. xiii, p. 130 and 134, 1889.</p> -</div> -<div class='footnote c030' id='f231'> -<p class='c031'><span class='label'><a href='#r231'>231</a>. </span>Journal méd. de Bruxelles, 1903.</p> -</div> -<div class='footnote c030' id='f232'> -<p class='c031'><span class='label'><a href='#r232'>232</a>. </span>Aubert: Pflüger Archiv, vol. vi, p. 539, 1872.</p> -</div> -<div class='footnote c030' id='f233'> -<p class='c031'><span class='label'><a href='#r233'>233</a>. </span>Professor Bunge: Lehrbuch der Physiologie des Menschen, Leipzig, 1905.</p> -</div> -<div class='footnote c030' id='f234'> -<p class='c031'><span class='label'><a href='#r234'>234</a>. </span>Memorabilien traduits par Levebier, p. 77, Genève, 1863.</p> -</div> -<div class='footnote c030' id='f235'> -<p class='c031'><span class='label'><a href='#r235'>235</a>. </span>Sir William Thompson, in “Heat,” Encyclopædia Britannica.</p> -</div> -<div class='footnote c030' id='f236'> -<p class='c031'><span class='label'><a href='#r236'>236</a>. </span>Latterly city men wear straw hats in summer and also the coachmen -and servants of the upper class.</p> -</div> -<div class='footnote c030' id='f237'> -<p class='c031'><span class='label'><a href='#r237'>237</a>. </span>Strasser und Blumenkranz: “Die Wirkung indifferenter und schweisstresbender -Bader bei Nephritis,” Med. klin., Beichfte Hefte 6, 1907.</p> -</div> -<div class='footnote c030' id='f238'> -<p class='c031'><span class='label'><a href='#r238'>238</a>. </span>Deutsche Med. Wochenschrift, p. 34, 1904.</p> -</div> -<div class='footnote c030' id='f239'> -<p class='c031'><span class='label'><a href='#r239'>239</a>. </span>v. Noorden: Pathologie des Stoffwechsel, vol. i, 1906.</p> -</div> -<div class='footnote c030' id='f240'> -<p class='c031'><span class='label'><a href='#r240'>240</a>. </span>Quoted after Sir Lauder Brunton, Harveyan Oration.</p> -</div> -<div class='footnote c030' id='f241'> -<p class='c031'><span class='label'><a href='#r241'>241</a>. </span>Arloing: C. R. de l’Academie des Sciences, p. 378 et 511, Paris, 1885.</p> -</div> -<div class='footnote c030' id='f242'> -<p class='c031'><span class='label'><a href='#r242'>242</a>. </span>Duclaux: Revue Scient., 1887.</p> -</div> -<div class='footnote c030' id='f243'> -<p class='c031'><span class='label'><a href='#r243'>243</a>. </span>Finsen: “Om anvendelsen af concentrerede chemiske Lysstraaler,” -Kjöbenhavn, 1896.</p> -</div> -<div class='footnote c030' id='f244'> -<p class='c031'><span class='label'><a href='#r244'>244</a>. </span>Oerum: Pflüger’s Archiv. f. d. g. Physiologie, vol. cxiv.</p> -</div> -<div class='footnote c030' id='f245'> -<p class='c031'><span class='label'><a href='#r245'>245</a>. </span>Hospitalstidende, p. 1209 and 1239, 1894.</p> -</div> -<div class='footnote c030' id='f246'> -<p class='c031'><span class='label'><a href='#r246'>246</a>. </span>Mohn: Quoted after Holm, Norsh Magazin. Laege, W. 6, 1906.</p> -</div> -<div class='footnote c030' id='f247'> -<p class='c031'><span class='label'><a href='#r247'>247</a>. </span>Meddelelser fra Finsen’s “Chemiske Lysinstitut,” Kjöbenhavn, 1899.</p> -</div> -<div class='footnote c030' id='f248'> -<p class='c031'><span class='label'><a href='#r248'>248</a>. </span>Viault: C. R. Acad. Sciences, p. 917, 1890 and p. 295, 1891.</p> -</div> -<div class='footnote c030' id='f249'> -<p class='c031'><span class='label'><a href='#r249'>249</a>. </span>Mintz: C. R. Acad. Sciences, p. 298, 1891.</p> -</div> -<div class='footnote c030' id='f250'> -<p class='c031'><span class='label'><a href='#r250'>250</a>. </span>Hufeland: “Makrobiotik,” p. 129.</p> -</div> -<div class='footnote c030' id='f251'> -<p class='c031'><span class='label'><a href='#r251'>251</a>. </span>Quoted after Landois: “Lehrbuch der Physiologie des Menschen,” Berlin, -Wien, 1905, eleventh edition, p. 235.</p> -</div> -<div class='footnote c030' id='f252'> -<p class='c031'><span class='label'><a href='#r252'>252</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f253'> -<p class='c031'><span class='label'><a href='#r253'>253</a>. </span>Dr. Harry Campbell on “Respiratory Exercise in the Treatment of Disease,” -London, 1907.</p> -</div> -<div class='footnote c030' id='f254'> -<p class='c031'><span class='label'><a href='#r254'>254</a>. </span>As well known, one gramme is the equivalent of 15 grains.</p> -</div> -<div class='footnote c030' id='f255'> -<p class='c031'><span class='label'><a href='#r255'>255</a>. </span>v. Noorden: “Die Zuckerkrankheit,” fourth edition; and “Pathologie -des Stoffwechsels,” fourth edition, vol. i.