Old Age Deferred

 THE CAUSES OF OLD AGE AND ITS POSTPONEMENT BY HYGIENIC AND THERAPEUTIC
                                MEASURES



                                                       Man does not die,
                                                       he kills himself.
                                                       —Seneca


                                   BY
                         _ARNOLD LORAND, M.D._




                            _FIFTH EDITION_

               Translated, with additions, by the Author
                     from the Third German Edition





                            Publisher’s Logo




                              PHILADELPHIA
                    F. A. DAVIS COMPANY, PUBLISHERS
                                  1920


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                            COPYRIGHT, 1910
                            COPYRIGHT, 1916
                                   BY
                          F. A. DAVIS COMPANY
                                  ───
             Copyright, Great Britain. All Rights Reserved
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REPRINTED: February, April, October, 1911; May, November, 1912; May,
1913; February, 1914; January, June, November, 1915; March, September,
1916; February 1917; February, June, September, 1920.



                                                    ───────────
                                                    PRESS OF
                                                    F. A. DAVIS COMPANY
                                                    PHILADELPHIA, U.S.A.
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                    PREFACE TO NEW REVISED EDITION.


THE sudden and premature deaths in recent years of numerous prominent
people, through arteriosclerosis, impressed me strongly that these
persons might be still alive if they had been better informed of
hygienic living. This gave me the idea of preparing a special section in
this new edition, dealing with the prevention of this high mortality
from arteriosclerosis and also with the prevention and treatment of high
blood-pressure. At the same time, I am availing myself of this
opportunity with an endeavor to augment, so far as possible, the general
purpose of this book, which is to fight old age by all means that are at
our disposal. I am also adding a few suggestions on the treatment of old
looks.

                                                      DR. ARNOLD LORAND.


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                                PREFACE.
                                   ──


WHOEVER takes up this book with the idea that the aged can be
transformed into sprightly adolescents will be disappointed. A work
based entirely on evidence of a scientific nature, as is the present
volume, cannot have such an end in view, since it is altogether
unattainable—at least with what knowledge is now available.

But while it is still impossible for us to create a young man out of an
old one, it is quite within the bounds of possibility, as we shall
endeavor to demonstrate herein, to prolong our term of youthfulness by
ten or twenty years. In other words we need no longer grow old at forty
or fifty; we may live to the age of ninety or one hundred years, instead
of dying at sixty or seventy. All this can be brought about by the
observance of certain hygienic measures, and by improving the functions
of a certain few of the glandular structures in our body, provided
incurable organic disorders have not already too gravely compromised one
or more of our main organs.

In a communication to the Paris Biological Society, presented in our
name by Dr. Gley, Professor of Physiology at the University of Paris,
and in an address delivered before the Brussels Royal Society of Medical
and Natural Sciences, we described old age as a chronic disease due to
degeneration of the glands with internal secretions (hereinafter
frequently referred to as the ductless glands), of the thyroid, the
sexual glands, and the adrenals in particular. In this work we will show
that this degeneration is amenable to treatment, just as are chronic
diseases in general.

The facts herein presented are illustrated and sustained by numerous
experimental and clinical observations. Being desirous of proving the
correctness of all our statements, we have had to enter, sometimes very
fully, into the question of the ductless glands, in order to point out
the marvelous influence they exert upon the various vital functions.

In view of the fact that the ductless glands have already been treated
in a very elaborate and exhaustive manner by a well-known American
author, Professor C. E. de M. Sajous, of Philadelphia, in his work on
the “Internal Secretions” (2 volumes) which introduces many new thoughts
and important discoveries, we have paid particular attention to the
thyroid and sexual glands, which we have carefully studied anatomically,
histologically, experimentally and clinically.

Not being a native of, or even resident in, either America or England,
though possessed of a fair knowledge of the English language—having
delivered addresses in several universities, and before numerous medical
societies in the United States, Canada, England, and Scotland—it was
very difficult for us to avoid idiomatic errors. We take great pleasure
in acknowledging, therefore, our indebtedness to our friend, Col. Frank
Haddan, of London, who, being impressed with the importance of our
subject and its humanitarian aspect, kindly volunteered to look through
our manuscript and correct most of our errors of style and grammar,
thereby rendering us valuable assistance. Our thanks are also due to Dr.
Leo Rosenthal, of New York, for the adjustment of many technical
sentences.

Every one will admit that the subject treated in this work is not an
easy one. It might be urged also that its presentation here is based on
entirely novel lines, scientific literature on old age being very
scarce.

Considering also that it has been necessary for us to take up questions
beyond the ordinary sphere of a medical practitioner, sometimes of a
philosophical, technical and physical nature, it is to be expected that
certain imperfections will be found. But, whatever may be the opinion of
the reader, he will not deny that none should fail to derive some
benefit from the numerous hints we have given for the preservation of
health and prolongation of life. If by reason of our advice we succeed
in saving but a single human life from a premature grave, our aim will
have been attained.


                                                      DR. ARNOLD LORAND.


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                               CONTENTS.
                                  ───


                               CHAPTER I.

                                                            PAGE

       ON THE APPEARANCE OF SYMPTOMS OF OLD AGE IN YOUNG       1
         PERSONS


                              CHAPTER II.

       ON THE AGENCIES WHICH GOVERN OUR EXTERNAL              11
         APPEARANCE AND THE NUTRITION OF THE TISSUES


                              CHAPTER III.

       ON THE AGENCIES WHICH GOVERN IMMUNITY AGAINST          21
         INFECTIONS AND INTOXICATIONS—THE ORIGIN OF FEVER


                              CHAPTER IV.

       ON THE AGENCIES THAT GOVERN THE CONDITION OF THE       35
         NERVOUS SYSTEM AND MENTALITY


                               CHAPTER V.

       ON THE INFLUENCE OF THE SEXUAL GLANDS UPON             45
         VITALITY AND LONG LIFE


                              CHAPTER VI.

       ON HEREDITY AND LONGEVITY                              55


                              CHAPTER VII.

       ON MEANS WHICH CAN HELP US TO DETERMINE THE            64
         PROBABLE DURATION OF LIFE


                             CHAPTER VIII.

       ON THE CAUSATION OF OLD AGE                            90


                              CHAPTER IX.

       THE RATIONAL PREVENTION OF PREMATURE OLD AGE AND      114
         THE TREATMENT OF OLD AGE


                               CHAPTER X.

       THE DESTRUCTION AND ELIMINATION OF TOXIC PRODUCTS     134
         FROM THE BODY AND HYGIENIC MEASURES FOR THE
         IMPROVEMENT OF THESE FUNCTIONS


                              CHAPTER XI.

       ON THE DESTRUCTION OF POISONOUS PRODUCTS THROUGH      138
         THE THYROID AND PARATHYROID GLANDS


                              CHAPTER XII.

       HYGIENE OF THE THYROID GLAND                          145


                             CHAPTER XIII.

       THE DESTRUCTION OF TOXIC PRODUCTS BY THE LIVER AND    149
         THE IMPROVEMENT OF ITS PROTECTIVE FUNCTIONS


                              CHAPTER XIV.

       THE HYGIENE OF THE LIVER                              155


                              CHAPTER XV.

       ON THE DESTRUCTION OF TOXIC PRODUCTS BY THE           159
         ADRENALS


                              CHAPTER XVI.

       HYGIENE OF THE ADRENALS AND OF THE CIRCULATORY        164
         SYSTEM—A FEW REMARKS ON THE CAUSE, PREVENTION,
         AND TREATMENT OF ARTERIOSCLEROSIS


                             CHAPTER XVII.

       THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE         170
         INTESTINES AND THE IMPROVEMENT OF THIS FUNCTION


                             CHAPTER XVIII.

       ON THE PREVENTION AND TREATMENT OF HABITUAL           175
         CONSTIPATION


                              CHAPTER XIX.

       HYGIENE OF THE INTESTINES                             182


                              CHAPTER XX.

       HYGIENE OF THE INTESTINES—A FEW REMARKS ON THE        192
         CAUSE AND PREVENTION OF APPENDICITIS


                              CHAPTER XXI.

       ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE      197
         KIDNEYS


                             CHAPTER XXII.

       HYGIENE OF THE KIDNEYS, AND THE PREVENTION OF         203
         RENAL DISEASE


                             CHAPTER XXIII.

       ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE      209
         SKIN


                             CHAPTER XXIV.

       THE HYGIENE OF THE SKIN—AIR BATHS                     215


                              CHAPTER XXV.

       ON RATIONAL CLOTHING                                  219


                             CHAPTER XXVI.

       IMPROVED HYGIENE OF THE SKIN AND KIDNEYS THROUGH      231
         BATHING—FOOT-BATHS


                             CHAPTER XXVII.

       HYGIENE OF THE SKIN AND KIDNEYS BY MEANS OF           237
         PERSPIRATION


                            CHAPTER XXVIII.

       ON EXERCISE, SWEDISH GYMNASTICS—MASSAGE—SPORT, AND    244
         WALKING AND RUNNING EXERCISE


                             CHAPTER XXIX.

       A FEW REMARKS ON COLD FEET—THEIR CAUSE AND            252
         TREATMENT


                              CHAPTER XXX.

       ON THE BENEFITS OF SUNLIGHT                           255


                             CHAPTER XXXI.

       ON THE ADVANTAGES OF AN OPEN AIR LIFE AND OF          262
         BREATHING EXERCISES


                             CHAPTER XXXII.

       ON THE DANGERS OF LIVING IN CONFINED AND              271
         ILL-VENTILATED QUARTERS


                            CHAPTER XXXIII.

       HYGIENE OF ARTIFICIAL HEATING—THE DANGERS OF HEAT     275
         BY STEAM AND A FEW HINTS ABOUT THEIR PREVENTION


                             CHAPTER XXXIV.

       FOOD HYGIENE—GENERAL REMARKS                          280


                             CHAPTER XXXV.

       ON PROTEID FOOD, ANIMAL FOOD, MEAT, FISH, EGGS,       294
         MILK, ETC.


                             CHAPTER XXXVI.

       ON CARBOHYDRATES AND FATS, AND THE GREAT              301
         ADVANTAGES OF VEGETABLES AND FRUIT


                            CHAPTER XXXVII.

       ON THE ADVANTAGES AND DISADVANTAGES OF A              309
         VEGETARIAN DIET


                            CHAPTER XXXVIII.

       ON THE DANGERS OF A TOO ABUNDANT MEAT DIET—A FEW      317
         HINTS ON THE DIETETICS OF MEAT


                             CHAPTER XXXIX.

       ON THE GREAT ADVANTAGES OF MUCH MILK IN THE DIET      325
         FOR THE PREVENTION AND TREATMENT OF OLD AGE


                              CHAPTER XL.

       ON BLOOD AS AN ARTICLE OF FOOD CONTAINING IRON AND    333
         ANIMAL EXTRACTS—SAUSAGES AND BLOOD PUDDINGS


                              CHAPTER XLI.

       SOME REMARKS ON THE HYGIENE OF EATING—HOW TO          339
         OBTAIN AN APPETITE—ON MASTICATION


                             CHAPTER XLII.

       ON THE USES OF SMALL DOSES, AND THE DELETERIOUS       347
         ACTION OF LARGE QUANTITIES OF ALCOHOL


                             CHAPTER XLIII.

       SOME REMARKS ON THE CAUSES AND PREVENTION OF THE      356
         ALCOHOL HABIT


                             CHAPTER XLIV.

       ON OTHER STIMULANTS—TEA, COFFEE, COCOA, TOBACCO:      362
         THEIR MERITS AND DISADVANTAGES


                              CHAPTER XLV.

       ON SLEEP, AND ITS IMPORTANCE IN RIDDING THE BODY      368
         OF TOXIC PRODUCTS


                             CHAPTER XLVI.

       ON THE CAUSATION OF SLEEP, SLEEPINESS, AND            372
         INSOMNIA


                             CHAPTER XLVII.

       HYGIENE OF SLEEP—PREVENTION OF INSOMNIA               377


                            CHAPTER XLVIII.

       THE TREATMENT OF SLEEPINESS AND INSOMNIA              383


                             CHAPTER XLIX.

       HYGIENE OF THE SEXUAL GLANDS—THE DANGERS OF SEXUAL    389
         OVERACTIVITY AND OF TOTAL SEXUAL ABSTINENCE


                               CHAPTER L.

       ON MARRIED LIFE AS AN IMPORTANT MEANS FOR             400
         PROLONGING LIFE


                              CHAPTER LI.

       HYGIENE OF THE MIND—EMOTIONS AND WORRY AS CAUSES      404
         OF OLD AGE


                              CHAPTER LII.

       HYGIENE OF THE MIND—RELIGIOUS BELIEF AS A MEANS OF    414
         PROLONGING LIFE


                             CHAPTER LIII.

       DISEASE CONSIDERED AS A SELF-DEFENCE OF NATURE        419


                              CHAPTER LIV.

       HYGIENE OF THE MIND—ADVICE TO BRAIN WORKERS           423


                              CHAPTER LV.

       ON THE PREVENTION OF PREMATURE OLD AGE, AND THE       426
         TREATMENT OF OLD AGE, THROUGH CERTAIN DRUGS:
         ARSENIC, IRON, AND IODIDES


                              CHAPTER LVI.

       ON THE PREVENTION OF PREMATURE OLD AGE AND ON THE     434
         TREATMENT OF OLD AGE BY ANIMAL EXTRACTS


                             CHAPTER LVII.

       A FEW HINTS ON YOUTHFUL APPEARANCE                    449


                             CHAPTER LVIII.

       THE “TWELVE COMMANDMENTS” FOR THE PRESERVATION OF     455
         YOUTH, AND THE ATTAINMENT OF A GREEN OLD AGE

       GLOSSARY                                              459

       INDEX                                                 467


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                          SPECIAL ANNOUNCEMENT

                 TO THE READERS OF “OLD AGE DEFERRED.”


WE have just recently received the manuscript for the following
introductory pages, which are intended as a message direct to the
American people by Dr. Lorand. Their importance justifies a careful
reading.

Although, in accordance with his duty as a citizen of Austria, Dr.
Lorand has had to practically abandon his private practice, and devote
his energies and his abilities to the service of his country in the time
of trial, he has, nevertheless, been so situated as to have a pretty
intimate knowledge of American affairs. He has been especially grieved
and shocked to learn of so many sudden, untimely, and in his judgment,
unnecessary deaths among prominent Americans since the great war began.
Counting as he did, a great number of friends, not only among American
physicians, but among American tourists, and knowing, as he does, so
intimately, the peculiar physical characteristics of the high-grade
American citizen, he is appalled at the wastage of valuable lives in a
country teeming with prosperity and incidental home comforts.

The following introduction is designed as a warning to high-pressure
Americans that by a little care and the exercise of reasonable judgment
a large number of these premature deaths may be prevented.

Even if you were to read no further, the careful perusal of this
introduction is well worth while, as it deals directly with the most
important personal problems.

                                                         THE PUBLISHERS.


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                          PREMATURE OLD LOOKS:

                    THEIR PREVENTION AND TREATMENT.

                                  ────


IN the previous editions of this book I have attributed premature old
age to the degeneration of certain glands of our body, such as the
thyroid gland and the ovaries. It is my intention now to show, that
precocious old looks can often be caused by certain faulty habits; thus
for instance by not drinking daily a sufficient amount of liquids. There
are many women, who be it by an unjustified fear of obesity, or for
other reasons, scarcely drink any liquids except possibly a cup of tea
or coffee for breakfast. They neither drink with their meals nor much at
other times. In such cases the tissues of the face will lack the
necessary amount of fluids to which is due, mainly, the roundness and
fullness of the cheeks which we so much admire in the fresh faces of
young girls and children. In consequence the face will appear lean and
haggard, the skin shrivelled and folded, and lines and wrinkles will
appear already in the faces of young women. Besides, as the sufficient
amount of fluids will be wanting, the toxic products formed daily in our
bodies is not washed out through those natural channels, the kidneys and
the intestines, but will take their way through the skin, and eruptions
and pimples will develop, much to the damage of the complexion. An
obstinate constipation will be another consequence, which, giving to the
skin of the face a dirty yellow-brown hue, naturally contributes to
produce an old appearance of the face. More and more, am I convinced
that a generous purging, as for instance by certain mineral waters, is a
most efficacious remedy to prevent old looks and at any rate to improve
them. Drugs as a general rule are far less wholesome and effective for
this purpose.

By not drinking sufficiently, such substances as, for example, uric
acid, cannot be washed out and their retention will cause a serious
damage to health, facilitating the origin of arteriosclerosis, which
very frequently is associated with such conditions. Persons suffering
from uric acid present frequently an older aspect than corresponds to
their years and the falling out of the hair, or the appearance of gray
hair, in early years, is often the case with them.

It is erroneous to think that water produces fatness. If this were the
case we would advise the poor people to drink plenty of water that costs
nothing, to get fat. It is not water that makes fat, but water that is
taken with the meals, together with copious food, thus aiding the
absorption and assimilation of the same. To avoid obesity after rich
food it is therefore advisable not to drink with the meals, but at other
times. Copious food must be avoided, especially fat, starchy food and
sweets. A diet consisting of plenty of meat, fats, and above all milk
and butter and sweets, is the surest road to obesity. They must be
avoided and the preference given to a diet of little meat, green
vegetables and fruits. For further details of such a diet I must refer
to the chapter, “The Treatment of Obesity,” in my book, “Health and
Longevity through Rational Diet,” publishers, F. A. Davis Co.,
Philadelphia. I must emphasize the necessity of great prudence in
reducing cures, for, as I know from my practice in Carlsbad, there is
scarcely anything, unless a serious disease, that can produce so rapidly
the appearance of age in young persons and the more in riper years, than
imprudent and reckless obesity cures, causing wrinkles and the hanging
and sunken cheeks.

I must certainly blame the eagerness of many ladies to transform their
fresh, round and elastic forms into lean and skinny ones, thinking that
thus they will look younger. No; I am certain that many young women look
considerably older after these atrocious and imprudent diet-cures.
Dieting is more permissible with older persons, if not exceeding certain
limits; but young women and girls I would strongly advise to eat hearty
meals of mixed food, for, as I also show in my above-mentioned book on
Diet, we are introducing in our systems very valuable substances, which
are in reality useful remedies with certain articles of food. Most
important among these are fresh milk (uncooked), numerous fruits,
certain kinds of animal food, which all contain considerable quantities
of important mineral salts, indispensable to our well-being, and to the
freshness and elasticity of mind and body. Besides these salts and
valuable ferments these articles of food contain also a most important
substance, called _vitamines_, which, as its name shows, conveys a kind
of vitality to the tissues. It is indispensable to the well-being of the
nervous system and also of the muscles, and thus also to the most
important muscle of the body, the heart. The vitamines are largely
represented in the outer coverings of the rice, of the corn, and also in
eggs, potatoes, etc. In fine white bread there is scarcely any, but
there is far more in the brown bread containing all parts of the grain.
Milk also contains them, but mainly fresh, uncooked milk; strong cooking
destroys the vitamines in the plants and the animal food, and besides
such cooking, as I show in the chapter on “Rational Cooking” of my book
on Rational Diet, also destroys other valuable ferments of great
importance for our body. It is certain that our looks, the beauty and
size of the human body and of animals, and even the color of the
feathers of the birds, depend very much, as I show in the same book, on
the wise selection of the food which we eat. Not only in young growing
persons, but also in the adult and even in aged persons.

Of the different faulty habits there is probably none that would produce
so rapidly the premature appearance of old age in young women as
smoking.


                    THE DANGERS OF SMOKING IN WOMEN.

If excessive smoking is deleterious to man, in the woman moderate
smoking may cause serious alterations. We must not forget that the
tissues of women are more delicate and tender than those of men, and
especially young women can in this respect be put in the same class with
children. The woman is not so well protected against the influence of
poisons such as nicotine as the man, for in her some of those glands
whose duty is to destroy such poisons, as, for instance, the thyroid,
are kept in much greater activity on account of the frequent changes in
the ovaries with each menstruation, pregnancy, the climacteric, etc.,
and with their consequent repercussion upon the thyroid gland, with
which the ovaries are closely related. If to this comes such extra work
by the daily introduction of poisonous substances, although even in
small quantities, the gland may the more readily lose its efficiency.
After my own observations which I made upon my patients in Carlsbad
coming from eastern countries in Europe, I know that smoking women
present a much older aspect, if they have indulged in this habit to a
large extent and for years. They soon fade, the cheeks are pale, as a
rule, and sunk in. The general nutrition suffers, there is loss of
appetite, frequently a catarrh of the stomach and very often pains in
the stomach; indeed there is often neurasthenia with sleeplessness. With
more excessive smoking there will appear all the symptoms which are
common to the chronic nicotine poisoning of men.

I am not prepared to maintain that, _after the dinner_, a cigarette or
sometimes two are dangerous to adult women. The aspect of a lady smoking
a cigarette after dinner surely cannot be called attractive, and it
certainly does hurt the æsthetic feelings of a normal man to see a woman
smoking one big cigar after another. It looks too masculine in a woman,
as I have observed in a ladies’ club in Copenhagen, where most of the
women sat with big cigars in their mouths. Such habits take away all
charm even from the finest looking women, and as a normal woman is
attracted by all that is manly in man and is repelled by an effeminate
man, we men dislike masculine women, just as we dislike a woman having a
mustache and whiskers. If I were a married man, I know I would not like
to kiss my wife if she strongly smelled of tobacco, just as it would be
repulsive to kiss a man; the smell of strong tobacco creating
involuntarily the sensation of associating with a man. Until recently
women have presented far less frequently the symptoms of
arteriosclerosis than men, excessive smoking being rare with them. But
as the effects of smoking are more deleterious to them, naturally
arteriosclerosis will arise much sooner in them, and as through the
hardening of the arteries the nutrition of the tissues suffer, the
nourishing blood not rendering them in sufficient amount—necessarily
such persons will begin to look old at a comparatively early period of
life.


          A FEW COSMETIC HINTS FOR THE REMEDYING OF OLD LOOKS.

In the previous editions of this book I have shown that it is possible
to improve old looks through hygienic measures, the use of the extracts
of certain glands, like the thyroid and ovaries and also by the
employment of certain drugs like arsenic and the preparations of iodine.
I would like to add now a few cosmetic hints against old looks some of
which I had already published a few years ago, as a collaborator to the
handbook of cosmetics of the dermatologist, Prof. M. Joseph, of Berlin
(M. Joseph, Handbuch der Kosmetik, Leipzig, 1912).

In persons of certain age and also in younger persons with a fading
expression of the face and beginning wrinkles I have found, as
efficacious in producing an immediate improvement, the gentle
application to the face of any kind of fats of pure quality and the
rubbing thereon of some reliable preparation of white powder. The powder
should afterward be wiped off very carefully. It should not be put on in
thick layers, for then, as after the use of pastes and paints in
general, lines may be created where they are not yet present and lines
already existing may be hollowed out to veritable wrinkles. No powder
should be visible on the face. The object is to add to faces with dry
skin the best variety of fat with reference to its animal origin so as
to make up for the wanting secretion of the sebaceous glands and to
replace, if possible to a certain extent, the fat wanting in the
tissues. All kinds of massaging of the skin should be avoided; only a
gentle rubbing is allowed. In fact, I consider massage as deleterious to
the face, except it is done by a qualified masseur who is an expert in
this kind of massage with a correct anatomical knowledge of the muscles
of the face and of the direction they are running. Special care must be
taken that the massage of the face should never be done with fats, as
this would promote the formation of lines and wrinkles and even of deep
ones, if done unskillfully. The massage of the face should consist in
gentle strokings of the face with the end of the fingers and always
following the direction of the muscles.

The powders used should be of the best possible quality. Before all they
should not contain any metallic salts and especially not lead. Unhappily
some of the very best powders are prepared with it, as lead gives to the
powders a specially white and attractive aspect. But I should like to
bring home to the ladies the fact, that these powders are the most apt,
especially in persons who perspire easily, to create lines and wrinkles
and to give to young faces in a short time an old appearance.

The best powders I consider those which consist of fine rice-powder,
amylum, or talcum, and they produce the best effect, if they are not
visible on the face. I have often seen the finest complexions ruined by
the frequent usage of thick powders, pastes, and paints. The
above-mentioned procedure of rubbing in fats and thereupon some of the
finest hygienic powders should only be done every other day. To give to
fading faces a certain tonicity I recommend the use of alcohol, diluted
with three times as much water, which, in the same manner as diluted
vinegar, will also improve the complexion. I have found that a very
strongly diluted solution of the extract of the suprarenal glands has
also a marked effect in toning up the muscles of the face, if rubbed in
gently. Only small quantities of the diluted solution should be used for
this purpose.

As gray hairs create, even in persons still young, an elderly
appearance, it might appear to their advantage to color them. It is best
to use such coloring only in regions of small extent rather than in a
general way. As the most inoffensive coloring of gray hair among dark
hair, I would consider the preparations containing nitrate of silver.
Those which contain lead or copper should be condemned.

After all the best weapon against old looks is a hygienic life by which
we can best avoid the development of a condition which already at an
early age gives an old aspect to the tissues, i.e., of arteriosclerosis,
or hardening of the arteries.


   RAPID AND EARLY DEATH THROUGH ARTERIOSCLEROSIS AND ITS PREVENTION.

For most arteriosclerotic persons there can be only little hope to live
up to a green old age, to become 80 or 90 years old or even to pass on
to still higher years. But there are exceptions not so very seldom, and
it gives comfort to my patients suffering from this disease and
apprehension of the future, when I tell them that nearly all the
brothers and sisters of both my parents suffered from this disease for
many years, which did not prevent them from attaining ages varying
between 80 and 96 years and more. My father ever after his forty-fifth
year suffered from attacks of asthma. As a child I was often awakened
through his nightly asthmas, but in spite of many symptoms of
arteriosclerosis he lived to a great age.

One of my aunts is still living, not very far from 100 years old,
although suffering in a high degree from arteriosclerosis for many
years. Such protracted cases generally happen in families of longevity
and they are only due to, as a rule, regular habits, although it is true
that my father was a great smoker in his younger years and even in his
last years enjoyed one or two light cigars daily.

Such long survivals constitute, however, a great exception in
arteriosclerosis, and it usually happens only in cases where there are
no symptoms of that most dreaded form of arteriosclerosis, i.e., the
sclerosis of the coronary arteries of the heart. These arteries are
probably the most important ones of our body, for they provide the
muscles of the heart with the nourishing blood without which they could
not do their work. It is the sclerosis—the hardening—of these arteries
which, causing an obstacle to the passage of the blood, is the most
frequent cause of rapid death in arteriosclerosis, often in
comparatively young people. It is a sad fact, that such a condition, as
so often is the case with arteriosclerosis, can exist without exhibiting
any marked symptoms of it being present. A very frequent symptom of
sclerosis of the coronary arteries is attacks of _genuine_ angina
pectoris (stenocardia),—to be distinguished from the pseudo-attacks of
angina pectoris of neurasthenic persons. In such attacks there are
strong radiating pains in the heart region, and a feeling of great
anxiety, of utter annihilation, and of instantaneous death; and indeed
not so seldom such attacks may terminate in death. These attacks may be
considered as a warning of nature that such persons stand on the verge
of a precipice and thus urging them to the greatest precautions to avoid
anything that may bring about such an attack. From my own observations,
rapidly fatal attacks of angina pectoris in such cases of
arteriosclerosis happen frequently after a heavy dinner. The stomach
being distended, the diaphragm is pushed upward and thus impeding the
movements of the heart, which has not sufficient space for the play of
its muscles. Such a condition may also be often caused by the ingestion
of dishes causing flatulence. In consequence heavy dinners and flatulent
foodstuffs must carefully be avoided, and I declare any person who
presents attacks of genuine angina pectoris as a determined suicide if
he continues to indulge in them. There should be taken 5 small meals a
day, so as to avoid the keen appetite which results in overloading the
stomach. Foodstuffs causing flatulence such as cabbage, fried potatoes,
etc., should, above all, be avoided. Food that is rich in cellulose
(wood fiber) is strictly forbidden in such cases. For further details on
food producing flatulence I must refer to my above-mentioned diet book,
which contains a special chapter on the best food in flatulency and also
a list on the amount of cellulose (wood fiber) in different articles of
food. For the treatment by drugs refer to the chapter of this book on
arteriosclerosis. Besides moderate habits, including the use of very
light cigars in the smallest possible quantity (if smoking cannot be
given up entirely), overexcitement of any kind, especially sexual, as
also overexertions (_hill climbing_), must strictly be avoided.
Transgression of these commands, especially hill climbing, may sometimes
mean instantaneous death in advanced cases. Persons suffering from
coronary sclerosis with attacks of angina pectoris will do very well to
give up their positions if heads of companies with great
responsibilities and heavy burdens resting upon their shoulders, as any
stormy shareholder meeting may prove fatal to them. As already said it
is a sad fact, that persons may suffer from coronary sclerosis without
even knowing it, as there are also thousands of victims of
arteriosclerosis who are utterly ignorant of their condition, as this
disease often presents no marked symptoms. I must deplore that most
stupid habit of seeking for medical aid only when the ravages of disease
have gone so far that reparation is impossible. How often do people
forget the wise English proverb: “An ounce of prevention is worth a
pound of cure.” Just the same as children are sent every three months to
the dentist to see if any of the teeth present may be decaying in order
to save them, people already before feeling ill ought to at least once a
year be examined thoroughly by a doctor to see if anything is wrong in
the human machinery. I feel certain that in such a case many thousands
of persons, instead of lying in their dark, cold graves below the earth,
could still tread the soil enjoying sunshine and the scent of the
flowers. There is no doubt that arteriosclerosis and especially coronary
sclerosis could be avoided in many cases, through such an examination,
for the onset of arteriosclerosis is generally insidious and slow,
especially if it develops in the younger years, when due to syphilis,
and thus, if in time recognized, it could be cured. But even without the
syphilitic infection, cases in young persons are more frequent than we
think.

It is to the present terrible war, raging and destroying so many lives,
that we owe the observation made by many of the military doctors that a
goodly number of young soldiers present symptoms of arteriosclerosis,
many of them having never suffered from syphilis. Often it is but a
slight elevation of the blood-pressure, but which, if persistent, may
indicate a beginning arteriosclerosis.


 THE PREVENTION AND TREATMENT OF HIGH BLOOD-PRESSURE AND THE PREVENTION
                              OF APOPLEXY.

Apoplexy is the consequence of a condition, which may be considered as
the highest degree of a scale whose lowest step is often a slight
elevation of the blood-pressure, when in a younger person. Thus, if
before the 45-70 year period the blood-pressure is somewhat elevated and
remains so for a certain length of time, we must, if there are no
special reasons for this elevation, for instance, kidney trouble, be
suspicious of arteriosclerosis. It is true, that there are cases of this
disease without a high blood-pressure, but if we find, besides
considerably elevated blood-pressure, traces of albumin in the urine and
also renal elements, a swelled liver and an accentuated second sound at
the aorta, there cannot be much doubt that we have probably to do with
arteriosclerosis. A high blood-pressure can most frequently be caused
through difficulties in the circulation of the kidneys; therefore in
each such case the urine must carefully be examined. By improving the
circulation through the kidneys we can also influence favorably the
blood-pressure. Certain drugs producing a great flow of urine have
indeed given good results in high blood-pressure, like, for instance,
diuretin in some cases. I am, however, averse to the use of drugs if
there are more natural remedies, and so I would advise the use of a
quite harmless one like the juice of lemons. It is very diuretic and, as
I have observed, there are also cases of chronic inflammatory conditions
of the kidneys which are very favorably influenced through a treatment
by lemons, in the same way as also gout and the uric acid ailments in
general. I have found that with lemon-juice given in mineral water we
obtain still better results if a little glycerin is added. Besides
lemon-juice the juice of certain other fruits like grape-fruit, oranges,
and grapes can also give good results. Besides a good diuresis, a
thorough cleaning of the intestines is desirable, high blood-pressure
often being caused by habitual constipation with stagnation of the
intestinal contents and subsequent flatulence. I must repeat with
emphasis again that daily bowel movements do not prove at all a clean
intestine following a good evacuation, and I am sure that the good
results obtained in the treatment of arteriosclerosis in certain spas,
like Carlsbad, Marienbad, and Kissingen, are not so much due to the
action of these waters upon arteriosclerosis, but simply to their
eminently purging action. Neither of these springs has a direct effect
upon arteriosclerosis, but besides the dietetic advantages of the
installation of these spas, the waters from their springs evacuate
thoroughly the intestines, ridding them of toxic products most
deleterious to the arteries, and at the same time facilitating in a
powerful way the circulation of the blood through the abdomen with its
most wholesome repercussion upon the whole general circulation. A
thorough intestinal evacuation can relieve a high blood-pressure nearly
the same way as an extensive venesection. A good perspiration can also
give good effects; however, to produce it there would be necessary to
take hot-water or air bath, which may prove most deleterious. There are
means, however, to avoid this for, as I know it from my own experiences,
it is possible to have a profuse perspiration without the sensation of
great heat and a red head through application of electric light bath
with blue light. In this blue light bath, studying its action, I have
myself obtained, after about twenty minutes’ time, the desired effect
without the depressive feeling afterward as so often is the case with
the usual steam bath. These baths are the more indicated in cases of a
nervous heart.

There are also different drugs, which may in many cases prove useful:
thus, a French preparation, prepared from the viscus kinds called
guipsin, then diuretin prepared by different concerns. Very valuable are
the nitrate preparations, especially in cases with coronary sclerosis,
also vasotonin, etc. But from my own experiences I give in many cases
the preference to preparations of iodine. But I have found that iodine
should not be given in too small doses and that they must also be taken
for a certain length of time. Besides iodine I have found, as most
efficacious in cases with very high blood-pressure, the application of
electric currents after the system of D’Arsonval (arsonvalization). In
each case of several patients I have seen the dropping of the
blood-pressure to the normal. As soon as we find a high blood-pressure
in a patient we must do our best to diminish it, for if we allow it to
become persistent the high blood-pressure will produce a loss of the
elasticity of the walls of the blood-vessels, there will arise
pathological alterations and arteriosclerosis may easily establish
itself. Aided by persistent, very high blood-pressure the degeneration
of the walls of the blood-vessels may in the long run go so far that a
destruction of their tissues can arise. Then by any sudden great
elevation of the blood-pressure it may come to a rupture of the vessel,
to apoplexy. If such a thing happens to a blood-vessel of the brain,
then such vital parts of the brain may be destroyed that sudden death
will follow. But in many cases, happily, other less important parts are
affected, without involving death, and then follows lameness of those
regions of the body which are provided with nerves coming or going to
these parts. Sclerosis and degeneration of arteries happen most
frequently in parts of the body where the circulation is the most
copious by hyperfunction of these parts; thus in the legs of country
people walking and climbing much (Romberg).

Mental exertions produce a great afflux of blood toward the brain each
time, with deep thinking more blood arrives to the brain and it is
therefore not surprising, as I show in my book on “Human Intellect and
its Improvement through Hygienic and Therapeutic Measures.” Such an
appalling number of prominent brain workers, men of science and of
business, are suffering from hardening of the brain-vessels and are
struck by apoplexy of the brain, sometimes even at early ages, before or
shortly after their fiftieth year. Indeed a vast majority of the great
men of science and business are thus afflicted, as I show in this book,
apoplexy being very frequent amongst them. It is reckless overwork,
unhygienic methods of mental work that may with surety produce a
hardening of the arteries of the brain. It would exceed the short space
allowed to this chapter if I should enter here upon the hygienics of
mental work, which I am treating in several chapters of my book on the
“Human Intellect,” but it will suffice here to emphasize the necessity
of interpolating resting days between days of mental overexertion. It
would be too much for me to demand that a successful man of business
retire entirely from his affairs, but what he could do, especially if
the head of the business, is to leave the city on Saturday for the
country, with the custom of walking about in the fresh air, returning
Monday with fresh strength; and, further, to avoid anything that
produces high blood-pressure, hill climbing, hot or cold drinks, strong
coffee, tea, and above all tobacco, which is one of the very surest
means to increase the blood-pressure. There is no condition where
smoking can produce such fatal effects as in arteriosclerosis, and
especially if the arteries of the brain, as so often in brain workers,
are affected. In inveterate smokers, perhaps a few de-nicotinized
cigarettes or cigars may be allowed. In place of regular coffee or tea,
coffee without caffeine and the Brazilian tea, maté, whose properties I
have described in my book on Rational Diet, may be allowed, but also not
in indiscriminate quantities. If too much of them is taken, they may
prove not less harmful, therefore also caffeine-free coffee and maté
should be taken with wise moderation. Against the troublesome symptoms
of arteriosclerosis of the brain like dizziness, loss of memory,
difficulty of reasoning, headaches, feeling of pressure upon the brain,
etc., I have seen, as I described in special chapters of my book “The
Human Intellect,” very good results through the combined use of
preparations of iodine and extracts of the thyroid gland. The dizziness
disappeared and also the headaches, the memory got much better and also
the reasoning power. These effects were, however, obtained in cases not
too advanced. As a preventive against arteriosclerosis of the brain and
as a remedy against headaches and feeling of pressure in the head I am
recommending snuffing in my book on Intellect, showing that through its
use the circulation of the congested brain is much relieved. In
confirmed cases of arteriosclerosis of the brain, however, snuffing
should be avoided, for it may have fatal results. Excessive snuffing is
also deleterious to healthy men, especially when tobacco is used. To
prevent apoplexy the hygienic advice we have given in the beginning of
this chapter to avoid high blood-pressure must strictly be followed. I
should like to add to them hot foot-baths for about five minutes, to
which mustard powder could be added. There should also be a special care
for a wise diet, avoiding constipation; of meat only very little should
be taken, fish should be preferred, and of meat only chicken and veal
allowed. The best food against arteriosclerosis and heart trouble
consists of a milk and egg diet, with vegetables and fruit, to which
fish and cheese may be added. As a most valuable food for overwork of
the heart and the general circulation, I recommend honey, whose merits I
show in next chapter.


                   THE BEST FOOD FOR A FAILING HEART.

There is one muscle in our body that never takes a rest. It never ceases
to work, either day or night, and the better for us, for if it should
stop it would mean the end of life. This muscle is the heart. Of course
we must feed well such a hard-working organ, and have special care to
select such a food that is the most genial for it and can the best
promote its activity. As the heart is a muscle we must give the food
that is best indicated for muscular activity. Observations have shown
that the muscles of our body are doing their work at the expense of a
certain sweet stuff (glycogen) contained in them. Experiments also prove
this, for it has been found that the heart of animals removed from the
body will survive for days the death of their owner if kept in a salt
solution, with grape- or fruit-sugar added. The addition of certain
mineral salts like lime and carbonate of sodium is also able to prolong
the survival of the cut-out heart of dead animals. So there can be no
doubt that the same elements must also prove useful to the heart of the
living, as is indeed the case.

As I have shown in my diet book the ingestion of sweets promotes
muscular activity and fatigues from bodily exertion are better borne.
And this also holds good for our most important muscle the heart. I have
seen in my heart patients very good results through the addition of a
generous amount of sweets to their ordinary diet. On the other hand, I
have, as a rule, observed a weak activity of the heart with my patients
in Carlsbad suffering from the graver forms of diabetes who were kept on
a diet strictly excluding sweets and starchy food in general. Indeed a
weak heart is most frequent in severe diabetes, as in such a condition
the sugar ingested cannot be utilized and entirely eliminated in the
urine. For this reason I consider it unwise to place severe cases of
diabetes on a strict diet and I recommend to them the use of fruit sugar
(levulose), which is often well utilized and especially in a case of
diabetes with heart-failure I like to do this. Such persons should never
be strongly dieted. As the best food for the heart I recommend honey on
the base of the above-mentioned observations. Honey is easily digested
and assimilated; it is the best sweet food, as it does not cause
flatulence and can even prevent it, to a certain extent promoting the
activity of the bowels. It can easily be added to the 5 meals a day I
recommend in cases of arteriosclerosis and of weak heart. As it would be
unwise to leave such a hard-working organ as the heart without any food
over the long hours of the night, I recommend heart patients to take
before going to bed a glass of water with honey and lemon-juice in it
and also to take it when awaking at night (honey dissolves in warm
water).

Before and after muscular exertion honey should be given in a generous
dose; no coachman would allow his horses to run for hours without giving
them food at the resting intervals. Only man is so unreasonable as to
undertake heavy exertions often with an empty stomach. No wonder that so
many sportsmen get a weak heart simply for just such a reason. The use
of sugar cannot well replace honey. In the same amount sugar is
chemically irritating to the stomach. At any rate the preference should
be given to cane-sugar; sugar of beet-root is chemically pure, although
through modern civilization it is, unhappily, deprived of the important
mineral salts the beet-root contains, and it has also been shown that
through the use of chemically pure sugar the body loses in lime, which
is eliminated in larger quantities. If honey is alone taken in larger
dose it is better borne if water is drunk afterward. Besides honey I
like to recommend grapes, as containing much sugar and also valuable
mineral salts like lime. If grape cures as conducted, for instance, in
Meran (Tyrol) give good results in arteriosclerosis and heart cases, the
results I think could be explained by the above observations. We can
best introduce lime in our bodies through milk, cheese, eggs, fruits,
and vegetables. The latter, especially fruits, are also rich in sodium
and potassium, which are also valuable elements for the activity of the
heart. I would especially insist upon the fact that the heart-muscle is
rich in lime, as it contains about seven times as much of it as the
other muscles. If we introduce in our system fresh, uncooked milk and
eggs we also introduce a very valuable substance of which we have spoken
before, vitamines. I believe that these substances must be very valuable
for the activity of the heart because in all the diseased conditions,
the deficiency diseases, arising, we have found, a want of this
substance (Funck). Besides, in nervous troubles a weakness of the heart
and muscles is common. If in one of this class of diseases, like
beriberi, even in the latent cases, strong muscular exertions are made,
then cardiac attacks will appear with great weakness of the heart.
According to Funck, chief of the laboratory of the London Cancer
Research Institute, muscular exertions are apt to make these diseases
break out at once in cases, until then latent, without any symptoms. He
also impresses upon the fact that when vitamines are wanting in the
food, it is the vitamine stores of the muscles which are attacked first
(Funck, “Die Vitamine,” Wiesbaden, 1914). But as the best proof for my
opinion that food containing vitamines is indisplaceable for the
heart-muscle I mention the fact, determined by Cooper and quoted by
Funck, _Journal of Hygienics_, 1913, that the heart-muscle is very rich
in vitamines. Beriberi and other deficiency diseases are the highest
degree of a condition that is due to the entire want of vitamines in the
blood. But no doubt there may be lower degrees due to the insufficient
amount of vitamines, in which may simply show symptoms of neurasthenia
with nervous heart troubles, as an expression of the craving of our
system after these substances. Milk containing vitamines, and also
containing a considerable amount of sugar and lime, it must be
considered as the most valuable food for the heart. But only fresh milk,
for by boiling it the vitamines are lost. Boiling above 100° C, and
especially in large apparatus under high pressure like in the autoclave
used in many of the large institutions and some of the big hotels,
destroys the vitamines. I have already in my diet book, in the chapter
on rational cooking, insisted upon the dangers of overcooking our food.
Another rich source of vitamines, the bran of wheat and rye, is taken
from us through another invention of our so-called modern civilization,
the machine milling, simply for technical reasons. Forty or fifty years
ago there was no cases of beriberi in the far east; the natives ate rice
with its wholesome outer layers; then modern civilization introduced
machine mills instead of the old hand mills, robbing the rice of the
silver fleece rich in vitamines, and beriberi appeared. It is true that
the bran presents obstacles to our intestinal juices, but there exist
certain methods by which it can be ground to a fine flour and all its
valuable parts assimilated and introduced in our body. We have quoted
here several instances of the fateful influence of our modern progress
upon our health. What is the good of the great progress of medicine if,
on the other hand, our modern progress through reckless inventions
separates us from Mother Nature and, inducing us to unnatural habits and
ways, exposes us to disease and untimely death. No wonder, then, if
arteriosclerosis and old age appear in relatively young people.


------------------------------------------------------------------------




                               CHAPTER I.

       ON THE APPEARANCE OF SYMPTOMS OF OLD AGE IN YOUNG PERSONS.


AS a general rule the first symptoms of old age do not appear before the
fortieth or forty-fifth year. There are, however, many persons who, much
earlier, occasionally even before thirty, show some of the typical
symptoms of senility: corpulence, gray hair, wrinkles in the face,
falling out of the hair and loss of teeth, etc., for example. The gums
also are retracted from the teeth, which consequently appear greatly
lengthened; later on the teeth become loosened and fall out. This then
causes the jaw bones to atrophy, when the face becomes sunken, and the
individual appears many years older. The hair loses its original color
and becomes dry and gray, especially on the temples. The appearance of
bald spots surrounded by gray hair increases the aged appearance of the
face. On examination, the pulse of such persons may exhibit a high
tension, the temporal arteries may be tortuous, and the skin found to be
dry. A sensation of cold in the extremities is especially frequent.
There is, as a rule, a tendency to constipation. The mental faculties
are also altered; the memory weakens, and the mind is often depressed.
Neurasthenia or hysteria become frequent in such persons, while
impotence in men and menstrual disorders in women develop. The urine may
be found to contain traces of albumin and occasionally a few hyaline
casts. The presence of these, according to Professor Senator,[1]
indicates a degeneration of the convoluted tubules of the kidneys, and
thus the loss of important elements of the chief excretory organ of the
human body.

Footnote 1:

  Hermann Senator: “Die Erkrankungen der Nieren;” Nothnagel’s “Handbuch
  der praktischen Medicin,” ii Auflage, 1902.

On examination of the state of nutrition in these persons, it may often
be found to be below the normal. It is certain that such a condition in
young people is abnormal, and, therefore, a pathological condition.

The question now arises: In which category of diseases is this condition
to be classified?

In typical cases of this class there is a diminution of metabolism,
i.e., of the assimilation and conversion of food into energy. We shall
have to think of the possibility of alterations in those organs which
govern the process of metabolism.

These organs are the glands with internal secretion (especially the
thyroid gland, testicles, ovaries, the adrenals and pituitary body),
according to recent researches, among which those of the author of this
book may be mentioned. He was among the first to show the fact that
glands with internal secretion control all the processes of
oxidation,[2] and that the diseases of metabolism: diabetes, obesity,
gout, etc., are the direct consequence of alterations in these important
glands. This is further sustained by the labors of Sajous[3] who was the
first to describe the mechanism through which these organs govern
oxidation and metabolism, and to explain how they produce the disorders
just enumerated.

Footnote 2:

  Intern. Congr. of Med., Madrid, April, 1903; and various Addresses to
  the Brussels Royal Society for Med. and Nat. Sciences, 1903, the
  Hamburg Med. Society, 1904, the Paris Biolog. Society, 1904, the
  London Path. Society, 1905, etc.

Footnote 3:

  Sajous: “Internal Secretions and the Principles of Medicine,” vol. i,
  1903, and vol. ii, 1907, and Philadelphia Medical Journal, March 7,
  1903.

The most important part herein is taken by the thyroid gland, whose
increased activity is followed by an augmentation of the processes of
oxidation in the body, whereas its degeneration is followed by a
diminution of these processes. When the thyroid gland is degenerated
entirely, as in myxœdema, there is also a great diminution of all
oxidation processes. There are also cases where the thyroid is only
partially altered by the increase of connective tissue, cases called
partial myxœdema, and in these cases, accordingly, the diminution of the
processes of oxidation does not take place to the same extent as in
complete myxœdema.

When we thus find symptoms of old age in young persons, together with,
in the most typical cases, a state of decreased oxidation, we have to
determine whether or not we are dealing with a degeneration of the
thyroid gland. And, indeed, such a condition is before us, for the
symptoms we have just mentioned are characteristic of myxœdema.

If complete myxœdema, the highest degree of this condition, is rare, on
the other hand the incomplete forms, where the thyroid is only partially
replaced by connective tissue, are fairly common.

This is shown by the fact that, after the fortieth or forty-fifth year,
the thyroid shows an increased amount of connective tissue, and thus
cannot be so active as a thyroid with more secreting elements and less
connective tissue.

We have thus reasons to suppose that the persons above mentioned, who
only exhibit some but not all of the symptoms of old age, symptoms which
are also found as typical in myxœdema, are suffering from a partial
myxœdema or hypothyroidia. And it does not necessarily follow that in
all such cases the processes of nutrition will be diminished, as is the
rule in typical cases of myxœdema.

The resemblance between senility and myxœdema was first pointed out in
1890 by Sir Victor Horsley, one of the foremost authors on myxœdema, and
afterward by Vermehren,[4] Ewald,[5] of Berlin, and the author. Horsley
ascribed old age to degeneration of the thyroid gland, and we have shown
(in a communication to the Paris Biological Society, presented by Dr.
Gley, Professor of Physiology at the University of Paris, December 4,
1904) that, besides the thyroid, there are also different other ductless
glands whose degeneration produces old age. These are the sexual glands,
the pituitary body, and the adrenals.

Footnote 4:

  Over Myxœdemet, Kjöbenhavn, 1895.

Footnote 5:

  Ewald: “Die Erkrankungen der Schilddrüse,” Nothnagel’s Handbuch,
  Vienna, 1896.

It is a well-known fact that extirpation of the testicles and of the
ovaries is followed by obesity and other symptoms of old age; in the
same way cessation of the menstruation with degeneration of the ovaries
at the climacteric is followed by all the symptoms of old age and
certain nervous disturbances, as, for instance, troublesome flushings,
which occur here, as after castration. Eunuchs, as a rule, look much
older than their age. The Oriental eunuchs, and also the members of a
religious caste in Russia, the Skopse, who castrate themselves through
fanaticism, because of their parchment-like face covered with
innumerable wrinkles, appear aged beyond their years.

Degeneration of the pituitary body is also followed by premature
senility. This is shown by the fact that acromegalic persons, as a rule,
look much older than their age. This also holds good in the case of
myxœdematous patients. We have had opportunity to see, quite recently,
the skeleton of a female acromegalic patient of Dr. G. A. Gibson in
Edinburgh, and found typical indications of old age, an enormous
augmentation of connective tissue and vascularization of the bones, with
great porosity.

It must be remembered that all the glands with internal secretions,
according to Pineles,[6] Sajous,[7] and the researches of the author,
stand in very close relation to one another. Thus, degeneration of the
thyroid is followed by that of the pituitary body. This was shown by the
experiments of Hofmeister,[8] Stieda,[9] Rogowitsch,[10] Benda, and many
others. Degeneration of the pituitary is followed by a similar lesion in
the thyroid.

Footnote 6:

  Pineles: Volkmann’s klin. Vorträge, N. 242, 1899.

Footnote 7:

  Sajous: “Internal Secretions,” Philadelphia, vol. i, p. 140, 1903.

Footnote 8:

  “Beiträge zur klin. Chirurgie,” 1894.

Footnote 9:

  Ziegler’s Beiträge, Bd. vii.

Footnote 10:

  Ziegler’s Beiträge, vol. iv, 1889.

Arteriosclerosis is a condition very frequently met with in elderly
persons, and, according to recent researches, this disease is caused by
a toxic agent with subsequent degeneration of the walls of the
blood-vessels. Such a change can be produced artificially, as shown by
Josué,[11] by injecting adrenal extract into rabbits.

Footnote 11:

  Josué: C. R. Société de biologie, Nov. 14, 1903.

That the ductless glands are closely related holds good also for the
thyroid and adrenals. This relation, however, is an antagonistic one.
The adrenals increase the blood-pressure (Oliver and Schäfer[12]), and
the thyroid diminishes it. It is an interesting fact, demonstrated by
Professor Eiselsberg[13] in Vienna, that extirpation of the thyroid
gland of dogs results in atheroma of the aorta. In connection with this
we also mention the clinical fact, that all those agencies which are
harmful to the thyroid gland, as syphilis, abundant meat food
(Breisacher,[14], Blum,[15] Lorand[16]), alcohol (Hertoghe and de
Quervain[17]), and tobacco (Hertoghe), are also those which are commonly
considered to be the causes of high tension and arteriosclerosis.
Infectious diseases are also brought in etiological relationship with
arteriosclerosis, and it has been shown by a series of authors, that in
infectious diseases the thyroid undergoes important alterations which
may involve its degeneration (Roger and Garnier, Crispino, Torri, Bayon,
de Quervain).

Footnote 12:

  Oliver and Schäfer: Journal of Physiology, vol. xviii, 1895.

Footnote 13:

  Eiselsberg: “Die Krankheiten der Schilddrüse,” Stuttgart, 1901.

Footnote 14:

  Breisacher: Archiv für Anat. und Physiologie, Suppl., Bd., p. 509,
  1890.

Footnote 15:

  Blum: Virchow’s Archiv, p. 495-514, 1899.

Footnote 16:

  Lorand: Transactions of the Path. Society of London, vol. lvii, Part.
  1, 1906.

Footnote 17:

  La Semaine Médicale, 1905.

Infectious diseases also induce changes in the adrenals, as shown by
many authors (see Chapter III).

Various toxic products, such as lead, alcohol, and tobacco, which are
considered causes of arteriosclerosis, are also able to produce
hypertrophy of the adrenals.

And, if we consider those agencies which are commonly considered the
causes of premature senility, we notice the singular fact that they are
also considered to be especially harmful to the various glands with
internal secretion, particularly the thyroid and sexual glands.

Among these agencies may be mentioned infectious diseases, sexual
excesses, frequent pregnancies, strong emotions continued for a long
time, such as grief and sorrow, chronic intoxications (by poisonous
products produced in the body, or introduced from without). We will show
later, in an exhaustive way, the action of these agencies upon the
glands with internal secretion.

Between the thyroid gland and the ovaries, a close relationship also
exists. Thus, invariably, when we find the thyroid altered, we can also
see changes in the ovaries. Consequently in myxœdema and Graves’s
disease we find, with great frequency, disturbances in the functions of
the ovaries, e.g., cessation of the menses, or disorders of
menstruation. In such conditions the ovaries have often been found to be
atrophied. We also frequently find such disturbances in acromegaly,
where they may either be due to changes in the pituitary, associated
with an altered condition of the ovaries, or they may be ascribed
directly to changes in the thyroid which, as we have shown in a
communication to the International Congress in Madrid, 1903, is very
often altered in acromegaly. If microscopically examined it is probably
found changed in every case. Indeed, we have attributed acromegaly to
the primary changes in the thyroid which lead only secondarily to those
in the pituitary body.

In diabetes, which disease, according to our investigations, is often
caused by changes in the thyroid,[18] and subsequently in the pancreas,
or _vice versâ_, amenorrhea or impotency is frequently met with.

Footnote 18:

  Lorand: “Die Entstehung der Zuckerkrankheit und ihre Beziehungen zu
  den Veränderungen der Blutgefässdrüsen,” Berlin, A. Hirschwald, 1903,
  and French Translation, Maloine, Paris, 1904.

On the other hand, changes in the ovaries are also, as a rule, followed
by changes in the thyroid gland, as may be seen in puberty,
menstruation, pregnancy, lactation, and the climacteric. We will enlarge
upon this later, in greater detail, but we will only briefly mention
here that we may frequently see a swelling of the thyroid gland as an
expression of increased activity during these conditions. We can also
see this in diseases of the ovaries, and, as certain authors show, even
sexual excesses can produce an altered state of the thyroid. This was
known to the ancient Hebrews, for they used to examine the neck of the
newly-married bride the morning following the wedding night to see if
the neck had become larger by the swelling of the thyroid gland.

Thus we can readily understand that, frequently, swelling of the thyroid
is the consequence of overwork of this organ, and, as in the case of
great sexual excesses or frequent pregnancies, may lead to exhaustion of
the gland with its grave clinical consequences.

Indeed it has been shown by the earliest authors on myxœdema, that this
disease is very frequently caused by too frequent pregnancies,
especially if connected with prolonged lactation (Ord, Morvan, Combe).
This will also explain why women more frequently show the symptoms of
precocious senility than men, whose sexual glands are not put to such
constant activity and change as are the female sexual glands. Similarly
women, after frequent pregnancies, especially with prolonged lactation,
or women with diseases of the ovaries, and also those addicted to
habitual sexual excess, such as prostitutes, very soon become fat and
fade before their time. Thus we may see symptoms of precocious senility
in such women even before the end of the third decade, especially if
they have begun to lead an immoral life at an early age. Even young
girls may look much older through the abuse of their ovaries from sexual
excesses. Their breasts become large and pendulous, and their faces
bloated and relaxed. Menstruation may likewise be made to appear in
early childhood by sexual abuses, as Pauline Tarnowska[19] has found
through the examination in St. Petersburg of 150 very young prostitutes.

Footnote 19:

  Tarnowska: “Etudes antropométriques sur les prostitutées et les
  voleuses,” Paris, 1889.

We shall show in the next chapter that obesity, which has nothing to do
with overfeeding, can be caused by like agencies.

That mental emotions, especially care, grief, sorrow, etc., powerfully
influence the different ductless glands, and are able to produce
degeneration of the thyroid, adrenals, and sexual glands, etc., is shown
by conclusive proofs in the chapter on the “Hygienics of the Mind.”

Infectious diseases are especially liable to cause change in the
kidneys, and in various infectious diseases, sometimes even in
tonsillitis, we may find an inflamed condition of these organs.

The kidneys can also be damaged by the passage of various toxic
products, which are either produced in the body (auto-intoxication) or
introduced with the food (condiments), or as stimulants—e.g., alcohol,
strong tea, etc. All these toxic agents are capable of doing damage to
the kidneys just as to the thyroid gland. We shall treat later on, in
separate chapters, of the action of these stimulants upon the ductless
glands.

The condition termed auto-intoxication may be induced by many different
factors, among which may be mentioned the products of intestinal
putrefaction (Senator[20]) and the waste products from the processes of
oxidation, such as uric acid, for example. Animal food is more apt to
produce intestinal putrefaction than any of the various other
foodstuffs.

Footnote 20:

  Senator: Berliner klin. Wochenschrift, Nu. 24, 1868.

There are three important organs which protect us against such a
condition of auto-intoxication; these are the kidneys, liver, and
thyroid, and possibly also the parathyroids.

The kidneys act by promptly eliminating such toxic products in the
urine. They are glands with internal secretion, as shown by the
experiments of Brown-Séquard,[21] E. Meyer,[22] and clinical
observations of Senator[23] and H. Strauss.

Footnote 21:

  Brown-Séquard: Archives de physiologie norm. et path, p. 778, 1893.

Footnote 22:

  E. Meyer: _Ibid._ p. 179, 1894.

Footnote 23:

  Senator: Loc. cit.

The liver, which, according to Gilbert, H. Strauss,[24] and others, is
also a gland with an internal secretion, is strongly antagonistic to
intestinal poisons. It destroys toxic products brought to it from the
intestine through the portal vein, and several authors, Professor Adami,
Sir Lauder Brunton and Bokenham,[25] show that it is also able to
eliminate such products with the bile after previous transformation. We
will treat of these protective functions of the liver in a separate
chapter, together with the hygienics of this important organ; but we
will just mention here that the liver plays a great rôle in the
transformation of the toxic end-products of albuminous food into
harmless substances, such as urea.

Footnote 24:

  H. Strauss, Senator: Festschrift.

Footnote 25:

  Sir Lauder Brunton and Bokenham: The Journal of Pathology and
  Bacteriology, p. 50, Nov., 1907.

The third important toxin-destroying organ is the thyroid gland, which,
as shown by the experiments of Dr. Leo Breisacher,[26] of Detroit,
formerly assistant to Professor Munk, of Berlin, and of Dr. F. Blum,[27]
of Frankfort, as well as Dr. Chalmers Watson,[28] of Edinburgh, destroys
those poisonous substances produced by the decomposition of proteid
food. Moreover, Sajous has shown that this is a prominent function of
the pituitary body, the thyroid and the adrenals, acting jointly as the
“adrenal system.”

Footnote 26:

  Breisacher: Loc. cit.

Footnote 27:

  Blum: Virchow’s Archiv, 1899.

Footnote 28:

  Lancet, Feb. 11, 1905.

It will be evident that these various glands can only do their work to
perfection so long as their parenchymatous tissue is not replaced to any
large extent by connective tissue. Of these glands the thyroid takes the
foremost rank, as it governs the other glands. As we have shown in a
communication to the French Congress of Medicine, in Liège, 1905, the
thyroid influences the liver, and in a paper before the Paris Biological
Society, February 25, 1907, we have shown that the thyroid also
influences the kidneys. In fact, the liver and kidneys are closely
allied to the thyroid, and when this organ is degenerated, the other two
glands follow suit.

Accordingly we may expect that, when the thyroid undergoes a process of
degeneration, such an event may also take place in these two protective
organs, as we have shown in our above-mentioned two communications. In
consequence of the diminished activity of these organs the development
of a condition of auto-intoxication may be facilitated. Patients showing
symptoms of old age in early years, also show to a greater or less
extent symptoms of such a condition, as do myxœdematous persons.

Meat food especially, if taken in large quantity, is a certain producer
of uric acid, and it is an interesting fact, shown by several authors
and also by the writer,[29] that by thyroid medication we can augment
the elimination of uric acid, and also prevent its formation in large
quantity, both in the case of uric acid formed in the body or introduced
from without by the food.

Footnote 29:

  Lorand: Comptes Rendus de la Société de biologie de Paris, Février 25,
  1907.

This fact stands in relation to the powerful influence exercised by the
ductless glands, and especially the thyroid, upon the process of
oxidation; and, as we are anxious to prove the assertions we here
advance, we shall show in the next chapter how these wonderful glands
influence the processes of nutrition in the tissues, and at the same
time the external appearance. We have already mentioned a form of
obesity that has nothing to do with overfeeding, as one of the symptoms
of precocious old age, and in the next chapter we will review in detail
the agencies which govern this condition.


------------------------------------------------------------------------




                              CHAPTER II.

 ON THE AGENCIES WHICH GOVERN OUR EXTERNAL APPEARANCE AND THE NUTRITION
                            OF THE TISSUES.


AS a general rule infants of both sexes look very much alike, so much
so, indeed, that sometimes it is only possible, upon close inspection,
to determine the difference in sex. This, however, can only be so for a
certain period until certain changes take place in the ductless glands,
especially in the sexual glands and the thyroid.

The latter contains but very little, if any, colloid substance in
infancy, and the colloid increases only gradually until it is present in
abundance at the time of puberty, when also the changes in the sexual
glands reach a climax coincident with the ripening of the follicles in
the ovaries and their rupture at a menstrual period. This latter process
is, as we have mentioned before, under the influence of the thyroid.
Puberty and menstruation do not take place, as a rule, in persons with a
degenerated thyroid gland.

With the onset of puberty there is seen, also, a change in the external
appearance of the individual and the attributes of virility—e.g.,
moustache, hair in the pubic region, alteration of the voice, etc.,
appear. In the female the development of the breast, hair on the pubis,
etc., occurs. At the same time the features attain the peculiar
characteristic which distinguishes the male face from the female, even
without the aid of a moustache.

In those persons in whom puberty has not occurred at the usual age
(fourteen to sixteen years in our climate) the attributes of sex are
absent. In these cases the male looks very much like the female. A
similar phenomenon may be seen in women after castration and the
climacteric, when they may even show a tendency to develop a moustache
and hair on their face in places, corresponding to the male beard.

This we can also observe in women whose ovaries have been altered by
disease or by sexual excesses.

These attributes of sex are also called external sexual characteristics,
and they are the direct result of the internal secretion of the sexual
glands. They only develop through the presence of such a secretion, and
this is easily demonstrated by the fact that after castration of the
infant, they do not appear at all. Hence, if we see grown-up men with no
trace of a moustache it may indicate an undeveloped condition of the
testicles. Again, we castrate a young cock, he will not grow a comb and
spurs, and other cocks will pass by, too proud to fight with a
degenerate deprived of its male attributes. If we now take the
extirpated testicle of such cock and graft it under his skin, the other
cocks will commence to fight with him, for his comb and spurs will
develop as in other normal cocks.

That the whole external appearance of a castrated animal or man is
changed, is also demonstrated by important changes in the skeleton and
size of such animals or persons.

As Poncet[30] has shown, the extremities of a castrated rabbit become
abnormally long, and it is a well-known fact that eunuchs have
abnormally long arms and legs. This also occurs in cases of infantilism,
which, as we know, is due to a non-development of the sexual glands.
Moreover, the thyroid of such individuals is also found to be in a
pathological condition, as was shown by Hertoghe.

Footnote 30:

  Poncet: C. R. de la Société de biologie de Paris, 55.

Men who have been castrated before puberty or whose testicles are
undeveloped, present such an external appearance. They have no
moustache, as above mentioned; their hair is dry and brittle and remains
short; their faces are pale, and of a yellowish hue; their hands are
cold and reddish blue. Often the skin of the face is like parchment and
has many wrinkles. Their intelligence is often diminished, as we will
show later on, and they are usually anæmic.

Women with undeveloped ovaries have flat breasts and hips; their faces
are often irregular in structure, and their jaws are often prominent;
their gums are shrunken and their teeth are long and soon fall out. Some
cases may show a colossal obesity, but in the partial forms of ovarian
insufficiency they may be remarkably thin. They also are, as a rule,
anæmic or chlorotic.

In some parts of the Orient, as in India, there are female eunuchs, such
as Roberts has seen on the way from Delhi to Bombay. Such eunuchs had no
bosom; the pubic hair was absent, and their buttocks were like those of
men; but the rest of the body was stouter. Of course these women had
been castrated during their childhood.

If we make a Roentgen-ray examination of the skeleton of a person
castrated in childhood, we shall find that the epiphysial cartilages
remain unossified for a long time after puberty.

It is a very interesting fact that, both after castration and in
myxœdema, the same persistence of the epiphysial cartilages and
retardation of ossification have been observed by means of the
Roentgen-rays: by Hertoghe in 1896; Springer and Serbanesco in 1897;
Gasne and Laude in 1898; Legry and Renault in 1902; Jeandelize in 1903.
The same thing has also been observed by Hertoghe in “Infantilism of the
Type of Lorraine.”

The influence of the thyroid upon the skeleton and size of the body is
easily shown by simple observations.

Children of parents with cachectic diseases like chronic tuberculosis,
syphilis, alcoholism, etc., in which the thyroid gland is, as a rule,
found degenerated (Gamier,[31] Hertoghe[32]), are (as shown by Prof.
Perrando[33] and Garnier) born with a congenital atrophy of the thyroid.
Just as young animals with an extirpated thyroid, so these children will
not grow, and we know that cretins (degeneration of the thyroid) remain
as a rule dwarfs all their life long. We can now produce in such persons
certain and very curious changes by feeding them with thyroid extract,
and we can see them, as Hertoghe has shown, grow inch by inch in a short
period; their mental faculties improving at the same time in an
incredible manner.

Footnote 31:

  Garnier: “La Thyroide dans les maladies infectieuses,” Thèse de Paris,
  1899.

Footnote 32:

  Hertoghe: Loc. cit.

Footnote 33:

  Perrando: “Sulla struttura della Tiroide,” Sassari, 1900.

The influence of the thyroid upon the skeleton is also shown by the
fact, established by Gauthier,[34] that in a fracture with but little
tendency to the formation of a callus, union takes place much more
quickly after administration of thyroid extract.

Footnote 34:

  Les Médications thyroidiennes, 1902.

In Graves’s disease, with exaggeration of the thyroid activity, there
is, on the other hand, an increased elimination of the most important
constituent of the skeletal tissues: calcium carbonate, and this occurs
also in acromegaly and diabetes, in which conditions the thyroid is very
frequently altered (Lorand[35]).

Footnote 35:

  Lorand: Loc. cit.

Osteomalacia, which is associated with an enormous elimination of
calcium carbonate is, as we at present consider, due to an exaggerated
ovarian activity (Fehling), and can be favorably influenced by
castration or, by what would be more reasonable, thyroid treatment.

No less powerful than that of the thyroid is the influence of the
pituitary body upon the skeleton, especially upon the hands, feet, and
skull. And if we wish to demonstrate how much the ductless glands
influence the looks of a person, it is sufficient to point out the great
changes that take place in the face of a patient with acromegaly. This
disease makes such persons look very much as “Punch” is depicted.

The skin and complexion of persons suffering from changes in the
ductless glands are also very different from normal. Thus Addison’s
disease, due, as well known, to a degeneration of the adrenals, makes a
white man look more or less like an Indian, and there is a pigmented
skin also in persons affected by the

partial form of that rare disease. We can also easily show that changes
in the thyroid are followed by changes in the condition of the skin.
Thus, with thyroid degenerations, as in myxœdema, the skin is pale with
a yellowish tinge. In Graves’s disease pigmentation of the skin can
often be observed, and not rarely cutaneous eruptions.

In affections of the sexual organs in woman similar conditions of the
skin can occur. Such persons often present wrinkles at a very early age,
and certainly look older than their years. Infants suffering from
congenital degeneration of the thyroid gland often look withered and
present a face as wrinkled as a sexagenarian. We see this also in
congenital syphilis (atrophy of the thyroid).

The hair also very often shows alterations in diseases of the thyroid,
or ovaries. Thus, in myxœdema there is an atrophy of the follicles of
the hair, which falls out, even in the case of the eye-brows.

It is particularly interesting that, by thyroid medication, a new growth
of hair has been observed in places where it had fallen out years
previously, as we have observed, with other authors, in several cases
after thyroid medication. And, very strange to say, this newly-grown
hair was quite dark while the hair that had previously been in its place
was gray in color. It has been authentically stated by several
authorities that old persons of sixty or seventy have acquired black
hair under thyroid treatment.

On the other hand, in much younger persons, perhaps under thirty, who
are suffering from complete or partial degeneration of the thyroid
gland, the hair very often turns gray; so much so that Hertoghe
considers this to be one of the typical symptoms of such a condition.

The falling out of hair, or its turning gray, after acute infectious
diseases or after grief and sorrow, may have some connection with the
well-known changes in the ductless glands, especially in the thyroid, in
these conditions. This is made quite clear by Sajous’s demonstration
that these glands collectively govern the activity of general oxidation,
that is to say the vital process itself.

As we have previously mentioned, a moustache or whiskers may grow in
women suffering from disease of the ovaries, just as after castration or
the climacteric. It is also very interesting that a premature grayness
often occurs in cases of insanity, and can be attributed to the frequent
changes in the thyroid and sexual glands in these conditions.

The nutrition of the skin is entirely under the influence of the
thyroid. After extirpation or degeneration of the thyroid, there occurs
atrophy of the sebaceous and sudorific glands.

In myxœdema the skin is dry and never perspires. On the contrary, in
Graves’s disease, or after thyroid medication in large doses, there is
abundant perspiration.

Deposits of tartar are common symptoms in all forms of thyroid
degeneration. Retraction of the gum follows and the teeth loosen and
fall out. This is also a common symptom in diabetes, but here only in
advanced cases. In such cases there is, as we[36] have shown, an
exhaustion of the thyroid gland, which develops as a consequence of the
previous hyperactivity of the thyroid gland in the early stages of the
disease. As a rule the teeth of a diabetic only fall out in the severer
form of the disease, generally after acetone has begun to show itself in
the urine.

Footnote 36:

  Lorand: “Die Entstehung der Zuckerkrankheit,” Berlin, 1903, and in
  French translation, Paris, 1904.

Important changes take place in the subcutaneous tissue after
extirpation of the thyroid gland. In such cases there is either
augmentation of connective tissue or of fat. Thus, in the case of a
young bull, whose history we followed, there has been an increase of
thirty pounds of fat within a few months after extirpation of the
thyroid. The same thing happened in the case of a young horse, whose
thyroid was also extirpated.

There are, however, still more facts which show the great influence of
the thyroid upon the metabolism of fat. Thus we know very well that by
thyroid medication we are able to reduce fat considerably. This is due
to the action of the thyroid which, as shown by many authors, increases
the process of oxidation. In Graves’s disease these processes are
augmented. In the opposite condition (myxœdema) they are diminished. By
giving thyroid extract we are able to augment, positively, the processes
of oxidation in the tissues, as shown by Professor Magnus-Levy,[37] of
Berlin, and many others.

Footnote 37:

  Magnus-Lévy: “Der Stoffwechsel bei Erkrankungen einiger Drusen ohne
  Ausführgang,” in v. Noorden’s “Handbuch der Pathologie des
  Stoffwechsels”, vol. ii, Berlin, 1907.

As we have shown in our previous researches, there is an abundant
formation of fat in the early cases of degeneration of the thyroid
gland, which sometimes progresses to a colossal obesity, which obesity
has nothing to do with overfeeding. Such individuals have, as a rule,
but poor appetites, and eat very little. Therefore, in a communication
to the French Congress of Internal Medicine in Paris, 1904, we
differentiated two kinds of obesity: 1. _Exogenous obesity_—i.e.,
arising by agencies coming from without by the food we introduce into
our body. 2. _Endogenous obesity_, having its origin within our economy,
and depending on changes in certain glands which govern the processes of
oxidation—e.g., thyroid sexual glands, pituitary body. This second form
is independent of our feeding. As we have shown, this latter can be
produced by any of those agencies which are harmful to the ductless
glands, especially the thyroid and sexual glands, as, for example,
infectious diseases, frequent pregnancies, certain toxic products
(alcohol), sexual excesses, climateric. All these conditions may have
the effect of producing obesity, which can be explained by an exhaustion
of the thyroid and ovaries following a pre-existing hyperactivity.

The influence of the ovaries upon the production of obesity can be
demonstrated by the sequels of castration, and also by the fact that
women, after one or more, especially several pregnancies, or after
sexual excesses, may become very fat. In such women this obesity may be
only partial and limited (as we have shown in a recent communication to
the International Congress of Medicine in Lisbon, 1906) to certain
parts—e.g., the mammary glands or hips.

There can be no doubt that the sexual glands influence the nutrition of
the tissues in a powerful manner, and this has also been shown,
experimentally, by the researches of two Berlin experimenters,
Professors Loewy and P. I. Richter,[38] performed in the physiological
institution of Professor Zunz. These savants have shown that after
castration there is a diminution of oxidation. By giving extracts of
dogs’ testicles to castrated male dogs, they were able to augment the
processes of oxidation. These processes, however, were still more
increased after the administration of female extracts to these castrated
male dogs. The administration of ovarian extracts to the spayed bitch
has, of course, given still better results. Thus there was here an
increase of 67.7 per cent. after castration, and 37.6 per cent. of the
original value. The increase of the oxidation in male dogs was 44.5 per
cent. after castration, by the treatment with ovarian extracts, and 24.8
per cent. above the normal value. If the results after feeding with male
extracts were not so successful, it must be attributed to the
circumstance that we are at present unable to produce testicular
extracts of the same efficacy as ovarian extracts.

Footnote 38:

  Loewy and Richter: Archiv für Anat. u. Physiologie, Supplement, 1899,
  and Berliner klin. Wochenschrift, 1899.

The action of the pituitary body upon metabolism has been shown by
Narbuth, who found a diminution of oxidation after degeneration of the
pituitary body, and an increase after medication with extracts of the
same organ. This fact is also shown clinically by cases of obesity after
degeneration of the pituitary body in acromegaly, and by the interesting
fact (shown by a great number of authorities and recently by
Fröhlich,[39] Berger,[40] and Erdheim[41]) that cases of pituitary tumor
may be met with, associated with obesity, and without any of the
symptoms of acromegaly. Especially interesting is the case of
Madelung[42] showing a colossal obesity in a girl aged 9 years, after a
gunshot injury of the pituitary body. This observation sustains, and is
clearly explained by, Sajous[43] who showed that the posterior or neural
lobe of the pituitary body contained a nerve center which governed the
functional activity of the thyroid, and that the secretion of the latter
insured the catabolism of fats by increasing their vulnerability to
oxidation.

Footnote 39:

  Wiener klin. Rundschau, p. 78, 1901.

Footnote 40:

  Zeitschrift für klin. Med., liv, p. 5, 6.

Footnote 41:

  Ziegler’s Beiträge, 1903.

Footnote 42:

  Archiv für klin. Chirurgie, p. 1066, 1904.

Footnote 43:

  Sajous: “Internal Secretions, etc.,” vol. ii, 1907.

The external appearance of such cases of obesity, which we have
described before the French Congress of Medicine in 1904, and the London
Pathological Society, February 21, 1905, as endogenous obesity, is also
clinically different from the appearance of those caused by overfeeding.
As we have shown, persons addicted to rich food, with little exercise,
are often red in the face, and are plethoric; they easily become
overheated and perspire freely. They seldom complain of constipation. On
the other hand persons suffering from endogenous obesity generally look
pale, always complain of cold and dry skin, and perspire very seldom, if
at all. As a rule they are also very constipated.

There is still another ductless gland which influences metabolism in a
powerful way. This is the pancreas which, by its three enzymes, brings
about the assimilation of the proteid carbohydrate and fatty materials.
To these may also be added its production of labferment. By its internal
secretion, which is probably produced by the islands of Langerhans, it
aids in the oxidation of the sugar, introduced into our alimentary canal
in the shape of starchy food, or contained in the carbohydrated radicle
of the albuminous molecules, as demonstrated by Pavy. The entire
degeneration of the pancreas, especially of the part containing the
islands of Langerhans, produces a disease that is, as a rule,
characterized by loss of weight and the production of emaciation often
to an astonishing degree—i.e., diabetes.

Persons suffering from the milder form of this disease often present a
rosy and healthy appearance, and as we have pointed out previously,
often look younger than their age. We believe that, as we shall show
further on, this fact is not without relation to the condition of the
thyroid in this disease. We have shown by researches made in the
laboratory of Professor Minkowski, then of the Augusta Hospital in
Cologne, that in diabetes the thyroid contains large, sometimes
enormous, quantities of colloid substance, thus indicating a condition
of thyroid hyperactivity.

As we have mentioned in the first chapter, corpulence is often one of
the first symptoms of old age, and we have also insisted upon the fact
that this can be brought about by infectious diseases (e.g., typhoid,
pneumonia, scarlet fever, etc.). As we have also mentioned the fact, in
the first chapter, that old age can be brought about by an infectious
disease which acts upon the ductless glands, especially the thyroid, we
believe it will be necessary to enter a little more in detail into this
subject, to which we will devote the next chapter. We will enlarge upon
the fact that our immunity against infectious diseases is entirely
dependent on the proper working order of certain ductless glands.


------------------------------------------------------------------------




                              CHAPTER III.

      ON THE AGENCIES WHICH GOVERN IMMUNITY AGAINST INFECTIONS AND
                   INTOXICATIONS—THE ORIGIN OF FEVER.


FROM the moment of our birth we are constantly exposed to the incessant
attacks of innumerable bacteria and to the effects of a large amount of
poisonous material formed within our body or introduced from without,
and if we survive this ceaseless battle it is due to the powerful weapon
we possess in the internal secretion of the ductless glands, especially
of the thyroid gland. That this gland possesses very energetic antitoxic
properties can be shown by the fact that when it is extirpated animals
or persons very readily acquire infectious diseases of all sorts. Thus,
the late Professor Charrin,[44] of Paris, showed several years ago how
readily dogs that have lost their thyroid succumb to all possible
infections. Professor W. S. Greenfield,[45] of Edinburgh, has found that
persons suffering from myxœdema (athyroidia) very often die from
tuberculosis, and Professor Pel,[46] of Amsterdam, found a great
frequency of tuberculosis in the families of myxœdematous persons. This
coincides with the conclusions of Prof. G. R. Murray,[47] Professor
Lanz, and ourself, that the properties of the thyroid can be inherited.
Sajous has shown, moreover, that the pituitary, the adrenals and the
thyroid constituted the autoprotective mechanism of the body against
disease, a fact not only sustained by the above evidence, but also by a
vast number of additional facts.

Footnote 44:

  Charrin: “Les Defenses naturelles de l’organisme,” Paris, 1898
  (Masson).

Footnote 45:

  Greenfield: Quoted after Ewald, “Die Erkrankungen der Schilddrüse,”
  Nothnagel’s Handbuch, Wien. p. 159, 1896.

Footnote 46:

  Pel: “Myxœdema,” Volkmann’s Sammlung klin. Vorträge, 1895, No. 123.

Footnote 47:

  Murray: “Diseases of the Thyroid Gland,” Part i, London, 1901.

As we showed at the last Congress of Tuberculosis in Paris, 1905,
tuberculosis is especially frequent as a sequel to any process
deleterious to the thyroid gland, as after the puerperium, especially
with prolongated lactation; after sexual excesses, as there is a
relation between the sexual glands and the thyroid; after various
infectious diseases; after rapid growth in puberty, due to hyperactivity
of the thyroid which influences the growth of the body; after severe
diabetes due to exhaustion of the thyroid; and after previous
hyperactivity in chronic alcoholism due to the action of alcohol upon
the thyroid. On the other hand, all those agencies which excite thyroid
activity may be a preventive against tuberculosis, such as raw meat and
milk. It has been shown that milk contains the internal secretion of the
thyroid.

The thyroid protects us against poisons of different origin, such as the
products of decomposition of protein food. This fact is shown by the
experiments of Dr. Leo Breisacher, of Detroit,[48] formerly assistant of
the late Professor Munk, of Berlin, and from those of Dr. Blum,[49] of
Frankfort. The experimental results of Dr. Chalmers Watson,[50] showing
alteration of the thyroid in certain animals after an exclusive diet of
raw meat, and those of Dr. D. Forsyth[51] concerning the pituitary body
in some animals, may be correlated with this fact. As is well known, the
thyroid and pituitary body stand in very close relationship. Galeotti
and Lindemann,[52] in 1897, have also shown that the products of
decomposition of meat produce an increase of the colloid substance of
the thyroid.

Footnote 48:

  Breisacher: “Untersuchung über die Gland Thyroidea,” Archiv für
  Anatomie und Physiologie, Suppl., Bd., p. 509, 1889.

Footnote 49:

  Blum: Pflüger’s Archiv, vol. xc., p. 285, 1902; Archiv für die
  Gesammte Physiologie, p. 617, 1902.

Footnote 50:

  Chalmers Watson: The Lancet, p. 347, Feb. 11, 1905.

Footnote 51:

  Forsyth: The Lancet, p. 154, Jan. 19, 1907.

Footnote 52:

  Lindemann: Virchow’s Archiv, p. 202, 1897.

The antitoxic properties of the thyroid against different products is
also shown by the observations of Lanz[53] and Walter Edmunds,[54] who
have found that animals without thyroid resist narcosis badly; and, as
we have shown in a communication to the Paris Biological Society,[55]
chloroform, like alcohol, produces a condition of hyperactivity in the
thyroid gland, which results also in an excited mental condition. The
observation that cases of Graves’s disease and of severe diabetes cannot
stand narcosis may be related to this fact.

Footnote 53:

  Lanz: Zur Schilddrüsenfrage, Leipzig, 1894.

Footnote 54:

  W. Edmunds: The Lancet, May 11th, p. 1317; 18th, p. 1381; 25th, p.
  1449, 1901.

Footnote 55:

  Lorand: C. R. de la Société de biologie, 1906.

It has been shown recently by Hunt[56] that the thyroid protects us
against poisons like acetonitril, and that iodine acts through the
thyroid. Garnier,[57] of Paris, has found that certain chemical
products, such as iodine, produce great alterations in the thyroid. As
is well known, cases of Graves’s disease (hyperthyroidia) have been
observed after iodine treatment. That the thyroid fulfils a protective
rôle against infectious diseases may already be considered proved by the
fact that, as Roger and Garnier,[58] Crispin,[59] Torre,[60] Bayon,[61]
of Würzburg; de Quervain, and others have found, the thyroid is, as a
rule, altered in infectious diseases. As Roger and Garnier have shown by
a series of investigations confirmed by the above-named authors, the
thyroid shows in acute infectious diseases with fever an increased
activity with enlargement of the follicles, which are filled with a
large quantity of colloid substance which may even enter into the
adjacent lymphatic spaces. However, this hyperactivity of the thyroid
gland may be followed by its exhaustion, and thus after a certain
duration of high fever there may be no colloid substance at all in the
folliculi.

Footnote 56:

  Hunt: International Congress of Physiology, Heidelberg, 1907.

Footnote 57:

  Garnier: “La Thyroide dans les maladies infectieuses,” Thèse de Paris,
  1899.

Footnote 58:

  Roger et Garnier: Presse médicale, April 19, 1899.

Footnote 59:

  Crespin: Giornale dell’ Associazione Napolitano di Medici, xii, 3.

Footnote 60:

  Torre: “La Tiroide nei Morbi Infettivi,” Il Policlinico, No. 6, p.
  145; No. 8, p. 226; No. 10, p. 280.

Footnote 61:

  Bayon: Würzburger Abhandlungen, 1904.

It is only logical to suppose that with anatomo-pathological alterations
of the thyroid, indicating a condition of hyperactivity, there must be
corresponding clinical symptoms and that these must necessarily be
similar to those found in another condition of hyperactivity of the
thyroid gland—i.e., in Graves’s disease, the condition of
hyperthyroidia. And, indeed, such must be the case, for, as we shall try
to show, fever and Graves’s disease have similar clinical symptoms. Thus
their most typical symptom is the same: tachycardia or increased
frequency of the pulse, without which no case of Graves’s disease should
be diagnosed. There is a sensation of heat in most of the cases of
Graves’s disease, and the temperature sometimes reaches a dangerous
degree in fully developed cases of this disorder. Thirst, frequent in
fever, is also a frequent symptom in Graves’s disease (polydipsia in 14
out of 59 cases recorded by Albert Kocher[62]), and can also be produced
by thyroid feeding (Lanz,[63] Georgiewski,[64] and others). After a
certain duration of fever further symptoms of an increased activity of
the thyroid appear, such as abundant perspiration—a typical feature of
Graves’s disease. Vaso-dilatation and excessive perspiration can also be
produced by thyroid feeding. The latter symptom of fever is a device by
which nature tries to eliminate toxic products, and accordingly there
generally follows upon it a fall in the temperature and an amelioration
of the symptoms of fever. The diarrhœa which we find in some infectious
diseases, like that of typhoid fever, trypanosomiasis, etc., is also a
typical symptom in Graves’s disease. When the fever subsides there
appears another typical symptom of this condition: polyuria. To complete
this analogy we may mention toxic decomposition of proteins, diminution
in the body weight, great muscular weakness, and increased elimination
of urea and uric acid as typical symptoms of both conditions. As in
Graves’s disease, there is also in fever an augmentation of the
processes of oxidation. Glycosuria is frequent in both conditions, and
acetonuria may occur in fever and also in Graves’s disease. Glycosuria
and diabetes in consequence of infectious diseases are, as we have shown
in a paper read before the London Pathological Society,[65] probably due
to the increased activity of the thyroid, and their disappearance,
occasionally after a high fever, may be ascribed to the exhaustion of
the thyroid after a previous hyperactivity. We know that a condition of
Graves’s disease may be followed by a myxœdematous condition in which,
as we have shown previously, glycosuria is very rare. In the few
hitherto published cases there was no complete myxœdema.

Footnote 62:

  A. Kocher: “Mittheilungen aus den Grenzgebeiten,” etc., 1901.

Footnote 63:

  Lanz: Quoted after Buschau, Wein, 1895.

Footnote 64:

  Georgiewski: Zeitschrift für klin. Medicin, Bd., xxxiii, f. 1-2, p.
  153, 1897.

Footnote 65:

  Lorand: Transactions of the Pathological Society of London, vol. lvii,
  part 1, 1906.

Both in Graves’s disease and fever there is an augmentation of the
processes of oxidation. After convalescence, however, oxidation may be
diminished, and this explains, as we have shown at the French Congress
of Medicine in 1904,[66] why obesity so frequently occurs after
infectious diseases on the basis of degenerative changes of the thyroid,
which governs oxidation; during the course of infectious disease with
fever increased activity of the thyroid and loss of weight occur, and
these are followed by exhaustion of thyroid activity and obesity.

Footnote 66:

  Lorand: Congrès Français de Médecine, Paris, 1904.

The conditions of delirium and maniacal exaltation in cases of high
fever are analogous to the condition of mental exaltation that may occur
in Graves’s disease. According to the late Moebius,[67] in cases of
Graves’s disease there are sometimes symptoms like those of alcoholic
intoxication due to the toxins of the thyroid. We believe that the
mental exaltation in chloroform narcosis and alcoholic intoxication
stands in relation with the action of these drugs upon the thyroid. That
alcohol acts upon the thyroid has been shown by de Quervain,
Hertoghe,[68] and others. Sajous in his work on the “Internal
Secretions,” urges that the thyroid is not directly excited by toxins
and other poisons which produce fever, but that these toxics excite
primarily the thyroid center (or better the adreno-thyroid center, for
he holds that the adrenals are also governed by this center) thus
increasing the secretory activity of the gland. The correctness of this
view is proved by the fact that, as shown by Sawandowski,[69] section of
the basal tissues, and, therefore, between the pituitary and the bulb,
prevented the production of fever, due to putrid materials, and also the
influence of antipyretics, antipyrin, for instance.

Footnote 67:

  Moebius: “Die Basedow’sche Krankheit,” Nothnagel’s Handbuch, second
  edition.

Footnote 68:

  Hertoghe: “Die Rolle der Schilddrüse,” etc., München, 1900; and
  “Paludisme et Myxœdème,” Progrès médical Belge, No. 2, 1902.

Footnote 69:

  Sawandowski: Centralbl. f. d. med. Wissensch. B. xxvi, S. 145, 161,
  1889.

Cutaneous eruptions may occur in fever or in Graves’s disease. In the
same way as in many skin diseases they may be considered as the
expression of an elimination of toxic products through the skin.

All the above symptoms of fever may be considered as expression of the
efforts of nature to defend herself by eliminating toxic products. All
toxic products which are the causes of infection act upon the thyroid
gland, this organ, through increased activity, produces symptoms such as
we see in Graves’s disease. That these symptoms, especially abundant
perspiration, polyuria, and diarrhœa, typical in some infectious
diseases, may be considered as the direct consequence of thyroid
activity, can best be shown by the fact that the thyroid gland governs
the functions of the skin, intestines, and kidneys.

That the symptoms of fever may be considered as due to increased thyroid
activity is also shown by the fact that nearly all such symptoms may be
produced by thyroid preparations. We have personally taken for
experimental purposes, during ten months, thyroid tablets and
experienced the sensation of heat, flushings, and abundant perspiration.
It is interesting to note that all kinds of wounds and contusions we got
during the time we took these tablets, healed with surprising rapidity
with fine granulations far better than previously; on the other hand, we
very frequently suffered from tonsillitis and acne eruptions.

Symptoms similar to fever have also been produced in animals by thyroid
feeding; thus, very often elevation of the frequency of the pulse from
100 to 140-160 beats (Lanz), and from 150 to 200 beats (Georgiewski),
while Ballet and Enriquez[70] produced regular fever in their animals;
Easterbrook[71] also produced “some pyrexia” in his animals and an
increase of pulse-rate of about 40 a minute. As Dr. Tanberg, former
assistant of the Physiological Institute in Christiania, told us, he has
produced an increase of the temperature of two and a half degrees in
animals, whose thyroid he had extirpated, after giving very large
quantities of thyroid gland.

Footnote 70:

  Ballet and Enriquez: Quoted after Buschau.

Footnote 71:

  Easterbrook: The Lancet, p. 546, August 27, 1898.

It is of great interest to the question at issue that the remedies which
we employ to fight fever should also produce symptoms like the thyroid
does when it is in increased activity. Thus salicylates produce a
vaso-dilatation and abundant perspiration, and afterward diminution of
the temperature. We have, ourself, taken salicylates or acetonitril
preparation and felt the sensation of heat and afterward perspiration.
When we take a hot air or steam bath for cold or gouty pains we produce
first, great heat, tachycardia, and then abundant perspiration, and the
typical symptoms of fever or increased thyroid activity.

We know that certain drugs, as found by Garnier, have an exciting action
upon the thyroid, such as iodine, and what is especially important,
pilocarpine. The great sudorific action of this drug may stand in some
relation to its effect upon the thyroid. It is permissible to suppose
that the different drugs which antagonize fever do so by acting first
upon the thyroid gland and exciting its increased activity to fight
infection. But if we gave too much of these we might exhaust the
activity of the gland in the same way as Garnier found an exhaustion of
the colloid of the thyroid after too much iodine. This shows that we
should not give antipyretics in too large doses. We should excite
thyroid activity but not overdo it.

That the thyroid is able to protect us against infectious diseases can
be best shown by the fact that it exercises a great influence upon
phagocytosis. According to the findings of Fassin, the alexins disappear
from the blood after the extirpation of the thyroid gland; and,
according to Sir Almroth Wright, the production of opsonins is dependent
upon internal secretions. Hence, it is of the greatest value to us that
Stepanoff[72], and Marbé have proved by experiments conducted in the
Pasteur Institute of Paris that the opsonins disappear after the
extirpation of the thyroid gland but increase after thyroid treatment,
these experiments thus proving the correctness of our clinical
observations on the rôle of the thyroid gland as an organ for protection
against infections, as published in _The Lancet_ two and one-half years
ago. Sajous, who was first (1907) to point out that the thyroid
secretion was the agent which Wright termed “opsonin,” is also shown to
have been right by the investigations of Fassin, Stepanoff and Marbé,
thus proving further the intimate relationship between the thyroid and
our immunizing functions.

Footnote 72:

  Stepanoff: Comptes Rendus de la S. B. de Paris, 1908.

Fever can be produced with similar symptoms by toxic products of
different origin, as from small elements of the vegetable kingdom like
bacteria, certain plants, and even fruits, as is shown by the urticaria
which follows in some persons after eating strawberries. Certain minute
elements of the animal kingdom have a similar power, such as protozoa
like trypanosomes, and we may also instance certain kinds of animal food
like oysters in certain persons, the poison of snakes, and certain
insects like tarantulas and scorpions; also certain minerals like
arsenic and phosphorus can produce fever. Besides these poisons coming
from without, fever with similar symptoms can also be produced by
poisons formed within our body by the hyperactivity of a gland—the
thyroid. When so many different poisons produce the same result it lies
near to suppose that they do this by means of the same agency, which,
according to the aforesaid observations, is very probably a thyroid
hyperactivity. The _modus operandi_ of all these agents is well studied
in Sajous’s work, to which the reader is referred.

As is well known, a condition of hyperactivity of the thyroid may be
followed by its exhaustion, and thus Graves’s disease may often be
followed by myxœdema, i.e., athyroidia. In the same way the
hyperactivity of the thyroid gland in infectious diseases may also be
followed by its exhaustion and a myxœdematous condition. Even complete
myxœdema most frequently appears after a previous infectious disease—a
fact recognized by the earliest English authors on this disease.
Accordingly, it is not surprising if an infectious disease like
trypanosomiasis is followed by a condition like sleeping sickness,
which, as we have shown at the German Congress for Internal Medicine in
1905, presents all the clinical symptoms of, and identical
anatomico-pathological alterations of the central nervous system noted
in, myxœdema. On the other hand, trypanosomiasis presents all the
typical symptoms of Graves’s disease. In syphilis also, after the fever
with eruptions in the secondary stage, in which we not infrequently see,
especially in women, a swelling of the thyroid, we find in the tertiary
stage many symptoms of a condition of myxœdema or hypothyroidia, and
with the iodine treatment we add to the blood the main element of the
thyroid gland. Iodine is also especially active, if not given in too
large doses, in exciting thyroid activity, and sometimes it even
provokes Graves’s disease.

Persons of healthy constitution with a good working thyroid may get the
sensation of heat and perspiration spontaneously after a cold, or gouty
pains, even without salicylates, and feel better afterward, whereas
persons with a deficient thyroid have difficulty in producing the
symptoms of fever. Recently we observed a young man, aged 22 years, with
symptoms of hypothyroidia as described by Hertoghe, who had follicular
tonsillitis. He presented none of the symptoms of fever, but it took him
ten days to get over it and he felt very weak afterward. There was this
summer an epidemic of typhoid fever in the lunatic asylum of Colorno,
near Pavia. We have it from Dr. Gassenghi, of the University of Pavia,
that half of the patients died; but it is very interesting to note that
there was no fever. This may be explained by the fact that many cases of
insanity and idiocy stand in etiological relation to alterations of the
thyroid gland, and may get better after the hyperactivity of the thyroid
through fever. Indeed, by some authors,—e.g. Wagner—an improvement has
been observed to occur in insanity by producing fever through injections
with tuberculin. We feel sorry not to be able to enter more fully into
this interesting subject, but we may briefly mention that, as we have
stated in the Neurological Society of New York (April 2, 1906), we have
observed several cases of dementia præcox and melancholia with
alterations of the thyroid and sexual glands in each case. Alcoholics
suffering from pneumonia seldom get high fever, but often die in a short
time. Alcohol in large quantities not only causes degenerative changes
in the heart, but also in the thyroid. And we should not forget that
there exist very close relations between the activity of these two
organs.

It seems to follow from these observations that persons with a good
sound thyroid have a better chance in fighting infections and
intoxications than persons with a degenerated thyroid. In persons with
an active thyroid, an increased activity of the gland, and thus a better
functioning of the eliminative organs which are governed by it, can take
place more easily than in persons with a degenerated thyroid, and, in
consequence, with a dry skin, constipated bowels, and lazy kidneys. Some
hints may be derived from these observations in the interest of
prophylaxis and prognosis, and also for the purposes of life insurance.

It seems to us that the conclusion is not unjustified, that fever is a
beneficial process of our organism which is produced by an increased
activity of the thyroid gland as a reaction against toxic products and
poisons in general. The symptoms of fever are the expression of this
increased activity, and they are directed toward the elimination of
noxious elements. It would be unreasonable to oppose this spontaneous
healing tendency of nature by fighting these salutary symptoms, unless
there be hyperpyrexia. Fever, as probably disease in general, serves the
ends of nature in the interest of our conservation. In addition to the
thyroid, the other ductless glands protect us from infections and
intoxications. Thus, the pituitary body which Casselli,[73]
Guerrini,[74] Torri, and many others found, as a rule, altered through
infectious diseases. Torri noticed a hyperplasia of the chromophile
cells of the pituitary body, and disappearance of the colloid from the
follicles in the majority of cases of pneumonia, typhoid fever,
tuberculosis, diphtheria, and other infectious diseases. Garnier also
noted changes in this gland in chronic tuberculosis. Thaon,[75] in his
recent thesis, also found changes in the pituitary body in many cases of
various sorts of infectious disease, and, what is most interesting, also
in intoxications from intestinal origin. We must conclude with Sajous
(1903) that the pituitary body reacts to the effects of infections and
intoxications and that these anatomo-pathological alterations of the
pituitary also provoke clinical symptoms. Renon[76] and Delille have
drawn attention to the fact that the decrease of the blood-pressure, and
increase in the number of pulsations, in fever, as also the other
symptoms of this condition, such as insomnia, heat, perspiration, etc.,
are due to the alteration of the pituitary body. When this is active and
healthy it augments blood-pressure, according to Oliver and Schäfer,[77]
Cyon, Livon, Garnier, Thaon, Hallion, and Carrion, etc. At the same time
the pulse is diminished, but when this gland is degenerated the pressure
naturally falls and the pulsation goes up.

Footnote 73:

  Studie anatomici e sperimentali sulla psycho-pathologia della glandula
  pituitaria, Reggio Emilia, 1900.

Footnote 74:

  Revista di Patol, nerv. e mentale, Nov., 1904; and La Sperimentale,
  lviii., 1904.

Footnote 75:

  Thèse de Paris, 1907.

Footnote 76:

  Société de therapeutique, Jan. 22, 1902.

Footnote 77:

  Journal of Physiology, t. xviii, 1895.

It is also very interesting that Renon, with his assistants, Delille and
Azam,[78] were able to increase blood-pressure in numerous cases of
infectious diseases and diminish the pulse, and also produce a marked
improvement in the feverish condition through the administration of
extracts of the pituitary body.

Footnote 78:

  Azam: Thèse de Paris, 1907.

We must insist on the fact that the thyroid and the pituitary body are
antagonistic; the thyroid diminishes, the pituitary augments,
blood-pressure. The same antagonistic relations exist also between the
thyroid and adrenals, as already mentioned.

The adrenals play an important rôle also in the defense of the organism
against infections and intoxications, as we will point out in a separate
chapter. We will only recall here that already (1903) Sajous[79] has
insisted upon the important rôle of the adrenals in the production of
fever.

Footnote 79:

  “Internal Secretions,” vol. i, p. 33.

The co-operation of the sexual glands in protecting the body from
infectious disease can be shown by the fact found by Professor
Cornil,[80] of Paris, that in infectious diseases, such, for instance,
as typhoid fever, there is frequently sudden menstruation, with abundant
metrorrhagia, the autopsy often showing hypertrophy of the corpus
luteum.

Footnote 80:

  Quoted after Loisel.

Metschnikoff[81] and Matschinski found, after injections of the bacilli
of tetanus, or of diphtheria, the greatest number of them in the
ovaries, or in the testicles, of the animals. It is also of great
interest that Lingard[82] found that the subcutaneous injection of
testicular extracts into cattle induces a resistance to infection from
bovine plague, against which other cattle can also be rendered immune
through the serum of the treated animals—which seems very important to
us. Brown-Sequard and d’Arsonval employed testicular extracts with good
result in tuberculosis, and Uspenski in cases of Asiatic cholera.[83]

Footnote 81:

  Metschnikoff: Annales de l’institut Pasteur, 1900.

Footnote 82:

  Lingard: Centralblatt für Bacteriologie, vol. xxxviii, Nu. 2, p. 246.

Footnote 83:

  Comptes Rendus de la Société de Biologie de Paris, Nov. 5, 1896.

In the chapter on the treatment of old age by organic extracts, we
submit evidence showing that infectious diseases have been treated
successfully by several authors by these extracts. Many others have also
shown that spermin, prepared by Professor Poehl from the testicles of
various animals, has also a marked effect against different infectious
diseases, sometimes even in cases of desperate septicæmia. It has been
shown by Professor Loewy and Dr. Richter, that after giving spermin
there is at first a great diminution of the leucocytes in consequence of
leucolysis, which is soon followed by hyperleucocytosis, and at the same
time there was considerable increase of alkalinity in the blood.[84]

Footnote 84:

  Richter: Organotherapie.

Loewy and Richter were able to cure animals by injecting spermin even in
cases of experimental pneumonia, where they had received three or four
times the fatal dose of pneumococci. These observers also tried spermin
in diphtheria, but here the results were less marked, although in some
cases where the exact fatal dose was given, a cure was effected.
According to Professor Poehl[85] the increase of alkalinity of the blood
through spermin, explains its action to increase immunity against
infection. Sajous also urges that immunity is closely related with
alkalinity.

Footnote 85:

  Poehl: Organotherapie, vol. i, St. Petersburg, 1905.

It is interesting to observe that spermin has also given good results in
intoxication through leucomaïnes, which play a great rôle in
auto-intoxications in the body. This applies to neurin and cholin, as
noted by Professor Prince Tarchanow, and Dr. Poehl.

We have already mentioned that the thyroid protects us against various
poisons, such as chloroform, and it is of interest to note that the
testicles may also have a similar action; for, as Tarchanow has shown in
frogs, and also dogs, after injection of spermin, these animals were
better able to resist chloroform narcosis, and could also withstand a
greater dose of it. Weljaminoff found the same also in man. Krüger found
that this applied also to ether narcosis.

The liver, as we shall show later in a separate chapter, also
antagonizes intoxication. Another organ in close relation to the
ductless glands—especially in infants—the thymus, must also be
considered in the same way as the spleen as taking an important part in
our protection against infections. As well known, the spleen is a
foremost organ for the production of protective substances, the frequent
swelling of the spleen in infectious diseases shows its co-operation in
the defense of the body (see also Chapter X). Respecting the thymus, it
has been shown by Brieger, Kitasato, and Wassermann, that cultures of
cholera bacilli lose their toxic action in extracts of the thymus.

There can be no doubt whatever, from the foregoing, that our immunity
against infections and intoxications depends on the intact condition of
the ductless glands, the great importance of which, as defensive organs,
has been demonstrated and explained by Professor Sajous in 1902.[86] As
he says: “The overactivity of the adrenal system is the inciting factor
of leucocytosis, and, therefore, of phagocytosis;” and later in the
second volume: “that the adrenal system, composed of the pituitary body,
the adrenals, and the thyroid apparatus, constitutes the immunizing
mechanism of the body.”

Footnote 86:

  Sajous: “Internal Secretions,” vol. i, p. 624, 1903 (see also vol. ii,
  p. 13, 1907).

When the ductless glands are not in good working condition, there are
three principal things which can occasion infection or intoxication.
These are deficient nutrition, exposure to cold, and a depressed mental
condition. By these the resistance of the cells against the energy of
the invading microbes is lowered, and the greater the invasion the
easier will be their victory.

We will often refer to this in the chapters on personal hygiene, and
propose certain remedies for avoiding these predisposing sources of
infection and intoxication.


------------------------------------------------------------------------




                              CHAPTER IV.

  ON THE AGENCIES THAT GOVERN THE CONDITION OF THE NERVOUS SYSTEM AND
                               MENTALITY.


BY treating with thyroid extracts a child that has remained backward in
his mental development we can make a curious observation. The child who
had previously been a cretinous idiot will not only improve bodily but
also mentally, and he will be transformed into an intelligent being with
normal mental faculties. The logical deduction is that the thyroid must
influence powerfully the condition of our nervous system and mentality.
Indeed, the physiological activity of the nervous system and mentality
depends entirely on the co-operation of the ductless glands with
internal secretion. In fact, we do not think we are going too far in
saying that the condition of the nervous system and mentality is mainly
governed by these glands. The truth of this assertion is shown by the
fact that any alteration of these glands, especially the thyroid and
sexual glands, and pituitary body, is always followed by alterations of
the nervous system. This is strikingly sustained by the elaborate
researches of Sajous who found that the reactions of fluids circulating
in all nervous elements corresponded with those of internal secretions
and particularly that of the adrenals.

Removal of the thyroid also produces far-reaching anatomical changes in
the central part of the nervous system which, as we have mentioned, has
been described by Albertoni, Tizzoni[87] Blum,[88] Walter Edmund,[89]
and others. These consisted of the destruction of nervous cells and
nervous processes, chromatolysis, and also the augmentation of the
neuroglia, which increases in the same way as the connective tissue in
all other organs and tissues.

Footnote 87:

  Arch. per le scienze Mediche, vol. x., p. 45, 1886.

Footnote 88:

  Blum: Virchow’s Archiv, 1899.

Footnote 89:

  Walter Edmunds: Transact. of the Path. Soc. of London, vol. liii.,
  Part 3, p. 343, 1902.

