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Title: Old Age Deferred

Author: Arnold Lorand

Release date: January 8, 2021 [eBook #64237]
Most recently updated: October 18, 2024

Language: English

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Old Age Deferred

THE CAUSES OF OLD AGE AND ITS POSTPONEMENT BY

HYGIENIC AND THERAPEUTIC MEASURES

Man does not die,
he kills himself.
—Seneca

By
ARNOLD LORAND, M.D.

FIFTH EDITION

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

PHILADELPHIA
F. A. DAVIS COMPANY, Publishers
1920

──────────
COPYRIGHT, 1910
COPYRIGHT, 1916
BY
F. A. DAVIS COMPANY
───
Copyright, Great Britain. All Rights Reserved
──────────

REPRINTED: February, April, October, 1911; May, November, 1912; May, 1913; February, 1914;
January, June, November, 1915; March, September, 1916; February 1917; February, June, September,
1920.

───────────
PRESS OF
F. A. DAVIS COMPANY
PHILADELPHIA, U.S.A.
───────────

PREFACE TO NEW REVISED EDITION.

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

PREFACE.
──

Whoever takes up this book with the idea that the aged can be
transformed into sprightly adolescents will be disappointed. A work based
entirely on evidence of a scientific nature, as is the present volume, cannot
have such an end in view, since it is altogether unattainable—at least with
what knowledge is now available.
But while it is still impossible for us to create a young man out of an old
one, it is quite within the bounds of possibility, as we shall endeavor to
demonstrate herein, to prolong our term of youthfulness by ten or twenty
years. In other words we need no longer grow old at forty or fifty; we may
live to the age of ninety or one hundred years, instead of dying at sixty or
seventy. All this can be brought about by the observance of certain hygienic
measures, and by improving the functions of a certain few of the glandular
structures in our body, provided incurable organic disorders have not
already too gravely compromised one or more of our main organs.
In a communication to the Paris Biological Society, presented in our
name by Dr. Gley, Professor of Physiology at the University of Paris, and in
an address delivered before the Brussels Royal Society of Medical and
Natural Sciences, we described old age as a chronic disease due to
degeneration of the glands with internal secretions (hereinafter frequently
referred to as the ductless glands), of the thyroid, the sexual glands, and the
adrenals in particular. In this work we will show that this degeneration is
amenable to treatment, just as are chronic diseases in general.
The facts herein presented are illustrated and sustained by numerous
experimental and clinical observations. Being desirous of proving the
correctness of all our statements, we have had to enter, sometimes very
fully, into the question of the ductless glands, in order to point out the
marvelous influence they exert upon the various vital functions.

In view of the fact that the ductless glands have already been treated in a
very elaborate and exhaustive manner by a well-known American author,
Professor C. E. de M. Sajous, of Philadelphia, in his work on the “Internal
Secretions” (2 volumes) which introduces many new thoughts and
important discoveries, we have paid particular attention to the thyroid and
sexual glands, which we have carefully studied anatomically, histologically,
experimentally and clinically.
Not being a native of, or even resident in, either America or England,
though possessed of a fair knowledge of the English language—having
delivered addresses in several universities, and before numerous medical
societies in the United States, Canada, England, and Scotland—it was very
difficult for us to avoid idiomatic errors. We take great pleasure in
acknowledging, therefore, our indebtedness to our friend, Col. Frank
Haddan, of London, who, being impressed with the importance of our
subject and its humanitarian aspect, kindly volunteered to look through our
manuscript and correct most of our errors of style and grammar, thereby
rendering us valuable assistance. Our thanks are also due to Dr. Leo
Rosenthal, of New York, for the adjustment of many technical sentences.
Every one will admit that the subject treated in this work is not an easy
one. It might be urged also that its presentation here is based on entirely
novel lines, scientific literature on old age being very scarce.
Considering also that it has been necessary for us to take up questions
beyond the ordinary sphere of a medical practitioner, sometimes of a
philosophical, technical and physical nature, it is to be expected that certain
imperfections will be found. But, whatever may be the opinion of the
reader, he will not deny that none should fail to derive some benefit from
the numerous hints we have given for the preservation of health and
prolongation of life. If by reason of our advice we succeed in saving but a
single human life from a premature grave, our aim will have been attained.

Dr. Arnold Lorand.

CONTENTS.
───

CHAPTER I.
PAGE
On the Appearance of Symptoms of Old Age in Young 1
Persons

CHAPTER II.
On the Agencies which Govern our External Appearance 11
and the Nutrition of the Tissues

CHAPTER III.
On the Agencies which Govern Immunity Against 21
Infections and Intoxications—The Origin of Fever

CHAPTER IV.
On the Agencies that Govern the Condition of the 35
Nervous System and Mentality

CHAPTER V.
On the Influence of the Sexual Glands upon Vitality and 45
Long Life

CHAPTER VI.
On Heredity and Longevity 55

CHAPTER VII.
On Means which can Help us to Determine the Probable 64
Duration of Life

CHAPTER VIII.
On the Causation of Old Age 90

CHAPTER IX.
The Rational Prevention of Premature Old Age and the 114
Treatment of Old Age

CHAPTER X.
The Destruction and Elimination of Toxic Products from 134
the Body and Hygienic Measures for the Improvement
of these Functions

CHAPTER XI.
On the Destruction of Poisonous Products Through the 138
Thyroid and Parathyroid Glands

CHAPTER XII.
Hygiene of the Thyroid Gland 145

CHAPTER XIII.

The Destruction of Toxic Products by the Liver and the 149
Improvement of its Protective Functions

CHAPTER XIV.
The Hygiene of the Liver 155

CHAPTER XV.
On the Destruction of Toxic Products by the Adrenals 159

CHAPTER XVI.
Hygiene of the Adrenals and of the Circulatory System— 164
A Few Remarks on the Cause, Prevention, and
Treatment of Arteriosclerosis

CHAPTER XVII.
The Elimination of Toxic Products Through the Intestines 170
and the Improvement of This Function

CHAPTER XVIII.
On the Prevention and Treatment of Habitual 175
Constipation

CHAPTER XIX.
Hygiene of the Intestines 182

CHAPTER XX.

Hygiene of the Intestines—A Few Remarks on the Cause 192
and Prevention of Appendicitis

CHAPTER XXI.
On the Elimination of Toxic Products Through the 197
Kidneys

CHAPTER XXII.
Hygiene of the Kidneys, and the Prevention of Renal 203
Disease

CHAPTER XXIII.
On the Elimination of Toxic Products Through the Skin 209

CHAPTER XXIV.
The Hygiene of the Skin—Air Baths 215

CHAPTER XXV.
On Rational Clothing 219

CHAPTER XXVI.
Improved Hygiene of the Skin and Kidneys through 231
Bathing—Foot-baths

CHAPTER XXVII.
Hygiene of the Skin and Kidneys by Means of Perspiration 237

CHAPTER XXVIII.
On Exercise, Swedish Gymnastics—Massage—Sport, and 244
Walking and Running Exercise

CHAPTER XXIX.
A Few Remarks on Cold Feet—Their Cause and 252
Treatment

CHAPTER XXX.
On the Benefits of Sunlight 255

CHAPTER XXXI.
On the Advantages of an Open Air Life and of Breathing 262
Exercises

CHAPTER XXXII.
On the Dangers of Living in Confined and Ill-Ventilated 271
Quarters

CHAPTER XXXIII.
Hygiene of Artificial Heating—the Dangers of Heat by 275
Steam and a Few Hints about their Prevention

CHAPTER XXXIV.
Food Hygiene—General Remarks 280

CHAPTER XXXV.

On Proteid Food, Animal Food, Meat, Fish, Eggs, Milk, 294
etc.

CHAPTER XXXVI.
On Carbohydrates and Fats, and the Great Advantages of 301
Vegetables and Fruit

CHAPTER XXXVII.
On the Advantages and Disadvantages of a Vegetarian 309
Diet

CHAPTER XXXVIII.
On the Dangers of a Too Abundant Meat Diet—A Few 317
Hints on the Dietetics of Meat

CHAPTER XXXIX.
On the Great Advantages of Much Milk in the Diet for 325
the Prevention and Treatment of Old Age

CHAPTER XL.
On Blood as an Article of Food Containing Iron and 333
Animal Extracts—Sausages and Blood Puddings

CHAPTER XLI.
Some Remarks on the Hygiene of Eating—How to Obtain 339
an Appetite—On Mastication

CHAPTER XLII.
On the Uses of Small Doses, and the Deleterious Action 347
of Large Quantities of Alcohol

CHAPTER XLIII.
Some Remarks on the Causes and Prevention of the 356
Alcohol Habit

CHAPTER XLIV.
On Other Stimulants—Tea, Coffee, Cocoa, Tobacco: 362
Their Merits and Disadvantages

CHAPTER XLV.
On Sleep, and Its Importance in Ridding the Body of Toxic 368
Products

CHAPTER XLVI.
On the Causation of Sleep, Sleepiness, and Insomnia 372

CHAPTER XLVII.
Hygiene of Sleep—Prevention of Insomnia 377

CHAPTER XLVIII.
The Treatment of Sleepiness and Insomnia 383

CHAPTER XLIX.

Hygiene of the Sexual Glands—the Dangers of Sexual 389
Overactivity and of Total Sexual Abstinence

CHAPTER L.
On Married Life as an Important Means for Prolonging 400
Life

CHAPTER LI.
Hygiene of the Mind—Emotions and Worry as Causes of 404
Old Age

CHAPTER LII.
Hygiene of the Mind—Religious Belief as a Means of 414
Prolonging Life

CHAPTER LIII.
Disease Considered as a Self-defence of Nature 419

CHAPTER LIV.
Hygiene of the Mind—Advice to Brain Workers 423

CHAPTER LV.
On the Prevention of Premature Old Age, and the 426
Treatment of Old Age, through Certain Drugs:
Arsenic, Iron, and Iodides

CHAPTER LVI.

On the Prevention of Premature Old Age and on the 434
Treatment of Old Age by Animal Extracts

CHAPTER LVII.
A Few Hints on Youthful Appearance 449

CHAPTER LVIII.
The “Twelve Commandments” for the Preservation of 455
Youth, and the Attainment of a Green Old Age

Glossary 459

Index 467

Footnotes 494

SPECIAL ANNOUNCEMENT

To the Readers of “Old Age Deferred.”

W E have just recently received the manuscript for the following
introductory pages, which are intended as a message direct to the
American people by Dr. Lorand. Their importance justifies a careful
reading.
Although, in accordance with his duty as a citizen of Austria, Dr. Lorand
has had to practically abandon his private practice, and devote his energies
and his abilities to the service of his country in the time of trial, he has,
nevertheless, been so situated as to have a pretty intimate knowledge of
American affairs. He has been especially grieved and shocked to learn of so
many sudden, untimely, and in his judgment, unnecessary deaths among
prominent Americans since the great war began. Counting as he did, a great
number of friends, not only among American physicians, but among
American tourists, and knowing, as he does, so intimately, the peculiar
physical characteristics of the high-grade American citizen, he is appalled at
the wastage of valuable lives in a country teeming with prosperity and
incidental home comforts.
The following introduction is designed as a warning to high-pressure
Americans that by a little care and the exercise of reasonable judgment a
large number of these premature deaths may be prevented.
Even if you were to read no further, the careful perusal of this
introduction is well worth while, as it deals directly with the most important
personal problems.
The Publishers.

PREMATURE OLD LOOKS:

Their Prevention and Treatment.

────

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

By not drinking sufficiently, such substances as, for example, uric acid,
cannot be washed out and their retention will cause a serious damage to
health, facilitating the origin of arteriosclerosis, which very frequently is
associated with such conditions. Persons suffering from uric acid present
frequently an older aspect than corresponds to their years and the falling out
of the hair, or the appearance of gray hair, in early years, is often the case
with them.
It is erroneous to think that water produces fatness. If this were the case
we would advise the poor people to drink plenty of water that costs nothing,
to get fat. It is not water that makes fat, but water that is taken with the
meals, together with copious food, thus aiding the absorption and
assimilation of the same. To avoid obesity after rich food it is therefore
advisable not to drink with the meals, but at other times. Copious food must
be avoided, especially fat, starchy food and sweets. A diet consisting of
plenty of meat, fats, and above all milk and butter and sweets, is the surest
road to obesity. They must be avoided and the preference given to a diet of
little meat, green vegetables and fruits. For further details of such a diet I
must refer to the chapter, “The Treatment of Obesity,” in my book, “Health
and Longevity through Rational Diet,” publishers, F. A. Davis Co.,
Philadelphia. I must emphasize the necessity of great prudence in reducing
cures, for, as I know from my practice in Carlsbad, there is scarcely
anything, unless a serious disease, that can produce so rapidly the
appearance of age in young persons and the more in riper years, than
imprudent and reckless obesity cures, causing wrinkles and the hanging and
sunken cheeks.
I must certainly blame the eagerness of many ladies to transform their
fresh, round and elastic forms into lean and skinny ones, thinking that thus
they will look younger. No; I am certain that many young women look
considerably older after these atrocious and imprudent diet-cures. Dieting is
more permissible with older persons, if not exceeding certain limits; but
young women and girls I would strongly advise to eat hearty meals of
mixed food, for, as I also show in my above-mentioned book on Diet, we
are introducing in our systems very valuable substances, which are in
reality useful remedies with certain articles of food. Most important among
these are fresh milk (uncooked), numerous fruits, certain kinds of animal
food, which all contain considerable quantities of important mineral salts,

indispensable to our well-being, and to the freshness and elasticity of mind
and body. Besides these salts and valuable ferments these articles of food
contain also a most important substance, called vitamines, which, as its
name shows, conveys a kind of vitality to the tissues. It is indispensable to
the well-being of the nervous system and also of the muscles, and thus also
to the most important muscle of the body, the heart. The vitamines are
largely represented in the outer coverings of the rice, of the corn, and also in
eggs, potatoes, etc. In fine white bread there is scarcely any, but there is far
more in the brown bread containing all parts of the grain. Milk also contains
them, but mainly fresh, uncooked milk; strong cooking destroys the
vitamines in the plants and the animal food, and besides such cooking, as I
show in the chapter on “Rational Cooking” of my book on Rational Diet,
also destroys other valuable ferments of great importance for our body. It is
certain that our looks, the beauty and size of the human body and of
animals, and even the color of the feathers of the birds, depend very much,
as I show in the same book, on the wise selection of the food which we eat.
Not only in young growing persons, but also in the adult and even in aged
persons.
Of the different faulty habits there is probably none that would produce
so rapidly the premature appearance of old age in young women as
smoking.

The Dangers of Smoking in Women.

If excessive smoking is deleterious to man, in the woman moderate
smoking may cause serious alterations. We must not forget that the tissues
of women are more delicate and tender than those of men, and especially
young women can in this respect be put in the same class with children. The
woman is not so well protected against the influence of poisons such as
nicotine as the man, for in her some of those glands whose duty is to
destroy such poisons, as, for instance, the thyroid, are kept in much greater
activity on account of the frequent changes in the ovaries with each
menstruation, pregnancy, the climacteric, etc., and with their consequent
repercussion upon the thyroid gland, with which the ovaries are closely
related. If to this comes such extra work by the daily introduction of
poisonous substances, although even in small quantities, the gland may the
more readily lose its efficiency. After my own observations which I made
upon my patients in Carlsbad coming from eastern countries in Europe, I
know that smoking women present a much older aspect, if they have
indulged in this habit to a large extent and for years. They soon fade, the
cheeks are pale, as a rule, and sunk in. The general nutrition suffers, there is
loss of appetite, frequently a catarrh of the stomach and very often pains in
the stomach; indeed there is often neurasthenia with sleeplessness. With
more excessive smoking there will appear all the symptoms which are
common to the chronic nicotine poisoning of men.
I am not prepared to maintain that, after the dinner, a cigarette or
sometimes two are dangerous to adult women. The aspect of a lady
smoking a cigarette after dinner surely cannot be called attractive, and it
certainly does hurt the æsthetic feelings of a normal man to see a woman
smoking one big cigar after another. It looks too masculine in a woman, as I
have observed in a ladies’ club in Copenhagen, where most of the women
sat with big cigars in their mouths. Such habits take away all charm even
from the finest looking women, and as a normal woman is attracted by all
that is manly in man and is repelled by an effeminate man, we men dislike
masculine women, just as we dislike a woman having a mustache and
whiskers. If I were a married man, I know I would not like to kiss my wife
if she strongly smelled of tobacco, just as it would be repulsive to kiss a

man; the smell of strong tobacco creating involuntarily the sensation of
associating with a man. Until recently women have presented far less
frequently the symptoms of arteriosclerosis than men, excessive smoking
being rare with them. But as the effects of smoking are more deleterious to
them, naturally arteriosclerosis will arise much sooner in them, and as
through the hardening of the arteries the nutrition of the tissues suffer, the
nourishing blood not rendering them in sufficient amount—necessarily such
persons will begin to look old at a comparatively early period of life.

A Few Cosmetic Hints for the Remedying of Old Looks.

In the previous editions of this book I have shown that it is possible to
improve old looks through hygienic measures, the use of the extracts of
certain glands, like the thyroid and ovaries and also by the employment of
certain drugs like arsenic and the preparations of iodine. I would like to add
now a few cosmetic hints against old looks some of which I had already
published a few years ago, as a collaborator to the handbook of cosmetics
of the dermatologist, Prof. M. Joseph, of Berlin (M. Joseph, Handbuch der
Kosmetik, Leipzig, 1912).
In persons of certain age and also in younger persons with a fading
expression of the face and beginning wrinkles I have found, as efficacious
in producing an immediate improvement, the gentle application to the face
of any kind of fats of pure quality and the rubbing thereon of some reliable
preparation of white powder. The powder should afterward be wiped off
very carefully. It should not be put on in thick layers, for then, as after the
use of pastes and paints in general, lines may be created where they are not
yet present and lines already existing may be hollowed out to veritable
wrinkles. No powder should be visible on the face. The object is to add to
faces with dry skin the best variety of fat with reference to its animal origin
so as to make up for the wanting secretion of the sebaceous glands and to
replace, if possible to a certain extent, the fat wanting in the tissues. All
kinds of massaging of the skin should be avoided; only a gentle rubbing is
allowed. In fact, I consider massage as deleterious to the face, except it is
done by a qualified masseur who is an expert in this kind of massage with a
correct anatomical knowledge of the muscles of the face and of the
direction they are running. Special care must be taken that the massage of
the face should never be done with fats, as this would promote the
formation of lines and wrinkles and even of deep ones, if done unskillfully.
The massage of the face should consist in gentle strokings of the face with
the end of the fingers and always following the direction of the muscles.
The powders used should be of the best possible quality. Before all they
should not contain any metallic salts and especially not lead. Unhappily
some of the very best powders are prepared with it, as lead gives to the

powders a specially white and attractive aspect. But I should like to bring
home to the ladies the fact, that these powders are the most apt, especially
in persons who perspire easily, to create lines and wrinkles and to give to
young faces in a short time an old appearance.
The best powders I consider those which consist of fine rice-powder,
amylum, or talcum, and they produce the best effect, if they are not visible
on the face. I have often seen the finest complexions ruined by the frequent
usage of thick powders, pastes, and paints. The above-mentioned procedure
of rubbing in fats and thereupon some of the finest hygienic powders should
only be done every other day. To give to fading faces a certain tonicity I
recommend the use of alcohol, diluted with three times as much water,
which, in the same manner as diluted vinegar, will also improve the
complexion. I have found that a very strongly diluted solution of the extract
of the suprarenal glands has also a marked effect in toning up the muscles
of the face, if rubbed in gently. Only small quantities of the diluted solution
should be used for this purpose.
As gray hairs create, even in persons still young, an elderly appearance, it
might appear to their advantage to color them. It is best to use such coloring
only in regions of small extent rather than in a general way. As the most
inoffensive coloring of gray hair among dark hair, I would consider the
preparations containing nitrate of silver. Those which contain lead or copper
should be condemned.
After all the best weapon against old looks is a hygienic life by which we
can best avoid the development of a condition which already at an early age
gives an old aspect to the tissues, i.e., of arteriosclerosis, or hardening of the
arteries.

Rapid and Early Death Through Arteriosclerosis and its
Prevention.

For most arteriosclerotic persons there can be only little hope to live up
to a green old age, to become 80 or 90 years old or even to pass on to still
higher years. But there are exceptions not so very seldom, and it gives
comfort to my patients suffering from this disease and apprehension of the
future, when I tell them that nearly all the brothers and sisters of both my
parents suffered from this disease for many years, which did not prevent
them from attaining ages varying between 80 and 96 years and more. My
father ever after his forty-fifth year suffered from attacks of asthma. As a
child I was often awakened through his nightly asthmas, but in spite of
many symptoms of arteriosclerosis he lived to a great age.
One of my aunts is still living, not very far from 100 years old, although
suffering in a high degree from arteriosclerosis for many years. Such
protracted cases generally happen in families of longevity and they are only
due to, as a rule, regular habits, although it is true that my father was a great
smoker in his younger years and even in his last years enjoyed one or two
light cigars daily.
Such long survivals constitute, however, a great exception in
arteriosclerosis, and it usually happens only in cases where there are no
symptoms of that most dreaded form of arteriosclerosis, i.e., the sclerosis of
the coronary arteries of the heart. These arteries are probably the most
important ones of our body, for they provide the muscles of the heart with
the nourishing blood without which they could not do their work. It is the
sclerosis—the hardening—of these arteries which, causing an obstacle to
the passage of the blood, is the most frequent cause of rapid death in
arteriosclerosis, often in comparatively young people. It is a sad fact, that
such a condition, as so often is the case with arteriosclerosis, can exist
without exhibiting any marked symptoms of it being present. A very
frequent symptom of sclerosis of the coronary arteries is attacks of genuine
angina pectoris (stenocardia),—to be distinguished from the pseudo-attacks
of angina pectoris of neurasthenic persons. In such attacks there are strong
radiating pains in the heart region, and a feeling of great anxiety, of utter

annihilation, and of instantaneous death; and indeed not so seldom such
attacks may terminate in death. These attacks may be considered as a
warning of nature that such persons stand on the verge of a precipice and
thus urging them to the greatest precautions to avoid anything that may
bring about such an attack. From my own observations, rapidly fatal attacks
of angina pectoris in such cases of arteriosclerosis happen frequently after a
heavy dinner. The stomach being distended, the diaphragm is pushed
upward and thus impeding the movements of the heart, which has not
sufficient space for the play of its muscles. Such a condition may also be
often caused by the ingestion of dishes causing flatulence. In consequence
heavy dinners and flatulent foodstuffs must carefully be avoided, and I
declare any person who presents attacks of genuine angina pectoris as a
determined suicide if he continues to indulge in them. There should be
taken 5 small meals a day, so as to avoid the keen appetite which results in
overloading the stomach. Foodstuffs causing flatulence such as cabbage,
fried potatoes, etc., should, above all, be avoided. Food that is rich in
cellulose (wood fiber) is strictly forbidden in such cases. For further details
on food producing flatulence I must refer to my above-mentioned diet book,
which contains a special chapter on the best food in flatulency and also a
list on the amount of cellulose (wood fiber) in different articles of food. For
the treatment by drugs refer to the chapter of this book on arteriosclerosis.
Besides moderate habits, including the use of very light cigars in the
smallest possible quantity (if smoking cannot be given up entirely),
overexcitement of any kind, especially sexual, as also overexertions (hill
climbing), must strictly be avoided. Transgression of these commands,
especially hill climbing, may sometimes mean instantaneous death in
advanced cases. Persons suffering from coronary sclerosis with attacks of
angina pectoris will do very well to give up their positions if heads of
companies with great responsibilities and heavy burdens resting upon their
shoulders, as any stormy shareholder meeting may prove fatal to them. As
already said it is a sad fact, that persons may suffer from coronary sclerosis
without even knowing it, as there are also thousands of victims of
arteriosclerosis who are utterly ignorant of their condition, as this disease
often presents no marked symptoms. I must deplore that most stupid habit
of seeking for medical aid only when the ravages of disease have gone so
far that reparation is impossible. How often do people forget the wise
English proverb: “An ounce of prevention is worth a pound of cure.” Just

the same as children are sent every three months to the dentist to see if any
of the teeth present may be decaying in order to save them, people already
before feeling ill ought to at least once a year be examined thoroughly by a
doctor to see if anything is wrong in the human machinery. I feel certain
that in such a case many thousands of persons, instead of lying in their dark,
cold graves below the earth, could still tread the soil enjoying sunshine and
the scent of the flowers. There is no doubt that arteriosclerosis and
especially coronary sclerosis could be avoided in many cases, through such
an examination, for the onset of arteriosclerosis is generally insidious and
slow, especially if it develops in the younger years, when due to syphilis,
and thus, if in time recognized, it could be cured. But even without the
syphilitic infection, cases in young persons are more frequent than we think.
It is to the present terrible war, raging and destroying so many lives, that
we owe the observation made by many of the military doctors that a goodly
number of young soldiers present symptoms of arteriosclerosis, many of
them having never suffered from syphilis. Often it is but a slight elevation
of the blood-pressure, but which, if persistent, may indicate a beginning
arteriosclerosis.

The Prevention and Treatment of High Blood-pressure and the
Prevention of Apoplexy.

Apoplexy is the consequence of a condition, which may be considered as
the highest degree of a scale whose lowest step is often a slight elevation of
the blood-pressure, when in a younger person. Thus, if before the 45-70
year period the blood-pressure is somewhat elevated and remains so for a
certain length of time, we must, if there are no special reasons for this
elevation, for instance, kidney trouble, be suspicious of arteriosclerosis. It is
true, that there are cases of this disease without a high blood-pressure, but if
we find, besides considerably elevated blood-pressure, traces of albumin in
the urine and also renal elements, a swelled liver and an accentuated second
sound at the aorta, there cannot be much doubt that we have probably to do
with arteriosclerosis. A high blood-pressure can most frequently be caused
through difficulties in the circulation of the kidneys; therefore in each such
case the urine must carefully be examined. By improving the circulation
through the kidneys we can also influence favorably the blood-pressure.
Certain drugs producing a great flow of urine have indeed given good
results in high blood-pressure, like, for instance, diuretin in some cases. I
am, however, averse to the use of drugs if there are more natural remedies,
and so I would advise the use of a quite harmless one like the juice of
lemons. It is very diuretic and, as I have observed, there are also cases of
chronic inflammatory conditions of the kidneys which are very favorably
influenced through a treatment by lemons, in the same way as also gout and
the uric acid ailments in general. I have found that with lemon-juice given
in mineral water we obtain still better results if a little glycerin is added.
Besides lemon-juice the juice of certain other fruits like grape-fruit,
oranges, and grapes can also give good results. Besides a good diuresis, a
thorough cleaning of the intestines is desirable, high blood-pressure often
being caused by habitual constipation with stagnation of the intestinal
contents and subsequent flatulence. I must repeat with emphasis again that
daily bowel movements do not prove at all a clean intestine following a
good evacuation, and I am sure that the good results obtained in the
treatment of arteriosclerosis in certain spas, like Carlsbad, Marienbad, and
Kissingen, are not so much due to the action of these waters upon

arteriosclerosis, but simply to their eminently purging action. Neither of
these springs has a direct effect upon arteriosclerosis, but besides the
dietetic advantages of the installation of these spas, the waters from their
springs evacuate thoroughly the intestines, ridding them of toxic products
most deleterious to the arteries, and at the same time facilitating in a
powerful way the circulation of the blood through the abdomen with its
most wholesome repercussion upon the whole general circulation. A
thorough intestinal evacuation can relieve a high blood-pressure nearly the
same way as an extensive venesection. A good perspiration can also give
good effects; however, to produce it there would be necessary to take hot-
water or air bath, which may prove most deleterious. There are means,
however, to avoid this for, as I know it from my own experiences, it is
possible to have a profuse perspiration without the sensation of great heat
and a red head through application of electric light bath with blue light. In
this blue light bath, studying its action, I have myself obtained, after about
twenty minutes’ time, the desired effect without the depressive feeling
afterward as so often is the case with the usual steam bath. These baths are
the more indicated in cases of a nervous heart.
There are also different drugs, which may in many cases prove useful:
thus, a French preparation, prepared from the viscus kinds called guipsin,
then diuretin prepared by different concerns. Very valuable are the nitrate
preparations, especially in cases with coronary sclerosis, also vasotonin, etc.
But from my own experiences I give in many cases the preference to
preparations of iodine. But I have found that iodine should not be given in
too small doses and that they must also be taken for a certain length of time.
Besides iodine I have found, as most efficacious in cases with very high
blood-pressure, the application of electric currents after the system of
D’Arsonval (arsonvalization). In each case of several patients I have seen
the dropping of the blood-pressure to the normal. As soon as we find a high
blood-pressure in a patient we must do our best to diminish it, for if we
allow it to become persistent the high blood-pressure will produce a loss of
the elasticity of the walls of the blood-vessels, there will arise pathological
alterations and arteriosclerosis may easily establish itself. Aided by
persistent, very high blood-pressure the degeneration of the walls of the
blood-vessels may in the long run go so far that a destruction of their tissues
can arise. Then by any sudden great elevation of the blood-pressure it may
come to a rupture of the vessel, to apoplexy. If such a thing happens to a

blood-vessel of the brain, then such vital parts of the brain may be
destroyed that sudden death will follow. But in many cases, happily, other
less important parts are affected, without involving death, and then follows
lameness of those regions of the body which are provided with nerves
coming or going to these parts. Sclerosis and degeneration of arteries
happen most frequently in parts of the body where the circulation is the
most copious by hyperfunction of these parts; thus in the legs of country
people walking and climbing much (Romberg).
Mental exertions produce a great afflux of blood toward the brain each
time, with deep thinking more blood arrives to the brain and it is therefore
not surprising, as I show in my book on “Human Intellect and its
Improvement through Hygienic and Therapeutic Measures.” Such an
appalling number of prominent brain workers, men of science and of
business, are suffering from hardening of the brain-vessels and are struck by
apoplexy of the brain, sometimes even at early ages, before or shortly after
their fiftieth year. Indeed a vast majority of the great men of science and
business are thus afflicted, as I show in this book, apoplexy being very
frequent amongst them. It is reckless overwork, unhygienic methods of
mental work that may with surety produce a hardening of the arteries of the
brain. It would exceed the short space allowed to this chapter if I should
enter here upon the hygienics of mental work, which I am treating in
several chapters of my book on the “Human Intellect,” but it will suffice
here to emphasize the necessity of interpolating resting days between days
of mental overexertion. It would be too much for me to demand that a
successful man of business retire entirely from his affairs, but what he could
do, especially if the head of the business, is to leave the city on Saturday for
the country, with the custom of walking about in the fresh air, returning
Monday with fresh strength; and, further, to avoid anything that produces
high blood-pressure, hill climbing, hot or cold drinks, strong coffee, tea, and
above all tobacco, which is one of the very surest means to increase the
blood-pressure. There is no condition where smoking can produce such
fatal effects as in arteriosclerosis, and especially if the arteries of the brain,
as so often in brain workers, are affected. In inveterate smokers, perhaps a
few de-nicotinized cigarettes or cigars may be allowed. In place of regular
coffee or tea, coffee without caffeine and the Brazilian tea, maté, whose
properties I have described in my book on Rational Diet, may be allowed,
but also not in indiscriminate quantities. If too much of them is taken, they

may prove not less harmful, therefore also caffeine-free coffee and maté
should be taken with wise moderation. Against the troublesome symptoms
of arteriosclerosis of the brain like dizziness, loss of memory, difficulty of
reasoning, headaches, feeling of pressure upon the brain, etc., I have seen,
as I described in special chapters of my book “The Human Intellect,” very
good results through the combined use of preparations of iodine and
extracts of the thyroid gland. The dizziness disappeared and also the
headaches, the memory got much better and also the reasoning power.
These effects were, however, obtained in cases not too advanced. As a
preventive against arteriosclerosis of the brain and as a remedy against
headaches and feeling of pressure in the head I am recommending snuffing
in my book on Intellect, showing that through its use the circulation of the
congested brain is much relieved. In confirmed cases of arteriosclerosis of
the brain, however, snuffing should be avoided, for it may have fatal results.
Excessive snuffing is also deleterious to healthy men, especially when
tobacco is used. To prevent apoplexy the hygienic advice we have given in
the beginning of this chapter to avoid high blood-pressure must strictly be
followed. I should like to add to them hot foot-baths for about five minutes,
to which mustard powder could be added. There should also be a special
care for a wise diet, avoiding constipation; of meat only very little should
be taken, fish should be preferred, and of meat only chicken and veal
allowed. The best food against arteriosclerosis and heart trouble consists of
a milk and egg diet, with vegetables and fruit, to which fish and cheese may
be added. As a most valuable food for overwork of the heart and the general
circulation, I recommend honey, whose merits I show in next chapter.

The Best Food for a Failing Heart.
There is one muscle in our body that never takes a rest. It never ceases to
work, either day or night, and the better for us, for if it should stop it would
mean the end of life. This muscle is the heart. Of course we must feed well
such a hard-working organ, and have special care to select such a food that
is the most genial for it and can the best promote its activity. As the heart is
a muscle we must give the food that is best indicated for muscular activity.
Observations have shown that the muscles of our body are doing their work
at the expense of a certain sweet stuff (glycogen) contained in them.
Experiments also prove this, for it has been found that the heart of animals
removed from the body will survive for days the death of their owner if
kept in a salt solution, with grape- or fruit-sugar added. The addition of
certain mineral salts like lime and carbonate of sodium is also able to
prolong the survival of the cut-out heart of dead animals. So there can be no
doubt that the same elements must also prove useful to the heart of the
living, as is indeed the case.
As I have shown in my diet book the ingestion of sweets promotes
muscular activity and fatigues from bodily exertion are better borne. And
this also holds good for our most important muscle the heart. I have seen in
my heart patients very good results through the addition of a generous
amount of sweets to their ordinary diet. On the other hand, I have, as a rule,
observed a weak activity of the heart with my patients in Carlsbad suffering
from the graver forms of diabetes who were kept on a diet strictly excluding
sweets and starchy food in general. Indeed a weak heart is most frequent in
severe diabetes, as in such a condition the sugar ingested cannot be utilized
and entirely eliminated in the urine. For this reason I consider it unwise to
place severe cases of diabetes on a strict diet and I recommend to them the
use of fruit sugar (levulose), which is often well utilized and especially in a
case of diabetes with heart-failure I like to do this. Such persons should
never be strongly dieted. As the best food for the heart I recommend honey
on the base of the above-mentioned observations. Honey is easily digested
and assimilated; it is the best sweet food, as it does not cause flatulence and
can even prevent it, to a certain extent promoting the activity of the bowels.
It can easily be added to the 5 meals a day I recommend in cases of

arteriosclerosis and of weak heart. As it would be unwise to leave such a
hard-working organ as the heart without any food over the long hours of the
night, I recommend heart patients to take before going to bed a glass of
water with honey and lemon-juice in it and also to take it when awaking at
night (honey dissolves in warm water).
Before and after muscular exertion honey should be given in a generous
dose; no coachman would allow his horses to run for hours without giving
them food at the resting intervals. Only man is so unreasonable as to
undertake heavy exertions often with an empty stomach. No wonder that so
many sportsmen get a weak heart simply for just such a reason. The use of
sugar cannot well replace honey. In the same amount sugar is chemically
irritating to the stomach. At any rate the preference should be given to cane-
sugar; sugar of beet-root is chemically pure, although through modern
civilization it is, unhappily, deprived of the important mineral salts the beet-
root contains, and it has also been shown that through the use of chemically
pure sugar the body loses in lime, which is eliminated in larger quantities. If
honey is alone taken in larger dose it is better borne if water is drunk
afterward. Besides honey I like to recommend grapes, as containing much
sugar and also valuable mineral salts like lime. If grape cures as conducted,
for instance, in Meran (Tyrol) give good results in arteriosclerosis and heart
cases, the results I think could be explained by the above observations. We
can best introduce lime in our bodies through milk, cheese, eggs, fruits, and
vegetables. The latter, especially fruits, are also rich in sodium and
potassium, which are also valuable elements for the activity of the heart. I
would especially insist upon the fact that the heart-muscle is rich in lime, as
it contains about seven times as much of it as the other muscles. If we
introduce in our system fresh, uncooked milk and eggs we also introduce a
very valuable substance of which we have spoken before, vitamines. I
believe that these substances must be very valuable for the activity of the
heart because in all the diseased conditions, the deficiency diseases, arising,
we have found, a want of this substance (Funck). Besides, in nervous
troubles a weakness of the heart and muscles is common. If in one of this
class of diseases, like beriberi, even in the latent cases, strong muscular
exertions are made, then cardiac attacks will appear with great weakness of
the heart. According to Funck, chief of the laboratory of the London Cancer
Research Institute, muscular exertions are apt to make these diseases break
out at once in cases, until then latent, without any symptoms. He also

impresses upon the fact that when vitamines are wanting in the food, it is
the vitamine stores of the muscles which are attacked first (Funck, “Die
Vitamine,” Wiesbaden, 1914). But as the best proof for my opinion that
food containing vitamines is indisplaceable for the heart-muscle I mention
the fact, determined by Cooper and quoted by Funck, Journal of Hygienics,
1913, that the heart-muscle is very rich in vitamines. Beriberi and other
deficiency diseases are the highest degree of a condition that is due to the
entire want of vitamines in the blood. But no doubt there may be lower
degrees due to the insufficient amount of vitamines, in which may simply
show symptoms of neurasthenia with nervous heart troubles, as an
expression of the craving of our system after these substances. Milk
containing vitamines, and also containing a considerable amount of sugar
and lime, it must be considered as the most valuable food for the heart. But
only fresh milk, for by boiling it the vitamines are lost. Boiling above 100°
C, and especially in large apparatus under high pressure like in the
autoclave used in many of the large institutions and some of the big hotels,
destroys the vitamines. I have already in my diet book, in the chapter on
rational cooking, insisted upon the dangers of overcooking our food.
Another rich source of vitamines, the bran of wheat and rye, is taken from
us through another invention of our so-called modern civilization, the
machine milling, simply for technical reasons. Forty or fifty years ago there
was no cases of beriberi in the far east; the natives ate rice with its
wholesome outer layers; then modern civilization introduced machine mills
instead of the old hand mills, robbing the rice of the silver fleece rich in
vitamines, and beriberi appeared. It is true that the bran presents obstacles
to our intestinal juices, but there exist certain methods by which it can be
ground to a fine flour and all its valuable parts assimilated and introduced in
our body. We have quoted here several instances of the fateful influence of
our modern progress upon our health. What is the good of the great progress
of medicine if, on the other hand, our modern progress through reckless
inventions separates us from Mother Nature and, inducing us to unnatural
habits and ways, exposes us to disease and untimely death. No wonder,
then, if arteriosclerosis and old age appear in relatively young people.

CHAPTER I.

On the Appearance of Symptoms of Old Age in Young Persons.

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

The question now arises: In which category of diseases is this condition
to be classified?
In typical cases of this class there is a diminution of metabolism, i.e., of
the assimilation and conversion of food into energy. We shall have to think
of the possibility of alterations in those organs which govern the process of
metabolism.
These organs are the glands with internal secretion (especially the thyroid
gland, testicles, ovaries, the adrenals and pituitary body), according to
recent researches, among which those of the author of this book may be
mentioned. He was among the first to show the fact that glands with
internal secretion control all the processes of oxidation,[2] and that the
diseases of metabolism: diabetes, obesity, gout, etc., are the direct
consequence of alterations in these important glands. This is further
sustained by the labors of Sajous[3] who was the first to describe the
mechanism through which these organs govern oxidation and metabolism,
and to explain how they produce the disorders just enumerated.
The most important part herein is taken by the thyroid gland, whose
increased activity is followed by an augmentation of the processes of
oxidation in the body, whereas its degeneration is followed by a diminution
of these processes. When the thyroid gland is degenerated entirely, as in
myxœdema, there is also a great diminution of all oxidation processes.
There are also cases where the thyroid is only partially altered by the
increase of connective tissue, cases called partial myxœdema, and in these
cases, accordingly, the diminution of the processes of oxidation does not
take place to the same extent as in complete myxœdema.
When we thus find symptoms of old age in young persons, together with,
in the most typical cases, a state of decreased oxidation, we have to
determine whether or not we are dealing with a degeneration of the thyroid
gland. And, indeed, such a condition is before us, for the symptoms we have
just mentioned are characteristic of myxœdema.
If complete myxœdema, the highest degree of this condition, is rare, on
the other hand the incomplete forms, where the thyroid is only partially
replaced by connective tissue, are fairly common.

This is shown by the fact that, after the fortieth or forty-fifth year, the
thyroid shows an increased amount of connective tissue, and thus cannot be
so active as a thyroid with more secreting elements and less connective
tissue.
We have thus reasons to suppose that the persons above mentioned, who
only exhibit some but not all of the symptoms of old age, symptoms which
are also found as typical in myxœdema, are suffering from a partial
myxœdema or hypothyroidia. And it does not necessarily follow that in all
such cases the processes of nutrition will be diminished, as is the rule in
typical cases of myxœdema.
The resemblance between senility and myxœdema was first pointed out
in 1890 by Sir Victor Horsley, one of the foremost authors on myxœdema,
and afterward by Vermehren,[4] Ewald,[5] of Berlin, and the author. Horsley
ascribed old age to degeneration of the thyroid gland, and we have shown
(in a communication to the Paris Biological Society, presented by Dr. Gley,
Professor of Physiology at the University of Paris, December 4, 1904) that,
besides the thyroid, there are also different other ductless glands whose
degeneration produces old age. These are the sexual glands, the pituitary
body, and the adrenals.
It is a well-known fact that extirpation of the testicles and of the ovaries
is followed by obesity and other symptoms of old age; in the same way
cessation of the menstruation with degeneration of the ovaries at the
climacteric is followed by all the symptoms of old age and certain nervous
disturbances, as, for instance, troublesome flushings, which occur here, as
after castration. Eunuchs, as a rule, look much older than their age. The
Oriental eunuchs, and also the members of a religious caste in Russia, the
Skopse, who castrate themselves through fanaticism, because of their
parchment-like face covered with innumerable wrinkles, appear aged
beyond their years.
Degeneration of the pituitary body is also followed by premature senility.
This is shown by the fact that acromegalic persons, as a rule, look much
older than their age. This also holds good in the case of myxœdematous
patients. We have had opportunity to see, quite recently, the skeleton of a
female acromegalic patient of Dr. G. A. Gibson in Edinburgh, and found

typical indications of old age, an enormous augmentation of connective
tissue and vascularization of the bones, with great porosity.
It must be remembered that all the glands with internal secretions,
according to Pineles,[6] Sajous,[7] and the researches of the author, stand in
very close relation to one another. Thus, degeneration of the thyroid is
followed by that of the pituitary body. This was shown by the experiments
of Hofmeister,[8] Stieda,[9] Rogowitsch,[10] Benda, and many others.
Degeneration of the pituitary is followed by a similar lesion in the thyroid.
Arteriosclerosis is a condition very frequently met with in elderly
persons, and, according to recent researches, this disease is caused by a
toxic agent with subsequent degeneration of the walls of the blood-vessels.
Such a change can be produced artificially, as shown by Josué,[11] by
injecting adrenal extract into rabbits.
That the ductless glands are closely related holds good also for the
thyroid and adrenals. This relation, however, is an antagonistic one. The
adrenals increase the blood-pressure (Oliver and Schäfer[12]), and the thyroid
diminishes it. It is an interesting fact, demonstrated by Professor
Eiselsberg[13] in Vienna, that extirpation of the thyroid gland of dogs results
in atheroma of the aorta. In connection with this we also mention the
clinical fact, that all those agencies which are harmful to the thyroid gland,
as syphilis, abundant meat food (Breisacher,[14], Blum,[15] Lorand[16]), alcohol
(Hertoghe and de Quervain[17]), and tobacco (Hertoghe), are also those
which are commonly considered to be the causes of high tension and
arteriosclerosis. Infectious diseases are also brought in etiological
relationship with arteriosclerosis, and it has been shown by a series of
authors, that in infectious diseases the thyroid undergoes important
alterations which may involve its degeneration (Roger and Garnier,
Crispino, Torri, Bayon, de Quervain).
Infectious diseases also induce changes in the adrenals, as shown by
many authors (see Chapter III).
Various toxic products, such as lead, alcohol, and tobacco, which are
considered causes of arteriosclerosis, are also able to produce hypertrophy
of the adrenals.

And, if we consider those agencies which are commonly considered the
causes of premature senility, we notice the singular fact that they are also
considered to be especially harmful to the various glands with internal
secretion, particularly the thyroid and sexual glands.
Among these agencies may be mentioned infectious diseases, sexual
excesses, frequent pregnancies, strong emotions continued for a long time,
such as grief and sorrow, chronic intoxications (by poisonous products
produced in the body, or introduced from without). We will show later, in an
exhaustive way, the action of these agencies upon the glands with internal
secretion.
Between the thyroid gland and the ovaries, a close relationship also
exists. Thus, invariably, when we find the thyroid altered, we can also see
changes in the ovaries. Consequently in myxœdema and Graves’s disease
we find, with great frequency, disturbances in the functions of the ovaries,
e.g., cessation of the menses, or disorders of menstruation. In such
conditions the ovaries have often been found to be atrophied. We also
frequently find such disturbances in acromegaly, where they may either be
due to changes in the pituitary, associated with an altered condition of the
ovaries, or they may be ascribed directly to changes in the thyroid which, as
we have shown in a communication to the International Congress in
Madrid, 1903, is very often altered in acromegaly. If microscopically
examined it is probably found changed in every case. Indeed, we have
attributed acromegaly to the primary changes in the thyroid which lead only
secondarily to those in the pituitary body.
In diabetes, which disease, according to our investigations, is often
caused by changes in the thyroid,[18] and subsequently in the pancreas, or
vice versâ, amenorrhea or impotency is frequently met with.
On the other hand, changes in the ovaries are also, as a rule, followed by
changes in the thyroid gland, as may be seen in puberty, menstruation,
pregnancy, lactation, and the climacteric. We will enlarge upon this later, in
greater detail, but we will only briefly mention here that we may frequently
see a swelling of the thyroid gland as an expression of increased activity
during these conditions. We can also see this in diseases of the ovaries, and,
as certain authors show, even sexual excesses can produce an altered state
of the thyroid. This was known to the ancient Hebrews, for they used to

examine the neck of the newly-married bride the morning following the
wedding night to see if the neck had become larger by the swelling of the
thyroid gland.
Thus we can readily understand that, frequently, swelling of the thyroid is
the consequence of overwork of this organ, and, as in the case of great
sexual excesses or frequent pregnancies, may lead to exhaustion of the
gland with its grave clinical consequences.
Indeed it has been shown by the earliest authors on myxœdema, that this
disease is very frequently caused by too frequent pregnancies, especially if
connected with prolonged lactation (Ord, Morvan, Combe). This will also
explain why women more frequently show the symptoms of precocious
senility than men, whose sexual glands are not put to such constant activity
and change as are the female sexual glands. Similarly women, after frequent
pregnancies, especially with prolonged lactation, or women with diseases of
the ovaries, and also those addicted to habitual sexual excess, such as
prostitutes, very soon become fat and fade before their time. Thus we may
see symptoms of precocious senility in such women even before the end of
the third decade, especially if they have begun to lead an immoral life at an
early age. Even young girls may look much older through the abuse of their
ovaries from sexual excesses. Their breasts become large and pendulous,
and their faces bloated and relaxed. Menstruation may likewise be made to
appear in early childhood by sexual abuses, as Pauline Tarnowska[19] has
found through the examination in St. Petersburg of 150 very young
prostitutes.
We shall show in the next chapter that obesity, which has nothing to do
with overfeeding, can be caused by like agencies.
That mental emotions, especially care, grief, sorrow, etc., powerfully
influence the different ductless glands, and are able to produce degeneration
of the thyroid, adrenals, and sexual glands, etc., is shown by conclusive
proofs in the chapter on the “Hygienics of the Mind.”
Infectious diseases are especially liable to cause change in the kidneys,
and in various infectious diseases, sometimes even in tonsillitis, we may
find an inflamed condition of these organs.