</p> -</div> -<div class='footnote c030' id='f256'> -<p class='c031'><span class='label'><a href='#r256'>256</a>. </span>Chittenden: “Physiological Economy of Nutrition,” New York, 1904, -and “The Nutrition of Man,” London, 1907.</p> -</div> -<div class='footnote c030' id='f257'> -<p class='c031'><span class='label'><a href='#r257'>257</a>. </span>H. Fletcher: “The A, B-Z of Nutrition,” New York, 1904.</p> -</div> -<div class='footnote c030' id='f258'> -<p class='c031'><span class='label'><a href='#r258'>258</a>. </span>Rubner: “Physiologic der Nahrung und der Ernährungtherapie,” Leipzig, -1897.</p> -</div> -<div class='footnote c030' id='f259'> -<p class='c031'><span class='label'><a href='#r259'>259</a>. </span>Achard and Loeper: C. R. Soc. biologie, 23 Mars, 1901.</p> -</div> -<div class='footnote c030' id='f260'> -<p class='c031'><span class='label'><a href='#r260'>260</a>. </span>Strauss: Die chronischen Nierenentzundungen, Berlin, 1902.</p> -</div> -<div class='footnote c030' id='f261'> -<p class='c031'><span class='label'><a href='#r261'>261</a>. </span>Vidal et Javal: Soc. Méd. des Hôpitaux, 26 J., 1903; Vidal: “Le -regime dechlorusé,” Liége Congrès de Méd., 1905.</p> -</div> -<div class='footnote c030' id='f262'> -<p class='c031'><span class='label'><a href='#r262'>262</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f263'> -<p class='c031'><span class='label'><a href='#r263'>263</a>. </span>Rubner: “Physiologie der Nahrung und der Ernährungtherapie,” Leipzig, -1897.</p> -</div> -<div class='footnote c030' id='f264'> -<p class='c031'><span class='label'><a href='#r264'>264</a>. </span>Haig: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f265'> -<p class='c031'><span class='label'><a href='#r265'>265</a>. </span>T. König: “Chemie der menschlichen Nahrungs und Genussmittel,” second -edition, Berlin, 1882.</p> -</div> -<div class='footnote c030' id='f266'> -<p class='c031'><span class='label'><a href='#r266'>266</a>. </span>Walker Hall: Berliner klin. Wochenschrift, p. 868, 1903.</p> -</div> -<div class='footnote c030' id='f267'> -<p class='c031'><span class='label'><a href='#r267'>267</a>. </span>Lunin: Diss Dorpat, 1880. Zeitschrift für Physiolog. Chemie, vol. -v. March 1, 1881; quoted after Bunge.</p> -</div> -<div class='footnote c030' id='f268'> -<p class='c031'><span class='label'><a href='#r268'>268</a>. </span>Förster: Zeitschrift für Biologie, vol. ix, p. 247, 1873; quoted after Bunge.</p> -</div> -<div class='footnote c030' id='f269'> -<p class='c031'><span class='label'><a href='#r269'>269</a>. </span>Roese, “Erdsalzarmuth und Entartung,” Berlin, 1908.</p> -</div> -<div class='footnote c030' id='f270'> -<p class='c031'><span class='label'><a href='#r270'>270</a>. </span>Bunge: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f271'> -<p class='c031'><span class='label'><a href='#r271'>271</a>. </span>J. Weiss: Zeitschrift für Physiolog. Chemie, vol. xxv, p. 303, 1898; vol. -xxvii, p. 216.</p> -</div> -<div class='footnote c030' id='f272'> -<p class='c031'><span class='label'><a href='#r272'>272</a>. </span>Weiske: Zeitschrift für Biologie, vol. vi, p. 456.</p> -</div> -<div class='footnote c030' id='f273'> -<p class='c031'><span class='label'><a href='#r273'>273</a>. </span>Dettweiler: German Congress of Internal Medicine, 1905.</p> -</div> -<div class='footnote c030' id='f274'> -<p class='c031'><span class='label'><a href='#r274'>274</a>. </span>Grawitz: “Klinische Pathologie des Blutes.” third edition, 1906.</p> -</div> -<div class='footnote c030' id='f275'> -<p class='c031'><span class='label'><a href='#r275'>275</a>. </span>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.</p> -</div> -<div class='footnote c030' id='f276'> -<p class='c031'><span class='label'><a href='#r276'>276</a>. </span>Forsyth: Lancet, 1907.</p> -</div> -<div class='footnote c030' id='f277'> -<p class='c031'><span class='label'><a href='#r277'>277</a>. </span>Houssaye: C. R. Académie des Sciences, p. 934, 1903.</p> -</div> -<div class='footnote c030' id='f278'> -<p class='c031'><span class='label'><a href='#r278'>278</a>. </span>Lorand: “Die rationelle Behandlung der Zuckerkrankheit,” second -edition, Berlin, 1909.</p> -</div> -<div class='footnote c030' id='f279'> -<p class='c031'><span class='label'><a href='#r279'>279</a>. </span>v. Noorden: Deutscher Naturforscher Congress, 1902.