ON MEANS : . 
 
 i II ill 
 
 FOR HHlJl 
 
 PROLONGATION 
 
 
THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 MRS. PRUDENCE W. KOFOID 
 
ON MEANS 
 
 FOR 
 
 THE PROLONGATION OF LIFE 
 
ON MEANS 
 
 FOR 
 
 THE PROLONGATION OF LIFE 
 
 THIRD AND ENLARGED EDITION OF A LF.CTURE DELIVERED BEFORE THE 
 ROYAL COLLEGE OF PHYSICIANS ON DECEMBER 3RD, 1903 
 
 BY 
 
 SIR HERMANN WEBER, M.D., F.R.C.P. 
 
 CONSULTING PHYSICIAN TO THE GERMAN HOSPITAL, THE NATIONAL HOSPITAL 
 
 FOR CONSUMPTION, VENTNOR, AND THE MOUNT VERNON HOSPITAL 
 
 FOR CONSUMPTION, AND A MEMBER OF THE CONSULTING 
 
 COMMITTEE OF KING EDWARD VII. SANATORIUM 
 
 AT MIDHDRST 
 
 Work and Moderation are the main sources of health, 
 happiness, and long life 
 
 Xonfcon 
 JOHN BALE, SONS & DANIELSSON, LTD. 
 
 OXFORD HOUSE 
 
 83-91, GREAT TITCHFIELD STREET, OXFORD STREET, W. 
 
 1908 
 
 (Copyright. All rights reserved,) 
 
 
PREFACE TO THE THIRD EDITION. 
 
 IN publishing an enlarged edition of " Means 
 for the Prolongation of Life," I have acted on 
 some suggestions made to me by readers of the 
 former editions. Thus I have added a short 
 description of most of the more common articles 
 of food, their digestibility and their role in the 
 nutrition of the body. I have also divided the 
 contents of the little treatise into a number of 
 sections for easier reference ; but I have other- 
 wise left the arrangements and the greater part 
 of the text as in the original lecture. 
 
 I have also endeavoured to make the Biblio- 
 graphy and the Index rather more complete. 
 
 Since the delivery of this lecture in 1903, 
 several excellent communications on the same 
 subject have appeared, by Sir Lauder Brunton, 
 Professor Metchnikoff, Dr. William Ewart, M. 
 Jean Finot, and others, from which I have 
 derived much useful information. 
 
 During the years which have passed since the 
 
 M374330 
 
vi. Preface to the Third Edition 
 
 first edition I have been strengthened in my 
 views by intimations from many aged persons, 
 who had carried out my advice for ten and 
 twenty years, and more. 
 
 Grosvenor Street, HERMANN WEBER. 
 
 London, W., 
 
 June, 1908. 
 
TABLE OF CONTENTS. 
 
 I. INTRODUCTORY ... 1 
 
 II. NATURAL TERM OF LIFE 5 
 
 III. MODE OF LIFE OF LONG-LIVED PERSONS ... 10 
 
 IV. INFLUENCE OF HEREDITY 13 
 
 To counteract unfavourable heredity ... 17 
 
 V. SENILE ATROPHY, THE CAUSE OF DEATH FROM 
 
 OLD AGE 24 
 
 To counteract premature senility 25 
 
 VI. ACTION OF EXERCISE ON THE HEART AND 
 
 BLOOD-VESSELS 26 
 
 (1) Walking exercise 30 
 
 (2) Days of prolonged exercise 39 
 
 (3) Walking and climbing tours 44 
 
 (4) Respiratory exercises 47 
 
 (5) Other forms of exercise 54 
 
 Swedish or Danish exercises, military train- 
 ing, gymnastic exercises of different kinds, 
 static or tension exercises, cycling, golf, 
 fencing, angling, gardening, shooting, 
 riding, hunting, &c. 
 
 VII. DIGESTIVE ORGANS AND FOOD 58 
 
 Different articles of food from the animal 
 
 and vegetable kingdoms 58 
 
 Great moderation ... ... ... ... 75 
 
 Mastication 98 
 
 Cooking 100 
 
 Quantity of food required 104 
 
viii. Table oj Contents 
 
 PAGE 
 
 VIII. ALCOHOL Ill 
 
 IX. TEA, COFFEE, COCOA 125 
 
 X. TOBACCO 133 
 
 XI. ACTION OF THE BOWELS 136 
 
 XII. THE NERVOUS SYSTEM 143 
 
 The brain 144 
 
 Mental occupation 145 
 
 Influence of joy and of mental depression ... 150 
 
 Cheerfulness 154 
 
 Strength of will 158 
 
 Exercise of the intellect in old age 162 
 
 XIII. SLEEP ... ... 168 
 
 XIV. THE SKIN 175 
 
 The hair 179 
 
 Massage of the head ... ... 180 
 
 XV. IMPORTANCE OF THE GLANDULAR ORGANS ... 181 
 
 The thyroid gland 181 
 
 XVI. PREVENTION OF DISEASE 184 
 
 Prevention of infection 185 
 
 Education 185 
 
 Clothing ... 186 
 
 The house ... 187 
 
 Travelling 188 
 
 Climate 190 
 
 XVII. RECAPITULATION 192 
 
 XVIII. BIBLIOGRAPHY 194 
 
 XIX. INDEX 203 
 
ON MEANS FOR 
 
 THE PROLONGATION OF LIFE. 
 
 I . INTRODUCTORY. 
 
 MR. PRESIDENT, FELLOWS OF THE COLLEGE 
 AND GENTLEMEN, The subject of the prolonga- 
 tion of life is a very large one, especially if 
 considered with regard to the whole population 
 from infancy onward. 
 
 The diminution of infant mortality and the 
 improvement of the hygienic conditions of 
 towns and houses have raised, and will con- 
 tinue to raise, the average duration of life. 
 Here is a wide field of usefulness, and one of 
 the most important sections of it will be the 
 combat with the various forms of pathogenic 
 microbes (Pfliiger [100]), in which men like 
 E. Tenner, Pasteur, Lister, Koch, and others 
 have rendered immortal services to humanity. 
 And besides, the greater cleanliness in all things, 
 the improvement of dwellings and food supply 
 to the labouring classes, and the hygienic and 
 
2 The Prolongation of Life 
 
 physical education of the entire population, 
 which ought to commence in the nursery, and 
 ought to be insisted on at all schools, public and 
 private, will not only contribute to the pro- 
 longation of life, but improve the whole race, 
 so that our grandchildren ought not to hear any 
 more of the deterioration of the physique of 
 recruits and other candidates for the army and 
 the professions and trades. By such means the 
 resisting power of the organism to disease ought 
 to be developed from an early period of life. 
 The education, moral and physical, of each 
 individual ought to lead to the development of 
 the entire organism for the adequate perform- 
 ance of active work during a long period of 
 mature life, followed by the period of old age, 
 in fairly vigorous health with enjoyment of 
 useful work, leading at last to the final period of 
 gradual and painless cessation of the functions 
 of life. We do not expect this evolution at 
 once ; but we must steadily work for its attain- 
 ment in future generations. Dr. P. K. Pel 
 [98], in an excellent address on the art of living 
 long and happily, urges with justice that all 
 school boys and girls ought to be taught how 
 to maintain their health and to avoid injurious 
 influences. This very promising subject will, 
 
Introductory 3 
 
 however, as far as possible, not be touched in 
 the present discourse, which will relate prin- 
 cipally to the prolongation of the life of adults 
 by the arrangement of the manner of living. 
 This more limited field of work deserves like- 
 wise our serious attention, since the death-rate 
 of persons after about 55 or 60 has scarcely 
 decreased during the last thirty or forty years, 
 while that of children and adults below 45 is 
 now considerably lower than it was then, as 
 shown by the annual reports of the Registrar- 
 General. We must endeavour to reduce also 
 the death-rate of persons in advanced years 
 by increasing the longevity of the individuals. 
 This lecture, I must premise, is a purely 
 empirical and preventive contribution, and does 
 not enter into the pathological anatomy so ably 
 treated by Sir G. Humphry [58], by Dr. Savill 
 [109] in his interesting papers before the 
 Medical Society in March, 1897, nor into the 
 clinical symptoms sketched by Sir Clifford 
 Allbutt [i, 2 and 3], by Dr. Savill, Dr. F. 
 Parkes Weber [132], Oertel [88], G. W. 
 Balfour [10], Metchnikoff [76 and 77], and 
 others ; nor shall I say much about the mental 
 changes which have quite lately been dis- 
 cussed by Prof. Osier [93] and by Sir Samuel 
 
4 The Prolongation of Life 
 
 Wilks [142]. I shall only suggest a manner of 
 living by which they may be postponed as long 
 as possible, excluding in this discourse treatment 
 by pharmaceutical remedies, and by organo- and 
 serum-therapy. 
 
 I must also abstain from entering into the 
 interesting subject of " comparative longevity," 
 for which I may refer to the works of Buffon, 
 Flourens, Sir E. Ray Lankester [69], and others, 
 and restrict myself entirely to the longevity of 
 man. 
 
 Much has been written on this subject from 
 remote antiquity up to the present time. When 
 I think, for instance, of Galen's " De Sanitate 
 tuenda," Cicero's " De Senectute," Bacon's 
 "Historia Vitas et Mortis," Sir William Temple's 
 chapter " of health and longevity," Hufeland's 
 " Makrobiotik " [57], Sir John Sinclair's " Code 
 of Health" [114], Pfluger's [100], Ebstein's 
 [33], and many others good essays on this subject, 
 it may look presumptuous that I address on it 
 so learned a body ; but the facts that I have 
 occupied myself with it for half a century, and 
 with a certain measure of success as well in 
 others as myself, and that I may perhaps open 
 up some fresh aspects, embolden me to place 
 before you in a condensed form some of my 
 
Natural Duration of Life 5 
 
 experiences and views ; and I am further moved 
 to this course by an astonishing disregard of 
 the means of prolonging life on the part of the 
 public as well as the profession. Since the delivery 
 of this lecture in 1903, several excellent com- 
 munications have appeared on prolongation of 
 life, amongst which I may mention Sir Lauder 
 Brunton's address [15], Professor Ewald [3&A], 
 Dr. W. Ewart's [37] and Professor MetchnikofFs 
 very instructive and philosophical works [76 
 and 77], and M. Jean Finot [39]. 
 
 II. NATURAL DURATION OF LIFE. 
 
 Before we consider, how we can attain the 
 natural term of life, we must say a few words 
 about what we may regard as the natural term. 
 The great ages attributed to the Hebrew patri- 
 archs need not occupy us here. It is enough to 
 point out that at the time of the Psalmist no 
 such ages were reached, since he puts the limit 
 at 70 and 80 years. This may at the present 
 time be considered the natural or normal term 
 of life, but by careful arrangement of the 
 manner of living this term may be increased 
 in many persons to 90 and 100, and occasion- 
 ally to more, which we might call supernormal 
 
6 The Prolongation of Life 
 
 longevity, at least under present conditions, 
 though in course of time it may become normal 
 longevity. The difficulties of verifying the 
 statements of great ages in past generations are 
 very great, and due criticism has not been 
 exercised. Even the generally accepted great 
 ages of Henry Jenkins, Thomas Parr, and the 
 Countess of Desmond are, according to the 
 investigations of Mr. W. Thorn [122], to some 
 degree mythical. We have no proof that 
 these three persons reached the ages which are 
 attributed to them, but Mr. T. E. Young 
 ("On Centenarians," 1899) cites from the 
 records of life assurance and annuity societies 
 in England 7 cases of male and 15 cases 
 of female lives having lived to between a 
 hundred years and a hundred and five years 
 and eight months. This statement we may 
 receive as perfectly trustworthy, but con- 
 sidering the very large number of lives among 
 which these 22 cases of the duration of life be- 
 yond a hundred years have occurred, we see that 
 such a duration of life is excessively rare. Dr. 
 Tatham, Superintendent of Statistics of the 
 General Register Office, has kindly informed 
 me that according to the census of 1901 there 
 were, in the whole population of England and 
 
Natural Duration of Life 7 
 
 Wales, living above ninety years, 3,056 males 
 and 6,482 females, in all 9,538 ; and above 
 a hundred years, 47 males and 99 females, in 
 all 146. 
 
 The Registrar-General of Scotland reports 
 [102] that in 1903 the deaths of all ages were 
 38,136 males, 37,866 females ; the deaths at 
 or above i oo years of age were 8 males, 1 1 
 females. In 1904 the deaths of all ages, 
 38,851 males, 39,130 females ; the deaths at 
 or above a hundred, 3 males, 1 3 females. In 
 1905 the deaths of all ages were 37,196 males, 
 37,340 females ; the deaths at or above a hun- 
 dred, 7 males, 14 females. Sir Lauder Brunton, 
 in his suggestive address on Longevity, states 
 on the authority of the Registrar-General, that 
 during the last half-century a continuous in- 
 crease of the average duration of lite has taken 
 place, from a little over 40 in 1854, to a little 
 under 48 in 1900 ; but that in the decades 
 from 60 to 90 years there is a slight diminution, 
 and that this is also the case at the age of i oo in 
 males, while there is a little increase in females. 
 "The number of men living to 100 years per 
 100,000 of the population from 1891 to 1900 
 is only 7, and of women 24, as compared with 
 15 men and 36 women in 1838 to 1854." 
 
8 The Prolongation of Life 
 
 These figures are, however, Sir Lauder fears, 
 vitiated by the fact that there is a tendency to 
 over-statement between the ages of 55 to 65, 
 " a tendency which grows as the age advances, 
 so that very little reliance can be put on the 
 data of extreme ages." With greater strictness 
 in registration during the last decades, reliance 
 can be placed on the more recent figures. 
 
 There can be no doubt that circumstances 
 which we may comprise by the term " environ- 
 ment >!> influence the duration of life. Those 
 who live in crowded industrial districts ; those 
 who are obliged to share small and ill-ventilated 
 rooms with many others ; those who have to 
 spend the whole day in confined factories, easily 
 fall victims to infectious disease, or become 
 sooner decrepit than those who live in the open 
 air and sleep in well-aired bedrooms. Other- 
 wise the nature of occupation or profession, 
 provided there is nothing actually unhealthy in 
 it, does not seem to exercise a decided influence 
 on longevity ; but the latter is different in 
 different countries. Thus, according to com- 
 munications by Dr. Ormstein, a greater propor- 
 tion of people reach high ages in Greece than 
 in most other countries, a fact which already 
 Lord Bacon had noticed; and Metchnikoff makes 
 
Natural Duration of Life 9 
 
 a similar statement with regard to the Balkans. 
 This is probably due to the climate and other 
 environments. We know that in Norway, Den- 
 mark and Sweden the average duration of life 
 is longer than in the South of Europe ; and 
 Hufeland [57] mentioned already in the i8th 
 century that life in colder regions is longer than 
 in warmer ; but that extremes of cold are not 
 conducive to longevity. 
 
 It has been stated that some races are more 
 long-lived than others. This is to some degree 
 true, but much of the difference seems to depend 
 on climate and other environments. There is, 
 however, one race which is decidedly more long- 
 lived than other races, namely, that of the Jews, 
 unless they are living in the greatest poverty and 
 in most unhygienic circumstances, as in Russia. 
 In whatever climate they live, they are, as a rule, 
 distinguished by comparative longevity. It may 
 be that they were originally better constituted, 
 but it appears almost certain that they have 
 derived much benefit from their having obeyed 
 during many centuries the wise hygienic and 
 moral laws of Moses. Through this, we may 
 assume, a peculiar kind of heredity for long 
 life has been gradually developed. Dr. Josse 
 Johnson [62] has quite lately discussed this point 
 
io The Prolongation of Life 
 
 before the Life Assurance Medical Officers* 
 Association. 
 
 III. MODE OF LIFE OF LONG-LIVED PERSONS. 
 
 In examining the circumstances under which 
 man is likely to reach the natural term of life, 
 and especially the manner of living by which 
 this end can be promoted, we must not allow 
 ourselves to be deterred by the experience that 
 some of the most long-lived persons have led 
 injudicious lives, and that great longevity occurs 
 occasionally under the most different circum- 
 stances. After, having carefully entered into the 
 records of more than 100 cases of very long- 
 lived persons, I have reason to say that by far 
 the majority of them were temperate ; were 
 small meat-eaters ; lived much in the open air ; 
 led an active life ; many a life of toil, with great 
 restrictions as to food and comforts ; that most 
 of them were early risers ; that a great number 
 of them had a joyful disposition, and performed 
 their work cheerfully ; and that only a few were 
 intemperate or idle and lazy persons. We must 
 keep before our eyes the means and circum- 
 stances by which the health of man is produced 
 and maintained, and those by which it is usually 
 
Mode of Life of Long- lived Persons 1 1 
 
 deteriorated, since the former are likely to pro- 
 mote, while the latter are almost sure to prevent, 
 longevity in the large majority of cases. 
 
 We must, in laying down certain rules towards 
 the promotion of a long life, and of a vigorous 
 and happy old age, not be checked by the re- 
 marks which we constantly hear, that such rules 
 are irksome, that it is better for man to live a 
 short and enjoyable life than a long and tedious 
 one with many restrictions ; that it is not worth 
 while to live to an old age full of suffering and 
 of physical and mental weakness. No, we do 
 not wish to prolong life merely for living long ; 
 but to prolong mental and bodily energy, and 
 this with a measure of enjoyment and usefulness, 
 and without bodily suffering. I have been in 
 intimate relation with many distinguished per- 
 sons, male and female, who had reached old age. 
 It is true that some of them were suffering, and 
 that the mental faculties of some were impaired, 
 but the majority had retained their interest in 
 the development of science, in the evolution of 
 social problems, and in the condition of their 
 own families ; they were often able to give wise 
 counsel, and to show the way to progress and 
 fortune ; they were eager to read and to learn, 
 and never found a day too long. Dr. Frank 
 
12 The Prolongation of Life 
 
 reminds me of the conversation on this subject 
 between Socrates and Cephalus in Plato's " Re- 
 public," where Cephalus maintains that those 
 who possess a well-regulated mind find old 
 age no intolerable burden, but, on the contrary, 
 are more happy in the mental repose and freedom 
 from passions. Many of my old friends who had 
 been pessimistic in youth and early manhood, 
 have become optimistic in old age, attended by 
 " hope, the kind nurse of old age." 
 
