Transcriber’s notes:

The text of this eBook has been preserved as in the original. Italic
text is denoted by _underscores_ and bold text by *asterisks*.

New original cover art included with this eBook is granted to the
public domain.




WHY DO WE DIE?




THE ROAD TO A HEALTHY OLD AGE

BY T. BODLEY SCOTT, M.R.C.S. (Eng.).

_Author of “The Religion of a Doctor.”_

SECOND EDITION.

Crown 8vo, cloth, *5/-* net.

Third Impression.


  “In this book an attempt is made
  to demonstrate both to the medical
  profession and the laity that premature
  decay, physical and mental, may within
  limits be prevented.... We have perused
  the book with pleasure, and cordially
  recommend it to our readers.”--_Medical
  Times._

  “We can cordially commend this work to
  readers of advancing years, whether
  medical or lay. To the former it
  presents an old subject in a new
  way, and to the latter will convey
  some very wholesome material for
  thought.”--_Lancet._

  T. Fisher Unwin Ltd.      London.




WHY DO WE DIE?


BY

T. BODLEY SCOTT
M.R.C.S. Eng., L.R.C.P. Ed.


T. FISHER UNWIN LTD.
LONDON: ADELPHI TERRACE




_First published in 1921_


(_All rights reserved_)




PREFACE


The attitude and the pretensions of the “medicine man” may perhaps have
had some value in the days when the multitude was full of superstition
and had no scientific knowledge, but we hope those days of ignorance
have passed, though we fear superstition remains. The “medicine
man” was a more or less clever poseur, who used his small amount of
knowledge to conceal his very large amount of ignorance. The medical
profession, till the more recent years, cannot be entirely acquitted
of the same sort of dishonesty, but a new era of open-mindedness and
honesty has, I think, begun.

To get any real success in the treatment of disease, we must get
confidences, not one-sided, but on both sides, between ourselves and
our patients, and so alone shall we get that co-operation without which
there can be little expectation of success. At present we see this
success more in the wonderful results of psychotherapy than in the
treatment of objective disease, but I firmly maintain that mutual trust
will prove its great value in this also. Is it reasonable to expect
that men of equal learning and intelligence as ourselves will accept
our treatment and advice without knowing the rationale of them? Should
we do it in the case of legal or religious matters? Our patients know
as well as we do that medical knowledge is in a continuous state of
flux and that as yet we are nowhere near finality. The dazzling garment
of omniscience will be discovered to be the somewhat shop-worn cloak of
ignorance. A wise and observant patient can help us enormously in the
investigation of a difficult problem in disease, for the subjective
symptoms are often as important as the objective. What the eye does not
see may be there all the time.

The history of the world right up to the present time has shown the
futility of dividuality as against individuality both in politics
and religion. The greater part of our Christian teaching is against
separateness, and towards mutual love, consideration, and help. For
this reason I have tried to write so that all may grasp the hope and
possibility of a longer and more effectual life. Co-operation is the
watchword of the future, isolation the disease and explanation of the
past.




GLOSSARY OF MEDICAL TERMS


There are parts of this book that can only be fully grasped by a
physician, but I have tried to write it so that any intelligent reader
may be able to see not only the drift of the argument, but may be
able to make a personal application of it. To this end I am giving a
glossary with definitions of the more abstruse scientific words.

 *Pathological.*--The branch of medical science that treats of diseased
 conditions, their nature and causes.

 *Ventricle.*--The left ventricle is the chief pump of the heart which
 by its powerful contraction forces the blood forward into the aorta,
 the first part of the arterial system. It is the initial motor of the
 circulation.

 *Systole.*--The contraction of the heart that drives the blood onward.

 *Diastole.*--The dilating time of the ventricle in which the blood
 flows in to fill it for its next contraction.

 *Sphygmomanometer.*--The name of the instrument that measures the
 blood pressure.

 *Peripheral.*--The parts farthest from the centre.

 *Tinnitus.*--A singing or ringing in the ears.

 *Hyperpiesis.*--Abnormal increase of blood pressure.

 *Atheroma.*--A form of fatty degeneration with hardening of the inner
 coats of the arteries.

 *Endocrine.*--A name given to certain glands of the body which have no
 external outlet or secretion (ἐνδον, within, and κρίνω, to separate),
 such as the thyroid.

 *Protein.*--The entire amount of nitrogenous material in organic
 substances.

 *Hypophysis.*--The pituitary gland situated at the base of the brain.




CONTENTS


                                                  PAGE
  PREFACE                                            5

  GLOSSARY OF MEDICAL TERMS                          9

  CHAPTER I
  THE CHOICE OF WAYS                                15

  CHAPTER II
  ARTERIO-SCLEROSIS: ITS NATURE AND ITS CAUSES      27

  CHAPTER III
  THE WAY OF SAFETY                                 65

  CHAPTER IV
  THE MEDICINAL TREATMENT OF SCLEROSIS             101




CHAPTER I

THE CHOICE OF WAYS


Why do we die so long before our time? And what do we die of? These are
the two most crucial questions, as far as this life is concerned, that
affects us all, but which most of us seem content to ignore.

Putting on one side the accidents of life--and among the accidents I
include the acute diseases, such as pneumonia, rheumatic fever, and
the infectious diseases, which attack from without, and the so far
unexplained cancer--we must allow that our lives and our health are to
a great extent in our own keeping, and of our own making. Three score
years and ten was David’s estimate of the working years of a man’s
life, but under modern conditions of improved sanitation the term of
life should be at least four score years and ten, and this extra 20 per
cent. should not be a time of pain and sorrow, but of peace and rest,
with still some capacity for work.

Many of us used to be content to answer the first question, “Why do
we die?” by saying our time had come. The unreflecting but so-called
religious person seemed to think that God had placed a time limit
against each individual when he came into the world. This is pure
fatalism, and unworthy of the name of reason or of faith in the Divine
justice. “Let us eat and drink, for to-morrow we die” is almost the
logical position of such minds. We cannot hope to solve individually or
in detail the mysteries of life and death, why one is cut off in the
full tide of his energy, and another, who seems to be going out on the
ebb, remaineth. But we must put these following questions honestly to
ourselves--Are free will, scientific work, knowledge, self-restraint,
and self-denial to be so much wasted powder? Are we to work out our
destiny, the sport of chance, hopelessly, illogically, without ambition
and without a healthy pride in our work? Is the man who spends his
life in riotous living, in over-eating and drinking, and in committing
every physiological sin that he can think of, to live as long and as
healthily as the wise and sober man? Has the great Father of us all
given us no motive for life, no work to do for Him or for our brothers?

Must not we, as separate sections of the Divine image and of His
all-pervading spiritual force, endeavour with all our strength and
knowledge to prolong the life given us to the utmost limit? Surely
the fact of our life, the gift of our life, becomes a great personal
responsibility, an acknowledged debt to our Maker that we can only
repay by regarding it as a treasure to be daily cared for and
cherished. Thus the promotion of health and the prevention of disease
must manifestly be our first considerations, for without health our
output of work ceases, or becomes both in quantity and character a poor
thing.

The despairing cry of “Why was I born?” comes to most of us in the
sorrows and tragedies of life, but it is the cry of faithlessness, of
relativity, of blindness to the sure, but half-seen purposes of the
Absolute God.

That which we in our presumption are pleased to call civilization,
should certainly further such aims for health, but the whole story
of the world, of past and gone kingdoms, and of our own times also,
show that civilization works up to a point of luxury that defeats
and destroys itself. Babylon, Egypt, and Rome all testify to this
end. These old civilizations perished, perhaps, more from enervating
luxury and dissipation than from violence; though some of them gave way
through feebleness, physical and mental, to a stronger, hardier race
from without. In our own times there seems to loom the same danger,
but the attack comes from another side. We neither eat nor drink to
such excess as our forefathers, and we are not grossly luxurious
or debauched, but the strain and the competition of life, both in
professions and in business, has become so intense that our nervous
systems break down long before their time. This produces rather a new
type of an old disease. What is this disease but arterio-sclerosis?--a
word which means only thickening of the arteries, but which, after
fifty, in its far-reaching results destroys life and working capacity
far more than cancer or any other disease. And this disease is, in the
great majority of people, the result of the almost incessant nervous
strain that seldom allows our hearts and our arteries, and especially
the arteries of our brains, to get their proper quota of rest.

Though the average duration of life has increased during the last
fifty years, much of this is due to a lower mortality in infancy and
childhood. There has been an actual increase in the mortality rate
among males between the ages of fifty-five and sixty-five. One-third
of the total deaths in this period are due to diseases of the heart
and blood vessels. In America it is stated to be 10 per cent. higher.
If the causes of death in certificates were given more exactly, this
proportion would be without doubt still greater. These deaths cannot
be fairly brought under the heading “Old age.” This is what we die
of! According to our death certificates we die of paralysis, of
strokes, of Bright’s disease, of softening of the brain, of cardiac
degeneration, of angina pectoris, but in nearly every case the
foundation, the _causa causans_ is arterial disease.

Sir Clifford Allbutt, in his distinctive way, says:--

“We recognize now, all of us, that, in the lapse of men’s years,
one long reckoning of his mortality is, and from all known ages has
been, written on the walls of his vessels. We may suppose that in the
primitive man, by external conditions if not by innate capacity, life
was of comparatively brief duration. Domestic animals seem, as a rule,
not to live long enough to use up their arteries or not to live ill
enough to abuse them, and amongst these creatures atheroma, though not
unknown, has not been commonly observed. We may reasonably conjecture
that, as in Stable Societies human life became protracted, the
arteries got time to wear out.”

There is plenty of evidence from the mummies of Egypt that atheroma
and sclerosis were common, not only in advanced age, but in the middle
years of life. We cannot know intimately the life that these old
people lived, but we can pretty well picture from history both the
height of luxury and the nervous strain. Civilization brings without
doubt more comfort, more luxury, and more scientific knowledge, but
it seldom brings more true personal wisdom. The philosophical calm
and contentment with simple pleasures, and wise simplicity of life,
are still the exception. To use a slang expression, we are nearly all
of us “on the make,” stretching forth eager hands and hearts towards
the will-o’-the-wisp of wealth and advancement, while we let the real
values and beauties of life pass us by and so we continually miss our
markets. The great war has taught us one good lesson, viz., that we
can live and be well--nay, better--on much less food and on simpler
than was our former custom; but it has increased, at any rate for the
present, the struggle for and the pain of mere existence.

We must nevertheless be optimistic, and hope that the great advance
in science may soon make life easier, and the food of the world once
again sufficient for its inhabitants; then, please God, materialism may
shrink into the background and things spiritual come into their own.
Not, however, by a reformed and wiser life alone do I hope to show the
more excellent way, but to show that modern science has placed in our
hands a preventer of decay and a prolonger of life and energy. I cannot
promise that this discovery will take twenty years off a woman’s life
and put twenty years on to her beauty, but I know that it will give
many more years of fruitful and enjoyable work, with greater strength
and better health.




CHAPTER II

ARTERIO-SCLEROSIS: ITS NATURE AND ITS CAUSES


The thickening chiefly of the middle coat of the arteries that we find
in this disease is the first pathological sign, and it implies that
morbid structural changes have begun; but long before this occurs, the
predisposing causes have been at work. The actual structural change
is the visible effect of the law that over-use of a muscle produces
over-growth or hypertrophy. This is not a law of disease, but of
purposeful utility, designed to meet emergencies of life. Still there
is a further law in nature, that long-continued excessive use of any
muscle leads to a form of hypertrophy which cannot maintain its
vitality, but degenerates. Arteries must be treated as muscles, for
their muscular coats contract and dilate, as circumstances demand,
under the control of the nervous system.

Dr. George Oliver, in his third edition of _Studies in Blood Pressure_,
among his fundamental data lays down this law:

“Though the left ventricle--dispensing its blood under a high pressure
into the aorta--is the master hand in maintaining the arterial blood
pressure, the height to which that pressure rises depends primarily
on the resistance encountered in the peripheral arterial system, and
in the capillaries, and, secondly, on the response of the ventricle
to overcome that resistance. Given a normal ventricle the arterial
tonus largely determines the ventricular response and the level of the
arterial blood pressure; and this is the keynote of the physiological
and pathological variations of that pressure.”

Arterial tension may be described thus: During the resting-time of the
heart, between each beat, the circulation of the blood is maintained by
the contractile power of the arteries, which steadily urges the blood
onwards into the capillary vessels, and so into the veins. This power
is known as arterial tension or pressure, and it is estimated fairly
accurately by the sphygmomanometer. A large number of observations have
taught us what is the average pressure at different ages of life, and
thus we are able to talk about a normal or abnormal pressure.

If we hope to understand and successfully treat abnormal pressure
and sclerosis, we must visualize the whole of this picture clearly,
wisely, and in its due proportions. This we have not always done.
The heart man, as Osler wittily said, “tinkers at the pump,” while
the pressure man, with his manometer, concentrates on the pipes. To
give a scientific description and explanation of the physics of the
circulation is far beyond me, and would be inappropriate in a small
practical work of this sort, but a study of some elaborate standard
work, such as Sir Clifford Allbutt’s _Diseases of the Arteries_, or
Halliburton’s _Physiology_, would do much to give a fair understanding
of this intricate subject: but, as they so often acknowledge, the
vital problem of the circulation, with its ever-changing demands, both
general and local, can hardly be solved by the known laws of physics.
Heat and cold, joy and grief, anger and fear, acting through the nerves
of the vaso-motor system, all help to complicate the problem and often
to confuse cause and effect.

As far as we can as yet judge, the first objective symptom that
points to threatening sclerosis is a more or less continuous rise of
systolic pressure, as measured by the sphygmomanometer (the use of this
instrument is imperative). The following extract from the _Lancet_
January 8, 1916, puts the matter very clearly: “The clinical value of
observations on Blood Pressure is doubted only by those who have never
made them. It is true that the finger can detect some difference in
pulse tension, but it is often entirely at fault, since it can only
estimate total pressure, thus missing a high pressure, if the volume
be small. In the same way, although the hand can detect differences of
temperature, it cannot replace the thermometer. The sphygmomanometer
has enlarged our ideas, cleared up difficulties in diagnosis, and
helped in prognosis. This has naturally reacted on treatment; it has
enlarged our ideas on ‘heart failure.’ The heart is adjusted to work
at certain pressures, and though within considerable limits it can
adjust itself to variations, those limits may be exceeded.”

There are subjective signs, especially in middle age, which point the
same way, but we can seldom get hold of patients at this early stage.
These are chiefly shortness of breath, on slight exertion, which makes
a man realize that he has almost suddenly got out of condition, that
the elasticity of youth has gone; a feeling of brain fatigue, quite
out of proportion to the work done; sometimes giddiness and tinnitus,
especially on stooping. Whether these symptoms appear before there is
a rise of pressure it is difficult to say, but they should certainly
in all cases suggest blood pressure testing. The key to the patient’s
future then lies first in our hands, and then in his, life or death,
health or disease, a full working life and happiness or incapacity
and failure. The examination must be carefully made and frequently.
The best time to take pressure is about two hours after food, when
there has been a time of physical quiet, and no hurry or emotion. The
position should be either recumbent or sitting in a chair, with the arm
resting on a table (the muscles of the arm should not be in action),
and the wrist should be on the same level as the heart. Pressure
readings are higher when standing than sitting, and when sitting than
lying down, the difference being from four to eight millimetres. In the
early stages pressure varies a good deal, and will not show a rise at
all times of day; in the early morning particularly it is often quite
normal.

The question now arises, What is the normal? For our purpose we may
leave out the question of pressures in childhood and early life, and
may take the following figures as a fair average for our calculation:--

  From 40 years of age to 50, 130 mm. to 135 mm.
       50     "     "     60, 135 mm. to 145 mm.
       60     "     "     70, 140 mm. to 150 mm.

I think there can be no doubt that there is a period, often of months,
when there is only increased contraction of the muscular coats of the
arteries. This is due to the increased strain of life generally, and is
in consonance with our experience generally of muscular overgrowth and
overwork. Huchard called this “the pre-sclerotic stage.”

I think we may say that any pressures at about fifty years of age
below 120 mm. are a sign of debility, and above 150 mm. are signs of
threatening arterial trouble. Over sixty there is a natural tendency
to hardening of the arteries, and many men seem to lead healthy lives
with a pressure of 160 mm. Still, with a pressure of that height
they cannot afford to put any excessive strain on their arteries. At
about eighty there is a decided tendency for pressure to fall, even if
there has been plus pressure before. It is rare to find high pressure
over ninety for the reason that people who live to that age must have
had healthy hearts and arteries all the time, but even in them we not
infrequently find passing rises; these are often missed, but they
cause much mental distress and even delusions, but at this age, under
treatment, the pressure soon falls and the mind clears. I had one lady
who lived to ninety-seven, and during the last six years of her life
she had visions and slight delusions when her pressure rose, but in the
intervals her mind was quite clear. She learned to recognize the cause
of her trouble.