The kidneys can also be damaged by the passage of various toxic
products, which are either produced in the body (auto-intoxication) or
introduced with the food (condiments), or as stimulants—e.g., alcohol,
strong tea, etc. All these toxic agents are capable of doing damage to the
kidneys just as to the thyroid gland. We shall treat later on, in separate
chapters, of the action of these stimulants upon the ductless glands.
The condition termed auto-intoxication may be induced by many
different factors, among which may be mentioned the products of intestinal
putrefaction (Senator[20]) and the waste products from the processes of
oxidation, such as uric acid, for example. Animal food is more apt to
produce intestinal putrefaction than any of the various other foodstuffs.
There are three important organs which protect us against such a
condition of auto-intoxication; these are the kidneys, liver, and thyroid, and
possibly also the parathyroids.
The kidneys act by promptly eliminating such toxic products in the urine.
They are glands with internal secretion, as shown by the experiments of
Brown-Séquard,[21] E. Meyer,[22] and clinical observations of Senator[23] and
H. Strauss.
The liver, which, according to Gilbert, H. Strauss,[24] and others, is also a
gland with an internal secretion, is strongly antagonistic to intestinal
poisons. It destroys toxic products brought to it from the intestine through
the portal vein, and several authors, Professor Adami, Sir Lauder Brunton
and Bokenham,[25] show that it is also able to eliminate such products with
the bile after previous transformation. We will treat of these protective
functions of the liver in a separate chapter, together with the hygienics of
this important organ; but we will just mention here that the liver plays a
great rôle in the transformation of the toxic end-products of albuminous
food into harmless substances, such as urea.
The third important toxin-destroying organ is the thyroid gland, which, as
shown by the experiments of Dr. Leo Breisacher,[26] of Detroit, formerly
assistant to Professor Munk, of Berlin, and of Dr. F. Blum,[27] of Frankfort,
as well as Dr. Chalmers Watson,[28] of Edinburgh, destroys those poisonous
substances produced by the decomposition of proteid food. Moreover,
Sajous has shown that this is a prominent function of the pituitary body, the
thyroid and the adrenals, acting jointly as the “adrenal system.”

It will be evident that these various glands can only do their work to
perfection so long as their parenchymatous tissue is not replaced to any
large extent by connective tissue. Of these glands the thyroid takes the
foremost rank, as it governs the other glands. As we have shown in a
communication to the French Congress of Medicine, in Liège, 1905, the
thyroid influences the liver, and in a paper before the Paris Biological
Society, February 25, 1907, we have shown that the thyroid also influences
the kidneys. In fact, the liver and kidneys are closely allied to the thyroid,
and when this organ is degenerated, the other two glands follow suit.
Accordingly we may expect that, when the thyroid undergoes a process
of degeneration, such an event may also take place in these two protective
organs, as we have shown in our above-mentioned two communications. In
consequence of the diminished activity of these organs the development of
a condition of auto-intoxication may be facilitated. Patients showing
symptoms of old age in early years, also show to a greater or less extent
symptoms of such a condition, as do myxœdematous persons.
Meat food especially, if taken in large quantity, is a certain producer of
uric acid, and it is an interesting fact, shown by several authors and also by
the writer,[29] that by thyroid medication we can augment the elimination of
uric acid, and also prevent its formation in large quantity, both in the case of
uric acid formed in the body or introduced from without by the food.
This fact stands in relation to the powerful influence exercised by the
ductless glands, and especially the thyroid, upon the process of oxidation;
and, as we are anxious to prove the assertions we here advance, we shall
show in the next chapter how these wonderful glands influence the
processes of nutrition in the tissues, and at the same time the external
appearance. We have already mentioned a form of obesity that has nothing
to do with overfeeding, as one of the symptoms of precocious old age, and
in the next chapter we will review in detail the agencies which govern this
condition.

CHAPTER II.

On the Agencies which Govern our External Appearance and
the Nutrition of the Tissues.

As a general rule infants of both sexes look very much alike, so much so,
indeed, that sometimes it is only possible, upon close inspection, to
determine the difference in sex. This, however, can only be so for a certain
period until certain changes take place in the ductless glands, especially in
the sexual glands and the thyroid.
The latter contains but very little, if any, colloid substance in infancy, and
the colloid increases only gradually until it is present in abundance at the
time of puberty, when also the changes in the sexual glands reach a climax
coincident with the ripening of the follicles in the ovaries and their rupture
at a menstrual period. This latter process is, as we have mentioned before,
under the influence of the thyroid. Puberty and menstruation do not take
place, as a rule, in persons with a degenerated thyroid gland.
With the onset of puberty there is seen, also, a change in the external
appearance of the individual and the attributes of virility—e.g., moustache,
hair in the pubic region, alteration of the voice, etc., appear. In the female
the development of the breast, hair on the pubis, etc., occurs. At the same
time the features attain the peculiar characteristic which distinguishes the
male face from the female, even without the aid of a moustache.
In those persons in whom puberty has not occurred at the usual age
(fourteen to sixteen years in our climate) the attributes of sex are absent. In
these cases the male looks very much like the female. A similar
phenomenon may be seen in women after castration and the climacteric,
when they may even show a tendency to develop a moustache and hair on
their face in places, corresponding to the male beard.

This we can also observe in women whose ovaries have been altered by
disease or by sexual excesses.
These attributes of sex are also called external sexual characteristics, and
they are the direct result of the internal secretion of the sexual glands. They
only develop through the presence of such a secretion, and this is easily
demonstrated by the fact that after castration of the infant, they do not
appear at all. Hence, if we see grown-up men with no trace of a moustache
it may indicate an undeveloped condition of the testicles. Again, we castrate
a young cock, he will not grow a comb and spurs, and other cocks will pass
by, too proud to fight with a degenerate deprived of its male attributes. If
we now take the extirpated testicle of such cock and graft it under his skin,
the other cocks will commence to fight with him, for his comb and spurs
will develop as in other normal cocks.
That the whole external appearance of a castrated animal or man is
changed, is also demonstrated by important changes in the skeleton and size
of such animals or persons.
As Poncet[30] has shown, the extremities of a castrated rabbit become
abnormally long, and it is a well-known fact that eunuchs have abnormally
long arms and legs. This also occurs in cases of infantilism, which, as we
know, is due to a non-development of the sexual glands. Moreover, the
thyroid of such individuals is also found to be in a pathological condition,
as was shown by Hertoghe.
Men who have been castrated before puberty or whose testicles are
undeveloped, present such an external appearance. They have no
moustache, as above mentioned; their hair is dry and brittle and remains
short; their faces are pale, and of a yellowish hue; their hands are cold and
reddish blue. Often the skin of the face is like parchment and has many
wrinkles. Their intelligence is often diminished, as we will show later on,
and they are usually anæmic.
Women with undeveloped ovaries have flat breasts and hips; their faces
are often irregular in structure, and their jaws are often prominent; their
gums are shrunken and their teeth are long and soon fall out. Some cases
may show a colossal obesity, but in the partial forms of ovarian
insufficiency they may be remarkably thin. They also are, as a rule, anæmic
or chlorotic.

In some parts of the Orient, as in India, there are female eunuchs, such as
Roberts has seen on the way from Delhi to Bombay. Such eunuchs had no
bosom; the pubic hair was absent, and their buttocks were like those of
men; but the rest of the body was stouter. Of course these women had been
castrated during their childhood.
If we make a Roentgen-ray examination of the skeleton of a person
castrated in childhood, we shall find that the epiphysial cartilages remain
unossified for a long time after puberty.
It is a very interesting fact that, both after castration and in myxœdema,
the same persistence of the epiphysial cartilages and retardation of
ossification have been observed by means of the Roentgen-rays: by
Hertoghe in 1896; Springer and Serbanesco in 1897; Gasne and Laude in
1898; Legry and Renault in 1902; Jeandelize in 1903. The same thing has
also been observed by Hertoghe in “Infantilism of the Type of Lorraine.”
The influence of the thyroid upon the skeleton and size of the body is
easily shown by simple observations.
Children of parents with cachectic diseases like chronic tuberculosis,
syphilis, alcoholism, etc., in which the thyroid gland is, as a rule, found
degenerated (Gamier,[31] Hertoghe[32]), are (as shown by Prof. Perrando[33]
and Garnier) born with a congenital atrophy of the thyroid. Just as young
animals with an extirpated thyroid, so these children will not grow, and we
know that cretins (degeneration of the thyroid) remain as a rule dwarfs all
their life long. We can now produce in such persons certain and very
curious changes by feeding them with thyroid extract, and we can see them,
as Hertoghe has shown, grow inch by inch in a short period; their mental
faculties improving at the same time in an incredible manner.
The influence of the thyroid upon the skeleton is also shown by the fact,
established by Gauthier,[34] that in a fracture with but little tendency to the
formation of a callus, union takes place much more quickly after
administration of thyroid extract.
In Graves’s disease, with exaggeration of the thyroid activity, there is, on
the other hand, an increased elimination of the most important constituent
of the skeletal tissues: calcium carbonate, and this occurs also in

acromegaly and diabetes, in which conditions the thyroid is very frequently
altered (Lorand[35]).
Osteomalacia, which is associated with an enormous elimination of
calcium carbonate is, as we at present consider, due to an exaggerated
ovarian activity (Fehling), and can be favorably influenced by castration or,
by what would be more reasonable, thyroid treatment.
No less powerful than that of the thyroid is the influence of the pituitary
body upon the skeleton, especially upon the hands, feet, and skull. And if
we wish to demonstrate how much the ductless glands influence the looks
of a person, it is sufficient to point out the great changes that take place in
the face of a patient with acromegaly. This disease makes such persons look
very much as “Punch” is depicted.
The skin and complexion of persons suffering from changes in the
ductless glands are also very different from normal. Thus Addison’s disease,
due, as well known, to a degeneration of the adrenals, makes a white man
look more or less like an Indian, and there is a pigmented skin also in
persons affected by the
partial form of that rare disease. We can also easily show that changes in
the thyroid are followed by changes in the condition of the skin. Thus, with
thyroid degenerations, as in myxœdema, the skin is pale with a yellowish
tinge. In Graves’s disease pigmentation of the skin can often be observed,
and not rarely cutaneous eruptions.
In affections of the sexual organs in woman similar conditions of the skin
can occur. Such persons often present wrinkles at a very early age, and
certainly look older than their years. Infants suffering from congenital
degeneration of the thyroid gland often look withered and present a face as
wrinkled as a sexagenarian. We see this also in congenital syphilis (atrophy
of the thyroid).
The hair also very often shows alterations in diseases of the thyroid, or
ovaries. Thus, in myxœdema there is an atrophy of the follicles of the hair,
which falls out, even in the case of the eye-brows.
It is particularly interesting that, by thyroid medication, a new growth of
hair has been observed in places where it had fallen out years previously, as
we have observed, with other authors, in several cases after thyroid

medication. And, very strange to say, this newly-grown hair was quite dark
while the hair that had previously been in its place was gray in color. It has
been authentically stated by several authorities that old persons of sixty or
seventy have acquired black hair under thyroid treatment.
On the other hand, in much younger persons, perhaps under thirty, who
are suffering from complete or partial degeneration of the thyroid gland, the
hair very often turns gray; so much so that Hertoghe considers this to be
one of the typical symptoms of such a condition.
The falling out of hair, or its turning gray, after acute infectious diseases
or after grief and sorrow, may have some connection with the well-known
changes in the ductless glands, especially in the thyroid, in these conditions.
This is made quite clear by Sajous’s demonstration that these glands
collectively govern the activity of general oxidation, that is to say the vital
process itself.
As we have previously mentioned, a moustache or whiskers may grow in
women suffering from disease of the ovaries, just as after castration or the
climacteric. It is also very interesting that a premature grayness often occurs
in cases of insanity, and can be attributed to the frequent changes in the
thyroid and sexual glands in these conditions.
The nutrition of the skin is entirely under the influence of the thyroid.
After extirpation or degeneration of the thyroid, there occurs atrophy of the
sebaceous and sudorific glands.
In myxœdema the skin is dry and never perspires. On the contrary, in
Graves’s disease, or after thyroid medication in large doses, there is
abundant perspiration.
Deposits of tartar are common symptoms in all forms of thyroid
degeneration. Retraction of the gum follows and the teeth loosen and fall
out. This is also a common symptom in diabetes, but here only in advanced
cases. In such cases there is, as we[36] have shown, an exhaustion of the
thyroid gland, which develops as a consequence of the previous
hyperactivity of the thyroid gland in the early stages of the disease. As a
rule the teeth of a diabetic only fall out in the severer form of the disease,
generally after acetone has begun to show itself in the urine.

Important changes take place in the subcutaneous tissue after extirpation
of the thyroid gland. In such cases there is either augmentation of
connective tissue or of fat. Thus, in the case of a young bull, whose history
we followed, there has been an increase of thirty pounds of fat within a few
months after extirpation of the thyroid. The same thing happened in the case
of a young horse, whose thyroid was also extirpated.
There are, however, still more facts which show the great influence of the
thyroid upon the metabolism of fat. Thus we know very well that by thyroid
medication we are able to reduce fat considerably. This is due to the action
of the thyroid which, as shown by many authors, increases the process of
oxidation. In Graves’s disease these processes are augmented. In the
opposite condition (myxœdema) they are diminished. By giving thyroid
extract we are able to augment, positively, the processes of oxidation in the
tissues, as shown by Professor Magnus-Levy,[37] of Berlin, and many others.
As we have shown in our previous researches, there is an abundant
formation of fat in the early cases of degeneration of the thyroid gland,
which sometimes progresses to a colossal obesity, which obesity has
nothing to do with overfeeding. Such individuals have, as a rule, but poor
appetites, and eat very little. Therefore, in a communication to the French
Congress of Internal Medicine in Paris, 1904, we differentiated two kinds of
obesity: 1. Exogenous obesity—i.e., arising by agencies coming from
without by the food we introduce into our body. 2. Endogenous obesity,
having its origin within our economy, and depending on changes in certain
glands which govern the processes of oxidation—e.g., thyroid sexual
glands, pituitary body. This second form is independent of our feeding. As
we have shown, this latter can be produced by any of those agencies which
are harmful to the ductless glands, especially the thyroid and sexual glands,
as, for example, infectious diseases, frequent pregnancies, certain toxic
products (alcohol), sexual excesses, climateric. All these conditions may
have the effect of producing obesity, which can be explained by an
exhaustion of the thyroid and ovaries following a pre-existing hyperactivity.
The influence of the ovaries upon the production of obesity can be
demonstrated by the sequels of castration, and also by the fact that women,
after one or more, especially several pregnancies, or after sexual excesses,
may become very fat. In such women this obesity may be only partial and
limited (as we have shown in a recent communication to the International

Congress of Medicine in Lisbon, 1906) to certain parts—e.g., the mammary
glands or hips.
There can be no doubt that the sexual glands influence the nutrition of the
tissues in a powerful manner, and this has also been shown, experimentally,
by the researches of two Berlin experimenters, Professors Loewy and P. I.
Richter,[38] performed in the physiological institution of Professor Zunz.
These savants have shown that after castration there is a diminution of
oxidation. By giving extracts of dogs’ testicles to castrated male dogs, they
were able to augment the processes of oxidation. These processes, however,
were still more increased after the administration of female extracts to these
castrated male dogs. The administration of ovarian extracts to the spayed
bitch has, of course, given still better results. Thus there was here an
increase of 67.7 per cent. after castration, and 37.6 per cent. of the original
value. The increase of the oxidation in male dogs was 44.5 per cent. after
castration, by the treatment with ovarian extracts, and 24.8 per cent. above
the normal value. If the results after feeding with male extracts were not so
successful, it must be attributed to the circumstance that we are at present
unable to produce testicular extracts of the same efficacy as ovarian
extracts.
The action of the pituitary body upon metabolism has been shown by
Narbuth, who found a diminution of oxidation after degeneration of the
pituitary body, and an increase after medication with extracts of the same
organ. This fact is also shown clinically by cases of obesity after
degeneration of the pituitary body in acromegaly, and by the interesting fact
(shown by a great number of authorities and recently by Fröhlich,[39] Berger,
[40]
and Erdheim[41]) that cases of pituitary tumor may be met with,
associated with obesity, and without any of the symptoms of acromegaly.
Especially interesting is the case of Madelung[42] showing a colossal obesity
in a girl aged 9 years, after a gunshot injury of the pituitary body. This
observation sustains, and is clearly explained by, Sajous[43] who showed that
the posterior or neural lobe of the pituitary body contained a nerve center
which governed the functional activity of the thyroid, and that the secretion
of the latter insured the catabolism of fats by increasing their vulnerability
to oxidation.
The external appearance of such cases of obesity, which we have
described before the French Congress of Medicine in 1904, and the London

Pathological Society, February 21, 1905, as endogenous obesity, is also
clinically different from the appearance of those caused by overfeeding. As
we have shown, persons addicted to rich food, with little exercise, are often
red in the face, and are plethoric; they easily become overheated and
perspire freely. They seldom complain of constipation. On the other hand
persons suffering from endogenous obesity generally look pale, always
complain of cold and dry skin, and perspire very seldom, if at all. As a rule
they are also very constipated.
There is still another ductless gland which influences metabolism in a
powerful way. This is the pancreas which, by its three enzymes, brings
about the assimilation of the proteid carbohydrate and fatty materials. To
these may also be added its production of labferment. By its internal
secretion, which is probably produced by the islands of Langerhans, it aids
in the oxidation of the sugar, introduced into our alimentary canal in the
shape of starchy food, or contained in the carbohydrated radicle of the
albuminous molecules, as demonstrated by Pavy. The entire degeneration of
the pancreas, especially of the part containing the islands of Langerhans,
produces a disease that is, as a rule, characterized by loss of weight and the
production of emaciation often to an astonishing degree—i.e., diabetes.
Persons suffering from the milder form of this disease often present a
rosy and healthy appearance, and as we have pointed out previously, often
look younger than their age. We believe that, as we shall show further on,
this fact is not without relation to the condition of the thyroid in this
disease. We have shown by researches made in the laboratory of Professor
Minkowski, then of the Augusta Hospital in Cologne, that in diabetes the
thyroid contains large, sometimes enormous, quantities of colloid
substance, thus indicating a condition of thyroid hyperactivity.
As we have mentioned in the first chapter, corpulence is often one of the
first symptoms of old age, and we have also insisted upon the fact that this
can be brought about by infectious diseases (e.g., typhoid, pneumonia,
scarlet fever, etc.). As we have also mentioned the fact, in the first chapter,
that old age can be brought about by an infectious disease which acts upon
the ductless glands, especially the thyroid, we believe it will be necessary to
enter a little more in detail into this subject, to which we will devote the
next chapter. We will enlarge upon the fact that our immunity against

infectious diseases is entirely dependent on the proper working order of
certain ductless glands.

CHAPTER III.

On the Agencies which Govern Immunity Against Infections and
Intoxications—The Origin of Fever.

From the moment of our birth we are constantly exposed to the incessant
attacks of innumerable bacteria and to the effects of a large amount of
poisonous material formed within our body or introduced from without, and
if we survive this ceaseless battle it is due to the powerful weapon we
possess in the internal secretion of the ductless glands, especially of the
thyroid gland. That this gland possesses very energetic antitoxic properties
can be shown by the fact that when it is extirpated animals or persons very
readily acquire infectious diseases of all sorts. Thus, the late Professor
Charrin,[44] of Paris, showed several years ago how readily dogs that have
lost their thyroid succumb to all possible infections. Professor W. S.
Greenfield,[45] of Edinburgh, has found that persons suffering from
myxœdema (athyroidia) very often die from tuberculosis, and Professor Pel,
[46]
of Amsterdam, found a great frequency of tuberculosis in the families of
myxœdematous persons. This coincides with the conclusions of Prof. G. R.
Murray,[47] Professor Lanz, and ourself, that the properties of the thyroid can
be inherited. Sajous has shown, moreover, that the pituitary, the adrenals
and the thyroid constituted the autoprotective mechanism of the body
against disease, a fact not only sustained by the above evidence, but also by
a vast number of additional facts.
As we showed at the last Congress of Tuberculosis in Paris, 1905,
tuberculosis is especially frequent as a sequel to any process deleterious to
the thyroid gland, as after the puerperium, especially with prolongated
lactation; after sexual excesses, as there is a relation between the sexual
glands and the thyroid; after various infectious diseases; after rapid growth
in puberty, due to hyperactivity of the thyroid which influences the growth

of the body; after severe diabetes due to exhaustion of the thyroid; and after
previous hyperactivity in chronic alcoholism due to the action of alcohol
upon the thyroid. On the other hand, all those agencies which excite thyroid
activity may be a preventive against tuberculosis, such as raw meat and
milk. It has been shown that milk contains the internal secretion of the
thyroid.
The thyroid protects us against poisons of different origin, such as the
products of decomposition of protein food. This fact is shown by the
experiments of Dr. Leo Breisacher, of Detroit,[48] formerly assistant of the
late Professor Munk, of Berlin, and from those of Dr. Blum,[49] of Frankfort.
The experimental results of Dr. Chalmers Watson,[50] showing alteration of
the thyroid in certain animals after an exclusive diet of raw meat, and those
of Dr. D. Forsyth[51] concerning the pituitary body in some animals, may be
correlated with this fact. As is well known, the thyroid and pituitary body
stand in very close relationship. Galeotti and Lindemann,[52] in 1897, have
also shown that the products of decomposition of meat produce an increase
of the colloid substance of the thyroid.
The antitoxic properties of the thyroid against different products is also
shown by the observations of Lanz[53] and Walter Edmunds,[54] who have
found that animals without thyroid resist narcosis badly; and, as we have
shown in a communication to the Paris Biological Society,[55] chloroform,
like alcohol, produces a condition of hyperactivity in the thyroid gland,
which results also in an excited mental condition. The observation that
cases of Graves’s disease and of severe diabetes cannot stand narcosis may
be related to this fact.
It has been shown recently by Hunt[56] that the thyroid protects us against
poisons like acetonitril, and that iodine acts through the thyroid. Garnier,[57]
of Paris, has found that certain chemical products, such as iodine, produce
great alterations in the thyroid. As is well known, cases of Graves’s disease
(hyperthyroidia) have been observed after iodine treatment. That the thyroid
fulfils a protective rôle against infectious diseases may already be
considered proved by the fact that, as Roger and Garnier,[58] Crispin,[59]
Torre,[60] Bayon,[61] of Würzburg; de Quervain, and others have found, the
thyroid is, as a rule, altered in infectious diseases. As Roger and Garnier
have shown by a series of investigations confirmed by the above-named
authors, the thyroid shows in acute infectious diseases with fever an

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

thyroid, and their disappearance, occasionally after a high fever, may be
ascribed to the exhaustion of the thyroid after a previous hyperactivity. We
know that a condition of Graves’s disease may be followed by a
myxœdematous condition in which, as we have shown previously,
glycosuria is very rare. In the few hitherto published cases there was no
complete myxœdema.
Both in Graves’s disease and fever there is an augmentation of the
processes of oxidation. After convalescence, however, oxidation may be
diminished, and this explains, as we have shown at the French Congress of
Medicine in 1904,[66] why obesity so frequently occurs after infectious
diseases on the basis of degenerative changes of the thyroid, which governs
oxidation; during the course of infectious disease with fever increased
activity of the thyroid and loss of weight occur, and these are followed by
exhaustion of thyroid activity and obesity.
The conditions of delirium and maniacal exaltation in cases of high fever
are analogous to the condition of mental exaltation that may occur in
Graves’s disease. According to the late Moebius,[67] in cases of Graves’s
disease there are sometimes symptoms like those of alcoholic intoxication
due to the toxins of the thyroid. We believe that the mental exaltation in
chloroform narcosis and alcoholic intoxication stands in relation with the
action of these drugs upon the thyroid. That alcohol acts upon the thyroid
has been shown by de Quervain, Hertoghe,[68] and others. Sajous in his work
on the “Internal Secretions,” urges that the thyroid is not directly excited by
toxins and other poisons which produce fever, but that these toxics excite
primarily the thyroid center (or better the adreno-thyroid center, for he
holds that the adrenals are also governed by this center) thus increasing the
secretory activity of the gland. The correctness of this view is proved by the
fact that, as shown by Sawandowski,[69] section of the basal tissues, and,
therefore, between the pituitary and the bulb, prevented the production of
fever, due to putrid materials, and also the influence of antipyretics,
antipyrin, for instance.
Cutaneous eruptions may occur in fever or in Graves’s disease. In the
same way as in many skin diseases they may be considered as the
expression of an elimination of toxic products through the skin.

All the above symptoms of fever may be considered as expression of the
efforts of nature to defend herself by eliminating toxic products. All toxic
products which are the causes of infection act upon the thyroid gland, this
organ, through increased activity, produces symptoms such as we see in
Graves’s disease. That these symptoms, especially abundant perspiration,
polyuria, and diarrhœa, typical in some infectious diseases, may be
considered as the direct consequence of thyroid activity, can best be shown
by the fact that the thyroid gland governs the functions of the skin,
intestines, and kidneys.
That the symptoms of fever may be considered as due to increased
thyroid activity is also shown by the fact that nearly all such symptoms may
be produced by thyroid preparations. We have personally taken for
experimental purposes, during ten months, thyroid tablets and experienced
the sensation of heat, flushings, and abundant perspiration. It is interesting
to note that all kinds of wounds and contusions we got during the time we
took these tablets, healed with surprising rapidity with fine granulations far
better than previously; on the other hand, we very frequently suffered from
tonsillitis and acne eruptions.
Symptoms similar to fever have also been produced in animals by thyroid
feeding; thus, very often elevation of the frequency of the pulse from 100 to
140-160 beats (Lanz), and from 150 to 200 beats (Georgiewski), while
Ballet and Enriquez[70] produced regular fever in their animals;
Easterbrook[71] also produced “some pyrexia” in his animals and an increase
of pulse-rate of about 40 a minute. As Dr. Tanberg, former assistant of the
Physiological Institute in Christiania, told us, he has produced an increase
of the temperature of two and a half degrees in animals, whose thyroid he
had extirpated, after giving very large quantities of thyroid gland.
It is of great interest to the question at issue that the remedies which we
employ to fight fever should also produce symptoms like the thyroid does
when it is in increased activity. Thus salicylates produce a vaso-dilatation
and abundant perspiration, and afterward diminution of the temperature. We
have, ourself, taken salicylates or acetonitril preparation and felt the
sensation of heat and afterward perspiration. When we take a hot air or
steam bath for cold or gouty pains we produce first, great heat, tachycardia,
and then abundant perspiration, and the typical symptoms of fever or
increased thyroid activity.

We know that certain drugs, as found by Garnier, have an exciting action
upon the thyroid, such as iodine, and what is especially important,
pilocarpine. The great sudorific action of this drug may stand in some
relation to its effect upon the thyroid. It is permissible to suppose that the
different drugs which antagonize fever do so by acting first upon the thyroid
gland and exciting its increased activity to fight infection. But if we gave
too much of these we might exhaust the activity of the gland in the same
way as Garnier found an exhaustion of the colloid of the thyroid after too
much iodine. This shows that we should not give antipyretics in too large
doses. We should excite thyroid activity but not overdo it.
That the thyroid is able to protect us against infectious diseases can be
best shown by the fact that it exercises a great influence upon phagocytosis.
According to the findings of Fassin, the alexins disappear from the blood
after the extirpation of the thyroid gland; and, according to Sir Almroth
Wright, the production of opsonins is dependent upon internal secretions.
Hence, it is of the greatest value to us that Stepanoff[72], and Marbé have
proved by experiments conducted in the Pasteur Institute of Paris that the
opsonins disappear after the extirpation of the thyroid gland but increase
after thyroid treatment, these experiments thus proving the correctness of
our clinical observations on the rôle of the thyroid gland as an organ for
protection against infections, as published in The Lancet two and one-half
years ago. Sajous, who was first (1907) to point out that the thyroid
secretion was the agent which Wright termed “opsonin,” is also shown to
have been right by the investigations of Fassin, Stepanoff and Marbé, thus
proving further the intimate relationship between the thyroid and our
immunizing functions.
Fever can be produced with similar symptoms by toxic products of
different origin, as from small elements of the vegetable kingdom like
bacteria, certain plants, and even fruits, as is shown by the urticaria which
follows in some persons after eating strawberries. Certain minute elements
of the animal kingdom have a similar power, such as protozoa like
trypanosomes, and we may also instance certain kinds of animal food like
oysters in certain persons, the poison of snakes, and certain insects like
tarantulas and scorpions; also certain minerals like arsenic and phosphorus
can produce fever. Besides these poisons coming from without, fever with
similar symptoms can also be produced by poisons formed within our body

by the hyperactivity of a gland—the thyroid. When so many different
poisons produce the same result it lies near to suppose that they do this by
means of the same agency, which, according to the aforesaid observations,
is very probably a thyroid hyperactivity. The modus operandi of all these
agents is well studied in Sajous’s work, to which the reader is referred.
As is well known, a condition of hyperactivity of the thyroid may be
followed by its exhaustion, and thus Graves’s disease may often be
followed by myxœdema, i.e., athyroidia. In the same way the hyperactivity
of the thyroid gland in infectious diseases may also be followed by its
exhaustion and a myxœdematous condition. Even complete myxœdema
most frequently appears after a previous infectious disease—a fact
recognized by the earliest English authors on this disease. Accordingly, it is
not surprising if an infectious disease like trypanosomiasis is followed by a
condition like sleeping sickness, which, as we have shown at the German
Congress for Internal Medicine in 1905, presents all the clinical symptoms
of, and identical anatomico-pathological alterations of the central nervous
system noted in, myxœdema. On the other hand, trypanosomiasis presents
all the typical symptoms of Graves’s disease. In syphilis also, after the fever
with eruptions in the secondary stage, in which we not infrequently see,
especially in women, a swelling of the thyroid, we find in the tertiary stage
many symptoms of a condition of myxœdema or hypothyroidia, and with
the iodine treatment we add to the blood the main element of the thyroid
gland. Iodine is also especially active, if not given in too large doses, in
exciting thyroid activity, and sometimes it even provokes Graves’s disease.
Persons of healthy constitution with a good working thyroid may get the
sensation of heat and perspiration spontaneously after a cold, or gouty
pains, even without salicylates, and feel better afterward, whereas persons
with a deficient thyroid have difficulty in producing the symptoms of fever.
Recently we observed a young man, aged 22 years, with symptoms of
hypothyroidia as described by Hertoghe, who had follicular tonsillitis. He
presented none of the symptoms of fever, but it took him ten days to get
over it and he felt very weak afterward. There was this summer an epidemic
of typhoid fever in the lunatic asylum of Colorno, near Pavia. We have it
from Dr. Gassenghi, of the University of Pavia, that half of the patients
died; but it is very interesting to note that there was no fever. This may be
explained by the fact that many cases of insanity and idiocy stand in

etiological relation to alterations of the thyroid gland, and may get better
after the hyperactivity of the thyroid through fever. Indeed, by some
authors,—e.g. Wagner—an improvement has been observed to occur in
insanity by producing fever through injections with tuberculin. We feel
sorry not to be able to enter more fully into this interesting subject, but we
may briefly mention that, as we have stated in the Neurological Society of
New York (April 2, 1906), we have observed several cases of dementia
præcox and melancholia with alterations of the thyroid and sexual glands in
each case. Alcoholics suffering from pneumonia seldom get high fever, but
often die in a short time. Alcohol in large quantities not only causes
degenerative changes in the heart, but also in the thyroid. And we should
not forget that there exist very close relations between the activity of these
two organs.
It seems to follow from these observations that persons with a good
sound thyroid have a better chance in fighting infections and intoxications
than persons with a degenerated thyroid. In persons with an active thyroid,
an increased activity of the gland, and thus a better functioning of the
eliminative organs which are governed by it, can take place more easily
than in persons with a degenerated thyroid, and, in consequence, with a dry
skin, constipated bowels, and lazy kidneys. Some hints may be derived
from these observations in the interest of prophylaxis and prognosis, and
also for the purposes of life insurance.
It seems to us that the conclusion is not unjustified, that fever is a
beneficial process of our organism which is produced by an increased
activity of the thyroid gland as a reaction against toxic products and poisons
in general. The symptoms of fever are the expression of this increased
activity, and they are directed toward the elimination of noxious elements. It
would be unreasonable to oppose this spontaneous healing tendency of
nature by fighting these salutary symptoms, unless there be hyperpyrexia.
Fever, as probably disease in general, serves the ends of nature in the
interest of our conservation. In addition to the thyroid, the other ductless
glands protect us from infections and intoxications. Thus, the pituitary body
which Casselli,[73] Guerrini,[74] Torri, and many others found, as a rule,
altered through infectious diseases. Torri noticed a hyperplasia of the
chromophile cells of the pituitary body, and disappearance of the colloid
from the follicles in the majority of cases of pneumonia, typhoid fever,

tuberculosis, diphtheria, and other infectious diseases. Garnier also noted
changes in this gland in chronic tuberculosis. Thaon,[75] in his recent thesis,
also found changes in the pituitary body in many cases of various sorts of
infectious disease, and, what is most interesting, also in intoxications from
intestinal origin. We must conclude with Sajous (1903) that the pituitary
body reacts to the effects of infections and intoxications and that these
anatomo-pathological alterations of the pituitary also provoke clinical
symptoms. Renon[76] and Delille have drawn attention to the fact that the
decrease of the blood-pressure, and increase in the number of pulsations, in
fever, as also the other symptoms of this condition, such as insomnia, heat,
perspiration, etc., are due to the alteration of the pituitary body. When this is
active and healthy it augments blood-pressure, according to Oliver and
Schäfer,[77] Cyon, Livon, Garnier, Thaon, Hallion, and Carrion, etc. At the
same time the pulse is diminished, but when this gland is degenerated the
pressure naturally falls and the pulsation goes up.
It is also very interesting that Renon, with his assistants, Delille and
Azam,[78] were able to increase blood-pressure in numerous cases of
infectious diseases and diminish the pulse, and also produce a marked
improvement in the feverish condition through the administration of
extracts of the pituitary body.
We must insist on the fact that the thyroid and the pituitary body are
antagonistic; the thyroid diminishes, the pituitary augments, blood-pressure.
The same antagonistic relations exist also between the thyroid and adrenals,
as already mentioned.
The adrenals play an important rôle also in the defense of the organism
against infections and intoxications, as we will point out in a separate
chapter. We will only recall here that already (1903) Sajous[79] has insisted
upon the important rôle of the adrenals in the production of fever.
The co-operation of the sexual glands in protecting the body from
infectious disease can be shown by the fact found by Professor Cornil,[80] of
Paris, that in infectious diseases, such, for instance, as typhoid fever, there
is frequently sudden menstruation, with abundant metrorrhagia, the autopsy
often showing hypertrophy of the corpus luteum.
Metschnikoff[81] and Matschinski found, after injections of the bacilli of
tetanus, or of diphtheria, the greatest number of them in the ovaries, or in

the testicles, of the animals. It is also of great interest that Lingard[82] found
that the subcutaneous injection of testicular extracts into cattle induces a
resistance to infection from bovine plague, against which other cattle can
also be rendered immune through the serum of the treated animals—which
seems very important to us. Brown-Sequard and d’Arsonval employed
testicular extracts with good result in tuberculosis, and Uspenski in cases of
Asiatic cholera.[83]
In the chapter on the treatment of old age by organic extracts, we submit
evidence showing that infectious diseases have been treated successfully by
several authors by these extracts. Many others have also shown that
spermin, prepared by Professor Poehl from the testicles of various animals,
has also a marked effect against different infectious diseases, sometimes
even in cases of desperate septicæmia. It has been shown by Professor
Loewy and Dr. Richter, that after giving spermin there is at first a great
diminution of the leucocytes in consequence of leucolysis, which is soon
followed by hyperleucocytosis, and at the same time there was considerable
increase of alkalinity in the blood.[84]
Loewy and Richter were able to cure animals by injecting spermin even
in cases of experimental pneumonia, where they had received three or four
times the fatal dose of pneumococci. These observers also tried spermin in
diphtheria, but here the results were less marked, although in some cases
where the exact fatal dose was given, a cure was effected. According to
Professor Poehl[85] the increase of alkalinity of the blood through spermin,
explains its action to increase immunity against infection. Sajous also urges
that immunity is closely related with alkalinity.
It is interesting to observe that spermin has also given good results in
intoxication through leucomaïnes, which play a great rôle in auto-
intoxications in the body. This applies to neurin and cholin, as noted by
Professor Prince Tarchanow, and Dr. Poehl.
We have already mentioned that the thyroid protects us against various
poisons, such as chloroform, and it is of interest to note that the testicles
may also have a similar action; for, as Tarchanow has shown in frogs, and
also dogs, after injection of spermin, these animals were better able to resist
chloroform narcosis, and could also withstand a greater dose of it.

Weljaminoff found the same also in man. Krüger found that this applied
also to ether narcosis.
The liver, as we shall show later in a separate chapter, also antagonizes
intoxication. Another organ in close relation to the ductless glands—
especially in infants—the thymus, must also be considered in the same way
as the spleen as taking an important part in our protection against infections.
As well known, the spleen is a foremost organ for the production of
protective substances, the frequent swelling of the spleen in infectious
diseases shows its co-operation in the defense of the body (see also Chapter
X). Respecting the thymus, it has been shown by Brieger, Kitasato, and
Wassermann, that cultures of cholera bacilli lose their toxic action in
extracts of the thymus.
There can be no doubt whatever, from the foregoing, that our immunity
against infections and intoxications depends on the intact condition of the
ductless glands, the great importance of which, as defensive organs, has
been demonstrated and explained by Professor Sajous in 1902.[86] As he
says: “The overactivity of the adrenal system is the inciting factor of
leucocytosis, and, therefore, of phagocytosis;” and later in the second
volume: “that the adrenal system, composed of the pituitary body, the
adrenals, and the thyroid apparatus, constitutes the immunizing mechanism
of the body.”
When the ductless glands are not in good working condition, there are
three principal things which can occasion infection or intoxication. These
are deficient nutrition, exposure to cold, and a depressed mental condition.
By these the resistance of the cells against the energy of the invading
microbes is lowered, and the greater the invasion the easier will be their
victory.
We will often refer to this in the chapters on personal hygiene, and
propose certain remedies for avoiding these predisposing sources of
infection and intoxication.

CHAPTER IV.

On the Agencies that Govern the Condition of the Nervous
System and Mentality.

By treating with thyroid extracts a child that has remained backward in
his mental development we can make a curious observation. The child who
had previously been a cretinous idiot will not only improve bodily but also
mentally, and he will be transformed into an intelligent being with normal
mental faculties. The logical deduction is that the thyroid must influence
powerfully the condition of our nervous system and mentality. Indeed, the
physiological activity of the nervous system and mentality depends entirely
on the co-operation of the ductless glands with internal secretion. In fact,
we do not think we are going too far in saying that the condition of the
nervous system and mentality is mainly governed by these glands. The truth
of this assertion is shown by the fact that any alteration of these glands,
especially the thyroid and sexual glands, and pituitary body, is always
followed by alterations of the nervous system. This is strikingly sustained
by the elaborate researches of Sajous who found that the reactions of fluids
circulating in all nervous elements corresponded with those of internal
secretions and particularly that of the adrenals.
Removal of the thyroid also produces far-reaching anatomical changes in
the central part of the nervous system which, as we have mentioned, has
been described by Albertoni, Tizzoni[87] Blum,[88] Walter Edmund,[89] and
others. These consisted of the destruction of nervous cells and nervous
processes, chromatolysis, and also the augmentation of the neuroglia, which
increases in the same way as the connective tissue in all other organs and
tissues.
These changes have been found by Whitwell[90] also in myxœdematous
persons. In accordance with these anatomo-pathological changes we must

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

We have also frequently seen a marked improvement in the mental
faculties of adults through thyroid treatment. Thus last winter, during a stay
in Nice, we were consulted by an American lady of 69 years who was
suffering from arteriosclerosis and dizziness. Through thyroid treatment the
intelligence of this lady improved so much that it became very noticeable to
her English trained nurse, who told us that whereas before she could do
anything with this mentally torpid woman without comment, now she first
demanded to know the reason for everything before she complied with the
dietary and hygienic measures the nurse wanted her to follow.
That the thyroid gland affects the intellect is also proved by the very
important fact that the serum of animals whose thyroid has been extirpated,
and which is thus antagonistic to the thyroid gland, is able to impair the
intellect. Dürig[92] noticed this after using large doses of such serum in a
woman with Graves’s disease, thereby causing an appearance of great
stupidity, loss of memory, and incapability of thinking, so that he had to
suspend the treatment. These symptoms continued for fourteen days after
the treatment had been discontinued.
Sleep is also one of the functions controlled by the thyroid, and as its
changes are able to promote senility, we believe it will be well to discuss
this more fully in a special chapter (XLIII).
We cannot recall any alteration of the thyroid gland that is not
accompanied by nervous symptoms. In Graves’s disease (exaggerated
activity of the thyroid) we observe a condition of great nervousness, so
much so that, according to some authorities, Graves’s disease may be
termed a neurasthenia with tachycardia. There are many women treated for
simple hysteria who are, in fact, suffering from a partial form of Graves’s
disease with its cardinal symptom: tachycardia. In cases of Graves’s disease
we often find conditions of exaltation, even manias, and very frequently, at
the very least, great irritability. On the other hand, in myxœdema there is,
usually, a condition of melancholia, and it is interesting in this connection,
that in a number of cases of melancholia we have found a swelling of the
thyroid with a cessation of the menstrual flow; such cases improved after
thyroid treatment, particularly when conjoined with treatment by ovarian
extracts. In the lunatic asylum of Pontiac, Michigan, some 100 cases of
swelling of the thyroid have been traced out of 600 insane inmates, as we

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

From the foregoing we shall understand why so many people, whether
male or female—possibly the latter in greater number—who live in total
sexual abstinence, present symptoms of neurasthenia or hysteria; for it has
been shown by Rigaud and also by Mingazzini, that animals, living in total
sexual abstinence, present alterations in the epithelia of the sexual glands
(see Chapter XLVII).
It would be simply hypocrisy and unworthy of a scientific work which
should always aspire to reveal the truth, were we to deny the fact that many
old bachelors and spinsters present a series of nervous symptoms, especially
dyspepsia and hyperchlorhydria and pains in the stomach, far more than
other persons, which we must explain by the action of impulses coming
from the sexual organs to the sympathetic and pneumogastric, the principal
nerves of the stomach and intestines, and thus producing a hyperæsthesia of
the nerves of the stomach. In such persons some kinds of food, well
digested by a normal stomach, will act as an injurious foreign body, and be
felt as such by the over-sensitive stomach nerves, and the gastric glands will
respond with a large flow of secretion and much acid upon agencies that
produce no such stimulation in a normal stomach.
That the sexual glands also influence the intellect is best proved by the
observation that in cases of testicular or ovarian insufficiency intelligence is
often diminished. Thus we were consulted by the parents of a young man of
eighteen years who was mentally backward; he could not remember
anything; his arms and legs were abnormally long, but his body short, thus
resembling a eunuch’s—and indeed I found his testicles were not yet
descended. His voice was that of a child, and he also exhibited the other
symptoms of testicular insufficiency described in the second chapter of this
book.
On the other hand we may see a precocious highly developed intellect in
children with a premature sexual development. We know of a boy of six
years who tried to have sexual intercourse with a little girl of the same age,
and who at the age of four and one-half years knew all the capitals of the
world by heart. Hence the education of precociously bright children should
be especially guarded, for they can become great men but also not rarely, if
neglected, great criminals.

As, however, in these days of scepticism we do not believe in anything
until demonstrated by experiments (often forgetting the fact that what does
for dogs or rabbits does not always do for man) which should only assist
our judgment, but not exclusively govern it, we shall have to prove the
correctness of our clinical observations on the influence of the sexual
glands—i.e., on the nervous system and mentality—by experiment, and we
believe we have sufficient facts at hand to do so.
About a hundred years ago it was shown by Gall—who was attacked by
several authors, among them Rieger, as innovations always are, but who
was also successfully defended by the celebrated German nerve specialist
and philosopher, Moebius[93]—that castrated animals or persons have an
alteration in the back part of the skull indicating an impoverishment of the
cerebellum. And, indeed, he produces his own evidence and that of several
other authorities, Darnecy, Rousseau, etc., which gives the history of
several autopsies on castrated persons, all of whom showed an atrophy of
this structure. In cases where only one of the testicles was destroyed, this
atrophy was always present in the hemisphere of the small brain on the
opposite side.
It has been found by numerous authorities that the skull and brain of
castrated animals and persons is smaller than the normal. Gall[94] noted this
fact, and after him Vimont,[95] from experiments on animals; and, according
to the latter observer castration of both sides produces a considerable
diminution of the cerebellum. Leuret and Hoffmann[96] found a diminution
of the head in horses, sheep, and pigs after such an operation, and that the
other parts of the skeleton are always altered is a fact recorded by a large
number of authorities as stated already.
As we have pointed out above, any alteration of the testicles or ovaries is
followed by nervous disturbances, and, consequently, the total removal of
these glands produces far more deleterious effects, and these will vary
according to whether such persons have been castrated at an early age or
later. In these latter cases nervous disorders will be more acutely felt, and as
the celebrated French authority, Dupuytren, states, melancholia is a
common phenomenon in castrated men. According to more recent
observations in cases of enlargement of the prostate that have been treated
by castration, the patients exhibit melancholia. We may here remark that the
testicles and the prostate are in close relation, the latter always becoming

atrophied after castration. There is experimental evidence to show that a too
large amount of testicular or ovarian secretion may produce toxic effects.
Thus, Loisel, by injecting testicular or ovarian extracts into animals, could
produce toxic symptoms in every instance. This may account for the fact
mentioned previously that persons living for a long time in complete sexual
abstinence, occasionally exhibit symptoms of disorder of the nervous
system.
The marvelous influence of the sexual glands on the mind and character
is at once apparent if we consider the aberration from the normal of the
castrated person. The authorities who have studied the eunuchs in Egypt
and the Skopze in Russia (a religious sect who adopt castration as a tenet),
found typical characteristics in these people that distinguished them from
the normal.
Thus, as a rule (and as stated by Moebius), the biography of remarkable
eunuchs of the old and middle ages shows that they are entirely deficient in
courage, which seems to be dependent entirely on the possession of
testicles, and the same fact may be noted also in the case of the lower
animals. Thus, an ox is a coward compared to a bull, and an ordinary
horseman prefers to ride a mare rather than a stallion. The best means of
taming certain animals is by depriving them of their testicles at an early
age. Intelligence also is much influenced, not only by the thyroid, as already
shown, but by the testicles. Thus persons of literary or other fame, such as
artists and the like, have become impaired in their capacity after castration:
Abelard, for example.
Moebius, in the history of the world, could find no castrates of great
intelligence. Knowledge gained by diligent labor is not referred to here. We
merely wish to express our conviction that great ideas, such as are found in
men of genius, are impossible in men devoid of their testicles; and it
appears out of the question to imagine such men as Napoleon, Goethe, or
others, as castrates. On the contrary, we are inclined to believe that such
great men had a private life that would have rendered them unfit for the
position of superintendent of an American Sunday School.
Courage is a specific feature that can only be found in a man who is still
in possession of healthy sexual glands; it is entirely wanting in eunuchs.
Cowardice, superstition, laziness, avarice, vanity, cruelty, and other bad

qualities are typical features in eunuchs. Our friend Sir Hugh Adcock,
formerly physician to the late Shah of Persia, told us that his own
experience with hundreds of eunuchs showed him that they all had these
bad qualities. Capacity for hard work, generosity, kind-heartedness, and
religion may be found in persons who are in the possession of healthy,
vigorous, sexual glands; but by exhaustion, after sexual excesses, a
condition may be created analogous to myxœdema after previous Graves’s
disease. This exhaustion of the sexual glands may create a condition in
which some of the features of the castrated may appear. This is noticeable in
the character of many of the dignitaries of oriental countries who possess
large harems, and also in occidental countries in many men who lead a life
of debauchery. The influence of the pituitary is shown by changes that
invariably occur in the nervous system and mind after any alteration in it.
Thus, in two millionaires suffering from acromegaly we have observed
great stinginess. We do not intimate that this is a characteristic of
millionaires, but these gentlemen were quite the reverse before becoming
afflicted with their disease. In one case of acromegaly, for the knowledge of
which we are indebted to Dr. Dercum of Philadelphia, there was a great
distrust of anything new, even the most useful of innovations. This caused
great discontent among the gentleman’s business partners, although he
himself showed this disposition only after the symptoms of his disease were
apparent. In acromegaly there exists a hyperactivity of the pituitary; Renon
was able to produce the disease by giving large doses of pituitary extracts,
and Hochenegg obtained good results in his treatment of it by extirpating
the pituitary body.
Extirpation of the adrenals is also followed by important alterations in the
nervous system, as was noted by Jersoni and others. Also, in Addison’s
disease, which is accompanied by a degeneration of these glands, we notice
a diminution of the intellect together with a general mental depression.
The influence of the ductless glands on character, and the change in the
same after alterations in those glands, may easily lead to crime, as the two
principal barriers against crime are will-power, by which we control our
passions; and sound judgment, by which we distinguish right from wrong. It
is evident that a cretinous or myxœdematous person will have no great will-
power, for this, as already shown, is dependent on the thyroid secretion; nor
do they possess intelligent sound judgment enough to realize what is right;

and, as the possible consequences of their defective action, castrated
persons, as above shown, are more attracted to crimes due to avarice or
cruelty. Those who are interested in this question may read our lecture
delivered before the Medical Jurisprudence Society in Philadelphia,[97] in
which we endeavored to prove in detail our assertions that the origin of
crime is due to nervous changes succeeding alterations of the ductless
glands. As persons of advanced age often have a complete atrophy of the
sexual glands, changes in their character may be explained on these
grounds.