</p> -</div> -<div class='footnote c030' id='f280'> -<p class='c031'><span class='label'><a href='#r280'>280</a>. </span>Congress für Innere Medicin, 1904.</p> -</div> -<div class='footnote c030' id='f281'> -<p class='c031'><span class='label'><a href='#r281'>281</a>. </span>Haig: “Uric Acid in the Causation of Disease,” sixth edition, London, -1904.</p> -</div> -<div class='footnote c030' id='f282'> -<p class='c031'><span class='label'><a href='#r282'>282</a>. </span>Senator: “Die Erkrankungen der Nieren,” Nothnagel’s Handbuch.</p> -</div> -<div class='footnote c030' id='f283'> -<p class='c031'><span class='label'><a href='#r283'>283</a>. </span>Adler: Berliner klin. Wochenschrift, 1908.</p> -</div> -<div class='footnote c030' id='f284'> -<p class='c031'><span class='label'><a href='#r284'>284</a>. </span>Baumann and Ross: Zeitschrift für Phys. Chemie, 21-319, 1895; 22-1, -1896.</p> -</div> -<div class='footnote c030' id='f285'> -<p class='c031'><span class='label'><a href='#r285'>285</a>. </span>Charrin et Bouriet: C. R. Soc. biologie, c-2-339.</p> -</div> -<div class='footnote c030' id='f286'> -<p class='c031'><span class='label'><a href='#r286'>286</a>. </span>L. Mendel: Journal of American Medical Assn., 3-2-’85.</p> -</div> -<div class='footnote c030' id='f287'> -<p class='c031'><span class='label'><a href='#r287'>287</a>. </span>Jollin: Nord. Med. Arch., 1897, Test number.</p> -</div> -<div class='footnote c030' id='f288'> -<p class='c031'><span class='label'><a href='#r288'>288</a>. </span>Magnus-Levy: v. Noorden, “Pathologie der Stoffwechsels,” i, 472.</p> -</div> -<div class='footnote c030' id='f289'> -<p class='c031'><span class='label'><a href='#r289'>289</a>. </span>Quoted after Humphrey.</p> -</div> -<div class='footnote c030' id='f290'> -<p class='c031'><span class='label'><a href='#r290'>290</a>. </span>Bang: “Ueber die Aurscheidungs des Jodothyrius durch die Milch,” -Berl. klin. Wochenschrift, Dec. 27, 1897.</p> -</div> -<div class='footnote c030' id='f291'> -<p class='c031'><span class='label'><a href='#r291'>291</a>. </span>C. R. de l’Académie de Medicine, 1898.</p> -</div> -<div class='footnote c030' id='f292'> -<p class='c031'><span class='label'><a href='#r292'>292</a>. </span>Hemp: Verhandlungen des Congresses Deutscher Naturforscher und -Aertze, Dresden, vol. i, p. 112, 1907.</p> -</div> -<div class='footnote c030' id='f293'> -<p class='c031'><span class='label'><a href='#r293'>293</a>. </span>Behring: Beiträge zür experimentellen Therapie, 8 fl, 1906.</p> -</div> -<div class='footnote c030' id='f294'> -<p class='c031'><span class='label'><a href='#r294'>294</a>. </span>Breisacher: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f295'> -<p class='c031'><span class='label'><a href='#r295'>295</a>. </span>Blum: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f296'> -<p class='c031'><span class='label'><a href='#r296'>296</a>. </span>Fordyce: British Med. Journal, vol. x, p. 619, 1902.</p> -</div> -<div class='footnote c030' id='f297'> -<p class='c031'><span class='label'><a href='#r297'>297</a>. </span>Chalmers Watson: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f298'> -<p class='c031'><span class='label'><a href='#r298'>298</a>. </span>Forsyth: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f299'> -<p class='c031'><span class='label'><a href='#r299'>299</a>. </span>Bunge: Lehrbuch der Physiologie, Berlin, 1907.</p> -</div> -<div class='footnote c030' id='f300'> -<p class='c031'><span class='label'><a href='#r300'>300</a>. </span>Naunyn: In Schwalbe’s Lehrbuch der greisenkrankheiten, Berlin, 1909.</p> -</div> -<div class='footnote c030' id='f301'> -<p class='c031'><span class='label'><a href='#r301'>301</a>. </span>Grawitz: Hidem and also in “Klinische Pathologie des Blutes,” third -edition, Leipzig, 1906.</p> -</div> -<div class='footnote c030' id='f302'> -<p class='c031'><span class='label'><a href='#r302'>302</a>. </span>Abderhalden: Zeitschrift für Physiolog. Chemie, 1898, 25, 56 (for pigs’ -blood); and Hidem, 1897, 23, 521 (for ox blood).</p> -</div> -<div class='footnote c030' id='f303'> -<p class='c031'><span class='label'><a href='#r303'>303</a>. </span>J. König: “Die menschlichen Nahrungs und Genussmittel,” Berlin, -1903, I, p. 76.</p> -</div> -<div class='footnote c030' id='f304'> -<p class='c031'><span class='label'><a href='#r304'>304</a>. </span>Quoted after Hufeland, Makrobiotik, edited by Steinthal, Berlin, p. 13, -1887.