These changes have been found by Whitwell[90] also in myxœdematous
persons. In accordance with these anatomo-pathological changes we must
also expect clinical symptoms, and we shall thus find in persons with
degenerated thyroids an idiotic condition termed cretinism, while in
persons suffering from myxœdema mentality is considerably altered. Thus
Pilcz[91] notes as typical symptoms of myxœdema: slowness of thought,
apathy, defective memory, and somnolence. In fact, after removal of the
thyroid gland or after its degeneration by disease, we observe changes
in all those functions which, according to our present knowledge of
physiology, are situated in the cortex cerebri, such as intelligence,
power of imagination, will power, memory, sleep, etc. The thyroid must
govern these functions, as they are seriously damaged after the
degeneration of this gland. Thus, myxœdematous people think and speak
very slowly, have a weakened intelligence, are completely apathetic, and
have no will-power, and the memory is either gone or is defective. In
the same way, as in old age, myxœdematous people can remember events
which have happened a long time ago, but cannot do so as regards recent
events—all facts we explain by assuming they are able to remember what
has happened at the time prior to the degeneration of the thyroid; but
after such a condition they are not able to mirror recent events in the
greater brain. The wonderful effect of the thyroid on intelligence can
be observed, as above mentioned, in backward or cretinous children who,
by means of the thyroid extract, become intelligent children gifted with
a better memory. We, ourselves, through personal observation and
experiments, observed the fact that thyroid tablets improve the memory
(see also Chapter LIII), and it is interesting to mention here the case
of a very stout patient who, after the first day of thyroid treatment,
felt in such a condition of mental activity that he sat down, in the
middle of the night, at his writing table to compose a scientific
article instead of going to sleep. We did not mention to this
gentleman—a lawyer—anything about the effects that the thyroid might
have. Dr. Hertoghe, the well-known authority on the thyroid gland, told
us that he sometimes takes before strenuous mental work, such as the
delivery of a lecture, three or four thyroid tablets at a single dose.
We must not, however, allow ourselves to be seduced to thyroid
medication by the action of thyroid on mentality, unless the condition
of our gland demands it, for the administration of such extracts in
large doses and without special diet and precautions may produce
disagreeable symptoms, a description of which we will give in a special
chapter on the treatment of old age by means of extracts from the organs
of animals.

Footnote 90:

  Whitwell: British Med. Journal, p. 730, Feb. 1892.

Footnote 91:

  Quoted after Oppenheim: “Lehrbuch der Nervenkrankheiten,” p. 1383,
  Berlin, 1906.

We have also frequently seen a marked improvement in the mental
faculties of adults through thyroid treatment. Thus last winter, during
a stay in Nice, we were consulted by an American lady of 69 years who
was suffering from arteriosclerosis and dizziness. Through thyroid
treatment the intelligence of this lady improved so much that it became
very noticeable to her English trained nurse, who told us that whereas
before she could do anything with this mentally torpid woman without
comment, now she first demanded to know the reason for everything before
she complied with the dietary and hygienic measures the nurse wanted her
to follow.

That the thyroid gland affects the intellect is also proved by the very
important fact that the serum of animals whose thyroid has been
extirpated, and which is thus antagonistic to the thyroid gland, is able
to impair the intellect. Dürig[92] noticed this after using large doses
of such serum in a woman with Graves’s disease, thereby causing an
appearance of great stupidity, loss of memory, and incapability of
thinking, so that he had to suspend the treatment. These symptoms
continued for fourteen days after the treatment had been discontinued.

Footnote 92:

  Dürig: Münchener Med. Woch., 1908, Nu. 18.

Sleep is also one of the functions controlled by the thyroid, and as its
changes are able to promote senility, we believe it will be well to
discuss this more fully in a special chapter (XLIII).

We cannot recall any alteration of the thyroid gland that is not
accompanied by nervous symptoms. In Graves’s disease (exaggerated
activity of the thyroid) we observe a condition of great nervousness, so
much so that, according to some authorities, Graves’s disease may be
termed a neurasthenia with tachycardia. There are many women treated for
simple hysteria who are, in fact, suffering from a partial form of
Graves’s disease with its cardinal symptom: tachycardia. In cases of
Graves’s disease we often find conditions of exaltation, even manias,
and very frequently, at the very least, great irritability. On the other
hand, in myxœdema there is, usually, a condition of melancholia, and it
is interesting in this connection, that in a number of cases of
melancholia we have found a swelling of the thyroid with a cessation of
the menstrual flow; such cases improved after thyroid treatment,
particularly when conjoined with treatment by ovarian extracts. In the
lunatic asylum of Pontiac, Michigan, some 100 cases of swelling of the
thyroid have been traced out of 600 insane inmates, as we heard on the
occasion of our visit to our friend, Dr. Edwin S. Sherril, of Detroit,
four years ago.

As we have seen already, the thyroid stands in very close relation to
the ovaries, and, as we have often stated, the alteration of the
ovaries is very apt to produce a swelling of the thyroid, as witnessed
during menstruation, puberty, pregnancy, the puerperium, lactation,
and the climacteric. Not only may the thyroid swell in many of these
conditions, but the mental system is also changed during each of these
processes. Sometimes it may be simple irritability, but at times the
changes of the mind may develop into lunacy. Thus, in young girls, we
occasionally see in the years of puberty mental changes, such as a
tendency to wandering away from home, and even cases of lunacy, the
so-called psychoses of puberty. Similar cases of insanity are equally
frequent in pregnancy, and during the climacterium or after the
experimental climacterium—castration. Again, insanity is not
unfrequent in cases of degenerative disease of the ovaries; to such an
extent, indeed, that sometimes a gynæcologist can treat a case of
insanity in women better than a specialist in psychiatry. Not only in
women, but in men changes in the sexual organ always produce
far-reaching changes in the mind. Chronic gonorrhœa is the more to be
feared on account of its invariably involving the prostate, the
inflammation of which, in the same way as that of the testicles, is
usually followed by symptoms of neurasthenia. If we now note this and
remember that, according to Baldwin, in most cases of hysteria we may
find at the autopsy alterations in the ovaries, we shall understand
that the author of this book did not go too far when he stated, in a
communication to the Belgian Congress of Neurologists, in Brussels, in
1906, that all cases of neurasthenia and hysteria are based upon
pathological anatomical alterations, and that it is not true that, in
contra-distinction to all other diseases, these should be the only
ones without any pathological anatomical foundations. In fact, in
nearly all cases of neurasthenia or hysteria we shall find changes in
some of the ductless glands, particularly the thyroid, sexual, or
pituitary body, if we only take the trouble to search for them. The
degenerative alterations of the pituitary body are, as a rule,
followed by the symptoms of the disease called acromegaly, and this
also presents all the symptoms of a neurasthenic or hysteric
condition.

From the foregoing we shall understand why so many people, whether male
or female—possibly the latter in greater number—who live in total sexual
abstinence, present symptoms of neurasthenia or hysteria; for it has
been shown by Rigaud and also by Mingazzini, that animals, living in
total sexual abstinence, present alterations in the epithelia of the
sexual glands (see Chapter XLVII).

It would be simply hypocrisy and unworthy of a scientific work which
should always aspire to reveal the truth, were we to deny the fact that
many old bachelors and spinsters present a series of nervous symptoms,
especially dyspepsia and hyperchlorhydria and pains in the stomach, far
more than other persons, which we must explain by the action of impulses
coming from the sexual organs to the sympathetic and pneumogastric, the
principal nerves of the stomach and intestines, and thus producing a
hyperæsthesia of the nerves of the stomach. In such persons some kinds
of food, well digested by a normal stomach, will act as an injurious
foreign body, and be felt as such by the over-sensitive stomach nerves,
and the gastric glands will respond with a large flow of secretion and
much acid upon agencies that produce no such stimulation in a normal
stomach.

That the sexual glands also influence the intellect is best proved by
the observation that in cases of testicular or ovarian insufficiency
intelligence is often diminished. Thus we were consulted by the parents
of a young man of eighteen years who was mentally backward; he could not
remember anything; his arms and legs were abnormally long, but his body
short, thus resembling a eunuch’s—and indeed I found his testicles were
not yet descended. His voice was that of a child, and he also exhibited
the other symptoms of testicular insufficiency described in the second
chapter of this book.

On the other hand we may see a precocious highly developed intellect in
children with a premature sexual development. We know of a boy of six
years who tried to have sexual intercourse with a little girl of the
same age, and who at the age of four and one-half years knew all the
capitals of the world by heart. Hence the education of precociously
bright children should be especially guarded, for they can become great
men but also not rarely, if neglected, great criminals.

As, however, in these days of scepticism we do not believe in anything
until demonstrated by experiments (often forgetting the fact that what
does for dogs or rabbits does not always do for man) which should only
assist our judgment, but not exclusively govern it, we shall have to
prove the correctness of our clinical observations on the influence of
the sexual glands—i.e., on the nervous system and mentality—by
experiment, and we believe we have sufficient facts at hand to do so.

About a hundred years ago it was shown by Gall—who was attacked by
several authors, among them Rieger, as innovations always are, but who
was also successfully defended by the celebrated German nerve specialist
and philosopher, Moebius[93]—that castrated animals or persons have an
alteration in the back part of the skull indicating an impoverishment of
the cerebellum. And, indeed, he produces his own evidence and that of
several other authorities, Darnecy, Rousseau, etc., which gives the
history of several autopsies on castrated persons, all of whom showed an
atrophy of this structure. In cases where only one of the testicles was
destroyed, this atrophy was always present in the hemisphere of the
small brain on the opposite side.

Footnote 93:

  Moebius: “Die Wirkungen der Castration,” Halle, 1902.

It has been found by numerous authorities that the skull and brain of
castrated animals and persons is smaller than the normal. Gall[94] noted
this fact, and after him Vimont,[95] from experiments on animals; and,
according to the latter observer castration of both sides produces a
considerable diminution of the cerebellum. Leuret and Hoffmann[96] found
a diminution of the head in horses, sheep, and pigs after such an
operation, and that the other parts of the skeleton are always altered
is a fact recorded by a large number of authorities as stated already.

Footnote 94:

  Gall: “Anatomie et Physiologie du Système nerveux,” T. iii., p. 108,
  Paris, 1818.

Footnote 95:

  Vimont: “Traité de Phrenologie humaine et compareè,” two vols. et
  atlas, vol. ii., p. 233, Paris, 1835.

Footnote 96:

  Hoffmann: “Ueber die Castration der Hausthiere Schneidermühls Thier
  medecin,” Vorträge ii., 12. 1892.

As we have pointed out above, any alteration of the testicles or ovaries
is followed by nervous disturbances, and, consequently, the total
removal of these glands produces far more deleterious effects, and these
will vary according to whether such persons have been castrated at an
early age or later. In these latter cases nervous disorders will be more
acutely felt, and as the celebrated French authority, Dupuytren, states,
melancholia is a common phenomenon in castrated men. According to more
recent observations in cases of enlargement of the prostate that have
been treated by castration, the patients exhibit melancholia. We may
here remark that the testicles and the prostate are in close relation,
the latter always becoming atrophied after castration. There is
experimental evidence to show that a too large amount of testicular or
ovarian secretion may produce toxic effects. Thus, Loisel, by injecting
testicular or ovarian extracts into animals, could produce toxic
symptoms in every instance. This may account for the fact mentioned
previously that persons living for a long time in complete sexual
abstinence, occasionally exhibit symptoms of disorder of the nervous
system.

The marvelous influence of the sexual glands on the mind and character
is at once apparent if we consider the aberration from the normal of the
castrated person. The authorities who have studied the eunuchs in Egypt
and the Skopze in Russia (a religious sect who adopt castration as a
tenet), found typical characteristics in these people that distinguished
them from the normal.

Thus, as a rule (and as stated by Moebius), the biography of remarkable
eunuchs of the old and middle ages shows that they are entirely
deficient in courage, which seems to be dependent entirely on the
possession of testicles, and the same fact may be noted also in the case
of the lower animals. Thus, an ox is a coward compared to a bull, and an
ordinary horseman prefers to ride a mare rather than a stallion. The
best means of taming certain animals is by depriving them of their
testicles at an early age. Intelligence also is much influenced, not
only by the thyroid, as already shown, but by the testicles. Thus
persons of literary or other fame, such as artists and the like, have
become impaired in their capacity after castration: Abelard, for
example.

Moebius, in the history of the world, could find no castrates of great
intelligence. Knowledge gained by diligent labor is not referred to
here. We merely wish to express our conviction that great ideas, such as
are found in men of genius, are impossible in men devoid of their
testicles; and it appears out of the question to imagine such men as
Napoleon, Goethe, or others, as castrates. On the contrary, we are
inclined to believe that such great men had a private life that would
have rendered them unfit for the position of superintendent of an
American Sunday School.

Courage is a specific feature that can only be found in a man who is
still in possession of healthy sexual glands; it is entirely wanting in
eunuchs. Cowardice, superstition, laziness, avarice, vanity, cruelty,
and other bad qualities are typical features in eunuchs. Our friend Sir
Hugh Adcock, formerly physician to the late Shah of Persia, told us that
his own experience with hundreds of eunuchs showed him that they all had
these bad qualities. Capacity for hard work, generosity,
kind-heartedness, and religion may be found in persons who are in the
possession of healthy, vigorous, sexual glands; but by exhaustion, after
sexual excesses, a condition may be created analogous to myxœdema after
previous Graves’s disease. This exhaustion of the sexual glands may
create a condition in which some of the features of the castrated may
appear. This is noticeable in the character of many of the dignitaries
of oriental countries who possess large harems, and also in occidental
countries in many men who lead a life of debauchery. The influence of
the pituitary is shown by changes that invariably occur in the nervous
system and mind after any alteration in it. Thus, in two millionaires
suffering from acromegaly we have observed great stinginess. We do not
intimate that this is a characteristic of millionaires, but these
gentlemen were quite the reverse before becoming afflicted with their
disease. In one case of acromegaly, for the knowledge of which we are
indebted to Dr. Dercum of Philadelphia, there was a great distrust of
anything new, even the most useful of innovations. This caused great
discontent among the gentleman’s business partners, although he himself
showed this disposition only after the symptoms of his disease were
apparent. In acromegaly there exists a hyperactivity of the pituitary;
Renon was able to produce the disease by giving large doses of pituitary
extracts, and Hochenegg obtained good results in his treatment of it by
extirpating the pituitary body.

Extirpation of the adrenals is also followed by important alterations in
the nervous system, as was noted by Jersoni and others. Also, in
Addison’s disease, which is accompanied by a degeneration of these
glands, we notice a diminution of the intellect together with a general
mental depression.

The influence of the ductless glands on character, and the change in the
same after alterations in those glands, may easily lead to crime, as the
two principal barriers against crime are will-power, by which we control
our passions; and sound judgment, by which we distinguish right from
wrong. It is evident that a cretinous or myxœdematous person will have
no great will-power, for this, as already shown, is dependent on the
thyroid secretion; nor do they possess intelligent sound judgment enough
to realize what is right; and, as the possible consequences of their
defective action, castrated persons, as above shown, are more attracted
to crimes due to avarice or cruelty. Those who are interested in this
question may read our lecture delivered before the Medical Jurisprudence
Society in Philadelphia,[97] in which we endeavored to prove in detail
our assertions that the origin of crime is due to nervous changes
succeeding alterations of the ductless glands. As persons of advanced
age often have a complete atrophy of the sexual glands, changes in their
character may be explained on these grounds.

Footnote 97:

  Journal of the American Med. Association, May 10, 1907.


------------------------------------------------------------------------




                               CHAPTER V.

   ON THE INFLUENCE OF THE SEXUAL GLANDS UPON VITALITY AND LONG LIFE.


WHEN we study the history of people who present a youthful appearance
late in life, and reach an extraordinary old age,—up to 120 or 140, or
even 160,—we are surprised at the unmistakable evidence of a strong
sexual activity in most of them, which is only possible by being
possessed of healthy and active sexual glands; and thus it would appear
that the possession of such glands may impart a strong vitality and the
best chances for a long life. That such is the case we will endeavor to
show by evidence of an experimental nature, and also by facts gathered
from observation of the long lives of the patriarchs.

When the sexual glands of a person are extirpated, such castrated
people, be it man or woman, soon get old. This we can see in the case of
eunuchs who get wrinkled even in their youth, such also get fat, and
present other symptoms of premature old age; and the same is observable
in women whose ovaries have been removed.

Matthew Paris,[98] the historian, in his description of eunuchs and the
appearance of early old age, tells us that in 1253 Frederick II, Emperor
of Germany, married Isabella, sister of the King of England, and he
presented to his wife several Moorish slaves who were eunuchs, for
servants, who looked like old masks. Pelikan[99] also mentions that the
whole community of castrated Skopze in Russia, has a withered aspect;
and in his book Merschejewski relates that their skin is withered and
wrinkled, and that they look worn out, aged, and senile.

Footnote 98:

  Quoted after Moebius, “Die Wirkungen der Castration,” p. 43, Halle,
  1907.

Footnote 99:

  Pelikan: “Gerichlach Med. Untersuchenger über das Skopzentham in
  Russland,” Giessen, 1876.

Besides provoking senility at an early period, castration or a
degenerated condition of the sexual glands, especially in women, is able
to produce alterations in organs, which are of great importance to the
vitality of individuals, and to a long life, such as the heart, stomach,
intestines, and liver. Experienced authorities have noted heart troubles
in dysmenorrhœa and amenorrhœa, and also neurosis of the heart with
long, lasting alterations of the female sexual glands. Professor
Kisch[100] also noted tachycardia in such conditions. Professor
Landau[101] has very often observed a degeneration of the heart after
myoma of the uterus. Lehman and Strassmann, in the Berlin Charité, have
seen such a degenerated condition of the heart in 44 per cent. of
patients with myomas of the uterus.

Footnote 100:

  Kisch: “Das Geschlestrlehen der Frau,” second edition, Vienna, 1908.

Footnote 101:

  Quoted after Kisch.

It has been shown by experiments that there is a close relation between
the condition of the ovaries and the heart. Professor Hegar[102] has
demonstrated that castration, or simple tugging of the ovaries, is able
to produce a diminution of the heart beats, or even a stoppage of the
heart. Lucas Championnière has also noted the same after a tearing of
the ovaries, and Mariagalli and Negri have also noted tachycardia after
laparotomy.

Footnote 102:

  Quoted after Kisch; as also other authors on the relation between
  heart and stomach, and the ovaries.

Very important also are the relations between the ovaries and the
digestive organs. Kretschy observed, in a case of fistula in the
stomach, that alterations of the female sexual organs regularly produced
also alterations of the digestive functions; for instance, during
menstruation there is always an increased flow of hydrochloric acid. The
same has been found by Fleischer, who noted during this period a
sluggishness in digestion, which improved after menstruation.

Tanecki found dyspeptic troubles in cases of retroflexion of the uterus,
and Eisenheart has observed the disappearance of acute gastric troubles
after a cure of retroflexion.

P. Muller also declares that there are intimate relations between the
sexual glands and the digestive organs. He also observed dyspeptic
troubles during menstruation; and Professor Leyden has noted neuralgia
and hyperæsthesia of the stomach in young girls after menstrual
troubles.

Habitual chronic constipation, which is so frequent after a degenerated
condition of the sexual glands, points to the existence of close
relations between these organs and the intestines.

Based upon clinical observations, we have advanced the theory that
alterations of the ovaries are able to produce alterations also of the
liver, and the circulation of the bile, with formation of gall-stones.
Castration also produces alterations of the thyroid: first, its
hyperactivity with increase of colloid substance, and, afterward, its
degeneration.

Castrated animals or persons seem to offer less resistance to infection,
which may be on account of the connection, as shown by the experiments
of Metschnikoff[103] and others, that the testicles are altered in
infections, which has been shown to be equally the case with the ovaries
(Professor Cornil). The sexual glands, as the ductless glands in
general, have the duty also of protecting the body against the various
kinds of intoxication and infections, as already emphasized.

Footnote 103:

  Metschnikoff: Loc. cit.

From the foregoing there can be no doubt that degenerated conditions of
the sexual glands, by producing alterations in important organs,
diminish vitality and the chances of an advanced old age.

This seems also to apply to males, for there is no evidence showing that
any eunuch has reached a very advanced age, whereas there is plenty of
evidence of persons with strong sexual glands having lived far beyond
100 years. The vitality of persons if totally castrated is, as a rule,
diminished.

Again if we study the history of persons who attained the maximum span
of life, we find many evidences of the existence of strong sexual
impulses. Thomas Parr, who lived to nearly 153, has been accused of
having committed a sexual offense in his 102d year, for which he was
found guilty and punished. Reaching even a greater age, his sexual
appetite does not seem to have diminished, for he married, eighteen
years after, a widow, who said she could discover nothing that would
betray his great age.

Drakenberg, a Dane, who is buried in the cathedral in Aarhus, Denmark,
lived 146 years, and reached this advanced age although he was more
often drunk than sober. When he was 111 he married a woman of 60, and
after she died he fell in love in his 130th year with a young peasant
girl; but this blooming flower of the Jutland peninsula, famous for its
fresh and healthy girls, refused her ancient wooer, who, nothing
daunted, tried his luck with several other young maidens but with no
better success; therefore he had perforce to remain a widower, and he
lived an additional sixteen years. Possibly if he had addressed widows
or elderly spinsters, he might have succeeded; but it is very
instructive that this ancient Methuselah insisted on marrying a young
girl, which certainly speaks in favor of strong sexual feelings in so
old a man, and, indeed, we may say it is an object lesson to us to
observe that these ancients were always anxious to marry again so soon
as they became widowers. That it was more than a mere formality, or bond
of platonic affection, was attested to by Thomas Parr’s wife when he was
in his 130th year.

If many children be considered a sign of sexual activity and capacity,
these very old men distinguished themselves in this respect, as most of
them had numerous progeny. Several had a score of children after they
were 80. Peter Albrecht, who lived to be 123, married in his 85th year,
and had 7 children. Another patriarch, Gurgen Douglas, born in
Marstrand, near Gothenburg, in Sweden, who reached to 120 years and 7
months, married in his 85th year and had 8 children, one of which was
born when he was in his 103rd year. This child was an idiot, but as it
is very interesting to note, otherwise physically well developed.

An Italian, Baron Baravicino de Capellis, died in 1770 at Meran, a
climatic resort in the Tyrol (Austria), in his 107th year. He had 4
wives, the first of whom he married when he was 14, and the last when he
was 84. He had 7 children, and it is an interesting fact that his wife
was pregnant when he died.

As an English paper has reported, in 1796 there was a shoemaker, R.
Glan, living near Philadelphia, Pa., who died at 114, and never missed a
Sunday service. At his decease his third wife was but 30, and his virile
powers were normal.

We need not be too skeptical as to the legitimacy of the children of
fathers of such advanced age for reasons we will mention later. Examples
of fathers at ages above 60 or 70 are not so exceedingly rare. A very
good example of this is that of a crowned head of one of the European
countries, married morganatically, who, in his 72nd year, was presented
by his wife with a child, and nobody who is acquainted with the powerful
constitution of this monarch and his predilection for the fair sex will
doubt his happiness as a father. He is noted for his marvelous
intellect, which, again, is so frequently met with in persons with very
active sexual glands.

Several of these ancient patriarchs, at the autopsy, presented a
wonderfully good state of preservation of the various organs. Thomas
Parr died in his 153d year, and his autopsy was made by one of the
greatest physicians in the history of medicine—the celebrated Harvey,
the discoverer of the circulation of the blood. Harvey found every organ
in this wonderful old man in perfect condition. His death was attributed
by Harvey to over-eating, as Parr had always lived a very frugal life.
The King of England invited this astonishing personage to London in his
152d year, as he wanted to know this most interesting of his subjects;
but the rich food he received in the royal household did not prove
beneficial to him, and though his 152 years of frugal life were unable
to kill him, nine months of an opposite style of living succeeded in so
doing.

We should not wish to omit mentioning again the important fact that,
with few exceptions, the persons who lived to such an extraordinary age
were married, and some of them three or four times, which again serves
to show us the great importance of marriage as a means to reach a good,
old age.

We have quoted these instances of longevity from Hufeland,[104] one of
the greatest German physicians of the eighteenth century, of whose
truthfulness there can be no doubt. The great German physiologist,
Pflüger, also quoted some of the above examples of great age in his
address in celebration of the birthday of Emperor William II, at the
University of Bonn. When Parr had been found guilty of a misdemeanor in
his 102d year facts were adduced in the courts which showed that, as
Pflüger says, this “100 jährige durchaus die Eigenschaften eines
Kräftegen jugendlichen mannes besass” (the man of 100 years really had
the qualities of a powerful young man). Pflüger quotes this from
Flourens, and we were pleased to find an account of the autopsy of the
celebrated patriarch in a letter from Harvey, himself, to his nephew,
published by the Sydenham Society[105]: “The body was in such a good
condition in a man of 153 that the cartilages of the chest bones were
not yet ossified.” Harvey put it: “The cartilages were soft and
flexible,” black hair on the forearms, and the organs apparently
healthy. Probably the fact that the testes, as Harvey says, “were sound
and large,” had something to do with it. He was also an affectionate
husband, and to quote Harvey again, “His wife told me that until twelve
years ago he never ceased to embrace her frequently”; that is, when he
was 140 years old! At the autopsy of John Bayley, of Northampton, who
died 130 years old, Dr. James Keill[106] found his testes of large size.

Footnote 104:

  Hufeland: Loc. cit.

Footnote 105:

  The works of William Harvey, M.D., edition of the Sydenham Society, p.
  590, London, 1847.

Footnote 106:

  Philosoph. Transactions, xxv., 1706.

We have also knowledge of a very interesting case, that of an Irishman,
an ex-navy man, who, according to the admiralty official statistics, was
113 years old, and whose body was dissected by Professor Cunningham,
Professor of Anatomy of Edinburgh University. As Dr. Cunningham,
himself, told us, the testes were sound and healthy looking, and the
cartilages of the chest bone not yet ossified. Death was not due to old
age, but to a prostate abscess, except for which the body was in good
condition.

Metschnikoff also mentions in his “Etudes sur la Nature Humaine”
examples of old men between 94 and 104 years, who suffered from copious
spermatorrhœa, and in whose semen he has found a great quantity of
spermatozoa. He and Dr. Weinberg observed similar conditions in old dogs
of 18 to 22 years of age, one of whom, just before his death, had shown
marked sexual tendencies.[107] Saverio Spangaro,[108] examining the
testicles of a number of old men, found many of them atrophied, but
others showed microscopically no difference to the testicles of younger
individuals; there were only slight microscopical changes. This again
proves our theory, that old age is not due to the degeneration of one,
but of several glands with internal secretion, similarly to other
diseases of these glands, like diabetes, acromegaly, etc.

Footnote 107:

  Essais optimistes, p. 47, Paris, 1907.

Footnote 108:

  S. Spangaro: Anatomische, Hefte, Heft lx., p. 630, Wiesbaden, 1902.

The above facts of the preservation of the sexual glands in advanced old
age, proves also the important fact that though the actual age be there,
the symptoms of it may not be very pronounced if but the sexual glands
are in good order. Of course the condition of the other ductless glands
is of importance, for old age must be regarded as the consequence of the
degeneration of the different ductless glands, and not of one gland
alone.

When we consider the splendid health enjoyed by most of these patriarchs
and the good condition of their organs, why should we deny the
possibility that they were disposing of at least one lively
spermatozoön, and thus we shall have no reason to doubt their happiness
as fathers.

We must also add that the truth of the extraordinary age of these
persons has been proved, in most cases, by documents, sometimes even in
courts of law; also by the recollections of very old people who, in
their own early childhood, personally knew them.

That people with strong sexual impulses very often reach a very advanced
old age, we can often observe. There are plenty of examples in the
history of the world. Thus, the greatest debauchery did not prevent
Louis XV becoming very old, and the Emperor Tiberius lived to be 78
after his notorious life. However, in the same way as with alcohol and
tobacco, we would here repeat “Quod licet Jovi, non licet bovi” (or,
“what suits Peter may not suit Paul”).

We may also refer to a few instances coming under our own observation. A
few years ago one of our confrères at Carlsbad died, 96 years of age.
His intellect was perfect, and a few months before his death we had a
consultation together about a patient who was 83, at which he gave
evidence of a wonderfully clear intelligence. In his behavior toward the
fair sex (whom he much admired) he showed a chivalry and gallantry
outvying men of half his age. Up to the last he never failed to attend a
theatrical performance when there was an operetta or a ballet. There was
nothing to prevent his attaining a greater age, but, falling in his
room, he contracted a fracture of the femur, followed by pneumonia,
which put an end to his medical practice, for this wonderful old man in
his advanced years paid his daily visits, which he only intended to
cease, as he said, when he reached 100.

A prominent member of the aristocracy of one of the northern countries
of Europe, who is at present 90 years old, having been reproached
several years ago by his relatives for his amorous advances to the fair
sex, gave the answer, “You do not know what it means to be an old man
with the body of a young man.” This old man still rides on horseback and
still goes shooting. The fact that he looks a handsome man of 60 may be
explained on the basis of our above observation.

In advanced old age the preservation of the sentiments toward the
opposite sex, which allows us to presume the presence, and not yet
extinction, of an internal secretion of the sexual glands, is often
found in combination with a high intellect. This is also proved by the
example of Goethe in his 83d year, for in his old age his intellect
would have been creditable to a man of 30. When he was over 81 he
astonished his audience by the uninterrupted current of his ideas, also
the extraordinary richness of his inventions.[109] Commenting on the
above, Moebius, in an interesting biography on Goethe, says: “From the
physiological standpoint the astonishment evoked by the works of this
old man is almost greater than that about his juvenile activity.” He
finished the second part of “Faust” when he was over 82. As Metschnikoff
says: “It is love that was the greatest stimulant of the genius of
Goethe,” for it is well known that Goethe was an ardent admirer of the
fair sex. When he was 74 he was passionately in love with Ulricke
Lewetzow, who was still in her teens. He danced like a youth when in her
company, and it was at this time that he wrote to his son that he had
never, up to this, felt so well in mind and body. He wanted to marry the
young girl, and the Grand Duke of Saxe-Weimar asked in Goethe’s name for
her hand; but the mother was not willing to allow a marriage between
persons of such divergence in age. So much was Goethe in love with the
young girl that his disappointment contributed to develop a serious
illness (Eckermann). Even when he was much older he again renewed his
relations with Miss Marianne Young, and was then, to a certain extent,
consoled for his disappointment over Miss Lewetzow. He preserved his
admiration for the fair sex until his death, and even in the closing day
of his life in his delirium he called out, “Look at that beautiful
woman’s head with dark curls on a black background!”[110]

Footnote 109:

  Eckermann: Quoted after Metschnikoff.

Footnote 110:

  Lewes: Vol. ii., p. 372; quoted from Metschnikoff.

A similar retention of the sexual sense we see in the advanced years of
Victor Hugo, whose admiration of the opposite sex continued till his
death. Ibsen, the celebrated Norwegian dramatist, kept up a well-known
correspondence with a young lady whom he met at Marienbad a short time
before he died in advanced old age.

Sometimes in women of extreme age instances are quoted that would seem
to indicate that in them also the activity of the sexual glands may not
have been extinct. It is stated that Ninon de l’Enclos[111] was in her
90th year still so beautiful that a young abbé fell desperately in love
with her. We know an Italian lady of 69 who is still good-looking,
presenting the appearance of 45, and she still menstruates. That she was
sexually active is shown by the fact that she has 12 children. There is
more fire in the eyes of this Italian matron than in many women of half
her age. That the possession of active sexual glands influences the
looks very much can also be proved by the pale, yellow-gray and aged
looks of even young women suffering from serious chronic diseases of the
sexual glands, and also of women who have caused these organs to
degenerate owing to sexual excesses.

Footnote 111:

  Quoted from Professor Kisch.

The fact that persons who have attained advanced old age in robust
health and perfect intellect often show signs of preservation of the
sexual glands, permits the inference, especially considering the
foregoing examples, that a perfect condition of these glands is an
important factor toward vitality and long life, for which reason we
devote a long chapter to the best hygiene of the sexual glands (see
Chapter XLIX).


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                              CHAPTER VI.

                       ON HEREDITY AND LONGEVITY.


WE occasionally witness the peculiar fact that persons who live very
moderately and eat very sparingly, and who totally abstain from alcohol,
nevertheless become old before their time, while, on the other hand,
there are those who, in spite of having been addicted all their lives to
the pleasures of a bounteous table and unstinted quantity of wine or
spirits, yet enjoy a green old age. We had an opportunity of observing
an old gentleman of 76 (some say he was really older) belonging to our
own profession, with whom we had the pleasure of traveling from Lisbon
to Paris in the same small railway compartment. This gentleman,
notwithstanding his age, was in full possession of all his mental
powers, of which he has given remarkable proofs in his recent
publications which might have well been written by a man younger by some
scores of years, and which, in fact, convey that impression. This
gentleman’s age cannot be gauged by his words, neither was it shown by
the hearty appetite with which he partook of the six courses of the
dinner, nor by the enjoyment with which he disposed of his bottle of
claret; and he smoked a large cigar afterward with such appreciation
that we began to envy the old man. We almost believe that he stood the
long-continuous journey of thirty-seven hours much better than we did,
and we were surprised at his fresh appearance the following morning
after the discomforts of a night in a small berth of the Compagnie
Internationale des Wagons-lits, half the size of the ordinary American
Pullman car berth. We must remark, however, at once, that such instances
as these are exceptional. Nature is always just, and even here we have
an illustration of the Golden Rule, for such persons inherit the health
of their fathers.

Even character and appearance may be inherited by offspring. The height
of parents is, as a rule, though not in every case, inherited by their
children, as also are many features of their external appearance. As we
have seen in the previous chapter, the size of an individual and his
outward appearance are dependent on the internal secretions of the
ductless glands; and as these qualities are inherited, so we may presume
that the properties of the ductless glands, which produce these effects,
may also be inherited; and that this is not a vague supposition is
demonstrated, we think, in a paper we read on the subject of heredity at
the German Congress of Internal Medicine at Leipzig, in 1907, in which
we showed that the alterations of the ductless glands are inherited with
remarkable frequency. Thus Graves’s disease can frequently be inherited,
and the children descended from such parents, especially after puberty,
often have a small goiter. In such cases a slight protuberance of the
eyes can also be noticed; they are frequently very nervous, and any
sudden shock will be sufficient to induce a typical case of Graves’s
disease. Oesterreicher[112] found 9 cases of exophthalmic goiter in one
family. The frequent instances of heredity in Graves’s disease are
insisted upon by Brouwer[113] and other authors.

Footnote 112:

  Quoted after Moebius, “Die Basedow’sche Krankheit,” second edition,
  1906.

Footnote 113:

  Quoted after Oppenheim, “Lehrbuch des Nervenkrankheiten,” Berlin,
  1906.

Degenerative changes of the pituitary body may also be inherited. Thus
Bonardi and Schwoner and others also showed cases of acromegaly of
hereditary origin.

Diabetes is, as we have said, a disease of the ductless glands, and we
have especially emphasized, on previous occasions, how frequently, if
not invariably, diabetes originates through heredity. We have also shown
in a communication published in the _Practitioner_, of London, in
October, 1903, that the children of diabetic persons have an inherited
tendency to alimentary glycosuria, which occurs very frequently among
them.

Myxœdematous persons, as a rule, have children displaying symptoms of
congenital myxœdema, and cretins have cretinous children. The very
interesting case has been published of a woman who, until the age of 40,
had two normal children. She then acquired a goiter, and the child that
was born later was a cretin with a goiter (Lanz).

Parents suffering from diseases in which the thyroid has degenerated,
such as chronic tuberculosis, malaria, syphilis, and other cachectic
diseases, have children whose growth is slow, and who remain backward
physically and mentally. Such children easily acquire any infectious
disease. Tuberculosis, as we have shown at the International Congress on
Tuberculosis in Paris, in 1905, is remarkably frequent among them. We
can easily appreciate the fact, if we realize that the children of such
parents in whom the thyroid has degenerated through disease are born
usually with a congenital atrophy of the thyroid gland, which has been
proved by Gamier and Perrando. These children have inherited from their
forefathers the bad qualities of their thyroid, and this will also
explain why such children, when fully grown up, will not remain, as a
rule, for so long a time as youthful looking as other persons who have
inherited healthy thyroids; they early become aged-looking and, also, as
a rule, their lives are shortened owing to their tendency to contract
easily all kinds of infections.

Evidence founded on experiments is at our disposal to prove our
assertion that irregularities of the thyroid are inherited by offspring.
Professor Lanz,[114] of Amsterdam, formerly an assistant of Professor
Kocher in Bern, has extirpated the thyroid gland of goats, and he found
that in each case the young of such animals, as compared with normal
kids of the same age, remained backward in growth. There can thus be no
doubt that the qualities of the ductless glands of the parents are
inherited by their descendants.

Footnote 114:

  Beiträge zur klin. Chirurgie, xiv., p. 1, 1905.

We often find diseases of the various ductless glands present among
members of the same families. We can trace, not infrequently, diabetes,
Graves’s disease, etc., and acromegaly, occurring in different members
of the same family, and this will be observed most often in the case of
diabetes and Graves’s disease. Thus I have observed in the case of two
fathers (coming from the same city in Hungary, but belonging to
different nationalities) diabetes, and their daughters had protuberant
eyes; they had a small goiter, and the typical fingers characteristic of
Graves’s disease, emaciated and pointed like those of the Madonna of
Perugino, which have been mentioned already by other authors as symptoms
of Graves’s disease. There was no tachycardia as yet in either of these
two cases which had Graves’s disease. Very probably any mental shock, as
in so many other cases, would here have caused sudden development into
Graves’s disease.

We have already noted that in syphilis and other cachectic diseases such
as alcoholism, malaria, tuberculosis, etc., the thyroid gland becomes
degenerated (Garnier, Hertoghe, etc.), and that the fœtuses of such
parents demonstrate congenital atrophy of the thyroid (Garnier[115] and
Perrando[116]). We can thus understand the observations of Hertoghe, who
found that nearly all cases of infantile or congenital myxœdema were
born of parents suffering from the above-named diseases. Of very great
value, also, is the observation of Professor Pel.[117] He diagnosed a
case of syphilis in the father, myxœdema in the daughter and acromegaly
in the son.

Footnote 115:

  Garnier: “Les maladies infectieuses,” Thèse de Paris, 1899.

Footnote 116:

  Perrando: “Sulla struttura della Tiroide,” Sassari, 1900.

Footnote 117:

  Pel: Berl. klin. Wochenschrift, 44^a, 1905.

As shown by many observers, including ourself, the ductless glands stand
together in a very close relationship, and thus we may find that when
one member of a family shows an alteration of the ductless glands, we
may discover in the same family other members affected by alterations of
the same or other ductless glands. The case of Pel is a fine
illustration of this point; the syphilis of the father with its morbid
influence on his thyroid resulting in the hereditary transmission of a
degenerated thyroid to the daughter, and the consequent supervention of
myxœdema. The son had an altered condition of the pituitary body, and
thus developed acromegaly. The altered condition of the pituitary body
may have been secondary to the previous alteration of the thyroid
inherited congenitally, if we take into consideration the fact that, as
I showed in a communication to the International Congress of Medicine in
Madrid, in 1903, acromegaly is due to primary alterations in the thyroid
which, in the same way as is demonstrated by experiments on animals, may
lead secondarily to alterations of the pituitary closely connected with
the former gland. The qualities of the sexual glands can also be
inherited. Thus, there are cases of mothers whose menstruation began
very early, i.e., at the age of 9 or 10, and lasted until the age of 56
to 60, and who had many children, among whom were daughters showing
similar conditions. On the other hand, we may see difficulties of
menstruation in the mother also inherited by the daughter.

If the bad qualities of the ductless glands are inherited, it is only
logical to expect the same for the good qualities also. It stands on
this basis that we may frequently find longevity in the same family.
Longevity, as illustrated by the many facts adduced in this book from
the field of clinical and experimental observations, is closely allied
with a thorough performance of the functions of the ductless glands,
especially of the thyroid gland; if these are in good condition, and
especially if proper hygiene is also observed at the same time,
longevity will follow. The good condition of the ductless glands is
largely dependent upon a life based on hygienic principles, although
when these glands are of the best quality they may stand a good deal and
not degenerate so soon, even after excessive activity following
injudicious or fast living.

But if a long life be dependent on a good state of the ductless glands
and if the qualities of these are inherited—which cannot be doubted
after the foregoing observations on heredity,—it must necessarily follow
that longevity is inherited too, and this is a fact which can be proved
by a large number of observations.

If we study the history of persons who have lived over 100 years, we
shall find in nearly every case that their forefathers, or their
descendants, or other relatives of the same blood have, as a rule, also
lived to a great age. This will be illustrated by a few examples which
we will now give.

In the year 1724 there died in Hungary in a village called Köprös, about
ten miles from Temesvar, a man, Petraz Czarten, who was 185 years of
age. When he died, his son was 95.

We have already referred to the case of a man named Thomas Parr in our
chapter on the influence of the sexual glands upon vitality and long
life. This man died in 1635 in his 153d year, and after death his body
was dissected by the great physician Harvey. That longevity had existed
in his family was shown by the fact that one of his female descendents
died in Cork, in Ireland, at the age of 103.

In the year 1797, in a village near Bergen, there died a man, Joseph
Surrington, in his 160th year. That he left a young widow, after having
been married several times, is not so extraordinary if we consider the
facts in the chapter in this book on the influence of the sexual glands
upon vitality and long life. When this man died his eldest son was 103
and his youngest only 9!

In a Finnish village near St. Petersburg there lived an old peasant
woman, Maria Willamow. She was born in 1692, and died on September 10,
1807, after having lived 115 years, 9 months, and 4 days; her brother
had already died in 1768 at the age of 108. All her relatives and
descendants were remarkable for their longevity.

Jean Thuret was a soldier, and in spite of having been wounded in
several battles, he lived beyond the age of 104. His mother died when
118 and his uncle at 130. The high old age of many of these patriarchs
is proved by legal evidence. Thus, H. Jenkins, from Yorkshire, has
appeared before a court of justice as witness in a matter that happened
140 years ago. He was accompanied by two sons, of whom one had reached
100 and the other 102 years. Again, conclusive proof of the inheritance
of long life.[118]

Footnote 118:

  Quoted after Professor Pel.

To the history of these patriarchs I can add a few personal
observations. My mother’s father lived to the age of 104. He never
smoked and could read without spectacles all his life. He had eleven
children, of whom one (an aunt of mine) is 95, and I have every reason
for believing that she will continue to live yet many years in her
present condition. Another daughter is at present 85; a son is 83, and
another 78.

We are acquainted with the history of the family of a physician in
Amsterdam, in which the great grandfather was 96. He had six sons who,
between them, totaled 600 years, one of them living to the age of 102,
some of the others to 80 and 90; and there is a daughter 79 years of
age.

From the foregoing it seems that persons descended from long-lived
families have themselves a good chance of living to a great age; but to
do this it is essential that they should observe the rules of hygiene to
prevent the deterioration of their ductless glands.

That the observance of good hygiene is of the greatest importance to
attain longevity can be best adduced by the fact that persons descended
from short-lived parents may also attain a green old age in robust
health, as I will show by a few examples which have come under my
personal observation.

Sir Herman Weber, the author of a valuable work on the prolongation of
life, is descended from parents who both died at an early age. This
savant has himself followed the excellent advice he gives in his books
on long life, with what result can be best judged by his healthy and
vigorous looks. His appearance is that of a man many years his junior,
yet Sir Herman was 82 a few years ago when we were together climbing a
very steep and high hill in Carlsbad. When we arrived at the summit
nothing could restrain Sir Herman, but he insisted on also mounting a
lofty tower to see the surrounding mountains, without taking any rest
between his exertions, and this in spite of the warmth of the weather.

On the day that we began to pen these lines we were congratulating one
of the multifarious professors of the medical faculty of Berlin on his
73d birthday. He is in perfect and robust health, and is at present
engaged on the third edition of his work, which is well known in medical
circles all over the world. He told us his father was 33 and his mother
48 when they died, and several of his brothers died before reaching old
age. However, his grandfather lived to be 90. This savant has always led
a sober and regular life.

Sometimes chronic diseases, like syphilis, etc., do not prevent people
who come from a long-lived family from attaining to a very old age. Thus
a patient of mine, a French gentleman of 72 years, who still shows
symptoms of the tertiary form of syphilis acquired fifty-two years ago,
is still looking in splendid health, like a man of 60, and was
complaining to me about his too strong sexual feelings. Likewise, the
father of a patient of mine has reached his 96th year in spite of his
syphilis, which he acquired an age ago.

If we now consider the environments where the longest-lived persons are
found, we shall find that those who always live in the open air, and
also moderately, rising early in the morning and leading day by day the
same regular life, have attained the longest lives. A great number of
long-lived patriarchs can be found among the peasants, or at least among
persons living in the country and out in the fresh air all day.
Undoubtedly the greatest number of long-lived people are to be found in
the British Islands, especially in Scotland. The inhabitants of Great
Britain are well known to appreciate fresh air, and on the Continent we
often see them, especially Scotchmen, going about without any overcoat
even on a cold winter’s day.

We shall see in various chapters of this book how essentially important
is a sound hygiene to ensure long life, and we shall demonstrate in
separate chapters the great importance of fresh air and of exercise in
the open air.

If we would inquire where are to be found the greatest number of persons
over 100 years of age, the palm must be given to Bulgaria, if what is
claimed be true, _viz._, that there are 3800 persons over that age, and
all these folk partake daily of “jogurth,” a sour milk containing three
different microbes, the most efficacious among them being the maeja
bacillus. In Germany, with its 61,000,000 of inhabitants, there are but
71 persons over 100 years old, while Bulgaria, with only 7,000,000,
claims to have 3800, and that it is due to the jogurth eaten every day.
We will deal more fully with jogurth in the chapter on the elimination
of toxic products from the intestines.


------------------------------------------------------------------------




                              CHAPTER VII.

 ON MEANS WHICH CAN HELP US TO DETERMINE THE PROBABLE DURATION OF LIFE.


WE have seen in the first chapter of this book that we may find the
symptoms of old age, in quite early years, in persons whose ductless
glands (the thyroid, ovaries, testicles, liver, kidneys, pancreas,
adrenals, pituitary body) are degenerated by disease; nervous
affections; alterations of the mind: grief, sorrow, etc.; chronic
infections; numerous pregnancies, etc., or by faulty hygienics: excesses
in food, alcohol, sexual pleasures, etc. We have also seen in the third
chapter that the immunity of an individual against infections—be it by
bacterial invasion or by poisonous food or drugs, etc.—is dependent upon
the correct functionating condition of these glands. We have seen that
those in whom these glands are degenerated fall easy victims to all
manner of infections, and the previous chapter on heredity shows that
the same happens to children, the offspring of parents suffering from
alcoholism, tuberculosis, or malaria, as the children of these parents
are born with a congenital degeneration of the thyroid, and thus remain
backward in growth, both mentally and physically, and, especially, fall
easy victims to tuberculosis. Their life is generally short. While such
a sad cloud hangs over the head of persons whose glands are damaged,
either congenitally or by disease, much more favorable is the lot of
those who have inherited healthy glands and by careful living have
preserved them intact, or who, though born with ductless glands not
entirely normal, and possibly bordering on a condition of congenital
myxœdema, have, by suitable treatment and hygiene, succeeded in
improving the condition of their glands.

We have seen that the thyroid influences powerfully the production of
those safeguards of our body against infections—the anti-bodies being,
as shown by Prof. Sajous (1903-1907), beyond a doubt products of
ductless glands—and the better the condition of the glands, the more
protective substances will be produced in order to fight down the
murderous microbes, or organic poisons, which continually threaten us
with destruction. In this fight, a person with healthy ductless glands
will always attain a longer life than one with ductless glands of
inferior quality. The better the condition of the thyroid the greater
will be the activity of those organs that are under its direct command
(e.g., the kidneys, liver, skin, and intestines), and by the increased
activity of the main emunctories of the body poisonous products will be
eliminated by means of a greater flow of urine, an abundant
perspiration, and thorough purging. Also the myriads of toxic products
that are brought from the intestine to the liver will be promptly
destroyed, or transformed into less dangerous combinations.

Thus there can be no doubt that a person with healthy ductless glands,
especially the thyroid and testicles or ovaries, will live long
provided, of course, no other vital organ be irreparably diseased.

The question now arises, by what means can we ascertain whether the
ductless glands are in good condition or not? We will now try to answer
this important question.

We can diagnose a healthy condition of the ductless glands either
directly, by the examination of those glands which are available for a
digital examination, as the thyroid, sexual glands or liver, or
indirectly, by the examination of the state of those functions which are
governed by these glands; e.g., the heart’s action, the pulse,
regulation of temperature, defæcation, diuresis, digestion, activity of
the skin and its glands, condition of the nervous system, etc.

Before entering upon the examination of these glands we must first
ascertain whether our patient comes of a long-lived stock, or, if not,
whether diseases that are particularly harmful to the ductless gland,
and are commonly hereditary, like tuberculosis and syphilis, have
occurred in the family. According to our observation boys more
frequently look like their mothers, and girls like their fathers, and
also inherit their qualities. After having ascertained the family
history, we must inquire whether the patient has had any diseases that
are specially harmful to the ductless glands: e.g., infectious
diseases—scarlet fever, diphtheria, typhoid, etc.—and also ascertain his
usual diet and habits, keeping in mind the bad effects of abundant meat
food upon the thyroid, as well as of certain stimulants like alcohol and
tobacco. As these, if of bad quality and taken in quantity for a long
time, have the most damaging influence on the ductless glands, our
prognosis of a long life will be duly influenced, and in particular
unfavorably for those who come of a short-lived stock, or who have been
weakened by previous infectious diseases. If some persons, otherwise
healthy and of good family history, can with impunity indulge till old
age in wine and tobacco, yet this is not a general rule. Individuals are
known who drank and smoked till over one hundred years of age, but such
cases are rare, and we may quote the Latin proverb: “Quod licet Jovi,
non licet bovi.” Everybody will admit that the expectation of life in
those who are moderate in the use of wine and tobacco and also, let us
insist, of tea and coffee, is much greater than in the immoderate. We
will further deal with this question in our chapters on alcohol and
tobacco.

After having given an exhaustive history of the persons whose probable
lifetime we are trying to determine, we next proceed to the examination
of those ductless glands which are available for direct examination, and
first of all, the thyroid.

The examination of the thyroid gland by palpation is a very difficult
undertaking and necessitates a thorough knowledge of the anatomy and
physiology of the gland. We must bear in mind the fact that, in men, we
generally find only two lobes, the lateral ones, which lie on either
side of the trachea, as the median lobe is generally undeveloped in the
male. The right lobe is usually larger than the left. In women the
median lobe is often well developed and can be distinctly seen in
enlargement of the gland, for instance, during puberty, menstruation,
pregnancy, etc., and especially when a goiter exists which, for reasons
we have mentioned previously, is more common in the female.

When the thyroid shows a considerable swelling, as in goiter, it can be
seen and felt easily, but not always, for cases certainly exist where in
life no thyroid could be felt, and yet at the autopsy a large goiter has
been found. Thus, in a case of acromegaly a thyroid of about 130 grammes
was found by Holsti,[119] though during life nothing could be discovered
by palpation. When a large thyroid can be seen and felt, we are
justified in diagnosing a swelling of the gland; but in cases where we
neither see nor feel it, we are not always justified in stating that it
is not enlarged.

Footnote 119:

  Holsti: Zeitschrift für klin. Medicin, p. 272, 1892.

When palpating the thyroid we must note whether it is soft or hard. If
soft, the tissue present is probably parenchymatous in nature and so,
probably, entirely secreting tissue, while a goiter that feels hard may
denote excess of connective tissue, and thus, apparently, an inactive
gland. The presence of cystic formations raises the possibility of a
large quantity of colloid substance, either healthy or degenerate.

Thus, inspection and palpation of the thyroid can give us, to a certain
extent, valuable information; we must, however, not rely entirely upon
the results of this external examination but, especially in cases where
no thyroid can be felt, we must add to the external examination an
inquiry into the condition of those functions which are governed by the
thyroid—we must, in fact, examine the condition of those organs whose
function is dependent upon the internal secretion of the thyroid.

Thus, we must examine the skin and note whether it is dry or moist, and
whether the sweat glands are acting normally. A dry skin, with
diminished perspiration, denotes an inactive thyroid, especially when
excess of subcutaneous fat is present. Excess of fat, of the consistence
of bacon, is characteristic of a greater degeneration of the
thyroid—i.e., myxœdema,—and indicates a great loss of function of the
thyroid gland. Pallor of the face, with round red patches on the cheeks,
and dilated capillaries, are also characteristic signs of such a
condition in its early stages, and so are a wrinkled forehead,
especially with two perpendicular folds, and puffy eyelids. Wrinkling of
the skin of the hands, taken in conjunction with other signs, is also a
point of diagnostic value.

The condition of the musculature can also give us some valuable
information. The thyroid and other ductless glands, as the sexual
glands, govern the tonicity of all the muscles. In children, especially
about the age of puberty, the muscles are firm and elastic, but in later
years, or even in young women, consequent upon various conditions which
are harmful to the ductless glands, such as sexual excesses or numerous
pregnancies, the muscles lose their tonicity and become lax and flabby.
This also occurs in myxœdema arising from other causes. The viscera,
deprived of their muscular support, become displaced, and in this way
arise the various forms of visceroptosis.

Premature grayness is an indication of probable changes in the thyroid.
This is confirmed by the fact that, as a rule, such persons are also
very nervous. Premature grayness constitutes a typical symptom of
myxœdema and hypothyroidia, and as such has been described already by
Hertoghe.[120] Falling out of the hair is also a symptom of importance,
if it appears in early years, especially if it is accompanied by falling
out of the eye-brows and the hair on the back of the head. On the other
hand, Sajous found that in appropriate cases, thyroid extract promotes
the growth of hair, while adrenal extract encourages, besides, the
growth of the eye-brows.

Footnote 120:

  Nouvelle: Iconographie de la Salpêtrière, Juillet-Aout, 1899.

In examining the circulatory system we must bear in mind the powerful
influence of the ductless glands upon the circulation, especially that
of the adrenals, thyroid, and pituitary body. As shown by Oliver and
Schäfer, the thyroid secretion diminishes blood-pressure, whereas the
adrenal secretion increases it. Thus, these two glands are antagonistic
and it can easily be understood that if there is not sufficient thyroid
secretion to counterbalance that of the adrenals, the blood-pressure
will increase. If this lasts for some length of time, very serious
effects will follow. Atheroma and arteriosclerosis may ensue, both of
which conditions tend to shorten life. The adrenals can be stimulated to
such over-secretion by mental emotions, which act upon the sympathetic
(splanchnic) nerves. Besides mental emotion they can also be stimulated
by various poisons, such as alcohol, tobacco, or infectious diseases
(see Chapter III). We must keep these facts in mind when we examine the
circulatory system, and we must ascertain the condition of the arteries,
whether soft or hard, and of the blood-pressure. Tortuosity of the
temporal artery in young persons is also a sign of some value. The
condition of the coronary arteries is of the utmost importance. We must
also not forget the fact, that even in severe cases of arteriosclerosis
the pulse may be found soft. Everything will depend upon the examination
of the heart, and special attention must be paid to the second sound at
the aortic orifice, and to any accentuation of that sound.

In the examination of the digestive organs we must pay special attention
to the state of the appetite. Very often with a degenerated thyroid this
may be wanting. The appetite, as shown by Pawlow, is under the influence
of the mind as we will see. With a sad melancholic disposition, as is
often found in persons with a degenerated thyroid, there is insufficient
or no secretion of gastric juice. Besides, in myxœdematous conditions
all glandular secretions are more or less checked. Thus food passes into
a stomach with insufficient gastric juice, remains there in stagnation
and causes fermentation. The stomach makes vain efforts to drive the
food into the intestine. Slowly an atonic condition of the gastric walls
arises, and later dilatation of this organ. The fermenting foodstuffs in
the stomach set up a chronic intoxication of the organism.

Concerning the condition of the intestines we should consider the
chances of long life greater in those persons whose bowels act regularly
and who are never constipated. Such persons are able to eliminate toxic
products much better than those who are suffering from chronic
constipation. The function of the intestines is powerfully influenced by
the thyroid gland, chronic constipation being a typical symptom of all
conditions in which this gland is degenerated, whereas in the opposite
conditions, such as Graves’s disease (exophthalmic goiter), diarrhœa is
common. By giving thyroid gland we can treat successfully those
obstinate cases of constipation, which are based etiologically on such
grounds. Besides the thyroid gland, the ovaries also influence, to a
large extent, the intestines, constipation occurring, as a rule, in
diseased conditions of the female sexual organs.

Flatulency and distention of the bowels are very frequently met with in
women with diseased thyroids or ovaries, and are due to an irritated
condition of the nerves of the intestines.

When examining the nervous system we must inquire for headaches,
especially in the occipital region, migraines, and the previous
occurrence of neuralgia, these being very frequent symptoms in persons
with athyroidia or hypothyroidia. Most characteristic are alterations in
the mental condition. Thus, memory for recent events may be gone. There
may be apathy, with hesitation before every movement, such persons
disliking to move about. They may sit indefinitely in the same position.
As already mentioned in the chapter on the influences of the ductless
glands upon the nervous system such people are frequently somnolent.
Therefore we must inquire about the hours of sleep. Besides sleeping
long, such persons are apt to awake in the night after dreams of a
terrifying nature. Our diagnosis of a condition of athyroidia or
hypothyroidia has often been helped, by inquiring whether such persons
have seen little animals (rats or mice) creeping through the room while
sitting quiet, or before going to sleep. Such a symptom has been
described by Murray,[121] in his book on myxœdema, in the early stages
of this disease; the mind being then so much altered that even manias of
persecution and suicide may arise.

Footnote 121:

  Murray: “Disease of the Thyroid Gland,” p. 72, London, 1901.

Neurasthenia is a disease which, as we have tried to show, is very often
based upon changes in the ductless glands, especially the thyroid,
sexual glands, and pituitary body. The same holds good for hysteria.
Therefore the presence of such conditions will influence us in our
judgment as to the future of such persons. In cases of great
nervousness, especially when associated with mental depression, there is
less resistance to infection, for causes already mentioned (see Chapters
III and L). Great mental excitability may predispose to certain diseases
which shorten life, like diabetes, and in people in whom, owing to an
unstable nervous system, there is a frequent increase in the
blood-pressure, the possibility of apoplexy is to be feared, if such
persons are of a plethoric build. The wear and tear of life is certainly
far more felt by persons whose minds are very easily impressed and
excited by events of little importance; and, considering the great
influence of mind upon body, persons, who like a weak tree are easily
beaten down by the smallest storm, will have less chance of long life
than persons who have a better control over themselves and stronger
will-power (see “Hygienics of the Mind,” Chapter L).

Having thus briefly described the principal functions governed by the
thyroid gland: shown how, by observing changes in these functions, we
can judge as to the healthy condition of this gland, let us now see if
any means exists by which we can ascertain the functionating condition
of the other ductless glands.

After the thyroid the sexual glands claim our attention, as these glands
are of the utmost importance on account of their enormous influence upon
the processes of metabolism and the maintenance of life (see Chapter V).
We must first call to mind that their work is essentially under the
influence of the thyroid, changes in which invariably produce changes in
the sexual glands. Thus, in degenerated conditions of the thyroid, we
find impotency in men and sterility in women. In such conditions atrophy
of the testicles, or of the ovaries, can often be found. These clinical
observations can be confirmed by experiments. Thus Lanz[122] found
sterility common in goats whose thyroids had been extirpated. In cretins
an atrophic condition of the testicles, or of the ovaries, is present as
a rule, and such patients very frequently show lack of sexual desires.

Footnote 122:

  Lanz: Loc. cit.

Direct examination of the sexual glands can be more easily carried out
in men than in women.

The presence of varicose veins is of great importance, as varicoceles
are generally accompanied by great disturbances of the nervous system,
sometimes even going as far as insanity. Suicide is not unfrequently
committed in such a condition.

After the testicles the prostatic gland must be examined. As direct
examination of this gland is only possible by a painful examination
through the rectum, we shall have to inquire into the condition of the
functions of this gland. We must find out whether there is a flow of
prostatic liquid and semen (frequency of pollution). It must be
remembered, however, that the flow of a little semen in constipation and
sexual abstinence has no importance.

We must specially inquire about previous attacks of gonorrhœa. Examining
the urine in two fractions, we must ascertain whether the first fraction
is as clear as the second. The presence of a few filaments tells a tale
of previous gonorrhœa, but is of no consequence for the prognosis. It
may be, however, that they possibly indicate the presence of gonococci
in the deeper lying glands of the urethra which, after sexual excesses,
can again come to the surface even after years.

Inquiring for gonorrhœa in the past, we must find out whether the
patient was treated by local applications with instruments to the
posterior part of the urethra, this being the only radical treatment of
chronic gonorrhœa. As a rule, every chronic gonorrhœa invades the
posterior part of the urethra and, usually, inflammation of the
posterior part of the urethra involves also the prostatic gland.

The presence of strictures and hypertrophy of the prostate, unless they
occur in connection with a gonorrhœa, are indicative of a faulty
activity of those glands which influence the formation of fatty or
connective tissue in the body, as will be shown. It may indicate changes
in the thyroid, after extirpation or degeneration of which the
connective tissue in the body is increased, to which fact is also
largely due the occurrence of prostatic hypertrophy.

We must inquire as to the passage of urine. An interrupted stream with
pain on micturition may indicate, in elderly persons, a hypertrophy of
the prostate, especially if these pains are more frequent in cold
weather. The bladder must be examined for the presence of stone. The
presence of stone, as also of long-standing gleet and strictures that
are not cured, lessen the chances of a long life, the dangers of
cystitis, and ascending pyelonephritis, and nephritis, hanging, as the
sword of Damocles, over the heads of their unfortunate possessors.

Gonorrhœa, if it occurs frequently and attacks the prostate, is a great
danger both to the mental stability and sexual powers. The presence of
great sexual desires, with more or less impotence, must also be taken
into consideration when we are collecting evidence to find out the
chances of long life in an individual.

Regarding the examination of the female sexual organs and of their
functions, it cannot be the object of these lines to describe how to
conduct a thorough gynæcologic examination. We must limit ourselves to
those points by which we can ascertain the condition of those functions
which are under the control of the ovaries, with special reference to
their internal secretion. Thus, we need merely observe whether the
external sexual characteristics (e.g., breasts, hips, etc.) are well
developed, since these are under the direct influence of the internal
secretion of the ovaries.

A chlorotic condition allows us to draw the inference that a faulty
condition of the ovaries exists (ovarian origin of chlorosis—v.
Noorden), and also of the thyroid, as this gland often shows change in
chlorosis. The extirpation of these glands is followed by a diminution
in the number of red blood-corpuscles and in the percentage of
hæmoglobin. Both of these elements of the blood can be increased by the
use of thyroid or ovarian extracts, as has been noted by several
authorities.

The condition of menstruation can give us valuable information. The late
appearance of the first menstrual period, irregularities of
menstruation, its appearance at irregular intervals, and frequent
disappearance for months, will give us an unfavorable idea of the
ovarian activity, especially when each menstrual period is accompanied
by pain. So will sterility, as this condition is common, not only in
association with ovarian inactivity (if not due to malpositions of the
uterus or impotency of the husband), but also with thyroid deficiency.
On the other hand, too frequent pregnancies or miscarriages will also
unfavorably influence our judgment, as these agencies have, as a rule, a
deteriorating effect upon these important glands, causing their
exhaustion and, at the same time, that of the thyroid. In women with
thyroid insufficiency and general loss of muscular tone, prolapse of the
uterus may be frequent, and also metrorrhagia. As Hertoghe found, we can
stop uterine hæmorrhages in women with thyroid insufficiency by the
administration of thyroid extracts. The history of previous gonorrhœal
infection must be specially investigated, as this disease, if not
treated, which is unhappily so often the case, will always involve the
ovaries, causing their destruction and often their obliteration.
Gonorrhœa in women is far oftener overlooked than in men, as it so often
passes for a simple discharge, until by microscopical examination
gonococci are found, and the ovaries already injured. It is a sad fact
that a large majority of the cases of pelvic disease in married women
are due to infection by the husband, for an enormous number of men enter
upon marriage with gonorrhœa that is imperfectly cured, or not cured at
all. Let us hope that there will come a time when a law will be passed
obliging every man to be examined thoroughly before entering upon
marriage, especially for gonorrhœa and syphilis. Such legal precautions
would soon check the transmission of these diseases to the wife and of
syphilis to the innocent descendants. It may be that thus, to a large
extent, the propagation of some of the greatest scourges of humanity can
be checked, viz.: of tuberculosis, alcoholism, and crime[123] which, as
shown previously, flourish on the soil prepared for them by hereditary
syphilis.

Footnote 123:

  Arnold Lorand: “Pathogeny of Crime,” Address to the Philadelphia Med.
  Jurisprudence Society. Monthly Cyclopædia of Practical Medicine, 1907.

A total lack of sexual desire in women is not normal, and may indicate
changes in the ovaries. On the other hand, there is an increase of
sexual desire at the period of augmented ovarian activity, as in the
days preceding menstruation. We have had the opportunity of hearing
praise of ovarian treatment from husbands of women with tendencies to
sexual frigidity.

Very valuable information about the activity of the ovaries can be
gained from the examination of the breasts. It must be borne in mind
that the ovaries and the breasts stand in very close relation. Changes
in the ovaries are always followed by changes in the breasts, and it is
a very interesting fact that cases of cancer of the breast have been
cured by extirpation of the ovaries.

Comparing the breasts of an innocent young girl between sixteen and
twenty years with those of women of the same age leading an immoral
life, or of women after many pregnancies or in advanced age, we notice
at once the great difference between the large flabby breasts and the
firm tissue of a young girl leading a moral life. According to our
observations we have described[124] cases of fatty enlargement of the
breasts, following all those agencies which are hurtful to the ovaries,
as masturbation, sexual excesses, many pregnancies, etc. On the other
hand, in degenerated conditions of the ovaries and thyroid, especially
if these conditions are congenital, we may find the breasts quite
undeveloped.

Footnote 124:

  International Congress of Medicine, Lisbon, 1906, reported in Presse
  médicale, 1907.

After the thyroid and ovaries we will direct our attention to the
pituitary body. Direct examination of this ductless gland being out of
question, owing to its position on the base of the skull, in the _sella
turcica_, we have to judge of its vitality by indirect methods. We know
that by the alterations of this gland a condition is produced, called
acromegaly, characterized by enlargement of the toes, fingers and nose,
prominence of the lower jaw, sinking in of the temple and of the _fossa
canina_ in the cheek-bones, prominence of the occipital bone, etc. As
with all diseases of the ductless glands, besides the extreme form just
described, which constitutes the highest degree of such a degeneration,
there are also marked cases where all of the above deformities are only
slightly pronounced. We must inquire whether the features of such
persons have changed, or the nose, hands, and feet become larger. This
is best determined by comparison of old and recent photographs.

A history of headache, especially nocturnal, of mental change, e.g.,
great susceptibility or symptoms of neurasthenia, taken together with
the external appearances, may aid our diagnosis. The simultaneous
discovery of an ocular lesion (hemianopsia) will confirm our suspicions
beyond doubt.

The pancreas, also, can only be examined by indirect evidences of its
activity. A history of frequent or occasional epigastric colic, of large
quantities of unformed shapeless stools of a yellow or yellow-gray
color, containing undigested fat, together with loss of weight, will
make us think of the possibility of disease of the pancreas. The most
exact proof of such change can only be obtained by microscopical
examination of the fæces.

Examination of the urine for sugar can also tell us whether there is
disease of the pancreas, especially of those parts of the pancreas which
constitute a ductless gland, independently of the rest of the viscus,
namely, the islands of Langerhans.[125]

Footnote 125:

  Langerhans: Thèse, Berlin, 1869; G. Lange.

As Mering and Minkowski[126] first showed, every dog whose pancreas is
extirpated invariably becomes diabetic, and this diabetes is similar to
that of man. In many cases of diabetes changes in the pancreas have been
found at autopsy; and although a good number of cases without any
apparent change in the pancreas have been recorded, the cause of these
has been revealed by an American author, Dr. Opie,[127] then of the
Johns Hopkins University in Baltimore. This author has found in a few
cases of diabetes alterations in the islands of Langerhans in the
pancreas. This fact has been confirmed by a good many authors, of whom I
may mention Sobolew,[128] Weichselbaum[129] and Stengel, Sauerbeck, and
others. As is invariably the case, the statements of these authorities
have been attacked by others, as Hanseman, who have found no such
changes in the islets in diabetes. We must, however, state here, that an
apparently perfect anatomical condition of glandular structure after
death need be no proof of a perfect secretory activity during life.
Every epithelial formation, and the islands of Langerhans are of this
nature, must furnish a secretion, and this flows in every gland only
under a nervous stimulation. As Pawlow has shown, the pancreas secretes
under nervous impulse. Therefore the findings of pathological anatomy
cannot show us whether these glands have been secreting properly during
life or not, especially in a nervous disease such as diabetes.

Footnote 126:

  Mering und Minkowski: Archiv für exper. Path. und Pharm., xxvi, 1889.

Footnote 127:

  Opie: Journal of Experiment. Medicine, p. 827, 1901.

Footnote 128:

  Virchow’s Archiv, clxviii, p. 1.

Footnote 129:

  Wiener klin. Wochenschrift, 1901-1902.

According to the experiments of Diamare and Kuliabko, the islands of
Langerhans furnish a secretion which aids in the inversion of grape
sugar. We have shown at meetings of the Biological Department of the
Hamburg Medical Society (Germany), and of the London Pathological
Society, specimens of the pancreas of diabetic persons where there were
changes only in the islands of Langerhans and none in other parts of the
pancreas while, in one case, nearly the whole of the pancreas was
destroyed by cirrhosis, but without any diabetes, for in this case the
islands of Langerhans were not changed at all. It is interesting to note
that these changes in the islands of Langerhans were also present in
mild cases of diabetes.

Thus, the finding of sugar in the urine usually indicates the
probability of changes in the pancreas. Even small quantities of sugar,
such as appear only after starchy meals (alimentary glycosuria _ex
amylo_) may be brought into connection with changes in the pancreas; for
Wille[130] found in Hamburg from a large series of autopsies, that in a
considerable number of cases with alimentary glycosuria, there were also
changes in the pancreas.

Footnote 130:

  Quoted after Professor Oser: Deutsche klinik., vol. v, p. 158.

We must not forget the very important fact, that even when we find no
sugar we cannot at once exclude diabetes. There are many cases of mild
diabetes which do not show any sugar on an ordinary diet. To recognize
these cases we must give them a test meal of either about three ounces
of grape sugar two hours after a light breakfast of coffee and a roll,
or, as we have recommended in our book on the rational treatment of
diabetes,[131] we must give a test meal of much starchy food, such as
rice and cakes, and examine the urine two hours later. If then no sugar
is found, or not exceeding 0.2 per cent., diabetes may be excluded.
Persons with 0.1 per cent. to 0.3 per cent. of sugar after such a
starchy test meal may be considered as on the border line of diabetes.
Such persons show a diminished tolerance of carbohydrates, and they have
lost the power to consume all the sugar they introduce into their body.
Therefore, especially if they come of diabetic parents, they should
avoid eating much starchy food so as not to develop further this
dangerous tendency.

Footnote 131:

  Second edition, Berline, 1909.

Diabetes, in the majority of cases, considerably shortens the patient’s
life. Mild cases of diabetes may however live for fifteen or twenty
years, or often even longer. In predicting the chances of longevity in
diabetic subjects everything depends on the question whether diacetic
acid has been found in the urine or not. This can be easily ascertained
by putting a few drops of a solution of perchloride of iron into a test
tube with the diabetic urine. If diacetic acid is present, the liquid
will become Burgundy red in color, and the deeper this red color, the
greater is the percentage of diacetic acid present. In such cases the
chances are very bad, such patients living on an average for only one to
two years. Exceptions to this rule, however, are not infrequent, and we
know of a case of acromegaly with severe diabetes, who has passed large
quantities of diacetic acid for the last fourteen years.

Cases of severe diabetes, with diacetic acid, can often be easily
recognized by their appearance. They are thin, the cheeks are often
flushed, and they show nearly all the signs of a myxœdematous condition,
as already described, whereas cases of mild diabetes present often
symptoms of hyperactivity of the thyroid gland, as in exophthalmic
goiter. As we have shown, diabetes is often due to an overactivity of
the thyroid gland,[132] as well as to degeneration of the pancreas,
these glands being antagonistic to one another. This is confirmed and
amplified by Sajous, who ascribes one form of diabetes to overactivity
of the adrenal system, which includes the thyroid gland. Overactivity of
the latter organ may also be followed by its exhaustion, with symptoms
of myxœdema, as is the rule in severe diabetes.

Footnote 132:

  “Die Entstehung der Zuckerkrankheit,” Berlin, 1903, and its French
  translation, Maloine, Paris, 1904.

Patients with mild diabetes often have a fresh look and a rosy face, and
very frequently look much younger than they are. We believe that the
healthy working condition of their thyroids has something to do with
this fact.

The pancreas is a very important organ for the maintenance of life as it
produces certain bodies (enzymes) which are of enormous importance in
the assimilation of food. One of these bodies (they are three in
number), helps the assimilation of albuminous products and is called
trypsin. It also plays an important rôle in the treatment of cancerous
growths. Besides this the pancreas produces an enzyme that helps the
assimilation of the carbohydrates (amylopsin) and another that is
indispensable for the perfect assimilation of fat (steapsin).

As we have shown by experiments made in the laboratory of Professor
Minkowski (then in Cologne), the pancreas stands in definite relation to
the thyroid. These two glands seem to be antagonistic to one another,
for on extirpation of the pancreas of three dogs, thus rendering them
diabetic, in every case the thyroid showed a condition of hyperactivity,
whereas in one case, after previous extirpation of the thyroid, the
pancreas showed an enormous number of islands of Langerhans—(thirty-six
to forty in one field).[133]

Footnote 133:

  Comptes-Rendus de la Société de biologie, Paris, 25 Mars, 1904.

It was also of great interest, that each diabetic dog ceased to
eliminate sugar two days after extirpation of the thyroid.

As with the thyroid, the pancreas has also very important relations with
the liver. Dr. Steinhaus found, in a research conducted in the
laboratory of Professor Minkowski, that in a large number of cases of
hepatic cirrhosis there were also similar changes in the pancreas.
Similar observations have also been made by Opie, Amato, Kliffel and
Lefas,[134] and others. This may be the reason that in diseases of the
liver we have had good results from the administration of pancreatic
extract. In every case we have found a better assimilation of food, and
especially a better appetite. This stomachic effect of pancreatic
extracts we have found in nearly every case and even when the patients
were not suffering from pancreatic or hepatic disease. (See also Chapter
LIV.)

Footnote 134:

  Revue de médecine, 23, 1903.

Still more than the pancreas is the liver indispensable for the
maintenance of life. It destroys the deadly poisons which are conveyed
to it by the portal vein for neutralization. Besides this it produces
certain bodies which help to destroy poisons arising from the
decomposition of albuminous food. (See also Chapter XIII.)

The liver also produces certain bodies, as urea, which play a very
important part in metabolism, and it also serves as a large depot for
glycogen, the stored sugar of the body. The liver forms a large amount
of glycogen, and stores it up for the wants of the body. By a ferment,
also produced by the liver cells, the glycogen is transformed into
sugar, and in this form is given off to the body. If the liver were
extirpated the blood would contain no more sugar, as was found by
Minkowski through experiments on animals.

Besides sugar, the liver also produces, as just mentioned, another very
important substance, and this is urea. This body is produced in the
liver from ammonia, which, as the final product of decomposition of
albuminous substances, is brought to the liver by the blood. From
carbamic acid, also, the liver forms urea. Ammonia and carbamic acid are
poisonous products which arise from the decomposition of albuminous
material, and, by transforming them into urea, the liver saves our body
from continuous intoxication. Thus we can see that in diseases of the
liver the quantity of urea falls and the elimination of ammonia
increases. A normal man eliminates about thirty to forty grammes of urea
in a day. Much smaller quantities per diem would thus indicate
diminished activity of the liver.

Besides glycogen and urea, the liver also produces another substance,
which is indispensable to the perfect process of digestion and
assimilation. This is the bile. The bile transforms fat in the intestine
into an emulsion, and thus makes it possible for the fat-splitting
ferment of the pancreas to act upon it, and to split it up into glycerin
and fatty acids, and thus make it serviceable for the uses of the
organism. The bile augments the action of the pancreatic ferments; it
stimulates the movements of the intestine, and is a powerful antiseptic
to the contents of the intestine, as it hinders to a certain extent
their putrefaction. Another important action is that it increases the
water content of the fæces, and thus materially helps an easy evacuation
of the bowels.

After having thus briefly passed in review the important functions of a
healthy active liver, let us now say a few words about its examination.
The liver is one of the few ductless glands which are available for
manual examination by percussion and palpation. We must ascertain if it
extends considerably below the costal margin, and by palpation we must
ascertain whether the enlarged liver is soft or hard and cirrhotic. In
the former condition we can diagnose hyperactivity of the liver,
probably due to its efforts to safeguard the body against a
long-continued intoxication, as may be the case in those who overeat,
and also in long-continued digestive troubles, especially with
dilatation of the stomach, chronic constipation, etc. Following on this
hyperactivity, as is the case with all organs, there may come an
exhaustion, more especially after long-continued intoxications. Thus in
chronic alcoholism a simple hypertrophy of the liver may go on to
cirrhosis, and later the hypertrophy may be followed by an atrophy, with
all its harmful consequences, as ascites, etc.

On examining the liver we must not forget the sclerotics, and must note
whether, on looking upward, there is any yellow discoloration.

While palpating the liver we must specially note whether it is tender,
and also if the gall-bladder is tender. This is a typical symptom of
chronic inflammation of the gall-bladder, or cholecystitis, which is so
frequently associated with gall-stones. We find such a tender
gall-bladder very frequently in elderly women, in whom gall-stones are
particularly common. In fact, they occur so frequently that Halck[135]
in Copenhagen, found them in 29 per cent. of 4140 autopsies on persons
above 50 years of age. However the mere presence of gall-stones does not
constitute gall-stone disease, the essential point being an inflammation
of the gall-bladder and bile-ducts. Such an inflammation of the
gall-bladder is revealed by tenderness on pressure with the examining
hand. It is a frequent symptom of all those conditions (as we have found
and communicated to the French Congress of Medicine, 1905) in which the
thyroid or sexual glands are diseased. For instance, after pregnancies,
after infectious diseases in old age, etc., it is often accompanied and
preceded by obesity, which is also a consequence of inactivity of the
thyroid and sexual glands. Frerich, many years ago, observed enlargement
of the liver and a tender gall-bladder in women at the climacteric, and
many other authors have made similar observations. Hertoghe found such
conditions common in women suffering from inactivity of the thyroid or
hypothyroidia.

Footnote 135:

  Quoted from Hoppe-Seyler in Nothnagel’s “Practice,” p. 548, 1904.

It has been found by experiments, made by Blumenthal and Jacobi, that
extirpation of the thyroid is followed by a dilation of the
gall-bladder, and many authors have noted the presence of biliary
constituents in the urine of animals whose thyroid has been extirpated.

We can readily understand why women with changes in the thyroid and
sexual glands are so often attacked by gall-stone disease. In these
women there is, as a rule, atony of the intestines, with habitual
constipation. This intestinal atony is also accompanied by an atony of
the gall-ducts, and so the bile is more or less stagnant in these ducts.

As shown by Morat and Doyon,[136] the gall-ducts contract rhythmically
every ten to twenty seconds, and the bile is thus expressed. The
periodical compression of the liver by the diaphragm at each inspiration
also helps this expression of the bile. Thus it flows under a certain
pressure through the choledochus, and it is easy to understand that the
billions of microbes which infest the intestines, will have great
difficulty in passing the narrow and tortuous passages of the bile-ducts
through which bile is circulating at great pressure. And this is of the
utmost importance, for if microbes are able to pass the common duct and
thus enter the bile-ducts, they will set up inflammation, as was shown
by several French authors: Gombault, Charcot, Gilbert, etc.

Footnote 136:

  Traité de Physiologie.

Inflammation of the bile-ducts plays a most important part in the origin
of gall-stone disease, for, as Naunyn and his pupils have shown,
inflammation of the bile-ducts leads to a precipitation of cholesterin,
and so to the formation of gall-stones.

In women gall-stone disease is more frequent than in men. This depends
upon the greater frequency of diseases of the thyroid and sexual glands
in women. Changes in the sexual organs produce an irritation of the
splanchnic with checking of the peristaltic movements of the intestine
and, at the same time, relaxation of the muscular coat of the
bile-ducts. Thus there arises a deficient expression of bile, and
stagnation follows, with invariable immigration of bacilli producing
inflammation and precipitation of cholesterin and gall-stones. For the
above-mentioned reasons constipation is far more frequent in the female,
and constipation, being always accompanied by atony of the bile-ducts
with stagnation of the bile, directly exposes to the risk of gall-stone
disease.

In men gall-stone disease may often be considered a manifestation of old
age. It appears, as a rule, after the fortieth year, and is often
brought about by previous infectious diseases. In such cases obesity
often develops first, and later gall-stone disease. For those who are
interested in this subject we would refer to our communication[137] on
the origin of gall-stone disease following changes in certain ductless
glands. Considerable, sometimes enormous, loss of weight is a very
frequent symptom of gall-stone disease, and is probably due to
pancreatic alterations.

Footnote 137:

  Archives générales de médecine, Octobre, 1905, and Monthly Cyclopædia
  of Practical Medicine, 1906.

Gall-stone disease may be regarded as of great importance in estimating
an individual’s prospects of longevity, and at the same time as a
pathological manifestation of an inactive thyroid, or deficient sexual
glands in women. This applies equally well to the cause of renal colic,
gravel, which was found by Professor Sajous to be prevented by thyroid
preparations and a suitable diet.

Constipation, an important predisposing cause, has been shown to be an
expression of such conditions. The truth of these assertions is proved
by experimental evidence.

Extirpation of the thyroid provokes important changes in the liver. In
myxœdema there is a condition of hepatic cirrhosis, as shown by
Prun-Hudden, Vermehren,[138] and others. Two years after we had shown
that the thyroid and liver stand in close relation to one another,
Professor Neusser, of Vienna, brought forward the same conclusion at the
German Congress of Internal Medicine in 1906.

Footnote 138:

  Over Myxœdemet, Kjöbenhavn, 1895.

Another important gland that has a very close connection with the
thyroid is the kidney. A direct examination of this organ is not
possible, but we have means of readily judging of its efficiency by
observing how it performs its function. This is to eliminate waste and
poisonous products from the body by means of its secretion—the urine.
Thus from the examination of the urine we may gather all the information
necessary about the activity of the kidneys.

In examining the urine we must first pay attention to its appearance,
the daily amount, and its specific gravity. Less than about two pints a
day of a light colored urine, with a specific gravity below 1020,
indicates a faulty action of the kidneys, and the possibility of a large
amount of toxic products being retained, instead of being eliminated.
Such a urine can often be seen in cases of thyroid insufficiency, as
this condition of the thyroid causes a diminution in the activity of the
kidneys. As we have shown in a communication to the Paris Biological
Society,[139] the thyroid and the kidneys are very closely related,
changes in the thyroid always being followed by changes in the kidneys.
Thus it was found by Albertoni and Tizzoni, by Blum and others, that
extirpation of the thyroid is followed by fibrosis of the kidneys.
Interstitial nephritis is the rule in myxœdema, and is very frequent in
all conditions with insufficiency of the thyroid. In such patients the
quantity of urine is diminished, and also its specific gravity, as well
as the quantity of urea and uric acid, which in consequence are retained
in the body.

Footnote 139:

  Loc. cit.

The quantity of the eliminated uric acid being diminished, its retention
in the body explains why gout is so frequent in people with thyroid
insufficiency, and why these persons so often complain of rheumatic
pains. As we have shown in our above-mentioned communication, gout is
due to a degenerative change in the thyroid and kidneys, with retention
of uric acid as a sequel.

The presence of albumin in quantities greater than 0.5 gramme to the
liter is of grave import, and denotes important change in the kidneys.
Smaller quantities, or just a trace, may not be of great importance.
Traces of albumin occur from a great number of causes, and are often due
to the passage of toxic products through the kidney which this organ
eliminates, as one of its main functions is to eliminate toxic products
from the body.

More serious than small quantities of albumin is the appearance of casts
and renal epithelium. These, if present, indicate a destructive process
in the kidneys. Even the occasional occurrence of hyalin casts is not
without danger, for, according to Professor Senator,[140] of Berlin,
hyalin casts are formed by degeneration of the epithelium of the
convoluted tubules, which play an important rôle in the separation of
solid products from the blood into the urine. The loss of these
structures means a hampering of the most important function of the
kidneys. Even when we find only one such cast in one or two specimens,
we must not forget that a pint of the urine may contain a very large
number, and thus every day large quantities of valuable kidney elements
are wasted and one of the most important functions in our body is
hindered. Therefore we must not pass by such a condition of things
without serious thought for the future of such persons. The length of
their lives will largely depend upon their diet, just as in cirrhosis of
the liver. If these persons are addicted to an abundant meat diet, their
chances of longevity will certainly be smaller than with milk and
vegetable food. As we have seen, the liver is constantly dealing with
poisons arising from the decomposition of albuminous food, especially
meats. The kidneys are destined to eliminate such products from the
blood and pass them out with the urine. We will treat of this subject
later in a separate chapter.

Footnote 140:

  Die Erkrankungen der Nieren, second edition, Berlin, 1906.

In patients with diseases of the kidneys, the condition of the skin is
of the utmost importance, as the skin is our second kidney. Therefore
patients with thyroid insufficiency have less chance of a long life if
their kidneys are in any way incapacitated.

Besides the above-named vital organs, there are certain portions of our
anatomy which are also of importance in the determination of our chances
of life. Take, for example, the nose. In the children of parents with
degenerated thyroids there is a great tendency to adenoid vegetations.
These are, strictly speaking, not a disease of childhood alone, for
often they may be met with in adults, even in middle age. If large they
necessitate breathing through the mouth instead of through the nose,
especially at night. Such children are liable to frequent catarrhs, and
what is more serious, to pulmonary troubles. They are also liable to
suppurative otitis media and frequent attacks of tonsillitis. These
frequent attacks of tonsillitis may constitute a serious danger, as they
may induce an inflammation of the kidneys. As a rule, in such cases the
nephritis passes off in a few days, often without being recognized, the
symptoms being ascribed only to the tonsillitis. Although the acute
symptoms may have disappeared and nothing remain but a few red
blood-corpuscles in the urine and occasionally a few casts and
epithelial cells, yet under the ashes the fire may still creep on and
chronic nephritis develop. In fact, a good number of cases of chronic
nephritis whose origin is wrapped in mystery are due to such a
tonsillitis.

The condition of the teeth must also be inspected, for people without
sufficient teeth cannot chew their food properly, and thus gastric and
intestinal catarrhs may arise.

Just as important, if not more so, than the condition of the
above-mentioned vital organs, is the mental state. Thousands of years
ago it was a manifest truth that the mind governs the body. In judging
an individual’s chances of long life, we cannot omit the importance of
his mental character. As a rule a man with a well-balanced mind, who is
not disturbed by the smaller worries of life, has more chances of a
green old age than a man whose easily impressionable mind exposes him to
continual agitation and anxiety, and who is overwhelmed by the slightest
untoward event. A man who is a born optimist and who views everything in
a rosy light, has got far more chance than a pessimist who sees
everything in a cloud. A man who is ambitious and never satisfied is
more liable to mental and physical change than one who asks for little
and easily gets it. Being disappointed in his ambition, as so often
happens, he becomes despondent, especially if he is lacking in
will-power, which depends on the activity of the thyroid as previously
mentioned. In this condition he may not only lose his appetite and
become ill-nourished, but he is also more liable to succumb to the
incessant attacks of microbes, among which he lives, and which gain easy
access to the body in melancholic conditions. Sorrow may act in the same
harmful manner.

The chances of a bachelor or spinster for a long life are always less
than those of a married person. Single people are more subject to
nervous change and digestive troubles, and have a greater tendency to
become despondent and melancholic. In bachelors, also, the acquisition
of contagious diseases is a continual danger, and when they get older
after their former merry lives, if merry it was, gloom invariably
follows. Married life is the best guarantee for a long life and happy
old age (see Chapter XLVIII).

Before closing this chapter we would state that it was not our intention
to give a description of the physical examination of a patient from the
point of view of life insurance, but to indicate certain points which
must guide us in forming an opinion on a person’s chance of longevity.
All vital phenomena are under the influence of the internal secretions
of the ductless glands, which govern every organ of our bodies.
Therefore everything depends upon finding out the condition of these
glands. Any well instructed physician can make a thorough examination of
the different organs of the body for the purposes of life insurance;
therefore we did not think it necessary to describe here the examination
of the heart or lungs, etc.

By such examination of the ductless glands we are not only able to
forecast the approximate length of life, but we are able to judge a
patient’s power to withstand disease when we are called to his bedside.
If we find the ductless glands of such a patient (especially the thyroid
and adrenals, kidneys and liver) in good working order, we can predict a
successful and rapid termination to the malady. It is easy to understand
that any one with a healthy skin, normally acting bowels, and plentiful
urine, will more readily eliminate poisonous products than a person with
a dry skin, constipation, and scanty urine. Also his tissues will be in
better condition, and in the case of wounds granulations will more
quickly form and fractures heal readily with firm callus.

Such an examination as the above can, however, also help us, as we
readily shall understand, to foretell the chances of a person as to the
prolongation of youth and the retardation of old age.


------------------------------------------------------------------------




                             CHAPTER VIII.

                      ON THE CAUSATION OF OLD AGE.


WE have seen in the first chapter of this book that the symptoms of old
age may appear in quite young persons after changes in the ductless
glands, especially the thyroid, ovaries, testicles, etc. We have also
shown how these glands influence the condition of the tissues, and our
external appearance, our immunity from infections and intoxications, and
the condition of our nervous system and mind. We have also seen how
these wonderful glands influence the length of our life and our
prospects of a green old age, and thus it is evident that these glands
are in close relation with the origin of old age. It is justifiable,
therefore, to enter fully into a discussion as to whether old age is
really due to degeneration of the ductless glands, which supposition
must have occurred to anyone who has read the previous chapters of this
book.

Sir Victor Horsley, of University College Hospital, London, was the
first to bring old age into causal relation with degeneration of the
thyroid, and after him Vermehren and Ewald of Berlin.

In a communication we made to the Biological Society at Paris, December
4, 1907, we showed that old age is not alone due to degeneration of the
thyroid, but to changes in several ductless glands, of which the chief
are the thyroid, ovaries, testicles, adrenals, and pancreas. In a
communication to the International Medical Congress in Lisbon, in 1902,
we added to these glands the liver and kidneys, which also possess an
internal secretion.

Let us now see if there is any evidence in support of such a statement.

As we shall show, such proofs do exist and they are of a pathological,
anatomical, experimental, and clinical nature. To begin with, it is a
well-established fact that at a certain age the different ductless
glands show important changes, notably an increase of connective tissue,
with subsequent degeneration of the secreting tissue.

Sir Victor Horsley[141] found that the thyroid gland, after a certain
age, shows an increase of connective tissue, with fatty degeneration of
the epithelium and shrinking (concentration) of the contents of the
follicles. Hale White[142] also, examining at autopsy seventy thyroid
glands, found an atrophic condition in old subjects, an atrophy which is
more marked the older the subject, and that these changes are already
present in the thyroids of persons fifty years old.

Footnote 141:

  “On the Thyroid and Pituitary Bodies,” British Medical Journal, 1890,
  and Proceedings of the Royal Society, 1886.

Footnote 142:

  Hale White: Med.-Chirurg. Transactions, vol. lxxi, 182.

The thyroid, together with the parathyroids, have been found degenerated
in old age by Erdheim.[143] Bauman found only very little iodine in the
thyroid of aged persons.

Footnote 143:

  Beiträge zur path. Anatomie, xxxiii, p. 158, 1903.

Let us add that, luckily, not every thyroid shows important changes
after the age of forty or fifty, although there is usually a slight
increase of connective tissue at that age. On the other hand there are
thyroids in subjects of advanced age which show no important
degenerative change. This, however, is, according to our experience at
autopsies, a very rare occurrence. The point of main importance is the
amount of colloid substance present. A thyroid with much colloid, if it
is of normal quality (which can be recognized by the way it stains with
eosin), is a thyroid of good activity. As we know, the thyroid contains
more iodine than any other part of the body. The main bulk of the iodine
in our body comes from the thyroid. It follows from the investigations
of Docent Oswald,[144] in Zurich, that the quantity of iodine in the
thyroid depends upon the amount of colloid substance. Hence a thyroid
with much colloid substance contains much iodine, and a large goiter
composed of connective tissue alone and containing no colloid, cannot
contain any iodine.

Footnote 144:

  Oswald: Zeitschrift für physiolog. Chemie, 1899, and Virchow’s Archiv,
  169, p. 444, 1902.

Differing with a famous French physician who said that the age of a man
depended upon his arteries, we would state that it depends upon the
quality of his thyroid. For the condition of the arteries, as we have
shown in different parts of this book (Chapters II and VI), depends very
much upon the condition of the thyroid gland, which governs the whole
circulatory system.

The parathyroid glands, which are in relation with the thyroid, and
changes in which may produce cramps, as shown by Jeandelize,[145]
Pineles,[146] etc., also present an increase of connective tissue, with
fatty degeneration of the epithelium, in old age, as was shown by
Erdheim,[147] of the Vienna Pathological Institute.

Footnote 145:

  L’insuffisance thyroidienne et parathyroidienne, Paris, 1904.

Footnote 146:

  Grenzgebiete f. Med. Chirurg., 1905.

Footnote 147:

  Erdheim: Loc. cit.

As is well known, the ovaries also, between the ages of forty-six and
fifty, undergo important changes and involution, with consequent
cessation of the menses. There is an increase of connective tissue with
degeneration of the epithelial structure. There is also a retrograde
metamorphosis of the Graafian follicles into fibrous tissue. The
testicles have been found atrophied in old age by Professor
Langhans,[148] but there are many exceptions, as shown by S.
Spangaro.[149]

Footnote 148:

  Langhans: “Hoden Atrophie,” Handbuch der Deutschen Chirurgie,
  Stuttgart, 1887.

Footnote 149:

  Spangaro: Anatomische Hefte, lx, 1902.

As Sajous[150] and we[151] also have shown in our already cited
researches, that the various ductless glands are closely related, and
thus changes in the thyroid are always accompanied by changes in the
other ductless glands. This rule applies to the present case and after
senile changes in the thyroid, with increase of connective tissue, the
other ductless glands also show similar changes. These are found in the
pituitary body, the adrenals, the liver, and kidneys. We have several
times insisted upon this fact in various chapters of this book.

Footnote 150:

  Sajous: Loc. cit.

Footnote 151:

  Loc. cit.

The adrenals of old people have been examined by Minervini,[152] and he
found a true cirrhosis of these glands which had included nearly the
whole gland. He also found drops of fat in the cells of the medulla.
Dellamare[153] found a hypertrophic condition of this gland in old age.

Footnote 152:

  Minervini: Journal d’anat. et de physiol., p. 449 and p. 639, 1904.

Footnote 153:

  Dellamare: Soc. de biologie, 17 Octobre, 1903.

In nature every cause has a sequel. Therefore, when we see such
important changes in glands with internal secretions, there logically
must be sequels to the alterations in these important organs. And these
exist. When the thyroid is degenerated, to a greater or less extent all
those symptoms appear which are characteristic of changes in the
functions governed by the thyroid, and of which we have spoken in
previous chapters.

Therefore, when the thyroid is degenerated, symptoms appear which are
characteristic of myxœdema. And, indeed, Sir Victor Horsley was the
first to draw attention to the fact that in old age we find all the
symptoms of myxœdema; and after him, Vermehren[154] and Ewald.[155] They
have compared the symptoms of myxœdema with those of old age, and found
the two conditions very similar. According to our own observations the
most prominent of these corresponding symptoms are:—

Footnote 154:

  Studier over Myxœdemet, Kjöbenhavn, 1895.

Footnote 155:

  Ewald: “Die Erkrankungen der Schilddrüse,” Nothnagel’s Handbuch,
  Vienna, 1896.

The wrinkles on the face and the drooping of the lower eyelids, in
extreme cases amounting to ectropion. Then the great number of wrinkles
on the hands of myxœdematous people, even at an early age, and the
feeling of cold in the hands and feet and their bluish color.

With advancing age, obesity is often the first symptom, just as in
myxœdema, and, as we have said above, obesity can be caused by
degeneration of the thyroid and sexual glands.

The hair in both conditions is very often gray, and there is atrophy of
the papillæ of the hair and of the sebaceous and sudorific glands, with
dryness and falling out of the hair.

Constipation or irregularity of the bowels is also common. There is
often great fatigue, slow speech, and an apathetic condition in both
these states. The memory shows the same typical deficiency, events of
long ago being more easily remembered than those of quite recent date.
The character of the patient becomes egotistical and avaricious. There
is great sensibility to cold and difficulty in keeping warm. The urine
is generally below the normal quantity; often it is scanty and of low
specific gravity, with retention of solid constituents. The processes of
oxidation are diminished both in typical myxœdema and in advanced old
age. There is a diminution of the blood-corpuscles and of hæmoglobin in
both conditions.

After the initial obesity in early myxœdema and old age, there comes as
a second stage a loss of fat, characteristic of the advanced stage of
myxœdema (the cachectic stage) and advanced old age.

There is an increase of fatty tissue after extirpation of the thyroid
gland, and later of connective tissue, just as in myxœdema and old age.
This increase of connective tissue is typical of old age. It first
appears in the arteries, leading to atheroma, and the typical symptoms
of arteriosclerosis. In myxœdematous persons, although they may still be
young, we find atheromatous arteries and arteriosclerosis. Impotence is
common in myxœdema, especially in advanced cases, and is also found in
senility, being more marked the greater the patient’s age.

There is no denying the fact that in old age we find, besides
degeneration of the thyroid, symptoms of degeneration in various other
tissues and functions, and the question now arises, whether these
changes in the tissues are really the sequel of previous degeneration of
the ductless glands, or whether both are only accidental and in no
causal relation We have already answered this question four years ago in
our communication to the Paris Biological Society, showing that old age
is due to degeneration of the ductless glands, and stating that these
glands govern the tissues and not _vice versa_. Still, we shall enter
here more fully upon this question, showing by experimental and clinical
evidence that the changes in the ductless glands are primary, and
followed by a degeneration of the tissues as a consequence.

We can produce experimentally typical symptoms of old age in young
animals by extirpation of the ductless glands, more especially the
thyroid, ovaries, and testicles.

When we extirpate the thyroid gland of an animal we get an increase of
fat in the subcutaneous tissue, or an increase of connective tissue. We
know of the case of a young bull which, two months after extirpation of
the thyroid, gained about thirty kilos in weight, due to an increase in
fat. The same thing occurred in a colt. We are indebted for our
knowledge of both these cases to Dr. Hertoghe, of Antwerp, the
well-known authority on the thyroid gland.

After extirpation of the thyroid gland prominent writers have found a
diminution in the processes of oxidation; and by thyroid gland feeding
we can augment these processes, as was shown by Vermehren, Magnus-Levy,
Thiele, Nehring, and many others. This property of the thyroid gland is
made use of in the medicinal treatment of obesity. Since writing these
lines we have observed a loss of forty pounds in a man, a patient of
Professor Launois, of Paris, who, after this loss, felt better. We
treated him in Carlsbad for six weeks with thyroid extracts, and the
average loss was about a pound a day. True, this patient was also taking
Carlsbad water, but we have never seen so considerable a loss due to
this water alone. The diet of this patient had not been strict. This
loss of weight, then, is mainly to be ascribed to the thyroid treatment.
This treatment is dangerous, however, unless carefully regulated by a
physician.

Thus extirpation of the thyroid is undoubtedly in causal relationship to
obesity, which, as already mentioned, is often the first symptom of old
age. But it also can produce another sign of old age, and this is the
increase of connective tissue in the various organs and tissues. That
connective tissue formation is an attribute of old age has been clearly
shown by Demange and Oettinger, who found at every autopsy on old
persons an increase of connective tissue in the walls of the
capillaries. Ord and Mahomet found exactly the same thing in the
capillaries of persons suffering from myxœdema. This has been proved
experimentally by Professor Eiselsberg,[156] of Vienna, who found
atheromatosis of the aorta and other blood-vessels in dogs whose
thyroids he had removed.

Footnote 156:

  “Die Krankheiten der Schilddrüse,” Stuttgart, 1901.

This increase in connective tissue has been found in various viscera
after removal of the thyroid; thus it was found by Kishi[157] in the
liver of one hundred and fifty dogs and monkeys. Rosenblatt and
Jeandelize[158] also described an interstitial hepatitis in similar
cases.

Footnote 157:

  Virchow’s Archiv, p. 260, 1904.

Footnote 158:

  Loc. cit.

The same change has also been noted in the kidneys after extirpation of
the thyroid (e.g., Blum[159] found an interstitial nephritis), and in
the brain an increase of neuroglia occurs, as observed by Blum, Walter
Edmunds, and others.

Footnote 159:

  Blum: Loc. cit.

Increase of connective tissue in the skin is a common occurrence after
thyroid extirpation, and the name “myxœdema” is probably derived from
the fact that in some cases, as the disease advances, the connective
tissue is transformed into a mucinoid substance. The name “cachexie
pachydermatique,” as suggested by Charcot, seems to be far more
adequate.

Formation of fat and of connective tissue is not only seen after removal
of the thyroid, but can also be observed after extirpation of the sexual
glands, the ovaries and testicles.

As mentioned in Chapter II, Loewy and Richter,[160] of Berlin, observed
that removal of the sexual glands always produced a diminution of the
oxidation processes.

Footnote 160:

  Archiv für Anat. u. Physiol., Supplement, 1899; and Ergebnisse der
  Physiologie, ii, 1902.

The experiments of Prof. Loewy and Prof. P. F. Richter are not
invalidated, in our opinion, by the experiments of Lüthje, who did not
find an increase in metabolism after ovarian feeding. The reason for
this may be that he was not in possession of active extracts. Anyone who
works with animal extracts knows what a great difference there is
between various organo-therapeutical preparations, some being more
efficacious than others.

As a rule castrated animals take on fat, and this fact has for many
years been made use of by farmers. At the same time the flesh of such
animals acquires a better flavor, the pronounced flavor of the meat of
non-castrated animals being objectionable to some consumers. This
demonstrates the very instructive fact that the internal secretion of
the testicles has its effect on all parts of the body.

Castration in man is very frequently followed by obesity and symptoms of
old age. Thus the eunuchs of eastern countries are very often fat and,
at the same time, look much older.

The influence of the ovaries upon fat formation can also be shown by
their therapeutical action in obesity. Although not so active as thyroid
extracts, we have found that by the combined use of thyroid and ovarian
extracts, we could produce a considerable loss in weight, when, by
thyroid treatment alone, we could not obtain it. This, however, is only
in the case of women. We will treat of this subject more fully in the
chapter on ovarian treatment.

Besides the above-mentioned experimental facts, which show that these
attributes of old age—obesity and increase of connective tissue—can be
produced by removal of the thyroid or sexual glands, we also have to
deal with facts gained by clinical observation, which show that any
cause inimical to the ductless glands, especially the thyroid and
ovaries, may bring about old age. Take, for example, infectious
diseases. They have a very damaging effect on the various ductless
glands, especially so if they are of long duration. Their influence upon
the thyroid has been clearly shown by various observers. (Roger and
Garnier, Crispino, Torri, Bayon, de Quervain, and others. See Chapter
III.)

Not only the thyroid gland, but other ductless glands, are affected by
infectious diseases, and in the third chapter of this book we have shown
that the adrenal glands show alterations indicating hyperactivity in
infectious diseases.

The pituitary gland is also altered in infections, as shown in the same
chapter.

Changes in the pituitary body may also be a factor in producing
premature old age. It is a fact that all people suffering from
acromegaly appear much older than their age. In fact, one of the first
symptoms that arouses the anxiety of the relatives of such a patient is
that he looks so much older, and it is only later that they notice the
overgrowth of the nose, the hands, and feet. Since, in many people who
are getting older, the head and nose may increase in size, we may
suppose that this is the clinical expression of senile changes in the
pituitary body. There is a condition known as “acromegalie fruste,” in
which the symptoms are only slightly pronounced and which is often
unrecognized. As we have already said, all diseases of the ductless
glands may be only partially developed. This is due to the fact that
only a proportion of the thousands of follicles, of which such a gland
is composed, need be affected.

The ovaries and testicles also show changes as an evidence of their
fight against infections, and we have mentioned the findings of
Professor Metschnikoff with regard to these glands.

In every severe infectious disease the liver shows great change in its
parenchymatous tissue, with a subsequent increase of connective tissue.

The increase of connective tissue in various organs, and especially in
the blood-vessels, after infectious diseases, can be regarded as an
illustration of our remarks on these same changes following
degenerations of the thyroid. It is a well recognized fact that atheroma
can be caused by various infectious diseases, and can also be
artificially produced by several infectious agents.

The kidneys, through their rôle as eliminative organs, usually suffer,
even more than the other glands, in the course of infectious diseases.
Even a slight angina may produce an acute parenchymatous nephritis, and
the more virulent the infection, the more will the kidneys suffer.

Not infrequently, unknown to us, important parts of the renal tissue are
lost after such infections, and a chronic nephritis may creep on
insidiously. After such loss there may be proliferation of connective
tissue, and the kidneys thus become unable to fulfill the most important
eliminative functions in the body. Owing to this incomplete elimination,
toxic substances may be retained in the body.

From the above considerations we can see how important it is to guard
against the risk of infection. This is often impossible, considering the
billions of microbes by which we are surrounded day and night. The best
precaution is to keep those organs in good working order which safeguard
us against infections—i.e., the ductless glands.

Even more potent than infectious diseases in producing old age are the
results of degenerative changes in the ovaries. The effects of
castration have already been mentioned. Much in the same way do those
causes act which exhaust the internal secretion of the ovaries, e.g.,
many pregnancies, or sexual excesses. We must take into consideration
the fact that, as shown by many authors, the different ductless glands
are altered during pregnancy (Launois,[161] Guieysse, etc.). Many
mothers of large families look old before their time, as do also many of
those who lead a professedly immoral life. Even in young girls we can
see the consequences of such deteriorating agencies in hypertrophy of
the mammæ, developing in very short time, and also a tendency to
deposition of fat on the abdomen, which becomes pendulous in women who
have had many children. The features of women who indulge in sexual
excesses undergo a striking change even in early life. They become
coarse, bloated, less sharply defined, and the cheeks and chin become
fat and flabby. Indeed we have often been struck by the great
resemblance of such a face to that of an early stage of myxœdema, a
condition due to deficiency of thyroid secretion, which in turn, as
shown by Sajous, influences other ductless glands. The effects of
numerous pregnancies are far more marked if lactation is prolonged.

