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try than elsewhere and are in fact materially decreasing through sanitary measures.

Sixth, poisons produced within the body. As I have pointed out, arterial degeneration is able to be produced in young people by a great variety of infections. This damage to the arterial walls is in all probability effected by the presence of the poisons in the blood as it circulates through the arteries. These poisons are received from without the body. There are also poisonous materials which originate within the body, that are no less deadly. Normal urine injected into healthy animals kills them. Therefore normal urine is poisonous. Now, the poisons contained in normal urnie are derived from four sources, viz., I, Disassimilation of all the tissues of the body in their ordinary life processes; 2, certain glandular secretions, especially the bile; 3, substances contained in the food; 4, the products of intestinal putrefaction. It is the duty of the blood to carry oxygen and other nutritive substances to every part of the body. It is a no less important duty for it to gather up and carry away waste materials which would quickly destroy the body if not eliminated from it. Hence normal blood is to a certain degree toxic. Upon the kidneys chiefly rests the duty of extracting these poisons from the blood and discharging them in the urine. Von Noorden remarks: "Whenever we cause substances to circulate through the kidneys that are capable of being excreted we produce irritation of these organs and as soon as a disproportion is established between the irritation exercised by these excretory bodies and the functional powers of the kidneys, then we necessarily damage the kidneys." It is well known that the functional ability of the kidneys far execeeds the demand upon it under ordinary conditions, but when this functional capacity is worked habitually to near its limit the danger to these organs referred to by Von Noorden will surely follow. Note the conditions of the blood meanwhile. Its normal degree of toxicity leaves the arteries uninjured. Of necessity, however, when the kidneys are working to the limit the blood must be loaded to an extraordinary degree with toxic bodies. As the specific infections circulating in the arteries of children produce degenerative changes in their walls and as the toxic bodies in excess passing through the kidneys damage the kidneys, so an abnoraml amount in the blood of these same poisons developes an irritation in the arterial walls along which they are carried and eventually produces degenerative changes in their structure.

I am confident that the heart often suffers along with the arteries though I have not the time to discuss that question.

Now, when the food, especially nitrogenous food, is habitually eaten in quantity above the requirements of the body the blood receieves food imperfectly digested and the products of intestinal putrefaction in excessive amount. The kidneys are continuously taxed beyond their capacity and become diseased and likewise the arterial walls degenerate by reason of the condition of the blood. It is my firm conviction that here we have the true explanation of the problem under consideration, viz., improper diet and excesses in eating.

It has become quite the proper thing to expaciate upon the high tension of American life. The speed with which we do things as compared with the methods of our fathers is referred to in a spirit of commiseration toward the former generation. So universal is this attitude of mind that one rarely encounters a person who has the temerity to call in question the fact, as alleged, that we as a nation are wearing ourselves out by reason of our wondrous energy and enterprise. This popular cry has arisen through thoughtlessness or ignorance or cant, or perhaps vanity. That we do conduct our affairs more rapidly is certain. It is quite possible that we accomplish more. The utilization of steam and electricity and the mechanical inventions at our disposal have made this possible. That these changes involve more wear and tear of mind or body I deny. On the contrary, I affirm that precisely the opposite is true. Compare the telegram and its quick reply with the annoyance, perhaps anxiety and loss incident to a letter. Is it less wearing to send a messenger to another part of town and await his return than to complete your business in three minutes over the telephone? Do you exhaust your vitality to a greater degree while sitting in a comfortable chair and dictating to your typewriter than when you are doubled over a desk pushing a pen? Is the integrity of your nervous system jeopardized the more when you ride in an equally heated electric car or when you jolt along in a cold and windy rattle-trap, hauled by a pair of decrepid horses?

You eat your dinner as the train pulls out of the station. You retire to the buffet car and smoke your cigar in pleasant company until bed time. After a restful night in bed you awaken in time for breakfast and business in another city. Does this tax your endurance more than a journey of the old sort? Or, suppose you are a farmer. Instead of a working day that includes every hour of sunlight in the longest days of the year and many hours of darkness, when the days are shorter, you now are not expected to work more than ten hours in a day. Instead of swinging the cradle or scythe through the heavy grain, you climb

to your seat upon the reaper and sit under a sun umbrella. Instead of pitching with the fork in your hands, every pound of hay or grain, you thrust the harpoon into it and a horse lifts it to whatever spot you may desire. And when your work of the day is done you go to your home which is furnished with the comforts of modern life. Your telephone and rural mail delivery have forever removed you from that heart-breaking isolation, which formerly developed in the farming population a larger percentage of insanity than any other occupation could show.

How about the professional man? Undoubtedly the sum of knowledge is greater than it was thirty years ago. This is true, for example, in the medical profession. However no one expects to possess all of this knowledge. Specialism has developed and each individual devotes himself to the acquisition of so much knowledge as he is able to master. Man's mental capacity has not changed at all and certainly students worked as hard and were as thorough a generation ago as now. Worry is not a new thing. Neurasthenia is not a new thing. We have been told that these mantal states cause variations in arterial tension and therefore induce arterial degeneration. If we admit the premise the conclusion, as I have pointed out is unwarranted. In short, I am contending, not that these various alleged causes of arteriosclerosis are guiltless, bnt that modern life instead of augmenting the occurrence of arteriosclerosis from these causes, in reality tends to ameliorate our conditions so as to materially diminish its occurrence. The so-called "Strenuous life" does not account for the increased mortality which we are considering.