CHAPTER V.

On the Influence of the Sexual Glands upon Vitality and Long
Life.

When we study the history of people who present a youthful appearance
late in life, and reach an extraordinary old age,—up to 120 or 140, or even
160,—we are surprised at the unmistakable evidence of a strong sexual
activity in most of them, which is only possible by being possessed of
healthy and active sexual glands; and thus it would appear that the
possession of such glands may impart a strong vitality and the best chances
for a long life. That such is the case we will endeavor to show by evidence
of an experimental nature, and also by facts gathered from observation of
the long lives of the patriarchs.
When the sexual glands of a person are extirpated, such castrated people,
be it man or woman, soon get old. This we can see in the case of eunuchs
who get wrinkled even in their youth, such also get fat, and present other
symptoms of premature old age; and the same is observable in women
whose ovaries have been removed.
Matthew Paris,[98] the historian, in his description of eunuchs and the
appearance of early old age, tells us that in 1253 Frederick II, Emperor of
Germany, married Isabella, sister of the King of England, and he presented
to his wife several Moorish slaves who were eunuchs, for servants, who
looked like old masks. Pelikan[99] also mentions that the whole community
of castrated Skopze in Russia, has a withered aspect; and in his book
Merschejewski relates that their skin is withered and wrinkled, and that they
look worn out, aged, and senile.
Besides provoking senility at an early period, castration or a degenerated
condition of the sexual glands, especially in women, is able to produce

alterations in organs, which are of great importance to the vitality of
individuals, and to a long life, such as the heart, stomach, intestines, and
liver. Experienced authorities have noted heart troubles in dysmenorrhœa
and amenorrhœa, and also neurosis of the heart with long, lasting alterations
of the female sexual glands. Professor Kisch[100] also noted tachycardia in
such conditions. Professor Landau[101] has very often observed a
degeneration of the heart after myoma of the uterus. Lehman and
Strassmann, in the Berlin Charité, have seen such a degenerated condition
of the heart in 44 per cent. of patients with myomas of the uterus.
It has been shown by experiments that there is a close relation between
the condition of the ovaries and the heart. Professor Hegar[102] has
demonstrated that castration, or simple tugging of the ovaries, is able to
produce a diminution of the heart beats, or even a stoppage of the heart.
Lucas Championnière has also noted the same after a tearing of the ovaries,
and Mariagalli and Negri have also noted tachycardia after laparotomy.
Very important also are the relations between the ovaries and the
digestive organs. Kretschy observed, in a case of fistula in the stomach, that
alterations of the female sexual organs regularly produced also alterations
of the digestive functions; for instance, during menstruation there is always
an increased flow of hydrochloric acid. The same has been found by
Fleischer, who noted during this period a sluggishness in digestion, which
improved after menstruation.
Tanecki found dyspeptic troubles in cases of retroflexion of the uterus,
and Eisenheart has observed the disappearance of acute gastric troubles
after a cure of retroflexion.
P. Muller also declares that there are intimate relations between the
sexual glands and the digestive organs. He also observed dyspeptic troubles
during menstruation; and Professor Leyden has noted neuralgia and
hyperæsthesia of the stomach in young girls after menstrual troubles.
Habitual chronic constipation, which is so frequent after a degenerated
condition of the sexual glands, points to the existence of close relations
between these organs and the intestines.
Based upon clinical observations, we have advanced the theory that
alterations of the ovaries are able to produce alterations also of the liver,

and the circulation of the bile, with formation of gall-stones. Castration also
produces alterations of the thyroid: first, its hyperactivity with increase of
colloid substance, and, afterward, its degeneration.
Castrated animals or persons seem to offer less resistance to infection,
which may be on account of the connection, as shown by the experiments
of Metschnikoff[103] and others, that the testicles are altered in infections,
which has been shown to be equally the case with the ovaries (Professor
Cornil). The sexual glands, as the ductless glands in general, have the duty
also of protecting the body against the various kinds of intoxication and
infections, as already emphasized.
From the foregoing there can be no doubt that degenerated conditions of
the sexual glands, by producing alterations in important organs, diminish
vitality and the chances of an advanced old age.
This seems also to apply to males, for there is no evidence showing that
any eunuch has reached a very advanced age, whereas there is plenty of
evidence of persons with strong sexual glands having lived far beyond 100
years. The vitality of persons if totally castrated is, as a rule, diminished.
Again if we study the history of persons who attained the maximum span
of life, we find many evidences of the existence of strong sexual impulses.
Thomas Parr, who lived to nearly 153, has been accused of having
committed a sexual offense in his 102d year, for which he was found guilty
and punished. Reaching even a greater age, his sexual appetite does not
seem to have diminished, for he married, eighteen years after, a widow, who
said she could discover nothing that would betray his great age.
Drakenberg, a Dane, who is buried in the cathedral in Aarhus, Denmark,
lived 146 years, and reached this advanced age although he was more often
drunk than sober. When he was 111 he married a woman of 60, and after
she died he fell in love in his 130th year with a young peasant girl; but this
blooming flower of the Jutland peninsula, famous for its fresh and healthy
girls, refused her ancient wooer, who, nothing daunted, tried his luck with
several other young maidens but with no better success; therefore he had
perforce to remain a widower, and he lived an additional sixteen years.
Possibly if he had addressed widows or elderly spinsters, he might have
succeeded; but it is very instructive that this ancient Methuselah insisted on
marrying a young girl, which certainly speaks in favor of strong sexual

feelings in so old a man, and, indeed, we may say it is an object lesson to us
to observe that these ancients were always anxious to marry again so soon
as they became widowers. That it was more than a mere formality, or bond
of platonic affection, was attested to by Thomas Parr’s wife when he was in
his 130th year.
If many children be considered a sign of sexual activity and capacity,
these very old men distinguished themselves in this respect, as most of them
had numerous progeny. Several had a score of children after they were 80.
Peter Albrecht, who lived to be 123, married in his 85th year, and had 7
children. Another patriarch, Gurgen Douglas, born in Marstrand, near
Gothenburg, in Sweden, who reached to 120 years and 7 months, married in
his 85th year and had 8 children, one of which was born when he was in his
103rd year. This child was an idiot, but as it is very interesting to note,
otherwise physically well developed.
An Italian, Baron Baravicino de Capellis, died in 1770 at Meran, a
climatic resort in the Tyrol (Austria), in his 107th year. He had 4 wives, the
first of whom he married when he was 14, and the last when he was 84. He
had 7 children, and it is an interesting fact that his wife was pregnant when
he died.
As an English paper has reported, in 1796 there was a shoemaker, R.
Glan, living near Philadelphia, Pa., who died at 114, and never missed a
Sunday service. At his decease his third wife was but 30, and his virile
powers were normal.
We need not be too skeptical as to the legitimacy of the children of
fathers of such advanced age for reasons we will mention later. Examples of
fathers at ages above 60 or 70 are not so exceedingly rare. A very good
example of this is that of a crowned head of one of the European countries,
married morganatically, who, in his 72nd year, was presented by his wife
with a child, and nobody who is acquainted with the powerful constitution
of this monarch and his predilection for the fair sex will doubt his happiness
as a father. He is noted for his marvelous intellect, which, again, is so
frequently met with in persons with very active sexual glands.
Several of these ancient patriarchs, at the autopsy, presented a
wonderfully good state of preservation of the various organs. Thomas Parr
died in his 153d year, and his autopsy was made by one of the greatest

physicians in the history of medicine—the celebrated Harvey, the
discoverer of the circulation of the blood. Harvey found every organ in this
wonderful old man in perfect condition. His death was attributed by Harvey
to over-eating, as Parr had always lived a very frugal life. The King of
England invited this astonishing personage to London in his 152d year, as
he wanted to know this most interesting of his subjects; but the rich food he
received in the royal household did not prove beneficial to him, and though
his 152 years of frugal life were unable to kill him, nine months of an
opposite style of living succeeded in so doing.
We should not wish to omit mentioning again the important fact that,
with few exceptions, the persons who lived to such an extraordinary age
were married, and some of them three or four times, which again serves to
show us the great importance of marriage as a means to reach a good, old
age.
We have quoted these instances of longevity from Hufeland,[104] one of
the greatest German physicians of the eighteenth century, of whose
truthfulness there can be no doubt. The great German physiologist, Pflüger,
also quoted some of the above examples of great age in his address in
celebration of the birthday of Emperor William II, at the University of
Bonn. When Parr had been found guilty of a misdemeanor in his 102d year
facts were adduced in the courts which showed that, as Pflüger says, this
“100 jährige durchaus die Eigenschaften eines Kräftegen jugendlichen
mannes besass” (the man of 100 years really had the qualities of a powerful
young man). Pflüger quotes this from Flourens, and we were pleased to find
an account of the autopsy of the celebrated patriarch in a letter from Harvey,
himself, to his nephew, published by the Sydenham Society[105]: “The body
was in such a good condition in a man of 153 that the cartilages of the chest
bones were not yet ossified.” Harvey put it: “The cartilages were soft and
flexible,” black hair on the forearms, and the organs apparently healthy.
Probably the fact that the testes, as Harvey says, “were sound and large,”
had something to do with it. He was also an affectionate husband, and to
quote Harvey again, “His wife told me that until twelve years ago he never
ceased to embrace her frequently”; that is, when he was 140 years old! At
the autopsy of John Bayley, of Northampton, who died 130 years old, Dr.
James Keill[106] found his testes of large size.

We have also knowledge of a very interesting case, that of an Irishman,
an ex-navy man, who, according to the admiralty official statistics, was 113
years old, and whose body was dissected by Professor Cunningham,
Professor of Anatomy of Edinburgh University. As Dr. Cunningham,
himself, told us, the testes were sound and healthy looking, and the
cartilages of the chest bone not yet ossified. Death was not due to old age,
but to a prostate abscess, except for which the body was in good condition.
Metschnikoff also mentions in his “Etudes sur la Nature Humaine”
examples of old men between 94 and 104 years, who suffered from copious
spermatorrhœa, and in whose semen he has found a great quantity of
spermatozoa. He and Dr. Weinberg observed similar conditions in old dogs
of 18 to 22 years of age, one of whom, just before his death, had shown
marked sexual tendencies.[107] Saverio Spangaro,[108] examining the testicles
of a number of old men, found many of them atrophied, but others showed
microscopically no difference to the testicles of younger individuals; there
were only slight microscopical changes. This again proves our theory, that
old age is not due to the degeneration of one, but of several glands with
internal secretion, similarly to other diseases of these glands, like diabetes,
acromegaly, etc.
The above facts of the preservation of the sexual glands in advanced old
age, proves also the important fact that though the actual age be there, the
symptoms of it may not be very pronounced if but the sexual glands are in
good order. Of course the condition of the other ductless glands is of
importance, for old age must be regarded as the consequence of the
degeneration of the different ductless glands, and not of one gland alone.
When we consider the splendid health enjoyed by most of these
patriarchs and the good condition of their organs, why should we deny the
possibility that they were disposing of at least one lively spermatozoön, and
thus we shall have no reason to doubt their happiness as fathers.
We must also add that the truth of the extraordinary age of these persons
has been proved, in most cases, by documents, sometimes even in courts of
law; also by the recollections of very old people who, in their own early
childhood, personally knew them.
That people with strong sexual impulses very often reach a very
advanced old age, we can often observe. There are plenty of examples in

the history of the world. Thus, the greatest debauchery did not prevent
Louis XV becoming very old, and the Emperor Tiberius lived to be 78 after
his notorious life. However, in the same way as with alcohol and tobacco,
we would here repeat “Quod licet Jovi, non licet bovi” (or, “what suits Peter
may not suit Paul”).
We may also refer to a few instances coming under our own observation.
A few years ago one of our confrères at Carlsbad died, 96 years of age. His
intellect was perfect, and a few months before his death we had a
consultation together about a patient who was 83, at which he gave
evidence of a wonderfully clear intelligence. In his behavior toward the fair
sex (whom he much admired) he showed a chivalry and gallantry outvying
men of half his age. Up to the last he never failed to attend a theatrical
performance when there was an operetta or a ballet. There was nothing to
prevent his attaining a greater age, but, falling in his room, he contracted a
fracture of the femur, followed by pneumonia, which put an end to his
medical practice, for this wonderful old man in his advanced years paid his
daily visits, which he only intended to cease, as he said, when he reached
100.
A prominent member of the aristocracy of one of the northern countries
of Europe, who is at present 90 years old, having been reproached several
years ago by his relatives for his amorous advances to the fair sex, gave the
answer, “You do not know what it means to be an old man with the body of
a young man.” This old man still rides on horseback and still goes shooting.
The fact that he looks a handsome man of 60 may be explained on the basis
of our above observation.
In advanced old age the preservation of the sentiments toward the
opposite sex, which allows us to presume the presence, and not yet
extinction, of an internal secretion of the sexual glands, is often found in
combination with a high intellect. This is also proved by the example of
Goethe in his 83d year, for in his old age his intellect would have been
creditable to a man of 30. When he was over 81 he astonished his audience
by the uninterrupted current of his ideas, also the extraordinary richness of
his inventions.[109] Commenting on the above, Moebius, in an interesting
biography on Goethe, says: “From the physiological standpoint the
astonishment evoked by the works of this old man is almost greater than
that about his juvenile activity.” He finished the second part of “Faust”

when he was over 82. As Metschnikoff says: “It is love that was the greatest
stimulant of the genius of Goethe,” for it is well known that Goethe was an
ardent admirer of the fair sex. When he was 74 he was passionately in love
with Ulricke Lewetzow, who was still in her teens. He danced like a youth
when in her company, and it was at this time that he wrote to his son that he
had never, up to this, felt so well in mind and body. He wanted to marry the
young girl, and the Grand Duke of Saxe-Weimar asked in Goethe’s name
for her hand; but the mother was not willing to allow a marriage between
persons of such divergence in age. So much was Goethe in love with the
young girl that his disappointment contributed to develop a serious illness
(Eckermann). Even when he was much older he again renewed his relations
with Miss Marianne Young, and was then, to a certain extent, consoled for
his disappointment over Miss Lewetzow. He preserved his admiration for
the fair sex until his death, and even in the closing day of his life in his
delirium he called out, “Look at that beautiful woman’s head with dark
curls on a black background!”[110]
A similar retention of the sexual sense we see in the advanced years of
Victor Hugo, whose admiration of the opposite sex continued till his death.
Ibsen, the celebrated Norwegian dramatist, kept up a well-known
correspondence with a young lady whom he met at Marienbad a short time
before he died in advanced old age.
Sometimes in women of extreme age instances are quoted that would
seem to indicate that in them also the activity of the sexual glands may not
have been extinct. It is stated that Ninon de l’Enclos[111] was in her 90th year
still so beautiful that a young abbé fell desperately in love with her. We
know an Italian lady of 69 who is still good-looking, presenting the
appearance of 45, and she still menstruates. That she was sexually active is
shown by the fact that she has 12 children. There is more fire in the eyes of
this Italian matron than in many women of half her age. That the possession
of active sexual glands influences the looks very much can also be proved
by the pale, yellow-gray and aged looks of even young women suffering
from serious chronic diseases of the sexual glands, and also of women who
have caused these organs to degenerate owing to sexual excesses.
The fact that persons who have attained advanced old age in robust
health and perfect intellect often show signs of preservation of the sexual
glands, permits the inference, especially considering the foregoing

examples, that a perfect condition of these glands is an important factor
toward vitality and long life, for which reason we devote a long chapter to
the best hygiene of the sexual glands (see Chapter XLIX).

CHAPTER VI.

On Heredity and Longevity.

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

Even character and appearance may be inherited by offspring. The height
of parents is, as a rule, though not in every case, inherited by their children,
as also are many features of their external appearance. As we have seen in
the previous chapter, the size of an individual and his outward appearance
are dependent on the internal secretions of the ductless glands; and as these
qualities are inherited, so we may presume that the properties of the
ductless glands, which produce these effects, may also be inherited; and that
this is not a vague supposition is demonstrated, we think, in a paper we read
on the subject of heredity at the German Congress of Internal Medicine at
Leipzig, in 1907, in which we showed that the alterations of the ductless
glands are inherited with remarkable frequency. Thus Graves’s disease can
frequently be inherited, and the children descended from such parents,
especially after puberty, often have a small goiter. In such cases a slight
protuberance of the eyes can also be noticed; they are frequently very
nervous, and any sudden shock will be sufficient to induce a typical case of
Graves’s disease. Oesterreicher[112] found 9 cases of exophthalmic goiter in
one family. The frequent instances of heredity in Graves’s disease are
insisted upon by Brouwer[113] and other authors.
Degenerative changes of the pituitary body may also be inherited. Thus
Bonardi and Schwoner and others also showed cases of acromegaly of
hereditary origin.
Diabetes is, as we have said, a disease of the ductless glands, and we
have especially emphasized, on previous occasions, how frequently, if not
invariably, diabetes originates through heredity. We have also shown in a
communication published in the Practitioner, of London, in October, 1903,
that the children of diabetic persons have an inherited tendency to
alimentary glycosuria, which occurs very frequently among them.
Myxœdematous persons, as a rule, have children displaying symptoms of
congenital myxœdema, and cretins have cretinous children. The very
interesting case has been published of a woman who, until the age of 40,
had two normal children. She then acquired a goiter, and the child that was
born later was a cretin with a goiter (Lanz).
Parents suffering from diseases in which the thyroid has degenerated,
such as chronic tuberculosis, malaria, syphilis, and other cachectic diseases,
have children whose growth is slow, and who remain backward physically

and mentally. Such children easily acquire any infectious disease.
Tuberculosis, as we have shown at the International Congress on
Tuberculosis in Paris, in 1905, is remarkably frequent among them. We can
easily appreciate the fact, if we realize that the children of such parents in
whom the thyroid has degenerated through disease are born usually with a
congenital atrophy of the thyroid gland, which has been proved by Gamier
and Perrando. These children have inherited from their forefathers the bad
qualities of their thyroid, and this will also explain why such children, when
fully grown up, will not remain, as a rule, for so long a time as youthful
looking as other persons who have inherited healthy thyroids; they early
become aged-looking and, also, as a rule, their lives are shortened owing to
their tendency to contract easily all kinds of infections.
Evidence founded on experiments is at our disposal to prove our
assertion that irregularities of the thyroid are inherited by offspring.
Professor Lanz,[114] of Amsterdam, formerly an assistant of Professor
Kocher in Bern, has extirpated the thyroid gland of goats, and he found that
in each case the young of such animals, as compared with normal kids of
the same age, remained backward in growth. There can thus be no doubt
that the qualities of the ductless glands of the parents are inherited by their
descendants.
We often find diseases of the various ductless glands present among
members of the same families. We can trace, not infrequently, diabetes,
Graves’s disease, etc., and acromegaly, occurring in different members of
the same family, and this will be observed most often in the case of diabetes
and Graves’s disease. Thus I have observed in the case of two fathers
(coming from the same city in Hungary, but belonging to different
nationalities) diabetes, and their daughters had protuberant eyes; they had a
small goiter, and the typical fingers characteristic of Graves’s disease,
emaciated and pointed like those of the Madonna of Perugino, which have
been mentioned already by other authors as symptoms of Graves’s disease.
There was no tachycardia as yet in either of these two cases which had
Graves’s disease. Very probably any mental shock, as in so many other
cases, would here have caused sudden development into Graves’s disease.
We have already noted that in syphilis and other cachectic diseases such
as alcoholism, malaria, tuberculosis, etc., the thyroid gland becomes
degenerated (Garnier, Hertoghe, etc.), and that the fœtuses of such parents

demonstrate congenital atrophy of the thyroid (Garnier[115] and
Perrando[116]). We can thus understand the observations of Hertoghe, who
found that nearly all cases of infantile or congenital myxœdema were born
of parents suffering from the above-named diseases. Of very great value,
also, is the observation of Professor Pel.[117] He diagnosed a case of syphilis
in the father, myxœdema in the daughter and acromegaly in the son.
As shown by many observers, including ourself, the ductless glands stand
together in a very close relationship, and thus we may find that when one
member of a family shows an alteration of the ductless glands, we may
discover in the same family other members affected by alterations of the
same or other ductless glands. The case of Pel is a fine illustration of this
point; the syphilis of the father with its morbid influence on his thyroid
resulting in the hereditary transmission of a degenerated thyroid to the
daughter, and the consequent supervention of myxœdema. The son had an
altered condition of the pituitary body, and thus developed acromegaly. The
altered condition of the pituitary body may have been secondary to the
previous alteration of the thyroid inherited congenitally, if we take into
consideration the fact that, as I showed in a communication to the
International Congress of Medicine in Madrid, in 1903, acromegaly is due
to primary alterations in the thyroid which, in the same way as is
demonstrated by experiments on animals, may lead secondarily to
alterations of the pituitary closely connected with the former gland. The
qualities of the sexual glands can also be inherited. Thus, there are cases of
mothers whose menstruation began very early, i.e., at the age of 9 or 10, and
lasted until the age of 56 to 60, and who had many children, among whom
were daughters showing similar conditions. On the other hand, we may see
difficulties of menstruation in the mother also inherited by the daughter.
If the bad qualities of the ductless glands are inherited, it is only logical
to expect the same for the good qualities also. It stands on this basis that we
may frequently find longevity in the same family. Longevity, as illustrated
by the many facts adduced in this book from the field of clinical and
experimental observations, is closely allied with a thorough performance of
the functions of the ductless glands, especially of the thyroid gland; if these
are in good condition, and especially if proper hygiene is also observed at
the same time, longevity will follow. The good condition of the ductless
glands is largely dependent upon a life based on hygienic principles,

although when these glands are of the best quality they may stand a good
deal and not degenerate so soon, even after excessive activity following
injudicious or fast living.
But if a long life be dependent on a good state of the ductless glands and
if the qualities of these are inherited—which cannot be doubted after the
foregoing observations on heredity,—it must necessarily follow that
longevity is inherited too, and this is a fact which can be proved by a large
number of observations.
If we study the history of persons who have lived over 100 years, we
shall find in nearly every case that their forefathers, or their descendants, or
other relatives of the same blood have, as a rule, also lived to a great age.
This will be illustrated by a few examples which we will now give.
In the year 1724 there died in Hungary in a village called Köprös, about
ten miles from Temesvar, a man, Petraz Czarten, who was 185 years of age.
When he died, his son was 95.
We have already referred to the case of a man named Thomas Parr in our
chapter on the influence of the sexual glands upon vitality and long life.
This man died in 1635 in his 153d year, and after death his body was
dissected by the great physician Harvey. That longevity had existed in his
family was shown by the fact that one of his female descendents died in
Cork, in Ireland, at the age of 103.
In the year 1797, in a village near Bergen, there died a man, Joseph
Surrington, in his 160th year. That he left a young widow, after having been
married several times, is not so extraordinary if we consider the facts in the
chapter in this book on the influence of the sexual glands upon vitality and
long life. When this man died his eldest son was 103 and his youngest only
9!
In a Finnish village near St. Petersburg there lived an old peasant woman,
Maria Willamow. She was born in 1692, and died on September 10, 1807,
after having lived 115 years, 9 months, and 4 days; her brother had already
died in 1768 at the age of 108. All her relatives and descendants were
remarkable for their longevity.
Jean Thuret was a soldier, and in spite of having been wounded in several
battles, he lived beyond the age of 104. His mother died when 118 and his

uncle at 130. The high old age of many of these patriarchs is proved by
legal evidence. Thus, H. Jenkins, from Yorkshire, has appeared before a
court of justice as witness in a matter that happened 140 years ago. He was
accompanied by two sons, of whom one had reached 100 and the other 102
years. Again, conclusive proof of the inheritance of long life.[118]
To the history of these patriarchs I can add a few personal observations.
My mother’s father lived to the age of 104. He never smoked and could
read without spectacles all his life. He had eleven children, of whom one
(an aunt of mine) is 95, and I have every reason for believing that she will
continue to live yet many years in her present condition. Another daughter
is at present 85; a son is 83, and another 78.
We are acquainted with the history of the family of a physician in
Amsterdam, in which the great grandfather was 96. He had six sons who,
between them, totaled 600 years, one of them living to the age of 102, some
of the others to 80 and 90; and there is a daughter 79 years of age.
From the foregoing it seems that persons descended from long-lived
families have themselves a good chance of living to a great age; but to do
this it is essential that they should observe the rules of hygiene to prevent
the deterioration of their ductless glands.
That the observance of good hygiene is of the greatest importance to
attain longevity can be best adduced by the fact that persons descended
from short-lived parents may also attain a green old age in robust health, as
I will show by a few examples which have come under my personal
observation.
Sir Herman Weber, the author of a valuable work on the prolongation of
life, is descended from parents who both died at an early age. This savant
has himself followed the excellent advice he gives in his books on long life,
with what result can be best judged by his healthy and vigorous looks. His
appearance is that of a man many years his junior, yet Sir Herman was 82 a
few years ago when we were together climbing a very steep and high hill in
Carlsbad. When we arrived at the summit nothing could restrain Sir
Herman, but he insisted on also mounting a lofty tower to see the
surrounding mountains, without taking any rest between his exertions, and
this in spite of the warmth of the weather.

On the day that we began to pen these lines we were congratulating one
of the multifarious professors of the medical faculty of Berlin on his 73d
birthday. He is in perfect and robust health, and is at present engaged on the
third edition of his work, which is well known in medical circles all over
the world. He told us his father was 33 and his mother 48 when they died,
and several of his brothers died before reaching old age. However, his
grandfather lived to be 90. This savant has always led a sober and regular
life.
Sometimes chronic diseases, like syphilis, etc., do not prevent people
who come from a long-lived family from attaining to a very old age. Thus a
patient of mine, a French gentleman of 72 years, who still shows symptoms
of the tertiary form of syphilis acquired fifty-two years ago, is still looking
in splendid health, like a man of 60, and was complaining to me about his
too strong sexual feelings. Likewise, the father of a patient of mine has
reached his 96th year in spite of his syphilis, which he acquired an age ago.
If we now consider the environments where the longest-lived persons are
found, we shall find that those who always live in the open air, and also
moderately, rising early in the morning and leading day by day the same
regular life, have attained the longest lives. A great number of long-lived
patriarchs can be found among the peasants, or at least among persons
living in the country and out in the fresh air all day. Undoubtedly the
greatest number of long-lived people are to be found in the British Islands,
especially in Scotland. The inhabitants of Great Britain are well known to
appreciate fresh air, and on the Continent we often see them, especially
Scotchmen, going about without any overcoat even on a cold winter’s day.
We shall see in various chapters of this book how essentially important is
a sound hygiene to ensure long life, and we shall demonstrate in separate
chapters the great importance of fresh air and of exercise in the open air.
If we would inquire where are to be found the greatest number of persons
over 100 years of age, the palm must be given to Bulgaria, if what is
claimed be true, viz., that there are 3800 persons over that age, and all these
folk partake daily of “jogurth,” a sour milk containing three different
microbes, the most efficacious among them being the maeja bacillus. In
Germany, with its 61,000,000 of inhabitants, there are but 71 persons over
100 years old, while Bulgaria, with only 7,000,000, claims to have 3800,

and that it is due to the jogurth eaten every day. We will deal more fully
with jogurth in the chapter on the elimination of toxic products from the
intestines.

CHAPTER VII.

On Means which can Help us to Determine the Probable
Duration of Life.

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

shown by Prof. Sajous (1903-1907), beyond a doubt products of ductless
glands—and the better the condition of the glands, the more protective
substances will be produced in order to fight down the murderous microbes,
or organic poisons, which continually threaten us with destruction. In this
fight, a person with healthy ductless glands will always attain a longer life
than one with ductless glands of inferior quality. The better the condition of
the thyroid the greater will be the activity of those organs that are under its
direct command (e.g., the kidneys, liver, skin, and intestines), and by the
increased activity of the main emunctories of the body poisonous products
will be eliminated by means of a greater flow of urine, an abundant
perspiration, and thorough purging. Also the myriads of toxic products that
are brought from the intestine to the liver will be promptly destroyed, or
transformed into less dangerous combinations.
Thus there can be no doubt that a person with healthy ductless glands,
especially the thyroid and testicles or ovaries, will live long provided, of
course, no other vital organ be irreparably diseased.
The question now arises, by what means can we ascertain whether the
ductless glands are in good condition or not? We will now try to answer this
important question.
We can diagnose a healthy condition of the ductless glands either
directly, by the examination of those glands which are available for a digital
examination, as the thyroid, sexual glands or liver, or indirectly, by the
examination of the state of those functions which are governed by these
glands; e.g., the heart’s action, the pulse, regulation of temperature,
defæcation, diuresis, digestion, activity of the skin and its glands, condition
of the nervous system, etc.
Before entering upon the examination of these glands we must first
ascertain whether our patient comes of a long-lived stock, or, if not, whether
diseases that are particularly harmful to the ductless gland, and are
commonly hereditary, like tuberculosis and syphilis, have occurred in the
family. According to our observation boys more frequently look like their
mothers, and girls like their fathers, and also inherit their qualities. After
having ascertained the family history, we must inquire whether the patient
has had any diseases that are specially harmful to the ductless glands: e.g.,
infectious diseases—scarlet fever, diphtheria, typhoid, etc.—and also

ascertain his usual diet and habits, keeping in mind the bad effects of
abundant meat food upon the thyroid, as well as of certain stimulants like
alcohol and tobacco. As these, if of bad quality and taken in quantity for a
long time, have the most damaging influence on the ductless glands, our
prognosis of a long life will be duly influenced, and in particular
unfavorably for those who come of a short-lived stock, or who have been
weakened by previous infectious diseases. If some persons, otherwise
healthy and of good family history, can with impunity indulge till old age in
wine and tobacco, yet this is not a general rule. Individuals are known who
drank and smoked till over one hundred years of age, but such cases are
rare, and we may quote the Latin proverb: “Quod licet Jovi, non licet bovi.”
Everybody will admit that the expectation of life in those who are moderate
in the use of wine and tobacco and also, let us insist, of tea and coffee, is
much greater than in the immoderate. We will further deal with this
question in our chapters on alcohol and tobacco.
After having given an exhaustive history of the persons whose probable
lifetime we are trying to determine, we next proceed to the examination of
those ductless glands which are available for direct examination, and first of
all, the thyroid.
The examination of the thyroid gland by palpation is a very difficult
undertaking and necessitates a thorough knowledge of the anatomy and
physiology of the gland. We must bear in mind the fact that, in men, we
generally find only two lobes, the lateral ones, which lie on either side of
the trachea, as the median lobe is generally undeveloped in the male. The
right lobe is usually larger than the left. In women the median lobe is often
well developed and can be distinctly seen in enlargement of the gland, for
instance, during puberty, menstruation, pregnancy, etc., and especially when
a goiter exists which, for reasons we have mentioned previously, is more
common in the female.
When the thyroid shows a considerable swelling, as in goiter, it can be
seen and felt easily, but not always, for cases certainly exist where in life no
thyroid could be felt, and yet at the autopsy a large goiter has been found.
Thus, in a case of acromegaly a thyroid of about 130 grammes was found
by Holsti,[119] though during life nothing could be discovered by palpation.
When a large thyroid can be seen and felt, we are justified in diagnosing a

swelling of the gland; but in cases where we neither see nor feel it, we are
not always justified in stating that it is not enlarged.
When palpating the thyroid we must note whether it is soft or hard. If
soft, the tissue present is probably parenchymatous in nature and so,
probably, entirely secreting tissue, while a goiter that feels hard may denote
excess of connective tissue, and thus, apparently, an inactive gland. The
presence of cystic formations raises the possibility of a large quantity of
colloid substance, either healthy or degenerate.
Thus, inspection and palpation of the thyroid can give us, to a certain
extent, valuable information; we must, however, not rely entirely upon the
results of this external examination but, especially in cases where no
thyroid can be felt, we must add to the external examination an inquiry into
the condition of those functions which are governed by the thyroid—we
must, in fact, examine the condition of those organs whose function is
dependent upon the internal secretion of the thyroid.
Thus, we must examine the skin and note whether it is dry or moist, and
whether the sweat glands are acting normally. A dry skin, with diminished
perspiration, denotes an inactive thyroid, especially when excess of
subcutaneous fat is present. Excess of fat, of the consistence of bacon, is
characteristic of a greater degeneration of the thyroid—i.e., myxœdema,—
and indicates a great loss of function of the thyroid gland. Pallor of the face,
with round red patches on the cheeks, and dilated capillaries, are also
characteristic signs of such a condition in its early stages, and so are a
wrinkled forehead, especially with two perpendicular folds, and puffy
eyelids. Wrinkling of the skin of the hands, taken in conjunction with other
signs, is also a point of diagnostic value.
The condition of the musculature can also give us some valuable
information. The thyroid and other ductless glands, as the sexual glands,
govern the tonicity of all the muscles. In children, especially about the age
of puberty, the muscles are firm and elastic, but in later years, or even in
young women, consequent upon various conditions which are harmful to
the ductless glands, such as sexual excesses or numerous pregnancies, the
muscles lose their tonicity and become lax and flabby. This also occurs in
myxœdema arising from other causes. The viscera, deprived of their

muscular support, become displaced, and in this way arise the various forms
of visceroptosis.
Premature grayness is an indication of probable changes in the thyroid.
This is confirmed by the fact that, as a rule, such persons are also very
nervous. Premature grayness constitutes a typical symptom of myxœdema
and hypothyroidia, and as such has been described already by Hertoghe.[120]
Falling out of the hair is also a symptom of importance, if it appears in early
years, especially if it is accompanied by falling out of the eye-brows and the
hair on the back of the head. On the other hand, Sajous found that in
appropriate cases, thyroid extract promotes the growth of hair, while
adrenal extract encourages, besides, the growth of the eye-brows.
In examining the circulatory system we must bear in mind the powerful
influence of the ductless glands upon the circulation, especially that of the
adrenals, thyroid, and pituitary body. As shown by Oliver and Schäfer, the
thyroid secretion diminishes blood-pressure, whereas the adrenal secretion
increases it. Thus, these two glands are antagonistic and it can easily be
understood that if there is not sufficient thyroid secretion to counterbalance
that of the adrenals, the blood-pressure will increase. If this lasts for some
length of time, very serious effects will follow. Atheroma and
arteriosclerosis may ensue, both of which conditions tend to shorten life.
The adrenals can be stimulated to such over-secretion by mental emotions,
which act upon the sympathetic (splanchnic) nerves. Besides mental
emotion they can also be stimulated by various poisons, such as alcohol,
tobacco, or infectious diseases (see Chapter III). We must keep these facts
in mind when we examine the circulatory system, and we must ascertain the
condition of the arteries, whether soft or hard, and of the blood-pressure.
Tortuosity of the temporal artery in young persons is also a sign of some
value. The condition of the coronary arteries is of the utmost importance.
We must also not forget the fact, that even in severe cases of arteriosclerosis
the pulse may be found soft. Everything will depend upon the examination
of the heart, and special attention must be paid to the second sound at the
aortic orifice, and to any accentuation of that sound.
In the examination of the digestive organs we must pay special attention
to the state of the appetite. Very often with a degenerated thyroid this may
be wanting. The appetite, as shown by Pawlow, is under the influence of the
mind as we will see. With a sad melancholic disposition, as is often found

in persons with a degenerated thyroid, there is insufficient or no secretion of
gastric juice. Besides, in myxœdematous conditions all glandular secretions
are more or less checked. Thus food passes into a stomach with insufficient
gastric juice, remains there in stagnation and causes fermentation. The
stomach makes vain efforts to drive the food into the intestine. Slowly an
atonic condition of the gastric walls arises, and later dilatation of this organ.
The fermenting foodstuffs in the stomach set up a chronic intoxication of
the organism.
Concerning the condition of the intestines we should consider the
chances of long life greater in those persons whose bowels act regularly and
who are never constipated. Such persons are able to eliminate toxic
products much better than those who are suffering from chronic
constipation. The function of the intestines is powerfully influenced by the
thyroid gland, chronic constipation being a typical symptom of all
conditions in which this gland is degenerated, whereas in the opposite
conditions, such as Graves’s disease (exophthalmic goiter), diarrhœa is
common. By giving thyroid gland we can treat successfully those obstinate
cases of constipation, which are based etiologically on such grounds.
Besides the thyroid gland, the ovaries also influence, to a large extent, the
intestines, constipation occurring, as a rule, in diseased conditions of the
female sexual organs.
Flatulency and distention of the bowels are very frequently met with in
women with diseased thyroids or ovaries, and are due to an irritated
condition of the nerves of the intestines.
When examining the nervous system we must inquire for headaches,
especially in the occipital region, migraines, and the previous occurrence of
neuralgia, these being very frequent symptoms in persons with athyroidia or
hypothyroidia. Most characteristic are alterations in the mental condition.
Thus, memory for recent events may be gone. There may be apathy, with
hesitation before every movement, such persons disliking to move about.
They may sit indefinitely in the same position. As already mentioned in the
chapter on the influences of the ductless glands upon the nervous system
such people are frequently somnolent. Therefore we must inquire about the
hours of sleep. Besides sleeping long, such persons are apt to awake in the
night after dreams of a terrifying nature. Our diagnosis of a condition of
athyroidia or hypothyroidia has often been helped, by inquiring whether

such persons have seen little animals (rats or mice) creeping through the
room while sitting quiet, or before going to sleep. Such a symptom has been
described by Murray,[121] in his book on myxœdema, in the early stages of
this disease; the mind being then so much altered that even manias of
persecution and suicide may arise.
Neurasthenia is a disease which, as we have tried to show, is very often
based upon changes in the ductless glands, especially the thyroid, sexual
glands, and pituitary body. The same holds good for hysteria. Therefore the
presence of such conditions will influence us in our judgment as to the
future of such persons. In cases of great nervousness, especially when
associated with mental depression, there is less resistance to infection, for
causes already mentioned (see Chapters III and L). Great mental excitability
may predispose to certain diseases which shorten life, like diabetes, and in
people in whom, owing to an unstable nervous system, there is a frequent
increase in the blood-pressure, the possibility of apoplexy is to be feared, if
such persons are of a plethoric build. The wear and tear of life is certainly
far more felt by persons whose minds are very easily impressed and excited
by events of little importance; and, considering the great influence of mind
upon body, persons, who like a weak tree are easily beaten down by the
smallest storm, will have less chance of long life than persons who have a
better control over themselves and stronger will-power (see “Hygienics of
the Mind,” Chapter L).
Having thus briefly described the principal functions governed by the
thyroid gland: shown how, by observing changes in these functions, we can
judge as to the healthy condition of this gland, let us now see if any means
exists by which we can ascertain the functionating condition of the other
ductless glands.
After the thyroid the sexual glands claim our attention, as these glands
are of the utmost importance on account of their enormous influence upon
the processes of metabolism and the maintenance of life (see Chapter V).
We must first call to mind that their work is essentially under the influence
of the thyroid, changes in which invariably produce changes in the sexual
glands. Thus, in degenerated conditions of the thyroid, we find impotency
in men and sterility in women. In such conditions atrophy of the testicles, or
of the ovaries, can often be found. These clinical observations can be
confirmed by experiments. Thus Lanz[122] found sterility common in goats

whose thyroids had been extirpated. In cretins an atrophic condition of the
testicles, or of the ovaries, is present as a rule, and such patients very
frequently show lack of sexual desires.
Direct examination of the sexual glands can be more easily carried out in
men than in women.
The presence of varicose veins is of great importance, as varicoceles are
generally accompanied by great disturbances of the nervous system,
sometimes even going as far as insanity. Suicide is not unfrequently
committed in such a condition.
After the testicles the prostatic gland must be examined. As direct
examination of this gland is only possible by a painful examination through
the rectum, we shall have to inquire into the condition of the functions of
this gland. We must find out whether there is a flow of prostatic liquid and
semen (frequency of pollution). It must be remembered, however, that the
flow of a little semen in constipation and sexual abstinence has no
importance.
We must specially inquire about previous attacks of gonorrhœa.
Examining the urine in two fractions, we must ascertain whether the first
fraction is as clear as the second. The presence of a few filaments tells a tale
of previous gonorrhœa, but is of no consequence for the prognosis. It may
be, however, that they possibly indicate the presence of gonococci in the
deeper lying glands of the urethra which, after sexual excesses, can again
come to the surface even after years.
Inquiring for gonorrhœa in the past, we must find out whether the patient
was treated by local applications with instruments to the posterior part of
the urethra, this being the only radical treatment of chronic gonorrhœa. As a
rule, every chronic gonorrhœa invades the posterior part of the urethra and,
usually, inflammation of the posterior part of the urethra involves also the
prostatic gland.
The presence of strictures and hypertrophy of the prostate, unless they
occur in connection with a gonorrhœa, are indicative of a faulty activity of
those glands which influence the formation of fatty or connective tissue in
the body, as will be shown. It may indicate changes in the thyroid, after
extirpation or degeneration of which the connective tissue in the body is

increased, to which fact is also largely due the occurrence of prostatic
hypertrophy.
We must inquire as to the passage of urine. An interrupted stream with
pain on micturition may indicate, in elderly persons, a hypertrophy of the
prostate, especially if these pains are more frequent in cold weather. The
bladder must be examined for the presence of stone. The presence of stone,
as also of long-standing gleet and strictures that are not cured, lessen the
chances of a long life, the dangers of cystitis, and ascending pyelonephritis,
and nephritis, hanging, as the sword of Damocles, over the heads of their
unfortunate possessors.
Gonorrhœa, if it occurs frequently and attacks the prostate, is a great
danger both to the mental stability and sexual powers. The presence of great
sexual desires, with more or less impotence, must also be taken into
consideration when we are collecting evidence to find out the chances of
long life in an individual.
Regarding the examination of the female sexual organs and of their
functions, it cannot be the object of these lines to describe how to conduct a
thorough gynæcologic examination. We must limit ourselves to those points
by which we can ascertain the condition of those functions which are under
the control of the ovaries, with special reference to their internal secretion.
Thus, we need merely observe whether the external sexual characteristics
(e.g., breasts, hips, etc.) are well developed, since these are under the direct
influence of the internal secretion of the ovaries.
A chlorotic condition allows us to draw the inference that a faulty
condition of the ovaries exists (ovarian origin of chlorosis—v. Noorden),
and also of the thyroid, as this gland often shows change in chlorosis. The
extirpation of these glands is followed by a diminution in the number of red
blood-corpuscles and in the percentage of hæmoglobin. Both of these
elements of the blood can be increased by the use of thyroid or ovarian
extracts, as has been noted by several authorities.
The condition of menstruation can give us valuable information. The late
appearance of the first menstrual period, irregularities of menstruation, its
appearance at irregular intervals, and frequent disappearance for months,
will give us an unfavorable idea of the ovarian activity, especially when
each menstrual period is accompanied by pain. So will sterility, as this

condition is common, not only in association with ovarian inactivity (if not
due to malpositions of the uterus or impotency of the husband), but also
with thyroid deficiency. On the other hand, too frequent pregnancies or
miscarriages will also unfavorably influence our judgment, as these
agencies have, as a rule, a deteriorating effect upon these important glands,
causing their exhaustion and, at the same time, that of the thyroid. In
women with thyroid insufficiency and general loss of muscular tone,
prolapse of the uterus may be frequent, and also metrorrhagia. As Hertoghe
found, we can stop uterine hæmorrhages in women with thyroid
insufficiency by the administration of thyroid extracts. The history of
previous gonorrhœal infection must be specially investigated, as this
disease, if not treated, which is unhappily so often the case, will always
involve the ovaries, causing their destruction and often their obliteration.
Gonorrhœa in women is far oftener overlooked than in men, as it so often
passes for a simple discharge, until by microscopical examination
gonococci are found, and the ovaries already injured. It is a sad fact that a
large majority of the cases of pelvic disease in married women are due to
infection by the husband, for an enormous number of men enter upon
marriage with gonorrhœa that is imperfectly cured, or not cured at all. Let
us hope that there will come a time when a law will be passed obliging
every man to be examined thoroughly before entering upon marriage,
especially for gonorrhœa and syphilis. Such legal precautions would soon
check the transmission of these diseases to the wife and of syphilis to the
innocent descendants. It may be that thus, to a large extent, the propagation
of some of the greatest scourges of humanity can be checked, viz.: of
tuberculosis, alcoholism, and crime[123] which, as shown previously, flourish
on the soil prepared for them by hereditary syphilis.
A total lack of sexual desire in women is not normal, and may indicate
changes in the ovaries. On the other hand, there is an increase of sexual
desire at the period of augmented ovarian activity, as in the days preceding
menstruation. We have had the opportunity of hearing praise of ovarian
treatment from husbands of women with tendencies to sexual frigidity.
Very valuable information about the activity of the ovaries can be gained
from the examination of the breasts. It must be borne in mind that the
ovaries and the breasts stand in very close relation. Changes in the ovaries
are always followed by changes in the breasts, and it is a very interesting

fact that cases of cancer of the breast have been cured by extirpation of the
ovaries.
Comparing the breasts of an innocent young girl between sixteen and
twenty years with those of women of the same age leading an immoral life,
or of women after many pregnancies or in advanced age, we notice at once
the great difference between the large flabby breasts and the firm tissue of a
young girl leading a moral life. According to our observations we have
described[124] cases of fatty enlargement of the breasts, following all those
agencies which are hurtful to the ovaries, as masturbation, sexual excesses,
many pregnancies, etc. On the other hand, in degenerated conditions of the
ovaries and thyroid, especially if these conditions are congenital, we may
find the breasts quite undeveloped.
After the thyroid and ovaries we will direct our attention to the pituitary
body. Direct examination of this ductless gland being out of question,
owing to its position on the base of the skull, in the sella turcica, we have to
judge of its vitality by indirect methods. We know that by the alterations of
this gland a condition is produced, called acromegaly, characterized by
enlargement of the toes, fingers and nose, prominence of the lower jaw,
sinking in of the temple and of the fossa canina in the cheek-bones,
prominence of the occipital bone, etc. As with all diseases of the ductless
glands, besides the extreme form just described, which constitutes the
highest degree of such a degeneration, there are also marked cases where all
of the above deformities are only slightly pronounced. We must inquire
whether the features of such persons have changed, or the nose, hands, and
feet become larger. This is best determined by comparison of old and recent
photographs.
A history of headache, especially nocturnal, of mental change, e.g., great
susceptibility or symptoms of neurasthenia, taken together with the external
appearances, may aid our diagnosis. The simultaneous discovery of an
ocular lesion (hemianopsia) will confirm our suspicions beyond doubt.
The pancreas, also, can only be examined by indirect evidences of its
activity. A history of frequent or occasional epigastric colic, of large
quantities of unformed shapeless stools of a yellow or yellow-gray color,
containing undigested fat, together with loss of weight, will make us think

of the possibility of disease of the pancreas. The most exact proof of such
change can only be obtained by microscopical examination of the fæces.
Examination of the urine for sugar can also tell us whether there is
disease of the pancreas, especially of those parts of the pancreas which
constitute a ductless gland, independently of the rest of the viscus, namely,
the islands of Langerhans.[125]
As Mering and Minkowski[126] first showed, every dog whose pancreas is
extirpated invariably becomes diabetic, and this diabetes is similar to that of
man. In many cases of diabetes changes in the pancreas have been found at
autopsy; and although a good number of cases without any apparent change
in the pancreas have been recorded, the cause of these has been revealed by
an American author, Dr. Opie,[127] then of the Johns Hopkins University in
Baltimore. This author has found in a few cases of diabetes alterations in
the islands of Langerhans in the pancreas. This fact has been confirmed by a
good many authors, of whom I may mention Sobolew,[128] Weichselbaum[129]
and Stengel, Sauerbeck, and others. As is invariably the case, the statements
of these authorities have been attacked by others, as Hanseman, who have
found no such changes in the islets in diabetes. We must, however, state
here, that an apparently perfect anatomical condition of glandular structure
after death need be no proof of a perfect secretory activity during life.
Every epithelial formation, and the islands of Langerhans are of this nature,
must furnish a secretion, and this flows in every gland only under a nervous
stimulation. As Pawlow has shown, the pancreas secretes under nervous
impulse. Therefore the findings of pathological anatomy cannot show us
whether these glands have been secreting properly during life or not,
especially in a nervous disease such as diabetes.
According to the experiments of Diamare and Kuliabko, the islands of
Langerhans furnish a secretion which aids in the inversion of grape sugar.
We have shown at meetings of the Biological Department of the Hamburg
Medical Society (Germany), and of the London Pathological Society,
specimens of the pancreas of diabetic persons where there were changes
only in the islands of Langerhans and none in other parts of the pancreas
while, in one case, nearly the whole of the pancreas was destroyed by
cirrhosis, but without any diabetes, for in this case the islands of
Langerhans were not changed at all. It is interesting to note that these

changes in the islands of Langerhans were also present in mild cases of
diabetes.
Thus, the finding of sugar in the urine usually indicates the probability of
changes in the pancreas. Even small quantities of sugar, such as appear only
after starchy meals (alimentary glycosuria ex amylo) may be brought into
connection with changes in the pancreas; for Wille[130] found in Hamburg
from a large series of autopsies, that in a considerable number of cases with
alimentary glycosuria, there were also changes in the pancreas.
We must not forget the very important fact, that even when we find no
sugar we cannot at once exclude diabetes. There are many cases of mild
diabetes which do not show any sugar on an ordinary diet. To recognize
these cases we must give them a test meal of either about three ounces of
grape sugar two hours after a light breakfast of coffee and a roll, or, as we
have recommended in our book on the rational treatment of diabetes,[131] we
must give a test meal of much starchy food, such as rice and cakes, and
examine the urine two hours later. If then no sugar is found, or not
exceeding 0.2 per cent., diabetes may be excluded. Persons with 0.1 per
cent. to 0.3 per cent. of sugar after such a starchy test meal may be
considered as on the border line of diabetes. Such persons show a
diminished tolerance of carbohydrates, and they have lost the power to
consume all the sugar they introduce into their body. Therefore, especially
if they come of diabetic parents, they should avoid eating much starchy
food so as not to develop further this dangerous tendency.
Diabetes, in the majority of cases, considerably shortens the patient’s life.
Mild cases of diabetes may however live for fifteen or twenty years, or
often even longer. In predicting the chances of longevity in diabetic subjects
everything depends on the question whether diacetic acid has been found in
the urine or not. This can be easily ascertained by putting a few drops of a
solution of perchloride of iron into a test tube with the diabetic urine. If
diacetic acid is present, the liquid will become Burgundy red in color, and
the deeper this red color, the greater is the percentage of diacetic acid
present. In such cases the chances are very bad, such patients living on an
average for only one to two years. Exceptions to this rule, however, are not
infrequent, and we know of a case of acromegaly with severe diabetes, who
has passed large quantities of diacetic acid for the last fourteen years.