 We are convinced, from a large experience, 
 that the manner of living required for the pro- 
 longation of life is irksome only at the begin- 
 ning, that it becomes easy by habit and leads to 
 health of mind and body, to usefulness, to free- 
 dom from suffering, and to happiness much 
 greater than that to be obtained by yielding to 
 the desire of indulgence in sensual or frivolous 
 enjoyment. When I hear that a life of work and 
 moderation is tedious, I am always reminded 
 of the words of Fernando in " The Tempest " : 
 
 " And most poor matters 
 Point to rich ends." 
 
 At first the walking and working may appear 
 poor matters, and not less so the moderation, 
 when one has to curb a good appetite before 
 a richly covered table ; but then come the rich 
 
Heredity 1 3 
 
 ends, health and happiness, and a long and happy 
 life, full of activity, to terminate frequently by 
 falling asleep without suffering. 
 
 On the other side, it is a fallacy to think that 
 those who indulge themselves by immoderate 
 eating, drinking, and sensual enjoyment can do 
 so without the risk of great suffering, often 
 associated with unhappiness in advancing years. 
 Experience has shown us that the majority of 
 those who have habitually indulged themselves 
 do not die suddenly and easily in the midst of 
 their enjoyment, but suffer often for months and 
 years before death releases them. 
 
 Self-indulgence leads mostly to failure and un- 
 happiness, self-control to success and happiness. 
 
 IV. HEREDITY. 
 
 Amongst the circumstances connected with 
 longevity the most prominent is heredity^ which 
 means an inherited good constitution. I have 
 endeavoured to ascertain what are the principal 
 factors of this inherited longevity, whether it is 
 to be ascribed more to one system of the body 
 than to another. Though almost all seemed to 
 have had an all-round good constitution, yet 
 there were differences in the different long-lived 
 
14 The Prolongation of Life 
 
 families ; but all of them were endowed, as far 
 as I could learn, with a vigorous heart and good 
 blood-vessels, and I am inclined to ascribe to the 
 circulatory system the greatest share, which, 
 however, cannot be separated from the respira- 
 tory system and from the vaso-motor part of the 
 nervous system. It is, as a rule, not the vigour 
 of the muscular system which leads to longevity ; 
 athletes and men with great muscular strength 
 form no large percentage of the long-lived 
 people ; nor does great intellectual power seem 
 to be a prominent feature ; nor a strong diges- 
 tive system, which, although useful when well- 
 managed, often gives rise to the temptation of 
 over-feeding, while a weak digestion compels 
 moderation, and thus leads frequently to a longer 
 life and happier old age than is obtained by 
 those endowed with a strong digestive system. 
 
 The chances of a person belonging to a long- 
 lived family are, cceteris paribus^ much better than 
 those belonging to ordinary families, but it is 
 a dangerous fallacy to rely too much on such 
 a privilege. In a family well known to me, 
 for instance, out of 1 1 children, whose parents 
 (both) died above ninety, 5 men and 4 women, 
 leading satisfactory lives, lived to 88 and more, 
 while 2 addicted to alcohol died between 60 
 
Heredity 1 5 
 
 and 70. In another family of 8 children, whose 
 father had lived to 87, while the mother had 
 reached the age of 96, only half of them, viz., 
 3 daughters and i son, lived beyond 86, while 
 
 3 sons and i daughter died under 70. The first 
 
 4 had lived judiciously, while of the 4 dying 
 rather prematurely, 2 sons had over-indulged 
 themselves with eating as well as drinking, 
 i with drinking only, and the daughter having 
 had a large family became mentally depressed 
 by frequent sources of grief and anxiety. 
 
 The tendency to early death is likewise here- 
 ditary in some families to such a degree that 
 careful assurance offices refuse members of such 
 families ; but by judicious management, if com- 
 menced early enough, the life can be consider- 
 ably prolonged in spite of the inherited tendency 
 to early death, which seems to be mostly asso- 
 ciated with a weak vaso-motor system. 
 
 We must endeavour to profit by the favour- 
 able influences of heredity, but counteract the 
 unfavourable ; we need not die at the same 
 early ages as our forefathers did ; we must not 
 adhere to fatalism, which is one of the worst 
 doctrines, but trust in our own work, and in 
 the truth of the proverb that " God helps those 
 who help themselves." Most persons descended 
 
1 6 The Prolongation of Life 
 
 from short-lived ancestors have it in their power 
 to prolong their lives by a judicious manner of 
 living. 
 
 It seems to me a matter of importance to 
 keep the idea of our power of influencing 
 heredity constantly before our mind. In the 
 same way as different hereditary varieties can be 
 produced in animals and plants, hereditary 
 tendencies can, I think, be produced in 
 man to long life by protecting him from, or 
 making him avoid, injurious influences dietetic, 
 meteorological, climatic, hygienic, social, &c., 
 and by replacing the injurious by favourable 
 influences. If this view were to be taken up 
 generally, and acted upon, we might have, in 
 the course of time, many long-lived and few 
 short-lived families. Much, no doubt, can be 
 done by physical education, great moderation 
 and suitable occupation ; but the most powerful 
 influence would be exerted by well-selected 
 marriages, and by preventing ill-suited ones ; 
 but this, I fear, will never be sufficiently in 
 our power ; and it would not be quite natural, 
 since love is not generally influenced by con- 
 siderations of health. 
 
 In advising persons with a hereditary ten- 
 dency to rather early death, it is most important 
 
To combat Unfavourable Hereditary Tendencies 1 7 
 
 to become acquainted with their family history, 
 the causes of death of their parents and blood rela- 
 tives^ since by combating the tendency to these 
 causes of death, from as early a period as pos- 
 sible, we mostly succeed in prolonging life. 
 This is conceded by the majority of medical 
 men with regard to tuberculosis ; but numerous 
 deaths between 50 and 70, which are caused 
 by the weakness of the fibres of the heart and 
 of the coats of the arteries and capillaries, can 
 be avoided or, at all events, greatly retarded, by 
 regular exercises, including walking and breath- 
 ing exercises, and great moderation in food and 
 alcohol ; the tendency to atheromatous and 
 allied changes, to arterio-sclerosis, to apoplexy 
 and paralysis, by similar means ; and not less so 
 that to stone in the urinary organs, where the 
 great restriction with regard to food rich in 
 purin is especially important ; the tendency to 
 senile bronchitis and pneumonia, which form so 
 frequent causes of death in advanced life, 1 by 
 much air in and out of doors, by respiratory 
 and other exercises tending to strengthen the 
 heart and the lungs ; the tendency to epilepsy 
 and to certain forms of dipsomania which are 
 
 1 See the statistics in Dr. SaviU's paper already quoted. 
 2 
 
1 8 The Prolongation q/ Life 
 
 allied to epilepsy by total abstinence from youth 
 onwards ; and almost all other hereditary causes 
 of early death can mostly be warded off by 
 judicious arrangement of the manner of living. 
 By appreciating the individual constitution, the 
 tendencies to disease indicated by the family 
 history, by the habit of the body, the occupation, 
 &c., we are often able to prevent disease, and 
 the prevention of disease is one of the great means 
 of prolonging life. The progress of public 
 hygiene will in this matter, we may hope, bear 
 more and more fruit, but every single individual 
 must in his own case endeavour to avoid ex- 
 posure to disease and infection, above all things 
 syphilis (Mechnikoff). We must endeavour to 
 recognise all the weak points of the entire organ- 
 ism, especially the weakest, and direct our atten- 
 tion to strengthening these 'weak points, z^bove 
 all things we must bear in mind that good air in 
 and out of doors is one of the most powerful 
 factors in improving and maintaining health, 
 and prolonging life. We have often heard from 
 many persons the objection that they cannot 
 bear much open air, that it causes with them 
 catarrh, rheumatism, neuralgia and many other 
 complaints, but most of these objectors became 
 gradually convinced that it was not the abund- 
 
To combat Unfavourable Hereditary Tendencies 19 
 
 ance of air which caused these troubles, but the 
 injudicious and imperfect way in which the air 
 was admitted into the room ; for instance, by 
 small chinks in the windows instead of by fully 
 opened windows, or by imperfectly closing 
 doors, and by sitting between the door and 
 the fireplace, or by driving in close carriages 
 with the window of one side partly open, 
 instead of driving in an open carriage or in 
 an open bath-chair. Admitting the air through 
 a small opening causes draught^ which often pro- 
 duces in sensitive persons a local chill of the 
 eye, the ear, the neck, or other parts, while 
 by allowing the air to reach the whole 
 body the latter becomes soon accustomed to 
 it, is strengthened, and gains in resisting power. 
 It is scarcely necessary to add that I do not 
 intend to recommend old or delicate persons to 
 expose themselves to a combination of cold air 
 with high wind. 1 
 
 1 The question of living in good air has many aspects. 
 To mention only a few points, we ought not only to spend 
 several hours every day in the open air, but the house we 
 live in, if in town, ought to lie in a broad street or an open 
 space, not in a narrow lane, shut out from sun and air ; 
 if in the country, not in a hollow surrounded by high 
 hills, or in a deep valley, but on the brow or slope of a 
 hill, well above the bottom, or in an open locality, fully 
 exposed to the sun and air. The house itself must be 
 
2O The Prolongation of Life 
 
 I could give a great many instances of persons 
 who escaped the diseases of their parents and near 
 relatives by well-adapted management. I will, how- 
 ever, only mention five, beginning with my own 
 case, because you know me and see me before you. 
 
 CASE i. My mother died before she was 60 
 from weakness of the heart, inherited from father 
 and grandfather, which led to frequent attacks of 
 bronchitis and general dropsy ; my father died in 
 his sixtieth year from cerebral apoplexy ; he had 
 not been an abstainer himself, and his forefathers, 
 during four or five generations, had taken largely 
 the strongest kinds of hock and port, and died 
 from affections of gouty nature, including one of 
 paralysis and one of apoplexy. By moderation and 
 abundant exercise of mind and body, including 
 breathing exercises (p. 47), I have escaped death from 
 these causes, and have greatly prolonged my life, 
 although I must confess that I have not quite 
 effaced the gouty tendency inherited from five 
 generations, although it is much less in evidence. 
 
 CASE 2. Nearly fifty years ago a gentleman 
 consulted me at the age of 41, who suffered from 
 frequent attacks of bronchial catarrh, from weak- 
 ness of the heart, was rather stout, had a sedentary 
 occupation, took much meat, and was inclined to 
 constipation and bleeding piles. His father had 
 
 constantly kept well aired ; the windows of the bedroom 
 must be open during the whole day and, in part at least, 
 during the night. The beneficial influence which the 
 acting on these rules exercises on health can scarcely be 
 over-estimated ; it is most marked in children, but hardly 
 less so in adults and those far advanced in age. 
 
To combat Unfavourable Hereditary Tendencies 2 1 
 
 died from " chronic bronchitis with dropsy " at the 
 age Of 6 1, his paternal grandfather from " bronchitis 
 and congestion of the lungs " at 64 ; while his 
 mother, belonging to a rather short-lived family, 
 had died from " pneumonia," aged 59. By means 
 of great moderation in eating and drinking, with 
 attention to his bowels, by living much in the 
 open air and in well-ventilated houses and rooms, 
 by regular breathing exercises, abundant walking 
 exercise and regular occupation, the tendency to 
 bronchial catarrh, to constipation and piles dis- 
 appeared, and he lived to the age of 75, when he 
 succumbed to a severe attack of influenza. Three 
 brothers and one sister, who had not followed out 
 similar regimens, but had indulged themselves more 
 or less, died before they were 60, from chronic 
 diseases of the heart or of the respiratory organs. 
 
 CASE 3. In 1862 I was consulted by a gentle- 
 man aged 44, whose father and grandfather had 
 died under 64 years of age from apoplexy ; while 
 his mother, who had belonged to a fairly long-lived 
 family, had died after much grief and worry at the 
 age of 69. The patient was of florid complexion, 
 muscular, slightly above the average weight for his 
 height, had had two attacks of gout, and was in the 
 habit of eating and drinking abundantly. He was 
 induced to diminish the quantity of meat to a very 
 small amount, and to take it only on two days in the 
 week, to give up stimulants almost entirely, and to 
 take much open-air exercise, in addition to daily 
 breathing exercises (p. 47), with the result that the 
 attacks of gout ceased after some years, that his 
 general health became perfect, and that he was able 
 
22 The Prolongation of Life 
 
 to enjoy the pleasures of intellectual and social 
 work up to 78 years of age, when he began to 
 show signs of weakness of the heart after an acci- 
 dent which prevented his continuing to take active 
 exercise. The final cause of death was pneumonia. 
 Two brothers and a sister of this gentleman, who 
 had indulged their appetites and taken little active 
 exercise, died between 60 and 66, from apoplexy, 
 and others at earlier ages from bronchial attacks 
 and failure of the heart. 
 
 We may fairly assume that life in Case 3 was 
 considerably prolonged through his combating the 
 family tendency to apoplexy and failure of the 
 respiratory system and heart, by means of much 
 exercise and by a judicious manner of living ; and 
 the same may be said of the subject of Case 2 
 with regard to the inheritance of tendency to weak- 
 ness of the heart and respiratory system. 
 
 Compare on "The Prevention of Apoplexy," 
 Clifford Allbutt's paper [3]. 
 
 Still more striking is the effect of the manner 
 of living in counteracting the hereditary ten- 
 dency to early deaths in Cases 4 and 5. 
 
 CASE 4. A. C., a member of a family of five 
 sons and five daughters, consulted me when at the 
 age of 35, complaining of weakness, shortness of 
 breath, especially after lunch, frequent sleepiness, 
 particularly after meals. His family history was 
 very grave. His father had died at 49 from 
 bronchitis ; his paternal grandmother at 55 from 
 pneumonia ; his paternal grandfather at 48 from 
 
To combat Unfavourable Hereditary Tendencies 23 
 
 "dropsy"; his mother had died suddenly at 52 
 from " failure of the heart " ; his maternal grand- 
 father at 5 1 from apoplexy ; his maternal grand- 
 mother at 56 from "dropsy." His life had been 
 refused by several insurance offices. The patient 
 was a solicitor who took little exercise, lived freely 
 in eating and drinking, and slept mostly over eight 
 hours. The heart was feeble, the face was red from 
 congested capillaries. I advised him to take meat 
 only once a day ; to limit the stimulants to a quarter 
 of a bottle of light hock or claret, and the sleep to six 
 hours. In addition, he was ordered to take breath- 
 ing exercises (p. 47) every morning during a quarter 
 of an hour, a hot bath followed by a cold shower, 
 and to walk two hours a day. This manner of 
 living led, within two months, to great improve- 
 ment, after which the daily walking exercise was 
 supplemented by a whole day's walking or shooting 
 at least once a week. On this regime A. C. lived 
 in good health up to the age of 74, when he died 
 from influenza. 
 
 All the four brothers of A. C., who lived on the 
 plan that they must "sustain" themselves by eating 
 and drinking much, and avoid exertion in order to 
 prevent "wearing out," died between 49 and 56 (one 
 from failure of the heart, one from apoplexy, one 
 from an operation for stone, one from cause unknown 
 to me). Of the five sisters, three died from various 
 diseases under 56, one from accident at 45 ; the 
 fifth, who died at 75, is the subject of Case 5. 
 
 CASE 5. A married lady, aged 36, a sister of 
 the subject of Case 4, consulted me on account of 
 shortness of breath, cedema of the legs, and varicose 
 
24 The Prolongation of Life 
 
 veins. She had had four children, the youngest 
 being 3 years old. Her heart was dilated ; she was 
 rather stout ; the urine was normal. She was in 
 the habit of eating rather largely and taking much 
 water and soups at lunch and dinner. She took 
 scarcely any exercise. She was ordered to take 
 meat only once a day ; no soup and no other fluid 
 at the two principal meals ; to begin with very 
 gentle breathing exercises and two short walks 
 every day in all weathers, and gradually to increase 
 the amount of breathing and walking exercises. 
 Within four weeks the oedema of the legs had dis- 
 appeared, and after another month she was able to 
 walk two hours every day. On this plan her health 
 further improved and remained satisfactory up to 
 the age of 70, when I lost sight of her ; but I 
 heard later that she had died at 75. 
 
 V. CAUSE OF DEATH FROM OLD AGE. 
 
 Death from old age is caused by a kind of 
 atrophy of the tissues and organs connected with 
 changes in the capillary blood-vessels, and, in 
 some cases, atrophy of the ductless and hasmato- 
 genic glands. For the more accurate description 
 of these senile changes I again refer to Dr. 
 Savill's paper already mentioned [109], and to 
 the articles on " Old Age " in the second 
 edition of Allbutt and Rolleston's " System of 
 Medicine/' by Dr. Parkes Weber [131] and 
 
Cause of Death from Old Age 25 
 
 myself [134]. We must counteract this ten- 
 dency to senile atrophy by supplying the tissues 
 and organs with healthy blood ; and to do so we 
 must endeavour to produce a healthy state of 
 the blood and to maintain the blood-vessels and 
 lymphatics in a sound and vigorous condition. 
 Life, we may say, depends to a great extenton 
 the state of the organs of circulation, including 
 the heart, the capillaries and lymphatics, which 
 latter have in old age a great tendency to 
 obliteration, and our aim must be to keep the 
 lymphatics, arterioles and capillaries in working 
 condition, and to prevent or postpone as much 
 as possible their degeneration or obliteration by 
 atheromatous and other changes connected with 
 old age. It has often been said, with justice, 
 that the best way to effect this is by keeping 
 the organs in action^ while inaction leads to 
 decay, We must therefore endeavour to main- 
 tain the former and to prevent the latter. 
 
