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employed. The result of lumbar puncture, however, revealing the pneumococcus determined the danger of further spread.
Before autopsy the ear seemed a probable road of infection. Postmorterm examination left no shadow of doubt but that the nose was the avenue by which the virulent pneumococcus reached the meninges. The ear was probably involved secondary to the brain. Whether or not chronic sinusitis as revealed was the immediate cause is open to argument. Suffice to say it made the tract more viable for invasion.
One factor that we must take into consideration in this case is the general infection that existed as shown by recovering the pneumococcus in pure culture from the blood. What part did it play in moulding the course of the disease? Despite the extensive meningeal involvement I am almost inclined to think that the intense intoxication resulting from the pneumococcaemia had much to do in bringing about the rapidly fatal end.
"Reports of American Public Health Association," September, 1905.
ELSNER, H. L.: Medical News, April 8, 1905. "Symptoms and Diagnosis of Cerebrospinal Meningitis."
COUNCILMAN: Journal of American Medical Association, April 1, 1905. "Acute Meningitis."
WILLSON, R. N.: Medical News, October 14, 1905. "Four Cases of Cerebrospinal meningitis."
CUPLER, R. C.: Medical Record, November 18, 1905. "Primary Cryptogenic Pneumococcus Cerebrospinal Meningitis."
WILSON, J. C.: Jorunal of American Medical Association, April 28, 1905.
SPEER, G. G.: Medical Record, April 15, 1905. "Cerebrospinal MeningitisEpidemic and Sporadic."
GOTTSEEN, A.: Deutsche Medicinische Wochenschrift, Band XXXI, Number XXIII. "Die Geschichte von Cerebrospinal Meningitis."
HASTINGS: Medical News, June 17, 1905. "Cerebrospinal Meningitis." KOPLIK, H.: Medical News, June, 1904. "Clinical Features of Cerebrospinaf Meningitis."
"Notes of Epidemic Cerebrospinal
CHAPIN: Medical News, June, 1904. Meningitis."
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ABBOTT, A. C.: University of Pennsylvania Medical Bulletin, 1905. Occurrence of Epidemic Meningitis in Philadelphia."
GOODWIN, M. E., and voN SHOLLY, A. I.: Journal of Infectious Diseases, February, 1906. Frequency of the Meningococcus in the Nasal Cavity of Meningitis Patients and those in Direct Contact."
BOLDUAN, C., and GOODWIN, M. E.: Medical News, December 23, 1905. "Clinical and Bacteriological Study of Cerebrospinal Meningitis and the Probable Source of Contagion."
HARE, H. A.: New York Medical Journal, February 10, 1906. "Case of Cerebrospinal Meningitis Indicating that it may be of Contagious Nature."
WEICHSELBAUM, A.: Wiener Klinische Wochenschrift, Band XVIII, Number XXXI. "Zur Frage der Aetiologie und Pathogenese der Epidemischen Geneckstarre."
BILLINGS, J. S., JR.: Journal of the American Medical Association, June 2, 1906. "Cerebrospinal Meningitis in New York City during 1904 and 1905."
LESSONS IN LONGEVITY.
JOHN S. CAULKINS, M. D.
THESE studies* in longevity so far have considered the matter mainly from the physical or objective point of view, but not to leave the question half discussed it is equally necessary to look at the subjective side. We will now study the effect of the mental and moral factors that lead to the prolongation of active and useful life. Assuming that the human unit has received as fair treatment as the present imperfect conditions allow, he finds himself at puberty confronted with a change. He is no longer to have things done for him; he must do for himself, and for others, too. He becomes a worker and must do his share of the things the world needs done, thus repaying the debt he owes for what was done for him in infancy and youth. He must put into practice that which he has been taught and if possible improve on the teachings. As responsibilities increase, so do the influences which tend to produce conditions of mind unfavorable to longevity. These unfavorable conditions are the product of all violent passions: they are all life-shorteners and prominent among them is
ANGER, especially when it degenerates into unreasoning rage, leading to inveterate hatred and thoughts of revenge. Such anger is a consumer of energy—a constant flame which burns the store of stamen vitæ provided for the staff of declining age. Whoever wishes to reach a hale old age must learn to avoid sudden bursts of anger, and the earlier the lesson is learned the better.