This rule of normality stands pretty true for the majority of people,
but in practice we find a good many individual exceptions: in such,
the personal equation has to be solved. Women often, even in advanced
age, have very low pressures, even 120 mm. to 125 mm., and seem to
carry on quite well. They again get a period of high pressure about
the climacteric, which with careful treatment disappears, and their
subsequent years from about fifty-five to seventy-five are often the
best and the happiest working years of their lives. It is not uncommon
both in men and women who have led strenuous but healthy lives to find,
about sixty, steady pressures of 160 mm. to 170 mm., without causing
any symptoms of illness or distress. These people, though one cannot
consider them safe lives from the insurance point of view, have learned
to manage themselves and seem to have set up a new, personal normal
which is an effective compromise. If one has been able by careful
observation to satisfy oneself about such a case, it would certainly
be unwise to try to lower that pressure point. Even in cases where
there is manifest disease of some standing, one has to find out the
best working point of pressure for the individual. They can live and
work fairly comfortably at 160 mm. or 170 mm., but if you lower the
pressure to 140 mm. or 150 mm., their hearts get irregular and they
feel good for nothing; but I think we may make a working rule that
a pressure of 180 mm. and over should be lowered; the danger to the
cerebral arteries is too great. Even in the early stages a careful
watch should be kept on the kidneys. If albumen appears, it makes the
prognosis more grave, but it should cause no despair. Mahomed and the
early observers thought that kidney disease was almost inevitable
sooner or later, but further experience has shown us that many cases
live for years and then die without albuminuria. In other cases it is
often transient and responds to treatment.

Hitherto I have only dealt with systolic pressure, but the diastolic
pressure in senility and sclerosis is a matter of much importance, and
helps us both in treatment and prognosis. Brunton said: “The systolic
pressure shows the maximum height to which blood pressure is raised
by the wave of blood driven into the aorta by the contraction of
the left ventricle. It thus indicates in a general way the strength
of the ventricle. The diastolic pressure shows the minimum to which
the blood pressure sinks during the interval when no blood is coming
into the aorta from the heart, and the arterial system is emptying
itself through the capillaries into the veins. It therefore indicates
generally the degree of contraction or relaxation of the capillaries.”

For practical purposes we want to know the pulse pressure, and this
is roughly estimated by subtracting the diastolic from the systolic.
A systolic pressure of 140 and a diastolic of 100 would give a pulse
pressure of 40, which is about right. Any pulse pressure of over 40
points to hyper-tension, and under 20 to hypo-tension. The diastolic
pressure is more constant than systolic pressure, and is not so
susceptible to disturbing external influences; it is therefore a surer
guide in estimating hyper-tension. A continuous diastolic pressure
of over 100 certainly points to continuous hyper-tension. If the
difference between the systolic and the diastolic is normal, about 30
to 40, we may conclude that the heart’s impulse is normal, and that
even in conditions of marked sclerosis there is efficient compensation.

Sir Clifford Allbutt says (in _Diseases of the Arteries_, vol. i,
p. 92): “It is in the experience of us all that, as the walls of the
great vessels lose their elasticity, the systolic pressure mounts above
its proportion to the diastolic which falls. In aortic regurgitation
the difference between the systolic and diastolic figures may be
enormous, as much as 105 mm. to 210 mm. In a certain ‘Adams Stokes’
case of my own, at a pulse rate of 32, the systolic pressure was
180, the diastolic 90 mm. Thus, with the difference between the two
pressures waxing as the resilience wanes, the blood pressure moves
more suddenly and largely, bangs more, and thus racks the machinery.
The greater vaso-motor lability in youth has a like effect, but the
vessels are then much more resilient and energy is stored. In an early
hyperpietic, or nephritic subject the systolic exorbitancy may be
considerable or variable, while the diastolic is steadily in excess.
As age advances the amplitude increases to 80 and upwards; a systolic
pressure of 160 mm. may be associated with a diastolic of 75 mm. or
80 mm.”

Dr. H. C. Mann says: “That as compensation fails, the diastolic
pressure begins to fall, and the systolic becomes irregular.” It must
seem very difficult for a beginner, or even for an experienced busy
practitioner, to find his way through all these devious by-paths, which
must look to him often to be blind alleys and to lead nowhere, but out
of the welter a few good and sound working principles emerge.

“_Firstly_, that at middle age and afterwards the knowledge of an
habitual systolic pressure is of first-rate importance.

“_Secondly_, that this knowledge can be confirmed and sometimes
rectified by knowledge of the diastolic pressure (manifest valvular
diseases of the heart, especially aortic regurgitation, are excluded);
and that a continuous rise of systolic and diastolic pressure point
conclusively to threatening or confirmed arterio-sclerosis.

“_Thirdly_, that a steady ratio between the two pressures, even
when much above normal, is a sign that the heart is doing its work
well; and conversely, a falling diastolic ratio is a sign of failing
compensation.”

Dr. Louis M. Warfield, in his work on Arterio-Sclerosis, says: “It is
most important to estimate accurately the diastolic pressure as well
as the systolic, for only in this way can we obtain any data of value
regarding the driving power of the heart and the condition of the
vaso-motor. A high systolic pressure does not necessarily mean that a
great deal of blood is forced into the capillaries. Actually it may
mean that very little blood enters the periphery. The heart wastes
its strength in dilating constricted vessels without carrying on the
circulation adequately. The pulse pressure is the difference between
the systolic and diastolic pressure, and practically represents the
heart lode.”

All these considerations demonstrate the importance of watching closely
the pump as well as the pipes.

In the above figures I am presuming that the auscultatory method of
determining pressure has been used. It must also be manifest that, the
earlier treatment begins, the more sure will be the success. It may be
that all our theories will meet the ultimate fate of so many others and
be abandoned, or partially disproved, but the practical therapeutic
results will remain--an increased capacity for work and considerable
prolongation of the later years of life.

For a short and graphic description of the two methods of estimating
pressures I am poaching from an excellent book called _Blood-pressure
Technique Simplified_, by Dr. W. H. Cowing, of America (pp. 12–15):--

“There are two methods of determining blood pressure, that by
oscillation, and that by auscultation.

“We will first describe the method by oscillation.

“Place the bag over the arm with the two tubes well under the arm and
over the brachial artery. Wrap the remainder of the sleeve around
the arm much the same as you would apply a bandage, tucking at
least six inches of the sleeve under the last fold. Then place the
sphygmomanometer in one tube and the bulb in another, and you are ready
for reading. Care should be taken not to put the sleeve on tight enough
to cause any apprehensive feeling in the patient.

“Place the finger lightly over the radial artery and send the pressure
in the cuff to the point where the pulse has entirely disappeared,
then advance the hand about 2 cm. above this point of disappearance,
then release the air gradually and note the first perceptible pulse
wave felt by the palpating finger at the wrist. This represents the
true systolic or maximal pressure.

“Having now obtained the systolic or maximal pressure, release the air
gradually by means of the escapement valve, and note where the largest
oscillation or movement of the hand takes place, and the lowest point
of this largest oscillation is the diastolic or minimal pressure.

“For example, if the largest oscillation occurred between the divisions
90 to 96, 90, being the lowest, would be the reading.

“It is well to bear in mind to keep the eye concentrated on the scale
divisions, for the travel of the hand can be accurately determined when
this is done.

“In determining systolic (maximal) pressure, the pulse becomes more
feeble as the pressure advances, and when taken with the ends of the
fingers, the pressure of the fingers is involuntarily increased, so
that a very sensitive pulse may be closed off entirely by the finger
pressure; while, if taken with the ends of the fingers resting on the
upper curve of the bone of the wrist, permitting the balls of the
fingers to rest lightly over the radial, thus bringing in contact with
the pulse the most sensitive part of the fingers, any extra pressure
that might result would be directed against the bone and not the pulse.

“_Method by Auscultation._--This is by far the most accurate method
of determining the blood-pressure, and the results obtained in this
way should be free from error, or the dangers of personal equation in
palpating the artery at the wrist.

“_Systolic or Maximal Pressure._--Bare the arm and adjust the sleeve
well up; place the stethoscope over the brachial artery about 1 cm.
below the border of the cuff, then constrict the arm by inflating the
bag until no sound is heard in the artery through the stethoscope. At
this point release the air slowly by means of the escapement valve, and
soon a clear, clicking sound will be heard, which indicates the first
passage of the blood stream below the constricting arm band and is the
true systolic or maximal pressure.

“_Diastolic or Minimal Pressure._--Still gradually releasing the air,
this clear, clicking tone (first phase) is followed by a low tone or
murmur (second phase), and this murmur is followed by a loud, clear
tone (third phase), this in turn by a perceptibly dull tone (fourth
phase), and this dull tone represents the diastolic or minimal pressure.

“Below are given the five different phases of tone to be heard in the
auscultatory blood-pressure phenomena as found by Louis M. Warfield,
A.B., M.D., and confirmed by his clinical observations on animals.

“The first phase is due to the sudden expansion of the collapsed
portion of the artery below the cuff and to the rapidity of the blood
flow. This causes the first sharp clicking sound which measures the
systolic pressure.

“The second, or murmur and sound phase is due to the whorls in the
blood stream, as the pressure is further released and the part of the
artery below the cuff begins to fill with blood.

“The third tone phase is due to the greater expansion of the artery and
to the lowered velocity in the artery. A loud tone may be produced by
a stiff artery and a slow stream or by an elastic artery and a rapid
stream. This tone is clear cut, and in general is louder than the first
phase.

“The fourth phase is a transition from the third, and becomes duller in
sound as the artery approaches the normal size.

“The fifth phase, no-sound phase, occurs when the pressure in the cuff
exerts no compression on the artery and the vessel is full throughout
its length.”

He also says that blood pressure always depends on four factors, viz.:

  1. Cardiac energy.
  2. Peripheral resistance.
  3. Elasticity of the arterial walls.
  4. The amount of blood in circulation.

It is very important to remember these and to give due value to each
of them. With regard to No. 4, it is doubtful if this is of as much
importance as has been thought or as one would at first think; the
mass of blood in the body has such a large reserve of stowage room in
the muscles and in the internal viscera, that its effect on general
arterial pressure must be slight. The viscosity of this fluid is
probably of far more importance. If one bleeds a case of high pressure
freely, the pressure will fall, but only for a short time; the blood
is thinned, but the loss in mass is quickly restored by absorption
from the watery tissues of the body, and in a very few days the
viscosity returns to its former point. Bleeding is thus very good for
emergencies, such as threatening apoplexy or cardiac dyspnœa, but is of
little permanent use in the routine treatment of high pressure.

Sir Clifford Allbutt, wisely and correctly, I think, divides most
examples of abnormal high pressure into hyperpiesis, which describes
this symptom alone, and into senile atheroma. Clinically this is
important, for hyperpiesis, which generally comes on about fifty to
sixty, is a very serious disease, which, untreated, destroys life in a
few years, whereas senile atheroma may go on till advanced old age,
crippling energy perhaps, but in many cases hardly shortening life
at all. The former generally ends in cerebral hæmorrhage, cardiac
degeneration or Bright’s disease, but senile atheroma may escape all of
these. In hyperpiesis raised pressure is continuous and tends steadily
to increase; in atheroma there are times of high pressure, but as the
disease advances the pressure is often normal or subnormal, its gravity
depending much on the seat of the atheroma.

Are we justified in regarding arterio-sclerosis as a true disease? I
think not. One cannot justly compare it with entity diseases, such
as the acute infections, as cancer, as tuberculosis, or the diseases
that affect the brain and the spinal cord. It is, I think, one of the
penalties of an artificial over-civilization, of social, business and
competitive pressure, unwise in quantity and unscientific in method.
Unfitted, as yet, in development, and lacking the necessary knowledge,
men strive after a higher stage of evolution, or after illusions
which they think to be so. For a while they seem to succeed, but
involution and premature degeneration are the inevitable consequences.
To attain their “ambitious” ends they live and work intensely, stoking
their furnaces with far too much food, alcohol and other unnatural
stimulants. Intemperate in work, intemperate in living, prodigal in
waste, they come to an untimely end.

Such is the description of one type of case that we often meet, but
there is another and a sadder class, where unfavourable circumstances
through the greater part of life, pressure of poverty and ceaseless
anxiety for others, produce a careworn existence, with no joy or
colour in it, and often insomnia. Such as these, in spite of a sober,
abstemious life, often get sclerosis. Their pulses are small and
thready, but hard, and often deceive the finger. Paralysis from small
cerebral hæmorrhage is the frequent end. We may take it as an axiom
that happiness lowers pressure, while grief and care raise it. We must
all of us feel this as a personal truth, though we may not be able
to test it with a manometer. It is not only the cat that care kills.
In melancholia the pressure is almost always well above normal; in
maniacal conditions generally below.

Few of us know how to work with our brains; psychology has as yet
taught us but little of method and of practical value, though for this
we must blame ourselves rather than the psychologists. We drive our
conscious minds with few or no intervals of rest till brain exhaustion
comes; then the machinery gets out of control and the screw races;
so come insomnia and poor, confused results, with disappointment and
depression. We talk glibly about the sub-conscious mind, and are now
and again struck with some evidence of its working existence, but we
few of us use it systematically as our servant--the most competent
servant that exists, and one that never gives notice as long as life
lasts. Our upper story, in which we suppose our conscious-thought
machine works, is like a loft full of noisy machinery that often needs
oiling and that often gets out of order. Its physical motor power gets
slack or runs right down, and the output is poor or ceases. Sleep and
rest alone will restore it and set it going again.

Our sub-conscious mind seems to be almost independent of our physical
life; it works more or less continuously while the conscious mind is
working, fooling or sleeping. To continue the loft simile: beneath the
machine loft, with its clatter and dust, is a quiet darkened room, in
which our sub-conscious mind lives and functions in its own quiet
way. Men who know how to use it say that, when their conscious minds
become exhausted and have come to an impasse, all they have to do is
to open the trapdoor and pass the apparently insoluble problem down
into the quiet room below. They then banish the subject from their
minds completely, rest, play, or take up some other line of thought,
and by and by, in a day or two perhaps, when they are not thinking of
it, the problem turns up solved. There is no sense of fatigue or of
conscious effort in this process: it is just the old adage of sleeping
over a difficulty. Many of the world’s great inventors have, knowingly
or sometimes unknowingly, made their great discoveries in this way.
Our conscious minds are limited in motive power and always subject to
fatigue, but our sub-conscious minds rarely tire and are unlimited in
scope and power, for they are a part of our Divine inheritance, a
portion of the great undivided spiritual force that moves and governs
the universe, that slumbers not nor sleeps. To get into close touch
with this power needs persevering practice, but it is clearly of
inestimable value. We must not expect a clear and useful response
unless we have given concentrated attention to the matter in point;
a mass of ill-digested, uncertain data will remain as such; we must
be perfectly honest with our _alter ego_; it is of no use trying to
take him in. The more often and thoroughly we accustom what we call
ourselves and our sub-conscious minds to work together in a friendly
way, the better and the quicker will be the response.

The above is only a cursory sketch of a profound subject, but will
serve to show what great economies can be made in the working of our
limited human understandings.

The condition of our arteries that we call sclerosis is much more
common in the sedentary brain-worker than it is in the outdoor man. We
see it rarely in the farmer, the sailor, the labourer, unless it is as
the result of habitual intemperance; we see it rarely in the athlete.
The average blood-pressure of the indoor worker is certainly higher
than that of the open-air worker, even in perfect health.

It follows, therefore, that the more we systematize and economize
in our brain work, the less the strain on the arteries that supply
that organ with its life-blood. Few of us realize what can be done in
this direction. A much advertised system, which I need not further
particularize, has got hold of some of the right ideas and methods, and
its teaching will have a big effect in many directions. It is no new
system; like almost all wisdom, it comes from the East. The old Hindu
and Persian philosophers knew and practised it thousands of years ago,
and got results which we have not approached as yet. The foundation is
concentrated attention: we talk about giving attention to a thing, but
we most of us do it in a very perfunctory, superficial way. Kipling’s
_Kim_, which is full of old, out-of-the-way, unsuspected philosophy,
gives us a wonderful picture of concentrated attention in the contest
of observation and memory between Kim and the native boy in Lurgan
Sahib’s shop. We talk admiringly of a man with “singleness of purpose,”
but what is that but concentrated attention? We admire him because
he achieves his object, he gets there, while the ordinary man with
half-a-dozen half-concentrated purposes wanders down all sorts of side
ways and seldom arrives anywhere. In this world of keen competition
and of little leisure, waste of brain-power leads inevitably towards
disease and failure, while economy leads to health and attainment.

Beyond the question of the nature of our mental work lies the thing
worked for--the object: the importance of this from the health and
disease standpoint is very great. If the object is a worthy one,
something of use, something elevating, not only for ourselves but
for others, attainment will bring happiness and peace, and so tend
towards a healthy condition of brain. If, on the other hand, we strive
for an ignoble, selfish object, one that is almost certain to harm
others, attainment will be like Dead Sea fruit in our mouths, dry and
unsatisfying; there will be in us no sense of joy, and the injury we
have done to others will recoil on ourselves, bringing disappointment
and sorrow. These are they who walk in slippery places, while the
unthinking world, seeing not their end, regards them with envy.

By learning to use our minds wisely, intelligently and economically, we
shall accomplish far more and with far less expenditure of force; we
shall grow in the true philosophical love of a high and simple life.
The false aims, the conflicts, the disharmonies of this world will pass
us by and leave us at peace.

