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cases of arteriosclerosis can arise without any increase at all in
the blood-pressure. According to Professor Romberg,* 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 arterioscle-
rotic 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,'
Lemaire, and in four cases of Troin and Rivet.® At the last Con-
gress of German Physicians and Naturalists in Dresden, 1907, it
was proved by Schur and Wiesel, as also in their previous com-
munications, 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 pro-
duce 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 role performed by which, in the
production of arteriosclerosis, has been treated of very com-
petently by Professor Edgreen,'^ 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.



4Lehrbuch der Krankheiten destergens und der oxlutgefure. Stuttgart,
1906.

5 Parkes Weber : Transact. Path. Society, London, Iviii, 3.

6 Gazette des hSpitaux, Juin 14, 1906.
T "Die Arteriosclerose," Leipzig, 1898.



166 Old Age Deferred.



ovaries, pituitary body, pancreas, liver, kidneys, etc., upon which
we have enlarged in previous chapters of this book; and, more-
over, we have no knowledge of any work written on this subject ;
but as such a diet is very efficacious in producing a sclerotic con-
dition 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 in-
jurious 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 en-
deavor 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



Prevention and Treatment of Arteriosclerosis. 167

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 extir-
pation 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.^

All this is greatly strengthened by the recent investigations
of Sajous, which show that besides its action on the blood-pres-
sure 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 pro-
duction of arteriosclerosis: i. 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 men-
tioned 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 elas-
ticity of the vessels will eventually be impaired, especially so in the
aged, where one part of the elastic fibers is already replaced by

8 "Recherches sur la senescence des glandes surrgnales," Soc. biologie, 17
Oct, 1903.



168 Old Age Deferred.



connective tissue. As a result of the arteriosclerosis the passage
of blood through the capillaries will be impeded, and in conse-
quence 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: i. 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 pre-
viously 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^ 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, Miiller, and Inada.^" 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^ ^ 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 prepara-



9 Remlinger : "Dissertation on Arteriosclgrose," Marburg, 1905.

10 Preface of Romberg: Deutsche Med. Wochenscbrift, No. 78, 1904.

11 "Therapie der Gegenwart," March, 1907.



Prevention and Treatment of Arteriosclerosis. 169

tions, 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 con-
striction 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.

Siihilarly, 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 flat-
ulence, 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 peo-
ple suffer sudden death, should also be avoided. More than from
II to ij4 liters of liquids per day should not be allowed.



CHAPTER XVII.

The Elimination of Toxic Products Through the Intes-
tines AND the Improvement of This Function.

The intestines contain billions and billions of microbes, their
number increasing downward throughout the length of the intes-
tine. 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 inter-
mediate 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 dem-
onstrated that young chickens could not thrive on a sterilized
nutrition, and Nuttall and Thierfelder had great trouble in keep-
ing 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 nor-
mal 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 faeces for a very long
time cause mechanical lesions of the epithelium when, conditions
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Elimination of Toxic Products Through Intestines. 171

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 sub-
stances 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 facili-
tated 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 intes-
tines. 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 forma-
tion 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 intes-
tines, like indol and skatol, are not able to produce severe poison-
ing if injected into other animals ; still there is no doubt that in



172 Old Age Deferred.



medical practice not infrequently cases are observed where the
retention of all these products together results in very grave
conditions. Thus Ewald^ 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 faeces — pitch dark — she
recovered and the symptoms of intoxication disappeared. Sena-
tor 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 head-
ache, loss of appetite, and various nervous symptoms, neuras-
thenia, 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 food-
stuffs, 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, faecal 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



lEwald: "Die Autointoxication," Berl. klin. Wochenaohr., No. 7-8, 1900.



Elimination of Toxic Products Through Intestines. 173

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 fseces can yet re-
main 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 in-
stance, 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 faeces, and sometimes a
condition analagous 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 ;



174 Old Age Deferred.



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
anti-toxic action. Very important is the role of the bile for the
disinfection of the intestine, as it contains two acids, the glyco-
cholic 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 foecal
matter from the intestines takes place in such a manner that the
contents therein act as a kind of extraneous body with stimu-
lating 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 S)rstem, like strong emotions, shock, etc., may cause an
irritation of the pneumogastric, the motor nerve of the intes-
tines, and thus occasion a movement of the bowels. Different
toxic products may act also upon the pneumogastric; strong
motor action of the intestine with diarrhcea 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 diarrhoea 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

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176 Old Age Deferred.



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 diarrhoea 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. Dysmenorrhoea, amen-
orrhcea, 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 con-
stipation 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, fol-
lowing 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 faecal 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 fermenta-
tion 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



Habitual Constipation. 177

vegetables and fruit, which contain cellulose in the largest quan-
tity, 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 stim-
ulating action on the intestinal walls.

Vegetables are thus a valuable aid in the prevention of con-
stipation, 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.



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