</p> -</div> -<div class='footnote c030' id='f305'> -<p class='c031'><span class='label'><a href='#r305'>305</a>. </span>Congress für Innere Medicin, 1904.</p> -</div> -<div class='footnote c030' id='f306'> -<p class='c031'><span class='label'><a href='#r306'>306</a>. </span>“Observation on Mastication,” Lancet, vol. ii, 1903.</p> -</div> -<div class='footnote c030' id='f307'> -<p class='c031'><span class='label'><a href='#r307'>307</a>. </span>Horace Fletcher: “The A, B-Z of Nutrition,” New York, 1904.</p> -</div> -<div class='footnote c030' id='f308'> -<p class='c031'><span class='label'><a href='#r308'>308</a>. </span>v. Noorden: “Die Fettsucht,” Nothnagel’s Handbuch.</p> -</div> -<div class='footnote c030' id='f309'> -<p class='c031'><span class='label'><a href='#r309'>309</a>. </span>Quoted after Dr. Hollitscher, Präger med. Wochenschrift, 1907.</p> -</div> -<div class='footnote c030' id='f310'> -<p class='c031'><span class='label'><a href='#r310'>310</a>. </span>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.</p> -</div> -<div class='footnote c030' id='f311'> -<p class='c031'><span class='label'><a href='#r311'>311</a>. </span>Sajous: “Internal Secretions,” vol. ii, p. 1332, 1907.</p> -</div> -<div class='footnote c030' id='f312'> -<p class='c031'><span class='label'><a href='#r312'>312</a>. </span>de Quervain: Semaine Méd., 1895.</p> -</div> -<div class='footnote c030' id='f313'> -<p class='c031'><span class='label'><a href='#r313'>313</a>. </span>Sarbach: Mitth. Grenzgebiete Med. u. Chir., 1906, p. 213.</p> -</div> -<div class='footnote c030' id='f314'> -<p class='c031'><span class='label'><a href='#r314'>314</a>. </span>Hertoghe: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f315'> -<p class='c031'><span class='label'><a href='#r315'>315</a>. </span>International Congress of Anti-Alcoholics, Stockholm, 1902.</p> -</div> -<div class='footnote c030' id='f316'> -<p class='c031'><span class='label'><a href='#r316'>316</a>. </span>Quoted after Humphrey, “Old Age,” Cambridge, 1889.</p> -</div> -<div class='footnote c030' id='f317'> -<p class='c031'><span class='label'><a href='#r317'>317</a>. </span>“Die Basedow’sche Krankheit,” Nothnagel’s Handbuch, second edition.</p> -</div> -<div class='footnote c030' id='f318'> -<p class='c031'><span class='label'><a href='#r318'>318</a>. </span>Semaine Médicale, 1905.</p> -</div> -<div class='footnote c030' id='f319'> -<p class='c031'><span class='label'><a href='#r319'>319</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f320'> -<p class='c031'><span class='label'><a href='#r320'>320</a>. </span>Hutchison: “Food and the Principles of Dietetics,” London, 1901.</p> -</div> -<div class='footnote c030' id='f321'> -<p class='c031'><span class='label'><a href='#r321'>321</a>. </span>Koch and Kraepelin: “Psychologies die Arbeiten,” vol. i, p. 378, 1895.</p> -</div> -<div class='footnote c030' id='f322'> -<p class='c031'><span class='label'><a href='#r322'>322</a>. </span>Brunton: Lectures on the Action of Medicine, p. 321, 1897.</p> -</div> -<div class='footnote c030' id='f323'> -<p class='c031'><span class='label'><a href='#r323'>323</a>. </span>Esser: Arch. für exper. Path. und Pharm., xlix, p. 168.</p> -</div> -<div class='footnote c030' id='f324'> -<p class='c031'><span class='label'><a href='#r324'>324</a>. </span>Bunge: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f325'> -<p class='c031'><span class='label'><a href='#r325'>325</a>. </span>Weichardt: Munchener Med. Wochenschrift, Nu. 1, 1904; and Verhandlungen -der Physiolog. Gesellschaft, Berlin, Dec. 5, 1906.</p> -</div> -<div class='footnote c030' id='f326'> -<p class='c031'><span class='label'><a href='#r326'>326</a>. </span>Zeigan: Therapeutische Monatshefte, p. 193, 1904.</p> -</div> -<div class='footnote c030' id='f327'> -<p class='c031'><span class='label'><a href='#r327'>327</a>. </span>Quoted after Bunge.</p> -</div> -<div class='footnote c030' id='f328'> -<p class='c031'><span class='label'><a href='#r328'>328</a>. </span>Bouchard: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f329'> -<p class='c031'><span class='label'><a href='#r329'>329</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f330'> -<p class='c031'><span class='label'><a href='#r330'>330</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f331'> -<p class='c031'><span class='label'><a href='#r331'>331</a>. </span>Sajous: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f332'> -<p class='c031'><span class='label'><a href='#r332'>332</a>. </span>Path. des Stoffwechsels of v. Noorden, second edition, vol. ii.