The time spent in obtaining a careful history of a case is time well spent. Often the diagnosis can be made from the history alone, the physical examination merely adding confirmation to the data already obtained.

The younger the patient who has arteriosclerosis, the more probable is it that syphilis is the etiologic factor. A denial of infection should have little weight if the history of possible exposure is present. Miscarriages in a woman should arouse the suspicion of lues in her husband. The complement-fixation reaction will often clear up an apparently obscure diagnosis.

There are various ways of examining a patient but there is only one right way; the examination should be made on the bare skin. However skillful one may be in the art of physical diagnosis, he can gather few accurate data by examining over the clothes even if he use a phonendoscope.

The immoderate eater is laying up for himself a wealth of trouble at the time when he can least afford to bear it. The ounce of advice in time is worth more to him than the pounds of medicine later.

It is a wise maxim never to drive a horse too far. Apply that to the human being and the rule holds equally well.

There may be no symptoms in a case of advanced arteriosclerosis. Do not on that account neglect to advise a patient in whom the disease is accidentally discovered.

Many a man owes a debt of gratitude to the life insurance examiner. He rarely feels grateful.

When a competent ophthalmologist refers a case to a general practitioner with the statement that he believes from the appearance of the fundus of the eye that arteriosclerotic changes are present over the body, the case should be most carefully examined. The earliest diagnoses are not infrequently made by the ophthalmologist.

It is the part of wisdom never to have such a firmly preconceived idea of the diagnosis that facts observed are perverted in order to fit into the diagnosis. Let the facts speak for themselves.

Beware of the snap diagnosis. Even in a case of well-marked arteriosclerosis when the diagnosis seems to be written in large letters all over the patient, go through the routine. Nine times out of ten this may seem needless. The tenth time it saves your conscience and reputation. Always consider that you are examining a tenth case.

Gradual loss of weight in a person over fifty years old should arouse the suspicion of arteriosclerosis.

Do not call the nervous symptoms displayed by a middle-aged man or woman neurasthenia until you have ruled out all organic causes, particularly arteriosclerosis.

When palpating the radial artery, always use both hands according to the method already described. Pay attention to the superficial or deep situation of the artery.

The examination of one specimen of urine does not give much information, especially if it should be found to contain no abnormal elements. Fairly accurate data may be gathered from the mixed night and morning urine; most accurate data from the twenty-four hour specimen. To be of any real value there should be frequent examinations of the day's excretion.

In measuring the day's output a good rule is as follows: begin to collect urine after the first morning's micturition and collect all including the first quantity passed the next morning. It is best to examine the centrifugated urine for casts even though no albumin be present. It is useless to look for casts in an alkaline urine.

Casts are not infrequently found in chemically normal urine from a middle-aged patient. Other things being normal, the finding has no significance. The kidneys must be carefully tested functionally.

Blood pressure readings should always be taken with the patient in the same posture at every estimation. At the first examination it is advisable to take readings from both brachial arteries. Let the patient sit comfortably and relax all muscles.

Differentiate as soon as possible between the uncompensated heart caused by valvular disease and that caused by arteriosclerosis. There is a difference in prognosis. Both give the same symptoms, and are treated similarly until compensation returns; thereafter the management of the two forms is different.

Aortic incompetence that comes on late in life is generally the result of curling of the free margins of the valves caused by syphilitic arteriosclerosis. Prognosis is grave because of the fact that the heart muscle also is the seat of degenerative changes and compensatory hypertrophy is established with difficulty.

When laying down a regime for a patient, consider his disposition, and individualize the treatment. Remember that exercise is an essential feature of the hygiene of the patient's life but do not forget to be explicit about the amount and character of the permissible exercise.

In the prophylaxis of arteriosclerosis, a rational mode of living is the all-important factor. As a rule, the less meat one eats, the less is the liability of arterial degeneration as age advances. The exceptions to this rule are many, and probably depend upon the character of the "vital rubber" with which the individual begins life.

The diet in well-marked cases of arteriosclerosis should be carefully selected with regard to its nutritive and non-irritating character. Animal proteins should be sparingly used. Milk should have an important place in the dietary.

No drug relieves the pain of uncomplicated aneurysm as surely as iodide of potassium.Iodides frequently upset the stomach. Be cautious in the use of them. The irritable stomach may turn the scales against your patient.

Use cardiac stimulants with care and judgment. If all the valuable ammunition is used up at first, the fight will be lost.

Use digitalis with especial care. Its chief usefulness is in steadying the decompensated heart, improving the conduction of impulses, and increasing the tone of the cardiac muscle. It should never be given to patients with very slow pulses, the subjects of Stokes-Adams syndrome. Digitalis has been found to produce partial to complete heart block when therapeutically administered.

Remember that in the uncompensated heart morphine not only eases the oppressive dyspnea, but also steadies and stimulates the heart.

See to it that the patient has a daily movement of the bowels. In the early stage try the effect of liquid paraffin or of the mineral waters such as Pluto, or Hunyadi Janos, or artificial Carlsbad salts (Sprudel salts). These last can be made as follows: Sodium chloride, ?I; sodium bicarbonate, ?II; sodium sulphate, ?IV. Take two tablespoonsful of this in a glass of hot water before breakfast. Should these not succeed, assist the action of the drugs by the use of enemata. The pill of aloin, strychnine sulphate, and extract of cascara, with the addition of a small quantity of hyoscyamus, is a mild tonic purgative. In cases of constipation with high tension, there is no drug as valuable as calomel or one of the other mercurials given occasionally.

Never give Epsom salts unless copious watery stools are desired to deplete effusion into the serous cavities or into the subcutaneous tissue.

Chronic constipation increases the gravity of the prognosis.

In case of suppression of urine and anasarca, hot air packs may be of value. The patient may be wrapped in a hot wet sheet and covered with blankets. I do not believe in administering pilocarpine to assist the sweating.

Remember to treat the patient and not the disease. The careful hygienic and dietetic treatment, combined with the least amount of drugging, is the best and most rational method of treatment.