Arterio-sclerosis, then, except in the sad cases of heredity, is very
much of our own making; it almost comes under the heading of “an
occupation disease”; it is a natural result of non-natural conditions
of life. In the words of Isaiah: “Wherefore do ye spend money for that
which is not bread, and your labour for that which satisfieth not?”

Writers have for descriptive purposes, and in most cases rightly,
divided arterio-sclerosis into the two main types that I have described
on p. 50--the hyperpiesis type and the atheromatous; but in general
everyday practice we shall often come across cases that fall under
neither head. Raised blood pressure, even to a considerable degree,
170 mm. to 180 mm., is frequently a temporary affair only, brought
about by temporary causes, such as grief, anger, excitement or
injudicious feeding. An altered mental outlook or a dose of calomel may
banish it quickly; these cases are functional only. The wiser ones get
to recognize their symptoms and the causes: these symptoms are chiefly
a worried state of mind, irritability about little things, a sense of
brain hurry, without the power to accomplish, and there may be passing
vertigo and tinnitus. Such is the day of small things which should
never be ignored, for the day of small errors unheeded may pass on into
the long night of disease.




CHAPTER III

THE WAY OF SAFETY


The pre-sclerotic state of raised pressure may last a considerable
time--two or three years--but this can never be relied upon; every
attack means extra work for the heart, and uses up for a time the
reserve power of that long-suffering organ. Some hearts will respond
well to the call for many years, but others give out and dilate.
Continued raised pressure means one of two things--increased resistance
and partial obstruction in the small arteries and capillaries, or
increased ventricular action and force. An example of the first, which
is far the more common, is seen in sclerosis; of the second, in aortic
regurgitation. In the one case the heart is overcoming resistance--in
the other, compensating for a leak. In the first, the error or
departure from the normal is in the pipes--in the second, in the pump;
but as both are vital organs and not mere bits of mechanism, they in
time react on each other and both become altered. This change is, if
vitality be strong, in the direction of conservatism, of accommodation
to the new order of things. It is compromise, which may be effectual
for a long time, but which, like most compromises, comes to failure in
the end. Occasionally we find the sclerosis attacking the heart muscle
itself or its arteries; such cases are obviously more serious. This
condition generally comes on more or less at the end of the disease,
but in a few cases quite early. Probably many of the cases of true
angina pectoris occurring in early middle life are of this nature, the
coronaries being the chief point of attack.

Besides excess of work and unwise work there is another cause which
seems to raise pressure, and that is absorption of ptomaines or
of the products of imperfect digestion; the overstrain cause and
the absorption cause very often act concurrently, for imperfect
assimilation is often the result of the unwise life. We see this more
often, perhaps, where the unwise life is accompanied by overeating and
injudicious alcoholic stimulation, even if this is not very excessive:
such people rarely give themselves time to digest. The supply of nerve
energy that is necessary for perfect digestion is turned off at the
main long before its proper time. We doctors have a first-hand personal
knowledge of this cause, for owing partly to the intensive nature of
our work and partly to the exigeant importunity of our patients, we
more often practise the vices we deplore than the virtues we praise;
this is one of the reasons that our profession is the shortest-lived
of all.

It is not quite clear how this absorption causes hypertension, but it
is probably through an effect on endocrine glands, chiefly perhaps
on the suprarenal and secondly on the thyroid. McGarrison has shown
how often Graves’ disease is caused by faulty intestinal digestion,
and by the colitis that ensues; this he thinks stimulates the thyroid
to overactivity or to faulty secretion. The suprarenals are probably
affected still more than the thyroid, and the hyperthyroidism may be
due to the upset of the balance of power; for these two glands through
the sympathetic act and react on one another. It is fairly established
that in some cases of Graves’ disease we get hypertension and in some
hypotension, though both conditions vary a good deal. It may be that
the hypotension cases are those that are accompanied by suprarenal
deficiency and that benefit by suprarenal treatment, and I believe it
to be so. This would explain the conflicting opinions as to the value
of this treatment. It has certainly succeeded admirably in some cases.

The co-ordination of all endocrine actions is so intricate that we can
only puzzle out the way by careful clinical observation and experiment.
In sclerosis, as a rule, we get evidence of hyperadrenalism and more
certainly of hypothyroidism. Victor Horsley considered premature
senility to be a form of myxœdema, which of course means pronounced
hypothyroidism.

Biedl says: “A special pathogenetic significance is ascribed to thyroid
insuffiency in the changes which occur in later life, and which are
included in the term ‘cachexia of old age,’ or senile degeneration. The
foundation for the theory that old age results from the changes in the
thyroid gland lies in the fact that in old age the thyroid becomes
atrophied, its follicles shrink, and retrogressive changes take place
in the epithelial cells. This is reinforced by the fact that there is
a profound analogy between the signs of advanced old age and myxœdema.
The falling of the hair and the dropping out of the teeth, the dry and
wrinkled skin, the lowered temperature, the diminished perspiration,
the indolent digestion and consequent emaciation, the decrease of
mental power and the diminution of the activity of the entire nervous
system--these are all symptoms that characterize chronic myxœdema.”

From the old partially true adage, that a man is as old as his
arteries, we must go a step further back and say that a man is as
old as his thyroid. This statement is probably not a final one,
but it gives us a very valuable pointer in the way of treatment.
Arterio-sclerosis and arterial degeneration are the almost universal
accompaniments of thyroid deficiency, and are in most cases the result
of that condition.

There is no main or royal road to the successful management of
sclerosis; every little cause must be thought out and righted if
possible, but as a foundation nothing is so important, I think, as a
clean, healthy intestine, which hitherto has been much neglected. A
microscopical examination of the fæces will often show what is wrong,
and also the direction and results of treatment.

If the condition is thoroughly bad I begin with this rather drastic
regime--twenty-four hours’ absolute starvation in bed, a tenth of a
grain of calomel every hour for twelve hours and as much hot water as
the patient can comfortably drink. This has a wonderful effect, and
one’s subjective feelings after it tell us that evil has gone out of us
and that good has taken its place.

The treatment by bowel antiseptics has been generally very
unsatisfactory. Beta naphthol helps, perhaps, but the most good comes
from duodenal extract in some form. Two grains of the dried powder
about two hours after each meal in pill or tablet act well. Carnrick’s
Secretogen tablets and the much-advertized Jubol are good, and both
depend on some extract from the duodenal mucosa. The unpleasant
flatulence and the fermentation in the bowel soon disappear, and with
them the mucus that is often shed from the coats of the colon. Better
assimilation of food goes hand-in-hand with improved health and vigour.
Intestinal dyspepsia is more far-reaching in its effects than gastric
dyspepsia, but is often ignored.

The questions of food and cooking need most careful consideration. In
the affairs of the soul Christ taught “that which cometh out of the
man, that defileth the man”; in the affairs of the body, that which
goeth into a man, that defileth the man. Both teachings are true and
both are purposeful exaggerations and in a sense untrue. Out of the
same mouth proceed blessings and cursings and into the same mouth go
good food and poisons. The sin lies sometimes in the nature, but more
often perhaps in the excess. The word “temperance” has been made to
apply far too much to the use of alcohol. As a fact, I believe, far
more nowadays are intemperate in eating than in drinking. As the tale
of our years increases and as our physical life gets less strenuous
and active, we require less food, or at any rate a different kind of
food; the strong nitrogenous foods, as meat, become less called for,
and if taken beyond our needs become poisons. The imperfect products
of assimilation have to be dealt with by our excretory organs, which
become overworked and unable to meet the demands. The scavengers
cannot clear the dust-heaps. Hence arise kidney disease, faulty liver
action, and raised blood pressure. And yet, how many of us seek to
restore failing strength by stronger food and more stimulation? In
this futility, kind but ignorant friends aid and abet. Think on what a
little food a baby lives and grows, and, at the other end of life, on
what a simple frugal diet really old people thrive and work.

It is all very well to lay down rules for food, calculated in calories
for strong working men and athletes, but in approaching old age every
one must become more or less a lawgiver to himself; this especially,
if there is any tendency to hyperpiesis, for any food in excess of
the body’s needs becomes for the time a poison. What we can digest
easily and what with difficulty must be largely a personal question,
but the direction should certainly be towards a non-meat regime. The
difference of climate makes comparison between the vegetable feeders
of the tropics and ourselves of uncertain value, but it is a lesson to
see what the Scotch gillie can do on a diet that is mostly oatmeal,
milk and cheese. The gluttonous man and the wine bibber seem to get a
pleasure out of life that the sober men miss, but we doctors see the
other side of the shield, the after-suffering and the failure: the
broken law brings its own punishment and there is no escape.

The physiological process of digestion is rather elaborate, and,
fortunately for us, somewhat elastic. It is not a question entirely of
certain substances in a test-tube exposed to certain digestive agents.
This, of course, is the foundation, the basic process, but there is
much variation in the nature of the food, in the external conditions of
season, of heat and cold, of youth and age, of greater or less physical
or mental demands on the food digested, and lastly on the supplies of
saliva, of pepsin, of hydrochloric acid and of duodenal and pancreatic
secretions. These are all under the control of the autonomous nervous
system, which in the stresses of life often breaks down and fails to
function properly. In the full tide of youthful energy our digestions
seem to respond effectually to many and unreasonable demands, but
this is more apparent than real; the bills may be a long time before
they are sent in, but they come. The recuperative power of youth is
marvellous, but probably never quite complete. After forty years of
age it fails more and more, and then bills come in more quickly, while
in old age it becomes almost a question of cash on delivery. Realizing
this we should, in our own interests, treat our digestive apparatus
with deep respect, and not with the scant courtesy we generally show,
for on its faithful working depend our life, our health, our happiness
and our powers of work. The farmer in his feeding of cattle, the head
of a racing stable in his feeding and training of horses is far more
scientific and wise than we and most other men are in the management
of ourselves. This is why we end our days so often prematurely, or in
paralysis and pain.

To go into actual details of diet is a thankless task, and not very
helpful to the mass of men; it is better, I think, to point out
directions only. If there are symptoms of hyperpiesis, the chief object
is to arrange a diet that contains a minimum of protein (especially of
animal protein) compatible with life and energy. Most of such cases are
leading a life of no great physical strain and will do well on a diet
calculated in calories, that contains:

  Protein        90
  Fat            75
  Carbohydrate  330 = Calories 2,400.

If this is insufficient, add to the fat or carbohydrate rather than to
the protein.

The following tables from Dr. Sprigg’s excellent work classify the
common foods according as their energy production is due to protein,
carbohydrate or fat. It will be noticed that milk is the only food
in the lists which contains a good proportion of all three. Cheese,
Brazil nuts and bread contain a fair proportion of at least two of the
requisite food-stuffs.

If we take, for instance, the figures of lean beef in the first and
second column, viz.:

  Lean beef  90 + 10 we get its value
  Chicken    79 + 21 we get its value
  Bread      13 + 6 + 81 we get its value
  Cheese     25 + 73 + 2 we get its value

By roughly arranging foods according to such a table we can arrive
approximately at a suitable balance of its various constituents. But
the chemical side of the

PERCENTAGE OF TOTAL HEAT VALUE OF FOOD FURNISHED BY ITS

  PROTEIN                  FAT                    CARBOHYDRATE
                Per cent.              Per cent.               Per cent.
  Lean beef (boiled) 90    Butter           99    Tapioca (cooked)  98
  Chicken            79    Bacon            94    Prunes (dried)    97
  Mackerel           50    Cream            87    Figs (dried)      95
  Skim Milk          37    Brazil Nuts      86    Rice (boiled)     89
  Eggs               32    Fat Ham          81    Oysters           89
  Beef with fat      25    Fat Beef         75    Potatoes (boiled) 88
  Cheese             25    Cheese           73    Bread             81
  Fat Ham            19    Eggs             68    Peas              72
  Milk               19    Boiled Mutton    65    Milk              29
  Bread              13    Milk             52    Cream              8
  Potatoes           11    Mackerel         50    Brazil Nuts        4
  Boiled Rice        10    Chicken          21    Cheese             2
  Brazil Nuts        10    Boiled lean Beef 10
  Bacon               6    Bread             6
  Cream               5    Bananas           5
  Bananas             5    Potatoes          1
  Butter              5

problem is not the only one to study. Idiosyncrasy, appetite for
certain foods, distaste for others, and personal experience must all
receive due consideration. The appetite for certain foods varies much
at different periods of life. Fat is abhorrent to many children, and
their lives and digestions are much troubled by the parental, but
unscientific order to “clear up their plates.” In later years the
same persons will welcome fat and need it. Sugar again is loved by
children, scorned in middle age, when its place is often supplied by
wine or beer, and is again welcomed and of great value in old age, for
it helps much to maintain the failing heat of the body, to keep the
home fires burning. Good cane-sugar at all stages of life seems to
act as a special food, or at any rate stimulant, to the heart muscle;
given in large quantities it often gives a failing heart a new lease
of life. The digestibility of food is not governed entirely by its
chemical composition. Twice cooked meat must contain nearly as much
potential nourishment as once cooked, but experience tells most of us
that we digest it with difficulty; and if the digestion of a food is
not perfect, there is more unwholesome waste product to be cleared
away; there is impure blood circulating in all our organs, but we
feel it perhaps more in our brains; the lethargy, the depression,
the irritability that we all recognize as the accompaniments of
indigestion, all stand as cause and effect. Again hot fat and cold
fat must contain the same constituents, but many can do well with
cold fat, while they get bilious with the other. The same thing
applies to butter. All these things we must honestly observe, each
man for himself, and we must not let our likes and our appetites,
nor our prejudices, sway the conclusions of personal experience and
scientific knowledge. Dr. Haig has shown us how many of our ailments
are connected with excess of uric acid in the blood, and how much
this excess is due to certain foods such as meat, which contains what
Fischer named purine bodies. The following extract from Halliburton’s
_Handbook of Physiology_ will partially explain this subject:

*Origin of Uric Acid.*--Uric acid is not made by the kidneys; when
these organs are removed, uric acid continues to be formed, and
accumulates in the organs, especially in the liver and spleen. After
extirpation of the liver in birds (in which animals uric acid is such
an important katabolite) the formation of uric acid practically ceases,
and its place is taken by ammonia and lactic acid, and the conclusion
is therefore drawn that in these animals ammonia and lactic acid are
normally synthesized in the liver to form uric acid. But in mammals
this is not the history of uric acid formation; in these animals,
including man, uric acid is the end-product of the metabolism of
nuclein, from the bases of which it arises by oxidization. Nuclein,
the main constituent of the nuclei of cells, yields on decomposition
certain products called purine substances, and their close relationship
to uric acid is shown by their formulæ:

PURINE BASES.

  Purine                       C_{5}H_{4}N_{4}
  Hypoxanthine (monoxypurine)  C_{5}H_{4}N_{4}O
  Xanthine (dioxypurine)       C_{5}H_{4}N_{4}O_{2}
  Adenine (amino-purine)       C_{5}H_{3}N_{4}NH_{2}
  Guanine (amino-oxypurine)    C_{5}H_{3}N_{4}ONH_{2}
  Uric acid (trioxypurine)     C_{5}H_{4}N_{4}O_{3}

“Just as the ordinary protein metabolism is both exogenous and
endogenous, so is it the case with nuclein metabolism. There are
certain kinds of food (such as liver and sweetbread) which are rich
in nuclei, and others, such as meat, which are rich in purine bases
(especially hypoxanthine). The increase in uric acid excretion after
partaking of such food is exogenous, and those liable to uric acid
disorders should avoid such articles of diet. Other forms of diet
lead to an increase of uric acid formation by increasing the number
of leucocytes in the blood, and there is a consequent increase in
the metabolism of their nuclei. Increase in leucocytes may, however,
be present independently of diet, and in the disease known as
leucocythæmia this occurs to a marked degree; in such cases uric acid
formation increases. Although special attention has been directed to
the nuclei of leucocytes, because these can be readily examined during
life, it must be remembered that the nuclein metabolism of all cells
may contribute to uric acid formation. Uric acid, which originates by
metabolism, is spoken of as endogenous.”

These purine bodies taken in excess, it is almost certain, tend
to raise blood-pressure and to favour the production of gout and
arterio-sclerosis. Much can be done, when these threaten, by reducing
the amount of these in our food. There is, except in very extreme
cases, no need for an absolute purine-free diet, but the diet should
be in that direction and so towards a sensible, liberal vegetarianism.
The following table of ordinary foods, showing the purine contents in
grains per pound, pint or teacup, is from the _Lancet_, 1906, vol. ii,
p. 933, Potts:

  Sweetbread        70.43
  Liver             19.26
  Beef Steak        14.45
  Salmon             9.13
  Chicken            9.06
  Loin of Pork       8.48
  Veal               8.13
  Ham                8.08
  Mutton             6.75
  Halibut            7.14
  Plaice             5.56
  Cod                4.07
  Beans              4.16
  Lentils            4.16
  Oatmeal            3.45
  Coffee             1.70
  Ceylon Tea         1.21
  China Tea          0.75

In sclerosis perhaps the chief thing is to avoid the flesh extracts,
such as beef-tea, strong meat soups, and rich gravies; for this reason
boiled or stewed meats are better than fried or roast. This applies to
fish and chicken also; a plain grill is good, but the frying-pan is a
danger. Vegetable soups made with bone stock may be taken. Cheese, eggs
and milk should supply the greater part of the nitrogenous or protein
food. The better sorts of vegetable foods, such as oatmeal, lentils,
peas and nuts, will all help to take the place of albuminous animal
foods. A certain amount of fat should be taken. A fish and chicken diet
contains too little fat and should be perfected by bacon, hot or cold.
All the farinaceous foods are good, but the more starchy ones, such as
sago, rice and cornflour, are with some people more liable to cause
fermentative dyspepsia.