</p> -</div> -<div class='footnote c030' id='f333'> -<p class='c031'><span class='label'><a href='#r333'>333</a>. </span>Therapeutische monatshefte, p. 193, 1904.</p> -</div> -<div class='footnote c030' id='f334'> -<p class='c031'><span class='label'><a href='#r334'>334</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f335'> -<p class='c031'><span class='label'><a href='#r335'>335</a>. </span>Nederlandsch Tijdschrift voor Geneeskunde, 1905.</p> -</div> -<div class='footnote c030' id='f336'> -<p class='c031'><span class='label'><a href='#r336'>336</a>. </span>Quoted after Prof. Kisch “Das Geschlechtsleben des Weibes,” Vienna, -second edition, 1908.</p> -</div> -<div class='footnote c030' id='f337'> -<p class='c031'><span class='label'><a href='#r337'>337</a>. </span>Quoted after Prof. Kisch, as are most of the quotations in this chapter.</p> -</div> -<div class='footnote c030' id='f338'> -<p class='c031'><span class='label'><a href='#r338'>338</a>. </span>Loisel: Journal de l’Anat., xi, p. 536; C. R. S. B., L. ix, p. 403.</p> -</div> -<div class='footnote c030' id='f339'> -<p class='c031'><span class='label'><a href='#r339'>339</a>. </span>Regaud: Comptes rendus de l’Association des Anatomistes p. 198, 1903.</p> -</div> -<div class='footnote c030' id='f340'> -<p class='c031'><span class='label'><a href='#r340'>340</a>. </span>Mingazzini: Corpi lutes veri e falsi; R. F. Laboratorio di Anatomia -normale della Reale Universita di Roma, vol. iii, 1893.</p> -</div> -<div class='footnote c030' id='f341'> -<p class='c031'><span class='label'><a href='#r341'>341</a>. </span>Tsen-ki-tong: “China und die Chinesen,” German translation from the -Chinese, Leipzig, 1875.</p> -</div> -<div class='footnote c030' id='f342'> -<p class='c031'><span class='label'><a href='#r342'>342</a>. </span>Quoted after James Tyson. <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f343'> -<p class='c031'><span class='label'><a href='#r343'>343</a>. </span>Brown-Séquard: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f344'> -<p class='c031'><span class='label'><a href='#r344'>344</a>. </span>Journal der pract. Arzneikunde, vol. v, 1788.</p> -</div> -<div class='footnote c030' id='f345'> -<p class='c031'><span class='label'><a href='#r345'>345</a>. </span>Revue de Médecine Bulletin Académie de Médecine, vol. xliii, p. 116, 1900.</p> -</div> -<div class='footnote c030' id='f346'> -<p class='c031'><span class='label'><a href='#r346'>346</a>. </span>Sajous: “Internal Secretions,” vol. ii, p. 1312, 1907.</p> -</div> -<div class='footnote c030' id='f347'> -<p class='c031'><span class='label'><a href='#r347'>347</a>. </span>v. Noorden: “Die Bleichsucht” Nothnagel’s “Handbuch der pract. -Medicin.”</p> -</div> -<div class='footnote c030' id='f348'> -<p class='c031'><span class='label'><a href='#r348'>348</a>. </span>Sajous: “Internal Secretions,” vol. i, p. 87, Philadelphia, 1903.</p> -</div> -<div class='footnote c030' id='f349'> -<p class='c031'><span class='label'><a href='#r349'>349</a>. </span><i>Loc. cit.</i>, p. 95.</p> -</div> -<div class='footnote c030' id='f350'> -<p class='c031'><span class='label'><a href='#r350'>350</a>. </span>Congress of Belgian Neurologists, 1906.</p> -</div> -<div class='footnote c030' id='f351'> -<p class='c031'><span class='label'><a href='#r351'>351</a>. </span>Heinz: Virchow’s Archiv, clv, p. 44.</p> -</div> -<div class='footnote c030' id='f352'> -<p class='c031'><span class='label'><a href='#r352'>352</a>. </span>Murray: “Diseases of the Thyroid Gland,” vol. i, London, 1901.</p> -</div> -<div class='footnote c030' id='f353'> -<p class='c031'><span class='label'><a href='#r353'>353</a>. </span>Mackenzie: British Med. Journal, Oct. 29, 1892.</p> -</div> -<div class='footnote c030' id='f354'> -<p class='c031'><span class='label'><a href='#r354'>354</a>. </span>Hertoghe: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f355'> -<p class='c031'><span class='label'><a href='#r355'>355</a>. </span>Laache: Deutsche Med. Wochenschrift, 1893.</p> -</div> -<div class='footnote c030' id='f356'> -<p class='c031'><span class='label'><a href='#r356'>356</a>. </span>Oppenheim: Lehrbuch der Nervenkrankheiten, Nu. ii, p. 1390.</p> -</div> -<div class='footnote c030' id='f357'> -<p class='c031'><span class='label'><a href='#r357'>357</a>. </span>Ewald: “Die Erkrankungen der Schilddrüse,” second edition, 1909.