 Professor Metchnikoff, in his philosophical 
 and suggestive works, " The Nature of Man ' 
 [76, pp. 240-1] and "The Prolongation of 
 Life" [77, pp. 25 ss.], ascribes this decay to 
 the action of macrophages, which name he gives 
 to the larger kind of phagocytes, viz., cells 
 which effect the absorption of exudation, and 
 
26 The Prolongation of Life 
 
 the destruction of hostile microbes. He main- 
 tains that these cells, useful as they are in 
 absorbing haemorrhages and exudations, are in- 
 strumental also in the changes of old age, that 
 they surround the vital parts, the higher cells ot 
 the brain and other organs, the tubules of the 
 kidneys, &c., that they absorb them and trans- 
 form them into connective tissue, thus pro- 
 ducing the fibrous degeneration of organs which 
 is one of the main changes of senility. This 
 explanation of senile decay does not in any way 
 militate against the view that we must endeavour 
 by all means in our power to keep up the 
 nutrition and functions of all organs and tissues 
 of the body by promoting the activity of the 
 nutritive capillaries, since the macrophages attack 
 decaying but not healthy tissues. 
 
 VI. ACTION OF EXERCISE ON THE HEART 
 AND BLOOD-VESSELS. 
 
 The physiological processes connected with 
 the all-important question, the exercise of the 
 organs, have been studied by Ludwig and his 
 pupils, including in this country especially Sir 
 Lauder Brunton, and independently by Dr. 
 George Oliver, of Harrogate [91]. During 
 the action of an organ its arterioles become 
 
Action of Exercise on the Circulation 27 
 
 widened, more blood flows into the capillaries 
 and the lymph spaces ; more food and more 
 oxygen are carried to the tissues, and at the 
 same time the waste products are removed. 
 This has often been demonstrated on the muscle 
 whose regular contraction causes increase in size 
 and strength ; it is, however, not only the mus- 
 cular fibre which gains, but the nutritive vessels 
 and absorbents themselves gain equally much 
 by being kept in action. The increased afflux 
 of blood which is caused by the action of the 
 muscle forces the small vessels to work, and to 
 conduct more blood to the organs and tissues, 
 and thus their coats are maintained in a sound 
 condition. At the same time the lymphatics are 
 kept in action by the removal of the increased 
 amount of fluid from the lymph spaces, contain- 
 ing the used-up material. Similar is the case with 
 the brain and nerve centres ; the acts of think- 
 ing and of initiating movements in the voluntary 
 muscles lead to afflux of bloo.d to the nerve 
 centres, to increased nutrition of the ganglion 
 cells and nerve-fibres, and at the same time of 
 the minute vessels, efferent as well as afferent. 
 The increased afflux of blood to the brain by 
 the act of thinking has been shown by the 
 ingenious experiment of Mosso [81], one of 
 
28 The Prolongation of Life 
 
 Ludwig's pupils, who, as you know, has con- 
 structed a finely balanced table on which he 
 placed a man in the horizontal position, and 
 demonstrated that during the act of thinking 
 the head becomes heavier, so that the head 
 portion of the table goes down. 
 
 The healthy condition of the heart and blood- 
 vessels, which is necessary for maintaining the 
 nutrition of the organs and tissues, is effected 
 by keeping them in constant action. A certain 
 amount of action is inherent to them without 
 any effort of the will. This amount of inherent 
 action varies considerably in different individuals. 
 In many constitutions the system of circulation, 
 and, through it, the health of the organs, re- 
 mains satisfactory during a long life without any 
 special stimulus [p. 14]; but in other constitutions 
 it is apt to decay at a more or less early period 
 of life, and these tendencies to early decay are, as 
 already mentioned, in many families hereditary, 
 and must be counteracted by judicious means. 
 
 If we review the different means in our power 
 to prevent early decay and to keep the circula- 
 tory system in a healthy condition, we find that 
 the most efficacious means are given by the 
 different forms of exercise. Muscular exercise 
 is one of the most powerful means of preventing 
 
Action of Muscular Exercise on the Circulation 29 
 
 arterio-sclerosis which Sir Lauder Brunton in his 
 address on Longevity [15] calls "the great 
 enemy to longevity." 
 
 The mode of action of muscular exercise Dr. 
 George Oliver, of Harrogate, explains ingeniously 
 in his address delivered before the British Bal- 
 neological and Climatological Society in May, 
 1903. He has lately been making a large 
 number of experiments on the effects of res- 
 piratory and muscular exercises on the blood 
 pressure and on the tissue lymph circulation, 
 and he informs me " that all these exercises 
 (respiratory and muscular) produce the same 
 effects, namely : (a) A rise of blood pressure 
 and an increase of tissue fluid during the con- 
 tinuance of the exercise ; and (b) a rapid 
 decrease and immediate fall of the pressure, and 
 a diminution of the tissue fluid on the cessation 
 of them " ; and he has found " that the rise and 
 subsequent fall in pressure and in tissue lymph 
 are greater when these two forms of exercise 
 are combined, than when one or the other is 
 practised alone." He concludes " that exercise 
 (whether respiratory or solely muscular, or both 
 combined) stimulates the fluid exchange between 
 the blood and tissue space." Sir Lauder 
 Brunton, in his lecture on Atheroma [13], 
 
30 The Prolongation of Life 
 
 describes how each contraction of the muscle 
 drives the fluid onward, and how with each 
 relaxation its tissue juice and products of waste 
 are sucked into the lymph spaces and lym- 
 phatics. Thus amongst the effects of all forms 
 of exercise, one of the most important is the 
 promotion of the removal of the 'waste products 
 of the tissues. Many chronic affections, such as 
 gout, premature decay of the small nutritive 
 blood-vessels, are caused by the imperfect 
 removal of the waste materials. 
 
 Walking Exercise. The most natural form 
 of exercise is walking. By walking we all know 
 the action of the heart and the breathing are 
 accelerated ; more blood is passed into the blood- 
 vessels, which are obliged to contract more 
 vigorously and carry it with greater energy to 
 the different organs and tissues, nourish the latter 
 and become themselves nourished by the work. 
 At the same time the number and depth of in- 
 spirations are increased, more oxygen is taken 
 up and more carbonic acid is given out, and the 
 metabolism of the whole body is promoted. 
 Walking also influences the action of the heart 
 in another way ; by the contractions of the 
 muscles of the feet and legs more blood is 
 attracted to them and all afferent vessels of the 
 
Action of Walking Exercise 31 
 
 lower extremities carry to them more blood 
 from the heart, and the efferent vessels, the 
 veins and lymphatics carry more blood back to 
 the heart and force it to contract more ener- 
 getically. The condition of the veins of the 
 lower extremities is much improved by walking. 
 Many persons have naturally weak veins, which 
 are apt, owing to want of contractile power of 
 their coats, to become distended and varicose, 
 and under injurious influences, such as over- 
 feeding, habitual constipation, goutiness, long- 
 continued standing, &c., to become inflamed. 
 Thrombosis of the veins of the legs and phlebitis 
 are mostly due to such conditions and circum- 
 stances. Although much walking exercise is to 
 be avoided, while the veins are inflamed or 
 thrombosed, yet regular walking is one of the best 
 means of prevention. The circulation of the blood 
 and lymph in the abdominal cavity is likewise 
 powerfully accelerated by the act of walking ; 
 as well through the increased pumping action of 
 the heart, as also by the increased contractions of 
 the diaphragm and abdominal walls. All the 
 organs of the abdominal cavity, including the 
 sympathetic nervous system, share the improved 
 state of the circulation. In addition to these 
 effects of walking we must take into considera- 
 
32 The Prolongation of Life 
 
 tion the fluid exchange between the blood and 
 the tissues explained by Dr. Oliver's observations 
 previously mentioned. Another effect of walking 
 and of all muscular exercises, is the improve- 
 ment of the nutrition of the muscles, and this in 
 itself is a most important means of counteracting 
 the natural tendency to decay ; for the atrophy 
 of the muscles is in most persons one of the first 
 manifestations of senility, and is one of the main 
 causes of the loss of weight and the power of 
 heat-production in aged people. Yet another 
 effect of walking and other muscular exercise, is 
 a change in the distribution of blood in the 
 body : the action of the muscles produces in- 
 creased afflux of blood to them, by which blood 
 is removed from the internal organs, and stagna- 
 tion of blood in the latter is counteracted. 
 This circumstance explains also an experience 
 which many people of limited strength make 
 on themselves, viz., that hard walking or other 
 hard muscular exercise taken soon after meals 
 disturbs their digestion. One of the causes 
 of this is that the action of the voluntary 
 muscles attracts part of the blood which the 
 stomach requires for its work after meals. 
 
 Many persons, including men of literary 
 occupations, even medical men, and many 
 
Action of Walking Exercise 33 
 
 women, think that walking exercise is quite 
 unnecessary ; but the great majority of them 
 suffer in later years from the neglect of walking 
 or other active exercises. The organization of 
 man, the large lower extremities with which 
 he is provided, show that they are destined for 
 active use. 
 
 The amount of walking necessary and useful to 
 maintain health varies widely in different persons 
 and even in the same persons under different 
 circumstances ; we may say from half an hour 
 to two or three hours a day, part of which may 
 be taken in the morning, part in the afternoon. 
 
 We must consider not only what it is desirable 
 to do, but what can be done. Great is the 
 difference in different persons and even in the 
 same person at different times. It depends not 
 only on the general strength of a person, but also 
 on the varying state of health, on habit, on age, 
 on the meteorological surroundings, such as heat 
 or cold, humidity, movement or stagnation of air, 
 on the clothing and other circumstances. What 
 is only just sufficient for one is great excess to 
 another, or to the same person under different 
 circumstances. In persons unaccustomed to 
 exercise a long walk or an active climb of some 
 hours can produce an overstrain of the heart of 
 3 
 
34 The Prolongation of Life 
 
 grave import, while the same person after some 
 training can make a similar exertion without 
 even any feeling of fatigue. The amount which 
 is useful and possible must be judged by the 
 condition of the individual at the time being. 
 We cannot lay too great stress on this point. 
 We have repeatedly seen irretrievable harm and 
 even fatal termination caused by hard walking, 
 especially climbing in the Alps and in the 
 mountains of Scotland, and by exhausting run- 
 ning and rowing matches, in persons who were 
 not in a vigorous condition when they under- 
 took them, while they had been able to undergo 
 greater exertions six or twelve months before, 
 when they had become accustomed to them by 
 gradually increasing work. 
 
 The pace of the walk likewise deserves con- 
 sideration, and ought to be different in different 
 individual conditions. We hear sometimes that 
 persons are told to walk two, or three, or four 
 miles an hour, but no general rules can be laid 
 down excepting perhaps this, that the pace 
 ought not to be so great as to cause palpitation 
 of the heart or breathlessness, and, on the other 
 side, ought to be quick enough to produce a 
 gentle glow of the whole body. Here, again, 
 habit is of great importance, and this ought only 
 
Action of Walking Exercise 35 
 
 to be trained gradually, and not to be changed 
 suddenly. When a person, accustomed to a 
 rate of one or one and a half to two miles an 
 hour, is induced by companions to walk four 
 miles an hour or more, great harm is occasionally 
 done. It is said, sometimes, that a person above 
 65 ought not to exceed two miles an hour, and 
 ought on no account to run ; but by careful 
 training a habit may be produced which allows 
 a much quicker rate even at the age of 75 to 80 
 and more, if all the organs are sound. Whatever 
 can be maintained by the aged, as well with 
 regard to the pace as to the amount of exercise 
 without causing exhaustion, ought to be main- 
 tained, but exhaustion ought to be avoided. 'The 
 condition of the organs is of greater importance than 
 the number of years. 
 
 I may mention here that I have seen in 
 hundreds of cases, that persons advancing in 
 years after having been prevented by illness or 
 other causes from taking their regular walks, 
 felt fatigued when first resuming them, and in- 
 ferred from this that they were too old or too 
 weak to take proper walks, and in consequence 
 discontinued them, lost power and inclination, 
 and actually became prematurely old. If they had 
 commenced with short walks and gradually 
 
36 The Prolongation of Life 
 
 increased them, they would have acquired again 
 the habit of exercise, at least to a moderate degree, 
 and postponed the senile decay. Whenever I 
 have been in time to encourage the resuming of 
 exercise in a proper way, much of the former 
 power has been regained and the decay has been 
 prevented. The same holds good, with the 
 giving up of the exercise of the mind, or of pro- 
 fessional or other work. To many persons 
 the retiring from business or from work with 
 an old age pension is the cause of premature 
 decay. 
 
 People in advanced age mostly are unable to 
 take as much exercise as those in middle age ; 
 but, as already said, habit produces many ex- 
 ceptions, and short walks at all events ought to 
 be maintained, if possible, once, twice, or three 
 times a day. 
 
 Although, as already said, we exercise by 
 walking not only the muscles and blood-vessels 
 of the legs, but influence by it almost all other 
 parts, and all the tissues of the body and their 
 component cells, we ought also to practise 
 movements of the arms, the trunk and the neck. 
 Most persons can combine this with the regular 
 breathing exercises [p. 47], and those who cannot 
 ought to devote at least five to ten minutes once 
 
Walking in Bad as well as Good Weather 37 
 
 or twice every day to separate exercises of arms, 
 and neck and trunk. I ought to mention that 
 it is important to exercise the left hand and arm 
 as well as the right, since by neglecting the 
 proper use of the left arm, a portion of the right 
 hemisphere of the brain suffers in nutrition. 
 The thorough drying and rubbing after the 
 morning bath affords already some exercise 
 to the arms and trunk, and this can be advan- 
 tageously supplemented by further movement 
 before dressing again. We combine in this way 
 a short air bath^ with the water bath and the 
 exercises ; and this air bath exercises a beneficial 
 influence on the skin, and, through it, on the 
 nervous system and the circulation. 
 
 Those who possess fairly healthy organs of 
 circulation derive more benefit from gentle 
 uphill exercise than from walking downhill or 
 on the level ground. Also in weakness of the 
 muscular fibre of the heart and moderate degrees 
 of dilatation, graduated uphill exercise, as sug- 
 gested by Oertel [88], has a most beneficial effect. 
 
 It is scarcely necessary to remark that these 
 suggestions as to walking are intended only 
 for healthy persons (amongst whom we include 
 persons with old mitral affections with perfect 
 compensation), but not for convalescents from 
 
38 The Prolongation of Life 
 
 acute diseases, and least so from rheumatic fever 
 with recent heart complications. 
 
 This regular walking exercise, provided the 
 health is fairly good, ought not to be inter- 
 rupted by so-called bad weather ; it ought to be 
 taken in all kinds of weather, may it rain or 
 may the sun shine, may it be cold or warm. 
 Many people with a tendency to rheumatism 
 are excessively afraid that walking in rainy 
 weather may cause fresh attacks of rheumatism 
 or increase the rheumatic troubles from which 
 they are already suffering, and on this account 
 stay at home on rainy days ; but with proper 
 protection by clothing, strong boots and um- 
 brella, and changing the clothes at the end of 
 the walk, this fear is mostly unfounded, provided 
 the rain is not combined with strong cold winds. 
 Almost all otherwise healthy persons become 
 easily accustomed to every state of weather, and 
 the tendency to rheumatism and catarrh from 
 chills is either totally overcome by it, or at all 
 events very much diminished. This rule holds 
 good for children and aged persons as well 
 as for the age of manhood. When I asked, 
 through a mutual friend, Moltke, the great 
 general, by what means he had maintained his 
 health and activity, he answered : " By great 
 
Days of Extra Exercise 39 
 
 moderation in all things ; by regular outdoor 
 exercise in all weathers, good and bad ; never a 
 whole day at home." He was in his ninetieth 
 year at that time. This rule, however, is not 
 applicable to those whose resisting power is 
 already much weakened either by disease or by 
 old age, and to those who have a strong 
 tendency to bronchial attacks. They, or at all 
 events many of them, ought not to expose 
 themselves to the fogs or strong, cold winds of 
 our English winters and springs, but should 
 either stay at home on the more inclement days 
 and take indoor gymnastic and extra breathing 
 exercises, or, if they can afford it, spend those 
 seasons in warmer and sunnier climates, or at 
 one of the sheltered localities of the southern 
 or south-western sea coasts of England or 
 Ireland. These localities ought to be provided 
 with numerous divided open shelters where 
 invalids can sit for hours in the open air with- 
 out being exposed to cold winds and rain. 
 
 DAYS OF PROLONGED EXERCISE. 
 
 It is of great use for those who are still in 
 fair vigour to take regularly, once a week, a 
 day of more prolonged exercise, up to three, four 
 and six hours ; and those who live in town 
 
40 The Prolongation of Life 
 
 ought to spend this day of extra exercise in the 
 country, if possible, on account of the purer air 
 and the change of scene. The benefit of such 
 a long walk is increased if only a very small 
 quantity of food and fluid is taken during the 
 walk, for instance, a sandwich or a few plain 
 biscuits, and an apple or an orange. This is, 
 indeed, an important matter, for if much food, 
 and perhaps also fluid, especially alcoholic, is 
 taken during the long walk, part of its good 
 effect is lost ; and if, by increasing the appetite, 
 it leads to the consumption of too much food 
 during the following days, the benefit is likewise 
 diminished. One of the visible effects of such 
 a walk, combined with a very restricted taking 
 in, is that the body loses mostly between two 
 and seven pounds during the walk. The 
 amount of loss varies according to the condi- 
 tion of the walker, the duration of the walk, 
 and other circumstances ; as a rule, not with- 
 out exceptions, large persons lose more than 
 small ones ; fat persons more than lean ; those 
 who are unaccustomed to long walks lose 
 more than those who habitually take them ; 
 those who drink much before starting more 
 than those who have taken only a small amount 
 of fluid. A fast walk connected with some 
 
Over-rest more Frequent than Over-exercise 41 
 
 climbing leads to a greater loss than a walk at 
 a slow pace and on level ground. The amount 
 of, or the absence of, sunshine, the temperature, 
 the relative humidity of the air, the presence or 
 absence of wind, and other agencies, exercise con- 
 siderable influence on the amount of the loss of 
 weight. This loss consists almost entirely of in- 
 creased secretion of water through the skin, the 
 lungs and the kidneys, but with the water some 
 salts and excretory substances are removed. By 
 the simultaneously increased removal of fluid and 
 diminution of supply of solid food and of fluids 
 more used-up material is withdrawn, and the 
 somewhat thirsty blood and starved tissues are 
 enabled to take up more new material. The 
 weight lost on the long walk is usually regained 
 within two or three days. The increased removal 
 of waste products is one of the most beneficial 
 influences of such a weekly long walk. 
 