As age advances and our teeth fail in power we are apt to slip into
the way of eating chiefly soft, well-cooked foods, in which what are
known as vitamines are almost destroyed, but they are as essential as
ever, and some uncooked fruit, salads and unboiled milk should enter
into our diet.

When one thinks over the luxurious habits of our predecessors, the
enormous amount of food, in excess of body needs, taken at big dinners,
one must realize how we and they sinned against the light. The great
war has taught most of us, with the exception perhaps of the new rich,
how little we can live on and work on with complete efficiency. Economy
of food, simplicity of life, mean economy of waste and of expenditure
of vital force, and our bitter war experiences should prove to be the
path to longer lives, and to lives with a higher standard and greater
results.

The question of alcohol in sclerosis is difficult, but very
important. In the first place it depends somewhat on what a man has
been accustomed to take. If he has taken a moderate amount with his
food during the greater part of his life it does not always do to
stop it. Alcohol is not a pressure raiser, as many think, but rather
the reverse, and, if stopped suddenly, the digestive powers may be
lessened and the tone of the body depressed. Lauder Brunton says: “All
the Alcohols tend to dilate vessels, to diminish blood-pressure, and
ultimately to diminish activity of the nervous tissues, although at
first sight they may seem to have a stimulant action.”

Alcohol contains so little nutritious food (with the exception of
the sugars and extractives of wine and beers) that in itself it may
be said to give nothing to the body; but there is something a bit
beyond this--the bitter of the hop and the flavour, the bouquet of
the grape have a stimulating effect on the nerves of taste and smell,
and so produce, with some people, a better flow of saliva and gastric
juice. This probably is how wine and beer in moderate quantities help
digestion and appetite. There is still further the effect on the
general nervous system. Alcohol without doubt enables a man to draw
on his reserve of force, though it probably does not increase those
reserves. This is, of course, drawing on one’s capital, but the ability
to do this may be of great use in emergencies, for it can help a man to
live over evil times. But it must not be forgotten that such calls, if
too large or often repeated, must in the end empty the reservoirs and
leave him powerless and defenceless.

This question of alcohol must be regarded by physicians with common
sense backed by scientific knowledge. The world is never going to
be cured of alcoholic intemperance by intemperance in language and
inaccuracy in thought.

Before I go into the more detailed treatment of sclerosis, I must
just touch on the question of tobacco. Nicotine, without doubt, is
one of the most powerful raisers of arterial pressure known, but in
ordinary smoking very little gets into the system. Tobacco chewing and
snuff-taking, both nearly extinct, probably introduce more nicotine
into the body. The combustion in cigar smoking is so nearly complete
that very little poison remains except on the lips. In ordinary
cigarette smoking the combustion is about as complete as in the case of
cigars, but, if the smoke is habitually inhaled, the absorption through
the bronchial mucous membrane is much greater and, I think, must have
an appreciable effect on blood-pressure. As in alcohol, so in tobacco,
we must not lose sight of the effect on the general nervous system:
on many people tobacco, in moderation, has a distinctly soothing
influence, and so leads to a quietude of mind which compensates for
any other small evil effect. Used in excess, it certainly weakens
both nerve and will power, and often heart power. The first effect in
experimental nicotine poisoning is greatly raised blood pressure, but
at the end dangerously low pressure, and so we find that the ultimate
effect of excessive smoking is a feeble, low-tension pulse that is
often irregular. Oliver found that, in ordinary people who were not
excessive smokers, tobacco raised the systolic pressure 10 to 15 mm.,
but that the diastolic was unaffected; the variations between the two
thus becoming abnormal. This effect generally subsides in a quarter of
an hour after smoking is finished.

It follows, I think, that a man with sclerosis should think this out
for himself, for he is not in a position to take any unnecessary
chances. Of another of our daily habits, it is wise to remember that
coffee raises pressure more than tea, and China tea less than Indian.

There is no doubt that an indoor, sedentary life tends to high
pressure far more than an active, outdoor one. This is partly due to
the mental work and concentration that goes with it and partly to
oxygen deficiency. The inhalation of oxygen lessens the viscosity of
the blood and consequently the work of the heart and of the arterial
muscles, while an excess of carbon-dioxide in the air increases the
viscosity and the necessary heart force that must be expended. The
amount of oxygen we inhale in the open is necessarily more than in
confined buildings, and we all feel how difficult it is to drive our
brains in a close, stuffy atmosphere. This points to the economic value
of ventilation and space. Wise, moderate exercise also tends to lower
pressure by promoting a general quickening of circulation throughout
the whole body; the stagnant pools are flushed out and oxygenation
becomes more perfect. Even severe exercise in health only raises
pressure temporarily; the subsequent level in health is below the
original. But where there is evidence of cardio and arterial disease,
exercise must be taken wisely, moderately, and only slowly increased.
This is done very effectually in some health resorts, where the patient
is trained to mount gradually increasing slopes. The same effect is
reached by graduated exercises. In all these methods pulse rate and
arterial pressure are tested and serve as guides to further advance.
Certain Bath treatments, such as Nauheim and its English adaptations,
help materially to lower pressure and to hasten a sluggish blood flow.
These act chiefly by dilating the blood-vessels at the surface of the
whole body and thus relieving internal congestions and increasing
oxygen exchange.

The nature of our games and exercise in sclerosis needs careful
thought. Golf, for instance, is very good if taken quietly, but some
courses are so hilly that there is a good deal of strain put on the
heart. If one is compelled to play on such a course, one must take it
slowly, and not allow the spirit of the game to run away with one.
Quiet sculling is one of the best exercises, for it works all the
muscles of the body slowly and symmetrically, and the strain on heart
and lungs is entirely under one’s own control. Swimming, again, is a
most healthy exercise, if taken quietly and not in very cold water.
I know of nothing that improves one’s wind so quickly. But all these
exercises must be taken under advice and never pushed to the point of
real fatigue or exhaustion.

The need of rest is as great as the need of the right sort of
exercise. Late hours should be absolutely avoided and little brain work
should be done in the evening, so that the brain and all its important
arteries can sink into relaxation and sleep at once. The rest to the
heart and circulation is of course never so prolonged, but nature has
designed them to get their rest only in moments. The heart in an adult
rests more than thirteen hours out of the twenty-four, under quiet
normal conditions, the time of rest being the diastole, and the time
of work being the systole or contraction. There are few healthy men
who could not walk a thousand miles in six weeks, walking about eight
hours a day and resting for the remainder of their time; but there are
not many men who could walk a thousand miles in a thousand consecutive
hours, as the late Captain Barclay did, because the frequent
interruptions to their sleep would exhaust them completely. In the
same way, if the heart is forced to beat more quickly, it becomes
sooner exhausted, for the extra work is taken from the diastole, the
sleeping or resting time of the heart.

The blood pressure is generally ten degrees lower in the morning after
a good night’s rest; and for this reason, in severe cases, I often
advise people to take a whole day in bed once a week, so that this
lower pressure may be prolonged for twenty-four hours.

The non-medicinal treatment of sclerosis, prophylactic and curative,
consists then chiefly in a philosophical, calm mode of life, in a firm
restraint of passions, of worry and excitements, in a wise and economic
use of brain power, in great moderation in eating and drinking, in
giving as much of our time as is possible to fresh air and moderate,
unhurried exercise, and lastly to the avoidance of all severe strains
on mind or body. Very few of us are able to accomplish all these
positive and negative virtues, but as far as in us lies, they should be
our rule of life.




CHAPTER IV

THE MEDICINAL TREATMENT OF SCLEROSIS


The question now arises, what can the Physician, by real therapeutics,
do to help? Much, I feel sure, if he will carefully and courageously
apply the knowledge that has come to us of the late years. Firstly,
Lauder Brunton showed us how we can quickly reduce the blood pressure
that is one of the chief symptoms in angina pectoris, the immediate
effect of amyl nitrite in reducing arterial tension, and the slower but
very valuable effects of nitroglycerin and the other nitrites. This has
enabled us to meet many an emergency, but the effects of these are
not sustained enough to become a steady daily treatment. The orthodox
remedy has been for years Iodide of Potassium; this has been by the
teachers of the past so driven into us that, in spite of failures
that far outweigh the successes, it has become heterodox to doubt it.
Yet one must confess that one has been for years prescribing it more
from a sense of duty than from any confident hope of its results.
In a few cases, where there is cardiac pain and symptoms of new or
chronic aortitis, it certainly does good, but in the average case of
hyperpiesis it is a very poor reed to trust.

How does Iodide act? Chiefly, in all probability, by stimulating the
thyroid to pour more of its secretion into the blood stream. Thus is
produced the absorption of gummata, of new lowly formed tissues and
the thickenings of fibrositis and rheumatism. We see the same result
more decidedly and more constantly in the treatment of myxœdema by
thyroid feeding.

As I have shown before, senile degeneration, premature and normal, is
largely due to general endocrine degeneration and deficiency, and it
has many relations to myxœdema. Thyroid deficiency as a rule means
raised blood pressure, and, as has been shown in young animals deprived
of their thyroids, a strong tendency to get atheromatous disease of the
large arteries, even in youth.

The parallels are many, and so are the lessons they convey. If one had
a perfectly functioning thyroid in arterio-sclerosis, one might with
some confidence treat it by Iodides; but as we know that such is not
the condition in the great majority of cases, we should expect to
fail. One would have to give Iodide in enormous quantities with any
hope to whip up a senile thyroid into effectual activity, and then in
all probability fail. (This may be the explanation of the miracles
worked by big doses of Iodide in syphilitic gummata in the brain, but
in these cases there is rarely evidence of thyroid deficiency.)

Why then do we take the long and disagreeable route to our object by
giving Iodide? Thyroid feeding acts here just as it does in myxœdema.
We have to take into consideration the comparative failure of the other
endocrine glands, but that only adds to the charm and attractiveness of
the problem. The suprarenal and the pituitary are the most important,
but one must not neglect the sexual glands. I feel strongly that
thyroid treatment alone or in combination is the rational method to
adopt in sclerosis: personal experience confirms this every day. We
purposely side-track the worn-out thyroid of sclerosis and senility,
and, by thyroid feeding, restore to a great extent the whole endocrine
harmony, thus giving a new tone and stimulus to existence. We shall
have to use more or less thyroid feeding for the remainder of life, but
we must show our patients that it is not a medicine but a necessary
food. As in myxœdema, so in sclerosis, thyroid feeding is the only
means, as yet known, of producing absorption of those thickenings that
characterize both diseases.

I have had lately the opportunity of watching and treating a thorough
case of myxœdema in a lady about forty years of age, a very intelligent
and educated woman. She weighs her symptoms and knows exactly when she
needs more or less thyroid; she judges by her head feelings, vertigo,
the sense of fatigue, etc., and by her hair falling out. But thyroid
in sufficient doses produces a quick, irritable heart action; this she
can quiet by taking suprarenal extract. Under sufficient thyroid her
blood pressure comes down to normal and the suprarenal does not raise
it. With this balanced combination she can lead a useful and enjoyable
life. The same thing happens more or less in later life, where there is
high pressure and other signs of arterial thickening.

Suprarenal by the mouth seems to me to have the power of raising low
pressures to the normal--a most valuable property in the asthenia of
pneumonia and diphtheria--but there comes in some check action which
prevents its causing hypertension.

Dr. Sajous, the well-known scientific physician of America, at the
annual meeting of the American Therapeutic Society in May 1920, said:
“With regard to the adrenals, in his opinion, clinical experience with
the human subject did not bear out the statements of physiologists
that therapeutic doses of adrenalin had any inhibitory effects on the
functions of the gastro-intestinal canal; in fact, the effect was quite
the opposite. The supposed blood-pressure raising power of adrenalin
also proved misleading; indeed, one of his workers found that, if
there was one thing that adrenalin did not do, it was to raise blood
pressure.”

In this direction we must realize the wonderful selective action of
adrenalin, that of dilating the coronary arteries, contracting the
arteries and arterioles of the skin and of the great splanchnic area
and of dilating the deep arteries of the limbs. These selective actions
explain the great relief it gives in asthma and acute respiratory
distress, such as œdema of the lungs, where it bleeds a man into his
own distal vessels.

The absence of raised pressure in the brachial and radial arteries may
be thus explained also. Again we must not forget that there may be,
and probably is, something in the extract of the whole gland besides
adrenalin. Administered by stomach the extract has, I think, far more
effect than pure adrenalin given in the same way, and more lasting.
Given by rectum, adrenalin acts quickly and powerfully. In France
thyroid treatment is sometimes carried out by injections of an extract
of the whole gland subcutaneously, but it is difficult to get an
extract that is stable.

In persons of middle age it is far more common to get the unpleasant
heart effects of thyroid than in really old people, but it is not by
any means an absolute rule. I know of two women well over ninety who
cannot on this account take thyroid by itself for long. After sixty,
thyroid in combination with pitglandin (the dried extract of the
pars-anterior of the hypophysis) becomes very useful. At this time of
life the internal secretion of the sexual glands begins to fail, and
pitglandin, I think, compensates for their deficiency. When one thinks
of the extraordinary influence that the pars-anterior has in youth on
growth, and non-growth, causing gigantism and infantilism, one cannot
be surprised at its having some powerful influence at the other end
of life. It can be given in large doses, 1 or 2 grains, and seems to
have no poisonous effects. Unlike pituitrin (pars-posterior), it does
not raise blood pressure, but, I believe, has the opposite effect. The
secretions of testis and ovary are probably mild pressure raisers, and
as they enter into the formation of nearly all the pluri-glandular
preparations that are on the market, this should be recognized.
What may be of great value in neurasthenia, where the pressure is
generally sub-normal, may be harmful in sclerosis. Most of these
preparations contain also whole pituitary, and this again is harmful
in plus pressure. It always strikes me as unscientific to give whole
pituitary in any case, for the two parts are largely antagonistic in
their action. The extracts of the sexual glands have been given, with
the object of restoring sexual power (except for its side effects a
thing of doubtful value), but if they prove to be pressure raisers,
sclerosis will do better without them. In all probability pitglandin
has a stimulating effect on the gonads, as it has on sexual development
in childhood, but it does not raise pressure.

We must regard it as a clinical fact that the thyroid reduces pressure.
The original experiments of Oliver and Schäfer seem conclusive.
Brunton said: “Thyroid gland, when taken by the mouth, dilates the
peripheral vessels, making the skin warm and moist, and quickens the
pulse. In this respect it antagonizes the suprarenal secretion. Besides
this effect on blood pressure, it has other effects on metabolism
which are important.” Biedl says: “If thyroid or iodothyrin be given
continuously for two or three weeks, the amount of CO-excretion will
be increased by 15 to 16 per cent. The nitrogenous interchanges are
invariably disturbed by thyroid; the increased decomposition of albumen
is expressed by an increased excretion of nitrogen. Thyroidism also
brings about a considerable increase in the amount of calcium excreted
in the fæces, the calcium carrying off with it a large proportion of
phosphorus.” This phosphorus loss may explain some of the feeling of
weakness and exhaustion that thyroid feeding often causes; this a good
phosphate food such as Bynogen will help to remove.

It is thus evident that we have in thyroid medication something much
more than a mere tension depressor. Its other properties, influencing
excretion, explain to some extent its sphere of usefulness and its
drawbacks. The increased excretion of calcium may be very beneficial in
atheroma, but is probably not an advantage in other ways. An observant
man, who did not need it, was taking thyroid rather freely; he cut his
finger and could not get it to heal. Thinking that this might be the
result of calcium loss, he stopped the thyroid, and his wound healed,
as he said, in a few hours. To the increased general metabolism that
thyroid produces is due its striking effects in myxœdema: the new
tissues, abnormal in quantity if not in essence, are absorbed, and the
face and limbs resume their natural appearance. Senility and myxœdema
are so closely related that one would naturally expect the same results
to ensue. A fair steady trial will prove that such is the case, but all
such clinical experiments need to be carried out in each individual
case with thoroughness, faith and intelligent observation. Failure may
at first be the verdict, but it is in most cases due to some defect in
method. A thoughtful review of our physiological knowledge of endocrine
actions will often show where lies the fault. A carping critic may say,
What is your physiological knowledge of the action of these glands?
And one must humbly answer, Not very much. But we are going to find
our way through the twilight of our ignorance, partly by physiological
experiment, but chiefly by clinical results. We must also be encouraged
by the thought that all these clinical trials are without risk. What
matters it if we produce temporary symptoms of hyperthyroidism? We can
always correct them or retrace our steps. Russell Lowell’s proverb
was, “A man who never makes a mistake never makes anything.” In such
therapeutics we shall discover the pathways of natural curative
medicine. It is not the introduction into human bodies of vegetable
and mineral remedies or poisons; it is simply the introduction of
correlated gland extracts from other mammals. As far as we know, the
glands of the herbivora answer as well as the glands of the omnivora,
but we may have to correct this view.