Footnote 161:

  Launois et Mulon: “Hypophyse et femme enceinte,” Société de biologie,
  p. 448, 21 mars, 1903; and Thèse à la Faculté des Sciences, 30 juin,
  1904.

Not all women after many pregnancies, or after unduly frequent sexual
intercourse, will show symptoms of premature senility, as much depends
on heredity and also on the surroundings in which they live. Certainly
if they live in precarious circumstances, as do the poorer women of the
working classes in many European countries, especially Germany and
Austria, where these women perform hard bodily work and are badly fed,
and have much sorrow and care, they will soon appear old; and women
looking like matrons at thirty are of common occurence in the lower
classes of these countries. But this is seen also in the women of
southern Europe, although they do not work so hard. This is due to the
fact that in southern countries girls reach puberty early and are
married very young, in the East often at the age of twelve. Thus, sexual
activity begins earlier and ends much sooner. Its end, of course, means
the beginning of old age. As soon as retrograde changes commence in the
ovaries, the summer of a woman’s life is over; and, just as summer is
sometimes prolonged into autumn, so at this period of her life may she
still retain strong sexual desire. Happy the woman whose heart, as well
as her ovaries, undergoes a senile involution, for there is nothing more
terrible for a formerly beautiful woman than to see her charms wane
while her heart remains young.

Yvette Guilbert, in her novel the “Demi-vieilles,”[162] describes in a
picturesque manner the pangs of a woman at the climacteric age. Let us
quote a few lines: “They try to remain young, hide the gradual onset of
their ugliness, and look for a chance to taste of love again. They cry
out for the past, for even while they fight against time they cannot
detain it in its course.” This description, however, does not apply only
to the majority of middle-aged women, but more especially to
professional beauties.

Footnote 162:

  Quoted after Professor Kisch.

It can be seen from these considerations how necessary it is for a woman
who has frequent pregnancies to observe the rules of hygiene. That these
produce excellent results we have proved. We know of a score of ladies
of the aristocratic and wealthy classes who, though having six or even
seven children, look none the worse. A certain Austrian archduchess
still remains a beautiful woman, in spite of her eight children and the
fact that she is a grandmother. Such examples may be frequent in old
families with this hereditary tendency. Though the bearing of many
children can hasten old age, yet, on the other hand some women, after
the birth of their first child, become better and fresher looking. We
can see this especially in girls of twenty or more who, having appeared
somewhat withered before marriage, begin to bloom afresh after the birth
of the first child. Increased activity of the ovaries and thyroid is the
explanation of this phenomenon. As already mentioned, the thyroid takes
an active part in ovarian changes. In a young girl of fourteen, just
previous to menstruation and puberty, we may find a swelling of the
thyroid gland. During menstruation we can often see a distinct
enlargement of the thyroid, and at the same time certain nervous
symptoms such as are usually connected with thyroid change.

Increased activity of the thyroid during pregnancy is shown by a
swelling of the gland, often causing a regular goiter, and, at the same
time, not infrequently by the typical symptoms of exophthalmic goiter.
Lactation is also dependent upon thyroid activity. After prolonged
lactation there is an exhaustion of thyroid activity; and, on the other
hand, by giving thyroid extract we can increase the flow of milk.

The swelling of the thyroid in the above conditions can be explained by
the greater demand for thyroid secretion, and that this hyperactivity
occurs is also shown by the observations of the early writers on
myxœdema. Morvan, Ord, and Combe found that myxœdema was frequently
caused by numerous pregnancies, especially if associated with prolonged
lactation.

This also explains why women become prematurely old so much more
frequently than men, for their ovaries are much sooner exhausted, in
consequence of their activity being much greater than that of the male
sexual glands. There is a much greater demand not only on the female
sexual glands, but also on the female thyroid, which enlarges every
month in many women, and is greatly exhausted by each pregnancy. As
Hertoghe[163] says, with reference to this exhaustion of the thyroid by
pregnancies, “each child demands one tooth.”

Footnote 163:

  Hertoghe: “Die Erkrankungen der Schilddrüse und der chronische
  gutartige Hypothyreoidismu,” München, Lehmann, 1900.

According to Hertoghe, pregnancies are especially apt to produce
degenerated conditions of the thyroid gland.

Sexual excesses, on account of the concomitant nervous excitement, are
also very prejudicial to the adrenals, for just as frequent nervous
excitement in general, they produce alterations in the blood-pressure
and favor the development of arteriosclerosis.

Sexual excesses are also very harmful to men, although their action on
the thyroid, in men, has not yet been ascertained. It is a fact,
however, that they diminish the resistance to infections, and favor the
onset of neurasthenia and arteriosclerosis.

Changes in the thyroid also become manifest during the climacteric, and
the troublesome nervous manifestations at this period are largely due to
this fact. Later, on account of the degeneration of the thyroid and
ovaries in many of these women, there is an accumulation of fat, of a
bacon-like character, in the same situations as was described above in
women after many pregnancies and sexual excesses—_viz._, the breasts,
the hips, and the abdomen. The facial appearance of these women who
become obese after the climacteric resembles that of a typical case of
early myxœdema. In the later stages, as old age advances, just as in
myxœdema, the fat may disappear and be replaced by great thinness and
emaciation—the cachectic stage of myxœdema. This is less frequently seen
now-a-days, on account of the improvement and checking of the disease by
thyroid treatment.

It is a very strange fact that although sexual abuses soon bring about
symptoms of old age, as do also many pregnancies, clinical observations
show that total suppression of sexual activity is also, if not still
more, a powerful factor in the production of premature senility. There
is no denying the fact that spinsters, after the age of thirty or forty,
often look older than married women with small families. See also our
chapter on the “Hygiene of the Sexual Glands” on this subject, in which
we show by experimental evidence the dangers of the total suppression of
sexual activity.

Evidently nature will not be trifled with, and the ovaries and testicles
are made by the Almighty to serve a certain purpose, just as any other
organ. Their remaining in total idleness is no less harmful than in the
case of any other organ. We fail to see for what reason this organ alone
should be made an exception, and to deny this fact would be hypocrisy.

Persons who live in total sexual abstinence are very often of a nervous,
neurasthenic, or even melancholic disposition. If we consider how
intimate are the relations of the sexual organs with the thyroid, we
cannot exclude the possibility of changes in this important gland under
such conditions.

The relationship between the sexual glands and the thyroid is also
demonstrated by experimental evidence. Thus Cecca found, after
extirpation of the ovaries or testicles, that the thyroid shows an
accumulation of colloid substance; again, Jayle saw the appearance of
exophthalmic goiter in a case after castration; and, on the other hand,
Prof. Hoffmeister, of Strassburg, found a premature ripening of the
follicles in the ovaries after thyroidectomy.

Freund constantly found goiter in cases of fibromyoma of the uterus, and
in two cases the goiter has disappeared after operation on the uterine
tumor.

It is a well-known fact that exophthalmic goiter can be improved by
ovarian extracts, as Latzko, of Vienna, and others, have shown.

Changes in the thyroid, as a rule, produce certain changes in the sexual
glands. Thus, in exophthalmic goiter menstruation is usually irregular
and often disappears. In myxœdema there is atrophy of the ovaries and
sterility. The above conditions in man often produce sterility.

In partial cases of myxœdema metrorrhagia is frequent. By giving thyroid
extracts these uterine hæmorrhages may be stopped.

After having shown that old age can be caused with more or less
certainty by degenerative changes in the sexual organs, we will now try
to show that it can also be caused by various kinds of intoxication.
Especially is this true of large quantities of alcohol continued for
many years.

Alcohol specially influences the ductless glands. Small quantities may
at first stimulate their action, but large quantities, if taken for a
very long time, will cause degeneration.

In the third chapter of this book we have already briefly mentioned the
bad effects of alcohol upon the ductless glands. We have seen that, as
de Quervain, Hertoghe, etc., have shown, alcohol produces very marked
degeneration of the thyroid gland. This has been proved by autopsies on
chronic drunkards. As well as on the thyroid, alcohol also acts upon the
other ductless glands. It acts, for instance, upon the adrenals. Its
action in small doses is similar to that of adrenalin. Alcohol in small
tonic doses excites the activity of the splanchnic nerves, and so may
produce an increased flow of adrenalin and a higher blood-pressure (see
Chapter XV).

Alcohol in large doses may also have a degenerating effect on the sexual
glands. Small doses can stimulate, but large doses are decidedly
harmful. Temporary impotence may result in such cases, and chronic
impotence in inveterate drinkers.

Though alcohol in large doses is harmful, and if taken in very large
quantities for many years can hasten old age, there is absolutely no
reason to suppose that in small doses it has any etiological relation to
senility. In fact, there are many cases on record of persons who have
taken alcohol, especially wine in limited quantity, every day, and have
lived to enjoy a healthy old age.

One of our confrères, a surgeon of Lotharingia named Politiman, lived to
be 140. As Professor Pel, whom we quote, says, the historian explains
that this old age was due to the medicine this worthy doctor took every
day after doing his work. He had drunk his fill every night since the
age of twenty-five years. Another surgeon, Espagno, lived to be 112 with
no less moderate habits! Countess K——, who died in Nicolajew in Russia,
a few years ago, at the age of 111 years, took daily a cordial in the
form of a good drink of cognac; and about one and a half years ago the
_Daily Mail_ of London brought to public notice the case of a Mrs.
Anderson living in Springfield, near Glasgow, who, in spite of her 103
years, was taking daily a tablespoonful of whiskey.

A strong point against the anti-alcohol faddists is the case of
Brown,[164] an Irish peasant, who, after many years of heavy
beer-drinking, attained the age of 120. His tombstone exhibits the
following epitaph:—

Footnote 164:

  Quoted after Professor Pflüger.

“Here lies Brown, who became 120 only through the strong beer he was
drinking. He was constantly drunk, and in this condition so terrible,
that even death was afraid of him. When, however, one day contrary to
his habits he was sober and in a quiet mood, death got courage, seized
him, and thus at last was triumphant over this incorrigible drunkard.”
(See, further, Chapter XLI.)

All these examples merely show what we have so often insisted upon, that
everything depends upon heredity. There are many causes that produce
premature senility. It seems, also, that when only a few of these
causes, or only one, is acting, there is a possibility of a successful
fight against it. It is a different matter when all, or several, of the
causes of old age are present. As the German proverb says: “Viele Hunde
sind des Hasen Tod” (“many dogs mean death for the hare”).

It is a very interesting fact that seldom are all the various kinds of
immoderation united in the same person. Thus, some persons may drink and
smoke heartily and, perhaps as a result of the action of these poisons
upon the sexual glands, may be better able to combat their sexual
instincts. This will also explain the drinking habits of some old
spinsters or widows. They “drive out the Devil with Beelzebub,” as the
German proverb says. On the other hand, many total abstainers from
alcohol and tobacco are far less successful in combating their sexual
instincts, and for such persons marriage is a necessity.

As a rule, celibatarians show symptoms of old age much sooner than
married persons.

If among those addicted to drink there are many instances of long life,
among smokers such instances are much fewer.

As Professor Pel says, there was only one man among many, of those over
100, who was a smoker (see Chapter XLII).

It is also of interest that among very old people we find many with very
decided sexual tendencies. Evidently such persons must be in possession
of very active sexual glands, which indicates also a healthy thyroid
(see Chapter V).

We may class alcohol with tea and similar beverages. A small amount
every day may be a good thing, but in large quantities they may all
become injurious and tend to shorten life.

Tobacco, according to clinical observations (Huchard), is apt to cause
arteriosclerosis, just as alcohol in large doses; and this is also
proved by experiments—e.g., those of Isaac Adler and Hensel—which show
that atheroma of blood-vessels can be produced in animals,
experimentally, by nicotine.

Everything points to the fact that tobacco is especially injurious to
the adrenals. We will treat of this subject more fully later on when
discussing the hygienic treatment of old age.

Many conditions of chronic intoxication, and hence premature senility,
may be caused by faulty food, especially if taken in large quantity, for
a long time. Even fresh albuminous food of animal origin, if taken in
large quantity every day, may prove harmful. We have seen previously, in
Chapters III and IV, that meat produces by its decomposition certain
poisonous substances which should be destroyed by the ductless glands.

Premature old age frequently occurs in people who live a sedentary life,
and at the same time consume much rich food and alcohol. This causes
obesity, and the muscles and nerves which are little used, are prone to
show degenerative changes after a certain time. At any rate the
processes of metabolism are diminished in these structures, since their
supply of fresh arterial blood is always reduced if no work or exercise
be performed.

It is a well-known physiological fact, that nerves which are inactive
lose their excitability and degenerate. This holds good for motor
nerves, and we can also note degeneration of muscles and organs which
are not used. Thus, the nerves of an extremity, after amputation,
undergo a process of degeneration. The lower limbs of people affected
with infantile paralysis, or of persons obliged to remain in bed for a
long time, show atrophic changes. Hence we can easily see the necessity
for exercise, which increases the blood-supply to the muscles and
nerves. Work of any kind, even mental work alone, is a means of
preventing precocious senility; if manual exercise is combined with it,
it is still more efficacious.

Plutarch, in his “De educatione puerorum,” mentions that a certain
amount of work improves the mind, but excess of work is prejudicial.

We see the best illustration of this fact in American business men.
There are no men in any country who do such an amount of work, and at
the same time take so little recreation or exercise. They sit in their
offices till dusk, with a few minutes’ interval for a hasty meal,
consisting mainly of meat that has often been kept in cold storage for a
long time, after which business goes on again, at high pressure, until
the evening. Then, instead of walking home and taking exercise, they
take a car or carriage to their house or club, and pass the evening in
smoking and drinking, sometimes to excess. Day after day the same
killing of body and nerves goes on till these people look old long
before fifty, if, indeed, they reach that age. Arteriosclerosis,
diabetes, gout, and obesity find many victims among such men. It is sad
to think how many thousands of these splendid people, full of genius and
talent, could be saved for their native country if only they had been
taught in their youth the most elementary rules of hygienics. What joy
does money afford without health?

Some of the most powerful agencies in producing old age are frequent
mental emotions, especially sorrow and grief.

It is a common fact that after such emotions people soon look older. To
mention an example, there is positive evidence that young persons, after
a mental shock, have become gray in a single night, thus developing
abruptly one of the most typical symptoms of old age.

That mental emotions, especially anger, grief, sorrow, fright, anxiety,
etc., are very harmful to glands with an internal secretion, is shown by
a series of clinical observations. Sajous has in fact termed _sensorium
commune_, i.e., the center which receives all shocks, the governing
center of the ductless glands, located in the pituitary body.

With mental emotion there is often disturbance of a function,
interference with which is very liable to hasten the onset of old age,
and this is sleep.

We frequently notice that persons who have not slept well for several
nights, especially if passed on a railway journey, look worn out and
older. After a good night’s rest these effects disappear and they look
fresh and younger again.

There are other functional disturbances which are especially harmful as
they interfere with the elimination of harmful products either
introduced with the food or found in the body (e.g., uric acid). This
applies also to the bowels, perspiration, and diuresis. When these
important functions are checked, there is retention of poisonous
products and a condition of auto-intoxication. These functions are
governed by the ductless glands, especially the thyroid, as we have seen
in Chapter VI. It is easy to understand that by their interruption the
onset of old age is hastened, as these toxins will cause deterioration
and destruction of epithelium and the formation of connective tissue in
its place. Retained poisonous products play a very great etiological
rôle in the production of arteriosclerosis, which is found as a typical
symptom of old age in the large majority of aged persons.

We thus see that all those agencies which by common consent are usually
considered the most frequent causes of old age, are also very
detrimental to the ductless glands, especially the thyroid. They produce
hyperactivity, with subsequent exhaustion, in these important glands.
The pathological and anatomical changes indicating hyperactivity give
place to those of atrophy. We have given an example of this in
discussing the changes in the thyroid in infectious diseases. The
formation of connective tissue is the final result. Thus a condition of
the thyroid arises similar to that in myxœdema, which, as we have
stated, can be produced by causes similar to those which produce old
age—i.e., infectious diseases, exhaustion of the ovaries after
pregnancies or sexual excesses, mental emotions, etc.

The pathological and anatomical changes in the thyroid, consisting of an
increase in the connective tissue, as in myxœdema, will logically
produce clinical symptoms, and these symptoms are the same as those of
myxœdema.

Therefore we are justified in assuming that old age will show the same
clinical symptoms as myxœdema.

We have shown that, given changes in the thyroid gland, the other
ductless glands will be altered too; for instance, the liver and
kidneys. These glands have an important function in freeing the organism
of poisonous substances. As in old age their secreting elements are more
or less atrophied, they are unable to execute their task properly, and
these harmful products will accumulate. Now, there are important organs
which can act as corollaries to these glands. These are the intestines
and the skin. They also are under the influence of the thyroid. In
diseased conditions of the thyroid they are unable to perform their
functions regularly. The poisons will not be eliminated, and thus a
condition of auto-intoxication must arise.

Just as after extirpation of the thyroid there is an increase of
connective tissue or fat in various organs and tissues (as Demange
found), so in old age there arises a condition of sclerosis in the
tissues and organs.

On this account, strictures of the urethra are readily produced in old
men who have had gonorrhœa scores of years ago. The prostate gland,
owing to the abundant formation of connective tissue, will also enlarge,
although usually sclerosis of an organ is accompanied by diminution in
size. In the central nervous system, just as after extirpation of the
thyroid, there is proliferation of neuroglia. Through destruction of the
nerve cells those mental attributes arise that are deemed typical of old
age: Egotism, enmity against all new ideas, conservatism, etc., which we
described in our address on the origin of crime before the Philadelphia
Medical Jurisprudence Society, April 14, 1907.[165] The same mental
characteristics are also typical of degenerated conditions of the
thyroid and pituitary body, as we have seen in a case of acromegaly
whose history we owe to Dr. Dercum, of Philadelphia.

Footnote 165:

  Journal of the Amer. Med. Assoc., May 17, 1907.

To recapitulate, we may state that old age is caused by degeneration of
the ductless glands, and that there exists a condition of
auto-intoxication in old age.

The symptoms of old age are the result of breakdown of the tissues and
organs which, owing to shrinking of the blood-vessels, are
insufficiently supplied with blood, and, owing to the disappearance of
nervous elements, are devoid of proper nervous control.

Degeneration of the ductless glands and of the organs and tissues cannot
be simultaneous, for the latter are under the control of the former.
These glands govern the processes of metabolism and nutrition of the
tissues, and by their incessant antitoxic action protect the organism
from the numerous poisonous products, be they of exogenous origin,
introduced with air or food, or endogenous, formed as waste products
during vital processes. After degeneration of these glands the processes
of metabolism in the tissues are diminished, and there is an increase of
fibrous tissue at the expense of more highly differentiated structures.

The fact that the changes in the tissues are secondary and take place
only after primary changes in the ductless glands, is best proved by the
circumstance that they can be produced, either experimentally by the
extirpation of certain of the ductless glands, or spontaneously by the
degeneration of these glands in disease.

Our theory as to the causation of old age by degeneration of the
ductless glands has been confirmed by several writers, some of whom had
no knowledge of our existing work.

Thus Campbell, in July, 1905, published a short note in the _Lancet_,
attributing old age to degeneration of the ductless glands, overlooking
our previous communication to the Paris Biological Society.

Two years afterward Pineles, in an article published in the _Wiener
klin. Wochenschrift_, comparing the origin of diabetes, tetany, and old
age, came to the conclusion that old age was caused by the same agency
(i.e., alteration of the ductless glands) as the other conditions
mentioned.

Sir Herman Weber, in his interesting work on the prolongation of life,
also attaches great importance to degeneration of the ductless glands as
a cause of old age.

In his work on the same subject, Professor Metschnikoff admits, only
partially, the truth of our theory on the causation of old age. He
admits the great importance of the ductless glands in the pathology of
old age, as they serve to destroy poisons. He denies, however, the
relation of old age to a myxœdematous condition; but everyone who knows
the pathology of myxœdema will see that the arguments of Professor
Metschnikoff cannot stand, for they have no foundation.

His arguments are that there is an œdema in myxœdema, but not
necessarily in old age; that the hair falls out in myxœdema, and that
myxœdematous women have abundant menstruation, while old women have
none; that myxœdematous persons have strongly developed muscles, and old
people, on the contrary, weak and feeble muscles.

The truth is that there is often no œdema at all in myxœdema; that the
hair often does not fall out in myxoedema, especially in its partial
form (hypothyroidia); that myxœdematous women have, as a rule, no
menstruation (atrophy of the ovaries); and that myxœdematous people have
not a strongly developed muscular system, which is rather degenerated by
a new growth of fat, or connective tissue, or a mucinous tissue,
following the degeneration of the thyroid just as it follows its
extirpation. Professor Metschnikoff also states that certain animals
that soon become old do not develop cachexia after extirpation of the
thyroid.

This was the belief about eighteen years ago, but now we know that they
all develop cachexia if the operation is so performed that the
parathyroids, or at least some of them, are allowed to remain untouched.
Professor Metschnikoff’s views have been greatly weakened by the far
more extensive researches of Professor Sajous which have conclusively
shown that the life process, its activity and duration, is dependent
upon the ductless glands, including the thyroid.

It is evident from the above considerations that all hygienic errors, be
they errors of diet or any kind of excess, will bring about their own
punishment; and that premature old age, or a shortened life, will be the
result. In fact, it is mainly our own fault if we become senile at sixty
or seventy, and die before ninety or a hundred.

It may be the privilege of a few to live until ninety, even though
worshipping immoderately at the altars of Bacchus or Venus! But these
are very few, and as we have seen, they have lived on the heritage of
their forefathers, not merely in an illustrative sense, but also in
reality, for the greater number of such persons have grown up in easy
circumstances without knowing the wear and tear of care and sorrow.

Not only old age, but the majority of diseases, are due to our own fault
in undermining our natural immunity against infections, and subjecting
our various organs to unreasonable overwork and exertion. We do not
believe that the worst slave-driver of olden days subjected his slaves
to such treatment as we do our own organs, and especially our nerves. At
last they must rebel, and disease, with early death or premature old
age, will be the result.

It is literally true, as the German proverb says: “Jeder ist seines
Glückes Schmied” (every man is the locksmith of his own happiness), and
as a variation on this we would say: “Every man is the guardian of his
own health.”


------------------------------------------------------------------------




                              CHAPTER IX.

 THE RATIONAL PREVENTION OF PREMATURE OLD AGE AND THE TREATMENT OF OLD
                                  AGE.


                           _General Remarks._

WE have shown in previous chapters, through facts from pathological
anatomy, experimental pathology, and clinical medicine, that old age is
a disease characterized by the abundant growth of connective tissue,
diminution of the oxidations, and a condition of auto-intoxication.

This disease is caused by the degeneration of the glands with internal
secretion, especially the thyroid, ovaries, testicles, liver, and
kidneys.

In the same way, and to the same extent as most other diseases, this
disease is also amenable to treatment, although a thorough cure, except
in cases beginning in very early years, is just as little possible as in
most other diseases.

In keeping with the majority of diseases, old age is progressive, and,
in fact, is so to a far higher degree than other diseases. It is seldom
stationary; it goes on all the time. This we shall easily be brought to
understand from the fact that the more time progresses, the more food is
taken to sustain the processes of life. By the deficient action of the
glands, whose rôle is the proper assimilation of the food and the
destruction and elimination of poisonous products of the body, these
toxic substances will accumulate, day by day, especially if meat be
taken, and thus the continual poisoning will be augmented as time goes
on. Thus it must be our most important task to check the progress of a
condition in so high a degree injurious to the body.

Let us consider the means by which we can prevent this disease, for
“prevention is better than cure,” says the English proverb.

The preventive treatment of old age is in no less degree possible than
that of any other disease. To prevent old age rationally, we must avoid
all those harmful agencies which may be deleterious to the glands with
internal secretions, as it is the degeneration of these glands that
brings it about. These agencies, however, being exceedingly numerous, we
have mentioned in the previous chapter only those which are in the
highest degree detrimental and also the most frequent.

By avoiding these we believe we could successfully combat old age, but
only for a certain time; and if not longer, in spite of our careful
hygiene, it would not be our fault, but that of our ancestors of many
generations ago who did not observe the rules of hygiene even as well as
we do, and left us ductless glands of inferior quality.

Parents can only bequeath to their children ductless glands of the same
quality as they themselves possess. This undoubted fact is clearly
proved by the experimental, pathological, and anatomical results we have
mentioned in the chapter on heredity. We will illustrate this by the
following examples, which will show how often it is difficult to avoid
harmful agencies, and how much depends on having been born with healthy
ductless glands.

A person inhales air that contains virulent bacilli and contracts
tuberculosis. Another drinks a glass of water or milk, contaminated by
water or kept in vessels that have been washed with water containing the
bacilli of Eberth, and contracts typhoid fever. Conversely, others who
have inhaled the same air and drunk much more of the same water, have
remained free from any infection.

The cause of this is that the first mentioned have inherited defective
ductless glands from their ancestors, and probably afterward have
ill-treated these glands by an immoderate use of all those agencies that
are detrimental to them, such as alcohol, sexual excesses, much meat,
tobacco, tea and coffee in large quantities, etc., and thus could not
produce anti-bodies to counteract the infection.

Of course, the fault does not lie entirely with such people, but that
from their birth they are the victims of the immoderation of their
ancestors; and by this fact alone are doomed to more easily succumb in
the incessant fight against the microbes, and therefore a limited
lifetime has been already meted out to them at birth.

We have, in the chapter on heredity, quoted instances of persons coming
of short-lived families, who reached a great old age; but this was due
solely to exceedingly careful hygiene. It is not always easy to observe
these rules scrupulously, and besides often necessitates the possession
of means to carry them out and to enable us to be more exempt from the
wear and tear of life—cares and sorrow,—which shorten the lives even of
persons with healthy glands, though much more of persons who have
inherited defective ductless glands.

It has been shown by statistics[166] that the present generation is
longer lived, and that the average of life is longer, than was the case
one hundred years ago. This is solely due to the fact that now-a-days we
know more of hygiene than our forefathers did, although the struggle for
existence and competition everywhere has certainly become more keen,
with the inevitable worry and depression of mind which it so frequently
brings about. This lengthened life is certainly due to more careful
hygiene, especially against infectious diseases.

Footnote 166:

  Westergaard: “Die Lehre von der Mortalität u. Morbilität,” second
  edition, Jena, 1901.

The extended life of an individual depends always, first, on the
inherited qualities of the ductless glands, and, secondly, on a sound
observance of hygienic measures.

To prevent old age coming on too soon, the first condition necessary is
the possession of healthy ductless glands, and this will depend, as just
stated, on heredity. We can exert no influence on the generations that
have passed away, and must therefore direct all our attention to the
generations that are to come. This can only be done by influencing the
laws of marriage, and particularly by prohibiting the marriage of
persons suffering from diseases that are most detrimental to the glands
with internal secretions.

Children of people suffering from syphilis, tuberculosis, chronic
alcoholism, etc., are, as we have seen, born with congenital atrophy of
the thyroid gland, and are especially apt to acquire all infectious
diseases, such as tuberculosis, with the greatest facility.

The Bible is literally true when it says that the sins of the fathers
are visited even unto the third generation.

Thus we can influence the baby even before it is born; let us then
consider what we can do after its birth to prevent premature old age and
to secure for it a prolonged existence.

The mother of the future child must carefully avoid anything that may
prove fatal to the fœtus or influence its nutrition. It is a well
demonstrated fact that different kinds of harmful products, i.e., drugs
and probably also stimulants like alcohol, coffee, etc., can be conveyed
to the fœtus. A pregnant woman must, therefore, most strictly observe
all the rules of hygiene, and especially abstain from the use of drugs
which (as for instance, iodine, the bromides, etc.) can also take effect
on the fœtus and prove detrimental; emotions must especially be avoided.

When the child is born the best nutriment for the baby is the milk of
its mother, and if the mother be not available for this purpose, a wet
nurse must be obtained, for human milk is indispensable in the
nourishment of the baby if we desire to influence its future immunity
against infections; for this important purpose all the internal
secretions of the ductless glands go into the child through the milk
which contains them. Sajous holds that millions of infants die solely
because they are deprived of what nature provided for them, the maternal
milk, which not only nourishes them, but protects them against disease.

The infant is practically helpless against infections, for its thyroid
contains scarcely any colloid substance, sometimes none; and it also
contains no iodine,[167] especially in children who are descended from
parents suffering from chronic cachectic diseases, such as tuberculosis,
syphilis, malaria, insanity, etc. The other glands are also not yet
sufficiently developed, as this takes place generally in the years
toward puberty.

Footnote 167:

  Baumann: “Zeitschrift für Physiolog. Chemie,” 21, 319, 1895; 22, 1,
  1896.

All the internal secretions will, therefore, come to the children from
the mother or wet nurse.

The above fact also explains why infectious diseases are so very
frequent among infants, and also among children before the years of
puberty.

The avoidance of infectious diseases is especially important for
infants, for in later life many other infections will occur preferably
in those children whose ductless glands have been weakened by previous
infection. Therefore, even with adults, when we take the history of a
case we should inquire whether, in childhood or later, the patient has
suffered from infectious diseases. The necessity of such a procedure
will be more clear after we have shown their relationship with a
weakening of the ductless glands.

The possibility of premature old age is greater in a person who has
suffered from one or several infectious diseases in childhood than in
another who did not contract any.

Very interesting experiments have been made on puppies fed on their
mothers’ milk, and some with raw and boiled cows’ milk, showing the
superiority of the bitches’ milk, and also of the unboiled milk.

When human milk is not available for divers reasons, fresh cow’s milk
should be employed, using it raw, however, in order not to destroy, by
boiling, various substances of the nature of ferments. Before giving it
to the baby, the cow’s milk should be diluted with water, and milk-sugar
and cream should be added to make it more like human milk (see Chapter
on “Milk Diet”).

Of course, when giving raw milk, we must ascertain that it comes from
cows examined specially for tuberculosis, and that the milk is of the
best quality and very fresh since it has been shown that its power to
kill bacteria—and therefore to protect the child—begins to decrease soon
after it is drawn.

Not only for the infant in arms, but for the growing baby and child
during its first year, milk food, containing largely of milk and
cereals, will be the best diet, excluding meat entirely, since in these
tender years the ductless glands are not sufficiently developed to
destroy poisonous products that arise from the end-products of
decomposition of meat. By giving these little creatures meat we may
depreciate the efficiency of their ductless glands through unnecessary
strain in the destruction of poisons, and thus diminish their chances in
later life, of a prolongation of youth and a happy old age. For the same
reasons and even more weighty ones, alcohol, coffee, tea, etc., should
be avoided.

It is sad to reflect that, in some countries, alcohol is given to
children, who are even far more helpless against it than adults.

We have observed in Northern Hungary that the children of the Slovacks,
a Slav nation that inhabits certain parts of Hungary—the native land of
the writer,—are stunted in their growth. The reason for this is, that in
these parts of Hungary, where there are plenty of potatoes, but a
scarcity of other food, the peasants give brandy to their youngsters. As
we have seen in the second chapter of this book, the growth of the human
body depends on the thyroid gland. The fact that these children do not
grow shows that alcohol is deleterious to the thyroid. This question
will be considered more fully in the chapter on alcohol. The advantages
of milk food we shall also treat more fully in a separate chapter.

To deal with old age rationally, we must begin in childhood to fight
against it, as all those agencies that tend to produce it prematurely
can at this age prove far more deleterious; and as in this world no
action is lost—whether for good or evil—we must reap the results of our
imprudence in later life.

Unhappily at this tender age we have no reasoning powers, the glands
governing them not having been developed, and therefore our parents or
guardians must act for us. Their want must also be supplied by the
teacher, and we believe it would be productive of great good to teach
the elementary rules of hygiene in school at the same time as reading
and writing.

The impressions we first get in childhood remain throughout life and are
never forgotten; therefore, hygiene should be learned even by small
children. The soul of a child is like plaster of Paris, that can, like
dough, be moulded into any shape we desire. It is at this early age that
we should learn of the necessity of a bath every day, of moderation in
food, the avoidance of certain stimulants, such as alcohol, and also of
tea and coffee in large quantities.

Alcohol, coffee, and tea are especially injurious to children. The
celebrated German clinician, Strümpell, writes as follows in the
_Pædagogical Pathology_: “Among the acute as well as chronic
intoxications—which can be the cause not only of a temporary, but also
of a prolonged psychopathic condition,—intoxication by alcohol, and by
stimulants generally, plays the greatest rôle. Such abuse is especially
noxious to children, and causes an enormous number of diseases with
psychopathic results.” We ourselves believe that it is a crime to give
alcohol to children, and that it should be punishable as such.

Dr. F. Heyn, in a statistical contribution on “Idiocy,” that appeared
recently in the _Psychiatrisch Neurologische Wochenschrift_, showed that
in 17.6 per cent. of cases of idiocy in children the above-mentioned
fault in hygiene—the use of alcohol, tea, and coffee—was the cause.
Thirteen years ago Director Trüper, in a monograph on the psychopathic
conditions of childhood, insisted on abstinence not only from alcohol,
but also from coffee, by women during pregnancy; but it should be noted
also that these agencies continue to be deleterious years after a child
is born.

Above all else we must try to make a good man or woman of the child, as
this also is an essential safeguard against disease and premature old
age. We should endeavor to interest children while they are yet of a
school age in the fine arts, such as music, painting, and literature, as
they have a very favorable influence on the hygiene of the mind in after
years. Religious instruction also gives good results in this respect.

When children approach puberty it is important to avoid an agency that
may prove very deleterious to certain of the glands with internal
secretions, and this is masturbation.

We will not commit the error made by so many unscientific writers of
ascribing much greater importance to this matter than it deserves. It
certainly is not true that tabes dorsalis, dementia paralytica, or other
serious nervous diseases will result from this source; but it cannot be
denied that neurasthenia or hysteria or impotency—sexual
neurasthenia—can be promoted by the exaggeration of masturbation, if
indulged in many years.

Masturbation is always injurious to the sexual glands, more so to the
male than to the female organs, and in addition to the thyroid, and—if
in excess—to the adrenals. It also very unfavorably influences the mind
and character.

In youth, instruction as to the control of the sexual passions will be
of the utmost importance, even considering alone the dangers of
infections, especially of gonorrhœa, which not only endangers the future
husband, but the future wife also. We need here but mention the
well-known fact that the thorough and radical cure of syphilis may even
more readily be accomplished than that of chronic gonorrhœa.

We have mentioned above that after gonorrhœa (every chronic gonorrhœa
involves the prostate gland) there are severe disturbances of the
nervous system, which may also influence the mind, causing hypochondria.

To prevent all these dangers there has been formed in France a society
called “Société Française de Prophylaxie Sanitaire et Morale,” which
advocates the necessity of instructing boys and girls as to all the
dangers that threaten them and how to avoid them.

Happy is the young man who is able to live in perfect chastity without
harm to mind or body. We will enter more fully into the consequences of
complete sexual abstinence in the chapter on sexual hygiene; but the
great majority of young men have the danger from sexual intercourse
suspended, as the sword of Damocles, over their heads, and the best way
to avoid this is by marriage.

Marriage is, indeed, an invaluable aid in the struggle against old age;
but sometimes, although this is an exception, it may turn out to be a
double-edged sword.

By marriage a young man acquires regular habits, and by the assistance
of a loving wife is better able to control his passions; and last, but
not least, the hygiene of the mind will also be improved. The inevitable
hardships of life are thus less felt.

These great advantages of marriage can, however, exist only in cases
where the two halves make one whole—i.e., where the sun of happiness
shines in the marital sky. For this purpose each of these two halves
must endeavor best to please the other. The husband must, as is quite in
the nature of things, show the utmost forbearance to the wife, and never
forget that, on account of her different anatomical and physiological
constitution, the mind of the female is far more exposed to frequent
irritation as a natural consequence of the frequent alterations of the
sexual glands and thyroid in women. It would be unreasonable to blame
her for a condition for which not the woman, but her Maker, is
responsible.

If married life is one of the best means to defer old age, on the other
hand it is positively certain that unhappy marriages are the surest
means to hasten its oncoming; but these are the exception, and, as in
everything else, the exception only proves the rule.

A single man, or woman, is far more exposed to all the agencies we have
referred to above as being deleterious in causing old age and especially
depressed conditions of the mind, these being the consequences of total
sexual abstinence, faults of hygiene in diet, use of stimulants (alcohol
in men, coffee, tea, etc., in women), fewer precautions against disease,
and so many other agencies of less importance that there can be no doubt
that the bachelor or spinster, as a rule, will become old in earlier
years than the married person. Therefore, although himself still a
bachelor, the writer feels compelled to sing the praises of married life
as a hygienic factor favoring old age.

The possession of children is heavenly bliss to married people, and
their pride and joy in them, and in living with youngsters, renders the
parents young, as the German proverb says. But as every good thing, if
in excess, may turn out to be harmful, _omne quod est nimium vertitur in
vitima_, so too, many pregnancies may prove very harmful in the fight
against old age, especially when the mother nurses for a long period
each of the children. In women who produce much milk this may prove
advantageous to health if not too greatly prolonged; but in women with a
meager provision of milk—as in cases of thyroid insufficiency—it may
prove disastrous by destroying the means of keeping youthful till an
advanced period.

In married women with many pregnancies much will depend on external
circumstances of life, and it is certain that nothing will hasten the
advance of old age as many pregnancies, the mother suckling all the
children herself, in combination with deficient food, the wear and tear
of poverty, and with anxiety as to the morrow. This cruel struggle for
daily bread is what renders the women of the lower classes old before
their youth has passed.

To prevent the deleterious consequences of too many pregnancies on
beauty, health, and wealth, in certain countries, as in France, the
habit of having one or two children has been encouraged by artificial
means. However, as is always the case when our acts disregard Nature,
great mischief may thus arise, and even in cases where death has not
followed abortions, very often such irreparable damage is caused to the
organs on which youth and beauty depend that the oncoming of old age is
still further hastened.

The endometritis and peri- and parametritis of many years duration,
which are sometimes the result of such procedures, influence the
appearance of these persons more unfavorably than many pregnancies.

Parents who have many children may be regarded as the happiest of
mankind. Their name is forever perpetuated through their numerous sons,
and their flesh and blood survives in their children, to quote the great
German philosopher, Schopenhauer.

The years of the climacteric are the most troublesome in married life,
not only for the wife, who is directly affected by it, but also in
almost equal degree for the husband, who must show the greatest
forbearance to his wife at this period. The sun is setting! It is not
merely that the decline of the sexual functions produces certain changes
in the body, which are especially noticeable in the external appearance;
the influence on the mind also produces deleterious effects. Therefore
we must direct all our attention to the hygiene of the mind. In married
women with loving husbands and children the task will be much
facilitated. As we have already mentioned, this stage of human life is
most felt by professional beauties, who witness with chagrin the
vanishing of their power over the hearts of men. In many spinsters
living alone, friendless, this is also a frightful stage of life. Here
we have again an opportunity to observe the wonderful soothing effects
of religion, which offers us consolation in all our troubles. Religious
women will, therefore, much better withstand this most difficult part of
their life. Religion and philosophy, too, may be still more helpful to
overcome mental depression.

It is interesting to note that many women, even those previously little
given to religious practices, turn over a new leaf, and to make up lost
ground, become quite pious. Such as in their youth were haughty and
proud beauties, and only went to church to exhibit their new hats and
toilette, now become meek and modest, and never miss a religious meeting
or exercise.

Still, even after a woman has passed the climacteric, everything is not
lost if only she be a clever member of her sex. In fact, something
remains that may even place her above her much younger sisters, and that
is experience and knowledge of the world; and if, by the aid of a
skillful toilette, she is able to make the best of what good looks
remain from better days, it is probable that she will outdo many of her
sisters far below her in age.

Even if at this time of her life, aware of the approach of old age and
its cruelties, she may be inclined to say with Longfellow, “but the
hopes of youth fall thick in the blast,” still there are, in the present
state of science, plenty of resources open to her, no less than to a
man, to put off old age for a score of years, or to mitigate its effects
when it has asserted itself with all its terrors.

We owe our knowledge of the fact that there is a treatment for old age
to the famous French scientist, Professor Brown-Séquard, whose father
was American and who, for a time, was professor of physiology at Harvard
and later a practitioner in New York which he left to become professor
of physiology at the University of Paris. Although, before him, Claude
Bernard, a man of no less fame, had shown the existence of internal
secretions, Brown-Séquard was the first to draw practical conclusions
from this fact, and the first who gave a solid basis to the doctrine of
internal secretion.

Brown-Séquard was the first to use the extracts of a ductless gland (the
testicle) for therapeutic purposes, although thousands of years before
him the Chinese had used different organs for purposes of healing, and
the savages of Africa ate certain portions of their enemies—the liver
and the testicles—to enhance their own courage.

Brown-Séquard obtained surprising results by using the crushed extracts
of rabbits, guinea-pigs, and dogs, of which we will say more in the
chapter on the prevention and treatment of old age by organic extracts.

Unhappily, as human nature is prone to attack every innovation or to
ridicule it, in spite of the great reputation of this savant, his
discoveries were skeptically received; and if the extracts of another
similar gland—the thyroid—had not yielded such marvelous results,
probably the author of the present work would never have had the
opportunity to write on the treatment of old age with organic extracts.

It has been shown by many authorities that the thyroid gland is able—as
we have already mentioned several times in different parts of this
book—to augment the processes of oxidation, and it has also been stated
by several authorities, such as George Murray, Vermehren, Hertoghe, and
Laache, that persons treated with thyroid extracts appear much younger
after the treatment—sometimes, as Hertoghe mentions, ten to twenty years
younger.

Now, if a person suffering from complete myxœdema can obtain such a
result by the use of thyroid extracts, should not a person suffering
only from a partial form of the same disease be able to obtain similar
results? It would be quite contrary to our physiological conceptions
that a person in a bad condition of health and in physiologically
inferior circumstances should benefit more, by exactly the same
treatment, than another person who is in a much better condition of
health. Therefore, the thyroid treatment of old age is justified. And
indeed, we ourselves have seen astonishing results from thyroid
treatment, not only in old people, but also in persons under 40.

Thus the thyroid can be of valuable aid for the prevention of old age,
and for deferring its onset as long as possible; and for this purpose it
will be necessary to begin our treatment in women at about the age of
35, or in certain cases, such as where many pregnancies have occurred,
even before this age, and in men at some time after 40 (see also Chapter
LIII). Still, to avoid abuses in the use of this efficient drug, it
would be necessary to pass a law prohibiting its sale without a medical
prescription.

Besides the thyroid gland, the extracts of the sexual glands can also be
used; thus, ovarian extracts for women, and testicular extracts for men.

We have also witnessed good results with ovarian and testicular extracts
of pigs. Long before ourselves, Brown-Séquard and Professor von Poehl
and many others made very interesting observations on testicular
extract, on which we shall dwell in the chapter on the treatment with
testicular extracts.

Besides the above extracts, those of the kidneys and of the pancreas
have also given us, and others, very good results, and they can be used
with advantage in the prevention and rational treatment of old age in
combination with the other extracts, though preferably in cases where
the functions of these organs are deficient. In old age that has already
become manifest they should always be used, as they will facilitate the
work of these very important organs, and thus prolong their vitality. In
this manner an old man will be able to employ these organic extracts of
the pig to work for the benefit of his own organs, or, at any rate, to
assist in their work.

We have given above a sketch of the dangers that follow us from the
cradle until old age, and hasten its arrival, and shown by what means we
can avoid or diminish them in the different stages of life; we would now
like to offer a few hints that may prove useful for any of these periods
in life.

We have shown in the previous chapters that the degeneration of certain
glands with internal secretions, especially the thyroid, liver, and
kidneys, will produce a condition of auto-intoxication, as poisonous
products will not be destroyed in the proper manner, and also not
eliminated from the body. Therefore our whole energy must be turned to
working in time against this auto-intoxication of the body. This can be
most rationally done by a careful hygiene of these different ductless
glands—into which we will enter later in separate chapters—and also by
special cultivation of the functional efficiency of those organs that
eliminate poisonous products from the body, such as the kidneys,
intestines, and the skin.

These three organs are in close relation to each other, for when one is
threatened the others come to its assistance and aid it in the work of
elimination. Thus, when the kidneys are not functionating as they
should, the skin comes to the rescue and helps to eliminate a large part
of the remaining products by increased perspiration. Nature often does
this spontaneously before we come to her aid.

The intestines will do their best, in like manner, to expel a part of
these products. Recognizing this co-operative action of almighty Nature,
we must also try to be of assistance by careful hygiene, and later on we
shall see what will be the best way to effect this; but let us at once
urge here that the necessity of having the bowels moved daily should be
insisted on from earliest childhood. Especially is this of the greatest
importance in the case of young girls, for with them this most necessary
rule of hygiene is so often neglected. There is no doubt that, in many
persons, fæcal matter can stagnate in the intestines for a few days
without much consequence, as the epithelium of the intestines, when in
sound condition, may prevent the entrance of poisonous products. But it
may be different when this becomes a habit; and when the epithelium is
not in perfect order,—as is often the case after prolonged constipation,
or with catarrhs of any kind, or with excreta which by their shape may
injure the epithelium mechanically,—resorption will follow.

At any rate, it is an every day occurrence for persons who have not had
their bowels moved, even for one day, to complain of headache and other
symptoms of uneasiness, so that it is impossible to regard these as
simple reflex actions, as some are disposed to think, but rather as
symptoms of auto-intoxication. Therefore the necessity of clearing the
bowels every day should be insisted on, and again especially in the case
of the young girls, for it can easily become a bad habit once they have
begun to neglect it, and the sluggishness of the bowels, to which
females have a peculiar tendency, is thus further encouraged.

Everything should be done to prevent habitual constipation in young
girls, for the important reason that stagnation of blood in the adjacent
organs of the pelvis is otherwise promoted, and thereby also a tendency
to subsequent diseases of the sexual organs, from which many women
suffer, at any rate much more frequently than men.

This movement of the bowels every day can best be secured by appropriate
food, such as exercises a gently stimulating action on the walls of the
bowels. Drugs should be avoided as much as possible, for reasons we will
mention in another chapter.

Habitual constipation, if persisting for years, can certainly facilitate
the oncoming of old age, while its appearance can be considerably
deferred by a good movement every day, owing to the prompt release from
the organism of a mass of toxic products.

The great importance of this can be easily realized if we observe the
face of any one who has been constipated for several days. After a
thorough clearing out, the face becomes fresher and the eyes brighter.
The complexion that was previously a dirty gray becomes white and rosy
again, particularly in the case of young women. Should not this prove an
object lesson as to the vital importance of a thorough evacuation daily
as a safeguard against premature old age?

Every physician who practices in a place where the mineral waters have
purging effects has occasion to observe that persons coming to these
spas, looking worn out and gray in the face, with pendant cheeks, and
showing all the signs of auto-intoxication from the retention of
poisonous products, always look much fresher, and, indeed, many years
younger, after the cure. We could observe the same effects in our own
case after each purge, although we do not suffer from habitual
constipation.

There is no doubt that freedom from occupation, and particularly life in
the open air, in the woods and meadows, have a very great influence in
effecting such cures; but we may note the same effects after courses of
purging without the aid of such conditions as the above.

The care, not only of the bowels, but of the skin, must be impressed on
every one from earliest childhood, especially the necessity of a bath
daily. Unfortunately, this is too much neglected on the Continent, and
becomes prevalent only as Anglo-Saxon customs are diffused abroad.

By a bath with soap the pores of the skin are better opened, as the dirt
that clogs them is removed, and thus the poisonous products can be given
off through the skin more easily, and the skin thereby justifies its
name as chief assistant to the kidneys. It is, in fact, our second
kidney. When the skin comes into greater activity through the action of
the sudorific glands, a part of the solids in the urine and many harmful
matters, which otherwise would make their way through the kidneys, are
eliminated through the skin instead, in which manner the powers of the
kidneys are economized.

It is, therefore, only natural that we should do everything to promote
these important functions, especially since we may regard the skin not
only as a second kidney, but to a certain extent also as a second lung;
for it possesses respiratory functions in addition, receiving oxygen and
giving off carbonic acid to a certain degree.

To assist these functions in every possible way, we must allow the air
to reach the skin freely, for which purpose clothing and underwear
should be porous, in order not to impede the process of respiration and
elimination. This end will also be attained by exercise in the open air
and sunshine; in fact, by remaining out-of-doors as long as possible.
All these important features will be dealt with fully in separate
chapters.

Before leaving the subject of the prevention and rational treatment of
old age, we will give a few hints that may be of use in any stage of
life.

First, great moderation in the diet should be observed, as large
quantities of food may, in the long run, impair the powers of the
digestive organs, and also of several of the ductless glands, which are
concerned in the operations of digestion and assimilation—the pancreas
and liver. Sajous has shown that the secretion of the adrenals takes
actual part in the functions of all these organs. Everything that is
eaten should be thoroughly masticated and not “bolted”; digestion, in
reality, beginning in the mouth.

Meat should not be consumed in large quantities, as it is injurious to
various glands with internal secretions, especially the thyroid and
liver, and after having been taken for a long time in large quantities
can promote arteriosclerosis (see Chapter XVI).

The best nourishment for increasing the chances of a long life and to
defer the effects of old age, is a diet consisting of little meat, much
milk, and vegetables. We have for many weeks lived on a diet consisting
solely of milk, eggs, bread, butter, and fruits, and, we believe, have
never felt so fresh and well disposed to work as during that time and,
as friends remarked, never looked so well, either.

A strictly vegetarian diet, without milk and eggs, is distinctly unwise
and dangerous to health, if followed for a long time. Our anatomical and
physiological construction is not adapted to such nourishment (see the
chapter on this subject).

By many authorities wine is called “the milk of old age.” This is not
true, although it is a fact that many old people feel better after an
occasional glass of claret, when they have been in the habit of taking
it for years.

We will deal with alcohol and its deleterious effects in a separate
chapter. Far more injurious than red wine used in moderation, are tea
and coffee used in large quantities. Unfortunately, many of those who
fanatically fight against alcohol, indulge in many cups of black coffee
or tea daily, and thus poison their nervous system. Besides containing
thein and caffein, they also aid the formation of uric acid, as they
contain bodies from which the purin substances are produced (Haig,
Hutchison, Walker Hall).

Cocoa and chocolate may be taken in larger quantities than coffee or
tea. Cocoa with milk is, at the same time, very nutritious, as it
contains fatty substances.

Spices should be avoided as much as possible, especially sharp,
irritating condiments, which are so freely taken, particularly in
America.

We must not forget that the greater part of all we eat and drink must
pass through the kidneys, the fine epithelium of which is thus easily
endangered. For the same reason drugs should only be taken under medical
advice, and with great reserve, for if taken too freely they may not
only injure the kidneys and liver, but also the stomach, which first
receives them.

Sound sleep is of the greatest importance. Most of the organs rest
during sleep; the great brain in particular being completely at rest;
but the disintoxicating glands are most active during sleep. This
function should therefore be promoted by all means, and we shall devote
a special chapter to sleep, its causation, and the treatment of
insomnia. Let us, however, at once mention that sleep can best be
encouraged by the use of a large, airy room, and going to bed early,
say, at ten to half-past, and rising at five or half-past, when sleep
has been undisturbed during the night. Seven hours’ sleep is the best;
longer sleep, if over seven and one-half or eight hours, injurious,
except for anæmic girls and women. Many people do very well with six
hours’ sleep, but less than this will prove injurious in the long run.

It is astonishing to note the large proportion of persons living to a
very great age that were early risers; for which reason we may conclude
that “early to bed and early to rise” is a valuable factor in the
struggle against old age.

We emphatically repeat, over and over again, the importance of fighting
against our passions and cultivating the hygiene of the mind; this must
be commenced in early childhood and continued through life; and the good
qualities of the mind, which we will call the “positive” features of the
mind, should be especially cultivated, such as kindness,
good-heartedness, friendship, love, magnanimity, hope, modesty,
liberality, generosity, frugality, and above all things, contentment
with everything. On the other hand we may describe wickedness,
unfriendliness, hatred, and jealousy as “negative” features of the mind,
which should be smothered at their very inception in the child.

The most successful way to fight the battle of life is to cultivate
equanimity and follow the beautiful precepts of Hindu philosophy, which
teach us never to hunger after honors and riches, but to be content with
what comes in our way. It should be a lesson to us as to what to avoid
when we take note of the manner in which so many American business men
sacrifice their mind and health in an insatiable thirst for success and
riches, and after attaining them, by a real battle with life, find their
health so impaired that they reap no enjoyment from it. What is the use
of a million when all that life holds dear is lost in the struggle to
obtain it, and when, probably, our children will squander it, as do many
sons of millionaires who have worked themselves to death. Rather be a
living beggar than a dead millionaire!

In the succeeding chapters we will enter fully into detail on all the
subjects we have touched upon in these general remarks. We will describe
the functions by which the body rids itself of toxic products, and the
means by which these functions may be improved. At the same time we
shall set forth the rational hygiene of the organs that cause the
elimination of poisons either taken through food or introduced from
without; and after having demonstrated the most effective mode of
freeing the body from such poisons, we shall mention the best kinds of
food and deal more specifically with the advantages and disadvantages of
the various kinds of food. The effects of certain agencies of great
benefit to the health, such as the open air, sunshine, exercise, etc.,
will be treated in an exhaustive way. Finally, we shall show that we are
able to prevent premature old age in an effective manner, and even to
treat successfully by means of certain drugs and organic extracts the
condition of old age itself.


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                               CHAPTER X.

  THE DESTRUCTION AND ELIMINATION OF TOXIC PRODUCTS FROM THE BODY AND
       HYGIENIC MEASURES FOR THE IMPROVEMENT OF THESE FUNCTIONS.


THERE is not one thousandth of an inch of our body surface which does
not swarm with innumerable bacteria, and as soon as the continuity of
our skin is severed, as by a small wound, they immediately invade our
tissues and attack us. Happily we are not without means of defense. Our
organism is so well arranged that, as soon as a foreign body enters
which might become injurious, a kind of police organization comes into
action, and the leucocytes, like policemen, arrest the bacilli, and
render them harmless by eating them up. This is phagocytosis, first
described by the great French investigator, Metschnikoff. And so
marvelously arranged is our body, that there are also special
substances, the alexins (Buchner), which aid the leucocytes, and the
opsonins, which first act upon the bacteria, so as to make them more
digestible for the leucocytes.

To make the bacilli still more sensitive to the influence of the alexins
there are the agglutinins, observed by Bordet, and by Gruber and Durham,
which immobilize the microbes, and thus aid the phagocytes and alexins
in the performance of their task.

The leucocytes are formed in the lymphatic tissues, especially the lymph
glands and spleen. Thence they circulate through the body and offer
opposition to the microbes and other foreign bodies which they meet on
their way. The red blood-corpuscles of the adult are formed chiefly in
the bone marrow.

The lymphatic glands play an important rôle, not only as the birthplace
of leucocytes, but also in that they are able to arrest noxious
substances, such as microbes, and keep them from entering the
circulation. That the lymphatic structures are able to protect us
against bacillary infection can be shown by the swelling of the spleen
in infectious diseases,—such as typhoid fever, malaria, etc.

The tonsils are also of some importance for our protection against
harmful substances. They become inflamed in various infectious
diseases—such as scarlet fever, measles, acute nephritis, etc. Their
great value may best be shown by the fact that not infrequently, after
total extirpation of both tonsils, a generalized eruption has been
observed. Thus we must always seriously reflect before advising the
extirpation of these important organs, the rôle of which as sentinels is
shown by their anatomical position on either side of the entrance for
the most indispensable elements of our life: air and food. Unless
frequent inflammation, and possibly irritative nephritis, demand an
operation, it would be better not to undertake it. Even if it is done,
the glands should never be entirely removed.

A great number of microbes enter our system through the mouth with the
air and food, but happily they are antagonized by the saliva and the
gastric juice, which are able to destroy a large number of these
obnoxious invaders. Like the ductless glands, the lymphatic glands are
closely connected with one another, and thus changes in one of these
glands are apt to be followed by changes in the others. Hence we can see
how a lymphatic structure contained in the intestine,—the appendix,—can
often become inflamed after previous inflammation of the tonsils. As is
well known, the appendix shows great similarity in its histological
structure to the tonsils, so much so that some call it an intestinal
tonsil. Several authors have drawn attention to the fact that
appendicitis has often been observed after tonsillitis, and Delcour has
written a monograph in which he attributes appendicitis, indirectly, to
thyroid degeneration,—e.g., congenital myxœdema. Adenoid vegetations are
always accompanied by chronic pharyngitis and tonsillitis, which bring
about appendicitis. And since adenoid vegetations are an expression of
thyroid deficiency, Delcour attributes appendicitis to a deficient
thyroid. We are not prepared to accept Delcour’s statement, as there are
cases of adenoid vegetations without a deficient thyroid. However, as we
have personally observed, chronic nasal catarrh and tonsillitis are very
frequent in persons subject to appendicitis. The appendix is an
important lymphoid organ and, if possible, it should be preserved.

As I have already shown in a previous communication,[168] the lymphatic
glands stand in very close relation to the thyroid gland. In diseased
conditions of the thyroid we find, as a rule, enlarged lymphatic glands,
as in Graves’s disease, myxœdema, cretinism, acromegaly, and also in
diabetes. The thyroid seems to exert a great influence, not only upon
the lymphatic glands, but also on the blood-corpuscles. The red
blood-corpuscles are diminished after extirpation of the thyroid, as
also in myxœdema, as well as in old age. On the other hand, they can be
increased very considerably by thyroid feeding. The white
blood-corpuscles are also influenced by the thyroid, for, after
extirpation of the thyroid, their number is at first increased and later
diminished. Very important is the discovery of Mlle. Fassin[169] (in the
laboratory of the University of Liège, Belgium), who found a diminution
in the production of alexins after extirpation of the thyroid, thus
confirming what Sajous had pointed out four years earlier. According to
Sir Almroth Wright, the discoverer of opsonins, the production of these
bodies also depends upon the internal secretions. We have seen that
Sajous has shown (a fact confirmed by others since) that opsonins are
mainly composed of thyroid secretion.

Footnote 168:

  Policlinique de Bruxelles, Avril, 1903.

Footnote 169:

  Report in Centralblatt für Stoffwechsel, 1907.

Thus we see that the production of antitoxins is greatly under the
influence of the thyroid, which governs the processes of phagocytosis,
and thus powerfully helps in the defense of our system.

Besides microbes, we introduce into our body a large number of harmful
products through food and drink (stimulants). Many toxic substances are
formed by the decomposition of food, and also in the processes of
metabolism in the tissues. We are protected against these substances by
certain organs which destroy them (as the thyroid, parathyroids, and
liver), and by other organs which eliminate them (as the kidneys, the
skin, and the intestines). When these organs are all working well, we
may get rid of these products and not be affected by them; but in old
individuals it is different, as their protective and eliminative organs
have more or less degenerated. Then these substances are not destroyed
entirely, nor wholly eliminated. They are retained, and cause the
condition of auto-intoxication.

It is very difficult to prove definitely by experiments, that there
really exists such a condition as auto-intoxication; but, practically,
its existence cannot be denied. We note after changes in the above-named
organs, when their functions are in abeyance, signs of intoxication in a
patient, which include headaches and other nervous symptoms, with a
haggard and colorless face. After a good movement of the bowels,
perspiration, and abundant diuresis, we see a great change for the
better. Thus, even if scientific experiments which are made on small
animals do not strictly confirm the existence of auto-intoxication, the
great improvement in our condition after improved elimination speaks
very strongly for its existence. Therefore, to prevent such a condition,
we must do our best to keep these organs in good working order. In the
succeeding chapters we shall consider in detail the protective and
eliminative functions of these organs, and the possibilities of their
improvement by hygienic and therapeutic measures.


------------------------------------------------------------------------




                              CHAPTER XI.

    ON THE DESTRUCTION OF POISONOUS PRODUCTS THROUGH THE THYROID AND
                          PARATHYROID GLANDS.


THE earliest authorities on the thyroid gland, including Schiff and
others, have shown that when this gland is extirpated in a dog, as a
rule the animal develops convulsions after a few days, and subsequently
dies. It is very unusual to find a longer survival after such
operations.

Interesting and very instructive experiments by the American specialist,
Dr. Leo Breisacher, of Detroit, Mich. (formerly assistant to Professor
Munk, of Berlin), have demonstrated that it is possible to keep animals,
operated on as above, alive for a long time if they are debarred from
meat and kept on a milk diet.

A perfectly natural explanation of this prolonged survival, which had
never been observed until the above experiments, lies in the fact that
milk food is better adapted to animals deprived of their thyroid, and
that, as Dr. Breisacher maintained, meat acts in a poisonous manner on
the nervous system of dogs thus operated on. Thus we note that dogs in
this condition cannot live on a meat diet. The learned savant and others
noticed that dogs so fed succumbed very quickly, while at the same time
he observed that no attack of convulsions ever occurred in dogs fed on
milk, though many other authorities had noticed such symptoms in
corresponding cases.

He also observed,—and it is a most interesting point,—that dogs which
improved on a milk diet, again got worse after meat or bouillon was
taken and died in consequence. Of great importance also is his
observation that boiled meat is not dangerous to animals thus operated
upon, which he explains as being due to the fact that the extracts of
meat having a toxic action are soluble in water.

There can thus be no doubt, from these beautiful experiments of
Breisacher, that meat does contain substances that are poisonous, and we
may safely draw the conclusion therefrom that if we, who are in
possession of our thyroid, do not suffer from a meat diet, it is due to
the protection afforded us by this gland. If we remove this, as in the
instances given of the dogs, or if it is degenerated by disease, then
our immunity also disappears. In myxœdematous people this is
self-evident, for they are always worse after taking meat, and most of
them have an antipathy to this sort of food. Also in many cases of
severe diabetes (a myxœdematous condition), meat is very injurious, and
if taken in large quantities can contribute to the development of
acidosis.[170]

Footnote 170:

  “Untersuchungen über die Glandula Thyroidea,” Breisacher: Archiv für
  Anatomie und Physiologie, p. 504, 1890.

The above-mentioned experiments of Breisacher have been confirmed by F.
Blum, of Frankfort. He finds also that omnivorous animals operated on as
the dogs, if fed with meat, die from tetany in a few days. But when such
animals have been kept on milk for a long time, before and after the
operation, a large proportion have survived, or, at most, passed through
a mild form of tetany, and continued well until meat was again
administered, when their condition soon became worse, and death ensued,
as in the case of the animals kept on a meat diet. Some of the dogs fed
on milk also died, but before succumbing they underwent a long cachectic
illness. In any event they lived longer than the animals fed with meat,
which rapidly died with violent symptoms.

Dr. Blum arrived at the conclusion that the thyroid is a
disintoxicating organ (entgiftendes organ) the function of which is to
destroy poisonous products formed by the decomposition of the
albuminous food-substances.[171]

Footnote 171:

  Virchow’s Archiv für Path. Anatomie und Physiologie und klin. Medicin,
  vols. 158, 162.

The Japanese authority, Kishi, also arrived at the same conclusion,
after having removed the thyroid gland from 150 monkeys, dogs, and other
animals.

That the products of the decomposition of albuminoids can produce
changes in the thyroid has been proved by Galeotti and Lindemann, who
found an increase of colloid substance in the thyroid of animals after
the injection of leucin and tyrosin,—which are the products of
decomposition of albuminous substances. That meat acts in an injurious
manner on the thyroid gland, if eaten in very large quantities, has been
proved by clinical observations and by the experiments of Chalmers
Watson, into which we shall enter more fully in the chapter on the
dangers of too free a meat diet.

The thyroid not only protects us against the poisons in meat, but also
against many others; in fact, perhaps we may say, against poisons
generally. Let us, however, specially mention those poisonous products
which have been tried experimentally. That the thyroid protects the body
against bacillary attacks has been noted by Charrin in the case of dogs,
which succumb in a very short time to all kinds of infection after the
removal of the thyroid. We have demonstrated, in Chapter III, the
protective action of the gland against such poisons as chloroform, as
mentioned in our communication to the Paris Biological Society in 1906,
where we stated that in chloroform narcosis all the characteristics of
an increased activity of the thyroid are perceived,—including symptoms
such as we see in Graves’s disease. We have also found that the thyroid
of dogs contains an increased amount of colloid substance after
chloroform narcosis, which enables us to understand why this drug is not
well borne by animals operated upon as above, as discovered by Lanz and
by Walter Edmunds; likewise, we may thereby explain why patients
suffering from Graves’s disease of long standing, in which there
generally is a transition to a myxœdematous condition, are liable to a
fatal termination after an operation with anesthesia. Cases of diabetes
(in accord with frequency of thyroid changes) also often present serious
phenomena after an operation under anesthesia, including coma and even
death.

Alcohol also acts on the thyroid gland, there being a certain analogy
between intoxication by chloroform and by alcohol. The changes in the
thyroid after the long-continued use of alcohol are the consequences of
the frequent conditions of hyperactivity of this gland, expressive of
its antitoxic action. We have referred to the influence of alcohol on
the thyroid in other parts of this book. This gland also protects us
against injurious drugs. Hunt, of Washington, has shown from experiments
that when certain animals, such as rabbits, have been given acetonitril
and thyroid preparations at the same time, they do not become poisoned;
whereas when they have taken the former alone, they do. Jeandelize and
Perrin have also proved the protective action of the thyroid against
arsenic.

Garnier has also found that certain drugs, such as iodine, pilocarpin,
etc., when injected into animals, produce an increase of colloid
secretion in the thyroid glands. It is, therefore, but logical to regard
this hyperactivity of the thyroid gland as an expression of its
defensive action against toxic products (see Chapter III).

From the foregoing it is obvious what an important organ we possess in
the thyroid gland, and that by its degeneration, as in the state of
myxœdema or in the much more frequent athyroidia, we become more exposed
to all kinds of poisonous products; but what renders its degeneration a
still graver misfortune for us, is the fact that it is apt to bring
about the degeneration also of other organs which destroy and eliminate
poisonous products, viz.: the liver, kidneys, intestines, and skin.

The liver is always altered by extirpation of the thyroid gland,
likewise as a rule in myxœdema, and even in hypothyroidia; for
congestion and other changes follow, as found by Rogowitch, Sanquirico,
and Canales, Albertoni, Tizzoni, and others. A fatty degeneration of the
liver has also been described by Sciolla.

Laulanié has discovered, in the same way as Van der Ecke and Rosenblath,
very extensive changes in the liver after removal of the thyroid.
Jeandelize also found interstitial hepatitis after the removal of the
thyroid and parathyroids. Kishi also describes alterations in the
blood-vessels of the liver occurring in a great number of animals after
thyroidectomy.

Hun, Prudden, Mackenzie, G. Murray, and others, found usually a
cirrhosis of the liver in myxœdematous persons. Vermehren found an
interstitial hepatitis, with thickening of the blood-vessels of the
liver, and of the bile, in myxœdema.

It is also of great significance to note that Gley, Laulanié, and
others, constantly found biliary matters present in the urine of animals
from which the thyroid had been removed.

After due consideration of these facts it cannot be denied that the
liver and the thyroid stand in very close relationship, and this we
maintained at the last French Congress of Medicine at Liège, where we
were glad to see that the President of the Congress, Professor Bouchard
of Paris, and later Professor Neusser of Vienna, coincided in this
opinion.

We have also shown, as already mentioned (Chapter V), that degenerative
processes of the thyroid are able to facilitate the development of the
gall-stone complaint. The degeneration of the thyroid is not only
followed by degeneration of the liver, but also by that of the kidneys.

It has been noted by Albertoni and Tizzoni, that animals whose thyroid
has been removed show a condition of interstitial nephritis. Blum has
found the same thing, and has observed also that this condition
frequently comes about in an astonishingly short time after the
operation, say, in 18 to 20 days. The parenchyma also presents distinct
signs of inflammation; the urinary channels lose their epithelium and
present the appearance of hollow grooves. These changes occur in all
animals, except such as die a few days after the operation, and such as
are permanently immune from the intoxication that follows the removal of
the thyroid.

We can also observe clinically that removal or degeneration of the
thyroid are capable of producing changes in the kidneys; for after the
operation, as a rule, albumin appears in the urine.

In myxœdema and hypothyroidia there is also very frequently albumin in
the urine, as well as hyalin or granular casts. In such cases the urine
is usually not copious; very frequently it is scanty (oliguria), and its
light color and low specific gravity show that the solids have been
retained in the body. In such cases there is often retention of uric
acid. In a communication to the Paris Biological Society (February 25,
1905) we attributed gout to changes in the kidneys giving retention of
uric acid, after primary alterations of the thyroid as the cause (see
also Chapter V).

That the intestines also suffer changes after degeneration of the
thyroid is best established by the fact that there is obstinate
constipation in such cases,—as in myxœdema or in partial myxœdema and
hypothyroidia (old age). The functions of the skin also will be
diminished after degeneration of the thyroid, as we observe plainly in
the conditions of myxœdema and hypothyroidia. In these diseased
conditions there is an atrophy of the sudorific and sebaceous glands, so
that the skin cannot perspire; on this account a large amount of toxic
products is retained.

We can see plainly from the above that when a person has a degenerated
thyroid a condition of auto-intoxication must necessarily follow, as
there is in consequence a degeneration also of the other organs which
destroy and eliminate poisonous materials. The liver in such a case will
not be able to fulfill its function of destroying a mass of poisonous
substances; the sluggish kidneys and bowels will not eliminate them
sufficiently, and dry skin will also contribute to their retention,
since its insensible respiration is not taking place. All these
life-shortening agencies, which may combine to cause premature old age,
can be brought back to a primary cause—the degeneration of the thyroid
gland.

When the thyroid is removed from an animal, but the parathyroids are
allowed to remain, that animal will not then suffer convulsions, but
will only present the symptoms of cachexia typical of the operative
cases of myxœdema.

It has been shown by Gley, Vassale, and Generali, that these very small
glandular organs, of which there are four, two internal and two external
ones, possess quite a different structure from the thyroid gland.

It has been demonstrated by many authorities, among them Jeandelize,
that the convulsions which follow the removal of the thyroid are due to
the fact that the parathyroids have been removed completely, together
with the thyroid gland. Jeandelize was able to produce convulsions by
merely removing the parathyroids alone; he attributed tetany and
epilepsy to the changes in the parathyroids, in common with other
authorities, who have even obtained good results in epilepsy with
parathyroid treatment.

Several authorities besides Jeandelize have attributed tetany to
alterations of the parathyroids: for instance, Pineles; and at the
German Congress of Medicine in Munich, Erdheim communicated his
observations in three cases of tetany, in each of which, at the
post-mortem, there was found hypertrophy of the parathyroids.

Dr. Macallum, of Johns Hopkins University, has also reported the case of
a person who developed tetany in consequence of a dilatation of the
stomach, and in whom the parathyroids were found to be hypertrophied.

We learn from the foregoing that the parathyroids protect us against
poisons that arise from the stagnation of the contents of the stomach,
and that their integrity is necessary as a safeguard against important
alterations of the nervous system.

However, these glands, which were already described by Sandström
twenty-two years ago, have not been studied as yet to the same extent as
the thyroid, and we cannot enlarge further on this subject at the
present time.


------------------------------------------------------------------------




                              CHAPTER XII.

                     HYGIENE OF THE THYROID GLAND.


THE rational hygiene of the thyroid gland consists in the avoidance of
all agencies that may prove harmful to the gland, the most important of
which are infectious diseases; frequent pregnancies; sexual excesses;
intoxications by food, stimulants, or drugs; and emotions such as grief,
sorrow, etc.

It will not be difficult to prevent some of these, but it will be nearly
impossible to avoid others, such, for instance, as infectious diseases.
There is not the least doubt, however, that at times we expose ourselves
quite unnecessarily to infections, as when we drink water that has not
been boiled or filtered, or when we take milk from uninspected dairies
for a long time; or, again, when we remain too long a time in the
confined air of assembly halls, etc., and breathe the air that has been
exhaled by thousands of others, many of them possibly with infectious
diseases of the throat and lungs. Many a case of infectious disease,
with all its dangers to life or to important organs, such as the
thyroid, may be avoided by proper circumspection.

It is also quite unnecessary for us to expose ourselves to the dangers
arising from the decomposition of meat, which is particularly injurious,
when taken in large quantities, to the thyroid, as shown by the
experiments of Breisacher, Blum, Chalmers Watson, etc., more especially
if animal food be taken that is not quite fresh and can cause the
formation of ptomaines. According to Blum the thyroid has the special
function of destroying poisons formed in the intestines, in particular
by the decomposition of animal food. Now when too much work is thrown up
on this important gland, it is easy to understand that after a time it
will give out, and to prevent this we must avoid taking large quantities
of animal food or fish (which is meat also, a fact not realized by many
people), and when we do take it, we must first be certain that it is in
a fresh condition. To enable us to do this we are provided with special
sense-organs, and our eyes, nose, and the taste papillæ of our tongue
will inform us whether the meat, and especially the fish or crustacean,
is in a fit condition to be eaten.

We have mentioned several times that alcohol and tobacco, taken in large
quantities or for a long time, are deleterious to the thyroid, which
fact will justify our abstinence therefrom, or the greatest moderation
in their employment; those who can do without stimulants will always be
the best off.

Sexual excesses can also be easily avoided, and women who wish to retain
their youth will do well not to expose themselves to pregnancies year
after year after having had three or four children. It is, however,
great good fortune to have a numerous progeny, and by careful hygiene,
as plenty of instances prove, the struggle against premature old age can
be carried out successfully. In regard to this we may refer to the
chapters on the causes of old age and on sexual hygiene. Diseases of the
ovaries must be particularly avoided, as all changes in those glands
will react on the thyroid, which is closely related to them.

Doubtless one of the most difficult tasks will be the avoidance of
strong emotions: grief and sorrow; and yet we are not helpless against
them, as will be illustrated in the chapter on the hygiene of the mind
and on the advantages of a religious belief.

Having dwelt on the necessity of preventing injury to this important
gland, we will now show that there are certain means of enhancing its
vitality,—which effect we can obtain by improving the circulation, and
removing agencies by which this would be impaired. As Sir Herman Weber
has shown, it is possible to improve the working condition of this gland
by massage, which should be done daily and is readily carried out.

It is easy to see that a tight collar offers difficulty to the free
circulation of the blood through this gland, and therefore it is
advisable to wear a loose, and also low, one. Strange to say, many
ladies wear such tight, high collars, not availing themselves of their
immunity from such a yoke, which men have voluntarily endured for so
long a time. It is advantageous not to button both sides of the
shirt-band to which the collar-stud is fastened, but one side only,
which is easily done when low collars are worn and is not noticeable;
the great comfort and advantage of so doing will outweigh all other
considerations.

The vitality of the thyroid gland may be enhanced by various measures in
which thyroid secretion, or iodine—its main element,—is introduced into
the body. The easiest way to effect this is by taking foods, such as
plants and vegetables, which contain a maximum of iodine. The iodine in
the thyroid and other parts of the body is introduced therein mainly
with our food (or by drugs in the case of goiter). Another way is by
taking thyroid extracts. Since, at a certain age,—as mentioned in the
chapter on the causes of old age,—parts of the epithelium of the thyroid
are degenerated and replaced by connective tissue, thyroid extracts will
be the best means, if taken in very small doses, of supplying this
physiological need. Such doses of the extracts, freshly prepared and
from a reliable firm, can do no harm, but, on the contrary, will keep
the thyroid in good working order. As we have learned from personal
experience these very small doses can even be taken, at intervals, for a
long time, without injury to the health, and we need not await the
arrival of old age, but should use them as a preventative against it,
and in particular temporarily where there is, or has been, a great
demand for thyroid secretion, as, for instance, in convalescence after
an infectious disease, or after childbirth, especially if the flow of
milk is scanty, which is an expression of a defective thyroid; also
after sexual excesses, and in cases of mental depression, after we have
suffered grief; in fact, after any of the occurrences which we know to
be harmful to the thyroid gland, which, in such cases, has been giving
off larger amounts of its secretion.

We must, however, caution patients against ever taking these extracts
_save under medical advice_, since otherwise dangerous results may be
and have been produced, as will be shown elsewhere.

The diet of greatest hygienic value with regard to the thyroid will
consist of large quantities of milk, with little or no meat, but plenty
of vegetables.

With such a diet there will result less putrefaction in the intestines,
and thus also less demand for the thyroid secretion to destroy poisonous
matters; at the same time, along with the milk and vegetables, iodine,
the main element of the thyroid secretion, will be brought into the
body, and a loss of this product from it prevented.


------------------------------------------------------------------------




                             CHAPTER XIII.

 THE DESTRUCTION OF TOXIC PRODUCTS BY THE LIVER AND THE IMPROVEMENT OF
                       ITS PROTECTIVE FUNCTIONS.


THE liver is one of the most important of our organs. As Professor
Hemmeter, of Baltimore, says, “The liver is an organ secondary in
importance only to the heart. Living things can exist without stomachs.
They can live for forty days without eating, but mammalia can only live
a few days, sometimes not twenty-four hours, without a liver.” The
importance of the functions of the liver is illustrated in this
picturesque remark of Dr. Rovighi[172]: “Like unto Minos in Dante, the
liver tests the conscience of those that want to enter, and knows their
sins.”

Footnote 172:

  Quoted after Professor Hemmeter. Address to Sixty-first Annual Meeting
  of the Ohio State Medical Association, May 9-11, Canton, Ohio.

We introduce into our stomach and intestines a number of poisonous
substances which, if injected into our blood, would kill us, or at
least, cause grave intoxication. Yet because they are taken by the mouth
they are harmless, and the reason for this strange phenomenon is that
they must pass through the liver, being brought to this organ from the
intestines through the portal vein, and are there destroyed. This is
illustrated in the case of the Indian snake charmers, who acquire
immunity against snake-bites after having first sucked the poisonous
fang of the snakes and absorbed the toxin via the intestine. They
thereby gradually accustom their body to this terrible poison, which,
taken in this manner, is far less harmful, since it passes through the
liver. That the liver destroys various poisons was first shown by our
esteemed friend, Prof. Paul Heger,[173] of Brussels University, who
demonstrated by experiments that nicotin added to blood soon disappeared
after it had been passed through the liver artificially. After this
remarkable discovery other authorities have found reason to state that
the liver also destroys other poisons, in particular alkaloids:
strychnine and atropine (Professor Roger[174]), hyoscyamine (Heger and
Buys[175]), quinine, morphia, curare (Lussana). According to Schiff, and
Lautenbach, alkaloids undergo a chemical change under the influence of
the liver. As Slowzoff[176] found, the liver also protects us against
poisons such as arsenic; therefore we can understand why persons
suffering from hepatic disease cannot tolerate arsenic. This should be
taken into consideration when we are treating patients with cacodylates,
or with atoxyl.

Footnote 173:

  Thèse de Bruxelles, 1873; Journal méd. de Bruxelles, 1877; C. R. de
  l’Académie des Sciences, May, 1880.

Footnote 174:

  Thèse de Paris, 1887.

Footnote 175:

  Quoted from Hanot, Archives Gén. de Médecine, II, 895.

Footnote 176:

  Slowzoff: Beitr. zur chem. Physiologie u. Path., p. 281, 1901.

It has, however, been maintained by Zagari that this antitoxic action of
the liver fails in the case of bacteria and, according to Professor
Roger, especially with bacterial toxins in old cultures.

Yet other authors have shown that the liver probably has an antitoxic
action against bacteria and their toxins. Thus, Professor Adami, of
Montreal,[177] by experiments with a minute diplococcus similar to that
which is found in Pictou’s cattle disease, and Sir Lauder Brunton, and
Dr. Bokenham,[178] have shown that the lethal action of diphtheria toxin
is greatly diminished during the circulation of this toxin through the
liver, and also that the juice from such a liver has a slight antitoxic
power. These authors have also shown that the bile from such a liver has
a slight antitoxic action. They consider that the antitoxic power of the
liver does not depend upon the blood present in the organ, but on the
liver-tissue itself.

Footnote 177:

  Adami: Montreal Med. Journal, p. 485, July.

Footnote 178:

  Sir Lauder Brunton and Bokenham: The Journal of Pathology and
  Bacteriology, p. 50, Nov., 1907.

It has been shown that the liver excretes into the bile poisons which it
arrests during their circulation through the portal system. This has
been shown by Lussana in the case of curare. That poisonous substances
are excreted into the bile is shown also by the immunizing experiments
of Professor Koch against bovine plague. He employs the bile of animals
which died of plague. This contains attenuated plague bacilli, of which
Professor Koch makes use in his experiments.[179]

Footnote 179:

  Quoted after Metschnikoff.

Dr. Fraser[180] has shown that when increasing doses of snake-venom are
injected into an animal a condition of immunity is brought about, so
that finally fifty times the dose which would have proved fatal at
first, becomes innocuous. As Fraser found, the bile of such animals
contains an antivenine, and he made use of this bile as an antidote
against the original venom.

Footnote 180:

  Fraser: British Med. Journal, vol. ii, p. 595, 1897.

These experiments prove that the bile contains poisonous substances,
including pathogenic bacteria in an attenuated condition, and also that
it has antitoxic properties. Thus we may understand how it can
neutralize putrefactive products from the intestines. Not only bacteria,
but all the various kinds of poison which the liver destroys, are
eliminated by the bile; hence the importance of a free circulation of
this fluid. The liver serves as a depot for metallic substances like
iron and copper, and also for the more dangerous ones such as lead,
mercury, arsenic, or antimony. After first keeping them in storage, it
then attempts to eliminate these noxious substances. According to
Slowzoff and Bamossi, the various poisonous metals and alkaloids enter
into combinations with the proteid bodies of the liver. Animals that
have been richly fed have been found to be better protected against
these poisons because of their livers being richer in proteid contents
and glycogen.

The liver also protects the body against the numerous toxic products
formed in the stomach and intestines during the process of digestion and
assimilation. The most important of these are the carbamins and ammonia
salts, which would be injurious to us if the liver did not protect us by
converting them into urea.

When the liver is excluded from the circulation, as Nencky and his
pupils have done by establishing an Eck fistula, toxic symptoms arise
when the animals are given albuminous food, and these symptoms can only
be explained from the fact that the liver is unable to destroy toxic
products. The more albuminous food taken, the more marked are the
symptoms of intoxication.

The liver aids in the transformation of the poisonous end-products of
proteid metabolism by bringing about the combination of the toxic
end-products with sulphuric acid (Baumann, Emden and Glaesner). Thus
these dangerous substances are eliminated as ethereal sulphates, which
are practically harmless. Even when these ethereal sulphates are present
in large amounts in the urine there may be no symptoms of
auto-intoxication.

When the liver is extirpated, a condition of acidosis arises, and a
large quantity of ammonia is eliminated, which is produced in order to
neutralize the acids present. The liver protects us against acids formed
in the organism. After eating a quantity of meat, we would be menaced by
the acids formed through its decomposition, were the liver not active.

We can prevent acidosis if we eat a considerable amount of
carbohydrates, at least 100 grammes a day as Hirschfeld has proved. It
has been shown by Waldvogel that these carbohydrates do not prevent
acidosis if they are given by a method which precludes their passage
through the portal circulation,—e.g., subcutaneously.

As we have seen above, the liver receives an enormous amount of toxic
products from the stomach and intestine, which it transforms or
destroys. Like any other organ which is overworked, the liver may
undergo certain changes when continually subjected to a strain, and
great quantities of these toxins might be able, after a long-continued
action, to alter the liver tissue. Such a condition we may note in
gastric and intestinal diseases, especially in those cases where large
amounts of fatty acids are formed.

Bouchard found an enlargement of the liver in 23 per cent. of all his
cases of dilatation of the stomach.

We can understand that when fatty acids, as a result of
gastro-intestinal disease, pass for a long time through the liver, they
may destroy the delicate epithelium of this organ. Boix demonstrated
this by experiments. By feeding animals with lactic, butyric, and acetic
acids, he produced hepatic cirrhosis.

So long as the liver is healthy it is able to withstand the constant
inflow of toxins and will transform them into less harmful compounds.
But when the liver is altered, as in cirrhosis, things are different. We
then find a diminution of urea, and an increase of ammonia. Happily such
a condition arises only when there are considerable anatomical and
histological changes in the liver.

Salaskin and Zaleski have shown in animals that when there are serious
anatomical changes in the liver, the ammonia is increased, and the urea
is diminished. We may suppose that in old age, when the connective
tissue is more or less increased and important liver elements destroyed,
a similar decrease in the urea formation may take place just as in
chronic cirrhosis.

That in diseases of the liver toxic products are formed and eliminated
by the urine in increased amounts, has been shown by Professors
Bouchard[181] and Roger. They found that the urine of patients suffering
from diseases of the liver is more toxic than that of normal persons.

Footnote 181:

  Leçons sur les auto-intoxications dans les maladies.

That the normal urine is toxic has been proved by Séglas and
Vauquelin,[182] and also by Bocci.[183] Bouchard has designated as the
urotoxic unit the quantity of urine necessary to kill an animal weighing
1 kilogramme, and as the urotoxic co-efficient the relation of the
urotoxin eliminated in twenty-four hours to the body weight of the
animal. This latter, then, indicates the quantity of urotoxins a man
eliminates in twenty-four hours.

Footnote 182:

  Journal de Magendie, vol. ii, p. 357, 1822.

Footnote 183:

  Centralbl. für med. Wiss. 51, 1882.

All these calculations of Bouchard have had no great success, however,
for many authorities, as Gumprecht,[184] Heymans v. d. Bergh, etc., have
shown that the toxic effects of the injected urine may be explained in
part by the difference in osmotic pressure between the injected urine
and the blood.

Footnote 184:

  Centralbl. für Inner. Med., 24, 1897.

Still the fact remains that the urine of many cases of liver disease has
been found to be more toxic than the urine of other persons.

When the liver is damaged it cannot destroy poisons in the normal
manner, as was shown by experiments. Thus, the liver cells have been
experimentally injured when it was found that such a liver was not able
to destroy strychnine as well as a normal liver. Very important findings
have been made by Roger and Gamier.[185] They have ascertained that
privation, bad nutrition, etc., can also lower the vitality of the liver
and diminish its antitoxic properties.

Footnote 185:

  Roger et Garnier: C. R. Soc. de biol., p. 209, 1899.


------------------------------------------------------------------------




                              CHAPTER XIV.

                       THE HYGIENE OF THE LIVER.


WE have often observed that people suffering from diseases of the liver
feel and look much better after abstaining from meat and living on milk
and a vegetarian diet. If such a diet be beneficial in cases where the
tissues of the liver are degenerated, it appears reasonable to assume
that it will be equally efficacious when the liver has not yet been
altered by disease. We must realize that the various unwholesome matters
we eat or drink are carried to the liver to be dealt with, and that the
end-products of the decomposition of the meat, and other elements
contained in preserved meat which may not be perfectly sound, may injure
the liver-tissue, or, at any rate, throw more work on this organ than
food in the nature of vegetables or milk.

A milk diet has the further great advantages that it assists in
destroying toxic products in the intestine, and also that it can hinder
the development of gall-stone disease (see Chapter XXXIX).

Not only meat used in abundance, but also various kinds of spices,
condiments and stimulants may be very injurious, especially alcohol, if
taken in large quantity. Gin and brandy are the most deleterious in
their action. Wines containing little alcohol are less harmful, but acid
or strong white wines may injure the liver-tissue.

The well-being of this organ is essentially dependent on the good
condition of various other organs with which it stands in very close
relation, in particular the intestines, for instance. It is from here
that most of the toxic products enter the liver, either by the portal
vein or through the choledochus. The intestine always contains myriads
of microbes, which may enter the liver either by the blood or the bile,
and thus provoke very important changes in the liver-tissue. Professor
Adami,[186] of Montreal, found colon bacilli in a cirrhotic liver.

Footnote 186:

  Quoted from Quincke: “Diseases of the Liver” in Nothnagel’s
  “Practice.”

It follows, therefore, that we must maintain the intestine in the best
possible condition, and avoid constipation and stagnation of fæcal
matters, with the augmentation of toxic products. That constipation is
very deleterious to the liver can be best shown by the fact that very
often affections of the liver and bile-ducts,—and especially gall-stone
disease,—are developed in persons suffering from habitual constipation.
The best treatment for these liver affections is a purging treatment,
and it is mainly on account of their action in this manner that certain
alkaline mineral waters have attained so great a fame; in addition, due
to increased peristalsis, the circulation of the bile is enhanced.

Proper movements of the bowel are indispensable to a sound condition of
the liver and for the prevention of hepatic disease, and we, therefore,
refer the reader to the chapter that deals in detail with the prevention
and treatment of constipation.

Not only the intestine, but the stomach also, must be in good condition.
It has been noted by Bouchard and Hanot that chronic gastric and
intestinal troubles are apt to cause enlargement of the liver. Bouchard
has found an enlarged liver in 23 per cent. of his cases of dilatation
of the stomach. Hanot and Boit[187] have shown experimentally that the
different acids formed in the gastro-intestinal tract are able to
produce a genuine cirrhosis of the liver. Therefore acid fermentation
must be carefully avoided; and to prevent such fermentation in some
degree in the stomach and in the intestine, it is necessary to masticate
the food thoroughly, as will be shown.

Footnote 187:

  Hanot and Boit: Congresso Med. Internat. di Roma, 1894.

Another very important organ, the sound condition of which is of great
importance to the liver, is the pancreas. It has been found by several
authors, particularly by Steinhaus,[188] in his investigation of some 40
cases of hepatic cirrhosis, that the pancreas is also affected in each
case of this type; and we further know that after disease of the
pancreas, as in diabetes, for example, the liver is also, as a rule,
altered. Thus these two organs are in close relationship.

Footnote 188:

  Steinhaus: Deutsches Archiv für klin. Medicin, 1902.

As pancreatic diseases are among the most difficult to diagnose, and
people suffering from them live and die, as do also many diabetics,
without their particular state having been recognized, so, the rational
treatment of these diseases being still imperfect, we cannot offer
advice in regard to their prevention. But, at any rate, the safest
course will be moderation in diet, especially fatty food, which exacts
the active co-operation of the pancreas. As in the case of all other
organs, long-continued overwork will exhaust this gland, and thus induce
a diseased condition. Moderation in diet will be the best policy for the
pancreas, as also for the liver; and to maintain these organs in sound
working order, meat in particular should only be taken in small
quantities, and fat also should not be partaken of in large amount.

Milk and vegetable food, with but little meat, and that preferably as
fish, will certainly furnish the best diet to avoid diseases of the
liver. As Quincke[189] mentions, experience shows also that water in
large quantities, especially certain alkaline saline waters, can
increase the flow of the bile; and therefore, as also for other reasons
mentioned in this book in Chapters XXXIV and XLI, water should be drunk
in sufficient quantity every day. The alkaline waters referred to are
certainly superior in their action to ordinary water, especially those
kinds which at the same time cause purging.

Footnote 189:

  Quincke: “Diseases of the Liver,” in Nothnagel’s “Practice,” 1907.

Hot climates have a deteriorating effect on the liver. We have often
noted the great frequency of liver complaints under these conditions,
and we have never had a patient from the hot parts of Mexico who has not
had a hypertrophied liver. We are inclined to believe that it is not so
much the climate as faults in hygiene, especially in diet and in the use
of stimulants, which are the cause of such a condition in Europeans
residing in tropical climates.

A vegetarian diet is certainly the best in tropical countries, as we
personally found during a stay in Southern Florida, Texas, and Mexico.
Just as for the kidneys, so for the liver, a bath, and particularly a
sweat-bath, is of great benefit, since by means of it toxic products may
be eliminated which would otherwise be carried to the liver.

We have found these baths to be of great benefit in liver diseases, and
considering the amelioration of the processes of oxidation brought about
by such baths, it seems highly probable that they are capable of
improving also the working condition of a liver not as yet diseased.

In general, it is our opinion that to prevent disease in an organ the
surest method is to use those means through which that organ, when
diseased, is found to benefit. Of course this is only meant as a general
statement; but in the children of those suffering from liver complaints
such preventive treatment is particularly indicated, as these
conditions, we have found, are most frequently inherited. We have
treated cases where three or four generations of one family had been
sufferers from the same complaint.

Here, as always, let us follow the wise precept: “Prevention is better
than cure.”


------------------------------------------------------------------------




                              CHAPTER XV.

         ON THE DESTRUCTION OF TOXIC PRODUCTS BY THE ADRENALS.


THERE is ample evidence in support of the contention that the adrenals
play an important part in the destruction of toxic products in the body.
As long ago as 1853, one of the leading authorities on the adrenals as
ductless glands, Brown-Séquard, noticed that the blood of animals
without adrenals was more toxic than that of animals the adrenals of
which had not been removed.

Langlois and Abelous[190] confirmed the conclusions of Brown-Séquard.
They also established the fact that the blood and muscular extracts of
frogs whose adrenals had been removed, were toxic, and contained a
poison of the nature of curare. The animals died from auto-intoxication,
and these savants came to the conclusion that the adrenals were created
to neutralize or destroy poisons which are evolved during muscular work.
Frogs from which the adrenals had been removed showed also lessened
resistance to muscular fatigue. Similar results have been observed by
Langlois in the case of other animals: rabbits, dogs, guinea-pigs, etc.
Albanese[191] also found that animals operated on as above exhibited
more fatigue than those whose adrenals had been allowed to remain
intact. The recent labors of Sajous which have shown conclusively that
the adrenals furnish to the blood one of its important immunizing
constituents explain all the above observations.

Footnote 190:

  Abelous et Langlois: Archives de physiologic norm. et path., p. 267,
  vol. iii, 1892, and “Travaux de Laboratoire,” Lancet, August 20, 1898;
  Société de biologie, 1892.

Footnote 191:

  Albanese: Archiv. Ital. di Biologia, p. 338, 1892.

The fact, observed by all these authorities, that when one of the
adrenals is removed the other becomes hypertrophied, sometimes to a
great extent, seems also to point to the conclusion that greater demands
are made on the gland that remains, the hypertrophied condition of which
appears to be due to the increased work required of it in protecting the
body from infection.

That these organs really assist in the defense of the body against the
attacks of microbes or the introduction into it of certain toxic
products can be best demonstrated by the fact that after such infections
the adrenals are, as a rule, altered, showing that a pronounced reaction
antagonistic to these agencies has occurred.

It has thus been proved by a succession of authors: Charrin,[192]
Langlois, Roux, Yersin, Professor Roger, and more recently by Oppenheim
and Loeper,[193] that in experimental or in spontaneous infectious
diseases the adrenals present important alterations as a result of the
reaction against infection.

Footnote 192:

  Charrin: “Les défenses naturelles de l’organisme,” Paris, 1898; C. R.
  Soc. de biologie, 1892.

Footnote 193:

  Oppenheim et Loeper: C. R. Soc. de biol., 22 mars, 1901.

Oppenheim and Loeper found that important changes followed upon
experimental infectious diseases; for example, after infection by the
bacilli of diphtheria or anthrax, or by the pneumococcus; also in such
infectious diseases as diphtheria, pneumonia, small-pox, typhoid fever,
etc.; and also after experimental poisonings, as with arsenic,
phosphorus, or mercury. There occurred leucocytic reaction, diffuse
diapedesis, or infectious nodules, and also a congested condition of the
adrenals, sometimes so marked that hæmorrhage took place, with complete
destruction of the parenchymatous tissue of the glands.

Very important are the conclusions of Oppenheim,[194] that when animals
have received poisonous products, together with adrenal extracts, after
having previously lost these glands by operation, such animals show a
longer survival, sometimes even of indefinite duration, as compared with
animals without adrenals to which have been administered the same toxic
products, but without adrenal extracts.

Footnote 194:

  Oppenheim: “Les capsules surrénales,” Thèse de Paris, 1902.

With phosphorus and urinary poisons in particular, this author has
obtained most striking results from the injection into animals of
adrenal extracts at the same time as the poisonous substances.

Oppenheim comes to the same conclusion as Abelous, Charrin, Langlois and
Sajous: that the adrenals play a great rôle in the destruction or
neutralization of microbic or other poisons introduced into the system.

We are thus in possession of powerful arguments in support of the
presumption that the adrenals are antitoxic glands. The fact, found by
Langlois, that the adrenals contain less adrenalin after experimental
infectious diseases, and that established by Luksch, that after certain
experimental infectious diseases such as diphtheria, typhoid, or
tuberculosis, the extract from the adrenals no longer produces an
increased blood-pressure, do not seem to us sufficient to invalidate our
belief in the antitoxic properties of these glands; for here we are
witnessing the same occurrence as has been previously noted in reference
to the thyroid,—that the functional hyperactivity of the gland may be
followed by its exhaustion.

Moschini, Nicholas, and Bonnamour have also found histological evidences
in the adrenals in infectious diseases indicating a hyperactivity of
these glands.

The fact that different toxic products, such as alcohol, can produce
alterations in the adrenals, indicates also a rôle of these glands in
defending the body against toxic doses of this substance (see Chapter
III).

It was found by Aubertin[195] and other authors that there is a
hyperplasia of the adrenals after experimental intoxication of the
guinea-pig by alcohol. Bernard and Bigart found important alterations of
the adrenals after experimental poisoning by mercury, arsenic, lead,
etc. As shown by Professor Sajous,[196] various drugs act on these
glands, and he attributes the rise of blood-pressure therefrom to the
action of such drugs on the adrenals, whose function, as is well known,
is to raise the blood-pressure. We can thus understand how if alcohol be
taken in large quantities it is able to produce atheroma and
arteriosclerosis, as are also other toxic bodies, such as nicotine.

Footnote 195:

  Aubertin: C. E. Soc. de biologie, 22 juillet, 1902.

Footnote 196:

  Sajous: Loc. cit.

It is well known that arteriosclerosis is frequent in great smokers. It
has been found by several authorities, among them Borylac, that
inhalation, or mastication, of tobacco produces atheroma, and by Boverie
and Loeper[197] that similar changes have followed experiments with
tobacco or ergotin. Very important data have also been established by
Drs. Isaac Adler and Hensel, of New York,[198] who have found that
atheromatous alterations of the aorta can be produced experimentally by
powerful doses of nicotine. Such alterations were similar to those
effected by adrenalin, but were neither so constant, nor so marked.

Footnote 197:

  Société d’Anatomie, Mai 31, 1907.

Footnote 198:

  Deutsche Med. Wochenschrift 8, 1906.

These experimental facts, together with observations by Dr. Sajous,
prove that the atheromatous condition brought about after using certain
drugs, such as alcohol and tobacco, can be ascribed to the adrenals.
Josué, in 1893,[199] showed that by injecting adrenal extracts (solution
1:1000) into the veins of a rabbit, atheromatous patches of the aorta
will appear after five or six weeks. The changes described by Adler and
Hensel from the effects of nicotine confirm the probability that tobacco
acts on the adrenals first, then, by their medium, on the blood-vessels
(see, also, Chapter XLIII).

Footnote 199:

  C. R. Soc. biologie, Nov. 14, 1893.

The above observations show that the same is also probable in the case
of alcohol, to which we may add a case of Widal and Boivin, who found in
a young woman dipsomaniac a hyperplasia of the adrenals and atheroma of
the aorta; and to complete the value of these observations we subjoin
those of a series of cases of atheroma by Joshua, in three of which a
hyperplastic condition of the adrenals was found.

It follows logically from the foregoing effects of alcohol and tobacco,
that we must avoid large quantities of these substances if we desire to
keep in a normal condition the heart and blood-vessels, upon the perfect
state of which depends, in a great degree, our chances of a long life
and extended youthfulness.

We will deal further with the latter points in the following chapter.


------------------------------------------------------------------------




                              CHAPTER XVI.

 HYGIENE OF THE ADRENALS AND OF THE CIRCULATORY SYSTEM—A FEW REMARKS ON
       THE CAUSE, PREVENTION, AND TREATMENT OF ARTERIOSCLEROSIS.


IN order to obtain the best hygienic condition of the circulatory
system, it is indispensable to avoid all that are harmful to the
adrenals. There can no longer be any doubt that these glands exercise a
controlling influence on the heart and the whole circulatory system.
They are in intimate relation with the principal nerves that regulate
the heart: the sympathetic and the vagus. Thus, for instance, emotions
that act on these nerves excite through them a hypersecretion of the
adrenals and a contraction of the small blood-vessels, with a rise in
the blood-pressure. By the hyperactivity of these glands their
secretion, in larger quantity than usual, is thrown out into the system,
producing toxic effects which result in an atheromatous condition of the
arteries. According to our present knowledge, we imagine this
atheromatosis to be due to the toxic effect of the adrenals quite
independently of the increase in the blood-pressure, for it has been
distinctly shown that even substances which diminish blood-pressure,
such as amyl nitrite, for example, are also capable of producing
atheroma. The toxic effects of adrenalin are proved by the experiments
of Amberg[200] in the laboratories of the Johns Hopkins University.

Footnote 200:

  Amberg: Archives Internationales de Pharmakodynamie et Therapie, 1905.

We must especially insist on the fact that high blood-pressure is not a
condition essential to arteriosclerosis. It has been shown by
Sawada,[201] Groedel,[202] and Ferranini,[203] through measuring the
blood-pressure by Riva-Rocci’s instrument, that numerous cases of
arteriosclerosis can arise without any increase at all in the
blood-pressure. According to Professor Romberg,[204] there is only high
blood-pressure in such cases of arteriosclerosis where there is a
diseased condition of the kidneys. According to this leading authority
on heart diseases, high blood-pressure is one of the earliest symptoms
of kidney complication in arteriosclerotic persons. We believe that the
high blood-pressure found in kidney diseases may be brought into
correlation with the previous statement, by the fact that in such
conditions, and especially in sclerosis of the kidneys, the adrenals, if
examined, are frequently found to be hypertrophied, as was noted by
Parkes Weber,[205] Lemaire, and in four cases of Troin and Rivet.[206]
At the last Congress of German Physicians and Naturalists in Dresden,
1907, it was proved by Schur and Wiesel, as also in their previous
communications, that the blood of patients affected with kidney diseases
contained the characteristic substance that gives the adrenalin reaction
with perchloride of iron, and produced mydriasis if dropped into a
frog’s eyes.

Footnote 201:

  Deutsche Med. Wochenschrift, No. 12, 1907.

Footnote 202:

  Congress für Innere Medicin, 1907.

Footnote 203:

  Grom. Int. della Soc. Med., xxvi.

Footnote 204:

  Lehrbuch der Krankheiten destergens und der oxlutgefüre. Stuttgart,
  1906.

Footnote 205:

  Parkes Weber: Transact. Path. Society, London, lviii, 3.

Footnote 206:

  Gazette des hôpitaux, Juin 14, 1906.

It is of singular interest that all those agencies that produce a
hypersecretion of the adrenals are the same which are known to be
harmful in causing arteriosclerosis. In the front rank of such are
tobacco, alcohol, and different kinds of poison, such as lead, mercury,
etc.; also infectious diseases, especially syphilis, the important rôle
performed by which, in the production of arteriosclerosis, has been
treated of very competently by Professor Edgreen,[207] of Stockholm, and
Darier, of Paris. Arteriosclerosis can also be produced very frequently
by abundant meat food and by strong tea or coffee. There is as yet no
scientific proof to show that abundant meat food has the same
deleterious action on the adrenals as upon the thyroid, ovaries,
pituitary body, pancreas, liver, kidneys, etc., upon which we have
enlarged in previous chapters of this book; and, moreover, we have no
knowledge of any work written on this subject; but as such a diet is
very efficacious in producing a sclerotic condition of the kidneys, it
may, for these reasons alone, tend to further the development of
arteriosclerosis, considering that so often in such conditions both
kidneys and adrenals are found in a hypertrophic condition. This disease
may be produced by alcohol, tea, and coffee, by causing a great
variation in the tone of the capillaries. According to Professor Romberg
and others, it remains to be proved whether they affect the adrenals at
all; but we have already shown what their action is on the kidneys.

Footnote 207:

  “Die Arteriosclerose,” Leipzig, 1898.

To keep the adrenals in good condition and thus prevent
arteriosclerosis, it is necessary to avoid all the above harmful
agencies. It is true that there are some people who can enjoy these
things in large quantities with impunity and without injurious effects
until they reach a considerable age; but it is different when they all
act together. Especially deleterious are mental emotions, grief, and
sorrow, on which we have dwelt in the introduction to this chapter, and
on the effects of which we have previously remarked; they produce a
great variation in the tone and calibre of the blood-vessels. We will
therefore endeavor to treat of the prevention of a prolonged continuance
of this most disastrous agency in our chapters on the hygiene of the
mind. Emotions of a sexual character are, perhaps, more than emotions
from other sources, disastrous to the heart and blood-vessels, as shown
by the fact, which may often be observed, that persons addicted to
sexual excitations frequently die from sclerosis of the coronary
arteries. That the sexual glands are in intimate relations with the
heart, which can often be irritated in consequence of changes in these
glands, especially in women, has been already mentioned.

We should like to add that, as the above agencies are also harmful to
the thyroid gland, the antagonist of the adrenals, its degeneration can
further the development of arteriosclerosis in the same way that
Eiselsberg produced an atheromatosis of the aorta in dogs after
extirpating the thyroid gland. According to Minnich, arteriosclerosis is
very common in people with goiter, appearing in them at a very early
age. Fries and Pineles found that alterations of the blood-vessels
occurred in goats after extirpation of their thyroid gland.

Since arteriosclerosis is so frequent in old age it must be due to the
degeneration of the thyroid and also to the aggregation of all the
above-named harmful agencies during a prolonged period. To avoid it, and
also premature old age, it is, therefore, most essential to guard
against all agencies harmful to the thyroid and adrenals, to which we
have referred above; and this is the best basis for the rational
treatment of arteriosclerosis. It is most fortunate that Dellamare
discovered in old age a hypertrophy of the adrenals.[208]

Footnote 208:

  “Recherches sur la senescence des glandes surrénales,” Soc. biologie,
  17 Oct., 1903.

All this is greatly strengthened by the recent investigations of Sajous,
which show that besides its action on the blood-pressure and the heart,
the adrenal secretion actually supplies the substance which in the
lungs, takes up the oxygen from the air to sustain life in all our
tissues. It thus becomes evident that harm to our adrenals is bound to
shorten life.