GREED is equally, perhaps more, hurtful. The love of money has been designated the root of all evil, but conceding that there are other causes of evil it is plainly to be seen that the inordinate love of money for its own sake, or for the sake of the power it gives its possessor, leads to covetousness, dishonesty, and crime. Of course, in our imperfect state of human society, money is necessary as a medium of exchange and a common denominator of values, but too much of it is bad for the possessor and bad for the community, since in order that one may have too much it is necessary that others must be exploited and robbed of their rightful share. The tramp is the corollary of the millionaire.
FEAR is another mental condition inimical to long life, while its opposite, courage, is in the same degree friendly. Fear weakens and paralyzes the efforts of mind and body. Courage invigorates and strengthens. Courage does not consist in running heedlessly into danger, prudence being always commendable, but it is only the courageous. who can act prudently; one frightened out of his wits cannot. To live long requires a large stock of courage. Let everyone, then, retain his courage and banish fear by keeping in mind and emulating the example
*The writer of these papers did not have assurance to seat himself in the teacher's chair by calling them "Lessons," they being indebted for it to the friendly offices of the editor.
of the courageous. Where a lack of courage is accompanied by a too lively imagination and ill regulated nerves, results are especially deplorable, running into hypochondria and monomania. In illustration of this we are indebted, for the true story below, to Alexander Monro (Primus*), Professor of Anatomy at the University of Edinburgh in the first half of the eighteenth century. While finishing his studies under the celebrated Boerhaave, of Leyden-the greatest medical light. of the eighteenth century-he had, he says, a fellow-student of the above unfortunate type of mind, who was afflicted with fear to the degree that when Boerhaave lectured on any particular disease, he became firmly convinced that he himself had that very disease. The result was that in a short time he became really ill and was obliged to relinquish the study of medicine.
ENVY and jealousy of the good fortune of others is the vice of little minds and a great handicap in the race for long life, while contentment and good will to all are in the same degree assistants. Let us cultivate peace and good will to others and if inevitable misfortune overtakes us, not waste our strength in weak repinings and useless struggles, remembering that though our disappointment is great, we are still much better situated than many others who probably have feelings as acute as our own. This does not mean that we must tamely submit to injustice, resistance to that being a duty owed not only to oneself but to others. The sense of having discharged to the best of our ability a disagreeable duty; of having battled for the right, and done our best to resist the wrong, tends to make us independent of misfortune and trouble, and gives us the right to be proud of ourselves. Such feelings make strongly for longevity, being a mental tonic which the mind reflects onto the physical organization. Whoever is desirous of living to be very old must beware of that mental canker, envy. He must school himself to be what the shepherd in "As You Like It" says of himself, "envious of no man's good-content with his own harm.”
IDLENESS is another antagonist to longevity. Any mechanism, the human body not excepted, if kept well lubricated and clean wili last longer running than when lying idle and neglected. Work is good for us, but to have the best results we ought to love work and not overwork. Idleness means rust to mind and body. "It is better," says the proverb, "to wear out than to rust out." This proverb has reference to wearing out prematurely by overwork, for the certainty is evident, that we will all be worn out when our inherited stock of vital force is spent. A certain amount of manual labor, guaged according to strength and age, is good for every adult well person, rich or poor, and this should be complemented by some intellectual labor guaged in the same way,
*The University of Edinburgh had three professors of anatomy by the name Alexander Monro, their professorial careers extending from 1820 to 1859–139 years-father, son and grandson succeeding one another without break or interval. All three having been eminent in the pursuit of their chosen science-having written many books-they are cognosed from each other by the Latin numeral adjectives-Primus, Secundus, and Tertius.
but the plan is not very practicable in our present imperfect state of society, since the two idle classes-the blots on our civilization,—the idle rich and the idle poor will not do work of any kind. When the world is reorganized on a strictly scientific basis this evil will be corrected and every one will do as much manual labor as is good for him, leaving plenty of time for development of the intellect and recreation. from toil.
WORRIMENT is mentioned last, but it is not the least among the lifeshorteners. Fretfulness and peevishness are debasing habits-sadly detrimental to equanimity and serenity of mind necessary to growing old slowly. They frazzle out by their friction the stamen vitæ until it parts prematurely. Whoever feels himself attacked by them must sturdily resist or be crushed by the load that time will soon throw on his weakening shoulders.