 Many persons, including some medical men, 
 are of opinion that it is injurious to take much 
 active exercise, especially in advancing years, 
 that the body is sooner worn out by it than by 
 rest or very restricted exertion. A friend of 
 mine, who was known by many of you, the late 
 Mr. George Pollock, often told me this, and 
 tried to dissuade me from my long walks, as he 
 
42 The Prolongation of Life 
 
 believed that they would "wear me out " sooner 
 than rest. He did not succeed in dissuading 
 me, as I am sure that this " 'wearing out " 
 theory of the organs by making them work is 
 wrong. The animal body is not a machine 
 made of dead substance like wood or leather, 
 but is made of living organs and tissues which 
 by action are not worn out, but nourished and 
 maintained in working order, provided always 
 that the exercise is not over-exercise. Many 
 more people wear out too soon from over-rest 
 than from over-exercise ; and this is true, not 
 only with regard to the muscular, but also with 
 regard to the circulatory system and the brain. 
 It is true that work causes wear of tissue, but 
 the wear is compensated by increased supply and 
 increased power to assimilate this supply and 
 to remove the waste material. Dr. Martin 
 Luther's motto, "Rast ich^ so rost ich " (If I rest, 
 I rust), is perfectly true. Old persons accus- 
 tomed to much exercise may go on taking it 
 as long and as much as agrees 'with them^ and need 
 not think of the number of their years ; but they 
 must keep up the habit if they wish to keep up 
 their power, for if they leave off walking for 
 some weeks or months, it frequently happens 
 that they cannot resume it without injuring them- 
 
Beneficial Effect of Open-air Life 43 
 
 selves, unless they do so with great judgment and 
 very gradually (comp. pp. 35, 36 and 38). In 
 this respect there is a great difference between 
 the old and the young. Young people who have 
 been prevented taking active exercise by one 
 cause or another, can easily resume it and grad- 
 ually increase the amount ; but in old persons 
 the muscular fibre, the involuntary as well as 
 the voluntary, has a great tendency to become 
 atrophied, unless it is kept in action, since the 
 small nutritive vessels and the small lymphatics 
 become atrophied by want of action. 
 
 Another advantage of several hours exercise 
 in the country is the exposure to the open air, 
 which is scarcely to be overrated ; it strengthens 
 the skin and the nervous system, and through 
 this the digestive system and the whole 
 organism ; it cheers the mind ; it increases the 
 resisting power to meteorological influences, and 
 diminishes the liability to chills and other 
 morbid microbic affections, and this resisting 
 power is one of the great factors of longevity. 
 Life in the open air, by itself, even without 
 exercise, increases the resisting power, and ought 
 therefore to be arranged for delicate persons 
 who are unable to take much active exercise ; 
 it may be done by driving in open carriages or 
 
44 The Prolongation of Life 
 
 in bath chairs, by lying in hammocks, or by 
 sitting and lying in open verandahs, or in open 
 shelters^ such as now fortunately are being 
 multiplied at most of the seaside resorts, and 
 ought also to be abundantly supplied at all inland 
 health resorts and in private gardens and parks. 
 It is not for tuberculosis alone that open-air 
 treatment is useful, preventive as well as cura- 
 tive, but also for almost all other chronic devia- 
 tions of health and tendencies to disease, such 
 as affections of the blood, of the nervous and 
 digestive systems, chronic rheumatism and gout. 
 Prolonged daily exposure to the open air exercises 
 also a most beneficial influence in the bringing 
 up of children. 
 
 People to whom the so-called "walking with- 
 out an object v is tedious must endeavour to 
 find an object ; I have often, for instance, suc- 
 ceeded in inducing people to take regular walks, 
 by suggesting to them to keep dogs, and, in 
 consequence, they walked for the sake of their 
 dogs. When the dog scheme is impracticable, 
 I often succeed, though sometimes only with 
 difficulty, by explaining the ways by which 
 open-air exercise and open-air life influence the 
 health of the body. When persons understand 
 this, their knowledge stimulates their will, and 
 
Walking or Climbing Tours 45 
 
 the will overcomes the dislike, and increases 
 their power, and gradually the feeling of im- 
 proved health leads to actual enjoyment of that 
 which had formerly been tedious to them. 
 
 Walking or Climbing 'Tours. -Still more bene- 
 ficial than the once a week extra exercise 
 is the plan of taking once or twice a year a 
 walking or climbing tour of three to four weeks 
 or longer^ in mountainous districts, especially 
 in the neighbourhood of and on glaciers, with 
 three to six hours active walking, or climbing 
 on most days of the week, provided that the 
 organs of the body are free from disease, 
 and that they be gradually accustomed to the 
 increased work. The amount of benefit to be 
 obtained from such tours, if judiciously arranged, 
 can scarcely be exaggerated. They exercise an 
 actually rejuvenescing influence in which every 
 organ of the body shares more or less, from the 
 brain to the skin and hair. The power for 
 mental work is increased, the view of life's 
 duties and worries and hardships is corrected, and 
 often I have observed that the hair of the head 
 
 1 " On the Hygienic and Therapeutic Aspects of Climb- 
 ing," by Hermann Weber, M.D., Lancet, October 28 
 1893. 
 
46 The Prolongation of Life 
 
 and beard, when commencing to turn grey, has 
 resumed, after good courses of climbing, more 
 or less of the original colour. The action of 
 the heart is likewise in all persons tangibly 
 improved, in some to an astonishing degree. 
 Again and again I have witnessed in many 
 others and in myself, that while before the climb- 
 ing tour a slight exertion in walking caused 
 the pulse to rise from 60 or 65 to 1 10 and 130 
 and more, the same or even a much greater 
 exertion produced, after the climbing tour, only 
 a rise to 80 or 85. The pulse tracings by the 
 sphygmograph are equally significant. Insepar- 
 able from the strengthening of the heart is that 
 of the blood-vessels, especially the arterioles, the 
 capillaries and lymph vessels on which depends 
 the improvement of the nutrition of all the 
 tissues and organs of the body. The removal 
 of waste products to which I have already 
 alluded as an important effect of all forms of 
 exercises, is most thoroughly accomplished by 
 these walking and climbing tours. Dr. Austin 
 in his interesting paper, " On Mountain Climb- 
 ing for Professional Men " [6], justly remarks 
 that climbing tours exercise a powerful influence 
 on strengthening the will, the importance of 
 which I shall discuss later on. I must, how- 
 
Respiratory Exercises 47 
 
 ever, lay stress on the condition already men- 
 tioned, that the different organs of the body 
 must be sound if such courses of extra exercise 
 are to be practised. I have repeatedly seen 
 great harm follow them in persons affected with 
 diseases of the heart, the small blood-vessels, the 
 lungs, the liver, kidneys and spleen, in various 
 forms of diabetes, albuminuria, and anasmia. 
 For these, too, open air and exercises are very 
 beneficial, but their use must be carefully 
 arranged according to the individual condition ; 
 over-exertion is always very injurious. The 
 practical rules laid down by the late Professor 
 Oertel, of Munich, for diseased states of the 
 muscular fibres and valves of the heart are most 
 important [88] ; but similar rules and restric- 
 tions are required also for other morbid affections 
 besides those of the heart. 
 
 Respiratory JLxer rises. The remarkable im- 
 provement in the heart's nutrition and action, 
 and in the condition of the blood-vessels effected 
 by climbing tours, is, I think, to a great degree 
 caused by the deep inspirations which are neces- 
 sitated by the act of climbing, especially steady 
 and prolonged climbing. This consideration 
 has led me to pay particular attention to respira- 
 tory exercises^ which since then have been very 
 
48 The Prolongation of Life 
 
 useful to myself and many others, especially 
 persons with weak heart muscles. 
 
 I make no claim of originality for these move- 
 ments. Although I have come to them more 
 than thirty years ago by my own observations 
 and experience, I gladly acknowledge that I 
 have been forestalled in their publication by 
 others, and especially by Dr. Harry Campbell's 
 excellent work on " Respiratory Exercises in 
 the Treatment of Disease" [19]. As in walk- 
 ing and other bodily exercises, the amount and 
 modus of respiratory movements which are use- 
 ful greatly vary with the individual condition, 
 and must be adapted to the latter. It is often 
 injurious in cases of weakness of the heart or 
 lungs, or the sequelae of pneumonia or pleurisy, 
 or other acute disease, especially rheumatic 
 fever and influenza, to begin at once with- forced 
 respiratory movements. I have mostly com- 
 menced, even in healthy persons, with moder- 
 ately deep inspirations and expirations continued 
 during three to five minutes, once or twice a 
 day, and have gradually increased the exercises 
 to ten minutes or a quarter of an hour. The 
 depth of each inspiration and expiration, and 
 the duration of holding the breath, are likewise 
 to be only gradually increased. At the begin- 
 
Respiratory Exercises 49 
 
 ning an eighth, a sixth, or a quarter of a minute 
 for every inspiration and every expiration ought 
 to be sufficient ; if this is well borne, each act 
 may be gradually prolonged in duration, so that 
 in the majority of cases each inspiration and each 
 expiration may be brought up to a minute and 
 more, although in the majority of cases half a 
 minute is quite enough for each act. I usually 
 advise to inspire in the erect position with raised 
 arms and closed mouth, and to bend down the 
 body during expiration so that the fingers touch 
 the ground or the toes. The expiration may be 
 made quite well with open mouth, if preferred, 
 but for the inspiration the breathing through 
 the nose with the mouth shut has advantages, 
 such as warming the air and removing palpable 
 impurities by the passage through the nasal 
 cavities. By degrees one can learn to make 
 several up and down movements or various 
 exercises of the arms, such as bending and 
 stretching, or moving in a circle during every 
 inspiration, and bend and raise the body several 
 times during the expiration. By this alternate 
 bending and raising of the body we gain the 
 additional advantage of strengthening the lumbar 
 muscles, and through this successfully combating 
 the tendency to lumbago. Another useful com- 
 4 
 
50 7^i? Prolongation of Life 
 
 bination with the respiratory exercises is the 
 turning of the body in the erect position round 
 the axis of the spinal column alternately, with 
 deep inspiration from left to right, and with 
 expiration from right to left, with the arms 
 raised to the horizontal position. By this 
 movement we bring into action, in addition to 
 the lumbar muscles, some of the muscles of the 
 spine which are apt to be only imperfectly used 
 by most persons, especially in advanced years, 
 and the stiffness of the neck and spine and the 
 tendency to stoop, so common in old people, 
 can be to a great degree corrected by such 
 means, if commenced in good time, and prac- 
 tised regularly and thoroughly, although we 
 ought not to be satisfied with this, but ought 
 always to walk and stand in the fully erect 
 position. The swinging of the arms round the 
 shoulder-joint is likewise a useful combination, 
 say the swinging of the right arm with inspira- 
 tion, and of the left with expiration. Other 
 combinations with muscle and joint movements 
 will occur to those who have accustomed them- 
 selves to these respiratory movements ; but the 
 latter ought always to have our principal atten- 
 tion, since to them the beneficial effect on the 
 heart and lungs is mainly due. In addition to 
 
Respiratory Exercises 51 
 
 the influence on the circulation, the respiratory 
 movements keep up the nutrition and efficiency 
 of the lungs themselves, which undergo in old 
 age a kind of atrophy ; the walls of the smallest 
 divisions and air cells become thinner, and a 
 kind of senile emphysema is developed, which 
 by these exercises is to some degree prevented. 
 By improving the nutrition of the lungs we also 
 counteract the tendency to chronic bronchial 
 catarrh and to pneumonia which form frequent 
 causes of death in old age. Another important 
 influence consists in maintaining the elasticity 
 of the chest walls, which are apt to become stiff 
 in old age, and thus to interfere with the free 
 movements of the lungs and the pleura. If for 
 some reason the erect position should be incon- 
 venient, the mere respiratory movements can be 
 made also in the horizontal and sitting positions. 
 I have already alluded to the additional advan- 
 tage of the compression of the abdomen, which 
 is effected by deep expirations, and which ought 
 always to be practised thoroughly ; all the 
 organs contained in the abdominal cavity are 
 compressed, especially the stomach and intes- 
 tines, and the blood is squeezed out of the veins, 
 which yield more easily than the arteries, owing 
 to the flaccidity of their coats. We may further 
 
52 The Prolongation of Life 
 
 point out that the action of the serous mem- 
 branes of the pleura, the pericardium and the 
 peritoneum are also beneficially influenced by 
 the deep respiratory movements, which con- 
 stitute a kind of massage to the lungs, the 
 thoracic walls, pericardium and heart (Sir 
 Lauder Brunton). All the organs of circula- 
 tion, heart, arteries, veins and lymphatics are 
 powerfully influenced by the deep respiratory 
 movements. In trying to explain the effects of 
 these respiratory movements we must not forget 
 the important item of the fluid exchange pro- 
 duced by them between blood and tissues (Oliver) . 
 
 Breathing exercises, and also other gymnastic 
 exercises of a milder kind, are as necessary for 
 women as for men. They ought to be practised 
 by them without stays, as the free movements of 
 the organs of the chest and abdomen are im- 
 peded by them. 
 
 We must, however, not restrict our lung- 
 gymnastics to these few minutes of respiratory 
 exercises ; but we must create the habit of 
 always breathing not superficially but thoroughly, 
 and taking at several other times of each day 
 deep inspirations and expirations, especially while 
 walking. At first we are apt to forget this, but 
 by often reminding ourselves of it, it is not 
 
Respiratory Exercises 53 
 
 difficult to create this habit of deep breathing^ and 
 the advantages of it are very great, in improving 
 the condition of the blood, in strengthening 
 different organs, as explained, and in maintain- 
 ing the resisting power of the organism, and 
 thus preventing disease. 
 
 The benefit effected by these respiratory prac- 
 tices abundantly repays the time spent on them. 
 Very often I have seen that persons who got out 
 of breath by short v/alks and climbs, and for this 
 reason abstained from them, and in consequence 
 suffered in their health and spirits, have become, 
 with the help of these movements, active walkers 
 and climbers, improved in every function of the 
 body, and have outlived by many years their 
 brothers and sisters who had not practised them. 
 The breathing exercises are especially useful to 
 literary workers, statesman, professional men and 
 others who are unable to take one of the usual 
 modes of exercise. The most convenient times 
 for practising them are in the morning before 
 or after the bath, when the body is loosely 
 covered with flannel, and in the evening when 
 dressing for dinner, or before going to bed. I 
 ought to add that these ordinary breathing exer- 
 cises are not suitable for very delicate persons ; 
 they are, for instance, injurious in great dilata- 
 
54 The Prolongation of Life 
 
 tion of the heart, with or without valvular 
 disease ; such affections require much milder 
 movements, and are benefited by them, like 
 those practised at Nauheim ; nor are the more 
 energetic breathing movements suitable in active 
 tuberculosis and in tendency to pulmonary haemor- 
 rhage, and in the early stage of convalescence 
 from severe acute diseases. In more quiescent 
 forms of tuberculosis, or in arrested tuberculosis, 
 however, and in the imperfect expansion of the 
 lungs, resulting from pleuritic effusion, they can 
 be rendered beneficial by practising them judi- 
 ciously. I need scarcely say that by the im- 
 provement which walking and climbing tours 
 and respiratory exercises effect in the nutrition 
 of the tissues, they increase the resistance to 
 diseases, microbic and others, such, for instance, 
 as arterio-sclerosis. 
 
 Other Forms of ILxercise. These respiratory 
 exercises, combined with movements of the 
 limbs and trunk, are different from P. H. Ling's 
 so-called " Swedish gymnastics," but the latter 
 are likewise most useful for the maintenance of 
 health, and they can be adapted with numerous 
 modifications, according to individual conditions, 
 to many persons who are unable or disinclined 
 to take ordinary walking or riding exercises, or 
 
Various kinds of Exercise 55 
 
 who have local defects of movement from disease 
 or want of use. Sandow's well-known systematic 
 exercises, and the so-called Danish exercises, and 
 Streber's gymnastics (Streber's Zimmergymnas- 
 tik), too, have many similar advantages, and also 
 ordinary gymnastics as they are practised, espe- 
 cially in Germany, under the name of " Turnen," 
 although the latter, excellent as they are for the 
 maintenance of health and the muscular develop- 
 ment of the healthy, are rather less suitable to 
 old age than to the earlier periods of life, unless 
 they are specially adapted to the more or less 
 altered conditions of the aged body. The same 
 may be said of military training, which forms one 
 of the most beneficial means of development of 
 nations, physical and mental. All these exer- 
 cises not only increase and maintain the muscular 
 force, but strengthen the whole organism, and 
 its resisting power against disease. 
 
 Cycling has been strongly recommended by 
 some men as a good form of exercise, preferable 
 in many cases to walking ; but I think that 
 the great majority derive much more benefit 
 from walking. In some instances where the 
 dislike to walking is very great, or where there 
 is some defect in the feet or legs by which 
 walking is rendered difficult, cycling is often a 
 
56 The Prolongation of Life 
 
 good substitute. I have, however, seen a num- 
 ber of men, as well as women and children, who 
 -have become ill from over-exertion in cycling. 
 We can understand this, if we consider that the 
 feeling of fatigue in cycling is perceived less 
 than in walking, and that therefore the danger 
 of overstraining is greater in the former than in 
 the latter form of exercise. For the majority 
 of elderly persons, and such as are defective 
 in agility, the tricycle is preferable to the 
 bicycle. 
 
 A most useful form of exercise, which involves 
 a more or less prolonged and regular exercise in 
 the open air, occupying mind and body at the 
 same time, is Golf. Another kind of exercise 
 requiring still more mental attention, more than 
 any other gymnastic exercise or sport, is Fencing. 
 Every movement of the opponent requires to 
 be constantly watched and acted upon instan- 
 taneously. At the same time it promotes the 
 greatest precision and a certain degree of neat- 
 ness of movement, and brings into action almost 
 all the muscles of the body with the least ex- 
 penditure of force. 
 
 tangling is another pursuit to which many of 
 my friends have ascribed their health and happi- 
 ness and long life. Isaac Walton himself, the 
 
Various kinds of Exercise and Sport 57 
 
 father of angling, as we may call him, lived to be 
 90. Long hours in the open air, with constant 
 moderate exercise and meditative contentment 
 of mind, go far to explain this. 
 