</p> -</div> -<div class='footnote c030' id='f358'> -<p class='c031'><span class='label'><a href='#r358'>358</a>. </span>Vermehren: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f359'> -<p class='c031'><span class='label'><a href='#r359'>359</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f360'> -<p class='c031'><span class='label'><a href='#r360'>360</a>. </span>Burghart: Deutsche Med. Wochenschrift, p. 610 and 627, 1899.</p> -</div> -<div class='footnote c030' id='f361'> -<p class='c031'><span class='label'><a href='#r361'>361</a>. </span>Spillman and Etienne: C. R. du Congrès de Medecine de Nancy, p. 953, -1896.</p> -</div> -<div class='footnote c030' id='f362'> -<p class='c031'><span class='label'><a href='#r362'>362</a>. </span>Shattock and Seeligmann: Transactions of the London Path. Society, -p. 57, vol. lvi.</p> -</div> -<div class='footnote c030' id='f363'> -<p class='c031'><span class='label'><a href='#r363'>363</a>. </span>Shattock: <i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f364'> -<p class='c031'><span class='label'><a href='#r364'>364</a>. </span>Spangaro: Anatomische Hefte, Wiesbaden, vol. lx, 1902.</p> -</div> -<div class='footnote c030' id='f365'> -<p class='c031'><span class='label'><a href='#r365'>365</a>. </span>C. R. de la Société de biologie, 1 and 15, Juin, 1889.</p> -</div> -<div class='footnote c030' id='f366'> -<p class='c031'><span class='label'><a href='#r366'>366</a>. </span>Pflüger’s Archiv. vol. vi, pp. 335 and 379, 1896.</p> -</div> -<div class='footnote c030' id='f367'> -<p class='c031'><span class='label'><a href='#r367'>367</a>. </span>Poehl and Tarchanoff: Organotherapie, vol. i, St. Petersburg.</p> -</div> -<div class='footnote c030' id='f368'> -<p class='c031'><span class='label'><a href='#r368'>368</a>. </span>P. F. Richter: Organotherapie, Berlin.</p> -</div> -<div class='footnote c030' id='f369'> -<p class='c031'><span class='label'><a href='#r369'>369</a>. </span>Sajous: “Internal Secretions.”</p> -</div> -<div class='footnote c030' id='f370'> -<p class='c031'><span class='label'><a href='#r370'>370</a>. </span>C. R. Soc. de biologie, Nov. 5, 1892.</p> -</div> -<div class='footnote c030' id='f371'> -<p class='c031'><span class='label'><a href='#r371'>371</a>. </span>Petersburgh Med. Wochenschrift, Nu. 7, p. 67, 1904.</p> -</div> -<div class='footnote c030' id='f372'> -<p class='c031'><span class='label'><a href='#r372'>372</a>. </span>Journal für med. Chemie u. Pharm., Dec., 1892.</p> -</div> -<div class='footnote c030' id='f373'> -<p class='c031'><span class='label'><a href='#r373'>373</a>. </span>“Twentieth Century Practice” by Thomas Stedman, M.D., London, p. 491, -1897.</p> -</div> -<div class='footnote c030' id='f374'> -<p class='c031'><span class='label'><a href='#r374'>374</a>. </span>L’opothérapie, Paris, 1898.</p> -</div> -<div class='footnote c030' id='f375'> -<p class='c031'><span class='label'><a href='#r375'>375</a>. </span>Wratch, No. 27, 1899.</p> -</div> -<div class='footnote c030' id='f376'> -<p class='c031'><span class='label'><a href='#r376'>376</a>. </span>Soc. de biologie, p. 287, 1903.</p> -</div> -<div class='footnote c030' id='f377'> -<p class='c031'><span class='label'><a href='#r377'>377</a>. </span>Bull. gén. de thérapeutique, p. 30, 1907.</p> -</div> -<div class='footnote c030' id='f378'> -<p class='c031'><span class='label'><a href='#r378'>378</a>. </span>Teissier: Bull. Méd., No. 57, p. 617, 1907.</p> -</div> -<div class='footnote c030' id='f379'> -<p class='c031'><span class='label'><a href='#r379'>379</a>. </span>Abelmann: Quoted after Oser, Nothnagel’s “Practice” p. 109; “Diseases -of the Pancreas,” p. 101.</p> -</div> -<div class='footnote c030' id='f380'> -<p class='c031'><span class='label'><a href='#r380'>380</a>. </span>Salomon: Berl. klin. Wochenschrift, Nu. 3, 1902.</p> -</div> -<div class='footnote c030' id='f381'> -<p class='c031'><span class='label'><a href='#r381'>381</a>. </span>Meyer: Zeitschrift für exper. Path. u. Ther., vol. ii, 3 H.</p> -</div> -<div class='footnote c030' id='f382'> -<p class='c031'><span class='label'><a href='#r382'>382</a>. </span><i>Loc. cit.</i></p> -</div> -<div class='footnote c030' id='f383'> -<p class='c031'><span class='label'><a href='#r383'>383</a>. </span>Pel: <i>Loc. cit.