Arteriosclerosis comes to almost every one who lives out his allotted time of life. As has been noted within, many diseases and many habits of life are conducive to the early appearance of arterial degeneration. Decay and degeneration of the tissues are necessary concomitants of advancing years and none of us can escape growing old. From the period of adolescence certain of the tissues are commencing a retrograde metamorphosis, and hand in hand with this goes the deposit of fibrous tissue which later may become calcified. The arterial tissue is no exception to this rule, and we have already shown that certain changes normally take place as the individual grows older, changes which are arteriosclerotic in type and are quite like those caused in younger people by many of the etiologic factors of the disease.

We are absolutely dependent upon the integrity of our hearts and blood vessels for the maintenance of activity and span of life. Respiration may cease and be carried on artificially for many hours while the heart continues to beat. Even the heart has been massaged and the individual has been brought back to life after its pulsations have ceased, but such cases are few in number. We can not live without the heart beat and the prophylaxis of arteriosclerosis consists in the adjustment of our lives to our environment, so that we may get the maximum amount of work accomplished with the minimum amount of wear and tear on the blood vessels.

The struggle for existence is keen. Competition in every profession or trade is exceedingly acute, so much so that to rise to the head in any branch of human activity requires exceptional powers of mind. Among those who are entered in this keen competition, the fittest only can survive for any period of time. The weaklings are bound to succumb. A scion of healthy stock will stand the wear and tear far better than will the progeny of diseased parentage.

It is only necessary to call attention to the part that alcohol, syphilis and insanity play in heredity. These have been discussed fully in the earlier part of this book.

We live rapidly, burning the candle at both ends. It is not strange that so many comparatively young men and women grow old prematurely. While heredity is a factor as far as the prophylaxis of arteriosclerosis is concerned, of far more importance is the mode of life of the individual. Scarcely any of us lead strictly temperate lives. If we do not abuse our bodies by excessive eating and drinking and so wear out our splanchnic vessels and cause general sclerosis by the high tension thereby induced, we abuse our bodies by excessive brain work and worry with all their multitudinous evils. The prophylaxis of arteriosclerosis might well be labeled, "The plea for a more rational mode of life." Moderation in all things is the keynote to health, and to grow old gracefully is an art that admits of cultivation. Excesses of any kind, be they mental, moral, or physical, tend to wear out the organism.

People habitually eat too much; many drink too much. They throw into the vascular system excessive fluid combined frequently with toxic products that cause eventually a condition of high arterial tension. It has been shown how poisonous substances absorbed from the intestines have some influence on the blood pressure. Anything that causes constant increase of pressure should be studiously avoided.

Mild exercise is an essential feature of prophylaxis. One may, by judicious exercise and diet, make of himself a powerful muscular man without, at the same time, raising his average blood pressure. The man who goes to excess and continually overburdens his heart, will suffer the consequences, for the bill with compound interest will be charged against him. It is a great mistake for any one to work incessantly with no physical relaxation of any kind, and yet, after all, it is not so much physical relaxation that is necessary, as the pursuit of something entirely different, so that the mind may be carried into channels other than the accustomed routes. Diversification of interests is as a rule restful. That is what every man who reaches adult life should aim at. Hobbies are sometimes the salvation of men. They may be ridden hard, but even then they are helpful in bearing one completely away from daily cares and worries. The man who can keep the balance between his mental and physical work is the man who will, other things being equal, live the longest and enjoy the best health.

Nowadays the trend of medicine is toward prophylaxis. We give the state authority to control epidemics so far as it is possible by modern measures to control them.

We urge over and over again the value of early diagnosis in all chronic diseases, for we know that many of them, and this applies particularly to arteriosclerosis, could be prevented from advancing by the recognition of the condition and the institution of proper hygienic and medicinal treatment.

It is the patent duty of every physician to instruct the members of his clientele in the fundamental rules of health. Recently the President of the American Medical Association, in his address before the 1908 meeting, urged the dissemination of accurate knowledge concerning diseases among the laity. While this may be done by city and state boards of health, it seems far better for the modern trained physician to work among his own people. With concise information concerning the modes of infection and the dangers of waiting until a disease has a firm hold before consulting the health mender, people should be able to protect themselves from infections and be able to nip chronic processes in the bud. But it is difficult to turn the average individual away from the habit of having a drug-clerk prescribe a dose of medicine for the ailment that troubles him. It is really unfortunate that most of the pains and aches and morbid sensations that one has speedily pass away with little or no treatment. Herein lies the strength of charlatanism and quackery. Unfortunate, yes, for a man can not tell whether the trivial complaint from which he suffers is any different from the one that was so easily conquered six months ago. But instead of recovering, he grows worse. Hope that springs eternal in the human breast, leads him to dilly-dally until he at last seeks medical advice, only to find that the disease has made such progress that little can be done.

Instruct the public to consult the doctors twice a year. The dentists have their patients return to them at stated intervals only to see if all is well. How much more rational it would be if men and women past the age of forty had a physical examination made twice a year to find out if all is well.

The prophylaxis of arteriosclerosis is moderation in all the duties and pleasures of life. This in no sense means that a man has to nurse himself into neurasthenia for fear that something will happen to him. As one grows in years exercise should not be as violent as it was when younger, and food should be taken in smaller quantities. Many forms of exercise suggest themselves, particularly walking and golf. Walking is a much neglected form of exercise which, in these modern days with our thousand and one means of locomotion, is becoming almost extinct. There is no better form of exercise than graded walking. To strengthen the heart selected hill climbing is one of the best therapeutic methods that we have. The patient is made to exercise his heart just as he is made to exercise his legs, and as with exercise of voluntary muscles comes increase in strength, so by fitting exercise may the heart muscle be increased in power. A warning should be sounded, however, against over exercise. This leads naturally to hypertrophy with all its disastrous possibilities. Men who have been athletes when young should guard against overeating and lack of exercise as they grow older. Many of the factors which favor the development of arteriosclerosis are already there, and a sedentary, ordinary life, such as office all day, club in afternoon, a few drinks and much rich food, will inevitably lead to well-advanced arterial disease.

Karl Marx in his famous Socialistic platform said: "No rights without duties; no duties without rights." So we may paraphrase this and say: "No brain work without moderate physical exercise in the open air; no physical exercise without moderate brain work."

There is yet one other point that is important, the combination of concentrated brain work and constant whiskey drinking. This is most often seen in men of forty-five to fifty-five, heads of large business concerns who habitually take from six to twelve drinks of whiskey daily, and with possibly a bottle of wine for dinner. Such men appear ruddy and in prime health but, almost invariably, careful examination will reveal unmistakable signs of arterial disease. There is usually the enlarged heart and pulse of high tension with or without the trace of albumin in the urine. The lurking danger of this group of manifestations has so impressed the medical directors of several of the large insurance companies that a blood pressure reading must be made on all applicants over forty years of age. Should high blood pressure be found, the premium is increased, as the expectation of life is proportionately shorter in such men than in normal persons.

Therefore, let every physician act his part as guardian of health. Only in this way is the prophylaxis of arteriosclerosis possible.