 Gardening is likewise a source of health and 
 long life to many persons, rich and comparatively 
 poor. It occupies the mind in an agreeable 
 manner, and ensures a certain amount of exer- 
 cise without over-fatigue, in the open air. 
 
 Another convenient form of exercise, especially 
 useful in gouty people, recommended by Dr. 
 Oliver, is what he calls the static or tension 
 exercises, which consist in the static contraction 
 of all the muscles of the body, while standing, 
 from one to two minutes several times a 
 day. In goutiness the arterial pressure is in- 
 creased and the tissue fluid is prevented from 
 returning to the blood and lodges in the tissue 
 vacuoles. Tension of the muscles diminishes 
 the arterial pressure, and allows the tissue fluid 
 to be absorbed. Dr. Oliver finds that one 
 minute's tension clears up as much as 20 per 
 cent, of lymph. These tension exercises may 
 be practised best an hour before all meals, when 
 Nature itself produces a normal fall in the arterial 
 pressure ; but other times may be substituted, if 
 more convenient. 
 
58 The Prolongation of Life 
 
 While recommending walking and climbing 
 tours, and respiratory exercises, and various 
 forms of gymnastics, I must guard myself against 
 the indictment that I disregard the value of 
 riding on horseback, rowing, cricket, football, 
 tennis, swimming, hunting, shooting, and many 
 other kinds of sport. I, on the contrary, regard 
 them as most useful to a very large number of 
 persons, but I am unable to enter upon them 
 in this short discourse. To all, if properly exer- 
 cised^ may be applied the Arab saying, " The days 
 spent on the chase are not counted in life's 
 course." We might even say that they add to 
 the sum of life. 
 
 VII. DIGESTIVE ORGANS AND FOOD. 
 
 Attention to the digestive system and food is 
 almost as necessary for the promotion of longevity 
 as that to the circulatory and respiratory systems, 
 which are intimately connected with them. 
 
 We usually understand by food organic sub- 
 stances suitable for the maintenance or the increase 
 of the body, and serving as sources of energy 
 necessary for the execution of work and the forma- 
 tion of body heat (von Noorden [85]). The 
 ordinary articles of food consist of proteids, carbo- 
 hydrates, fats, different kinds of organic and in- 
 organic salts and water ; there are, besides, in the 
 food substances other constituents such as extrac- 
 tives, condiments, ethereal oils, which are not 
 
Food Substances 59 
 
 regarded as necessary for the body, and the func- 
 tions of which are not quite clear, but which may 
 act as stimulators of various groups of cells, and may 
 thus influence the metabolism (von Noorden). The 
 proteids, the mineral constituents and v/ater are 
 chiefly concerned in replacing waste, while the carbo- 
 hydrates and fats are the chief energy-yielding sub- 
 stances, in which function they are, however, greatly 
 assisted by the proteids (R. Hutchison [59]). The 
 mineral substances, especially phosphorus, play a 
 much greater role in the nutrition of the cells and 
 the metabolism of the body than is usually assumed. 
 
 We derive our food partly from the animal, 
 partly from the vegetable kingdom. The principal 
 articles of animal food are the different kinds of 
 meat or flesh food, eggs, milk and casein prepara- 
 tions. Under flesh food we may include beef, 
 mutton, lamb, veal, pork, poultry, venison, game, 
 the different kinds of fish, lobsters, crabs, oysters, 
 also snails, &c. Under vegetable food, the different 
 kinds of grain : wheat, rye, oats and barley, rice, 
 maize, millet, &c. ; almonds, nuts, dried beans, peas, 
 lentils, the green vegetables, tubers, fruit and mush- 
 rooms. 
 
 The various kinds of flesh food are characterized 
 by a large proportion of proteids ; they contain 
 about 25 per cent, of solids and 75 per cent, of 
 water ; the solids consist of 75 per cent, of 
 albumen and 25 per cent, of gelatinous matter, 
 extractive matters, fat and mineral substances. 
 The action of the different kinds of flesh food on 
 the body is not quite the same, but the idea enter- 
 tained by many persons that so-called butcher s 
 meat is much more liable to cause morbid changes 
 
60 The Prolongation of Life 
 
 in the metabolism, leading to diseases of the blood- 
 vessels, gout, excess of uric acid, &c., than the 
 so-called white meats and fish is not proved (von 
 Noorden [85]) ; and G. Oliver found the blood- 
 pressure, after the ingestion of white meats, very 
 similar to that after butcher's meats. I must lay 
 some stress on this point, because I have often 
 found that patients suffering from gout, renal 
 troubles, uric acid, stone, eczema, haemorrhoids, 
 &c., thought they might eat large quantities of 
 poultry, game, venison and fish, if they only avoided 
 beef and mutton, an error which had caused great 
 aggravation of their troubles, while the greatest 
 moderation in, or total avoidance of, all flesh foods, 
 and substitution of vegetables, milk, and milk 
 derivatives, led to perceptible improvement or cure. 
 Although the different kinds of flesh food exer- 
 cise a more or less similar influence on the meta- 
 bolism of the body, it does not follow that it is 
 to all persons the same, whether they eat half a 
 pound of beef, or of mutton, or veal, or pork, or 
 chicken, or fish. There are in this respect great differ- 
 ences in different persons, and even in the same 
 person according to the state of health. There is, 
 further, a wide difference in the digestibility of meat 
 according to the age of the animal or the state of 
 its nutrition, or the part of the body from which 
 it is taken, or the way of cooking. Allowing for 
 such differences we may roughly say that tender 
 and well-prepared meat belongs to the easily 
 digestible and most nourishing articles of food. It 
 does not, however, contain all the substances which 
 are necessary for the maintenance of health, and 
 must be supplemented by the addition of others. 
 
Milk 6 1 
 
 Different kinds of fish are differently borne by 
 the same person or by different persons. Whiting, 
 sole, brill, smelts, pike, and the more lean kind of 
 fish are, to the majority of people, more digestible 
 than the richer kinds, such as salmon, mackerel 
 and eel. We may designate the former, if carefully 
 cooked, easily digestible, but not more so than well- 
 selected and well-cooked meat. Fish cannot be 
 regarded as an entire food, still less so than meat. 
 
 Eggs are to the majority of people easily 
 digestible, but some persons cannot bear them, 
 and on a few they really act as a poison. They 
 are very nourishing. Hirschfeld calculated that 
 a hen's egg of medium size is equal to nearly 
 2 ounces of lean meat, and to nearly 9 ounces of 
 good milk. They are more easily digested in the 
 raw, or only slightly boiled, condition. The yolk 
 is more nourishing than the white, it contains less 
 water, more proteids, fat, and mineral matter, in- 
 cluding iron and phosphorus, the white is free 
 from fat. The latter raw, or only slightly boiled, 
 is more easily digested than the yolk. The late 
 Sir J. Y. Simpson, of Edinburgh, the celebrated 
 gynaecologist, was in the habit of restricting some 
 delicate patients for many weeks and months 
 almost entirely to the raw white of eggs, well 
 beaten up and seasoned with a little salt, and 
 did so with great benefit to their health, and I 
 have been able to corroborate his experience on 
 this point. Eggs have, to persons suffering from 
 the uric acid diathesis, the advantage of being 
 almost free from purin bodies. 
 
 Milk is one of the most useful articles of food, 
 I may even say the most perfect food, as it contains 
 
62 The Prolongation of Life 
 
 all the substances required for the building up and 
 the maintenance of the body. The sale of milk 
 ought, therefore, to be under the strictest super- 
 vision of the authorities, including the farm and its 
 inhabitants, the cows, the milk cans, the trans- 
 mission from the farm to the dairy in town, and 
 the supply of the public by the dairy. In addition to 
 all this, however, in the house of the consumer the 
 greatest care should be taken to avoid contamination 
 of the milk by exposure to impure air, or cats, or 
 flies, or by the use of unclean vessels. Metchnikoff 
 [77] directs attention to the very important point, 
 that milk gives rise in the stomach and intestines 
 to the development of the milk bacillus, a friendly 
 bacillus which combats the hostile bacilli found in 
 the intestinal tract, and thus counteracts putre- 
 faction with its injurious consequences (auto-intoxi- 
 cation). This bacillus is also developed outside the 
 stomach when the milk is allowed to stand and 
 become sour. Sour milk is often declared as in- 
 jurious, but this is by no means the case with 
 regard to the majority of people who bear it well. 
 To Sir Thomas E. Fuller, the former Agent- 
 General for Cape Colony, I owe the information 
 that a kind of sour milk forms an essential 
 article of food amongst Kaffirs, and that many 
 Europeans, affected with various chronic illnesses, 
 have lived on it almost entirely for long periods 
 and have ascribed their recovery to its use. 
 The addition of preservatives to the milk, to pre- 
 vent its becoming sour, which has of late become 
 general, is not always judicious, and ought to be 
 allowed only exceptionally and with great discretion. 
 The question of taking milk boiled or unboiled must 
 
Milk Derivatives 63 
 
 be answered principally according to the quality of 
 the milk ; if the milk is obtained from healthy cows, 
 and is otherwise pure, it is to most, though not all, 
 persons more digestible, and also more nourishing, in 
 the unboiled than in the boiled state, but if the purity 
 is uncertain it is more prudent to boil it. The actual 
 boiling ought, however, to be restricted to a few 
 minutes, or even less. For most purposes it is enough 
 to raise the temperature of the milk to about 60 to 
 66 C. (about 140 to 150 F.), and keep it at that 
 temperature for about a quarter of an hour. Strongly 
 boiled milk seems to have caused in some infants fed 
 on it a kind of scurvy. Many excellent articles have 
 been written on the value and digestibility of milk 
 (Pawlow, Metchnikoff, Verhaegen, Hutchison, &c.), 
 Buttermilk is easily digestible ; it is less nourishing 
 than ordinary milk, as it has lost a large por- 
 tion of fat, but it is still a valuable article of 
 food and is not sufficiently appreciated ; it is also 
 more diuretic than the whole milk. Cream con- 
 tains much more fat and much less casein than 
 milk ; it is well borne in moderate quantity by 
 many people, but causes in some a kind of bilious- 
 ness, and it is not so complete a food as ordin- 
 ary unskimmed milk. Skim milk contains more 
 casein and less fat than ordinary milk, and is a 
 cheap and good article of food when supple- 
 mented with carbohydrates, such as potato and 
 bread ; it agrees better with most persons suffering 
 from disease of the kidneys than unskimmed milk 
 or cream. 
 
 Butter, well prepared and fresh, is probably the 
 most easily digestible, and at the same time the 
 most palatable of the fatty substances used as food. 
 
64 The Prolongation of Life 
 
 The amount of real fat in butter varies consider- 
 ably; the average may be regarded as between 75 
 and 82 per cent, the remainder consists of water 
 and a small quantity of casein and milk sugar. 
 When I designate butter as easily digestible, I 
 mean in the raw state, for after having been 
 cooked, especially after having undergone frying, 
 it deranges the digestion of many persons by the 
 development of butyric and other fatty acids, in 
 which it is very rich. In this respect margarine 
 has an advantage over butter, as it contains scarcely 
 any fatty acids, and in consequence of this and the 
 absence of casein, keeps much longer and becomes 
 not so easily rancid. It has not the nice flavour 
 of the finest kind of butter, but it is a very good 
 article of food, especially for cooking, and is much 
 cheaper. The prejudice against margarine is un- 
 founded. 
 
 Cheese, another derivative of milk, varies con- 
 siderably according to the way of making it. There 
 are hard and soft varieties, according to the degree 
 of pressure exercised in removing the whey from 
 the casein. If the greater part of the fat is removed 
 from the milk, and a lean cheese is produced (such 
 as most of the Dutch cheeses are), it agrees much 
 better with persons of weak digestive powers, by 
 being less apt to develop butyric and other fatty 
 acids in the stomach. If all the cream is left, a 
 fatter cheese is produced, such as Cheddar and 
 Gruyere, and still more so if cream is added. 
 Cheese is very nutritious, i Ib. of cheese being 
 equal to about 3 Ibs. of beef, but it requires careful 
 mastication. The softer varieties of cheese, like 
 Brie, Camembert, Limburg, disagree rather fre- 
 
Vegetable Foods 65 
 
 quently, partly because they are mostly swallowed 
 without much mastication, partly from being taken 
 when already too much decomposed. A moderate 
 quantity of cheese, taken as a meal with bread, or 
 milk, or potatoes, is well borne by most persons ; 
 but, if taken at the end of a full meal, it often 
 disagrees, and cannot be recommended. 
 
 Valuable articles of food mainly derived from 
 milk, allied to cheese, and even more nutritive 
 and more digestible, are sanatogen, nutrose, 
 eucasin, and plasmon ; they are proteids of milk, 
 combined with small quantities of alkalies, especially 
 soda and ammonia. One of their merits is, that 
 they contain phosphorus in an organic combination 
 with albumin which is readily absorbed and enters 
 into the nutrition and metabolism of the cells of 
 the body, as shown by the experiments of Bed- 
 does and others with sanatogen (casein-sodium 
 glycerophosphate). 
 
 Much greater is the difference in the various 
 kinds of vegetable foods, as well with regard to their 
 chemical composition and nutritive value as with 
 regard to other influences on the organism. On 
 the whole, they are less rich in proteids, but are 
 the principal furnishers of carbohydrates, promin- 
 ently in the shape of starch, dextrin and sugar. 
 The majority of the vegetable foods, excepting the 
 nuts, almonds, and oil-bearing substances, contain 
 less fat than the animal substances. Another 
 characteristic constituent of vegetables is the cellu- 
 lose by which most of the carbohydrates are sur- 
 rounded, and which necessitates the dissolving 
 power of cooking, and the digestive processes to 
 effect the transformation of the carbohydrates into 
 5 
 
66 The Prolongation of Life 
 
 absorbable substances. Many of the vegetable 
 foods, especially fruit and green vegetables, are 
 further characterized by various vegetable acids, 
 and amongst the saline constituents by a larger 
 proportion of potash salts, which are of importance 
 in the metabolism of the body. 
 
 The most important group of the different veget- 
 able foods is formed by the cereals, the principal 
 representatives of which are wheat, rye, oats and 
 barley. They contain proteids and carbohydrates, 
 some fat, cellulose and mineral matters, in fact, all 
 the constituents of the human body. Wheat and 
 rye are of the greatest interest to us, as bread, our 
 staple article of food, is prepared from them. In 
 England, almost only wheat flour is used, while in 
 Germany, rye bread (black or grey bread) was in 
 former years eaten by the greater portion of the 
 population, wheat bread (white bread) only by the 
 richer classes, but gradually the use of white bread 
 has there, too, become more general. Rye bread 
 contains a much larger amount of cellulose, and, 
 owing to this, a larger proportion passes through 
 the bowels, unabsorbed, than of fine white bread, 
 it is, therefore, weight to weight, less nourishing 
 than white bread. On the other hand, rye bread 
 does not become dry so quickly as white bread, 
 and keeps longer fresh, which is an advantage in 
 some rural districts, where bread is, or used to be, 
 baked only once or twice a week. 
 
 There are a great many kinds of bread, differing 
 according to the fineness of the flour and the 
 manner of preparation, and the removal of parts 
 of the corn or the addition of other substances. 
 We cannot enter into a description of the different 
 
Cereals and Bread 67 
 
 kinds, but must say a few words about so-called 
 brown bread, known in Germany and France as 
 "Graham bread," from the fact that the celebrated 
 chemist, Professor Graham (afterwards Master of 
 the Mint) was the first who, in a scientific way, 
 brought the advantages of using, in the preparation 
 of bread, all the constituents of the wheat the bran 
 and adjacent parts rich in salts, as well as the fine 
 flour of the centre of the corn, before the public. 
 As Liebig devoted a special article, in his chemical 
 letters, to Graham's plan, the term " Graham Bread " 
 was adopted on the Continent. Not all kinds of 
 brown bread, however, are the same. The majority 
 of bakers mix a certain varying amount of bran with 
 white flour, while Graham wanted all the constituents 
 of the whole corn " whole-meal bread." The corn 
 may be so thoroughly ground that the flour is com- 
 paratively fine to suit certain delicate conditions 
 of the intestines, or only roughly ground, making 
 a coarser bread more useful to many persons. 
 
 The late Sir Henry Thompson [122] has given 
 a good prescription from which, for instance, 
 Spiking and Stewart make a very useful bread 
 (Thompson's whole-meal bread). This kind of 
 bread is nutritious, easily digestible to most people, 
 and helpful in assisting the action of the bowels. 
 Some persons, however, with an irritable mucous 
 membrane, or with a suspicion of ulceration in the 
 stomach or intestines, ought to use a bread pre- 
 pared from a much more finely ground corn, or 
 from flour deprived of the bran. A rather larger 
 proportion of brown bread passes off with the faecal 
 matter than of white bread, owing to the great 
 amount of cellulose contained in the bran, the 
 
68 The Prolongation of Life 
 
 faeces are usually rather more bulky, and a smaller 
 proportion is absorbed, compared with white bread. 
 Considering the advantages and disadvantages of 
 white and brown breads, the advantages of the 
 latter (Graham's and Thompson's bread) greatly 
 predominate for the majority of people, though 
 not for all. 
 
 Bread, although an excellent article of food, is 
 not quite as perfect as milk, but combined with the 
 latter, it is sufficient for the nutrition of the human 
 body. It is easy of digestion, if not taken too fresh, 
 and if thoroughly masticated. Biscuits, rusks, and 
 toast are still more so, partly because by their dry- 
 ness and friability more perfect mastication and 
 admixture of saliva are necessitated, partly also 
 because they are already digested to some degree 
 by the processes of preparation. Comparing 
 equal weights of toast and biscuits with ordinary 
 bread, the former contain more nourishment, since 
 they consist of more solid substance and less 
 water. 1 
 
 Oats are very nourishing if well ground or rolled. 
 They cannot be used, owing to the absence of 
 gluten, for making bread ; but the different pre- 
 parations in commerce, such as oatmeal, Quaker 
 Oats, Waverley Oats, &c., yield excellent porridge 
 and similar dishes, which when combined with milk 
 
 1 "There are several other preparations of wheat in use 
 which possess advantages with regard to digestibility and 
 nutritive power. The best known are macaroni, semo- 
 lina, shredded wheat, florador, granola, and Allenburys' 
 foods. 
 