</i></p> -</div> -<div class='pbb'> - <hr class='pb c003' /> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><i>Other Publications of F. A. Davis Company, Philadelphia</i></div> - </div> -</div> - -<hr class='c032' /> - -<div class='nf-center-c0'> - <div class='nf-center'> - <div><span class='xxlarge'>Health and Longevity Through Rational Diet</span></div> - <div class='c000'>PRACTICAL HINTS IN REGARD TO FOOD AND THE USEFULNESS</div> - <div>OR THE HARMFUL EFFECTS OF THE VARIOUS ARTICLES OF DIET.</div> - <div class='c000'>BY</div> - <div class='c000'><span class='large'>DR. ARNOLD LORAND</span></div> - <div class='c000'><i>Physician to the Baths, Carlsbad, Austria, etc., etc.</i></div> - </div> -</div> - -<p class='c010'>Translated from the Original German Edition, with an Introduction by -<span class='sc'>Victor C. Vaughan</span>, 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 -“<span class='sc'>Old Age Deferred</span>”). $3.00, net.</p> - -<div class='nf-center-c0'> - <div class='nf-center'> - <div>SYNOPSIS OF CONTENTS:</div> - </div> -</div> - -<p class='c010'>Introduction, with remarks upon the importance of the Appetite and -the Object of the Processes of Nourishment.</p> -<div class='lg-container-l c033'> - <div class='linegroup'> - <div class='group'> - <div class='line'>I. The Influence of Food Upon Man.</div> - </div> - <div class='group'> - <div class='line'>II. The Fundamental Laws of Rational Feeding.</div> - </div> - <div class='group'> - <div class='line'>III. The Injurious Modes of Feeding.</div> - </div> - <div class='group'> - <div class='line'>IV. The Good and Evil Effects of Various Food Substances.</div> - <div class='line'>Meat Diet. Fish Diet. Milk Diet. Cereals. Green Vegetables.</div> - <div class='line'>Fruit Diet. Beverages.</div> - </div> - <div class='group'> - <div class='line'>V. Vegetarianism and its Advantages and Disadvantages. Hints for</div> - <div class='line'>the Prevention of the Latter.</div> - </div> - <div class='group'> - <div class='line'>VI. The Practical Advantages of Rational Feeding. Useful Hints.</div> - </div> - <div class='group'> - <div class='line'>VII. Hints for Those Obliged to Take their Meals in Restaurants.</div> - <div class='line'>The Injurious Effects of the “Table d’Hôte” Diet.</div> - </div> - <div class='group'> - <div class='line'>VIII. The Increased Activity of Certain Functions Brought About</div> - <div class='line'>by Food.</div> - </div> - <div class='group'> - <div class='line'>IX. The Increased Muscular Power Resulting from a Suitable Diet.</div> - </div> - <div class='group'> - <div class='line'>X. Conclusion. The Relationship of Food to Old Age and Longevity.</div> - <div class='line'>Glossary. List of Diseases. Index.</div> - </div> - </div> -</div> - -<hr class='c034' /> - -<p class='c010'>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.</p> - -<hr class='c032' /> -<p class='c010'><span class='small'><span class='sc'>Journal of the American Medical Association</span> (Chicago, Ill.).</span></p> - -<p class='c010'><span class='small'>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.</span></p> -<div class='pbb'> - <hr class='pb c003' /> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='pageno' id='Page_495'>495</span><span class='xlarge'>Consumption: How to Prevent It and How to Live With It</span></div> - <div>ITS NATURE, CAUSES, PREVENTION, MODE OF LIFE, CLIMATE,</div> - <div>EXERCISE, FOOD, AND CLOTHING NECESSARY FOR</div> - <div>ITS CURE.</div> - <div class='c000'><span class='large'>By N. S. DAVIS, A.M., M.D.</span></div> - <div class='c000'>Second Revised Edition. 12mo. 172 pages. Extra Cloth. $1.00, net.</div> - </div> -</div> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c010'><span class='small'><span class='sc'>New Orleans Medical and Surgical Journal.</span></span></p> - -<p class='c010'><span class='small'>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.</span></p> -<hr class='c034' /> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='xlarge'>Safeguarding the Special Senses</span></div> - <div class='c000'>GENERAL ADVICE REGARDING THE USE AND PRESERVATION</div> - <div>OF THE EYES, EARS, NOSE AND THROAT.</div> - <div class='c000'>BY</div> - <div class='c000'><span class='large'>HENRY O. REIK, M.D.</span></div> - <div class='c000'>Illustrated with 4 Full-page Plates, 2 in Colors. 12mo. 123 pages.</div> - <div class='c000'>Attractively Bound in Cloth, 75 cents, net.</div> - </div> -</div> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<p class='c009'><span class='small'><span class='sc'>The Boston Medical and Surgical Journal.</span></span></p> - -<p class='c010'><span class='small'>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.