In treating hyperpiesis, we shall come across some cases that seem
to yield to thyroid treatment hardly at all, and here the trouble is
often found to be chiefly, if not entirely, in intestinal absorption
of deleterious products of faulty digestion; there may or may not
be signs of colitis; but, as I have said before, duodenal extract
freely given alters the condition rapidly in most cases. In these
cases probably the absorption of these residues of defective digestion
produces hyperadrenia, and the adrenal-thyroid balance is disturbed.
Dr. Sajous (in his paper previously mentioned) claims that calomel in
very small doses, not exceeding gr. 1/12, is a powerful activator of
the thyroid secretion; he claims that so given it has been effective
in checking epidemics of diphtheria. It probably acts partly as an
intestinal bactericide and partly by its action on the thyroid,
increasing the defensive anti-bodies in the blood.

There is one other medicine that has a very decided action on some
forms of raised pressure, and that is hippuric acid. This again is
a natural or endogenous cure. It was introduced by the late Dr.
George Oliver of Harrogate, and is chiefly used as sodium or lithium
hippurate. For some time before his death Dr. Oliver was seeking for a
reasonable explanation of its action, but his death unfortunately came
before he had carried this through. I can give no theory, but of its
effects in many cases I feel convinced, though I cannot say beforehand
in which class of case it will answer. In the pre-sclerotic cases of
middle life it often acts quickly and well, even better than thyroid.
Again, in old age, in cases where one would expect thyroid to give the
better results, it answers equally well.

Two of my patients--old ladies well over seventy--have had hyperpiesis
for twelve years or more; they were condemned by good men many
years ago. They have lived on hippurate almost without breaks all
these years, and it has kept their pressure down to a reasonable
working-point. With both I have tried thyroid treatment with very
slight success; they always come back to their hippurate as the
well-tried friend. I have another patient aged ninety-four, who has
had periods of high pressure for twenty years, and if she misses her
daily dose the pressure goes up and her head gets giddy and confused.
It is a very wholesome medicine, causes no gastric disturbance, and
is easily soluble; from 5 to 15 grains a day are generally needed. If
there are gouty symptoms I give the lithia salt; if not, the sodium.
The benzoates have, I believe, much the same action, but they are not
easily digested and large doses are required. In bad and obstinate
cases the hippurate and thyroid treatment sometimes act well together.

I have written now all that I know from personal experience about the
treatment of this complicated condition we call arterio-sclerosis;
and many of the symptoms and much of the treatment I have been able
to watch and verify for myself by almost hourly contact with it.
Nevertheless, this treatment will have to stand the racket and assaults
of both friendly and hostile critics, and so it should be. In the
practice of medicine we must be prepared to maintain our position and
to give a reason for the faith that is in us, for the issues are so
great and affect others rather than ourselves.

I have said that this is somewhat of an occupation disease: it is a
vicious circle, not originating necessarily in any vice, but in the
pressure of life and the stress of circumstances. The causes often we
cannot remove entirely, but only modify, and so we are compelled to
treat symptoms only; our ambition and longing will be to do much more
than this--to bring about a perfect reform; but in the management
of this, as in most morbid conditions, compromise, with as much true
wisdom as we can squeeze into it, is the only practical policy. Our
endeavour must be to break the vicious circle whenever and wherever we
can. The lowering of pressure does not sound a great thing in itself,
but it immediately lessens the work of the heart, sets more free the
circulation of blood in the brain, often restores the power of sleep
and so ensures comparative rest all round. It thus gives us a breathing
space in which we can consider and attack the origins of evil.

In conclusion I ask my readers to consider well Sir Clifford Allbutt’s
most wise words on this question: “In entering upon the discussion
of vaso-dilatation, as contrasted with agents which bring about this
change indirectly by modifying the causes of morbid constriction, we
have to consider how far mere dilatation--brought about, that is to
say, immediately and singly--serves any good purpose.

“We are told that to act thus directly upon the vessels is but to treat
a symptom, and is therefore absurd. But whatsoever be our judgment on
this or any such particular effect, the common denunciation of treating
symptoms, which sounds very philosophical, is surely but a parrot
phrase. Why should we not treat a symptom? If in granular kidney by
mere pressure reduction the grievous headache be abated, or in angina
pectoris the pain be thus charmed away, we have so far at any rate a
substantial gain.

“In renal diseases it is generally agreed that, on the whole, with due
caution, to lower pressure is helpful. Moreover, if by mitigation of
his suffering the patient gets a chance of picking up in many other
ways, are we not more than justified in our interference, narrow as it
may seem? We never know what interference may cut a link in a vicious
circle. If we cannot stop the crack in the water-pipe, we need not
throw away the mop.

“The warning should run not against the treatment of a ‘mere symptom,’
but lest, while giving our attention to the symptom and snatching at an
immediate advantage, we lose our grip of the case as a whole.”

In whatever treatment we adopt for sclerosis, we must bear in mind
that, under the raised pressure, the heart is very apt to dilate. To
lower pressure alone in this condition often ends in failure. We must
brace up the heart at the same time as we lower resistance. For the
purpose strophanthus in large doses and strychnia are the best drugs.
Digitalis is occasionally necessary, but more often does harm than
good. Given, however, in this well-tried old form it contracts the
ventricle without raising pressure:

  ℞ Pulv. Digitalis   ..  .. gr. 1–2
    Pil. Hydrarg.     ..  .. gr. 1
    Pil. Scillæ Co.   ..  .. gr. 1-1/2
    Ft. pil. to be taken twice a day.

The compound gland tablet that I chiefly use has this formula:

  ℞ Thyroid Extract dried    .. gr. 1/2
    Orchitic Extract dried   .. gr. 1/2
    Ovarian Extract dried    .. gr. 1/2
    Anterior Pituitary dried .. gr. 1/2
              Ft. tab. 1.

This can be taken three times daily and acts best, I think, if taken
before food. The amount of thyroid can be doubled if necessary. In
cases where there is much prostration the anterior pituitary can be
increased to 2 grains. The orchitic and the ovarian can be omitted if
thought advisable.

Hitherto many of us have looked on this condition, arterio-sclerosis,
as a tenant’s fixture, to be got rid of only when he moves into his
next habitation. This is neither fair to ourselves nor to our patients.
It is a hopeless stultification of our more recent physiological
knowledge and discoveries. It is a pessimistic faith that deserves
failure and gets it. It is a silent denial of those healing powers
which Christ so lovingly displayed when on earth, and which are still
the heritage of those who can see and believe.




  _Printed in Great Britain by_
  UNWIN BROTHERS, LIMITED
  WOKING AND LONDON




THE ROAD TO A HEALTHY OLD AGE

By T. BODLEY SCOTT, M.R.C.S. (Eng.), Author of “Why Do We Die?” etc.
Second Edition. Cloth, 5s. net.

“Written in a popular style, the book has been prepared alike for
doctors and laymen, and deals in a common-sense way with the subjects
of prolongation of life; conservation of health, and the habits
necessary for its promotion; food and food values; nature and treatment
of premature senility, especially arterio-sclerosis or thickening
of the arteries; thyroid treatment; and chronic bronchitis and
asthma.”--_Chambers’s Journal._

“We have perused this book with pleasure, and cordially recommend it to
our readers.”--_Medical Times._

“We can cordially commend this work to readers of advancing years,
whether medical or lay. To the former it presents an old subject in a
new way, and to the latter will convey some very wholesome material for
thought.”--_British Medical Journal._

T. FISHER UNWIN LTD, 1 Adelphi Terrace, London, W.C. 2


INSTINCTS OF THE HERD IN PEACE AND WAR

By W. TROTTER. Revised and Enlarged. Fifth Impression. Large Crown 8vo,
cloth. 8s. 6d. net.

“An exceedingly original essay on individual and social
psychology.”--_The New Statesman._

“It is a balanced and inspiring study of one of the prime factors of
human advance.”--_The Times._

“The main purpose of Mr. Trotter’s book, which may be recommended both
for its logic and its circumspection, is to suggest that the science of
psychology is not a mass of dreary and indefinite generalities, but if
studied in relation to other branches of biology, a guide in the actual
affairs of life, enabling the human mind to foretell the course of
human action.”--_Daily Telegraph._

T. FISHER UNWIN LTD, 1 Adelphi Terrace, London, W.C. 2


A HANDBOOK FOR WOMEN

WOMAN AND MARRIAGE

By MARGARET STEPHENS With a Preface by Dr. MARY SCHARLIEB and an
Introduction by Mrs. S. A. BARNETT (6th Impression.) Cloth, 6/- net
(post free 6/6).

“‘Woman and Marriage’ is an outspoken book which should be carefully
read by those for whom it was written. It is not a book for boys
and girls; it is a physiological handbook, thoroughly well written,
orderly, wholesome, and practical. We recommend this work to all who
want a full account in simple words of the physical facts of married
life. All the difficulties of the subject are handled fearlessly,
gravely, and reverently in this book, and as it must be kept out of the
reach of mere curiosity, so it deserves thoughtful study by those of us
whose lives it touches.”--_The Spectator._

“If more such books were written, and more such knowledge disseminated,
it would be a good thing for the wives and mothers of the present
day.”--_The Times._

T. FISHER UNWIN LTD, 1 Adelphi Terrace, London, W.C. 2 _and of all
Booksellers_.


PSYCHOPATHOLOGY OF EVERYDAY LIFE

By Professor SIGMUND FREUD, LL.D. Authorised English Edition with an
Introduction by A. A. BRILL, PH.B., M.D. Sixth Impression. Demy 8vo,
cloth. 12s. 6d. net.

“This book is a symptom of a welcome tendency in the study of
psychopathology, and provides, from one point of view, a very desirable
reaction from the methods of Lombroso, Kraft-Ebing, and similar
writers.... Professor Freud deserves the high praise and true gratitude
of genuine scientists.”--_The Observer._

“The book is extraordinarily interesting and full of hints for the
student of human nature.”--_Nature._

T. FISHER UNWIN LTD, 1 Adelphi Terrace, London, W.C. 2




UNWIN’S “CHATS” SERIES

PRACTICAL HANDBOOKS FOR COLLECTORS


Most people nowadays are collectors in a small way of Autographs,
China, Furniture, Prints, Miniatures, or Silver, and would take up
these fascinating hobbies more extensively, and collect with profit, if
they had a knowledge of the subject.

It is to the beginner and would-be collector that Unwin’s “Chats”
Series of practical handbooks especially appeal. They are the
recognized standard guides to collecting, each volume being the work of
an expert on the subject dealt with.

Each volume is profusely illustrated with carefully-chosen specimens of
the various styles and periods.

Full Indices, Bibliographies, and Lists of Sale Prices at Public
Auctions are included in the volumes.

 “As this is the age of collectors, so it is the age of books for their
 guidance. Mr. Unwin’s series of books for collectors now includes
 twenty-one volumes, and if bargains are missed it is certainly not the
 fault of the various writers.” _The Nation._


HOW TO COLLECT WITH PROFIT

is the keynote of the series. The phenomenal prices realized at auction
sales are obtained by those who have collected wisely. Prices are
still rising, and those who have the knowledge are buying for future
rises. Ask always for and see that you get UNWIN’S “Chats” Series--the
standard popular handbooks on collecting.


THE “CHATS” SERIES IS ON SALE AT ALL BOOKSELLERS THROUGHOUT THE WORLD
AND IS PUBLISHED BY T. FISHER UNWIN LTD., 1 ADELPHI TERRACE,
LONDON, W.C. 2

LIST OF VOLUMES

*Chats on English China.* By ARTHUR HAYDEN. Illustrated with
reproductions of 156 marks and 89 specimens of china. Cloth, 12s. 6d.
net. Sixth Impression.

This is the standard work on the subject. The volume will enable the
possessors of old china to determine the factories at which their ware
was produced.

 “It gives in a few chapters just what the beginner wants to know about
 the principal varieties of English ware. We can warmly commend the
 book to the china collector.”                     _Pall Mall Gazette._

 “So simply yet so thoroughly written, that it is a sage guide to the
 veriest tyro in china collecting.”                          _Bookman._


*Chats on Old Furniture.* By ARTHUR HAYDEN. With a coloured
frontispiece and 104 other Illustrations. Cloth, 12s. 6d. net. Fifth
Impression.

 “The hints to collectors are the best and clearest we have seen; so
 that altogether this is a model book of its kind.”         _Athenæum._

 “A fully illustrated practical guide for collectors.”     _The Times._

 “Mr. Hayden has worked at his subject on systematic lines, and has
 made his book what it purports to be--a practical guide for the
 collector.”                                     _The Saturday Review._


*Chats on Old Prints.* How to Collect and Identify. By ARTHUR HAYDEN.
With a coloured frontispiece and 72 full-page plates. Cloth, 10s. 6d.
net. Fifth Impression.

Every branch of the subject is carefully and explicitly handled in
this book, and valuable information as to technical processes and
identification of prints is given.

 “If there is a better book of its kind on print collecting we have not
 yet come across it.”                                  _Daily Graphic._

 “A very useful handbook for beginners, intended to help any reader of
 artistic tastes, but very moderate means, to collect to good purpose.”
                                                           _The Times._


*Chats on Costume.* By G. WOOLLISCROFT RHEAD, R.E. With a coloured
frontispiece and 117 other Illustrations. Cloth, 10s. 6d. net. Second
Impression.

A practical guide to historic dress. “Clothes” is a subject that has
been neglected by collectors, and this book will be a useful guide to
those who desire to repair that neglect by forming a collection.

 “A book that is at once the work of an authority on the subject of
 costumes, and one that helps to enlarge our range of selection.”
                                                   _Pall Mall Gazette._


*Chats on Old Miniatures.* By J. J. FOSTER, F.S.A. With a coloured
frontispiece and 116 other Illustrations. Cloth, 6s. net.

This book presents in a concise and popular form a variety of valuable
information on the collection and preservation of miniatures, on the
leading English and French artists, and on the specimens exhibited in
public galleries.

 “Mr. Foster is truly a guide, philosopher and friend. He tells us
 not only how to judge and how to buy miniatures, but how to take
 proper care of them.... The splendid photographs by which the book is
 enriched adds in a great measure to its attractiveness and utility.”
                                                 _Aberdeen Free Press._


*Chats on Old Lace and Needlework.* By MRS. LOWES. With a frontispiece
and 74 other Illustrations. Cloth, 10s. 6d. net. Third Impression.

Written by an expert and enthusiast in these most interesting branches
of art. The low price at which the work is issued is exceptional in
dealing with these subjects, and it is remarkable in view of the
technical knowledge displayed and the many photographic illustrations
which practically interleave the book.

 “In commendable, clear and concise style Mrs. Lowes explains the
 technical features distinguishing each example, making the book the
 utmost value in identifying samples of old lace.”--
                                               _Weldon’s Ladies’ Jour._


*Chats on Oriental China.* By J. F. BLACKER. With a coloured
frontispiece and 70 other Illustrations. Cloth, 10s. 6d. net. Third
Impression.

Will be of the utmost service to collectors and to all who may have
old Chinese and Japanese porcelain in their possession. It deals with
oriental china from the various standpoints of history, technique,
age, marks and values, and is richly illustrated with admirable
reproductions.

 “A treatise that is so informing and comprehensive that it commands
 the prompt recognisation of all who value the choice productions of
 the oriental artists.... The illustrations are numerous and invaluable
 to the attainment of expert knowledge, and the result is a handbook
 that is as indispensable as it is unique.”        _Pall Mall Gazette._


*Chats on English Earthenware.* A companion volume to “Chats on
English China.” By ARTHUR HAYDEN. With a coloured frontispiece, 150
Illustrations and tables of over 200 illustrated marks. Cloth,
10s. 6d. net. Third Impression.

 “To the ever-increasing number of collectors who are taking an
 interest in old English pottery ... will be found one of the most
 delightful, as it is a practical work on a fascinating subject.”
                                                     _Hearth and Home._

 “Here we have a handbook, written by a well-known authority, which
 gives in the concisest possible form all the information that the
 beginner in earthenware collecting is likely to need. Moreover,
 it contains one or two features that are not usually found in the
 multifarious “guides” that are produced to-day.”             _Nation._


*Chats on Autographs.* By A. M. BROADLEY. With 130 Illustrations.
Cloth, 6s. net.

 “Being an expert collector, Mr. Broadley not only discourses on the
 kinds of autograph he owns, but gives some excellent cautionary advice
 and a valuable ‘caveat emptor’ chapter for the benefit of other
 collectors.”                                    _Westminster Gazette._

 “It is assuredly the best work of the kind yet given to the public;
 and supplies the intending collector with the various sources of
 information necessary to his equipment.”        _Manchester Guardian._


*Chats on Pewter.* By H. J. L. J. MASSÉ, M.A. With 52 half-tone and
numerous other Illustrations. Cloth, 10s. 6d. net. Second Impression.