To recapitulate: There exist two chief agencies for the production of
arteriosclerosis: 1. A hyperactivity of the adrenals, causing a rise in
blood-pressure. 2. A degeneration of the thyroid gland, which, when
normal, antagonizes the first by lowering the blood-pressure. Although
from the above-mentioned facts high blood-pressure cannot be considered
as the chief cause of arteriosclerosis, still no doubt it certainly
contributes to it; for each time that there is a rise in the
blood-pressure more blood is forced through the arteries, thereby
causing them to dilate; and after a repeated number of such dilatations
the elasticity of the vessels will eventually be impaired, especially so
in the aged, where one part of the elastic fibers is already replaced by
connective tissue. As a result of the arteriosclerosis the passage of
blood through the capillaries will be impeded, and in consequence the
work of the heart will be increased; likewise the nutrition of the walls
of the vessels will be diminished. The best preventatives of
arteriosclerosis will therefore be: 1. To avoid all agencies which may
tend to cause excessive activity of the adrenals; and 2. To increase the
activity of the thyroid.

Moderation in food is necessary above all things, for much food causes
an increase in the abdominal circulation and a larger amount of blood to
be carried through the vessels; if the food consists of much meat, then
its viscosity is augmented, as previously stated, which indicates that a
vegetable diet, with milk, and little or no meat, is the best; but too
large quantities of milk should not be taken at one time.

Much bodily and other exercises, in excess, such as too much climbing,
should be avoided, as they promote arteriosclerosis by frequent
excitation of the splanchnics and adrenals. As Romberg observed, there
is sclerosis of the arteries in the extremities of persons who do much
physical labor, and Remlinger[209] found the same in the lower
extremities of peasant women who walked a great deal.

Footnote 209:

  Remlinger: “Dissertation on Arteriosclérose,” Marburg, 1905.

Not only by a diet, chiefly vegetarian, is the viscosity of the blood
diminished and the circulation facilitated as found by Determann, but
also by means of iodine administered in the shape of iodide of potassium
or iodide of sodium. This has been proved by the experiments of
Ottfried, Müller, and Inada.[210] For many years it has been well known
that iodine can greatly benefit the condition of arteriosclerotic
persons. In combination with a preparation of iodine, Professor
Senator[211] favors the use of nitrites, and Professor Huchard also
recommends nitroglycerine in the intervals between the iodide treatment.
Besides inorganic iodine, it would appear to us logical to try organic
iodine preparations, such as thyroid extracts, the principal element of
which is iodine. For the above reasons it is also necessary to take
special care of the condition of the kidneys, which can be done, as we
have shown, by hygienic and dietetic measures, already described in the
special chapters of this work. An improvement in the condition of the
kidneys, and probably also in the arteriosclerosis, may, in our
judgment, be obtained by the administration of kidney extracts, with
which we will deal more fully in the chapter on the treatment of old age
by organic extracts.

Footnote 210:

  Preface of Romberg: Deutsche Med. Wochenschrift, No. 78, 1904.

Footnote 211:

  “Therapie der Gegenwart,” March, 1907.

According to Edgreen, about 25 per cent. of the cases of
arteriosclerosis is caused by alcohol. It acts by causing a constriction
of the small vessels (Traube), just as does adrenalin.

But much more harmful in the production of arteriosclerosis is tobacco.
According to Claude Bernard, Huchard, Basch, Oser, Isaac Adler, and
Hensel, tobacco produces a constriction of the small blood-vessels. Thus
nicotin, adrenalin and alcohol have similar actions, which also
corresponds to the observations of Sir Lauder Brunton. We have had a
great many smokers among our arteriosclerotic patients; but, on the
other hand, we quote further on the cases of some great smokers who
lived to a very old age as we have seen. But this latter class is not
numerous.

Similarly, the hygiene of the intestines is of the utmost importance,
especially as poisons generated in the intestines play a leading part in
causing arteriosclerosis, according to Huchard, Senator, and others. We
must take great care to have a daily evacuation of the bowels, and
especially to prevent flatulence, for this distention of the colon or
the stomach, by carrying the diaphragm upward, may interfere with the
expansion of the lungs and thus produce a mechanical hindrance to the
movements of the heart and a free circulation of the blood. Those with a
tendency to angina pectoris must specially avoid such dangerous courses.
Hill climbing, during which not infrequently such people suffer sudden
death, should also be avoided. More than from 1 to 1½ liters of liquids
per day should not be allowed.


------------------------------------------------------------------------




                             CHAPTER XVII.

    THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE INTESTINES AND THE
                     IMPROVEMENT OF THIS FUNCTION.


THE intestines contain billions and billions of microbes, their number
increasing downward throughout the length of the intestine. The duodenum
contains the least, and in some parts of it there are none at all.

The presence of these bacteria is a great necessity to us, as without
their assistance we could not exist, for they take an active part in
intestinal digestion and help to form the intermediate substances,
especially from albuminous food and fat, for our nutrition. They also
assist fermentation and thus induce a better peristalsis of the
intestines, by which the contents are expressed.

That animals cannot exist without cultures of bacteria in the intestines
is shown by the experiment of Schottelius, who demonstrated that young
chickens could not thrive on a sterilized nutrition, and Nuttall and
Thierfelder had great trouble in keeping their guinea-pigs alive when
feeding them for a time on sterilized milk.

All those bacteria which are found in the intestines are, we may say,
innocuous; they assist digestion and do no harm. But among such are
often virulent bacilli against which, under normal circumstances, we are
well guarded, as the epithelium of the intestines is so wonderfully
arranged that so long as it is in a healthy condition it does not admit
the passage of these microbes; but in the aged, or in those exhausted by
debauchery or previous disease, or when there is an inflamed condition
of the intestines, stagnation of hard masses of fæces for a very long
time cause mechanical lesions of the epithelium when, conditions now
having changed, nothing will prevent these microbes from entering the
walls of the intestines and either cause disease, like typhoid or
tuberculosis, or from passing through and entering into the blood.

Besides these dangerous bacteria many other harmful substances pass from
the stomach down into the intestines, whence they are taken up by the
portal vein and brought to the liver. When the latter is in good
condition so much the better for us, but when they arrive in too large
quantities, or when the liver is more or less degenerated, as in old
people, drunkards, gourmands, etc., then trouble arises.

When the number of bacteria in the intestines is much greater than
usual, certain dangers arise from such a condition, as thereby the
immigration of bacilli into the bile-duct is facilitated causing
inflammation of the gall-ducts and gall-bladder, and subsequently
gall-stone disease. Further consequences of such a condition may be the
closure of the bile-duct, and then no bile can reach the intestines. The
presence of bile, however, is very important, for, according to current
opinion, this exerts an influence on the checking of putrefaction in the
intestines. Bile is a natural antiseptic of great efficacy, and has also
a stimulating effect on the nerves of the intestines, promoting their
peristaltic movements.

It would, therefore, greatly interfere with the useful work of those
organisms normally present if we permitted the formation of enormous
quantities of bacteria, especially of such as are harmful to us; so we
must endeavor to eliminate them and not give them the opportunity to
turn against us, and we must do all in our power to keep the peristalsis
of the bowels in good working order so as to prevent any stagnation of
their contents, as such a stagnation, in addition to favoring the growth
of bacteria, also facilitates the development of auto-intoxication. Even
if it is true that most of the end-products of proteid food in our
intestines, like indol and skatol, are not able to produce severe
poisoning if injected into other animals; still there is no doubt that
in medical practice not infrequently cases are observed where the
retention of all these products together results in very grave
conditions. Thus Ewald[212] has published the case of a woman who, for
about a month, retained the contents of the bowels and in consequence
presented a serious condition of intoxication; after eliminating a large
quantity of fæces—pitch dark—she recovered and the symptoms of
intoxication disappeared. Senator also published a very interesting case
of auto-intoxication with hydrothionuria.

Footnote 212:

  Ewald: “Die auto-intoxication,” Berl. klin. Wochenschr., No. 7-8,
  1900.

We often have occasion to note cases of persons having no bowel action
for two to three days, who then complain of headache, loss of appetite,
and various nervous symptoms, neurasthenia, etc., all of which may,
perhaps, be regarded as of reflex origin; but when we see in such people
a yellow or yellowish-gray complexion which, after a good purge, resumes
its clear condition, clinically, we regard it as auto-intoxication.

Even if, as already mentioned, most of the elements of albuminous
catabolism are not toxic if injected into animals, still, occasionally,
toxic products can be formed, such as cholin and neurin, which come from
the former. These elements arise from decomposition of the lecithin,
which, of our various foodstuffs, is contained in the greatest quantity
in eggs; and these substances can provoke serious nervous symptoms. In
such cases there is, of course, a stagnation of long duration of the
bowels, but such a condition as the latter can arise without a stricture
or obstruction, although these are the most frequent causes. Another
toxic product is the pepto-toxin of Brieger.

Stagnation takes place in sluggish bowels. As a general rule, fæcal
movement is caused by peristalsis of the intestines, which consists of
circular contractions of the bowel by which the contents are propelled
toward the end of the same; besides these movements there are also
pendular or vermicular contractions of certain parts of the intestines;
all these movements also assist the admixture of the chyme with the
juices of the intestines. All these contractions are caused by impulses
from the nerves which lie in the walls of the intestines, the plexus
myentericus; they can also be provoked by impulses coming from the
central nervous system.

The nerve ganglia that lie in the walls of the intestines can be
influenced mechanically by the contents of the intestines, when such are
bulky, and also when they are fermenting; therefore, the bacteria, by
promoting fermentation, also aid in peristalsis. The bulky condition of
the bowel contents can be best induced by food of the vegetable kingdom
through its cellulose contents, of which tissue the cells of plants or
fruits are largely formed. When these irritating agents act on the nerve
filaments in the intestines, the bowel will contract and expel its
contents.

But when food contains no irritating substances and is easily
assimilated without forming _residues_, or when the innervation by the
vagus is sluggish and the peristaltic movements are slow, the contents
of the intestines can remain longer, especially in the haustra of the
intestines. It may be that the bowels move every day, but that does not
prove that everything in the intestines has been expelled therefrom, for
some amount of fæces can yet remain in the haustra of the intestine even
for many days; so that in such cases there is still a constipation of
one part of the bowels. We have observed, personally, and on patients,
that, after a good opening of the bowels, when a purge is given—for
instance, directly after a meal—a short time afterward there has been
another copious discharge that had evidently remained behind. Thus, no
doubt a retention of fæces, and sometimes a condition analogous to
auto-intoxication, can be caused in people who have the bowels opened
every day, although not to the extent of those having obstruction or
habitual constipation.

To avoid such a condition a good purge should be taken at regular
intervals, say once a week, even by persons who have a movement daily,
in order to eliminate matter which may have remained. It will not be
necessary, naturally, to use a too powerful purgative, but one adapted
to the necessity of the case; taking, as a rule, such a purge as will
act a little better than the ordinary bowel movement, and graduated
according to the strength of the person so using it.

Before closing this chapter we must also briefly insist upon the
importance of the fact, that the secretions of the intestine and of its
glandular annexes have also an anti-bacterial and antitoxic action. Very
important is the rôle of the bile for the disinfection of the intestine,
as it contains two acids, the glycocholic and taurocholic, which possess
highly anti-fermentative properties. As already mentioned, the bile also
assists in the assimilation of fat, and also exercises a stimulating
action on the peristalsis of the intestines.


------------------------------------------------------------------------




                             CHAPTER XVIII.

       ON THE PREVENTION AND TREATMENT OF HABITUAL CONSTIPATION.


WE all know from physiology that the expulsion of fœcal matter from the
intestines takes place in such a manner that the contents therein act as
a kind of _extraneous_ body with stimulating action upon the walls of
the intestines and the plexus myentericus contained in the same.
Consequently there follows a contraction of the walls of the intestines,
and their contents are expelled. All nerves, the plexus myentericus
included, are under the control of the central nervous system, which
creates motor impulses through the medium of the pneumogastric (vagus),
or may cause a check to the peristaltic movements through the
intervention of the splanchnic nerves.

Thus, as we see, different agencies influencing the central nervous
system, like strong emotions, shock, etc., may cause an irritation of
the pneumogastric, the motor nerve of the intestines, and thus occasion
a movement of the bowels. Different toxic products may act also upon the
pneumogastric; strong motor action of the intestine with diarrhœa may
also be caused by the abundant secretion of the thyroid gland, as in
Graves’s disease, where an excess of toxic matters of the thyroid gland
are secreted.

In the same way we can also produce diarrhœa if we give thyroid extracts
in too abundant quantity; but giving the same in more moderate doses
will effect an improvement in the peristaltic movements.

That the thyroid gland has a controlling influence on the innervation of
the intestine is evident from the fact that, when the thyroid is
degenerated, the bowels are very sluggish. Under such conditions we
often find very stubborn constipation; but when we administer to such
persons thyroid extracts for a given time, we note a considerable
improvement of the bowels, which can even go to the extent, if too
excessive doses be given, of causing diarrhœa as already mentioned.

In addition to the thyroid gland, there are other ductless glands which
seem to influence the peristaltic movements by acting on the splanchnic
nerves, and these are the sexual glands. In women they are frequently
altered. Dysmenorrhœa, amenorrhœa, and other troubles are frequent, and
constipation is a typical symptom of such conditions. This may also
serve to explain why women are more often constipated than men.

But the alteration of the sexual glands can also cause constipation in
men, if we may draw the inference from the great frequency of
constipation in diseases of the prostate gland, which to some extent may
be in relation with the subject with which we are now dealing.

In order to avoid constipation we must therefore observe a careful
hygiene of the thyroid, and also of the sexual glands, following the
advice we offer in special Chapters XVIII and XLVIII.

Besides constipation, as above, from the central nervous system, the
same may be caused through the lack of a stimulation which may come from
the intestinal contents. As we have already seen, the peristaltic
movements of the intestine and the expulsion of fæcal matter take place
through the stimulation of the nerves in the intestinal walls by the
intestinal contents, which act either mechanically or by the irritation
which their fermentation causes.

To prevent constipation we must take such nourishment as will act in a
stimulating way, either mechanically, owing to its bulk, or by the
fermentation it causes. In order to have good bowel movements we must
create them, and this is best done, not by a diet of meat and finely
ground cereals, which are absorbed with scarcely any residue to effect
the purpose, but by one of vegetables and fruit, which contain cellulose
in the largest quantity, this substance forming the framework of the
structure in which the cells are imbedded; it constitutes the wall of
the cells. This cellulose provides us with the best residue from food,
which, if present in large quantities, will exercise a mechanically
stimulating action on the intestinal walls.

Vegetables are thus a valuable aid in the prevention of constipation,
and of these the following are the best: spinach, carrots, green beans,
and boiled lettuce, taking into consideration their action as laxative
food. Cabbage also acts well as a bulky food.

Graham bread and brown bread in general, and in particular a special
kind, called “cellulose” bread, are also very good agents with which to
prevent and to treat habitual constipation. Some breads, as various
kinds made from bran, are so coarse that, to a certain extent, they may
be considered as setting up a kind of internal massage of the
intestines.

Not only vegetables, but fruits, by reason of the fruit sugar and acids
they contain, may also prove laxative if taken in given quantities.
Fruits may be taken stewed, as a compote, or baked, as for instance,
apples; they may also be taken _au naturel_ if the condition of the
stomach permits. Of compotes the most laxative are plums, prunelles
(sour figs), and apples; also pineapples, cherries, and various berries,
all of which may also be partaken of in the form of a mush or purée, to
great advantage; also fruit juices and fruit wines, if free from
alcohol.

Of fresh fruits, grapes and, according to our observation, pineapples
also undoubtedly have the best laxative quality, as also have green
figs, which can be taken regularly as a preventive against constipation.
Figs when dried, especially the so-called Olympia figs from Smyrna, or
the California variety, are also most beneficial, their laxative
properties to a certain extent being probably due to the seeds which
they contain, which serve as a means for intestinal massage.

Orange and grape-fruit, taken on an empty stomach in the morning, may
also have a laxative effect, due probably to the quantity of fruit acids
they contain.

We sometimes hear patients complain of constipation after partaking of
milk. According to our experience, this is more often the case when
boiled milk, heated above 60° C., is taken. On the other hand, we
believe that when uncooked milk is taken it may act as a laxative in
many persons, due to the action of milk-sugar and acid. Acidulated milk
may have this property in a greater degree, as also may buttermilk, and
especially whey; all of these are, on the whole, good laxatives.

The diet of those suffering from habitual constipation should be as
follows: In the morning, on rising, take a glass of cold water and an
orange. For breakfast, one or two oranges or several slices of fresh
pineapple, or, in countries where one is so fortunate as to obtain such
delicious and wholesome fruit, a grape-fruit; after that one or two soft
boiled eggs, cereals, Graham or brown bread, or one of the kinds of
coarse breads rich in cellulose, and fresh butter thickly spread on the
bread (if the stomach is good). Then follow with orange marmalade or
purée of prunes, ending with some grapes. Honey (another excellent
laxative) may also be added. Two glasses of milk or more, for those who
can stand it; in fact, as much as they desire. For dinner, the following
is recommended: Roast or boiled meat, two sorts of green vegetables (by
preference spinach), French beans, carrots, boiled lettuce, one course
of stewed compote of fruit, and finish with dessert of grapes, figs
(dried or green), or preserved plums (California or Bordeaux). For
drink, mineral waters, such as the various light American kind, either
mixed with wine or alone. Alkaline waters, such as Biliner, Vichy, etc.,
if taken very cold, may also contribute to the laxative action. For
supper, something akin to breakfast. As we shall point out in the
chapter on the hygiene of food, we recommend meat only once a day.

We are confident, from experience gained with our own patients, that
people who follow such a regimen will have an easy bowel movement daily,
and will thus avoid those dangers which are connected with the habitual
use of laxative drugs.

For those who, in spite of such a course of diet, have sluggish bowels,
we recommend massage and electricity, and also certain hydrotherapeutic
procedures. The method of carrying out such must be obtained from the
special hand-books written for that purpose; but we would merely mention
here that massage should preferably be performed by one belonging to the
medical profession, or, at any rate, by one trained in the Swedish
system.

Electricity may be applied by either galvanic or faradic current, both
of which give excellent results.

Hydrotherapeutics must not be overdone or harm may result. We find that
a compress of lukewarm water (Pressnitz compress) worn round the abdomen
and back through the night, produces good results in many cases, if the
diet is, at the same time, appropriate.

For those who only suffer occasionally from constipation, as, for
instance, after a railway journey, it is an easy and always efficacious
method (if there is no inveterate constipation) to take a suppository of
glycerine and introduce it into the rectum. After only ten to fifteen
minutes interval there may be a copious evacuation.

In persons where the dietetic and above-mentioned mechanical remedies
have not proved effective, irrigation of the rectum and intestines
should be employed. We would not, however, advise the constant use of
this method, as torpidity of the intestine might result if practiced
daily (see chapter on the hygiene of the intestines).

In cases where there is a more serious degree of constipation a little
soap, or olive or castor oil, should be added to the water, together
with a little soda to assist the formation of an emulsion.

Enemata possess the advantage of having nothing to do with the stomach,
and thus this important organ can be spared much irritation which,
unfortunately, cannot be avoided when other purging remedies, such as
drugs, are given, all of which must pass through the stomach when taken
by the mouth. If we find it necessary to resort to laxative drugs by the
mouth we must first try such drugs as are least irritating to the
stomach and intestines, and foremost among these is rhubarb, which can
be taken in the form of a compote as well as a drug. To this it is well
to add magnesia and bicarbonate of soda. We should, if possible,
administer only the mildest purgatives, and, therefore, if rhubarb is
not effective, we may give cascara sagrada, or the pulp of tamarind,
which is, moreover, pleasant to take; but the action is not so
pronounced as in the case of cascara sagrada (rhamnus purshiana).

Before resorting to drugs, however, we think it would be better to try
the natural mineral waters, and only when these fail should we fall back
on drugs.

There are two kinds of mineral waters, each varying in its action: 1.
The milder acting water, of a laxative nature. 2. Stronger water, with
drastic action. Of the former we will mention those which are employed
for several weeks continuously for a regular cure: Germany: Kissingen;
Austria: Carlsbad; Marienbad. As the author of this book is himself a
practicing physician at one of these springs, he thinks it more becoming
to pass over in silence which of these waters is preferable. Each of
them, as also many others not mentioned for want of space, have their
undoubted merits. A teaspoonful of Sprudel salt, taken in a glass of
lukewarm water in the morning on an empty stomach, will give excellent
results; but it should not be taken every day for any length of time, as
otherwise, as with all other drugs if taken continuously, it may deaden
the excitability of the nerves of the intestines, and success depends
upon keeping these nerves in such a condition that they may respond,
upon a light stimulation, with a contraction of the intestinal walls and
expulsion of the fæcal matter.

Of the strong mineral waters with drastic action, there are several
excellent springs in America, some of them surpassing many of the
European mineral waters. In Europe there are in Hungary: Hunyadi-Janos,
Ferencz-Jozsefforrás, etc.; Spain: Rubinat, Villacabra-Loeches, etc.;
and elsewhere a number of such springs. As all are natural remedies they
should be used in preference to drugs when the intestine does not
respond to mild laxatives and a strong whip is needed. In my opinion
they are less fitted for every day treatment, though well adapted for a
thorough cleaning out of the intestine to get rid of stagnant matter
(see Chapter XIX).

These strong, drastic, natural waters act by causing a transudation into
the intestine, creating a condition somewhat similar to a catarrh, but
in a more benign way.

Briefly, the best and most rational treatment of sluggish bowels is by
stimulating the intestine by means of an appropriate diet which, at the
same time, tends to ward off old age.


------------------------------------------------------------------------




                              CHAPTER XIX.

                       HYGIENE OF THE INTESTINES.


AS the means by which we are able to keep the intestines in good working
order are of the same efficacy also for the stomach, all that is
necessary to mention in this chapter about the intestines will apply
equally to the hygiene of the stomach. The same applies also to the
pancreas, so that it is unnecessary to treat of its hygiene separately.
It is also our intention in this book to mention only the hygiene of
those organs which are able to rid the body of toxic products, as it is
mainly by their degeneration that premature old age is brought about.

There is scarcely a serious disorder of the stomach without an attendant
alteration of the intestinal functions. All the different agencies that
are dangerous to the stomach will also prove dangerous to the
intestines. We have mentioned several of these in the chapter on food
and the hygiene of eating, where we have pointed out that defective
mastication is very deleterious. Food introduced into the stomach passes
into the intestines, and if it reaches these insufficiently masticated
it will present great difficulties for the penetration of the intestinal
ferments. Not only will it not be well digested, but as the different
ferments cannot well penetrate these compact masses they will putrefy,
thus considerably increasing the natural fermentation, in consequence of
which a great amount of toxic products and a considerable irritation of
the intestinal mucous membrane will result, which may subsequently cause
disease. By thoroughly masticating everything we eat, we are not only
safeguarding the condition of the stomach, but also that of the
intestine.

The integrity of the functions of the intestines is of supreme
importance, for it is here that absorption and assimilation of most of
our food occurs. If our intestines are not in perfect order we shall
soon waste and dwindle away, even within a short period, and sometimes
very rapidly. Thus if we wish to retain our strength we must treat the
intestine with the greatest care. This is especially the case in old
age, for then an atrophy of the glandular mechanism of the digestive
tract, stomach, and intestines, takes place. Thus old people will not be
able to assimilate nourishment to the same extent as younger ones; they
will lose a portion of its nutritive value, and it will become more and
more difficult for them to completely digest their food. To such people,
therefore, it will be necessary to give food in a form that is easily
absorbed, preferably in liquid form; it would also be desirable to give
them their albuminous food in a predigested and soluble form. In
Germany, especially, are used a considerable number of so-called
“Nährpräparate,” a nutritive preparation which contains albumin in the
form of albumose, which naturally can be assimilated easier; there are
also carbohydrate preparations in which the starch is transformed into
dextrin or maltose. There is a legion of such preparations, but it would
lead us too far to enlarge on them by a longer description. They are
produced from proteids, many of them from fish, or from blood, or from
eggs; also from milk; while others consist of finely ground preparations
of wheat, oatmeal, barley, rice, arrowroot, sago, tapioca, buckwheat,
Indian corn, etc. As aged persons have greater difficulty in
assimilating in their intestines and stomach food in its natural state,
the use of the best of these predigested preparations would certainly be
advisable in order to insure a healthy condition of the intestines and a
prolongation of life. The last mentioned carbohydrate preparations
possess also the great advantage of preventing an excessive putrefaction
of the intestinal contents with its harmful consequences, which tendency
is always greater with albuminous food, starchy foods in large quantity
tending, as already stated, to produce acid fermentation in the
intestines by which many products of albuminous digestion can be
destroyed. Against these poisons formed in the intestinal tract we
possess a natural defense in certain ductless glands, the thyroid and
liver, which are degenerated in old people; therefore carbohydrate is
the best for them.

The prevention of intestinal putrefaction is, however, equally important
in younger people. As Combe proves, we can avoid this by the use of
certain kinds of food, especially carbohydrates and fruit, and by other
substances producing lactic acid, which is, indeed, the best
disinfectant for the intestines. The great benefit of various kinds of
sour milk generally has been pointed out by Metschnikoff and his
disciples. Among the causes of old age this savant attributes an
important rôle to the processes of putrefaction in the intestines, and
to avoid this he recommends the use of a certain kind of sour milk
produced by fermentation by a number of microbes, including the
Bulgarian _Bacillus maya_.

That certain kinds of food exercise poisonous effects when introduced
into the intestines is a matter of common observation. Thus, in not a
few cases, fever, accompanied by cutaneous eruption, may be witnessed
after partaking of strawberries or oysters, and especially after eating
meats (notably sausages) which are in a state of decomposition. Severe
cases of poisoning, even resulting in death, have occurred; and in
Germany there have been, from time to time, regular epidemics after
partaking of sausages in the above condition.

Of course everyone partaking of such poisonous food will not become
poisoned as this is prevented by the action of such glands as the
thyroid and liver, whose function it is to preserve us from such
effects. People in possession of healthy sensory organs,—eyes, nose, and
tongue,—will be enabled to tell whether meat is in a fit condition to be
eaten or not; but frequently we cannot discover by our senses a state of
decomposition when such is not in an advanced stage, and if such food is
taken regularly and in large quantities the great number of microbes we
thus introduce into the intestines will poison us slowly but surely.

Such poisonous microbes thrive and multiply very well in the alkaline
contents of the intestines, but the growth of such dangerous bacteria
can be greatly hindered by the introduction therein of acid substances,
especially lactic acid. It has been observed by several authorities,
such as Grundzach,[213] Schmitz,[214] and Singer,[215] that lactic acid
decreases intestinal putrefaction, and also the conjugated ether
sulphates in the urine.

Footnote 213:

  Grundzach: Zeitschrift für klin. Medicine, p. 79, 1893.

Footnote 214:

  Schmitz: Zeitschrift für Physiologische Chemie, vol. xix, 1897.

Footnote 215:

  Singer: Therapeutische Monatshafte, p. 441, 1901.

Professor Metschnikoff, of the Pasteur Institute in Paris, deserves
great credit for having insisted on the importance of introducing
certain microbes into the intestines for the purpose of transforming the
sugar of their carbohydrate contents into lactic acid, and thus causing
the disinfection of the intestines by destroying the noxious germs and
hindering their development. For this purpose the so-called Bulgarian
bacillus can best be employed, as it is able to transform the cultures
of pathologic microbes in the intestines into a beneficient growth that
is quite harmless.

This Bulgarian bacillus is well known because of its action in producing
the sour milk “yoghurt” of the Bulgarian population, to the use of
which, according to Metschnikoff, is due the very large number of
centenarians to be found in that country.

The action of the lactic bacilli has been proved by the experiments of
Dr. Herter, of New York,[216] who discovered that by the introduction of
large quantities of these bacilli into animals their intestinal
putrefaction was diminished.

Footnote 216:

  Herter: Brit. Med. Jour., p. 1898, Dec. 25, 1897.

Dr. Michel Cohendy[217] has performed similar experiments on himself.
After taking for twenty-five days his usual diet and subsequently noting
the degree of his intestinal putrefaction, he took pure cultures of a
lactic bacillus, extracted from “yoghurt.” For more than two months he
continued to take large quantities of these bacilli (280 to 350 grammes
a day). Not only during the course of the experiment did the urine
exhibit evidences of a diminution of intestinal putrefaction, but this
continued for seven weeks afterward, and he arrived at the conclusion
that the lactic acid fermentation due to this bacillus was able to
hinder the putrefying action of the microbes developed from the meat he
had taken during his experiments. He, therefore, comes to the conclusion
that it is unnecessary to discontinue meat food for the suppression of
intestinal intoxication if lactic bacilli be taken therewith.

Footnote 217:

  Cohendy: C. R. de la Société de Biologie, Mars 17, 1906.

Dr. Pochon, assistant to Professor Combe, of Lausanne, continued upon
himself the experiments of Dr. Cohendy. For several weeks he took sour
milk (lait caillé) which was prepared from cultures of pure lactic
microbes, and he found positive proofs of the checking of intestinal
putrefaction thereby.[218] In those, therefore, who are able to procure
and use a pure preparation of lactic bacilli, intestinal putrefaction
will be greatly diminished. But even when we cannot obtain these
preparations we can follow a diet that will tend to develop lactic acid
fermentation. This can be brought about by taking carbohydrates in large
quantities, especially those which are very rich in sugar, at the same
time taking milk, particularly sour milk.

Footnote 218:

  Combe: “L’Auto-intoxication intestinale,” Paris, 1906.

It is an absolute fact that in those who are addicted to a diet of
carbohydrates, intestinal putrefaction is diminished, owing to the
formation of lactic acid from the fermentation of the milk-sugar which
is contained in such carbohydrates.

Intestinal putrefaction is enhanced by the alkaline contents of the
intestines; it can, therefore, be checked by various agencies that
diminish the alkalinity of the intestine, such, for instance, as by
lactic acid, just referred to. Fatty and acetic acids also effect this;
likewise fatty food, which promotes the formation of fatty acids. Cheese
may produce fatty and also lactic acids; wherefore it is of value to
combat putrefaction in the intestines. Of the further benefits of cheese
as an article of food, we make mention in the chapter on the hygiene of
food; we also state there that it is unsuitable in those cases in which
the intestines are not in thorough order.

Great care should be exercised in the quality of the food. The freshness
of various foods is of the greatest importance to the intestines, since
the main function of the stomach is principally a mechanical one,
serving to reduce the food into a convenient form and carry it to the
intestines, ready to be there prepared, through the influence of the
intestinal juices, into a condition fit for absorption and assimilation.
During this process the food is being reduced to its simpler elements,
and the more noxious substances are being freed to commence their
baneful activity. These substances first of all create an inflamed
condition of the intestines; then, being absorbed into the blood, they
cause a general intoxication. Fortunately they are not frequently
absorbed, and thus their injurious effect is limited to the intestine.
Among other such injurious foods we may mention fish and oysters,
sausages and meats that are in a state of decomposition; fruit that is
unripe or unsound; and canned food in which certain drugs are used as
preservatives, such being poisonous in varying degree, examples being
salicylic boracic, and sulphuric acids, etc., and at times even the
terrible poison, verdigris. Fresh food should always be preferred to
canned food, or to food preserved in other forms for too long a period
(see also chapter on the hygiene of food).

The stomach, and intestines also, can frequently suffer damage from ice
cold drinks, especially if taken habitually and in large quantities. As
already mentioned in the chapter on the hygiene of the kidneys, we
should never forget that every sort of food or drink must pass a series
of delicate epithelia of our noblest organs, which can be injured by
sharp and poisonous substances with which they come in contact.

More injurious is the action of various kinds of noxious food,
especially if putrid, which remain for a long time in the intestines,
thus creating a chemical laboratory constantly preparing poisons. Even
the residue of less harmful foods, especially albuminous, even if of
good quality, when taken into the body, can become deleterious if it
remains too long in the intestines. It will, therefore, be a part of the
highest wisdom to exercise care in having these highly important organs,
on which all our nutrition depends, in thoroughly good working order by
keeping them clean and by removing stagnant material. We have already
designated the best way to effect this in a previous chapter, and we
desire here to say a few words on the abuse of, and great dangers
arising from, remedies constantly prescribed for constipation.

We have insisted in the foregoing pages on the necessity of a daily
bowel movement, and have stated that appropriate food is the best way to
attain this. Food that leaves no residue, like meat or finely ground
cereals, is incapable of producing a stool. Hence, as Schmidt has
pointed out, constipation is often caused by the food being too
completely absorbed. Strassberger, by analyzing and counting the number
of bacteria in the stools, found that certain cases of constipation were
caused by a diminished fermentation in the bowels. Lohrisch has found
that in persons whose intestines possess a marked power for absorption
there does not remain in them a residue sufficient for the action of the
bacteria, and thus there will not be a sufficient fermentation to act as
a stimulant to the intestinal walls to cause them to expel their
contents. Uncooked cold milk (especially buttermilk, whey, sour milk,
“yoghurt,” kefir, etc.), and dishes containing vegetables and fruit,
grapes, puree of prunes, marmalade of oranges, and brown bread (Graham,
Pumpernikel, etc.) should produce a movement of the bowels every day in
a normal man or woman. There are, however, many exceptions to this,
especially in the case of women, caused either by previous errors in
diet, or by negligence in answering at once the demands of the bowels
for an immediate evacuation, and also, very often, by an abuse of
purgatives. All this is, of course, aggravated in those in whom the
innervation of the bowels, which is controlled by the splanchnic nerves
and the vagus, is altered by the degenerative condition of certain
glands which influence these nerves: the sexual organs and the thyroid.

These alterations are far more common in women, as frequently mentioned
before, as their sexual glands and thyroid are so often irritated by
physiological and pathological processes peculiar to her sex, and which
so frequently recur during the life of a woman. It is a fact that most
of the diseases of the female sexual mechanism are followed by
alterations in the intestines, due, in part, to their close proximity to
the pelvic organs, but, in a greater degree, to the intimate relation of
these regions to the nerves that control the intestines. The same is
true to a lesser degree in man, so that after troubles with the
prostate, or after chronic gonorrhœa, a regulation of the bowels is an
important matter, constipation being usually very obstinate in such
cases.

In addition to this sluggishness of the bowels in females, owing to
anatomical and physiological causes, there may be associated faults
arising from a bad habit. Instead of paying special regard to the innate
tendency toward constipation and endeavoring to have a movement every
day, many women, especially young girls, neglect this by even resisting
the demand of the intestine to be evacuated, and deferring this most
important function to the following day, or even later. Such a course
necessarily lowers the vitality of the intestinal nerves and muscles. As
soon as such a nervous impulse is felt, we must promptly act on it;
should we not do so a greater nervous and muscular effort must follow,
and, if even then we neglect to obey the call of Nature, after several
such useless efforts the nerves and muscles of the intestines will
relax, particularly if such a foolish practice be often repeated, for it
is quite natural that such an intestine will not respond to the
stimulation by the pressure of its contents upon the nerves, and its
muscles will not contract to expel the fæcal contents, as in normal
people.

Unless, therefore, from force of circumstances, it is impossible, we
must at once respond to the first admonition of the intestines, and not
exhaust the vitality of its nerves and muscles by exposing them to
unnecessary efforts at our own expense. Some people are so impressed
with the importance of immediately answering such a call that they will
forego the most urgent business on that account. I know an authentic
case of a member in the profession—a great surgeon—who, a few years ago,
was urgently summoned to a member of the highest nobility who had met
with a hunting accident. Unfortunately for the patient the call came at
just such a moment as we have been speaking of; true to his principles,
he did not arrive immediately, but only after having fulfilled the
execution of this important part of the hygiene of his intestines, and
the patient lost his life.

Happily such an instance is of the rarest occurrence in our profession,
for we always ignore our own chance for a long life in favor of our
patient’s, which is fully proved by the fact that, of all professions,
the physician’s life is the shortest.

Corsets as worn by women contribute to develop in them ptosed
bowels—gastroptosis and enteroptosis—which can easily arise after
pregnancy; the strength of the intestinal muscles becomes still more
diminished and constipation is the consequence.

It is not to be wondered at if women, and men also, in cases where the
diet alone does not bring about an ordinary movement, should resort to
drugs, several of which we have mentioned previously. At first, even the
mildest drugs will act; but, unfortunately, after a time the intestine
becomes accustomed to them and they cease to act. Stronger drugs are
then resorted to, such as often contain aloes, which, besides injuring
the stomach, act in a very irritating way on the intestines; these
respond by a very strong action, causing copious stools accompanied by
colicky pains. But it is in the nature of things, as we have observed
holds true in any organ, that overstimulation of any function is
followed by its exhaustion; thus the nerves and muscles of the intestine
get over irritated and relax if obliged to overact. After a copious
evacuation caused by strong drugs we, therefore, find a still more
obstinate constipation than before. Stronger and stronger drugs are then
used until there is a complete breakdown and ruin of the intestinal
innervation and muscular action. We must, therefore, commence first with
a suitable diet, then use mild drugs if necessary, with massage and
electricity, as already described.

Intestinal enemata are also beneficial, but if a large amount of liquid
be used the muscular walls get too greatly dilated and may lose their
elasticity and vitality, particularly if strong drugs be used in such
enemas.

Many women suffer from habitual constipation by reason of their drinking
but little water, especially if the food they take contains little
fluid; the fæcal masses become solid and coagulated, and thus their
passage in the intestine toward the anal exit becomes more difficult,
whereas by a sufficient quantity of liquid, such as water, this movement
will be much facilitated; and that this is an important consideration is
quite evident in the case of women who have a tendency to lethargic
bowels. Such a thickening of the fæcal masses occurs particularly in
certain parts of the intestines, such as the cæcum, the ascending colon,
and the sigmoid flexure. In these parts the fæcal matters often become
detached, accumulate, and easily get condensed. They may remain there
sometimes for longer periods, which can easily be proved by experiments,
giving bismuth by mouth and then examining the abdomen by means of the
Roentgen rays.

It thus happens that people, under the impression that a good daily
stool has produced a clean bowel, still have a residue, and this can
instantly be seen by removing the same by purging drugs. We, therefore,
recommend the weekly use of a reliable purgative, such as bitter water,
thus cleaning the bowels of all residue, which frequently remains in
deep haustra of the intestines, as in Barlow’s disease.

The stagnation of fæces around the cæcum may also facilitate the
development of appendicitis, this being frequently due to neglect of the
hygiene of the intestines. It is also one of the commonest diseases, as
we will show in the succeeding chapter.


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                              CHAPTER XX.

 HYGIENE OF THE INTESTINES—A FEW REMARKS ON THE CAUSE AND PREVENTION OF
                             APPENDICITIS.


APPENDICITIS, in these days, is one of the most frequent causes of an
unexpected death. As this work is designed to set forth the means by
which we may prolong life, it is desirable not to miss the opportunity
of offering a few remarks, in connection with the chapters on the
preservation of the intestinal functions, upon the cause and prevention
of an intestinal disease by which particularly young and promising lives
are frequently cut off.

In the previous chapters we saw that the cæcum was one of the places of
selection for the stagnation of the fæcal contents in the intestinal
canal. As the pressure of such fæcal matter in the cæcum and colon is
greatest toward the appendix the contents may go more easily into than
away from the appendix, and particularly so when, from a long rest in
the cæcum, they are thickened. The return of fæcal matter from the
appendix is often hindered by a spindle-shaped thickening at the
junction of the appendix with the cæcum, which presents the appearance
of a narrow bridge.

This thickening of the mouth of the appendix is the consequence of the
very close contact of the psoas muscle, upon which, in many people, the
appendix lies, so to speak resting upon it. This has been shown by
Offerhaus[219] (a surgeon in the Hague Hospital) to be the case in 62
per cent. of normal men.

Footnote 219:

  Offerhaus: Proefschrift, “Eine mechanische oorzaak voorhet ontstaan
  van Appendicitis,” Leiden, 1901.

In certain movements, such as running or cycling, the psoas is
continually pressing against the appendix, and it is natural that such
continuous pressure against this organ will in time leave a permanent
mark, which is, indeed, seen in many cases of appendicitis. After a
certain time a circumscribed segmentation will be visible on the parts
of the appendix which are in contact with the psoas, and later this
becomes so marked that a circular kinking results, establishing the
narrow bridge to which we have already referred.

It is logical that the thicker the appendix, the more pronounced will be
the marks produced by the pressure of the psoas. The average size of the
appendix, even in the adult, is that of a somewhat slender worm, from
which is derived the name “vermiform appendix.” But when there is
stagnation of the fæcal contents in the appendix, and especially when
the thickened fæcal matters are of such hard consistency that a hard
stony concrement, such as the coprolith is formed, then the appendix
sometimes assumes quite a comparatively large size. We saw the case of a
girl of 16, operated on by Dr. Offerhaus at the Hague (details of which
case were published by him), in whom the appendix was of the size, in
circumference, of a large thumb.

In such large appendices the marks of the psoas will, of course, be more
pronounced, and frequently the narrow bridge referred to will develop.
This is caused by the appendix being further attached to the intestines
where, owing to the narrow connecting bridge, it is unable to evacuate
itself, and so grows larger and larger, the mischief thus constantly
increasing.

It is also evident that the nutrition of an organ whose blood-supply is
mechanically interfered with, as in the case of the appendix by its
close contact with the psoas, as described above, must necessarily be a
precarious one; and it is a pathological fact that an organ which is
badly supplied with blood is also more liable to disease, because the
insufficient supply of blood causes a diminution in the number of
phagocytes thereby weakening the defense of the organ against infection,
as explained in Chapters III and X. Consequently the microbes easily
prevail, particularly in a portion of the body like the intestines,
where they normally exist in such great numbers.

By the foregoing we have not only shown the cause, but also the
principles for a rational prevention, of appendicitis. As we have seen,
the starting point of all mischief is the close proximity of the psoas
to the appendix, and the occasional cause is constipation, with
stagnation of the fæcal contents. The best preventive against
appendicitis consists in avoiding both causes, which, however, is only
possible in the latter case by adopting all those measures we have
mentioned in the chapter on the treatment of constipation.

The first cause, the close contact of the psoas with the appendix, can
certainly not be prevented; but what we can do is to avoid all movements
by which the psoas is unduly pressed against the appendix. This can be
done by avoiding those exercises in which the psoas is brought into
frequent contraction and then pressed forcibly against the appendix: for
instance, running, cycling, etc. The young lady, already referred to,
with the large stone in the appendix, indulged freely in such sports.
The habit of sitting with one leg crossed over the other should also be
avoided.

We must now, however, determine who those persons are in whom such a
condition exists. They are those who frequently complain of pains in the
appendicular region, usually after quick walking or running, and
especially after cycling, and at times even without these; but in this
latter class the pain is milder. In order to make an exact diagnosis
whether such pains are caused by pressure of the psoas upon the
appendix, we must tell the patient to lift the right leg high and we
then press with the right hand against the thigh. If there is a latent
form of appendicitis due to the above-named anatomical relations, then
the patient will experience pain when we press with the left hand upon
McBurney’s point. By this means appendicitis can be diagnosed while it
is still in an early stage, and the life of many may be saved before it
is too late, and we know only too well how rapidly this treacherous
disease can lead to a premature death.

Having made the diagnosis in the above-mentioned way, we should prohibit
all active movements, especially running, cycling, etc., and take
special care to have a daily bowel movement by the use of a suitable
diet and those other means previously mentioned.

Pain in the appendicular region may be of a very pronounced character,
and yet there may be no appendicitis, for it may be caused by
inspissated fæces. The presence of stagnating fæcal matter often induces
the formation of gas, and by the distention so caused the intestinal
nerves are irritated and thus pain occasioned.

We can distinguish between appendicitis and pains following colics,
caused by flatulency, by giving carminatives, such as the decoction of
different carminative herbs called Aqua Carminativa Regia, which is much
used in Germany and Austria, where it is an official preparation of the
Pharmacopœia Austrica and Germanica. A few tablespoonfuls of this
decoction will produce free passage of gas, after which, in the case of
flatulent colic, the pain will disappear, especially if we add a
purgative and clear the intestines. Of course, in appendicitis the pain
will not disappear after the use of carminatives.

Besides the foregoing very frequent causes of appendicitis there are a
few others to deal with, all of which here is out of the question; our
intention is to confine ourselves to mentioning some of the more
frequent causes and not to deal exhaustively with the subject, which can
be found in the various hand-books on surgery. Yet we should like to
mention one cause that is not infrequent, and this deals with the
relation between the tonsils and the appendix. If we examine these
organs histologically, we shall find that both are of the same lymphoid
tissue, and, indeed, some writers go so far as to term the appendix the
tonsil of the intestine.

Now we can often observe that when one of the lymphoid structures is
changed, the others may follow; and this shows that just as the ductless
glands are in close relation to one another, so also the ductless glands
and the lymphoid structures stand in close mutual connection, as we have
mentioned in previous works, emphasizing the fact that the tonsils are
often much enlarged in myxœdema, Graves’s disease, acromegaly, diabetes,
etc.

In addition to these intimate relations there are also other causes
arising from the tonsils that affect the appendix. Such is the case when
the tonsils are inflamed and infectious matter arising therefrom reaches
the intestines. The cause of appendicitis from such a source has been
confirmed by the bacteriological examinations of Professors Lanz and
Tavel. Indeed, clinically, we can often see that appendicitis has been,
in quite a number of cases, the result of previous tonsillitis, this in
turn often being caused by the secretion from the inflamed posterior
part of the nose coming in contact with the tonsils, as has been
previously stated.

Very frequently such a condition exists in conjunction with adenoid
vegetations, and this explains the error into which Delcour has fallen
in his book on the relation of adenoid vegetations to appendicitis, in
which he attributes the immediate cause of the latter to a state induced
by an insufficiency of the thyroid gland. We can often observe that
adenoid vegetations can exist with a good thyroid and _vice versâ_,
although we cannot deny the fact that in children with thyroid
insufficiency adenoid vegetations are frequent.

It is very probable that the first mentioned causes of appendicitis and
the last named often go together, the one assisting and developing the
other. The unfavorable anatomical position and constipation, together,
offer a very favorable soil in which, through bacterial co-operation
after tonsillitis, influenza, or other infectious diseases, this much
dreaded disease can develop.

By a slight operation life is often saved. The pity is that such aid is
often invoked too late.


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                              CHAPTER XXI.

       ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE KIDNEYS.


IN the course of this work we have frequently insisted on the fact that
we are being continually poisoned during the processes of life, either
by poisons coming from without into our body through food or drink, or
by toxic substances being formed in our body through defective
metabolism. We have a series of glands with internal secretions which
have properties antagonistic to these poisons, the most important of
such glands being the thyroid, parathyroid glands, adrenals and the
liver, which act by destroying these injurious products.

The following can now happen: Either these toxic products may be
produced in such enormous quantities that even the increased functions
of these glands will be insufficient to overcome them, or the glands may
not be in a condition of complete integrity. In either of these cases
the bulk of these poisons will be carried to the eliminating organs to
be dealt with, viz.: the skin, the intestines, and the kidneys.

As we shall see, the skin alone is not able to eliminate more than a
certain portion of these products, even by the additional assistance of
perspiration. In addition to the skin the intestines may also assist the
work of the kidneys, by expelling principally the poisons from the
digestive organs. But only a small portion of the poison circulating in
the blood will be eliminated in this way, especially if there is a lazy
action of these organs. Thus the great bulk of all these products is
carried to the kidneys, which are, indeed, our most important organs for
the elimination of toxic products from the blood.

It is furthermore important to consider the kidneys because they are
also glands with internal secretion. This is evident from the fact that
uræmia is a condition which is dependent upon the absence of such a
secretion.[220] It is not caused only by the retention of urine and the
urea contained therein, for cases have been noted where there has been
no urine for as long a time as seven days, and yet there was no uræmia,
whereas uræmia rapidly develops at times in spite of an abundant flow of
urine and elimination of urea. Thus, logically, uræmia must be ascribed
to another factor, which can only be the absence of an internal
secretion from the kidneys, which may otherwise perfectly perform their
work. Another convincing proof of this statement is the fact that we are
able to treat with great effect, as we have personally observed,
diseased kidneys with extracts from the kidneys of pigs. We will
demonstrate the action of this in a separate chapter.

Footnote 220:

  Senator: Loc. cit., and others.

That the kidneys are glands with internal secretion has been proved
already by Brown-Séquard,[221] Meyer,[222] and other authors, among whom
we will mention as two of the last authorities on this question,
Professor Senator and Professor Hermann Strauss.

Footnote 221:

  Brown-Séquard: Archives de physiologie norm. et path., p. 778, 1893.

Footnote 222:

  Meyer: _Ibid._, p. 179, 1894.

The kidneys, being glands with internal secretion, must then stand in
close relation to the other ductless glands, according to the law
established by us in our previous works. As already mentioned, we have
shown in a communication to the Paris Biological Society, February 25,
1907, that these glands have an intimate relation to the thyroid gland,
and _vice versâ_. Thus, alterations of the thyroid always produce
changes in the condition of the kidneys. These alterations in the
kidneys may, however, not necessarily be based on the intimate relations
between thyroid and kidneys as ductless glands, but may be produced by
the fact that, when the thyroid is degenerated and cannot destroy toxic
products, these poisonous matters will be thrown on the kidneys (the
skin and intestines not being of assistance under such conditions) and
eliminated by them. Naturally the passage of such poisonous products
through the kidneys is liable to produce changes in them, and
albuminuria and hyaline or granular casts may show themselves in
consequence.

The same may also happen after changes in the liver. When this important
organ is not able to destroy poisons they are carried in increased
quantities to the kidneys, whence their passage will produce albuminuria
and hyaline and granular casts, as has been especially described by such
French authorities as Huchard, Teissier of Lyons, Molière and Gouget,
etc., as occurring in diseases of both liver and gall-ducts.

The appearance of albuminuria, and even of hyaline casts, must be taken
as a proof of an abnormal condition of the kidneys, and this
notwithstanding numerous authorities who are inclined to regard such an
occurrence in a more lenient way. We hold, with Professor Senator, that
the permanent presence of such elements in the urine is the proof of the
fact that the kidneys are not in a normal condition. Even the
orthostatic albuminuria of quite healthy persons, which, as its name
implies, only occurs when such persons have been standing for a time in
an upright position, has been considered by Senator as an expression of
the existence of certain changes in the kidneys. According to Senator,
the hyaline casts also are not such an innocuous symptom as certain
authorities claim, but they are formed from the degeneration of the
convoluted tubules. This is the most important element of the kidneys,
for the greater part of the solids and toxins are excreted by its cells
from the blood, and besides this function these epithelial cells also
have an internal secretion. The appearance, therefore, of hyaline casts
(which, as Senator found, could be proved under the microscope as having
been formed through degeneration of the epithelial cells) must be
considered as evidence of the loss of the secreting portion of the
kidneys and of the destruction of their most important elements, and can
be found regularly in all the toxic processes that take place in the
body, showing that the poisonous products of these processes have passed
through the kidneys and been eliminated.

Thus we find albuminuria and casts, and even signs of a serious
inflammation of the kidneys, in different infectious diseases, and even
after tonsillitis; also after other toxic conditions caused by the
secretion of toxic products in the body from certain ductless glands,
such as the sexual glands during puberty and the thyroid gland in
Graves’s disease. Likewise in certain diseases where waste products of
metabolism cause uric acid to be formed in large quantities, as also in
diabetes, where a quantity of other toxic products, besides uric acid,
are produced.

From the foregoing it is only natural to expect that different toxic
products which are introduced into the organism from without, either in
the food or in the drink, or which result from the decomposition of meat
and alcohol and other stimulants, will also, for the most part, be
eliminated by the kidneys, especially with a dilatory performance of the
other disintoxicating organs. When passing in large quantities, or
sometimes even in smaller numbers, they may be able to irritate the fine
epithelia of the tabula epithelia and also those of the glomeruli, and
produce casts (hyaline ones especially) and albuminuria. After large
quantities of alcohol such a condition can even become permanent if the
other toxin-secreting organs are sluggish.

In his experiments on animals Penzoldt has produced albuminuria by means
of English mustard, pepper, and particularly radishes, and still more so
after black tea. Gunzburg noted this also in a boy of 13, and Roth in a
child of 3½, in both cases after the use of black tea.

Albuminuria and casts can frequently be observed after the
administration of drugs in degrees varying according to the toxicity of
the drugs. We have published a case in which even epithelial cells of
the kidneys, single and in casts, as well as blood-casts in quantities,
have been found after an administration of chloride of potassium. Luttje
found casts in 33 cases out of 207, and in 92 of these albuminuria,
after the administration of salicylates, and he issues a warning against
their continual usage. That the same occurrence has also been observed
after the use of other poisonous drugs such as mercury, chloroform,
etc., will only appear to us as natural.

The skin and intestines, which co-operate continually with the kidneys,
are able to do a part of the work of the latter by eliminating poisons
which otherwise would have been carried to the kidneys, injuring the
delicate structures by which they are secreted and through which they
pass. As will be found in the chapter on the functions of the skin, this
tissue is able to eliminate (especially when its functions are
increased, as in cases of perspiration) a part of the harmful products,
among them being some of the nitrogenous end-products of metabolism, and
also common salt. But when the skin is unclean and its pores are clogged
by dirt and the products of perspiration, and when it is diseased, as in
skin diseases, or when it is burnt extensively and the sudorific glands
destroyed, then these poisonous products are directed to the kidneys,
whose secreting structure will naturally be injured by their passage.

The same may also happen after an obstruction or hindrance to the
intestinal functions. When the passage of fæcal matter is retarded for a
long time, a re-absorption of toxic matters can take place by the blood,
necessitating their elimination by the kidneys, with harmful
consequences to these important organs. This has been proved by
experiments made by Wallerstein, who mechanically closed the anus of
rabbits and dogs. After but twenty-four hours he found albuminuria and
different kinds of casts in the rabbits’, and casts only in the dogs’
urine. It is very important evidence in favor of our supposition that
the convoluted tubules of the kidneys play the most important part in
the excretion of harmful products from the blood, that Wallerstein
found, after four days, that the greatest change had occurred in the
convoluted tubules of the kidneys in these animals. The epithelial cells
of these tubules were greatly degenerated and in a state of coagulation
necrosis.

Similarly English[223] has found albuminuria and casts in cases of
strangulated hernia in men, in consequence of the stagnation of the
contents of the intestines and the re-absorption of toxic matters.
Similar results may also occur according to Leichtenstein, Senator,
Jaffé, etc., in cases of intussusception, incarceration, and similar
pathological conditions.

Footnote 223:

  Oesterr. Med. Jahrbuch, No. 2, 1884.

Thus we can all easily understand how the stagnation of the intestinal
contents, as, for instance, in chronic habitual constipation, may also
be injurious to the kidneys; and, indeed, Kobler and Huler have
described albuminuria as a consequence of constipation. Not only is the
elimination of excrementitious substances checked, but there is
re-absorption of poisonous products from the intestinal contents which
the kidneys must excrete.

That poisonous products coming from the intestinal tube are apt to
produce even serious changes in the kidneys has been proved by Heller
and Fishel after catarrhs of the stomach and intestines. At the same
time we will also mention that in cases of intestinal auto-intoxication
we can also observe a diminution in the quantity of urine, as noted by
several authors, of whom we specially mention Boas and Hemmeter.[224]

Footnote 224:

  Hemmeter: Loc. cit.

From the foregoing there can be no doubt that most of the toxic products
in the blood are eliminated by the kidneys. This is also the manner in
which the nitrogenous end-products of metabolism leave the body. The
kidneys act as a kind of filter for these products. When the kidneys,
however, are changed or degenerated by the formation of connective
tissue and loss of the elements of excretion, as in old age, then these
products will be retained in a greater or smaller number, and a
condition of auto-intoxication follows, to which we have previously
ascribed a great rôle in the pathology of old age. Logically, if we wish
to prevent old age coming on too soon, or a diminution of our chances
for a long life, we must do our best to prevent such a diseased
condition.


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                             CHAPTER XXII.

      HYGIENE OF THE KIDNEYS, AND THE PREVENTION OF RENAL DISEASE.


THE most rational hygiene of the kidneys for the prevention of kidney
diseases consists in the avoidance of all those causes which are
injurious to the kidneys, and which we have mentioned in the previous
chapter. A great part of the poisonous products that are eliminated by
the kidneys are introduced with the food and beverages, and it is
important for us to bear in mind the fact that what we eat or drink must
pass through our kidneys, and that the structure of these organs is
delicate; that the most important secreting parts are composed of fine
epithelium which can easily be desquamated by the passage of irritating
products. Thus we note the appearance of hyaline casts after different
kinds of spices and stimulating liquors, especially if taken in large
quantities.

There are many members of the profession who attach no importance to the
occasional appearance of a hyaline cast. But, considering the finding of
Professor Senator[225] that such casts are formed by degeneration of the
tubular epithelium, we cannot take such a lenient view; for even if we
find only one cast in two or three microscopic specimens, we must
realize how many thousands of these there may be in a liter of urine.
Thus every day thousands of these casts, and in a year enormous
quantities, may be lost. But as each cast means the loss of important
secreting elements, there can be no doubt that, after a certain time, we
shall have lost an important part of these most important organs, whose
place is taken by connective tissue. Thus the development of
interstitial nephritis can be hastened by faults in our alimentary
régime. In cases where meat is taken abundantly it is most probable that
the continual excretion from the blood of nitrogenous end-products of
metabolism means a serious overwork for the kidneys and grave damage to
their epithelium. And still more so if, owing to a diminished activity
of the liver due to senile degeneration, toxic products of a higher
toxicity than urea, and even uric acid, are passed.

Footnote 225:

  Senator: Loc. cit.

We have observed the great frequency of albuminuria and casts in the
urine of persons who were addicted for many years to a plentiful meat
diet. According to Dr. James Tyson,[226] who has been for many years
making accurate observations on diseases of the kidneys, and who has
published a standard work on them, interstitial nephritis can be
produced after the prolonged ingestion of much meat. If we wish to keep
our kidneys in the best condition, a lacto-vegetarian diet with only
little meat, once a day, is the most suitable. Still more than meat,
bouillon and meat gravies should be avoided, since they contain
irritating meat extracts.

Footnote 226:

  Tyson: A treatise on “Bright’s Disease and Diabetes,” second edition,
  London, 1904.

Milk diet in abundance is not only indicated in liver disease, but also
in chronic kidney troubles. But when there are coexisting changes in the
circulatory system, milk should not be given in large quantities, but in
smaller amounts. Milk has also the great advantage of being a strongly
diuretic substance, especially in its acidulated forms (yogurth or
kefyr, or simple sour milk); and at the same time it irritates the
kidneys very little, since it contains only a minute amount of common
salt.

According to Bunge, we take decidedly too much salt every day, and in
this way we injure our kidneys considerably. Achard,[227] Strauss,[228]
Vidal and Javal,[229] and simultaneously H. Strauss, have found that
diseased kidneys (especially in acute or chronic parenchymatous
inflammations) are unable to eliminate sodium chloride properly, and its
retention leads to œdema. According to these authorities, œdema is
caused by a retention of water and sodium chloride, the retention of the
latter playing the primary rôle, whereas according to Alexander Koranyi,
Richter, Kovesi, and Roth-Schulz, the retention of the water is the
primary factor.

Footnote 227:

  Achard: Presse méd., 1901.

Footnote 228:

  Strauss: “Die chronischen nierenentzundungen,” Berlin, 1902.

Footnote 229:

  Vidal et Javal: Soc. Méd. des Hôpitaux, Juil. 31, 1903.

For these reasons salt should only be taken in very small quantities.
Alcohol should also be avoided, except in small quantities, as being
very injurious to the kidneys; and considering that chronic nephritis
may be caused by the immoderate use of alcohol, Bunge thinks that the
chronic nephritis following large quantities of alcohol may be
attributed to the fact that, according to the researches of Keller,[230]
made in Bunge’s laboratory, the alcohol habit leads to an immoderate use
of salt with its deleterious effects upon the kidneys.

Footnote 230:

  Keller: Zeitschrift für Physiol. Chemie, vol. xiii, p. 130 and 134,
  1889.

According to Bunge, rice gives very little work to the kidneys, as in
twenty-four hours only 2 grammes of alkaline salts are eliminated. On
the other hand, potatoes cause a very great elimination of salt by the
kidneys. Bunge thinks that rice would be a good food for patients with
renal disease.

Not only alcohol, but other stimulants, like tea, can be of harm to the
kidneys if taken in large quantities, as we have mentioned in the
preceding chapter when speaking of black tea.

We do not think, however, that the daily use of black tea, in moderate
quantities, would have unfavorable effects on the kidneys. Its relation
to the production of uric acid should, however, be remembered (see
chapter on other stimulants: coffee, tea, tobacco, etc.).

For reasons already mentioned, irritating spices and adulterated sauces
should be very carefully avoided; also all kinds of food which contain
pungent ingredients. We have no doubt that by their use life is often
shortened. The passage of such poisonous substances for years through
our kidneys must injure their delicate structure and hasten the
development of the senile kidneys, with interstitial nephritis.

It is advisable to drink plenty of water, especially when much meat, or
the above-mentioned sauces, are eaten. By this means we can flush out of
our kidneys the end-products of proteid food, and also other toxic
substances. For the same reason it is well to use certain mineral waters
with diuretic properties. They should, however, not be taken at the same
moment as substances irritating to the kidneys are taken, or the kidneys
may be so injured that acute hæmorrhagic nephritis may ensue. We[231]
have published such a case, where even small quantities of chloride of
potassium taken on an empty stomach, together with Wildungen waters,
which have very diuretic properties, provoked a condition of acute
nephritis, with great quantities of blood clots, epithelial and granular
casts, many epithelial cells, and red and white blood-corpuscles in the
urine.

Footnote 231:

  Journal méd. de Bruxelles, 1903.

When taking various drugs, we must always remember that they must pass
through our kidneys. The drug habit, especially when irritating drugs
are taken, can have a ruinous effect on these vital organs and surely
diminish our prospects for a long life. Day by day many of the
epithelial cells will be desquamated, slowly but surely, and
inflammatory conditions of the kidneys will eventually appear. There is
nothing in this world without a cause, and if a chronic parenchymatous
or interstitial nephritis suddenly appear, it must have a pre-existing
cause. It is the result of our continual neglect and abuse of these most
important organs. As Prof. Friedlich Müller said a few years ago, the
kidneys never forget the wrong they once have suffered. Indeed, most of
the evil that befalls us in this world is our own fault, for doing
things we should not do and omitting those we should.

A frequent source of renal diseases is infectious diseases with the
passage of toxic products through the kidneys. This source of kidney
disease is often overlooked, the symptoms of acute nephritis being
mistaken for or confused with those of the infectious disease. Acute
nephritis after tonsillitis is often not diagnosed unless the symptoms
are very marked. In such cases occasional casts and epithelial cells,
with red and white blood-corpuscles, may remain for a long time in the
urine, sometimes permanently, and thus slowly and insidiously chronic
nephritis develops.

Tonsillitis is often caused by the dropping upon the tonsils of mucous
secretion from a post-nasal catarrh. This is commonly so in chronic
rhinitis caused by adenoid vegetations. The best prevention of renal
diseases in these cases is operation on the vegetations and treatment of
the rhinitis, rather than removal of the tonsils, which probably play a
great rôle in the defense of the organism against infections. This is
shown by the fact that they are inflamed in the early stages of many
infectious diseases.

The greatest care must be given to the condition of the skin and
intestines, if we wish to keep our kidneys in good order and prevent
their deterioration. We must try to eliminate through the skin and
intestines as many as possible of the toxic substances which otherwise
would make their way to the kidneys and increase their work, and perhaps
injure their epithelium. In this way we can save our kidneys for their
time of need.

Therefore, the skin and intestines should be kept in good working order.
We must do all we can to maintain the function of the skin, and in
several chapters of this book we have considered this question. We will
only mention briefly that the invisible perspiration of the skin should
be encouraged as much as possible. Damp and cold weather are apt to
suppress it. In such weather our skin also gives off too much warmth,
therefore we should be warmly clad, wool, especially for old persons,
being best. Still more important is this when the kidneys are already
damaged. For such persons a warn climate is advisable. By increasing the
perspiration to sweating, products which are harmful to the kidneys may
be eliminated. Hence such procedures will take work off the kidneys and
rid them of injurious substances. The sweating should be done
frequently, at least once a week, if we want to keep our kidneys in good
condition. For fuller particulars on the hygiene of the skin, and also
of the intestines, we refer to the chapters relative to these questions.


------------------------------------------------------------------------




                             CHAPTER XXIII.

         ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE SKIN.


THERE are some two and a half million small glandular formations—the
sudorific glands—on the whole surface of the body in the subcutaneous
tissue of the skin, from which issues a secretory tube somewhat of the
nature of a corkscrew to the external surface of the skin.

These glands are richly provided with blood-vessels, and a comparison
may be drawn, to a certain extent, between the glomerules of the kidneys
and these small glandular formations. The first receive certain
substances from the blood and give it off through the tubules which
carry away the urine, and the latter take both fluid and solid
substances from the blood and eliminate it in the form of sweat through
the excreting channels of the sudorific glands.

Gas can also be eliminated through the skin—carbonic acid—though in
infinitely smaller quantity than by the lungs, for while the latter
eliminate from 800 to 1200 grammes of carbonic acid, it has been shown
by the experiments of Aubert[232] that a human being eliminates through
the skin a maximum of 6.3 grammes and a minimum of 2.3 grammes in
twenty-four hours, which is certainly a very small quantity. Besides
carbonic acid the skin probably also eliminates other organic
combinations in the form of gas, though it would be very difficult to
analyze them by exact experiments. Pettenkoffer was able to demonstrate
from experiments, that, if many persons are in a confined place, it is
not carbonic acid alone that causes the very disagreeable sensation of
the foul air, but that it is a consequence of the accumulation of
harmful products of perspiration through the skin, the particular nature
of which has not been determined as yet.

Footnote 232:

  Aubert: Pflüger Archiv, vol. vi, p. 539, 1872.

On this account it is permissible to speak of a respiration through the
skin, although it has not yet been demonstrated by exact methods that
the skin is really absorbing small quantities of oxygen; and it is even
now not yet beyond doubt whether the small amount of carbonic acid may
not be ascribed, perhaps, to the decomposition of the excretions from
the skin, and of the epidermis that is shed, as stated by Prof.
Bunge.[233]

Footnote 233:

  Professor Bunge: Lehrbuch der Physiologie des Menschen, Leipzig, 1905.

But if it is not possible to prove the certainty of respiration through
the skin to a degree that would satisfy the postulates of exact science,
on the other hand the observations of ancient savants, whose chemical
knowledge and powers of observation were not inferior to those of their
present successors, in spite of a deficient education in chemistry, all
point to its existence, and we shall have to take it into account.

As a rule the various products of skin perspiration cannot be seen, as
they are eliminated in the form of vapor. This evaporation takes place
in this invisible form, however, only when it is not checked or when it
is not produced in excessive quantity. But when such evaporation is
hindered by clothing that is impermeable to such products, such as
rubber clothes or fur, or when it is too abundant, then it will be
eliminated in the form of water through the pores, and will appear in
drops. The human body loses from 1 to 1½ liters of this moisture, that
is to say, sweat, in a day.

Such checking of evaporation produces a very disagreeable feeling, a
fact that indicates the existence of skin respiration; as does also the
circumstance that persons clothed in a way that permits of the
circulation of air to the skin and the elimination of the products of
perspiration, and who also use other means for maintaining a good
hygiene of the skin, such as a bath, are always in better health than
those who neglect these points.

That the retention of various harmful products normally eliminated
through the skin is extremely injurious to health is best shown by the
fact that animals whose skin is varnished all over invariably succumb to
intoxication. Especially is this true in amphibia, who, as
Spallanzani[234] found, can live longer after the removal of the lungs
than after varnishing the whole skin. The cause of this is that in
amphibia the respiration by the skin is more important than that through
the lungs.

Footnote 234:

  Memorabilien traduits par Levebier, p. 77, Genève, 1863.

But even if, in higher animals, there is far more respiration through
the lungs than through the skin, the varnishing over of the skin on the
entire body can produce death in certain mammalia. This has also been
observed to have occurred in man. The day before the solemn entry into
Rome of Pope Leo XIII, a little boy was painted over his entire body
with gold leaf so as to represent an angel; but he suddenly died before
the procession began. We cannot, however, conceal the fact that the
death of higher animals, according to some authorities, is not due to
the retention of the products of perspiration, but rather to an
increased loss of warmth of the body, especially as these animals have
always been shaved prior to being varnished.

Still, for reasons we shall give later, we believe that this cannot
alter our views on the harmfulness of checking respiration through the
skin. The injurious action of this is also shown by the fact that
persons whose skin is burnt to a large extent, die, as a rule, by
intoxication. Certain opinions have been advanced which ascribe such a
death to a change in the constitution of the blood after extensive
burns. I am inclined to think that death may be due to the fact that the
skin respiration is, in such a case, more suppressed, as the body is
enveloped in bandages which, like sticking plaster, do not admit of air
circulation; and also because there is no elimination. At the same time
the other parts of the body are covered by the clothing instead of the
same being removed. If, however, after such burns the body be kept quite
naked and the air thus permitted a free circulation on all sides, then
even after the most extensive burns death will not follow, as we have
seen in several cases so treated by Dr. Sneve in St. Paul, Minn., whose
wards we inspected some years ago. Why should the changes in the blood
not induce death in these patients in the same way as it does in
patients swathed in bandages? Logically, this cannot be the reason for
death, but in all probability it is the suppression of the skin
respiration. But if death after extensive burns is due to this cause,
then the same may be given as the cause of death after varnishing the
body. The substances which are eliminated from the body through
perspiration are urea, uric acid (in small quantities only), common
salt, creatin, acetic acid, lactic acid, and a number of fatty acids.
Although exact science does not demonstrate that poisonous matters are
eliminated through perspiration, still some very noted men, like Ortner
and Goldscheider, are convinced of it. Arloing contends that the
perspiration of even a healthy man is toxic, whereas Queirolo admits
this to be so only in the case of sick persons.

We shall also be able to realize the great importance of the skin as an
eliminating organ for toxic products after a little consideration on the
origin of skin diseases, which we believe are due to two principal
causes: Firstly, the invasion of microbes into the skin after a
diminution of its resistance, which, in turn, is dependent upon the
condition of its nutrition by the blood. This is the external cause.
Secondly, by the elimination of toxic products which are formed in the
body and then pass through the skin. These may have originally been
introduced from the outside, either by food or by drugs, or they may
have been produced in the body through products arising from certain
glands, such as the thyroid, sexual glands, etc. The waste products of
metabolism, such as uric acid, may also be included in this category.
This is the internal cause of skin diseases. Both of these causes may
stand in relationship; thus the existence of the second may favor the
development of the first.

For the subject now under consideration the second cause is more
important, and we will say a few words on the matter as showing the
importance of the skin as an eliminating organ for toxic products.

We may frequently see persons who are affected by eruptions on the skin
after eating certain kinds of food, as oysters or strawberries; and
especially after eating oysters which have not been absolutely fresh. In
our own case, and in many others which we have observed, an eruption of
acne on the face has followed the eating of cheese. A similar state of
things may result from taking certain drugs; thus, after bromine or
iodine very often acne may be observed on the face. This interesting
fact we have experienced personally and have noted in patients who have
taken thyroid tablets in certain quantities, which also contain iodine.

If we examine acne eruptions we find in them certain microbes, such as
the bacillus of Unna, etc. In gout, which is caused by the retention of
uric acid, skin diseases are very frequent.

Sufferers from Graves’s disease, in which there is, as has been so often
mentioned, a hyperactivity of the thyroid gland, have very frequently
cutaneous eruptions, including acne, and often also a very irritating
pruritus. Also in diabetes, in which thyroid hyperactivity plays a
prominent rôle, it is not so much the sugar as the factor I have
referred to, which is the cause of the great frequency of skin diseases.
Here also a number of toxic products are eliminated through the skin.

In women, during menstruation, we often see cutaneous eruptions, as acne
or hives. The former is often very distressing in boys and girls in the
years of puberty, and it is quite impossible to deny that this may be a
symptom of a hyperactivity of the sexual glands. Thus, we often observe
acne in persons who are masturbating, or who for a long time live in
complete sexual abstinence, so that in certain places the laity term
these “pimples of chastity.” Here, again, married life is the best cure
for this disease, as it is for so many others.

It is very interesting to note during the question we are now discussing
that persons suffering from psoriasis feel relief from their affection
when they have had a good opening of the bowels, or when they perspire
freely; hence in hot summer weather they suffer less inconvenience than
in the winter; also by following a certain diet this disease may be
favorably influenced; that is to say, such persons have fewer psoriatic
patches when the toxic products are eliminated by the intestines or
kidneys. When there is a hyperactivity of the skin function, as in
perspiration, the toxic products are eliminated in the vapor or moisture
of the perspiration, but during a diminution of this function they form
the psoriatic patches.

When the skin function is increased, as in sweating, a number of
products that are otherwise eliminated through the urine pass through
the skin, which may eliminate a considerable part of the solid waste
products, and particularly a very important chemical product—common
salt. When the kidney is diseased the elimination of common salt and
other substances may become difficult, and thus still more injure the
kidneys; these products, and especially the common salt, will be
retained. Then comes the skin to the assistance of the kidneys. Not an
inconsiderable part of these substances may then pass through the skin
when it is in a condition of increased activity, in the form of sweat.
Thus the kidneys and skin work in harmony; they are companions, and may
be graphically called “Kidney and Co.,” the skin being the second
partner. The skin is thus one of our most important organs, and in the
following chapter we will deal with its hygiene.


------------------------------------------------------------------------




                             CHAPTER XXIV.

                   THE HYGIENE OF THE SKIN—AIR BATHS.


IN another part of this work we have attributed to the kidneys a very
important part in the causes of premature old age, as their degeneration
is one of the most striking causes of auto-intoxication, the immediate
cause of old age. The more injurious the products passing through the
kidneys, the quicker will these noble organs be degenerated and the
sooner will they decay.

It will thus be the wisest policy in the prevention of premature old age
and in the interests of a long life, to lighten the work of the kidneys,
and avoid their being overstrained by throwing a part of the work on
their partner—the skin. This organ, as stated at the close of the
preceding chapter, is, in a certain measure, a co-partner with the
kidneys. When, through cold weather, for instance, the functions of the
skin are diminished, a greater flow of liquid will pass through the
kidneys in the form of urine; but when the weather is hot and there is
perspiration, to a certain extent, less liquid will be secreted and
excreted by the kidneys: that is, they will work less. By perspiration,
also, more common salt will pass through the skin, and consequently less
through the kidneys.

It follows logically from these considerations that if we are anxious to
preserve the vitality of the kidneys and also free the blood from
noxious elements, we must pay special attention to a good action of the
skin, and this is only possible by a rational hygiene.

The sudorific glands are abundantly provided with small blood-vessels,
which bring a large quantity of warm blood to them, from which they
absorb watery and solid parts, and, in all probability, gaseous
substances also, and pass them through their tortuous excretory channels
to the surface of the skin. The mouths of these channels are the pores,
and it is of fundamental importance that they remain open; for if closed
these waste products cannot pass out and must remain in the body, while
in addition no air can pass into the pores, and so no exchange of
materials can take place.

These pores can easily be clogged; for example, by the
scales—cuticle—which we shed every day, mostly from the superficial
layers of the skin, and also by the oily secretion of the sebaceous
glands. The fat that these glands secrete is intended by Nature to serve
as a protection against liquids, like water, and against the
perspiration from the skin. In some persons this fat is secreted in too
large quantities and may then, especially with its products of
decomposition, clog the pores. In the same way the products of
perspiration, and also foreign materials, such as dust, may close the
pores. It will, therefore, be necessary to remove all these substances
which are preventing the proper aëration of the skin and the elimination
of harmful matters by it. It is also not impossible, when the products
of decomposition of the sweat remain long in close contact with the
skin, that some of those injurious elements may be re-absorbed.

The best method of getting rid of these harmful substances is by bathing
every day. But water alone, except it be very hot, and the bath of long
duration (and in this case it presents some inconvenience and may be
injurious also to health if taken daily), is not able to remove the oily
and fatty products of the skin. Therefore it is best to use soap in
addition to water, and to rub energetically with it the entire skin
surface of the body.

Besides removing, by a bath, the injurious products that clog the pores,
we must take particular care to allow air to penetrate to the pores as
freely as possible, thus permitting a free issue to the body exhalations
and facilitating respiration by the skin.

We should not, therefore, exclude the air by thick, non-porous clothing,
such as furs; nor should we use underwear that fits too closely to the
body. To permit of a thorough aëration of the skin it would be
advantageous to remain exposed naked to the air once or twice during
each twenty-four hours, and each time for at least five to ten minutes.
When the weather is warm and we bathe in the sea or a river, we combine
the advantages of a water and air bath. But in places where there is no
sea, lake, or river in which to bathe, we could, if living in the
country, enclose some spot for such an air bath which, in sunny weather,
would also become a sun bath at the same time. On the grass of a
clearing in a wood, or in a garden, such an air bath could best be
taken. In summer, if the air is not too warm, and if we are in the sun,
we may remain longer than ten minutes in such an air bath.

If we are not able to procure a place in which such a bath can be taken
quite naked without being seen, the next best thing is to clothe oneself
in amply large white pajamas, or, for women, in a very wide white mantle
or costume of the empire style, and thus attired to take a walk in the
garden or ground of one’s property.

In cities many can take such an air bath in one room every day when they
can spare ten minutes, the best time being before dressing and after
undressing. But also during the day, especially in summer, we should
spare a few moments to take such a bath. In winter the room must, of
course, be warmed for the purpose. In combination with the bath,
breathing exercises can also be performed to great advantage in the way
described in the chapter on the advantage of open air. In order to avoid
catching cold in such an air bath it is advisable to rub the entire skin
surface of the body. This causes much blood to be brought to the skin;
thus more blood is conveyed to the sudorific glands which are thereby
enabled to absorb a larger quantity of harmful matters from it, while at
the same time more air can be taken in by the pores. While rubbing—which
is best done by a brush—we can also move about, and while standing also
beat the periphery of the body with a thick rough towel in the same way
as in Finland they do with brushwood after hot baths. It is not painful
and is very effective in producing a hyperæmia of the surface of the
skin. When the skin is thus better nourished with blood it also offers
more resistance to germs that may cause diseases of the skin, and such
better nutrition and its improved hygienic condition is a safeguard
against catching cold.

Such an occurrence is more likely to occur in persons who neglect a
thorough cleansing of the body daily by baths and who go warmly clad; in
such cases the muscles which contract the pores are less active, and
because of this more body heat is lost and catching cold more easily
takes place. When we feel warm more blood circulates through the skin,
and when afterward cold air reaches us the pores, in a normal person,
contract quickly and the blood is retained in the interior of the body.
Thus we are prevented from giving off too much warmth from the body and
catching cold. Persons who have been trained since their early childhood
to cold water and cold air show a great facility for reaction against
cold. When cold air reaches the skin, which on account of warm
surroundings has become warm, filled with blood, red, and moist, the
skin will contract and become pale, the easy conduction of warmth will
be checked, and the heat retained in the body. Thus such persons will
not so easily catch cold as others whose skin is not kept in good
hygienic condition.

Many people have already shortened their existence by catching colds.
Pneumonia, pleurisy, nephritis, and many other dangerous ailments have
arisen from such a cause and led to premature death. A good hygiene of
the skin not only serves to eliminate toxic products from the body and
keep our kidneys in good order, but also prevents the tendency to
catching cold, which is so often the cause of an early death. We must,
therefore, do our best by a careful rational attention to the hygiene of
the skin, and for this purpose we will deal further with the subject in
two chapters on the hygiene of the skin by bathing and by rational
clothing.


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                              CHAPTER XXV.

                         ON RATIONAL CLOTHING.


THE chief object of rational clothing is to obtain porosity. All
underwear as well as outer coverings must be made out of some porous
substance which will in no way check the perspiration from the body or
the evaporation of such perspiration, and which will at the same time
allow of a free passage of air to all parts of the body.

First, we will discuss the question as to the nature of the underwear
which is most appropriate for keeping ourselves in a healthy condition.

Wool is the most suitable material for warmth for underclothing, as it
is a bad conductor of heat and can therefore best retain the natural
heat of the body. It follows, therefore, that this is the best for aged
persons to use.

In old age, especially when very advanced, less natural heat is produced
in the body. On account of the degenerative changes of the small
capillaries the surface of the body is not so well provided with the
heating element, which is the blood. At the same time, on account of the
loss in elasticity of the musculature, the skin of an aged person
contracts less readily from cold than does the skin of younger people;
thus, while on the one hand less warmth is produced, on the other hand
more warmth may be given off, a due consideration of which leads to the
logical conclusion that all aged persons had best wear woolen
underclothing.

Woolen underwear, though the best to retain the warmth of the body, has,
on the other hand, very serious drawbacks. Wool possesses the great
advantage of easily absorbing the perspiration of the body; it can, in
fact, absorb about 40 per cent. of the moisture, by weight, without
becoming so saturated as to be noticeable; but at the same time it gives
off this moisture again very slowly, necessitating the changing at once
of such damp covering.

The greatest drawback to wool, however, is that it soon loses its
porosity after it has been washed, for then it shrinks and its meshes
contract, and in consequence the material is no longer porous; while in
this condition it does not freely give off the moisture, but retains it,
the aëration of the skin is seriously hindered, and the products of
perspiration are not gotten rid of.

Everybody knows what a disagreeable feeling is produced by keeping on
such underwear after it has become dampened by perspiration, and this is
due to the prevention of the dissemination of the exhalations from the
body. Such disadvantages to the wearer of woolen underclothing may
possibly be discounted by making such underwear with large meshes; but
even in this case it is not easy to prevent the loss of porosity after
washing. It is therefore advisable to wear a large meshed linen garment
next the skin under the woolen underclothing; there will thus be a
cushion of air between the skin and the woolen garment; and linen also
has a great affinity for absorbing moisture and rapidly giving it off
again.

All kinds of underwear, whether of wool or other material, should be
loose about the body. It is a great mistake to have it too tight. There
should always be a considerable layer of air between the clothing and
the skin. This layer is warmed by the blood at the surface of the body,
and as air is a bad conductor of heat, even in the case of underwear not
so thick as wool, if such clothing is worn somewhat loosely about the
body and is porous, we shall not feel cold. The porosity of the tissue
permits the entrance of air, and such tissues, with air in their pores,
are abstracting a minimum of heat from the body, though such pores in
the tissue allow for the free passage and exit of the harmful
exhalations and evaporations from the body.

From the foregoing it follows that socks which do not fit too tightly
but fairly loosely, and which are made of porous material, such as good
wool, will also be the warmest. It is quite unnecessary to adopt heavy
double socks which fill up all the space in the shoes; as a matter of
fact in such a case we may have colder feet than if we wore light porous
good woolen socks that do not fit too tightly.

Linen possesses the great advantage that it easily absorbs moisture and
easily gives it off again, but as it is not such a bad conductor of heat
as wool, and freely gives off heat, it may most advantageously be
utilized in warm weather, and also in winter if worn under the other
woolen garments.

Linen is superior to wool in so far as the matter of cleaning it is
concerned, as it can be washed much more thoroughly than wool, which
easily retains dust and dirt. Linen is one of the most porous substances
for underwear.

Ramie is a material made from a tropical plant, the _Bæhmeria Nivea_,
and has lately come much into use. It readily absorbs the moisture from
the skin and does not retain it as long as does wool, but rapidly gives
it off again. It also does not abstract warmth so much as linen, and
next to wool is the warmest material for underwear. The drawbacks to it,
however, are that it is too heavy and does not last long. Silk underwear
also retains the warmth, and also very easily absorbs moisture; but it
is too expensive for ordinary use, and can readily be spoilt by
indifferent washing, unless the most expensive quality is used.

Of all the various materials for use as underwear possibly cotton has
the greatest average advantages. It gives off the moisture it has
absorbed from the skin, although not quite so efficaciously as does
linen. According to James Paton it absorbs moisture equally well as
linen; but Pettenkoffer is of a different opinion, as in his view cotton
does not absorb the moisture from the skin as readily as does linen.

The greatest advantage, however, of cotton over all other kinds of
material (except perhaps ramie) for underwear is its porosity. It is
about the most porous material there is, especially if in the course of
manufacture the maker takes particular care in selecting the very best
cotton; it does not shrink like wool, and therefore does not lose its
porosity in the same way when washed.

When cotton is so manufactured as to present the greatest possible
porosity, it has also the great advantage of being almost as warm as
wool, which is due to the fact that air can enter freely everywhere and
remain in the interstices of the material. It has already been mentioned
that air is a bad conductor of heat, so that cotton underwear of good
quality retains the warmth of the body and at the same time allows a
free exit for the exhalations of the skin. If, therefore, cotton be
prepared from the best possible material, and manufactured in such a
manner as to obtain the greatest amount of porosity, i.e., when it is
loosely woven, it can compete successfully with wool as material for
warm underwear; it is, therefore, quite an erroneous view to hold, as so
many do, that cotton is very different in this respect from wool;
everything depends upon the _quality_ and the manner in which it is
manufactured.

According to the researches of Sir William Thompson[235] there is
practically no difference between wool, cotton, and linen in regard to
their capacity as conductors of heat. Nevertheless we ourselves still
believe that in winter weather, or when there are cold northern winds,
wool is best, especially for the aged. This same holds good also for
those younger persons who catch cold easily.

Footnote 235:

  Sir William Thompson, in “Heat,” Encyclopædia Britannica.

In order to keep warm in winter it is, however, necessary that the
cotton material should be of a certain thickness, besides being of the
best quality and of the best make. As already mentioned it is of the
utmost importance that the underwear should not fit too closely around
the body, but that there should always be a layer of warm air between
the skin and the garment. Instead of the present custom of wearing
close-fitting trousers it would be much more beneficial to adopt the
very large loose linen trousers that are worn in certain countries, such
as Hungary. When once accustomed to such, and especially in the case of
the younger generation, they can readily be worn also in winter time.
Then, possibly, porous cotton can take the place of linen, although many
people may feel just as warm in porous linen underwear; or we could
possibly follow the example of an English gentleman who told me he never
wore any underdrawers at all.

In many European countries women, especially of the lower classes, wear
no undergarments on their legs at all. In healthy women such a custom
may be of great advantage, as it permits of the free passage of air and
the elimination of the perspiration from the skin, being in effect a
continuous free-air bath for the lower parts of the body.

It is not so necessary to keep the lower extremities, except the feet,
warm (provided that the feet are made warm by the constant motion of
their muscles), as we do not need to be so well protected there as on
the upper parts of the body; we also feel the cold less in these parts,
which we can all appreciate if we are in the habit of walking much and
not sitting about all day.

Before putting on clean underwear we must be careful to ascertain that
it has been thoroughly aired and is quite dry, for it happens in more
cases than one knows of that the linen arrives from the laundry quite
damp, although apparently it appears and feels dry. After having caught
cold each time I changed my linen, after having perspired, I had the
idea to put my vest over an electric lamp, and was surprised to see a
cloud of moisture arise from it. As moisture readily absorbs the warmth
of the body, we can therefore easily lose too much warmth and thus catch
cold. Before putting on clean linen it is also advisable to rub the body
with a brush (or rough towel) until the skin glows, and the linen itself
should of course be put into a hot-air cupboard or be aired before a
stove or fire, by which means many colds will be prevented; and these
precautions are particularly necessary in all cases after free
perspiration, in which latter case also a bath is very desirable before
putting on our clean linen. It is of primary importance to change
underwear every day, so as not to leave the products of perspiration on
the skin for several days (see chapters on the hygiene of the skin and
kidneys through perspiration).

We will now offer a few remarks on the subject of white linen. We should
not wear starched linen shirts, as they are less permeable to the air.
In lieu of these, porous linen shirts are advisable, or any other kind
of soft and porous material, without a starched front. The use of
starched shirts should be confined to dinner parties and social
functions.

The most absurd part of our linen outfit is unquestionably that
instrument of torture we wear as a yoke around our neck, preventing a
free circulation through our most important arteries and throttling one
of our most important organs—the thyroid gland. This we know as the
“starched collar,” without which we must not appear in decent society.
It is in any or all of its present shapes an unhealthy article of
clothing, but especially so when, from foolishness, it is worn standing
high up to the chin, keeping away the air from the neck and hindering
free circulation. Its bad effects upon the thyroid have already been
referred to in the chapter on the hygiene of the thyroid gland. It would
be more reasonable to wear a low collar, turned down, and of soft linen,
as worn by our forefathers. Women may have this privilege, but, sad to
say, they do not avail themselves of it, but instead, in many instances,
cover their necks, and even more than their neck, by impermeable
materials. Yet the neck is one of the parts of the human frame where
many sudorific glands are situated and where we perspire freely. These
parts especially should not be enclosed by clothing; neither should the
armpits and the toes of the feet, for here the sudorific glands of the
body are very numerous. Yet we wear the most impermeable materials, such
as leather, and often indeed thick leather, and _horribile dictu!_ even
rubbers, very often, on these important organs.

The outer garments should also be made, after careful consideration, to
afford the greatest amount of porosity. It would be the height of
hygienic triumph to wear clothes made to allow of the free inlet of
wholesome sunlight. Gray garments are, therefore, the best, and next to
this blue should be greatly preferred to dark colors.

The overcoat should never be too heavy nor too warm; as a general rule,
we should never wear clothes warmer than the temperature at the time
requires, always being guided by the thermometer and not by the
calendar. It is much better to be clad too lightly than too warmly, for
we thus avoid perspiring and thereby catching cold; or, in other words,
if clad simply lightly the likelihood of our taking cold is less than
when we are too warmly clothed, for then we also perspire less freely.
It may be that we shall more readily feel cold, but, fortunately, the
sensation of feeling cold does not imply catching cold. In fact, when
lightly clad we feel much more inclined to take brisk exercise. Then we
feel warm, and, as we shall show in the chapter on exercise, more blood
is sent to the periphery of the body and the general nutrition of the
skin is increased. Naturally, when we are lightly clad we do not sit
about without moving, but we endeavor to create a reaction in the skin
by brisk exercise. Englishmen, and especially Scotchmen, rarely wear an
overcoat, never sleep in a warmed room, and rarely ever catch cold,
which is certainly much more prevalent in countries with overheated
houses, as in America, and where the people are more accustomed to ride
in the street cars (also heated) than to walk.

Catching cold is best obviated by hardening the body against the
influence of cold, and this is best done by a continual aëration of the
skin, and by means of cold baths, commenced in a judicious manner. We
should become accustomed to permit the entrance of air as frequently as
possible to the whole surface of the body, which we can do by remaining
stark naked in our room for only a few moments several times a day, as
already advocated in the chapter on the hygiene of the skin. But still
more important is free access to the air, even though cold, if we desire
to be immune against colds. Most people who do catch cold contract it
first in the head, especially after being in a state of perspiration.

The frontal and temporal parts of the head are very well provided with
sudorific glands, and it is therefore most unreasonable to prevent free
air access by a warm covering. It is also unnecessary, because Nature
has already provided these parts with a natural covering, viz.: the
hair, which, with the skull, is intended for the adequate protection of
our most delicate organ, the special construction of which places us
above all other animal creation.

That young men with abundance of hair should wear heavy head coverings
is extremely unreasonable. It would be a far more healthy custom to go
without a hat, and thus preserve for a much longer period this natural
ornament to the head. At the same time we would perspire less in the
head and thus be less liable to take cold. By continuing this practice,
as is customary among the boys of a certain English school (The Blue
Coat School), the scalp of the head will become so much hardened against
climatic influences that we should be able to go out with uncovered head
even in cold weather. As, however, not all our neighbors and
acquaintance are keenly interested in the postulates of health and long
life they may laugh at first, but afterward they will themselves be
converted by the advantages of such a custom and will follow our
example.

Those whose scalp has become bald or only scantily covered with hair, by
excluding from the same too much air or by reason of disease, may not so
readily stand the effect of the cold, and for such a head gear may be
necessary, in which case the preference should be given to soft and very
light felt hats, and not to those made of hard material, which prevent
the circulation of the blood through the scalp and thus kill the roots
of the hair.

Those who are slaves to the prejudices of their short-sighted brethren
may wear their hat when in their company or in the streets, but by all
means take it off at other times, and especially when in the woods or in
the fields.

It is a singular anomaly that the English, who in many questions of
hygiene, as by conducting their sports in the open air, stand at the
head of all nations, yet obstinately stick to their tall hats and long
black coats in the warmest summer weather, sacrificing health and
comfort to social prejudices. How long will Bacon’s nation persist in
such a custom?[236]

Footnote 236:

  Latterly city men wear straw hats in summer and also the coachmen and
  servants of the upper class.

Other parts of the body richly provided with sudorific glands are the
feet. This must logically make it obligatory for all who wish strictly
to follow the rules of health and long life not to prevent the free
access of air by impermeable rubbers or heavy high boots. Leather, of
course, is not a porous material, like certain kinds of cloth, and
hinders the free passage of air and the evaporation from the surface of
the feet. The most suitable footwear, and that best adapted to the
demands of rational hygiene, would be sandals, similar to those worn by
the Greeks and the Romans. Such, however, could only, in present days,
be worn in villages, at the seaside, or in the country generally, if we
do not want to be criticized as queer or eccentric by our neighbors, who
have less knowledge of the hygienic methods of living.

It might be possible to make footwear in such a manner as to overcome
this feeling as to wearing them—of the nature of sandals, or part
sandals and part shoes—such as slippers or “pumps.” At any rate it is
advisable never to wear other footgear than half-shoes, and the author
of this work wears such even in winter time without inconvenience and
without feeling cold. The best half-shoes for summer wear would be those
made of canvas with leather soles. It goes without saying that one has
to get accustomed to this habit of wearing low shoes, by beginning in
warm weather and continuing uninterruptedly to the winter, and even
throughout that season, unless very severe weather prevails, when
gaiters should be worn above them.

If porous woolen socks of the best quality are worn in conjunction with
the half-shoes cold is not felt, especially if we do not remain still
but walk about briskly, which will practically convince us of the
necessity of walking and running for exercise.

Rubbers are unquestionably unhealthy things to wear, and to many will
cause a disagreeable sensation owing to the hindrance to foot
perspiration.

It is advisable to take off our shoes, as the Mohammedan does, as often
as possible during the day; for instance, while working or reading, and
at any time when we are in private, and only put them on again when
visitors are present. Everybody appreciates what an agreeable sensation
it is to take off one’s shoes and have a good airing of the feet,
especially after a long walk, in which latter case a foot-bath is also a
capital thing which will certainly increase our comfort, especially if
we have been wearing sandals or half-shoes and we have been wandering
about the country exposed to dust.

We have referred more fully to the use of the foot-bath in another
chapter. In the same way as with our footwear, we should reform our ways
by removing the yoke which cruel fashion obliges us to wear round our
necks—the high, stiff collar. How long shall we continue to put up with
these continuous impediments to our health? Top hats! tight collars!
tight boots with a pointed toe! and a fur coat over our dark clothes!
How can the sun and air penetrate such idiotic harness, and how can the
poisonous exhalations of the body find their way into the fresh air when
they are retarded by very heavy and warm woolen underwear? We must again
repeat that we catch cold much more easily when we are clad too warmly
than too lightly. The more freely we perspire in our clothes the more
easily we catch cold. We found this from personal experience. We were at
one time always catching cold, in consequence of too sedulously wrapping
ourself in woolen garments and heavy clothing. But since we have taken
to wearing linen or cotton underwear and light clothes, with half-shoes,
carrying our hat in the hand, and the overcoat rather on the arm than on
the body, we now rarely ever catch cold.

All of our garments should be loosely fitting, and in this respect the
American fashion for men’s clothing is superior to the European fashion
of tightly fitting garments. Also the present style of long, narrow
trousers is not only unæsthetic but also unhealthy and unsuitable for
quick movements. Let us go back to the knee-breeches of forefathers, who
were thereby made much more pleasing to the eyes—at least, those of
normal build were.

A sufficient aëration of the body is necessary not only by day, but by
night. In fact, it is more necessary at night, for as mentioned in the
chapter on sleep, the ridding of the body from toxic products is
performed more actively during the night. It will logically follow from
this consideration that heavy feather beds and, in fact, all kinds of
heavy coverlets are not beneficial to health, as they are apt to
suppress the exhalations of the body and to prevent the access of air to
the body. For the same reasons it is also imprudent to go to bed in
underwear, and particularly if woolen. I would even go so far as to
dispense with the use of the night-shirt, a garment which was quite
unknown to our ancestors until a few hundred years ago. By going to bed
quite nude, in a large bed, with ample bed clothes of a porous material
wrapped not too tightly about the body, we have thus a kind of air bath
in bed and feel more refreshed in the morning, especially after having
slept in a room where the air can enter freely. In cold weather in
winter a double woolen coverlet can be used.

It may be that in carrying out strictly the rules of a rational hygiene
of clothing as laid down above, many people may have to revolutionize
their old habits of an unhealthy and life-shortening way of living. But
the real question is: Do we want to live long and retain as long as
possible our youth that is passing away only too quickly in any case, or
do we want to descend into an early grave before our time? Those who
desire the first alternative and who wish to enjoy their lives up to the
very last may follow my advice; then they will soon be rewarded by
fresher looks and increased vital power.


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                             CHAPTER XXVI.

  IMPROVED HYGIENE OF THE SKIN AND KIDNEYS THROUGH BATHING—FOOT-BATHS.


EVERY day we are getting rid of the superficial layers of the skin,
which process can become so intense in some people that the skin looks
as though it were covered with flour dust; and in some persons with dry
skin such apparel as stockings sometimes gets full of this. These minute
scales, which get necrotised in the upper parts of the skin, are apt to
clog the pores, which can also become closed by particles of dust, or by
products of the sebaceous glands and by perspiratory residues. As the
free entrance of air to the pores is an essential condition for skin
respiration, and as the elimination of harmful products is only possible
when the pores remain open, we must get rid of the foreign matters which
clog them, for which purpose we take a bath. But water alone, even if it
be hot, is not able to effect a thorough cleansing of the skin on
account of the oily substance which is secreted by the sebaceous glands;
so, to obtain the fullest cleansing effects, we add the use of soap and
a brush, as already mentioned before. We must rub the soap well in, and
then rub it off energetically, if we desire to benefit by a fully
hygienic bath.

As we are daily getting rid of the above-mentioned skin scales, so it
behooves us to take a daily bath. It is not necessary to stay in the
bath more than ten to twelve minutes, or at the most fifteen. For the
reasons above mentioned the effect of bathing is a rational hygiene of
the skin.

By the action of the water, soap, and brush friction the skin receives
more blood, which is, at the same time, a great advantage to the
internal organs, as the blood drawn away from them facilitates the
circulation through them should they be congested. When more blood
reaches the skin the muscles that contract the pores are also better
nourished, and they then react better to certain agencies—cold, for
instance. They quickly contract the pores, so that the blood will be
kept back in the interior of the body and a cooling off of the periphery
of the body, with its dangerous consequences from catching cold, may
thus be avoided.

A daily bath can also be advantageous for those who perspire too freely.
After a bath, and this is one of its greatest advantages, the insensible
perspiration is much increased, and more water leaves the body through
the pores than before, and when a bath has been too hot, a very free
perspiration may ensue. But usually with people with a too free
perspiration, this tendency would be diminished, as it can often be
noted that those who daily take a lukewarm bath perspire less than
others on warm summer days.

Besides exciting the functions of the skin baths are also an excellent
means for diminishing a possible overwork of the kidneys, and thus
keeping them in good condition. It is possible to eliminate, through
bathing, such products by the skin which otherwise would have to be
eliminated through the kidneys.

It has recently been shown by experiments conducted by Strasser and
Blumenkranz[237] that baths taken for a long time and at a temperature
of 34-35°C., are able to create an increased elimination, not only of a
considerable quantity of water, but of common salt also, and of the
products of decomposition of nitrogenous matter.

Footnote 237:

  Strasser und Blumenkranz: “Die Wirkung indifferenter und
  schweisstresbender Bader bei Nephritis,” Med. klin., Beichfte Hefte 6,
  1907.

These authorities come to the conclusion that through bathing there can
be brought about a true increase not only of the water-secreting
activity of the kidneys, but also of their ability to eliminate
nitrogenous end-products and salt. They found an increase of diuresis to
double the usual amount and an increased elimination of from 50 to 100
per cent. of nitrogen, and from 100 to 200 per cent. of salt. According
to Liebermeister, Loewy, Rubner, and others, the processes of oxidation
can be increased by cold baths from 50 or 100 to 200 per cent., and by
hot baths, according to Winternitz and Rubner, 50 to 100 per cent.
Rubner also asserts that the processes of oxidation can be wonderfully
increased by cold douches.

There can thus be no doubt that baths are able to influence the
conditions of the kidneys in a very favorable way, and that their
vitality may be augmented by the daily use of the bath.

The drawback to the bath is that so many people easily catch cold
afterward; to prevent which, such persons should not wet the head, and
especially the back part of it, as otherwise catching cold is easily
effected; and it is also of importance that the bath-room should not be
left while the skin is hot. The best way is to allow cold water
gradually to enter the bath, getting out directly there is the least
sensation of cold. The rule should be not to leave the bath when the
skin is hot and red and the pores wide open, without letting cold water
contract them by taking a short douche, and on getting out of the bath
the skin should be quickly dried by energetic friction with a rough
towel until the skin becomes quite scarlet. Not sufficiently drying the
skin will cool it rapidly, and even intensely, owing to the evaporation
of the water from the periphery, and surely cause a severe cold.

To prevent the habit of catching cold the best way is to accustom the
skin to the action of cold water. Rubbing the skin with a cold wet towel
until the skin glows, especially the chest and extremities, is a good
way to effect this, beginning in warm summer weather and continuing
through the winter, but not _vice versa_. Decidedly the best
preventative to catching cold is to get the skin accustomed to fresh air
and cold water.

To prevent catching cold after a bath a reaction of the skin is
necessary, and this is best attained by a rough towel, as before
mentioned, and by rubbing the body with a hard brush. Massage is an
excellent addition to bathing, as by this means the circulation through
the skin and muscles is much increased, thereby increasing the oxidation
of the body. By kneading the muscles waste products are brought into the
lymphatics (see, also, chapters on exercise).

It is only logical that we must pay special attention to cleanliness in
those parts that have the greatest number of sudorific glands, such as
for example the axillæ and the toes of the feet. Circumstances often, as
when on a journey, do not allow of the luxury of a complete bath, and in
such cases we must be content to wash the body with water and soap, and
to rub down with a rough towel and brush, paying particular attention to
the axillæ and feet. These may also be bathed in alcohol and water, ½ to
⅓ of the latter, and also with vinegar and water; the feet can best be
cleansed in a foot-bath.

From ancient times, especially in the East, such foot-baths have been
largely used, probably for the reason that sandals were worn, which
allowed dust and dirt to accumulate on the feet; people whose feet
perspire freely should always use a foot-bath daily; and, because the
feet are a part of the body which are the worst aërated from being
covered with impermeable leather, while they are, at the same time, the
best provided with sudorific glands, a daily foot-bath is advised for
all.

When the feet perspire freely, hot water must be used; but after using
such we must immediately use cold water so that the opened pores will
close again. Pouring cold water into the bath or over the feet will
effect this, but it must be done quickly.

Foot-baths are excellent things for those who suffer from cold feet, and
what at first sight seems paradoxical, a cold foot-bath in particular,
which acts by enlivening the circulation in the feet; the bathing
should, however, only last about a couple of minutes. Cold baths for the
feet also act very beneficially in cases of headache, and especially in
insomnia. They act upon the distribution of blood in the brain; the
blood-vessels are thereby first distended and afterward they contract,
which, lasting for a certain time, induces sleep; for, as mentioned in
the chapter on sleep, the brain must be free from blood if sleep is to
result. In hot summer weather it is quite delightful to sit on the banks
of a river and allow our feet to dangle in the water, and we always feel
refreshed after it; walking with bare feet is also very pleasant and
healthy in summer time.

The action of a foot-bath is much increased by the addition of salt or
mustard, and with the latter is an excellent preventative against a
hyperæmic condition of the brain, such as apoplexy, as thereby we favor
a decreased congestion of this noble organ.

Cold foot-baths should not be used by very old people, as they distend
the brain-vessels which, as a rule, are altered in such people and may
more easily rupture; if taken, a wet, cold towel should be wound round
the head.

Cold baths generally are often beneficial in the case of certain nervous
troubles, such as neurasthenia and hysteria; only they must never be too
cold nor too prolonged, as otherwise the effects may be very depressing.
A short cold friction of the body every morning on rising is of great
advantage in the preservation of health. In kidney trouble we must,
however, be careful, as often an increase of albuminuria has been
observed after them. Sea baths are especially refreshing, owing to the
sodium content of the salt water. Our own observations teach us that a
bath had best be taken by first using water of the highest temperature
that can be borne (about 42 degrees C.). Those who can stand it might
continue to add hot water until the skin is quite red. Abundant
perspiration will then appear on the head, face, and neck. After having
perspired freely, we should then allow cold water to enter until the
bath has become cool. It usually takes some time to cool the water off
thus gradually, but after such a bath there is a feeling of great
exhilaration, especially after warm sea baths taken in this manner. We
consider that hot baths of long duration—say 30 to 45 minutes—are
especially useful in cases of kidney disease, or as a preventive of
such. We could take them twice a week as a means of eliminating the
toxic products of metabolism, but _it is an essential condition that the
heart and blood-vessels be in good condition_. The Japanese are in the
habit of taking such hot baths at an enormously high temperature, and
they feel the better for it.

Bathing generally is favorable not only to the kidneys, but to all the
organs, as the processes of oxidation are thereby promoted, and our
prospects for long youth and long life are bettered.


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                             CHAPTER XXVII.

       HYGIENE OF THE SKIN AND KIDNEYS BY MEANS OF PERSPIRATION.


UNDER normal conditions we daily lose a certain amount of water and also
of gaseous and solid products, among them many harmful ones, through the
invisible and insensible perspiration of the skin. That such a process
does actually take place is proved by our personal observation and by
the disagreeable feeling produced in cold and damp weather by the
checking of such perspiration. We can even be seriously affected if by
disease or by extensive burns a large portion of the skin be destroyed,
thus abolishing this insensible perspiration.

The invisible and insensible perspiration can become visible and
sensible when either its evaporation into the air is checked, as in the
case of tight-fitting clothing, such as a rubber overcoat, or when the
temperature of the medium around the body is raised. Both conditions can
be fulfilled by fur clothing, for which reason its use as wearing
apparel is to be deprecated.

When in a state of perspiration we should take special care that the
passage of the perspiratory products into the air shall not be impeded
by any means. Fur garments are not so unsuitable for old people in whom
the perspiratory functions of the skin are much diminished. We have, in
this connection, observed an old lady of 76 sitting at the dinner table,
close to an overheated fireplace, and wearing a large fur collarette, in
which she felt quite comfortable. As frequently mentioned in this book,
in old age there is a degeneration of the thyroid gland to a greater or
lesser degree, and consequently a lowering of the temperature of the
body and a diminution of the functions of the skin, which is dry and
rarely perspires.