</span></p> -<div class='pbb'> - <hr class='pb c003' /> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='pageno' id='Page_496'>496</span><span class='xlarge'>Health and Beauty</span></div> - <div class='c000'>BY</div> - <div class='c000'>JOHN V. SHOEMAKER, M.D., LL.D.</div> - <div class='c000'>Royal Octavo. 475 pages. Extra Cloth. Bevelled Boards. Price, $1.50, net.</div> - </div> -</div> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div>SYNOPSIS OF CONTENTS:</div> - </div> -</div> - -<div class='lg-container-l c033'> - <div class='linegroup'> - <div class='group'> - <div class='line'>I. The Skin and Complexion.</div> - <div class='line'>II. The Appendages of the Skin.</div> - <div class='line'>III. The Usefulness of the Skin and of the Hair.</div> - <div class='line'>IV. The Complexion.</div> - <div class='line'>V. The Elements of Beauty and Grace.</div> - <div class='line'>VI. World Influence of Woman’s Charms.</div> - <div class='line'>VII. Expression, Sexual Attraction, Wedlock.</div> - <div class='line'>VIII. How to Cultivate and Preserve a Good Complexion.</div> - <div class='line'>IX. The Bath.</div> - <div class='line'>X. Digestion and Indigestion.</div> - <div class='line'>XI. Education of the Body.</div> - <div class='line'>XII. Cultivation of the Mind.</div> - <div class='line'>XIII. Clothing and Dress.</div> - <div class='line'>XIV. The Influence of Climate Upon Health.</div> - <div class='line'>XV. Ventilation.</div> - <div class='line'>XVI. Disfigurement from Disease, with Some Treatment of it.</div> - <div class='line'>XVII. Eruptive Fevers.</div> - <div class='line'>XVIII. The Hair, its Fashions and its Diseases.</div> - <div class='line'>XIX. The Nails and Their Diseases.</div> - <div class='line'>XX. Cosmetic Preparations. Index.</div> - </div> - </div> -</div> - -<div class='pbb'> - <hr class='pb c003' /> -</div> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='pageno' id='Page_497'>497</span><span class='xlarge'>Confessions of a Neurasthenic</span></div> - <div class='c000'>BY</div> - <div class='c000'><span class='large'>WILLIAM TAYLOR MARRS, M.D.</span></div> - <div class='c000'>Eight Illustrations. 116 pages. Bound in Handsome Cloth. Price, $1.00.</div> - </div> -</div> - -<p class='c010'>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.</p> - -<p class='c010'>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.</p> -<hr class='c034' /> - -<div class='nf-center-c0'> -<div class='nf-center c003'> - <div><span class='xlarge'>The Practical Care of the Baby And Young Child</span></div> - <div class='c000'>BY</div> - <div class='c000'><span class='large'>THERON WENDELL KILMER, M.D.</span></div> - <div class='c000'><i>Lecturer on Pediatrics in New York Polyclinic Medical School and Hospital;</i></div> - <div><i>Attending Pediatrist, St. Bartholomew’s Clinic; Consulting Pediatrist,</i></div> - <div><i>Home of St. Giles, Garden City, New York, etc.</i></div> - <div class='c000'>With 68 Illustrations. Second Revised Edition. 158 pages.</div> - <div>12mo. Cloth, 75 cents, net.</div> - </div> -</div> - -<p class='c010'>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.</p> - -<p class='c010'>Kilmer’s “Care of the Baby” is a thoroughly safe counsellor in -the family, the clear text and numerous fine illustrations fulfilling -every requirement.</p> -<div class='pbb'> - <hr class='pb c003' /> -</div> -<p class='c010'> </p> -<div class='tnbox'> - - <ul class='ul_1 c003'> - <li>Transcriber’s Notes: - <ul class='ul_2'> - <li>Missing or obscured punctuation was silently corrected. - </li> - <li>Typographical errors were silently corrected. - </li> - <li>Inconsistent spelling and hyphenation were made consistent only when a predominant - form was found in this book. - </li> - </ul> - </li> - </ul> - -</div> -<p class='c010'> </p> - -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK OLD AGE DEFERRED ***</div> -<div style='display:block; margin:1em 0'>This file should be named 64237-h.htm or 64237-h.zip</div> -<div style='display:block; margin:1em 0'>This and all associated files of various formats will be found in https://www.gutenberg.org/6/4/2/3/64237/</div> -<div style='display:block; margin:1em 0'> -Updated editions will replace the previous one—the old editions will -be renamed. -</div> - -<div style='display:block; margin:1em 0'> -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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