 “It is a remarkably thorough and well-arranged guide to the subject,
 supplied with useful illustrations and with lists of pewterers and of
 their marks so complete as to make it a very complete and satisfactory
 book of reference.”                             _Manchester Guardian._

 “Before setting out to collect old pewter it would be as well to read
 Mr. Massé’s book, which is exhaustive in its information and its lists
 of pewterers, analytical index, and historical and technical chapters.”
                                                           _Spectator._


*Chats on Postage Stamps.* By FRED J. MELVILLE. With 57 half-tone and
17 line Illustrations. Cloth, 10s. 6d. net. Second Impression.

 “The whole book, with its numerous illustrations of excellent quality,
 is a _vade mecum_ for stamp collectors, even though their efforts
 may be but modest; we congratulate Mr. Melville on a remarkably good
 guide, which makes fascinating reading.”                    _Academy._

 “There is no doubt that Mr. Melville’s book fills a void. There is
 nothing exactly like it. Agreeably written in a popular style and
 adequately illustrated, it is certainly one of the best guides to
 philatelic knowledge that have yet been published.”           _World._


*Chats on Old Jewellery and Trinkets.* By MACIVER PERCIVAL. With nearly
800 Illustrations. Cloth, 6s. net.

 “The book is very thorough, dealing as it does with classic, antique
 and modern ornaments; with gold, silver, steel and pinchbeck; with the
 precious stones, the commoner stones and imitation.”--_Outlook._

 “‘Chats on Old Jewellery and Trinkets’ is a book which will enable
 every woman to turn over her jewel-case with a fresh interest and
 a new intelligence; a practical guide for the humble but anxious
 collector.... A good glossary of technicalities and many excellent
 illustrations complete a valuable contribution to collector’s lore.”
                                             _Illustrated London News._


*Chats on Cottage and Farmhouse Furniture.* A companion volume
to “Chats on Old Furniture.” By ARTHUR HAYDEN. With a coloured
frontispiece and 75 other Illustrations. Cloth, 10s. 6d. net. Second
Impression.

 “One gets very much for one’s money in this book. Seventy-three
 full-page illustrations in half-tone embellish a letterpress which is
 replete with wise description and valuable hints.”      _Vanity Fair._

 “Mr. Hayden’s book is a guide to all sorts of desirable and simple
 furniture, from Stuart to Georgian, and it is a delight to read as
 well as a sure help to selection.”                _Pall Mall Gazette._

 “Mr. Hayden writes lucidly and is careful and accurate in his
 statements; while the advice he gives to collectors is both sound and
 reasonable.”                                    _Westminster Gazette._


*Chats on Old Coins.* By FRED W. BURGESS. With a coloured frontispiece
and 258 other Illustrations. Cloth, 10s. 6d. net. Second Impression.

 “A most useful and instructive book ... will prove a boon to the
 intending collector of old coins and tokens, and full of interest to
 every collector. As was to be expected of any volume of this series,
 the illustrations are numerous and good, and greatly assist the reader
 to grasp the essentials of the author’s descriptions.”      _Outlook._

 “The author has not only produced ‘a practical guide for the
 collector’ but a handy book of reference for all. The volume is
 wonderfully cheap.”                               _Notes and Queries._


*Chats on Old Copper and Brass.* By FRED W. BURGESS. With a coloured
frontispiece and 86 other Illustrations. Cloth, 6s. net.

 “Mr. F. W. Burgess is an expert on old copper and bronze, and in
 his book there is little information lacking which the most ardent
 collector might want.”                                 _The Observer._

 “Italian bronzes, African charms, Chinese and Japanese enamels, bells,
 mortars, Indian idols, dials, candlesticks, and snuff boxes, all come
 in for their share of attention, and the reader who has mastered Mr.
 Burgess’s pages can face his rival in the auction-room or the dealer
 in his shop with little fear of suffering by the transaction.”
                                                          _The Nation._


*Chats on Household Curios.* By FRED W. BURGESS. With 94 Illustrations.
Cloth, 6s. net.

 “Mr. Burgess gives much information about such attractive antiques
 as old glass and enamels, old leather work, old clocks and watches,
 old pipes, old seals, musical instruments, and even old samplers and
 children’s toys. The book is, in short, an excellent and comprehensive
 guide for what one may call the general collector, that is, the
 collector who does not confine himself to one class of antique, but
 buys whatever he comes across in the curio line, provided that it is
 interesting and at moderate price.”             _Aberdeen Free Press._


*Chats on Japanese Prints.* By ARTHUR DAVISON FICKE. With a coloured
frontispiece and 56 Illustrations. Cloth, 6s. net. Third Impression.

 “Mr. Ficke writes with the knowledge of the expert, and his history
 of Japanese printing from very early times and his criticism of the
 artists’ work are wonderfully interesting.”                  _Tatler._

 “This is one of the most delightful and notable members of an
 attractive series.... A beginner who shall have mastered and made
 thoroughly his own the beauty of line and the various subtlety and
 boldness of linear composition displayed in these sixty and odd
 photographs will have no mean foundation for further study.”--
                                                   _Notes and Queries._


*Chats on Old Clocks.* By ARTHUR HAYDEN. With a frontispiece and 80
Illustrations. 2nd Ed. Cloth, 10s. 6d. net.

 “A practical handbook dealing with the examples of old clocks likely
 to come under the observation of the collector. Charmingly written and
 illustrated.”                                               _Outlook._

 “One specially useful feature of the work is the prominence Mr. Hayden
 has given to the makers of clocks, dealing not only with those of
 London, but also those of the leading provincial towns. The lists
 he gives of the latter are highly valuable, as they are not to be
 found in any similar book. The volume is, as usual with this series,
 profusely illustrated, and may be recommended as a highly interesting
 and useful general guide to collectors of clocks.”  _The Connoisseur._


*Chats on Old Silver.* By ARTHUR HAYDEN. With a frontispiece, 99
full-page Illustrations, and illustrated table of marks. Cloth, 10s.
6d. net. Third Impression.

 “Mr. Hayden’s ‘Chats on Old Silver’ deals very thoroughly with
 a popular branch of collecting. There are a hundred full-page
 illustrations together with illustrated tables and charts, and the
 student of this book can wander round the old curiosity shops of these
 islands with a valuable equipment of knowledge.... Altogether we have
 here a well-written summary of everything that one could wish to know
 about this branch of collecting.”                        _The Sphere._

 “The information it gives will be of exceptional value at this time,
 when so many families will be forced to part with their treasures--and
 old silver is among the most precious possessions of the present day.”
                                                        _Morning Post._


*Chats on Military Curios.* By STANLEY C. JOHNSON, M.A., D.Sc. With a
coloured frontispiece and 79 other Illustrations. Cloth, 6s. net.

 “Mr. Johnson in this book describes many of the articles a collector
 should be on the look out for, giving short but informative notes on
 medals, helmet and cap badges, tunic buttons, armour, weapons of all
 kinds, medallions, autographs, original documents relating to Army
 work, military pictures and prints, newspaper cuttings, obsolete
 uniforms, crests, stamps, postmarks, memorial brasses, money and
 curios made by prisoners of war, while there is also an excellent
 biography on the subject. The author has, indeed, presented the reader
 with a capital working handbook, which should prove a friendly and
 reliable guide when he goes collecting.”                      _Field._


*Chats on Royal Copenhagen Porcelain.* By ARTHUR HAYDEN. With a
frontispiece, 56 full-page Illustrations and illustrated tables of
marks. Cloth, 10s. 6d. net.

 “This very beautiful and very valuable book will be eagerly welcomed
 by lovers of porcelain.... Mr. Hayden describes with great skill and
 preciseness all the quality and beauty of technique in which this
 porcelain excels; he loves it and understands it, and the examples
 he has chosen as illustrations are a valuable supplement to his
 descriptions.”                                              _Bookman._


A NEW “CHATS” VOLUME TO BE ISSUED IN THE AUTUMN OF 1920. ORDER EARLY

*Chats on Old Sheffield Plate.* By ARTHUR HAYDEN. With frontispiece and
53 full-page Illustrations, together with makers’ marks. Cloth, about
10s. 6d. net.

Old plated ware has, by reason of its artistic excellence and its
technique, deservedly won favour with collectors. The art of making
plated ware, which originated at Sheffield (hence the name “Sheffield
plate”), was continued at Birmingham and London, where a considerable
amount of “old Sheffield plate” was made, in the manner of its first
inventors, by welding sheets of silver upon copper. The manufacture
lasted roughly a hundred years. Its best period was from 1776 (American
Declaration of Independence) to 1830 (Accession of William IV). The
author shows reasons why this old Sheffield plate should be collected,
and the volume is illustrated with many examples giving various
styles and the development of the art, together with makers’ marks.
Candlesticks and candelabra, tea-caddies, sugar-baskets, salt-cellars,
teapots, coffee-pots, salvers, spoons, and many other articles shown
and described in the volume indicate the exquisite craftsmanship of
the best period. The work stands as a companion volume to the author’s
“Chats on Old Silver,” the standard practical guide to old English
silver collecting.


*Bye Paths in Curio Collecting.* By ARTHUR HAYDEN, Author of “Chats on
Old Silver,” etc. With a frontispiece and 72 full-page Illustrations.
Cloth, 21s. net. Second Impression.

 “Every collector knows the name of Mr. Arthur Hayden, and knows him
 for a wise counsellor. Upon old furniture, old china, old pottery, and
 old prints there is no more knowing judge in the country; and in his
 latest volume he supplies a notable need, in the shape of a vade-mecum
 exploring some of the nondescript and little traversed bye-paths of
 the collector. There was never a time when the amateur of the antique
 stood more in need of a competent guide.... The man who wishes to
 avoid the pitfalls of the fraudulent will find much salutary advice in
 Mr. Hayden’s gossipy pages. There are chests, for example, a fruitful
 field for reproduction. Mr. Hayden gives photographs of many exquisite
 examples. There is a marriage coffer of the sixteenth century,
 decorated with carved figures of Cupid and Hymen, a fine Gothic chest
 of the fifteenth century, with rich foliated decorations; and a superb
 livery cupboard from Haddon Hall. From Flanders come steel coffers,
 with a lock of four bolts, the heavy sides strongly braized together.
 Then there are snuffers, with and without trays, tinder-boxes, snuff
 graters, and metal tobacco stoppers. The most fascinating designs are
 shown, with squirrels, dogs, and quaint human figures at the summit.
 Fans and playing-cards provide another attractive section.

    Chicken-skin, delicate, white,
    Painted by Carlo van Loo.

 The fan has always been an object of the collector’s passion, because
 of the grace of the article and its beauty as a display. Mr. Hayden
 shows a particularly beautiful one, with designs after Fragonard, the
 sticks of ivory with jewelled studs. Then there are watch-stands, a
 little baroque in design, and table-bells, some of them shaped as
 female figures with spreading skirts, old toys and picture-books, and,
 of course, cradles, of which every English farm-house once boasted its
 local variety. Altogether the book abounds in inviting pictures and
 curious information, and is certain of a large, appreciative public.”
                                                     _Daily Telegraph._


TO BE PUBLISHED IN THE AUTUMN, 1920

*The Fan Book*: Including Special Chapters on European Fans of the
Seventeenth and Eighteenth Centuries. By MACIVER PERCIVAL, author of
“Chats on Old Jewellery and Trinkets.” Fully Illustrated. Demy 8vo,
cloth, 21/- net.




*POETRY THAT THRILLS*
A COLLECTION OF SONGS FROM OVERSEAS THAT THRILL WITH VIVID
DESCRIPTIONS OF THE ADVENTUROUS LIFE IN THE FROZEN NORTH, IN THE
OUTPOSTS OF CIVILIZATION AND OF THE HEROISM OF SOLDIERS IN BATTLE


SONGS OF A SOURDOUGH. By ROBERT W. SERVICE. Crown 8vo. Cloth, 4/6 net.
Thirty-ninth Impression. Also a Pocket edition. Fcap. 8vo, cloth,
4/6 net.

 “Of the Canadian disciples of Kipling, by far the best is R. W.
 Service. His ‘Songs of a Sourdough’ have run through many editions.
 Much of his verse has a touch of real originality, conveying as it
 does a just impression of the something evil and askew in the strange,
 uncouth wilderness of the High North.”                    _The Times._

 “Mr. Service has got nearer to the heart of the old-time place miner
 than any other verse-maker in all the length and height of the
 Dominion.... He certainly sees the Northern Wilderness through the
 eyes of the man into whose soul it is entered.”        _Morning Post._


RHYMES OF A RED-CROSS MAN. By ROBERT W. SERVICE. Crown 8vo. Cloth, 4/6
net. Fifth Impression. Also a Pocket edition. Fcap. 8vo, cloth, 4/6 net.

 “It is the great merit of Mr. Service’s verses that they are literally
 alive with the stress and joy and agony and hardship that make up life
 out in the battle zone. He has never written better than in this book,
 and that is saying a great deal.”                           _Bookman._

 “Mr. Service has painted for us the unutterable tragedy of the war,
 the horror, the waste, and the suffering, but side by side with that
 he has set the heroism, the endurance, the unfailing cheerfulness and
 the unquenchable laughter.”                         _Scots Pictorial._


BALLADS OF A CHEECHAKO. By ROBERT W. SERVICE. Crown 8vo. Cloth, 4/6
net. Thirteenth Impression. Also a Pocket edition. Fcap. 8vo. Cloth,
4/6 net.

 “It is to men like Mr. Service that we must look for really original
 verse nowadays; to the men on the frontiers of the world. ‘Ballads of
 a Cheechako’ is magnificent.”                       _Oxford Magazine._

 “All are interesting, arresting, and worth reading in their own
 setting for their own sakes. They are full of life and fire and
 muscularity, like the strenuous and devil-may-care fight of a life
 they describe.”                                            _Standard._


RHYMES OF A ROLLING STONE. By ROBERT W. SERVICE. Crown 8vo. Cloth, 4/6
net. Fourteenth Impression. Also a Pocket Edition. Fcap. 8vo. Cloth,
4/6 net.

 “There is real rollicking fun in some of the rhymed stories, and
 some sound philosophy in the shorter serious poems which shows that
 Mr. Service is as many steps above the ordinary lesser poets in his
 thought as he is in his accomplishments.”                   _Academy._

 “Mr. Robert Service is, we suppose, one of the most popular
 verse-writers in the world. His swinging measures, his robust ballads
 of the outposts, his joy of living have fairly caught the ear of his
 countrymen.”                                              _Spectator._


THE SPELL OF THE TROPICS. By RANDOLPH H. ATKIN. Cloth, 4/6 net.

The poems are striking pen-pictures of life as it is lived by those
men of the English-speaking races whose lot is cast in the sun-bathed
countries of Latin-America. Mr. Atkin’s verses will reach the hearts
of all who feel the call of the wanderlust, and, having shared their
pleasures and hardships, his poems will vividly recall to “old-timers”
bygone memories of days spent in the Land of the Coconut Tree.


THE SONG OF TIADATHA. By OWEN RUTTER. Cloth, 4/6 net. Third Impression.

Composed on the familiar metre of “Hiawatha,” “The Song of Tiadatha”
(Tired Arthur), an extravaganza written in the highest spirits,
nevertheless is an epic of the war. It typifies what innumerable
soldiers have seen and done and the manner in which they took it.

 “This song of Tiadatha is nothing less than a little English epic of
 the war.”                                          _The Morning Post._

 “Every Army officer and ex-officer will hail Tiadatha as a brother.
 ‘The Song of Tiadatha’ is one of the happiest skits born of the war.”
                                                    _Evening Standard._


SONGS OUT OF EXILE: Being Verses of African Sunshine and Shadow and
Black Man’s Twilight. By CULLEN GOULDSBURY. Cloth, 4/6 net. Fourth
Impression.

 “The ‘Rhodesian Rhymes’ won for their author the journalistic title of
 ‘The Kipling of South Africa,’ and indeed his work is full of crisp
 vigour, fire and colour. It is brutal in parts; but its brutality is
 strong and realistic. Mr. Gouldsbury has spent many years in Rhodesia,
 and its life, black and white, is thoroughly familiar to him.... Mr.
 Gouldsbury is undoubtedly a writer to be reckoned with. His verse is
 informed by knowledge of wild life in open places and a measure of
 genuine feeling which make it real poetry.”--_Standard._


FROM THE OUTPOSTS. By CULLEN GOULDSBURY. Cloth, 4/6 net. Third
Impression.

 “Mr. Cullen Gouldsbury’s collections of his verses are always welcome,
 and the last, ‘From the Outposts,’ is as good as its predecessor. No
 one has quite Mr. Gouldsbury’s experience and gift.”      _Spectator._

 “It has been well said that Mr. Gouldsbury has done for the white man
 in Africa what Adam Lindsay Gordon in a measure accomplished for the
 Commonwealth and Kipling triumphantly for the British race, and he
 certainly is good to read.”                                   _Field._


THE HELL-GATE OF SOISSONS and other Poems. (“THE SONG OF THE GUNS.”) By
HERBERT KAUFMAN. Cloth, 4/6 net. Fifth Impression.

 “A singular gift for expressing in verse the facts, the heroism, even
 the humours of war; and in some cases voices its ideals with real
 eloquence.”                                               _The Times._

 “Mr. Kaufman has undoubtedly given us a book worthy of the great hour
 that has brought it forth. He is a poet with a martial spirit and a
 deep, manly voice.”                                      _Daily Mail._


LYRA NIGERIA. By ADAMU. (E. C. ADAMS). Cloth, 4/6 net. Second Impression.