We are confronted by a fact and not a theory. I feel that the subject is one that demands the earnest consideration of the medical profession. It is quite too momentous to be ignored. While maintaining that such explanations as are usually offered are inadequate, I have not now the time for more extended discussion of the matter. In brief, I suggest that a commission in detail of existing conditions in this country with those in England and Wales, and, in particular, a study of the points in which conditions in this country have changed during the last thirty years as compared with the conditions in England and Wales, may furnish a clue to the correct solution of the question. The problem presents an alluring field for investigation but, I pass it with the statement that, in my opinion, the explanation will be found in a consideration of the diet of the people. A long period of great prosperity has been experienced in this country and the average dietary of the people has become proportionately richer, especially in nitrogenous food. Referring to the compari

son again, I know of no respect in which there has probably developed during the life of the present generation, a wider divergence than in this between England and Wales on the one hand and our own country on the other. Our people are living in a perpetual state of auto-intoxication and this is the source of their arteriosclerosis heart disease, apoplexy and nephritis. The remedy which I propose is to popularize the boycott of the meat shop to the extent of reducing the consumption of meat by about 75 per cent, and to cultivate the simple life in respect to diet.

Dr. Pillsbury, Lincoln, Neb.

DISCUSSION.

It would be interesting to know to just how great an extent the fatigue poisons have to do with arterial sclerosis. Of course this is a point which it would not be easy to get at because we would have a number of things to contend with in this direction. We know that the blood pressure does rise with severe exertion and we are unable to say if any of the fatigue poisons bring this about. It is difficult to see just how an experiment might be planned to prove the point as to whether arterial sclerosis might be brought about by the continued action of fatigue poisons, but perhaps if we were able to transfuse into a laboratory animal day after day large quantities of blood from animals which were overworked and if we were able to continue the experiment long enough, we might be able to obtain some definite result. Of course this would be difficult to do and also to exclude the food poisons. It is a very difficult question.

It occurred to me to wonder whether in England and Wales and possibly in this country the diet of the people had changed very much. The amount of meat, for example. I do not know. Perhaps Dr. Milroy would like to say a word further upon the subject. Dr. Milroy does not lay much stress on the role of alcohol. Certain it is that alcohol was used very extensively 50 and 75 and 100 years ago and of course, perhaps to the same extent or more so now.

Dr. Milroy, closing:

My chief object in calling attention to this subject was not to answer questions so much as to bring your minds to this situation. I believe that this enormous and startling increase in the mortality in this country from these diseases, even supposing that such an increase existed in every country in the world, demands our attention. It is shown conclusively that it is not simply a case of those dying that were saved in childhood. So, as I say, there is a wonderful increase in mortality from these diseases.

I believe this is not fully realized. I know that a couple of years ago when I had my attention called to this I was very much surprised myself and I wonder if the profession as a whole fails to grasp the situation. I see very little reference to it in the current literature. The thing is seldom referred to and the writers thresh over the old subjects that we are all tired of and it seems that this is a subject that is worth paying attention to.

With reference to the question of Dr. McConaughy. I took that into consideration. The fact is that the same thing holds in respect to all parts of the country. We will take the United States registration area, about twothirds of the United States. A large area including, as I understand it, such portion of the country as prepares or keeps vital statistics of sufficient accuracy as to be of value. We, of course, know that this is not simply the coast. Here we have an increase in the diseases of the kidneys since Also 1880 of 131 per cent in the whole United States registration area. in Chicago an increase in the same since 1880 of 167 per cent. I wish to

call Dr. McConaughy's attention to the fact that it is not simply a condition applying to Massachusetts and the coast, as you will notice the same condition applies to the whole country apparently. Dr. Pillsbury calls attention to the fact that it is a very difficult thing to get to the bottom of this matter and I notice that he believes what we all almost unconsciously do, that a high tension is the cause of arterial degeneration, which I do not believe is the case. The teaching of many years is wrong in this particular. We have to set this aside and try to look somewhere else. The facts about the diet I do not claim to know and believe in this idea of studying over the situation and eliminating one after another of the alleged causes of these diseases in an effort to discover why this great increase has taken place in the mortality in this last generation, as well as looking into the great discrepancy between the two countries. I simply offered this as a suggestion, which to my mind offers a practical solution of the difficulty.

The fact is I wished to bring the whole matter before you as I said and if I have succeeded in awakening any interest in it I feel repaid for what I have done in presenting the paper.

Recent Advances in Syphilology,

*By ALFRED SCHALEK, M. D., Omaha, Neb.

There are very few diseases, if any, in which our knowledge has made such great progress in recent times as in syphilis. Ever since Schaudinn has reported the constant presence of a certain micro-organism in almost every product of this disease every year has brought forward another advance in its better understanding. Schaudinn's claims have been endorsed universally and today any lesion containing the spirochetae pallidae is accepted as syphilitic, clinical evidence to the contrary notwithstanding. At first this achievement was considered valuable from the diagnostic standpoint only. But it was only the first step toward all our progress which we have made since. Wasserman introduced the serum diagnosis, a positive indication of a syphilitic infection of the system at one time or another. It was due to Metchnikoff and Neisser that we changed our old idea of the immunity of animals to syphilis. This again opened up possibilities for further important animal experiments in the solution of pathological and therapeutic problems in syphilis and led up to the last triumph in chemo-therapy, the discovery of the arseno-benzol. It would take books to describe in detail these different accomplishments, so the writer will try to take up the essential points only and their value in every day practice.

Before the trepanoma pallidum was discovered syphilis was a disease recognized by its clinical manifestations only. Until such occurred, treatment could not be instituted with any satisfaction. Did the physician diagnose the disease mistakenly he

Read before the Nebraska State Medical Association, Omaha, May 2, 3 and 4, 1911.

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