Cases of severe diabetes, with diacetic acid, can often be easily
recognized by their appearance. They are thin, the cheeks are often flushed,
and they show nearly all the signs of a myxœdematous condition, as already
described, whereas cases of mild diabetes present often symptoms of
hyperactivity of the thyroid gland, as in exophthalmic goiter. As we have
shown, diabetes is often due to an overactivity of the thyroid gland,[132] as
well as to degeneration of the pancreas, these glands being antagonistic to
one another. This is confirmed and amplified by Sajous, who ascribes one
form of diabetes to overactivity of the adrenal system, which includes the
thyroid gland. Overactivity of the latter organ may also be followed by its
exhaustion, with symptoms of myxœdema, as is the rule in severe diabetes.
Patients with mild diabetes often have a fresh look and a rosy face, and
very frequently look much younger than they are. We believe that the
healthy working condition of their thyroids has something to do with this
fact.
The pancreas is a very important organ for the maintenance of life as it
produces certain bodies (enzymes) which are of enormous importance in
the assimilation of food. One of these bodies (they are three in number),
helps the assimilation of albuminous products and is called trypsin. It also
plays an important rôle in the treatment of cancerous growths. Besides this
the pancreas produces an enzyme that helps the assimilation of the
carbohydrates (amylopsin) and another that is indispensable for the perfect
assimilation of fat (steapsin).
As we have shown by experiments made in the laboratory of Professor
Minkowski (then in Cologne), the pancreas stands in definite relation to the
thyroid. These two glands seem to be antagonistic to one another, for on
extirpation of the pancreas of three dogs, thus rendering them diabetic, in
every case the thyroid showed a condition of hyperactivity, whereas in one
case, after previous extirpation of the thyroid, the pancreas showed an
enormous number of islands of Langerhans—(thirty-six to forty in one
field).[133]
It was also of great interest, that each diabetic dog ceased to eliminate
sugar two days after extirpation of the thyroid.
As with the thyroid, the pancreas has also very important relations with
the liver. Dr. Steinhaus found, in a research conducted in the laboratory of

Professor Minkowski, that in a large number of cases of hepatic cirrhosis
there were also similar changes in the pancreas. Similar observations have
also been made by Opie, Amato, Kliffel and Lefas,[134] and others. This may
be the reason that in diseases of the liver we have had good results from the
administration of pancreatic extract. In every case we have found a better
assimilation of food, and especially a better appetite. This stomachic effect
of pancreatic extracts we have found in nearly every case and even when
the patients were not suffering from pancreatic or hepatic disease. (See also
Chapter LIV.)
Still more than the pancreas is the liver indispensable for the maintenance
of life. It destroys the deadly poisons which are conveyed to it by the portal
vein for neutralization. Besides this it produces certain bodies which help to
destroy poisons arising from the decomposition of albuminous food. (See
also Chapter XIII.)
The liver also produces certain bodies, as urea, which play a very
important part in metabolism, and it also serves as a large depot for
glycogen, the stored sugar of the body. The liver forms a large amount of
glycogen, and stores it up for the wants of the body. By a ferment, also
produced by the liver cells, the glycogen is transformed into sugar, and in
this form is given off to the body. If the liver were extirpated the blood
would contain no more sugar, as was found by Minkowski through
experiments on animals.
Besides sugar, the liver also produces, as just mentioned, another very
important substance, and this is urea. This body is produced in the liver
from ammonia, which, as the final product of decomposition of albuminous
substances, is brought to the liver by the blood. From carbamic acid, also,
the liver forms urea. Ammonia and carbamic acid are poisonous products
which arise from the decomposition of albuminous material, and, by
transforming them into urea, the liver saves our body from continuous
intoxication. Thus we can see that in diseases of the liver the quantity of
urea falls and the elimination of ammonia increases. A normal man
eliminates about thirty to forty grammes of urea in a day. Much smaller
quantities per diem would thus indicate diminished activity of the liver.
Besides glycogen and urea, the liver also produces another substance,
which is indispensable to the perfect process of digestion and assimilation.

This is the bile. The bile transforms fat in the intestine into an emulsion, and
thus makes it possible for the fat-splitting ferment of the pancreas to act
upon it, and to split it up into glycerin and fatty acids, and thus make it
serviceable for the uses of the organism. The bile augments the action of the
pancreatic ferments; it stimulates the movements of the intestine, and is a
powerful antiseptic to the contents of the intestine, as it hinders to a certain
extent their putrefaction. Another important action is that it increases the
water content of the fæces, and thus materially helps an easy evacuation of
the bowels.
After having thus briefly passed in review the important functions of a
healthy active liver, let us now say a few words about its examination. The
liver is one of the few ductless glands which are available for manual
examination by percussion and palpation. We must ascertain if it extends
considerably below the costal margin, and by palpation we must ascertain
whether the enlarged liver is soft or hard and cirrhotic. In the former
condition we can diagnose hyperactivity of the liver, probably due to its
efforts to safeguard the body against a long-continued intoxication, as may
be the case in those who overeat, and also in long-continued digestive
troubles, especially with dilatation of the stomach, chronic constipation, etc.
Following on this hyperactivity, as is the case with all organs, there may
come an exhaustion, more especially after long-continued intoxications.
Thus in chronic alcoholism a simple hypertrophy of the liver may go on to
cirrhosis, and later the hypertrophy may be followed by an atrophy, with all
its harmful consequences, as ascites, etc.
On examining the liver we must not forget the sclerotics, and must note
whether, on looking upward, there is any yellow discoloration.
While palpating the liver we must specially note whether it is tender, and
also if the gall-bladder is tender. This is a typical symptom of chronic
inflammation of the gall-bladder, or cholecystitis, which is so frequently
associated with gall-stones. We find such a tender gall-bladder very
frequently in elderly women, in whom gall-stones are particularly common.
In fact, they occur so frequently that Halck[135] in Copenhagen, found them
in 29 per cent. of 4140 autopsies on persons above 50 years of age.
However the mere presence of gall-stones does not constitute gall-stone
disease, the essential point being an inflammation of the gall-bladder and
bile-ducts. Such an inflammation of the gall-bladder is revealed by

tenderness on pressure with the examining hand. It is a frequent symptom
of all those conditions (as we have found and communicated to the French
Congress of Medicine, 1905) in which the thyroid or sexual glands are
diseased. For instance, after pregnancies, after infectious diseases in old
age, etc., it is often accompanied and preceded by obesity, which is also a
consequence of inactivity of the thyroid and sexual glands. Frerich, many
years ago, observed enlargement of the liver and a tender gall-bladder in
women at the climacteric, and many other authors have made similar
observations. Hertoghe found such conditions common in women suffering
from inactivity of the thyroid or hypothyroidia.
It has been found by experiments, made by Blumenthal and Jacobi, that
extirpation of the thyroid is followed by a dilation of the gall-bladder, and
many authors have noted the presence of biliary constituents in the urine of
animals whose thyroid has been extirpated.
We can readily understand why women with changes in the thyroid and
sexual glands are so often attacked by gall-stone disease. In these women
there is, as a rule, atony of the intestines, with habitual constipation. This
intestinal atony is also accompanied by an atony of the gall-ducts, and so
the bile is more or less stagnant in these ducts.
As shown by Morat and Doyon,[136] the gall-ducts contract rhythmically
every ten to twenty seconds, and the bile is thus expressed. The periodical
compression of the liver by the diaphragm at each inspiration also helps this
expression of the bile. Thus it flows under a certain pressure through the
choledochus, and it is easy to understand that the billions of microbes which
infest the intestines, will have great difficulty in passing the narrow and
tortuous passages of the bile-ducts through which bile is circulating at great
pressure. And this is of the utmost importance, for if microbes are able to
pass the common duct and thus enter the bile-ducts, they will set up
inflammation, as was shown by several French authors: Gombault, Charcot,
Gilbert, etc.
Inflammation of the bile-ducts plays a most important part in the origin
of gall-stone disease, for, as Naunyn and his pupils have shown,
inflammation of the bile-ducts leads to a precipitation of cholesterin, and so
to the formation of gall-stones.

In women gall-stone disease is more frequent than in men. This depends
upon the greater frequency of diseases of the thyroid and sexual glands in
women. Changes in the sexual organs produce an irritation of the
splanchnic with checking of the peristaltic movements of the intestine and,
at the same time, relaxation of the muscular coat of the bile-ducts. Thus
there arises a deficient expression of bile, and stagnation follows, with
invariable immigration of bacilli producing inflammation and precipitation
of cholesterin and gall-stones. For the above-mentioned reasons
constipation is far more frequent in the female, and constipation, being
always accompanied by atony of the bile-ducts with stagnation of the bile,
directly exposes to the risk of gall-stone disease.
In men gall-stone disease may often be considered a manifestation of old
age. It appears, as a rule, after the fortieth year, and is often brought about
by previous infectious diseases. In such cases obesity often develops first,
and later gall-stone disease. For those who are interested in this subject we
would refer to our communication[137] on the origin of gall-stone disease
following changes in certain ductless glands. Considerable, sometimes
enormous, loss of weight is a very frequent symptom of gall-stone disease,
and is probably due to pancreatic alterations.
Gall-stone disease may be regarded as of great importance in estimating
an individual’s prospects of longevity, and at the same time as a
pathological manifestation of an inactive thyroid, or deficient sexual glands
in women. This applies equally well to the cause of renal colic, gravel,
which was found by Professor Sajous to be prevented by thyroid
preparations and a suitable diet.
Constipation, an important predisposing cause, has been shown to be an
expression of such conditions. The truth of these assertions is proved by
experimental evidence.
Extirpation of the thyroid provokes important changes in the liver. In
myxœdema there is a condition of hepatic cirrhosis, as shown by Prun-
Hudden, Vermehren,[138] and others. Two years after we had shown that the
thyroid and liver stand in close relation to one another, Professor Neusser,
of Vienna, brought forward the same conclusion at the German Congress of
Internal Medicine in 1906.

Another important gland that has a very close connection with the thyroid
is the kidney. A direct examination of this organ is not possible, but we have
means of readily judging of its efficiency by observing how it performs its
function. This is to eliminate waste and poisonous products from the body
by means of its secretion—the urine. Thus from the examination of the
urine we may gather all the information necessary about the activity of the
kidneys.
In examining the urine we must first pay attention to its appearance, the
daily amount, and its specific gravity. Less than about two pints a day of a
light colored urine, with a specific gravity below 1020, indicates a faulty
action of the kidneys, and the possibility of a large amount of toxic products
being retained, instead of being eliminated. Such a urine can often be seen
in cases of thyroid insufficiency, as this condition of the thyroid causes a
diminution in the activity of the kidneys. As we have shown in a
communication to the Paris Biological Society,[139] the thyroid and the
kidneys are very closely related, changes in the thyroid always being
followed by changes in the kidneys. Thus it was found by Albertoni and
Tizzoni, by Blum and others, that extirpation of the thyroid is followed by
fibrosis of the kidneys. Interstitial nephritis is the rule in myxœdema, and is
very frequent in all conditions with insufficiency of the thyroid. In such
patients the quantity of urine is diminished, and also its specific gravity, as
well as the quantity of urea and uric acid, which in consequence are
retained in the body.
The quantity of the eliminated uric acid being diminished, its retention in
the body explains why gout is so frequent in people with thyroid
insufficiency, and why these persons so often complain of rheumatic pains.
As we have shown in our above-mentioned communication, gout is due to a
degenerative change in the thyroid and kidneys, with retention of uric acid
as a sequel.
The presence of albumin in quantities greater than 0.5 gramme to the liter
is of grave import, and denotes important change in the kidneys. Smaller
quantities, or just a trace, may not be of great importance. Traces of
albumin occur from a great number of causes, and are often due to the
passage of toxic products through the kidney which this organ eliminates, as
one of its main functions is to eliminate toxic products from the body.

More serious than small quantities of albumin is the appearance of casts
and renal epithelium. These, if present, indicate a destructive process in the
kidneys. Even the occasional occurrence of hyalin casts is not without
danger, for, according to Professor Senator,[140] of Berlin, hyalin casts are
formed by degeneration of the epithelium of the convoluted tubules, which
play an important rôle in the separation of solid products from the blood
into the urine. The loss of these structures means a hampering of the most
important function of the kidneys. Even when we find only one such cast in
one or two specimens, we must not forget that a pint of the urine may
contain a very large number, and thus every day large quantities of valuable
kidney elements are wasted and one of the most important functions in our
body is hindered. Therefore we must not pass by such a condition of things
without serious thought for the future of such persons. The length of their
lives will largely depend upon their diet, just as in cirrhosis of the liver. If
these persons are addicted to an abundant meat diet, their chances of
longevity will certainly be smaller than with milk and vegetable food. As
we have seen, the liver is constantly dealing with poisons arising from the
decomposition of albuminous food, especially meats. The kidneys are
destined to eliminate such products from the blood and pass them out with
the urine. We will treat of this subject later in a separate chapter.
In patients with diseases of the kidneys, the condition of the skin is of the
utmost importance, as the skin is our second kidney. Therefore patients with
thyroid insufficiency have less chance of a long life if their kidneys are in
any way incapacitated.
Besides the above-named vital organs, there are certain portions of our
anatomy which are also of importance in the determination of our chances
of life. Take, for example, the nose. In the children of parents with
degenerated thyroids there is a great tendency to adenoid vegetations. These
are, strictly speaking, not a disease of childhood alone, for often they may
be met with in adults, even in middle age. If large they necessitate breathing
through the mouth instead of through the nose, especially at night. Such
children are liable to frequent catarrhs, and what is more serious, to
pulmonary troubles. They are also liable to suppurative otitis media and
frequent attacks of tonsillitis. These frequent attacks of tonsillitis may
constitute a serious danger, as they may induce an inflammation of the
kidneys. As a rule, in such cases the nephritis passes off in a few days, often

without being recognized, the symptoms being ascribed only to the
tonsillitis. Although the acute symptoms may have disappeared and nothing
remain but a few red blood-corpuscles in the urine and occasionally a few
casts and epithelial cells, yet under the ashes the fire may still creep on and
chronic nephritis develop. In fact, a good number of cases of chronic
nephritis whose origin is wrapped in mystery are due to such a tonsillitis.
The condition of the teeth must also be inspected, for people without
sufficient teeth cannot chew their food properly, and thus gastric and
intestinal catarrhs may arise.
Just as important, if not more so, than the condition of the above-
mentioned vital organs, is the mental state. Thousands of years ago it was a
manifest truth that the mind governs the body. In judging an individual’s
chances of long life, we cannot omit the importance of his mental character.
As a rule a man with a well-balanced mind, who is not disturbed by the
smaller worries of life, has more chances of a green old age than a man
whose easily impressionable mind exposes him to continual agitation and
anxiety, and who is overwhelmed by the slightest untoward event. A man
who is a born optimist and who views everything in a rosy light, has got far
more chance than a pessimist who sees everything in a cloud. A man who is
ambitious and never satisfied is more liable to mental and physical change
than one who asks for little and easily gets it. Being disappointed in his
ambition, as so often happens, he becomes despondent, especially if he is
lacking in will-power, which depends on the activity of the thyroid as
previously mentioned. In this condition he may not only lose his appetite
and become ill-nourished, but he is also more liable to succumb to the
incessant attacks of microbes, among which he lives, and which gain easy
access to the body in melancholic conditions. Sorrow may act in the same
harmful manner.
The chances of a bachelor or spinster for a long life are always less than
those of a married person. Single people are more subject to nervous change
and digestive troubles, and have a greater tendency to become despondent
and melancholic. In bachelors, also, the acquisition of contagious diseases
is a continual danger, and when they get older after their former merry lives,
if merry it was, gloom invariably follows. Married life is the best guarantee
for a long life and happy old age (see Chapter XLVIII).

Before closing this chapter we would state that it was not our intention to
give a description of the physical examination of a patient from the point of
view of life insurance, but to indicate certain points which must guide us in
forming an opinion on a person’s chance of longevity. All vital phenomena
are under the influence of the internal secretions of the ductless glands,
which govern every organ of our bodies. Therefore everything depends
upon finding out the condition of these glands. Any well instructed
physician can make a thorough examination of the different organs of the
body for the purposes of life insurance; therefore we did not think it
necessary to describe here the examination of the heart or lungs, etc.
By such examination of the ductless glands we are not only able to
forecast the approximate length of life, but we are able to judge a patient’s
power to withstand disease when we are called to his bedside. If we find the
ductless glands of such a patient (especially the thyroid and adrenals,
kidneys and liver) in good working order, we can predict a successful and
rapid termination to the malady. It is easy to understand that any one with a
healthy skin, normally acting bowels, and plentiful urine, will more readily
eliminate poisonous products than a person with a dry skin, constipation,
and scanty urine. Also his tissues will be in better condition, and in the case
of wounds granulations will more quickly form and fractures heal readily
with firm callus.
Such an examination as the above can, however, also help us, as we
readily shall understand, to foretell the chances of a person as to the
prolongation of youth and the retardation of old age.

CHAPTER VIII.

On the Causation of Old Age.

We have seen in the first chapter of this book that the symptoms of old
age may appear in quite young persons after changes in the ductless glands,
especially the thyroid, ovaries, testicles, etc. We have also shown how these
glands influence the condition of the tissues, and our external appearance,
our immunity from infections and intoxications, and the condition of our
nervous system and mind. We have also seen how these wonderful glands
influence the length of our life and our prospects of a green old age, and
thus it is evident that these glands are in close relation with the origin of old
age. It is justifiable, therefore, to enter fully into a discussion as to whether
old age is really due to degeneration of the ductless glands, which
supposition must have occurred to anyone who has read the previous
chapters of this book.
Sir Victor Horsley, of University College Hospital, London, was the first
to bring old age into causal relation with degeneration of the thyroid, and
after him Vermehren and Ewald of Berlin.
In a communication we made to the Biological Society at Paris,
December 4, 1907, we showed that old age is not alone due to degeneration
of the thyroid, but to changes in several ductless glands, of which the chief
are the thyroid, ovaries, testicles, adrenals, and pancreas. In a
communication to the International Medical Congress in Lisbon, in 1902,
we added to these glands the liver and kidneys, which also possess an
internal secretion.
Let us now see if there is any evidence in support of such a statement.
As we shall show, such proofs do exist and they are of a pathological,
anatomical, experimental, and clinical nature. To begin with, it is a well-

established fact that at a certain age the different ductless glands show
important changes, notably an increase of connective tissue, with
subsequent degeneration of the secreting tissue.
Sir Victor Horsley[141] found that the thyroid gland, after a certain age,
shows an increase of connective tissue, with fatty degeneration of the
epithelium and shrinking (concentration) of the contents of the follicles.
Hale White[142] also, examining at autopsy seventy thyroid glands, found an
atrophic condition in old subjects, an atrophy which is more marked the
older the subject, and that these changes are already present in the thyroids
of persons fifty years old.
The thyroid, together with the parathyroids, have been found degenerated
in old age by Erdheim.[143] Bauman found only very little iodine in the
thyroid of aged persons.
Let us add that, luckily, not every thyroid shows important changes after
the age of forty or fifty, although there is usually a slight increase of
connective tissue at that age. On the other hand there are thyroids in
subjects of advanced age which show no important degenerative change.
This, however, is, according to our experience at autopsies, a very rare
occurrence. The point of main importance is the amount of colloid
substance present. A thyroid with much colloid, if it is of normal quality
(which can be recognized by the way it stains with eosin), is a thyroid of
good activity. As we know, the thyroid contains more iodine than any other
part of the body. The main bulk of the iodine in our body comes from the
thyroid. It follows from the investigations of Docent Oswald,[144] in Zurich,
that the quantity of iodine in the thyroid depends upon the amount of
colloid substance. Hence a thyroid with much colloid substance contains
much iodine, and a large goiter composed of connective tissue alone and
containing no colloid, cannot contain any iodine.
Differing with a famous French physician who said that the age of a man
depended upon his arteries, we would state that it depends upon the quality
of his thyroid. For the condition of the arteries, as we have shown in
different parts of this book (Chapters II and VI), depends very much upon
the condition of the thyroid gland, which governs the whole circulatory
system.

The parathyroid glands, which are in relation with the thyroid, and
changes in which may produce cramps, as shown by Jeandelize,[145] Pineles,
[146]
etc., also present an increase of connective tissue, with fatty
degeneration of the epithelium, in old age, as was shown by Erdheim,[147] of
the Vienna Pathological Institute.
As is well known, the ovaries also, between the ages of forty-six and
fifty, undergo important changes and involution, with consequent cessation
of the menses. There is an increase of connective tissue with degeneration
of the epithelial structure. There is also a retrograde metamorphosis of the
Graafian follicles into fibrous tissue. The testicles have been found
atrophied in old age by Professor Langhans,[148] but there are many
exceptions, as shown by S. Spangaro.[149]
As Sajous[150] and we[151] also have shown in our already cited researches,
that the various ductless glands are closely related, and thus changes in the
thyroid are always accompanied by changes in the other ductless glands.
This rule applies to the present case and after senile changes in the thyroid,
with increase of connective tissue, the other ductless glands also show
similar changes. These are found in the pituitary body, the adrenals, the
liver, and kidneys. We have several times insisted upon this fact in various
chapters of this book.
The adrenals of old people have been examined by Minervini,[152] and he
found a true cirrhosis of these glands which had included nearly the whole
gland. He also found drops of fat in the cells of the medulla. Dellamare[153]
found a hypertrophic condition of this gland in old age.
In nature every cause has a sequel. Therefore, when we see such
important changes in glands with internal secretions, there logically must be
sequels to the alterations in these important organs. And these exist. When
the thyroid is degenerated, to a greater or less extent all those symptoms
appear which are characteristic of changes in the functions governed by the
thyroid, and of which we have spoken in previous chapters.
Therefore, when the thyroid is degenerated, symptoms appear which are
characteristic of myxœdema. And, indeed, Sir Victor Horsley was the first
to draw attention to the fact that in old age we find all the symptoms of
myxœdema; and after him, Vermehren[154] and Ewald.[155] They have
compared the symptoms of myxœdema with those of old age, and found the

two conditions very similar. According to our own observations the most
prominent of these corresponding symptoms are:—
The wrinkles on the face and the drooping of the lower eyelids, in
extreme cases amounting to ectropion. Then the great number of wrinkles
on the hands of myxœdematous people, even at an early age, and the feeling
of cold in the hands and feet and their bluish color.
With advancing age, obesity is often the first symptom, just as in
myxœdema, and, as we have said above, obesity can be caused by
degeneration of the thyroid and sexual glands.
The hair in both conditions is very often gray, and there is atrophy of the
papillæ of the hair and of the sebaceous and sudorific glands, with dryness
and falling out of the hair.
Constipation or irregularity of the bowels is also common. There is often
great fatigue, slow speech, and an apathetic condition in both these states.
The memory shows the same typical deficiency, events of long ago being
more easily remembered than those of quite recent date. The character of
the patient becomes egotistical and avaricious. There is great sensibility to
cold and difficulty in keeping warm. The urine is generally below the
normal quantity; often it is scanty and of low specific gravity, with retention
of solid constituents. The processes of oxidation are diminished both in
typical myxœdema and in advanced old age. There is a diminution of the
blood-corpuscles and of hæmoglobin in both conditions.
After the initial obesity in early myxœdema and old age, there comes as a
second stage a loss of fat, characteristic of the advanced stage of
myxœdema (the cachectic stage) and advanced old age.
There is an increase of fatty tissue after extirpation of the thyroid gland,
and later of connective tissue, just as in myxœdema and old age. This
increase of connective tissue is typical of old age. It first appears in the
arteries, leading to atheroma, and the typical symptoms of arteriosclerosis.
In myxœdematous persons, although they may still be young, we find
atheromatous arteries and arteriosclerosis. Impotence is common in
myxœdema, especially in advanced cases, and is also found in senility,
being more marked the greater the patient’s age.

There is no denying the fact that in old age we find, besides degeneration
of the thyroid, symptoms of degeneration in various other tissues and
functions, and the question now arises, whether these changes in the tissues
are really the sequel of previous degeneration of the ductless glands, or
whether both are only accidental and in no causal relation We have already
answered this question four years ago in our communication to the Paris
Biological Society, showing that old age is due to degeneration of the
ductless glands, and stating that these glands govern the tissues and not vice
versa. Still, we shall enter here more fully upon this question, showing by
experimental and clinical evidence that the changes in the ductless glands
are primary, and followed by a degeneration of the tissues as a consequence.
We can produce experimentally typical symptoms of old age in young
animals by extirpation of the ductless glands, more especially the thyroid,
ovaries, and testicles.
When we extirpate the thyroid gland of an animal we get an increase of
fat in the subcutaneous tissue, or an increase of connective tissue. We know
of the case of a young bull which, two months after extirpation of the
thyroid, gained about thirty kilos in weight, due to an increase in fat. The
same thing occurred in a colt. We are indebted for our knowledge of both
these cases to Dr. Hertoghe, of Antwerp, the well-known authority on the
thyroid gland.
After extirpation of the thyroid gland prominent writers have found a
diminution in the processes of oxidation; and by thyroid gland feeding we
can augment these processes, as was shown by Vermehren, Magnus-Levy,
Thiele, Nehring, and many others. This property of the thyroid gland is
made use of in the medicinal treatment of obesity. Since writing these lines
we have observed a loss of forty pounds in a man, a patient of Professor
Launois, of Paris, who, after this loss, felt better. We treated him in
Carlsbad for six weeks with thyroid extracts, and the average loss was about
a pound a day. True, this patient was also taking Carlsbad water, but we
have never seen so considerable a loss due to this water alone. The diet of
this patient had not been strict. This loss of weight, then, is mainly to be
ascribed to the thyroid treatment. This treatment is dangerous, however,
unless carefully regulated by a physician.

Thus extirpation of the thyroid is undoubtedly in causal relationship to
obesity, which, as already mentioned, is often the first symptom of old age.
But it also can produce another sign of old age, and this is the increase of
connective tissue in the various organs and tissues. That connective tissue
formation is an attribute of old age has been clearly shown by Demange and
Oettinger, who found at every autopsy on old persons an increase of
connective tissue in the walls of the capillaries. Ord and Mahomet found
exactly the same thing in the capillaries of persons suffering from
myxœdema. This has been proved experimentally by Professor Eiselsberg,
[156]
of Vienna, who found atheromatosis of the aorta and other blood-vessels
in dogs whose thyroids he had removed.
This increase in connective tissue has been found in various viscera after
removal of the thyroid; thus it was found by Kishi[157] in the liver of one
hundred and fifty dogs and monkeys. Rosenblatt and Jeandelize[158] also
described an interstitial hepatitis in similar cases.
The same change has also been noted in the kidneys after extirpation of
the thyroid (e.g., Blum[159] found an interstitial nephritis), and in the brain an
increase of neuroglia occurs, as observed by Blum, Walter Edmunds, and
others.
Increase of connective tissue in the skin is a common occurrence after
thyroid extirpation, and the name “myxœdema” is probably derived from
the fact that in some cases, as the disease advances, the connective tissue is
transformed into a mucinoid substance. The name “cachexie
pachydermatique,” as suggested by Charcot, seems to be far more adequate.
Formation of fat and of connective tissue is not only seen after removal
of the thyroid, but can also be observed after extirpation of the sexual
glands, the ovaries and testicles.
As mentioned in Chapter II, Loewy and Richter,[160] of Berlin, observed
that removal of the sexual glands always produced a diminution of the
oxidation processes.
The experiments of Prof. Loewy and Prof. P. F. Richter are not
invalidated, in our opinion, by the experiments of Lüthje, who did not find
an increase in metabolism after ovarian feeding. The reason for this may be
that he was not in possession of active extracts. Anyone who works with

animal extracts knows what a great difference there is between various
organo-therapeutical preparations, some being more efficacious than others.
As a rule castrated animals take on fat, and this fact has for many years
been made use of by farmers. At the same time the flesh of such animals
acquires a better flavor, the pronounced flavor of the meat of non-castrated
animals being objectionable to some consumers. This demonstrates the very
instructive fact that the internal secretion of the testicles has its effect on all
parts of the body.
Castration in man is very frequently followed by obesity and symptoms
of old age. Thus the eunuchs of eastern countries are very often fat and, at
the same time, look much older.
The influence of the ovaries upon fat formation can also be shown by
their therapeutical action in obesity. Although not so active as thyroid
extracts, we have found that by the combined use of thyroid and ovarian
extracts, we could produce a considerable loss in weight, when, by thyroid
treatment alone, we could not obtain it. This, however, is only in the case of
women. We will treat of this subject more fully in the chapter on ovarian
treatment.
Besides the above-mentioned experimental facts, which show that these
attributes of old age—obesity and increase of connective tissue—can be
produced by removal of the thyroid or sexual glands, we also have to deal
with facts gained by clinical observation, which show that any cause
inimical to the ductless glands, especially the thyroid and ovaries, may
bring about old age. Take, for example, infectious diseases. They have a
very damaging effect on the various ductless glands, especially so if they
are of long duration. Their influence upon the thyroid has been clearly
shown by various observers. (Roger and Garnier, Crispino, Torri, Bayon, de
Quervain, and others. See Chapter III.)
Not only the thyroid gland, but other ductless glands, are affected by
infectious diseases, and in the third chapter of this book we have shown that
the adrenal glands show alterations indicating hyperactivity in infectious
diseases.
The pituitary gland is also altered in infections, as shown in the same
chapter.

Changes in the pituitary body may also be a factor in producing
premature old age. It is a fact that all people suffering from acromegaly
appear much older than their age. In fact, one of the first symptoms that
arouses the anxiety of the relatives of such a patient is that he looks so
much older, and it is only later that they notice the overgrowth of the nose,
the hands, and feet. Since, in many people who are getting older, the head
and nose may increase in size, we may suppose that this is the clinical
expression of senile changes in the pituitary body. There is a condition
known as “acromegalie fruste,” in which the symptoms are only slightly
pronounced and which is often unrecognized. As we have already said, all
diseases of the ductless glands may be only partially developed. This is due
to the fact that only a proportion of the thousands of follicles, of which such
a gland is composed, need be affected.
The ovaries and testicles also show changes as an evidence of their fight
against infections, and we have mentioned the findings of Professor
Metschnikoff with regard to these glands.
In every severe infectious disease the liver shows great change in its
parenchymatous tissue, with a subsequent increase of connective tissue.
The increase of connective tissue in various organs, and especially in the
blood-vessels, after infectious diseases, can be regarded as an illustration of
our remarks on these same changes following degenerations of the thyroid.
It is a well recognized fact that atheroma can be caused by various
infectious diseases, and can also be artificially produced by several
infectious agents.
The kidneys, through their rôle as eliminative organs, usually suffer, even
more than the other glands, in the course of infectious diseases. Even a
slight angina may produce an acute parenchymatous nephritis, and the more
virulent the infection, the more will the kidneys suffer.
Not infrequently, unknown to us, important parts of the renal tissue are
lost after such infections, and a chronic nephritis may creep on insidiously.
After such loss there may be proliferation of connective tissue, and the
kidneys thus become unable to fulfill the most important eliminative
functions in the body. Owing to this incomplete elimination, toxic
substances may be retained in the body.

From the above considerations we can see how important it is to guard
against the risk of infection. This is often impossible, considering the
billions of microbes by which we are surrounded day and night. The best
precaution is to keep those organs in good working order which safeguard
us against infections—i.e., the ductless glands.
Even more potent than infectious diseases in producing old age are the
results of degenerative changes in the ovaries. The effects of castration have
already been mentioned. Much in the same way do those causes act which
exhaust the internal secretion of the ovaries, e.g., many pregnancies, or
sexual excesses. We must take into consideration the fact that, as shown by
many authors, the different ductless glands are altered during pregnancy
(Launois,[161] Guieysse, etc.). Many mothers of large families look old
before their time, as do also many of those who lead a professedly immoral
life. Even in young girls we can see the consequences of such deteriorating
agencies in hypertrophy of the mammæ, developing in very short time, and
also a tendency to deposition of fat on the abdomen, which becomes
pendulous in women who have had many children. The features of women
who indulge in sexual excesses undergo a striking change even in early life.
They become coarse, bloated, less sharply defined, and the cheeks and chin
become fat and flabby. Indeed we have often been struck by the great
resemblance of such a face to that of an early stage of myxœdema, a
condition due to deficiency of thyroid secretion, which in turn, as shown by
Sajous, influences other ductless glands. The effects of numerous
pregnancies are far more marked if lactation is prolonged.
Not all women after many pregnancies, or after unduly frequent sexual
intercourse, will show symptoms of premature senility, as much depends on
heredity and also on the surroundings in which they live. Certainly if they
live in precarious circumstances, as do the poorer women of the working
classes in many European countries, especially Germany and Austria, where
these women perform hard bodily work and are badly fed, and have much
sorrow and care, they will soon appear old; and women looking like
matrons at thirty are of common occurence in the lower classes of these
countries. But this is seen also in the women of southern Europe, although
they do not work so hard. This is due to the fact that in southern countries
girls reach puberty early and are married very young, in the East often at the
age of twelve. Thus, sexual activity begins earlier and ends much sooner. Its

end, of course, means the beginning of old age. As soon as retrograde
changes commence in the ovaries, the summer of a woman’s life is over;
and, just as summer is sometimes prolonged into autumn, so at this period
of her life may she still retain strong sexual desire. Happy the woman
whose heart, as well as her ovaries, undergoes a senile involution, for there
is nothing more terrible for a formerly beautiful woman than to see her
charms wane while her heart remains young.
Yvette Guilbert, in her novel the “Demi-vieilles,”[162] describes in a
picturesque manner the pangs of a woman at the climacteric age. Let us
quote a few lines: “They try to remain young, hide the gradual onset of their
ugliness, and look for a chance to taste of love again. They cry out for the
past, for even while they fight against time they cannot detain it in its
course.” This description, however, does not apply only to the majority of
middle-aged women, but more especially to professional beauties.
It can be seen from these considerations how necessary it is for a woman
who has frequent pregnancies to observe the rules of hygiene. That these
produce excellent results we have proved. We know of a score of ladies of
the aristocratic and wealthy classes who, though having six or even seven
children, look none the worse. A certain Austrian archduchess still remains
a beautiful woman, in spite of her eight children and the fact that she is a
grandmother. Such examples may be frequent in old families with this
hereditary tendency. Though the bearing of many children can hasten old
age, yet, on the other hand some women, after the birth of their first child,
become better and fresher looking. We can see this especially in girls of
twenty or more who, having appeared somewhat withered before marriage,
begin to bloom afresh after the birth of the first child. Increased activity of
the ovaries and thyroid is the explanation of this phenomenon. As already
mentioned, the thyroid takes an active part in ovarian changes. In a young
girl of fourteen, just previous to menstruation and puberty, we may find a
swelling of the thyroid gland. During menstruation we can often see a
distinct enlargement of the thyroid, and at the same time certain nervous
symptoms such as are usually connected with thyroid change.
Increased activity of the thyroid during pregnancy is shown by a swelling
of the gland, often causing a regular goiter, and, at the same time, not
infrequently by the typical symptoms of exophthalmic goiter. Lactation is
also dependent upon thyroid activity. After prolonged lactation there is an

exhaustion of thyroid activity; and, on the other hand, by giving thyroid
extract we can increase the flow of milk.
The swelling of the thyroid in the above conditions can be explained by
the greater demand for thyroid secretion, and that this hyperactivity occurs
is also shown by the observations of the early writers on myxœdema.
Morvan, Ord, and Combe found that myxœdema was frequently caused by
numerous pregnancies, especially if associated with prolonged lactation.
This also explains why women become prematurely old so much more
frequently than men, for their ovaries are much sooner exhausted, in
consequence of their activity being much greater than that of the male
sexual glands. There is a much greater demand not only on the female
sexual glands, but also on the female thyroid, which enlarges every month
in many women, and is greatly exhausted by each pregnancy. As
Hertoghe[163] says, with reference to this exhaustion of the thyroid by
pregnancies, “each child demands one tooth.”
According to Hertoghe, pregnancies are especially apt to produce
degenerated conditions of the thyroid gland.
Sexual excesses, on account of the concomitant nervous excitement, are
also very prejudicial to the adrenals, for just as frequent nervous excitement
in general, they produce alterations in the blood-pressure and favor the
development of arteriosclerosis.
Sexual excesses are also very harmful to men, although their action on
the thyroid, in men, has not yet been ascertained. It is a fact, however, that
they diminish the resistance to infections, and favor the onset of
neurasthenia and arteriosclerosis.
Changes in the thyroid also become manifest during the climacteric, and
the troublesome nervous manifestations at this period are largely due to this
fact. Later, on account of the degeneration of the thyroid and ovaries in
many of these women, there is an accumulation of fat, of a bacon-like
character, in the same situations as was described above in women after
many pregnancies and sexual excesses—viz., the breasts, the hips, and the
abdomen. The facial appearance of these women who become obese after
the climacteric resembles that of a typical case of early myxœdema. In the
later stages, as old age advances, just as in myxœdema, the fat may

disappear and be replaced by great thinness and emaciation—the cachectic
stage of myxœdema. This is less frequently seen now-a-days, on account of
the improvement and checking of the disease by thyroid treatment.
It is a very strange fact that although sexual abuses soon bring about
symptoms of old age, as do also many pregnancies, clinical observations
show that total suppression of sexual activity is also, if not still more, a
powerful factor in the production of premature senility. There is no denying
the fact that spinsters, after the age of thirty or forty, often look older than
married women with small families. See also our chapter on the “Hygiene
of the Sexual Glands” on this subject, in which we show by experimental
evidence the dangers of the total suppression of sexual activity.
Evidently nature will not be trifled with, and the ovaries and testicles are
made by the Almighty to serve a certain purpose, just as any other organ.
Their remaining in total idleness is no less harmful than in the case of any
other organ. We fail to see for what reason this organ alone should be made
an exception, and to deny this fact would be hypocrisy.
Persons who live in total sexual abstinence are very often of a nervous,
neurasthenic, or even melancholic disposition. If we consider how intimate
are the relations of the sexual organs with the thyroid, we cannot exclude
the possibility of changes in this important gland under such conditions.
The relationship between the sexual glands and the thyroid is also
demonstrated by experimental evidence. Thus Cecca found, after
extirpation of the ovaries or testicles, that the thyroid shows an
accumulation of colloid substance; again, Jayle saw the appearance of
exophthalmic goiter in a case after castration; and, on the other hand, Prof.
Hoffmeister, of Strassburg, found a premature ripening of the follicles in the
ovaries after thyroidectomy.
Freund constantly found goiter in cases of fibromyoma of the uterus, and
in two cases the goiter has disappeared after operation on the uterine tumor.
It is a well-known fact that exophthalmic goiter can be improved by
ovarian extracts, as Latzko, of Vienna, and others, have shown.
Changes in the thyroid, as a rule, produce certain changes in the sexual
glands. Thus, in exophthalmic goiter menstruation is usually irregular and

often disappears. In myxœdema there is atrophy of the ovaries and sterility.
The above conditions in man often produce sterility.
In partial cases of myxœdema metrorrhagia is frequent. By giving thyroid
extracts these uterine hæmorrhages may be stopped.
After having shown that old age can be caused with more or less
certainty by degenerative changes in the sexual organs, we will now try to
show that it can also be caused by various kinds of intoxication. Especially
is this true of large quantities of alcohol continued for many years.
Alcohol specially influences the ductless glands. Small quantities may at
first stimulate their action, but large quantities, if taken for a very long time,
will cause degeneration.
In the third chapter of this book we have already briefly mentioned the
bad effects of alcohol upon the ductless glands. We have seen that, as de
Quervain, Hertoghe, etc., have shown, alcohol produces very marked
degeneration of the thyroid gland. This has been proved by autopsies on
chronic drunkards. As well as on the thyroid, alcohol also acts upon the
other ductless glands. It acts, for instance, upon the adrenals. Its action in
small doses is similar to that of adrenalin. Alcohol in small tonic doses
excites the activity of the splanchnic nerves, and so may produce an
increased flow of adrenalin and a higher blood-pressure (see Chapter XV).
Alcohol in large doses may also have a degenerating effect on the sexual
glands. Small doses can stimulate, but large doses are decidedly harmful.
Temporary impotence may result in such cases, and chronic impotence in
inveterate drinkers.
Though alcohol in large doses is harmful, and if taken in very large
quantities for many years can hasten old age, there is absolutely no reason
to suppose that in small doses it has any etiological relation to senility. In
fact, there are many cases on record of persons who have taken alcohol,
especially wine in limited quantity, every day, and have lived to enjoy a
healthy old age.
One of our confrères, a surgeon of Lotharingia named Politiman, lived to
be 140. As Professor Pel, whom we quote, says, the historian explains that
this old age was due to the medicine this worthy doctor took every day after
doing his work. He had drunk his fill every night since the age of twenty-

five years. Another surgeon, Espagno, lived to be 112 with no less moderate
habits! Countess K——, who died in Nicolajew in Russia, a few years ago,
at the age of 111 years, took daily a cordial in the form of a good drink of
cognac; and about one and a half years ago the Daily Mail of London
brought to public notice the case of a Mrs. Anderson living in Springfield,
near Glasgow, who, in spite of her 103 years, was taking daily a
tablespoonful of whiskey.
A strong point against the anti-alcohol faddists is the case of Brown,[164]
an Irish peasant, who, after many years of heavy beer-drinking, attained the
age of 120. His tombstone exhibits the following epitaph:—
“Here lies Brown, who became 120 only through the strong beer he was
drinking. He was constantly drunk, and in this condition so terrible, that
even death was afraid of him. When, however, one day contrary to his
habits he was sober and in a quiet mood, death got courage, seized him, and
thus at last was triumphant over this incorrigible drunkard.” (See, further,
Chapter XLI.)
All these examples merely show what we have so often insisted upon,
that everything depends upon heredity. There are many causes that produce
premature senility. It seems, also, that when only a few of these causes, or
only one, is acting, there is a possibility of a successful fight against it. It is
a different matter when all, or several, of the causes of old age are present.
As the German proverb says: “Viele Hunde sind des Hasen Tod” (“many
dogs mean death for the hare”).
It is a very interesting fact that seldom are all the various kinds of
immoderation united in the same person. Thus, some persons may drink and
smoke heartily and, perhaps as a result of the action of these poisons upon
the sexual glands, may be better able to combat their sexual instincts. This
will also explain the drinking habits of some old spinsters or widows. They
“drive out the Devil with Beelzebub,” as the German proverb says. On the
other hand, many total abstainers from alcohol and tobacco are far less
successful in combating their sexual instincts, and for such persons
marriage is a necessity.
As a rule, celibatarians show symptoms of old age much sooner than
married persons.