Pulses 69 
 
 and its derivates, offer all that is required for 
 perfect nutrition. 
 
 Barley forms likewise a most useful article of 
 food, though it contains rather less proteid than 
 wheat. It is not quite suitable for making bread, 
 as it is poor in gluten ; but by the addition of wheat 
 flour it yields a satisfactory bread. 
 
 Different from the cereals just mentioned 
 is maize, which contains less proteid, but more 
 fat and carbohydrates. It cannot be used for bread 
 from its want of gluten, but it is easily digestible, 
 and has much nutritive value. The numerous 
 preparations in use, maizena, cornflour, oswego, 
 &c., form excellent puddings. I have often come 
 in contact with natives of Upper Italy in the Swiss 
 and Italian Alps, who for three or four months 
 every year lived entirely on polenta, milk and 
 cheese, performing much active work and enjoying 
 perfect health. The addition of milk and cheese 
 supplements the small proportion of proteid con- 
 tained in maize. 
 
 Rice contains still less proteid than maize, and 
 very little fat, but it is richer in starch. If well 
 boiled it is easily digested and almost entirely 
 absorbed. Tapioca and arrowroot and salep from 
 the roots of some plants, and sago from the sago 
 palm, may be regarded as forms of starch. 
 
 Another important class of vegetable seeds, 
 comprised under the term of pulses, is represented 
 in our dietary by lentils, peas and beans. There 
 are some differences between them, but they have 
 in common a large amount of a variety of proteid 
 named legumin, or vegetable casein ; they have 
 a smaller proportion of carbohydrates than the 
 
70 The Prolongation of Life 
 
 cereals, and are poor in fat. They are very 
 nourishing, but require a strong digestion. Owing 
 to their containing much sulphur they are apt to 
 give rise to flatulency. They ought to be taken 
 only as part of the food, i.e., together with other 
 kinds of food, such as green vegetables, fruit, 
 milk, bacon, &c., and only sparingly by persons of 
 sedentary habits and gouty disposition, since they 
 are comparatively rich in purin. 
 
 In the south of Europe chestnuts form a valu- 
 able article of food. They are rich in carbo- 
 hydrates and possess a fair proportion of proteids. 
 Well cooked, they are easy of digestion to most 
 healthy people, but people with delicate digestion 
 ought to avoid them. 
 
 I abstain from discussing the value of almonds, nuts, 
 fungi, olives, &c., since their use is rather limited. 
 
 Green vegetables are rich in water and in cellulose, 
 but poor in nitrogenous matter, in carbohydrates 
 and fat, and they contain a relatively large quan- 
 tity of mineral matter, such as potash and lime, 
 and combinations of phosphorus. By cooking they 
 lose a great part of their solid matter, and take up 
 water, so that some cooked vegetables contain only 
 i per cent, of solid matter and 99 per cent, of water. 
 They are not easily digestible for the majority of 
 persons with weak stomachs ; but much depends 
 on the process of cooking and their being fresh or 
 stale ; vegetables fresh from the garden are much 
 more easily digestible than stale ones. The dif- 
 ferent forms of cabbage, brussels sprouts, cauli- 
 flower, belong to the more nourishing kinds of 
 green vegetable, but cause in many persons flatu- 
 lency, while cooked lettuce and endive and veget- 
 
Green Vegetables and Potatoes 71 
 
 able marrow are less nourishing but well borne 
 by a larger number of persons. Spinach is, to the 
 majority of persons, the most useful vegetable, and 
 similar to it is cichory ; the branches of celery when 
 well cooked and young are likewise good. Green 
 beans require thorough cooking, and not less so 
 young peas ; the latter, when they become older 
 and more mealy, partake somewhat of the character 
 of pulses above-mentioned. Asparagus are fairly 
 well digested by most people, but ought to be taken 
 in only small quantities by gouty persons, since they 
 contain some purin. 
 
 Onions, the favourite vegetable of the inhabitants 
 of southern regions, are apt to cause flatulency in the 
 more northern climates where the habits of people 
 are different, and ought to be avoided by persons 
 with delicate digestion or taken only sparingly. 
 
 Vegetables with much oxalic acid, like rhubarb, 
 can likewise not be recommended to the majority 
 of persons, partly on account of the oxalic acid 
 they contain, partly, as in the case of rhubarb, on 
 account of the large quantity of sugar which is 
 generally added to it. 
 
 The nourishing value of green vegetables is small 
 compared with meat, cereals and pulses, but they 
 are useful by their saline constituents, especially 
 potash salts, which help to keep the blood alkaline 
 and render the urine less acid ; they are therefore 
 specially adapted to persons with tendency to gout, 
 stone, and some skin affections. Owing to the 
 large amount of cellulose contained in green veget- 
 ables only a small portion is absorbed, while a 
 larger portion passes off with the faecal matters, 
 giving them bulk, and stimulating the intestines, 
 
72 The Prolongation of Life 
 
 and thus, to some degree, counteracting consti- 
 pation. It must, however, be remarked that 
 in persons who endeavour to restrict themselves 
 almost entirely to green vegetables, the bulk re- 
 quired is so large, that it leads to great distension 
 of the stomach and intestines, which can only be 
 avoided by substituting for a portion of green 
 vegetables, cereals and pulses, milk, cheese, eggs, 
 or small quantities of flesh food. 
 
 Amongst the roots and tubers used as food, the 
 most important is the potato, owing to its large 
 amount of starch, combined with a small proportion 
 of nitrogenous substance, some salts and extractive 
 matters. Potatoes form a valuable article of food, 
 when combined with other nutrients, containing 
 more nitrogenous matter and fat, such as milk. 
 They are easily digestible when well prepared, 
 thoroughly cooked and mealy, and when they are 
 well masticated. Boiled or roasted in the skin 
 they retain most of their nourishing material, boiled 
 without the skin they lose a certain amount, 
 especially of their saline ingredients. Passed 
 through a fine sieve in the form of mashed potatoes 
 or thick soups they are mostly well borne ; but 
 fried in thin chips they are indigestible to many 
 persons, and have, besides, lost much of their food 
 value. 
 
 Amongst other roots, turnips, carrots and beet- 
 roots are much used ; they are characterized by a 
 large amount of water, carbohydrates (especially 
 sugar), and salts and a very small proportion of 
 nitrogenous matter. They form to healthy persons 
 a useful admixture to other articles of food, and 
 specially flesh foods. 
 
Fruit 73 
 
 In connection with the vegetables rich in carbo- 
 hydrates we may say a few words about sugar 
 which is the purest carbohydrate food. In moderate 
 quantities of i to 4 oz. a day it is easily 
 digestible to most healthy persons, though it dis- 
 agrees with a minority by causing rapid fermenta- 
 tion. Taken together with other food it is better 
 borne than by itself. In tendency to corpulence 
 and diabetes it is to be avoided. Sugar is called 
 by some authors a muscle food, but this term leads 
 to misunderstanding, as it cannot be actually trans- 
 formed into muscle, but it produces energy and 
 saves the muscle during exertion. I have often 
 found this in myself and my guides in severe 
 climbing ; when unprovided with tea or coffee, and 
 when our strength began to flag, a few lumps of 
 sugar helped us on wonderfully. Large quantities 
 of sugar, however, when taken together with a full 
 amount of animal or mixed food, prevent thorough 
 metabolism of the proteids, and may lead to diseases 
 of metabolism, such as gout, uric acid concretions, 
 diabetes, and indirectly also arterio-sclerosis. 
 
 The different kinds of fruit are mostly charac- 
 terized by a large amount of water (80 to 90 per 
 cent.), a varying quantity of sugar and dextrin 
 (about 4 to 10 per cent.), some vegetable acids, a 
 small quantity of starch (in some fruits only), and 
 a considerable quantity of cellulose. Their digest- 
 ibility varies according to their ripeness and the 
 amount of acid and cellulose. Ripe and tender 
 apples, grapes, raspberries, figs, cherries, plums, 
 apricots and peaches are to most fairly healthy 
 people easily digestible, if taken in small quantities, 
 and when the stomach is not already filled with 
 
74 The Prolongation of Life 
 
 other food, as it often is after dinner. Several fruits, 
 like strawberries, exercise an injurious influence on 
 some people, causing urticaria, eczema, and gouty 
 conditions. Many people suffer from flatulency and 
 diarrhoea after raw fruit, while they are able to bear 
 it cooked. By cooking, however, part of the carbo- 
 hydrates and fruit salts is lost. In apples this is 
 to a great degree avoided by simply baking them 
 in their skins, instead of boiling or stewing them 
 when peeled ; but even in this way they lose some of 
 their aperient action. Although the nutritive value 
 of fruit is small, they are useful by diminishing the 
 acidity of the urine and helping to keep the blood 
 alkaline, like green vegetables. 
 
 It is of great importance with regard to fruit, to 
 avoid the introduction into the body of impurities 
 microbic and other poisons attached to them. With 
 apples, pears, bananas, &c., this can be avoided by 
 peeling them, but with others, such as raspberries, 
 currants, grapes, strawberries, &c., it is difficult to 
 escape some degree of danger, excepting by the 
 greatest thoroughness in washing, and even this does 
 not give perfect safety. The same is the case with 
 green salads and other uncooked green vegetables. 
 
 It is impossible to lay down strict rules of 
 diet, as the rule which is good for one is 
 unnecessary and sometimes injurious to another. 
 Articles of food which cause indigestion in one 
 person, or at a certain period of life, or in a 
 certain condition of a person, as for instance 
 beef, eggs, lobster, strawberries, or mushrooms, 
 
Moderation in Food 75 
 
 are perfectly well borne by another person, or 
 even by the same person under changed con- 
 ditions, even in weak health. One has to study 
 in every case the constitution, the size, height 
 and weight, the age, the degree of activity 
 mental and bodily the individual peculiarities 
 and the influence of habit, and to arrange the 
 quality and quantity of food accordingly. 
 
 One rule, however, we can lay down with 
 perfect safety, viz., that great moderation in 
 the amount of food, and especially of the most 
 nourishing articles (flesh food, cheese and 
 pulses), ought to be practised by everybody, 
 particularly by old people, and that this 
 moderation is a great aid to longevity ; but 
 the term " moderation " must have a different 
 meaning for different persons and conditions, 
 and is to be judged individually. Many 
 people think that they may eat large quan- 
 tities of highly nutritious food if they ab- 
 stain from alcoholic stimulants, but this is 
 a great mistake. In acting on this erroneous 
 view they, or at all events many of them, 
 gradually develop changes in their blood- 
 vessels which may not come to their per- 
 ception at once, but for all that take 
 place, and may later on show themselves as 
 
76 The Prolongation of Life 
 
 gout, dilatation of the heart, arterio-sclerosis, 
 glycosuria, disease of the liver, the kidneys, 
 &c., &c. Professor Baeumler has explained 
 this in his recent contribution on arterio- 
 sclerosis [9]. An unnecessarily large amount 
 of food, especially flesh food, often, by de- 
 veloping disease of the minute blood-vessels, 
 impedes the flow of blood to the tissues, arid 
 causes, in fact, their starvation, while a limited 
 but sufficient amount, which is often errone- 
 ously called "starvation diet," improves arid 
 maintains their nutrition. Superabundance of 
 food leads, in fact, more frequently to starva- 
 tion of tissues than what is often misnamed " star- 
 vation diet," which maintains them in a healthy 
 condition. 
 
 It has been observed by others as well as 
 myself, that amongst great eaters, especially 
 meat - eaters, there are some sufferers from 
 anaemia (probably from alimentary auto-intoxi- 
 cation), and that this anaemia is increased by 
 continued excess of flesh food. In this respect, 
 some experiments on rats by Dr. Chalmers 
 Watson [128] are interesting. Watson found 
 that the bones of young rats fed entirely on 
 meat became soft, and that the bone-marrow 
 became diseased ; as the latter is intimately 
 
Advantages of Great Moderation 77 
 
 connected with the formation of blood, the 
 anaemia of some great meat-eaters may possibly 
 be explained by the result of these experiments, 
 but we cannot yet be sure on this subject. 
 The scientific basis of our knowledge of nutri- 
 tion is, at present, but small, our teaching must 
 still be based to a great degree on empiricism. 
 The experience of all those, however, who have 
 occupied themselves thoroughly with this ques- 
 tion of food and nutrition, shows that safety 
 lies only in moderation. Sir Michael Foster, 
 for instance, says that " there can be little doubt 
 that the ingestion of food and perhaps espe- 
 cially of proteid food in excess of what is, 
 under the best conditions, sufficient for main- 
 tenance and activity, can only be deleterious 
 to the organism, clogging it with waste pro- 
 ducts which may at times be of a directly 
 toxic nature." Sir Henry Thompson was in 
 the habit of saying, with regard to excessive 
 eaters, " they dug their graves with their 
 teeth." I may refer also to the two cases 
 mentioned on p. 89 ff, and the remarks of Sir 
 Lauder Brunton [15], that the ages obtained 
 by old persons maintained in workhouses are 
 often very great. " A workhouse diet," he 
 adds, " may not be very pleasing to the palate, 
 
78 The Prolongation of Life 
 
 but it certainly seems an efficient means of 
 prolonging life, and it might certainly be worth 
 while sometimes for others to adopt it whose 
 circumstances would allow them to indulge in 
 luxury." We may refer also to the remarks 
 of " overfeeding " made by Dr. Hutchison in 
 his work on " Food and Dietetics " [59], p. 53. 
 
 Often it has occurred to me in practice that 
 persons eating largely and constantly suffering 
 from various troubles dyspepsia, headaches, 
 neuralgia, rheumatism, &c. were placed for 
 several months on a very reduced diet, and, in 
 consequence, got rid of all their ailments ; 
 many of them afterwards, when returning to 
 their usual diet, began again to suffer, but 
 recovered almost immediately on reducing their 
 intake. 1 
 
 As a proof of the beneficial influence of great 
 moderation, I may mention the experience that 
 many wealthy persons with very delicate diges- 
 tion from an early age onwards, who could take 
 but very small quantities of food, only one-third 
 
 1 L. Cornaro [26] already remarked, that whenever he 
 was induced by his friends to take more than his usual 
 small allowance, he began to suffer in various ways, and 
 that all his troubles disappeared when he returned to his 
 limited diet. 
 
Great Moderation in Food 79 
 
 or one-fourth part of what the rest of their 
 family, and the majority of people took, and 
 only special kinds of food, such as milk, fari- 
 naceous food, and a few kinds of fruit and 
 vegetables, and eggs, without suffering, usually 
 were free from gout, rheumatism, neuralgia 
 and other complaints, and lived much longer 
 and enjoyed a much healthier old age than 
 the more vigorous companions of their youth, 
 who could and did eat large quantities of food 
 with enjoyment and with seeming impunity. 
 
 Many years ago I observed on myself that 
 the reduction of the amount of food, especially 
 meat and other flesh food, to half the quantity 
 I had been in the habit of taking, enabled 
 me to do a larger amount of work without 
 the feeling of mental fatigue and exhaus- 
 tion, and craving for tea or coffee some 
 hours after a meat lunch. When afterwards 
 patients complained of fits of yawning, sleepi- 
 ness, and inability to do good literary work 
 some hours after a heavy breakfast and lunch, 
 I induced them to substitute light breakfasts 
 and lunches without or with very little flesh 
 food, with the almost constant result of the 
 entire disappearance of the inconveniences 
 formerly felt. Dr. Scaly [i 1 3 A] reports the same 
 
8o The Prolongation of Life 
 
 experience, and mentions besides that his 
 patients enjoyed the less substantial and less 
 voluminous meals much more than the large 
 and more nourishing ones which they had 
 previously considered essential to their health. 
 He also points out the great improvement 
 caused by this plan in the circulation, the 
 nervous and digestive functions. He suggests 
 that much nerve force is used up by the 
 digestion and assimilation of large quantities 
 of flesh food. The nerve force saved by the 
 lighter meals becomes available for other func- 
 tions. I may add that I have almost invariably 
 observed also an improvement in the complexion 
 of persons who had exchanged light meals, with 
 less meat, for the heavy meals which they had 
 considered necessary. 
 
