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<div>*** START OF THE PROJECT GUTENBERG EBOOK 64237 ***</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'>&nbsp;</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'>&nbsp;</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>&nbsp;</td></tr>
  <tr>
    <td class='c012'><span class='sc'>Glossary</span></td>
    <td class='c013'><a href='#glo'>459</a></td>
  </tr>
  <tr><td>&nbsp;</td></tr>
  <tr>
    <td class='c012'><span class='sc'>Index</span></td>
    <td class='c013'><a href='#idx'>467</a></td>
  </tr>
  <tr><td>&nbsp;</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'>&nbsp;</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'>&nbsp;</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'>&nbsp;</td>
 <td class='blt c022'>&nbsp;</td>
 <td class='blt c022'>&nbsp;</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'>&nbsp;</td>
 <td class='blt c022'>&nbsp;</td>
 <td class='blt c022'>&nbsp;</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'>&nbsp;</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'>&nbsp;</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'>&nbsp;</td>
 <td class='blt c022'>&nbsp;</td>
 <td class='blt c022'>&nbsp;</td>
 <td class='blt c022'>Nitrogen</td>
 <td class='blm c022'>&nbsp;</td>
 <td class='blt c022'>&nbsp;</td>
 <td class='blt c022'>&nbsp;</td>
 <td class='blt c022'>&nbsp;</td>
  </tr>
  <tr>
    <td class='c022'>&nbsp;</td>
 <td class='blt c022'>Nitro-</td>
 <td class='blt c022'>&nbsp;</td>
 <td class='blt c022'>Free</td>
 <td class='blm c022'>&nbsp;</td>
 <td class='blt c022'>Nitro-</td>
 <td class='blt c022'>&nbsp;</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'>&nbsp;</td>
 <td class='bbt blt c022'>Substance</td>
 <td class='bbt blt c022'>&nbsp;</td>
 <td class='bbt blt c022'>Matters</td>
 <td class='bbt blm c022'>&nbsp;</td>
 <td class='bbt blt c022'>Substance</td>
 <td class='bbt blt c022'>&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Over Myxœdemet, Kjöbenhavn, 1895.</p>
</div>
<div class='footnote c030' id='f5'>
<p class='c031'><span class='label'><a href='#r5'>5</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>La Semaine Médicale, 1905.</p>
</div>
<div class='footnote c030' id='f18'>
<p class='c031'><span class='label'><a href='#r18'>18</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>H. Strauss, Senator: Festschrift.</p>
</div>
<div class='footnote c030' id='f25'>
<p class='c031'><span class='label'><a href='#r25'>25</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Lancet, Feb. 11, 1905.</p>
</div>
<div class='footnote c030' id='f29'>
<p class='c031'><span class='label'><a href='#r29'>29</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Les Médications thyroidiennes, 1902.</p>
</div>
<div class='footnote c030' id='f35'>
<p class='c031'><span class='label'><a href='#r35'>35</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Ziegler’s Beiträge, 1903.</p>
</div>
<div class='footnote c030' id='f42'>
<p class='c031'><span class='label'><a href='#r42'>42</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Bayon: Würzburger Abhandlungen, 1904.</p>
</div>
<div class='footnote c030' id='f62'>
<p class='c031'><span class='label'><a href='#r62'>62</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Thèse de Paris, 1907.</p>
</div>
<div class='footnote c030' id='f76'>
<p class='c031'><span class='label'><a href='#r76'>76</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Quoted after Loisel.</p>
</div>
<div class='footnote c030' id='f81'>
<p class='c031'><span class='label'><a href='#r81'>81</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Richter: Organotherapie.</p>
</div>
<div class='footnote c030' id='f85'>
<p class='c031'><span class='label'><a href='#r85'>85</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Quoted after Kisch.</p>
</div>
<div class='footnote c030' id='f102'>
<p class='c031'><span class='label'><a href='#r102'>102</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Philosoph. Transactions, xxv., 1706.</p>
</div>
<div class='footnote c030' id='f107'>
<p class='c031'><span class='label'><a href='#r107'>107</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Eckermann: Quoted after Metschnikoff.</p>
</div>
<div class='footnote c030' id='f110'>
<p class='c031'><span class='label'><a href='#r110'>110</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Quoted from Professor Kisch.</p>
</div>
<div class='footnote c030' id='f112'>
<p class='c031'><span class='label'><a href='#r112'>112</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Quoted after Professor Pel.</p>
</div>
<div class='footnote c030' id='f119'>
<p class='c031'><span class='label'><a href='#r119'>119</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Second edition, Berline, 1909.</p>
</div>
<div class='footnote c030' id='f132'>