If among those addicted to drink there are many instances of long life,
among smokers such instances are much fewer.
As Professor Pel says, there was only one man among many, of those
over 100, who was a smoker (see Chapter XLII).
It is also of interest that among very old people we find many with very
decided sexual tendencies. Evidently such persons must be in possession of
very active sexual glands, which indicates also a healthy thyroid (see
Chapter V).
We may class alcohol with tea and similar beverages. A small amount
every day may be a good thing, but in large quantities they may all become
injurious and tend to shorten life.
Tobacco, according to clinical observations (Huchard), is apt to cause
arteriosclerosis, just as alcohol in large doses; and this is also proved by
experiments—e.g., those of Isaac Adler and Hensel—which show that
atheroma of blood-vessels can be produced in animals, experimentally, by
nicotine.
Everything points to the fact that tobacco is especially injurious to the
adrenals. We will treat of this subject more fully later on when discussing
the hygienic treatment of old age.
Many conditions of chronic intoxication, and hence premature senility,
may be caused by faulty food, especially if taken in large quantity, for a
long time. Even fresh albuminous food of animal origin, if taken in large
quantity every day, may prove harmful. We have seen previously, in
Chapters III and IV, that meat produces by its decomposition certain
poisonous substances which should be destroyed by the ductless glands.
Premature old age frequently occurs in people who live a sedentary life,
and at the same time consume much rich food and alcohol. This causes
obesity, and the muscles and nerves which are little used, are prone to show
degenerative changes after a certain time. At any rate the processes of
metabolism are diminished in these structures, since their supply of fresh
arterial blood is always reduced if no work or exercise be performed.
It is a well-known physiological fact, that nerves which are inactive lose
their excitability and degenerate. This holds good for motor nerves, and we
can also note degeneration of muscles and organs which are not used. Thus,

the nerves of an extremity, after amputation, undergo a process of
degeneration. The lower limbs of people affected with infantile paralysis, or
of persons obliged to remain in bed for a long time, show atrophic changes.
Hence we can easily see the necessity for exercise, which increases the
blood-supply to the muscles and nerves. Work of any kind, even mental
work alone, is a means of preventing precocious senility; if manual exercise
is combined with it, it is still more efficacious.
Plutarch, in his “De educatione puerorum,” mentions that a certain
amount of work improves the mind, but excess of work is prejudicial.
We see the best illustration of this fact in American business men. There
are no men in any country who do such an amount of work, and at the same
time take so little recreation or exercise. They sit in their offices till dusk,
with a few minutes’ interval for a hasty meal, consisting mainly of meat that
has often been kept in cold storage for a long time, after which business
goes on again, at high pressure, until the evening. Then, instead of walking
home and taking exercise, they take a car or carriage to their house or club,
and pass the evening in smoking and drinking, sometimes to excess. Day
after day the same killing of body and nerves goes on till these people look
old long before fifty, if, indeed, they reach that age. Arteriosclerosis,
diabetes, gout, and obesity find many victims among such men. It is sad to
think how many thousands of these splendid people, full of genius and
talent, could be saved for their native country if only they had been taught
in their youth the most elementary rules of hygienics. What joy does money
afford without health?
Some of the most powerful agencies in producing old age are frequent
mental emotions, especially sorrow and grief.
It is a common fact that after such emotions people soon look older. To
mention an example, there is positive evidence that young persons, after a
mental shock, have become gray in a single night, thus developing abruptly
one of the most typical symptoms of old age.
That mental emotions, especially anger, grief, sorrow, fright, anxiety, etc.,
are very harmful to glands with an internal secretion, is shown by a series of
clinical observations. Sajous has in fact termed sensorium commune, i.e.,
the center which receives all shocks, the governing center of the ductless
glands, located in the pituitary body.

With mental emotion there is often disturbance of a function, interference
with which is very liable to hasten the onset of old age, and this is sleep.
We frequently notice that persons who have not slept well for several
nights, especially if passed on a railway journey, look worn out and older.
After a good night’s rest these effects disappear and they look fresh and
younger again.
There are other functional disturbances which are especially harmful as
they interfere with the elimination of harmful products either introduced
with the food or found in the body (e.g., uric acid). This applies also to the
bowels, perspiration, and diuresis. When these important functions are
checked, there is retention of poisonous products and a condition of auto-
intoxication. These functions are governed by the ductless glands,
especially the thyroid, as we have seen in Chapter VI. It is easy to
understand that by their interruption the onset of old age is hastened, as
these toxins will cause deterioration and destruction of epithelium and the
formation of connective tissue in its place. Retained poisonous products
play a very great etiological rôle in the production of arteriosclerosis, which
is found as a typical symptom of old age in the large majority of aged
persons.
We thus see that all those agencies which by common consent are usually
considered the most frequent causes of old age, are also very detrimental to
the ductless glands, especially the thyroid. They produce hyperactivity, with
subsequent exhaustion, in these important glands. The pathological and
anatomical changes indicating hyperactivity give place to those of atrophy.
We have given an example of this in discussing the changes in the thyroid
in infectious diseases. The formation of connective tissue is the final result.
Thus a condition of the thyroid arises similar to that in myxœdema, which,
as we have stated, can be produced by causes similar to those which
produce old age—i.e., infectious diseases, exhaustion of the ovaries after
pregnancies or sexual excesses, mental emotions, etc.
The pathological and anatomical changes in the thyroid, consisting of an
increase in the connective tissue, as in myxœdema, will logically produce
clinical symptoms, and these symptoms are the same as those of
myxœdema.

Therefore we are justified in assuming that old age will show the same
clinical symptoms as myxœdema.
We have shown that, given changes in the thyroid gland, the other
ductless glands will be altered too; for instance, the liver and kidneys. These
glands have an important function in freeing the organism of poisonous
substances. As in old age their secreting elements are more or less
atrophied, they are unable to execute their task properly, and these harmful
products will accumulate. Now, there are important organs which can act as
corollaries to these glands. These are the intestines and the skin. They also
are under the influence of the thyroid. In diseased conditions of the thyroid
they are unable to perform their functions regularly. The poisons will not be
eliminated, and thus a condition of auto-intoxication must arise.
Just as after extirpation of the thyroid there is an increase of connective
tissue or fat in various organs and tissues (as Demange found), so in old age
there arises a condition of sclerosis in the tissues and organs.
On this account, strictures of the urethra are readily produced in old men
who have had gonorrhœa scores of years ago. The prostate gland, owing to
the abundant formation of connective tissue, will also enlarge, although
usually sclerosis of an organ is accompanied by diminution in size. In the
central nervous system, just as after extirpation of the thyroid, there is
proliferation of neuroglia. Through destruction of the nerve cells those
mental attributes arise that are deemed typical of old age: Egotism, enmity
against all new ideas, conservatism, etc., which we described in our address
on the origin of crime before the Philadelphia Medical Jurisprudence
Society, April 14, 1907.[165] The same mental characteristics are also typical
of degenerated conditions of the thyroid and pituitary body, as we have seen
in a case of acromegaly whose history we owe to Dr. Dercum, of
Philadelphia.
To recapitulate, we may state that old age is caused by degeneration of
the ductless glands, and that there exists a condition of auto-intoxication in
old age.
The symptoms of old age are the result of breakdown of the tissues and
organs which, owing to shrinking of the blood-vessels, are insufficiently
supplied with blood, and, owing to the disappearance of nervous elements,
are devoid of proper nervous control.

Degeneration of the ductless glands and of the organs and tissues cannot
be simultaneous, for the latter are under the control of the former. These
glands govern the processes of metabolism and nutrition of the tissues, and
by their incessant antitoxic action protect the organism from the numerous
poisonous products, be they of exogenous origin, introduced with air or
food, or endogenous, formed as waste products during vital processes. After
degeneration of these glands the processes of metabolism in the tissues are
diminished, and there is an increase of fibrous tissue at the expense of more
highly differentiated structures.
The fact that the changes in the tissues are secondary and take place only
after primary changes in the ductless glands, is best proved by the
circumstance that they can be produced, either experimentally by the
extirpation of certain of the ductless glands, or spontaneously by the
degeneration of these glands in disease.
Our theory as to the causation of old age by degeneration of the ductless
glands has been confirmed by several writers, some of whom had no
knowledge of our existing work.
Thus Campbell, in July, 1905, published a short note in the Lancet,
attributing old age to degeneration of the ductless glands, overlooking our
previous communication to the Paris Biological Society.
Two years afterward Pineles, in an article published in the Wiener klin.
Wochenschrift, comparing the origin of diabetes, tetany, and old age, came
to the conclusion that old age was caused by the same agency (i.e.,
alteration of the ductless glands) as the other conditions mentioned.
Sir Herman Weber, in his interesting work on the prolongation of life,
also attaches great importance to degeneration of the ductless glands as a
cause of old age.
In his work on the same subject, Professor Metschnikoff admits, only
partially, the truth of our theory on the causation of old age. He admits the
great importance of the ductless glands in the pathology of old age, as they
serve to destroy poisons. He denies, however, the relation of old age to a
myxœdematous condition; but everyone who knows the pathology of
myxœdema will see that the arguments of Professor Metschnikoff cannot
stand, for they have no foundation.

His arguments are that there is an œdema in myxœdema, but not
necessarily in old age; that the hair falls out in myxœdema, and that
myxœdematous women have abundant menstruation, while old women
have none; that myxœdematous persons have strongly developed muscles,
and old people, on the contrary, weak and feeble muscles.
The truth is that there is often no œdema at all in myxœdema; that the
hair often does not fall out in myxoedema, especially in its partial form
(hypothyroidia); that myxœdematous women have, as a rule, no
menstruation (atrophy of the ovaries); and that myxœdematous people have
not a strongly developed muscular system, which is rather degenerated by a
new growth of fat, or connective tissue, or a mucinous tissue, following the
degeneration of the thyroid just as it follows its extirpation. Professor
Metschnikoff also states that certain animals that soon become old do not
develop cachexia after extirpation of the thyroid.
This was the belief about eighteen years ago, but now we know that they
all develop cachexia if the operation is so performed that the parathyroids,
or at least some of them, are allowed to remain untouched. Professor
Metschnikoff’s views have been greatly weakened by the far more
extensive researches of Professor Sajous which have conclusively shown
that the life process, its activity and duration, is dependent upon the ductless
glands, including the thyroid.
It is evident from the above considerations that all hygienic errors, be
they errors of diet or any kind of excess, will bring about their own
punishment; and that premature old age, or a shortened life, will be the
result. In fact, it is mainly our own fault if we become senile at sixty or
seventy, and die before ninety or a hundred.
It may be the privilege of a few to live until ninety, even though
worshipping immoderately at the altars of Bacchus or Venus! But these are
very few, and as we have seen, they have lived on the heritage of their
forefathers, not merely in an illustrative sense, but also in reality, for the
greater number of such persons have grown up in easy circumstances
without knowing the wear and tear of care and sorrow.
Not only old age, but the majority of diseases, are due to our own fault in
undermining our natural immunity against infections, and subjecting our
various organs to unreasonable overwork and exertion. We do not believe

that the worst slave-driver of olden days subjected his slaves to such
treatment as we do our own organs, and especially our nerves. At last they
must rebel, and disease, with early death or premature old age, will be the
result.
It is literally true, as the German proverb says: “Jeder ist seines Glückes
Schmied” (every man is the locksmith of his own happiness), and as a
variation on this we would say: “Every man is the guardian of his own
health.”

CHAPTER IX.

The Rational Prevention of Premature Old Age and the
Treatment of Old Age.

General Remarks.

We have shown in previous chapters, through facts from pathological
anatomy, experimental pathology, and clinical medicine, that old age is a
disease characterized by the abundant growth of connective tissue,
diminution of the oxidations, and a condition of auto-intoxication.
This disease is caused by the degeneration of the glands with internal
secretion, especially the thyroid, ovaries, testicles, liver, and kidneys.
In the same way, and to the same extent as most other diseases, this
disease is also amenable to treatment, although a thorough cure, except in
cases beginning in very early years, is just as little possible as in most other
diseases.
In keeping with the majority of diseases, old age is progressive, and, in
fact, is so to a far higher degree than other diseases. It is seldom stationary;
it goes on all the time. This we shall easily be brought to understand from
the fact that the more time progresses, the more food is taken to sustain the
processes of life. By the deficient action of the glands, whose rôle is the
proper assimilation of the food and the destruction and elimination of
poisonous products of the body, these toxic substances will accumulate, day
by day, especially if meat be taken, and thus the continual poisoning will be
augmented as time goes on. Thus it must be our most important task to
check the progress of a condition in so high a degree injurious to the body.
Let us consider the means by which we can prevent this disease, for
“prevention is better than cure,” says the English proverb.
The preventive treatment of old age is in no less degree possible than that
of any other disease. To prevent old age rationally, we must avoid all those
harmful agencies which may be deleterious to the glands with internal
secretions, as it is the degeneration of these glands that brings it about.
These agencies, however, being exceedingly numerous, we have mentioned
in the previous chapter only those which are in the highest degree
detrimental and also the most frequent.

By avoiding these we believe we could successfully combat old age, but
only for a certain time; and if not longer, in spite of our careful hygiene, it
would not be our fault, but that of our ancestors of many generations ago
who did not observe the rules of hygiene even as well as we do, and left us
ductless glands of inferior quality.
Parents can only bequeath to their children ductless glands of the same
quality as they themselves possess. This undoubted fact is clearly proved by
the experimental, pathological, and anatomical results we have mentioned
in the chapter on heredity. We will illustrate this by the following examples,
which will show how often it is difficult to avoid harmful agencies, and
how much depends on having been born with healthy ductless glands.
A person inhales air that contains virulent bacilli and contracts
tuberculosis. Another drinks a glass of water or milk, contaminated by
water or kept in vessels that have been washed with water containing the
bacilli of Eberth, and contracts typhoid fever. Conversely, others who have
inhaled the same air and drunk much more of the same water, have
remained free from any infection.
The cause of this is that the first mentioned have inherited defective
ductless glands from their ancestors, and probably afterward have ill-treated
these glands by an immoderate use of all those agencies that are detrimental
to them, such as alcohol, sexual excesses, much meat, tobacco, tea and
coffee in large quantities, etc., and thus could not produce anti-bodies to
counteract the infection.
Of course, the fault does not lie entirely with such people, but that from
their birth they are the victims of the immoderation of their ancestors; and
by this fact alone are doomed to more easily succumb in the incessant fight
against the microbes, and therefore a limited lifetime has been already
meted out to them at birth.
We have, in the chapter on heredity, quoted instances of persons coming
of short-lived families, who reached a great old age; but this was due solely
to exceedingly careful hygiene. It is not always easy to observe these rules
scrupulously, and besides often necessitates the possession of means to
carry them out and to enable us to be more exempt from the wear and tear
of life—cares and sorrow,—which shorten the lives even of persons with

healthy glands, though much more of persons who have inherited defective
ductless glands.
It has been shown by statistics[166] that the present generation is longer
lived, and that the average of life is longer, than was the case one hundred
years ago. This is solely due to the fact that now-a-days we know more of
hygiene than our forefathers did, although the struggle for existence and
competition everywhere has certainly become more keen, with the
inevitable worry and depression of mind which it so frequently brings
about. This lengthened life is certainly due to more careful hygiene,
especially against infectious diseases.
The extended life of an individual depends always, first, on the inherited
qualities of the ductless glands, and, secondly, on a sound observance of
hygienic measures.
To prevent old age coming on too soon, the first condition necessary is
the possession of healthy ductless glands, and this will depend, as just
stated, on heredity. We can exert no influence on the generations that have
passed away, and must therefore direct all our attention to the generations
that are to come. This can only be done by influencing the laws of marriage,
and particularly by prohibiting the marriage of persons suffering from
diseases that are most detrimental to the glands with internal secretions.
Children of people suffering from syphilis, tuberculosis, chronic
alcoholism, etc., are, as we have seen, born with congenital atrophy of the
thyroid gland, and are especially apt to acquire all infectious diseases, such
as tuberculosis, with the greatest facility.
The Bible is literally true when it says that the sins of the fathers are
visited even unto the third generation.
Thus we can influence the baby even before it is born; let us then
consider what we can do after its birth to prevent premature old age and to
secure for it a prolonged existence.
The mother of the future child must carefully avoid anything that may
prove fatal to the fœtus or influence its nutrition. It is a well demonstrated
fact that different kinds of harmful products, i.e., drugs and probably also
stimulants like alcohol, coffee, etc., can be conveyed to the fœtus. A
pregnant woman must, therefore, most strictly observe all the rules of

hygiene, and especially abstain from the use of drugs which (as for
instance, iodine, the bromides, etc.) can also take effect on the fœtus and
prove detrimental; emotions must especially be avoided.
When the child is born the best nutriment for the baby is the milk of its
mother, and if the mother be not available for this purpose, a wet nurse must
be obtained, for human milk is indispensable in the nourishment of the baby
if we desire to influence its future immunity against infections; for this
important purpose all the internal secretions of the ductless glands go into
the child through the milk which contains them. Sajous holds that millions
of infants die solely because they are deprived of what nature provided for
them, the maternal milk, which not only nourishes them, but protects them
against disease.
The infant is practically helpless against infections, for its thyroid
contains scarcely any colloid substance, sometimes none; and it also
contains no iodine,[167] especially in children who are descended from
parents suffering from chronic cachectic diseases, such as tuberculosis,
syphilis, malaria, insanity, etc. The other glands are also not yet sufficiently
developed, as this takes place generally in the years toward puberty.
All the internal secretions will, therefore, come to the children from the
mother or wet nurse.
The above fact also explains why infectious diseases are so very frequent
among infants, and also among children before the years of puberty.
The avoidance of infectious diseases is especially important for infants,
for in later life many other infections will occur preferably in those children
whose ductless glands have been weakened by previous infection.
Therefore, even with adults, when we take the history of a case we should
inquire whether, in childhood or later, the patient has suffered from
infectious diseases. The necessity of such a procedure will be more clear
after we have shown their relationship with a weakening of the ductless
glands.
The possibility of premature old age is greater in a person who has
suffered from one or several infectious diseases in childhood than in
another who did not contract any.

Very interesting experiments have been made on puppies fed on their
mothers’ milk, and some with raw and boiled cows’ milk, showing the
superiority of the bitches’ milk, and also of the unboiled milk.
When human milk is not available for divers reasons, fresh cow’s milk
should be employed, using it raw, however, in order not to destroy, by
boiling, various substances of the nature of ferments. Before giving it to the
baby, the cow’s milk should be diluted with water, and milk-sugar and
cream should be added to make it more like human milk (see Chapter on
“Milk Diet”).
Of course, when giving raw milk, we must ascertain that it comes from
cows examined specially for tuberculosis, and that the milk is of the best
quality and very fresh since it has been shown that its power to kill bacteria
—and therefore to protect the child—begins to decrease soon after it is
drawn.
Not only for the infant in arms, but for the growing baby and child during
its first year, milk food, containing largely of milk and cereals, will be the
best diet, excluding meat entirely, since in these tender years the ductless
glands are not sufficiently developed to destroy poisonous products that
arise from the end-products of decomposition of meat. By giving these little
creatures meat we may depreciate the efficiency of their ductless glands
through unnecessary strain in the destruction of poisons, and thus diminish
their chances in later life, of a prolongation of youth and a happy old age.
For the same reasons and even more weighty ones, alcohol, coffee, tea, etc.,
should be avoided.
It is sad to reflect that, in some countries, alcohol is given to children,
who are even far more helpless against it than adults.
We have observed in Northern Hungary that the children of the Slovacks,
a Slav nation that inhabits certain parts of Hungary—the native land of the
writer,—are stunted in their growth. The reason for this is, that in these
parts of Hungary, where there are plenty of potatoes, but a scarcity of other
food, the peasants give brandy to their youngsters. As we have seen in the
second chapter of this book, the growth of the human body depends on the
thyroid gland. The fact that these children do not grow shows that alcohol is
deleterious to the thyroid. This question will be considered more fully in the

chapter on alcohol. The advantages of milk food we shall also treat more
fully in a separate chapter.
To deal with old age rationally, we must begin in childhood to fight
against it, as all those agencies that tend to produce it prematurely can at
this age prove far more deleterious; and as in this world no action is lost—
whether for good or evil—we must reap the results of our imprudence in
later life.
Unhappily at this tender age we have no reasoning powers, the glands
governing them not having been developed, and therefore our parents or
guardians must act for us. Their want must also be supplied by the teacher,
and we believe it would be productive of great good to teach the elementary
rules of hygiene in school at the same time as reading and writing.
The impressions we first get in childhood remain throughout life and are
never forgotten; therefore, hygiene should be learned even by small
children. The soul of a child is like plaster of Paris, that can, like dough, be
moulded into any shape we desire. It is at this early age that we should learn
of the necessity of a bath every day, of moderation in food, the avoidance of
certain stimulants, such as alcohol, and also of tea and coffee in large
quantities.
Alcohol, coffee, and tea are especially injurious to children. The
celebrated German clinician, Strümpell, writes as follows in the
Pædagogical Pathology: “Among the acute as well as chronic intoxications
—which can be the cause not only of a temporary, but also of a prolonged
psychopathic condition,—intoxication by alcohol, and by stimulants
generally, plays the greatest rôle. Such abuse is especially noxious to
children, and causes an enormous number of diseases with psychopathic
results.” We ourselves believe that it is a crime to give alcohol to children,
and that it should be punishable as such.
Dr. F. Heyn, in a statistical contribution on “Idiocy,” that appeared
recently in the Psychiatrisch Neurologische Wochenschrift, showed that in
17.6 per cent. of cases of idiocy in children the above-mentioned fault in
hygiene—the use of alcohol, tea, and coffee—was the cause. Thirteen years
ago Director Trüper, in a monograph on the psychopathic conditions of
childhood, insisted on abstinence not only from alcohol, but also from

coffee, by women during pregnancy; but it should be noted also that these
agencies continue to be deleterious years after a child is born.
Above all else we must try to make a good man or woman of the child, as
this also is an essential safeguard against disease and premature old age. We
should endeavor to interest children while they are yet of a school age in the
fine arts, such as music, painting, and literature, as they have a very
favorable influence on the hygiene of the mind in after years. Religious
instruction also gives good results in this respect.
When children approach puberty it is important to avoid an agency that
may prove very deleterious to certain of the glands with internal secretions,
and this is masturbation.
We will not commit the error made by so many unscientific writers of
ascribing much greater importance to this matter than it deserves. It
certainly is not true that tabes dorsalis, dementia paralytica, or other serious
nervous diseases will result from this source; but it cannot be denied that
neurasthenia or hysteria or impotency—sexual neurasthenia—can be
promoted by the exaggeration of masturbation, if indulged in many years.
Masturbation is always injurious to the sexual glands, more so to the
male than to the female organs, and in addition to the thyroid, and—if in
excess—to the adrenals. It also very unfavorably influences the mind and
character.
In youth, instruction as to the control of the sexual passions will be of the
utmost importance, even considering alone the dangers of infections,
especially of gonorrhœa, which not only endangers the future husband, but
the future wife also. We need here but mention the well-known fact that the
thorough and radical cure of syphilis may even more readily be
accomplished than that of chronic gonorrhœa.
We have mentioned above that after gonorrhœa (every chronic
gonorrhœa involves the prostate gland) there are severe disturbances of the
nervous system, which may also influence the mind, causing hypochondria.
To prevent all these dangers there has been formed in France a society
called “Société Française de Prophylaxie Sanitaire et Morale,” which
advocates the necessity of instructing boys and girls as to all the dangers
that threaten them and how to avoid them.

Happy is the young man who is able to live in perfect chastity without
harm to mind or body. We will enter more fully into the consequences of
complete sexual abstinence in the chapter on sexual hygiene; but the great
majority of young men have the danger from sexual intercourse suspended,
as the sword of Damocles, over their heads, and the best way to avoid this is
by marriage.
Marriage is, indeed, an invaluable aid in the struggle against old age; but
sometimes, although this is an exception, it may turn out to be a double-
edged sword.
By marriage a young man acquires regular habits, and by the assistance
of a loving wife is better able to control his passions; and last, but not least,
the hygiene of the mind will also be improved. The inevitable hardships of
life are thus less felt.
These great advantages of marriage can, however, exist only in cases
where the two halves make one whole—i.e., where the sun of happiness
shines in the marital sky. For this purpose each of these two halves must
endeavor best to please the other. The husband must, as is quite in the
nature of things, show the utmost forbearance to the wife, and never forget
that, on account of her different anatomical and physiological constitution,
the mind of the female is far more exposed to frequent irritation as a natural
consequence of the frequent alterations of the sexual glands and thyroid in
women. It would be unreasonable to blame her for a condition for which
not the woman, but her Maker, is responsible.
If married life is one of the best means to defer old age, on the other hand
it is positively certain that unhappy marriages are the surest means to hasten
its oncoming; but these are the exception, and, as in everything else, the
exception only proves the rule.
A single man, or woman, is far more exposed to all the agencies we have
referred to above as being deleterious in causing old age and especially
depressed conditions of the mind, these being the consequences of total
sexual abstinence, faults of hygiene in diet, use of stimulants (alcohol in
men, coffee, tea, etc., in women), fewer precautions against disease, and so
many other agencies of less importance that there can be no doubt that the
bachelor or spinster, as a rule, will become old in earlier years than the
married person. Therefore, although himself still a bachelor, the writer feels

compelled to sing the praises of married life as a hygienic factor favoring
old age.
The possession of children is heavenly bliss to married people, and their
pride and joy in them, and in living with youngsters, renders the parents
young, as the German proverb says. But as every good thing, if in excess,
may turn out to be harmful, omne quod est nimium vertitur in vitima, so too,
many pregnancies may prove very harmful in the fight against old age,
especially when the mother nurses for a long period each of the children. In
women who produce much milk this may prove advantageous to health if
not too greatly prolonged; but in women with a meager provision of milk—
as in cases of thyroid insufficiency—it may prove disastrous by destroying
the means of keeping youthful till an advanced period.
In married women with many pregnancies much will depend on external
circumstances of life, and it is certain that nothing will hasten the advance
of old age as many pregnancies, the mother suckling all the children herself,
in combination with deficient food, the wear and tear of poverty, and with
anxiety as to the morrow. This cruel struggle for daily bread is what renders
the women of the lower classes old before their youth has passed.
To prevent the deleterious consequences of too many pregnancies on
beauty, health, and wealth, in certain countries, as in France, the habit of
having one or two children has been encouraged by artificial means.
However, as is always the case when our acts disregard Nature, great
mischief may thus arise, and even in cases where death has not followed
abortions, very often such irreparable damage is caused to the organs on
which youth and beauty depend that the oncoming of old age is still further
hastened.
The endometritis and peri- and parametritis of many years duration,
which are sometimes the result of such procedures, influence the
appearance of these persons more unfavorably than many pregnancies.
Parents who have many children may be regarded as the happiest of
mankind. Their name is forever perpetuated through their numerous sons,
and their flesh and blood survives in their children, to quote the great
German philosopher, Schopenhauer.

The years of the climacteric are the most troublesome in married life, not
only for the wife, who is directly affected by it, but also in almost equal
degree for the husband, who must show the greatest forbearance to his wife
at this period. The sun is setting! It is not merely that the decline of the
sexual functions produces certain changes in the body, which are especially
noticeable in the external appearance; the influence on the mind also
produces deleterious effects. Therefore we must direct all our attention to
the hygiene of the mind. In married women with loving husbands and
children the task will be much facilitated. As we have already mentioned,
this stage of human life is most felt by professional beauties, who witness
with chagrin the vanishing of their power over the hearts of men. In many
spinsters living alone, friendless, this is also a frightful stage of life. Here
we have again an opportunity to observe the wonderful soothing effects of
religion, which offers us consolation in all our troubles. Religious women
will, therefore, much better withstand this most difficult part of their life.
Religion and philosophy, too, may be still more helpful to overcome mental
depression.
It is interesting to note that many women, even those previously little
given to religious practices, turn over a new leaf, and to make up lost
ground, become quite pious. Such as in their youth were haughty and proud
beauties, and only went to church to exhibit their new hats and toilette, now
become meek and modest, and never miss a religious meeting or exercise.
Still, even after a woman has passed the climacteric, everything is not
lost if only she be a clever member of her sex. In fact, something remains
that may even place her above her much younger sisters, and that is
experience and knowledge of the world; and if, by the aid of a skillful
toilette, she is able to make the best of what good looks remain from better
days, it is probable that she will outdo many of her sisters far below her in
age.
Even if at this time of her life, aware of the approach of old age and its
cruelties, she may be inclined to say with Longfellow, “but the hopes of
youth fall thick in the blast,” still there are, in the present state of science,
plenty of resources open to her, no less than to a man, to put off old age for
a score of years, or to mitigate its effects when it has asserted itself with all
its terrors.

We owe our knowledge of the fact that there is a treatment for old age to
the famous French scientist, Professor Brown-Séquard, whose father was
American and who, for a time, was professor of physiology at Harvard and
later a practitioner in New York which he left to become professor of
physiology at the University of Paris. Although, before him, Claude
Bernard, a man of no less fame, had shown the existence of internal
secretions, Brown-Séquard was the first to draw practical conclusions from
this fact, and the first who gave a solid basis to the doctrine of internal
secretion.
Brown-Séquard was the first to use the extracts of a ductless gland (the
testicle) for therapeutic purposes, although thousands of years before him
the Chinese had used different organs for purposes of healing, and the
savages of Africa ate certain portions of their enemies—the liver and the
testicles—to enhance their own courage.
Brown-Séquard obtained surprising results by using the crushed extracts
of rabbits, guinea-pigs, and dogs, of which we will say more in the chapter
on the prevention and treatment of old age by organic extracts.
Unhappily, as human nature is prone to attack every innovation or to
ridicule it, in spite of the great reputation of this savant, his discoveries
were skeptically received; and if the extracts of another similar gland—the
thyroid—had not yielded such marvelous results, probably the author of the
present work would never have had the opportunity to write on the
treatment of old age with organic extracts.
It has been shown by many authorities that the thyroid gland is able—as
we have already mentioned several times in different parts of this book—to
augment the processes of oxidation, and it has also been stated by several
authorities, such as George Murray, Vermehren, Hertoghe, and Laache, that
persons treated with thyroid extracts appear much younger after the
treatment—sometimes, as Hertoghe mentions, ten to twenty years younger.
Now, if a person suffering from complete myxœdema can obtain such a
result by the use of thyroid extracts, should not a person suffering only from
a partial form of the same disease be able to obtain similar results? It would
be quite contrary to our physiological conceptions that a person in a bad
condition of health and in physiologically inferior circumstances should
benefit more, by exactly the same treatment, than another person who is in a

much better condition of health. Therefore, the thyroid treatment of old age
is justified. And indeed, we ourselves have seen astonishing results from
thyroid treatment, not only in old people, but also in persons under 40.
Thus the thyroid can be of valuable aid for the prevention of old age, and
for deferring its onset as long as possible; and for this purpose it will be
necessary to begin our treatment in women at about the age of 35, or in
certain cases, such as where many pregnancies have occurred, even before
this age, and in men at some time after 40 (see also Chapter LIII). Still, to
avoid abuses in the use of this efficient drug, it would be necessary to pass a
law prohibiting its sale without a medical prescription.
Besides the thyroid gland, the extracts of the sexual glands can also be
used; thus, ovarian extracts for women, and testicular extracts for men.
We have also witnessed good results with ovarian and testicular extracts
of pigs. Long before ourselves, Brown-Séquard and Professor von Poehl
and many others made very interesting observations on testicular extract, on
which we shall dwell in the chapter on the treatment with testicular extracts.
Besides the above extracts, those of the kidneys and of the pancreas have
also given us, and others, very good results, and they can be used with
advantage in the prevention and rational treatment of old age in
combination with the other extracts, though preferably in cases where the
functions of these organs are deficient. In old age that has already become
manifest they should always be used, as they will facilitate the work of
these very important organs, and thus prolong their vitality. In this manner
an old man will be able to employ these organic extracts of the pig to work
for the benefit of his own organs, or, at any rate, to assist in their work.
We have given above a sketch of the dangers that follow us from the
cradle until old age, and hasten its arrival, and shown by what means we
can avoid or diminish them in the different stages of life; we would now
like to offer a few hints that may prove useful for any of these periods in
life.
We have shown in the previous chapters that the degeneration of certain
glands with internal secretions, especially the thyroid, liver, and kidneys,
will produce a condition of auto-intoxication, as poisonous products will
not be destroyed in the proper manner, and also not eliminated from the

body. Therefore our whole energy must be turned to working in time against
this auto-intoxication of the body. This can be most rationally done by a
careful hygiene of these different ductless glands—into which we will enter
later in separate chapters—and also by special cultivation of the functional
efficiency of those organs that eliminate poisonous products from the body,
such as the kidneys, intestines, and the skin.
These three organs are in close relation to each other, for when one is
threatened the others come to its assistance and aid it in the work of
elimination. Thus, when the kidneys are not functionating as they should,
the skin comes to the rescue and helps to eliminate a large part of the
remaining products by increased perspiration. Nature often does this
spontaneously before we come to her aid.
The intestines will do their best, in like manner, to expel a part of these
products. Recognizing this co-operative action of almighty Nature, we must
also try to be of assistance by careful hygiene, and later on we shall see
what will be the best way to effect this; but let us at once urge here that the
necessity of having the bowels moved daily should be insisted on from
earliest childhood. Especially is this of the greatest importance in the case
of young girls, for with them this most necessary rule of hygiene is so often
neglected. There is no doubt that, in many persons, fæcal matter can
stagnate in the intestines for a few days without much consequence, as the
epithelium of the intestines, when in sound condition, may prevent the
entrance of poisonous products. But it may be different when this becomes
a habit; and when the epithelium is not in perfect order,—as is often the
case after prolonged constipation, or with catarrhs of any kind, or with
excreta which by their shape may injure the epithelium mechanically,—
resorption will follow.
At any rate, it is an every day occurrence for persons who have not had
their bowels moved, even for one day, to complain of headache and other
symptoms of uneasiness, so that it is impossible to regard these as simple
reflex actions, as some are disposed to think, but rather as symptoms of
auto-intoxication. Therefore the necessity of clearing the bowels every day
should be insisted on, and again especially in the case of the young girls, for
it can easily become a bad habit once they have begun to neglect it, and the
sluggishness of the bowels, to which females have a peculiar tendency, is
thus further encouraged.

Everything should be done to prevent habitual constipation in young
girls, for the important reason that stagnation of blood in the adjacent
organs of the pelvis is otherwise promoted, and thereby also a tendency to
subsequent diseases of the sexual organs, from which many women suffer,
at any rate much more frequently than men.
This movement of the bowels every day can best be secured by
appropriate food, such as exercises a gently stimulating action on the walls
of the bowels. Drugs should be avoided as much as possible, for reasons we
will mention in another chapter.
Habitual constipation, if persisting for years, can certainly facilitate the
oncoming of old age, while its appearance can be considerably deferred by
a good movement every day, owing to the prompt release from the
organism of a mass of toxic products.
The great importance of this can be easily realized if we observe the face
of any one who has been constipated for several days. After a thorough
clearing out, the face becomes fresher and the eyes brighter. The
complexion that was previously a dirty gray becomes white and rosy again,
particularly in the case of young women. Should not this prove an object
lesson as to the vital importance of a thorough evacuation daily as a
safeguard against premature old age?
Every physician who practices in a place where the mineral waters have
purging effects has occasion to observe that persons coming to these spas,
looking worn out and gray in the face, with pendant cheeks, and showing all
the signs of auto-intoxication from the retention of poisonous products,
always look much fresher, and, indeed, many years younger, after the cure.
We could observe the same effects in our own case after each purge,
although we do not suffer from habitual constipation.
There is no doubt that freedom from occupation, and particularly life in
the open air, in the woods and meadows, have a very great influence in
effecting such cures; but we may note the same effects after courses of
purging without the aid of such conditions as the above.
The care, not only of the bowels, but of the skin, must be impressed on
every one from earliest childhood, especially the necessity of a bath daily.

Unfortunately, this is too much neglected on the Continent, and becomes
prevalent only as Anglo-Saxon customs are diffused abroad.
By a bath with soap the pores of the skin are better opened, as the dirt
that clogs them is removed, and thus the poisonous products can be given
off through the skin more easily, and the skin thereby justifies its name as
chief assistant to the kidneys. It is, in fact, our second kidney. When the
skin comes into greater activity through the action of the sudorific glands, a
part of the solids in the urine and many harmful matters, which otherwise
would make their way through the kidneys, are eliminated through the skin
instead, in which manner the powers of the kidneys are economized.
It is, therefore, only natural that we should do everything to promote
these important functions, especially since we may regard the skin not only
as a second kidney, but to a certain extent also as a second lung; for it
possesses respiratory functions in addition, receiving oxygen and giving off
carbonic acid to a certain degree.
To assist these functions in every possible way, we must allow the air to
reach the skin freely, for which purpose clothing and underwear should be
porous, in order not to impede the process of respiration and elimination.
This end will also be attained by exercise in the open air and sunshine; in
fact, by remaining out-of-doors as long as possible. All these important
features will be dealt with fully in separate chapters.
Before leaving the subject of the prevention and rational treatment of old
age, we will give a few hints that may be of use in any stage of life.
First, great moderation in the diet should be observed, as large quantities
of food may, in the long run, impair the powers of the digestive organs, and
also of several of the ductless glands, which are concerned in the operations
of digestion and assimilation—the pancreas and liver. Sajous has shown
that the secretion of the adrenals takes actual part in the functions of all
these organs. Everything that is eaten should be thoroughly masticated and
not “bolted”; digestion, in reality, beginning in the mouth.
Meat should not be consumed in large quantities, as it is injurious to
various glands with internal secretions, especially the thyroid and liver, and
after having been taken for a long time in large quantities can promote
arteriosclerosis (see Chapter XVI).

The best nourishment for increasing the chances of a long life and to
defer the effects of old age, is a diet consisting of little meat, much milk,
and vegetables. We have for many weeks lived on a diet consisting solely of
milk, eggs, bread, butter, and fruits, and, we believe, have never felt so
fresh and well disposed to work as during that time and, as friends
remarked, never looked so well, either.
A strictly vegetarian diet, without milk and eggs, is distinctly unwise and
dangerous to health, if followed for a long time. Our anatomical and
physiological construction is not adapted to such nourishment (see the
chapter on this subject).
By many authorities wine is called “the milk of old age.” This is not true,
although it is a fact that many old people feel better after an occasional
glass of claret, when they have been in the habit of taking it for years.
We will deal with alcohol and its deleterious effects in a separate chapter.
Far more injurious than red wine used in moderation, are tea and coffee
used in large quantities. Unfortunately, many of those who fanatically fight
against alcohol, indulge in many cups of black coffee or tea daily, and thus
poison their nervous system. Besides containing thein and caffein, they also
aid the formation of uric acid, as they contain bodies from which the purin
substances are produced (Haig, Hutchison, Walker Hall).
Cocoa and chocolate may be taken in larger quantities than coffee or tea.
Cocoa with milk is, at the same time, very nutritious, as it contains fatty
substances.
Spices should be avoided as much as possible, especially sharp, irritating
condiments, which are so freely taken, particularly in America.
We must not forget that the greater part of all we eat and drink must pass
through the kidneys, the fine epithelium of which is thus easily endangered.
For the same reason drugs should only be taken under medical advice, and
with great reserve, for if taken too freely they may not only injure the
kidneys and liver, but also the stomach, which first receives them.
Sound sleep is of the greatest importance. Most of the organs rest during
sleep; the great brain in particular being completely at rest; but the
disintoxicating glands are most active during sleep. This function should
therefore be promoted by all means, and we shall devote a special chapter

to sleep, its causation, and the treatment of insomnia. Let us, however, at
once mention that sleep can best be encouraged by the use of a large, airy
room, and going to bed early, say, at ten to half-past, and rising at five or
half-past, when sleep has been undisturbed during the night. Seven hours’
sleep is the best; longer sleep, if over seven and one-half or eight hours,
injurious, except for anæmic girls and women. Many people do very well
with six hours’ sleep, but less than this will prove injurious in the long run.
It is astonishing to note the large proportion of persons living to a very
great age that were early risers; for which reason we may conclude that
“early to bed and early to rise” is a valuable factor in the struggle against
old age.
We emphatically repeat, over and over again, the importance of fighting
against our passions and cultivating the hygiene of the mind; this must be
commenced in early childhood and continued through life; and the good
qualities of the mind, which we will call the “positive” features of the mind,
should be especially cultivated, such as kindness, good-heartedness,
friendship, love, magnanimity, hope, modesty, liberality, generosity,
frugality, and above all things, contentment with everything. On the other
hand we may describe wickedness, unfriendliness, hatred, and jealousy as
“negative” features of the mind, which should be smothered at their very
inception in the child.
The most successful way to fight the battle of life is to cultivate
equanimity and follow the beautiful precepts of Hindu philosophy, which
teach us never to hunger after honors and riches, but to be content with
what comes in our way. It should be a lesson to us as to what to avoid when
we take note of the manner in which so many American business men
sacrifice their mind and health in an insatiable thirst for success and riches,
and after attaining them, by a real battle with life, find their health so
impaired that they reap no enjoyment from it. What is the use of a million
when all that life holds dear is lost in the struggle to obtain it, and when,
probably, our children will squander it, as do many sons of millionaires who
have worked themselves to death. Rather be a living beggar than a dead
millionaire!
In the succeeding chapters we will enter fully into detail on all the
subjects we have touched upon in these general remarks. We will describe

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

CHAPTER X.

The Destruction and Elimination of Toxic Products from the
Body and Hygienic Measures for the Improvement of these
Functions.

There is not one thousandth of an inch of our body surface which does
not swarm with innumerable bacteria, and as soon as the continuity of our
skin is severed, as by a small wound, they immediately invade our tissues
and attack us. Happily we are not without means of defense. Our organism
is so well arranged that, as soon as a foreign body enters which might
become injurious, a kind of police organization comes into action, and the
leucocytes, like policemen, arrest the bacilli, and render them harmless by
eating them up. This is phagocytosis, first described by the great French
investigator, Metschnikoff. And so marvelously arranged is our body, that
there are also special substances, the alexins (Buchner), which aid the
leucocytes, and the opsonins, which first act upon the bacteria, so as to
make them more digestible for the leucocytes.
To make the bacilli still more sensitive to the influence of the alexins
there are the agglutinins, observed by Bordet, and by Gruber and Durham,
which immobilize the microbes, and thus aid the phagocytes and alexins in
the performance of their task.
The leucocytes are formed in the lymphatic tissues, especially the lymph
glands and spleen. Thence they circulate through the body and offer
opposition to the microbes and other foreign bodies which they meet on
their way. The red blood-corpuscles of the adult are formed chiefly in the
bone marrow.
The lymphatic glands play an important rôle, not only as the birthplace of
leucocytes, but also in that they are able to arrest noxious substances, such

as microbes, and keep them from entering the circulation. That the
lymphatic structures are able to protect us against bacillary infection can be
shown by the swelling of the spleen in infectious diseases,—such as
typhoid fever, malaria, etc.
The tonsils are also of some importance for our protection against
harmful substances. They become inflamed in various infectious diseases—
such as scarlet fever, measles, acute nephritis, etc. Their great value may
best be shown by the fact that not infrequently, after total extirpation of
both tonsils, a generalized eruption has been observed. Thus we must
always seriously reflect before advising the extirpation of these important
organs, the rôle of which as sentinels is shown by their anatomical position
on either side of the entrance for the most indispensable elements of our
life: air and food. Unless frequent inflammation, and possibly irritative
nephritis, demand an operation, it would be better not to undertake it. Even
if it is done, the glands should never be entirely removed.
A great number of microbes enter our system through the mouth with the
air and food, but happily they are antagonized by the saliva and the gastric
juice, which are able to destroy a large number of these obnoxious invaders.
Like the ductless glands, the lymphatic glands are closely connected with
one another, and thus changes in one of these glands are apt to be followed
by changes in the others. Hence we can see how a lymphatic structure
contained in the intestine,—the appendix,—can often become inflamed
after previous inflammation of the tonsils. As is well known, the appendix
shows great similarity in its histological structure to the tonsils, so much so
that some call it an intestinal tonsil. Several authors have drawn attention to
the fact that appendicitis has often been observed after tonsillitis, and
Delcour has written a monograph in which he attributes appendicitis,
indirectly, to thyroid degeneration,—e.g., congenital myxœdema. Adenoid
vegetations are always accompanied by chronic pharyngitis and tonsillitis,
which bring about appendicitis. And since adenoid vegetations are an
expression of thyroid deficiency, Delcour attributes appendicitis to a
deficient thyroid. We are not prepared to accept Delcour’s statement, as
there are cases of adenoid vegetations without a deficient thyroid. However,
as we have personally observed, chronic nasal catarrh and tonsillitis are
very frequent in persons subject to appendicitis. The appendix is an
important lymphoid organ and, if possible, it should be preserved.

As I have already shown in a previous communication,[168] the lymphatic
glands stand in very close relation to the thyroid gland. In diseased
conditions of the thyroid we find, as a rule, enlarged lymphatic glands, as in
Graves’s disease, myxœdema, cretinism, acromegaly, and also in diabetes.
The thyroid seems to exert a great influence, not only upon the lymphatic
glands, but also on the blood-corpuscles. The red blood-corpuscles are
diminished after extirpation of the thyroid, as also in myxœdema, as well as
in old age. On the other hand, they can be increased very considerably by
thyroid feeding. The white blood-corpuscles are also influenced by the
thyroid, for, after extirpation of the thyroid, their number is at first increased
and later diminished. Very important is the discovery of Mlle. Fassin[169] (in
the laboratory of the University of Liège, Belgium), who found a
diminution in the production of alexins after extirpation of the thyroid, thus
confirming what Sajous had pointed out four years earlier. According to Sir
Almroth Wright, the discoverer of opsonins, the production of these bodies
also depends upon the internal secretions. We have seen that Sajous has
shown (a fact confirmed by others since) that opsonins are mainly
composed of thyroid secretion.
Thus we see that the production of antitoxins is greatly under the
influence of the thyroid, which governs the processes of phagocytosis, and
thus powerfully helps in the defense of our system.
Besides microbes, we introduce into our body a large number of harmful
products through food and drink (stimulants). Many toxic substances are
formed by the decomposition of food, and also in the processes of
metabolism in the tissues. We are protected against these substances by
certain organs which destroy them (as the thyroid, parathyroids, and liver),
and by other organs which eliminate them (as the kidneys, the skin, and the
intestines). When these organs are all working well, we may get rid of these
products and not be affected by them; but in old individuals it is different,
as their protective and eliminative organs have more or less degenerated.
Then these substances are not destroyed entirely, nor wholly eliminated.
They are retained, and cause the condition of auto-intoxication.
It is very difficult to prove definitely by experiments, that there really
exists such a condition as auto-intoxication; but, practically, its existence
cannot be denied. We note after changes in the above-named organs, when
their functions are in abeyance, signs of intoxication in a patient, which

include headaches and other nervous symptoms, with a haggard and
colorless face. After a good movement of the bowels, perspiration, and
abundant diuresis, we see a great change for the better. Thus, even if
scientific experiments which are made on small animals do not strictly
confirm the existence of auto-intoxication, the great improvement in our
condition after improved elimination speaks very strongly for its existence.
Therefore, to prevent such a condition, we must do our best to keep these
organs in good working order. In the succeeding chapters we shall consider
in detail the protective and eliminative functions of these organs, and the
possibilities of their improvement by hygienic and therapeutic measures.

CHAPTER XI.

On the Destruction of Poisonous Products Through the Thyroid
and Parathyroid Glands.