When the temperature of the medium which surrounds the body is raised to
a high degree, the capillaries of the skin are widened and more blood
circulates through them; thus also more blood is conveyed to the
sudorific glands, and naturally more water is then excreted by them, and
at the same time also more of the solid and harmful products. According
to Camerer, the sweat contains in each 100 grammes 50.6 g. ashes, 10 g.
fat, and 10 g. nitrogenous matters, of which 30 per cent. is urea and 75
per cent. is ammonia. Uric acid was also found in the sweat of healthy
people, but Magnus-Levy found it missing in gouty patients. By frequent
sweating procedures the hygienic conditions of the skin can be promoted,
and especially so in individuals whose skin is generally dry and
inactive. In those who perspire much too freely, however, after several
procedures of this kind the overactivity of the sudorific glands can be
diminished. After very free perspiration the condition of the skin will
be improved, and then we will note the disappearance of certain skin
diseases, such as psoriasis in hot summer weather.

Habitual excessive perspiration can, however, impair the skin through
the elimination of harmful products, although the skin is, to a certain
extent, protected by the greasy matters secreted through the sebaceous
glands. Likewise we can also note the loss of hair in persons perspiring
very much about the head and more particularly in those parts where the
sudorific glands are situated, such as the forehead and temples. This is
most frequently observed in those who have dry hair, in whom accordingly
there is a diminution of the functions of the sebaceous glands. In
persons who wear fur caps and whose head is always covered, we most
frequently find bald heads, especially if they have a tendency to
perspiring about the head. For this reason it is also more reasonable
never to wear hats if we desire to retain as long as possible the
natural ornament of the head.

We can cause abundant perspiration by all the various means by which the
temperature of the body is raised. In such cases more blood comes to the
periphery of the body, and thus also to the sudorific glands. The
essential factor is the widening of the capillaries, and this can be
produced not only by agencies influencing the body from without, such as
hot air or a vapor bath, but also by agencies from within the body which
act on the vasomotor centers and thereby cause a widening of the
capillaries, such as certain drugs like salicylates, and also organic
preparations like thyroid extracts; mental emotion will also cause such
an occurrence. Salicylates are excellent drugs for producing abundant
perspiration, and are also less dangerous than pilocarpine. After the
use of the former and very free perspiration, we notice an improvement
in the symptoms of gout, for reasons we will give later.

Of the different baths which are used to induce perspiration we award
the preference to electric light baths, where we obtain a double
advantage, for we can unite the advantages of perspiration with those of
the influence of light upon the body. We are able to prepare such a bath
so that the chemically active rays (see chapter on the advantages of
sunshine) are obtained. Not only is a very abundant perspiration
produced (indeed sometimes about a liter of sweat can be removed from
the body in from twenty to twenty-two minutes), but also the processes
of oxidation can be augmented. As a consequence we often note a great
diminution of fat in persons with a superabundant accumulation of this
substance. When in such baths blue light is used and the blue rays are
acting in overwhelming quantity, the condition of the nervous system can
be influenced in a very favorable way, and especially can excited
conditions be calmed. It is also probable that by such sweating
procedures toxic products, which are deleterious to the nervous system,
can be removed. Perspiration can also be caused by bodily movement
through exercise. In such cases, as proved by physiological experiments,
impulses are sent to the vasomotor centers, which result in a widening
of the capillaries through the excitation of such centers. Thus sweating
is created by fast walking, running, and frequently also by horseback
riding, and by various kinds of sports, such as cycling. In all these
cases it is essential, however, to change the clothes and underwear
which we have worn when perspiring, and to take a bath; for the
possibility is not to be denied that a part of the toxic products which
adhere to the skin after such sweating exercises may be re-absorbed,
although we are not in a position to give exact experiments to prove
such a supposition.

Taking a bath and using soap and brush, and creating a friction until
there is a red reaction of the skin, may then prevent the danger of
catching cold, but after such a bath it is most important not to leave
with a hot, red skin and opened pores, but to cause their contraction by
a quick cold douche, continued at intervals until the skin is cooled and
the pores thereby contracted. An energetic friction of the skin must
follow before leaving the bathing place.

After such a bath we shall experience a sensation of great comfort, and
shall feel much lighter and fresher. Such baths should be taken
frequently, at least once a week, and if we are very desirous of keeping
a youthful appearance for a long time, even more frequently. In stout
people, however, it is necessary for such baths that the muscles of the
heart be not degenerated; and also that there should be no serious
affection of the heart valves or of the blood-vessels, if baths of a
very high temperature and lasting a considerable time are indulged in.

In cases of chronic intoxication and such like diseases of metabolism,
such as gout, and in cases of old age, perspiration induced by very hot
baths, providing the circulatory system is in good condition, should be
tried and given often if the results prove satisfactory, as we thus
obtain the benefit of the bath and also of the perspiration.

The sweat baths should not exceed 15 to 20 minutes in duration unless
they are well borne, when a few more minutes may be added. In old people
cold douches should not be resorted to, but directly after the bath they
should be put to bed, which should have been previously warmed by
hot-water bottles. In persons where the processes of oxidation are
diminished and the skin very inactive, as is the case with many aged
people, such baths give very excellent results.

Sweating improves the functions of the kidneys in a much greater degree
than those of the skin. By insensible perspiration water is eliminated,
together with certain harmful solid products which otherwise would make
their way through the kidneys; this occurs much more so when the
perspiration is greatly increased by sweating processes. In such cases
about a liter of water can pass through the skin daily, and in addition
a considerable part of the nitrogenous end-products of metabolism and of
common salt. It has been discovered by Professor Hermann Strauss[238]
that in a liter of sweat, under favorable circumstances, fully six
grammes of common salt can be removed from the body. Leube once found
2.31 grammes of chlorides in 800 grammes of sweat.

Footnote 238:

  Deutsche Med. Wochenschrift, p. 34, 1904.

Of nitrogenous bodies, according to Strauss, about 2 grammes can be
removed through the skin daily, and according to Professor von
Noorden[239] only 1 gramme. Leube discovered, about thirty years ago,
that the amount of nitrogen in the urine was 2 grammes less on such days
as sweating processes had been used than was usual on other occasions.
Kovesi and Roth-Schulz found 29 grammes of nitrogen and 29 grammes of
common salt in the sweat of patients suffering from Bright’s disease.
Strasser and Blumenkranz found, after electric light baths, a
considerable increase in the elimination of common salt up to 18
grammes, 4 grammes more than had been ingested. Nitrogenous bodies have
also been eliminated in larger quantities than have been introduced, as
has also more water. This has been proved in experiments on the effects
of bathing, in which people with diseased kidneys have been used as the
subjects. In these cases the elimination of common salt and nitrogenous
products is certainly greater than in normal individuals. Still there
can be no doubt that with such, by perspiration and bathing, an
increased elimination of these products can be obtained.

Footnote 239:

  v. Noorden: Pathologie des Stoffwechsel, vol. i, 1906.

The experiments of Roth-Schulz and Kovesi are most interesting. These
authorities discovered, and before them H. Strauss, that the sudorific
glands of nephritic patients when in increased activity can secrete a
liquid that is more concentrated than the blood. Thus a compensatory
action can be obtained. They hold that, through sweating, from 10 to 20
per cent. of the solids in the urine can be eliminated through the skin.

It is also most important that they discovered a reduction in the
molecular concentration of the blood, which, as we know, is increased in
nephritic conditions. The frequency of sweating processes for persons
suffering from affections of the kidneys is all the more indicated
because such persons, generally, have a pale and very dry skin, the
temperature of which is, as a rule, diminished.

To this great amelioration of the kidney functions by perspiration is
also due the fact that gouty patients are much relieved after frequent
sweatings. As already mentioned we attribute gout to an alteration of
the tissues of the kidneys, by which uric acid is retained. By diverting
the end-products of the nitrogenous bodies to the skin and relieving the
kidneys of a part of this strain, we may also improve their condition
and thereby the gouty element. At the same time, in consequence of these
procedures, the excretion of urine has much increased; and this has been
going on for several days, not only after the bath, but after the
sweating. By such an increased diuresis the condition of gout can also
be much improved, as everything that improves the kidneys improves that.

From the observations of Haig, the elimination of uric acid is rendered
more difficult by reason of the presence of common salt; the increased
elimination, therefore, through the skin must necessarily be more
advantageous in the case of gouty people.

There can be no doubt that sweating processes are of great benefit, not
only to the kidneys, but also to the other organs, such as the liver.

We also generally observe perspiration in all processes of infection or
intoxication, and it may therefore be regarded as a probable species of
self-defense of the human body against the attacks of microbes or other
toxic products, for it would seem that by this means nature desires
spontaneously to get rid of the various toxic matters. Indeed, when we
treat fever with salicylates we are assisting nature to this end, for we
thus create perspiration. As already mentioned in Chapter III, persons
with a dry skin, who perspire but rarely, have less protection from
infectious diseases than others. Thus everything supports the theory
that the various toxic products, including those from microbes, are
eliminated by perspiration. Many years ago we tried to find microbes in
the sweat of typhoid fever patients in the St. Pierre Hospital in
Brussels, but as has been found in the bacteriological laboratory of the
Institute Solvay, the cultures that formed were due to a pollution of
the perspiratory products with foreign microbes. The efforts of other
authorities have also failed up to now to discover, by exact research,
the presence of microbes in sweat, as expressive of their elimination
through sweating. But, even if not supported by exact evidence, we feel
inclined to believe that by perspiration in abundance a number of toxins
of bacterial origin can be eliminated from the blood, because in
feverish ailments, after great perspiration, as in the case of
pneumonia, a great improvement takes place in the condition of the
patient. In former times bleeding gave similar results, perhaps in a
greater degree; but in the present day sweating has superseded this.

To the hygiene of the skin through bathing we would wish to add, before
concluding this chapter, that carbonic acid baths may also give good
results, as they cause a better circulation of the blood through the
skin, which gets red. Such baths are also excellent preventatives
against arteriosclerosis.


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                            CHAPTER XXVIII.

 ON EXERCISE, SWEDISH GYMNASTICS—MASSAGE—SPORT, AND WALKING AND RUNNING
                               EXERCISE.


ALL kinds of exercise have one essential point to them—they produce a
contraction of the muscles. As Ludwig and his disciples have shown,
contraction of the muscles produces an increased supply of blood in
them; more arterial blood being brought to the muscles, more oxygen and
heat is generated through them, which results in a general increase of
the process of oxidation.

When muscles are undergoing contraction impulses are conveyed to the
splanchnic nerves, which are the regulators of the vasomotor system.
Through the irritation of these nerves, the blood-vessels of the
internal organs supplied by the splanchnics contract, and more blood is
despatched to the periphery of the body. The capillaries of the skin
will be dilated, and more blood will also be brought to the sudorific
glands; these also excrete more water, which takes the form of sweat.
Thus, by exercise that causes some exertion, abundant perspiration
follows, by which means we can obtain the advantages we have mentioned
in the chapter on the hygiene of the skin and kidneys; and it is for
this reason also that we place this chapter on exercise immediately
after the above-named one.

The essential point in these exercises is that a great part of the
circulating blood will be brought to the periphery of the body, and thus
the congestion of the internal organs will be prevented or relieved.
Among these organs the kidneys will be benefited, but only in a
preventive sense, for in inflammatory conditions of the kidneys,
especially in the parenchymatous forms, all kinds of exercise should be
avoided. Besides the kidneys and other organs, the heart also may
benefit by exercise if such be taken in moderation. The greatest
benefit, especially for those with a diseased heart, will follow
exercises carried out in the form of Swedish gymnastics.

The originator of the Swedish gymnastic movements was Peter Ling, who
gained great credit for himself and his country by the invention of this
system, which has prolonged the life of many persons suffering from
chronic ailments. In the Royal Central Institute for Gymnastics in
Stockholm, and also in private schools in that city, many experts have
been trained in these methods, and from thence they have spread all over
the world, many coming to the United States, where Dr. S. Weir Mitchell
introduced these salutary systems, and also massage.

Massage was known thousands of years before Ling’s time, notably in
India, Java, and other countries of the Malayan race. Even the great
Harvey knew the effects of massage, for he quotes the case of a man who,
in consequence of an insult which he could not avenge, became so
overcome with passion and rage that he fell into a strange
disorder—suffering from extreme compression and pain in the heart and
chest, from which he only eventually received some relief when his chest
was pummeled by a powerful man—just as a baker kneads dough.[240]

Footnote 240:

  Quoted after Sir Lauder Brunton, Harveyan Oration.

The essential thing in massage is the kneading of the muscles. We thus
artificially increase the flow of the blood in them through the local
irritation of the skin and the mechanical diffusion of the blood in the
direction of the muscle. We thus produce artificial hyperæmia, not
unlike the effects of a mustard plaster, and, in the same way as the
plaster, we are also drawing blood from the congested organs, and
especially from the engorged heart; thus we obtain a better distribution
of the blood throughout the body and facilitate the action of the heart.

It has been shown by the experiments of Sir Lauder Brunton and
Tunnicliffe that kneading the muscles increases circulation through them
in the same manner as massage. They found that during such kneading the
amount of venous blood which issued from them was sometimes diminished
and sometimes increased; that just after the kneading was over the flow
diminished (apparently from the blood accumulating in the muscles), and
this diminution was again succeeded by a greatly increased flow. The
clinical results are precisely what one would expect from increased
circulation in the muscles, and cases apparently hopeless sometimes
recover most wonderfully under this treatment.

By means of massage the functions of the heart can thus be facilitated,
for massage mechanically diminishes the resistance of small capillaries
to the oncoming blood-waves sent from the heart. It mechanically
quickens the circulation of the blood through the capillaries by
dilating them in a way similar to exercise (see, also, Chapter XVIII).

By certain massage movements applied to the exterior region of the
heart—such as vibratory massage—this organ can also be favorably
influenced; and by kneading, friction, and massage together applied to
the periphery of the body, and by passive movements of the extremities,
many cases of heart disease have been treated with good results, and
premature death prevented. Still more thorough is the effect of such
treatment if carbonic acid baths are used in connection with the above,
as at Nauheim, for such baths stimulate the skin, which becomes better
provided with blood. We have referred to the effect of such baths in a
previous chapter on the hygiene of the skin and kidneys by means of
bathing.

The Nauheim treatment affords good results in mild cases of
arteriosclerosis, dilatation of the heart, and various other forms of
heart disease.

Massage is also an excellent thing in chronic diseases of metabolism, as
it helps the resorption of waste products and augments the processes of
oxidation; in cases of gout, obesity, and also diabetes, it can
therefore give very good results.

In the case also of healthy people who can afford to be massaged daily,
vital functions can be rendered more active and youthfulness prolonged;
and for those who do not possess facilities for being massaged by
others, they can perform it themselves by friction, rubbing the body at
rising and just before going to bed.

The Swedish movements can also be performed not only by free gymnastics,
but also by the use of mechanical apparatus, such as that invented by
Dr. Zander of Stockholm. These movements, combined with massage, also
give good results in many of the above-mentioned ailments, but it would
lead us too far to enlarge upon them here.

Much more strenuous for the body than Swedish movements and massage are
the exercises of sports, a complete description of which would exceed
the limits of the present work; but whether it be football, tennis,
golf, athletics, or cycling, the great object in all is to easily create
perspiration, by which the benefits described in the chapter on hygiene
of the skin and kidneys are obtained. It goes without saying, that a
diseased state of the kidneys excludes all kinds of violent exercise
which require a severe bodily movement. By means of sport the processes
of oxidation are also rendered more active, and thus obesity can be
prevented and cured, and at the same time the waste products are more
thoroughly consumed. Neurasthenic conditions, insomnia, etc., may be
improved if the sport adopted does not lead to too great fatigue;
otherwise they may be made worse. Taking into consideration, however,
the conditions of the circulatory mechanism, sport is a two-edged sword.
If undertaken in moderation all sport can improve our physical
condition; but it may prove disastrous if reason be not exercised and it
is indulged in to excess. By the strong muscular exertions referred to
an irritation of the splanchnic nerves takes place, resulting in a high
blood-pressure; more blood will pass with greater vigor through the
arteries and capillaries, which, consequently, become dilated. If this
occurs too frequently they will, as is only natural, lose their
elasticity, in which case degeneration of the arteries and development
of arteriosclerosis may follow.

When a succession of severe muscular exertions takes place an
accumulation of blood occurs in the right side of the heart, and, as the
right ventricle cannot empty itself, shortness of breath, and even
death, may result. The left ventricle then becomes dilated, and such
dilatation of the heart not infrequently persists for a long time, even
in persons who have been in good health before undertaking severe
exercises. If, therefore, the normally healthy may suffer from an
irrational indulgence in sport, how much more fatal must be the results
to those with heart or kidney complaints, and with degenerative
conditions of the blood-vessels?

To persons of advanced age sport may be very pernicious, for here the
elasticity of the arteries is wanting; they are more rigid, and
consequently cannot so readily dilate. Overexertion in such cases may
lead to the gravest results.

As those engaged in sport lose a large quantity of fluid, they soon feel
thirsty, and so may be inclined to make up the deficiency of water in
the blood by partaking of alcoholic beverages, such as beer, whisky, or
wine; and if such are taken in large quantities, necessarily further
dilatation of the heart and blood-vessels will result, as is usual from
the frequent use of large quantities of liquids, not taking into account
the mischief caused to the various organs by the alcohol. As a general
form of exercise sport in moderation can be beneficial to the heart.
Naunyn has shown that blood-pressure falls from continuous exercise, and
Masey has also demonstrated this on galloping horses. The best form of
exercise is walking or moderate climbing. Moritz has shown that after
exercise the volume of the heart is diminished, and the rate of the
pulse increased.

There are certain sports which do not require great bodily exertion, and
these are, in consequence, less harmful to the heart. Take, for example,
horseback riding, which produces a more or less accentuated rhythmic
shaking movement of the body. In a particular style of riding called
“the English trot,” the body rises and falls at regular intervals, which
causes—as we noted in our own person—free perspiration; the circulation,
especially in the abdominal organs and lower extremities, is also
promoted. We consider riding to be one of the most beneficial kinds of
exercise. We frequently note the healthy appearance of horseback riders
(except jockeys, who are underfed in their training). A well-known
member of the medical faculty in Berlin, a world-renowned specialist,
was a great horseman. He took part in the last Medical Congress in
Dresden, coming on horseback through the pouring rain from Berlin.
Possibly his good health was due to the vigorous exercise of which he
was so fond. By a strange irony of fate, this enthusiastic admirer of
riding died in consequence of an accident caused by his automobile a
short time ago.

In certain kinds of sport, such as riding and cycling, the greater
possibility of accidents is a drawback, and in nervous individuals
serious traumatic neurosis, and often diabetes, may sometimes develop,
particularly in those cases where such people are descended from
diabetic parents. We published a case of this kind some years ago. For
such people this kind of exercise should be prohibited, especially in
those descended from diabetic parents. Cycling has the additional
drawback, according to Zunz, that from it fatigue is not so soon felt,
and thus overindulgence may more easily occur.

Less injurious than sport, and much easier to be performed, is walking
exercise. As walking on the level does not necessitate great exertion,
unless performed rapidly, it can give good results if continued for a
considerable distance. It is desirable to walk as much as possible, and
never to use a street car or a carriage unless pressed for time; by this
means health may be greatly improved. In walking especially the muscles
of the lower extremities are contracted, and at the same time the
circulation is improved, the more so, of course, in the lower
extremities, but also in other parts of the body; and this is still more
the case when we walk briskly. For those possessing a good circulatory
mechanism, it is always advisable to walk briskly, thus indulging in a
healthy and practical and muscular exercise; and for such, also, running
for a few minutes several times daily is excellent, as perspiration can
thus be created, whereby harmful products are eliminated from the body.
This latter exercise is more suited to those living in the country, or
if in cities, to those who have a garden or large yard.

It is advisable not to run too fast, as such would cause severe exertion
with bad effects upon the heart; but if undertaken at all it should only
be for a minute or so. Running at a moderate speed, breathing deeply and
rhythmically at the same time, and with rhythmical, rather short steps,
can be kept up even for eight to ten minutes without any particular harm
to the circulatory system. Personally we used to do this, and often,
when the thermometer stood below zero, without hat or overcoat,
finishing thoroughly warm and comfortable. Standing still after running,
when so attired, might lead to catching cold, but running out of the
house and back again without stopping causes no such risk, even in a
strong wind, as we have personally proven. Such running may best be done
three times a day, before breakfast, dinner, and supper, as this running
in and out of the garden is the best of appetizers, and is far more
beneficial than drugs for those men and women who sit about all day and
complain of want of appetite. Such running practice is only good for
those who have sound blood-vessels, heart and kidneys. Deep regular
breathing while exercising is also indispensable.

Walking up a hill will naturally require greater exertion than walking
on the level, and may be more beneficial to the health than sports
conducted to a similar degree. At first the blood-pressure will
increase, but it will afterward decrease. Deeper respirations will have
to be taken, so that a larger supply of oxygen will be brought to the
lungs and tissues.

Climbing high mountains should be strictly forbidden persons suffering
from disease of the heart and arteriosclerosis, for the greater exertion
then required has often caused death in persons so afflicted. To prevent
the bad circulatory effects of climbing it is necessary to breathe
deeply and regularly, and this, indeed, should not be overlooked in all
forms of exercises; even masseurs are unable to work properly unless
they take deep regular breathing.

In mild cases of heart trouble, and even in more serious cases if
applied judiciously, Oertel’s treatment of each day slowly walking up a
steeper and steeper hill will give good results, giving good training
for the heart-muscle. But this treatment should only be carried out
under the direction of a competent specialist.

The great advantage of the various kinds of sport and of walking,
climbing, and running exercise is that several other agencies can be
combined with them that are very important in the treatment and
prevention of the effects of old age. These are fresh air and sunshine.
We think that the combination of the three agencies—exercise, fresh air,
and sunshine—is the best and most necessary means for the preservation
of youthfulness and for the prolongation of life.


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                             CHAPTER XXIX.

         A FEW REMARKS ON COLD FEET—THEIR CAUSE AND TREATMENT.


IT is intentional that we present this chapter immediately after those
on the improvement of the functions of the skin and on exercise, as
these are the principal means by which, as a general rule, we are able
to prevent cold feet.

These are, for the most part, occasioned by an insufficient supply of
arterial blood to the extremities. This can be caused either by a
hindrance to the circulation—as for example in the case of irrational
use of articles of clothing—or through the want of muscular contraction
by exercise. In old people, especially, cold feet can be occasioned by
the degenerative alterations of the blood-vessels, in consequence of
which less arterial blood reaches the feet. If to this anatomical cause
there are other factors added, then naturally the sensation of cold feet
will much more easily result. We must bear in mind that the feet, like
the nose also, are the most distant parts of the body from the center of
the circulatory system—the heart, so that naturally in these parts,
through the less effective warmth of the arterial blood in old people,
and even in younger anæmic women, the sensation of cold will easily
arise.

Cold feet through irrational clothing can be caused by using garters or
thick footwear with tight shoes, owing to the circulation of the blood
being thus impeded in the lower extremities. It is of no use to wear the
thickest woolen socks or stockings as a protection against cold feet,
which should serve to retain the natural warmth of the feet, and then to
prevent this warmth being given off, this latter resulting in the
sensation of cold feet. But how can this thick footwear retain the heat,
the generation of which it prevents by mechanically compressing the
blood-vessels and thus rendering the influx of warm blood impossible?

It is also useless to wear thick socks if there be no layer of air
between them and the skin, which layer is the best means of retaining
warmth, as mentioned in the chapter on the hygiene of the skin in
connection with rational clothing. Neither the footwear nor the shoes
must, therefore, be close fitting. Many people wear such tight-fitting
socks or stockings, and boots or shoes, that the pattern of the socks is
impressed on the feet, in which case of course it need cause no surprise
if they complain of cold feet in spite of the thickness of their socks
or stockings.

As already mentioned in the chapter on hygienic clothing, it would be
preferable to wear thin wool of the best quality and low half-shoes;
when so clad we will not suffer from cold feet if we take exercise. The
writer of this book wears such even in winter, in which season he puts
on gaiters only when the temperature is below 20° F. On some very cold
days he might feel cold in them, but then only in the morning, for after
a brisk walk, or better, after a smart run (see previous chapter) the
cold sensation disappears for the rest of the day.

Exercise is, as a rule, the best preventative against, and the best
method of treatment for, cold feet, as it is through the muscular
contraction produced by walking or running that heat is generated, as
explained in the previous chapter on exercise.

Rubbing and massage of the feet will produce results similar to those
obtained by exercise, and are still more effective if supplemented by
walking.

When we sit still our body will naturally cool off. It is therefore a
good plan to make circular or other movements with the feet and not
allow them to remain still if we feel cold in them.

While residing as a guest with an elderly lady, the head of an
aristocratic Dutch family, I observed her putting her feet on a silver
warming utensil, in which her footman constantly burnt a little oil
lamp, in order to keep her feet warm. I told her she could easily
dispense with this if she would make up her mind to take exercise on
foot instead of driving in her luxurious carriage, and not confine
herself to merely walking from one room to another.

Defective circulation of the blood to the feet can not only result in
cold feet, but also in very serious ailments, and even in a shortening
of the ordinary span of life. Thus, in consequence of a deficient influx
of arterial blood and the stagnation of the venous circulation,
especially in old people with sclerotic changes of the blood-vessels, a
very trying and long-continued ulceration of the feet may result. By
bringing more arterial blood to the feet and causing hyperæmia,
according to Bier, we can cure this condition.

Still more serious consequences may be brought about by defective
circulation in the feet, and especially in the toes, in the form of
senile gangrene, which is far more frequently found in diabetic persons,
and sometimes even before the commencement of old age. In cases of
arteriosclerosis, where cold feet are the consequence of defective
blood-supply owing to arterial degeneration, iodides together with
thyroid extracts will be found successful. They produce a dilation of
the blood-vessels, diminish the viscosity of the blood, and thus produce
the sensation of heat. The method of application will be found in the
chapter on the treatment of old age by organic extracts.

As the promotion of a hygienic condition is an excellent preventative
against cold feet and also excellent for their treatment we repeat again
that a foot-bath should be used daily in such cases, and not only warm,
but also cold water should be used therein. Cold water acts as already
mentioned as a stimulant when applied as a foot-bath; but it should only
be used for a very short time, after which energetic rubbing of the feet
will produce active circulation and the feeling of warmth in them. We
recommend for cold feet to rub them with a cold wet towel, then to pour
over them a little eau de cologne or alcohol, and again rub them till
they begin to become red; we must next move the toes forward and
backward twenty or thirty times with our hand. We will then feel in the
feet a sensation of agreeable warmth.


------------------------------------------------------------------------




                              CHAPTER XXX.

                      ON THE BENEFITS OF SUNLIGHT.


IT is a matter of everyday observation that when we leave plants in a
room, where no sunshine can penetrate, they lose their color and soon
show quantities of parasites. Similar changes occur in persons who live
in dark rooms and seldom come into the sunlight. They become pale, and
are liable to all kinds of bacillary infections, especially
tuberculosis. An Italian proverb says, very justly, “Dove no viene il
sole viene il medico”—“Where comes no sun, the physician is coming,” and
a German proverb again says, “Auf die schattige seite der strasse kommt
der Leichenwagen doppelt so oft, als auf die sonnige,” which means in
English, “The funeral coach turns twice as often on the shady side of
the street as on the sunny side,” which saying, like most proverbs,
contains much truth.

We often notice that on days when there is no sunshine especially when
at the same time it is cold and damp, we feel depressed in mind. In such
an atmosphere there is a diminution of the respiratory and transpiratory
functions of the skin, and, in consequence, a retention of toxic
products. On the other hand, on sunny and dry days these functions are
facilitated, and there is less work to be thrown upon the kidneys. Such
a rest does good to an organ that is almost constantly at work, and is a
wise economy for the days of old age. It is astonishing how sunshine can
influence our mental condition. We feel better able to work, and also to
take outdoor exercise, on sunny days. Particularly in old age is
sunshine precious, and we see our old house dog and our cat lying in the
sunshine and taking a sun bath. In the same way, instinct tells old
people that the sun is good for them, and thus they eagerly watch for it
to shine, and like to sit in it, especially on cold days.

It has been shown by exact researches that the sun’s rays can kill
bacteria, and statistics have shown that in sunny weather there are
fewer infectious diseases, like influenza, than in dull weather. In
sunshine there are two elements which possess antitoxic and healing
properties: light and warmth. Its light is made use of in the treatment
of certain infectious diseases, like lupus (Finsen treatment). Both
these properties can be used to great advantage in the sunbath
treatment. Lying in the sun for a certain length of time causes a
dilatation of the blood-vessels and, later on, abundant perspiration.

The ancient Romans made use of the therapeutic action of sunshine, and
many of them took sun baths on the roofs of their houses. There were
also public sun-baths, much visited by the population. The ancient
physicians recognized the value of sunshine in the treatment of various
ailments. According to Hippocrates, the sun-bath augments transpiration
and makes us more resistant against disease, giving us more strength.
Celsus also advised its use in nervous diseases.

Certain people have undertaken scientific experiments on animals to
prove the great effects of light. Moleschott, the great physiologist,
found that the embryos of frogs gave off far more carbonic acid under
the influence of light than when they were in the dark. The stronger the
light the more carbonic acid was given off. Edwards found that such
embryos could not develop at all in the dark.

Very important was the discovery of Arloing,[241] and also of
Duclaux,[242] that the growth of bacteria when exposed to the sun is
checked, and that later on they will even be killed. This is mainly due
to the action of blue and ultra-violet rays.

Footnote 241:

  Arloing: C. R. de l’Academie des Sciences, p. 378 et 511, Paris, 1885.

Footnote 242:

  Duclaux: Revue Scient., 1887.

The chemical action of sunlight is exercised by the blue and
ultra-violet rays (Finsen), and the heat comes mainly from the red rays.
From our point of view, however, the chemical rays play the more
important part.

When we sit in the sun for a long time and get an inflamed skin, this is
due mainly to the chemical rays. This fact was established by Charcot on
the basis of clinical observations. Charcot’s work has been confirmed by
the researches of Widmark, and especially by the exact experiments of
the famous Danish physician, Niels Finsen,[243] in 1906. The latter
showed that when strong light killed bacteria, this was due to the
action of the chemical rays alone, and, specifically, to the
ultra-violet rays. He also showed that these are the rays which produce
dilatation of the blood-vessels and an inflammatory condition of the
skin.

Footnote 243:

  Finsen: “Om anvendelsen af concentrerede chemiske Lysstraaler,”
  Kjöbenhavn, 1896.

To the red cheeks of those people who pass much time in the open air and
sun, we can compare, as a contrast, the pale faces with a greenish hue
of those who live in the dark, like polar explorers. If strong light
dilates the blood-vessels, and sends much blood to the periphery of the
body, thus promoting the insensible perspiration and metabolism, on the
other hand, in the long night of the arctic regions there is contraction
of the blood-vessels, and the blood is kept back in the interior of the
body, with the retention of excretory products. It has been shown by
Oerum,[244] through experiments on animals, that the quantity of their
blood and its percentage of hæmoglobin is dependent upon the light. They
are reduced in the darkness and increased in the light. Through a light
bath the quantity of blood was increased 25 per cent. within four hours.
Finsen[245] has also found, through examination of twenty-nine persons,
that there is less hæmoglobin in the blood in winter than in summer, due
to the lack of sunlight in winter. Grawitz and Graffenberger have seen a
diminution of the hæmoglobin, as also of the quantity of the whole
blood, in animals which were kept in the dark. Marti found that the red
blood corpuscles are diminished in such animals, but become augmented
when they are again exposed for a time to the sunshine.

Footnote 244:

  Oerum: Pflüger’s Archiv. f. d. g. Physiologie, vol. cxiv.

Footnote 245:

  Hospitalstidende, p. 1209 and 1239, 1894.

We should aim to get our share of direct sunlight in the open air, for,
as Finsen has shown, the valuable chemical rays of the sun are excluded
by glass; and, after all, it is not warmth alone we seek, but also the
chemical and anti-bacterial action of the sunlight, together with its
effects upon the blood-vessels and nervous system.

To absorb as much of the active rays as possible, it is best to wear
light or light blue or light gray clothing, which allows the sun’s rays
to pass, whereas dark cloth does not, as found by Boubnoff and Lenkey.
The rays of the sun are always valuable, but their action varies with
the altitude. Thus, the higher the altitude and the rarer the
atmosphere, the more efficacious will be the action of the sun’s rays.
In lower altitudes the rays have to pass through dense strata of air
filled with vapors of carbonic acid and dust, and thus much of their
strength is lost. As Prof. Mohn[246] says in his book on “Meteorology”:
“The rays of the sun in transit meet always denser and denser air, which
contains large quantities of vapor, carbonic acid, and dust. A part of
their strength is absorbed by the substances contained in the air, and
these, as well as the air, are heated. Hereby some of the power of the
sunshine gets lost, as the rays of the sun are reflected off these
substances. Furthermore, they pass through clouds. Hence the rays of the
sun lose more and more of their strength before they reach the earth.”

Footnote 246:

  Mohn: Quoted after Holm, Norsh Magazin. Laege, W. 6, 1906.

It is also an important fact that the higher the altitude, the more
numerous are the chemical rays of the sun which have the greatest
heating properties. In high localities sunshine contains much more of
the blue and ultra-violet rays, whose wonderful action upon the red
blood-corpuscles has been shown by the experiments of Niels Finsen.[247]
Not only on the blood, but also on the nerves, they exercise a tonic
action. As Niels Finsen has shown, it is due to these blue and violet
rays that insects regain their vitality as soon as the sun shines. As
Dr. Holm says, it is probably due to these rays that the quantity of red
blood-corpuscles and of hæmoglobin is increased at altitudes of 500 or
600 meters above the sea level, as found by Viault[248] and Mintz.[249]

Footnote 247:

  Meddelelser fra Finsen’s “Chemiske Lysinstitut,” Kjöbenhavn, 1899.

Footnote 248:

  Viault: C. R. Acad. Sciences, p. 917, 1890 and p. 295, 1891.

Footnote 249:

  Mintz: C. R. Acad. Sciences, p. 298, 1891.

As a logical consequence of the above, we must try to enjoy sunshine on
mountains, or on the terraces of high buildings, as there can be no
doubt but that sunshine is more beneficial in such places. In high
altitudes sunshine is far more warming than lower down, probably due to
the fact that the sun’s rays pass fewer strata with vapor and foreign
substances, and thus less of their warmth is absorbed. Thus we can
explain the observations that, by exposure for a certain time to the
rays of the sun on the top of high mountains in mid-winter, erythematous
or eczematous eruptions were produced. At such great heights the air is
usually very dry, and so there is less loss of heat from the body.
Therefore we can sit comfortably in the sun at such heights without an
overcoat, even in winter, whereas several hundred meters lower down we
should feel cold even with an overcoat on, especially in a coast
climate.

Let us be grateful for every ray of sunshine and take advantage of it.
Some ladies avoid the sun, but it would be wiser to seek it and, if
possible, to expose our whole bodies to its rays. Let us remove all the
curtains from the rooms in which we sleep or sit, especially from our
work room. In the train let us sit on the sunny side, and not draw the
curtain unless we are reading; in short, let us seek the sun wherever it
shines. We shall soon observe how much better we feel after a long
sojourn in the sun. We have often been surprised at the appearance of
patients whom we have sent for a holiday to the Riviera in Egypt or to
other sunny places. Thus we have often seen pale patients come back
rosy-cheeked and flourishing, and in our own case we have observed the
same thing after staying in California, Arizona, Mexico, and Florida for
several weeks. There is no denying that, as a rule, those who spend much
time in the sun look better and healthier than those who live in dark
rooms or offices. It must be understood that we are talking about
sunshine at a moderate temperature. But even a somewhat higher
temperature, with sunshine, can do no harm, especially to persons
suffering from chronic kidney trouble. In old age, as in other
conditions of athyroidia, we often find chronic interstitial nephritis
and sluggish kidney functions. Therefore we should relieve the kidneys
of any overwork and make the skin do more, which can be accomplished by
warm sunshine. Old people, if their means allow it, should never be left
to pass a winter in cold climates, but should be sent to warm sunny
climates like the Riviera, Egypt, or California or Florida in America.
They require as much sunshine as possible. Americans may use with great
profit the climatological charts of Dr. Charles Denison, of Denver,
Colo., which show with great exactness those parts of America where the
greatest number of sunny days occur.

Against old age sunlight should be regarded as an excellent protection.
It safeguards our kidney functions by promoting skin activity, and it
aids the processes of metabolism. It is best used in combination with
exercise, like riding or some form of sport, and a daily sun bath. It is
our belief that, by such means, both youth and life may be prolonged.

The wonderful effects of sunshine are illustrated by an interesting
experiment of Benjamin Franklin. According to Hufeland[250] this savant
had received wine from Madeira which he was putting into bottles on his
Pennsylvania estate. In this wine he found a few flies, which were
apparently dead. The sharp-minded savant put these flies in the July sun
of the hot Pennsylvania climate, and before long the life that had been
so long interrupted appeared again. The flies became lively and soon
flew away. They thus showed the same reaction to the beneficent effects
of sunshine as the insects in the above-mentioned experiment of Niels
Finsen. The fly is a most objectionable animal, but it possesses one
good trait that reconciles me to its existence; and that is that it is
so fond of the sunlight that it may thereby serve as an example to those
foolish people who do their best to avoid it.

Footnote 250:

  Hufeland: “Makrobiotik,” p. 129.


------------------------------------------------------------------------




                             CHAPTER XXXI.

   ON THE ADVANTAGES OF AN OPEN AIR LIFE AND OF BREATHING EXERCISES.


WHEN we note the faces of persons who, by reason of their occupations,
pass their lives in the open air, such as peasants, gardeners, etc., we
usually find them healthy and fresh-looking, and looking more youthful
than their actual age. This is especially so in the case of their wives
and daughters, who are more exempt from certain injurious habits, such
as smoking, and are less addicted to other harmful agencies, like
alcohol. Their fresh rosy faces speak in eloquent terms of the benefits
of fresh country air.

On the other hand we see that others, whose daily avocations compel them
to stay all day in a close atmosphere, very frequently look pale and
sickly. Among such persons, as observation shows, infectious diseases
are frequent, and especially tuberculosis. This disease most frequently
develops in persons who pass all their time in close places, especially
when they are poorly fed at the same time. We can trace this plainly in
the working classes in certain European countries where, in Vienna, for
instance, until the past several years, about 70 per cent. of the total
mortality was due to tuberculosis.

If we now take such tuberculous persons and place them in a hospital or
sanatorium and subject them to the open air treatment, compelling them
to pass all their time exposed to the fresh air, both day and night, we
soon witness a marvelous change. Their appearance is improved, and also
their appetite; and after a time in most of the cases there will be an
increase in bodily weight. We thus see that the open air produces
wonderful effects in such persons, who, as a rule, have been immured in
close places, they shattering their health.

We have thus witnessed the clinical demonstration of the fact that fresh
air is able to improve our health. Fresh air contains much oxygen, and
this is a most indispensable substance, for without it we cannot live.
The red corpuscles in the blood which, loaded with carbonic acid, the
veins convey to the lungs, eagerly absorb the oxygen from the air that
we inhale and then convey it to the tissues to satisfy their
requirements for this precious substance.

By absorbing oxygen the elimination of carbonic acid is at the same time
facilitated. The greater the number of red blood corpuscles that comes
to the surface of the lungs the greater will be the volume of oxygen
which is taken into the system, and afterwards the larger will be the
volume of carbonic acid gas expelled. Thus in the lungs there takes
place a distintoxication of the organisms, and, according to certain
authorities, the cells of the lungs are co-operating in this process in
a manner analogous to the internal secretion by the cells of other
glandular structures.

The more fresh air, i.e., the more oxygen we get into our lungs, the
more we can contribute to the processes of oxidation in the tissues.
When the processes of circulation and of breathing are checked, and when
insufficient oxygen is absorbed, we soon see a very important change for
the worse in the condition of such persons, as exemplified by cases of
heart and lung trouble.

Given the great importance of oxygen, we must try by every means to get
as much of it into our lungs as possible; we shall get more of it from
air that is not stagnating, but always in circulation. When we are in a
closed room, after a certain time we absorb all the oxygen in it,
particularly when there are several persons present who are sharing with
us the oxygen in the air.

Staying for a long time in air so vitiated that it contains but little
oxygen and much carbonic acid and many microbes exhaled by the others,
we are liable to reap the disadvantages we have set forth in the chapter
on the dangers of a close room. According to Pettenkofer, the
exhalations from the persons present in a close room are much more
noxious than the carbonic acid gas. We, therefore, open the window and
door in order to create a current of fresh air, and so allow the oxygen
to be renewed. In this we but imitate nature, which sends a wind to
purify the close atmosphere on warm summer days. This is natural
ventilation.

If we want to preserve our youth for a long time and attain an old age,
we must take all available means to avoid such air contaminated by
billions of microbes and vitiated by the exhalation of so many human
beings and animals, who also absorb much of the oxygen. To this is added
the smoke from the numerous manufactories, houses, and plants, and the
dust and exhalations from many noxious substances of various kinds. As,
however, fortunately, all this vitiated air is generally found in the
lower strata, always endeavor to find a lodging in the more elevated
portions of the city, and on the highest floor possible if staying in an
apartment house or in a hotel. If possible our houses should be built on
the outskirts of the city, and preferably near a park, or wood, or at
least a meadow where there is a free circulation of pure air.

In our rooms, and especially in the sleeping room, the window, or at any
rate the transom, should always stand open, and if possible also during
the night. But when obliged to sleep in a room with a closed window to
avoid the noise of the street traffic, the first thing to do in the
morning, directly one gets up, is to open the window and let in the
fresh air, and do not close the window again until night-time. When we
are well covered we need not be afraid of catching cold. As a rule only
those take cold who keep in a warm room and live at enmity with fresh
air. Fresh air, as a matter of fact, never does any harm to its friends;
it is only dangerous to its enemies. As Captain Svaerdrup, a member of
Nansen’s expedition to the North Pole, told us, he and his comrades
never suffered from colds as long as they were in the polar regions.
They first caught them when they approached Christiania.

When standing at the window inhale the fresh air deeply several times
and retain it as long as possible before exhaling it.

Indeed we could preserve our health much more effectively if we imitated
the Indian and slept in the open air. It is a fact that many Indians
possess great immunity to all kinds of fatigue, enjoy very robust
health, and reach a green old age. This is undoubtedly due to the fact
that they pass the whole of their life in the open air. When tuberculous
people are kept under the free-air treatment we are, after all, only
following the example of the red man. Nobody who is accustomed to live
in a close room with heavy curtains at an average temperature of 75° to
80° from October to May, can imagine the pleasures of a wooden hut or
tent for day and night use. When Dr. Pottenger, of the Monrovia
Sanatorium, near Los Angeles, California, showed me around his little
wooden cottages in which his patients lived, I simply envied them. I
cannot imagine a more healthy dwelling-place than a tent in summer and a
wooden hut in winter, with a stove in it for the cold weather; and if we
cannot raise the heat over 75°, so much the better.

The son of a family in England, who are great friends of mine, has
formed a resolution not to sleep any longer in the comfortable family
mansion, but in a tent in the meadows of his property during both winter
and summer. His family and friends regarded this as an eccentricity,
against which they warned him; but still he got on very well in his
tent, and looks fresher and healthier than ever before. We are always
put down as eccentric if we have the courage to resist the foolish
prejudices of our surroundings. For my part I prefer to live to be 100,
and to attain this I do not object to be considered “eccentric.”

Anyone who is anxious to live long and preserve his youth should
endeavor to spend as much time as possible in the open air. After the
day’s work is finished we should always get out into the air, preferably
in a park or wood adjacent to our home, where there is more oxygen
contained in the air. We should follow the example of those English
people who leave town on Saturday and remain in the country until
Monday, leaving behind them the cares of business. There is probably no
nation which likes exercise in the open air so much as the English,
Scotch, and Irish, and among them is to be found the greatest longevity.
An agreeable way to get plenty of fresh air is by automobiling, and for
those whose means can afford it long journeys by automobile may
constitute an excellent fresh air cure, as they tend to improve the
appetite, produce sleep, and relieve neurasthenic conditions in general.
But automobiling can only be considered as a hygienic means for
longevity when the speed does not exceed twenty to twenty-five miles an
hour.

When in the country we should always prefer mountains, and the higher
they are the purer is the air and the more oxygen does it contain, as a
rule. At the same time very much depends also on the presence of
forests, especially of pines and fir trees. High mountains with such
arborization generally have pure fresh air full of oxygen, and there is
no drug in pharmacy that can equal this in its beneficial effects. It is
a fact, established by leading physiologists, that persons living on
mountains have more red blood-corpuscles than those living in the
plains. When patients are sent to spots so elevated in the air as
mountains with forests, we find them, as a rule, looking healthy and
fresh when they return from their holiday in the fresh air.

As found by A. and Y. Loewy and Luntz,[251] mountain air improves the
processes of oxidation and increases the number and depth of the
respirations. All this, however, according to these savants, is the
result of the exciting action of the sunshine. It speaks volumes for the
health-giving properties of mountain air that the inhabitants of such
spots, especially in Scotland, Switzerland, and Norway, have such fresh
rosy cheeks. These we notice more particularly among the females,
especially in young girls who are freer from the agencies harmful to
good health, such as alcohol, sexual excesses, etc. In Norway almost all
the young girls have fresh red cheeks, for which, indeed, they are
noted, due to the delightful air on its mountains and forests, with
which the whole land is almost covered.

Footnote 251:

  Quoted after Landois: “Lehrbuch der Physiologie des Menschen,” Berlin,
  Wien, 1905, eleventh edition, p. 235.

I had the opportunity of proving for myself, after spending a certain
time in a resort on the top of a mountain in Norway, the delightful
purity and invigorating quality of the air, which was due to the large
amount of oxygen. As a confrère expressed it, there was champagne in the
air! It was not soiled here by any manufacturing plant, the curse of so
many places with fine air. Norway, one of the most extensive countries
in Europe, has at the same time a very small population, only about two
millions, and very few factories, so that the air is not polluted either
by a dense population or by the smoke of manufactories. Scotland, with
its highlands, has also a similar air, and the color of the Scotch
lassies is not far behind their Norwegian sisters. This can be admitted
as a scientific argument for the relations of health in the country.

But Americans need not travel so far. There is as good a climate and
wonderfully fresh air in the Rocky Mountains, and also in other highly
elevated places, of which America can boast many more than Europe. But
whether there or in Europe it would be necessary to give up all
occupations for a few months, or at least for several weeks after every
six months. This time we should pass in those elevated places where we
can climb every day; climbing presents an excellent opportunity to get
much fresh air into our lungs, as we are then obliged to take much
deeper inspirations, thereby obtaining more oxygen from the pure air of
the mountains. As we shall show in the next chapter, exercise combined
with fresh air is of the greatest importance to our health and chances
for a long life and a green old age.

But in order to get plenty of air it is not indispensable to go to
forests or mountains or to the seaside; we can also get it at home,
although not with the same amount of oxygen. To absorb much air we must
breathe deeply and keep in the inspired air, and endeavor to get it into
all parts of the lungs. In ordinary life we forget this and we get just
as much air into us with our superficial breathing as is necessary to
keep us alive and to feel no harm from our want of air. Most people
breathe only superficially, and only inspire deeper when mounting the
staircase, unless, indeed, they adopt the less healthy habit of reaching
the first floor by the elevator. But as it is of apparent benefit to us
to get as much air into our lungs as possible, we improve this state of
affairs by breathing exercises. The great importance of these breathing
exercises for the prolongation of human life has been especially
insisted on by Sir Herman Weber.[252] But before him, Hamel and Harry
Campbell[253] had already demonstrated the great therapeutic results of
respiratory exercises. Sir Herman Weber recommends commencing with
moderately deep inspirations and expirations, continued during from
three to five minutes once or twice a day, and then gradually increasing
to ten minutes or a quarter of an hour. The depth of each inspiration
and expiration, and the duration of holding the breath, are to be
increased only gradually. Sir Herman Weber advises inspiring in an erect
position, with raised arms and closed mouth, bending the body forward
during expiration so that the fingers touch the ground or the toes.

Footnote 252:

  Loc. cit.

Footnote 253:

  Dr. Harry Campbell on “Respiratory Exercise in the Treatment of
  Disease,” London, 1907.

According to this authority, besides the influence on the circulation,
the respiratory movements keep up the nutrition and efficiency of the
lungs, and also maintain the elasticity of the chest walls, which are
apt to become stiff in old age and thus interfere with the free action
of the lungs and pleura.

These respiratory exercises can also be performed in a sitting or
horizontal position.

According to Sir Lauder Brunton, the deep respiratory movements act as a
kind of massage to the lungs, thoracic walls, pericardium, and heart.

Sir Herman Weber mentions that he has seen persons who get out of
breath, even after short walks and climbs, and who for this reason
abstained from such, and consequently suffered in health and spirits,
become, by means of these movements, active walkers and climbers,
gaining improvement in every function of the body, and outliving by many
years their brothers and sisters who had not practiced them. He also
specially recommends these breathing exercises to literary workers,
statesmen, professional men, and others who get no time to take the
usual methods of exercise.

In certain heart troubles—for example, dilatation of the heart—these
movements are contraindicated.

It is natural that if we practice these exercises in the fresh air of
the forests or mountains their salutary action will be still more
pronounced. But if we are too indolent to perform the regular breathing
exercises, whose beneficial effect upon the heart’s nutrition and action
is so great, it will suffice for us to take deep inspirations and
expirations while walking. We must get into the habit of doing this
every day, and thus prolong our life.

As a general rule we only breathe with one part of our lungs, sadly
neglecting the other, by which the aëration of the blood will not be so
thorough. Independently even of the breathing exercises, it would be
very advantageous to our health if we gently took a long breath, which
should be so prolonged that we feel our stomach distended. The air will
thus reach the deeper portions of our lungs. This will also be the best
practice while singing; indeed, the latter would be the very best of
ways in which to obtain a good and thorough aëration of the lungs. We
have heard of cases where people without a voice have taken singing
lessons, for the simple reason that they were descended from families in
which tuberculosis was hereditary.

This latter disease is one of the most frequent causes of a shortened
existence, and it is, therefore, our duty to point out here the great
advantages not only of a generous diet, consisting of a certain amount
of underdone fresh meat, uncooked milk of healthy cows or goats, and
many eggs, sausages and puddings made of the blood of pigs (see Chapter
XXXIX), but also of regular deep breathing, thereby permitting of the
entry of oxygen to all parts of the lungs.

We always recommend breathing through the nose, as doing so through the
mouth dries up the mucous membranes, especially if throughout the night,
during sleep, the mouth is kept open. This bad habit permits of the
entrance of cold air which, not being warmed by passing through the
nasal passages, may be injurious to the lungs. The Indians are fully
cognizant of this fact, for in some tribes the mother binds up the mouth
of her child and thus compels it to breathe through the nose.

In the foregoing we have shown the great advantages of abundant fresh
air. We have referred to the fresh appearance of country people,
especially of those who live on mountains, as also to the improved
condition of tuberculous persons after having been exposed to as much
fresh air as possible. I ask, therefore, why, if people suffering from
this disease derive so much benefit from fresh air, should not we, who
are still healthy, be also benefited by it? Let us therefore remain in
the open air as much as possible, and never prevent its close approach
to us; for it gives health, long youth, and a good old age.


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                             CHAPTER XXXII.

   ON THE DANGERS OF LIVING IN CONFINED AND ILL VENTILATED QUARTERS.


Persons in the enjoyment of complete health and vigor are frequently
very sensitive to recognize the different agencies deleterious to their
health. In the same way as animals they possess a certain instinct in
this respect. In fact it is by this faculty alone that they can enjoy a
normal and robust health, as they are thus enabled to avoid all kinds of
dangers to their health, the integrity of their healthy mind also giving
them the necessary will-power for this purpose.

Against all sorts of dangers to their health such persons, as a rule,
are prompt to act; thus, when they come into a close room the air will
soon become offensive to them, and they will either leave or ask for the
opening of a window or of a ventilator, closed through folly. On the
other hand sickly persons, or people who do not otherwise enjoy perfect
health or well-balanced minds, will remain in such a vicious air and
contract all the dangers consequent to it, shortening their prospects
for a healthy youth and long life.

That living in the vitiated air of a close room is deleterious to health
is proved by a simple observation of the faces of those stopping for a
long time, or habitually doing so by reason of their professions, in
close localities. They will present a pale, gray sickly appearance, and
it is a fact that they very rapidly acquire all sorts of infections;
especially is tuberculosis very prevalent in such cases. We observe
precisely the same thing in the case of plants which, if kept in a close
room, especially where little light reaches them, soon lose their color
and are destroyed by parasites; and exactly the same happens in the case
of man. Prisoners, unfortunate work-people, living and laboring in large
numbers in small and close quarters, waiters and similar employees, are
those in whom tuberculosis is most frequently found. In respect to
workmen, this may be more truly the case in Europe, where they live
under more miserable conditions, than in America, where their position
is possibly the most enviable of all wage earners.

Close air, just as much as stagnant water, promotes the growth of
dangerous microbes, and the chances of infection are greatly enhanced
where a number of people are gathered together in such places. Many of
them may be suffering from infectious diseases of the respiratory
organs; they exhale, and also eject by coughing or sneezing, an enormous
number of microbes, which mingle with the air and multiply at their
leisure in such close atmospheres; and this is especially so when they
are assisted in their growth by the great heat prevalent in such places,
particularly in winter time. Bacteriological examinations made of the
air of such localities have shown an enormous number of dangerous
microbes. We need, therefore, not be surprised when persons, and
especially children whose resistance is diminished, often contract
tonsillitis, diphtheria, bronchitis, or pneumonia, etc., after having
passed an evening in such a place, the air being hot, and particularly
if, at the same time, the temperature outside was very low.

Living in a close room will soon tell on the general health, and this is
easily visible in the appearance of such persons. Their pale faces form
a striking contrast to the fresh rosy cheeks of those who habitually
live in the fresh air. Those who have to pass their lives in offices are
to be pitied, although, to a large extent, it is their own fault; they
deprive themselves of the benefit of fresh air, which, after office
hours, they would have ample opportunity to obtain if they would not
persist in spending their leisure time in a club or other close place,
instead of taking a brisk walk and exercise in the fresh air. No wonder
that such people easily acquire dyspepsia and stomach troubles! Exercise
in the open air is most valuable for promoting an appetite, and persons
sitting constantly in close places often lack this; thus their gastric
juice, which is indispensable to a thorough digestion (see chapter on
hygiene of eating—how to obtain an appetite) fails, and eating without
this juice their food will not be well digested and will create stomach
troubles, which are extremely frequent in such office workers, but rarer
in the case of peasants, coachmen, and other fortunate individuals whose
occupation keeps them in the fresh open air. There is an increased
amount of carbonic acid in the air of all localities where many persons
are present. According to Pettenkofer, even in our living-rooms the
carbonic acid content of the air is increased above the normal; and
still more is this so in lecture-halls (3.2 per cent., against a normal
content of 0.5 per cent.), in public houses (4.9 per cent.), and most of
all in school rooms (7.2 per cent.).

We should, therefore, always keep a window open and never close the
ventilator. Fresh air is the thing we are most in need of to carry on
the oxidizing processes in our body. Exclude this and you exclude
health. We must also remove from the rooms all those things which can
absorb the air or hinder its entrance. There should never be flowers,
and particularly no potted plants, in a living room, as they require air
like ourselves; while to sleep in a room with plants is very deleterious
(see chapter on sleep).

Curtains should all be removed, especially those of a heavy nature and
dark color, which would prevent the entrance of the beneficial sunshine.
Every room should be provided with openings for ventilation, and the
transoms used in America are especially useful when they are open, and
not used only to let the electric light into the sleeping room during
the night, thus disturbing sleep. As a close room tends to shorten life
it should be the policy of the government authorities never to allow the
use of any newly built house, especially of public buildings, unless it
contains openings for ventilation, the closing of which should be very
severely punished by law.

If, during the day, it is necessary to have fresh air in every room,
there is still greater necessity for this during the night, as we
require more air during sleep than while awake; and, therefore, we
should never sleep in a room that is entirely closed, but always leave
the window (the upper part by preference) or the ventilator open.

We can easily convince ourselves how injurious it is to sleep in a close
room by leaving our room in the morning, taking a walk in the fresh air,
and then re-entering our sleeping chambers that have remained closed as
we left them, and we shall at once realize the unhealthy condition of
the air in such a room, filled as it is with carbonic acid that has been
exhaled during the night, and also loaded with the other deleterious
toxic substances cast off by our lungs and skin. We shall then certainly
make up our minds not to inhale during the next night the same air
again, but to allow it to escape by the open window and thus permit the
entrance of fresh air into our lungs, whose need for air is much
increased during sleep in order to replace the large volume of carbonic
acid exhaled.

As a consequence of passing the night in such a close room, we feel, on
the following morning, very heavy, and often have a headache; we also
often have no appetite for breakfast after such a night, unless we first
take a walk in the fresh morning air.

The danger of the close room should be brought home to all, even
children, through instruction in hygiene in the public schools; and even
from their very youngest days this should be instilled into the minds of
youth, together with the contra-advantages of fresh air. By these means
they will be accustomed to the fresh air and its beneficial effects, as
much as they will learn to detest the horrors of the air exhaled by
other people, which is the source of so many infections. Every one who
wishes to enjoy life during youth, and live to a good old age, should
abominate a close room and never, if he can possibly help it, pass an
hour in such an atmosphere.


------------------------------------------------------------------------




                            CHAPTER XXXIII.

  HYGIENE OF ARTIFICIAL HEATING—THE DANGERS OF HEAT BY STEAM AND A FEW
                     HINTS ABOUT THEIR PREVENTION.


OLD people are particularly sensitive to cold, and they therefore need a
warm room when the temperature falls in the autumn. In old age,
especially in its advanced stage, the processes of oxidation are
diminished, and thus less natural warmth is produced; but, as we give
off more heat in cold weather, it is only natural that they will feel
the cold then much more than younger individuals.

The rooms, therefore, in which old people live must be kept very warm,
in the same manner as we do with infants, especially for those who come
of parents with degenerated thyroids. Thus we see again how old age and
infancy present many parallel features.

But, if a very warm room be compulsory for aged folks, no such necessity
exists in the case of the young or middle aged, and it is abusing their
health if they remain long in rooms heated above 75° to 85°, or
sometimes 90°, where, at the same time, every window is sedulously
closed on all sides, so that no fresh air can find entrance. Such
overheated rooms we usually find in northern climates, and the air in
such cases is frequently hotter in the house in winter than we find it
in the open on a comfortably warm summer day, when, being in the open,
the heat can certainly be better borne than in a close room.

In America many things are better than in Europe; but this certainly
does not apply to the method of heating used in the majority of the
houses, hotels, and office buildings, all of which are mostly
overheated, and that by steam heat, and very frequently with defective
ventilation, if there be any at all. The worst part of it is that a
uniform heat is maintained, whether it be a warm or a cold day; thus,
the air temperature was 55° F. on October 15, 1906, when I was in New
York, and in one of the most fashionable hotels the temperature was 75°
F. In Houston, Texas, there was a heat wave in February, 1907, with
disagreeable hot weather, yet 70° F. of steam-generated heat was
maintained in the hotels, which made life unbearable for those who, like
the author of this book, are so fond of fresh air.

As we are endeavoring in this work to give hints how to reach a ripe old
age and prevent diseases which may dissipate our hopes in that
direction, it is our duty to protest and to point out the dangers of
such irrational heating.

It seems to me, however, that in some northern countries in Europe
things are not much better, especially since steam heat is becoming more
and more used, as in Norway, even in the private houses. In some of
these countries—Russia, for instance—cotton is put around the window
panes to exclude the air, and also to absorb the moisture condensed on
the inside of the double windows.

In many European countries, however, fireplaces and stoves are common.
The most rational method of heating, though not the most economical, is
the open fireplace in England, whence the most ventilation is obtained;
for the essence of the problem is to obtain warmth and fresh air at the
same time. English, Scotch, and Irish are most sensitive to an
overheated room, and they are probably the most healthy inhabitants of
Europe, too. While a guest, some years ago, of friends in Derbyshire, I
well remember that, directly the temperature rose above 65, the windows
were thrown open.

Americans in Europe often complain that they are not warmed at the
fireplace, which only keeps the face and not the body warm. This,
however, will only apply to those who only feel comfortable at a
temperature of 75° F., which is distinctly unhealthy; for the open
English grate can very easily produce the standard temperature of 15° R.
(about 18° C.), which should not be exceeded if we want to have a
healthy warmed atmosphere in our rooms. Of course such fireplaces can
produce a much higher temperature, but even then the air is never so
offensive as that of rooms heated by steam.

It would seem, at first thought, that women can withstand cold much
better than men, considering how much lighter is their dress and how
much more it exposes them to cold air. We sometimes see young girls of
the poorer class in such light clothing in mid-winter, standing in the
streets and talking with their friends, that we men shiver at the mere
idea of such clothing. Yet it is women who most need a warm room,
probably because their dress is much the same indoors in mid-winter as
in mid-summer. They, however, when out-of-doors wear heavy furs which
entirely check the respiration of their skin; and their light clothes,
when indoors, do not afford much opportunity for their skin respiration,
for then there is usually no fresh air in the house, but an oppressive
heat, all air ventilators being sedulously closed. It is strange how
people try, by every means, to destroy their health!

In warm weather we give off less warmth and do not require so much food
in order to produce warmth, as the natural temperature also requires
less of us; in summer, therefore, we need less nourishment.

Circumstances, also, become much more equalized in the artificial summer
of the overheated room. Whereas people taking a brisk walk in a cold and
bracing atmosphere return with rosy cheeks and a roaring appetite, the
unfortunates who persist in passing the day in overheated, especially
steam-heated places with a confined atmosphere will not feel a natural
hunger, will eat without a healthy appetite, and will have insufficient
gastric juice (see chapter on appetite), exposing themselves to
digestive troubles in consequence. Their need for food will be less, and
a bad condition of health will follow.

Another and most imminent danger of overheated rooms is the facility
with which we are apt to take cold by walking from a room kept at summer
heat to the outside cold of winter. We all know how we catch cold, as a
rule, but we never know how it may end. Sometimes a simple cold is
followed by sore throat, but often also by catarrh of the bronchi, and
even of the lungs. In persons addicted to alcohol a fatal pneumonia from
such a cause is common; but, in any event, there is a great failing of
the general health for a long time, all of which may have originated
from an overheated room which has made us more sensitive to the effects
of cold.

When we keep ourselves cool we are less liable to catch cold, as is well
known; for then our body is not first heated up and then cooled off
rapidly. This has been shown by experiments on animals. It is certain
that people accustomed to a temperature of 15° R. have much less
tendency to take cold than those living in rooms at 75° to 90° F. Such a
temperature is also a breeding place for billions of dangerous microbes,
which certainly prosper better at such a warm temperature.

Still more dangerous are the consequences from the overheating of
railway compartments, as then it is still less impossible to avoid rapid
changes of temperature. When there are many persons in overheated
places, and the exhaled air from all of them contains an enormous
quantity of virulent bacilli, the danger of infection is still greater;
especially so when there is steam-generated heat, with its injurious
effects on the mucous membranes, whose resistance to bacillary invasion
is thus lowered.

Steam heat is the most injurious of all heat, as it dries up the mucous
membranes and renders them thereby more liable to infection. We have
often noticed in persons with large tonsils inflammation of these
glands, which commenced every time that such persons inhaled
steam-generated heat for several hours. Such frequent tonsillitis will
also undermine the health, especially if we consider that not
infrequently an acute glomerulo-nephritis may ensue (and often does
follow, in an insidious way, without even being diagnosed). There have
also been plenty of cases of appendicitis in which the tonsillitis has
been in prior etiological relation to its development.

We have observed persons who, in consequence of such frequent
tonsillitis due to steam heat, have run down in health, lost their
appetite, and presented a pale, gray and miserable appearance, whereas
before they were rosy-cheeked and vigorous. In others, continued
pharyngitis, bronchitis, and sometimes asthma, may be observed.

In order to mitigate these dangers of steam heat we must place basins
filled with hot water in the localities where the steam heat is
produced. Such basins can be readily placed behind and attached to the
radiators; but they must be of large dimensions and must be kept
properly filled.

Steam heat is most dangerous when there is insufficient ventilation;
there should, therefore, be behind the radiators, and also in the
opposite wall at a certain height, an opening for ventilation. It is, of
course, understood that such ventilators are to be always kept open and
not, as is unhappily so often the case, closed. It is of the utmost
importance that the radiators be thoroughly dusted every day, as this
heated dust is most injurious to health. This is a rule that should be
especially observed in railway cars.

Fireplaces and stoves, which allow of a renovation of the air in a room,
are superior to the steam heat. In a room with an open fireplace or a
good stove the air is renewed, for a current of air is created which
removes from the room microbes and dust. Thus the air is purified. But
it is quite different with steam heat, which does not remove bad air
from the room. Fancy, now, a steam-heated hall, with many people in it,
which is overheated at the same time, and you will understand the
frequency of tonsillitis and bad colds after staying in such a
hall—which we would feel inclined to spell in a different way, to show
better its real nature.

Hot-water heating is superior to steam heating.

Everyone who desires to preserve youth for a long time and attain a good
old age, should avoid living continually in places overheated by steam,
without proper ventilation, as this is one of the surest means of
shortening life.


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                             CHAPTER XXXIV.

                     FOOD HYGIENE—GENERAL REMARKS.


THE leading principle in the use of food is that we should eat to live,
but not live to eat. It is certain that more people die from eating too
much than too little. It is wonderful to consider how little food
animals, or human beings, can exist upon for a long time and remain in
good health; and it is certain that the foundations of many diseases are
laid by excessive eating. It must be borne in mind that the elaboration
and assimilation of a large quantity of food requires the activity, or
even hyperactivity, of several of our most important organs, upon the
condition of which our length of life depends. And here we may repeat
the statement that has been made so often in the course of this book,
that overactivity of an organ may be followed by its exhaustion. By
laying too great a burden upon an organ, and continually overworking it
without giving it any rest for recuperation, we are burning the candle
at both ends, and rapidly exhausting the vitality of such important
organs as the liver, kidneys, pancreas, stomach, and intestines, not
forgetting those important glands, the thyroid and parathyroid, which
take a great share in the destruction of poisonous products formed in
our bodies from the end-products of food.

We have just mentioned that with very little food animals, or human
beings, can live for a long time. But prolonged underfeeding may be
quite as dangerous as overfeeding. In starvation the resistance against
infectious diseases, and especially tuberculosis, is diminished. This
disease, the most common of all maladies, is found most often in
underfed people, especially if they live in confined localities with
little air and no sunshine. Moderation in food, as in everything else,
is the only way to attain a happy old age.

The Romans had a very appropriate proverb which ran: “Omne quod est
nimium, vertitur in vitium,” “Everything in excess becomes a vice.”

Much depends upon the quality of the food we take, for some foods are of
very little nutritive value; and even of the most nutritive food, some
parts may pass out as waste products, because those organs which
elaborate and assimilate food may be partially, or wholly, changed by
disease, and so unable to fulfill the work for which they are destined.

Therefore, given a moderate amount of food, the condition of the body
and the maintenance of strength will depend mainly upon the nutritive
value of that food. An exact method of estimating the nutritive value of
food has been shown by Frankland, Stohmann, Danilewsky, and Rubner.

The best method of calculating the nutritive value of any food consists
in estimating how many calories it produces in the body during
combustion. One calorie is the amount of heat necessary to raise the
temperature of one gramme of water one degree Centigrade. Comparing our
system to an oven in which food represents the fuel: Just as oxygen is
necessary for combustion in the oven, so we could not carry out the
processes of combustion in our system without a plentiful supply of
oxygen through our lungs and skin. Also, just as gases produced in a
furnace must have free exit, so the carbonic acid, formed in our tissues
in the processes of combustion, must be eliminated by the lungs and
skin, otherwise auto-intoxication will occur. The above-named
authorities have reckoned exactly how many calories the various kinds of
food produce in our body.

All articles of diet can be classified into three principal groups:
proteids, carbohydrates, and fats. According to the above-named
authorities one gramme[254] of proteid produces 4.1 calories; one gramme
of carbohydrates, 4.1 calories; but one gramme of fat produces more than
twice as many, i.e., 9.3 calories.

Footnote 254:

  As well known, one gramme is the equivalent of 15 grains.

In order to maintain life without waste or without exposing ourselves to
disease, it is necessary to use all three kinds of food; for although
many animals, or human beings, can live for a certain time on only one
variety of food, most of them would die if this were persisted in for a
long time. The total exclusion of proteids especially would produce,
after a certain time, a considerable wasting of the body tissues and
certain death. According to Voith, it is necessary to take about 100
grammes of albumin a day if we want to avoid waste of body tissue.
Proteid food cannot be replaced by either of the other two groups of
food.

There are a series of facts which show that the estimate given by Voith
is perhaps too high. Horace Fletcher has shown by experiments on
himself, controlled by Professor Chittenden, that he could live in
splendid health with food not containing more than 45 grammes albumin,
and of 1600 calories heat value, in twenty-four hours, with a body
weight of 186 pounds.

As shown by Professor Noorden,[255] in Vienna, a man must take 30 to 34
calories for each kilo (2⅕ pounds) of his bodyweight when he is doing no
work, and 34 to 40 calories with light, and 40 to 60 calories with
harder work. Accordingly a man weighing 70 kilos would require to take
food equivalent to about 2800 calories for light work, and about 3500 to
4000 calories for heavy work. But Fletcher got along well on 1600
calories with a body weight of 186 pounds. However, he lost some weight,
36 pounds, but became healthier and stronger than he was previously.
Later on he still further reduced his diet and lived on 38 grammes of
albumin and 1581 calories, continuing in perfect health.

Footnote 255:

  v. Noorden: “Die Zuckerkrankheit,” fourth edition; and “Pathologie des
  Stoffwechsels,” fourth edition, vol. i.

By a series of experiments on a number of healthy American soldiers,
continued for a long time, Chittenden[256] and Horace Fletcher[257]
found that these men could do very hard work with an average of only 55
grammes albumin and 2700 calories; and, what is more interesting, their
muscular power was doubled.

Footnote 256:

  Chittenden: “Physiological Economy of Nutrition,” New York, 1904, and
  “The Nutrition of Man,” London, 1907.

Footnote 257:

  H. Fletcher: “The A, B-Z of Nutrition,” New York, 1904.

The same result was obtained by Professor Chittenden by experiments on
seven of the finest athletes among the 2300 students of Yale University.
He found the strength of these students increased as much as 48 per
cent. One of them won the championship in gymnastics, open to all
American universities, during the course of these experiments.
Rechenberg found that the weavers of Zittau in Germany required 65
grammes of proteids a day.

Very interesting are the observations of Professor Baelz, of Tokio, made
on the Japanese coolies, who drew the jinrickshaw containing Professor
Baelz, who then weighed 160 pounds. These coolies took carbohydrates,
mainly rice, with a proteid content of only 60 to 80 grammes. They were
able to do their work exceedingly well on this meager diet. One day
Professor Baelz gave them a little meat which they took for three days,
and then refused it, saying they would take it after their journey was
done. Baelz made the interesting observation that these men were able to
go about 60 miles, drawing a man of 108 pounds, whereas Baelz, who
followed riding in a carriage, had to change his horse six times and
only beat them by half an hour.

The author of this book has observed that while taking 1½ liters of milk
a day, 2 eggs, 40 grammes of butter, 3 rolls, 3 oranges, a pound of
cherries, a cup of coffee with milk, and one tart, he was able to live
very well for about two months without any loss in weight. The milk was
of excellent quality, containing about 700 calories to the liter, and
about 34 grammes albumin; thus he was taking about 70 grammes albumin
and about 2300 calories a day, with a bodyweight of 155 pounds, and
leading a very active life and he felt better than ever before.

Still we would not like to generalize and say that 55 or 60 grammes
albumin in the day would be a suitable amount for every individual.
Here, as everywhere, individuality and many other circumstances must be
considered. What is good for one may not answer in the same way for
another. The Japanese have constitutions different to the Europeans, for
which reason we cannot apply to Europeans facts which hold good for
Asiatics. Moreover, not everyone’s digestive organs are capable of
utilizing ingested food to the same degree. The quality of the food is
also of great importance, and likewise its digestibility. Therefore the
question is very complex, and, for these and other reasons, the
discussion of which would lead us too far, we cannot recommend a diet
containing such a small amount of albumin for general use.

Everybody likes to judge from his own experience, and so the author is
inclined to the belief that, when milk is taken in large quantities, in
addition to fats and carbohydrates, it is possible to get along with a
smaller amount of albumin, and of calories in general. Milk, in healthy
stomachs and intestines, is very easily absorbed, and the food leaves
less residue than most other kinds of food. Then, again, milk contains
in a wonderful combination all the three main groups of food. So we
believe that when milk is taken as the main article of diet we can get
along with a smaller number of calories, without any prejudice to our
health.

According to Rubner[258] the following number of calories are indicated
daily:—

                                               Albu-       Carbo-
                                                min    Fat hydrates Calories

 For an adult of 50 kilos (doing light work)      90    37   262  2102

 For an adult of 70 kilos (doing light work)     123    46   317  2631

 For an adult of 50 kilos (doing heavy work)      96    44   404  2472

 For an adult of 70 kilos (doing heavy work)     118    56   500  3094

                                                  91    45   322  2111

Footnote 258:

  Rubner: “Physiologic der Nahrung und der Ernährungtherapie,” Leipzig,
  1897.

Albuminous food serves, according to the prevalent opinion, to build up
our body tissues, carbohydrates to produce the energy that is necessary
for muscular work, and the fats to produce heat.

Accordingly, persons who are growing will need more albumin in order to
produce body tissues; and albuminous food will be indicated for those
who have had much loss of tissue, as in convalescence after wasting
disease. By albuminous food the waste of body tissues can best be
replaced. Also after different kinds of excesses where tissue is wasted
(e.g., after sexual excesses) albuminous food will be indicated.

Such a food is also necessary for women during pregnancies, and
especially during lactation.

In any of these conditions the minimum of albuminous food, taken daily,
should certainly be 100 grammes. But other persons can often manage with
less without any wasting of the body proteids, so long as carbohydrates
and fats are taken simultaneously in sufficient quantities.

Besides the three principal groups of food there are certain other kinds
which are almost as indispensable, e.g., mineral matter and water,
without which no animal or man could live, and vegetable acids and
cellulose.

The most important mineral matters are lime salts, mainly in the form of
phosphates. They are present in greatest amounts in cows’ milk. Common
salt is a most important element of food, for which animals and men
often risk their life. As Bunge shows, where vegetables that contain
much potassium are taken, then common salt must be taken as well. He has
shown by experiment upon himself, that when potassium salts are taken a
great quantity of sodium chloride is eliminated from the body. The
reason is, that when a potassium salt is taken, e.g., carbonate of
potassium, and this, in the blood, meets with chloride of sodium, then
chloride of potassium and carbonate of sodium are formed. But the
kidney’s duty is to see that the composition of the blood is maintained,
and that foreign substances, or the surplus of a normal substance like
carbonate of sodium, are eliminated. Hence the carbonate of sodium and
the chloride of potassium are together eliminated, and thus our blood
loses two important elements: chlorine and sodium. Thus, when potassium
is taken, the body loses sodium chloride, and then more of this
substance is required.

A diet of potatoes necessitates much salt, as they are rich in
potassium; on the other hand, rice contains only minimal quantities of
potash. Potatoes contain 42 grammes of potassium in 100 grammes; rice
only 1 gramme. Thus rice as food would require only the smallest amount
of salt.

At the same time Bunge points out the great dangers to the kidneys of a
diet from which quantities of an alkali salt are formed and circulate
through these organs. We can draw a practical conclusion of great value
from Bunge’s observations, and not use much salt in our food, nor too
large quantities of vegetables containing much potassium, if we want to
save our kidneys from harm. That salt is deleterious to the kidneys,
especially when previously damaged, is shown by the works of Achard and
Loeper,[259] Strauss,[260] Vidal and Javal,[261] and others. We have
enlarged upon this in our chapters on the functions of the kidneys and
their hygiene.

Footnote 259:

  Achard and Loeper: C. R. Soc. biologie, 23 Mars, 1901.

Footnote 260:

  Strauss: Die chronischen Nierenentzundungen, Berlin, 1902.

Footnote 261:

  Vidal et Javal: Soc. Méd. des Hôpitaux, 26 J., 1903; Vidal: “Le regime
  dechlorusé,” Liége Congrès de Méd., 1905.

A mineral of great importance is iron, which is contained in pig’s blood
to the largest extent, and in certain vegetables and fruit in
considerable quantities. Vegetables and fruit are also rich in vegetable
acids, and also contain a large amount of cellulose, which plays an
important rôle in the normal evacuation of the bowels, being the most
natural stimulus for this purpose.

Condiments are also indispensable in a certain quantity with our food,
for without them the food would have no taste and would not stimulate
appetite, which is of great importance for digestion. On the other hand,
too much of these condiments would irritate vital organs, like the
stomach, intestines, liver, kidneys, etc. Therefore they should only be
used in moderation, and the more potent ones, like mustard and pepper,
should be avoided, or only taken in minimal quantities. Vinegar would
not be so bad if it did not so often contain sulphuric acid. Certain
sharp sauces which are much used are veritable poisons to the kidneys.
This is true of soup that contains them, and even strong bouillon, when
it is taken every day in large quantities, may be injurious to the
kidneys and affect unfavorably the blood pressure since it contains many
meat extracts. To minimize the dangers of all these kinds of harmful
materials, and also of the end-products of nitrogenous food when passing
through the kidneys, it is best and healthiest to drink large quantities
of water, hard water being most desirable, according to Roese, because
of its richness in lime salts. It is advisable to drink this after
meals; but if water is not taken in too large quantities it may be
perfectly harmless to take it during meals. It helps the appetite in
many persons, and encourages the absorption of the food. If taken in too
large quantities it may dilute the gastric juice, although in such a
case the glands of the stomach strive to keep up the standard acidity,
and secrete more acid in consequence. As shown previously, a certain
degree of fluidity of the intestinal contents is indispensable for the
healthy action of the bowels. For all these reasons we recommend a
moderate amount of good fresh water daily. Happily, most of our
foodstuffs, especially green vegetables and fruit, contain water in
large quantities.

Under the name stimulants we include various kinds of food accessories.
The most important of these are alcoholic drinks. It has been shown by
physiologic experiments that when alcohol is taken in moderate
quantities it is harmless, and at the same time may be of value as a
nutrient foodstuff. It is evident from the result of the experiments of
Atwater and Benedict that alcohol has a nutritive value, and that as a
kind of fuel it can largely replace carbohydrates and fats. In such
quantities it also stimulates digestion and other functions, e.g., those
of the heart and nervous system. Such small quantities of alcohol are
contained in beer and wine. According to Rubner, 100 parts of beer
contain:—


                             Alcohol  Albumin  Extracts

                Bavarian     3.45     0.61     5.3
                beer

                Pilsner      3.46     0.4      5.0


English and American beers, however, are much stronger in alcohol; thus
Scotch ale contains 8.50 per cent. of alcohol; London porter, 6.90 per
cent.; lager beer, 3.90 per cent.

Beer is also of nutritive value on account of its sugar and dextrine,
which are in considerable amount, especially in dark beers; it also
contains an appreciable amount of albumin. On the other hand, beer has
the disadvantage of forming uric acid in considerable quantities, as
shown by Walker Hall and Haig. Beer also conduces to obesity. There can,
however, be no harm in taking a small amount of light beer every day.

Wine contains proteid substances, carbohydrates, and salts. In some
kinds of wine, like port, sherry, Tokayer, Malaga, and Madeira, there
are large quantities of sugar. The alcohol contents of the different
kinds of wine are given by Rubner as follows:—


                                          per
                                          cent.

                     Tyrolean wines       8.3

                     French red wine      9.4

                     Rhine wines          11.1

                     Palatial (Pfalz)     11.5
                     wines

                     Mosel                12.1


Thus, Tyrolean wines are the lightest, French wines come next, but Mosel
wines are the strongest, in spite of the popular belief that they
contain only little alcohol.

Wines contain more acids than beer (0.41 per cent. to 0.69 per cent.,
according to Rubner), whereas beer has only 0.1 per cent. As wine
contains vegetable acids, just as do vegetables and fruit, they may be
of a certain dietetic value on this account.

We do not think it harmful if old people drink, every day, a few glasses
of good French claret, although we are not prepared to indorse the
dictum of Hufeland that wine is the milk of the old. Much greater
precaution must be taken in the enjoyment of spirits: brandy (cognac),
whiskey, and rum. These beverages contains 50 to 60 per cent. of
alcohol. Still we do not think that small amounts of whiskey, if taken
occasionally and in measured quantities, can be dangerous. Care must be
taken to get whiskey of good quality. There can be no doubt, however,
that when large quantities are taken, as in dipsomania, old age is
brought on sooner. It is claimed that after taking whiskey less uric
acid is eliminated than after taking the other alcoholic beverages, as
beer or some kinds of wine.

Coffee, tea, and cocoa also belong to the class of stimulants, and we
will treat of them in a special chapter, as also of tobacco.

Great moderation must be observed in the amount of food we take daily.
Too rich food would induce not only diseases of the digestive organs,
but also disorders of metabolism, like obesity, gout, or diabetes, and
thus shorten life. Arteriosclerosis is also promoted by such a diet.

The more food also the more exercise should be taken, and the more we
work the more food should we take.

Aged persons should take less proteid food and more carbohydrates.
Proteid food is better suited to young persons who are growing. Besides
carbohydrates, milk is also especially indicated for old persons, as are
also certain amounts of fat, butter, etc.

The amount of food should also depend upon the climate; thus, in winter
more fat should be taken, for fat produces heat. Inhabitants of northern
climes eat much fat, and in Scandinavia more butter is taken than in
southern countries. In hot summer weather little proteid food is
required, and carbohydrates, vegetables, and fruit are more suitable.

Much depends on the preparation of food. In the process of cooking the
food should be brought into the most advantageous form for absorption
and assimilation. Therefore much depends upon the way in which the food
is cooked, and the great importance of this fact is shown by the
establishing of courses in cooking in Berlin under the direction of
Prof. H. Strauss.

In the choice of food attention must be paid to its digestibility. A
robust man, who works hard and takes much exercise, can digest easily
the most indigestible vegetable food, whereas a man occupied with
scientific work and sitting down all day will have a greater difficulty
in digesting it. Aged persons, whose digestive glands are atrophied, are
unable to digest food which presents great difficulties to the action of
their juices. Therefore raw milk, whipped eggs, tripe, lamb, rice, sago,
tapioca, barley, and soft boiled eggs, are the most digestible foods for
them. Of the vegetables, rice is among the easiest to digest, and it
will also soonest disappear from the stomach. There are special
preparations made from various kinds of cereals, finely ground, and
containing the most nourishing elements, and these may be advisable for
aged persons. There are also albuminous foodstuffs in which the albumin
is changed into the form of peptones. However, it has been shown by
Professor Ewald that they contain very little peptone, but mainly
albumose, its precursor. Others of these foodstuffs have the starch
transformed into dextrin or maltose. There can be no doubt that aged
persons will thrive and prosper on the best of these preparations, which
also have the advantage that they can be taken in conjunction with milk.
Another point in their favor is that they require little mastication.

We add here a table after Professor Ewald, of Berlin, on the
digestibility of the various kinds of food:—


     TABLE INDICATING THE DIGESTIBILITY OF DIFFERENT KINDS OF FOOD.

        The following food leaves the stomach in 1 to 2 hours:—

          100 to 200 gr. of pure water.
          220 gr. aërated water.
          200 gr. tea.
          200 gr. coffee.
          200 gr. beer.
          200 gr. light wine.
          100 to 200 gr. milk.
          200 gr. bouillon.
          100 gr. eggs (soft boiled).


   A longer time, 2 to 3 hours, is required for the digestion of the
                            following food:—

          200 gr. coffee with cream.
          200 gr. cocoa with milk.
          300 to 500 gr. water.
          300 to 500 gr. beer.
          300 to 500 gr. milk.
          100 gr. raw eggs, hard boiled eggs, or omelette.
          250 gr. sweetbread, boiled.
          200 gr. dried cod, boiled.
          150 gr. asparagus, boiled.
          150 gr. potatoes, boiled.
          150 gr. potatoes, mashed.
          150 gr. cherries, a compôte.
          150 gr. cherries, raw.
           70 gr. white bread, new or stale, dry or with tea.
           72 gr. fresh oysters, boiled.
          200 gr. carp, boiled.
          200 gr. pike, boiled.
          200 gr. haddock.
           70 gr. biscuit, fresh or stale, dry or with tea.
           50 gr. Albert biscuits.


          A still longer time, 3 to 4 hours, is required by:—

          230 gr. young chickens, boiled.
          230 gr. partridges.
          220 to 260 gr. pigeons.
          195 gr. pigeon, roast or broiled.
          250 gr. beef, boiled.
          160 gr. ham, raw or boiled.
          100 gr. roast veal, hot or cold.
          100 gr. beefsteak, roasted.
          100 gr. sirloin of beef.
          200 gr. salmon, boiled.
           72 gr. caviar, salted.
          150 gr. dark bread.
          150 gr. brown bread.
          150 gr. white bread.
          100 to 150 gr. Albert biscuits.
          150 gr. potatoes.
          150 gr. kohlrabs, boiled.
          150 gr. carrots.
          150 gr. spinach.
          150 gr. cucumber salads.
           50 gr. apples.


    The following food demands the longest time for its digestion:—

          210 gr. pigeons, roasted.
          250 gr. filet of beef, roasted.
          250 gr. beef steak, roasted.
          250 gr. tongue, smoked.
          200 gr. hare, roasted.
          240 gr. partridges, roasted.
          250 gr. goose, roasted.
          250 gr. duck, roasted.
          200 gr. herring, salad.
          150 gr. lentils, mashed.
          200 gr. peas, mashed.
          150 gr. green beans, boiled.


The digestibility of these various kinds of food is calculated for the
normal stomach. By following the above table we can make the best choice
of easily digestible food. Especially for aged persons we should choose
such, and at the same time we should mince them, or give them in the
form of porridge, which is still better. We must do this because aged
persons do not possess, as a rule, good teeth, if any, and thus cannot
fulfill the demands of mastication, which we will treat of later on in a
separate chapter.

The food should not be too hot nor too cold, as, if it is, the stomach,
and even intestines may be damaged; on the other hand, as a rule, warm
food disappears sooner from the stomach; but there are many exceptions
to this rule.

The keynote in the hygiene of food is moderation. We should never eat
more than necessary to satisfy hunger. Most people know when they have
had enough; and as a rule animals never eat more than enough to satisfy
them, and then they will refuse more food. But with the intelligent
human being it is different, and there are not a few who eat more than
they require, and thus dig their graves with their teeth. Moderation is
all important; it is, indeed, the cause of longevity of those persons
who live about 100 years.

We know the story of Cornaro, who became ill at 40 through immoderate
living. He recovered his health by reducing his food to the necessary
amount only, and then lived, happy and healthy, to 100 years. Mr. Horace
Fletcher,[262] and many other persons, have recovered their health
through moderation in food, after having come to the brink of death
through immoderation. Such examples we may often see, and they are
eloquent advocates of moderation in diet.

Footnote 262:

  Loc. cit.

We will show later that we can only digest food that we eat with relish;
therefore never let us be persuaded to partake of food, or compel
ourselves to eat, when we are not hungry. Therefore, at least six hours
should pass between dinner and supper, and five hours between breakfast
and dinner. It is more healthy, and especially conducive to healthy
sleep, to have dinner at 12 or 1, and supper at 6 or 7. Meat should only
be taken once a day, at dinner, and in the evening much less should be
eaten than at noon. Meat should never be taken for breakfast. We would
recommend the following diet:—


                               BREAKFAST.

Grape fruit or oranges, 2 eggs (soft boiled), cereals, stewed fruit,
white or brown bread, fresh butter, a teaspoonful of marmalade or other
kind of jam, fresh cherries, or fresh strawberries, or other fruit in
season, especially grapes, half to one pint of milk.


                                DINNER.

Soup, fish or meat, vegetables, stewed fruit, fresh fruit, white or
brown bread.


                                SUPPER.

Like breakfast: one pint of milk, or half a pint of sour milk, kefir, or
koumiss. Also, if liked, sour milk during the day.

In the above diet list we have a variety of foods, which variety is of
great importance.

It is very advantageous, according to our observation, to append to this
diet some milk, carbohydrates, fat, green vegetables, and fruit, with
the exclusion of meat. This we may do, especially if the weather is warm
in spring, summer, or early autumn; but in winter the above diet with
meat should be taken. It would be an excellent thing to take these two
diets in alternating periods. Much will depend upon the tastes of each
person, and the special indications which we give later on in their
respective chapters.

When no meat is eaten, then at least 1½ to 2 liters of rich milk should
be taken, and some cream cheese.

After these general remarks on food we will treat of the merits and
drawbacks of the various kinds of food.


------------------------------------------------------------------------




                             CHAPTER XXXV.

       ON PROTEID FOOD, ANIMAL FOOD, MEAT, FISH, EGGS, MILK, ETC.


MEAT is the commonest animal food, is the most nutritious, and most
closely resembles in its composition our own bodily tissues. Because the
albumin of meat is much better absorbed than any other kind of albumin,
such food can replace wasted body elements in a shorter time than can
any other kind of nutriment.

Even the albumin of milk leaves more residue than that of meat. From
this latter, therefore, is derived the most benefit during the period of
bodily growth, or in the other conditions above mentioned; but it will
not be so efficacious in those whose growth is already finished, or
whose body tissues are wasted by disease or by other demands on them.

Meat contains very valuable nutritive elements, such as large quantities
of proteids and fat, but very little carbohydrates; also various
important salts, such as chlorides, phosphates, and carbonate of
potassium. Meat also contains iron, the largest amount being found in
the blood of pigs. We can estimate the nutritive value of different
kinds of meat from the following table; according to Professor
Rubner,[263] each 100 parts contain:—


               ────────────┬──────────┬──────┬──────────
               Food.       │ Albumin. │ Fat. │Calories.
               ────────────┼──────────┼──────┼──────────
               Lean beef   │   20.6   │ 1.5  │    98
               Fat beef    │   16.9   │ 27.2 │   327
               Fat pork    │   14.5   │ 37.3 │   406
               Lean pork   │   19.9   │ 6.8  │   145
               Lean veal   │   19.8   │ 0.8  │    89
               Fat veal    │   18.9   │ 7.4  │   146
               Fat chicken │   18.5   │ 9.3  │   162
               Hare        │   23.3   │ 1.1  │   106
               Herring     │   10.1   │ 7.1  │   107
               Bacon       │          │ 95.3 │   886
               ────────────┴──────────┴──────┴──────────


Footnote 263:

  Rubner: “Physiologie der Nahrung und der Ernährungtherapie,” Leipzig,
  1897.

In addition to the above nutritive elements there are also a series of
extractive substances to which is due the pleasant taste of the meat.
When such food is boiled these substances and salts pass into the water,
and such meat loses in flavor, though not in its nutritive qualities,
for the water i.e., the soup is not nutrimental at all. Meat, if
prepared for the table directly after the animal is killed, would not be
palatable; and it is, therefore, necessary for it be kept for a given
time before it is eaten. Dr. Wiley, of Washington, considers that meat
improves if kept not exceeding fourteen days in cold storage, after
which time it begins to lose its best qualities.

When meat is chilled it does not lose its pleasant taste; but when it is
frozen the case is very different, for then it loses its beneficial
juices, which escape into the surrounding ice. In such meats, therefore,
the extractives which give the pleasant flavor are wanting. Refrigerated
meat generally arrives in Europe in excellent condition from America.

Before animals are slaughtered to be used for food a rigorous
examination by veterinarians must be made, in order to avoid poisoning
from meat in a condition of putrefaction, or from diseased animals. Some
animals, such as pigs, very often suffer from acute inflammatory
diseases caused by catching cold while on long journeys prior to being
slaughtered. Fortunately, in the early stages of such illness there is
little danger, for it can be avoided by thorough bleeding. The Jewish
method of bleeding an animal is thus particularly to be recommended, for
by this means poisonous products can leave the animals’ bodies in large
quantities. Meat retaining all the natural blood decomposes very
rapidly, especially in hot climates, and we must not forget that such
poisonous substances, as ptomaines, in meat, are not destroyed by the
process of cooking.

The greatest danger from poisoning lies in oysters, which are otherwise
a most digestible food. This is owing to the frequent presence of sewage
contamination in the waters where they are bred, thereby causing
veritable epidemics of typhoid fever. Just as in fish foods, oysters and
mussels, sausages in the meat foods are the most frequent cause of
poisoning when they are not quite fresh and thoroughly sound, and from
such a cause epidemics from poisoning are frequent in Germany. Sausages
are a very nutritious food, as they contain a large amount of fat; their
greater value when made from the blood of pigs, on account of its
richness in iron, will be specially dealt with in another chapter.

Fish contain somewhat less albumin and much more water than meat, but
some of them are rich in fat, such as the eel. We show in the following
table the nutritive values in each 100 parts of some of the most
frequently eaten fish:—


               ────────────┬──────────┬──────┬──────────
                           │ Albumin. │ Fat. │Calories.
               ────────────┼──────────┼──────┼──────────
               Herring     │   10.1   │ 7.1  │   107
               (Rubner)    │          │      │
               Haddock     │   17.1   │ 0.3  │    73
               (Rubner)    │          │      │
               Salmon      │  16.10   │ 5.50 │   110
               (Pavy)      │          │      │
               Eel (Rubner)│   17.8   │ 28.4 │   317
               White fish  │  18.10   │ 2.90 │   102
               (Pavy)      │          │      │
               ────────────┴──────────┴──────┴──────────


Fish contain as a rule very little extractive substances compared with
meat, and are therefore less tasteful; but still the fatter fish have an
agreeable flavor, and are pleasant to the taste. As a general rule, they
are more digestible than meat, and also have less of other disadvantages
than meat food, on which we will dwell more fully in another chapter.

On the other hand, it is more important than with meat that fish should
be absolutely fresh, which would be best attained by keeping them alive
in water until just before being required for the table. Boiled fish is
the most digestible, fried less so, and pickled or smoked the least.

The most perfect animal food is milk, as it contains all the three
principal elements of nourishment, and in normal digestive organs is
easily resorbed. As in the case of meat diet, we will deal more fully
with this most important and wholesome food in a special chapter. We
will content ourselves with mentioning here that milk not only contains
the three principal elements of food, but also most of the equally
important organic and inorganic minerals, without which life would be
impossible. It contains very important organic phosphorized combinations
in the shape of lecithin and nuclein; and of the inorganic salts, lime
exists in milk in a much greater degree than in any other food. Besides
the albumin, carbohydrates, and fat which it contains, milk comes under
the category of foods which are richest in mineral salts, especially
lime, of which cows’ milk contains 1510 milligrammes in every 100
grammes of desiccated substance, according to Bunge. In iron only is
cows’ milk very poor, and therefore when milk forms the main part of our
daily nourishment it will be necessary to partake of iron at the same
time, which we can best do by eating sausage and puddings made from
pigs’ blood (see Chapter XXXVIII).

According to Professor Rubner milk and the various products of milk
contain the three main elements of food, in each 100 parts, as follows:—


          ────────────┬──────────┬──────┬──────────┬──────────
                      │ Albumin. │ Fat. │  Carbo-  │Calories.
                      │          │      │hydrates. │
          ────────────┼──────────┼──────┼──────────┼──────────
          Cows’ milk  │   3.4    │ 3.6  │   4.8    │    67
          Cream       │   3.7    │ 25.7 │   3.5    │   268
          Buttermilk  │   3.8    │ 1.2  │   4.6    │    41
          Whey        │   0.8    │ 0.2  │   3.4    │    24
          Butter      │   0.9    │ 83.1 │   0.5    │   404
          Cream cheese│   27.2   │ 30.4 │   2.5    │   779
          ────────────┴──────────┴──────┴──────────┴──────────


According to Bunge the following is the composition of cows’ milk, human
milk, and the milk of some animals which rank nearest to human milk;
each 100 parts contain:—


          ────────────┬──────────┬────────┬──────────┬────────
                      │ Casein.  │Albumin.│   Fat.   │  Sugar.
          ────────────┼──────────┼──────┬─┴────────┬─┴────────
                      │          │      │ { 3.1 }  │ { 5.9 }
          Woman       │   1.2    │ 0.5  │ { 3.3 }  │ {  to }
                      │          │      │ { 3.8 }  │ { 6.5 }
          Cow         │   3.0    │ 0.5  │   3.7    │   4.9
          Horse       │   1.2    │ 0.8  │   1.2    │   5.7
          Ass         │   0.7    │ 1.6  │   1.6    │   6.0
          Goat        │   2.4    │ 0.8  │   4.3    │   3.6
          ────────────┴──────────┴──────┴──────────┴──────────


The milks nearest to human milk in composition are those of the horse,
ass, and goat. It is a very interesting fact that goats’ milk contains
ten times as much iron and nearly seven times as much lime as human
milk, and also ten times as much iron and eight times as much lime as
cows’ milk. On account of its nearer similitude to human milk than the
cows’ milk, and also because of its being richer in valuable minerals,
we will later on, in the chapter on the advantages of milk food,
advocate its use in preference to cows’ milk. We will also show at the
same time that milk must not be boiled, for by so doing very valuable
ferments contained in the milk will be destroyed. Woman’s milk is richer
in these ferments. According to Beauchamp, Bouchut, and Moro, there is a
diastatic ferment in breast milk, but not in cows’ milk. Manfur and
Gillet found a saponifying ferment in mothers’ milk which is less active
in that of cows. Luzatti and Bianchini found a starch-separating ferment
in woman’s milk which is absent in cows’ and goats’ milk. According to
Spolverini, cows’ milk has the same ferments as has human milk, except
the amylolytic ferment, and also a salol splitting element that has been
discovered by Nobecourt and Merklen in the milk of woman.

Butter is a milk product in daily use, and is one of the foods most used
in our diet; and as it is consumed in connection with carbohydrates, we
will refer to it later, when discussing the question of carbohydrates
generally; but we may mention here that butter must be taken only in a
fresh condition, and it should not contain a greater proportion of salt
than 2.5 grains per ounce, for reasons we have so often insisted upon in
our general remarks on food when referring to common salt, and also in
the chapter on the hygiene of the kidneys. When butter is in a rancid
condition it produces acid fermentation in the stomach, and also
disorders of the intestinal functions.

Cheese is a milk product very rich in fat, consisting of the coagulated
casein of the milk fats and salts. American, Canadian, and English
cheese are manufactured from pure milk, while the majority of cheeses of
other manufacture are made from skimmed milk. A very nutritive cheese is
made in Norway from the pure milk of goats; this has a very pleasant
taste and is very easy to digest. By moderately pressing fresh curds
cream cheese is made; and we are of the opinion that in this form it is
more hygienic than old cheese, and we therefore give the preference to
cream cheese, or to cheese made from pure milk that is not old or sour.
Cheese is a very valuable article of nourishment on account of the large
amount of albumin and fat that it contains. Gervais and other sorts of
cream cheese have a very high percentage of fat.

Dr. Haig[264] recommends cheese as a valuable article of food in the
dietetic treatment of uric acid diathesis. It has also the great
advantage of being able to check intestinal putrefaction, owing to its
milk and fatty acid contents.

Footnote 264:

  Haig: Loc. cit.

On the other hand, sometimes very old cheese may cause intestinal
putrefaction, with symptoms of intoxication, and serious catarrh of the
intestines. Professor Vaughan, of Ann Arbor, found toxic ptomaine bodies
in cheese and old and stale milk.

Many people are unable to digest cheese well; others develop skin
eruptions or acne after eating it; but, for those who can take it, it is
very valuable as an article of diet when a lacto-vegetarian regimen is
followed, as suggested in our general remarks on diet.

In addition to milk and meat, the next most important animal food is
eggs, which are very rich in a most soluble animal albumin, and also in
a substance which plays an important part in the structure of the
nervous system—lecithin. According to König[265] chicken’s eggs have, in
their natural watery condition, 13 per cent. of albumin and 0.3 per
cent. of fat; and 89 per cent. of albumin and 2 per cent. of fat in the
dried substance of the white part; whereas the yolk, in the natural
watery state, contains 16 per cent. of albumin and 32 per cent. of fat,
while, if dried, 33 per cent. of albumin and 65 per cent. of fat. Eggs
also contain much lime.

Footnote 265:

  T. König: “Chemie der menschlichen Nahrungs und Genussmittel,” second
  edition, Berlin, 1882.

Eggs with milk, carbohydrates, and fat together constitute a food which,
in our opinion, is the most perfect, and one which will enable us to
live a longer life in perfect health, even with a complete exclusion of
meat; though if we take in addition a little of this latter at dinner we
may increase considerably in weight, notwithstanding bodily exercise, as
the author found from personal experience and from observations on a
series of patients. Therefore, we again repeat that the above appears to
be the most beneficial diet to follow if we wish to obey the dictates of
health and enjoy a prosperous long life.


------------------------------------------------------------------------




                             CHAPTER XXXVI.

 ON CARBOHYDRATES AND FATS, AND THE GREAT ADVANTAGES OF VEGETABLES AND
                                 FRUIT.


SPEAKING generally, by the title “carbohydrates” is principally meant
vegetable food, in the same way that by “albuminous” animal food is
mainly designated. Still there are vegetables which contain more albumin
in their natural watery condition than meat; thus peas contain 23 per
cent. of albumin, whereas lean beef has barely 21 per cent., and fat
beef only 17 per cent. But one thing must especially be considered, and
that is the fact that a considerable portion of peas (about 28 per
cent.) is not absorbed, as Rubner has shown, whereas nearly the whole
albumin contents of lean beef is.

Most albumin is found in leguminous vegetables, such as peas, beans, and
lentils; and these are also rich in carbohydrates, as will be seen from
the following table of percentages by Rubner, in which reference is also
made to the nutritive value of our most important fresh vegetable
foods:—


   ─────────────────┬─────────┬──────┬──────────┬─────────┬─────────
   Food.            │Albumin. │ Fat. │  Carbo-  │ Cellu-  │Calories.
                    │         │      │hydrates. │  lose.  │
   ─────────────────┼─────────┼──────┼──────────┼─────────┼─────────
   Flour of peas    │  25.7   │ 1.8  │   57.2   │   1.3   │   362
   Flour of beans   │  23.2   │ 2.1  │   58.9   │   1.8   │   363
   Flour of lentils │  25.7   │ 1.9  │   56.8   │   2.1   │   364
   Flour of rice    │   6.9   │ 0.5  │   77.6   │   0.1   │   351
   Flour of Indian  │  14.0   │ 3.8  │   67.6   │   3.1   │   382
   corn             │         │      │          │         │
   Flour of wheat   │  10.2   │ 0.9  │   74.7   │   0.3   │   357
   Flour of rye     │  10.9   │ 4.8  │   70.5   │   1.2   │   383
   Wheat bread      │   6.8   │ 0.8  │   57.4   │   0.4   │   252
   Rye bread        │   6.0   │ 0.5  │   47.8   │   0.3   │   226
   Potatoes         │   2.1   │ 0.1  │   21.0   │   0.7   │   98
   Carrots          │   1.0   │ 0.2  │   4.4    │   1.4   │   50
   ─────────────────┴─────────┴──────┴──────────┴─────────┴─────────


From the above we see that peas, beans, and lentils have the most
nutritive properties, for they contain not only much albumin but also
much carbohydrates, and also more fat (except in the case of ground
Indian corn and rye), than the other above-mentioned vegetables.

Thus we shall not be surprised to learn that we can thrive very well for
a long time by using such exclusively for food, as has been proved by
the experiments of Rubner and Woroschiloff. The drawback to this kind of
food is that it requires the stomach and intestinal juices to perform
much more work, for reasons already mentioned; and, in consequence, less
of it is utilized; and, after a certain time, the development of stomach
and intestinal troubles is facilitated.

Another drawback attending vegetables is that they contain purin bodies
and form uric acid, indeed in considerable quantities, especially peas
and beans, as Walker Hall[266] discovered from experiments conducted in
the Caroline Institution at Stockholm. Of the various kinds of cereal
foods rice forms the least uric acid, and also, as already mentioned,
contains the least salt, for both of which reasons it is the best food
for the kidneys. It is, at the same time, a very valuable nutritive
food, as it contains a very large quantity of carbohydrates, viz.: 77.6
per cent., and almost the least cellulose of all foodstuffs, as shown in
the table above; but it is very poor in fat, and has also but a small
amount of albumin. As it contains so little proteid and fat its adoption
by people with vegetarian proclivities necessitates the simultaneous use
of leguminous vegetables and of fats. It has the advantage over
leguminous vegetables in that its starch components are extremely
digestible. Thus it is the most valuable vegetable food, in spite of its
being poor in mineral matters.

Footnote 266:

  Walker Hall: Berliner klin. Wochenschrift, p. 868, 1903.

Granted the enormous value of rice as a foodstuff, we must express our
surprise that it enters in so small a degree into our daily diet. In
Europe, and in other parts of the world where persons of European
descent reside, as also in America, the potato takes the same place as
rice does in Asiatic countries, though the former is much less rich in
nutritive qualities, as we will show later on.

Rice must be a most excellent food, for the natives of Asiatic
countries, who live almost exclusively on this, offer us examples of
great tenacity, and of resistance against bodily fatigue. Take the
Japanese for example. Their coolies, as shown already, are able to do
enormous muscular work on rice and fish food, and in athletics, such as
jiujitsiu, they present a great example of muscular strength, though it
cannot be denied that it is more their dexterity and knack than their
superiority in mere strength that leads them to victory. That by means
of rice diet, as by carbohydrates, great muscular energy can be
obtained, is a well-known physiological fact.

The starchy portion is converted, through the digestive ferments in the
saliva, pancreatic, and intestinal juices, into dextrin and grape sugar;
absorbed through the intestines, it is deposited in the form of glycogen
in the liver, the muscles also absorbing a large part of this glycogen.
Through work this glycogen is exhausted. Thus work is performed mainly
at the expense of the carbohydrates, which are the prime generators of
muscular energy. We have also seen that the above-mentioned Japanese
coolies perform their incredible muscular efforts largely on such food
only. Still, a part of the muscular energy of the body can also be
provided by the proteids and fats.

Carbohydrate foods, and especially those that are poor in fatty
contents, such as rice, and especially potatoes, which are the most
deficient of all (having but 0.1 per cent. of fat), necessitate the
simultaneous use also of fat; for this kind of exclusively carbohydrate
diet would invariably lead to starvation unless there was a plentiful
supply of fat with it; and the best and most agreeable form to introduce
fat into the body is by means of butter.