<p class='c031'><span class='label'><a href='#r132'>132</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Traité de Physiologie.</p>
</div>
<div class='footnote c030' id='f137'>
<p class='c031'><span class='label'><a href='#r137'>137</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Over Myxœdemet, Kjöbenhavn, 1895.</p>
</div>
<div class='footnote c030' id='f139'>
<p class='c031'><span class='label'><a href='#r139'>139</a>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f140'>
<p class='c031'><span class='label'><a href='#r140'>140</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f152'>
<p class='c031'><span class='label'><a href='#r152'>152</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f159'>
<p class='c031'><span class='label'><a href='#r159'>159</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Quoted after Professor Kisch.</p>
</div>
<div class='footnote c030' id='f163'>
<p class='c031'><span class='label'><a href='#r163'>163</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Quoted after Professor Pflüger.</p>
</div>
<div class='footnote c030' id='f165'>
<p class='c031'><span class='label'><a href='#r165'>165</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Thèse de Paris, 1887.</p>
</div>
<div class='footnote c030' id='f175'>
<p class='c031'><span class='label'><a href='#r175'>175</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Quoted after Metschnikoff.</p>
</div>
<div class='footnote c030' id='f180'>
<p class='c031'><span class='label'><a href='#r180'>180</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>“Die Arteriosclerose,” Leipzig, 1898.</p>
</div>
<div class='footnote c030' id='f208'>
<p class='c031'><span class='label'><a href='#r208'>208</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Achard: Presse méd., 1901.</p>
</div>
<div class='footnote c030' id='f228'>
<p class='c031'><span class='label'><a href='#r228'>228</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Duclaux: Revue Scient., 1887.</p>
</div>
<div class='footnote c030' id='f243'>
<p class='c031'><span class='label'><a href='#r243'>243</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Hufeland: “Makrobiotik,” p. 129.</p>
</div>
<div class='footnote c030' id='f251'>
<p class='c031'><span class='label'><a href='#r251'>251</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f253'>
<p class='c031'><span class='label'><a href='#r253'>253</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f263'>
<p class='c031'><span class='label'><a href='#r263'>263</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Forsyth: Lancet, 1907.</p>
</div>
<div class='footnote c030' id='f277'>
<p class='c031'><span class='label'><a href='#r277'>277</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Quoted after Humphrey.</p>
</div>
<div class='footnote c030' id='f290'>
<p class='c031'><span class='label'><a href='#r290'>290</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Semaine Médicale, 1905.</p>
</div>
<div class='footnote c030' id='f319'>
<p class='c031'><span class='label'><a href='#r319'>319</a>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f320'>
<p class='c031'><span class='label'><a href='#r320'>320</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Quoted after Bunge.</p>
</div>
<div class='footnote c030' id='f328'>
<p class='c031'><span class='label'><a href='#r328'>328</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f330'>
<p class='c031'><span class='label'><a href='#r330'>330</a>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f331'>
<p class='c031'><span class='label'><a href='#r331'>331</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f335'>
<p class='c031'><span class='label'><a href='#r335'>335</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f360'>
<p class='c031'><span class='label'><a href='#r360'>360</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>Sajous: “Internal Secretions.”</p>
</div>
<div class='footnote c030' id='f370'>
<p class='c031'><span class='label'><a href='#r370'>370</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span>L’opothérapie, Paris, 1898.</p>
</div>
<div class='footnote c030' id='f375'>
<p class='c031'><span class='label'><a href='#r375'>375</a>.&nbsp;&nbsp;</span>Wratch, No. 27, 1899.</p>
</div>
<div class='footnote c030' id='f376'>
<p class='c031'><span class='label'><a href='#r376'>376</a>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</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>.&nbsp;&nbsp;</span><i>Loc. cit.</i></p>
</div>
<div class='footnote c030' id='f383'>
<p class='c031'><span class='label'><a href='#r383'>383</a>.&nbsp;&nbsp;</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'>&nbsp;</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'>&nbsp;</p>

<div>*** END OF THE PROJECT GUTENBERG EBOOK 64237 ***</div>
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