 Most persons accustomed to indulge a large 
 appetite, whether abstainers from alcohol or 
 not, if you tell them that they must reduce the 
 amount of food, must take only little meat and 
 flesh food and alcoholic stimulants, think that 
 you are going to starve them, that it is 
 impossible for them to do their work on 
 reduced allowances. They are mostly con- 
 firmed in this view by their relatives and 
 friends, especially ladies. They ascribe any 
 
Great Moderation in Food 81 
 
 feeling of lassitude, headache, neuralgia, dis- 
 inclination to active work, although this is 
 very common in persons taking too large meals, 
 to the diminution of alcohol and meat, and 
 under this impression discontinue carrying out 
 your suggestions. It is quite true that in some 
 people such reductions, when made too suddenly, 
 have injurious effects, at least temporarily ; but if 
 the reduction is made gradually, the body be- 
 comes easily accustomed to it and the mind too. 
 Some of the inconveniences felt are with some 
 persons due merely to the fear of being lowered. 
 Experience in many hundreds of cases authorizes 
 me to say that gradual reduction, carried out 
 with judgment and perseverance, leads almost 
 always to increase of mental and physical power, 
 cheerfulness, and the prevention of premature old 
 age, and the privations and sufferings connected 
 with it. The majority of Japanese live in perfect 
 health, and perform a large amount of work on 
 so small an amount of food as the majority of 
 Europeans would consider insufficient to main- 
 tain life. Few people know how little food is 
 required to maintain health, especially in ad- 
 vanced age. Professor Chittenden's experiments 
 at the Yale University indisputably show that 
 the amount of food required for the maintenance 
 
 6 
 
82 The Prolongation of Life 
 
 of perfect health and strength is much smaller 
 than had previously been assumed. In Chitten- 
 den's experiments the quantity of meat, and all 
 other flesh food and eggs, was reduced to . a 
 small proportion of the entire intake. Amongst 
 the results arrived at by the " Collective Inves- 
 tigation Committee " we find that only few 
 (5 per cent.) of the persons above 80 years had 
 been large eaters of animal food, and that the 
 majority had eaten only little meat (Humphry, 
 Professor G., "Old Age," Cambridge, 1889, 
 p. 127), and this is the result of my own 
 experience. Sir Henry Thompson has given 
 excellent advice in " Diet in Relation to Age 
 and Activity," and not less so Dr. George 
 Keith in "Plea for a Simpler Life" (1896) 
 and "Fads of an Old Physician >: (1897), 
 and also Dr. Burney Yeo in " Food in Health 
 and Disease " : but their lessons are not acted 
 upon by the majority. As long ago as 1558, 
 L. Cornaro, of Venice, showed by the descrip- 
 tion of his own manner of living, when he 
 was more than 90, in his " Discourses on 
 a Sober and Temperate Life " [26], how, on a 
 very small amount of food and wine, one can 
 maintain perfect health and happiness, and reach 
 a very advanced age. He lived to over 100 
 
Great Moderation in Food 83 
 
 and died without suffering. Addison gave a 
 paragraph on this book in the Spectator, vol iii., 
 No. 195, and Abernethy evidently recognized 
 the practical correctness of Cornaro's precepts, 
 if we may judge from an amusing sketch in the 
 possession of the Medico-Chirurgical Society, 
 to which Dr. Parkes Weber has directed my 
 attention. It represents Abernethy lying on 
 the floor, near a table covered with food and 
 wine, at which two ladies and a gentleman sit ; 
 to them Abernethy delivers a short lecture, 
 from which I will only quote a few words : 
 " You should take my blue pill now and then, 
 fasting. Read Cornaro on Temperance, he 
 lived to nearly the age of Methuselah ! 
 Practise his rules and regimen (if you can), get 
 up before sunrise and get to bed after sunset. 
 Sluice yourself every morning, winter and 
 summer, with cold water. Lie on your back as 
 you see I do, every day after dinner/' Cornaro 
 did not require blue pills, because he ate less 
 than we may suppose Abernethy's patients did. 
 
 Sir William Temple says, in the chapter " Of 
 Health and Long Life," essentials amongst 
 primitive people are : great temperance, open 
 air, easy labour, little care, simplicity of diet, 
 "rather fruits and plants than flesh' [120]. 
 
84 The Prolongation of Life 
 
 During my observations on this subject, ex- 
 tending over more than fifty years, I have been 
 able to enquire into the manner of living and 
 other antecedents of over eighty persons living 
 to between 86 and 100 years. Although most 
 of these persons belonged to the well-to-do 
 classes, and were not obliged to restrict them- 
 selves, there were not more than six amongst 
 them who had more or less habitually indulged 
 themselves by eating or drinking largely ; many, 
 on the contrary, were remarkable for great 
 moderation in both eating and drinking ; some 
 lived almost entirely on vegetables and fruit in 
 large quantities, with the addition of milk, 
 cheese, butter, and occasionally eggs, and only 
 exceptionally took meat, fish and poultry ; the 
 remainder had been judicious and moderate, 
 as well with regard to diet as with regard to 
 their entire manner of living. 
 
 Vegetarians^ strict as well as modified, can 
 attain long life and can perform the same 
 amount of work as meat eaters and mixed food 
 eaters ; but I have not been able to convince 
 myself that in the great majority of fairly 
 healthy people a moderate amount of meat, 
 fish, poultry and game causes any bad effects. 
 At the same time I must again state my 
 
Great Moderation in Flesh Food 85 
 
 conviction, based on ample experience, that 
 most people enjoy better health and live longer 
 with only little meat and flesh food, and the 
 substitution for the reduced meat allowance 
 of a larger quantity of green vegetables, to 
 which milk and milk products, and sometimes 
 eggs, may be added with advantage. It is 
 especially in advanced age and in persons suffer- 
 ing from gout, chronic rheumatism, arterio- 
 sclerosis and diseases of liver and kidneys that 
 meat ought to be taken very sparingly. Not 
 only in graver diseases, but also in some minor 
 complaints, meat, including poultry and also fish, 
 in large and even in moderate quantity is not 
 well borne. There are some people who cannot 
 bear meat, and others on whom fish exercises an 
 injurious influence. I have often succeeded in 
 curing eczema, acne, roughness and scaliness of 
 the skin, and foetor of breath, by total abstinence 
 during months and years from flesh and fish, 
 and the substitution of vegetables, especially 
 green vegetables, milk and cheese with modera- 
 tion, and occasionally eggs. Often this diet 
 led also to great improvement of the com- 
 plexion. Excessive eating, we may remark, 
 occurs also amongst vegetarians, especially those 
 who consume large quantities of pulses, and it 
 
86 The Prolongation of Life 
 
 produces similarly injurious effects as excess in 
 meat eaters. 
 
 Dr. A. Haig [48 and 49] gives judicious 
 instructions about diet, but the very strict rules 
 laid down by him, entirely excluding meat, tea 
 and coffee, although well suited for some, are 
 certainly not necessary for all persons, even not 
 for the majority, and we may add that we have 
 seen a number of persons who, after having 
 conscientiously tried Dr. Haig's restricted diet 
 for many months, considered themselves obliged 
 to return to a moderate addition of flesh food, 
 on account of loss of strength and weight, 
 although possibly, if they had been able to over- 
 come their dislike to milk and its derivate 
 articles of food, they might have better suc- 
 ceeded. To this question, as to so many others, 
 Goethe's words are specially adapted : 
 
 " Eines ziemt sich nicht fiir Alle, 
 Suche Jeder wie er's treibe." 
 
 ("One plan does not suit all, 
 
 Each must try how he fares best.") 
 
 Or better : 
 
 " What is fit for A is not fit for B ; 
 Let everyone to his own course see." 
 
 A very strict adherence to stringent rules 
 
Man not a Carnivorous Animal 87 
 
 of diet is not necessary to every healthy person ; 
 it might even cause a species of hypochon- 
 driasis. A healthy man has arrangements in 
 his body which allow him great latitude in 
 dietetic and hygienic matters, without causing 
 harm. The powers of adaptation and com- 
 pensation are in strong constitutions very great. 
 What is desirable is the acquisition of a 
 habit of living adapted to the individual, which 
 may be acted upon without constantly asking 
 oneself, " Will this do me good or harm ? ' 
 Even persons with very delicate digestion can 
 acquire this habit. 
 
 Many persons assert that the teeth and the 
 digestive tract of man point to his requiring 
 a large share of flesh food in his diet. This 
 is by no means in accordance with fact ; the 
 teeth, jaws and intestines resemble much more 
 those of herbivora than those of carnivora. 
 They are similar to those of monkeys, which 
 thrive better on vegetable than on flesh diet. 
 It is well known that some monkeys, which 
 never have taken any meat possess great strength, 
 for instance, the orang-utan and the gorilla, 
 whose teeth and intestinal organs closely resem- 
 ble those of man. From this alone we might 
 infer that meat is not necessary for strength 
 
88 The Prolongation of Life 
 
 in the human being, and experiment proves 
 the correctness of this inference ; but we see 
 no reason to say more than " not necessary." 
 
 If we examine the longevity of animals we 
 find some herbivora very long lived, like the 
 elephant and the parrot, others short lived, like 
 the hare and the monkey ; some flesh feeders, 
 like the hawk and the eagle, are rather long 
 lived, others, like the fox, short lived. We can 
 therefore draw no inference from this compari- 
 son with man. 
 
 Those who maintain that a large quantity of 
 flesh flood is necessary for average mental and 
 physical vigour are more wrong than those 
 who forbid it entirely. I have had intimate 
 acquaintance with some men and women after 
 the middle of life enjoying good health with 
 a very fair amount of mental and bodily strength 
 and activity, who took only green vegetables, 
 carbohydrates, milk and cheese, all in moderate 
 quantity, and who lived to a happy old age. 
 They were in reality more or less strict vege- 
 tarians belonged, in fact, to the minority of 
 which I have just spoken. They took, how- 
 ever, also a certain quantity, not immoderate, 
 of tea and coffee without any inconvenience. 
 Excess of food, on the other hand, especially 
 
Therapeutic Restriction of Food 89 
 
 of food rich in proteids, causes, as Sir W. H. 
 Allchin justly says [5], often lassitude, want of 
 energy, headache, constipation, skin affections 
 and feebleness of the heart. I have no accurate 
 experience of how little is required to maintain 
 vigorous health. Several physiologists have 
 ascertained this by experiments and calculation. 
 I may refer to Voit, Playfair, and to the more 
 recent researches by Horace Fletcher [40], 
 Chittenden [23], and to the contribution on 
 " Dietetics," by Sir Dyce Duckworth and Dr. 
 Hutchison, in the "System of Medicine " [31]. 
 Fletcher and Chittenden conclusively show that 
 the health and strength of adults can be main- 
 tained by a much smaller amount of food than 
 has been assumed by Voit, Playfair, and other 
 authorities. There are very few adults who 
 take too little food, but children are not rarely 
 underfed, even in the well-to-do classes of 
 society. 
 
 I venture to record here two cases which, 
 although they are not accurate enough for 
 scientific value, give a fair idea of the small 
 quantity of food required for the maintenance 
 of perfect health : 
 
 L. T., aged 61, consulted me first in November, 
 1872, on account of attacks of gout and hsemor- 
 
90 The Prolongation of Life 
 
 rhoids. His father died of apoplexy, aged 66 ; 
 mother of cancer at 68. He was himself a power- 
 ful man, 6ft. i in. in height, weighing 1351. 5 Ib. 
 He was a country gentleman with literary tastes ; 
 took much meat and little exercise and slept about 
 ten hours a day. He suffered from frequent attacks 
 of gout, constipation, haemorrhoids and dyspepsia. 
 
 Advice : Daily breathing exercises, daily walks of 
 two or three hours. Less meat, more green vege- 
 tables, restriction of alcoholic stimulants to i oz. 
 of whisky, 4 oz. of Friedrichshall bitter water three 
 times a week for two months. To sleep not over 
 seven hours. 
 
 In the course of a year the weight diminished 
 by 12 Ib., and he was altogether better; but he 
 had had several attacks of gout. He then left off 
 butcher's meat entirely, .and alcoholic beverages 
 almost so. In May, 1874, he was further improved; 
 but he was not satisfied with the gain, as he felt 
 sometimes heavy, sleepy, unfit for mental work, 
 and we settled on the following diet (for twenty- 
 four hours) : 
 
 4 oz. fish or poultry, 
 
 1 pint milk, 
 
 2 oz. butter, 
 
 8 oz. brown bread, 
 6 oz. potatoes, 
 12 oz. green vegetables, 
 2 or 3 apples, 
 i oz. whisky. 1 
 
 On this diet, to which he kept very strictly, and 
 1 The whisky was left off in August, 1874. 
 
Therapeutic Restriction of Food 91 
 
 which was carefully superintended by his intelligent 
 local doctor, the attacks of gout disappeared entirely, 
 and he kept perfectly well until 1880, when he became 
 mentally depressed by the death of his only brother 
 from apoplexy (aged 67) and a sister from pneu- 
 monia (aged 65). After travelling for some months 
 he regained his cheerfulness and remained well 
 till the autumn of 1890, when chronic bronchitis 
 developed itself. He could not be induced to go 
 to a warmer climate, and died in December, in his 
 eightieth year. 
 
 F. W., aged 49, came under my observation in 
 March, 1871. His family history was not good : 
 father had died, aged 65, from " dropsy " ; mother, 
 aged 61, likewise from " dropsy." Of three brothers, 
 two were gouty, one had died from phthisis. He 
 led an active life in the country fishing, shooting 
 and rowing. He had during the last five years 
 rather frequent attacks of old-fashioned "podagra." 
 He took a large quantity of animal food, and about 
 i pint of port or sherry or champagne daily. 
 Height, 5 ft. 5 in. ; weight, 1 1 st. 5 Ib. ; red face, 
 large stomach a condition which some German 
 physicians call " alimentary plethora." The urine 
 contained traces of albumin and large amounts of 
 uric acid and urates, with medium specific gravity. 
 After a course of treatment at Carlsbad the albu- 
 min disappeared, the stomach became natural, and 
 he felt well ; but later on the attacks of gout 
 returned, and in 1874 he consented to the following 
 plan of diet, which his doctor in the country 
 carefully superintended, weighing the food at 
 intervals. Ration of food for twenty-four hours : 
 
92 The Prolongation of Life 
 
 3 oz. meat, or fish or poultry, 
 
 6 oz. potatoes, 
 1 6 oz. green vegetables, 
 16 oz. milk, 
 
 6 oz. brown bread, 
 
 1 oz. butter, 
 
 2 small cups of weak tea, 
 
 Half a bottle of Zeltinger (Moselle). 
 
 This diet he adhered to with only rare intervals, 
 and whenever he took a larger quantity he began 
 to feel less well. He became free from gout, took 
 regular breathing exercises, much open-air exercise, 
 besides some work in his parish and county. After 
 his seventieth year he further diminished the quan- 
 tity of food and left off wine ; he died at the age 
 of 8 1 in his sleep. Both his brothers died before 
 they were 67, from "gouty complaints," after pro 
 tracted illness. 
 
 In these two men, to which I could add 
 many others, we may assume that their health 
 was much improved and their lives were pro- 
 longed by the change of diet from abundance 
 to great moderation. In neither case was the 
 family history good, and both outlived all their 
 near relations by many years. We also see that 
 much less food is required for maintaining 
 health and vigour than is taken by at least nine 
 persons out of ten. It is very probable that the 
 food taken by these two men might have been 
 
Diminution of Food in Advanced Age 93 
 
 further reduced if it had been necessary ; but 
 as they enjoyed perfect health and strength, 
 there was no necessity for trying an experiment. 
 It is scarcely necessary to add that I do not 
 ascribe the prolongation of life in these cases to 
 the reduction of food alone, but that I attribute 
 also a share to the breathing and other exercises. 
 Almost all authorities are agreed on the sub- 
 ject that in old age the amount of food ought 
 to be very limited; Dr. George Cheyne, for 
 instance, says in one of his rules : " The aged 
 should lessen the quantity and lower the quality 
 of their food gradually as they grow older 
 even before a manifest decay of appetite forces 
 them to it" [22]. Sir Henry Thompson says : 
 " Less nutriment must be taken in proportion 
 as age advances, or rather as activity diminishes, 
 or the individual will suffer " [122]. With 
 advancing years the tendency to arterio-sclerosis 
 and other degenerations of the small blood- 
 vessels frequently shows itself. One of the 
 prominent signs is increased blood-pressure, to 
 which Sir Clifford Allbutt has recently directed 
 attention [i, 2, 3]. This symptom, combined 
 with others, ought to be a warning that the 
 amount of food and alcohol ought to be re- 
 duced, sometimes even restricted to milk and 
 
94 The Prolongation of Life 
 
 vegetables. If the disease is in an advanced 
 state, the benefit can only be limited. Prevention 
 is the great point, and the most powerful means 
 are great moderation, especially in flesh food 
 and food rich in purin, in tobacco and in stimu- 
 lants, and this combined with a certain amount 
 of physical exercise adapted to the physical 
 condition (p. 33 ff.). We must bear in mind that 
 the metabolism in old age is much diminished, 
 and that the cells have only a limited power of 
 assimilating and decomposing nutrient materials 
 (von Noorden, Ebstein, &c.). 
 
 Erroneous ideas are often entertained by the 
 public with regard to the external appearance 
 and the weight of the body. Many old persons 
 are alarmed by their becoming thinner, and to 
 avoid this think they must eat more ; but this 
 is mostly quite wrong. In the majority of 
 cases increase of weight after 70 or 75 is not 
 good, and corpulence where it occurs is to be 
 counteracted by the quantity and quality of 
 the food, exercise and other means. A slow 
 decrease in weight is mostly observed in those 
 who reach a very advanced age. Corpora sice a 
 durant was a true saying already in antiquity. 
 
 Inseparable from food is the common salt 
 (chloride of sodium), which the majority of 
 people consume with many articles of food. 
 
Drinking Water 95 
 
 Almost all foodstuffs contain certain quantities 
 of common salt as well as of other salts (of 
 potassium, calcium, magnesium and iron) which 
 form part of the animal body, and only few 
 articles, especially vegetables, require an addition 
 of salt. The addition of a small quantity is, 
 however, not injurious, and is, to some persons 
 at all events, useful, since it renders some food 
 substances more palatable to them, which is 
 an important point ; but the addition of large 
 quantities of salt, which is a matter of habit 
 with many people, cannot be recommended. It 
 may be quite harmless to some persons, but to 
 some it is injurious, especially to the gouty. In 
 most persons suffering from eczema or a ten- 
 dency to it, this is increased by the use of much 
 salt ; the substitution of chloride of potassium 
 for chloride of sodium is advisable in such cases. 
 Large quantities of salt are said to increase the 
 blood-pressure and to assist, therefore, the de- 
 velopment of arterio-sclerosis. Some observers, 
 however, have lately denied the increase of blood- 
 pressure by salt. The suspicion that the use of 
 common salt may predispose to cancer is entirely 
 without proof. 
 
 The drinking water deserves more considera- 
 tion than it usually receives. Water may be 
 regarded as a nutriment, it forms a large part 
 
g6 The Prolongation of Life 
 
 of the human organism, and a certain quantity 
 is absolutely necessary for the various processes 
 of nutrition, metabolism and excretion. The 
 amount required for an average person under 
 ordinary circumstances is about 4 pints in the 
 twenty-four hours, but a great part of this is 
 not taken in the shape of drinking water, but 
 is contained in the various articles of fluid and 
 solid food, meat, vegetables, milk, tea, coffee, 
 and accessories. We cannot enter upon this 
 subject thoroughly, but may say that the water 
 ought to be almost free from organic matter, 
 and to contain only a small quantity of inorganic 
 matter, say not more than about grain of lime 
 and i grain of common salt, and not much car- 
 bonic acid. The fear that soft water or rain- 
 water, free from impurities, is injurious is quite 
 unfounded ; but hard water, especially when it 
 contains much sulphate of lime, causes in some 
 persons constipation, and in some urinary 
 concretions, possibly also gall-stones. Some 
 authorities think that chalky water may cause 
 calcification of small arteries, but this is not 
 proved. The water arising from granite and 
 gneiss agrees best with most persons. 
 