 “Mr. E. C. Adams (Adamu) is a singer of Nigeria, and it can safely
 be said he has few, if any, rivals. There is something in these
 illustrations of Nigerian life akin to the style of Kipling and
 Service. The heart of the wanderer and adventurer is revealed, and in
 particular that spirit of longing which comes to all ... who have gone
 out to the far-lands of the world.”               _Dundee Advertiser._


SUNNY SONGS. Poems. By EDGAR A. GUEST. Cloth, 4/6 net.

In America Mr. Guest is an extraordinarily popular writer of verses,
though this is his first introduction in book form to the British
public. He brims over with sound sense and tonic cheeriness. He
is keenly sensible of the humour of domestic life, but is deeply
sympathetic with the associations which combine in the word “Home.”
Hence he is read by women with amusement and pleasure. During the war
his poem, “Said the Workman to the Soldier,” circulated by the hundred
thousand. Like Béranger and all successful poets, he is essentially
lyrical; that is to say, there is tune and swing in all his verses.




RICHARD MIDDLETON’S WORKS

POEMS AND SONGS (_First Series_). By RICHARD MIDDLETON. Cloth, 5/- net.

 “We have no hesitation in placing the name of Richard Middleton beside
 the names of all that galaxy of poets that made the later Victorian
 era the most brilliant in poetry that England had known since the
 Elizabethan.”                                `   _Westminster Review._


POEMS AND SONGS (_Second Series_). By RICHARD MIDDLETON. Cloth, 5/- net.

 “Their beauty is undeniable and often of extraordinary delicacy, for
 Middleton had a mastery of craftmanship such as is usually given to
 men of a far wider imaginative experience.”           _Poetry Review._

 “Among the ‘Poems and Songs’ of Richard Middleton are to be found some
 of the finest of contemporary lyrics.”                 _Country Life._


OTHER WORKS BY RICHARD MIDDLETON

 THE GHOST SHIP AND OTHER STORIES.

 MONOLOGUES.

 THE DAY BEFORE YESTERDAY.


THE WAITING WOMAN and other Poems. By HERBERT KAUFMAN. Cloth, 4/6 net.

 “Mr. Kaufman’s work possesses in a high degree the qualities of
 sincerity and truth, and it therefore never fails to move the
 reader.... This volume, in short, is the work of a genuine poet and
 artist.”                                        _Aberdeen Free Press._

 “A versifier of great virility and power.”        _Review of Reviews._


BY W. B. YEATS AND OTHERS

POEMS. By W. B. YEATS. Second edition. Large Crown 8vo, Cloth, 10/6 net.
Ninth Impression.

 “Love songs, faery themes, moods of meditation, scenes of legendary
 wonder ... is it possible that they should become so infinitely
 thrilling, touching, haunting in their fresh treatment, as though they
 had never been, or poets had never turned to them? In this poet’s
 hands they do so become. Mr. Yeats has given us a new thrill of
 delight, a new experience of beauty.”               _Daily Chronicle._


OTHER POEMS BY W. B. YEATS

COUNTESS CATHLEEN. A Dramatic Poem. Paper cover, 2/- net.

THE LAND OF HEART’S DESIRE. Paper cover, 1/6 net.


WHY DON’T THEY CHEER? By R. J. C. STEAD. Cloth, 4/6 net.

 “Before the war Mr. Stead was known to Canadians as ‘The Poet of the
 Prairies.’ He must now be ranked as a ‘Poet of the Empire.’ ... There
 is a strength, a beauty, a restrained passion in his war verses which
 prove his ability to penetrate into the heart of things such as very
 few of our war poets have exhibited.”--_Daily Express._


SWORDS AND FLUTES. By WILLIAM KEAN SEYMOUR. Cloth, 4/- net.

 “Among the younger poets Mr. Seymour is distinguished by his delicacy
 of technique. ‘Swords and Flutes’ is a book of grave and tender beauty
 expressed in lucent thought and jewelled words. ‘The Ambush’ is a
 lyric of mastery and fascination, alike in conception and rhythm,
 which should be included in any representative anthology of Georgian
 poetry.”                                              _Daily Express._




THE MERMAID SERIES

THE BEST PLAYS OF THE OLD DRAMATISTS

Literal Reproductions of the Old Text. With Photogravure Frontispieces.
Thin Paper edition. Boards, 3/-net; Cloth, 5/- net per volume. Leather,
7/6 net.

Marlowe. THE BEST PLAYS OF CHRISTOPHER MARLOWE. Edited, with Critical
Memoir and Notes, by Havelock Ellis; and containing a General
Introduction to the Series by John Addington Symonds.

Otway. THE BEST PLAYS OF THOMAS OTWAY. Introduction and Notes by the
Hon. Roden Noel.

Ford. THE BEST PLAYS OF JOHN FORD. Edited by Havelock Ellis.

Massinger. THE BEST PLAYS OF PHILLIP MASSINGER. With Critical and
Biographical Essay and Notes by Arthur Symons.

Heywood (T.). THE BEST PLAYS OF THOMAS HEYWOOD. Edited by A. W.
Verity. With Introduction by J. A. Symonds.

Wycherley. THE COMPLETE PLAYS OF WILLIAM WYCHERLEY. Edited, with
Introduction and Notes, by W. C. Ward.

NERO AND OTHER PLAYS. Edited by H. P. Horne, Arthur Symons, A. W.
Verity and H. Ellis.

Beaumont. THE BEST PLAYS OF BEAUMONT AND FLETCHER. Introduction and
Notes by J. St. Loe Strachey. 2 vols.

Congreve. THE COMPLETE PLAYS OF WILLIAM CONGREVE. Edited by Alex. C.
Ewald.

Symonds (J. A.). THE BEST PLAYS OF WEBSTER AND TOURNEUR. With an
Introduction and Notes by John Addington Symonds.

Middleton (T.). THE BEST PLAYS OF THOMAS MIDDLETON. With an
Introduction by Algernon Charles Swinburne. 2 vols.

Shirley. THE BEST PLAYS OF JAMES SHIRLEY. With Introduction by Edmund
Gosse.

Dekker. THE BEST PLAYS OF THOMAS DEKKER. Notes by Ernest Rhys.

Steele (R.). THE COMPLETE PLAYS OF RICHARD STEELE. Edited, with
Introduction and Notes, by G. A. Aitken.

Jonson. THE BEST PLAYS OF BEN JONSON. Edited, with Introduction and
Notes, by Brinsley Nicholson and C. H. Herford. 2 vols.

Chapman. THE BEST PLAYS OF GEORGE CHAPMAN. Edited by William Lyon
Phelps.

Vanbrugh. THE SELECT PLAYS OF SIR JOHN VANBRUGH. Edited, with an
Introduction and Notes, by A. E. H. Swain.

Shadwell. THE BEST PLAYS OF THOMAS SHADWELL. Edited by George
Saintsbury.

Dryden. THE BEST PLAYS OF JOHN DRYDEN. Edited by George Saintsbury. 2
vols.

Farquhar. THE BEST PLAYS OF GEORGE FARQUHAR. Edited, and with an
Introduction, by William Archer.

Greene. THE COMPLETE PLAYS OF ROBERT GREENE. Edited with Introduction
and Notes by Thomas H. Dickinson.




THE ADVANCE OF SOUTH AMERICA

A FEW NOTES ON SOME INTERESTING BOOKS DEALING WITH THE PAST HISTORY,
PRESENT AND FUTURE POSSIBILITIES OF THE GREAT CONTINENT


When in 1906 Mr. Fisher Unwin commissioned the late Major Martin
Hume to prepare a series of volumes by experts on the South American
Republics, but little interest had been taken in the country as a
possible field for commercial development. The chief reasons for this
were ignorance as to the trade conditions and the varied resources
of the country, and the general unrest and instability of most of
the governments. With the coming of the South American Series of
handbooks the financial world began to realize the importance of the
country, and, with more settled conditions, began in earnest to develop
the remarkable natural resources which awaited outside enterprise.
Undoubtedly the most informative books on the various Republics are
those included in THE SOUTH AMERICAN SERIES, each of which is the work
of a recognized authority on his subject.

 “The output of books upon Latin America has in recent years been very
 large, a proof doubtless of the increasing interest that is felt
 in the subject. Of these the ‘South American Series’ is the most
 noteworthy.”                                              _The Times._

 “When the ‘South American Series’ is completed, those who take
 interest in Latin-American affairs will have an invaluable
 encyclopædia at their disposal.”                _Westminster Gazette._

 “Mr. Unwin’s ‘South American Series’ of books are of special interest
 and value to the capitalist and trader.”--
                                         _Chamber of Commerce Journal._

Full particulars of the volumes in the “South American Series,” also of
other interesting books on South America, will be found in the pages
following.

1 *Chile*. By G. F. SCOTT ELLIOTT, M.A., F.R.G.S. With an Introduction
by MARTIN HUME, a Map and 89 Illustrations. Cloth, 15/- net. Fifth
Impression.

 “An exhaustive, interesting account, not only of the turbulent history
 of this country, but of the present conditions and seeming prospects.”
                                                 _Westminster Gazette._

2 *Peru*. By C. REGINALD ENOCK, F.R.G.S. With an Introduction by MARTIN
HUME, a Map and 64 Illustrations. Cloth, 18/- net. Fifth Impression.

 “An important work.... The writer possesses a quick eye and a keen
 intelligence; is many-sided in his interests, and on certain subjects
 speaks as an expert. The volume deals fully with the development of
 the country.”                                             _The Times._

3 *Mexico*. By C. REGINALD ENOCK, F.R.G.S. With an Introduction by
MARTIN HUME, a Map and 64 Illustrations. Cloth, 15/- net.  Fifth
Impression.

 “The book is most comprehensive; the history, politics, topography,
 industries, resources and possibilities being most ably discussed.”
                                                  _The Financial News._

4 *Argentina*. By W. A. HIRST. With an Introduction by Martin Hume, a
Map and 64 Illustrations. Cloth, 15/- net. Fifth Impression.

 “The best and most comprehensive of recent works on the greatest and
 most progressive of the Republics of South America.”
                                                 _Manchester Guardian._

5 *Brazil*. By PIERRE DENIS. Translated, and with an Historical Chapter
by BERNARD MIALL. With a Supplementary Chapter by DAWSON A. VINDIN, a
Map and 86 Illustrations. Cloth, 15/- net. Third Impression.

 “Altogether the book is full of information, which shows the author to
 have made a most careful study of the country.”--_Westminster Gazette._

6 *Uruguay*. By W. H. KOEBEL. With a Map and 55 Illustrations. Cloth,
15/- net. Third Impression.

 “Mr. Koebel has given us an expert’s diagnosis of the present
 condition of Uruguay. Glossing over nothing, exaggerating nothing, he
 has prepared a document of the deepest interest.”--_Evening Standard._

7 *Guiana*. British, French and Dutch. By JAMES RODWAY. With a Map and
82 Illustrations. Cloth, 18/- net. Second Impression.

 “Mr. Rodway’s work is a storehouse of information, historical,
 economical and sociological.”                             _The Times._

8 *Venezuela*. By LEONARD V. DALTON, F.G.S., F.R.G.S. With a Map and 45
Illustrations. Cloth, 15/- net. Third Impression.

 “An exhaustive and valuable survey of its geography, geology, history,
 botany, zoology and anthropology, and of its commercial possibilities
 in the near future.”                            _Manchester Guardian._

9 *Latin America*: Its Rise and Progress. By F. GARCIA-CALDERON. With a
Preface by RAYMOND POINCARÉ, President of the French Republic. With a
Map and 84 Illustrations. Cloth, 15/- net. Fifth Impression.

President Poincaré, in a striking preface to this book, says: “Here is
a book that should be read and digested by every one interested in the
future of the Latin genius.”

10 *Colombia*. By PHANOR JAMES EDER, A.B., LL.B. With 2 Maps and 40
Illustrations. Cloth, 15/- net. Fourth Impression.

 “Mr. Eder’s valuable work should do much to encourage investment,
 travel and trade in one of the least-known and most promising of the
 countries of the New World.”                    _Manchester Guardian._

11 *Ecuador*. By C. REGINALD ENOCK, F.R.G.S. With 2 Maps and 87
Illustrations. Cloth, 15/- net. Second Impression.

 “Mr. Enock’s very thorough and exhaustive volume should help British
 investors to take their part in promoting its development. He has
 studied and described the country in all its aspects.”
                                                 _Manchester Guardian._

12 *Bolivia*. By PAUL WALLE. With 4 Maps and 59 Illustrations. Cloth,
18/- net. Second Impression.

Bolivia is a veritable El Dorado, requiring only capital and enterprise
to become one of the wealthiest States of America. This volume is the
result of a careful investigation made on behalf of the French Ministry
of Commerce.

13 *Paraguay*. By W. H. KOEBEL. With a Map and 32 Illustrations. Cloth,
15/- net. Second Impression.

 “Gives a great deal of serious and useful information about the
 possibilities of the country for the emigrant, the investor and
 the tourist, concurrently with a vivid and literary account of its
 history.”                                                 _Economist._

14 *Central America*: Guatemala, Nicaragua, Costa Rica, Honduras,
Panama and Salvador. By W. H. KOEBEL. With a Map and 25 Illustrations.
Cloth, 15/- net. Second Impression.

 “We strongly recommend this volume, not only to merchants looking
 ahead for new openings for trade, but also to all who wish for an
 accurate and interesting account of an almost unknown world.”
                                                     _Saturday Review._



BOOKS ON SOUTH AMERICA

_OTHER BOOKS ON SOUTH AMERICA_


*Spanish America*: Its Romance, Reality and Future. By C. R. ENOCK,
Author of “The Andes and the Amazon,” “Peru,” “Mexico,” “Ecuador.”
Illustrated and with a Map. 2 vols. Cloth, 30/- net the set.

Starting with the various States of Central America, Mr. Enock then
describes ancient and modern Mexico, then takes the reader successively
along the Pacific Coast, the Cordillera of the Andes, enters the land
of the Spanish Main, conducts the reader along the Amazon Valley, gives
a special chapter to Brazil and another to the River Plate and Pampas.
Thus all the States of Central and South America are covered. The work
is topographical, descriptive and historical; it describes the people
and the cities, the flora and fauna, the varied resources of South
America, its trade, railways, its characteristics generally.


*South America*: An Industrial and Commercial Field. By W. H. KOEBEL.
Illustrated. Cloth, 18/- net. Second Impression.

 “The book considers such questions as South American commerce,
 British interests in the various Republics, international relations
 and trade, communications, the tendency of enterprise, industries,
 etc. Two chapters devoted to the needs of the continent will be of
 especial interest to manufacturers and merchants, giving as they do
 valuable hints as to the various goods required, while the chapter on
 merchandise and commercial travellers affords some sound and practical
 advice.”                                _Chamber of Commerce Journal._


*Vagabonding down the Andes.* By HARRY A. FRANCK, author of “A Vagabond
Journey Round the World,” etc. With a Map and 176 Illustrations. Cloth,
25/- net. Second Impression.

 “The book is a brilliant record of adventurous travel among strange
 scenes and with even more strange companions, and vividly illustrates,
 by its graphic text and its admirable photographs, the real conditions
 of life in the backwood regions of South America.”
                                                 _Manchester Guardian._

 “Mr. Franck is to be congratulated on having produced a readable and
 even fascinating book. His journey lay over countries in which an
 increasing interest is being felt. Practically speaking, he may be
 said to have started from Panama, wandered through Colombia, spending
 some time at Bogota, and then going on to Ecuador, of which Quito is
 the centre. Next he traversed the fascinating country of the Incas,
 from the borders of which he entered Bolivia, going right across that
 country till he approached Brazil. He passed through Paraguay, cut
 through a corner of the Argentine to Uruguay, and so to the River
 Plata and the now well-known town of Buenos Ayres.”    _Country Life._


*In the Wilds of South America*: Six Years of Exploration in Colombia,
Venezuela, British Guiana, Peru, Bolivia, Argentina, Paraguay and
Brazil. By LEO E. MILLER, of the American Museum of Natural History.
With 48 Full-page Illustrations and with Maps. Cloth, 21/- net.

This volume represents a series of almost continuous explorations
hardly ever paralleled in the huge areas traversed. The author is a
distinguished field naturalist--one of those who accompanied Colonel
Roosevelt on his famous South American expedition--and his first object
in his wanderings over 150,000 miles of territory was the observation
of wild life; but hardly second was that of exploration. The result is
a wonderfully informative, impressive and often thrilling narrative
in which savage peoples and all but unknown animals largely figure,
which forms an infinitely readable book and one of rare value for
geographers, naturalists and other scientific men.


*The Putumayo: The Devil’s Paradise.* Travels in the Peruvian Amazon
Region and an Account of the Atrocities committed upon the Indians
therein. By E. W. HARDENBURG, C.E. Edited and with an Introduction by
C. REGINALD ENOCK, F.R.G.S. With a Map and 16 Illustrations. Demy 8vo,
Cloth, 10/6 net. Second Impression.

 “The author gives us one of the most terrible pages in the history of
 trade.”                                             _Daily Chronicle._


*Tramping through Mexico, Guatemala and Honduras.* By HARRY A. FRANCK,
With a Map and 88 Illustrations. Cloth, 7/6 net.