We are taught by this review of the mental conditions that wear us out and destroy our opportunity for a longer existence, that we must, in the words of a certain ritual, learn to subdue our passions. The earlier we learn the lesson the better our chance for success will be.
Little need be said on the moral side of the question, the laws of morality having varied little in any age and country since history was first written. Recent discoveries of records reaching several thousand years before the Christian era to the time of Hamarubi, the lawgiver of ancient Chaldea, show that he made laws against the same vices and crimes that our legislators do. It only remains to say in this connection that we must be good citizens and obey the laws of our country, remembering that there are things that statute laws cannot punish that are contrary to the unwritten laws of honor and honesty. Christ sums this all up in His Golden Rule, "Do unto others as you would have them do unto you." Whoever makes this his undeviating rule of action need have no fear that there is a skeleton in the closet to frighten him from living peacefully as long as he can.
DEDUCTION FROM THE ABOVE, AND PRACTICAL RULES TO KEEP ONE YOUNG.
Since we are no older than we feel ourselves to be, and those who can eat, digest and sleep well, are really well, it follows that the answer to the question how to delay the arrival of decrepit old age, lies in discovering how and what it is best to eat and what will best promote sound healthful sleep. We are made of what we eat, and hence we must supply good material. We cannot live without sleep and therefore it behooves us to study its laws and comply with its requirements. In the schedule of rules below every one is based on its relation to diet or to sleep.
(1) Never eat unless you are hungry.
(2) Do not eat too much-stop before full repletion.
(3) Never drink while eating, but take a satisfactory drink of pure cold water afterward.
(4) Bread is the staff of life. Let it form the main part of every meal. It includes whatever is made from the cereal grains-the baked loaf, crackers, griddle cakes, mushes, et cetera.
(5) Wheat makes the best bread for our climate-Indian corn is a good second, oatmeal a third, then follow rice, buckwheat and rye. (6) Do not forget to salt the bread well. Employ about twice as much salt as most cooks do.
(7) Besides bread, eat garden vegetables in season; fruits; nuts; eggs; the products of the dairy-milk, butter, and cheese-the best cheese being the cottage or Dutch variety made of sour milk with a very gentle heat, leaving out the black pepper.
(8) Elect a dietary comprising the following:
For breakfast.-Mush of some kind, mostly of whole wheat meal; toasted bread with butter; perhaps custard eaten cold, or stewed prunes. For dinner.-Bean soup; vegetables in season; a pudding of bread made with eggs, milk, and sugar, eaten with cream; melon in season. For supper.-Bread and milk; apples-baked or raw, and a little cheese.
(9) Importance is attached to the plan of using the garden vegetables in the order of season. By so doing we get nearer to Nature's heart and the simple life; we collect from each of her perishable products, the good things she has just formed for us in their fresh and most perfect condition. This remark applies to many other kinds of food-eggs and butter especially, as well as to vegetables. Careful observation of this caution helps us to live on the best and purest food all the time. We cannot be too careful about the quality of our food. Poor nutrition means imperfect cell formation and that means short life.
HINTS ON THE USE OF A SUCCESSION OF VEGETABLES.
As soon as the frost is out of the ground we have oyster plant, parsnips and horseradish, of which the first is the most important, parsnips being rather indigestible, and horseradish valuable mainly for its medicinal qualities as a prophylactic against scorbutic diseases; but oyster plant is a most important article of diet. It is a root full of rich, nutritious milk which cannot be too highly recommended. Then follows the pieplant which fills a wide sphere of usefulness as the earliest acid sauce. About the middle of May comes, in the opinion of the writer, the most useful of all garden vegetables, asparagus, and it is in season until July. This high estimate of its value rests on the fact that for fifty years, he, for six weeks each year, made his noon meal almost wholly of bread and asparagus. A still older friend of his has done the same for a longer period. We can be quoted for hale old folks. We of course know "that one swallow does not make a summer," but we cannot help thinking that the immense amount of asparagus we have eaten has had something to do with our prolonged heartiness. For July our staples