Butter is very nutritious, as it contains, according to Rubner, 83.1 per
cent. of fat, 0.9 per cent. of albumin, and 0.5 per cent. of
carbohydrates. One hundred grammes of butter contain, according to
Rubner, 779 calories. In addition to the above, butter also contains
salts, and from 8 to 12 per cent. of water. A diet rich in carbohydrates
could not be well assimilated without butter; but, at the same time, the
abundant use of the latter also necessitates the use of carbohydrates,
which are the best vehicle for butter; therefore, when in diabetes we
prescribe much butter or other fats, we make it a rule, also, to give
some kind of food that contains some amount of carbohydrates, such as
brown bread or green vegetables, or sometimes, in mild cases, also
boiled potatoes.

Potatoes, when new and watery, contain 16 per cent. of carbohydrates;
when they are old, 22 per cent. In many European countries they form a
most important article of diet. Though, as shown in the foregoing table,
they contain only 2 per cent. of proteids, they contain also important
salts, such as a certain amount of citric acid and citrates of
potassium, sodium, and lime. Thus potatoes, by means of these salts, are
also an alkaline food, and if consumed in very large quantities, the
acidity of the urine can become much diminished. These salts are burned
in the body, and the potassium is then transformed into a carbonate
salt. Mossé recommends potatoes in large quantities as a preventive of
diabetes.

Thus, after food which is rich in such vegetables as potatoes, or after
fruit with much fruit acids, the urine can become less acid; but after
food that abounds in proteids the urine becomes acid. This happens after
eating much meat, or leguminous vegetables rich in proteids. Such a very
acid urine is often passed by diabetics; therefore in their diet a
certain amount of fruits, rich in salts but poor in sugar, may give good
results.

The most rational diet is that which combines all the principal items of
nourishment—in the greatest proportion proteids, as from such the body
is built up and waste tissues replaced; next in proportion
carbohydrates, from which, as already shown, we obtain muscular energy;
and to a smaller extent than the two preceding must be taken fat, which
serves to produce heat in the body. Besides these three important
constituents there is a further class of valuable substances
indispensable for our well-being, and these are the mineral matters.
From experiments made by Lunin[267] in Bunge’s laboratory, and by
Förster,[268] it has been shown that animals cannot live if fed on food
that is devoid of mineral matters; and the latter savant has further
shown that animals can live longer without any food at all than with
food that has no salt whatever. We need these salts for different
purposes, such as building up the skeleton; and the condition of the
teeth depends also on the richness of our bodies in lime, and in order
to obtain this it is indispensable to introduce food that contains a
maximum of it. This is of special importance in the nutrition of
children.

Footnote 267:

  Lunin: Diss Dorpat, 1880. Zeitschrift für Physiolog. Chemie, vol. v.
  March 1, 1881; quoted after Bunge.

Footnote 268:

  Förster: Zeitschrift für Biologie, vol. ix, p. 247, 1873; quoted after
  Bunge.

We give below a table by Bunge showing the amount of lime contained in
many of our common articles of diet; 100 grammes of dried substance
yields milligrammes of lime:—


                          Cows’ milk     1510

                          Human milk      243

                          Strawberries    483

                          Figs            400

                          Yolk of eggs    380

                          Prunes          160

                          Peas            137

                          Dates           108

                          White of egg    130

                          Potatoes        100

                          Pears            95

                          Malaga           60
                          grapes

                          Graham bread     77

                          But beef,        24
                          only


Probably no cell growth can take place without lime, and even if grown
animals are fed on a diet containing no lime they soon become weak and
will certainly die at some time from it; therefore not only children,
but adults also, must obtain a sufficient quantity of this, and milk or
water that contains lime is certainly the best means by which to get it.
Very interesting are the observations of Roese,[269] showing that in
parts of Germany where water poor in lime is drunk less people are fit
for military service and the teeth of the population generally are in
bad condition. Lime is indispensable for our body, for it has a
favorable influence upon the work of the heart, the secretion of stomach
juice, and the movements of the intestines; it increases the quantity of
the urine; and, as Lehmann, Posner, and v. Noorden have shown, the
carbonate of lime dissolves uric acid.

Footnote 269:

  Roese, “Erdsalzarmuth und Entartung,” Berlin, 1908.

Another most important mineral salt is iron, this being an essential
element of the hæmoglobin of the blood. This latter is the red coloring
matter of the blood, and consists of the combination of an albuminous
body-globulin with a ferruginous body, the hæmatin. According to
Bunge,[270] a man weighing 70 kilos has in his blood 3.2 grains of iron,
and according to Schmidt from 2.4 to 2.7 grains.

Footnote 270:

  Bunge: Loc. cit.

Bunge maintains that organic iron is more readily absorbed than
inorganic iron, and that the best way to obtain sufficient iron in the
body will be to choose a food that is rich in iron

We present below a table by Bunge, showing the various articles of food
that contain the greatest percentage of iron; 100 grammes dried
substance contain milligrammes of iron:—


                      Pig’s blood              226

                      Spinach             33 to 39

                      Asparagus                 20

                      Yolk of eggs        10 to 24

                      Beef                      17

                      Cabbage, green            17
                      leaves

                      Apples                    13

                      Red cherries              10

                      Almonds                  9.5

                      Lentils                  9.5

                      Strawberries          8.6 to
                                               9.3

                      Carrots                  8.6

                      White beans           6.2 to
                                               6.6

                      Black cherries           7.2

                      Peas                  6.2 to
                                               6.6

                      Potatoes                 6.4

                      Huckleberries            5.7

                      Grapes                   5.6

                      Wheat                    5.5

                      Rye                      4.9

                      Barley                   4.5

                      Raspberries              3.9

                      Figs                     3.7

                      Human milk            2.3 to
                                               3.1

                      Cows’ milk               2.3

                      Dates                    2.1

                      Pears                    2.0

                      But rice, only        1.0 to
                                               2.0


We thus see that certain kinds of fruits and vegetables are noticeably
very rich, not only in lime, but also in iron; such are strawberries,
Malaga or California grapes, peas, potatoes, etc.

If not rich in lime, yet, on the other hand, rich in iron, are certain
vegetables and fruits, such as spinach, asparagus, the outer leaves of
cabbages, lentils, almonds, apples, cherries, etc.

As it is very probable that organic iron is more easily assimilated than
inorganic, it would be advisable in those cases which require a better
nutrition of the blood and an increase of its contents in iron, to give
plentifully the above-named vegetables and fruits.

The fruits mentioned as being rich in iron, such as apples and cherries,
or in iron and lime, such as strawberries and grapes, can not only
increase the amount of iron in the blood, but increase its alkalinity;
and at any rate if they cannot increase it they can at least preserve
it; and not in the blood only, but also in the other fluids of the body,
this being effected through the acids contained in such vegetables, such
as citric, tartaric, malic, acetic, and oxalic acids, which are either
in a free state or in combination with alkalies, as alkaline salts.
After the combustion of the acids in the body they appear as carbonates,
thus increasing the alkalinity of the blood and other fluids.

Of the above acids, grape-fruit contains mostly citric acid, as also do
oranges, lemons, gooseberries, etc.; apples and peas contain malic acid,
and grape juice, tartaric acid.

There can be no doubt that the above-named fruits and vegetables—and let
us not omit the important potato—are able to do us good service in the
prevention and treatment of the condition of acid intoxication that we
find in severe forms of diabetes or in serious disorders of the liver;
but also in uric acid diathesis they can render valuable assistance.

For a long time past through various kinds of fruit, especially berries,
various cases of gout have been successfully treated. Strawberries,
cherries, and apples especially have been recommended in such
conditions, and the value of such a prescription has been confirmed by
the experiments of J. Weiss,[271] made in Bunge’s laboratory. We also
used grapes in large quantities, besides the above-named fruits.

Footnote 271:

  J. Weiss: Zeitschrift für Physiolog. Chemie, vol. xxv, p. 303, 1898;
  vol. xxvii, p. 216.

In case of gravel, also, where the concrements consist of uric acid, the
administering of such fruit can give beneficial results.

Besides mineral salts and vegetable acids, fruits and vegetables contain
a third important substance, which is cellulose, the framework of their
cell tissues. Although this is very difficult to digest, still there can
be no doubt, from the experiments made on animals and also on man by
Weiske,[272] that cellulose is also a nourishing food, for he proved on
himself and another person that from 46 per cent. to 65 per cent. of the
cellulose can be digested.

Footnote 272:

  Weiske: Zeitschrift für Biologie, vol. vi, p. 456.

The chief advantage, however, of cellulose does not lie in its
nourishing properties, which are not great, but in the fact that it acts
as the best natural stimulus to the peristaltic movements of the
intestines. Thus food that contains such a residue (which is contained
most largely in vegetables and fruit) is also the best to use if we
desire to keep the intestines open and to observe the most important
precept of their hygiene. This hygienic condition can also be much
advanced by vegetables of the cereal kind, which, as shown in the
chapter on hygiene of the intestines, may act as a disinfectant of the
same through the milk acid that is formed therefrom in the intestines.

Vegetables and fruit have thus very great advantages, and even in winter
our daily diet should consist plentifully of them, as grape-fruit,
oranges, etc., can be obtained at that time of the year. But when
vegetables and fruit are exclusively used as a diet they present certain
dangers, as we point out in the next chapter on the advantages and
disadvantages of a vegetarian diet.


------------------------------------------------------------------------




                            CHAPTER XXXVII.

       ON THE ADVANTAGES AND DISADVANTAGES OF A VEGETARIAN DIET.


OWING to certain peculiarities in our anatomical construction we are not
intended by Nature to be vegetarians. This is amply demonstrated when we
consider the formation of our teeth. These are neither the teeth of
carnivorous nor of herbivorous animals. We have, in fact, teeth similar
to those found among omnivorous animals, such as the dog and pig, while
our whole metabolism, the transformation and assimilation of food in our
bodies, presents great similarity to that of the dog.

The construction of our intestines is further evidence that Nature did
not intend us to be numbered among the herbivorous animals, which are
required to have an enormously long intestine to store up and assimilate
the very large quantity of herbs or vegetables which are necessary to
satisfy their wants. We should have to possess an intestine many times
longer than we are provided with in order to be able to exist on
vegetables alone; and even with such an intestine it would be very
difficult for us to live comfortably for a long period on a purely
vegetarian diet. It is, however, certainly possible to exist on such a
diet for a certain time; and it may be of direct advantage for those
persons who have overtaxed their digestive organs by large quantities of
meat food, as it will afford the said organs a well merited rest. In
order to live for a long period without risk on a vegetarian diet, it is
necessary to add certain products of animal sources, such as milk and
eggs. We know from personal experience that with a vegetarian diet
supplemented by cereals, especially rice, milk, butter, and eggs, it is
possible to exist very comfortably for a long time, and to thrive on it,
for we have frequently witnessed a considerable increase in the weight
of the body. This experience we have also gained and confirmed by
personal test.

A vegetarian diet, when supplemented by milk and butter, can be indulged
in for a considerable time, and advantage may be gained therefrom. In
many cases of nervous diseases it is of excellent value, especially in
neurasthenia and hysteria, Graves’s disease, myxœdema, etc., when meat
food is deleterious, for reasons we have often given. With such a diet
we can also avoid all the dangers which threaten us from the formation
of uric acid. We must, however, avoid taking in large quantities of such
vegetables as beans, peas, etc., which, according to Walker Hall,
contain purin bodies, the mother substances of uric acid.

Rice is the vegetable which will form the least uric acid, and it is at
the same time one of the most nourishing of vegetarian foods, as it
contains 77 per cent. of carbohydrates.

Thus with vegetarian diet we can avoid, in great probability, those
diseases which arise from an excessive formation of uric acid. As
Professor Dettweiler,[273] of Freiburg, demonstrated at the German
Congress of Medicine in 1907, the viscosity of blood is greatly
diminished by a vegetarian diet. As gout is a disease which is due, in
all probability, to a retention of uric acid (after preliminary changes
in the thyroid and kidneys, as we have pointed out in a communication to
the Paris Biological Society, February 25, 1907), a long extended
vegetarian diet can unquestionably be of a great benefit for the
prevention and treatment of this disease. It is, however, necessary that
such a diet should be prescribed for a very long time (for several
months at least) if we desire to reap the full benefit from it.

Footnote 273:

  Dettweiler: German Congress of Internal Medicine, 1905.

To prevent the development of diabetes, also, especially in cases of
children of diabetic parents, a vegetarian diet can be of great use. In
the chapter on the deleterious action of excessive meat food, we refer
in detail to the fact that diabetes is most often found in persons
addicted to much meat food, especially if carbohydrates are taken in
large quantities at the same time. Obesity is seldom found in persons
who live on a vegetarian diet. Carbohydrates can be taken in large
quantities without producing obesity, if only meat is not taken at the
same time in more than a limited amount.

Arteriosclerosis is very seldom found in persons who have been addicted
for many years to vegetarianism. Not only is this due to the fact that a
vegetarian diet is the least deleterious to the circulatory system, but
as we have mentioned above, the viscosity of the blood is also
diminished; but with a vegetarian diet, coupled with milk, there is much
less intestinal putrefaction, if any, than with a meat diet. It is well
known that the production of arterial sclerosis can be facilitated by
the products of intestinal putrefaction.

As Brissaud and Siccard have shown, the injection of adrenalin and uric
acid at the same time into animals produces atheromatosis in each case.
We also know, from clinical observation generally, that arteriosclerosis
is of greater frequency among gouty people, and the frequency of
diabetes among such can be attributed to arteriosclerotic changes in the
pancreas (endarteritis obliterans, Flexner).

Marcel Labbé has shown at the French Congress of Internal Medicine in
Paris, 1907, that a diet of cereals, milk, butter, and sugar diminishes
the quantity of uric acid, while the addition of nucleo-albumins
augments it.

Vegetarian diet is of great service to the intestines, their torpidity
being thereby greatly overcome; and if milk be taken at the same time
intestinal putrefaction is checked and the tendency to catarrh improved.
Such a diet is also of great value to other important organs: the
thyroid, liver, and kidneys; as in cases where such are in a diseased
condition, the chances of recovery or for a more prolonged life are much
enhanced, because such a diet is least harmful to these organs.

But the greatest advantages of a vegetarian diet are seen in the
prevention of the ravages of old age by this means. By the use of such a
diet we can, to a certain extent, check the degeneration of those organs
which play the most important pathological roll in the development of
old age, and which have already been mentioned several times, viz.: the
thyroid, liver, and kidneys (see the hygiene of these organs). The
degeneration of these may produce the retention of toxic products and a
condition of auto-intoxication; but by a vegetarian diet, coupled with
milk, these troubles may be more easily avoided.

A vegetarian diet, with milk and a few eggs daily, is the best
nourishment for old people; the greater the age the more of the latter
should be taken. In fact, persons advanced in age will do well to eat
very little meat, for reasons which are fully given in the chapter on
the dangers of a too abundant meat diet.

We have thus seen that a vegetarian diet can give the best results, not
only in the prevention and cure of many diseases, but also in the
preservation of health in old age. It is a fact that we often see
persons who follow such a diet looking much fresher and more youthful
than those who partake of much meat, especially when they have passed
the seventies.

But if milk and vegetarian diet, with a few eggs daily, can be taken for
many years and yield good results, it is quite a different case with
those people who are in the habit of living only on vegetables to the
exclusion of any article of animal food; such are vegetarian fanatics,
and if they keep up this deleterious habit for a lengthened period, they
must inevitably suffer for it.

Even if we do not admit the pretensions of certain authors, who declare
that the albumin of the vegetable is less nourishing than the albumin of
animals, still it is impossible for us to introduce into our bodies the
quantity of vegetables which would contain the number of calories
necessary in order that we should not suffer from a deficiency of them,
and at the same time would allow for waste. To satisfy the requirements
of our bodies we would have to eat enormous quantities of vegetables and
thus overload the stomach and intestines, with the result that even the
strongest stomach would undoubtedly give way after a certain time, and
dyspepsia, especially sour stomach, and eventually atony, and in many
cases even dilatation, of the stomach would follow; and abnormal
fermentation would readily take place in the intestines after a certain
time. Consider, also, what large amounts of enzymes, how much saliva,
hydrochloric acid, bile, etc., must be produced in order to insure a
good digestion and assimilation of the food, though it is of course true
that the ferments, at least, can readily act in a very small degree upon
large quantities of food. Vegetarian diet has also the drawback that,
for reasons already mentioned, more salt must be taken when we partake
of it.

There are many people who develop hyperchlorhydria after a vegetarian
diet, and we frequently had to have our patients abandon such a diet
when they got acid stomachs; and they only recovered from these ill
effects after animal food had been given in certain quantities. It is
certain that the present capacity of the stomach and intestines, and
their present anatomical and histological structure, also, is not
sufficient or adequate for the continued use of a vegetarian diet, the
greatest danger of which lies, however, in the threatening
_under_-nutrition, and in consequence the imminent danger of bacterial
infection.

It is a positive pathological fact that under-nutrition (or defective
nutrition) through lack of the necessary amount of proteids in the diet
exposes one more to infection by bacilli. This is plainly to be seen
every day, especially in regard to tuberculosis; and as the best
preventive to this we strongly recommend plenty of nutrition, especially
rare meat and milk. We have personal knowledge of several cases of
tuberculosis arising from a purely vegetarian diet (see, also, Chapter
III). The findings of Grawitz[274] indicate that an insufficient proteid
diet predisposes also to anæmia. The importance of this fact is
emphasized by Sajous who has shown (1903) that defective nutrition
weakens the activity of the pituitary, thyroid and adrenals, the
products or secretions of which take an active part in the destruction
of bacteria and their toxins.

Footnote 274:

  Grawitz: “Klinische Pathologie des Blutes.” third edition, 1906.

In our chapter on the destruction of toxic products by the liver, we
referred to evidence gained from actual experiments, that
under-nutrition predisposes to infection. We have referred to Roger and
Garnier, who have proved that the liver loses its antitoxic properties
in cases of under-nutrition, and it is probable that the other antitoxic
organs exhibit a similar condition.

There are two primary conditions on which infection depends: 1. The
invasion of the microbes. The greater their number and virulence the
more easily will infection take place. 2. The diminution of our normal
resistance against infection, which, as we have seen in the third
chapter, can be caused by different factors, among which is
under-nutrition.

In any case we are surrounded by countless millions of microbes every
day, which are only too anxiously awaiting a favorable moment to attack
us; and should we be so foolish as to encourage their attacks by
adopting fads in our nourishment?

The greatest danger of a strictly vegetarian diet is for those persons
whose parents suffered from chronic cachectic diseases, such as
tuberculosis, chronic alcoholism, etc., in whose cases the perils of
infection are much more menacing. Should such expose themselves still
more by insufficient nourishment, such a course can be called by no
other name than culpable negligence, leading to suicide. It is the
object of this book to demonstrate the best way to reach a ripe old age
and to avoid disease; it is, therefore, my duty to emphasize the dangers
of a sole vegetarian diet, especially for weak people.

As the processes of oxidation are, as a rule, diminished in old age,
especially in its advanced stage, such persons can exist on less food
and need not introduce so many calories into their system; and as they
also take less exercise, so they require less nourishment. Consequently,
they can live better on a vegetarian diet than can the young and robust.
Even then, however, it may be prejudicial to their health to live solely
on vegetables, and it will be necessary to supplement this with milk and
a few eggs daily. For young people such a diet, continued for a
prolonged period, will present evils, and it would therefore be
advisable not to continue such nourishment longer than four or six
weeks, and then add meat once a day to the former diet of vegetables.
This is mixed vegetarian diet, and should be interposed in the ordinary
diet routine at intervals and at times of necessity. Thus when symptoms
of over-nutrition may present themselves a purely vegetarian regimen may
be followed, but not for longer than three or four weeks; but for those
having a weak constitution and great tendency to infection, a purely
vegetarian diet is not indicated, even for so short a time as a week.

Judging from my own personal experience, I do not think it possible for
persons who confine themselves solely to a vegetable diet to prosper and
look well, especially if they exist on such insufficient food for
several months, and still less so if they continue such a course for a
longer time. We know that all the people of our acquaintance who existed
for a long time on such a diet, presented a pale, haggard and miserable
appearance, so that we could not but pity them. We, personally, tried to
follow their example, but after a short experience hunger forced us to
abandon the idea. Even long and careful mastication did not satisfy our
craving for food, so that we had to add milk, cheese, and eggs. We
admit, however, that for those of an unhealthy constitution, requiring
less food, and especially for those who are in the habit of
overeating,[275] there may be found some satisfaction in such a system
of under-nutrition; but even they have no right to call it a healthy
method of nourishment. We have found, that as a whole, women can stand
more easily, and also for a longer time, a vegetarian diet.

Footnote 275:

  As an illustration we may mention the amusing story of the rich
  Dutchman, who, while en route to an Austrian watering place for the
  treatment of his obesity, was arrested in Germany for some imprudent
  utterances termed “lèse majesté,” and after having been kept in prison
  for four months on a largely vegetarian diet came home as a slender
  man cured of his corpulency.

Those who point out by historical facts that man was destined to
vegetarian diet may not be right, for it is certain that many thousands
of years ago man was a fruit eater, when he also lived in trees. When he
began to reside on terra firma, compelled to so do by the scarcity of
fruit in consequence of the increase of humanity, he turned hunter and
meat eater. When we visit ethnographical museums, we find that from 10
to 5000 years before Christ man fashioned spear heads and knives from
flint, with which he killed animals, upon the meat of which he
subsisted; and at such times he lived chiefly on meat and fish, only
later becoming agriculturist and omnivorous in diet.

Many believers in a sole vegetarian diet like to point to animals as an
example, for these, they maintain, prosper on, and are contented with
herbs. Let us follow up this statement and see what we find to be the
case in the animal world.

We maintain that the truth of the matter is that there are few animals
of the nobler kind to be found among those existing on herbs. We find
the monarchs of the animals among the carnivorous class, and if we take
them as our example, the courage and valor of the lion will appeal to us
far more forcibly than the cowardice and helplessness of the sheep.

Energy gained by the addition of a certain amount of animal food does
not exclude the nobler qualities peculiar to the human brain, freed from
fads and fanaticism, and it is a valuable factor in combating the
numerous vicissitudes of life.


------------------------------------------------------------------------




                            CHAPTER XXXVIII.

ON THE DANGERS OF A TOO ABUNDANT MEAT DIET—A FEW HINTS ON THE DIETETICS
                                OF MEAT.


MOST of us have experienced a feeling of heaviness after a dinner
consisting of rich meat, and not infrequently there is also a sensation
of drowsiness after it, which is not easy to overcome. The first may be
due to the difficulty of digestion; but we may not experience this after
taking even twice as much carbohydrate and green vegetable food. We
know, from the observations on food already referred to, that meat is
far more digestible, unless it contains much connective tissue and
sinewy matter, than the majority of cereals and green vegetables, and
especially fruit; and yet after a dinner of the latter we will not feel
so heavy as after a meal in which we have taken a smaller amount of
food, but of which the greater part was meat.

This feeling of heaviness can, therefore, not be attributed to
difficulty of digestion, and as there is, at the same time, a greater
disinclination to work and a feeling of sleepiness after a meal with
much meat than after one of vegetables alone, or of milk and vegetables,
meat must, undoubtedly, have a more deleterious effect upon the central
nervous system than have other kinds of food.

That this mere clinical observation is not fallacious is also shown by
the fact that after eating much meat nervous disorders are far more
frequent; and we find many more instances of neurasthenia and hysteria
among eaters of much meat than among vegetarians; and in the treatment
of many nervous disorders far better results are obtained after
excluding meat from the diet.

It is noticeable in a marked degree in Graves’s disease, and also in
myxœdema, that patients suffering from them will not improve with meat,
and after partaking of it their symptoms are aggravated. This is only
natural, as these diseases are caused by changes in the thyroid gland,
to which we have referred in Chapter II, where we have also shown that
this gland undergoes changes through an overabundance of meat. We have
there mentioned the very interesting experiments of Leo Breisacher, of
Detroit, and of Blum, of Frankfort, and others. But we would wish to
remark here that it has been demonstrated by the experiments of Chalmers
Watson, of Edinburgh, that when certain animals, such as fowls, eat much
meat to the exclusion of all other kinds of food, they present great
enlargement of the follicles of the thyroid gland, and that rats, kept
on the same diet, exhibit even a degeneration of the gland, which can
even go to the extent of presenting the clinical picture of Graves’s
disease. Not only the thyroid, but the other ductless glands also, have
been found altered after an exclusive meat diet. Forsyth[276] found also
an enlargement of the follicles of the pituitary body in birds of prey,
and Houssaye[277] found that chickens lost their fertility after such a
diet, which affected their ovaries.

Footnote 276:

  Forsyth: Lancet, 1907.

Footnote 277:

  Houssaye: C. R. Académie des Sciences, p. 934, 1903.

There are numerous clinical and anatomo-pathological evidences to show
that the other ductless glands also—that is, the glands with internal
secretion, such as the liver, kidneys, and even also the pancreas—are
altered by an abundance of meat food if long continued.

We have already dwelt on the fact that the liver has the function of
destroying the harmful products that are formed by the decomposition of
meat food. Thus the more meat we eat the more work is thrown on the
liver, which may first become hyperæmic, but, through the continuation
of the harmful agency more deleterious conditions may develop. Every
physician can observe daily, as we have, that when patients suffering
from disorders of the liver take meat, they gradually get worse, but
when they give up meat they soon get better. If, therefore, we desire to
retain our vitality for a long time, it is best for us not to take too
much meat.

In the same way the kidneys can also be kept in good condition if too
much meat be not taken. These eliminate the end-products of meat food,
and the more of such products that pass through the kidneys, the more of
them are taken from the blood and excreted by means of the fine
epithelia of the kidney tubules, and thus the more is the work done by
these organs; and we have mentioned that any overwork of an organ may be
followed by its exhaustion. As a consequence of eating meat sometimes
very harmful products pass through the kidneys, especially in the case
of preserved, strongly seasoned, or spiced meat, for such preserved food
may contain disease germs, ptomaine bodies, mineral poisons, etc. But
even the passage of normal end-products of meaty food—for example, if
urea be continually passed for years in large quantities—can produce
serious alterations. Many authorities, such as Dr. James Tyson, of
Philadelphia, who is well known by his works on the kidneys, attribute
to the very frequent taking of such food many cases of interstitial
nephritis; and nearly all such authorities, including Senator, of
Berlin, prohibit the use of meat in most of the disorders of the
kidneys. But we have already referred to the danger of such a diet to
the liver and kidneys, and it is only because of the importance of the
subject that we have again referred to the matter.

There is some clinical evidence in favor of the opinion that the
pancreas may also be altered by an abundant meat diet. We know that when
this organ is diseased we may discover a quantity of unabsorbed meat
fibers in the fæces, indicating that the pancreas has failed to fulfill
its task of assisting in the digestion of meat by the production of its
ferment—the trypsin. Meat, when taken in large quantities, can thus
cause the pancreas considerable overwork, which, in the long run, as is
well-known, may cause trouble, as is shown by the fact learned from
observation, that diabetes develops generally in meat eaters. Even in
dogs an abundant meat diet can produce spontaneous diabetes, a fact we
have already published. Diabetes may not only be due to the changes in
the pancreas, but also as we have shown[278] to those in the thyroid
gland, consequent upon such nourishment.

Footnote 278:

  Lorand: “Die rationelle Behandlung der Zuckerkrankheit,” second
  edition, Berlin, 1909.

It is a very important fact that much meat can become most injurious to
diabetic patients, and, as v. Noorden[279] observed, even slight cases
of diabetes can be transformed into severe ones in consequence of such a
diet; thus, in our opinion, in all severe cases of this disease meat
should be prohibited.

Footnote 279:

  v. Noorden: Deutscher Naturforscher Congress, 1902.

Not only can diabetes, especially if of an hereditary nature, be
increased by abundant meat food, but gout also, as is well known, may be
caused thereby, and, existing, may be made worse. Such diet not only
provokes the elimination of sugar, but of uric acid as well, which
latter is a cause of gout.

Many authorities, especially Walker Hall and Haig, have demonstrated
that even small quantities of meat can produce uric acid, especially
when such meat contains a large quantity of nuclein bodies from which
uric acid can be formed, such as the glandular organs, especially
kidneys, liver, sweetbreads, shortbread, etc.

Meat food in abundance is also deleterious to other organs, as, for
instance, to the intestines, which, receiving a food so easily digested
and absorbed, lack the natural stimulus for good peristaltic movements,
which can best be produced by a cellulose food like vegetables and
fruit.

The greatest danger to the circulatory apparatus lies in meat, for, as
already mentioned, the viscosity of the blood is thereby increased, as
discovered by Determann,[280] and thus its circulation through the
blood-vessels impaired. It is a well-established fact that
arteriosclerosis can very often be observed in persons who have been
largely addicted to a meat diet for a long time. Apoplexy also is more
frequent among such.

Footnote 280:

  Congress für Innere Medicin, 1904.

These conditions can, however, be improved if the meat be suppressed and
replaced by a vegetarian diet.

It would lead us beyond the limits of this book if we attempted to point
out in an exhaustive manner various other dangerous consequences of a
too abundant meat diet. All we desire is to discuss the question
whether, in view of the various dangers to which a meat diet may lead,
to which we have referred, we should or should not give up meat.

We think we should be guilty of fanatical prejudice if, because of the
above accounts of the dangerous consequences ensuing on an unlimited
_abuse_ of meat, we should discard meat entirely, even in small
quantities. Such a course is, indeed, strongly advocated by Haig,[281]
but we cannot follow him so far.

Footnote 281:

  Haig: “Uric Acid in the Causation of Disease,” sixth edition, London,
  1904.

It is quite true that even a moderate amount of meat may create uric
acid, but there is not one hour out of the twenty-four that we do not
produce a small amount of uric acid in our system, even if we exclude
food of every description, such being the uric acid produced
endogenously through the decomposition of the nuclein-containing
albuminous bodies in the system, and which it is hardly possible to
avoid; and if our kidneys be in good condition they will easily
eliminate this small amount.

Should we therefore prohibit a person of 50 or 60, who has been in the
habit of eating meat every day of his life since childhood, and who is
in quite a normal state of health, from taking a moderate amount of meat
once a day, and thus knock him out of all his old habits? We do not
think this would be a wise proceeding on the part of any physician of
wide clinical experience and of unprejudiced mind, as everyone must have
observed that such a radical change in the habits of a lifetime may lead
to consequences unfavorable to the general health. No! We desire to be
temperate ourselves and to preach moderation. We must bear in mind that
it is the _im_moderate use of meat that is to be condemned, and not its
use in small quantities. We may, therefore, allow a moderate amount of
meat, once a day, well cooked to destroy, if possible, certain harmful
matters which can be rendered innocuous by sufficient cooking; and, by
preference, we recommend boiled meat, as such food has all the
nourishing properties of roast meat but less extractive substances,
which might, perhaps, irritate the kidneys. Fresh meat should be taken
in preference to canned food, as in the latter at times there is present
certain additional matter, such as preservative salts, boracic acid,
etc.

White meat is always preferable to red, although it is the pretension of
Offer and Rosenquist that in their action both kinds of meat are
similar; still, for clinical reasons, we agree with Professor
Senator[282] who, from his experience, considers white meat better for
the kidneys. The correctness of this opinion has been proved recently by
the researches of Max Adler.[283] We have seen the sugar disappear from
the urine of our diabetic patients when they were placed upon a diet
poor in extractive substances, such as fish (except salmon and carp),
veal, etc., and vegetables poor in carbohydrates; indeed, after such a
diet they were able to tolerate quantities of carbohydrates without
eliminating sugar. It is also of importance to remember that meats
containing many extractive substances, or broths made from such meats,
are capable of greatly increasing the blood-pressure; for this reason
red meats should be forbidden to the aged. The meat of animals that have
been hunted and subjected to great exhaustion before death should not be
used, or used only with very great moderation. Meat strongly seasoned
and spiced, or pickled, should also not be eaten. Sausages should also
be omitted from the diet. We must also remember that fish is also a meat
food, although on account of the greater amount of water it contains and
its more tender structure, and especially because of its smaller content
of extractive substances (except salmon, carp, etc.), it is preferable
to meat proper; yet if taken in large quantities, especially such fish
as salmon, it is quite as harmful as meat. At any rate fish, except the
red-fleshed kind, should always be preferred to ordinary meat.

Footnote 282:

  Senator: “Die Erkrankungen der Nieren,” Nothnagel’s Handbuch.

Footnote 283:

  Adler: Berliner klin. Wochenschrift, 1908.

It is best not to give meat to little children nor to persons in
advanced years—above 70, or earlier than this if they are decrepit. As
found by Baumann,[284] Charrin,[285] Lafayette Mendel,[286] and others,
the thyroid of infants contains no iodine; after the first year there is
some, but even then very little. Baumann and Jollin[287] also found that
the thyroid of old people contained only little iodine, which, as this
is the main element of the thyroid gland, gives to such persons less
chance of destroying toxic products; and by reason of this no meat
should be given either to little children or to persons of advanced age.

Footnote 284:

  Baumann and Ross: Zeitschrift für Phys. Chemie, 21-319, 1895; 22-1,
  1896.

Footnote 285:

  Charrin et Bouriet: C. R. Soc. biologie, c-2-339.

Footnote 286:

  L. Mendel: Journal of American Medical Assn., 3-2-’85.

Footnote 287:

  Jollin: Nord. Med. Arch., 1897, Test number.

We must also remember, as already mentioned, that proteid food is needed
to build up the body, and this is not necessary in senility. All
authorities agree that aged people require very little proteid in their
food, and Prof. Magnus-Levy[288] accepts this opinion. There is,
consequently, no necessity to force them to take meat, neither is it
rational to permit its use, for they are more defenseless against the
harmful products formed by the decomposition of meat than are younger
people, for their thyroids and parathyroids, liver and kidneys, are
degenerated. Thus they would be able neither to destroy such products
nor to eliminate them from the body. Exception may be made in the case
of the aged who are in robust health and enjoying a green old age, for
in such we may expect to find more active ductless glands, and they will
therefore be better able to resist the dangers of meat food.

Footnote 288:

  Magnus-Levy: v. Noorden, “Pathologie der Stoffwechsels,” i, 472.

There are certain precautionary measures that, perhaps, can mitigate
such dangers; thus, by the daily use of water in proportion to the
amount of meat the end-products of the meat can be washed away. We
should also with much meat eat also much fruit and vegetables. Abundant
meat diet produces acids in the system; but, as mentioned in Chapter X,
by means of green vegetables we can raise the alkalinity of the blood.
Whether much or little meat be taken, sour milk, kefir, yogurth, or even
ordinary milk and cheese should be taken also. We have not mentioned
here another danger from meat diet, which is the putrefaction that may
arise in the intestines, but on which we have enlarged in Chapter XIX.
By means of sour or ordinary milk, or cheese, the putrefaction can be
avoided, through the lactic acid formed.

With a meat diet, especially when taken in large quantities, it is
obvious that a good cleansing of the bowels will be all the more
necessary, and this is best obtained by the addition to such a diet of
fruit, vegetables, and sour milk.

By precautions such as these the harm from a too abundant meat diet may
be reduced or at least limited; but for those who are desirous of
attaining an advanced old age, the greatest moderation in the matter of
meat consumption is strongly recommended.

When we study the nature of the diet enjoyed by persons who have lived
to and over 100, we find, indeed, exceedingly few who are great meat
eaters; very many are persons who eat no meat at all; and in many cases,
also, the original meat diet was subsequently abandoned in advanced age.
According to the report of the Collective Investigation Committee of the
British Medical Association, the 55 centenarians whose cases they
examined were, for the most part, small meat eaters.[289]

Footnote 289:

  Quoted after Humphrey.


------------------------------------------------------------------------




                             CHAPTER XXXIX.

ON THE GREAT ADVANTAGES OF MUCH MILK IN THE DIET FOR THE PREVENTION AND
                         TREATMENT OF OLD AGE.


WE have often observed that patients taking large quantities of milk
daily, together with eggs and vegetables, and little meat, soon begin to
look better, and sometimes even younger. We have also observed upon
ourselves the great advantage of such a diet in comparison with other
diets.

It is not surprising that persons using large quantities of milk daily
look fresher and younger if we consider that when we take much fresh raw
milk we are also taking extracts of various ductless glands, and
especially of the thyroid.

It has been shown by Bang,[290] Mossé,[291] and others, that the
internal secretion of the thyroid passes into the milk. There are,
indeed, several facts which prove that thyroid secretion is contained in
the milk. As we know, the iodine in our body comes mainly from the
thyroid, which, of all organs, is the richest in iodine. Now there can
be no doubt that iodine enters the milk, for when we give iodine to the
mother it can pass, by way of the milk, into the infant. As the thyroid
of the infant, or of puppies, contains very little or no colloid
substance, upon which, as shown by R. Hutchison and Oswald, the quantity
of iodine depends, they must receive the iodine from the maternal milk.
Mario Flamini (Revue mensuelle des maladies de l’enfance, 20, 97-120),
by injecting iodipin into a goat, obtained milk containing as much as
0.12 gramme iodine to the liter. Another very important fact is that
children suffering from congenital myxœdema never show any symptom of
this condition so long as they are taking their mothers’ milk; but as
soon as they are weaned symptoms of myxœdema appear, which we must
logically ascribe to want of thyroid secretion.

Footnote 290:

  Bang: “Ueber die Aurscheidungs des Jodothyrius durch die Milch,” Berl.
  klin. Wochenschrift, Dec. 27, 1897.

Footnote 291:

  C. R. de l’Académie de Medicine, 1898.

Another fact, upon which we would like to insist, is that when we
extirpate the thyroid gland of goats or other animals, their milk
contains (as shown by Professor Lanz in the case of goats) a substance
which acts upon the thyroid gland, diminishing its activity. Logically,
we think, we may conclude that the milk of goats with intact thyroids
must contain a substance antagonistic to the substance contained in the
milk of thyroidless goats. Such a substance is the thyroid secretion.

Besides thyroid secretion the milk also contains important nutritive
substances, like albumin, milk-sugar, and fat; also lecithin, etc.,
certain ferments, and mineral matters, as lime, magnesia, iron, etc.
(see, also, chapter on animal food). The valuable ferments which
facilitate the digestion of the milk are, however, only contained in raw
milk, and to a less extent in milk which is heated above 75° C. Behring
has shown that even this temperature, if maintained as long as thirty
minutes, is apt to deteriorate the milk. Pasteurized milk that is never
heated above 70° C., and is cooled immediately afterward, contains a
considerable amount of these important ferments. But if milk is heated
to higher temperatures, as happens in boiling, the ferments are killed.
It is of the greatest significance that raw milk has also the property
to kill microbes to a certain extent. Thus Walter Hesse found in 1894
that the microbes of cholera died in raw milk. In experiments he has
made recently with Hemp,[292] it was shown that raw milk of certain
kinds of cattle had also the property to kill the bacilli of typhoid
fever. But it is of the utmost importance to remember that these
bactericidal properties of raw milk are destroyed if the milk is heated
to 60° C. (140° F.). These authors have found that refrigerated milk,
even if it is cooled down from 70° C., does not lose its bactericidal
properties.

Footnote 292:

  Hemp: Verhandlungen des Congresses Deutscher Naturforscher und Aertze,
  Dresden, vol. i, p. 112, 1907.

There is a wonderful difference in the effects of boiled and raw milk.
Animals, or children, never thrive so well on boiled as on raw milk.
Professor Behring, of Marburg,[293] has shown that animals fed on milk
heated to a high temperature never thrive well. Calves have been reared
in Marburg, or on Bohemian or Hungarian farms, on boiled milk, and
others on raw milk. Experiments with hundreds of such calves have shown
that boiled milk is not a suitable food for them.

Footnote 293:

  Behring: Beiträge zür experimentellen Therapie, 8 fl, 1906.

In children, also, we can see the bad effects of using boiled milk. It
has been shown by many authors that Barlow’s disease and rickets may be
due to drinking overheated milk, especially when such milk is not fresh.
Behring has now shown by experiments that when calves are fed on boiled
milk they acquire rickety deformities of the bones and scorbutic
conditions. The majority of the calves died from exhausting diarrhœas,
just as do infants in large cities.

Thus it is evident that we should always use raw milk, and only when
there is doubt as to the origin of the milk should we heat it, and then
not above 60° to 70° C. (140 F.), so as not to destroy all its valuable
properties. Considering the enormous importance of this question for the
public welfare, it would be advisable to put all establishments for the
supply of milk under the control of physicians or veterinary surgeons.
As the welfare of many children depends upon the condition of the cow
that is giving them its milk, cows should be kept with great care and
regarded as a kind of wet nurse. Just as prisoners, or men who work all
day in close and badly ventilated rooms, are apt to develop
tuberculosis; so, also, are cows if they are kept in dark stables with
no fresh air. Therefore cows should be let out to pasture on the meadows
every day, and kept there at night if the weather permits. The milk is
also improved in quality if the cow gets some food rich in proteids in
addition to her grain and hay. Every cow should be tested by tuberculin
injections, and if this is positive the animal should be destroyed. The
milking of the cows should be done with scrupulous cleanliness. The
udders and surrounding parts should be washed, and the milkers
themselves should be dressed in clean white clothes, and their hands
should be clean, preferably by washing them with some antiseptic liquid.
Unless the cow is tubercular or otherwise sick, its milk never contains
any harmful substances. As soon as it is obtained the milk should be put
into an ice chest, as this is the best way to preserve it, and air
should be excluded. It has been shown that milk cooled off to -16° C.
does not lose its good qualities, and can be kept in fresh condition for
many days.

By undergoing acid fermentation milk does not lose its valuable
properties. Important substances like lecithin, iron, lime, native
albumin, and valuable ferments are contained in such milk. Whey and
buttermilk are also milk foods of the highest value.

Besides its contents of internal secretions, valuable ferments, and
mineral matters, milk must also be considered as an ideal form of
nourishment owing to the fact that it contains all the necessary
elements of human food. It is the most nourishing of all foods since it
contains albumin, fat, and carbohydrates, the three main elements of
human food, in large quantity. Good cows’ milk contains about 35 grammes
of albumin, 40 grains of milk-sugar, and 35 to 40 grammes of fat to the
liter. Thus if a person takes 2 liters of milk a day, or even less, 3 to
4 eggs, a little butter and several rolls, he can live comfortably
without meat. We have made an experiment on ourselves by taking 1½
liters of milk, 4 eggs, 2 rolls, and 20 grammes butter a day as our only
food, and after two weeks of such a diet, with a bodyweight of 68 kilos,
we felt very well, and even lost no weight at the end of the trial. We
have found in our own case, and in many patients, that with one plate of
meat at dinner, together with vegetables and the above diet, with
cheese, it is possible to live prosperously for months and to increase
considerably in weight. The rosy cheeks of persons living on such a diet
are the best proof of its efficiency.

Those who do not like milk in large quantity may add a little cocoa, or
a little weak coffee to it. For those whose stomachs cannot tolerate
pure milk, a milk obtained by fermentation—kefir—is indicated. This can
be prepared by fermenting cows’ milk with grains of kefir. It should not
be fermented, for most purposes, for longer than one-half a day. By
virtue of the carbonic acid which it contains it has a soothing action
upon the walls of the stomach, and also promotes a better flow of
gastric juice. Thus it is more easily digested than ordinary milk, whose
valuable properties, however, it retains.

Milk is also of value when taken in large quantity, since it checks the
formation of bacterial and toxic products in the intestine, which, as we
know, is enormously rich in such products, especially after having eaten
animal food, like meat. milk-sugar and lactic acid are very powerful
antiseptic substances probably the best natural intestinal antiseptics
of which we know. This fact is made use of by Metschnikoff in the
production of his lactobacilline, by which, through the formation of
milk acid, the multiplication of the intestinal bacilli can be checked,
and thus, according to Metschnikoff, old age prevented to some extent
(see, also, Chapters XIX and XX).

It is a very interesting fact that in countries where much of a certain
kind of acid milk is used (e.g., Bulgarian “yogurth,” prepared with the
aid of the Maya bacillus), there are many persons who live to be more
than 100 (see Chapters VI and XIX). Some of the long-lived patriarchs
whom we mention in this book, as Parr, who has lived to be over 152
years old, lived mainly on a milk diet.

In addition to the above-mentioned properties of milk, this food has
also the great advantage of throwing the minimum amount of work upon
those organs whose duties are concerned with the assimilation of food
and the elimination of its waste products. We have already mentioned
that animals whose thyroids have been extirpated can only survive if
they are put on a milk diet. (Breisacher,[294] Blum.[295]) This shows
that when the thyroid is extirpated or, what is the same thing, entirely
degenerated, only milk food can be tolerated, for the poisons of other
food, like meat, are normally destroyed to a great extent by the thyroid
gland.

Footnote 294:

  Breisacher: Loc. cit.

Footnote 295:

  Blum: Loc. cit.

In old age there is greater or less degeneration of the thyroid gland.
Just as is the case with infants, whose thyroids are not yet developed,
so also old people, as a general rule, are more helpless against poisons
formed by the decomposition of meat. For such persons evidently, just as
for infants, milk food is the best.

Here, again, we see the similarity that exists between infancy and
senility, and we realize the truth of the saying that in senility we
return to childhood. That milk is the best food to keep the thyroid in
good working order has been proved by the experimental researches of
Fordyce.[296]

Footnote 296:

  Fordyce: British Med. Journal, vol. x, p. 619, 1902.

In our opinion one of the greatest advantages of milk as a food is that
it exacts for its assimilation so little work from some of our most
overworked and most important organs, like the stomach, liver, and
kidneys.

It is certainly a boon to an overworked stomach, which is otherwise
normal, when we prescribe a diet of raw milk, which, for many persons,
is more digestible than most other foods. It is a fundamental principle
in the treatment of old age to give a rest to those organs of the body
which are the most active. Such a rest will certainly do good to the
stomach, especially in the case of heavy eaters, and will improve its
vitality. The same maxim holds good for the liver and kidneys.

There is no food which, with the same nutritive content, contains so few
harmful toxic products as milk. Imagine the difference between the liver
or thyroid of a heavy meat eater, and those of one who has long taken
mainly milk. The experiments of Chalmers Watson[297] and of Forsyth[298]
speak volumes on this point.

Footnote 297:

  Chalmers Watson: Loc. cit.

Footnote 298:

  Forsyth: Loc. cit.

Since milk food contains scarcely any products harmful to the liver,
even when taken in large quantities, and considering at the same time,
the antiseptic action of milk food upon the bacilli in the intestines,
it is easy to understand that with such a diet little work is thrown
upon the liver, and its tissues are not damaged. We have been surprised
to see how well patients with liver or gall-stone trouble looked after a
diet of milk and vegetables for several weeks. The importance of such a
diet upon the condition of the bile passages is shown by the well-known
fact that inflammation of the bile-ducts and gall-bladder can be caused
by the immigration of bacilli from the intestine. It follows that with a
lessened amount of intestinal bacilli, the bile passages will not be so
liable to infection, and by a milk diet, especially one of sour milk,
kefir, koumiss, etc., we can limit, to a large extent, the number of
bacteria in our intestines. Therefore such a diet would be calculated to
prevent disorders of the gall-ducts and bladder and gall-stone disease,
which are so often found in elderly persons.

Milk is a food which contains scarcely any extractives. In consequence
it is an ideal food for the kidneys, through which it passes without
causing the least injury to these vital organs, which cannot be said of
meat with its numerous extractive substances. Milk contains very little
salt, which qualifies it as a most excellent food for the kidneys. Milk
diet has rightly been given since the early days of medicine in kidney
troubles. Since in old age there is an increase of connective tissue in
the kidneys, with impairment of their eliminative capacity, on this
account also milk diet is the most suitable for old persons.

In order to derive the greatest possible benefit from this most
excellent food, it would be necessary to take human milk, as thus we
introduce into our system the internal secretions of human ductless
glands and human ferments. Such good fortune can, however, only fall to
the lot of infants, and, we are sorry to say, not to all of them.
Therefore we are obliged to use the milk of those animals which is next
best to human milk—for example, asses’ milk. This, however, cannot be
obtained easily; two pints of it would cost, in some places, about a
dollar. The next best substitute is goats’ milk, which also contains ten
times as much iron as cows’ milk. It is a great puzzle to us why the
milk of this animal, which is richer in fat and albumin than cows’ milk,
is not more used. Perhaps the main objection is the occasionally
disagreeable smell, which, however, can be avoided by keeping the goat
very clean. The goat is rarely subject to tuberculosis, which also is a
strong argument for the use of its milk.

There can be no doubt that, for those who can stand it in large
quantities, milk is an excellent aid in the fight against old age and in
its treatment. As most constituents of the blood enter the milk, perhaps
it is not too daring to say that drinking milk is, in a measure,
drinking blood. Evidently blood contains all the internal secretions of
the ductless glands as well as most valuable ferments; hence the
rational prevention and treatment of old age would consist in drinking
blood. There is, however, no general tendency to such bloodthirsty
methods at the present time, but, maybe, it will be used in the future.
But if we cannot drink blood let us drink milk, the most valuable food
there is.


------------------------------------------------------------------------




                              CHAPTER XL.

       ON BLOOD AS AN ARTICLE OF FOOD CONTAINING IRON AND ANIMAL
                 EXTRACTS—SAUSAGES AND BLOOD PUDDINGS.


IRON is a most important element of our blood, the lack of which, as in
chlorosis and various anæmic conditions, may produce very serious
symptoms. To replace this deficiency iron is introduced into our system,
and this can be done in two ways: either by the natural way, i.e., by
food which contains iron, or artificially, by means of drugs which
contain iron. It is the opinion of Bunge that iron, given in drugs,
especially as inorganic iron, is not so readily absorbed and assimilated
as organic iron, i.e., iron as it occurs in various articles of food,
and especially in the blood.

Therefore an effort has been made with more or less success by
manufacturing chemists to make preparations of iron obtained from the
blood, and Professor Bunge[299] has experimented on animals by using
iron containing nuclein, separated from the yolk of eggs; and in
Professor Kossel’s laboratory such a preparation has been made from the
eggs of the carp. It was found that these preparations were perfectly
absorbed and assimilated.

Footnote 299:

  Bunge: Lehrbuch der Physiologie, Berlin, 1907.

Professor Bunge, and also his pupils Abderhalden and Haüsermann, found
that all animals which received food containing but little iron, became
anæmic, e.g., young rabbits fed only on milk, which, as above mentioned,
is very poor in iron. Later food was given that contained iron (as green
vegetables, cabbage, herbs, etc.; or meat, yolks of eggs, and fruit),
and soon afterward the iron contents of their blood was found to be
increased. Even if we are not anæmic or chlorotic, it is necessary to
take a certain amount of iron, preferably organic iron, into our
systems.

Anæmia of slight degree is very frequent in women, especially after
degeneration of the ovaries, as after the menopause. As we have already
mentioned, the ovaries influence in a remarkable way the condition of
the blood. In the adult the bone marrow is the chief seat of formation
for the red blood corpuscles; but the bone marrow, and indeed the whole
skeleton, as we have shown in the second chapter of this book, is under
the control of the ovaries and of the thyroid. As these organs are, as a
rule, degenerated in old age, anæmia must result, and indeed Prof.
Naunyn[300] says: “Old people are anæmic.” Geist has already emphasized
the diminution in the quantity of the blood in old age. That blood
formation is deficient in old age is demonstrated by Besançon and Labbé,
who found the activity of the bone marrow diminished in old age, and by
Grawitz,[301] who found that bone marrow underwent important changes in
old age, being transformed into a jelly-like substance. According to
Grawitz, iron—and he always prefers to prescribe an organic rather than
an inorganic iron preparation—is less efficacious in old age. We
attribute this to the degeneration of the blood-forming organs, through
whose intermediary action iron produces its effect. If, however, these
organs are not entirely degenerated, but only partially so, as in the
first few years following the menopause—in women until the end of the
fifties—we can obtain better results; and indeed after giving such women
iron we may observe that they look better, and often fresher (see, also,
Chapter LIII). As organic iron is more easily assimilated, this form is
to be preferred, and the question arises: How should we take it? Of all
kinds of food used at present, spinach and the yolk of eggs contain the
most iron; so we could give these. Fortunately spinach is obtainable at
all seasons in the United States. For those who prefer eggs, yolks in
quantities large enough to satisfy our needs would not be easily
digested, and also as eggs would be difficult to procure fresh every
day, we must think of another expedient. We may take iron preparations
obtained from the blood of animals. But why not take the blood itself,
which contains iron in a form similar to that in our blood, and in
larger quantities than in any other food? This would certainly be more
efficacious, and also less expensive.

Footnote 300:

  Naunyn: In Schwalbe’s Lehrbuch der greisenkrankheiten, Berlin, 1909.

Footnote 301:

  Grawitz: Hidem and also in “Klinische Pathologie des Blutes,” third
  edition, Leipzig, 1906.

Bunge mentions that the chlorotic girls of Basel (Bâle) come to the
slaughterhouses in order to drink the blood of animals that have just
been slaughtered. The question arises as to which animal’s blood is the
best. That of the pig is preferable for several reasons. Its blood
contains much iron (according to Bunge 226 milligrammes in every 100
grammes), its organs are anatomically and histologically very like our
own, and the pig is an omnivorous animal, as we are, being able to eat
even 14 to 20 pounds of meat a day. Several of the organo-therapeutic
preparations, like ovarian extracts, and testicular and kidney extracts,
are, if obtained from the pig, more active than those obtained from
other animals. And, finally, from pigs’ blood very savory sausages and
puddings can be prepared.

In Denmark and Norway a favorite pudding is prepared from pigs’ blood,
together with flour, sugar, barley, groats, and raisins, and we have
found it very palatable. In these countries many physicians prescribe
this pudding and blood sausages (in England called “black puddings”) to
chlorotic girls.

We consider pigs’ blood to be of very great value, not only on account
of its iron, but also because it contains, as does blood in general
(according to Claude Bernard), extracts of the ductless glands in their
most assimilable form, and by taking this blood we, at the same time,
introduce these organic extracts. To obtain the greatest possible
benefit from these properties the blood should be drunk fresh; but as
this is not very easy to do for obvious reasons, we can substitute blood
sausages and black puddings. Blood contains chemical substances of great
importance, as iron, manganese, phosphorus and small quantities of
iodine, besides also lecithin, glycogen, glucose, jecorin, etc. It also
contains important ferments, as diastase, and sugar- and fat-splitting
ferments. Likewise it contains important immunizing substances,
opsonins, alexins, etc.

The blood of pigs is very nourishing, for it is rich in albumin. Indeed,
considering that this blood is wasted in the slaughter houses, it is
necessarily the cheapest kind of food. And it is also an article of food
which is easily digested, absorbed, and assimilated. It is hard to
understand why this article of diet has not been made more use of long
ago. Professor Bunge, the well-known physiologist, likewise strongly
recommends the use of blood as an important article of diet. We show in
the following table, compiled from the researches of Abderhalden,[302]
the composition of pigs’ blood and of ox blood in respect to their
nourishing qualities and different mineral contents.

Footnote 302:

  Abderhalden: Zeitschrift für Physiolog. Chemie, 1898, 25, 56 (for
  pigs’ blood); and Hidem, 1897, 23, 521 (for ox blood).


                                          PIGS’    OX
                                          BLOOD  BLOOD
                                           per    per
                                          cent.  cent.

                Water                       71.6  80.89

                Hæmoglobin                 14.22  10.31

                Albumin                     4.66   6.98

                Fat                         0.11  0.052

                Fatty Acids                 0.04

                Sugar                      0.069   0.02

                Cholesterin                0.044  0.199

                Lecithin                   0.231  0.135

                Phosphoric Acid w.         0.006  0.003
                  Nuclein

                Oxide of Iron              0.696  0.054

                Calcium                    0.068  0.007

                Magnesium                  0.089  0.004

                Potassium                 0.2303  0.004

                Sodium                    0.2406 0.0364

                Entire Phosphoric Acid    0.1002 0.0040

                Anorg. Phosphoric Acid     0.749  0.017

                Chlorides                 0.2690


According to the researches of T. König,[303] Farwick and C. Kraut blood
sausages have the following composition:—


 ───────────────────────────────────┬───────────────────────────────────
      IN THE NATURAL SUBSTANCE      │           DRY SUBSTANCE
 ────────┬────────┬────────┬────────┼────────┬────────┬────────┬────────
         │        │        │Nitrogen│        │        │        │
         │ Nitro- │        │  Free  │        │ Nitro- │        │Nitrogen
  Water  │ genous │  Fat   │Extract │ Ashes  │ genous │  Fat   │and Dry
         │Substance│        │Matters │        │Substance│        │Substance
 ────────┼────────┬┴───────┬┴───────┬┴───────┬┴───────┬─┴──────┬─┴──────
  49.93% │ 11.81% │ 11.48% │ 25.09% │  1.64  │ 23.59% │ 22.90% │ 3.77%
 ────────┴────────┴────────┴────────┴────────┴────────┴────────┴────────


Footnote 303:

  J. König: “Die menschlichen Nahrungs und Genussmittel,” Berlin, 1903,
  I, p. 76.

Experiments were made in England centuries ago by transfusing the blood
of young animals into the veins of old animals (sheep, cows, and
horses), which latter, by this means, became more lively and active. In
some cases the special senses became more acute—hearing especially,
according to Dr. Hufeland. On man such transfusion has also been tried;
Dever and Riva,[304] in Paris, succeeded in treating certain diseases by
transfusion of animals’ blood, and, as Hufeland states, a lunatic
recovered his health after transfusion with calves’ blood.

Footnote 304:

  Quoted after Hufeland, Makrobiotik, edited by Steinthal, Berlin, p.
  13, 1887.

It is strange that this treatment is not more used now. Should we not be
able to treat certain diseases, such as old age, by transfusing the
blood of younger individuals, or of certain animals? This is certainly a
bold question, and we are not yet in a position to answer it definitely.
We must take into consideration the fact that the transfusion of blood,
even though human, into other individuals presents certain dangers. Bier
has tried transfusion in a few cases of lupus, and there appeared at
first symptoms of intoxication followed later by a marked amelioration.
But if transfusion by present surgical methods is not free from dangers
we can give the blood in a more rational manner by the mouth. As Bunge
has shown, the hæmatin is absorbed by the intestines, while the
diapedesis of the blood corpuscles themselves through the intestines has
been demonstrated in the experiments of Grawitz. The serum of Moebius
(anti-thyroidin) also acts if taken by the mouth.

At the present time nothing hinders us from using the blood of pigs in
the way just mentioned. But care must be taken to obtain fresh and
healthy blood. Pigs often get pneumonia through catching cold during
transportation. Therefore those pigs whose blood we use must have been
previously specially examined.

For this purpose also pigs should not be too fat. As we learned from
observations in the slaughter houses, a fat pig of 200 pounds may not
have more than a liter of blood, whereas oxen of 900 pounds have nearly
10 to 12 liters of blood. Still, for reasons already mentioned,
preference should be given to pigs’ blood.

It is most important that, when the diet consists of much milk and
little or no meat, some iron-containing food be taken in addition.


------------------------------------------------------------------------




                              CHAPTER XLI.

   SOME REMARKS ON THE HYGIENE OF EATING—HOW TO OBTAIN AN APPETITE—ON
                              MASTICATION.


IF we desire to derive benefit from what we eat in order to keep the
body in good condition, and thus successfully resist the onslaught of
old age, we must possess a good digestion and be able to make use of our
gastric juice. Without this secretion all, or the greater part, of what
we eat will remain undigested in the stomach and intestines, and by its
stagnation produce much disturbance and lessen the vitality of these
important organs. Everything, therefore, depends upon being provided
with an adequate supply of gastric juice. There are two ways of aiding
this: First, by the direct action of the food on the walls of the
stomach. Second, by various means which act on the nervous system that
governs the glands of the stomach and provokes their secretion. As by
the first means only a small amount of gastric juice is secreted, we
will deal with the second.

The nerves of the gastric glands can be stimulated by various agencies
which influence the central nervous system, and thus provoke appetite;
for instance, sight, for we know of old how the sight of tasty dishes
provokes our appetite. Professor Pawlow, of St. Petersburg, has shown by
experiments on dogs, in whose stomachs he had made a fistula, that
merely showing them a piece of meat was sufficient to cause them to
secrete a large quantity of stomach juice. Umber has also shown on man
that optic influence was able to produce the secretion of gastric juice.

In addition to sight, smell produces similar results. Professor
Bickel,[305] of Berlin, has experimented on a girl of 23, who, after an
injury from caustic potash, had to have a fistulous opening made into
her stomach, her œsophagus being completely strictured. By holding
steaming hot soup under her nose he caused the secretion of a clear
stomach juice to run through the open fistula.

Footnote 305:

  Congress für Innere Medicin, 1904.

The secretion of the stomach juice can also be produced by the sense of
taste. Professor Bickel showed this in the above case by placing on the
girl’s tongue a solution of sugar, and again of salt, and there followed
each time a secretion of stomach juice.

Pawlow has also proved this by ingenious experiments on dogs. After
making a fistula in their œsophagus he gave them pieces of meat to eat,
which, on being swallowed, fell out again by the open œsophagus, so that
they never reached the stomach; and yet the taste of the meat and
chewing were sufficient to cause the production of a large amount of
gastric juice.

Thus the secretion of the gastric juice is under nervous influence. But
if pleasant nervous impulses are able to promote its secretion, on the
other hand, as shown by the observations of Beaumont, and also of
Sommerfeld on men, disagreeable impressions are able to check it. Bickel
and Sasaki have also observed this to have occurred in persons who have
been in a state of anger, which coincides with our own observations that
when we are in a depressed mental condition, or when we receive
disagreeable news, we often lose our appetite. If, therefore, we want to
eat with relish we must put aside all mental pre-occupation and worry,
and go to the table in a cheerful mood. Persons of a melancholy
temperament seldom have an appetite, and in melancholia there is often a
refusal to eat, so that nourishment has to be maintained artificially.

When any one has been working in the open air all day and is of a
cheerful disposition, he will not need anything appetizing to make him
eat. By his work he has digested his food easily, his body craves for
more to keep up his energy, and his empty stomach requires to be filled;
he will be hungry and have a good appetite without any artificial
stimulus.

But it is a different thing with ladies who sit all day long in their
rooms, or with men who sit all day at their office desks. Such persons
very often need an artificial stimulus for a good appetite and
sufficient gastric juice. We must then resort to small artifices to
induce these. A snow white table cloth, beautiful service, choice fruit
in artistic vases, wearing clean linen and evening dress, and having
agreeable society and possibly music at dinner, will, perhaps,
sufficiently act on the different senses to produce appetite and a free
secretion of the gastric juice.

In certain restaurants we often see an open buffet with the choicest
dishes displayed, from which we can select our meal; and this certainly
acts as an appetizer. In certain countries, also, it is the custom to
take before dinner little _hors d’œuvres_ or delicacies, like the
Zakuski in Russia, or the smörgasbord in Sweden, which certainly serve
to enhance the appetite.

Those whose appetite needs stimulation may receive benefit from meat
extracts, such as bouillon, before dinner. These extracts are some of
the few things which can produce a sufficient secretion in the stomach
directly, without the intervention of appetite, as has been shown by the
experiments of many authorities. Such an appetizer would not, however,
be advisable, because bouillon, containing extractive substances, is
more injurious than meat if taken often and in large quantities.

For such as have no appetite it may be of advantage to wash the tongue
before meals with a solution of salt; this, to a certain extent, will
also cleanse a coated tongue, with which a good appetite is not easily
attained; and at the same time, according to Bickel’s above-mentioned
experiment, it may provoke a secretion of stomach juice. Vinegar and
water will have the same effect as the saline wash. A coated tongue
should always be cleansed before meals, for when the papillæ of taste
are covered, the direct action of the food on them may be prevented.

Just before dinner, and for an hour after it, no mental work should be
done; and it is often better to open a letter after than before dinner,
so as not to spoil the appetite. A short walk in the fresh air before
dining will also be an appetizer. We have personally noticed a
diminution in appetite on those days when no exercise was taken.

Much depends on the way the meals are served. Above all things food must
be pleasant to the eye and to the palate, and it is the great art of the
cook to fulfill this. The greatest possible cleanliness is paramount,
for with many people the sight of a dirty cloth or napkin is able to
kill all appetite and check the secretion of gastric juice.

Reading while eating is contrary to the above indications, unless
perhaps it be something humorous, like Mark Twain’s “Adventures of
Huckleberry Finn,” for instance. If we have the chance of choosing our
neighbors at the dinner table let us rather sit next some one having the
characteristics of Mark Twain than an undertaker or one who talks
business.

Besides the gastric juice the saliva also plays a very important rôle,
as it contains a valuable ferment which facilitates the digestion of
starch into sugar: the diastatic ferment. In order to have a good supply
of saliva the food must be kept longer on the tongue, as the flow of
saliva is best induced by the stimulation of the nerves of taste; so we
must masticate longer, and move the food between the teeth and on the
tongue for as long a time as possible, so that it will act on the nerves
of taste.

The secretion of the salivary glands under nervous influence is actuated
in the same way as is that of the gastric juice. It is powerfully
influenced by psychical impressions; for instance, by impulses coming
from sight to the nervous centers and thence to the salivary glands, as
can easily be seen by daily observation. If we offer a hungry dog a
sausage we shall all witness an abundant flow of saliva, and the same
may also be seen in man, and the German saying, “das wasser läuft im
Munde zusammen,” may be literally true.

The secretion of saliva can be provoked by much the same agencies as
that of the stomach juice, but above all by mastication. This has the
greatest effect on the flow of saliva, especially when accompanied by
good appetite; in fact, we may say good appetite provokes the flow of
saliva and mastication maintains it for a long time. We are thus able,
by abundant salivation, to aid digestion wonderfully, especially with
regard to starchy food, as the diastatic ferment of the saliva assists
in transforming starch into sugar; otherwise such material would be
rather difficult to digest, only depending then on the pancreatic and,
perhaps, intestinal ferments. Another great advantage of thorough
mastication is that the food reaches the stomach in the smallest
possible pieces, perhaps in liquid form, and thus the stomach juice can
reach it freely from all sides, whereby digestion is greatly
facilitated.

Not only the digestion in the stomach, but also the absorption of food
transformed into a liquid from the intestines is much assisted by
thorough mastication; while, as the result of insufficient mastication,
as with fast eaters, the food may cause much greater work to the walls
of the stomach. Being much less absorbed from the intestine it may
irritate it as a foreign body until expelled by greater efforts of the
intestinal walls. Long-lasting gastric and intestinal catarrhs may
result from insufficient mastication.

The great advantage of methodical long mastication has been shown by
Harry Campbell,[306] Horace Fletcher,[307] and Van Sommeren, of Venice.
According to their recommendation it would be necessary to masticate
food until it has almost lost its taste. It certainly requires long
practice, especially in the case of fast eaters, to acquire the habit of
prolonged mastication, for nothing is so difficult as to give up habits
indulged in since childhood. Fast eating is not only injurious to
health, but if indulged in in company, it is a breach of good manners.

Footnote 306:

  “Observation on Mastication,” Lancet, vol. ii, 1903.

Footnote 307:

  Horace Fletcher: “The A, B-Z of Nutrition,” New York, 1904.

The authorities on thorough mastication also claim that by so doing they
are able to do with less food, which is the more readily to be believed,
as they are able to digest and absorb everything better, their food
leaves less residue, and they profit more by what they eat than do fast
eaters and bad masticators.

Good mastication means also good exercise for the teeth, the good
condition of which is of the utmost importance for a healthy digestion
just as it is important for all other organs of the body. When we eat
fast we are inclined to wash down the imperfectly masticated food by
large quantities of water, which may be prejudicial, as we are thus too
freely diluting the contents of the stomach. Many women abstain from
drinking at their meals for fear of getting fat, which is an erroneous
idea, as Prof. Van Noorden has shown that this cannot produce
obesity.[308] On the other hand, not drinking during meals may lead to
bad results. We are accustomed to take most of the water we drink with
our meals; not taking any at meals may largely decrease the amount of
fluid in the body, which has many bad effects. As shown by Pawlow, and
also by Bickel, more stomach juice is secreted when the body contains
more fluid. Then drinking a certain amount of water at meals may assist
in the absorption of the food. There is also the great advantage that by
the aid of fluids the end-products of nitrogenous matters, which have
toxic actions, may be more easily eliminated from the body than with a
dry diet. We believe it is preferable to take even an excess of water,
than none at all, with meals, and there are many people who have no
appetite unless they drink while eating.

Footnote 308:

  v. Noorden: “Die Fettsucht,” Nothnagel’s Handbuch.

The question whether after meals we should rest or take exercise must be
answered individually; those suffering from obesity or other disorders
of metabolism, like gout or diabetes, had better take some form of
exercise after a meal, while weak persons should rest. In general, a
short walk after meals, and then remaining quiet for an hour, will prove
to be best; but mental occupation for at least an hour after meals
should be strictly prohibited.

The time for meals should be when we are hungry, as we should never eat
at other times for fear of not being able to digest well, owing to the
absence of stomach juice. It is essential to take our meals every day at
the same time; our stomach is of such a clock-like mechanism that it
best indicates the hour for meals. If well disciplined it will secrete
its gastric juice every day at the same hour. If possible we should
always eat in company, for then we will eat slower, masticate better,
and, if the company is jovial, probably secrete more gastric juice.

Just as after meals, so also before them, any strenuous exercise should
be forbidden. A little exercise may promote the gastric digestive
secretions; but if we become tired from much exercise, then certainly
not much and sometimes no gastric juice will be secreted; then meat
extracts, bouillon, or soup will be necessary for obtaining an appetite.
Some people eat too much bread, which may cause overwork for the
stomach, as to digest bread gives it more work than does other food. It
has been found that the albuminous parts of bread require five times
more ferments and pepsin of the stomach than does meat; besides which,
as we have found in many of our patients, there is nothing that causes
an acid stomach so often as does too much bread, especially in nervous
people.

The most digestible food for most stomachs is meat, if it does not
contain much connective tissue. Meat sauces and bouillon are excellent
appetizers. However, such nourishment at every meal has its
inconveniences, on which we will enlarge in another chapter. It is most
desirable only to take meat once a day—at dinner.

The albumin in meat is much easier to digest than that in vegetables; to
digest the latter, particularly potatoes, cabbage, etc., we need to have
a thoroughly good stomach. Fat dishes are able to diminish the quantity
of stomach juice, and fatty potatoes or other vegetables with much fat,
demand sound stomachs, in the same way as does rich pastry. Butter is an
easily digested fat if it is fresh, but certainly not when it contains
free fatty acids.

Besides meat, cereals, such as are taken in America at breakfast,
especially when finely ground and taken in the form of flour, are most
easily digested. It is an excellent American custom to commence
breakfast with grape-fruit, which is somewhat astringent and very
refreshing; but to begin breakfast with an apple or a pear is the
greatest possible offense to a normal stomach, and occurs only because
of the lack of a thorough knowledge of the physiology of the stomach.


------------------------------------------------------------------------




                             CHAPTER XLII.

    ON THE USES OF SMALL DOSES, AND THE DELETERIOUS ACTION OF LARGE
                         QUANTITIES OF ALCOHOL.


IN everyday life we are exposed to worry and disappointment; and also,
as many of us easily tire after work, we frequently feel an inclination
to take something to cheer us up and to incite us to further exertions;
thus we take stimulants, such as alcohol, tea, coffee, tobacco, etc.

We may fairly compare these stimulants to a whip with which we urge on a
horse. A short reflection, however, will teach us that rest would be the
best stimulant for a tired horse; but, unfortunately, physiological
thinking is not yet the commonsense view of all.

A willing horse requires no whip, and many of us are able to attain a
good old age without requiring any stimulants. The grandfather of the
author of this work has attained the age of 105 without taking any
stimulants.

As our numerous friends, both in America and England, know, we do not
take any alcohol, not from principle, but because we find no pleasure in
so doing. Still we don’t feel inclined to follow the anti-alcohol
fanatics in their crusade, because we detest fanaticism of any kind,
whether displayed by Chinese, by Mohammedans in Bochara or Morocco, or
by Christians in England or America. We also do not uphold such
narrow-mindedness as prohibiting even the smallest amount of alcohol to
those who only take it in the greatest moderation, solely on the ground
that there are some good-for-nothings who can never take it without
getting drunk. With equal justice might we take away the fortune from a
man who has gained it by his labor, on the ground that there are others
starving because they will not work. We are not prepared, either, to
accept the dictum of the anti-alcoholics that alcohol is a poison even
in small quantities. We do not deny that there are many among them who
cannot stand even small quantities, which is a probable reason why they
are so clamorous against it; but they do not possess normal health,
physically or mentally; and the supposition is not unjustified that
there is in some of them a lessened tolerance for alcohol owing to their
previous immoderate libations.

The truth is, as shown by many physiologists, such as Atwater and
Benedict, and also by Professor Tigersted,[309] even at the
Anti-Alcoholic Congress at Stockholm, that alcohol may be regarded, but
in small doses only, as a precious gift, for by it we may preserve
important parts of the bodily tissues—carbohydrate and fatty substances,
which may be economized by the use of certain quantities of alcohol. The
nourishing effect can be attained only if not too much be taken, for in
over-abundance a decomposition of albuminous substances can be produced
as a toxic effect.

Footnote 309:

  Quoted after Dr. Hollitscher, Präger med. Wochenschrift, 1907.

Alcohol in small doses is unquestionably an excellent stimulant for the
nervous system and the circulatory apparatus. There are many people who
are able to do more work, especially of a physical nature, when they
take a certain amount of alcohol; and at the same time they have a
better appetite for food. Alcohol, however, is of more benefit in this
respect if we take wine; and of all alcoholic drinks, except beer, wine
contains the least percentage of alcohol, especially French wines, which
normally contain only 9 per cent. But this stimulating effect only holds
good when we do not take large amounts, for in the latter case the
quality of work is impaired, especially mental labor.

In a given quantity, and preferably in the shape of red wine, alcohol is
able to cheer us up, and to a certain extent diminish grief and sorrow;
but after taking large quantities we feel more depressed.

Beer is more nourishing than wine, but has a more sluggish effect.
English and some kinds of American beer often contain nearly as much
alcohol as some kinds of wine, sometimes more than light Tyrolean or
Italian wines.

The most beneficial form of alcohol is a light wine, and, as a medical
stimulant, the older vintages of French wines. Beer may, to some extent,
assist digestion, owing to its bitter constituents. It is true that it
contains the least percentage of alcohol of all beverages of this
nature, but it has the disadvantage that it is taken in larger
quantities as one gets accustomed to it, and thus more alcohol and a
larger amount of liquid may be introduced, the result of which may be
injurious to the circulatory system (see “Hygiene of the Food”).

Observation proves that many old people thrive well on a small amount of
claret or other red wine taken daily at meal times. In such cases it may
be regarded as a harmless tonic, if taken only in small quantities, and
if their health be otherwise normal except for the debility attributable
to old age. Dr. Savile, of London, has also found salutary effects from
moderate and exactly regulated quantities of alcohol in the aged inmates
of the workhouse infirmary.

In our judgment we shall be best guided by the way in which our regular
patients tolerate alcohol. When, having been accustomed to it all their
life, they ask for wine or whiskey, and they can tolerate it well, we
admit that small amounts act as a kind of tonic for them; but it should
never be given if there is an incompatibility for it, for then it is
distinctly harmful and should be avoided.

Brandy is the most dangerous form of alcohol,[310] but whiskey in small
doses may be reckoned much less harmful; but the least injurious of all
are light wines and the still lighter kinds of beer, which contain only
some 3 per cent. of alcohol.

Footnote 310:

  There may be exceptions, however. The father-in-law of a Swedish lady
  patient of ours is at present 96½ years old. For a good many years the
  old gentleman has been drinking daily a large amount of cognac.

That wine may be taken without harm, even to considerable old age, can
be illustrated by a series of examples, of which we have mentioned some
already, where persons have reached 100 years of age in spite of
drinking wine every day. They might, perhaps, have lived longer had they
taken no alcohol, for, as a rule, such persons come from long-lived
families, and, as we have said previously, such people may permit for
themselves greater license in this respect; but this must be distinctly
regarded as the exception, for, as the statistics of the United
Temperance Association in England show, total abstainers have a much
greater chance for a long life than have others. According to Neisson’s
investigation of 6111 persons from 16 to 90 years of age who were taking
alcohol, the ratio of mortality among them was three times greater than
for the whole population of England.

Sir Isambard Owen shows, by a careful analysis of the results of the
Collective Investigation Returns, comprising 4287 persons, that the
average duration of life is greatest among total abstainers and very
moderate drinkers, and that but few addicted to much alcohol were among
the long lived; those in the latter condition can only expect a
shortening of life, which proves conclusively that alcohol is very
deleterious to the organism.

As post-mortem examinations show, all the organs of the body suffer
degeneration after coming in contact with large quantities of alcohol.
It would be impossible to dilate here upon all these different changes.
We will, therefore, only mention the effects of alcohol on the most
important organs—for example, the heart and blood-vessels.

As is well known, alcohol, if taken in large quantities, degenerates the
heart muscles and also produces the condition of arteriosclerosis. Its
effects on the brain are particularly deleterious. If taken once only,
but in large measure, it is sufficient to cause intoxication, with
changes in the mental faculty. Taken habitually, as by chronic
alcoholics, these mental changes may develop into a permanent character,
and thus insanity may follow. According to the official statistics of
the Kingdom of Württemburg, about 60 per cent. of the inmates of lunatic
asylums were alcoholics. Out of 579 lunatics of the Provincial Insane
Asylum, in Vienna, in 1899, there were 40 per cent. alcoholics.

As we have shown in our address at a special meeting of the Philadelphia
Medical Jurisprudence Society, insanity and crime stand in very close
relationship, and, in fact, crime may be regarded as a nervous disease.
We should, therefore, not be surprised to find so many criminals among
alcoholics. According to statistics prepared in Germany, some 63 per
cent. of cases of injury to the person, 69 per cent. of robbery and
murder, and 77 per cent. of sexual crimes were committed by persons
under the influence of alcohol; and according to Dr. Scharffenberg, of
Christiania, if there were no alcoholics crime would be diminished by
one-half.

A person committing a crime while under the influence of alcohol is no
more responsible than a person who does the same thing while in a state
of delirium caused by some infectious disease, or while under the
influence of such a poison as muscarin or atropin, which produces an
intoxication similar to that of alcohol.

Of the other organs which are injured by alcohol we must put in the
front rank the various ductless glands, which are of special importance
to us.

The frequency of impotency in chronic alcoholism proves how injurious to
the sexual glands are large quantities of alcohol. The same applies to
the adrenals, as shown by the frequency of arteriosclerosis in
alcoholics. From one dose of alcohol we can often see an increase in
blood-pressure. It has been shown by Dr. Sajous that alcohol acts in a
very deleterious way upon the pituitary body when taken in anything but
small quantities or well diluted as in beer or light wines; he
illustrates this fact in a very instructive microscopic specimen.[311]

Footnote 311:

  Sajous: “Internal Secretions,” vol. ii, p. 1332, 1907.

In the same way the bad effects of alcohol on the kidneys and liver are
amply demonstrated in the handbooks of clinical medicine and
pathological anatomy, with which we are all well acquainted; and the
constant occurrence of cirrhosis of the liver and interstitial nephritis
in alcoholics plainly show this.

A matter of grave importance to us is also the degeneration of the
thyroid in alcoholics, as found by the researches of de Quervain[312]
and Sarbach[313] and the clinical observations of Hertoghe.[314]

Footnote 312:

  de Quervain: Semaine Méd., 1895.

Footnote 313:

  Sarbach: Mitth. Grenzgebiete Med. u. Chir., 1906, p. 213.

Footnote 314:

  Hertoghe: Loc. cit.

These degenerating effects of alcohol on the ductless glands will
explain why premature old age is so often found in alcoholics,
especially when brandy and liqueurs are taken; but still worse
consequences than this also arise, viz.: the diminution of the powers of
resistance to infection or intoxication, in consequence of the lack of
those important protective elements which, as we see in Chapter III, are
derived from the ductless glands, a fact which various epidemics amply
prove. My friend, Dr. MacMeans, told me during a stay in Monterey,
Mexico, that in an epidemic of yellow fever, he observed that alcoholics
were among the first to contract it.

We know the great frequency of tuberculosis in alcoholics, and the great
mortality in such persons from pneumonia. They are unable to withstand
the high fever and cannot combat the infection, and the heart soon
fails; and also, as a general rule, in all cases of infectious diseases
their chances are much worse than are those of other people.

We note in Chapter VI that heredity depends on the condition of the
ductless glands of the parents. This is also the case with alcoholics,
and it is a fact that the descendants of such are heavily handicapped;
and, as also mentioned in Chapter VI, congenital myxœdema and
scrofulosis is prevalent among them, and their chances for a long youth
discounted. Nervous diseases are also of constant occurrence among
these, such as idiocy, epilepsy, etc., very interesting data as to which
are given by Legrain. A certain alcoholic was eight times in the insane
asylum for delirium tremens. He had nine children; three died at birth
from general debility, one died of convulsions within the first year,
and the other five suffered from trembling in the extremities. The
father of this person was also a drunkard, who hanged himself; the
mother, a brother, and a sister were also dipsomaniacs.

Martin found in 60 out of 83 female epileptics, alcoholism in the
parents. Demme examined 57 children among such, and found only 10 who
were normal, physically and mentally.

A terrible genealogy is that traced by Dr. Klausner concerning a woman
named Ada Take, born in 1740, who was a dipsomaniac. She had 709
descendants, among whom were 100 illegitimate children, 181 prostitutes,
142 beggars, 46 workhouse inmates, 76 criminals, and the remainder were
more or less habitual drunkards. This one family cost the country or
prison authorities for their support over three million florins
($1,200,000).

In tropical climates the effects of alcohol are most pernicious.
According to Dr. Hueppe, it is the greatest enemy to the European. From
the official report of the British Commissioner General for Central
Africa, in 1894, “the use of beer, wine, and spirits is more destructive
to our tropical colonies than all the bacilli and plasmodia;” and
according to the great African explorer, Emin Pasha, the tropics offer
no dangers to the health of such as can abstain from large amounts of
stimulants. It is very likely that what atrocities have been credited to
Europeans in Africa were due to alcohol.

From the foregoing facts it is clear that large quantities of alcohol
are most injurious, but there is no scientific evidence to prove, with
exactitude, that small doses are harmful.

Some experiments in this direction have been made by Laitinen,[315] but
they were performed on rabbits and guinea-pigs, to which he gave very
small doses (only 0.1 centimeter per kilo bodyweight). He found that the
hæmolytic ability of the blood was impaired, and that there was a
greater mortality among their young than among the young of those kept
on water. Laitinen, himself, did not dare to draw conclusions from these
experiments; nor can we, for there is a great difference between a man
and a rabbit. But if an inference may be deduced from such, we can apply
it to children, for, as is well known, the effects of drugs on small
animals offer better comparisons for children than for adults. For this
purpose, however, we need not refer to the experiments of Laitinen, for
Dr. Maurice Kende has lately experimented on 20 children between 6 and
15 years of age, who, after very small quantities of wine, exhibited an
impairment of their mental faculties.

Footnote 315:

  International Congress of Anti-Alcoholics, Stockholm, 1902.

Dr. Hercod has also shown that out of 591 Viennese school children, the
best certificates for scholarship were gained by those who took no
alcoholic drinks; instructional results were not quite so satisfactory
in those who occasionally did so; but the worst scholars of all were
those who took alcohol two or three times a day. According to Viennese
life, beer is generally meant by the term “alcohol,” and, in a much less
degree, wine.

That children are susceptible to alcohol, as to all poisons in general,
has been already mentioned in Chapter X; so it is not surprising if only
small quantities should unfavorably affect their mental faculties. We
have also previously insisted upon the necessity of considering it a
crime, meriting a heavy punishment, to give alcohol to children. But we
again repeat that there is not sufficient strictly scientific evidence,
as yet, to prove that small quantities of alcohol (especially beer or
wine, and possibly whiskey) are deleterious to the majority of adults;
those who cannot stand even small quantities will be best without any;
but we fail to see why a working man, when he comes from his daily
labor, should be forbidden to take his glass of beer. It is certainly
not the temperate users of stimulants, the hard workers, that should be
persecuted by anti-alcoholics, but the intemperate users, who are a real
curse to humanity. If those fanatics will limit their action in this
useful direction only, every physician will be only too anxious to
support them; but instead of this, like Don Quixote against the
windmills, they forbid the use of alcohol entirely to persons who simply
cannot exist without it; in fact, they might just as reasonably forbid
them to eat, drink, or sleep!

We firmly believe that the best course is to discover the cause which
compels such people to drink so much that they cannot discontinue the
habit, and by finding the cause we shall ascertain the origin of the
disease and can then treat it rationally, as we will endeavor to show in
the succeeding chapter. Physicians, and not clergymen, are best
qualified to fight the alcoholic habit, just as they are best qualified
to fight all other diseases. That alcohol in small quantities cannot be
such a poison as claimed by these faddists, is also shown by the great
number of moderate drinkers who live to be much above 100 years old. At
the present time there are also within our knowledge several persons
over 100 years old who take every day a certain amount of alcohol. Thus
an old general in Berlin, who reached his 103d birthday last December,
is accustomed to go, every day, to a beer house to have his glass of
beer. Mrs. Andie Campbell, of Springburn, near Glasgow, who attained her
103d birthday in January, 1908, attributes, as the newspapers stated,
her old age to the moderate use of whiskey, which she has been
accustomed to drink all her life. According to the report of the
Collective Investigation Committee of the British Medical Association,
most of the 51 centenarians, whose cases were investigated, were total
abstainers, but 5 were very fond of alcohol. One of them, Peggy Walsh,
who is said to have attained 127 years, was in the habit of taking daily
before dinner an ounce of whiskey in water.[316] Thus it seems
conclusive that the use of moderate quantities of alcohol does not
seriously impair our chances for living to a good old age.

Footnote 316:

  Quoted after Humphrey, “Old Age,” Cambridge, 1889.


------------------------------------------------------------------------




                             CHAPTER XLIII.

    SOME REMARKS ON THE CAUSES AND PREVENTION OF THE ALCOHOL HABIT.


IT is a strange fact, but one in which all observers agree, that women
who have never been accustomed to take alcohol, can stand considerable,
and sometimes very large, quantities of it during convalescence after
infectious diseases, such as pneumonia, etc. It is equally strange that
in severe cases of diabetes, where previously opium had never been
taken, very large doses of this drug may be used without any
inconvenience. We have also observed that women suffering from severe
diabetes, though unaccustomed to alcohol, could take large quantities of
it—for instance, one or two tablespoonfuls of whiskey three times a
day—without displaying any symptom of mental excitation or other signs
of having taken liquor in a quantity which might provoke a state of
excitation in persons not used to alcohol; in fact, the alcohol has been
well tolerated and taken with pleasure.

In both these conditions—diabetes (Lorand) and infectious diseases—the
thyroid gland plays an etiological rôle, as we have frequently indicated
in this work. It is, therefore, justifiable now to discuss the point
whether the thyroid has something to do with the apparent paradox that
alcohol can be taken, without the display of any signs of intoxication,
by women who are otherwise never in the habit of taking spirits.

That this is really so cannot be denied, _a priori_, for the reason that
between the activity of the thyroid and the influence of alcohol a
certain relationship exists. This is evidenced from the observation,
mentioned previously, that alcohol acts upon the thyroid gland, at first
causing hyperactivity, and later on exhaustion of it. As we have already
mentioned, there is a certain analogy between the action of chloroform
and that of alcohol on the thyroid gland. In fact, we think that it is
permissible to assume that drunkenness is a consequence of the
hyperactivity of the thyroid, for in such a condition there are
observable a series of symptoms of thyroid hyperactivity; and it has
been shown by Moebius[317] that in women suffering from Graves’s disease
(hyperactivity of the thyroid) we may find a condition of intoxication
similar to that seen in alcoholic intoxication, although such women had
not taken even a drop of alcohol. This condition is provoked by the
over-abundance of thyroid secretion in the blood. In other words, women
suffering from this disease can be drunk without having taken any
alcohol at all, simply because of the entering into their blood of the
secretion of the thyroid in large, i.e., in toxic, quantity, this having
produced such a condition.

Footnote 317:

  “Die Basedow’sche Krankheit,” Nothnagel’s Handbuch, second edition.

According to several authors, whom we have already quoted (de
Quervain,[318] Hertoghe[319]), alcohol has a great influence on the
thyroid, and in chronic alcoholism the thyroid is found to be
degenerated.

Footnote 318:

  Semaine Médicale, 1905.

Footnote 319:

  Loc. cit.

If it can be admitted that drunkenness is caused by the toxic products
of the thyroid, due to the alcohol acting on the thyroid and causing its
hypersecretion, we can also explain the mystery why persons bitten by
poisonous snakes can also, in the same way, take very large quantities
of alcohol without showing its effects, even when they have previously
been quite unaccustomed to it. Snake poison, as do all poisons, creates
a hyperactivity of the thyroid which results in the throwing off of a
large amount of colloid substance. Exhaustion follows this
hyperactivity, and in this condition, as in convalescence from
infectious diseases, and in severe diabetes, where there is also a
similar exhaustion of the thyroid after a previous hyperactivity, a
large quantity of alcohol can be taken, merely because of the fact that
when the thyroid is devoid of its colloid, a condition of hyperactivity,
which is the cause of drunkenness, cannot easily be provoked, unless
enormous doses are given. We must, therefore, in cases of snake
poisoning give greatly increased doses of alcohol in order to again
provoke an increased activity of the thyroid, and thus cause the
eventual destruction of the harmful toxalbumins of the snake poison.

If women, in a state of convalescence after pneumonia, or with severe
diabetes, and unaccustomed to taking spirits, can stand large quantities
of alcohol without exhibiting any signs of excitation, it is very
probably due to the circumstance that the thyroid has already thrown off
its available amount of colloid, is exhausted, and the doses given are
not yet sufficient to produce a fresh secretion, and thus the symptoms
of drunkenness do not develop.

The result of these observations is that a degenerated thyroid cannot
easily provoke a condition of drunkenness, which may also explain the
curious coincidence that frequently chronic alcoholics, even after large
quantities of alcohol, do not present typical symptoms of drunkenness;
in fact, sometimes so few of such signs are visible that, if a crime is
committed under such influences, it is difficult to prove they were
really intoxicated at the time, as they present no visible signs of such
a condition.

From the foregoing we shall, therefore, not be surprised to find that
persons suffering from hypothyroidia or myxœdema can take large
quantities of alcohol, and at the same time evince a great liking for
the same; in fact, at times, they have a regular craving for it. Several
things will explain why myxœdematous people like to take alcohol. They
invariably feel cold, as the thyroid regulates the temperature of the
body; they thus desire to obtain warmth from the spirit (which may
excite the function, in a small degree, of such parts of the thyroid as
are not yet degenerated), and thus produce symptoms of thyroid
hyperactivity, by which warmth may be produced, though they do not
realize that subsequently they will be all the colder. Such people are
also generally of a dull apathetic disposition, never cheerful, but in a
depressed mood, owing to the degenerated condition of the thyroid; and
being thus despondent they are easily dejected by worries or
disappointment. That such people should resort to drink is but natural,
if we consider that they can take alcohol without visible effects. We
must not forget that there are many degrees of hypothyroidia, from light
cases with a simple insufficiency of the thyroid up to graver forms
nearly approaching myxœdema; and all we have said on the above subject
will apply in varying degrees to them.

From this we shall now also understand why aged people can sometimes
take much alcohol without exhibiting signs of drunkenness, which is
probably the origin of the erroneous idea that “wine is the milk of the
aged.” This can have very baneful results, for if small doses can
undoubtedly produce—especially when light French wines are taken—a tonic
and stimulating effect on the thyroid, after larger doses the
hyperactivity may more readily be followed by exhaustion, in which case,
in old age, the degeneration of the thyroid will be still more
quickened.

If persons with a degenerated thyroid can take large quantities of
alcohol without getting drunk, on the other hand, those with an
overactive thyroid cannot stand alcohol so well; and that the latter is
the case in Graves’s disease has been already shown by the fact such
people can exhibit the symptoms of intoxication even when they have
taken no alcohol at all. Young girls and women generally, except those
past the climacteric age, are very sensitive to the effects of alcohol,
and easily get intoxicated, owing to the fact that the thyroid is, with
them, more active on account of the intimate connection between it and
the ovaries. Thus, during thyroid treatment we have seen intoxication
appear after a single glass of claret in persons who previously could
drink much more without becoming so affected.

During treatment with thyroid tablets alcohol is not well borne,
according to our observations.

It is probable that the sexual glands have also something in common with
this question. We have observed that people with marked sexual
inclinations are seldom habitual drunkards; in fact, we do not recall
having ever come across an instance; also, among total abstainers men of
strong sexual inclination are not infrequently met with, whereas
alcoholics do not usually seem to care much for the fair sex, which
should surprise us the less, in as much as among them impotency is very
frequent, alcohol in large quantities always having a baneful effect on
the sexual glands. In small quantities, to a certain extent, it may
prove stimulating to these glands.

It is an interesting fact that in those with degenerated sexual glands
there is always a greater liking for alcohol; thus women, after the
menopause, have a greater predilection for spirits, and the greatest
number of cases of drunkenness in women is to be observed among such.
Eunuchs also have a greater inclination for intoxicating agents than
have their more fortunate brethren who are still in possession of their
sexual glands. We do not think that psychic impulses, consequent on such
conditions, can be of sufficient influence to explain the craving for
alcohol, except, perhaps, through the circumstance that persons deprived
of the active sexual glands do not enjoy a high state of mental activity
and are unable to judge of the fatal consequences of the drink habit. If
women, after the menopause, exhibit a greater inclination to drink, we
think it cannot be explained solely by their seeking to drown the
sorrows of lost youth and by substituting for the pleasures of sexual
life those of the bottle. This may certainly influence them to a certain
degree, but in any case it is certain that without the possession of
healthy sexual glands the desire for stimulants is greater; and it would
seem also that in advanced age they can take alcohol more freely than in
their prosperous younger days. Such persons have a partiality for strong
sweet liqueurs. Happily such women are in a great minority. All we wish
to point out is that it is among the older people that this craving
exists, as in the younger ones alcohol cannot be so well borne.

From such observations on the greater frequency of the alcohol habit
among persons suffering from degenerated conditions of the thyroid and
sexual glands, and on its greater rarity in opposite conditions, we
believe that some therapeutic hints may be gained. The best preventive
against the alcohol habit (which is induced usually by the want of, and
a real craving for, stimulants) will be the satisfying of this tendency
by other means than alcohol. We can even prevent this craving if we can
improve the state of their thyroid or sexual glands. For single persons
marriage is an excellent stimulant, and a first-class psychic treatment
as well. Treatment by means of thyroid gland can also give good results,
as by this the mental condition will be improved and a cheerful
disposition may be gained, which will enable them the better to
withstand worry and depression after disappointment. At the same time
the temperature of the body will be increased, a feeling of warmth
produced, and fatigue much better borne. Thus no whip will be needed,
and the craving for stimulants will be prevented. To women not only
thyroid, but ovarian, extracts should be given. Both exercise a powerful
influence on the mental condition, relieve depression, and remove the
craving for constant stimulation. By these means we possess a basis for
the rational treatment of alcoholism, besides the psychical and ethical
one, on which we will not enter here. But we must emphatically remark
that we must, in the first instance, get rid of the real cause of
alcoholism, viz., the diseased condition of the thyroid and sexual
glands which induces it, and by the removal of the cause we also remove
the consequences. By merely forbidding the use of alcohol and doing
nothing to cure the diseased condition which sets up such an insatiable
craving for it, is like filling a barrel, which has a hole in it, with
water, before we have tried to stop up the orifice.


------------------------------------------------------------------------




                             CHAPTER XLIV.

   ON OTHER STIMULANTS—TEA, COFFEE, COCOA, TOBACCO: THEIR MERITS AND
                             DISADVANTAGES.


In many people the use of the above stimulants produces greater energy,
especially for mental work, and the process of thought may be
facilitated by their means, although we are not prepared to approve them
as a general rule. At any rate if such properties are to be found in
these stimulants, they are available only in small amounts and not
exceeding a given limit, for in excess the same rule applies to them as
to alcohol.

There are, indeed, certain authorities who condemn them, and go so far
even as to call them poisonous. But it is a leading principle of this
work to condemn exaggeration and fanaticism in any form, and always to
observe the means that are best for all rules of life. Sobriety and
impartiality in everything must be the guiding stars for such a work as
this. We must not forget that the millions of human beings that are on
the earth have each a different kind of constitution, and many of them
practically cannot exist without the assistance of certain stimulants,
without which life would be a burden to them; and as it does no good to
make prohibitions which cannot be kept, even though made with the best
of intentions, all we can do is to endeavor to control certain things
and to see that some limit is set for their use.

There are two varieties of tea, both of which, however, are gathered
from the same plant; their only difference lies in their method of
preparation; their differentiation is in color—black and green. The
former undergoes a process of fermentation and is then dried slowly over
charcoal fires, while green tea derives its color from having been dried
in a fresh condition over a wood fire.

When we want to make good tea we must take finely washed leaves and make
an infusion, so that the greatest possible surface of the leaves shall
come in contact with the boiling water; and it is best to let this
contact be only for a short time, as otherwise the tea will be too
strong and less beneficial to health.

The most important elements in tea are thein, a substance that is
identically similar to caffein in coffee, ethereal oils, tannin, and
extractives. Green tea contains more thein and ethereal oils, and also
more tannic acid, than black tea; and the longer it is in contact with
boiling water the greater will be the quantity of tannic acid derived
from it. According to R. Hutchison,[320] the ashes of tea contain a
large percentage of manganates (1.09 per cent. manganese hydroxide) and
much iron (4.47 per cent. oxide of iron).

Footnote 320:

  Hutchison: “Food and the Principles of Dietetics,” London, 1901.

After taking a cup of tea there is a feeling of great comfort; we feel
lighter and less fatigued, which is due, as discovered by Koch and
Kraepelin,[321] to the combined action of the ethereal oils and of the
thein. The tannic acid contained in tea may also give good results in
the treatment of certain diarrhœas. The actions of tea are very similar
to those of coffee, which is only natural, since both contain the same
chemical agent, thein or caffein. Still, though chemically the same,
physiologically doubtless there are some slight differences. Although
both promote endurance in physical and mental work, according to some
views, still in many people nervous irritability, such as sleeplessness,
is greater from tea than from coffee. Coffee is a better diuretic than
tea, and it has been found that common salt is eliminated in the larger
quantity after taking coffee. For weak stomachs neither is advisable.

Footnote 321:

  Koch and Kraepelin: “Psychologies die Arbeiten,” vol. i, p. 378, 1895.

In many cases tea is less easily assimilated than coffee, on account of
digestive disturbance caused by its tannin contents; while to many
others tea proves more suitable than coffee. When these beverages are
taken in large quantities there are very serious symptoms of nervous
disorders, such as great excitability, sleeplessness, palpitation of the
heart, trembling, etc. Indeed, sometimes the very serious condition of
actual intoxication is brought about.

It is quite amazing what large quantities of tea are consumed in certain
countries—in England, for example; and in many instances the moderate
use of good wine would certainly create less mischief than the
immoderate use of tea. Tea is not so beneficial to the kidneys as
coffee, and as we have mentioned in the chapter on the hygiene of the
kidneys, irritation of the kidney tissues may be at times observed after
the use of tea. As in the case of alcohol, moderation with tea and
coffee is necessary. According to the researches of Böttger even weak
infusions of tea and coffee are harmful to children, and strong
infusions to grown up people.

The most important substance in coffee is caffein, a product already
mentioned as being chemically identical with thein. When we take a cup
of coffee about 0.1 gramme of caffein enters the system, and also 0.2
gramme of tannic acid, as shown by Robert Hutchison. When coffee is
roasted aromatic oils arise, which give coffee its delicious aroma.
Coffee acts as a stimulant to the heart and also to muscular
contractions. Its beneficial action on the kidneys has been referred to.
When coffee is taken it is more hygienic to take it not too strong, and
invariably with cream or milk.

According to Emil Fisher, caffein is a thrice methylated xanthin, from
which it can be produced artificially. As caffein, or thein, contains
purin bodies, they also augment the amount of uric acid in the body, and
especially so when they are taken in large quantities. Because coffee,
tea, or cocoa give rise to uric acid, Haig would like to banish them
entirely from the diet. We do not feel inclined to follow Haig in such a
fanatical view, for after all it is nearly impossible to so live that we
should not introduce some small amount of uric acid into the system; we
are always producing a certain amount of it in the system, as already
mentioned, and whether a trifle more or less be taken can make no
difference, as minute quantities of uric acid cannot play an important
rôle if our kidneys are in good condition to eliminate them. With a
large amount of meat we eliminate two grams of uric acid in every
twenty-four hours, and even with an entirely vegetarian diet the urine
still contains 0.2 to 0.7 gramme, according to Bunge. Should we be so
unreasonable as to refuse a person a cup of weak tea or coffee, after
their having been accustomed to such for a lifetime, merely to avoid a
few more atoms of uric acid. Especially should we refuse them a weak cup
of coffee, remembering that such is a good diuretic and assists in the
elimination of baneful products through the kidneys? Only to actually
gouty people might such a veto, perhaps, be reasonably applied.

Cocoa is a very valuable article of food, and at the same time a very
mild stimulant. As its active principle it contains theobromin, which is
a twice methylated xanthin. In its chemical and physiological actions
theobromin is very similar to caffein. It is, however, in some respects
superior to caffein. Thus it can assist muscular activity, according to
some authorities, to a higher degree than caffein or thein.

Cocoa has the further advantage of being more digestible than coffee or
tea; and as a foodstuff it shows a great superiority over both the
latter, as it contains 12 per cent. of albumin, 13 per cent. of
carbohydrates, and contains fat—indeed, about 50 per cent.—in a fresh
condition.

Cocoa presents fewer drawbacks than tea or coffee; it is less exciting
to the nervous system, more digestible, and much more nutritious also.
We think, therefore, it is clearly indicated as the best of all
stimulants, and, for reasons already stated, we are not afraid to
recommend it, in spite of the fact that it may nominally increase the
amount of uric acid. Cocoa was also the favorite beverage of the great
botanist Linné.

Chocolate is composed of cocoa and a large quantity of sugar, and is
quite a pleasant sugar food, which doubtless can be used with profit as
a dessert to a lacto-vegetarian diet. It is also suitable for the use of
tourists and sporting men in order to enable them the better to endure
great fatigue. We often recommend its use in its best quality and in
small quantities to those people from whose diet meat is excluded.

Tobacco is a plant, the leaves of which, when prepared by a special
process and smoked in the shape of cigars, or in pipes, are able to
produce in many people a feeling of exhilaration; and many such smokers
are able to do more work, especially brain work, with the aid of a good
cigar. Tobacco contains, in addition to noxious salts, a poisonous
alkaloid, nicotine, which produces in small amounts in those not
accustomed to it, and in all people if in larger quantity, a condition
of intoxication. When nicotine is taken for many years, and sometimes
even in a shorter time, either by smoking or chewing, very injurious
consequences from nicotine poisoning may ensue. According to König,
cigarettes are the most dangerous in this respect. It is quite a mistake
to think that no nicotine is introduced into the system through smoking;
and in chewing mixtures the presence of foreign matters must not be
overlooked. Nicotine may exercise a fatal action on various organs—for
instance, on the inner parts of the eye and the optic nerve, and the
nervous system; but without doubt its most injurious action is on the
heart and the stomach. At first it may cause only an irregular pulse and
an occasional feeling of a stopping of the heart; but if continued, in
spite of these symptoms, for a long time, it can undoubtedly produce the
condition of atheromatosis, and will assist in the development of
arteriosclerosis, which is probably caused by the action of this
substance on the adrenals; for it has been noted by many leading
authorities—e.g., Prof. Isaac Adler, of New York—that tobacco produces
effects similar to adrenalin.

According to Sir Lauder Brunton[322] and others, tobacco raises the
blood-pressure, sometimes enormously. As Brunton says: “I do not know
that there is anything that causes such a tremendous contraction of the
vessels and raises blood-pressure to such an enormous extent as does
nicotine, except, perhaps, the extract of suprarenal capsules, which has
an action almost identical with nicotine.”

Footnote 322:

  Brunton: Lectures on the Action of Medicine, p. 321, 1897.

It has also been shown by Esser[323] that chronic nicotine poisoning is
able to produce in animals a great disturbance of the heart and
histological alterations of the vagus fibers, and that if nicotine is
injected into the circulation it excites the vagus and slows the action
of the heart.

Footnote 323:

  Esser: Arch. für exper. Path. und Pharm., xlix, p. 168.

Clinically we have observed the great frequency of arteriosclerosis in
great smokers, but we do not think that two or three light cigars a day,
but never before meals, can do any harm, save in exceptional cases.
Indeed, there are a few instances of persons living to be over 100,
notwithstanding the fact that they were smokers—a fact contrary to the
observations of Hufeland, who pretends that he never heard of such a
case. The famous English painter, Mr. Frithe, who died in October, 1909,
used to smoke six cigars a day; and Mr. F——, of Chartres, in France,
passed last year his 100th birthday in spite of his having taken snuff
all his life.


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                              CHAPTER XLV.

  ON SLEEP, AND ITS IMPORTANCE IN RIDDING THE BODY OF TOXIC PRODUCTS.


SLEEP is one of the most important functions of the body. As the
physiologist, Bunge,[324] remarks, “a man can live for a month without
food, but he must succumb after only a few days if he fails to sleep.”

Footnote 324:

  Bunge: Loc. cit.

That sleeplessness leads to death has been proved by experiments on
animals by Maria de Manasseine, who has demonstrated that animals from
three to four months old invariably died if treated in such manner that
they could not sleep at all. At the same time their temperature fell
four to five degrees, and the number of their red blood-corpuscles
decreased from five millions to two millions per cubic millimeter.
Manasseine also discovered important changes in the brain of animals
which had died from sleeplessness.

Before we get sleepy, as a rule, we feel tired and suffer from fatigue.
Working from morning to night—for even idle persons work through the
action of their organs—our muscles make numerous contractions, and it
has been demonstrated by Weichardt[325] that toxic products are thus
accumulated in them. This savant made animals perform very fatiguing
movements for several consecutive hours; he then injected extracts from
those muscles which had been subjected to such exercise, into other
animals, which animals in turn exhibited symptoms of great fatigue; and
he has gone so far as to show that such animals may even die during the
next twenty to forty hours.

Footnote 325:

  Weichardt: Munchener Med. Wochenschrift, Nu. 1, 1904; and
  Verhandlungen der Physiolog. Gesellschaft, Berlin, Dec. 5, 1906.