 “Mr. Harry Franck is a renowned vagabond with a gift for vivid
 description.... His record is well illustrated and he tells his story
 in an attractive manner, his descriptions of scenery being so well
 done that one feels almost inclined to risk one’s life in a wild race
 dwelling in a land of lurid beauty.”              _Liverpool Mercury._

 “Mr. Franck has combined with an enthralling and amusing personal
 narrative a very vivid and searching picture, topographical and
 social, of a region of much political and economic interest.”
                                                      _Glasgow Herald._


*Mexico* (Story of the Nations). By SUSAN HALE. With Maps and 47 Illus.
Cloth, 7/6 net. Third Impression.

 “This is an attractive book. There is a fascination about Mexico which
 is all but irresistible.... The authoress writes with considerable
 descriptive power, and all through the stirring narrative never
 permits us to lose sight of natural surroundings.”    _Dublin Review._


*Things as they are in Panama.* By HARRY A. FRANCK. With 50 Illustra-
tions. Cloth, 7/6 net.

 “Mr. Franck writes from personal knowledge, fortified by the aptitude
 of a practical and shrewd observer with a sense of humour, and the
 result is a word-picture of unusual vividness.”--_Standard._

 “A sparkling narrative which leaves one wondering again why the
 general reader favours modern fiction so much when it is possible to
 get such vivacious yarns as this about strange men and their ways in a
 romantic corner of the tropics.”                         _Daily Mail._


*The Spell of the Tropics.* POEMS. By RANDOLPH H. ATKIN. Cloth, 4/6 net.

The author has travelled extensively in Central and South America,
and has strongly felt the spell of those tropic lands, with all their
splendour and romance, and yet about which so little is known. The
poems are striking pen-pictures of life as it is lived by those men
of the English-speaking races whose lot is cast in the sun-bathed
countries of Latin-America. Mr. Atkin’s verses will reach the hearts
of all who feel the call of the wanderlust, and, having shared their
pleasures and hardships, his poems will vividly recall to “old-timers”
bygone memories of days spent in the land of the Coconut Tree.


*Baedeker Guide to the United States.* With Excursions to Mexico, Cuba,
Porto Rico and Alaska. With 33 Maps and 48 Plans. Fourth Edition, 1909.
Cloth, 20/- net.


IMPORTANT. Travellers to the Republics of South America will find
WESSELY’S ENGLISH-SPANISH and SPANISH-ENGLISH DICTIONARY and WESSELY’S
LATIN-ENGLISH and ENGLISH-LATIN DICTIONARY invaluable books. Bound in
cloth, pocket size. Price 4/- net each.

Ask for Wessely’s Edition, published by Mr. T. Fisher Unwin.




THE STORY OF THE NATIONS

THE GREATEST HISTORICAL LIBRARY IN THE WORLD :: :: 67 VOLUMES

Each volume of “The Story of the Nations” Series is the work of a
recognized scholar, chosen for his knowledge of the subject and ability
to present history in an attractive form, for the student and the
general reader. The Illustrations and Maps are an attractive feature of
the volume, which are strongly bound for constant use. _67 Volumes._
_Cloth, 7s. 6d. net each._

See page 2 for an announcement of a new volume.

 “It is many years since Messrs. T. Fisher Unwin commenced the
 publication of a series of volumes now entitled “The Story of the
 Nations.” Each volume is written by an acknowledged authority on the
 country with which it deals. The series has enjoyed great popularity,
 and not an uncommon experience being the necessity for a second, third,
 and even fourth impression of particular volumes.”         _Scotsman._

 “Probably no publisher has issued a more informative and valuable
 series of works than those included in “The Story of the Nations.””
                                                              _To-Day._

 “The series is likely to be found indispensable in every school
 library.”                                         _Pall Mall Gazette._

 “An admirable series.”                                    _Spectator._

 “Such a universal history as the series will present us with in its
 completion will be a possession such as no country but our own can
 boast of. Its success on the whole has been very remarkable.”
                                                     _Daily Chronicle._

 “There is perhaps no surer sign of the increased interest that is now
 being taken in historical matters than the favourable reception which
 we believe both here and in America is being accorded to the various
 volumes of “The Story of the Nations” as they issue in quick succession
 from the press. More than one volume has reached its third edition
 in England alone.... Each volume is written by one of the foremost
 English authorities on the subject with which it deals.... It is almost
 impossible to over-estimate the value of the series of carefully
 prepared volumes, such as are the majority of those comprising this
 library.... The illustrations make one of the most attractive features
 of the series.”--_Guardian._




A NEW VOLUME IN “THE STORY OF THE NATIONS” READY IN THE AUTUMN, 1920

BELGIUM

FROM THE ROMAN INVASION TO THE PRESENT DAY

By EMILE CAMMAERTS. With Maps and Illustrations. Large Crown 8vo.
Cloth, 7/6 net.

A complete history of the Belgian nation from its origins to its
present situation has not yet been published in this country. Up
till now Belgian history has only been treated as a side issue in
works concerned with the Belgian art, Belgian literature or social
conditions. Besides, there has been some doubt with regard to the
date at which such a history ought to begin, and a good many writers
have limited themselves to the modern history of Belgium because they
did not see in olden times sufficient evidence of Belgian unity.
According to the modern school of Belgian historians, however, this
unity, founded on common traditions and common interests, has asserted
itself again and again through the various periods of history in spite
of invasion, foreign domination and the various trials experienced
by the country. The history of the Belgian nation appears to the
modern mind as a slow development of one nationality constituted by
two races speaking two different languages but bound together by
geographical, economic and cultural conditions. In view of the recent
proof Belgium has given of her patriotism during the world-war, this
impartial enquiry into her origins may prove interesting to British
readers. Every opportunity has been taken to insist on the frequent
relationships between the Belgian provinces and Great Britain from
the early middle ages to the present time, and to show the way in
which both countries were affected by them. Written by one of the most
distinguished Belgian writers, who has made a specialty of his subject,
this work will be one of the most brilliant and informing contributions
in “The Story of the Nations.”




A COMPLETE LIST OF THE VOLUMES IN “THE STORY OF THE NATIONS” SERIES.
THE FIRST AND MOST COMPLETE LIBRARY OF THE WORLD’S HISTORY PRESENTED IN
A POPULAR FORM


1 *Rome*: From the Earliest Times to the End of the Republic. By ARTHUR
GILMAN, M.A. Third Edition. With 48 Illustrations and Maps.

2 *The Jews*: In Ancient, Mediæval and Modern Times. By Professor JAMES
K. HOSMER. Eighth Impression. With 37 Illustrations and Maps.

3 *Germany*. By S. BARING-GOULD, M.A. Seventh Impression. With 108
Illustrations and Maps.

4 *Carthage: or the Empire of Africa*. By Professor ALFRED J. CHURCH,
M.A. With the Collaboration of Arthur Gilman, M.A. Ninth Impression.
With 43 Illustrations and Maps.

5 *Alexander’s Empire*. By JOHN PENTLAND MAHAFFY, D.D. With the
Collaboration of Arthur Gilman, M.A. Eighth Impression. With 43
Illustrations and Maps.

6 *The Moors in Spain*. By STANLEY LANE-POOLE. With the Collaboration
of Arthur Gilman, M.A. Eighth Edition. With 29 Illustrations and Maps.

7 *Ancient Egypt*. By Professor GEORGE RAWLINSON, M.A. Tenth Edition.
Eleventh Impression. With 50 Illustrations and Maps.

8 *Hungary*. In Ancient, Mediæval and Modern Times. By Professor
ARMINIUS VAMBÉRY. With Collaboration of Louis Heilpin. Seventh Edition.
With 47 Illustrations and Maps.

9 *The Saracens*: From the Earliest Times to the Fall of Bagdad. By
ARTHUR GILMAN, M.A. Fourth Edition. With 57 Illustrations and Maps.

10 *Ireland*. By the Hon. EMILY LAWLESS. Revised and brought up to date
by J. O’Toole. With some additions by Mrs. Arthur Bronson. Eighth
Impression. With 58 Illustrations and Maps.

11 *Chaldea*: From the Earliest Times to the Rise of Assyria. By
ZÉNAÏDE A. RAGOZIN. Seventh Impression. With 80 Illustrations and Maps.

12 *The Goths*: From the Earliest Times to the End of the Gothic
Dominion in Spain. By HENRY BRADLEY. Fifth Edition. With 85
Illustrations and Maps.

13 *Assyria*: From the Rise of the Empire to the Fall of Nineveh.
(Continued from “Chaldea.”) By ZÉNAÏDE A. RAGOZIN. Seventh Impression.
With 81 Illustrations and Maps.

14 *Turkey*. By STANLEY LANE-POOLE, assisted by C. J. W. Gibb and
Arthur Gilman. New Edition. With a new Chapter on recent events (1908).
With 43 Illustrations and Maps.

15 *Holland*. By Professor J. E. THOROLD ROGERS. Fifth Edition. With 57
Illustrations and Maps.

16 *Mediæval France*: From the Reign of Huguar Capet to the beginning
of the 16th Century. By GUSTAVE MASSON, B.A. Sixth Edition. With 48
Illustrations and Maps.

17 *Persia*. By S. G. W. BENJAMIN. Fourth Edition. With 56 Illustrations
and Maps.

18 *Phœnicia*. By Professor GEORGE RAWLINSON, M.A. Third Edition. With
47 Illustrations and Maps.

19 *Media, Babylon, and Persia*: From the Fall of Nineveh to the
Persian War. By ZÉNAÏDE A. RAGOZIN. Fourth Edition. With 17
Illustrations and Maps.

20 *The Hansa Towns*. By HELEN ZIMMERN. Third Edition. With 51
Illustrations and Maps.

21 *Early Britain*. By Professor ALFRED J. CHURCH, M.A. Sixth
Impression. With 57 Illustrations and Maps.

22 *The Barbary Corsairs*. By STANLEY LANE-POOLE. With additions by
J. D. KELLY. Fourth Edition. With 39 Illustrations and Maps.

23 *Russia*. By W. R. MORFILL, M.A. Fourth Edition. With 60
Illustrations and Maps.

24 *The Jews under Roman Rule*. By W. D. MORRISON. Second Impression.
With 61 Illustrations and Maps.

25 *Scotland*: From the Earliest Times to the Present Day. By JOHN
MACKINTOSH, LL.D. Fifth Impression. With 60 Illustrations and Maps.

26 *Switzerland*. By LINA HUG and R. STEAD. Third Impression. With
over 54 Illustrations, Maps, etc.

27 *Mexico*. By SUSAN HALE. Third Impression. With 47 Illustrations
and Maps.

28 *Portugal*. By H. MORSE STEPHENS, M.A. New Edition. With a new
Chapter by Major M. HUME and 5 new Illustrations. Third Impression.
With 44 Illustrations and Maps.

29 *The Normans*. Told chiefly in Relation to their Conquest of
England. By SARAH ORNE JEWETT. Third Impression. With 35 Illustrations
and Maps.

30 *The Byzantine Empire*. By C. W. C. OMAN, M.A. Third Edition. With
44 Illustrations and Maps.

31 *Sicily*: Phœnician, Greek, and Roman. By Professor E. A. FREEMAN.
Third Edition. With 45 Illustrations.

32 *The Tuscan Republics* (Florence, Siena, Pisa, Lucca) *with Genoa*.
By BELLA DUFFY. With 40 Illustrations and Maps.

33 *Poland*. By W. R. MORFILL. Third Impression. With 50 Illustrations
and Maps.

34 *Parthia*. By Professor GEORGE RAWLINSON. Third Impression. With 48
Illustrations and Maps.

35 *The Australian Commonwealth*. (New South Wales, Tasmania, Western
Australia, South Australia, Victoria, Queensland, New Zealand.) By
GREVILLE TREGARTHEN. Fifth Impression. With 36 Illustrations and Maps.

36 *Spain*. Being a Summary of Spanish History from the Moorish
Conquest to the Fall of Granada (A.D. 711–1492). By HENRY EDWARD WATTS.
Third Edition. With 36 Illustrations and Maps.

37 *Japan*. By DAVID MURRAY, Ph.D., LL.D. With a new Chapter by JOSEPH
W. LONGFORD. 35 Illustrations and Maps.

38 *South Africa*. (The Cape Colony, Natal, Orange Free State, South
African Republic, Rhodesia, and all other Territories south of the
Zambesi.) By Dr. GEORGE MCCALL THEAL, D.Litt., LL.D. Revised and
brought up to date. Eleventh Impression. With 39 Illustrations and Maps.

39 *Venice*. By ALETHEA WIEL. Fifth Impression. With 61 Illustrations
and a Map.

40 *The Crusades*: The Story of the Latin Kingdom of Jerusalem. By
T. A. ARCHER and C. L. KINGSFORD. Third Impression. With 58
Illustrations and 3 Maps.

41 *Vedic India*: As embodied principally in the Rig-Veda. By ZÉNAÏDE
A. RAGOZIN. Third Edition. With 36 Illustrations and Maps.

42 *The West Indies and the Spanish Main*. By JAMES RODWAY, F.L.S. Third
Impression. With 48 Illustrations and Maps.

43 *Bohemia*: From the Earliest Times to the Fall of National
Independence in 1620; with a Short Summary of later Events. By C.
EDMUND MAURICE. Second Impression. With 41 Illustrations and Maps.

44 *The Balkans* (Rumania, Bulgaria, Servia and Montenegro). By W.
MILLER, M.A. New Edition. With a new Chapter containing their History
from 1296 to 1908. With 39 Illustrations and Maps.

45 *Canada*. By Sir JOHN BOURINOT, C.M.G. With 63 Illustrations and
Maps. Second Edition. With a new Map and revisions, and a supplementary
Chapter by EDWARD PORRITT. Third Impression.

46 *British India*. By R. W. FRAZER, LL.D. Eighth Impression. With 30
Illustrations and Maps.

47 *Modern France, 1789–1895*. By ANDRÉ LEBON. With 26 Illustrations
and a Chronological Chart of the Literary, Artistic, and Scientific
Movement in Contemporary France. Fourth Impression.

48 *The Franks*. From their Origin as a Confederacy to the
Establishment of the Kingdom of France and the German Empire. By LEWIS
SERGEANT. Second Edition. With 40 Illustrations and Maps.

49 *Austria*. By SIDNEY WHITMAN. With the Collaboration of J. R.
MCILRAITH. Third Edition. With 35 Illustrations and a Map.

50 *Modern England before the Reform Bill*. By JUSTIN MCCARTHY. With 31
Illustrations.

51 *China*. By Professor R. K. DOUGLAS. Fourth Edition. With a new
Preface. 51 Illustrations and a Map. Revised and brought up to date by
IAN C. HANNAH.

52 *Modern England under Queen Victoria*: From the Reform Bill to the
Present Time. By JUSTIN MCCARTHY. Second Edition. With 46 Illustrations.

53 *Modern Spain, 1878–1898*. By MARTIN A. S. HUME. Second Impression.
With 37 Illustrations and a Map.

54 *Modern Italy, 1748–1898*. By Professor PIETRO ORSI. With over 40
Illustrations and Maps.

55 *Norway*: From the Earliest Times. By Professor HJALMAR H. BOYESEN.
With a Chapter by C. F. KEARY. With 77 Illustrations and Maps.

56 *Wales*. By OWEN EDWARDS. With 47 Illustrations and 7 Maps. Fifth
Impression.

57 *Mediæval Rome*: From Hildebrand to Clement VIII, 1073–1535. By
WILLIAM MILLER. With 35 Illustrations.

58 *The Papal Monarchy*: From Gregory the Great to Boniface VIII. By
WILLIAM BARRY, D.D. Second Impression. With 61 Illustrations and Maps.

59 *Mediæval India under Mohammedan Rule*. By STANLEY LANE-POOLE.
With 59 Illustrations. Twelfth Impression.

60 *Parliamentary England*: The Evolution of the Cabinet System,
1660–1832. By EDWARD JENKS. With 47 Illustrations.

61 *Buddhist India*. By T. W. RHYS DAVIDS. Fourth Impression. With 57
Illustrations and Maps.

62 *Mediæval England, 1066–1350*. By MARY BATESON. With 93 Illustra-
tions.

63 *The Coming of Parliament*. (England, 1350–1660.) By L. CECIL JANE.
With 51 Illustrations and a Map.

64 *The Story of Greece*: From the Earliest Times to A.D. 14. By
E. S. SHUCKBURGH. With 2 Maps and about 70 Illustrations.

65 *The Story of the Roman Empire*. (29 B.C. to A.D. 476.) By H. STUART
JONES. Third Impression. With a Map and 52 Illustrations.

66 *Sweden and Denmark*. With Chapters on Finland and Iceland. By JON
STEFANSSON. With Maps and 40 Illustrations.

67 *Belgium*. (_See page 2 for special announcement._)

  IMPORTANT--ASK YOUR BOOKSELLER TO LET YOU EXAMINE A SPECIMEN VOLUME OF
  “THE STORY OF THE NATIONS” SERIES


  T. FISHER UNWIN Ltd., 1 Adelphi Terrace, London, W.C.2
  And of all Booksellers throughout the World