The earliest authorities on the thyroid gland, including Schiff and others,
have shown that when this gland is extirpated in a dog, as a rule the animal
develops convulsions after a few days, and subsequently dies. It is very
unusual to find a longer survival after such operations.
Interesting and very instructive experiments by the American specialist,
Dr. Leo Breisacher, of Detroit, Mich. (formerly assistant to Professor Munk,
of Berlin), have demonstrated that it is possible to keep animals, operated
on as above, alive for a long time if they are debarred from meat and kept
on a milk diet.
A perfectly natural explanation of this prolonged survival, which had
never been observed until the above experiments, lies in the fact that milk
food is better adapted to animals deprived of their thyroid, and that, as Dr.
Breisacher maintained, meat acts in a poisonous manner on the nervous
system of dogs thus operated on. Thus we note that dogs in this condition
cannot live on a meat diet. The learned savant and others noticed that dogs
so fed succumbed very quickly, while at the same time he observed that no
attack of convulsions ever occurred in dogs fed on milk, though many other
authorities had noticed such symptoms in corresponding cases.
He also observed,—and it is a most interesting point,—that dogs which
improved on a milk diet, again got worse after meat or bouillon was taken
and died in consequence. Of great importance also is his observation that
boiled meat is not dangerous to animals thus operated upon, which he
explains as being due to the fact that the extracts of meat having a toxic
action are soluble in water.

There can thus be no doubt, from these beautiful experiments of
Breisacher, that meat does contain substances that are poisonous, and we
may safely draw the conclusion therefrom that if we, who are in possession
of our thyroid, do not suffer from a meat diet, it is due to the protection
afforded us by this gland. If we remove this, as in the instances given of the
dogs, or if it is degenerated by disease, then our immunity also disappears.
In myxœdematous people this is self-evident, for they are always worse
after taking meat, and most of them have an antipathy to this sort of food.
Also in many cases of severe diabetes (a myxœdematous condition), meat is
very injurious, and if taken in large quantities can contribute to the
development of acidosis.[170]
The above-mentioned experiments of Breisacher have been confirmed by
F. Blum, of Frankfort. He finds also that omnivorous animals operated on as
the dogs, if fed with meat, die from tetany in a few days. But when such
animals have been kept on milk for a long time, before and after the
operation, a large proportion have survived, or, at most, passed through a
mild form of tetany, and continued well until meat was again administered,
when their condition soon became worse, and death ensued, as in the case
of the animals kept on a meat diet. Some of the dogs fed on milk also died,
but before succumbing they underwent a long cachectic illness. In any
event they lived longer than the animals fed with meat, which rapidly died
with violent symptoms.
Dr. Blum arrived at the conclusion that the thyroid is a disintoxicating
organ (entgiftendes organ) the function of which is to destroy poisonous
products formed by the decomposition of the albuminous food-substances.
[171]

The Japanese authority, Kishi, also arrived at the same conclusion, after
having removed the thyroid gland from 150 monkeys, dogs, and other
animals.
That the products of the decomposition of albuminoids can produce
changes in the thyroid has been proved by Galeotti and Lindemann, who
found an increase of colloid substance in the thyroid of animals after the
injection of leucin and tyrosin,—which are the products of decomposition
of albuminous substances. That meat acts in an injurious manner on the
thyroid gland, if eaten in very large quantities, has been proved by clinical

observations and by the experiments of Chalmers Watson, into which we
shall enter more fully in the chapter on the dangers of too free a meat diet.
The thyroid not only protects us against the poisons in meat, but also
against many others; in fact, perhaps we may say, against poisons generally.
Let us, however, specially mention those poisonous products which have
been tried experimentally. That the thyroid protects the body against
bacillary attacks has been noted by Charrin in the case of dogs, which
succumb in a very short time to all kinds of infection after the removal of
the thyroid. We have demonstrated, in Chapter III, the protective action of
the gland against such poisons as chloroform, as mentioned in our
communication to the Paris Biological Society in 1906, where we stated
that in chloroform narcosis all the characteristics of an increased activity of
the thyroid are perceived,—including symptoms such as we see in Graves’s
disease. We have also found that the thyroid of dogs contains an increased
amount of colloid substance after chloroform narcosis, which enables us to
understand why this drug is not well borne by animals operated upon as
above, as discovered by Lanz and by Walter Edmunds; likewise, we may
thereby explain why patients suffering from Graves’s disease of long
standing, in which there generally is a transition to a myxœdematous
condition, are liable to a fatal termination after an operation with anesthesia.
Cases of diabetes (in accord with frequency of thyroid changes) also often
present serious phenomena after an operation under anesthesia, including
coma and even death.
Alcohol also acts on the thyroid gland, there being a certain analogy
between intoxication by chloroform and by alcohol. The changes in the
thyroid after the long-continued use of alcohol are the consequences of the
frequent conditions of hyperactivity of this gland, expressive of its antitoxic
action. We have referred to the influence of alcohol on the thyroid in other
parts of this book. This gland also protects us against injurious drugs. Hunt,
of Washington, has shown from experiments that when certain animals,
such as rabbits, have been given acetonitril and thyroid preparations at the
same time, they do not become poisoned; whereas when they have taken the
former alone, they do. Jeandelize and Perrin have also proved the protective
action of the thyroid against arsenic.
Garnier has also found that certain drugs, such as iodine, pilocarpin, etc.,
when injected into animals, produce an increase of colloid secretion in the

thyroid glands. It is, therefore, but logical to regard this hyperactivity of the
thyroid gland as an expression of its defensive action against toxic products
(see Chapter III).
From the foregoing it is obvious what an important organ we possess in
the thyroid gland, and that by its degeneration, as in the state of myxœdema
or in the much more frequent athyroidia, we become more exposed to all
kinds of poisonous products; but what renders its degeneration a still graver
misfortune for us, is the fact that it is apt to bring about the degeneration
also of other organs which destroy and eliminate poisonous products, viz.:
the liver, kidneys, intestines, and skin.
The liver is always altered by extirpation of the thyroid gland, likewise as
a rule in myxœdema, and even in hypothyroidia; for congestion and other
changes follow, as found by Rogowitch, Sanquirico, and Canales,
Albertoni, Tizzoni, and others. A fatty degeneration of the liver has also
been described by Sciolla.
Laulanié has discovered, in the same way as Van der Ecke and
Rosenblath, very extensive changes in the liver after removal of the thyroid.
Jeandelize also found interstitial hepatitis after the removal of the thyroid
and parathyroids. Kishi also describes alterations in the blood-vessels of the
liver occurring in a great number of animals after thyroidectomy.
Hun, Prudden, Mackenzie, G. Murray, and others, found usually a
cirrhosis of the liver in myxœdematous persons. Vermehren found an
interstitial hepatitis, with thickening of the blood-vessels of the liver, and of
the bile, in myxœdema.
It is also of great significance to note that Gley, Laulanié, and others,
constantly found biliary matters present in the urine of animals from which
the thyroid had been removed.
After due consideration of these facts it cannot be denied that the liver
and the thyroid stand in very close relationship, and this we maintained at
the last French Congress of Medicine at Liège, where we were glad to see
that the President of the Congress, Professor Bouchard of Paris, and later
Professor Neusser of Vienna, coincided in this opinion.
We have also shown, as already mentioned (Chapter V), that
degenerative processes of the thyroid are able to facilitate the development

of the gall-stone complaint. The degeneration of the thyroid is not only
followed by degeneration of the liver, but also by that of the kidneys.
It has been noted by Albertoni and Tizzoni, that animals whose thyroid
has been removed show a condition of interstitial nephritis. Blum has found
the same thing, and has observed also that this condition frequently comes
about in an astonishingly short time after the operation, say, in 18 to 20
days. The parenchyma also presents distinct signs of inflammation; the
urinary channels lose their epithelium and present the appearance of hollow
grooves. These changes occur in all animals, except such as die a few days
after the operation, and such as are permanently immune from the
intoxication that follows the removal of the thyroid.
We can also observe clinically that removal or degeneration of the
thyroid are capable of producing changes in the kidneys; for after the
operation, as a rule, albumin appears in the urine.
In myxœdema and hypothyroidia there is also very frequently albumin in
the urine, as well as hyalin or granular casts. In such cases the urine is
usually not copious; very frequently it is scanty (oliguria), and its light color
and low specific gravity show that the solids have been retained in the body.
In such cases there is often retention of uric acid. In a communication to the
Paris Biological Society (February 25, 1905) we attributed gout to changes
in the kidneys giving retention of uric acid, after primary alterations of the
thyroid as the cause (see also Chapter V).
That the intestines also suffer changes after degeneration of the thyroid is
best established by the fact that there is obstinate constipation in such cases,
—as in myxœdema or in partial myxœdema and hypothyroidia (old age).
The functions of the skin also will be diminished after degeneration of the
thyroid, as we observe plainly in the conditions of myxœdema and
hypothyroidia. In these diseased conditions there is an atrophy of the
sudorific and sebaceous glands, so that the skin cannot perspire; on this
account a large amount of toxic products is retained.
We can see plainly from the above that when a person has a degenerated
thyroid a condition of auto-intoxication must necessarily follow, as there is
in consequence a degeneration also of the other organs which destroy and
eliminate poisonous materials. The liver in such a case will not be able to
fulfill its function of destroying a mass of poisonous substances; the

sluggish kidneys and bowels will not eliminate them sufficiently, and dry
skin will also contribute to their retention, since its insensible respiration is
not taking place. All these life-shortening agencies, which may combine to
cause premature old age, can be brought back to a primary cause—the
degeneration of the thyroid gland.
When the thyroid is removed from an animal, but the parathyroids are
allowed to remain, that animal will not then suffer convulsions, but will
only present the symptoms of cachexia typical of the operative cases of
myxœdema.
It has been shown by Gley, Vassale, and Generali, that these very small
glandular organs, of which there are four, two internal and two external
ones, possess quite a different structure from the thyroid gland.
It has been demonstrated by many authorities, among them Jeandelize,
that the convulsions which follow the removal of the thyroid are due to the
fact that the parathyroids have been removed completely, together with the
thyroid gland. Jeandelize was able to produce convulsions by merely
removing the parathyroids alone; he attributed tetany and epilepsy to the
changes in the parathyroids, in common with other authorities, who have
even obtained good results in epilepsy with parathyroid treatment.
Several authorities besides Jeandelize have attributed tetany to alterations
of the parathyroids: for instance, Pineles; and at the German Congress of
Medicine in Munich, Erdheim communicated his observations in three
cases of tetany, in each of which, at the post-mortem, there was found
hypertrophy of the parathyroids.
Dr. Macallum, of Johns Hopkins University, has also reported the case of
a person who developed tetany in consequence of a dilatation of the
stomach, and in whom the parathyroids were found to be hypertrophied.
We learn from the foregoing that the parathyroids protect us against
poisons that arise from the stagnation of the contents of the stomach, and
that their integrity is necessary as a safeguard against important alterations
of the nervous system.
However, these glands, which were already described by Sandström
twenty-two years ago, have not been studied as yet to the same extent as the
thyroid, and we cannot enlarge further on this subject at the present time.

CHAPTER XII.

Hygiene of the Thyroid Gland.

The rational hygiene of the thyroid gland consists in the avoidance of all
agencies that may prove harmful to the gland, the most important of which
are infectious diseases; frequent pregnancies; sexual excesses; intoxications
by food, stimulants, or drugs; and emotions such as grief, sorrow, etc.
It will not be difficult to prevent some of these, but it will be nearly
impossible to avoid others, such, for instance, as infectious diseases. There
is not the least doubt, however, that at times we expose ourselves quite
unnecessarily to infections, as when we drink water that has not been boiled
or filtered, or when we take milk from uninspected dairies for a long time;
or, again, when we remain too long a time in the confined air of assembly
halls, etc., and breathe the air that has been exhaled by thousands of others,
many of them possibly with infectious diseases of the throat and lungs.
Many a case of infectious disease, with all its dangers to life or to important
organs, such as the thyroid, may be avoided by proper circumspection.
It is also quite unnecessary for us to expose ourselves to the dangers
arising from the decomposition of meat, which is particularly injurious,
when taken in large quantities, to the thyroid, as shown by the experiments
of Breisacher, Blum, Chalmers Watson, etc., more especially if animal food
be taken that is not quite fresh and can cause the formation of ptomaines.
According to Blum the thyroid has the special function of destroying
poisons formed in the intestines, in particular by the decomposition of
animal food. Now when too much work is thrown up on this important
gland, it is easy to understand that after a time it will give out, and to
prevent this we must avoid taking large quantities of animal food or fish
(which is meat also, a fact not realized by many people), and when we do
take it, we must first be certain that it is in a fresh condition. To enable us to

do this we are provided with special sense-organs, and our eyes, nose, and
the taste papillæ of our tongue will inform us whether the meat, and
especially the fish or crustacean, is in a fit condition to be eaten.
We have mentioned several times that alcohol and tobacco, taken in large
quantities or for a long time, are deleterious to the thyroid, which fact will
justify our abstinence therefrom, or the greatest moderation in their
employment; those who can do without stimulants will always be the best
off.
Sexual excesses can also be easily avoided, and women who wish to
retain their youth will do well not to expose themselves to pregnancies year
after year after having had three or four children. It is, however, great good
fortune to have a numerous progeny, and by careful hygiene, as plenty of
instances prove, the struggle against premature old age can be carried out
successfully. In regard to this we may refer to the chapters on the causes of
old age and on sexual hygiene. Diseases of the ovaries must be particularly
avoided, as all changes in those glands will react on the thyroid, which is
closely related to them.
Doubtless one of the most difficult tasks will be the avoidance of strong
emotions: grief and sorrow; and yet we are not helpless against them, as
will be illustrated in the chapter on the hygiene of the mind and on the
advantages of a religious belief.
Having dwelt on the necessity of preventing injury to this important
gland, we will now show that there are certain means of enhancing its
vitality,—which effect we can obtain by improving the circulation, and
removing agencies by which this would be impaired. As Sir Herman Weber
has shown, it is possible to improve the working condition of this gland by
massage, which should be done daily and is readily carried out.
It is easy to see that a tight collar offers difficulty to the free circulation
of the blood through this gland, and therefore it is advisable to wear a loose,
and also low, one. Strange to say, many ladies wear such tight, high collars,
not availing themselves of their immunity from such a yoke, which men
have voluntarily endured for so long a time. It is advantageous not to button
both sides of the shirt-band to which the collar-stud is fastened, but one side
only, which is easily done when low collars are worn and is not noticeable;

the great comfort and advantage of so doing will outweigh all other
considerations.
The vitality of the thyroid gland may be enhanced by various measures in
which thyroid secretion, or iodine—its main element,—is introduced into
the body. The easiest way to effect this is by taking foods, such as plants
and vegetables, which contain a maximum of iodine. The iodine in the
thyroid and other parts of the body is introduced therein mainly with our
food (or by drugs in the case of goiter). Another way is by taking thyroid
extracts. Since, at a certain age,—as mentioned in the chapter on the causes
of old age,—parts of the epithelium of the thyroid are degenerated and
replaced by connective tissue, thyroid extracts will be the best means, if
taken in very small doses, of supplying this physiological need. Such doses
of the extracts, freshly prepared and from a reliable firm, can do no harm,
but, on the contrary, will keep the thyroid in good working order. As we
have learned from personal experience these very small doses can even be
taken, at intervals, for a long time, without injury to the health, and we need
not await the arrival of old age, but should use them as a preventative
against it, and in particular temporarily where there is, or has been, a great
demand for thyroid secretion, as, for instance, in convalescence after an
infectious disease, or after childbirth, especially if the flow of milk is
scanty, which is an expression of a defective thyroid; also after sexual
excesses, and in cases of mental depression, after we have suffered grief; in
fact, after any of the occurrences which we know to be harmful to the
thyroid gland, which, in such cases, has been giving off larger amounts of
its secretion.
We must, however, caution patients against ever taking these extracts
save under medical advice, since otherwise dangerous results may be and
have been produced, as will be shown elsewhere.
The diet of greatest hygienic value with regard to the thyroid will consist
of large quantities of milk, with little or no meat, but plenty of vegetables.
With such a diet there will result less putrefaction in the intestines, and
thus also less demand for the thyroid secretion to destroy poisonous
matters; at the same time, along with the milk and vegetables, iodine, the
main element of the thyroid secretion, will be brought into the body, and a
loss of this product from it prevented.

CHAPTER XIII.

The Destruction of Toxic Products by the Liver and the
Improvement of its Protective Functions.

The liver is one of the most important of our organs. As Professor
Hemmeter, of Baltimore, says, “The liver is an organ secondary in
importance only to the heart. Living things can exist without stomachs.
They can live for forty days without eating, but mammalia can only live a
few days, sometimes not twenty-four hours, without a liver.” The
importance of the functions of the liver is illustrated in this picturesque
remark of Dr. Rovighi[172]: “Like unto Minos in Dante, the liver tests the
conscience of those that want to enter, and knows their sins.”
We introduce into our stomach and intestines a number of poisonous
substances which, if injected into our blood, would kill us, or at least, cause
grave intoxication. Yet because they are taken by the mouth they are
harmless, and the reason for this strange phenomenon is that they must pass
through the liver, being brought to this organ from the intestines through the
portal vein, and are there destroyed. This is illustrated in the case of the
Indian snake charmers, who acquire immunity against snake-bites after
having first sucked the poisonous fang of the snakes and absorbed the toxin
via the intestine. They thereby gradually accustom their body to this terrible
poison, which, taken in this manner, is far less harmful, since it passes
through the liver. That the liver destroys various poisons was first shown by
our esteemed friend, Prof. Paul Heger,[173] of Brussels University, who
demonstrated by experiments that nicotin added to blood soon disappeared
after it had been passed through the liver artificially. After this remarkable
discovery other authorities have found reason to state that the liver also
destroys other poisons, in particular alkaloids: strychnine and atropine
(Professor Roger[174]), hyoscyamine (Heger and Buys[175]), quinine, morphia,

curare (Lussana). According to Schiff, and Lautenbach, alkaloids undergo a
chemical change under the influence of the liver. As Slowzoff[176] found, the
liver also protects us against poisons such as arsenic; therefore we can
understand why persons suffering from hepatic disease cannot tolerate
arsenic. This should be taken into consideration when we are treating
patients with cacodylates, or with atoxyl.
It has, however, been maintained by Zagari that this antitoxic action of
the liver fails in the case of bacteria and, according to Professor Roger,
especially with bacterial toxins in old cultures.
Yet other authors have shown that the liver probably has an antitoxic
action against bacteria and their toxins. Thus, Professor Adami, of
Montreal,[177] by experiments with a minute diplococcus similar to that
which is found in Pictou’s cattle disease, and Sir Lauder Brunton, and Dr.
Bokenham,[178] have shown that the lethal action of diphtheria toxin is
greatly diminished during the circulation of this toxin through the liver, and
also that the juice from such a liver has a slight antitoxic power. These
authors have also shown that the bile from such a liver has a slight antitoxic
action. They consider that the antitoxic power of the liver does not depend
upon the blood present in the organ, but on the liver-tissue itself.
It has been shown that the liver excretes into the bile poisons which it
arrests during their circulation through the portal system. This has been
shown by Lussana in the case of curare. That poisonous substances are
excreted into the bile is shown also by the immunizing experiments of
Professor Koch against bovine plague. He employs the bile of animals
which died of plague. This contains attenuated plague bacilli, of which
Professor Koch makes use in his experiments.[179]
Dr. Fraser[180] has shown that when increasing doses of snake-venom are
injected into an animal a condition of immunity is brought about, so that
finally fifty times the dose which would have proved fatal at first, becomes
innocuous. As Fraser found, the bile of such animals contains an antivenine,
and he made use of this bile as an antidote against the original venom.
These experiments prove that the bile contains poisonous substances,
including pathogenic bacteria in an attenuated condition, and also that it has
antitoxic properties. Thus we may understand how it can neutralize
putrefactive products from the intestines. Not only bacteria, but all the

various kinds of poison which the liver destroys, are eliminated by the bile;
hence the importance of a free circulation of this fluid. The liver serves as a
depot for metallic substances like iron and copper, and also for the more
dangerous ones such as lead, mercury, arsenic, or antimony. After first
keeping them in storage, it then attempts to eliminate these noxious
substances. According to Slowzoff and Bamossi, the various poisonous
metals and alkaloids enter into combinations with the proteid bodies of the
liver. Animals that have been richly fed have been found to be better
protected against these poisons because of their livers being richer in
proteid contents and glycogen.
The liver also protects the body against the numerous toxic products
formed in the stomach and intestines during the process of digestion and
assimilation. The most important of these are the carbamins and ammonia
salts, which would be injurious to us if the liver did not protect us by
converting them into urea.
When the liver is excluded from the circulation, as Nencky and his pupils
have done by establishing an Eck fistula, toxic symptoms arise when the
animals are given albuminous food, and these symptoms can only be
explained from the fact that the liver is unable to destroy toxic products.
The more albuminous food taken, the more marked are the symptoms of
intoxication.
The liver aids in the transformation of the poisonous end-products of
proteid metabolism by bringing about the combination of the toxic end-
products with sulphuric acid (Baumann, Emden and Glaesner). Thus these
dangerous substances are eliminated as ethereal sulphates, which are
practically harmless. Even when these ethereal sulphates are present in
large amounts in the urine there may be no symptoms of auto-intoxication.
When the liver is extirpated, a condition of acidosis arises, and a large
quantity of ammonia is eliminated, which is produced in order to neutralize
the acids present. The liver protects us against acids formed in the
organism. After eating a quantity of meat, we would be menaced by the
acids formed through its decomposition, were the liver not active.
We can prevent acidosis if we eat a considerable amount of
carbohydrates, at least 100 grammes a day as Hirschfeld has proved. It has
been shown by Waldvogel that these carbohydrates do not prevent acidosis

if they are given by a method which precludes their passage through the
portal circulation,—e.g., subcutaneously.
As we have seen above, the liver receives an enormous amount of toxic
products from the stomach and intestine, which it transforms or destroys.
Like any other organ which is overworked, the liver may undergo certain
changes when continually subjected to a strain, and great quantities of these
toxins might be able, after a long-continued action, to alter the liver tissue.
Such a condition we may note in gastric and intestinal diseases, especially
in those cases where large amounts of fatty acids are formed.
Bouchard found an enlargement of the liver in 23 per cent. of all his
cases of dilatation of the stomach.
We can understand that when fatty acids, as a result of gastro-intestinal
disease, pass for a long time through the liver, they may destroy the delicate
epithelium of this organ. Boix demonstrated this by experiments. By
feeding animals with lactic, butyric, and acetic acids, he produced hepatic
cirrhosis.
So long as the liver is healthy it is able to withstand the constant inflow
of toxins and will transform them into less harmful compounds. But when
the liver is altered, as in cirrhosis, things are different. We then find a
diminution of urea, and an increase of ammonia. Happily such a condition
arises only when there are considerable anatomical and histological changes
in the liver.
Salaskin and Zaleski have shown in animals that when there are serious
anatomical changes in the liver, the ammonia is increased, and the urea is
diminished. We may suppose that in old age, when the connective tissue is
more or less increased and important liver elements destroyed, a similar
decrease in the urea formation may take place just as in chronic cirrhosis.
That in diseases of the liver toxic products are formed and eliminated by
the urine in increased amounts, has been shown by Professors Bouchard[181]
and Roger. They found that the urine of patients suffering from diseases of
the liver is more toxic than that of normal persons.
That the normal urine is toxic has been proved by Séglas and Vauquelin,
[182]
and also by Bocci.[183] Bouchard has designated as the urotoxic unit the
quantity of urine necessary to kill an animal weighing 1 kilogramme, and as

the urotoxic co-efficient the relation of the urotoxin eliminated in twenty-
four hours to the body weight of the animal. This latter, then, indicates the
quantity of urotoxins a man eliminates in twenty-four hours.
All these calculations of Bouchard have had no great success, however,
for many authorities, as Gumprecht,[184] Heymans v. d. Bergh, etc., have
shown that the toxic effects of the injected urine may be explained in part
by the difference in osmotic pressure between the injected urine and the
blood.
Still the fact remains that the urine of many cases of liver disease has
been found to be more toxic than the urine of other persons.
When the liver is damaged it cannot destroy poisons in the normal
manner, as was shown by experiments. Thus, the liver cells have been
experimentally injured when it was found that such a liver was not able to
destroy strychnine as well as a normal liver. Very important findings have
been made by Roger and Gamier.[185] They have ascertained that privation,
bad nutrition, etc., can also lower the vitality of the liver and diminish its
antitoxic properties.

CHAPTER XIV.

The Hygiene of the Liver.

We have often observed that people suffering from diseases of the liver
feel and look much better after abstaining from meat and living on milk and
a vegetarian diet. If such a diet be beneficial in cases where the tissues of
the liver are degenerated, it appears reasonable to assume that it will be
equally efficacious when the liver has not yet been altered by disease. We
must realize that the various unwholesome matters we eat or drink are
carried to the liver to be dealt with, and that the end-products of the
decomposition of the meat, and other elements contained in preserved meat
which may not be perfectly sound, may injure the liver-tissue, or, at any
rate, throw more work on this organ than food in the nature of vegetables or
milk.
A milk diet has the further great advantages that it assists in destroying
toxic products in the intestine, and also that it can hinder the development
of gall-stone disease (see Chapter XXXIX).
Not only meat used in abundance, but also various kinds of spices,
condiments and stimulants may be very injurious, especially alcohol, if
taken in large quantity. Gin and brandy are the most deleterious in their
action. Wines containing little alcohol are less harmful, but acid or strong
white wines may injure the liver-tissue.
The well-being of this organ is essentially dependent on the good
condition of various other organs with which it stands in very close relation,
in particular the intestines, for instance. It is from here that most of the toxic
products enter the liver, either by the portal vein or through the
choledochus. The intestine always contains myriads of microbes, which
may enter the liver either by the blood or the bile, and thus provoke very

important changes in the liver-tissue. Professor Adami,[186] of Montreal,
found colon bacilli in a cirrhotic liver.
It follows, therefore, that we must maintain the intestine in the best
possible condition, and avoid constipation and stagnation of fæcal matters,
with the augmentation of toxic products. That constipation is very
deleterious to the liver can be best shown by the fact that very often
affections of the liver and bile-ducts,—and especially gall-stone disease,—
are developed in persons suffering from habitual constipation. The best
treatment for these liver affections is a purging treatment, and it is mainly
on account of their action in this manner that certain alkaline mineral waters
have attained so great a fame; in addition, due to increased peristalsis, the
circulation of the bile is enhanced.
Proper movements of the bowel are indispensable to a sound condition of
the liver and for the prevention of hepatic disease, and we, therefore, refer
the reader to the chapter that deals in detail with the prevention and
treatment of constipation.
Not only the intestine, but the stomach also, must be in good condition. It
has been noted by Bouchard and Hanot that chronic gastric and intestinal
troubles are apt to cause enlargement of the liver. Bouchard has found an
enlarged liver in 23 per cent. of his cases of dilatation of the stomach. Hanot
and Boit[187] have shown experimentally that the different acids formed in
the gastro-intestinal tract are able to produce a genuine cirrhosis of the liver.
Therefore acid fermentation must be carefully avoided; and to prevent such
fermentation in some degree in the stomach and in the intestine, it is
necessary to masticate the food thoroughly, as will be shown.
Another very important organ, the sound condition of which is of great
importance to the liver, is the pancreas. It has been found by several
authors, particularly by Steinhaus,[188] in his investigation of some 40 cases
of hepatic cirrhosis, that the pancreas is also affected in each case of this
type; and we further know that after disease of the pancreas, as in diabetes,
for example, the liver is also, as a rule, altered. Thus these two organs are in
close relationship.
As pancreatic diseases are among the most difficult to diagnose, and
people suffering from them live and die, as do also many diabetics, without
their particular state having been recognized, so, the rational treatment of

these diseases being still imperfect, we cannot offer advice in regard to their
prevention. But, at any rate, the safest course will be moderation in diet,
especially fatty food, which exacts the active co-operation of the pancreas.
As in the case of all other organs, long-continued overwork will exhaust
this gland, and thus induce a diseased condition. Moderation in diet will be
the best policy for the pancreas, as also for the liver; and to maintain these
organs in sound working order, meat in particular should only be taken in
small quantities, and fat also should not be partaken of in large amount.
Milk and vegetable food, with but little meat, and that preferably as fish,
will certainly furnish the best diet to avoid diseases of the liver. As
Quincke[189] mentions, experience shows also that water in large quantities,
especially certain alkaline saline waters, can increase the flow of the bile;
and therefore, as also for other reasons mentioned in this book in Chapters
XXXIV and XLI, water should be drunk in sufficient quantity every day.
The alkaline waters referred to are certainly superior in their action to
ordinary water, especially those kinds which at the same time cause
purging.
Hot climates have a deteriorating effect on the liver. We have often noted
the great frequency of liver complaints under these conditions, and we have
never had a patient from the hot parts of Mexico who has not had a
hypertrophied liver. We are inclined to believe that it is not so much the
climate as faults in hygiene, especially in diet and in the use of stimulants,
which are the cause of such a condition in Europeans residing in tropical
climates.
A vegetarian diet is certainly the best in tropical countries, as we
personally found during a stay in Southern Florida, Texas, and Mexico. Just
as for the kidneys, so for the liver, a bath, and particularly a sweat-bath, is
of great benefit, since by means of it toxic products may be eliminated
which would otherwise be carried to the liver.
We have found these baths to be of great benefit in liver diseases, and
considering the amelioration of the processes of oxidation brought about by
such baths, it seems highly probable that they are capable of improving also
the working condition of a liver not as yet diseased.
In general, it is our opinion that to prevent disease in an organ the surest
method is to use those means through which that organ, when diseased, is

found to benefit. Of course this is only meant as a general statement; but in
the children of those suffering from liver complaints such preventive
treatment is particularly indicated, as these conditions, we have found, are
most frequently inherited. We have treated cases where three or four
generations of one family had been sufferers from the same complaint.
Here, as always, let us follow the wise precept: “Prevention is better than
cure.”

CHAPTER XV.

On the Destruction of Toxic Products by the Adrenals.

There is ample evidence in support of the contention that the adrenals
play an important part in the destruction of toxic products in the body. As
long ago as 1853, one of the leading authorities on the adrenals as ductless
glands, Brown-Séquard, noticed that the blood of animals without adrenals
was more toxic than that of animals the adrenals of which had not been
removed.
Langlois and Abelous[190] confirmed the conclusions of Brown-Séquard.
They also established the fact that the blood and muscular extracts of frogs
whose adrenals had been removed, were toxic, and contained a poison of
the nature of curare. The animals died from auto-intoxication, and these
savants came to the conclusion that the adrenals were created to neutralize
or destroy poisons which are evolved during muscular work. Frogs from
which the adrenals had been removed showed also lessened resistance to
muscular fatigue. Similar results have been observed by Langlois in the
case of other animals: rabbits, dogs, guinea-pigs, etc. Albanese[191] also
found that animals operated on as above exhibited more fatigue than those
whose adrenals had been allowed to remain intact. The recent labors of
Sajous which have shown conclusively that the adrenals furnish to the
blood one of its important immunizing constituents explain all the above
observations.
The fact, observed by all these authorities, that when one of the adrenals
is removed the other becomes hypertrophied, sometimes to a great extent,
seems also to point to the conclusion that greater demands are made on the
gland that remains, the hypertrophied condition of which appears to be due
to the increased work required of it in protecting the body from infection.

That these organs really assist in the defense of the body against the
attacks of microbes or the introduction into it of certain toxic products can
be best demonstrated by the fact that after such infections the adrenals are,
as a rule, altered, showing that a pronounced reaction antagonistic to these
agencies has occurred.
It has thus been proved by a succession of authors: Charrin,[192] Langlois,
Roux, Yersin, Professor Roger, and more recently by Oppenheim and
Loeper,[193] that in experimental or in spontaneous infectious diseases the
adrenals present important alterations as a result of the reaction against
infection.
Oppenheim and Loeper found that important changes followed upon
experimental infectious diseases; for example, after infection by the bacilli
of diphtheria or anthrax, or by the pneumococcus; also in such infectious
diseases as diphtheria, pneumonia, small-pox, typhoid fever, etc.; and also
after experimental poisonings, as with arsenic, phosphorus, or mercury.
There occurred leucocytic reaction, diffuse diapedesis, or infectious
nodules, and also a congested condition of the adrenals, sometimes so
marked that hæmorrhage took place, with complete destruction of the
parenchymatous tissue of the glands.
Very important are the conclusions of Oppenheim,[194] that when animals
have received poisonous products, together with adrenal extracts, after
having previously lost these glands by operation, such animals show a
longer survival, sometimes even of indefinite duration, as compared with
animals without adrenals to which have been administered the same toxic
products, but without adrenal extracts.
With phosphorus and urinary poisons in particular, this author has
obtained most striking results from the injection into animals of adrenal
extracts at the same time as the poisonous substances.
Oppenheim comes to the same conclusion as Abelous, Charrin, Langlois
and Sajous: that the adrenals play a great rôle in the destruction or
neutralization of microbic or other poisons introduced into the system.
We are thus in possession of powerful arguments in support of the
presumption that the adrenals are antitoxic glands. The fact, found by
Langlois, that the adrenals contain less adrenalin after experimental

infectious diseases, and that established by Luksch, that after certain
experimental infectious diseases such as diphtheria, typhoid, or
tuberculosis, the extract from the adrenals no longer produces an increased
blood-pressure, do not seem to us sufficient to invalidate our belief in the
antitoxic properties of these glands; for here we are witnessing the same
occurrence as has been previously noted in reference to the thyroid,—that
the functional hyperactivity of the gland may be followed by its exhaustion.
Moschini, Nicholas, and Bonnamour have also found histological
evidences in the adrenals in infectious diseases indicating a hyperactivity of
these glands.
The fact that different toxic products, such as alcohol, can produce
alterations in the adrenals, indicates also a rôle of these glands in defending
the body against toxic doses of this substance (see Chapter III).
It was found by Aubertin[195] and other authors that there is a hyperplasia
of the adrenals after experimental intoxication of the guinea-pig by alcohol.
Bernard and Bigart found important alterations of the adrenals after
experimental poisoning by mercury, arsenic, lead, etc. As shown by
Professor Sajous,[196] various drugs act on these glands, and he attributes the
rise of blood-pressure therefrom to the action of such drugs on the adrenals,
whose function, as is well known, is to raise the blood-pressure. We can
thus understand how if alcohol be taken in large quantities it is able to
produce atheroma and arteriosclerosis, as are also other toxic bodies, such
as nicotine.
It is well known that arteriosclerosis is frequent in great smokers. It has
been found by several authorities, among them Borylac, that inhalation, or
mastication, of tobacco produces atheroma, and by Boverie and Loeper[197]
that similar changes have followed experiments with tobacco or ergotin.
Very important data have also been established by Drs. Isaac Adler and
Hensel, of New York,[198] who have found that atheromatous alterations of
the aorta can be produced experimentally by powerful doses of nicotine.
Such alterations were similar to those effected by adrenalin, but were
neither so constant, nor so marked.
These experimental facts, together with observations by Dr. Sajous,
prove that the atheromatous condition brought about after using certain
drugs, such as alcohol and tobacco, can be ascribed to the adrenals. Josué,

in 1893,[199] showed that by injecting adrenal extracts (solution 1:1000) into
the veins of a rabbit, atheromatous patches of the aorta will appear after five
or six weeks. The changes described by Adler and Hensel from the effects
of nicotine confirm the probability that tobacco acts on the adrenals first,
then, by their medium, on the blood-vessels (see, also, Chapter XLIII).
The above observations show that the same is also probable in the case of
alcohol, to which we may add a case of Widal and Boivin, who found in a
young woman dipsomaniac a hyperplasia of the adrenals and atheroma of
the aorta; and to complete the value of these observations we subjoin those
of a series of cases of atheroma by Joshua, in three of which a hyperplastic
condition of the adrenals was found.
It follows logically from the foregoing effects of alcohol and tobacco,
that we must avoid large quantities of these substances if we desire to keep
in a normal condition the heart and blood-vessels, upon the perfect state of
which depends, in a great degree, our chances of a long life and extended
youthfulness.
We will deal further with the latter points in the following chapter.

CHAPTER XVI.

Hygiene of the Adrenals and of the Circulatory System—A Few
Remarks on the Cause, Prevention, and Treatment of
Arteriosclerosis.

In order to obtain the best hygienic condition of the circulatory system, it
is indispensable to avoid all that are harmful to the adrenals. There can no
longer be any doubt that these glands exercise a controlling influence on the
heart and the whole circulatory system. They are in intimate relation with
the principal nerves that regulate the heart: the sympathetic and the vagus.
Thus, for instance, emotions that act on these nerves excite through them a
hypersecretion of the adrenals and a contraction of the small blood-vessels,
with a rise in the blood-pressure. By the hyperactivity of these glands their
secretion, in larger quantity than usual, is thrown out into the system,
producing toxic effects which result in an atheromatous condition of the
arteries. According to our present knowledge, we imagine this
atheromatosis to be due to the toxic effect of the adrenals quite
independently of the increase in the blood-pressure, for it has been
distinctly shown that even substances which diminish blood-pressure, such
as amyl nitrite, for example, are also capable of producing atheroma. The
toxic effects of adrenalin are proved by the experiments of Amberg[200] in
the laboratories of the Johns Hopkins University.
We must especially insist on the fact that high blood-pressure is not a
condition essential to arteriosclerosis. It has been shown by Sawada,[201]
Groedel,[202] and Ferranini,[203] through measuring the blood-pressure by
Riva-Rocci’s instrument, that numerous cases of arteriosclerosis can arise
without any increase at all in the blood-pressure. According to Professor
Romberg,[204] there is only high blood-pressure in such cases of
arteriosclerosis where there is a diseased condition of the kidneys.

According to this leading authority on heart diseases, high blood-pressure is
one of the earliest symptoms of kidney complication in arteriosclerotic
persons. We believe that the high blood-pressure found in kidney diseases
may be brought into correlation with the previous statement, by the fact that
in such conditions, and especially in sclerosis of the kidneys, the adrenals, if
examined, are frequently found to be hypertrophied, as was noted by Parkes
Weber,[205] Lemaire, and in four cases of Troin and Rivet.[206] At the last
Congress of German Physicians and Naturalists in Dresden, 1907, it was
proved by Schur and Wiesel, as also in their previous communications, that
the blood of patients affected with kidney diseases contained the
characteristic substance that gives the adrenalin reaction with perchloride of
iron, and produced mydriasis if dropped into a frog’s eyes.
It is of singular interest that all those agencies that produce a
hypersecretion of the adrenals are the same which are known to be harmful
in causing arteriosclerosis. In the front rank of such are tobacco, alcohol,
and different kinds of poison, such as lead, mercury, etc.; also infectious
diseases, especially syphilis, the important rôle performed by which, in the
production of arteriosclerosis, has been treated of very competently by
Professor Edgreen,[207] of Stockholm, and Darier, of Paris. Arteriosclerosis
can also be produced very frequently by abundant meat food and by strong
tea or coffee. There is as yet no scientific proof to show that abundant meat
food has the same deleterious action on the adrenals as upon the thyroid,
ovaries, pituitary body, pancreas, liver, kidneys, etc., upon which we have
enlarged in previous chapters of this book; and, moreover, we have no
knowledge of any work written on this subject; but as such a diet is very
efficacious in producing a sclerotic condition of the kidneys, it may, for
these reasons alone, tend to further the development of arteriosclerosis,
considering that so often in such conditions both kidneys and adrenals are
found in a hypertrophic condition. This disease may be produced by
alcohol, tea, and coffee, by causing a great variation in the tone of the
capillaries. According to Professor Romberg and others, it remains to be
proved whether they affect the adrenals at all; but we have already shown
what their action is on the kidneys.
To keep the adrenals in good condition and thus prevent arteriosclerosis,
it is necessary to avoid all the above harmful agencies. It is true that there
are some people who can enjoy these things in large quantities with

impunity and without injurious effects until they reach a considerable age;
but it is different when they all act together. Especially deleterious are
mental emotions, grief, and sorrow, on which we have dwelt in the
introduction to this chapter, and on the effects of which we have previously
remarked; they produce a great variation in the tone and calibre of the
blood-vessels. We will therefore endeavor to treat of the prevention of a
prolonged continuance of this most disastrous agency in our chapters on the
hygiene of the mind. Emotions of a sexual character are, perhaps, more than
emotions from other sources, disastrous to the heart and blood-vessels, as
shown by the fact, which may often be observed, that persons addicted to
sexual excitations frequently die from sclerosis of the coronary arteries.
That the sexual glands are in intimate relations with the heart, which can
often be irritated in consequence of changes in these glands, especially in
women, has been already mentioned.
We should like to add that, as the above agencies are also harmful to the
thyroid gland, the antagonist of the adrenals, its degeneration can further the
development of arteriosclerosis in the same way that Eiselsberg produced
an atheromatosis of the aorta in dogs after extirpating the thyroid gland.
According to Minnich, arteriosclerosis is very common in people with
goiter, appearing in them at a very early age. Fries and Pineles found that
alterations of the blood-vessels occurred in goats after extirpation of their
thyroid gland.
Since arteriosclerosis is so frequent in old age it must be due to the
degeneration of the thyroid and also to the aggregation of all the above-
named harmful agencies during a prolonged period. To avoid it, and also
premature old age, it is, therefore, most essential to guard against all
agencies harmful to the thyroid and adrenals, to which we have referred
above; and this is the best basis for the rational treatment of arteriosclerosis.
It is most fortunate that Dellamare discovered in old age a hypertrophy of
the adrenals.[208]
All this is greatly strengthened by the recent investigations of Sajous,
which show that besides its action on the blood-pressure and the heart, the
adrenal secretion actually supplies the substance which in the lungs, takes
up the oxygen from the air to sustain life in all our tissues. It thus becomes
evident that harm to our adrenals is bound to shorten life.

To recapitulate: There exist two chief agencies for the production of
arteriosclerosis: 1. A hyperactivity of the adrenals, causing a rise in blood-
pressure. 2. A degeneration of the thyroid gland, which, when normal,
antagonizes the first by lowering the blood-pressure. Although from the
above-mentioned facts high blood-pressure cannot be considered as the
chief cause of arteriosclerosis, still no doubt it certainly contributes to it; for
each time that there is a rise in the blood-pressure more blood is forced
through the arteries, thereby causing them to dilate; and after a repeated
number of such dilatations the elasticity of the vessels will eventually be
impaired, especially so in the aged, where one part of the elastic fibers is
already replaced by connective tissue. As a result of the arteriosclerosis the
passage of blood through the capillaries will be impeded, and in
consequence the work of the heart will be increased; likewise the nutrition
of the walls of the vessels will be diminished. The best preventatives of
arteriosclerosis will therefore be: 1. To avoid all agencies which may tend
to cause excessive activity of the adrenals; and 2. To increase the activity of
the thyroid.
Moderation in food is necessary above all things, for much food causes
an increase in the abdominal circulation and a larger amount of blood to be
carried through the vessels; if the food consists of much meat, then its
viscosity is augmented, as previously stated, which indicates that a
vegetable diet, with milk, and little or no meat, is the best; but too large
quantities of milk should not be taken at one time.
Much bodily and other exercises, in excess, such as too much climbing,
should be avoided, as they promote arteriosclerosis by frequent excitation
of the splanchnics and adrenals. As Romberg observed, there is sclerosis of
the arteries in the extremities of persons who do much physical labor, and
Remlinger[209] found the same in the lower extremities of peasant women
who walked a great deal.
Not only by a diet, chiefly vegetarian, is the viscosity of the blood
diminished and the circulation facilitated as found by Determann, but also
by means of iodine administered in the shape of iodide of potassium or
iodide of sodium. This has been proved by the experiments of Ottfried,
Müller, and Inada.[210] For many years it has been well known that iodine
can greatly benefit the condition of arteriosclerotic persons. In combination
with a preparation of iodine, Professor Senator[211] favors the use of nitrites,

and Professor Huchard also recommends nitroglycerine in the intervals
between the iodide treatment. Besides inorganic iodine, it would appear to
us logical to try organic iodine preparations, such as thyroid extracts, the
principal element of which is iodine. For the above reasons it is also
necessary to take special care of the condition of the kidneys, which can be
done, as we have shown, by hygienic and dietetic measures, already
described in the special chapters of this work. An improvement in the
condition of the kidneys, and probably also in the arteriosclerosis, may, in
our judgment, be obtained by the administration of kidney extracts, with
which we will deal more fully in the chapter on the treatment of old age by
organic extracts.
According to Edgreen, about 25 per cent. of the cases of arteriosclerosis
is caused by alcohol. It acts by causing a constriction of the small vessels
(Traube), just as does adrenalin.
But much more harmful in the production of arteriosclerosis is tobacco.
According to Claude Bernard, Huchard, Basch, Oser, Isaac Adler, and
Hensel, tobacco produces a constriction of the small blood-vessels. Thus
nicotin, adrenalin and alcohol have similar actions, which also corresponds
to the observations of Sir Lauder Brunton. We have had a great many
smokers among our arteriosclerotic patients; but, on the other hand, we
quote further on the cases of some great smokers who lived to a very old
age as we have seen. But this latter class is not numerous.
Similarly, the hygiene of the intestines is of the utmost importance,
especially as poisons generated in the intestines play a leading part in
causing arteriosclerosis, according to Huchard, Senator, and others. We
must take great care to have a daily evacuation of the bowels, and
especially to prevent flatulence, for this distention of the colon or the
stomach, by carrying the diaphragm upward, may interfere with the
expansion of the lungs and thus produce a mechanical hindrance to the
movements of the heart and a free circulation of the blood. Those with a
tendency to angina pectoris must specially avoid such dangerous courses.
Hill climbing, during which not infrequently such people suffer sudden
death, should also be avoided. More than from 1 to 1½ liters of liquids per
day should not be allowed.

CHAPTER XVII.

The Elimination of Toxic Products Through the Intestines and
the Improvement of This Function.

The intestines contain billions and billions of microbes, their number
increasing downward throughout the length of the intestine. The duodenum
contains the least, and in some parts of it there are none at all.
The presence of these bacteria is a great necessity to us, as without their
assistance we could not exist, for they take an active part in intestinal
digestion and help to form the intermediate substances, especially from
albuminous food and fat, for our nutrition. They also assist fermentation
and thus induce a better peristalsis of the intestines, by which the contents
are expressed.
That animals cannot exist without cultures of bacteria in the intestines is
shown by the experiment of Schottelius, who demonstrated that young
chickens could not thrive on a sterilized nutrition, and Nuttall and
Thierfelder had great trouble in keeping their guinea-pigs alive when
feeding them for a time on sterilized milk.
All those bacteria which are found in the intestines are, we may say,
innocuous; they assist digestion and do no harm. But among such are often
virulent bacilli against which, under normal circumstances, we are well
guarded, as the epithelium of the intestines is so wonderfully arranged that
so long as it is in a healthy condition it does not admit the passage of these
microbes; but in the aged, or in those exhausted by debauchery or previous
disease, or when there is an inflamed condition of the intestines, stagnation
of hard masses of fæces for a very long time cause mechanical lesions of
the epithelium when, conditions now having changed, nothing will prevent
these microbes from entering the walls of the intestines and either cause

disease, like typhoid or tuberculosis, or from passing through and entering
into the blood.
Besides these dangerous bacteria many other harmful substances pass
from the stomach down into the intestines, whence they are taken up by the
portal vein and brought to the liver. When the latter is in good condition so
much the better for us, but when they arrive in too large quantities, or when
the liver is more or less degenerated, as in old people, drunkards,
gourmands, etc., then trouble arises.
When the number of bacteria in the intestines is much greater than usual,
certain dangers arise from such a condition, as thereby the immigration of
bacilli into the bile-duct is facilitated causing inflammation of the gall-ducts
and gall-bladder, and subsequently gall-stone disease. Further consequences
of such a condition may be the closure of the bile-duct, and then no bile can
reach the intestines. The presence of bile, however, is very important, for,
according to current opinion, this exerts an influence on the checking of
putrefaction in the intestines. Bile is a natural antiseptic of great efficacy,
and has also a stimulating effect on the nerves of the intestines, promoting
their peristaltic movements.
It would, therefore, greatly interfere with the useful work of those
organisms normally present if we permitted the formation of enormous
quantities of bacteria, especially of such as are harmful to us; so we must
endeavor to eliminate them and not give them the opportunity to turn
against us, and we must do all in our power to keep the peristalsis of the
bowels in good working order so as to prevent any stagnation of their
contents, as such a stagnation, in addition to favoring the growth of
bacteria, also facilitates the development of auto-intoxication. Even if it is
true that most of the end-products of proteid food in our intestines, like
indol and skatol, are not able to produce severe poisoning if injected into
other animals; still there is no doubt that in medical practice not
infrequently cases are observed where the retention of all these products
together results in very grave conditions. Thus Ewald[212] has published the
case of a woman who, for about a month, retained the contents of the
bowels and in consequence presented a serious condition of intoxication;
after eliminating a large quantity of fæces—pitch dark—she recovered and
the symptoms of intoxication disappeared. Senator also published a very
interesting case of auto-intoxication with hydrothionuria.