Similar conditions prevail in human beings to a greater or less degree.
According to Prof. Obersteiner, of Vienna, and Binz, sleep is produced
by an accumulation of the products of fatigue in the brain, and these
substances are carried off during sleep. Thus sleep is similar to a
condition of auto-intoxication caused by the accumulation of the
products of work, be it muscular or mental, during the time that we are
awake.

In the next chapter we shall show that sleeplessness occurs in all cases
where the thyroid gland is degenerated. This gland, as we show in
different parts of this book, destroys the toxic products formed in the
body. When this gland is degenerated these products cannot be destroyed,
and thus a condition of auto-intoxication will follow, as in myxœdema,
which has sleeplessness as one of its most typical symptoms.

According to our present physiological knowledge the center of sleep is
seated in the brain just as are other functions, such as intelligence,
will-power, imagination, etc. As we have mentioned in the chapter on the
agencies which control the condition of our nervous system and
mentality, all these are changed when the thyroid is altered, for they
suffer alteration after the thyroid is removed or destroyed by disease;
and, on the other hand, they can be improved by thyroid treatment. Thus,
sleep being one of these functions, it is only logical to assume that
the thyroid controls sleep, which proposition we shall support with a
mass of evidence in our next chapter; we will also mention there that
after the injection of adrenalin, in the vicinity of the brain, Dr.
Zeigan[326] has produced sleepiness in animals. Adrenalin produces an
anæmic condition of the parts into which it is injected, caused by the
contraction of the blood-vessels.

Footnote 326:

  Zeigan: Therapeutische Monatshefte, p. 193, 1904.

There has been a dispute on this question, whether it is hyperæmia of
the brain, or its anæmic condition, which induces sleep.

In addition to the experiments of Dr. Zeigan, which we have referred to,
and with which we will deal further in our next chapter, there are also
other circumstances which support the idea that in sleep the brain must
be in an anæmic condition.

We know that in order to fall asleep the brain must be at complete rest,
for otherwise it is impossible to sleep; if the function of the brain is
roused by any exciting influence, as for instance, if we ponder deeply
over any scientific problem, sleep is out of the question. We think this
can be amply proved by a very interesting experiment carried out by the
physiologist, Mosso, in order to show that the process of thought
produces a hyperæmia of the brain. Mosso made a man lie horizontally on
a sort of scale, so that the balance was perfectly level. The subject
was then told to think deeply, and upon so doing the head end became
heavier, and the balance was depressed in that direction.

We can also note that any other agency which produces a greater flow of
blood to the brain will be an impediment to sleep. For instance, many
people are unable to sleep when they have taken a certain amount of
alcohol, such as wine, just before going to bed; and this is more
observable in those who are unaccustomed to alcohol, and who become
flushed, feel hot in the head, and become mentally excited after taking
even small quantities. On the other hand persons accustomed to spirit
drinking, in whom no such symptoms are exhibited, may possibly be able
to sleep; this demonstrates toxic action, which may be followed by deep
sleep, by the action of alcohol on the thyroid gland. Taken in small
quantities alcohol excites thyroid action, but taken in large quantities
it causes its exhaustion as already previously mentioned.

Long ago it was accepted as a well-known fact that a hot head and
flushed face prevent good sleep; but good regular sleep is obtained when
the head is cold.

Sleepiness after dinner is attributed by Bunge to the accumulation of
blood in the digestive organs, which produces an anæmia of the brain. As
we show in the next chapter, the alteration in the thyroid by its
destruction of toxic products from the intestine, may also in part do
this.

Very interesting experiments have been carried out by Christern,[327]
under the direction of Prof. Kreis, of Freiburg, who showed that the
pressure of blood in the cavity of the skull of a boy decreased while he
was asleep.

Footnote 327:

  Quoted after Bunge.

As we have already stated, sleep is attributed generally to a condition
of auto-intoxication. When we rise in the morning, after having slept
well and soundly during the night, we feel so fresh that these toxic
products must assuredly have left the body during the night. On the
other hand, after a sleepless night we feel so miserable and weak that
the supposition is not unjustified that possibly we have not gotten rid
of these harmful products. Professor Bouchard[328] has endeavored to
show, by an examination of urine passed during the night, that this has
a greater toxic action when injected into animals than has urine passed
during the day.

Footnote 328:

  Bouchard: Loc. cit.

As before mentioned, according to Obersteiner and Binz, during sleep the
products of fatigue, which have accumulated in the brain during the day,
are removed by the blood.

Everything points to the fact that through sleep we are getting rid of
toxic products; and sleep is thus a function, the regularity of which is
of the utmost importance for our prospects for a prolonged youth and
healthy old age.


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                             CHAPTER XLVI.

          ON THE CAUSATION OF SLEEP, SLEEPINESS, AND INSOMNIA.


WHEN any one is affected by African sleeping sickness, he wants to sleep
at all times. We observed the case of an officer of the Belgian Congo
Army, suffering from this sickness, who actually fell asleep over his
soup while at table. Dr. Willems, of Brussels, also mentions a case of a
patient who fell asleep during his wedding, and of another who went to
sleep on the doorstep while in the act of calling on him for advice.

Discovery of the cause of such a marked degree of sleepiness caused by
disease should be of the greatest possible assistance in solving the
mystery which enshrouds the lesser degree of sleepiness found in normal
cases. We will, therefore, now discuss the question of the cause of the
uncontrollable desire to sleep in cases of sleeping sickness.

As we pointed out in a communication to the German Congress of Medicine
in Wiesbaden, in 1905, sleeping sickness is clinically and essentially a
condition quite different to trypanosomiasis. It undoubtedly is the
consequence of the former, which is caused by the bite of the tsetse fly
(Glossina Palpalis); but sleeping sickness presents entirely different
clinical symptoms from the first, and it also takes a much longer time,
sometimes five to seven years, to develop, after the preceding
trypanosomiasis.

As we could not fail to observe, the above case presented all the
appearances of a myxœdematous condition, among others the same walk,
slowness of movement and of speech, and the same apathetic mental state,
with the same dullness of memory; and it was surprising to witness how
all these symptoms improved only a few days after thyroid treatment had
been instituted.

The pathological and anatomical changes in patients suffering from
African sleeping sickness, described by the English and Portuguese
Commission charged with the study of this disease, present also a great
similarity to the changes found in myxœdema, and this is especially the
case in connection with the central nervous system. Thus we find in both
conditions similar changes, such as destruction of the nerve cells and
nerve processes, chromatolysis, disappearance of the Nissl bodies, and
also the same typical agglomeration of white blood-corpuscles in and
around the blood-vessels, etc. The most striking point in reference to
this similarity is the fact that the condition in the central nervous
system is in both conditions named alike, viz., pylo-encephalo-myelitis.
Walter Edmunds has found similar changes in dogs and monkeys after
removal of the thyroid.

This singular similarity also coincides with the etiology of the two
conditions. Myxœdema is most often the consequence of a previous
infectious disease; in the case of sleeping sickness, this previous
infectious disease is trypanosomiasis. In trypanosomiasis we find all
the symptoms of Graves’s disease. In the chapter on the agencies which
grant us immunity against infections and intoxications, we explain the
presence of the symptoms of Graves’s disease. The symptoms of
trypanosomiasis can be explained in the same way, as can those which
occur in other infectious diseases, as they are expressions of the
defense of the thyroid against infection. The consequence of such
overwork of the thyroid is its degeneration, which results in the
symptoms of a myxœdematous condition, as found in sleeping sickness.

According to Koch, arsenic, in the form of atoxyl, can give good results
in such a condition; but with arsenic we introduce one of the main
elements contained in the thyroid gland, and arsenic can also afford
favorable results in the treatment of myxœdema.

The most typical symptom of African sleeping sickness is the great
somnolence which cannot be controlled or resisted, as stated in the few
examples given above. This somnolence is also one of the typical
symptoms of myxœdema, being according to Pilcz, one of the four cardinal
symptoms of this disease. We also find this in animals or persons in
which the thyroid has been removed. We have observed dogs in which this
has been done, and they were always so fast asleep that the loudest
noise could not rouse them. From the foregoing there can be no doubt
that the thyroid gland has something to do with sleep, and this is best
exemplified by the circumstance that there is sleepiness in all those
conditions where the thyroid gland is degenerated, as in the instances,
just quoted, of myxœdema and of animals in which the thyroid has been
removed. In addition to these examples, sleepiness can also be observed
in cases of tumors of the pituitary body—for instance, in acromegaly.
However, as has been shown by Gley, Rogowitsch,[329] Stieda,[330]
Sajous,[331] and others, the pituitary gland and the thyroid are in a
very close relationship, and, as I have also pointed out in a previous
paper, we find pretty constantly alterations of the thyroid gland in
acromegaly. Salmon also mentions that in tumors of the pituitary body,
with sleepiness, there was generally found an atrophic condition of the
thyroid.

Footnote 329:

  Loc. cit.

Footnote 330:

  Loc. cit.

Footnote 331:

  Sajous: Loc. cit.

Sleepiness is frequently observed in certain cases of obesity. Such a
condition was described several years ago, under the name narcolepsy, by
Sainton. I have also observed similar cases. Thus, an English patient of
mine, a gentleman weighing 260 pounds, would fall asleep on any
occasion—in church, at the theatre, and at concerts; and I have heard of
a similar case from a confrère (related to me by Dr. Echlin, of Ottawa),
who was a very fat man and who snored much louder during an operation
than did the narcotized young lady, whom Dr. Echlin was operating on for
appendicitis.

The sleepiness in these cases must also be attributed to the thyroid
gland, which governs metabolism, as shown by the researches of Prof.
Magnus-Levy,[332] of Berlin, Thiele, Nehring, etc., and also by my own
works. The fat-reducing action of thyroid extracts confirms this
clearly.

Footnote 332:

  Path. des Stoffwechsels of v. Noorden, second edition, vol. ii.

Sleepiness is a frequent symptom of chlorosis; and it is a fact that in
chlorosis the thyroid is very often altered, which might thus explain
it.

Sleep produced by narcotics and alcohol can also be brought in relation
with altered thyroid functions. We have already mentioned that we have
observed during narcosis with chloroform and ether a marked swelling of
the thyroid gland, indicating a condition of hyperactivity, which is
followed by exhaustion; and after previous mental excitation, depression
and sleep follow. The action of alcohol on the thyroid has also been
explained in a previous chapter on alcohol.

The sleepiness we notice after a heavy dinner, and more particularly
after partaking of a large amount of meat, can also be traced to thyroid
changes; for we know that the thyroid gland destroys toxic products
formed in the intestines, especially those toxines caused by the
destruction of albuminoids, as shown by Blum.

The best proof, however, of the truth of the assertion that a
degenerated state of the thyroid produces sleepiness, is to be found in
the fact, which we have established by a number of observations on
patients, and also on ourselves, that the serum of animals, in which the
thyroid has been removed, causes sleep. We will deal more fully with
this in our next chapter on the treatment of sleeplessness.

If sleepiness is so frequent in all degenerative changes of the thyroid,
on the other hand insomnia is the rule in cases of hyperactivity of the
thyroid gland, as in Graves’s disease, in which we know there exists a
condition of hyperactivity of the thyroid. We also find insomnia in
diabetes, but only in the preliminary stages, where there is no acetone
and diacetic acid in the urine. In severe cases we often find, on the
contrary, sleepiness; and this may be attributed to the fact that severe
cases of diabetes present features of a myxœdematous condition, as we
have found by the disappearance of the acetone and diacetic acid through
treatment with thyroid extracts. Sleeplessness can also be produced
artificially by giving thyroid preparations in large quantities.

If sleepiness may be produced by thyroid degeneration, and sleeplessness
through thyroid hyperactivity, the conclusion is not unjustified that
the thyroid exerts a controlling influence upon sleep; it is, however,
quite possible that the other ductless glands may also influence sleep.

Subsequently to my communication to the German Congress of Internal
Medicine in 1905, wherein I showed that the thyroid governs sleep, Dr.
Salmon, of Florence, in a monograph on sleep, tried to show, _without
any knowledge of my communication_, that sleep is governed by the
pituitary body. As, however, the pituitary body and the thyroid are in
close relationship, and as Salmon also mentions that in cases of tumors
of the pituitary body the thyroid has been found atrophic, I am inclined
to attribute the primary rôle to the thyroid. We can produce sleepiness
by the serum of thyroidectomized animals, and sleeplessness by thyroid
extracts; but we do not yet know any similar facts about the pituitary
body.

From the communications of various authorities, it appears possible also
that the adrenals influence sleep as first pointed out by Professor
Sajous in 1903 in the first volume of his work (p. 520) on the Internal
Secretions. Dr. Zeigan[333] injected a milligramme of adrenalin, mixed
with 5 grammes of physiological salt solution, into the vicinity of the
brain of cats, producing, within one minute, a deep sleep lasting from
thirty to fifty minutes; and when the cats awoke they remained very
drowsy for some time afterward.

Footnote 333:

  Therapeutische monatshefte, p. 193, 1904.

From the above observations therapeutic conclusions may also be deduced,
as we will show in the chapter on the treatment of sleepiness and
sleeplessness.


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                             CHAPTER XLVII.

                HYGIENE OF SLEEP—PREVENTION OF INSOMNIA.


WE are all acquainted with the tale of the man who was blind in one eye
and deaf in one ear, who at once went to sleep when his sound eye and
ear were closed. In this case there was nothing to stimulate the centers
of perception in the brain.

This example is very instructive for the question we shall now have to
discuss. The best hygiene of sleep is to avoid all agencies that may
cause excitation of the brain. We have seen, in the preceding chapter,
that an anæmic condition of the brain must be sought; and this is best
attained when the brain is at complete rest and nothing is acting on it
which may cause an afflux of blood, and thus hinder an anæmic condition.
A sleeping brain must not work, as any kind of mental labor, even the
smallest noise, when it is able to attract attention by having been
conveyed to the centers of perception, may impede sleep. Sometimes the
loudest noise, such as an electric car passing with bell ringing, will
not awaken us, or prevent our falling asleep, if we are accustomed to
it; for it will then excite no attention and consequently will cause no
work for the brain; but should some one speak loudly in an adjoining
room, or should any unusual noise occur in our vicinity, although
infinitely less than the above mentioned, it may be sufficient to
prevent our sleeping, for we pay more attention to it, and thus the
repose of the brain is prevented.

The miller will sleep soundly in spite of the rumbling of his mill
wheels, to which he has been accustomed for years; but should the mill
stop he may awake, for this would arrest his attention.

From the foregoing it follows logically that in order to sleep soundly
it is best to exclude everything that can arouse the organs of
perception, and which, if conveyed to the brain, may invite attention
and thereby brain work. We must, therefore, exclude noise and light from
our sleeping chamber, as we all know from personal observation that we
sleep soundest in a room that is thoroughly darkened and where no noise
can penetrate.

Some people are accustomed to a slight light in the room during the
night, for complete darkness would create attention, and thus they would
not be able to sleep so well. For such the light through the transom
will be advantageous; but for many people such light would prevent them
falling asleep.

When a sleeping chamber is too warm we may be prevented from sleeping;
people mostly sleep best in a room that is not warmed, as this favors an
anæmic condition of the brain and excludes the sensation of heat that is
adverse to sleep. We also sleep better in autumn and winter than in
summer, unless the room be heated and an artificial summer created
thereby.

The air in the room must not be oppressive, so as not to invite the
attention of our senses of perception; it would, therefore, be wisest to
take the largest room in the house to sleep in, and not the smallest, as
many do. People with a large bedroom and small sitting-room will have
more chances for a long life than those reversing this order of things.
A hygienic bedroom must be large, not heated during the night, and the
upper part at least of the window should always be open, and preferably
one at a part of the house facing a large garden or open space.

In order that the brain may be at rest it is essential that the other
organs should also be resting. Any organ that is working, particularly
if the work be laborious, or if the organ be diseased, will send
impulses to the brain. It is very difficult to sleep if any part of the
body is aching; the sensory nerves bring this to the center of
perception in the brain, and this awakens us. When the stomach is loaded
we may the sooner drop to sleep, for reasons mentioned in the preceding
chapter; but digestion during sleep is more labored, and thus again
impulses will be sent to the brain. The same occurs when the intestines
are filled with gases.

This necessitates the practical advice not to eat too much for supper,
and particularly not to go to bed for some two and a half to three hours
at least after that meal; and most people will sleep better if they do
not take much meat, and for such as suffer from sleeplessness not any
meat at all, at night. The most hygienic hour for our evening meal would
be about 7 o’clock, not later; and for the prevention of sleeplessness 6
o’clock is better.

But if it is difficult to sleep with the stomach full, an empty stomach
may also cause difficulties, particularly when there is much
hydrochloric acid in the stomach. A glass of milk and a biscuit is a
good remedy if awakened from such causes.

Flatulency also may often be the cause of disturbed sleep, and to
prevent this certain kinds of food, liable to cause it, should not be
taken in the evening; such are beans, peas, or lentils, and potatoes
especially, if beer be taken at the same time. By such combinations a
regular chemical laboratory in the intestines will be formed during the
night, and for five to six hours after such a meal, or longer, according
to the time we go to bed, sleep will be disturbed. So long as there is
flatulency it is impossible to sleep, and the quickest way to put an end
to it is to insert a suppository of glycerine into the rectum, which
will soon cause a copious evacuation, provided that the intestines have
not been previously weakened by too many drugs. After this remedy the
flatulency will cease, and sound sleep for the rest of the night will
follow.

Many people are apt to awake during the night after five or six hours’
sleep if they have partaken of much meat at the evening meal and then
gone at once to bed. Only to catch an early morning train would it be
permissible to commit such a breach of the true hygiene of sleep. To
observe this hygiene fully we must also avoid taking mineral waters with
diuretic action for some time before going to bed, for the dilatation of
the bladder from the accumulated urine may convey sensations to the
brain and thus disturb sleep.

Total sexual abstinence may cause insomnia, especially in persons who do
not observe complete chastity; for this marriage is the best preventive,
as it is for other troubles of a like nature.

In women, when menstruation comes on, there is also disturbed sleep very
frequently; and many unmarried women suffer from insomnia.

Sleep can the more easily be disturbed when it is the lightest, which is
generally the case during the early morning, for which reason at this
period all noise should be most carefully avoided. Sleep about midnight
is generally the deepest, and a noise that would not disturb us at that
hour will frequently do so in the early morning hours; thus, the
midnight hours being the best for sleep, it seems advisable to go to bed
about ten or half-past ten, and it is certainly not hygienic to retire
after twelve, as then it is more difficult for most people to get asleep
than it is at ten or eleven.

It follows from the preceding considerations that mental work in the
hours before going to bed will be contrary to the hygiene of sleep. When
the brain is engaged in intense thought there is an afflux of blood
thereto, as mentioned before. It takes some time before the brain
becomes sufficiently anæmic for sleep; for which reason also it is not
wise to read books, especially interesting ones, in bed. It is a very
bad habit to read in bed until late in the night, as is done by many
ladies who complain of insomnia and take somnifacient drugs instead of
extinguishing the light as soon as they go to bed, and excluding all
agencies that may excite their attention, in order to allow the brain to
come to a state of rest.

We must now answer the question: How many hours’ sleep shall we indulge
in?

On an average, for the adult male, six to seven hours’ sleep is
necessary to feel rested thereafter and to fully appreciate the saying
that “Sleep is Nature’s sweet restorer.” Young girls and women require
much more sleep than do men; but children, and especially infants,
require the most.

Infants are usually almost always asleep, possibly owing to the fact
that the thyroid and other ductless glands are not yet fully active; and
for this reason children also require longer sleep. The older we get the
less sleep we require. Sometimes in old age there is obstinate insomnia,
which is due to changes in the blood-vessels of the brain, by which high
blood-pressure is caused and the anæmic condition of sleep prevented.

It is unwise to say you must sleep six, seven, or eight hours to have
enough. Each individual requires a different time according to his
bodily requirements, which he must study by careful observation. The
deeper the sleep, the shorter will be the time that will be required for
it. The essential thing is to feel rested in the morning, and it does
not matter if we have slept only five and one-half hours if we only feel
that we have slept enough. There are many people, usually over 50 years
of age, who feel rested and perfectly well after but five hours’ sleep.
But if after even seven hours’ sleep we still have a feeling of
weariness and depression, so to speak, we have not freed the body of
toxic products during sleep, so the time was insufficient and must be
made up the following night.

It is a very strange thing, when we have not been able to sleep long
enough for one or two nights, and we do not feel in good condition in
consequence, that a longer sleep on the third night will be able to
restore us entirely. I believe this is a clinical argument in favor of
the theory that sleep serves to free the body from the products of
intoxication, which may be stored up for two or three days and disappear
after one night’s sufficient sleep.

Too much sleep may be nearly as bad as too little. After sleep too long
continued we feel very heavy and oppressed; we must, therefore, observe
the right medium in this as in everything else. The greatest maxim for
longevity is moderation in all things.

Granted the great importance of sleep as a function of ridding the body
of toxic products and of replacing spent energy, it will be only too
natural for us to do our best to assure its regular performance if we
are desirous of living long and retaining the vigor of youth as much as
possible. Indeed, sleeplessness, if continued for a few nights, is most
dangerous in tending to produce premature old age. We have only to look
at the face of a person who has passed a sleepless night or nights and
we shall see sunken eyes, hollow cheeks, and pendant features which bear
a strong resemblance to the face of an elderly person. It is then
interesting to note how one night of sound sleep will restore the normal
youthful appearance, which is an indication of the beneficial influence
of sleep in the problem of senility.

Sleepless nights must be avoided by every means. If possible never
travel at night, unless we feel assured that our sleep on the train will
not be disturbed; always, if we can, give the preference to day travel.
The less often we go to bed after midnight the better will be our
chances for the retention of youth and a long life.

Going to bed early enables us to rise early; and this is a powerful
factor in long life, proven by the fact that the majority of people
living to be 100 or over were early risers. The great importance of this
has been perpetuated by Franklin, the founder of many notable societies
and institutions, in the familiar verse:—

                “Early to bed, and early to rise,
                 Makes a man healthy, wealthy, and wise.”

Franklin lived to be 85 years old.

We have often noticed very old people go to bed after sunset and rise
with the earliest dawn. As a rule, people who go to bed early, some
hours before midnight, enjoy the soundest sleep because of the fact that
sleep is always deepest at about midnight. Usually only those living in
villages can indulge in this healthy habit, and doubtless this is one of
the reasons for their long life and robust health.


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                            CHAPTER XLVIII.

               THE TREATMENT OF SLEEPINESS AND INSOMNIA.


WE have mentioned in a previous chapter that insomnia is a source of
great danger to our prospects for a continued youthfulness and a long
life.

Before dealing fully with this subject it may be useful to refer to the
treatment of sleepiness also, as our remarks concerning this will tend
to explain better the novel and most rational treatment of insomnia
which we here advocate.

We have already seen that the degeneration or removal of the thyroid
gland produces sleepiness, and its hyperactivity sleeplessness, as in
Graves’s disease. It therefore appears rational that if we wish to treat
sleepiness we must first create a condition of hyperactivity in the
thyroid gland, or at least we must improve its action.

The best way to attain this is to administer thyroid extracts, which,
as we have stated before, are able, according to our researches, not
only to improve sleepiness, but even to create the opposite
condition—sleeplessness.

We have already referred in another part of this book to our observation
of a case of sleeping sickness in an officer of the Belgian Congo Army,
who was almost always asleep. To him we administered thyroid tablets,
and after a few days there was a marked change in his mental attitude
and in his whole condition, and the sleepiness improved. But we obtained
still better results in the case of a very stout man weighing 124 kilos,
who was always falling asleep, so much so that he was arrested in the
picture gallery at Versailles, where he had fallen asleep while looking
at the pictures. This patient would fall asleep when out walking, and
this occurring in the streets of Carlsbad, he was picked up under the
impression that he was drunk, while in reality he was perfectly sober.
Having treated him for a few weeks with thyroid tablets, his sleepiness
was much improved, so much so that he did not fall asleep in our waiting
room, where formerly the other patients would prevent him from falling
off his chair when sleeping. This gentleman was the patient of Professor
Launois, of Paris, and on his return home after a six weeks’ treatment
we found that he was cured of his sleepiness and had lost 16 kilos (35½
English pounds).

We were also able to observe, in our own person, the action of thyroid
extracts; for, having for a few weeks taken two tablets daily (about 10
grains), we began to suffer from sleeplessness, and our rest did not
again become natural until after we had discontinued the thyroid
treatment. This was an experiment that we made for our own personal
instruction, and judging from the results, we considered that they
indicated the trial of thyroid extracts in cases of habitual sleepiness.

To treat insomnia we naturally must first endeavor to prevent it, to do
which we must bear in mind the advice tendered in the chapter on the
hygiene of sleep. The best means to insure good sleep is to partake of a
light early supper, and to have a very dark and quiet room. It is
decidedly unreasonable to resort to injurious drugs for sleeplessness,
instead of darkening the window and transom to exclude the light, and
sleeping in a room where no noise can penetrate.

Persons suffering from sleeplessness must, above all, lead a hygienic
life; they must take exercise every day, walking or running in the open
air, even in cold weather, so as to produce some fatigue before going to
bed. Sitting the whole afternoon and living in an overheated room is
absolutely inimical to sound sleep; but overexercise and excessive
fatigue may also be as bad.

It is an excellent thing for persons, whose sleep is not as it should
be, to drive in an automobile or carriage for an hour, at least, before
going to bed, the former being preferable owing to the greater current
of fresh air. We often notice children getting drowsy after being out in
the pure open air; and in places which are situated at a certain height
up a mountain, we often obtain excellent results in insomnia.

Many people sleep better after a warm (not hot) bath, lasting twenty
minutes at least, just before going to bed; on the other hand, a cold
bath might prove too stimulating and hinder sleep.

Some people experience difficulty in falling asleep; others easily do
this, but awake soon, after four to five hours of sound sleep, and then
cannot fall asleep again. A very dark and quiet room may overcome this
perhaps, but a room into which light enters from the street or through
the transom will never do so. When there has been no sleep for a whole
night, and no sleep on the second night till after midnight, we may give
a remedy to produce sleep, but not otherwise. In principle we are
decidedly against the use of remedies to induce sleep, and we only
permit such after two partially sleepless nights—when on the third night
there is no sleep until midnight, or after a thoroughly sleepless night
when there is also no sleep the following night till midnight.

We have already mentioned that the effects of one sleepless, or several
partially sleepless, nights, may be compensated for by one thoroughly
good night’s sleep. As through sleeplessness toxic products are, in all
probability, retained in the body, certain hygienic rules must be
observed after a sleepless night, thus, for instance, a cold room ought
to be heated before we get up, for the effects of such a night are,
according to our observations, felt more when we get up in a cold room
than when we get up in a well-warmed one.

It will also be most beneficial to take a very hot, or even a Turkish or
Russian, bath after a sleepless night, in order to eliminate toxic
products by abundant perspiration. An electric light bath may give
better results, using principally the blue rays, as such have a soothing
effect upon the nervous system, besides creating a free sudorific
action.

If all the hygienic rules above indicated are applied and fail, then the
conditions are such that we may resort to sleeping remedies, adopting,
however, the principle to try first the most innocuous, and especially
such as the patient will not become addicted to the use of.

The principal object is to diminish the excitability of the brain, and
bromide is one of the least dangerous remedies to obtain this result. We
will therefore first try sodium bromide, say, 20 grains, in a glass of
water. Valerian also can give good results, and is not a dangerous
remedy. There is a German preparation, bromural, composed of bromide and
valerian, which is a very mild sleeping mixture. Chloral is also an
excellent drug for reducing the excitability of the brain, but it is not
so harmless as the others. There has, of recent years, been introduced
from Germany a preparation, isopral, made from chloral, and for which it
is claimed that it is a mild sleeping mixture to the use of which people
do not become addicted.

Such remedies may be prescribed when there is only a temporary
sleeplessness and not one of habitual long standing. When sleeplessness
is more inveterate and obstinate the above remedies will give no result,
and then stronger drugs must be resorted to, such as veronal; but this
must never be given in large doses, as it may produce in certain persons
symptoms of intoxication if more than 1 gramme (15 grains) be taken. The
principle of this remedy, which contains urea, is to produce a condition
analogous to intoxication, by producing fatigue. None of these agents
should be used otherwise than under the supervision of a physician.

Some of our patients complained of heaviness in the head after the use
of veronal, while others approved of it and found that they could also
sleep on the following night, even after only the one dose.

It would be most injurious to health to use these sleeping mixtures
habitually, especially opium and morphine. We have mentioned here only a
few with which we have experimented on ourselves or tried on patients in
cases of necessity, as all such remedies may be injurious to the brain
if taken often.

We feel inclined to attribute greater importance to a sleeping remedy
which is based on physiological observations of sleep. As we have
already stated, thyroid degeneration or removal produces sleepiness; we
have, therefore, tried the serum of animals whose thyroid has been
extirpated, and, as will be proved, we have had good results in each
case.

Being struck by the similarity of the symptoms of diabetes to those of
Graves’s disease, and as a logical consequence of our researches on the
frequency of a hyperactivity of the thyroid in diabetes, we tried a
remedy for this condition which has produced as good results as many
authorities have obtained in their treatment of Graves’s disease. This
is the serum of goats from which the thyroid has been removed, prepared
according to the formula of the celebrated neurologist, Dr. Moebius, of
Leipzig, who died recently. This remedy, named after its discoverer
“anti-thyroidin Moebius,” has not only afforded us good results in the
diminution of glycosuria, as we showed by a number of cases in the book
that we published upon the origin of diabetes, but also, what is still
more interesting to our present subject, every patient suffering from
insomnia exhibited an improvement; in fact, there was not a single case
which did not benefit by this treatment.[334]

Footnote 334:

  Loc. cit.

Following an automobile accident we suffered much from insomnia. We
tried this remedy personally, and after doses of 5 grammes (75 grains)
we were each time able to sleep for about eight hours, and felt
refreshed afterward. We have found this remedy superior even to veronal,
for the latter, when tried personally and afterward in patients, did not
give the same effect as anti-thyroidin.

This remedy has, however, one great drawback, and that is the exorbitant
cost; and it requires to be taken in considerable amounts, at least 45
to 70 grains at a dose, although in some patients a soothing result has
been obtained from 20 grains three times a day.

This drug diminishes the excitability of the nervous system, and is,
therefore, an excellent remedy for insomnia, for it depends on a
physiological appreciation of our knowledge of the influence of the
thyroid gland on sleep. We have lately published an article on the
hypnotic effect of anti-thyroidin Moebius in the “Therapie der
Gegenwart” of Berlin, November, 1907.

Instead of the anti-thyroidin Moebius—the extravagant price of which
forbids its general use—we would recommend extirpating the thyroid gland
of a goat, which is a very simple operation, and making use of the milk,
following the example of Professor Lanz, of Amsterdam, and of Walter
Edmunds in London.

Our observations on the great influence of anti-thyroidin on sleep were
confirmed by Professor Lanz in a discussion following an address we
delivered before the Society for the Advancement of the Medical and
Natural Sciences, in Amsterdam, on the 15th of March, 1905.[335] He also
mentioned the case of a dog whose master, a peasant, was tending the
professor’s goats, whose thyroids had been removed and whose milk was
being administered by the professor to his patients suffering from
Graves’s disease. The peasant was told to give the goats’ milk to his
dog, but after a time, the peasant refused to do this, as since the
goats’ milk had been given to the dog, he always wanted to go to sleep,
even when accompanying his master in his walks.

Footnote 335:

  Nederlandsch Tijdschrift voor Geneeskunde, 1905.


------------------------------------------------------------------------




                             CHAPTER XLIX.

 HYGIENE OF THE SEXUAL GLANDS—THE DANGERS OF SEXUAL OVERACTIVITY AND OF
                        TOTAL SEXUAL ABSTINENCE.


WE have referred, in previous chapters of this work, to the great
influence of the sexual glands on several of the most important organs,
and shown in what a marvelous way these glands affect our vitality and
prospects of longevity (see Chapter V); consequently it is only natural
that we should use our best endeavors to maintain these glands in good
working condition, which we can do in a rational manner by protecting
them from all harmful agencies, which may be numerous. It would exceed
the limits of this book to enumerate all the different causes of
diseases of the sexual glands, so we will confine ourselves to the most
frequent, which, although not immediately producing actual disorders of
the glands, may yet lower their vitality in the long run and finally
lead to their degeneration.

The infectious diseases of the sexual glands, acquired by contagion
through sexual intercourse, occupy a prominent place among the agencies
deleterious to them. They are well dealt with in the handbooks on this
subject, so will not be further referred to here. The best way to avoid
them is by marriage. This may, in the majority of cases, be a safeguard
for the man but not for the woman; for, unhappily, in very many
instances women are infected by their husbands as soon as they enter the
bonds of matrimony.

In Chapter VII we mentioned the injurious consequences of these
infections, not only for men, but also for women, and told how in the
former sexual potency, and in the latter fertility, may be ruined by
such. The best way to deal with the matter would be to pass a law
enforcing the examination of the prospective husband by a physician; and
if such a law were applied also to the woman, the propagation of certain
hereditary diseases might be arrested. Long ago Plato thought of such an
emergency. He recommended that before a marriage judges should examine
both man and woman, the man to be stark naked, and the woman partially
so; after the inspection the judges were to deliver their opinion
whether the couple should be married or not.

Nearly as injurious as infectious diseases may be the abuse of the
sexual glands by too frequent intercourse, by masturbation, or by other
irritations of these glands, such as excitation, without subsequent
satisfaction, especially in cases of interrupted copulation with a view
to avoid offspring.

Too frequent sexual intercourse may soon sap the vitality of these
glands and, indeed, hasten the symptoms of old age, even in young
persons. As already mentioned, even young girls may acquire some of the
attributes of old age by such means. They soon become fat and bloated,
the features lose their juvenile aspect, and the cheeks become pendant;
the muscles lose their tonicity, and there is a marked difference
between the muscles of a young maiden and those of a woman of the same
age who has been leading a life of debauchery for some time. The latter
will invariably, if not always, look older—which ought to be an object
lesson on this subject. Premature old age can similarly be brought about
by constant conditions of exhaustion of the ovaries consequent to
frequent pregnancies. When a woman has a child year after year, as a
rule, especially if living in straitened circumstances, she usually
looks older; but this is not so in all cases, as we have before
remarked.

Moderation, therefore, must be strictly observed.

The ancient Hindoos recommended to men sexual abstinence of long
duration, thinking that by this means the internal secretion of the
sexual glands would be absorbed into the system and that they would
thereby reap all the benefits inherent in such a secretion. By this it
seems that thousands of years before Claude Bernard and Brown-Séquard
the Hindoos already appreciated the great importance of the internal
secretions.

According to the Prophet Mohamed, sexual intercourse should not be more
frequent than once in eight days. Zoroaster recommends once in nine,
Solon and Socrates once in ten, and Moses eight days before and eight
days after menstruation, and Luther twice a week (der Woche Zwie). The
Holy Book of the Jews, The Talmud,[336] an encyclopædia of Jewish
knowledge embracing a period of from 500 years before to 500 years after
Christ, recommends the following in respect to marital intercourse:
Young strong men, every day; workmen, once a week; mental workers, once
a month. Acton advises copulation once only in from seven to ten
days.[337]

Footnote 336:

  Quoted after Prof. Kisch “Das Geschlechtsleben des Weibes,” Vienna,
  second edition, 1908.

Footnote 337:

  Quoted after Prof. Kisch, as are most of the quotations in this
  chapter.

Pomeroy says matrimony is Nature’s nectar, but if we indulge too freely,
instead of nectar Nature will offer us water or bile, and finally deadly
poison. To avoid sexual overactivity in married people Kisch recommends
a separate bed for man and wife.

Far more dangerous than too frequent intercourse are frequent
excitations of the sexual organs without final sexual satisfaction. In
this way a continual hyperæmia of the caput gallinaginis in the prostate
can be set up; and as this is where the ducts of the seminal vesicles
end, premature emissions and impotency may result. Thus we see that
masturbation and interrupted copulation may produce the same effect;
indeed, these practices are far more injurious to virility than sexual
overactivity if indulged in in the normal way.

Frequent sexual excitations are also very deleterious to the female
sexual organs, which are thereby brought into a hyperæmic condition; and
if this dangerous practice be often repeated serious disorders may
follow, and especially is this the case if intercourse be interrupted
before the seminal emission.

According to Professor Kish such preventive coition (_congressus
interruptus_) may be followed by a relaxation of the uterus and chronic
metritis. The hyperæmia and stagnation of the blood may lead to
inflammation of the ovaries and parametritis, and perhaps to new
growths. Neugebauer and Pigeolet have often observed cancer of the
uterus in women who made a habit of indulging in sexual intercourse with
the use of preventives against conception. Metritis and parametritis
after such a proceeding have been observed by Bircher, Valente, etc.

Certain abuses of the female sexual organs, such as copulation during
menstruation, may also be ruinous to those organs; metritis,
parametritis, ovarian inflammation, etc., may be the result of such
grave violations of this most elementary rule of the hygiene of the
sexual glands.

The ancient Mosaic Laws prescribed the punishment of death for
intercourse during menstruation. During this period all kind of work
should be prohibited, and for many women it would be wisest to rest
completely, especially during the first day.

Women should not marry under a certain age, preferably not under 20.
With the Spartans no man was allowed to marry before 30, and no woman
before 20, and we know what a robust and strong nation they were. This
is most essential to avoid premature senility, which can easily develop
in women who commence sexual intercourse at an early age. No woman
should be permitted to marry until she is fully developed physically and
mentally. There are cases where women are not fully developed at 18, or
even at 20, and in such cases marriage should be deferred to a later
period.

Close observation of the rules for a rational hygiene of the sexual
organs also demands that chlorotic girls should not marry until their
condition is improved by iron treatment, the sexual organs in cases of
severe chlorosis or anæmia not being fit for use.

We have referred to the dangers of sexual overactivity, and we will now
endeavor to show that the opposite extreme, viz., complete inactivity of
these glands, may also lead to disastrous consequences. When nature
created our different organs they were intended to be used, and there is
no part and no organ in the body that should not fulfil its function
(even the appendix, as lymphatic tissue, has one). No exception can be
made in favor of the sexual organs, although the hypocrisy of certain
faddists would have us believe that these organs alone out of the whole
body should serve no purpose whatever. Indeed, the whole anatomical
construction and the physiological working of these organs—differing in
each sex—shows that Nature intended them to be used in conjunction with
each other.

These organs are glandular formations having, like all other glands of
the body, a secretion, which, like the secretions of the other ductless
glands—as, for example, the thyroid—if produced in too large quantities,
may have toxic effects. That this really is the case is shown by the
experiments of Loisel, who found that the extracts from the testicles,
and still more so from the ovaries, if injected into other animals, have
toxic effects.

The sexual glands, being glands with an epithelial formation, must
certainly produce a secretion; they could not be an exception to one of
the fundamental laws of anatomy and histology. The accumulation of this
secretion may produce certain toxic effects, judging from the
experiments of Loisel.[338] We may, therefore, conclude that the
complete inactivity of these glands or, in other words, total sexual
abstinence, may have injurious effects on the general health, as also on
the condition of the glands themselves; and we are able, by experiments
and clinical and anatomo-pathological observations, to confirm this
view.

Footnote 338:

  Loisel: Journal de l’Anat., xi, p. 536; C. R. S. B., L. ix, p. 403.

Regaud[339] has observed that when guinea-pigs are kept for a long time
in complete sexual abstinence, away from their females, the testicles
present degenerative changes, and at the same time the volume of the
gland is considerably diminished. The seminal epithelium shows many
cells with signs of degeneration. He also observed similar signs in the
epithelium of the seminiferous tubules during winter hibernation, and
also in the spring when the animals were not sleeping but if they were
kept in total sexual abstinence. Although they were well nourished these
animals showed no spermatogenesis.

Footnote 339:

  Regaud: Comptes rendus de l’Association des Anatomistes p. 198, 1903.

Regaud comes to the conclusion that “la continence forcée peut done
avoir pour conséquence des modifications importantes de l’épithélium
séminal”—enforced abstinence (sexual) may thus lead consequently to
important modifications of the seminal epithelium.

According to Mingazzini,[340] the ovaries of female animals that are
kept in captivity and sexual abstinence present degenerated follicles,
this being very different to the ovaries of other females living in
freedom, the comparisons having been made in the same season of the
year.

Footnote 340:

  Mingazzini: Corpi lutes veri e falsi; R. F. Laboratorio di Anatomia
  normale della Reale Universita di Roma, vol. iii, 1893.

There is some evidence to show that similar results may happen in man.
When men live a long time—not for weeks or a few months, but for a very
lengthened period—in total sexual abstinence, the size of the testicles
may sometimes be found diminished. Unfortunately there have not as yet
been made, at least to our knowledge, histological examinations of the
sexual glands of those who really have led a life of total sexual
abstinence. But a remote proof in support of our proposition that such a
condition may lead to histological changes in these important glands, is
the fact that Baldwin has discovered histological changes in the ovaries
of hysterical women, of whom a large proportion were either spinsters or
women who became widows early in life. Of course this is but a very
indirect proof, devoid of the scientific value of the observations of
Regaud and Mingazzini.

There are, however, important clinical facts which support the
supposition that total sexual abstinence may lead to alteration of these
glands. Thus we have observed impotence in the cases of several men
after sexual abstinence of long duration, which entirely disappeared in
nearly every case after copulation at regular intervals; and we arrive
at the conclusion that a regular use of these organs, which are intended
by Nature to be used, is a necessity, and that impotence can frequently
be best cured by marriage. In marriage only can hygienic and regular
sexual intercourse best take place; and thus marriage is the best
hygiene for the sexual glands. For this and other important reasons we
will devote a special chapter on marriage, which will succeed this. In
some maidens near the thirties we can note the appearance of symptoms of
fading; through the loss of fatty tissue those parts of the body that
were formerly round become angular, and there thus develops the
condition of leanness so typical of old spinsters; hairs may also appear
on the chin and upper lip. That all this is caused by the inactivity of
the sexual glands, which, as already explained, influence the outward
appearance of the body, is best demonstrated by the fact that after
marriage a great change takes place in such women, and the fading
rose-tree blooms again. Thus marriage re-creates youth.

The deleterious effects of total sexual abstinence on the sexual glands
have also been observed. Professor Kisch noted that with women who had
lived an active sexual life and who had had several children, whom they
had fed from the breast, menstruation continued till a later period in
life than it did in old maids, or in women who early in life had become
widows, or in barren women.

That total sexual abstinence may have very injurious effects on the
nervous system, as mentioned in Chapter IV, and assist in the
development of hysteria and neurasthenia, is shown by the fact that when
there is an accumulation of semen in the male, or a swelling of the
Graafian follicles in the female, then an excitation of the nervous
system follows, with sexual desire. That the nervous system can be
excited and even seriously damaged by too frequent and too excessive
impulses conveyed from the sexual glands, has been mentioned by us at
various times in this book.

The continual resistance to satisfy sexual desire, and especially
satisfaction by artificial means, may lead to ruinous consequences for
the nervous system and the sexual glands.

Happily there can be no doubt that many men and women lead healthy
lives, in spite of their struggles against satisfying the desire of the
sexual organs to follow their natural bent; but such cases are not the
rule, and most of such people have some kind of disorder, especially of
the nervous system or the digestive organs, as, for instance,
cardialgia, or acidity of the stomach. We have already referred to the
alteration in these organs following changes in the sexual organs.

There are people with a frigid disposition,—which is certainly not
normal—and such may not be troubled by their sexual glands. On the other
hand, there are people with too great a sexual inclination. The
suppression of these desires in them may often lead to ruin of the
nervous system. Prof. Krafft-Ebing found that individuals with
neuropathic constitutions often have their desires exaggerated in a
pathological way, and he came to the conclusion that in such persons,
through enforced sexual abstinences, the nervous system may be ruined.
Professor Erb, the famous Heidelberg specialist for nervous diseases,
declared at the Congress of the German Society for the Suppression of
Vice, held a few years ago at Frankfort, that there are adult
individuals in whom sexual abstinence for a long time produces serious
mischief in the nervous system.

Buddha says: “Sexual instinct is stronger than the iron hook with which
wild elephants are tamed; it is hotter than fire; it is an arrow that
pierces the soul of man.”

Briefly, neurologists, especially since Freud’s labors, now realize the
importance of the injurious influences of an abnormal sexual life, many
disorders of the nervous system and mind having been traced to the
conflict between the demands of nature and a too rigorous sexual
repression, through fear, disgust, shame, etc.

One of the pioneers of the movement in Germany for the emancipation of
women—Johanna Elberskirchen—demands free scope for the sexual feelings
of women and their satisfaction within physiological limits and
according to physiological necessity.

We are of the opinion that, as a rule, there is a certain difference
between sexual desire in man and the same in woman. Man mostly wants
satisfaction simply; in women there is generally a higher motive: she
demands love, and refuses satisfaction alone.

Nature, who has created the sexual organs of male and female as a
masterpiece of very clever and skilful construction, with admirable
forethought in even the smallest details of this very complicated
mechanism, has appointed to them a very important purpose, viz., the
propagation of the race; and she pursues her ends in a most artful way,
giving to each sex certain attributes by which the opposite may be
attracted. The peacock, for instance, is furnished with a wonderful
collection of beautiful feathers to excite the sexual feelings of the
hen, which has a much plainer exterior. In man the relations are
reversed; here beauty is more conspicuous in the female, and it is by
their charms, the attributes of their sex, that men are attracted,—who,
unfortunately, look rather to the beauty of the outside, which is
transient, than to that of the soul, which is eternal.

This book is a plea for a simple and natural life, and for obedience to
the laws of Nature rather than for neglect or abuse of them. Sexual
desires are the outcome of the existence of the sexual glands, and they
are enforced upon us in a way that is sometimes nearly irresistible
after long-continued sexual abstinence. Disobedience to the imperious
commands of Nature will draw down upon us her revenge and punishment,
and ailments and disease, and bodily and mental misery, may be the
consequences of the complete suppression of the functions of these
glands in adults. There may be exceptions, and certain women or men may
pass a lifetime in such an unnatural way without any apparent ill
consequences to their health; but such are rare. It has been observed
not infrequently that spinsters were fast fading when they were married,
but that after a time they looked much younger, especially after their
first child. As already quoted above from Kisch, sexual life and,
therefore, youth are longer preserved in women who use their sexual
glands and have children than in those who do not. Thus there is no
alternative, and marriage is the safest course. Marriage, if the
partners are well suited, is indeed the most useful and beneficial
institution there is; and, as we will show in the next chapter, it is
one of the most important agencies in the treatment of old age, and for
the longest possible conservation of youth.

But the question now arises, what should those do who cannot get
married, not through any fault of their own, if they should escape all
the mischief due to an unnatural suppression of the sexual functions or
their satisfaction in an unnatural way? We will now endeavor to give a
few useful hints on the subject.

First of all, a hyperæmic condition of the sexual organs should be
avoided by all means, and care should especially be taken to have the
bowels opened every day, as otherwise hyperæmia of the pelvic organs
will follow. This may also be a consequence of rich food and a sedentary
life, which, therefore, should be avoided. Cold hydrotherapeutic
washings of the surface of the body, particularly of the sexual parts,
may also be beneficial. As during long sexual abstinence the probability
is that toxic products are being evolved and are accumulating in the
system, a good purge every five or six days would seem to be a
necessity, as also would a hot bath. Reading light literature should be
avoided. We especially recommend much exercise in the open air and
sunshine, long walks, mountain climbing, sports, long journeys
(especially by automobile), etc.

The best safeguard against sexual desires is an active busy life, which
affords no opportunity for idle thoughts.

For persons doomed, from one cause or another, to lead a life of
complete sexual abstinence, the best and safest course to prevent sexual
desire is to lead a strenuous business life, drowning the desires in a
flood of useful and busy occupations.

Thus unmarried girls and widows may well pass their time in charity,
nursing the sick, and other occupations tending to make them useful,
rather than spend their time in fruitless dreams; and by such
occupations they obtain a happiness which they might not have found,
perhaps, even in married life.

The surest kind of occupation for the prevention of the above-mentioned
desires is strenuous mental work. When the mind is busy with serious
problems these desires cannot obtrude themselves; and, indeed, we have
often observed in persons whose lives have been devoted to serious
scientific work, which has entirely absorbed them, a total absence of
sexual desire for a long time, and even impotency. This, however, we
will consider later as a consequence of defective hygiene during mental
labor (see Chapter L, on the hygiene of the brain worker).

We do not recommend mental work so exaggerated beyond the ordinary
limits that it might cause harm to the brain and nervous system; but it
is certain that when mental work is done within reasonable limits, and
when it occupies the greater part of our time, but not all, it is a
great protection against sexual desires, restricting them without any
injury to the functions of the sexual glands.

Thus, as we see, there are certain remedies against sexual desires for
those that cannot satisfy them; but the most natural solution of this
question can be brought about in the safest way by marriage.


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                               CHAPTER L.

       ON MARRIED LIFE AS AN IMPORTANT MEANS FOR PROLONGING LIFE.


OPINIONS differ as to whether married life can be generally considered
as a source of happiness; some there are who say it is the acme of
happiness, while others do not agree that it is exactly a heaven on
earth.

Personally we possess positive evidence in favor of the view that
marriage can make people very happy; for we know of a number of cases of
suicide following the loss of husband or wife, and we have a clear
recollection of seeing many widows or widowers break down at the mere
mention of their departed, years after the bond of matrimony had been
thus severed.

Certainly agencies that can make people happy, such as marriage, ought
to be able to lengthen existence and remove petty cares, worry, and
sorrow that are so prevalent in this life, and which, in the long run,
tend to induce premature old age. As the Germans say, “Getheiltes Leid
ist halbes Leid” (“a sorrow shared is but half a sorrow”), and the man
who can share his misfortunes with a beloved wife does not carry his
burden alone.

This is of the greatest importance, for, as we shall show in the next
chapter, the body is governed by the mind, and thus mental emotions of a
depressing nature assist in the development of disease and the symptoms
of premature old age, in combating which a single man is always at a
great disadvantage.

We shall also show that, as a rule, our mishaps and disappointments are
due to our own fault of omission or commission, to want of foresight,
etc. It is a positive fact that many a man, famous in history, owed his
position and success to the advice and assistance of a clever and
sympathetic better half; this term is, indeed, not devoid of foundation,
for a man does not so seldom become perfect through his better half, the
woman. The female character is so essentially different to the male,
because of her different anatomical and physiological constitution, that
by the uniting of the female to the male some deficiency in the
character in the latter may be supplied, and _vice versâ_, with equal
benefit to both. Thus the uniting of the woman to the man is most
desirable, if only for this reason.

It would lead us too far to insist on the enormous advantage of married
life for public morality, for the prevention and repression of crime,
and even for the welfare of the State, the soundest foundation of which
is family life. Each family is a little community in itself, with the
father at the head as king, and the mother as queen. And as the State
wants subjects, so the family wants children; for the great pleasures
connected with the various stages of a child’s growth from the cradle to
the altar, serve as the key to a lengthened and the longest possible
existence. Cornaro gives us a very instructive example in his saying “in
the society of the young we become young again;” and so children restore
youth.

Not only because of the favorable mental influence exercised by marriage
must this be recommended as one of the most efficient means for
attaining a long life, but also because of various other advantages
induced by the improved hygienic conditions of various organs. Thus,
marriage is able to satisfy the sexual desires,—the complete suppression
of which is so injurious to most healthy men and women,—without there
being any risk of contracting diseases of the sexual organs with their
terrible consequences. For this reason alone married persons have the
best chances for preserving their youth, provided they exercise
moderation and do not indulge in the pleasures of matrimonial life
beyond the physiological limits.

It is much easier to observe the rules of hygiene for the various
organs, as outlined previously, in married than in single life; for in
the latter condition one is concerned for himself alone, whereas in the
former, four eyes instead of two are on the watch. Thus the first
symptoms of disease are often visible to the eyes of a loving wife, and,
as prevention is better than cure, such a disease may then be checked by
promptly applied treatment. Most diseases could be cured if treatment
could be administered at the very beginning, whereas curable diseases
often terminate fatally from neglect of a sufficienctly early treatment.
There can be no doubt about it, but that as a rule, a married man is far
better nursed, in case of sickness, than is a single man; and we all
know that a good nurse can often do just as much good, sometimes even
more, than the most skilful physician. It is certain that the
therapeutic results in the English and American hospitals would be
inferior to those obtained at present if there were not such excellent
nurses, of whom these countries may indeed well be proud. Marriage,
through the regular habits it causes, can also favorably influence
certain chronic diseases; thus, according to Rénon, even heart
affections can be favorably influenced by married life.

As a rule married life also implies the possession of a home, whereas a
single man or woman most often have no real home. They are obliged to
frequent restaurants for their meals, where there is great likelihood of
their damaging their stomach or intestines by irregularities in food or
drink—at least in the case of men, who also have no reason to stay
indoors in the evening, and are thus more exposed to the life-shortening
influences of an irregular life.

As we have already seen, the best means for attaining a very long life
is moderation in everything; and there is no doubt that this can be much
better observed in married than in single life.

For all the foregoing reasons we must emphatically advise all who desire
long life and the preservation of youthfulness as long as possible, to
marry, and if they become bereaved, to marry again. Celibacy is a
condition unknown to uncivilized nations; the ancient Hindoos considered
it a crime that should be punished; and, according to Du Perron, the
Parsees of the present time, who still follow the religion of Zoroaster,
regard celibacy as a deadly sin. According to Tsen-ki-tong,[341] an old
maid is a phenomenal rarity in China.

Footnote 341:

  Tsen-ki-tong: “China und die Chinesen,” German translation from the
  Chinese, Leipzig, 1875.

The best proof of the supposition that marriage is conducive to long
life is the example given us by the long-lived patriarchs mentioned in
another chapter, nearly all of whom were married; for if they became
widowers, even though over 100 years in age, they soon married again.

It is one of the saddest sights on earth to see an old bachelor alone in
the world; and we consider that the happiest beings are those who, in
their green old age, are surrounded by numerous children and
grandchildren. According to Schopenhauer, such persons never die, for
their flesh and blood survive in their descendants.

Being still a bachelor we may incur the reproach that we speak of
marriage as the blind man speaks of color, and particularly by seeming
blind to the evils that may be present in the married state. We cannot
deny the fact that some people are most unhappy; but it is our firm
belief that all the ills that befall us on this earth are due to
ourselves. If we select our nuptial mate with care and sound judgment,
paying more attention to the internal rather than the external
qualities, treating her with the utmost consideration of character,
first studying and then adapting ourselves to them, we shall not find
sharp edges but smooth sides, and we shall never come into collision
with them. Everywhere and anywhere, everyone is the author of his own
luck.


------------------------------------------------------------------------




                              CHAPTER LI.

      HYGIENE OF THE MIND—EMOTIONS AND WORRY AS CAUSES OF OLD AGE.


WHEN the famous surgeon Vesalius was dissecting a woman, he discovered
that her heart was still feebly beating. He was so overcome by mental
distress at his discovery that he suddenly dropped dead. Other
instances, also showing that strong emotions of the mind are able to
kill people, are known, and history also tells us of the case of Louis
of Bourbon who dropped dead from fright at witnessing the exhumation of
his father’s bones. Not only can severe emotions caused by fear or
grief, but pleasing ones, when they exceed a certain limit, are also
able to produce instantaneous death. Thus it is said that when
Leibnitz’s niece found a large amount of gold under the bed of the
famous philosopher, after his death, she had such a powerful emotion of
joy that she fell dead. The same sudden end was the fate of Sophocles
when he heard that one of his tragedies had been awarded the highest
prize.

Death is happily rather rare under such circumstances; but diseases of a
serious kind, especially diabetes, can be caused frequently from strong
mental emotions of a depressing nature. We have published two cases of
young women who suddenly contracted severe diabetes after a fright,
while previously there had been no symptoms of such; and in a third case
glycosuria was increased very considerably. This last case was one of
mild diabetes; the sugar increased to a very great extent the day
following the intelligence that he had lost half his fortune through a
coal mine accident. Professor Naunyn, in his book on diabetes, after
quoting our own observations, also states the interesting fact that
after the bombardment of Strassburg in the war of 1870, many cases of
diabetes developed in consequence of the fear and anxiety brought about
by it.

Strong emotions of the mind thus tend to shorten existence by their
fatal action on several of the most important organs, such as the heart,
and in particular the ductless glands: the adrenals, thyroid, pituitary,
pancreas, liver, kidneys, and the sexual glands. These are governed by
the sympathetic and vagus, and mental emotions, by acting on these
nerves, produce alterations in these important glands.

By acting on the adrenals mental emotions produce higher blood-pressure,
in consequence of the toxic action of the increased adrenal secretion,
and thus favor the development of diseases of the heart and circulatory
system, especially arteriosclerosis, which so very frequently shortens
life (see also Chapter XVI).

That mental emotions act upon the thyroid is shown by the alteration of
this gland in consequence, which can sometimes go so far that often
Graves’s disease (hyperthyroidia) has been observed, at times shortly,
and at other times suddenly, after the mental shock. The hyperactivity
of the thyroid may eventually be followed by its exhaustion; and so it
happens that as one of the causes of myxœdema mental depression is often
mentioned.

That alterations of the pituitary body after mental emotions can take
place, is shown conclusively by the fact that competent authorities,
like Professor Pel and many others, have published cases of acromegaly
after such a cause. We personally observed a case in which grief from
incarceration caused the disease to which also diabetes was added.
Sajous has long urged that the pituitary is the _sensorium commune_,
i.e., the central organ upon which all severe emotions react.

It is indeed tragical that diabetes mellitus so frequently attacks those
who suffer reverses in their life. Unlike death in the cases above
mentioned, it is only brought about in those who have had mental emotion
in consequence of disappointment, loss of fortune, and, in some cases, a
wife’s infidelity, etc. Thus, not satisfied with bringing misfortunes,
Fate adds disease, so that their lives are threatened with being
shortened. We shall insist, later on, that this disease, as most
diseases generally, only develops in consequence of our own fault or the
fault of our forefathers.

The alterations of the pancreas in consequence of mental emotions can be
best demonstrated by the frequency of diabetes after such a cause, as
just referred to above. Pawlow observed a checking of the pancreatic
juice after such an agency.

The action of mental emotions on the sexual glands is shown by the
sudden appearance of menstruation. We have recently heard of a young
lady who attempted suicide because of disappointment in love; she threw
herself into a river, which fortunately was not deep at the moment, and
this act caused the sudden return of her menstrual period.

Cases of sudden menstruation after various kinds of mental emotion have
often been observed; and in men under similar circumstances impotency is
not infrequently noted, though, in most cases, it is only temporary.

The alterations of the liver are shown by jaundice, and of the kidneys
by an increased flow of urine in consequence of mental emotions.
According to Clifford Allbutt,[342] strong, mental emotions play an
important part in the origin in many cases of interstitial nephritis.

Footnote 342:

  Quoted after James Tyson. Loc. cit.

It is a well-known fact that persons, after strong mental emotion of a
distressing kind, have suddenly turned gray, as is related of Marie
Antoinette, Queen of France; and we ourselves have seen a similar case
in a young lady, one of our relatives, who in one night had her
jet-black hair turned white.

That care, worry, grief, and sorrow are able to bleach the hair,
although not so suddenly as above, is generally known; and not only gray
hair, but a haggard, worn appearance, and all the other attributes of
old age, with changes in the arteries, as is so often the case in old
age, have over and over again been attributed to the above causes. It is
a well-known fact that premature old age is probably brought about more
frequently by the above agencies than by any of the other contributory
causes.

Not only premature old age, but also premature death, can be caused by
such agencies; for there is no longer any doubt that, in persons with
mental depression, resistance against infections and intoxications is
reduced, and that such persons are thus at the mercy of the microbes,
which are to be found in billions everywhere. On the other hand, we can
often observe that a merry disposition may cause long-lasting youth and
a very long life. The celebrated English painter, Mr. Frithe, who died
quite recently at the age of 92, when asked the reasons for his vigor
and robustness used to answer: “No worries, and six cigars a day.”
Having seen on the island of Capri an old boatswain of 80 years
vigorously handling his oars, we inquired of him the reasons for his
robustness and received as his answer: “Sempre allegre” (always merry).
This “sempre allegre” should also be our own motto for life, because of
its efficacy in warding off old age.

There are some admirable teachings in the Upanishads and Vedanta of the
Hindoos: never to seek for riches and fame, and to give up ambition.
Indeed this, more than anything else, would assure a perfect
tranquillity of the mind, as exemplified by the image of Buddha; but for
the future of mankind and the progress of scientific research, a certain
amount of ambition is necessary. We think the noblest aim is to do good
for its own sake, and not for the sake of honors; but if honors are
obtained, to accept them calmly, going on in the usual way; for
otherwise it happens, as we so often witness, that too much ambition,
with its wear and tear, exposes us to premature disease by
arteriosclerosis, the most prevalent disease among men who have reached
fame, especially among statesmen, whose honors are, indeed, dearly paid
for.

It would lead us too far to enter into particulars as to how the various
organs, even the stomach, can possibly, even in a powerful way,
influence the conditions of the mind; but we must make an exception in
the case of the ductless glands. If the mind influences these, on the
other hand they exercise a marvelous action on the mind, as already
stated.

Degenerated conditions of the thyroid are always followed by weakening
of the mental powers, and they are also able to alter the normal
conditions of the mind. As a rule, as we so often see, persons having
such are low spirited and possess no will-power or energy. The loss of
will-power through extirpation of the thyroid or by its degeneration has
been already mentioned in Chapter IV.

People with a weak thyroid, and especially if to this be added a
degenerated state of the testicles, or of the ovaries are usually
melancholy and despondent. They have exceedingly often what the French
call “idées noires”—they are always full of “dark ideas.” In everything
they undertake they always foresee a bad issue; and it is not singular
that this bad issue very often really comes about, for it is caused with
mathematical certainty by their own incapability, absentmindedness, and
entire want of foresight. This is another illustration of our theory
that most of our want of success and our mishaps, if not all of them, we
bring upon ourselves by our own faults. We often notice that such people
lack the most elementary rules of foresight, precaution and
circumspection. They are horribly absentminded, a fact we have noted
especially in old spinsters, who may pass their best friends a dozen
times on the street without recognizing them. Such persons may also
easily fall victims to accidents, as being run over by a carriage, etc.

The fact that these “dark ideas” are frequent in people with a
degenerated thyroid has also been observed by Dr. Leopold Levi, of
Paris, and Dr. Baron Henry de Rothschild, who, in their Annals on
Children’s Diseases, published by Dr. de Rothschild’s Hospital for Sick
Children, give a detailed description of the alterations in the mind in
cases of thyroid degeneration. That these dark ideas must be ascribed to
degeneration of the thyroid and of the sexual glands, besides the proof
from the observations mentioned in Chapter IV, is best shown by the fact
that, as we have seen in many cases, they may be much improved and, not
infrequently, may disappear through the use of thyroid, testicular, and
ovarian extracts. Courage, as was shown in the same chapter, is a
quality of the mind which is entirely dependent upon the intact
condition of the sexual glands; it is lacking in castrates, and seldom
seen in persons with degenerated sexual glands.

These persons are like a reed in the wind, waving backward and forward
without any energy; the least untoward event may beat them down. They
are pained by circumstances and are always governed by them, whereas a
person with a healthy thyroid and healthy testicles, like the heroes
sculptured by the Greek artists, who have fire and courage in their
eyes, faces all circumstances. Such as these control all circumstances,
sometimes even fate, and it is not fate that governs them. Sometimes we
feel inclined to think that there is no such thing as fate, at least for
such men. They mould their own destiny themselves, and always succeed in
pushing on with their iron will.

Will-power is, as repeatedly mentioned, essentially a product of
thyroid, and also probably of intact testicular or ovarian, activity. It
is always wanting in persons who have been castrated, and is very often
absent in those leading a life of sexual debauchery.

According to the above, persons with weak thyroids or weak and
degenerated sexual glands are bound to fail in their undertakings, and
are thus more exposed to disappointments of all kinds, reverses of
fortune, etc.; therefore, such people are the most frequent subjects of
mental depression.

Taking into consideration what has been said above, we conclude that the
source of disappointment lies, in many cases, if not in most, in our own
fault, because of loss of foresight or some slight omission, which,
indeed, is so often apt to overthrow all our most beautiful plans. Often
it is due to errors of judgment, and frequently also to want of
perseverance, the consequence of defective will-power.

We have already shown in Chapter IV, and above, that degeneration of the
thyroid and of the sexual glands is always followed by similar
alterations of the mind.

If we want rationally to prevent mental depression we must first remove
its cause. In many cases it is caused by alterations of mental activity
subsequent to changes in different ductless glands, and also in other
organs that influence the condition of the mind. Logically, we must
improve the functions of these glands if we want to proceed rationally,
and then our mental activity will improve, and failures like
disappointments may, in all probability, be avoided. We can effect this
by means of extracts of certain animal organs.

It has been shown by the celebrated physiologist, Brown-Séquard,[343] by
experiments on himself, that testicular extracts were able to improve
his mental vigor and enabled him to do a much greater amount of work. We
have made similar observations in several cases, especially when at the
same time thyroid extracts were used, but also without them. Thus we
think that we do not go too far, on the basis of the observations of
Brown-Séquard and other authorities, including our own, when we say
that, through the improvement of our mental power by therapeutic
measures, like organic extracts, we may be able to influence success to
a favorable degree, and that everybody is, indeed, as already quoted,
“the smith of his own luck,” as the German proverb says; and thus we can
protect ourselves against failure, disappointment, and mental
depression. We are thus justified in saying that a man with healthy
ductless glands in perfect working condition, and thus of perfect mental
power, is the man who can face any emergency and, to a certain extent,
direct fate at his own pleasure. Such a man can get practically
everything he wants, and Napoleon probably was made of such stuff. For
such men there are no obstacles in the world.

Footnote 343:

  Brown-Séquard: Loc. cit.

It is of great importance that not only the glands with internal
secretion, but also all the other organs of the body, should be kept in
hygienic condition, carrying out the rules laid down in other parts of
this book.

It has been shown by noted historians that great men, such as Napoleon,
had to blame their downfall indirectly to faulty hygiene—for instance,
of the digestive organs. That the condition of the stomach—this too
often ill-used organ—influences the mind in a powerful way, is borne out
by many interesting examples.

There can be no doubt, however, that there are causes of ill-luck which
we cannot avoid, as, for instance, loss of near relatives by death, such
as parents or children, or disappointment in nuptial affection or
love—although here, to a great extent, omissions, lack of sound
judgment, and last, but not least, lack of perseverance can be imputed.

If then, in spite of all our precaution, an accident or death of a dear
relative occurs, we must use every endeavor to control our grief and
sorrow. Fortunately the human frame is so wonderfully built that there
is self-defense not only against disease, but also against affections of
the mind. Thus we have the gift of forgetfulness, and if this sometimes
be a drawback, in most cases it is a divine blessing. We must endeavor
to obliterate the remembrance of our disappointments. We must remember
that mourning for a great number of years will not restore life for one
minute to the dear departed, but that a day of it is sufficient to run
down our own health and create deep furrows in our face. Happily,
average man is so constituted that, as time goes on, he must naturally
lose his sorrow; time heals all grief, and here also will-power has its
effects; and those who lack it, examples of whom we have referred to
above, are easily subject to suicide.

It would also be necessary to change such of our habits as are allied to
superstition and prejudice. As in many things, the Chinese are more
rational in their customs; at their times of mourning every one is
dressed in shining and beautiful white; they use a white coffin, which
is much more pleasing to the sight, and certainly much more cheerful,
than our depressing dark ones; and when the whole house and church are
draped in black our depression, with its terrible consequences to our
health and vitality, is so much the more increased. Thus the dead often
shorten the lives of the living.

Then, living in total seclusion, garbed in deep black, with long black
veil, remaining away from all places where the mind can be cheered, not
even allowed to attend a concert, how can a poor widow forget,
especially if her will-power from causes mentioned, is diminished? Shall
we then be greatly surprised if, as occurs occasionally, such a widow or
widower commits suicide, to which such irrational prejudices are simply
impelling them?

And yet it will certainly not be impossible to ameliorate such a state.
With a strong will-power systematically trained from childhood, we can
accustom ourselves to drive out disagreeable thoughts of bereavement,
fear, anxiety, etc. Realizing that what is irreparably lost can never be
recovered, notwithstanding oceans of tears and the deepest sorrow, we
must succeed in understanding the uselessness of it and make up our mind
to eradicate entirely from our recollections things that can never be
altered. Not to worry about anything is the surest and most successful
way to attain long life and a green old age, and by the exercise of some
will-power and consistent training such a mental condition can be
obtained.

There are certain external agencies which can powerfully assist to bring
about forgetfulness. Such are music, the arts, literature, and above all
scientific occupations. Where is there a grief that cannot be soothed by
one of the beautiful symphonies of Beethoven, or by the works of Mozart,
or by other classics: Haydn, Haendel, Bach, Schubert, Chopin, Wagner,
Grieg; or by the paintings of Velasquez, Rembrandt or Van Dyck; or by
the pictures of the beautiful women painted by the great English masters
Gainsborough, Reynolds, Romney, and Lawrence; and which of the saddest
faces will not turn to a smile when reading Mark Twain? The pursuit of
scientific research is also a mighty weapon, and we know a famous savant
who passed the remainder of the day in his laboratory after he had
accompanied the hearse of his wife to the cemetery.

When we are deeply depressed over a severe loss if we pay a visit to a
museum, where we can see the manifestations of life that existed
hundreds or thousands of years ago, it may give us some comfort.
Considering the bodies in the British Museum of Egyptian kings and
queens, etc., that lived thousands of years ago, together with the
jewels that they were wearing, and all the other signs of splendor that
existed so many ages before, we ask: in the face of these thousands of
years what are those few years of worry on earth? As Schopenhauer said:
“The world existed 50,000 years ago, and will last 50,000 years more,
and what are the few years of our life in face of these thousands?”—and
we would like to say “in face of these millions” of years, as the
scientific history of mankind attests.

A trip to the country, mountains, forests, or seaside, being out in the
flower-covered fields and sunshine, and especially foreign travel,
thereby changing all our surroundings and habits, should soon be able to
soothe our sorrows. In early childhood a love for the fine arts, music,
painting and literature should be developed, as these form a valuable
support for the mind in later years. A knowledge of Latin and Greek,
which are soon forgotten, should not be the aim of the school education,
but rather the refinement of character in the child.

The most valuable aid in the treatment of mental depression is religion,
for this gives what nothing else can give in equal degree—Hope! Hope,
without which we should always exist in continual gloom! We will point
out, in a few words in the next chapter, the advantages of religious
belief.


------------------------------------------------------------------------




                              CHAPTER LII.

  HYGIENE OF THE MIND—RELIGIOUS BELIEF AS A MEANS OF PROLONGING LIFE.


A RELIGIOUS lady of the Dutch aristocracy, whom we have known for years,
lost within a short time both her grown-up son and her husband, to whom
she was most devotedly attached. Imagining that she must have been
completely crushed, we inquired of a member of the family how she had
sustained these terrible losses. The answer was that she was perfectly
calm and that she was the most composed member of the whole family.

We know from personal observation that this lady was truly religious;
and we are, therefore, inclined to believe that only her great sense of
religion enabled her to withstand so well these terrible shocks. Her
case is a typical one, showing that persons of a truly religious belief
are better able to withstand depressing impressions. They will not give
way to despair so readily as most irreligious people, and it is
exceedingly rare to find a case of suicide among such.

Not only will truly religious people avoid suicide and mental
depression, with all their fatal consequences, as we have shown in the
preceding chapters, but they will also, as a rule, withstand diseases
better than others. As we have noted, truly religious people, when
seriously ill, have such a strong faith and hope in their recovery—they
invariably are convinced that God will help them—that this has proved to
us a most invaluable aid in their medical treatment. The importance of
this fact is also confirmed by our friend, Dr. Eberson, one of the
busiest practitioners in Amsterdam, who remarked to us that the outlook
for recovery was always more favorable in such cases. As Prof. Charles
Beck, of New York, told us, he often remarked that his religious
patients could stand narcosis better: they showed less anxiety, and thus
the heart action became less excited. Thus religion can undoubtedly tend
to prolong life; and in this we are not saying anything novel, for it is
well known that the mind has a wonderful influence over the body.
Religion acts on the mind, and the mind powerfully governs the body.

This is made use of by certain religious sects in what are known as
“faith cures;” and that in certain cases, and especially in nervous
diseases, such as hysteria or neurasthenia, these cures may be of
service, cannot be denied on the ground of the above observations.

The influence of the mind over the body was recognized hundreds of years
ago by all great physicians. The great philosopher, Kant,[344] insisted
upon it in a special article, and Charcot has effected some wonderful
cures by such means in hysteria, as have hundreds of other physicians.
We all agree, for we see it every day, that the mind governs the body;
but there are also certain agencies that govern the mind, and religion
is one of the most important of these.

Footnote 344:

  Journal der pract. Arzneikunde, vol. v, 1788.

Therefore, happy are they who are truly religious, for their days may be
longer, and they are better prepared to meet the vicissitudes of life!

There are many scientific people who do not believe in a Superior Being
because His presence cannot be scientifically proved. But there are many
things that are quite inexplicable, but which none the less do exist,
and in which we do believe. Are there not many such things, even in
medicine, which are most mysterious, but nevertheless true? If we
consider the human body we find that to the smallest details, to the
minutest of the millions and millions of cells of which it is composed,
it is built up in a most marvelous way. It is admirable with what
ingenuity and forethought the smallest particles are put together to
suit one another. There may be an artistic genius who can erect one
wonderful construction, as a masterpiece of art; but in the human body
the microscope will reveal thousands and thousands of such masterpieces,
perfect in the smallest details, which no artist could be capable of
putting together and of making them work admirably in unison.

And the physician must be an artist, too, to discover which of the
wheels in this most wonderful machinery are not doing their duty; and if
it took but a second to conceive a human body, it takes a whole lifetime
to study all the recesses and angles of this masterpiece of mechanism.

The admirable forethought with which the different parts are formed in
man or animal, must give us the idea that it must be the sequence of a
cause, as indeed there is in this world no effect without a cause; and
this cause must be the action of a Superior Power.

To give one of the numberless examples for the truth of this, we should
like to quote the ingenious mechanism affecting the eyes of certain
young animals, such as dogs. As is well known, puppies cannot see for a
few days after birth, but are prevented from so doing by a delicate
mucous membrane that covers their eyes. And yet there is a cause for
this, which cause is the result of a most tender circumspection; for
these little animals are provided with this membrane so that strong
light, like sunshine, shall not irritate the eye until certain
modifications have taken place in the inner eye, which allow these parts
to stand such a light; and as this requires a few days, the membrane in
question closes the eye during that time. It seems as if Almighty Nature
stands with her hands over the eyes of these puppies to protect them
from being harmed by the light.

Maternal love is a necessity in all animals to save the race from
extinction. There are a few exceptions in which animals occasionally
kill their young for certain reasons; but this is confined to a few of
them such as cats and dogs, and only happens the first or second days
after labor, being due probably to mental alterations induced by the
processes of birth; it may happen also in man. It is truly marvelous how
insects provide for their descendants, which they will never see, for
they themselves die prior to their development. An interesting example
has been lately quoted by a naturalist. The wasp, before dying, thinks
of a most ingenious way for providing food for her larvæ. This is in the
form of a worm; but as this worm would putrefy before the development of
the larvæ, the wasp does not kill the worm but merely stings it in the
spinal cord. This does not kill the worm, but simply paralyzes it, and
thus the worm will live on till the larvæ are developed, when there they
will find their food ready prepared for them by their far-seeing mother.
Who is the cause of such foresightedness being given to these insects?

There are certain people who cannot believe in a Supreme Being, because
injustice, mishaps, and accidents happen daily. But there are natural
laws which must pursue their course. When a child falls out of a top
floor window and is killed on the pavement below, the law of gravity is
acting; but the accident may be due also to a want of foresight on the
parents’ part. If disease overtakes us it is also frequently, if not
always, due to our own fault, or that of our forefathers. On the other
hand, we see the wonderful work of Nature; for, as already shown in
Chapter III, our body is wonderfully provided with every means of
defense against disease; and like a careful mother, Nature warns us
first, for hardly ever do we get ill without there being some
premonitory symptoms. Thus, before chronic kidney affections come on, we
eliminate for some months, and sometimes longer, casts; and before
diabetes comes on traces of sugar, as a rule, appear in the urine for a
certain time; and then is the time for us to follow a diet in order to
avoid these diseases. Infectious diseases also give warning symptoms
before they develop, and these, as well as others, may sometimes be
prevented by a timely defense and certain hygienic measures on our part.
Even against poisonous animals we are protected in a wonderful way.
Thus, before the rattlesnake bites he utters a warning by his rattles,
and before the mosquito gives us malaria through its sting a premonitory
hum falls on our ear. Unfortunately we have not sufficient space to give
further examples of the admirable way in which a Superior Power is doing
His best to protect us, and if mishaps do very often occur, very
frequently, if not always, as already mentioned, it may be traced to
certain of our own actions.


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                             CHAPTER LIII.

            DISEASE CONSIDERED AS A SELF-DEFENCE OF NATURE.


MANY a man bemoans his fate when bed-ridden and tortured by pain, and
yet we cannot fail to recognize, upon further consideration, that such
suffering often serves but to pave the way for recovery. Very frequently
the advent of slight pain is the earliest indication that something in
our organism is amiss, and promptly leads us to think of measures for
the prevention of further trouble. A sickness can often be controlled at
the outset upon using proper measures, and thus entirely averted. Severe
pains not infrequently mean the saving of life, since they compel
indolent or careless persons to seek the physician’s help while there is
still time. How few persons, indeed, would consult the doctors and
discontinue excessive eating, were they not forced to do so by their
aches and pains.

Not a few diseases are to be classed as serious and dangerous to life
owing to the fact that, of themselves, they do not give rise to
discomfort, and lull their victims into a false sense of security. Many
a diabetic would live longer, were he reminded by tormenting pains of
the necessity of careful treatment and restriction in his diet. Thus
even pain is of service to mankind.

Other annoying symptoms of disease must also be regarded as expressions
of nature’s efforts towards self-cure. When a person makes use of an
article of food that has undergone deterioration, nature often endeavors
to remove it by an evacuation of the intestinal canal. Again, no harm is
done when a glutton at length upsets his stomach, loses his appetite,
and allows the ill-used organ to rest. And he is being let off cheaply,
if his over-burdened stomach procures its own relief by vomiting. When a
person has an attack of gout and sweats profusely, noxious substances
are likewise eliminated thereby. When the illness is over, however, one
feels not infrequently all the more fresh and rested after
convalescence, whence the ancient Greeks not incorrectly said: “Το παθὸς
ἱάτρος έστι.”

Indeed that sickness is oftentimes directly beneficial in its effects is
a matter of frequent observation. If, for example, a markedly obese
person becomes diabetic—in such cases the disease appears in a mild
form, as a rule,—his chances of long life are thereby not infrequently
improved. I observed this in the case of an American lady who weighed
162 kilogrammes (357 pounds). The mild form of diabetes which this lady
developed was certainly not to her detriment, for whilst she could lose
weight as a result and live for a long period, her situation would have
been far different had the obesity progressed still further.

We have already endeavored to show that fever is in reality an
expression of efforts of the body at self-healing, as we likewise
maintained with reference to skin affections. So, too, the syphilitic
patient who exhibits diffuse skin-eruptions, as well as other localized
manifestations in the peripheral tissues, has a better outlook with
respect to the dreadful nervous consequences of this disease than one
who never exhibits the outer signs of the infection.

We perceive, therefore, that that which we call disease is nought else
but nature’s attempt to attain health—a kind of defensive reaction
against harmful substances. The disease proper has often already been
present for some time; it already exists at the very instant in which
the invading foe makes its entrance into the body. Between this time and
the moment when the reaction of the body,—that is, what we are in the
habit of calling the disease,—appears, a considerable period may
frequently elapse; oftentimes it may even extend through several years,
as in leprosy or in the sleeping sickness. It would thus be entirely
rational to interfere at a time when the enemy has not yet penetrated
into the body. Unfortunately the signs which might acquaint us with its
presence have not at that time found distinctive expression. Vague
symptoms such as mild headache, want of appetite, lassitude, low
spirits, etc., may alone exist, and yet it is necessary that even these
should be watched for. Already in this period it would be advisable to
seek the physician’s aid, and if many be deterred therefrom because of
the expense involved, it should be recalled that oftentimes fifty visits
cannot procure the result which might have been obtained by a few
preventive measures. Thus the very mildest symptoms of illness are not
to be disregarded,—a fact with which children in particular must be
impressed. Older persons and teachers should likewise be made familiar
with this precept. What a multitude of human lives could be saved in
this way!

But in order to recognize the slightest indications of an approaching
illness, deviations from the normal state of health would have to be
closely studied. The science which apprises us of the functions of
normal organs would have to be given more extensive recognition, and
physiology would have to become the basis of the physician’s every
thought and method of treatment. The system prevailing among the
Chinese, who in many ways surpass us in logic, and who pay the doctor
only so long as they are in health, is thus not so unreasonable. The
best plan of all would be for each family to have its own
house-physician, whom it could consult regularly, especially if there be
children; for such a person alone is capable of recognizing the earliest
deviations from the normal. The prevention of disease would have to
constitute the basis of all our therapeutic endeavors.

In order to become of real assistance to Nature, however, the physician
must be continually following in the wake of her efforts to secure
health. If the defensive reaction brought about by Nature against toxic
materials is too feeble, he must assist her by proper remedies. Thus
when the use of spoiled food is followed by diarrhœa, he must not arrest
the latter; otherwise he would, indeed, be locking the wolf in with the
sheep. On the contrary, he must imitate Nature and accordingly
administer a purgative. Again, if on taking cold or during a gouty
attack a person falls into a profuse sweat, it would certainly be
illogical to administer a remedy to counteract this beneficent
influence; another means of producing perspiration should rather be
availed of, as, for example, the salicylates. If, on the other hand, the
reaction is too strongly marked, as, for instance, in a young girl with
very active thyroid gland, who in consequence of typhoid exhibits a
dangerous rise of temperature or hyperpyrexia, then the physician must
put on the brakes and save her life by appropriate antipyretic measures.

In view of the above deductions, it is not unjustifiable to believe that
the symptoms of disease, i.e., what we designate as disease, together
with many other supposed ills, in reality contribute toward the
preservation of mankind.


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                              CHAPTER LIV.

              HYGIENE OF THE MIND—ADVICE TO BRAIN WORKERS.


SCHOLARS, who live entirely from the product of their mental labors,
often do not present a healthy appearance, and are not infrequently
subject to nervous, gastric or intestinal disorders, chronic
constipation, etc. In laborious mental activity an excessive amount of
blood flows to the brain, that of other organs being withdrawn, and thus
diminished formation of gastric juice is favored and the appetite
reduced. Intellectual activity should, if possible, be suspended a full
hour before and after meals. Congestion of the brain likewise interferes
with proper sleep, which, as a rule, can only become truly deep when the
brain is bloodless. Intellectual efforts should therefore be avoided for
a period of one to two hours before going to bed, and especially one
should not read in bed.

After a good night’s sleep the brain is adequately rested and hence
capable of doing the most work. For this reason the morning hours are
the best of all for mental labor; the very early hours have the
additional advantage of absolute quiet and freedom from disturbance.
Personally I work preferably from 5 to 8 o’clock in the morning,
especially in the winter time when one cannot well go out walking so
early.

In a previous chapter I mentioned the fact that organs upon which great
demands are made more readily become the seat of arteriosclerosis
because of the abundant flow of blood to them. In persons of great
intellectual activity we accordingly find marked sclerosis of the
cerebral arteries, especially if they have the bad habit of smoking and
drinking excessively. Besides, drinking interferes with the quality of
work done. The influence of smoking in the production of
arteriosclerosis we have already discussed. Under normal conditions
intellectual workers can live to an advanced age—this we know from
numerous celebrated instances: Hippocrates, Democritus, Plato, Plutarch,
Leibnitz, Newton, Galileo, Michael Angelo, Carlyle, etc. Socrates wrote
his Panathenæ in his 94th year, the celebrated Dr. Hufeland the fifth
edition of his “Makrobiotik” at a ripe old age, while Goethe’s powers of
execution remained to the last undiminished. Recently I received from an
English colleague 80 years of age, who had attained eminence by his
studies on metabolism, an excellent work on diabetes, which he had just
brought out.

With but very few exceptions, we find that the great master-intellects
who attained to an advanced age led lives of moderation in every
respect—not only as to their bodies, but also their minds. Whoever lives
as hygienically as did Newton, can, like him, become very old in spite
of bodily weakness. Newton was a very frugal eater, had no passions and
never worked until over-fatigued. Not to work to excess, to permit one’s
self to rest at the proper time—this is the chief precept in the hygiene
of the mind. The brain requires rest even more than any other organ from
which great activity is demanded. One should not work more than a few
hours at a stretch.

I strongly recommend going to bed at ten or eleven o’clock, rising at
five to half-past six o’clock, and then after refreshing one’s self, at
once settling down to work. Breakfast may be eaten at about eight
o’clock. A walk should then be taken before going back to work, which
should be interrupted an hour before dinner-time and only resumed an
hour after the meal. In the warmer seasons it is best to work in the
garden or in the woods whenever the nature of the work permits. It is
advisable to leave off one hour before supper, and then, as a general
rule, do nothing further, but take a walk, if possible also before
supper. In general, mental workers need plenty of exercise in the open
air; especially in the woods or elsewhere in the midst of foliage is the
flow of ideas more easily aroused. When it is not too hot, one may sit
out in the sun while working, though the eyes and the book or paper
should be shaded. The combination of pure air, sunshine, and mental
occupation is of great value. Laboratories and libraries should be so
disposed as to correspond strictly to all rules of hygiene regarding air
and light.

In winter time one gains distraction by visiting friends, attending
society meetings, concerts, theatres, etc. In every season of the year
it would be well to spend Sundays in the country. It is necessary,
likewise, to follow the general rules of hygiene. Insofar as the diet is
concerned it is strongly to be recommended during heavy mental labor,
especially where much thinking is required, that meat-eating be given up
and a vegetarian diet, with the addition of milk products and eggs,
adopted. At any rate, a diet rich in meats must be avoided; it not only
makes one heavy and dull, but also creates a want for alcohol, coffee,
tobacco and other unwholesome stimulants, for which a diet containing
little or no meat need evoke no desire.

Regularity and moderation heighten the expectations of long life in
mental workers and guard against the premature failure of the
intellectual powers which must sooner or later follow upon overwork.
This not infrequently happens quite early in life. Boerhaave could
already cite two such cases; “I have known a young man who knew
everything and was a prodigy of learning, but who hardly lived to the
age of 25, and another who worked day and night with the industry of a
bee, and without any definite illness died in his nineteenth year in a
state of emaciation.” In common with scholars and men of letters
physicians must take particular care of themselves, their brains being
continually on a stretch. The efforts they make to prolong the lives of
others shorten their own—the irony of fate! Few callings demand as much
mental work as that of the medical man. We physicians often have to deal
with infectious diseases; since the continued mental strain is capable
of injuring our bodily health and hence diminishing our resisting power
against infections, it is advisable for us as far as possible to avoid
all harmful influences,—and especially excess of any kind.


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                              CHAPTER LV.

 ON THE PREVENTION OF PREMATURE OLD AGE, AND THE TREATMENT OF OLD AGE,
           THROUGH CERTAIN DRUGS: ARSENIC, IRON, AND IODIDES.


IT can often be observed that people who habitually take arsenic, either
for medicinal or other purposes, look better and younger; and we have,
ourselves, noted in some of them a disappearance of wrinkles. Wrinkles
are caused by the loss of the fatty tissue from under the skin, and as
arsenic causes an increase of fat in the tissues it may improve such a
condition.

As is well known in some parts of Europe, notably in Styria, the habit
of eating arsenic is very prevalent among the peasants; and it is
strange to note that most of these people live to a great age, and at
the same time are extremely immune to all kinds of bodily fatigue—for
instance, they can climb the highest peaks in their native mountainous
country without great exertion. They take arsenic because it enables
them to undertake harder work, such as climbing, with greater ease, and
also improves their appearance.

We have known several ladies, famous actresses among them, who have
indulged in this habit from vanity. A very interesting case was tried,
about ten years ago, before an Austrian court of justice, in which a
servant girl tried to poison her mistress by arsenic in small
quantities. To the dismay of the servant, however, the lady continued to
become more beautiful; so the murderess determined to give a larger
dose, which induced grave symptoms of intoxication, and caused the
discovery of the plot.

It is equally well known that animals obtain a glossy and sleek coat
through the administration of arsenic in small quantities.

There can be no doubt that when arsenic is taken in small quantities it
may prove of therapeutic value against old age; but as very aged people
are often antagonistic to its use, it would seem to offer better results
if used as a preventive against premature old age rather than as a cure
after old age had much advanced.

As arsenic can give good results, especially in combination with iron,
in anæmia, and also in neurasthenia and hysteria, we think that its use
would be particularly beneficial in women near the forties, and
especially during the years before and after the climacteric until about
the sixtieth year. According to Grawitz, arsenic acts better than iron
in the anæmia of the aged.

Arsenical treatment has given us excellent results also in nervous
troubles of women at a much earlier age. It has often produced an
increase in the weight and an improvement in the personal appearance of
our patients.

As, according to Gauthier[345] and Bertrand, the thyroid gland contains
arsenic, we are thus administering an important element of this gland.
The observation of Dr. Sajous[346] is of great importance, that arsenic
dilates the arterioles. Indeed, we have also made similar observations;
thus we found after the use of arsenic in several cases a higher
vascular pressure and irregularities of the pulse similar to those
occurring after tobacco smoking, which, as shown before, has also a
stimulating action upon the adrenals. In a few cases there was also
pigmentation of the skin. By using arsenic while taking thyroid extracts
we stimulate the antagonists of the thyroid, the adrenals; and thus the
symptoms of hyperthyroidia can be avoided by simultaneously giving
arsenic in small doses. As we shall, in the next chapter, recommend the
use of thyroid extracts in the prevention of premature old age, and in
the treatment of old age, this simultaneous use of arsenic can increase
the benefit of such treatment; but for the purpose in question arsenic
should be given in the smallest possible doses, as Fowler’s solution,
beginning with 3 drops and increasing to not more than 5 or 6 drops per
day, by slow and gradual degrees, and then decreasing slowly again, but
not for longer than for three or four weeks altogether. In women
something more could be given. Far better than Fowler’s solution would
be the various mineral waters that contain the most useful form of
arsenic, as such waters usually contain also iron, which still further
increases their value. Such mineral waters can be found in various
countries, viz.: in Austria, in the Tyrol: Levico, very rich in arsenic
and iron, and Roncegno, rich in arsenic; in Bosnia: Guberquelle, very
rich in iron; in Switzerland: Val Sinistra; in France: Royat, Bourboule,
etc. They are absolutely innocuous if taken under medical care. We must
begin by taking one tablespoonful of these arsenical waters, and
gradually increase to five or six tablespoonfuls a day, when we must
then again gradually diminish the amount.

Footnote 345:

  Revue de Médecine Bulletin Académie de Médecine, vol. xliii, p. 116,
  1900.

Footnote 346:

  Sajous: “Internal Secretions,” vol. ii, p. 1312, 1907.

By taking such waters, increasing slowly and gradually and then
decreasing in a similar way, the most efficacious arsenic and iron
treatment can be obtained, and a simultaneous thyroid treatment better
endured. It is better to take such remedies after meals, and the patient
must be kept under constant medical supervision, just as they are during
iodine or thyroid treatment.

We have often observed that women, especially in the forties or fifties,
looked much younger after a treatment by iron preparations, particularly
when in combination with iron and arsenic; mineral mud baths, containing
much iron, have been used; and we are quite emphatic in asserting that
such treatment, possibly more in women than in men, though in these we
have not infrequently noted the same results, is able to improve the
symptoms of old age; for we have had opportunities of observing this in
many cases, sometimes even in women at the beginning of the sixties.

The best results can be observed in women between 30 and 60, even though
they sometimes have no previous anæmia, who look much healthier after
such a combined iron, arsenic, mineral water, and mud-bath treatment. In
men similar results have been noted; but in the case of women it must be
regarded as a specific.

In the same way as iodides act on the thyroid, we are inclined to think
that arsenic and iron are specifics to promote a better action of the
sexual glands, especially the ovaries, and probably also of the
adrenals.

According to Professor von Noorden[347] and other authors, chlorosis is
due to a degenerated condition of the ovaries. But the adrenals also may
be altered, causing the great muscular weakness of chlorotic girls. Thus
Dr. Sajous[348] has attributed chlorosis to adrenal degeneration. If, as
observed for centuries, arsenic and iron are specifics in augmenting
hæmoglobin in the blood, it is a question whether this effect is
obtained by the action of these preparations upon the ovaries, or upon
the adrenals, as advocated by Dr. Sajous.[349] The probability is that
they act upon both glands. Mud baths which are rich in iron are
especially potent and successful against chlorosis and anæmic
conditions, and at the same time against ailments of the ovaries and
uterus, as is well known to gynæcologists. Iron seems also to exercise
beneficent action on the male sexual glands. Impotency, as we have also
seen, can often be improved by iron preparations, or by mineral waters
containing iron and arsenic. Hysteria, as ancient physicians supposed it
to be, and as we have tried to show,[350] is due, in great probability,
very frequently to alterations in the female sexual organs, and iron
treatment, especially arsenic and iron mineral waters, improves many
cases.

Footnote 347:

  v. Noorden: “Die Bleichsucht” Nothnagel’s “Handbuch der pract.
  Medicin.”

Footnote 348:

  Sajous: “Internal Secretions,” vol. i, p. 87, Philadelphia, 1903.

Footnote 349:

  Loc. cit., p. 95.

Footnote 350:

  Congress of Belgian Neurologists, 1906.

As well known to urologists, the general condition in cases of chronic
posterior gonorrhœa, and in prostate troubles from such a cause, is
often improved through iron treatment; as also is neurasthenia, even
though some cases are not in etiological relation with such a cause.

We must thus consider iron, especially when in combination with arsenic,
as one means of improving the condition of the sexual organs judging
from the foregoing reported clinical observations. The fact that iron of
itself is no longer regarded as being useful in senility—i.e., when the
sexual glands are more or less degenerated—points to the value of its
combination with arsenic. We consider iron, especially in the form of
the easily absorbed iron mineral waters, and in the form of the iron
contained in mud baths, as a valuable means for the prevention of
premature old age, and for the treatment of old age. Iron, and
especially inorganic iron, is indicated as a preventive of old age for
the reason that it stimulates to greater activity the blood forming
organs, as has been shown by Harnack and von Noorden. It is a fact, upon
which we have already insisted, that the organs which control the
condition of the bone marrow, the seat of the blood forming
mechanism—i.e., the thyroid and the ovaries,—are degenerated in old age.
Iron acts upon the bone marrow through the intermediate agency of these
glandular structures.

It can be administered in the form of the perchloride or of other
inorganic preparations. According to Bunge, organic iron preparations
and iron contained in food have the advantage of being more readily
absorbed and assimilated. (See chapter on the blood as an article of
iron-containing food.) But Grawitz still prefers to prescribe inorganic
iron, such as reduced iron or perchloride of iron. An old iron
preparation of great efficacy is the Blaud pills.

A very successful method of iron treatment is by mineral waters which
are rich in iron—in Austria, Franzersbad; in Germany, Langenswalbach. We
prefer such waters as contain arsenic besides iron, as already
mentioned.

When mud baths are used simultaneously, it will be advisable not to take
thyroid extracts also; but to await doing so till after the course of
baths is finished.

Increase of fat and of connective tissue are the most typical and
anatomo-pathological changes in the tissues produced by old age. It is
evident that drugs which can combat these changes are also able to treat
and improve the condition of old age. There is no inorganic drug which
can give such good results in these conditions, according to our present
knowledge, as the iodides. It is generally believed that through the use
of potassium iodide we are able to diminish fat in many cases. The
increase of connective tissue in different organs, that takes place in
the cirrhosis of these organs, has also been treated by iodides with
success, according to some authorities, and, according to others,
without any. At any rate, in arteriosclerosis there can be no doubt that
iodides do give good results as they facilitate the circulation of the
blood by diminishing its viscosity. According to Heinz,[351] iodides can
combat connective tissue hypertrophy by rendering the vessel walls more
permeable. They also increase the activity of the leucocytes.

Footnote 351:

  Heinz: Virchow’s Archiv, clv, p. 44.

When we administer iodides we give in them the main element of the
thyroid gland—iodine, so that iodide treatment acts on these glands and
increases their iodine contents. Iodine is a rational remedy for
preventing old age, for the reason that, as Baumann and Jollin have
found, the thyroid gland of aged persons contains but little iodine. We
know, through the researches of Blum, Baumann, Kocher, Aeschbacher,
etc., that by administering iodide we increase not only the iodine
content of the thyroid, but also, as the experiments of Garnier show,
its colloid substance. Iodides are best taken in the form of a saturated
solution of sodium iodide, or other preparations containing this salt.
They act best when taken in small quantities (not over 15 grains of the
iodide a day), such amounts stimulating thyroid activity; larger doses,
by overstimulating, may cause a subsequent exhaustion of the thyroid.

That iodide treatment is able to increase thyroid activity is best shown
by the fact that it may be followed by iodism, which presents most of
the symptoms that follow large doses of thyroid extracts. It is very
probable that many benefits obtained by iodide treatment can be
explained through its action in increasing thyroid activity.

Instead of using inorganic iodine, it would seem more logical to use
organic iodine, as contained in the thyroid gland. We could thereby, to
a certain extent, replace iodides successfully by thyroid extracts; the
drawback, however, is that some thyroid preparations contain only a
minimum quantity of iodine, while others contain more. It would,
therefore, be advisable, when thyroid extracts are used, which contain
only a very little iodine, to use in combination therewith, very small
quantities of iodide of potassium; say, one day one or two thyroid
tablets, and the next day the iodide. It is best, when we are trying to
treat the symptoms of senility by combined iodide and thyroid
preparations, to feel our way very cautiously, every third day examining
the heart and pulse (see following chapter).

Such treatment should be undertaken only when a thorough knowledge is
possessed of the physiology and pathology of the thyroid gland.

The fact that iodides improve the circulation of the blood makes them,
in old age, especially useful, as arteriosclerosis is then very frequent
and the iodides become of special value. Similar remedies are also
indicated in all conditions arising from tertiary syphilis, which is
very often a cause of premature senility. For all the reasons given
above we think that iodide treatment, in small doses, especially in
combination with thyroid treatment, can give good results in our
struggles against old age, and in its treatment when it has advanced on
us.

We have often observed that old people taking iodides for
arteriosclerosis, present a much more youthful appearance after such
treatment; and Dr. G. W. Gibson, physician of the Royal Infirmary in
Edinburgh, tells us that he has observed the same thing. We might
especially mention the case of an English gentleman 58 years of age, who
had six years ago a hemorrhage in the right eye; since that time he has
been taking iodides, and in spite of his age is looking quite fresh and
youthful—indeed, he recently married a young lady of 18 years.


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                              CHAPTER LVI.

ON THE PREVENTION OF PREMATURE OLD AGE AND ON THETREATMENT OF OLD AGE BY
                            ANIMAL EXTRACTS.


WHEN, some twenty-two years or more ago, the first accounts came to hand
of the marvelous effects of extracts from the thyroid gland of sheep,
they were at first received, as in general are all reports about
wonderful cures, with incredulity or scepticism; and it is quite
possible that the same might be the case regarding the success of our
method of treating the symptoms of old age, and the prevention of their
premature development, by thyroid and other organic extracts, were it
not that we are supported by a mass of evidence, to which we will at
once refer.

It has been noticed by all the leading investigators on the effects of
thyroid extracts, such as G. Murray,[352] Hector Mackenzie,[353]
Hertoghe,[354] and others, that the majority of old people treated for
myxœdema by thyroid extracts, after a certain period of treatment,
presented a much younger appearance, sometimes even to the extent of
from ten to twenty years. This fact is perfectly true, as we can see
from the photographs of these cases, taken before and after treatment,
by Murray, Laache,[355] Oppenheim,[356] Ewald,[357] Hertoghe, and many
others; the greater number of these photographs show persons looking
very much younger after but a few months’, and in some instances less,
treatment. Several of the above-mentioned authorities, and also
Vermehren[358] and others, report that dark hair has grown on places
which, before the treatment, were bare, and where previously gray hair
had fallen off. This would appear incredible were it not a fact,
familiar to all who are in the habit of prescribing, in many cases,
treatment by thyroid extracts.

Footnote 352:

  Murray: “Diseases of the Thyroid Gland,” vol. i, London, 1901.

Footnote 353:

  Mackenzie: British Med. Journal, Oct. 29, 1892.

Footnote 354:

  Hertoghe: Loc. cit.

Footnote 355:

  Laache: Deutsche Med. Wochenschrift, 1893.

Footnote 356:

  Oppenheim: Lehrbuch der Nervenkrankheiten, Nu. ii, p. 1390.

Footnote 357:

  Ewald: “Die Erkrankungen der Schilddrüse,” second edition, 1909.

Footnote 358:

  Vermehren: Loc. cit.

Similar facts have been observed by us personally in a number of cases,
among them two, of a very interesting character, in the wards of Dr.
Hector Mackenzie, at St. Thomas’s Hospital, in London. One was a woman
of 65, who looked more like 42 after several years’ treatment with
thyroid extracts; the other was a woman of 42 who, as it seemed to me,
looked quite ten years younger after taking daily one thyroid tablet for
twelve months. About 2 years ago we saw in the wards of Dr. G. A.
Gibson, at the Glasgow Royal Infirmary, a woman of 72 who, after a
similar treatment during the past twenty years, looked, as we agreed
with Dr. Gibson, only between 50 and 60. Most of the above cases were
those of persons suffering from myxœdema; so the question arises whether
all other people, not affected with this complaint to the same extent,
may not also derive equal benefit from a similar treatment.

We have shown in several chapters of this book that in old age the
iodine content of the thyroid gland is much diminished and the tissue of
the gland itself is degenerated in varying degrees, at times
approximating to myxœdema; and, as found also by Sir Victor Horsley,
Hale White, Vermehren, Ewald, and ourselves, old age presents clinical
symptoms similar to those of myxœdema.

Naturally not every old man has the whole thyroid gland degenerated, and
clinically, therefore, there will be varying degrees in the myxœdematous
conditions, some presenting more and some less of the symptoms; so that
some men of 80 years of age may look younger than others at 65 or 70.

If a man of 60, suffering from absolute myxœdema, that is, a complete
degeneration of the thyroid gland, will present an appearance of 50 or
less, after thyroid treatment, as shown in the photographs of the
above-mentioned authorities, and as seen by ourselves, why should
another man of 60, having only partial symptoms of this complaint, as
usual at this age, not benefit to the same extent and look younger after
similar treatment? It would be quite adverse to all notions of pathology
for a man, in a better condition of general health and suffering only
from a mitigated and partial form of a disease, not to derive equal or
greater benefit from a similar treatment as the other person of the same
age affected by a complete development and thus increased degree of the
same disease. This, indeed, would be contrary to all sound reasoning.

But we have had personal opportunities of treating numerous persons, not
actually myxœdematous, but exhibiting only slight symptoms of such a
condition, such as are found in people with premature senility, and also
in many cases of obesity and arteriosclerosis, and in every case we have
been able to observe a more youthful appearance afterward.

The features have become notably more refined and more sharply defined,
and there were many other benefits that may often follow thyroid
treatment, such as loss of excessive weight, increased quantity of urine
and of perspiration, and better action of the intestines. The gait
especially became much easier; some were able to climb hills, whereas
prior to the treatment they became fatigued from less than a ten minutes
walk. The improvement in the mental condition was sometimes striking;
memory especially became much better, as did also the general
intelligence. It was also very interesting to note that abrasions, or
any kind of sores, healed rapidly with fine granulations; for which
reason such a treatment may give good results also in leg ulcers. We
have obtained the best results from our thyroid treatment in those
persons who were prematurely ageing; but even in the aged we have
produced an improvement in the symptoms.

By the amelioration of the functions of the skin, kidneys, and
intestines, which functions are, as a rule, impaired in old age, such
treatment may already be indicated; and especially since the production
of heat is thereby augmented, which is a great advantage to old people,
who usually complain of cold. At the same time we are able to increase
the processes of oxidation, which are, as already mentioned, diminished
in old age. Thus, from the improvement in all these functions from the
administration of thyroid extracts in old age, the treatment is, _prima
facie_, justified. Great care must, however, be exercised in prescribing
such extracts, and they should never be given unless the effects on the
patient can be properly observed every three or four days, as all the
drugs which are as effective as the thyroid, such as arsenic or other
active drugs, can do much mischief if taken in large quantities. For
such, so to say, physiological purposes as we are required to give them,
thyroid extracts should be administered in a quantity just sufficient to
make up the amount of thyroid secretion which the body demands; the
greater the age, the larger the dose; but we must not forget that, as in
advanced cases of myxœdema, so also in advanced senility, we must not
expect too great results from the treatment. The thyroid extracts that
we give can only act if the thyroid gland still has some of its
secreting structure intact and is not yet completely degenerated, which
latter is the case in complete myxœdema and advanced senility. It is
best to commence at about 40, and in persons with symptoms of premature
senility, even before this. Simultaneous obesity will offer the best
opportunity for this treatment, and by the mere reduction of superfluous
fat a more youthful appearance may be obtained. In younger people, about
or prior to middle age, one tablet daily, or sometimes two for a week or
so, then going back to one a day, will be the best method. It also is
necessary to have free intervals of five or six days between treatments,
and then to commence _de novo_. We must bear in mind that the effects of
the thyroid gland may be cumulative.

From observations on ourselves and on patients we recommend for such as
are not advanced in age, say, below 40 or 45, one tablet for a week or
two, then stop for a few days, resuming with one tablet for a week; then
an interval of three days before commencing again; while for those with
symptoms of premature senility two or more tablets could be given,
proceeding as above. In more advanced age two or three tablets may be
given for two, three or four weeks before a free interval of several
days takes place.

We must emphasize the fact, however, that a physician who prescribes
such extracts, should have a thorough knowledge of the physiology and
pathology of the thyroid gland for his safe guidance. On the other hand,
we again urge that patients should never use them otherwise than under
the guidance of a physician.