We often have occasion to note cases of persons having no bowel action
for two to three days, who then complain of headache, loss of appetite, and
various nervous symptoms, neurasthenia, etc., all of which may, perhaps, be
regarded as of reflex origin; but when we see in such people a yellow or
yellowish-gray complexion which, after a good purge, resumes its clear
condition, clinically, we regard it as auto-intoxication.
Even if, as already mentioned, most of the elements of albuminous
catabolism are not toxic if injected into animals, still, occasionally, toxic
products can be formed, such as cholin and neurin, which come from the
former. These elements arise from decomposition of the lecithin, which, of
our various foodstuffs, is contained in the greatest quantity in eggs; and
these substances can provoke serious nervous symptoms. In such cases
there is, of course, a stagnation of long duration of the bowels, but such a
condition as the latter can arise without a stricture or obstruction, although
these are the most frequent causes. Another toxic product is the pepto-toxin
of Brieger.
Stagnation takes place in sluggish bowels. As a general rule, fæcal
movement is caused by peristalsis of the intestines, which consists of
circular contractions of the bowel by which the contents are propelled
toward the end of the same; besides these movements there are also
pendular or vermicular contractions of certain parts of the intestines; all
these movements also assist the admixture of the chyme with the juices of
the intestines. All these contractions are caused by impulses from the nerves
which lie in the walls of the intestines, the plexus myentericus; they can
also be provoked by impulses coming from the central nervous system.
The nerve ganglia that lie in the walls of the intestines can be influenced
mechanically by the contents of the intestines, when such are bulky, and
also when they are fermenting; therefore, the bacteria, by promoting
fermentation, also aid in peristalsis. The bulky condition of the bowel
contents can be best induced by food of the vegetable kingdom through its
cellulose contents, of which tissue the cells of plants or fruits are largely
formed. When these irritating agents act on the nerve filaments in the
intestines, the bowel will contract and expel its contents.
But when food contains no irritating substances and is easily assimilated
without forming residues, or when the innervation by the vagus is sluggish

and the peristaltic movements are slow, the contents of the intestines can
remain longer, especially in the haustra of the intestines. It may be that the
bowels move every day, but that does not prove that everything in the
intestines has been expelled therefrom, for some amount of fæces can yet
remain in the haustra of the intestine even for many days; so that in such
cases there is still a constipation of one part of the bowels. We have
observed, personally, and on patients, that, after a good opening of the
bowels, when a purge is given—for instance, directly after a meal—a short
time afterward there has been another copious discharge that had evidently
remained behind. Thus, no doubt a retention of fæces, and sometimes a
condition analogous to auto-intoxication, can be caused in people who have
the bowels opened every day, although not to the extent of those having
obstruction or habitual constipation.
To avoid such a condition a good purge should be taken at regular
intervals, say once a week, even by persons who have a movement daily, in
order to eliminate matter which may have remained. It will not be
necessary, naturally, to use a too powerful purgative, but one adapted to the
necessity of the case; taking, as a rule, such a purge as will act a little better
than the ordinary bowel movement, and graduated according to the strength
of the person so using it.
Before closing this chapter we must also briefly insist upon the
importance of the fact, that the secretions of the intestine and of its
glandular annexes have also an anti-bacterial and antitoxic action. Very
important is the rôle of the bile for the disinfection of the intestine, as it
contains two acids, the glycocholic and taurocholic, which possess highly
anti-fermentative properties. As already mentioned, the bile also assists in
the assimilation of fat, and also exercises a stimulating action on the
peristalsis of the intestines.

CHAPTER XVIII.

On the Prevention and Treatment of Habitual Constipation.

We all know from physiology that the expulsion of fœcal matter from the
intestines takes place in such a manner that the contents therein act as a
kind of extraneous body with stimulating action upon the walls of the
intestines and the plexus myentericus contained in the same. Consequently
there follows a contraction of the walls of the intestines, and their contents
are expelled. All nerves, the plexus myentericus included, are under the
control of the central nervous system, which creates motor impulses
through the medium of the pneumogastric (vagus), or may cause a check to
the peristaltic movements through the intervention of the splanchnic nerves.
Thus, as we see, different agencies influencing the central nervous
system, like strong emotions, shock, etc., may cause an irritation of the
pneumogastric, the motor nerve of the intestines, and thus occasion a
movement of the bowels. Different toxic products may act also upon the
pneumogastric; strong motor action of the intestine with diarrhœa may also
be caused by the abundant secretion of the thyroid gland, as in Graves’s
disease, where an excess of toxic matters of the thyroid gland are secreted.
In the same way we can also produce diarrhœa if we give thyroid extracts
in too abundant quantity; but giving the same in more moderate doses will
effect an improvement in the peristaltic movements.
That the thyroid gland has a controlling influence on the innervation of
the intestine is evident from the fact that, when the thyroid is degenerated,
the bowels are very sluggish. Under such conditions we often find very
stubborn constipation; but when we administer to such persons thyroid
extracts for a given time, we note a considerable improvement of the
bowels, which can even go to the extent, if too excessive doses be given, of
causing diarrhœa as already mentioned.

In addition to the thyroid gland, there are other ductless glands which
seem to influence the peristaltic movements by acting on the splanchnic
nerves, and these are the sexual glands. In women they are frequently
altered. Dysmenorrhœa, amenorrhœa, and other troubles are frequent, and
constipation is a typical symptom of such conditions. This may also serve to
explain why women are more often constipated than men.
But the alteration of the sexual glands can also cause constipation in men,
if we may draw the inference from the great frequency of constipation in
diseases of the prostate gland, which to some extent may be in relation with
the subject with which we are now dealing.
In order to avoid constipation we must therefore observe a careful
hygiene of the thyroid, and also of the sexual glands, following the advice
we offer in special Chapters XVIII and XLVIII.
Besides constipation, as above, from the central nervous system, the
same may be caused through the lack of a stimulation which may come
from the intestinal contents. As we have already seen, the peristaltic
movements of the intestine and the expulsion of fæcal matter take place
through the stimulation of the nerves in the intestinal walls by the intestinal
contents, which act either mechanically or by the irritation which their
fermentation causes.
To prevent constipation we must take such nourishment as will act in a
stimulating way, either mechanically, owing to its bulk, or by the
fermentation it causes. In order to have good bowel movements we must
create them, and this is best done, not by a diet of meat and finely ground
cereals, which are absorbed with scarcely any residue to effect the purpose,
but by one of vegetables and fruit, which contain cellulose in the largest
quantity, this substance forming the framework of the structure in which the
cells are imbedded; it constitutes the wall of the cells. This cellulose
provides us with the best residue from food, which, if present in large
quantities, will exercise a mechanically stimulating action on the intestinal
walls.
Vegetables are thus a valuable aid in the prevention of constipation, and
of these the following are the best: spinach, carrots, green beans, and boiled
lettuce, taking into consideration their action as laxative food. Cabbage also
acts well as a bulky food.

Graham bread and brown bread in general, and in particular a special
kind, called “cellulose” bread, are also very good agents with which to
prevent and to treat habitual constipation. Some breads, as various kinds
made from bran, are so coarse that, to a certain extent, they may be
considered as setting up a kind of internal massage of the intestines.
Not only vegetables, but fruits, by reason of the fruit sugar and acids they
contain, may also prove laxative if taken in given quantities. Fruits may be
taken stewed, as a compote, or baked, as for instance, apples; they may also
be taken au naturel if the condition of the stomach permits. Of compotes
the most laxative are plums, prunelles (sour figs), and apples; also
pineapples, cherries, and various berries, all of which may also be partaken
of in the form of a mush or purée, to great advantage; also fruit juices and
fruit wines, if free from alcohol.
Of fresh fruits, grapes and, according to our observation, pineapples also
undoubtedly have the best laxative quality, as also have green figs, which
can be taken regularly as a preventive against constipation. Figs when dried,
especially the so-called Olympia figs from Smyrna, or the California
variety, are also most beneficial, their laxative properties to a certain extent
being probably due to the seeds which they contain, which serve as a means
for intestinal massage.
Orange and grape-fruit, taken on an empty stomach in the morning, may
also have a laxative effect, due probably to the quantity of fruit acids they
contain.
We sometimes hear patients complain of constipation after partaking of
milk. According to our experience, this is more often the case when boiled
milk, heated above 60° C., is taken. On the other hand, we believe that
when uncooked milk is taken it may act as a laxative in many persons, due
to the action of milk-sugar and acid. Acidulated milk may have this
property in a greater degree, as also may buttermilk, and especially whey;
all of these are, on the whole, good laxatives.
The diet of those suffering from habitual constipation should be as
follows: In the morning, on rising, take a glass of cold water and an orange.
For breakfast, one or two oranges or several slices of fresh pineapple, or, in
countries where one is so fortunate as to obtain such delicious and
wholesome fruit, a grape-fruit; after that one or two soft boiled eggs,

cereals, Graham or brown bread, or one of the kinds of coarse breads rich in
cellulose, and fresh butter thickly spread on the bread (if the stomach is
good). Then follow with orange marmalade or purée of prunes, ending with
some grapes. Honey (another excellent laxative) may also be added. Two
glasses of milk or more, for those who can stand it; in fact, as much as they
desire. For dinner, the following is recommended: Roast or boiled meat,
two sorts of green vegetables (by preference spinach), French beans,
carrots, boiled lettuce, one course of stewed compote of fruit, and finish
with dessert of grapes, figs (dried or green), or preserved plums (California
or Bordeaux). For drink, mineral waters, such as the various light American
kind, either mixed with wine or alone. Alkaline waters, such as Biliner,
Vichy, etc., if taken very cold, may also contribute to the laxative action.
For supper, something akin to breakfast. As we shall point out in the chapter
on the hygiene of food, we recommend meat only once a day.
We are confident, from experience gained with our own patients, that
people who follow such a regimen will have an easy bowel movement
daily, and will thus avoid those dangers which are connected with the
habitual use of laxative drugs.
For those who, in spite of such a course of diet, have sluggish bowels, we
recommend massage and electricity, and also certain hydrotherapeutic
procedures. The method of carrying out such must be obtained from the
special hand-books written for that purpose; but we would merely mention
here that massage should preferably be performed by one belonging to the
medical profession, or, at any rate, by one trained in the Swedish system.
Electricity may be applied by either galvanic or faradic current, both of
which give excellent results.
Hydrotherapeutics must not be overdone or harm may result. We find that
a compress of lukewarm water (Pressnitz compress) worn round the
abdomen and back through the night, produces good results in many cases,
if the diet is, at the same time, appropriate.
For those who only suffer occasionally from constipation, as, for
instance, after a railway journey, it is an easy and always efficacious
method (if there is no inveterate constipation) to take a suppository of
glycerine and introduce it into the rectum. After only ten to fifteen minutes
interval there may be a copious evacuation.

In persons where the dietetic and above-mentioned mechanical remedies
have not proved effective, irrigation of the rectum and intestines should be
employed. We would not, however, advise the constant use of this method,
as torpidity of the intestine might result if practiced daily (see chapter on
the hygiene of the intestines).
In cases where there is a more serious degree of constipation a little soap,
or olive or castor oil, should be added to the water, together with a little
soda to assist the formation of an emulsion.
Enemata possess the advantage of having nothing to do with the stomach,
and thus this important organ can be spared much irritation which,
unfortunately, cannot be avoided when other purging remedies, such as
drugs, are given, all of which must pass through the stomach when taken by
the mouth. If we find it necessary to resort to laxative drugs by the mouth
we must first try such drugs as are least irritating to the stomach and
intestines, and foremost among these is rhubarb, which can be taken in the
form of a compote as well as a drug. To this it is well to add magnesia and
bicarbonate of soda. We should, if possible, administer only the mildest
purgatives, and, therefore, if rhubarb is not effective, we may give cascara
sagrada, or the pulp of tamarind, which is, moreover, pleasant to take; but
the action is not so pronounced as in the case of cascara sagrada (rhamnus
purshiana).
Before resorting to drugs, however, we think it would be better to try the
natural mineral waters, and only when these fail should we fall back on
drugs.
There are two kinds of mineral waters, each varying in its action: 1. The
milder acting water, of a laxative nature. 2. Stronger water, with drastic
action. Of the former we will mention those which are employed for several
weeks continuously for a regular cure: Germany: Kissingen; Austria:
Carlsbad; Marienbad. As the author of this book is himself a practicing
physician at one of these springs, he thinks it more becoming to pass over in
silence which of these waters is preferable. Each of them, as also many
others not mentioned for want of space, have their undoubted merits. A
teaspoonful of Sprudel salt, taken in a glass of lukewarm water in the
morning on an empty stomach, will give excellent results; but it should not
be taken every day for any length of time, as otherwise, as with all other

drugs if taken continuously, it may deaden the excitability of the nerves of
the intestines, and success depends upon keeping these nerves in such a
condition that they may respond, upon a light stimulation, with a
contraction of the intestinal walls and expulsion of the fæcal matter.
Of the strong mineral waters with drastic action, there are several
excellent springs in America, some of them surpassing many of the
European mineral waters. In Europe there are in Hungary: Hunyadi-Janos,
Ferencz-Jozsefforrás, etc.; Spain: Rubinat, Villacabra-Loeches, etc.; and
elsewhere a number of such springs. As all are natural remedies they should
be used in preference to drugs when the intestine does not respond to mild
laxatives and a strong whip is needed. In my opinion they are less fitted for
every day treatment, though well adapted for a thorough cleaning out of the
intestine to get rid of stagnant matter (see Chapter XIX).
These strong, drastic, natural waters act by causing a transudation into
the intestine, creating a condition somewhat similar to a catarrh, but in a
more benign way.
Briefly, the best and most rational treatment of sluggish bowels is by
stimulating the intestine by means of an appropriate diet which, at the same
time, tends to ward off old age.

CHAPTER XIX.

Hygiene of the Intestines.

As the means by which we are able to keep the intestines in good
working order are of the same efficacy also for the stomach, all that is
necessary to mention in this chapter about the intestines will apply equally
to the hygiene of the stomach. The same applies also to the pancreas, so that
it is unnecessary to treat of its hygiene separately. It is also our intention in
this book to mention only the hygiene of those organs which are able to rid
the body of toxic products, as it is mainly by their degeneration that
premature old age is brought about.
There is scarcely a serious disorder of the stomach without an attendant
alteration of the intestinal functions. All the different agencies that are
dangerous to the stomach will also prove dangerous to the intestines. We
have mentioned several of these in the chapter on food and the hygiene of
eating, where we have pointed out that defective mastication is very
deleterious. Food introduced into the stomach passes into the intestines, and
if it reaches these insufficiently masticated it will present great difficulties
for the penetration of the intestinal ferments. Not only will it not be well
digested, but as the different ferments cannot well penetrate these compact
masses they will putrefy, thus considerably increasing the natural
fermentation, in consequence of which a great amount of toxic products and
a considerable irritation of the intestinal mucous membrane will result,
which may subsequently cause disease. By thoroughly masticating
everything we eat, we are not only safeguarding the condition of the
stomach, but also that of the intestine.
The integrity of the functions of the intestines is of supreme importance,
for it is here that absorption and assimilation of most of our food occurs. If
our intestines are not in perfect order we shall soon waste and dwindle

away, even within a short period, and sometimes very rapidly. Thus if we
wish to retain our strength we must treat the intestine with the greatest care.
This is especially the case in old age, for then an atrophy of the glandular
mechanism of the digestive tract, stomach, and intestines, takes place. Thus
old people will not be able to assimilate nourishment to the same extent as
younger ones; they will lose a portion of its nutritive value, and it will
become more and more difficult for them to completely digest their food.
To such people, therefore, it will be necessary to give food in a form that is
easily absorbed, preferably in liquid form; it would also be desirable to give
them their albuminous food in a predigested and soluble form. In Germany,
especially, are used a considerable number of so-called “Nährpräparate,” a
nutritive preparation which contains albumin in the form of albumose,
which naturally can be assimilated easier; there are also carbohydrate
preparations in which the starch is transformed into dextrin or maltose.
There is a legion of such preparations, but it would lead us too far to enlarge
on them by a longer description. They are produced from proteids, many of
them from fish, or from blood, or from eggs; also from milk; while others
consist of finely ground preparations of wheat, oatmeal, barley, rice,
arrowroot, sago, tapioca, buckwheat, Indian corn, etc. As aged persons have
greater difficulty in assimilating in their intestines and stomach food in its
natural state, the use of the best of these predigested preparations would
certainly be advisable in order to insure a healthy condition of the intestines
and a prolongation of life. The last mentioned carbohydrate preparations
possess also the great advantage of preventing an excessive putrefaction of
the intestinal contents with its harmful consequences, which tendency is
always greater with albuminous food, starchy foods in large quantity
tending, as already stated, to produce acid fermentation in the intestines by
which many products of albuminous digestion can be destroyed. Against
these poisons formed in the intestinal tract we possess a natural defense in
certain ductless glands, the thyroid and liver, which are degenerated in old
people; therefore carbohydrate is the best for them.
The prevention of intestinal putrefaction is, however, equally important
in younger people. As Combe proves, we can avoid this by the use of
certain kinds of food, especially carbohydrates and fruit, and by other
substances producing lactic acid, which is, indeed, the best disinfectant for
the intestines. The great benefit of various kinds of sour milk generally has
been pointed out by Metschnikoff and his disciples. Among the causes of

old age this savant attributes an important rôle to the processes of
putrefaction in the intestines, and to avoid this he recommends the use of a
certain kind of sour milk produced by fermentation by a number of
microbes, including the Bulgarian Bacillus maya.
That certain kinds of food exercise poisonous effects when introduced
into the intestines is a matter of common observation. Thus, in not a few
cases, fever, accompanied by cutaneous eruption, may be witnessed after
partaking of strawberries or oysters, and especially after eating meats
(notably sausages) which are in a state of decomposition. Severe cases of
poisoning, even resulting in death, have occurred; and in Germany there
have been, from time to time, regular epidemics after partaking of sausages
in the above condition.
Of course everyone partaking of such poisonous food will not become
poisoned as this is prevented by the action of such glands as the thyroid and
liver, whose function it is to preserve us from such effects. People in
possession of healthy sensory organs,—eyes, nose, and tongue,—will be
enabled to tell whether meat is in a fit condition to be eaten or not; but
frequently we cannot discover by our senses a state of decomposition when
such is not in an advanced stage, and if such food is taken regularly and in
large quantities the great number of microbes we thus introduce into the
intestines will poison us slowly but surely.
Such poisonous microbes thrive and multiply very well in the alkaline
contents of the intestines, but the growth of such dangerous bacteria can be
greatly hindered by the introduction therein of acid substances, especially
lactic acid. It has been observed by several authorities, such as Grundzach,
[213]
Schmitz,[214] and Singer,[215] that lactic acid decreases intestinal
putrefaction, and also the conjugated ether sulphates in the urine.
Professor Metschnikoff, of the Pasteur Institute in Paris, deserves great
credit for having insisted on the importance of introducing certain microbes
into the intestines for the purpose of transforming the sugar of their
carbohydrate contents into lactic acid, and thus causing the disinfection of
the intestines by destroying the noxious germs and hindering their
development. For this purpose the so-called Bulgarian bacillus can best be
employed, as it is able to transform the cultures of pathologic microbes in
the intestines into a beneficient growth that is quite harmless.

This Bulgarian bacillus is well known because of its action in producing
the sour milk “yoghurt” of the Bulgarian population, to the use of which,
according to Metschnikoff, is due the very large number of centenarians to
be found in that country.
The action of the lactic bacilli has been proved by the experiments of Dr.
Herter, of New York,[216] who discovered that by the introduction of large
quantities of these bacilli into animals their intestinal putrefaction was
diminished.
Dr. Michel Cohendy[217] has performed similar experiments on himself.
After taking for twenty-five days his usual diet and subsequently noting the
degree of his intestinal putrefaction, he took pure cultures of a lactic
bacillus, extracted from “yoghurt.” For more than two months he continued
to take large quantities of these bacilli (280 to 350 grammes a day). Not
only during the course of the experiment did the urine exhibit evidences of
a diminution of intestinal putrefaction, but this continued for seven weeks
afterward, and he arrived at the conclusion that the lactic acid fermentation
due to this bacillus was able to hinder the putrefying action of the microbes
developed from the meat he had taken during his experiments. He,
therefore, comes to the conclusion that it is unnecessary to discontinue meat
food for the suppression of intestinal intoxication if lactic bacilli be taken
therewith.
Dr. Pochon, assistant to Professor Combe, of Lausanne, continued upon
himself the experiments of Dr. Cohendy. For several weeks he took sour
milk (lait caillé) which was prepared from cultures of pure lactic microbes,
and he found positive proofs of the checking of intestinal putrefaction
thereby.[218] In those, therefore, who are able to procure and use a pure
preparation of lactic bacilli, intestinal putrefaction will be greatly
diminished. But even when we cannot obtain these preparations we can
follow a diet that will tend to develop lactic acid fermentation. This can be
brought about by taking carbohydrates in large quantities, especially those
which are very rich in sugar, at the same time taking milk, particularly sour
milk.
It is an absolute fact that in those who are addicted to a diet of
carbohydrates, intestinal putrefaction is diminished, owing to the formation

of lactic acid from the fermentation of the milk-sugar which is contained in
such carbohydrates.
Intestinal putrefaction is enhanced by the alkaline contents of the
intestines; it can, therefore, be checked by various agencies that diminish
the alkalinity of the intestine, such, for instance, as by lactic acid, just
referred to. Fatty and acetic acids also effect this; likewise fatty food, which
promotes the formation of fatty acids. Cheese may produce fatty and also
lactic acids; wherefore it is of value to combat putrefaction in the intestines.
Of the further benefits of cheese as an article of food, we make mention in
the chapter on the hygiene of food; we also state there that it is unsuitable in
those cases in which the intestines are not in thorough order.
Great care should be exercised in the quality of the food. The freshness of
various foods is of the greatest importance to the intestines, since the main
function of the stomach is principally a mechanical one, serving to reduce
the food into a convenient form and carry it to the intestines, ready to be
there prepared, through the influence of the intestinal juices, into a
condition fit for absorption and assimilation. During this process the food is
being reduced to its simpler elements, and the more noxious substances are
being freed to commence their baneful activity. These substances first of all
create an inflamed condition of the intestines; then, being absorbed into the
blood, they cause a general intoxication. Fortunately they are not frequently
absorbed, and thus their injurious effect is limited to the intestine. Among
other such injurious foods we may mention fish and oysters, sausages and
meats that are in a state of decomposition; fruit that is unripe or unsound;
and canned food in which certain drugs are used as preservatives, such
being poisonous in varying degree, examples being salicylic boracic, and
sulphuric acids, etc., and at times even the terrible poison, verdigris. Fresh
food should always be preferred to canned food, or to food preserved in
other forms for too long a period (see also chapter on the hygiene of food).
The stomach, and intestines also, can frequently suffer damage from ice
cold drinks, especially if taken habitually and in large quantities. As already
mentioned in the chapter on the hygiene of the kidneys, we should never
forget that every sort of food or drink must pass a series of delicate epithelia
of our noblest organs, which can be injured by sharp and poisonous
substances with which they come in contact.

More injurious is the action of various kinds of noxious food, especially
if putrid, which remain for a long time in the intestines, thus creating a
chemical laboratory constantly preparing poisons. Even the residue of less
harmful foods, especially albuminous, even if of good quality, when taken
into the body, can become deleterious if it remains too long in the intestines.
It will, therefore, be a part of the highest wisdom to exercise care in having
these highly important organs, on which all our nutrition depends, in
thoroughly good working order by keeping them clean and by removing
stagnant material. We have already designated the best way to effect this in
a previous chapter, and we desire here to say a few words on the abuse of,
and great dangers arising from, remedies constantly prescribed for
constipation.
We have insisted in the foregoing pages on the necessity of a daily bowel
movement, and have stated that appropriate food is the best way to attain
this. Food that leaves no residue, like meat or finely ground cereals, is
incapable of producing a stool. Hence, as Schmidt has pointed out,
constipation is often caused by the food being too completely absorbed.
Strassberger, by analyzing and counting the number of bacteria in the
stools, found that certain cases of constipation were caused by a diminished
fermentation in the bowels. Lohrisch has found that in persons whose
intestines possess a marked power for absorption there does not remain in
them a residue sufficient for the action of the bacteria, and thus there will
not be a sufficient fermentation to act as a stimulant to the intestinal walls to
cause them to expel their contents. Uncooked cold milk (especially
buttermilk, whey, sour milk, “yoghurt,” kefir, etc.), and dishes containing
vegetables and fruit, grapes, puree of prunes, marmalade of oranges, and
brown bread (Graham, Pumpernikel, etc.) should produce a movement of
the bowels every day in a normal man or woman. There are, however, many
exceptions to this, especially in the case of women, caused either by
previous errors in diet, or by negligence in answering at once the demands
of the bowels for an immediate evacuation, and also, very often, by an
abuse of purgatives. All this is, of course, aggravated in those in whom the
innervation of the bowels, which is controlled by the splanchnic nerves and
the vagus, is altered by the degenerative condition of certain glands which
influence these nerves: the sexual organs and the thyroid.

These alterations are far more common in women, as frequently
mentioned before, as their sexual glands and thyroid are so often irritated by
physiological and pathological processes peculiar to her sex, and which so
frequently recur during the life of a woman. It is a fact that most of the
diseases of the female sexual mechanism are followed by alterations in the
intestines, due, in part, to their close proximity to the pelvic organs, but, in a
greater degree, to the intimate relation of these regions to the nerves that
control the intestines. The same is true to a lesser degree in man, so that
after troubles with the prostate, or after chronic gonorrhœa, a regulation of
the bowels is an important matter, constipation being usually very obstinate
in such cases.
In addition to this sluggishness of the bowels in females, owing to
anatomical and physiological causes, there may be associated faults arising
from a bad habit. Instead of paying special regard to the innate tendency
toward constipation and endeavoring to have a movement every day, many
women, especially young girls, neglect this by even resisting the demand of
the intestine to be evacuated, and deferring this most important function to
the following day, or even later. Such a course necessarily lowers the
vitality of the intestinal nerves and muscles. As soon as such a nervous
impulse is felt, we must promptly act on it; should we not do so a greater
nervous and muscular effort must follow, and, if even then we neglect to
obey the call of Nature, after several such useless efforts the nerves and
muscles of the intestines will relax, particularly if such a foolish practice be
often repeated, for it is quite natural that such an intestine will not respond
to the stimulation by the pressure of its contents upon the nerves, and its
muscles will not contract to expel the fæcal contents, as in normal people.
Unless, therefore, from force of circumstances, it is impossible, we must
at once respond to the first admonition of the intestines, and not exhaust the
vitality of its nerves and muscles by exposing them to unnecessary efforts at
our own expense. Some people are so impressed with the importance of
immediately answering such a call that they will forego the most urgent
business on that account. I know an authentic case of a member in the
profession—a great surgeon—who, a few years ago, was urgently
summoned to a member of the highest nobility who had met with a hunting
accident. Unfortunately for the patient the call came at just such a moment
as we have been speaking of; true to his principles, he did not arrive

immediately, but only after having fulfilled the execution of this important
part of the hygiene of his intestines, and the patient lost his life.
Happily such an instance is of the rarest occurrence in our profession, for
we always ignore our own chance for a long life in favor of our patient’s,
which is fully proved by the fact that, of all professions, the physician’s life
is the shortest.
Corsets as worn by women contribute to develop in them ptosed bowels
—gastroptosis and enteroptosis—which can easily arise after pregnancy;
the strength of the intestinal muscles becomes still more diminished and
constipation is the consequence.
It is not to be wondered at if women, and men also, in cases where the
diet alone does not bring about an ordinary movement, should resort to
drugs, several of which we have mentioned previously. At first, even the
mildest drugs will act; but, unfortunately, after a time the intestine becomes
accustomed to them and they cease to act. Stronger drugs are then resorted
to, such as often contain aloes, which, besides injuring the stomach, act in a
very irritating way on the intestines; these respond by a very strong action,
causing copious stools accompanied by colicky pains. But it is in the nature
of things, as we have observed holds true in any organ, that overstimulation
of any function is followed by its exhaustion; thus the nerves and muscles
of the intestine get over irritated and relax if obliged to overact. After a
copious evacuation caused by strong drugs we, therefore, find a still more
obstinate constipation than before. Stronger and stronger drugs are then
used until there is a complete breakdown and ruin of the intestinal
innervation and muscular action. We must, therefore, commence first with a
suitable diet, then use mild drugs if necessary, with massage and electricity,
as already described.
Intestinal enemata are also beneficial, but if a large amount of liquid be
used the muscular walls get too greatly dilated and may lose their elasticity
and vitality, particularly if strong drugs be used in such enemas.
Many women suffer from habitual constipation by reason of their
drinking but little water, especially if the food they take contains little fluid;
the fæcal masses become solid and coagulated, and thus their passage in the
intestine toward the anal exit becomes more difficult, whereas by a
sufficient quantity of liquid, such as water, this movement will be much

facilitated; and that this is an important consideration is quite evident in the
case of women who have a tendency to lethargic bowels. Such a thickening
of the fæcal masses occurs particularly in certain parts of the intestines,
such as the cæcum, the ascending colon, and the sigmoid flexure. In these
parts the fæcal matters often become detached, accumulate, and easily get
condensed. They may remain there sometimes for longer periods, which can
easily be proved by experiments, giving bismuth by mouth and then
examining the abdomen by means of the Roentgen rays.
It thus happens that people, under the impression that a good daily stool
has produced a clean bowel, still have a residue, and this can instantly be
seen by removing the same by purging drugs. We, therefore, recommend
the weekly use of a reliable purgative, such as bitter water, thus cleaning the
bowels of all residue, which frequently remains in deep haustra of the
intestines, as in Barlow’s disease.
The stagnation of fæces around the cæcum may also facilitate the
development of appendicitis, this being frequently due to neglect of the
hygiene of the intestines. It is also one of the commonest diseases, as we
will show in the succeeding chapter.

CHAPTER XX.

Hygiene of the Intestines—A Few Remarks on the Cause and
Prevention of Appendicitis.

Appendicitis, in these days, is one of the most frequent causes of an
unexpected death. As this work is designed to set forth the means by which
we may prolong life, it is desirable not to miss the opportunity of offering a
few remarks, in connection with the chapters on the preservation of the
intestinal functions, upon the cause and prevention of an intestinal disease
by which particularly young and promising lives are frequently cut off.
In the previous chapters we saw that the cæcum was one of the places of
selection for the stagnation of the fæcal contents in the intestinal canal. As
the pressure of such fæcal matter in the cæcum and colon is greatest toward
the appendix the contents may go more easily into than away from the
appendix, and particularly so when, from a long rest in the cæcum, they are
thickened. The return of fæcal matter from the appendix is often hindered
by a spindle-shaped thickening at the junction of the appendix with the
cæcum, which presents the appearance of a narrow bridge.
This thickening of the mouth of the appendix is the consequence of the
very close contact of the psoas muscle, upon which, in many people, the
appendix lies, so to speak resting upon it. This has been shown by
Offerhaus[219] (a surgeon in the Hague Hospital) to be the case in 62 per
cent. of normal men.
In certain movements, such as running or cycling, the psoas is
continually pressing against the appendix, and it is natural that such
continuous pressure against this organ will in time leave a permanent mark,
which is, indeed, seen in many cases of appendicitis. After a certain time a
circumscribed segmentation will be visible on the parts of the appendix

which are in contact with the psoas, and later this becomes so marked that a
circular kinking results, establishing the narrow bridge to which we have
already referred.
It is logical that the thicker the appendix, the more pronounced will be
the marks produced by the pressure of the psoas. The average size of the
appendix, even in the adult, is that of a somewhat slender worm, from
which is derived the name “vermiform appendix.” But when there is
stagnation of the fæcal contents in the appendix, and especially when the
thickened fæcal matters are of such hard consistency that a hard stony
concrement, such as the coprolith is formed, then the appendix sometimes
assumes quite a comparatively large size. We saw the case of a girl of 16,
operated on by Dr. Offerhaus at the Hague (details of which case were
published by him), in whom the appendix was of the size, in circumference,
of a large thumb.
In such large appendices the marks of the psoas will, of course, be more
pronounced, and frequently the narrow bridge referred to will develop. This
is caused by the appendix being further attached to the intestines where,
owing to the narrow connecting bridge, it is unable to evacuate itself, and so
grows larger and larger, the mischief thus constantly increasing.
It is also evident that the nutrition of an organ whose blood-supply is
mechanically interfered with, as in the case of the appendix by its close
contact with the psoas, as described above, must necessarily be a precarious
one; and it is a pathological fact that an organ which is badly supplied with
blood is also more liable to disease, because the insufficient supply of blood
causes a diminution in the number of phagocytes thereby weakening the
defense of the organ against infection, as explained in Chapters III and X.
Consequently the microbes easily prevail, particularly in a portion of the
body like the intestines, where they normally exist in such great numbers.
By the foregoing we have not only shown the cause, but also the
principles for a rational prevention, of appendicitis. As we have seen, the
starting point of all mischief is the close proximity of the psoas to the
appendix, and the occasional cause is constipation, with stagnation of the
fæcal contents. The best preventive against appendicitis consists in avoiding
both causes, which, however, is only possible in the latter case by adopting

all those measures we have mentioned in the chapter on the treatment of
constipation.
The first cause, the close contact of the psoas with the appendix, can
certainly not be prevented; but what we can do is to avoid all movements by
which the psoas is unduly pressed against the appendix. This can be done
by avoiding those exercises in which the psoas is brought into frequent
contraction and then pressed forcibly against the appendix: for instance,
running, cycling, etc. The young lady, already referred to, with the large
stone in the appendix, indulged freely in such sports. The habit of sitting
with one leg crossed over the other should also be avoided.
We must now, however, determine who those persons are in whom such a
condition exists. They are those who frequently complain of pains in the
appendicular region, usually after quick walking or running, and especially
after cycling, and at times even without these; but in this latter class the
pain is milder. In order to make an exact diagnosis whether such pains are
caused by pressure of the psoas upon the appendix, we must tell the patient
to lift the right leg high and we then press with the right hand against the
thigh. If there is a latent form of appendicitis due to the above-named
anatomical relations, then the patient will experience pain when we press
with the left hand upon McBurney’s point. By this means appendicitis can
be diagnosed while it is still in an early stage, and the life of many may be
saved before it is too late, and we know only too well how rapidly this
treacherous disease can lead to a premature death.
Having made the diagnosis in the above-mentioned way, we should
prohibit all active movements, especially running, cycling, etc., and take
special care to have a daily bowel movement by the use of a suitable diet
and those other means previously mentioned.
Pain in the appendicular region may be of a very pronounced character,
and yet there may be no appendicitis, for it may be caused by inspissated
fæces. The presence of stagnating fæcal matter often induces the formation
of gas, and by the distention so caused the intestinal nerves are irritated and
thus pain occasioned.
We can distinguish between appendicitis and pains following colics,
caused by flatulency, by giving carminatives, such as the decoction of
different carminative herbs called Aqua Carminativa Regia, which is much

used in Germany and Austria, where it is an official preparation of the
Pharmacopœia Austrica and Germanica. A few tablespoonfuls of this
decoction will produce free passage of gas, after which, in the case of
flatulent colic, the pain will disappear, especially if we add a purgative and
clear the intestines. Of course, in appendicitis the pain will not disappear
after the use of carminatives.
Besides the foregoing very frequent causes of appendicitis there are a few
others to deal with, all of which here is out of the question; our intention is
to confine ourselves to mentioning some of the more frequent causes and
not to deal exhaustively with the subject, which can be found in the various
hand-books on surgery. Yet we should like to mention one cause that is not
infrequent, and this deals with the relation between the tonsils and the
appendix. If we examine these organs histologically, we shall find that both
are of the same lymphoid tissue, and, indeed, some writers go so far as to
term the appendix the tonsil of the intestine.
Now we can often observe that when one of the lymphoid structures is
changed, the others may follow; and this shows that just as the ductless
glands are in close relation to one another, so also the ductless glands and
the lymphoid structures stand in close mutual connection, as we have
mentioned in previous works, emphasizing the fact that the tonsils are often
much enlarged in myxœdema, Graves’s disease, acromegaly, diabetes, etc.
In addition to these intimate relations there are also other causes arising
from the tonsils that affect the appendix. Such is the case when the tonsils
are inflamed and infectious matter arising therefrom reaches the intestines.
The cause of appendicitis from such a source has been confirmed by the
bacteriological examinations of Professors Lanz and Tavel. Indeed,
clinically, we can often see that appendicitis has been, in quite a number of
cases, the result of previous tonsillitis, this in turn often being caused by the
secretion from the inflamed posterior part of the nose coming in contact
with the tonsils, as has been previously stated.
Very frequently such a condition exists in conjunction with adenoid
vegetations, and this explains the error into which Delcour has fallen in his
book on the relation of adenoid vegetations to appendicitis, in which he
attributes the immediate cause of the latter to a state induced by an
insufficiency of the thyroid gland. We can often observe that adenoid

vegetations can exist with a good thyroid and vice versâ, although we
cannot deny the fact that in children with thyroid insufficiency adenoid
vegetations are frequent.
It is very probable that the first mentioned causes of appendicitis and the
last named often go together, the one assisting and developing the other.
The unfavorable anatomical position and constipation, together, offer a very
favorable soil in which, through bacterial co-operation after tonsillitis,
influenza, or other infectious diseases, this much dreaded disease can
develop.
By a slight operation life is often saved. The pity is that such aid is often
invoked too late.

CHAPTER XXI.

On the Elimination of Toxic Products Through the Kidneys.

In the course of this work we have frequently insisted on the fact that we
are being continually poisoned during the processes of life, either by
poisons coming from without into our body through food or drink, or by
toxic substances being formed in our body through defective metabolism.
We have a series of glands with internal secretions which have properties
antagonistic to these poisons, the most important of such glands being the
thyroid, parathyroid glands, adrenals and the liver, which act by destroying
these injurious products.
The following can now happen: Either these toxic products may be
produced in such enormous quantities that even the increased functions of
these glands will be insufficient to overcome them, or the glands may not be
in a condition of complete integrity. In either of these cases the bulk of
these poisons will be carried to the eliminating organs to be dealt with, viz.:
the skin, the intestines, and the kidneys.
As we shall see, the skin alone is not able to eliminate more than a
certain portion of these products, even by the additional assistance of
perspiration. In addition to the skin the intestines may also assist the work
of the kidneys, by expelling principally the poisons from the digestive
organs. But only a small portion of the poison circulating in the blood will
be eliminated in this way, especially if there is a lazy action of these organs.
Thus the great bulk of all these products is carried to the kidneys, which
are, indeed, our most important organs for the elimination of toxic products
from the blood.
It is furthermore important to consider the kidneys because they are also
glands with internal secretion. This is evident from the fact that uræmia is a
condition which is dependent upon the absence of such a secretion.[220] It is

not caused only by the retention of urine and the urea contained therein, for
cases have been noted where there has been no urine for as long a time as
seven days, and yet there was no uræmia, whereas uræmia rapidly develops
at times in spite of an abundant flow of urine and elimination of urea. Thus,
logically, uræmia must be ascribed to another factor, which can only be the
absence of an internal secretion from the kidneys, which may otherwise
perfectly perform their work. Another convincing proof of this statement is
the fact that we are able to treat with great effect, as we have personally
observed, diseased kidneys with extracts from the kidneys of pigs. We will
demonstrate the action of this in a separate chapter.
That the kidneys are glands with internal secretion has been proved
already by Brown-Séquard,[221] Meyer,[222] and other authors, among whom
we will mention as two of the last authorities on this question, Professor
Senator and Professor Hermann Strauss.
The kidneys, being glands with internal secretion, must then stand in
close relation to the other ductless glands, according to the law established
by us in our previous works. As already mentioned, we have shown in a
communication to the Paris Biological Society, February 25, 1907, that
these glands have an intimate relation to the thyroid gland, and vice versâ.
Thus, alterations of the thyroid always produce changes in the condition of
the kidneys. These alterations in the kidneys may, however, not necessarily
be based on the intimate relations between thyroid and kidneys as ductless
glands, but may be produced by the fact that, when the thyroid is
degenerated and cannot destroy toxic products, these poisonous matters will
be thrown on the kidneys (the skin and intestines not being of assistance
under such conditions) and eliminated by them. Naturally the passage of
such poisonous products through the kidneys is liable to produce changes in
them, and albuminuria and hyaline or granular casts may show themselves
in consequence.
The same may also happen after changes in the liver. When this
important organ is not able to destroy poisons they are carried in increased
quantities to the kidneys, whence their passage will produce albuminuria
and hyaline and granular casts, as has been especially described by such
French authorities as Huchard, Teissier of Lyons, Molière and Gouget, etc.,
as occurring in diseases of both liver and gall-ducts.

The appearance of albuminuria, and even of hyaline casts, must be taken
as a proof of an abnormal condition of the kidneys, and this notwithstanding
numerous authorities who are inclined to regard such an occurrence in a
more lenient way. We hold, with Professor Senator, that the permanent
presence of such elements in the urine is the proof of the fact that the
kidneys are not in a normal condition. Even the orthostatic albuminuria of
quite healthy persons, which, as its name implies, only occurs when such
persons have been standing for a time in an upright position, has been
considered by Senator as an expression of the existence of certain changes
in the kidneys. According to Senator, the hyaline casts also are not such an
innocuous symptom as certain authorities claim, but they are formed from
the degeneration of the convoluted tubules. This is the most important
element of the kidneys, for the greater part of the solids and toxins are
excreted by its cells from the blood, and besides this function these
epithelial cells also have an internal secretion. The appearance, therefore, of
hyaline casts (which, as Senator found, could be proved under the
microscope as having been formed through degeneration of the epithelial
cells) must be considered as evidence of the loss of the secreting portion of
the kidneys and of the destruction of their most important elements, and can
be found regularly in all the toxic processes that take place in the body,
showing that the poisonous products of these processes have passed through
the kidneys and been eliminated.
Thus we find albuminuria and casts, and even signs of a serious
inflammation of the kidneys, in different infectious diseases, and even after
tonsillitis; also after other toxic conditions caused by the secretion of toxic
products in the body from certain ductless glands, such as the sexual glands
during puberty and the thyroid gland in Graves’s disease. Likewise in
certain diseases where waste products of metabolism cause uric acid to be
formed in large quantities, as also in diabetes, where a quantity of other
toxic products, besides uric acid, are produced.
From the foregoing it is only natural to expect that different toxic
products which are introduced into the organism from without, either in the
food or in the drink, or which result from the decomposition of meat and
alcohol and other stimulants, will also, for the most part, be eliminated by
the kidneys, especially with a dilatory performance of the other
disintoxicating organs. When passing in large quantities, or sometimes even

in smaller numbers, they may be able to irritate the fine epithelia of the
tabula epithelia and also those of the glomeruli, and produce casts (hyaline
ones especially) and albuminuria. After large quantities of alcohol such a
condition can even become permanent if the other toxin-secreting organs
are sluggish.
In his experiments on animals Penzoldt has produced albuminuria by
means of English mustard, pepper, and particularly radishes, and still more
so after black tea. Gunzburg noted this also in a boy of 13, and Roth in a
child of 3½, in both cases after the use of black tea.
Albuminuria and casts can frequently be observed after the
administration of drugs in degrees varying according to the toxicity of the
drugs. We have published a case in which even epithelial cells of the
kidneys, single and in casts, as well as blood-casts in quantities, have been
found after an administration of chloride of potassium. Luttje found casts in
33 cases out of 207, and in 92 of these albuminuria, after the administration
of salicylates, and he issues a warning against their continual usage. That
the same occurrence has also been observed after the use of other poisonous
drugs such as mercury, chloroform, etc., will only appear to us as natural.
The skin and intestines, which co-operate continually with the kidneys,
are able to do a part of the work of the latter by eliminating poisons which
otherwise would have been carried to the kidneys, injuring the delicate
structures by which they are secreted and through which they pass. As will
be found in the chapter on the functions of the skin, this tissue is able to
eliminate (especially when its functions are increased, as in cases of
perspiration) a part of the harmful products, among them being some of the
nitrogenous end-products of metabolism, and also common salt. But when
the skin is unclean and its pores are clogged by dirt and the products of
perspiration, and when it is diseased, as in skin diseases, or when it is burnt
extensively and the sudorific glands destroyed, then these poisonous
products are directed to the kidneys, whose secreting structure will naturally
be injured by their passage.
The same may also happen after an obstruction or hindrance to the
intestinal functions. When the passage of fæcal matter is retarded for a long
time, a re-absorption of toxic matters can take place by the blood,
necessitating their elimination by the kidneys, with harmful consequences

to these important organs. This has been proved by experiments made by
Wallerstein, who mechanically closed the anus of rabbits and dogs. After
but twenty-four hours he found albuminuria and different kinds of casts in
the rabbits’, and casts only in the dogs’ urine. It is very important evidence
in favor of our supposition that the convoluted tubules of the kidneys play
the most important part in the excretion of harmful products from the blood,
that Wallerstein found, after four days, that the greatest change had occurred
in the convoluted tubules of the kidneys in these animals. The epithelial
cells of these tubules were greatly degenerated and in a state of coagulation
necrosis.
Similarly English[223] has found albuminuria and casts in cases of
strangulated hernia in men, in consequence of the stagnation of the contents
of the intestines and the re-absorption of toxic matters. Similar results may
also occur according to Leichtenstein, Senator, Jaffé, etc., in cases of
intussusception, incarceration, and similar pathological conditions.
Thus we can all easily understand how the stagnation of the intestinal
contents, as, for instance, in chronic habitual constipation, may also be
injurious to the kidneys; and, indeed, Kobler and Huler have described
albuminuria as a consequence of constipation. Not only is the elimination of
excrementitious substances checked, but there is re-absorption of poisonous
products from the intestinal contents which the kidneys must excrete.
That poisonous products coming from the intestinal tube are apt to
produce even serious changes in the kidneys has been proved by Heller and
Fishel after catarrhs of the stomach and intestines. At the same time we will
also mention that in cases of intestinal auto-intoxication we can also
observe a diminution in the quantity of urine, as noted by several authors, of
whom we specially mention Boas and Hemmeter.[224]
From the foregoing there can be no doubt that most of the toxic products
in the blood are eliminated by the kidneys. This is also the manner in which
the nitrogenous end-products of metabolism leave the body. The kidneys act
as a kind of filter for these products. When the kidneys, however, are
changed or degenerated by the formation of connective tissue and loss of
the elements of excretion, as in old age, then these products will be retained
in a greater or smaller number, and a condition of auto-intoxication follows,
to which we have previously ascribed a great rôle in the pathology of old

age. Logically, if we wish to prevent old age coming on too soon, or a
diminution of our chances for a long life, we must do our best to prevent
such a diseased condition.

CHAPTER XXII.

Hygiene of the Kidneys, and the Prevention of Renal Disease.

The most rational hygiene of the kidneys for the prevention of kidney
diseases consists in the avoidance of all those causes which are injurious to
the kidneys, and which we have mentioned in the previous chapter. A great
part of the poisonous products that are eliminated by the kidneys are
introduced with the food and beverages, and it is important for us to bear in
mind the fact that what we eat or drink must pass through our kidneys, and
that the structure of these organs is delicate; that the most important
secreting parts are composed of fine epithelium which can easily be
desquamated by the passage of irritating products. Thus we note the
appearance of hyaline casts after different kinds of spices and stimulating
liquors, especially if taken in large quantities.
There are many members of the profession who attach no importance to
the occasional appearance of a hyaline cast. But, considering the finding of
Professor Senator[225] that such casts are formed by degeneration of the
tubular epithelium, we cannot take such a lenient view; for even if we find
only one cast in two or three microscopic specimens, we must realize how
many thousands of these there may be in a liter of urine. Thus every day
thousands of these casts, and in a year enormous quantities, may be lost.
But as each cast means the loss of important secreting elements, there can
be no doubt that, after a certain time, we shall have lost an important part of
these most important organs, whose place is taken by connective tissue.
Thus the development of interstitial nephritis can be hastened by faults in
our alimentary régime. In cases where meat is taken abundantly it is most
probable that the continual excretion from the blood of nitrogenous end-
products of metabolism means a serious overwork for the kidneys and grave
damage to their epithelium. And still more so if, owing to a diminished

activity of the liver due to senile degeneration, toxic products of a higher
toxicity than urea, and even uric acid, are passed.
We have observed the great frequency of albuminuria and casts in the
urine of persons who were addicted for many years to a plentiful meat diet.
According to Dr. James Tyson,[226] who has been for many years making
accurate observations on diseases of the kidneys, and who has published a
standard work on them, interstitial nephritis can be produced after the
prolonged ingestion of much meat. If we wish to keep our kidneys in the
best condition, a lacto-vegetarian diet with only little meat, once a day, is
the most suitable. Still more than meat, bouillon and meat gravies should be
avoided, since they contain irritating meat extracts.
Milk diet in abundance is not only indicated in liver disease, but also in
chronic kidney troubles. But when there are coexisting changes in the
circulatory system, milk should not be given in large quantities, but in
smaller amounts. Milk has also the great advantage of being a strongly
diuretic substance, especially in its acidulated forms (yogurth or kefyr, or
simple sour milk); and at the same time it irritates the kidneys very little,
since it contains only a minute amount of common salt.
According to Bunge, we take decidedly too much salt every day, and in
this way we injure our kidneys considerably. Achard,[227] Strauss,[228] Vidal
and Javal,[229] and simultaneously H. Strauss, have found that diseased
kidneys (especially in acute or chronic parenchymatous inflammations) are
unable to eliminate sodium chloride properly, and its retention leads to
œdema. According to these authorities, œdema is caused by a retention of
water and sodium chloride, the retention of the latter playing the primary
rôle, whereas according to Alexander Koranyi, Richter, Kovesi, and Roth-
Schulz, the retention of the water is the primary factor.
For these reasons salt should only be taken in very small quantities.
Alcohol should also be avoided, except in small quantities, as being very
injurious to the kidneys; and considering that chronic nephritis may be
caused by the immoderate use of alcohol, Bunge thinks that the chronic
nephritis following large quantities of alcohol may be attributed to the fact
that, according to the researches of Keller,[230] made in Bunge’s laboratory,
the alcohol habit leads to an immoderate use of salt with its deleterious
effects upon the kidneys.

According to Bunge, rice gives very little work to the kidneys, as in
twenty-four hours only 2 grammes of alkaline salts are eliminated. On the
other hand, potatoes cause a very great elimination of salt by the kidneys.
Bunge thinks that rice would be a good food for patients with renal disease.
Not only alcohol, but other stimulants, like tea, can be of harm to the
kidneys if taken in large quantities, as we have mentioned in the preceding
chapter when speaking of black tea.
We do not think, however, that the daily use of black tea, in moderate
quantities, would have unfavorable effects on the kidneys. Its relation to the
production of uric acid should, however, be remembered (see chapter on
other stimulants: coffee, tea, tobacco, etc.).
For reasons already mentioned, irritating spices and adulterated sauces
should be very carefully avoided; also all kinds of food which contain
pungent ingredients. We have no doubt that by their use life is often
shortened. The passage of such poisonous substances for years through our
kidneys must injure their delicate structure and hasten the development of
the senile kidneys, with interstitial nephritis.
It is advisable to drink plenty of water, especially when much meat, or
the above-mentioned sauces, are eaten. By this means we can flush out of
our kidneys the end-products of proteid food, and also other toxic
substances. For the same reason it is well to use certain mineral waters with
diuretic properties. They should, however, not be taken at the same moment
as substances irritating to the kidneys are taken, or the kidneys may be so
injured that acute hæmorrhagic nephritis may ensue. We[231] have published
such a case, where even small quantities of chloride of potassium taken on
an empty stomach, together with Wildungen waters, which have very
diuretic properties, provoked a condition of acute nephritis, with great
quantities of blood clots, epithelial and granular casts, many epithelial cells,
and red and white blood-corpuscles in the urine.
When taking various drugs, we must always remember that they must
pass through our kidneys. The drug habit, especially when irritating drugs
are taken, can have a ruinous effect on these vital organs and surely
diminish our prospects for a long life. Day by day many of the epithelial
cells will be desquamated, slowly but surely, and inflammatory conditions
of the kidneys will eventually appear. There is nothing in this world without

a cause, and if a chronic parenchymatous or interstitial nephritis suddenly
appear, it must have a pre-existing cause. It is the result of our continual
neglect and abuse of these most important organs. As Prof. Friedlich Müller
said a few years ago, the kidneys never forget the wrong they once have
suffered. Indeed, most of the evil that befalls us in this world is our own
fault, for doing things we should not do and omitting those we should.
A frequent source of renal diseases is infectious diseases with the passage
of toxic products through the kidneys. This source of kidney disease is often
overlooked, the symptoms of acute nephritis being mistaken for or confused
with those of the infectious disease. Acute nephritis after tonsillitis is often
not diagnosed unless the symptoms are very marked. In such cases
occasional casts and epithelial cells, with red and white blood-corpuscles,
may remain for a long time in the urine, sometimes permanently, and thus
slowly and insidiously chronic nephritis develops.
Tonsillitis is often caused by the dropping upon the tonsils of mucous
secretion from a post-nasal catarrh. This is commonly so in chronic rhinitis
caused by adenoid vegetations. The best prevention of renal diseases in
these cases is operation on the vegetations and treatment of the rhinitis,
rather than removal of the tonsils, which probably play a great rôle in the
defense of the organism against infections. This is shown by the fact that
they are inflamed in the early stages of many infectious diseases.
The greatest care must be given to the condition of the skin and
intestines, if we wish to keep our kidneys in good order and prevent their
deterioration. We must try to eliminate through the skin and intestines as
many as possible of the toxic substances which otherwise would make their
way to the kidneys and increase their work, and perhaps injure their
epithelium. In this way we can save our kidneys for their time of need.
Therefore, the skin and intestines should be kept in good working order.
We must do all we can to maintain the function of the skin, and in several
chapters of this book we have considered this question. We will only
mention briefly that the invisible perspiration of the skin should be
encouraged as much as possible. Damp and cold weather are apt to suppress
it. In such weather our skin also gives off too much warmth, therefore we
should be warmly clad, wool, especially for old persons, being best. Still
more important is this when the kidneys are already damaged. For such

persons a warn climate is advisable. By increasing the perspiration to
sweating, products which are harmful to the kidneys may be eliminated.
Hence such procedures will take work off the kidneys and rid them of
injurious substances. The sweating should be done frequently, at least once
a week, if we want to keep our kidneys in good condition. For fuller
particulars on the hygiene of the skin, and also of the intestines, we refer to
the chapters relative to these questions.

CHAPTER XXIII.

On the Elimination of Toxic Products Through the Skin.

There are some two and a half million small glandular formations—the
sudorific glands—on the whole surface of the body in the subcutaneous
tissue of the skin, from which issues a secretory tube somewhat of the
nature of a corkscrew to the external surface of the skin.
These glands are richly provided with blood-vessels, and a comparison
may be drawn, to a certain extent, between the glomerules of the kidneys
and these small glandular formations. The first receive certain substances
from the blood and give it off through the tubules which carry away the
urine, and the latter take both fluid and solid substances from the blood and
eliminate it in the form of sweat through the excreting channels of the
sudorific glands.
Gas can also be eliminated through the skin—carbonic acid—though in
infinitely smaller quantity than by the lungs, for while the latter eliminate
from 800 to 1200 grammes of carbonic acid, it has been shown by the
experiments of Aubert[232] that a human being eliminates through the skin a
maximum of 6.3 grammes and a minimum of 2.3 grammes in twenty-four
hours, which is certainly a very small quantity. Besides carbonic acid the
skin probably also eliminates other organic combinations in the form of gas,
though it would be very difficult to analyze them by exact experiments.
Pettenkoffer was able to demonstrate from experiments, that, if many
persons are in a confined place, it is not carbonic acid alone that causes the
very disagreeable sensation of the foul air, but that it is a consequence of the
accumulation of harmful products of perspiration through the skin, the
particular nature of which has not been determined as yet.
On this account it is permissible to speak of a respiration through the
skin, although it has not yet been demonstrated by exact methods that the

skin is really absorbing small quantities of oxygen; and it is even now not
yet beyond doubt whether the small amount of carbonic acid may not be
ascribed, perhaps, to the decomposition of the excretions from the skin, and
of the epidermis that is shed, as stated by Prof. Bunge.[233]
But if it is not possible to prove the certainty of respiration through the
skin to a degree that would satisfy the postulates of exact science, on the
other hand the observations of ancient savants, whose chemical knowledge
and powers of observation were not inferior to those of their present
successors, in spite of a deficient education in chemistry, all point to its
existence, and we shall have to take it into account.
As a rule the various products of skin perspiration cannot be seen, as they
are eliminated in the form of vapor. This evaporation takes place in this
invisible form, however, only when it is not checked or when it is not
produced in excessive quantity. But when such evaporation is hindered by
clothing that is impermeable to such products, such as rubber clothes or fur,
or when it is too abundant, then it will be eliminated in the form of water
through the pores, and will appear in drops. The human body loses from 1
to 1½ liters of this moisture, that is to say, sweat, in a day.
Such checking of evaporation produces a very disagreeable feeling, a fact
that indicates the existence of skin respiration; as does also the
circumstance that persons clothed in a way that permits of the circulation of
air to the skin and the elimination of the products of perspiration, and who
also use other means for maintaining a good hygiene of the skin, such as a
bath, are always in better health than those who neglect these points.
That the retention of various harmful products normally eliminated
through the skin is extremely injurious to health is best shown by the fact
that animals whose skin is varnished all over invariably succumb to
intoxication. Especially is this true in amphibia, who, as Spallanzani[234]
found, can live longer after the removal of the lungs than after varnishing
the whole skin. The cause of this is that in amphibia the respiration by the
skin is more important than that through the lungs.
But even if, in higher animals, there is far more respiration through the
lungs than through the skin, the varnishing over of the skin on the entire
body can produce death in certain mammalia. This has also been observed
to have occurred in man. The day before the solemn entry into Rome of

Pope Leo XIII, a little boy was painted over his entire body with gold leaf
so as to represent an angel; but he suddenly died before the procession
began. We cannot, however, conceal the fact that the death of higher
animals, according to some authorities, is not due to the retention of the
products of perspiration, but rather to an increased loss of warmth of the
body, especially as these animals have always been shaved prior to being
varnished.
Still, for reasons we shall give later, we believe that this cannot alter our
views on the harmfulness of checking respiration through the skin. The
injurious action of this is also shown by the fact that persons whose skin is
burnt to a large extent, die, as a rule, by intoxication. Certain opinions have
been advanced which ascribe such a death to a change in the constitution of
the blood after extensive burns. I am inclined to think that death may be due
to the fact that the skin respiration is, in such a case, more suppressed, as
the body is enveloped in bandages which, like sticking plaster, do not admit
of air circulation; and also because there is no elimination. At the same time
the other parts of the body are covered by the clothing instead of the same
being removed. If, however, after such burns the body be kept quite naked
and the air thus permitted a free circulation on all sides, then even after the
most extensive burns death will not follow, as we have seen in several cases
so treated by Dr. Sneve in St. Paul, Minn., whose wards we inspected some
years ago. Why should the changes in the blood not induce death in these
patients in the same way as it does in patients swathed in bandages?
Logically, this cannot be the reason for death, but in all probability it is the
suppression of the skin respiration. But if death after extensive burns is due
to this cause, then the same may be given as the cause of death after
varnishing the body. The substances which are eliminated from the body
through perspiration are urea, uric acid (in small quantities only), common
salt, creatin, acetic acid, lactic acid, and a number of fatty acids. Although
exact science does not demonstrate that poisonous matters are eliminated
through perspiration, still some very noted men, like Ortner and
Goldscheider, are convinced of it. Arloing contends that the perspiration of
even a healthy man is toxic, whereas Queirolo admits this to be so only in
the case of sick persons.
We shall also be able to realize the great importance of the skin as an
eliminating organ for toxic products after a little consideration on the origin

of skin diseases, which we believe are due to two principal causes: Firstly,
the invasion of microbes into the skin after a diminution of its resistance,
which, in turn, is dependent upon the condition of its nutrition by the blood.
This is the external cause. Secondly, by the elimination of toxic products
which are formed in the body and then pass through the skin. These may
have originally been introduced from the outside, either by food or by
drugs, or they may have been produced in the body through products arising
from certain glands, such as the thyroid, sexual glands, etc. The waste
products of metabolism, such as uric acid, may also be included in this
category. This is the internal cause of skin diseases. Both of these causes
may stand in relationship; thus the existence of the second may favor the
development of the first.
For the subject now under consideration the second cause is more
important, and we will say a few words on the matter as showing the
importance of the skin as an eliminating organ for toxic products.
We may frequently see persons who are affected by eruptions on the skin
after eating certain kinds of food, as oysters or strawberries; and especially
after eating oysters which have not been absolutely fresh. In our own case,
and in many others which we have observed, an eruption of acne on the
face has followed the eating of cheese. A similar state of things may result
from taking certain drugs; thus, after bromine or iodine very often acne may
be observed on the face. This interesting fact we have experienced
personally and have noted in patients who have taken thyroid tablets in
certain quantities, which also contain iodine.
If we examine acne eruptions we find in them certain microbes, such as
the bacillus of Unna, etc. In gout, which is caused by the retention of uric
acid, skin diseases are very frequent.
Sufferers from Graves’s disease, in which there is, as has been so often
mentioned, a hyperactivity of the thyroid gland, have very frequently
cutaneous eruptions, including acne, and often also a very irritating pruritus.
Also in diabetes, in which thyroid hyperactivity plays a prominent rôle, it is
not so much the sugar as the factor I have referred to, which is the cause of
the great frequency of skin diseases. Here also a number of toxic products
are eliminated through the skin.

In women, during menstruation, we often see cutaneous eruptions, as
acne or hives. The former is often very distressing in boys and girls in the
years of puberty, and it is quite impossible to deny that this may be a
symptom of a hyperactivity of the sexual glands. Thus, we often observe
acne in persons who are masturbating, or who for a long time live in
complete sexual abstinence, so that in certain places the laity term these
“pimples of chastity.” Here, again, married life is the best cure for this
disease, as it is for so many others.
It is very interesting to note during the question we are now discussing
that persons suffering from psoriasis feel relief from their affection when
they have had a good opening of the bowels, or when they perspire freely;
hence in hot summer weather they suffer less inconvenience than in the
winter; also by following a certain diet this disease may be favorably
influenced; that is to say, such persons have fewer psoriatic patches when
the toxic products are eliminated by the intestines or kidneys. When there is
a hyperactivity of the skin function, as in perspiration, the toxic products
are eliminated in the vapor or moisture of the perspiration, but during a
diminution of this function they form the psoriatic patches.
When the skin function is increased, as in sweating, a number of products
that are otherwise eliminated through the urine pass through the skin, which
may eliminate a considerable part of the solid waste products, and
particularly a very important chemical product—common salt. When the
kidney is diseased the elimination of common salt and other substances may
become difficult, and thus still more injure the kidneys; these products, and
especially the common salt, will be retained. Then comes the skin to the
assistance of the kidneys. Not an inconsiderable part of these substances
may then pass through the skin when it is in a condition of increased
activity, in the form of sweat. Thus the kidneys and skin work in harmony;
they are companions, and may be graphically called “Kidney and Co.,” the
skin being the second partner. The skin is thus one of our most important
organs, and in the following chapter we will deal with its hygiene.

CHAPTER XXIV.

The Hygiene of the Skin—Air Baths.

In another part of this work we have attributed to the kidneys a very
important part in the causes of premature old age, as their degeneration is
one of the most striking causes of auto-intoxication, the immediate cause of
old age. The more injurious the products passing through the kidneys, the
quicker will these noble organs be degenerated and the sooner will they
decay.
It will thus be the wisest policy in the prevention of premature old age
and in the interests of a long life, to lighten the work of the kidneys, and
avoid their being overstrained by throwing a part of the work on their
partner—the skin. This organ, as stated at the close of the preceding
chapter, is, in a certain measure, a co-partner with the kidneys. When,
through cold weather, for instance, the functions of the skin are diminished,
a greater flow of liquid will pass through the kidneys in the form of urine;
but when the weather is hot and there is perspiration, to a certain extent,
less liquid will be secreted and excreted by the kidneys: that is, they will
work less. By perspiration, also, more common salt will pass through the
skin, and consequently less through the kidneys.
It follows logically from these considerations that if we are anxious to
preserve the vitality of the kidneys and also free the blood from noxious
elements, we must pay special attention to a good action of the skin, and
this is only possible by a rational hygiene.
The sudorific glands are abundantly provided with small blood-vessels,
which bring a large quantity of warm blood to them, from which they
absorb watery and solid parts, and, in all probability, gaseous substances
also, and pass them through their tortuous excretory channels to the surface
of the skin. The mouths of these channels are the pores, and it is of

fundamental importance that they remain open; for if closed these waste
products cannot pass out and must remain in the body, while in addition no
air can pass into the pores, and so no exchange of materials can take place.
These pores can easily be clogged; for example, by the scales—cuticle—
which we shed every day, mostly from the superficial layers of the skin, and
also by the oily secretion of the sebaceous glands. The fat that these glands
secrete is intended by Nature to serve as a protection against liquids, like
water, and against the perspiration from the skin. In some persons this fat is
secreted in too large quantities and may then, especially with its products of
decomposition, clog the pores. In the same way the products of
perspiration, and also foreign materials, such as dust, may close the pores. It
will, therefore, be necessary to remove all these substances which are
preventing the proper aëration of the skin and the elimination of harmful
matters by it. It is also not impossible, when the products of decomposition
of the sweat remain long in close contact with the skin, that some of those
injurious elements may be re-absorbed.
The best method of getting rid of these harmful substances is by bathing
every day. But water alone, except it be very hot, and the bath of long
duration (and in this case it presents some inconvenience and may be
injurious also to health if taken daily), is not able to remove the oily and
fatty products of the skin. Therefore it is best to use soap in addition to
water, and to rub energetically with it the entire skin surface of the body.
Besides removing, by a bath, the injurious products that clog the pores,
we must take particular care to allow air to penetrate to the pores as freely
as possible, thus permitting a free issue to the body exhalations and
facilitating respiration by the skin.
We should not, therefore, exclude the air by thick, non-porous clothing,
such as furs; nor should we use underwear that fits too closely to the body.
To permit of a thorough aëration of the skin it would be advantageous to
remain exposed naked to the air once or twice during each twenty-four
hours, and each time for at least five to ten minutes. When the weather is
warm and we bathe in the sea or a river, we combine the advantages of a
water and air bath. But in places where there is no sea, lake, or river in
which to bathe, we could, if living in the country, enclose some spot for
such an air bath which, in sunny weather, would also become a sun bath at

the same time. On the grass of a clearing in a wood, or in a garden, such an
air bath could best be taken. In summer, if the air is not too warm, and if we
are in the sun, we may remain longer than ten minutes in such an air bath.
If we are not able to procure a place in which such a bath can be taken
quite naked without being seen, the next best thing is to clothe oneself in
amply large white pajamas, or, for women, in a very wide white mantle or
costume of the empire style, and thus attired to take a walk in the garden or
ground of one’s property.
In cities many can take such an air bath in one room every day when they
can spare ten minutes, the best time being before dressing and after
undressing. But also during the day, especially in summer, we should spare
a few moments to take such a bath. In winter the room must, of course, be
warmed for the purpose. In combination with the bath, breathing exercises
can also be performed to great advantage in the way described in the
chapter on the advantage of open air. In order to avoid catching cold in such
an air bath it is advisable to rub the entire skin surface of the body. This
causes much blood to be brought to the skin; thus more blood is conveyed
to the sudorific glands which are thereby enabled to absorb a larger quantity
of harmful matters from it, while at the same time more air can be taken in
by the pores. While rubbing—which is best done by a brush—we can also
move about, and while standing also beat the periphery of the body with a
thick rough towel in the same way as in Finland they do with brushwood
after hot baths. It is not painful and is very effective in producing a
hyperæmia of the surface of the skin. When the skin is thus better nourished
with blood it also offers more resistance to germs that may cause diseases
of the skin, and such better nutrition and its improved hygienic condition is
a safeguard against catching cold.
Such an occurrence is more likely to occur in persons who neglect a
thorough cleansing of the body daily by baths and who go warmly clad; in
such cases the muscles which contract the pores are less active, and because
of this more body heat is lost and catching cold more easily takes place.
When we feel warm more blood circulates through the skin, and when
afterward cold air reaches us the pores, in a normal person, contract quickly
and the blood is retained in the interior of the body. Thus we are prevented
from giving off too much warmth from the body and catching cold. Persons
who have been trained since their early childhood to cold water and cold air

show a great facility for reaction against cold. When cold air reaches the
skin, which on account of warm surroundings has become warm, filled with
blood, red, and moist, the skin will contract and become pale, the easy
conduction of warmth will be checked, and the heat retained in the body.
Thus such persons will not so easily catch cold as others whose skin is not
kept in good hygienic condition.
Many people have already shortened their existence by catching colds.
Pneumonia, pleurisy, nephritis, and many other dangerous ailments have
arisen from such a cause and led to premature death. A good hygiene of the
skin not only serves to eliminate toxic products from the body and keep our
kidneys in good order, but also prevents the tendency to catching cold,
which is so often the cause of an early death. We must, therefore, do our
best by a careful rational attention to the hygiene of the skin, and for this
purpose we will deal further with the subject in two chapters on the hygiene
of the skin by bathing and by rational clothing.

CHAPTER XXV.

On Rational Clothing.

The chief object of rational clothing is to obtain porosity. All underwear
as well as outer coverings must be made out of some porous substance
which will in no way check the perspiration from the body or the
evaporation of such perspiration, and which will at the same time allow of a
free passage of air to all parts of the body.
First, we will discuss the question as to the nature of the underwear
which is most appropriate for keeping ourselves in a healthy condition.
Wool is the most suitable material for warmth for underclothing, as it is a
bad conductor of heat and can therefore best retain the natural heat of the
body. It follows, therefore, that this is the best for aged persons to use.
In old age, especially when very advanced, less natural heat is produced
in the body. On account of the degenerative changes of the small capillaries
the surface of the body is not so well provided with the heating element,
which is the blood. At the same time, on account of the loss in elasticity of
the musculature, the skin of an aged person contracts less readily from cold
than does the skin of younger people; thus, while on the one hand less
warmth is produced, on the other hand more warmth may be given off, a
due consideration of which leads to the logical conclusion that all aged
persons had best wear woolen underclothing.
Woolen underwear, though the best to retain the warmth of the body, has,
on the other hand, very serious drawbacks. Wool possesses the great
advantage of easily absorbing the perspiration of the body; it can, in fact,
absorb about 40 per cent. of the moisture, by weight, without becoming so
saturated as to be noticeable; but at the same time it gives off this moisture

again very slowly, necessitating the changing at once of such damp
covering.
The greatest drawback to wool, however, is that it soon loses its porosity
after it has been washed, for then it shrinks and its meshes contract, and in
consequence the material is no longer porous; while in this condition it does
not freely give off the moisture, but retains it, the aëration of the skin is
seriously hindered, and the products of perspiration are not gotten rid of.
Everybody knows what a disagreeable feeling is produced by keeping on
such underwear after it has become dampened by perspiration, and this is
due to the prevention of the dissemination of the exhalations from the body.
Such disadvantages to the wearer of woolen underclothing may possibly be
discounted by making such underwear with large meshes; but even in this
case it is not easy to prevent the loss of porosity after washing. It is
therefore advisable to wear a large meshed linen garment next the skin
under the woolen underclothing; there will thus be a cushion of air between
the skin and the woolen garment; and linen also has a great affinity for
absorbing moisture and rapidly giving it off again.
All kinds of underwear, whether of wool or other material, should be
loose about the body. It is a great mistake to have it too tight. There should
always be a considerable layer of air between the clothing and the skin. This
layer is warmed by the blood at the surface of the body, and as air is a bad
conductor of heat, even in the case of underwear not so thick as wool, if
such clothing is worn somewhat loosely about the body and is porous, we
shall not feel cold. The porosity of the tissue permits the entrance of air, and
such tissues, with air in their pores, are abstracting a minimum of heat from
the body, though such pores in the tissue allow for the free passage and exit
of the harmful exhalations and evaporations from the body.
From the foregoing it follows that socks which do not fit too tightly but
fairly loosely, and which are made of porous material, such as good wool,
will also be the warmest. It is quite unnecessary to adopt heavy double
socks which fill up all the space in the shoes; as a matter of fact in such a
case we may have colder feet than if we wore light porous good woolen
socks that do not fit too tightly.
Linen possesses the great advantage that it easily absorbs moisture and
easily gives it off again, but as it is not such a bad conductor of heat as

wool, and freely gives off heat, it may most advantageously be utilized in
warm weather, and also in winter if worn under the other woolen garments.
Linen is superior to wool in so far as the matter of cleaning it is
concerned, as it can be washed much more thoroughly than wool, which
easily retains dust and dirt. Linen is one of the most porous substances for
underwear.
Ramie is a material made from a tropical plant, the Bæhmeria Nivea, and
has lately come much into use. It readily absorbs the moisture from the skin
and does not retain it as long as does wool, but rapidly gives it off again. It
also does not abstract warmth so much as linen, and next to wool is the
warmest material for underwear. The drawbacks to it, however, are that it is
too heavy and does not last long. Silk underwear also retains the warmth,
and also very easily absorbs moisture; but it is too expensive for ordinary
use, and can readily be spoilt by indifferent washing, unless the most
expensive quality is used.
Of all the various materials for use as underwear possibly cotton has the
greatest average advantages. It gives off the moisture it has absorbed from
the skin, although not quite so efficaciously as does linen. According to
James Paton it absorbs moisture equally well as linen; but Pettenkoffer is of
a different opinion, as in his view cotton does not absorb the moisture from
the skin as readily as does linen.
The greatest advantage, however, of cotton over all other kinds of
material (except perhaps ramie) for underwear is its porosity. It is about the
most porous material there is, especially if in the course of manufacture the
maker takes particular care in selecting the very best cotton; it does not
shrink like wool, and therefore does not lose its porosity in the same way
when washed.
When cotton is so manufactured as to present the greatest possible
porosity, it has also the great advantage of being almost as warm as wool,
which is due to the fact that air can enter freely everywhere and remain in
the interstices of the material. It has already been mentioned that air is a bad
conductor of heat, so that cotton underwear of good quality retains the
warmth of the body and at the same time allows a free exit for the
exhalations of the skin. If, therefore, cotton be prepared from the best
possible material, and manufactured in such a manner as to obtain the

greatest amount of porosity, i.e., when it is loosely woven, it can compete
successfully with wool as material for warm underwear; it is, therefore,
quite an erroneous view to hold, as so many do, that cotton is very different
in this respect from wool; everything depends upon the quality and the
manner in which it is manufactured.
According to the researches of Sir William Thompson[235] there is
practically no difference between wool, cotton, and linen in regard to their
capacity as conductors of heat. Nevertheless we ourselves still believe that
in winter weather, or when there are cold northern winds, wool is best,
especially for the aged. This same holds good also for those younger
persons who catch cold easily.
In order to keep warm in winter it is, however, necessary that the cotton
material should be of a certain thickness, besides being of the best quality
and of the best make. As already mentioned it is of the utmost importance
that the underwear should not fit too closely around the body, but that there
should always be a layer of warm air between the skin and the garment.
Instead of the present custom of wearing close-fitting trousers it would be
much more beneficial to adopt the very large loose linen trousers that are
worn in certain countries, such as Hungary. When once accustomed to such,
and especially in the case of the younger generation, they can readily be
worn also in winter time. Then, possibly, porous cotton can take the place of
linen, although many people may feel just as warm in porous linen
underwear; or we could possibly follow the example of an English
gentleman who told me he never wore any underdrawers at all.
In many European countries women, especially of the lower classes,
wear no undergarments on their legs at all. In healthy women such a custom
may be of great advantage, as it permits of the free passage of air and the
elimination of the perspiration from the skin, being in effect a continuous
free-air bath for the lower parts of the body.
It is not so necessary to keep the lower extremities, except the feet, warm
(provided that the feet are made warm by the constant motion of their
muscles), as we do not need to be so well protected there as on the upper
parts of the body; we also feel the cold less in these parts, which we can all
appreciate if we are in the habit of walking much and not sitting about all
day.

Before putting on clean underwear we must be careful to ascertain that it
has been thoroughly aired and is quite dry, for it happens in more cases than
one knows of that the linen arrives from the laundry quite damp, although
apparently it appears and feels dry. After having caught cold each time I
changed my linen, after having perspired, I had the idea to put my vest over
an electric lamp, and was surprised to see a cloud of moisture arise from it.
As moisture readily absorbs the warmth of the body, we can therefore easily
lose too much warmth and thus catch cold. Before putting on clean linen it
is also advisable to rub the body with a brush (or rough towel) until the skin
glows, and the linen itself should of course be put into a hot-air cupboard or
be aired before a stove or fire, by which means many colds will be
prevented; and these precautions are particularly necessary in all cases after
free perspiration, in which latter case also a bath is very desirable before
putting on our clean linen. It is of primary importance to change underwear
every day, so as not to leave the products of perspiration on the skin for
several days (see chapters on the hygiene of the skin and kidneys through
perspiration).
We will now offer a few remarks on the subject of white linen. We should
not wear starched linen shirts, as they are less permeable to the air. In lieu
of these, porous linen shirts are advisable, or any other kind of soft and
porous material, without a starched front. The use of starched shirts should
be confined to dinner parties and social functions.
The most absurd part of our linen outfit is unquestionably that instrument
of torture we wear as a yoke around our neck, preventing a free circulation
through our most important arteries and throttling one of our most
important organs—the thyroid gland. This we know as the “starched collar,”
without which we must not appear in decent society. It is in any or all of its
present shapes an unhealthy article of clothing, but especially so when,
from foolishness, it is worn standing high up to the chin, keeping away the
air from the neck and hindering free circulation. Its bad effects upon the
thyroid have already been referred to in the chapter on the hygiene of the
thyroid gland. It would be more reasonable to wear a low collar, turned
down, and of soft linen, as worn by our forefathers. Women may have this
privilege, but, sad to say, they do not avail themselves of it, but instead, in
many instances, cover their necks, and even more than their neck, by
impermeable materials. Yet the neck is one of the parts of the human frame

where many sudorific glands are situated and where we perspire freely.
These parts especially should not be enclosed by clothing; neither should
the armpits and the toes of the feet, for here the sudorific glands of the body
are very numerous. Yet we wear the most impermeable materials, such as
leather, and often indeed thick leather, and horribile dictu! even rubbers,
very often, on these important organs.
The outer garments should also be made, after careful consideration, to
afford the greatest amount of porosity. It would be the height of hygienic
triumph to wear clothes made to allow of the free inlet of wholesome
sunlight. Gray garments are, therefore, the best, and next to this blue should
be greatly preferred to dark colors.
The overcoat should never be too heavy nor too warm; as a general rule,
we should never wear clothes warmer than the temperature at the time
requires, always being guided by the thermometer and not by the calendar.
It is much better to be clad too lightly than too warmly, for we thus avoid
perspiring and thereby catching cold; or, in other words, if clad simply
lightly the likelihood of our taking cold is less than when we are too
warmly clothed, for then we also perspire less freely. It may be that we shall
more readily feel cold, but, fortunately, the sensation of feeling cold does
not imply catching cold. In fact, when lightly clad we feel much more
inclined to take brisk exercise. Then we feel warm, and, as we shall show in
the chapter on exercise, more blood is sent to the periphery of the body and
the general nutrition of the skin is increased. Naturally, when we are lightly
clad we do not sit about without moving, but we endeavor to create a
reaction in the skin by brisk exercise. Englishmen, and especially
Scotchmen, rarely wear an overcoat, never sleep in a warmed room, and
rarely ever catch cold, which is certainly much more prevalent in countries
with overheated houses, as in America, and where the people are more
accustomed to ride in the street cars (also heated) than to walk.
Catching cold is best obviated by hardening the body against the
influence of cold, and this is best done by a continual aëration of the skin,
and by means of cold baths, commenced in a judicious manner. We should
become accustomed to permit the entrance of air as frequently as possible
to the whole surface of the body, which we can do by remaining stark naked
in our room for only a few moments several times a day, as already
advocated in the chapter on the hygiene of the skin. But still more important

is free access to the air, even though cold, if we desire to be immune against
colds. Most people who do catch cold contract it first in the head, especially
after being in a state of perspiration.
The frontal and temporal parts of the head are very well provided with
sudorific glands, and it is therefore most unreasonable to prevent free air
access by a warm covering. It is also unnecessary, because Nature has
already provided these parts with a natural covering, viz.: the hair, which,
with the skull, is intended for the adequate protection of our most delicate
organ, the special construction of which places us above all other animal
creation.
That young men with abundance of hair should wear heavy head
coverings is extremely unreasonable. It would be a far more healthy custom
to go without a hat, and thus preserve for a much longer period this natural
ornament to the head. At the same time we would perspire less in the head
and thus be less liable to take cold. By continuing this practice, as is
customary among the boys of a certain English school (The Blue Coat
School), the scalp of the head will become so much hardened against
climatic influences that we should be able to go out with uncovered head
even in cold weather. As, however, not all our neighbors and acquaintance
are keenly interested in the postulates of health and long life they may laugh
at first, but afterward they will themselves be converted by the advantages
of such a custom and will follow our example.
Those whose scalp has become bald or only scantily covered with hair,
by excluding from the same too much air or by reason of disease, may not
so readily stand the effect of the cold, and for such a head gear may be
necessary, in which case the preference should be given to soft and very
light felt hats, and not to those made of hard material, which prevent the
circulation of the blood through the scalp and thus kill the roots of the hair.
Those who are slaves to the prejudices of their short-sighted brethren
may wear their hat when in their company or in the streets, but by all means
take it off at other times, and especially when in the woods or in the fields.
It is a singular anomaly that the English, who in many questions of
hygiene, as by conducting their sports in the open air, stand at the head of
all nations, yet obstinately stick to their tall hats and long black coats in the

warmest summer weather, sacrificing health and comfort to social
prejudices. How long will Bacon’s nation persist in such a custom?[236]
Other parts of the body richly provided with sudorific glands are the feet.
This must logically make it obligatory for all who wish strictly to follow the
rules of health and long life not to prevent the free access of air by
impermeable rubbers or heavy high boots. Leather, of course, is not a
porous material, like certain kinds of cloth, and hinders the free passage of
air and the evaporation from the surface of the feet. The most suitable
footwear, and that best adapted to the demands of rational hygiene, would
be sandals, similar to those worn by the Greeks and the Romans. Such,
however, could only, in present days, be worn in villages, at the seaside, or
in the country generally, if we do not want to be criticized as queer or
eccentric by our neighbors, who have less knowledge of the hygienic
methods of living.
It might be possible to make footwear in such a manner as to overcome
this feeling as to wearing them—of the nature of sandals, or part sandals
and part shoes—such as slippers or “pumps.” At any rate it is advisable
never to wear other footgear than half-shoes, and the author of this work
wears such even in winter time without inconvenience and without feeling
cold. The best half-shoes for summer wear would be those made of canvas
with leather soles. It goes without saying that one has to get accustomed to
this habit of wearing low shoes, by beginning in warm weather and
continuing uninterruptedly to the winter, and even throughout that season,
unless very severe weather prevails, when gaiters should be worn above
them.
If porous woolen socks of the best quality are worn in conjunction with
the half-shoes cold is not felt, especially if we do not remain still but walk
about briskly, which will practically convince us of the necessity of walking
and running for exercise.
Rubbers are unquestionably unhealthy things to wear, and to many will
cause a disagreeable sensation owing to the hindrance to foot perspiration.
It is advisable to take off our shoes, as the Mohammedan does, as often
as possible during the day; for instance, while working or reading, and at
any time when we are in private, and only put them on again when visitors
are present. Everybody appreciates what an agreeable sensation it is to take

off one’s shoes and have a good airing of the feet, especially after a long
walk, in which latter case a foot-bath is also a capital thing which will
certainly increase our comfort, especially if we have been wearing sandals
or half-shoes and we have been wandering about the country exposed to
dust.
We have referred more fully to the use of the foot-bath in another chapter.
In the same way as with our footwear, we should reform our ways by
removing the yoke which cruel fashion obliges us to wear round our necks
—the high, stiff collar. How long shall we continue to put up with these
continuous impediments to our health? Top hats! tight collars! tight boots
with a pointed toe! and a fur coat over our dark clothes! How can the sun
and air penetrate such idiotic harness, and how can the poisonous
exhalations of the body find their way into the fresh air when they are
retarded by very heavy and warm woolen underwear? We must again repeat
that we catch cold much more easily when we are clad too warmly than too
lightly. The more freely we perspire in our clothes the more easily we catch
cold. We found this from personal experience. We were at one time always
catching cold, in consequence of too sedulously wrapping ourself in woolen
garments and heavy clothing. But since we have taken to wearing linen or
cotton underwear and light clothes, with half-shoes, carrying our hat in the
hand, and the overcoat rather on the arm than on the body, we now rarely
ever catch cold.
All of our garments should be loosely fitting, and in this respect the
American fashion for men’s clothing is superior to the European fashion of
tightly fitting garments. Also the present style of long, narrow trousers is
not only unæsthetic but also unhealthy and unsuitable for quick movements.
Let us go back to the knee-breeches of forefathers, who were thereby made
much more pleasing to the eyes—at least, those of normal build were.
A sufficient aëration of the body is necessary not only by day, but by
night. In fact, it is more necessary at night, for as mentioned in the chapter
on sleep, the ridding of the body from toxic products is performed more
actively during the night. It will logically follow from this consideration
that heavy feather beds and, in fact, all kinds of heavy coverlets are not
beneficial to health, as they are apt to suppress the exhalations of the body
and to prevent the access of air to the body. For the same reasons it is also
imprudent to go to bed in underwear, and particularly if woolen. I would

even go so far as to dispense with the use of the night-shirt, a garment
which was quite unknown to our ancestors until a few hundred years ago.
By going to bed quite nude, in a large bed, with ample bed clothes of a
porous material wrapped not too tightly about the body, we have thus a kind
of air bath in bed and feel more refreshed in the morning, especially after
having slept in a room where the air can enter freely. In cold weather in
winter a double woolen coverlet can be used.
It may be that in carrying out strictly the rules of a rational hygiene of
clothing as laid down above, many people may have to revolutionize their
old habits of an unhealthy and life-shortening way of living. But the real
question is: Do we want to live long and retain as long as possible our youth
that is passing away only too quickly in any case, or do we want to descend
into an early grave before our time? Those who desire the first alternative
and who wish to enjoy their lives up to the very last may follow my advice;
then they will soon be rewarded by fresher looks and increased vital power.

CHAPTER XXVI.

Improved Hygiene of the Skin and Kidneys through Bathing—
Foot-baths.

Every day we are getting rid of the superficial layers of the skin, which
process can become so intense in some people that the skin looks as though
it were covered with flour dust; and in some persons with dry skin such
apparel as stockings sometimes gets full of this. These minute scales, which
get necrotised in the upper parts of the skin, are apt to clog the pores, which
can also become closed by particles of dust, or by products of the sebaceous
glands and by perspiratory residues. As the free entrance of air to the pores
is an essential condition for skin respiration, and as the elimination of
harmful products is only possible when the pores remain open, we must get
rid of the foreign matters which clog them, for which purpose we take a
bath. But water alone, even if it be hot, is not able to effect a thorough
cleansing of the skin on account of the oily substance which is secreted by
the sebaceous glands; so, to obtain the fullest cleansing effects, we add the
use of soap and a brush, as already mentioned before. We must rub the soap
well in, and then rub it off energetically, if we desire to benefit by a fully
hygienic bath.
As we are daily getting rid of the above-mentioned skin scales, so it
behooves us to take a daily bath. It is not necessary to stay in the bath more
than ten to twelve minutes, or at the most fifteen. For the reasons above
mentioned the effect of bathing is a rational hygiene of the skin.
By the action of the water, soap, and brush friction the skin receives more
blood, which is, at the same time, a great advantage to the internal organs,
as the blood drawn away from them facilitates the circulation through them
should they be congested. When more blood reaches the skin the muscles
that contract the pores are also better nourished, and they then react better

to certain agencies—cold, for instance. They quickly contract the pores, so
that the blood will be kept back in the interior of the body and a cooling off
of the periphery of the body, with its dangerous consequences from
catching cold, may thus be avoided.
A daily bath can also be advantageous for those who perspire too freely.
After a bath, and this is one of its greatest advantages, the insensible
perspiration is much increased, and more water leaves the body through the
pores than before, and when a bath has been too hot, a very free
perspiration may ensue. But usually with people with a too free
perspiration, this tendency would be diminished, as it can often be noted
that those who daily take a lukewarm bath perspire less than others on
warm summer days.
Besides exciting the functions of the skin baths are also an excellent
means for diminishing a possible overwork of the kidneys, and thus keeping
them in good condition. It is possible to eliminate, through bathing, such
products by the skin which otherwise would have to be eliminated through
the kidneys.
It has recently been shown by experiments conducted by Strasser and
Blumenkranz[237] that baths taken for a long time and at a temperature of 34-
35°C., are able to create an increased elimination, not only of a considerable
quantity of water, but of common salt also, and of the products of
decomposition of nitrogenous matter.
These authorities come to the conclusion that through bathing there can
be brought about a true increase not only of the water-secreting activity of
the kidneys, but also of their ability to eliminate nitrogenous end-products
and salt. They found an increase of diuresis to double the usual amount and
an increased elimination of from 50 to 100 per cent. of nitrogen, and from
100 to 200 per cent. of salt. According to Liebermeister, Loewy, Rubner,
and others, the processes of oxidation can be increased by cold baths from
50 or 100 to 200 per cent., and by hot baths, according to Winternitz and
Rubner, 50 to 100 per cent. Rubner also asserts that the processes of
oxidation can be wonderfully increased by cold douches.
There can thus be no doubt that baths are able to influence the conditions
of the kidneys in a very favorable way, and that their vitality may be
augmented by the daily use of the bath.

The drawback to the bath is that so many people easily catch cold
afterward; to prevent which, such persons should not wet the head, and
especially the back part of it, as otherwise catching cold is easily effected;
and it is also of importance that the bath-room should not be left while the
skin is hot. The best way is to allow cold water gradually to enter the bath,
getting out directly there is the least sensation of cold. The rule should be
not to leave the bath when the skin is hot and red and the pores wide open,
without letting cold water contract them by taking a short douche, and on
getting out of the bath the skin should be quickly dried by energetic friction
with a rough towel until the skin becomes quite scarlet. Not sufficiently
drying the skin will cool it rapidly, and even intensely, owing to the
evaporation of the water from the periphery, and surely cause a severe cold.
To prevent the habit of catching cold the best way is to accustom the skin
to the action of cold water. Rubbing the skin with a cold wet towel until the
skin glows, especially the chest and extremities, is a good way to effect this,
beginning in warm summer weather and continuing through the winter, but
not vice versa. Decidedly the best preventative to catching cold is to get the
skin accustomed to fresh air and cold water.
To prevent catching cold after a bath a reaction of the skin is necessary,
and this is best attained by a rough towel, as before mentioned, and by
rubbing the body with a hard brush. Massage is an excellent addition to
bathing, as by this means the circulation through the skin and muscles is
much increased, thereby increasing the oxidation of the body. By kneading
the muscles waste products are brought into the lymphatics (see, also,
chapters on exercise).
It is only logical that we must pay special attention to cleanliness in those
parts that have the greatest number of sudorific glands, such as for example
the axillæ and the toes of the feet. Circumstances often, as when on a
journey, do not allow of the luxury of a complete bath, and in such cases we
must be content to wash the body with water and soap, and to rub down
with a rough towel and brush, paying particular attention to the axillæ and
feet. These may also be bathed in alcohol and water, ½ to ⅓ of the latter,
and also with vinegar and water; the feet can best be cleansed in a foot-bath.
From ancient times, especially in the East, such foot-baths have been
largely used, probably for the reason that sandals were worn, which allowed

dust and dirt to accumulate on the feet; people whose feet perspire freely
should always use a foot-bath daily; and, because the feet are a part of the
body which are the worst aërated from being covered with impermeable
leather, while they are, at the same time, the best provided with sudorific
glands, a daily foot-bath is advised for all.
When the feet perspire freely, hot water must be used; but after using
such we must immediately use cold water so that the opened pores will
close again. Pouring cold water into the bath or over the feet will effect this,
but it must be done quickly.
Foot-baths are excellent things for those who suffer from cold feet, and
what at first sight seems paradoxical, a cold foot-bath in particular, which
acts by enlivening the circulation in the feet; the bathing should, however,
only last about a couple of minutes. Cold baths for the feet also act very
beneficially in cases of headache, and especially in insomnia. They act upon
the distribution of blood in the brain; the blood-vessels are thereby first
distended and afterward they contract, which, lasting for a certain time,
induces sleep; for, as mentioned in the chapter on sleep, the brain must be
free from blood if sleep is to result. In hot summer weather it is quite
delightful to sit on the banks of a river and allow our feet to dangle in the
water, and we always feel refreshed after it; walking with bare feet is also
very pleasant and healthy in summer time.
The action of a foot-bath is much increased by the addition of salt or
mustard, and with the latter is an excellent preventative against a
hyperæmic condition of the brain, such as apoplexy, as thereby we favor a
decreased congestion of this noble organ.
Cold foot-baths should not be used by very old people, as they distend
the brain-vessels which, as a rule, are altered in such people and may more
easily rupture; if taken, a wet, cold towel should be wound round the head.
Cold baths generally are often beneficial in the case of certain nervous
troubles, such as neurasthenia and hysteria; only they must never be too
cold nor too prolonged, as otherwise the effects may be very depressing. A
short cold friction of the body every morning on rising is of great advantage
in the preservation of health. In kidney trouble we must, however, be
careful, as often an increase of albuminuria has been observed after them.
Sea baths are especially refreshing, owing to the sodium content of the salt