When thyroid is taken in an irrational way in large doses, or when
continued for too long a time, we may sometimes have the very opposite
symptoms for a time—even more fat, and in some cases older looks; but if
we abandon the treatment for two or three weeks we may witness, as we
ourselves have done, a general improvement in the condition and personal
appearance; after iodide treatment we may observe the same, sometimes
with increase of fat. Thyroid extracts cause a greater activity of the
thyroid, and at times even an overactivity—thyroidism—which may be
followed by its exhaustion. This has been proved by experiments by
Christiani, who transplanted a fresh thyroid gland on an animal with
healthy thyroid, and thereby produced a degeneration of the latter.
Walter Edmunds, by feeding monkeys and dogs on too large a quantity of
thyroid extract, produced in their central nervous systems changes
similar to those following extirpation of the thyroid gland. Much iodide
of potassium is apt to produce, not only a diminution in size of the
thyroid, but sometimes its degeneration (see Garnier,[359] Chapter III).
As we have observed, the symptoms of exhaustion of the thyroid after
thyroid treatment are, as a rule, merely temporary, and may pass off
after a rest of a week or so; but yet we must sound a warning against
hasty and imprudent treatment.

Footnote 359:

  Loc. cit.

These extracts contain more or less iodine according to their
manufacture; and it has been shown by Claude Bernard that iodine is not
easily eliminated from the body, but is retained for a given time; so
that the effects of the treatment may be felt also in the free interval,
and according to our observations, often better then than during actual
treatment. Taking the extracts for too long a time without intervals
may, at times, produce disagreeable symptoms, such as palpitation of the
heart, nervous excitability, sleeplessness, etc.; so that during the
course of the treatment the patient should be examined every three or
four days as to the condition of the heart and urine; and if the pulse
rises above 90, if it were lower before, the treatment should be
suspended for a few days; much meat, alcohol, strong tea or coffee,
should be avoided. When thyroid extract in large doses and much meat are
taken together, according to our observation in a few cases, traces of
sugar may appear in the urine up to, say, from 0.1 per cent. to 0.4 per
cent., which quickly disappear if the meat is reduced, in spite of
continuing the thyroid cure, as we have noted in two cases. It is, of
course, well understood that thyroid treatment should not be tried in
patients who show symptoms of a hyperactive condition of the thyroid
gland—e.g., a rapid heart action, etc.; but we must rather try to
improve only a _deficient_ activity of the thyroid gland. By giving
small quantities of iodides before beginning thyroid treatment we could
best ascertain the condition of the thyroid gland; for if symptoms of
iodism appeared we would then be in the presence of a very active
thyroid, and thyroid treatment would be contraindicated. In many cases
of inactivity of the thyroid gland we have obtained excellent results by
administering simultaneously thyroid preparations and small quantities
of iodides. The use of stimulants such as alcohol, strong tobacco, and
strong tea or coffee, should be forbidden during thyroid treatment.

Taken in the above manner with the necessary precautions and only under
medical supervision, thyroid as a preventive for premature senility, and
as a treatment for the symptoms of senility, is entirely harmless. We
have never observed the least inconvenience in any of the numerous cases
we have treated when our instructions as to doses and diet were carried
out, nor in ourselves. We have personally, for experimental purposes,
taken these extracts for the past five years—once for ten months with
short intervals—and stood it very well. Sometimes a few occasional
pimples were seen, and sometimes sore throat developed, and in some
patients headache. It is essential that only fresh preparations from a
reliable source should be used.

The effects of these extracts on the nervous system and mentality are
very remarkable. As already mentioned, we noted greater immunity from
fatigue, bodily and mental, in many patients, and also in ourselves.
Memory seems to have been much improved.

The same has also been noted by Hertoghe, who told us that he used to
take three tablets immediately before beginning his lectures. We do not
think it advisable to exceed two or three tablets a day; and even then
it is best not to take this quantity, as a general rule, for longer than
one week, when we must then reduce this quantity to one tablet.

In combination with thyroid extracts or alone, ovarian extracts have
given us favorable results in the treatment of aged women, and also in
younger ones before the menopause, especially after oöphorectomy.
Obesity that follows the menopause, or the degeneration or extirpation
of the ovaries, and which may also be regarded as one of the primary
symptoms of old age, has been in nearly every case very favorably
influenced by ovarian extracts, particularly in such cases as thyroid
extracts were used at the same time.

A very interesting case is mentioned by Burghart[360] of obesity in a
young woman of 20, consequent to an undeveloped condition of the ovaries
and uterus. By giving ovarian extracts he was able to reduce the weight
by 8 kilos, and when the treatment was discontinued, obesity returned.

Footnote 360:

  Burghart: Deutsche Med. Wochenschrift, p. 610 and 627, 1899.

As we have already shown, the ovaries also influence the processes of
oxidation. Loewy and Richter were able to considerably increase
oxidation in animals by ovarian extracts. Very important also is the
fact that Spillman and Etienne[361] observed an increase in the number
of red blood-corpuscles after ovarian treatment. For the above reasons
alone, ovarian extracts should be tried in old age, where we find, as
already stated, a diminution of oxidation, and very frequently also, in
old women, an anæmic condition. Chroback and Landau were the first to
employ with good results ovarian preparations for the relief of the
symptoms following castration in women. According to our observations on
many women under our care, the greatest benefit can be afforded by
ovarian treatment to cases having the disagreeable nervous disorders
which follow the menopause, such as hot flushes, nervous depression,
headaches, nervous insomnia, etc., these symptoms having disappeared in
nearly every case after several weeks’ treatment.

Footnote 361:

  Spillman and Etienne: C. R. du Congrès de Medecine de Nancy, p. 953,
  1896.

We consider ovarian extracts to be a specific against the painful
feelings of heat in women in the years succeeding the menopause, or
after oöphorectomy in younger years. In order that these extracts should
be active, it is necessary that they should be prepared from the corpus
luteum part of the ovaries, which contains their internal secretions.
The pig would be the best animal for the purpose, for its ovaries have
been found superior to those of other animals; and they also contain
more iodine, much more than the ovaries of cattle.

When prescribing ovarian extracts we may give larger doses than of
thyroid extracts, as they are less dangerous when taken in large
quantities than the latter. We usually begin with two tablets,
increasing to four, a day.

Less active than the ovarian preparations are the extracts of the
testicles, at least in the form in which they are at present used. It is
very probable that this may be due to the testicles of bulls being
mainly used up to now, for just as their ovaries are, so also may the
testicles of cattle be less efficacious. In addition it is also probable
that these extracts do not contain certain effective parts of the
testicles. It has been demonstrated by several authorities, as Shattock
and Seeligmann,[362] Ansele, and Bouin, that the internal secretion of
the testicles is derived, to a certain extent, from the interstitial
cells, a group of cells imbedded in the spaces between the individual
tubules. In some animals, as in the pig, as found by Shattock, these
cells are contained in such amount that they form a special part of the
testicles called by Shattock “paratubular glands;”[363] and for this
reason alone pigs’ testicles should be preferred. It seems that the
interstitial cells can only play a rôle in combination with certain
other parts of the male sexual organs, for certainly when alone they
cannot represent the part of the testicles which gives the real internal
secretion. This is shown by the fact that they are found in the largest
number in degenerated conditions of the testicles—for example: in
cretins (Lanz), in undescended testicles (Bellingham Smith), and in
atrophied testicles of old men (Haviero Spangaro[364]).

Footnote 362:

  Shattock and Seeligmann: Transactions of the London Path. Society, p.
  57, vol. lvi.

Footnote 363:

  Shattock: Loc. cit.

Footnote 364:

  Spangaro: Anatomische Hefte, Wiesbaden, vol. lx, 1902.

That testicular extracts are able to improve the symptoms of senility
has been shown by the celebrated physiologist, Brown-Séquard,[365] from
experiments on himself. He used an extract prepared from the crushed
testicles of guinea-pigs or dogs. After injecting these extracts into
his arms and legs, this old savant of 72 noted a considerable increase
in his muscular and mental powers. As he mentioned in his communication
to the Paris Biological Society, he observed in himself an augmentation
of the energies of the nervous centers; he found that he could do more
work than formerly, and that without getting tired he could more easily
ascend the staircase, nearly running, just as he used to do until he was
60; and by the dynamometer he noticed a decided increase in the muscular
power of his extremities. All his excretory functions were improved; he
had laxative action of the bowels without resorting to purges to the
same degree as formerly; his stream of urine became much longer, thus
indicating a better muscular power in the urethra; he could work
standing for a few hours, whereas before he was always obliged to be
seated; and he found that his intellectual powers increased
considerably.

Footnote 365:

  C. R. de la Société de biologie, 1 and 15, Juin, 1889.

It is almost unnecessary to add that this startling communication was
received, in spite of his great fame, with scepticism, and by many even
with derision. And yet it is these discoveries by Brown-Séquard that
have laid the foundation of our present knowledge of the internal
secretions. That the effects were not due to auto-suggestion has been
shown by the experiments of Zoth and Pregl,[366] who found, by means of
Mosso’s ergograph, an increase of muscular power through the injection
of testicular extracts. It is also very interesting to note that in a
few diseases which usually occur only in advanced age, testicular
extracts have given good results, such as in Parkinson’s disease and in
tabes dorsalis, as shown in the communications of Brown-Séquard and
D’Arsonval to the Paris Biological Society in 1892.

Footnote 366:

  Pflüger’s Archiv. vol. vi, pp. 335 and 379, 1896.

We have also, for experimental purposes, tried on ourselves testicular
extracts from the pig, and indeed we found a decided increase in
muscular and mental powers. Thus we were able to climb the highest hills
much more quickly and with much less fatigue than before; and we made
the same observation in regard to increased mental activity; and we must
strictly defend ourselves from any suspicion of having been influenced
by auto-suggestion, which is not to be inferred after similar
observations of other authorities. Similar results we have personally
observed after injection of spermin (Poehl). This substance, obtained
from the testicles of animals, was introduced by Prof. v. Poehl,[367] of
St. Petersburg, and has been commented upon by many authorities, among
them Professor Senator and P. F. Richter. According to Poehl it advances
all the processes of oxidation in the tissues, as is shown also by the
experiments of other authorities—for instance, Prof. Tarchanoff, Prof.
Loewy, Richter,[368] etc.—who found that it is able also to powerfully
alkalinize the blood. It has been proved by a mass of experimental
evidence that spermin is a catalytic ferment, and that it regulates
tissue oxidation. Poehl insists that the diminution of alkalinity of the
blood may also reduce the resistance of the body to infection, a fact
fully sustained by the theory of Dr. Sajous,[369] that immunity is
influenced by alkalinity; and it is probably due to this that many
authorities have obtained good results from spermin treatment in various
infectious diseases and in conditions of auto-intoxication. Loewy and P.
F. Richter found that spermin increases hyperleucocytosis and the
alkalinity of the blood. The same effects have been claimed by
Brown-Séquard and D’Arsonval for testicular extracts. They reported
cases of successful cures in tuberculosis, and Ouspenski[370] has
successfully treated Asiatic cholera with them.

Footnote 367:

  Poehl and Tarchanoff: Organotherapie, vol. i, St. Petersburg.

Footnote 368:

  P. F. Richter: Organotherapie, Berlin.

Footnote 369:

  Sajous: “Internal Secretions.”

Footnote 370:

  C. R. Soc. de biologie, Nov. 5, 1892.

In the experiments made by Loewy and Richter, at the suggestion of
Professor Senator, on animals, it was found that experimental diseases,
such as pneumonia, terminated much better after an injection of spermin
(see, also, Chapter III).

As found by Bukojemsky,[371] Hirsch, etc., spermin treatment has given
good results in senile marasmus; and senile pruritus can be improved by
it, as stated in two cases by Bosse.[372] Very interesting, also, are
this latter savant’s observations in a case of optic atrophy due to
syphilis, when spermin was used. The patient was nearly blind, and after
sixteen injections of spermin he could again see the hands of a watch.

Footnote 371:

  Petersburgh Med. Wochenschrift, Nu. 7, p. 67, 1904.

Footnote 372:

  Journal für med. Chemie u. Pharm., Dec., 1892.

Spermin is contained in different organs, especially in the ductless
glands; and among these the testicles are naturally the richest in such
a secretion. In order to obtain the best testicular preparation, the
whole substance of the testicles must be taken, together with the
interstitial cells, and not the latter only. Brown-Séquard prepared his
extracts from guinea-pigs and dogs, which do not have a large number of
these cells. We should like to take into consideration the discovery of
Professor Lanz, who found in the testicles of impotent cretins a large
quantity of interstitial cells; yet neither the physical nor mental
condition of cretins permit the inference of very active sexual glands.

In our opinion, the most active testicular extracts would be those
derived from the testes of the pig; but not from the testicles only, for
the preparation should also contain extracts from the prostate as well,
for in the human body the action of the testicles is inseparable from
that of the prostate. This has been shown by the experiments of Camus
and Gley, who found that seminal fluid exhibits more lively movement of
the spermatozoa when a little prostatic liquid is added to it. It is
thus very probable that by adding prostatic extracts to those of the
testicles, the vitality of such extracts may be enhanced.

It is important to note that in his article on old age in Dr. Stedman’s
well-known work, Boy-Teissier[373] relates that he obtained very good
results from Brown-Séquard’s testicular extracts in the treatment of old
age.

Footnote 373:

  “Twentieth Century Practice” by Thomas Stedman, M.D., London, p. 491,
  1897.

We have seen in Chapter V what a marvelous influence the sexual glands
exercise on vitality and long life; if, therefore, by testicular
extracts we can enhance the activity of the sexual glands, it would
really be worth while to do so.

In addition to thyroid, ovarian, and testicular preparations, the
extracts also of the kidneys should give good results in the treatment
of old age and in the prevention of a prematurely aged condition, by
improving the eliminative functions of the kidneys.

It has been found by many authorities, of whom we especially mention
Gilbert and Carnot,[374] Obolenski,[375] Dubois,[376] Renaut,[377] and
Teissier,[378] that by giving extracts of the kidneys they were able to
improve the condition of patients suffering from various forms of renal
diseases, especially when suffering from uræmic conditions and
parenchymatous inflammations. We have also tried such extracts and
found, indeed, beneficial results in many cases, as reported in an
address we gave to the Medical Association of Greater New York on
October 15, 1906. Since then we have had opportunities of noting similar
results in a still greater number of patients, especially in aged
people, among them being several with arteriosclerosis. In each case we
have observed a decrease in the number of casts. In some cases of
chronic parenchymatous nephritis we were surprised to find that there
were no casts at all, after several weeks’ treatment by renal
extracts—four tablets a day—whereas, before treatment, there were found
in one case twenty hyaline and granular casts in one specimen of urine
only. We have also noticed, in many cases, a notable diminution of
albumin, although it seems to us that the decrease in the number of
casts has been more prominent; and in many cases there has been an
increased flow of urine.

Footnote 374:

  L’opothérapie, Paris, 1898.

Footnote 375:

  Wratch, No. 27, 1899.

Footnote 376:

  Soc. de biologie, p. 287, 1903.

Footnote 377:

  Bull. gén. de thérapeutique, p. 30, 1907.

Footnote 378:

  Teissier: Bull. Méd., No. 57, p. 617, 1907.

From the above results of treatment by renal extracts, such a treatment
with extracts prepared by maceration of the kidneys of pigs, appears
indicated, as a means to prevent premature old age, and also in old
people generally, especially since we never observed any deleterious
symptoms after administering two to four tablets a day. It would,
possibly, be useful to recommend in such cases pigs’ kidneys daily; and
as they are not palatable raw, unless tolerated in that condition, they
can be grilled.

Good effects, and probably to a greater degree, may be observed also
after the use of pancreatic extracts. Their use in old age is indicated
by the fact that there is in the pancreas, just as there is in the
kidneys or thyroid, an increase of connective tissue in old age, and
thus the pancreas is not able to produce the necessary amount of
ferments for the digestion and assimilation of the proteid,
carbohydrate, and fat food. We also often see, therefore, aged people
lose weight, especially in advanced senility.

According to the observations of many authorities, among them
Abelmann,[379] H. Salomon,[380] and E. Meyer,[381] it would seem that,
by the use of certain pancreatic extracts, there is a very decidedly
better assimilation of proteid, of amylaceous, and especially of fatty
matters. As in old age there is often a decrease of stomach and
pancreatic juice, pancreatic extracts seem to be especially indicated.

Footnote 379:

  Abelmann: Quoted after Oser, Nothnagel’s “Practice” p. 109; “Diseases
  of the Pancreas,” p. 101.

Footnote 380:

  Salomon: Berl. klin. Wochenschrift, Nu. 3, 1902.

Footnote 381:

  Meyer: Zeitschrift für exper. Path. u. Ther., vol. ii, 3 H.

We have obtained good results in each case that we have treated by
pancreatic extracts, and also in experiments on ourselves, having used a
preparation introduced by H. Salomon. Even in aged persons we have noted
easier digestion and the disappearance of digestive trouble after two or
three tablets of the extract of pancreas taken immediately after dinner
and supper. In cases of liver and gall-stone troubles, where previously
there was a considerable loss of bodily weight, in nearly every case
after pancreatic treatment there was no more falling off in the weight,
and in some instances we have even found a considerable increase in
weight. It is our custom to apply these extracts to every case where we
want to increase bodily weight by a better assimilation of the food.
Especially in cases where we have given much milk do we find that it is
much better tolerated by the addition of these extracts to the food. We
have also found, by experiments on ourselves, that the feeling of
oppression and heaviness in the stomach after hearty meals, especially
of indigestible food, has been much improved by the use of two to three
of these pancreatic tablets. Especially have they proved useful after
late dinners in preventing a disturbance of the sleep.

We have given above an account of the different organic preparations by
which we can treat the symptoms of old age with good results. According
to our experience it is not advisable to use all these extracts at one
and the same time, but only a few. At any rate, thyroid tablets can be
used for a long time, but in every case with intervals between the
treatment. With these ovarian or testicular extracts can be used, as can
also pancreatic extracts. The last mentioned ones should be used only as
long as necessary—until digestion is improved and bodily weight is
increased, if so desired. They may then be discarded until again needed.
Thyroid extract should also be discarded, after two weeks’ or one
month’s use, for a week or so, and then slowly begun again. It is
difficult to give general instructions that will suit every case; it is
therefore best to treat cases in an individual manner, the prime maxim
being that by such extracts the function of certain glands should be
improved until what was defective or deficient has been made up. The
thyroid extracts require that the effects should be carefully watched;
but all the other extracts are free from harmful consequences,
especially if not taken in abusive doses, and provided also, of course,
that they are fresh and not decomposed by long keeping.


------------------------------------------------------------------------




                             CHAPTER LVII.

                  A FEW HINTS ON YOUTHFUL APPEARANCE.


THE youthful appearance of a person is dependent chiefly upon the
condition of the complexion, of the teeth and of the hair. If a person
has a fresh complexion, and if the muscles of the face are firm and not
relaxed his face will show a youthful appearance. A few wrinkles around
the eyes and the crow-feet, which we find especially with persons of a
vivid, lively disposition, whose faces show a sensitive expressiveness
do not prejudice the youthful appearance of such persons.

In order to keep the complexion fresh and to protect the skin from
fading there are a few hygienic measures to follow. It is not
advantageous to wash the face daily with a soap. It is much better to
dip the towel, when we get up, in cold, soft water, the best in rain
water and then to wet the face all over, or to bend over a basin with
cold rain water and to throw with the hand the water against all parts
of the face. Thus by the refreshing cold of the water the muscles of the
face will be “toned up” and their relaxation prevented. The same way it
will be advisable to wet the face with a little eau de cologne or
alcohol of 30 per cent. whenever fatigued during the day in order to
prevent the relaxation of the muscles of the face. The skin of the face
should be made only lightly wet, for the frequent thorough washing of
the skin will tend to make it very dry. In order to remove the dirt from
the face the best method is to employ a very mild soap which contains
much fat. It is advisable to put on the face in the evening before going
to bed an ointment that is made out of animal fat, e.g., lanolin to
which may be added glycerine or some other kind of fat of animal origin.
But it is not necessary to do this every day. Massage of the face, by
which the blood-supply of the muscles can be augmented may be of great
benefit, if it is done in a scientific way and carefully. To improve the
complexion of the face and to prevent the unæsthetic reddish skin with
dilated blood-vessels, the tincture of benzoin or cosmetics that contain
it can be used with profit. Those, however, who are so happy as to have
a naturally fresh, rosy complexion should never use benzoin, for
according to our observations the strong tinctures made with it may be
detrimental to their skin.

Of great importance to the freshness of the complexion is also a regular
daily thorough cleaning of the intestines, we have often made the
observation, that the yellowish dark complexion of constipated persons
gets much improved after a copious evacuation; thus in this sense the
use of purgative mineral waters, and also the use of laxative fruits
like grapes taken daily in large quantities often much improve the
complexion. Then also the condition of the liver is of great importance
for a fine complexion, and everything that improves the functions of the
liver can contribute to conserve the same. In this connection we refer
the reader to our chapter on the hygiene of the liver.

Of great use also are bodily exercises, for instance long walks in the
open air, as thus the circulation of the blood is much improved in the
periphery of the body and thus also is the face and the nutrition of the
tissues of the skin improved. It is also of importance to carefully
observe our teachings on the rational hygienic use of food as given
previously. It is a fact that the complexion of great meat eaters is not
so fresh and finely delicate as that of persons living on
lacto-vegetable foods. We have also often made the observation, that
persons eating meat in abundance gain a better complexion after having
been put on a diet of milk, eggs, butter, cereals and other vegetable
foods, especially abundance of fruit.

It is also a fact that a bright, cheerful disposition favorably
influences the expression of the face and the complexion. Passions,
grief and sorrow may prove very detrimental, as they often leave lines
and wrinkles in the face.

We have already mentioned previously that certain drugs such as arsenic,
iron and iodides can prove of great benefit for the production of
youthful looks, as they powerfully influence the formation of the blood
and affect its circulation through the tissues, and also the general
nutrition. Furthermore the thyroid preparations can bring about the same
results and they also contribute to obtain and retain a youthful
appearance as we have shown previously. We will only mention here the
important fact that wrinkles in the face are of frequent occurrence in
degenerated conditions of the thyroid gland; in young individuals and
even in infants this may be seen. On the other hand may be observed the
disappearance of wrinkles after thyroid treatment as shown in our
chapter on the treatment of old age through animal extracts. Hot baths
are also useful to aid in retaining a youthful appearance as they
promote a better circulation of the blood through the tissues of the
skin and an improvement of the functions of the skin.

Above all it is the condition of the teeth that is of utmost importance
for youthful looks. For if they fall out atrophy of the alveolar process
takes place, and when the lips and the cheeks lack their osseous support
they will fall in. The chin in consequence gets pointed, the height of
the face is diminished and the whole face looks much older. To avoid
this everything should be done to keep the teeth in good condition and
to prevent their decay and their falling out.

The ruin of the teeth may be brought about by external and internal
causes. The first are less dangerous, for they are chiefly of bacterial
origin and they can be avoided by a scrupulous cleaning of the teeth.
Much more serious and sometimes even unavoidable are the internal causes
thus especially the bad nutrition of the gums. If the gums are not
sufficiently supplied with blood or if the blood is lacking certain
important elements, or if it contains elements of a toxic nature as for
instance in diabetes, they become atrophic. They retract and the support
the teeth receives is insufficient.

When the saliva is of an acid nature tartar gets deposited on the teeth
and this may cause the formation of pus in the alveoli of the teeth
i.e., produce alveolar pyorrhœa. In such a condition the base of the
teeth is surrounded by pus, which destroys the substance of the teeth
which are then lost. Most frequently we find an acid saliva in meat
eaters and in certain diseases, especially in diabetes, gout, etc.
According to Paterson the above condition is very frequent in persons
with chronic nasal and pharyngeal catarrhs, especially when breathing
through the mouth.

The best means to obtain a regular supply of blood to the gums is the
massage of the gums by the finger, on which may be put a little olive
oil, and then gently rub the lower jaw from below upwards, and the upper
jaw from above downwards. Equally a rubbing of the teeth with a brush
that is put in an alcoholic solution of 30 per cent. will do good. The
acid saliva can be remedied by an alkaline mouth water, or a paste
containing bicarbonate of sodium in large quantities. It is also very
beneficial to the gum to clean it with alcohol of 30 per cent. gargling
or drawing it between the teeth, as is also the use of certain
antiseptic and stringent mouth waters like borax with tincture of myrrh,
or ratanhia with myrrh, etc. Hydrogen peroxide is an ideal antiseptic
for the teeth and gums, and in strong solution it may prove useful in
cases of a hyperæmic and inflamed condition of the gum.

The condition of the sexual glands and of the thyroid gland also
powerfully influence the condition of the teeth, which can be seen
plainly by the fact that all the alterations of these glands, as in
pregnancy, in chlorotic conditions, etc., may produce important changes
in the condition of the teeth and the alveolary processes. In some cases
we were able to improve a swelled and hyperæmic condition of the gum by
the administration of thyroid extracts.

Youthful looks also very much depend upon the condition of the hair.
When the hair is scarce and what there is left is gray a person appears
much older than he really is. When we get to a certain age—and many
persons even before—the connective tissue in the capillaries which
provide the hair root with blood becomes augmented and the elasticity of
their walls become lost. Thus there will be a difficulty in the regular
blood-supply to the hair roots or bulbs. We have already in these pages
insisted on the fact that iodides are able to improve the circulation of
the blood in the capillaries and thus they may give good results in such
cases, especially in aged persons. We may also improve the blood
circulation by massage of the scalp done in a gentle way and carefully.
According to Ehrmann the faradization of the hair gives also good
results. Above all we should not make difficult the blood-supply to the
hair roots by the wearing of hard stiff hats which compress the
blood-vessels. Less often the falling out of the hair is caused by
bacterial diseases and such can be best combated by antiseptic ointments
by sublimate, alcohol, by washing with tar soap, etc.

There exists here also a sympathetic connection between the condition of
the hair and that of the thyroid and the sexual glands. In the
degenerated conditions of these glands we frequently find the hair very
spare, it remains short, dry and brittle and falls out very easily.
After having treated such cases for a certain time with thyroid
extracts, we can obtain often a great improvement in the condition of
the hair. It may in the beginning fall out the more, but this happens
only with hair that is already morbidly decayed, but afterwards we will
observe a still better growth of new hair. Arsenic may also give similar
results according to our own observations and that of other authorities.

Youthful looks can also be obtained by a slender figure. Slender persons
look often younger than they are, whereas corpulency conveys more the
impression of a higher age than would correspond to the real number of
years. Therefore those who wish to look young must avoid becoming
corpulent. Above all the quantity of meat should be limited, for
corpulency can be best brought about by much meat in the diet, if at the
same time also amylaceous or starchy foods and sweets are taken in
quantity. Besides a frugal diet, much exercise contributes in most
persons to the prevention of obesity. Turkish baths, and according to
the prevalent opinion, also the use of certain purgative mineral waters
like those of Carlsbad, Marienbad or Kissingen will also give good
results. Very often we can see good results with a great loss in the
weight of corpulent persons after the use of thyroid preparations as we
have mentioned previously.


------------------------------------------------------------------------




                             CHAPTER LVIII.

    THE “TWELVE COMMANDMENTS” FOR THE PRESERVATION OF YOUTH, AND THE
                     ATTAINMENT OF A GREEN OLD AGE.


IN his report on the autopsy of Thomas Parr, who lived to the age of 152
years and 9 months, Dr. Harvey, physician to the king, attributed his
death to the change from a frugal diet of subrancid cheese, milk in
every form, and coarse, hard bread, to the rich feeding he received in
London, and to the change from the healthy air of the country to the
foggy climate of the metropolis. We also dwelt on the important fact
that by his leading such a peasant’s life, free from care owing to its
simplicity it contributed to his very advanced age; for, as the great
Harvey pithily put it, “sorry fare, but free from care.”

We thus see that this celebrated discoverer of the circulation of the
blood ascribed special importance, for the attainment of an advanced old
age, to these same agencies, viz.: living temperately and in the open
air, and absence from worry, the importance of which we have
demonstrated by scientific evidence in the various chapters of this
book.

We have found, among the cases of those who lived to a great age,
sometimes much over one hundred years, very numerous instances of
persons who were in poor circumstances, existing on a very simple diet,
but who were free from cares. To attain such a measure of simple diet
does not require any very great effort of mind; peasants obtain it
without care or worry. If we were asked for the best means of living to
be 100 years old we would say: become a peasant or a pauper and be
received into an English workhouse.

It is astonishing how many of the inmates of the English workhouses and
other similar institutions for the poor become very aged. They have no
anxieties about getting their daily bread, and oftentimes they are fed
better than they would have been in their homes, although only the
minimum amount of hygienic food is given. (This certainly would not have
applied to the English workhouses before the days of Charles Dickens.)
Workhouse inmates lead a very regular and frugal life, rising in the
small hours of the morning and retiring to bed early in the evening.
Thus, in winter time, they can never contract pneumonia by coming home
late from the overheated theatre, concert, or club-house. They also need
not worry about their fortunes, for they have none.

We may thus conclude that a workhouse may be a more favorable place for
reaching a good old age than a palace, which coincides with the pithy
words of Dr. Harvey already quoted.

To the three agencies of frugality, fresh air, and no worries we would
like to add the great advantage of sunshine, plenty of milk in the diet,
and little meat, a daily proper action of the bowels, a daily bath,
rational clothing, and above all—considering the great importance of the
functions of the glands with internal secretion as a means of freeing
our body from poisonous products, and thus preventing premature old
age—we must insist on the rational hygiene of these organs, and on the
reinforcement of their functions, if changed by age or disease, by means
of extracts obtained from similar organs of healthy animals.

From long study of the lives of the patriarchs of great age—who,
according to evidence, sometimes legal, and acknowledged also by such
authorities as Professor Pflüger[382] and Pel,[383] have attained an age
much over 100, and in some cases even of 160—we have come to the
conclusion that, by following the hygienic rules we have laid down in
the various chapters in this book, we certainly can preserve our
youthfulness till 50 or 60, and our life to 100 or over.

Footnote 382:

  Loc. cit.

Footnote 383:

  Pel: Loc. cit.

We fully acknowledge the value of descent from long-lived families, but
we may refer to the instances we have quoted of persons descended from
short-lived families and yet living to be nearly 100.

It would, indeed, be most foolish to feel like an old man or woman when
but 40 or 50, and to die perhaps at 60, when, by the exercise of a
little judgment, we can considerably prolong our youth, which may
otherwise be fast flitting away, preparing us for an early grave, and
enjoy our life twice as much by being free from pains and ailments.

Most of the evils that befall us in this world, including premature old
age and early death, are, in our opinion, as we have often repeated,
solely due to our own negligence; and to avoid such a fate we recommend
the following precepts:—

1. To be as much as possible in the open air, and especially in the
sunshine; and to take plenty of exercise, taking special care to breathe
deeply and regularly.

2. To live on a diet consisting of: meat once a day, eggs, cereals,
green vegetables, fruit, and raw milk of healthy cows (as much as the
stomach will permit); and to masticate properly.

3. To take a bath daily; and in addition, once a week or once every two
weeks, to take a sweat bath (if the heart can stand it).

4. To have a daily action of the bowels; and in addition to take a
purgative once a week if there is any tendency to constipation.

5. To wear very porous underwear, preferably cotton; porous clothing,
loose collars, light hat (if any), and low shoes.

6. To go to bed early, and to rise early.

7. To sleep in a very dark and very quiet room, and with a window open;
and not to sleep less than six to six and one-half hours, or more than
seven and one-half, and for women eight and one-half, hours.

8. To have one complete day’s rest in each week, without even reading or
writing.

9. To avoid mental emotions, and also worries about things that have
happened and cannot be altered, as well as about things that may happen.
Never to say unpleasant things, and to avoid listening to such, if
possible.

10. To get married; and if a widow or widower, to marry again; and to
avoid sexual activity beyond the physiological limit, as also to avoid a
total suppression of the functions of these organs.

11. To be temperate in the use of alcohol and tobacco, and also in the
use of coffee or tea.

12. To avoid places that are overheated, especially by steam, and badly
ventilated. To replace or reinforce the functions of the organs which
may have become changed by age or disease, by means of the extracts from
the corresponding organs of healthy animals; but only to do this _under
the strict supervision of medical men_ who are thoroughly familiar with
the functions of the ductless glands.


------------------------------------------------------------------------




                               GLOSSARY.


=Acetone, Acetonum.= An inflammable, colorless liquid of an acrid taste
    and a penetrating odor. Occurring in small quantities in the blood
    and urine and in considerable quantities at times in diabetic urine.

=Acetonitrile.= Methyl cyanide. A colorless volatile liquid.

=Acetonuria.= The presence of an abnormal amount of acetone in the
    urine.

=Acromegalia, Acromegaly.= A chronic nervous disease, usually of adults
    and marked by abnormal processes of growth, especially in the head,
    face, and extremities: Marie’s disease. It has in many cases been
    found to be associated with disease of the pituitary body and the
    thyroid gland.

=Adenoid.= Resembling a gland. Name given to masses of hypertrophied
    glands normally present in the nasopharynx.

=Adolescence.= Youth: the period between puberty and full development.

=Adrenal.= Situated near the kidney. The suprarenal capsule.

=Agglutinin.= A substance, occurring according to some investigators in
    blood-plasma, according to others only in the serum after
    coagulation, comparatively resistant to heat, drying, putrefaction,
    etc., showing many of the characteristics of proteids, and producing
    agglutination or sticking together by its action on the surface of
    foreign cells.

=Alexin.= Any principle that accompanies a pathogenic cell growth and is
    antagonistic to its evil effects, a defensive proteid. Any
    albuminous preparation used for protective inoculation.

=Alkalimetry.= The process of determining the amount of free alkali in
    various substances.

=Alveolar.= Belonging to the alveoli.

=Alveoli.= (_a_) Bony socket of a tooth; (_b_) an air-cell of the lung;
    (_c_) a cavity, pit, or recess.

=Amenorrhea.= Absence or stoppage of the menstrual discharge, normal
    during pregnancy.

=Amphibia.= A class of vertebrates forming a transitional group between
    the fishes and air-breathing animals, usually having gills in the
    larval form and lungs in the adult.

=Amyl Nitrite.= A drug which produces vasodilation—opening of the
    blood-paths. Formerly used in trigeminal neuralgia and malaria.

=Amylaceous.= Composed of starch: starch-like.

=Amylolytic.= Tending to dissolve starch, and thus to favor its
    conversion into sugar: sometimes applied to the saliva.

=Analogous Tissue.= A diseased tissue resembling a normal elementary
    tissue of the body.

=Anemia.= Deficiency of the blood in quantity or quality, either general
    or local.

=Anomaly.= Irregularity: deviation from rule.

=Antipyretic.= A remedy to lower temperature.

=Antipyrin.= A colorless, almost odorless, crystalline powder or tabular
    crystals, with a slightly bitter taste, prepared by the condensation
    of phenylhydrazine with aceto-acetic ether with the subsequent
    menthylation of the product.

=Antitoxic.= The quality of counteracting poisons: overcoming toxic
    influences.

=Antivenin, Antivenomous Serum.= A polyvalent blood-serum prepared from
    animals rendered immune to snake-venom.

=Aorta.= The larger arterial trunk arising from the left ventricle of
    the heart, and indirectly giving origin to every artery except the
    pulmonary and its ramifications.

=Arborization.= A branching distribution of veinlets or of
    nerve-filaments, especially the branched terminal ramifications of a
    nerve-axon.

=Arteriosclerosis.= Sclerosis or hardening of the walls of an artery,
    especially of the inner coats.

=Atheroma.= A form of fatty degeneration of the coats of the arteries in
    arteriosclerosis, producing patches of induration or of softening.

=Athyroidia.= A condition caused by an insufficiency of thyroid
    secretion.

=Atrophy.= A regressive metamorphosis, “wasting away” (not always due to
    imperfect nutrition), in which the parts become smaller by
    diminution of their elements, either in size or in number.

=Attenuated.= Drawn out thin. The lessening of weight, as by dietetic
    and medicinal treatment.

=Auto-intoxication.= Poisoning with toxic products elaborated within the
    body. Self-infection from self-formed poisons.

=Axilla.= The armpit.

=Bacteria.= Any of the microscopic, unicellular masses of protoplasm
    referred to a genus. Each is surrounded by an envelope, the total
    vital capacity of each species being represented by every cell.

=Butyric.= Relating to or derived from butter.

=Cachexia.= A depraved condition or habit of body or nutrition.

=Calcium Carbonate.= A soft, white, inodorous substance. =Chalk.= It
    occurs in shells, bones, and marble.

=Callus.= The osseous substance deposited between and around the divided
    portions of a fractured bone. Unnatural hardness or induration of
    any soft part or a thickening of the cuticle, caused by pressure or
    friction.

=Calorie.= The unit of heat, or the quantity of heat required to raise 1
    gram of water 1 degree centigrade.

=Carbohydrate.= Any one of a group of chemical compounds in which carbon
    is combined with hydrogen and oxygen, which exist in the same
    proportions as in water, the carbon atoms usually being a multiple
    of six.

=Catabolism.= The production of a simpler substance from a more complex.
    Passage of tissue material from a higher to a lower plane of
    specialization or complexity.

=Catalysis.= In chemistry a reaction that appears to take place owing to
    the mere presence of another body that apparently undergoes no
    change.

=Catalytic.= Belonging to or causing catalysis.

=Cellulose.= A carbohydrate forming the framework or skeleton of plants,
    and the most abundant substance in the vegetable kingdom except
    water.

=Chlorotic.= Relating to chlorosis. A person affected with chlorosis, or
    “green sickness,” a form of anemia.

=Choledochus.= The common bile-duct.

=Choline.= A ptomaine found in brain tissues, in the bile, in yolks of
    egg, and in many decomposing animal and vegetable tissues.

=Chromatolysis.= The breaking down and dissolution of the chromatin of
    cell-nuclei.

=Chromophile.= Stainable or easily stained, or absorbing of color.

=Cirrhosis.= A disease of the liver or other organs marked by
    proliferation and increase of the interstitial connective tissue,
    which subsequently contracts or shrinks, producing atrophy and
    degeneration of the parenchymatous substance.

=Climacteric.= A particular epoch of the ordinary term of life marked by
    periods of seven years, at which the body is supposed to be
    peculiarly affected, and to suffer considerable change. Used to
    indicate the “change of life,” or cessation of menstruation in
    women.

=Clinical.= Pertaining to the sick-bed treatment of a patient.

=Colloid.= Resembling glue.

=Connective tissue.= The framework tissue which supports and connects
    other tissues and organs.

=Convoluted Tubule.= The contorted portion of a uriniferous tubule.

=Corpus Luteum.= “Yellow body,” the yellow mass in the ovary occupying
    the place of a Graafian follicle which has discharged its ovum.

=Cretinism.= A congenital disease, characterized by goiter, stunted
    growth, swelled abdomen, wrinkled skin, wan complexion, vacant and
    stupid countenance, misshapen cranium, idiocy, and comparative
    insensibility. Disturbance of the function of the thyroid gland is
    accredited as the cause.

=Cystitis.= Inflammation of the urinary bladder.

=Dementia Præcox.= Any form of dementia beginning at puberty and marked
    by negativism, stereotypy, mannerisms, and verbigeration.

=Desquamation.= A scaling off. The separation of laminæ or scales from
    the skin, or from mucous or serous surfaces, or from bones.

=Dextrin.= A soluble carbohydrate into which starch is converted by
    action of diastase or dilute acids.

=Diabetes Mellitus.= A disorder of metabolism characterized by chronic
    hyperglycemia and glycosuria on a diet not containing excessive
    amounts of sugar, and associated with polyuria, polydipsia,
    polyphagia, emaciation; often dryness of the mouth and skin;
    sometimes boils, carbuncles, spontaneous gangrene, loss of sexual
    power, or nervous affections.

=Diuresis.= Increased discharge of urine, from whatever cause.

=Ductless Glands=. Glands without an excretory duct.

=Dynamometer.= An instrument with which to measure the force of muscular
    contraction, especially of the hand grasp.

=Ectropion.= Eversion of the edge of a part, especially of the eyelid or
    eyelids.

=Edema.= A swelling from effusion of serous fluid into the cellular
    substance.

=Emunctory.= Excretory. Any excretory duct of the body.

=Endometritis.= Inflammation of the inner lining membrane of the body of
    the uterus.

=Enemata.= Liquids or injections thrown into the rectum; clysters.

=Enteroptosis.= Prolapse of the intestines.

=Enzyme.= A ferment. A substance showing proteid-like reactions, easily
    destroyed by moderate heat, originating from living cells, either
    directly or through the intermediate stage of a pro-enzyme, and
    showing a metabolic activity in converting a specific substance or
    substances into certain other products in a manner and to an extent
    independent of the amount of enzyme present and without being itself
    used up in the process.

=Epiphysial.= Pertaining to or of the nature of an epiphysis.

=Epiphysis.= A piece of bone growing upon another, as the bulky
    extremities of long bone which are in early life separated by
    cartilage from the shaft.

=Epithelium, -lia.= Epithelial cells: cells which form the surface of
    the skin, mucous membranes, and line all canals having
    communications with the external air.

=Erythematous.= Of the nature of erythema; redness of the skin.

=Ethnographical.= Concerning the science of the characteristics of the
    human family.

=Etiology.= The science of the causation of disease.

=Exophthalmic Goiter.= Synonyms: Graves’s disease, Basedow’s disease. A
    disease marked by protrusion of the eyes, enlarged thyroid gland,
    anemia, and overaction of the heart.

=Extirpation.= The complete removal or eradication of a part by the
    knife or by caustic.

=Faradization.= A method of treating disease by a localized application
    of induction currents.

=Follicle.= A little bag: applied in anatomy to a very small cavity or
    tubular gland, as the hair glands and the sebaceous glands of the
    skin.

=Follicular.= Resembling or belonging to a follicle.

=Gastroptosis.= A downward displacement of the stomach.

=Glomerulus.= (1) A small, rounded mass. (2) A part of the kidney; a
    coil of blood-vessels projecting into the extended ends of each
    uriniferous tubule.

=Glycosuria.= The presence of sugar in the urine.

=Graves’s Disease.= (See Exophthalmic Goiter.)

=Hemianopsia.= Blindness in one-half of the field of vision of one or
    both eyes.

=Hemoglobin.= A red, crystalline substance, of uncertain and very
    complex composition, found in red blood-corpuscles of the venous
    blood, and believed to consist of hemochromogen and a proteid.

=Histology.= The science of the minute structure and composition of the
    different tissues of organized bodies.

=Hyaline Cast.= A nearly transparent and clear urinary cast.

=Hydrothyonuria.= The presence of hydrogen sulphide in the urine.

=Hyperactivity.= Abnormal activity.

=Hyperemia.= Excess of blood in any part due to increased influx or
    obstruction of the outflow.

=Hyperesthesia.= Morbid increase of the general sensibility, or of one
    of the special senses.

=Hyperleucocytosis.= Increase in the number of leucocytes in the blood.

=Hyperplasia.= The increase of the number of the individual structural
    elements of a tissue.

=Hyperpyrexia.= Abnormally high fever, especially when over 42° C. or
    106° F.

=Hypersecretion.= Excessive secretion.

=Hypertrophy.= Enlargement of a part or an organ, especially when due to
    over-nutrition.

=Hypothyroidia.= Diminished function of the thyroid gland.

=Impermeable.= Not permeable: not permitting a passage through.

=Interstitial Hepatitis.= Inflammation of the interstitial connective
    tissue of the liver.

=Interstitial Nephritis.= Acute or chronic inflammation of the kidneys.

=Lab-ferment.= The ferment (or enzyme) of rennet which coagulates milk,
    forming curds.

=Lactation.= The time or period of secreting milk.

=Lactic.= Pertaining to or derived from milk.

=Lanolin.= A body consisting of cholesterin and fatty acids obtained
    from sheep’s wool: used as a basis for ointments, especially with
    equal parts of petrolatum, on account of its ready absorption and
    its peculiar resistance to the growth of bacteria.

=Lecithin.= A complex nitrogenous fatty substance occurring widely
    spread throughout the animal body; chemically, a glycerophosphate of
    neurin.

=Leguminous.= Pertaining to the fruit or seed that is used as a food,
    such as peas, beans, etc., rarely any esculent vegetable.

=Leucocyte.= A white blood-corpuscle or one of the cells resembling it.

=Leucocytolysis.= The destruction of leucocytes, as by bacterial
    extracts.

=Leucomaine.= Any of a number of basic bodies, such as ornithin, the
    hexone and purin bases, etc., which are the normal products of
    tissue metabolism.

=Maceration.= The act of steeping a substance in hot or cold water,
    usually to extract its virtues.

=Maltose.= Malt-sugar, identical in composition with milk-sugar, but in
    its properties much more like grape sugar. It is derivable from
    starch or glycogen, by the action of saliva, pancreatic juice, or
    malt diastase.

=Menstrual.= Having to do with menstruation. The blood discharged in
    menstruation.

=Metabolism.= The process by which living cells or organisms are capable
    of incorporating substances obtained from food into an integral part
    of their own bodies.

=Metrorrhagia.= Excessive discharge (usually hemorrhagic) from the womb,
    especially when occurring at other times than during menstruation.
    Uterine hemorrhage.

=Molecular.= Pertaining to molecule. A very small particle of matter.

=Muscarine.= A poisonous alkaloid obtained from Agaricus muscarius.

=Mydriasis.= A preternatural or morbid dilatation of the pupil of the
    eye.

=Myxedema.= The name given to a condition characterized by a
    hyperplastic and modified deposit of connective tissue in all parts
    of the body.

=Narcosis.= The progress of narcoma or the production of narcotism by
    drugs, as opium, or by poisonous products originating in the body.
    Narcoma, stupor, or the state of being under the influence of
    narcotic medicine.

=Necrotized.= Lifeless.

=Nephritis.= Inflammation of the kidneys, which, when acute, involves
    chiefly the renal parenchyma, and, when chronic, either the
    parenchyma or the connective tissue or both.

=Neural.= Belonging to nerves.

=Neurasthenia.= Nervous debility. Nervous prostration. An exhausted
    condition with irritability; a functional derangement of the nervous
    system, either spinal or cerebral, due usually to overwork or other
    excessive expenditure of energy.

=Neuroglia.= The tissue, probably of ectodermic origin, forming the
    basis of the supporting framework of the nervous tissue of the
    cerebrospinal axis.

=Neuron.= The cerebrospinal axis.

=Neuropathic Constitution.= The nervous diathesis: that constitution of
    body and mind which predisposes to nervous disease.

=Nuclein.= The phosphorized proteid or nitrogenous substance found in
    cell-nuclei. It is believed to furnish the functional activity of
    the cell.

=Omnivorous.= Feeding or subsisting on food of all kinds.

=Oöphorectomy.= Excision of one ovary.

=Opsonin.= From opsono, “I prepare the ground for.” An undetermined,
    unstable substance in the serum of the blood that renders bacteria
    more susceptible to ingestion by phagocytes.

=Osteomalacia.= A chronic disease marked by progressive softening of all
    bones, due to the loss of their earthy constituents, so that they
    become flexible and fragile and unable to support the body.

=Oxidation.= The combining of a certain quantity of oxygen with metals
    or other substances. The formation of an oxide.

=Palpation.= Examination by the hand or by touch: manipulation of a part
    with the fingers for the purpose of determining the condition of the
    underlying organs.

=Pancreas.= A long, flat, racemose gland of a reddish color situated in
    the epigastric region beneath the stomach on a level with the first
    to the third lumbar vertebræ. Its function is an important part of
    the digestion of proteids, fats, and carbohydrates.

=Parametritis.= Inflammation of the connective tissues in the immediate
    vicinity of the uterus.

=Parathyroid.= Situated beside the thyroid gland. One of the small
    glands, usually four to five in number, distinct from the accessory
    thyroids, lying along the lateral lobes, and possessing an important
    internal secretion independent of the thyroid gland.

=Parenchymatous Tissue, Pulp Tissue.= The tissue forming the pulp or
    parenchyma of an organ.

=Pathology.= The doctrine or consideration of diseases, and, in a broad
    sense, of every deviation from normal structure, composition, or
    function. That branch of medicine which treats of disease, their
    origin, nature, and termination, special attention being paid to the
    disorders of function and alterations of structure preceding and
    resulting therefrom.

=Perchloride.= A chloride containing more chlorine than a protochloride.

=Percussion.= The act of striking any part of the body with the fingers,
    or with an instrument, to ascertain its condition by the sound
    obtained.

=Pericardium.= The membranous bag which contains the heart. It consists
    of an external layer of fibrous tissue and an internal serous layer,
    the latter of which surrounds the heart.

=Peristalsis.= A peculiar worm-like movement of the intestines and other
    tubular organs by which they gradually propel their contents onward.

=Pernicious.= Highly dangerous.

=Phagocytosis.= The ingestion of foreign bodies, microbes, etc., by the
    action of phagocytes (certain of the colorless blood-cells).

=Pigmentation.= The coloring matter in the skin.

=Pituitary Body.= The small ellipsoidal body which rests on the sella
    turcica and is attached to the base of the brain by a pedicle.

=Plethoric.= Fullness; a state marked by excess of blood in the vessels.

=Plexus Myentericus.= Auerbach’s plexus. A plexus of sympathetic fibers
    between the longitudinal and circular intestinal muscle-fibers.

=Pneumococcus (of Friedländer).= The bacterium of pneumonia.

=Polydipsia.= Excessive thirst.

=Polyuria.= A disease characterized by thirst and by a persistently
    excessive flow of watery urine.

=Porosity.= The state of having pores.

=Portal Veins.= The large veins entering the liver at the transverse
    fissure and bringing to it the blood from the digestive tract and
    the spleen.

=Prognosis.= The foreknowledge of the course of a disease drawn from a
    consideration of its signs and symptoms.

=Proliferation.= Reproduction of similar forms, both normal and morbid,
    but especially applied to cell-genesis.

=Propagation.= Reproduction.

=Prophylaxis.= The art of guarding against disease. The observation of
    the rules necessary to the preservation of health, or the prevention
    of disease.

=Proteid.= Any one of a class of complex, nitrogenous, levorotatory
    organic compounds forming the essential part of animal and vegetable
    tissues.

=Protozoa.= The name for the primary type of lowest division of the
    animal kingdom.

=Psoriasis.= A cutaneous disease, characterized by a rough, scaly
    cuticle, continuous, or in separate, irregular patches, generally
    with fissures of the skin, and occurring especially on the extensor
    surfaces of the body.

=Psychoses.= Disturbances of the mind.

=Ptosis.= A falling, or prolapsus, especially applied to a drooping of
    the upper eyelid due to paralysis of the levator palpebræ superioris
    muscle.

=Puerperium.= The state or period of confinement of a pregnant female.

=Pyrexia.= The state of fever.

=Radicle.= An ultimate division of a vessel or nerve.

=Retrograde-metamorphosis.= The process by which somewhat complex bodies
    are broken up into simpler ones, and in the end into waste products.

=Salicylate.= A salt of salicylic acid.

=Sebaceous.= Fatty. Suety. Applied to glands which secrete an oily
    matter resembling suet.

=Segmentation.= The process of division by which the fertilized ovum
    divides before differentiation into layers occurs.

=Sella Turcica.= The depression within the three clinoid processes of
    the sphenoid bone, lodging the pituitary body.

=Senility.= Old age.

=Septicemia.= Blood poisoning. Fever and prostration due to the entrance
    of pyogenic or other micro-organisms or ptomaines into the
    circulation.

=Serum.= The clear liquid which separates in the clotting of blood from
    the clot and the corpuscles, or any clear liquid resembling it.

=Skeletal.= Of or relating to a skeleton.

=Spermatorrhea.= An involuntary emission of semen without copulation.

=Spermin.= A preparation of the prostate gland and testicle of animals.

=Subcutaneous.= Situated, introduced, or living just under the skin.

=Sudorific.= Inducing or causing sweat.

=Suppurative.= Producing or discharging pus.

=Tabes Dorsalis.= Locomotor ataxia. A chronic disease due to
    degeneration and sclerosis of the posterior columns of the spinal
    cord, and marked by lightning-like flashes of pain and a peculiar
    gait.

=Tachycardia.= A disturbed condition of the heart’s action in which
    great acceleration of the pulse occurs.

=Tertiary.= Third degree.

=Theobromine.= A bitter, colorless, crystalline powder, capable of
    forming salts with acids, and sparingly soluble in hot water.

=Thymus.= A bilobed, elongated body which develops from the entoderm of
    the last two visceral clefts, and is situated in the neck and thorax
    of the newborn child.

=Thyroid Gland.= A reddish organ, one of the so-called ductless glands,
    giving rise to one or more internal secretions and situated in front
    of and on either side of the trachea.

=Thyroidectomy.= Excision of the thyroid gland or of its cartilage.

=Tonicity.= The state of normal tone or tension.

=Tortuosity.= Bent or twisted irregularly.

=Transudation.= The morbid passing or oozing of blood, or other fluid,
    practically unaltered, through the pores of the skin or membranes.

=Trypanosome.= One of any species of trypanosoma. The organism is a
    spindle-shaped, more or less elongated, protoplasmic body,
    containing two chromatic masses, a centrosome generally placed at
    the posterior end and a larger nucleus mesially situated, with a
    flagellum and an undulatory membrane, starting from the centrosome,
    and running along the protoplasmic body.

=Trypanosomiasis.= A diseased condition produced by trypanosomes.

=Trypsin.= A ferment of pancreatic juice which has the power of
    converting proteids into peptones, best in alkaline solution, but
    also active in neutral solution.

=Unesthetic.= Not having lost sensation.

=Unossified.= Not having formed bone.

=Urea.= A white, transparent, crystallizable solid, the principal solid
    constituent of urine.

=Uric Acid.= A crystalline substance obtained from urine.

=Urotoxic.= Relating to the poisonous elements of the urine.

=Urticaria.= “Hives.” An exanthematous fever characterized by an
    eruption like the elevations produced on the skin by the sting of a
    nettle, and attended with burning and itching.

=Vascularization.= The act or process of becoming vascular, as in
    neoplasms, thrombi, etc., or furnished with new blood-vessels.

=Vasodilatation.= Widening of the walls of the blood-vessels; admitting
    more blood to the periphery.

=Vermicular.= Worm-like.

=Viscosity.= Adhesiveness.


------------------------------------------------------------------------




                                 INDEX.


 Abderhalden, 333, 336.

 Abelard, 43.

 Abelmann, 447.

 Abelous, 161.

 Achard, 204, 286.

 Acne, microbes in, 213.

 Acton, 391.

 Adami, 9, 150, 156.

 Adcock, Sir Hugh, 43.

 Adler and Hensel, 162.

 Adler, Isaac, 107, 169, 366.

 Adler, Max, 322.

 Adrenals and circulatory system, hygiene of, 164.
   adrenal hypersecretion, 165.
   adrenals and cardiac nerves, 164.
   agencies, harmful, to avoid, 166.
   arteriosclerosis, 164, 165.
     causes of, 165.
     high blood-pressure and, 164.
       and kidney disease, 165.
         blood-test for, 165.
     preventives of, 168.
   atheroma, 164.
   mental emotions, 165.
   sexual glands, 165.
   thyroid gland, 166.
   tobacco a stimulant of, 427.

 Aeschbacher, 431.

 Age, old, blood-drinking for, 332.
   commandments for, 455.
   milk diet for. See _Diet, milk_.
   premature, from alcohol, 352.
   prevention and treatment of,
     arsenic, 426.
     for women, 427.
     for sexual glands, 429.
     in mineral waters, 428.
   gland, thyroid, 434.
     iodides for, 431.
       for arteriosclerosis, 431.
     iron, 429.
       for sexual glands, 429.
     kidney extracts, 445.
     ovarian extracts, 440.
     pancreatic extracts, 445.
     prostatic extracts, 445.
     spermin, 444.
     testicular extracts, 441.
   value of vegetarian diet to prevent, 311.

 Air, close, 272.
   fresh, automobiling for, 266.
     forests, 267.

 Air, mountain, 266.
   indoor, results of, 277.
   outdoor, benefits of, 277.
   vitiated, 264.

 Albertoni, 35, 86, 141, 142.

 Albuminuria from constipation, 202.

 Alcohol habit, cause and prevention of, 356.
     gland, thyroid, exhaustion of, as cause of drunkenness, 357.
     glands, sexual, and, 360.
     preventive, 361.
     treatment of, 361.
       ovarian extracts, 361.
       thyroid, 361.
   immunity to large doses of, 356.
   persons easily affected by, 359.
   quantities, large, effects of, 350.
     age, old, premature, 352.
     arteriosclerosis, 350.
     brain, 350.
     delirium tremens, 353.
       progeny of, 353.
     epileptics, 353.
     genealogy, a terrible, 353.
     glands, ductless, 351.
       liver, 351.
       kidneys, 351.
       pituitary, 351.
       sexual, 351.
       thyroid, 352.
     heart muscles, 350.
     insanity, 350.
       and crime, 351.
     in tropical climates, 353.
     on children, 354.
     on thyroid gland, 357, 358.
   quantities, large, immunity to, 357, 358.
   resistance, diminution, 351.
     diseases, nervous, 352.
     fever, yellow, 352.
     myxœdema, 352.
     of powers of, 352.
     pneumonia, 352.
     scrofulosis, 352.
     tuberculosis, 352.
   uses of, 347.
     as a preservative of tissues, 348.
     as a stimulant, 348.
       circulatory apparatus, 348, 349.
       nervous system, 348.
       wine, 348.
       beer, 348.
       brandy, 349
       disadvantage, 349.
       for snake poison, 358.
       least injurious, 349.
       longevity, 350, 355.
       most injurious, 349.
       overabundance, effect of, 348.
       tonic, 349.
       whiskey, 349.
       wine, 348, 349.

 Allbutt, Clifford, 406.

 Amato, 80.

 Amberg, 164.

 Anderson, Mrs., 105.

 Ansele, 442.

 Appearance, youthful, hints on, 449.
   baths, 454.
   diet, 453.
   disposition, cheerful, 450.
   drugs, 451.
   exercise, 450, 454.
   glands, sexual, 452.
   hair, 452.
     and thyroid gland, 453.
   skin, care of, 449.
   slenderness, 453.
   teeth, care of, 451.

 Appendicitis. See _Intestines_.

 Arloing, 212, 256.

 Arteriosclerosis, etiology, 165, 167.
   diet, 165.
     coffee, 165.
     meat, 165.
     tea, 165.
   diseases, infectious, 165.
     syphilis, 165.
   in brain workers, 423.
   poisons, 165.
     alcohol, 165.
     lead, 165.
     mercury, 165.
     tobacco, 165.
   preventives of, 168.
     adrenals, reduction of activity of, 168.
     blood, viscosity of, 168.
     diet, 168.
     exercise, 168.
     thyroid, increase of activity of, 168.

 Atwater, 287, 348.

 Aubert, 209.

 Aubertin, 161.


 Baelz, 283.

 Baldwin, 39, 394.

 Ballet and Enriquez, 27.

 Bamossi, 151.

 Bang, 325.

 Basch, 169.

 Baumann, 91, 118, 152, 323, 431.

 Bayon, 5, 23, 98.

 Beck, Charles, 414.

 Bedclothing, 229.

 Behring, 326, 327.

 Benda, 4.

 Benedict, 287, 348.

 Berger, 18.

 Bernard and Bigart, 161.

 Bernard, Claude, 125, 169, 335, 391, 439.

 Bertrand, 427.

 Besançon, 334.

 Bianchini, 298.

 Bickel, 339, 340, 341, 344.

 Bier, 337.

 Binz, 369, 371.

 Bircher, 392.

 Blood as food, 333, 337.
   chemicals in, 335.
   experiments with, 337.
   ferments in, 335.
   immunizing substances in, 336.
   iron in, 333.
     in drugs, 333.
     in food, 333.
     lack of, in chlorosis, 333.
       in anæmia, 333.
     organic and inorganic, 333.
       blood, 334.
         best, 335.
     eggs, 334.
     nuclein of eggs, 333.
     spinach, 334.
   ox, 336.
   pigs’, 335, 336.
     extracts in, 335.
     puddings, 335.
     sausages, 335, 336.
   transfusion, dangers of, 337.

 Blum, 5, 9, 22, 35, 86, 96, 139, 142, 145, 318, 329, 375, 431.

 Blumenkranz, 232, 241.

 Blumenthal and Jacobi, 83.

 Boas, 202.

 Bocci, 153.

 Boerhaave, 425.

 Boix, 153.

 Bokenham, 9, 150.

 Bonardi, 56.

 Bonnamour, 161.

 Bordet, 134.

 Borylac, 162.

 Bosse, 444.

 Böttger, 364.

 Boubnoff, 258.

 Bouchard, 142, 153, 154, 371.

 Bouchard and Hanot, 156.

 Bouchut, 298.

 Bouin, 442.

 Boverie and Loeper, 162.

 Breathing, deep, 267.
   benefits of, 269.
   contra-indications, 269.
   nasal, 270.

 Breisacher, Leo, 5, 9, 22, 138, 145, 318, 329.

 Brieger, 34, 172.

 Brissaud, 311.

 Brown, 105.

 Brown-Séquard, 8, 32, 125, 159, 198, 391, 410, 442, 443, 444, 445.

 Brunton, Sir Lauder, 9, 150, 169, 245, 268, 366.

 Buchner, 134.

 Buddha, 396.

 Bukojemsky, 444.

 Bunge, 204, 205, 210, 285, 286, 297, 305, 306, 307, 333, 335, 336, 337,
    365, 368, 370, 430.

 Burghart, 440.


 Camerer, 238.

 Campbell, 111.

 Campbell, Harry, 268, 343.

 Camus, 445.

 Carrion, 31.

 Casselli, 31.

 Cecca, 103.

 Celibacy, 402.

 Celsus, 256.

 Charcot, 84, 96, 257, 415.

 Charrin, 21, 140, 160, 161, 323.

 Chittenden, 282, 283.

 Christern, 371.

 Christiani, 438.

 Chroback, 441.

 Circulatory system and adrenals, hygiene of, 164.

 Cirrhosis, hepatic, production of, 153.

 Clothing, rational, 219.
   (See _Skin, Hygiene of_.)

 Cohendy, Michel, 185, 186.

 Cold, to prevent, 233, 278.
   feet. See _Feet_.

 Combe, 7, 102, 184, 186.

 Constipation, habitual, prevention and treatment of, 175.
   conditions, associated, in women, 176.
   diet for, 178.
   drugging for, 190.
   emotions, effect of, 175.
   fermentation, 188.
   glands, ductless, 176.
     sexual, 176.
       hygiene of, 176.
   nerves, intestinal, 176.
     splanchnics, 176.
   prevention of, 176.
     diet, 176, 178.
       cereals, 176, 177.
       fruits, 177.
       meat, 176.
       milk, 178.
       special, 178.
       vegetables, 177.
   thyroid, effect of, 175.
   treatment, 179.
     cascara sagrada, 180.
     electricity, 179.
     enemata, 179.
     hydrotherapeutics, 179.
     laxatives, 180.
     massage, 179.
     mineral waters, 180.
     rectum, irrigation of, 179.
     rhubarb, 180.
   vagus, action of, 175.

 Cornaro, 292, 401.

 Cornil, 32, 47.

 Crispino, 5, 23, 98.

 Cunningham, 51.

 Cyon, 31.


 Danilewsky, 281.

 Darier, 165.

 Darnecy, 41.

 D’Arsonval, 32, 443, 444.

 Delcour, 135, 136, 196.

 De l’Enclos, Ninon, 54.

 Dellamare, 93, 167.

 Demange, 110.

 Demange and Oettinger, 96.

 De Manasseine, Marie, 368.

 Demme, 353.

 Denison, Charles, 260.

 De Quervain, 5, 23, 25, 98, 104, 352, 357.

 Dercum, 44, 110.

 Determann, 168, 320.

 Dettweiler, 310.

 Dever, 337.

 Diabetes, opium in, 356.
   sleepiness and, 376.

 Diamare and Kuliabko, 78.

 Diet, blood. See _Blood_.
   for habitual constipation, 178.
   meat, avoidance of, in aged, 323.
       in infancy, 323.
     boiled, 322.
     canned, 322.
       preservatives in, 322.
     catharsis for, 324.
     dangers of, 317.
       heaviness following, 317.
       in disease, 317.
     dangers of, nervous disorders, 317.
     results of, 317, 324.
       absence of, from, 321.
       in diabetes, 320.
       in gout, 320.
       on ductless glands, 317.
       on kidneys, 319.
       on pancreas, 319.
       on uric acid formation, 320.
     fresh, 322.
     moderate, 322.
     on circulatory apparatus, 320.
     putrefaction, 324.
       acids for, 324.
     roasted, 322.
     water and, 323.
     white, 322.
   milk, additions to, 329.
     advantages of, 330.
       for old age, 330, 332, 335.
     antiseptic action of, 331.
     asses’, 332.
     boiled, 327.
     digestibility of, 329.
       ease of, on kidneys, 330.
         on liver, 330.
         on stomach, 330.
     for athyroidia, 329.
     goats’, 332.
     human, 331.
     ideal, 328, 331.
     in childhood, 330.
     kefir, 329.
     longevity by, 329.
     of thyroidectomized goats, 326.
     raw, 327.
     secretions of ductless glands in, 325.
     substances in, 325, 326.
       in acid fermented, 328.
     suppression of myxœdema by, 325.
     yogurth, 329.
   vegetarian, advantages of, 309, 310, 311.
     age, old, value to prevent, 311, 312.
     conditions improved by, 321.
     disadvantages of, 309, 312, 313, 314.
       anatomical, 309.
     diseases avoided by, 310, 311.
     diseases from, 313, 314.
       condition for, 314.
       predisposition to, 314.
     lack of obesity from, 311.
     results of, 315.
     to reduce uric acid, 311.
     with proteids and fats, 309, 310.
     Diet, vegetarian, with proteids and fats, in disease, 310.

 Disease a self-defense, 419.
   benefits of, 420.
   early recognition of, 421.
   treatment, 421.

 Dubois, 446.

 Duclaux, 256.

 Du Perron, 402.

 Dupuytren, 42.

 Dürig, 37.

 Dwellings, situations for city, 264.


 Easterbrook, 27.

 Eating, appetite, æsthetics for, 342.
   checking, 340.
   conditions producing, 340.
   lost, in the sedentary, 340.
   normal, 340.
   stimulation for, 341.
     bouillon, 341.
     exercise, 342, 344, 345.
     _hors d’œuvres_, 341.
     smörgasbord, 341.
     tongue washing, 341.
     vinegar and water, 341.
   dinner, rest before and after, 341.
   food, most digestible, 345.
     butter, 345.
     cereals, 345.
     fat, 345.
     meat, 345.
     vegetables, 345.
   gastric juice, adequate supply of, 339.
     augmenting, 339.
       mentally, 339, 340.
         sight, 339.
         smell, 339.
         taste, 340.
   hygiene of, 339.
     insalivation, 342.
       advantages of, 343.
   meals, companions at, 342.
     drinking with, 344.
     time for, 344.
   reading while eating, 342.
     exceptions, 342.
   saliva, secretion of, 342.
     stimulation of, 342.
       mastication, 342.
   teeth and, 344.

 Eberson, 414.

 Echlin, 374.

 Eckermann, 53.

 Edgreen, 165, 169.

 Edmunds, Walter, 22, 35, 96, 140, 373, 388, 438.

 Edwards, 256.

 Ehrmann, 453.

 Eiselsberg, 5, 96, 167.

 Eisenheart, 47.

 Elberskirchen, Johanna, 397.

 Emden, 152.

 English, 202.

 Erb, 396.

 Erdheim, 19, 91, 92, 144.

 Espagno, 105.

 Esser, 367.

 Ewald, 3, 90, 93, 172, 290, 434, 435.

 Exercise, advantages of, 251.
   benefits of, 244.
   breathing, 262.
   effects of, 244.
   massage, antiquity of, 245.
     by self, 247.
     effects of, 245, 246.
       on heart, 246.
       Harvey, 245.
   sports, 247.
     best, 248.
     climbing, 250.
       for heart trouble, 251.
       Oertel’s treatment, 251.
     contra-indications, 247.
     cycling, 249.
     dilatation of heart, 248.
     effects of, 247.
     horseback riding, 248.
     riding, 249.
     running, 250.
   Swedish gymnastics, 245.
     Ling, Peter, 245.
     Mitchell, S. Weir, 245.
   to induce perspiration, 239.
   treatment, Nauheim, 246.
   walking, 249.


 Farwick, 336.

 Fassin, 28, 136.

 Feet, cleanliness of, 234.
   cold, 252.
     cause, 252.
       circulation, 252, 254.
         senile gangrene, 254.
       clothing, 252.
         shoes, 252.
         socks, 253.
     treatment, 253, 254.
       exercise, 253.
       massage, 253.
       rubbing, 253.

 Fehling, 14.

 Ferranini, 164.

 Finsen, 256, 257, 258, 261.

 Fishel, 202.

 Fisher, Emil, 364.

 Flamini, Mario, 325.

 Fleischer, 46.

 Fletcher, Horace, 282, 292, 343.

 Flexner, 311.

 Flourens, 50.

 Food, blood. See _Blood_.
   carbohydrates, 301.
     cellulose, 308.
       advantage of, 308.
     vegetables, 301.
       diet, rational, 304.
       disadvantages of, 302.
       fats in, 301.
       leguminous, 301.
         albumin in, 301.
         butter with, 304.
         composition of, 301.
         containing iron, 306, 307.
       minerals, 305.
         lime, 305.
         iron, 305.
       potatoes, 304.
       rice, value of, 302.
   digestibility, 289, 290, 291.
     cold, 291.
     hot, 291.
     in aged, 290.
     in robust, 289.
   hygiene, 280.
     albumin, 283, 284.
     bouillon, 287.
     carbohydrates, 281, 284.
     condiments, 286.
       harmfulness of, 286.
       sauces, 286.
       vinegar, 286.
     diet, model, 292, 293.
     eating, excessive, 280.
     experiments, 282, 283.
     fats, 281, 284.
     feeding, over-, dangers of, 280.
       principle of, 280.
       under-, dangers of, 280.
     groups of, 281.
     in pregnancy, 285.
     iron, 286.
     keynote, 291.
     minerals, 285.
     nutritive value of, 281.
     potatoes, 286.
     proteid, 281, 284.
     rice, 283, 286.
     salt, 285.
       alkali, 286.
     soup, 287.
     stimulants, 287.
       alcohol, 287.
         beer, 287.
         whiskey, 288.
         wine, 288.
       cocoa, 289.
       coffee, 289.
       tea, 289.
       tobacco, 289.
     three kinds, uses of, 284.
     time for meals, 292.
       Food, hygiene, water, 285.
       hard, 287.
       in foodstuffs, 287.
       with meals, 287.
   most digestible, 345.
   preparation of, 289.
   proteid, 294.
     albumin, 294.
     animals, examination of slaughtered, 295.
     butter, 298, 303.
     cheese, 298.
       digestion of, 299.
       putrefaction of, 299.
     eggs, 299.
     fish, 296.
     meat, 294.
       composition of, 294.
       cold storage, 295.
       extractives, 295.
     milk, 296.
       composition of, 296, 297, 298.
     most perfect, 300.
     oysters, 295.
   quantity of, 289.
   sausages, 296.
   too rich, 289.
     diseases caused by, 289.
     weather requirements of, 289.

 Fordyce, 330.

 Förster, 305.

 Forsyth, 318, 330.

 Forsyth, D., 22.

 Franklin, Benjamin, 260, 281.

 Fraser, 151.

 Frerich, 83.

 Fries, 167.

 Frithe, 367.

 Fröhlich, 18.


 Galeotti and Lindemann, 22, 140.

 Gall, 41.

 Garnier, 13, 23, 27, 31, 57, 58, 141, 314, 431, 438.

 Gasne and Laude, 13.

 Gassenghi, 30.

 Gauthier, 14, 427.

 Geist, 334.

 Generali, 144.

 Georgiewski, 24, 27.

 Gibson, 432.

 Gibson, G. A., 4, 435.

 Gilbert, 8, 84.

 Gilbert and Carnot, 446.

 Gillet, 298.

 Glaesner, 152.

 Gland. See individual glands, by name.
   thyroid, administration of, skin eruptions following, 213.
     a function of, 139.
     Gland, thyroid, alcohol and chloroform on, 357.
     and alcohol, 356, 357.
     and temperature, 237.
     death following extirpation of, 138.
     degeneration of, in alcoholics, 352.
     exhaustion of, 357, 358.
     extirpation of, effects of, 167.
     hyperactivity as cause of drunkenness, 357.
     in infants, 323.
     maintaining life after extirpation of, 139.
     milk as stimulant of, 330.
     results of disease of, on other organs, 141.
       intestines, 143.
       kidneys, 142, 143.
       liver, 141, 142.
     sleeplessness and, 369.

 Glands, ductless, effects of meat on, 317.
   secretions of, in blood, 335.
     in milk, 325.
   parathyroids, influence on convulsions, 144.
   sexual, abuse of, 390, 391, 392.
     arsenic for, 429.
     diseases of, 389.
       frequency of, 391.
     hygiene of, 389.
     hyperactivity of, 213.
     inactivity of, 393.
       treatment of, in unmarried, 398.
     intercourse, too frequent, 390.
     interrupted, 392.
     iron for, 429.
     marriage, age for, 392.
   sudorific, 215, 226.
   thyroid, destruction of poisonous products through, 138.

 Gley, 3, 142, 144, 374, 445.

 Goethe, 43, 53.

 Goldscheider, 212.

 Gombault, 84.

 Gouget, 199.

 Gout, skin diseases in, 213.

 Graffenberger, 257.

 Grawitz, 257, 313, 334, 337, 427, 430.

 Greenfield, W. S., 21.

 Groedel, 164.

 Gruber and Durham, 134.

 Grundzach, 185.

 Guerrini, 31.

 Guieysse, 99.

 Guilbert, Yvette, 101.

 Gumprecht, 154.

 Gunzburg, 200.

 Gymnastics. See _Exercise_.


 Haig, 131, 242, 288, 299, 320, 321, 364.

 Halck, 83.

 Hall, Walker, 131, 288, 302, 310, 320.

 Hallion, 31.

 Hamel, 268.

 Hanot and Boit, 156.

 Hanseman, 77.

 Harnack, 430.

 Harvey, 49, 50, 245, 455, 456.

 Haüsermann, 333.

 Heating, artificial, air, indoor, effects of, 277.
   air, outdoor, effects of, 277.
   cold, catching, avoidance of, 278.
     from warm rooms, 277.
   diseases, respiratory, 278.
   for old people, 275.
   for young people, 275.
   hot water, 279.
   hygiene of, 275.
   method of, most rational, 276.
     fireplace, open, 276.
   railways, overheated, 278.
   steam, injuriousness of, 278, 279.
     effects after, 279.
     mitigation of, 279.
     radiators, dusty, 279.
     tonsillitis from, 278.
   temperature, high, 275.
       without ventilation, 275.
     indoor, best, 276.

 Hegar, 46.

 Heger and Buys, 150.

 Heger, Paul, 149.

 Heinz, 431.

 Hemmeter, 149, 202.

 Hemp, 326.

 Hensel, 107, 169.

 Hercod, 354.

 Heredity and the ductless glands, 352.

 Hertoghe, 5, 12, 13, 14, 15, 25, 29, 37, 58, 68, 83, 95, 102, 104, 126,
    352, 357, 434, 440.

 Herter, 185.

 Hesse, Walter, 326.

 Heyn, F., 120.

 Hippocrates, 256.

 Hirsch, 444.

 Hirschfeld, 152.

 Hochenegg, 44.

 Hofmeister, 4, 104.

 Holm, 259.

 Horsley, Sir Victor, 3, 90, 91, 93, 435.

 Houssaye, 318.

 Huchard, 107, 168, 169, 199.

 Hueppe, 353.

 Hufeland, 50, 260, 288, 337, 367, 424.

 Hugo, Victor, 54.

 Huler, 202.

 Humphrey, 324, 355.

 Hun, 142.

 Hunt, 23, 141.

 Hutchison, 131, 325.

 Hutchison, R., 363, 364.


 Ibsen, 54.

 Inada, 168.

 Indian, longevity of, 265.

 Insomnia. See also _Sleep_.
   treatment of, 384.
     medical, 386.
       milk of thyroidectomized goats, 388.
       serum of thyroidectomized goats, 387.
     preventive, 384.
       bath, 385.
       hygiene, 384.
       room, 385.

 Intestines, hygiene of, 182.
   acid, lactic, 184, 185, 186.
     bacillus maya, 184.
     yoghurt, 184.
   albumins, prepared, 183.
     for the aged, 183.
   appendicitis, 192.
     adenoids, 196.
     cause and prevention of, 192.
     causes of, 194, 195.
     constipation, 194.
     exercise, 194.
     psoas, influence of, 192.
     test for, 194, 195.
     tonsils, 195.
   assimilation in the aged, 183.
   bowel movement, residue after, 191.
   constipation, 188. See _Constipation_.
     and fermentation, 188.
     appendicitis from, 191.
     drugging for, 190.
   corsets, effects of, 190.
   defense, natural, 184.
     liver, 184.
     thyroid, 184.
   diet, 186.
     fats, 186.
     cheese, 186.
   diseases of, coincident with stomach disorders, 182.
   drinks, ice-cold, 187.
   enemata, 191.
   fæcal impaction, 191.
   Intestines, hygiene of, food, quality of, 187.
   foods, 184.
     injurious, 187.
       canned, 187.
       fish, 187.
       fruits, 187.
       meats, 187.
       oysters, 187.
       preservatives, 187.
       sausages, 187.
       unmasticated, 182.
         fermentation of, 182.
     poisonous effects, 184.
   glands, sexual, 189.
   habits, 189.
   purgation, 188.
   putrefaction, 183, 184, 186.
     meat, 186.
   water, lack of, 191.

 Iron. See _Blood, iron in_.
   in drugs, 333.
   in food, 333.
   lack of, in anæmia, 333.
     in chlorosis, 333.
   organic and inorganic, 333.


 Jaffé, 202.

 Javal, 286.

 Jayle, 104.

 Jeandelize, 13, 92, 141, 142, 144.

 Jersoni, 44.

 Jollin, 323, 431.

 Josué, 5, 162, 163.


 Kant, 415.

 Keill, James, 51.

 Keller, 205.

 Kende, Maurice, 354.

 Kidney disease, test for, 165.

 Kidneys, benefits of sweating upon, 242.
   hygiene of, 203.
     alcohol, 205.
     casts, hyaline, 203.
     clothing, 208, 231.
     diet, lacto-vegetarian, 204.
     diseases, infectious, 206.
     drugs, 206.
     importance of, 215.
     intestines, 207.
     liver, 204.
     meat, 204.
     milk, 204.
     rhinitis and, 207.
     rice, 205.
     salt, 204, 215.
     sauces, 205.
     skin, 207, 215.
     spices, 205.
     tea, 205.
     tonsillitis and, 207.
     Kidneys, hygiene of, water, 206.
       mineral, 206.
   internal secretion of, 198.
   milk an ideal food for, 331.
     diet and, 330, 331.

 Kisch, 46, 391, 392, 395, 398.

 Kishi, 96, 140, 142.

 Kitasato, 34.

 Klausner, 353.

 Kliffel, 80.

 Kobler, 202.

 Koch, 151, 373.

 Koch and Kraepelin, 363.

 Kocher, Albert, 24, 431.

 König, 299.

 König, T., 336.

 Koranyi, Alexander, 205.

 Kossel, 333.

 Kovesi, 205, 241, 242.

 Krafft-Ebing, 396.

 Kraut, C., 336.

 Kreis, 371.

 Kretschy, 46.

 Krüger, 34.


 Laache, 126, 434.

 Labbé, 334.

 Labbé, Marcel, 311.

 Laitinen, 353, 354.

 Landau, 46, 441.

 Langhans, 92.

 Langlois, 159, 160, 161.

 Lanz, 21, 22, 24, 27, 57, 72, 140, 196, 326, 388, 442, 445.

 Latzko, 104.

 Laulanié, 142.

 Launois, 95, 99, 384.

 Lautenbach, 150.

 Lefas, 80.

 Legrain, 352.

 Legry and Renault, 13.

 Lehman and Strassmann, 46.

 Lehmann, 306.

 Leichtenstein, 202.

 Lemaire, 165.

 Lenkey, 258.

 Leube, 241.

 Leuret and Hoffmann, 41.

 Levi, Leopold, 408.

 Levy, Magnus, 238, 323, 374.

 Leyden, 47.

 Liebermeister, 233.

 Life, indoor, 262.
     effects of, 263.
     examples of, 262.
   married, as a means of morality, 401.
     children in, 401.
     disease, venereal and, 401.
     happiness in, 400.
     longevity, 403.
     Life, married, meals and, 402.
     means for prolonging life, 400.
     sickness and, 401.
   open air, 262.
     effects of, 262, 263.
     examples of, 262, 267.

 Ling, Peter, 245.

 Lingard, 32.

 Liver, hygiene of, 155.
   bathing, 158.
   climates, hot, 157.
     hypertrophied liver, 157.
   diet, alcohol, 155.
     best, 157, 158.
     condiments, 155.
     meat, 155.
     milk, 155, 157.
     spices, 155.
     stimulants, 155, 157.
     vegetable, 155, 157, 158.
     water, 157.
   milk diet and, 330, 331.
   other organs and, 155.
     intestines, 155.
     pancreas, 156.
     stomach, 156.

 Livon, 31.

 Loeper, 286.

 Loewy, 18, 33, 233, 441, 444.

 Loewy, A. and Y., 266.

 Loewy and Richter, 97.

 Lohrisch, 188.

 Loisel, 42, 393.

 Longevity, alcohol and, 350.
   greatest, 266.

 Longfellow, 125.

 Lucas Championnière, 46.

 Ludwig, 244.

 Luksch, 161.

 Lunin, 305.

 Luntz, 266.

 Lussana, 150, 151.

 Luther, 391, 396.

 Luttje, 200.

 Luzatti, 298.


 Macallum, 144.

 Mackenzie, 142.

 Mackenzie, Hector, 434, 435.

 Mac Means, 352.

 Madelung, 19.

 Magnus-Levy, 17, 95.

 Mahomet, 96.

 Manfur, 298.

 Marbé, 28.

 Mariagalli and Negri, 46.

 Marriage, age for, 392.

 Marti, 257.

 Martin, 353.

 Masey, 248.

 Massage. See _Exercise_.

 Meat. See _Diet_.

 Mendel, Lafayette, 323.

 Mering and Minkowski, 77.

 Merklen, 298.

 Merschejewski, 46.

 Metschnikoff, 47, 51, 53, 98, 112, 124, 184, 185, 329.

 Metschnikoff and Matschinski, 32.

 Meyer, E., 8, 198, 447.

 Milk. See _Diet_.
   of thyroidectomized goats, 326.
   raw, for stomach, liver, and kidneys, 330.

 Mind, hygiene of, 404.
   arteriosclerosis in, 423.
   brain workers, advice to, 423.
     bedtime, 424.
     exercise, 424.
     mealtime, 424.
     moderation, 423, 424.
     outdoor life, 424, 425.
     rest, 423.
   diseases from, 404.
     diabetes, 404, 405.
   emotions, strong, death from, 404, 407.
     organs affected by, 405.
       adrenals, 405.
       hair, 406.
       liver, 406.
       pancreas, 406.
       pituitary, 405.
       sexual glands, 406, 409.
       stomach, 411.
       thyroid, 405, 408, 409.
   ideational channels, 411.
     causes of depressed, 411, 412.
     enlivening, 413.
   life, religious belief for prolonging, 414.
       Cause, the great, 416.
       effect on anæsthesia, 415.
       faith, 414.

 Minervini, 93.

 Mingazzini, 39, 394.

 Minkowski, 80.

 Minnich, 167.

 Mintz, 259.

 Mitchell, S. Weir, 245.

 Moebius, 25, 41, 42, 43, 53, 357, 387.

 Mohammed, 391.

 Mohn, 258.

 Moleschott, 256.

 Molière, 199.

 Morat and Doyon, 83.

 Moritz, 248.

 Moro, 298.

 Morvan, 7, 102.

 Moschini, 161.

 Moses, 391.

 Mossé, 304, 325, 370, 391, 443.

 Müller, 168.

 Müller, Friedlich, 206.

 Muller, P., 47, 168.

 Murray, 71.

 Murray, G., 21, 126, 142, 434.


 Napoleon, 43.

 Narbuth, 18.

 Naunyn, 84, 248, 334, 404.

 Nehring, 95, 374.

 Neisson, 350.

 Nencky, 152.

 Neugebauer, 392.

 Neusser, 85, 142.

 Nicholas, 161.

 Nobecourt, 298.

 Nuclein for yolk of eggs, 333.

 Nuttall and Thierfelder, 170.


 Obersteiner, 368, 371.

 Obolenski, 446.

 Oertel, 251.

 Oeruni, 257.

 Oesterreicher, 56.

 Offer, 322.

 Offerhaus, 192, 193.

 Old age, milk diet for. See _Diet, milk_.

 Oliver and Schäfer, 5, 31, 69.

 Opie, 77, 80.

 Opium in diabetes, 356.

 Oppenheim, 160, 434.

 Oppenheim and Loeper, 160.

 Ord, 7, 96, 102.

 Ortner, 212.

 Oser, 169.

 Oswald, 91, 325.

 Ottfried, 168.

 Ouspenski, 444.

 Ovaries, influence of, on the blood, 334.

 Owen, Sir Isambard, 350.


 Paris, Matthew, 45.

 Parr, 329.

 Parr, Thomas, autopsy on, 455.

 Pasha, Emin, 353.

 Paterson, 452.

 Paton, James, 221.

 Pavy, 19.

 Pawlow, 69, 77, 339, 340, 344, 406.

 Pel, 21, 58, 105, 106, 405, 456.

 Pelikan, 45.

 Penzoldt, 200.

 Perrando, 13, 57, 58.

 Perrin, 141.

 Pettenkoffer, 209, 221, 263, 273.

 Pflüger, 50, 456.

 Pigeolet, 392.

 Pilcz, 36, 374.

 Pineles, 4, 92, 111, 144, 167.

 Plato, 390.

 Plutarch, 107.

 Poehl, 33, 127, 443, 444.

 Poison, snake, alcohol for, 358.

 Politiman, 105.

 Pomeroy, 391.

 Poncet, 12.

 Posner, 306.

 Pottenger, 265.

 Pregl, 443.

 Products, poisonous, destroyed through thyroid and parathyroid glands,
    138.
   thyroidectomy, effects of, 138.
     on animals, meat-fed, 138.
     on animals on meatless diet, 138.
     on animals on milk diet, 138.
   toxic, destruction of, by adrenals, 159.
     after adrenalectomy, 159.
     from muscular exercise, 368.
     immunizing constituent, 159.
     infectious diseases, 160.
     microbes, 160.
     poisons, microbic, 161.
   destruction of, by the liver, 149.
     albuminoids, 152.
     carbohydrates, 152.
     enlargement of liver, 153.
     excretion of, 150.
       bile, 150.
       urine, 153.
     hepatic cirrhosis, 153.
     reduction in liver disease, 154.
   elimination of, through intestines, 170.
     constipation, 172, 202.
       internal, 173.
     fæcal intoxications, 172.
     intestines, microbes in, 170.
       effect on liver, 170.
     purgation, regular, 173.
     secretions, anti-bacterial, 174.
   elimination of, through kidneys, 197.
     albuminuria, 199.
       from constipation, 202.
     casts, urinary, 199.
     chloroform, 201.
     drugs, poisonous, alcohol and, 200.
     kidneys, internal secretion of, 198.
     liver and, 199.
     mercury, 201.
     mustard and, 200.
     pepper, 200.
     potassium chloride, 200.
     radishes, 200.
     Products, toxic, elimination of, salicylates, 201.
     tea, black, 200.
     thyroid and, 198.
   elimination of, through the skin, 209.
     carbonic acid, 209.
     perspiration, 210, 212.
     retention of, 211.
     skin, causes of diseases of, 212.
       burns, 212.
       eruptions of, 213.
       glands of, 209.
       respiration through, 210.

 Prudden, 142.

 Prun-Hudden, 85.

 Puddings, blood, 335.


 Quarters, ill-ventilated, dangers of, 271, 272.
   air of, 272.
     microbes in, 272.
   infectious diseases from, 272.
   persons, sickly, 271.
     unused to, 271.
   schoolrooms, 273.
   sleeping room, 273.
     flowers in, 273.
     furnishings of, 273.
     ventilation of, 274.
     windows, open, 273.

 Queirolo, 212.

 Quincke, 156.


 Rechenberg, 283.

 Remlinger, 168.

 Renaut, 446.

 Rénon, 402.

 Rénon and Delille, 31.

 Rénon, Delille, and Azam, 32.

 Richter, P. I., 18, 33, 205, 441, 444.

 Rieger, 41.

 Rigaud, 39, 393, 394.

 Riva, 337.

 Roese, 287, 305.

 Roger, 150, 153, 160, 314.

 Roger and Garnier, 5, 23, 98, 154.

 Rogowitsch, 4, 141, 374.

 Romberg, 165, 166, 168.

 Rooms, sleeping, 264.

 Rosenblath, 142.

 Rosenblatt and Jeandelize, 96.

 Rosenquist, 322.

 Rothschild, Baron Henry, 408.

 Roth-Schulz, 205, 241, 242.

 Rousseau, 41.

 Roux, 160.

 Rovighi, 149.

 Rubner, 233, 281, 284, 287, 288, 294, 297, 301, 302, 303.


 Sainton, 374.

 Sajous, 2, 4, 9, 19, 21, 25, 28, 31, 32, 33, 34, 35, 65, 68, 79, 85,
    92, 112, 117, 130, 136, 159, 161, 162, 167, 313, 351, 374, 376, 405,
    427, 429, 444.

 Salaskin and Zaleski, 153.

 Salmon, 374, 376.

 Sandstrom, 144.

 Sanquirico and Canales, 141.

 Sarbach, 352.

 Sasaki, 340.

 Sauerbeck, 77.

 Sausages, 335, 336.

 Savile, 349.

 Sawada, 164.

 Sawandowski, 26.

 Scharffenberg, 351.

 Schiff, 138, 150.

 Schmidt, 188, 306.

 Schmitz, 185.

 Schopenhauer, 124, 403, 413.

 Schottelius, 170.

 Schur and Wiesel, 165.

 Schwoner, 56.

 Sciolla, 141.

 Séglas and Vauquelin, 153.

 Senator, Hermann, 1, 8, 86, 168, 172, 198, 199, 202, 203, 319, 322,
    444.

 Sexual glands, 165, 176, 351, 452.
   and emotions, 406, 409.
   spermin, 444.

 Shattock, 442.

 Shattock and Seeligmann, 442.

 Sherril, Edwin, S., 38.

 Siccard, 311.

 Singer, 185.

 Skin and kidneys, hygiene of, bathing, 231.
   baths, carbonic acid, 243.
     foot-, 234.
     cold, 234, 235.
   baths, sea, 235.
     heart in, 236.
     hot, 235.
     warm, 235.
   by means of perspiration, 237.
     composition of perspiration, 238, 241.
     fur clothing, 237.
 circulation in, 231.
   massage, 233.
   rubbing, 233.
 diseases, etiology of, 212.
 eruptions, 213.
   acne, 213.
   from cheese, 213.
   from drugs, 213.
   from oysters, 213.
   Skin eruptions, in diabetes, 213.
   in gout, 213.
   in Graves’s disease, 213.
   in masturbation, 213.
   in menstruation, 213.
   in sexual abstinence, 213.
   pimples of chastity, 214.
   psoriasis, 214.
   dust, 231.
   elimination of toxic products through, 209.
   excretion by, 214, 232, 244.
   exfoliation, 231.
     pores, 231.
   perspiration, abundant, 238.
     baths, 240.
       for old people, 240.
     baths to induce, 239.
       electric, 239.
       exercise, 239.
       light, 239.
     effect on kidneys, 241.
     excessive, 238.
   salicylates for, 239, 243.
     soap, 231.
     water, 231.

 Skin, hygiene of, 215.
   advantages of, 218.
   armpits, 224.
   bathing, 216, 225, 240. (See also _Skin and Kidneys, hygiene of,
      through bathing_.)
     air, 217, 225.
     cold, 218, 225.
     foot-bath, 228, 234.
     for old people, 240.
     water, 216, 225.
   clothing, blue, 225, 258.
     bedclothing, 229.
     changing, 224.
     collar, starched, 224, 228.
       harmfulness of, 224.
     cotton, 221.
       advantages of, 221.
     dry, 223.
     fur, 237.
     gray, 225, 258.
     hats, 226.
     health, impediments to, 228.
     leather, 224, 227.
     light, 225.
       advantages of, 225.
     linen, 220, 221.
       starched, 224.
     loose, 220, 229.
     night-shirt, 229.
     overcoat, 225.
     porous, 219.
     pumps, 227.
     Skin, clothing, ramie, 221.
     rational, 219.
     rubbers, 225, 227, 228.
     sandals, 227.
     shoes, 227.
       canvas, 227.
       half-shoes, 227.
       slippers, 227.
     silk, 221.
     trousers, 229.
     wool, 219.
       drawbacks to, 219, 220.
   cold, catching, 225.
   glands, sudorific, 215, 226.
   importance of, 215.
   neck, 224.
   scalp, 226.
   soles, 224.

 Sleep and its value, 368.
   adrenalin and, 369, 376.
   after dinner, 370.
   alcohol, 370.
   brain, anæmia and, 369.
     hyperæmia and, 369.
   cause of, 369.
     auto-intoxication, 371.
   control of, by thyroid gland, 369.
   death from loss of, 368.
   experiment of Mosso, 370.
   function of, 381.
   hygiene of, 377.
     brain, excitation of, 377.
     chamber, sleeping, 378.
     food, 378.
     hours of, 380.
     noise, 380.
   sleepiness, 373.
     gland, thyroid, 374.
   sleepiness, and insomnia, cause of, 372.
   sleeping sickness, 372.
     cause of, trypanosomiasis, 373.
     changes, pathological, 373.
     treatment, 373.

 Sleepiness and insomnia, treatment of, 383.
   treatment of, thyroid extract, 383.

 Sleeplessness, effects of, 382.

 Slowzoff, 150, 151.

 Smith, Bellingham, 442.

 Sneve, 212.

 Sobolew, 77.

 Socrates, 391, 424.

 Solomon, H., 447.

 Solon, 391.

 Sommerfeld, 340.

 Spallanzani, 211.

 Spangaro, Saverio, 51, 92, 442.

 Spillman and Etienne, 441.

 Spolverini, 298.

 Sports. See _Exercise_.

 Springer and Serbanesco, 13.

 Stedman, 445.

 Steinhaus, 80, 156.

 Stengel, 77.

 Stepanoff, 28.

 Stieda, 4, 374.

 Stimulants, 347, 362. See also _Food_.
   chocolate, 365.
   cocoa, 365.
     advantages of, 365.
     theobromin, 365.
   coffee, 364.
     black, 362.
     caffein, 364.
     effects of, 364.
   for digestion, 341, 342.
   tea, 362.
     and coffee, comparison of, 363.
       effects of, 362.
     good, 363.
     green, 362.
     thein, 363.
   tobacco, 366.
     nicotine, 366.
     effects of, 366.
       arteriosclerosis, 367.
       poisonous, 366.

 Stohmann, 281.

 Stomach, milk diet and, 330.

 Strassberger, 188.

 Strasser, 232, 241.

 Strauss, 204, 286.

 Strauss, H., 8, 198, 204, 241, 242, 289.

 Strümpell, 120.

 Sunlight, action of, chemical, 256, 257.
     therapeutic, 256.
   altitude, 258.
   bactericidal effect of, 256.
   benefits of, 255, 259, 260.
   cheeks, pale, 257.
     red, 257.
   clothing for, 258.
   corpuscles, red, 257.
   experiments with, 256.
   hæmoglobin, 257, 259.
   in old age, 260.
   in the open air, 258.
   mental effects of, 255.
   rays, chemical, and altitude, 258.
     ultra-violet, 256, 257.

 Svaerdrup, Captain, 264.

 System, circulatory, and adrenals, hygiene of, 164.


 Take, Ada, 353.

 Tanberg, 27.

 Tanecki, 46.

 Tarchanoff, 444.

 Tarchanow, 33.

 Tarnowska, Pauline, 7.

 Tavel, 196.

 Teissier, 199, 446.

 Tigersted, 348.

 Tizzoni, 35, 86, 141, 142.

 Thaon, 31.

 Thiele, 95, 374.

 Thompson, Sir William, 222.

 Thyroid gland. (See _Gland_.)

 Torri, 5, 23, 31.

 Traube, 169.

 Troin and Rivet, 165.

 Trüper, 120.

 Tsen-ki-tong, 403.

 Tuberculous persons, 262, 265.

 Tunnicliffe, 245.

 Twain, Mark, 342.

 Tyson, James, 204, 319, 406.


 Unna, 213.

 Uspenski, 32.


 Valente, 392.

 Van der Bergh, Heymans, 154.

 Van der Ecke, 142.

 Van Sommeren, 343.

 Vassale, 144.

 Vaughan, 299.

 Vegetables. See _Food_.

 Vegetarian diet. See _Diet_.

 Vermehren, 3, 85, 90, 93, 95, 126, 142, 434, 435.

 Vesalius, 404.

 Viault, 259.

 Vidal, 286.

 Vidal and Javal, 204.

 Vimont, 41.

 Voith, 282.

 Von Noorden, 74, 241, 282, 306, 320, 344, 374, 429, 430.


 Wagner, 30.

 Waldvogel, 152.

 Wallerstein, 201.

 Wassermann, 34.

 Water. See _Food_.

 Waters, mineral, arsenic in, 428.
   iron, in, 430.

 Watson, 318.

 Watson, Chalmers, 9, 22, 140, 145, 330.

 Weber, Parkes, 165.

 Weber, Sir Herman, 111, 146, 268.

 Weichardt, 368.

 Weichselbaum, 77.

 Weinberg, 51.

 Weiske, 308.

 Weiss, J., 307.

 Weljaminoff, 34.

 Westergaard, 116.

 White, Hale, 91, 435.

 Whitwell, 36.

 Widal and Boivin, 162.

 Widmark, 257.

 Wiley, 295.

 Wille, 78.

 Willems, 372.

 Winternitz, 233.

 Woroschiloff, 302.

 Wright, Sir Almroth, 28, 136.


 Xanthin bodies, 364.

 Xanthin bodies, caffein, 364.
   theobromin, 365.


 Yersin, 160.


 Zagari, 150.

 Zander, 247.

 Zeigan, 369, 376.

 Zoroaster, 391, 403.

 Zoth, 443.

 Zunz, 18, 249.


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       _Other Publications of F. A. Davis Company, Philadelphia_

       ---------------------------------------------------------

               Health and Longevity Through Rational Diet

          PRACTICAL HINTS IN REGARD TO FOOD AND THE USEFULNESS
        OR THE HARMFUL EFFECTS OF THE VARIOUS ARTICLES OF DIET.

                                   BY

                           DR. ARNOLD LORAND

        _Physician to the Baths, Carlsbad, Austria, etc., etc._

Translated from the Original German Edition, with an Introduction by
VICTOR C. VAUGHAN, M.D., Ann Arbor, Mich. Being a complete code of
instructions as to the different foods and how they can be best
employed. Royal Octavo. 425 pages. Handsomely Bound in Cloth (uniform
with “OLD AGE DEFERRED”). $3.00, net.

                         SYNOPSIS OF CONTENTS:

Introduction, with remarks upon the importance of the Appetite and the
Object of the Processes of Nourishment.

    I. The Influence of Food Upon Man.

    II. The Fundamental Laws of Rational Feeding.

    III. The Injurious Modes of Feeding.

    IV. The Good and Evil Effects of Various Food Substances.
    Meat Diet. Fish Diet. Milk Diet. Cereals. Green Vegetables.
    Fruit Diet. Beverages.

    V. Vegetarianism and its Advantages and Disadvantages. Hints for
    the Prevention of the Latter.

    VI. The Practical Advantages of Rational Feeding. Useful Hints.

    VII. Hints for Those Obliged to Take their Meals in Restaurants.
    The Injurious Effects of the “Table d’Hôte” Diet.

    VIII. The Increased Activity of Certain Functions Brought About
    by Food.

    IX. The Increased Muscular Power Resulting from a Suitable Diet.

    X. Conclusion. The Relationship of Food to Old Age and Longevity.
    Glossary. List of Diseases. Index.


       ---------------------------------------------------------

Many people naturally sidestep books on diet because they expect to be
warned against their pet dietary follies. This is not the Lorand way. In
a most entertaining manner Dr. Lorand explains to the reader the
advantages, disadvantages and nutritive values of different foods so
clearly that a person of ordinary intelligence can exercise good
judgment. Obviously, no person of reasonable common sense deliberately
follows the path of error in diet; if he has the facts he can go ahead
and choose for himself; Dr. Lorand’s book provides the facts.

       ---------------------------------------------------------

JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (Chicago, Ill.).

Methods of cooking are described and interesting remarks are made as to
the size and distribution of the ill effects arising from various
special and one-sided diets. It is full of valuable hints from which all
can profit. It may be recommended to the layman as well as to the
practitioner.


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         Consumption: How to Prevent It and How to Live With It
         ITS NATURE, CAUSES, PREVENTION, MODE OF LIFE, CLIMATE,
               EXERCISE, FOOD, AND CLOTHING NECESSARY FOR
                               ITS CURE.

                       By N. S. DAVIS, A.M., M.D.

   Second Revised Edition. 12mo. 172 pages. Extra Cloth. $1.00, net.

Most families unfortunately give little attention to the prevention of
Consumption until the subject has been brought to their notice in a
menacing way. The author with great clearness has set forth the cardinal
principles not only of the prevention of the disease, but of its
hygienic treatment when established.

This work provides much valuable information as to climates, diet,
exercise, environment and family safeguards identified with the
treatment of a case in the family when once established.

NEW ORLEANS MEDICAL AND SURGICAL JOURNAL.

Dr. Davis has written a thoroughly practical book. He handles the
subject in such a way that the intelligent victim of consumption can
read it with profit. It is the kind of book which the physician can
recommend to his patients and their relatives.


       ---------------------------------------------------------


                    Safeguarding the Special Senses

           GENERAL ADVICE REGARDING THE USE AND PRESERVATION
                  OF THE EYES, EARS, NOSE AND THROAT.

                                   BY

                          HENRY O. REIK, M.D.

   Illustrated with 4 Full-page Plates, 2 in Colors. 12mo. 123 pages.

              Attractively Bound in Cloth, 75 cents, net.

Any defect in the sight, hearing, or organs of speech tremendously
reduces a person’s efficiency. A neglected child therefore may
reasonably be expected to later on blame the parents who failed in their
duty. Adults who are careless about colds affecting the ears, or who
defer the use of glasses when necessary, may rightly expect the onset of
defective hearing or cataract in their later years.

It is said that probably 50 per cent. of the practice of specialists is
made up of attempts to remedy the results of these forms of neglect.


THE BOSTON MEDICAL AND SURGICAL JOURNAL.

Such a book as this should find an especially useful place among the
laity as well as in the profession. In fact, the simplicity of style is
such that persons of small medical training would find it entirely
understandable.


------------------------------------------------------------------------


                           Health and Beauty

                                   BY

                     JOHN V. SHOEMAKER, M.D., LL.D.

  Royal Octavo. 475 pages. Extra Cloth. Bevelled Boards. Price, $1.50,
                                  net.

This work is based upon an enormous experience not only as a specialist
in skin diseases, but as a physician engaged in general practice. The
contents of the book are therefore authentic and founded upon actual
knowledge rather than theory.

There may be good health without good looks, but seldom good looks
without good health. This treatise tells you how these two highly
desirable conditions may be co-existent. There is a place in every
family library for a book of this kind.


                         SYNOPSIS OF CONTENTS:

    I. The Skin and Complexion.
    II. The Appendages of the Skin.
    III. The Usefulness of the Skin and of the Hair.
    IV. The Complexion.
    V. The Elements of Beauty and Grace.
    VI. World Influence of Woman’s Charms.
    VII. Expression, Sexual Attraction, Wedlock.
    VIII. How to Cultivate and Preserve a Good Complexion.
    IX. The Bath.
    X. Digestion and Indigestion.
    XI. Education of the Body.
    XII. Cultivation of the Mind.
    XIII. Clothing and Dress.
    XIV. The Influence of Climate Upon Health.
    XV. Ventilation.
    XVI. Disfigurement from Disease, with Some Treatment of it.
    XVII. Eruptive Fevers.
    XVIII. The Hair, its Fashions and its Diseases.
    XIX. The Nails and Their Diseases.
    XX. Cosmetic Preparations. Index.


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                     Confessions of a Neurasthenic

                                   BY

                       WILLIAM TAYLOR MARRS, M.D.

 Eight Illustrations. 116 pages. Bound in Handsome Cloth. Price, $1.00.

CONFESSIONS OF A NEURASTHENIC is designed to show the mental absurdities
of that extremely cautious and anxious individual who wishes under any
and all circumstances to take extraordinary good care of himself.

The hero of this sketch has always found real, continuous effort too
severe a tax upon his health. Therefore, he shifts from one occupation
to another. His various adventures in search of a calling at once
congenial and devoid of mental and physical strain are not only very
amusing to read, but point a most useful moral.


       ---------------------------------------------------------


             The Practical Care of the Baby And Young Child

                                   BY

                      THERON WENDELL KILMER, M.D.

   _Lecturer on Pediatrics in New York Polyclinic Medical School and
                               Hospital;
 Attending Pediatrist, St. Bartholomew’s Clinic; Consulting Pediatrist,
            Home of St. Giles, Garden City, New York, etc._

       With 68 Illustrations. Second Revised Edition. 158 pages.
                      12mo. Cloth, 75 cents, net.

The remarkable reduction in the death rate among infants in New York
City is the answer to what physicians there have been doing in recent
years. They have given extraordinary attention to the care of children.
Dr. Theron W. Kilmer has been closely identified in this good work and
in compiling his book for the public, he was guided not only by an
extensive personal experience, but by a thorough knowledge of what
numerous other specialists in the Care of the Infant and Young Child
have been doing.

Kilmer’s “Care of the Baby” is a thoroughly safe counsellor in the
family, the clear text and numerous fine illustrations fulfilling every
requirement.


------------------------------------------------------------------------




 ● Transcriber’s Notes:
    ○ Missing or obscured punctuation was silently corrected.
    ○ Typographical errors were silently corrected.
    ○ Inconsistent spelling and hyphenation were made consistent only
      when a predominant form was found in this book.
    ○ Text that was in italics is enclosed by underscores (_italics_);
      text that was bold by “equal” signs (=bold=).
    ○ The use of a caret (^) before a letter (or letters) shows that the
      following letter or letters was intended to be a superscript, as
      in S^t Bartholomew or 10^{th} Century.