 The sparkling waters, often called table 
 waters, so much in favour at present, are to 
 
Sparkling Waters 97 
 
 the majority of persons unnecessary. The 
 term table waters in itself points to a kind of 
 misuse, in so far as it indicates that they are 
 to be taken at meals, while much fluid of any 
 kind taken during the principal meals is unad- 
 visable, since it interferes with the digestion ; 
 and sparkling waters, in addition, cause, by 
 development of gas, distension of the stomach, 
 and through this, disturbance of the action of 
 the heart in many persons. They are better 
 borne, and to some persons beneficial, on an 
 empty stomach or between meals. When the 
 ordinary water is pure, it is to the majority 
 preferable to sparkling waters ; but when its 
 purity is doubtful, as is often the case while 
 travelling, natural sparkling waters form a good 
 substitute, although, by taking the ordinary 
 water filtered and boiled the dangers of its 
 impurities are minimized. Filtering alone is 
 mostly unsafe. 
 
 It is not only the quality and quantity of food 
 which we take, but also the manner in which 
 it is taken, on which health depends. Food 
 ought not to be taken when the mind or body 
 is exhausted by overwork ; rest ought to pre- 
 cede the meal under such conditions ; further, 
 if possible, food ought not to be taken while the 
 7 
 
98 The Prolongation of Life 
 
 mind is in a state of anger or violent excite- 
 ment. 
 
 All-important is thorough mastication , a subject 
 constantly preached, but almost as constantly 
 neglected. Many forms of indigestion and of 
 serious disease of the stomach and intestines, 
 many states of imperfect nutrition of the whole 
 body, are caused by imperfect mastication and 
 by what is called bolting the food. Quite lately 
 Dr. Harry Campbell [18], Dr. van Someren, of 
 Venice [126], Mr. Horace Fletcher [40], and 
 others have again directed attention to this 
 matter in a judicious and forcible manner. Sir 
 Lauder Brunton [15] justly points out the possi- 
 bility that imperfect mastication may be a cause 
 of cancer of the stomach through the irritation 
 of the mucous membrane by hard particles of 
 insufficiently masticated food. Combined with 
 the fault of bolting is often that of washing down 
 the food before it is properly masticated, a grave 
 mistake committed frequently by large eaters 
 and by those who take much fluid during the 
 meals, which in itself is a very injurious habit. 
 No food ought to be swallowed before it has 
 been transformed by mastication and admixture 
 of saliva into a thin pap. Many articles of 
 food, especially those containing starch, are 
 imperfectly digested unless they have been 
 
Attention to the Teeth 99 
 
 thoroughly mixed in the mouth with saliva, by 
 which the starch is transformed into dextrin. 
 Even fluid food, such as porridge, gruel, soups, 
 coffee, tea, and chocolate, ought not to be gulped 
 down rapidly, but ought to be taken slowly, so 
 as to allow them to be mixed with saliva. 
 
 Amongst the great benefits of thorough mas- 
 tication is the diminution of the formation of 
 gas in the stomach and intestines (flatulency) 
 and, further, the prevention or great limitation 
 of putrid fermentation of the food in the intes- 
 tines, which latter is connected with the develop- 
 ment of ptomaines and pathogenic microbes. 
 
 Another effect of mastication is that less food 
 is required, because more of the quantity taken 
 in is absorbed, and for the same reason the bulk 
 of fascal matter is diminished, and the evacua- 
 tions may become less frequent without the 
 disadvantages of retention. 
 
 As proper mastication is one of the most 
 powerful and beneficial means of maintaining 
 health, it is self-evident that the organs of 
 mastication, especially the teeth and the jaws, 
 ought to be carefully attended to from early life 
 to old age. Important in this respect is the 
 selection of food for children. Many parents 
 and nurses think it. necessary to give children up 
 
ioo The Prolongation of Life 
 
 to 3 or 4 and even 5 years of age only fluid or 
 semifluid food, such as milk, milk puddings, 
 porridge, bread-crumbs with gravy, minced 
 meats, by which the organs of mastication 
 muscles, jaws with their alveolar processes, and 
 teeth are not sufficiently exercised. Children 
 above 15 or 1 8 months old ought to have in 
 addition to these articles of food dry crusts, 
 dry biscuits, bread not soaked in milk, but 
 eaten separately. We must leave this subject 
 to dentists, but we must insist on the import- 
 ance of instruction on the management of 
 the teeth in children as well as adults, and the 
 use of good artificial teeth after the loss of 
 the natural teeth wherever they can be afforded. 
 This, we hope, will be facilitated by the manu- 
 facture of cheaper artificial teeth. 
 
 It would lead too far to enter here on the 
 cooking of food by roasting, boiling, baking, 
 frying, stewing, and other processes, although 
 this is an important matter. I must, however, 
 allude to one or two points which are frequently 
 ignored. It has been shown by experiments 
 that some kinds of food become by cooking 
 more, others less, digestible. The amylaceous 
 vegetables, such as potatoes, rice, maize, corn, 
 gain in digestibility by cooking, since through 
 
Cooking 101 
 
 it the cellulose coating, in which the starch 
 granules are enclosed, is burst, and the gran- 
 ules thus become exposed to the diges- 
 tive ferment (ptyalin). All the vegetables rich 
 in cellulose are rendered more digestible by the 
 process of cooking. Many, however, lose some 
 of their salts and soluble substances, which pass 
 into the water in which they are boiled. Stew- 
 ing is therefore preferable to ordinary boiling, 
 whenever it is desirable to retain all the consti- 
 tuents of the vegetables. Most animal foods, 
 on the other hand, are somewhat impaired in 
 their nourishing value by cooking, as heat ap- 
 proaching the boiling point coagulates the pro- 
 teids and renders the fibres of meat harder and 
 less digestible. As, however, most people feel 
 great repugnance against raw flesh, and as, 
 besides, raw meat contains sometimes injurious 
 parasites, we must endeavour to use methods of 
 cooking by which the taste of rawness and the 
 danger of parasites are removed, while the fibres 
 retain their tenderness and the flavour is not 
 destroyed. This is attained by exposing meat 
 and poultry only for a few minutes to a tempera- 
 ture of 100 C. (212 F.) or more, and thus 
 produce a kind of crust which prevents the 
 loss of juice from the interior, and then continue 
 
IO2 The Prolongation of Life 
 
 the cooking process at a lower temperature 
 not exceeding 180 F. for a longer period. 
 Altogether the process of long cooking at a 
 low temperature renders the flesh tender and 
 preserves the natural flavour. This object can 
 also be obtained by the process of roasting and 
 also by that of stewing^ which has the great 
 advantage of rendering the fibre very tender 
 and preserving all the salts and other ingre- 
 dients, if the stewed meat is taken together 
 with the juice. The process of ordinary boiling 
 is less to be recommended, because a great por- 
 tion of the salts and extractive matters passes 
 into the water in which the meat is boiled, unless 
 the boiling is done very carefully as just stated. 
 For gouty persons, however, to whom the ex- 
 tractive matters of meat are injurious, tender 
 boiled meat is preferable to roast. 
 
 Salt beef^ which is a favourite article of food 
 with many people, cannot be recommended ; 
 it contains too large a quantity of common salt 
 while it is deprived of most of its original salts 
 important for the organism (potash), and the 
 fibres are less tender than in stewed meat. The 
 frequent occurrence of scurvy amongst sailors on 
 long sea voyages in former years was probably due 
 to the large proportion of salt meat in their diet 
 
Cooking 103 
 
 without the addition of vegetable substances rich 
 in potash and vegetable acids. 
 
 It is necessary to render the food not only 
 as easily digestible but also as palatable as possible, 
 since the act of eating ought not to be a mere 
 duty, but also a source of pleasure. The enjoy- 
 ment of food causes an increased flow of saliva 
 and gastric juices, and thus greatly assists the 
 digestion. Delicate persons with poor appetites 
 and convalescents from acute diseases ought to 
 be indulged with articles of food which they 
 like and which are cooked according to their 
 taste as far as the condition of their digestive 
 organs allows this to be done. 
 
 In urging the necessity of careful preparation 
 and palatableness of food for delicate persons, we 
 must, however, not fall into the other extreme, 
 against which Metchnikoff justly protests : " I 
 shall content myself with saying that most of 
 the delicate dishes provided in the homes, hotels, 
 and restaurants of the rich stimulate the organs 
 of digestion and secretion in a harmful way. 
 It would be true progress to abandon cuisine, 
 and to go back to the simple dishes of our 
 ancestors " [76]. 
 
 For most persons, excepting the strongest, it 
 is desirable that they should avoid exertion of 
 
IO4 The Prolongation of Life 
 
 mind and body before, during, and soon after 
 the principal meals, so that the stomach should 
 receive as well the blood as the nerve power 
 necessary for the digestive processes. 
 
 Quantity of Food. The public often ask for 
 strict rules about the quantity and quality of 
 food. It is, as already mentioned, impossible to 
 give such in a satisfactory way for people in 
 general, since there are great differences in the 
 requirement of different persons according to 
 constitution, age, height, size and weight of 
 body, physical and mental exercise, proportion 
 of muscle to fat and bone, meteorological sur- 
 roundings, climate, season, and other matters. 
 
 It must also be taken into consideration 
 whether the food is taken in a finely divided 
 or in a coarsely divided state. We may, for 
 instance, mention that lentils or dried peas, or 
 barley or rice, when cooked entire are not so 
 thoroughly taken up from the intestines as when 
 finely ground, that a larger portion of the former 
 passes away with the fasces than of the latter. 
 
 Rules can only be good when they are adapted 
 to the individual case under given circumstances. 
 Much has been written about the exact quantity 
 of food required under different circumstances. 
 There is a great difference in the views of 
 
Quantity of Food 105 
 
 Voit and the older authorities and more recent 
 observers (Chittenden, Fletcher, &c.). 
 
 We will, however, mention a rough estima- 
 tion of the daily rations which we have found 
 satisfactory by prolonged observation and experi- 
 ments made fifty-eight years ago on six men 
 in good health, between 22 and 35 years 
 of age, 5 ft. 7 in. to 5 ft. 9 in. in height, 
 weighing between 140 Ib. and 156 Ib. These 
 men did every day mental work between six 
 and eight hours, and walked between 4 to 6 
 English miles. They carried out this way of 
 living during three to six months, with intervals 
 of several days every three or four weeks. They 
 maintained perfect health during the period of 
 experiment, and did not vary more than i to 2 
 kilos, or 2 Ib. to 4 Ib., in weight from the 
 beginning to the end. They were medical 
 students and young doctors at Bonn. 
 
 The rations consisted of about : - 
 
 Milk, 30 oz. 
 
 Cooked meat, 6 to 8 oz. 
 
 Cooked green vegetables and fruit, 16 oz. 
 
 Bread, 16 oz. 
 
 Potatoes, 6 oz. 
 Butter, i to 2 oz. 
 Water, about 50 oz. 
 
ro6 The Prolongation of Life 
 
 The water was consumed partly as pure water, 
 partly as coffee, tea, wine or beer (rather less 
 than a pint of either, not of both). 
 
 In this list eggs, fish, poultry, game and 
 cheese may be substituted for butcher's meat, 
 taking into consideration that i oz. of cheese 
 contains about three times as much nitro- 
 genous substance as the same weight of cooked 
 meat. Lentils, white beans, dry peas, mush- 
 rooms, and even asparagus must only be spar- 
 ingly contained in the allowance of vegetables, 
 since they contain a very much larger amount 
 of proteids and also purin bodies ; none was 
 consumed by the six experimenters. Farina- 
 ceous puddings may take the place of bread 
 or potatoes. 
 
 Further experience has shown me that the 
 rations mentioned are more than sufficient for 
 healthy adults in the middle ages of life, of 
 average weight, doing a moderate amount of 
 physical or mental work. Thus, for instance, I 
 have suggested to many adults, men as well as 
 women, a daily diet consisting of about i| to 
 2 pints of milk, 2 to 4 oz. of meat, or, instead 
 of meat, i to 2 oz. of cheese, 10 to 15 oz. 
 of bread, 10 to 16 oz. of green vegetables, 
 4 oz. of potatoes, or i oz. of rice, 6 to 8 oz. 
 
Food according to Age and Activity 107 
 
 of fruit, I pint to i pint of weak tea, or 
 coffee, or cocoa. Almost all felt perfectly well 
 with this diet, and were able to do much work, 
 mental and physical. Some took as a change 
 instead of tea, or coffee, or occasionally in 
 addition to it, half a pint of light wine or beer. 
 Some, who were too stout, lost at first 5 to 
 10 Ib. and even more, but when they had 
 descended to their normal weight, they scarcely 
 changed afterwards. Others, who were too 
 thin, gained weight and then kept to it. 
 
 There are, however, morbid conditions, such 
 as tuberculosis, in which a larger amount of 
 food is required, especially of milk, butter and 
 meat ; and others suffering from neurasthenia 
 or having an abnormally low blood-pressure 
 ought not to be debarred from roast meats, 
 meat extracts, gravies, &c., which act in them 
 as cardiac stimulants. During the period of 
 growth and development girls as well as boys, 
 occupied with lessons and active games, or 
 other forms of physical exercise, require more 
 food for the same weight than adults. On 
 the other hand, persons approaching the 
 period of old age, say from 45 or 50 to 70 
 years of age, ought to be satisfied with barely 
 three-quarters of the rations mentioned, and 
 
io8 The Prolongation of Life 
 
 after 70 with still less. We can speak, how- 
 ever, only of a rule which allows many ex- 
 ceptions, due either to peculiarities of constitu- 
 tion, or to habit, or to special occupation, or to 
 increased or diminished physical or mental exer- 
 cise. Thus, for instance, soldiers or labourers 
 on fatigue duty or extra work require more 
 than the average ; even old men doing an 
 unusual amount of labour are through this 
 enabled to consume more than those at only 
 ordinary work. On the other side, persons 
 doing comparatively little work require for the 
 same body-weight rather less than the more 
 active ones. 
 
 It is often said that persons doing a large 
 amount of brain-work require a large amount of 
 food and stimulants ; but careful observation 
 does not prove this to be the case. I have 
 known many hard brain-workers who did their 
 work best when they ate and drank very little. 
 Dr. Keith, in his "Plea for a Simpler Life" [64], 
 mentions that Sir Isaac Newton, Napoleon, and 
 Wellington took scarcely any food while they 
 were engaged in great problems. Several of 
 my own friends occupied during long periods 
 in arduous literary work took during such 
 periods much less food than at periods of 
 
Food according to Personal Condition 109 
 
 leisure, since they had found that they worked 
 much better with little than with much food. 
 
 The proportion of the different kinds of 
 food ought to be arranged according to the 
 peculiarities of the body. Persons with a large 
 mass of muscle have a greater waste of nitro- 
 genous matter than persons with small muscles ; 
 the former require a larger amount of nitro- 
 genous food than the latter in order to maintain 
 the equilibrium. The degree of activity of 
 the nervous system has likewise to be taken 
 into account in determining the amount of food 
 required, and still more so the habitual energy 
 of breathing, in which different persons greatly 
 differ. The shape of the body, too, has to be 
 considered, for a long and thin body loses for 
 the same weight more heat than a round and 
 fat one. The amount and nature of clothing 
 exercises likewise influence on the amount of 
 heat lost by the body. In cold climates and 
 cold weather more food is, by most men, re- 
 quired, especially of fat and carbohydrates, than 
 in warm climates and warm weather ; also the 
 manner in which the food is taken influences 
 the amount required. If the food is thoroughly 
 masticated and insalivated, as already said, a 
 lesser amount is required than if the food is 
 swallowed without proper mastication. 
 
no The Prolongation of Life 
 
 The distribution of the food consumed during 
 twenty-four hours can be varied considerably 
 according to constitution, state of health, occu- 
 pation, social custom and personal habits. Some 
 strong persons can take all their food at one 
 meal, others require only two, but the majority 
 feel best with three, and some do not feel well 
 with less than five ; the latter is especially the 
 case during convalescence from acute disease and 
 in neurasthenics and weakly subjects. Every 
 physician, however, who has occupied himself 
 much with derangements of the digestion and 
 assimilation, has met with many cases where 
 the reduction of meals from four or five to two 
 has effected a complete cure without any medi- 
 cine, either only breakfast and dinner or lunch 
 and dinner according to circumstances. Too 
 many meals interfere in some persons with the 
 secretion of the digestive juices and lead occa- 
 sionally to a kind of semi-starvation. For the 
 majority of persons it is best to take the two 
 principal meals without, or with very little, 
 fluid, and to take a tumblerful of water, hot or 
 cold according to circumstances, an hour before 
 or after meals, or only night and morning. 
 Some persons maintain that there ought to 
 be no regular hours for meals, but that food 
 
Alcohol 1 1 1 
 
 ought only to be taken when there is a 
 feeling of hunger. This may be satisfactory 
 for independent people who live alone or need 
 only think of themselves, but those occupied in 
 offices or manufactories, in the Navy or Army, 
 or in schools, or who live in families, must take 
 their meals according to convenience, at more 
 or less fixed times. 
 
 Alcohol. On the much-debated and all- 
 important question of alcohol^ I will try to be 
 as short as possible. It cannot be denied that 
 alcohol causes to many people transitory enjoy- 
 ment, by its taste and local stimulation in the 
 cavity of the mouth, and by its exhilarating 
 effect ; but it is nevertheless true, as Sir Frederick 
 Treves [i 24] says, that it is a poison which ought 
 to be avoided by everybody, excepting in the 
 smallest quantities ; there can be no doubt that 
 total abstinence from alcoholic beverages would 
 greatly promote the health of the human race. 
 Alcohol is not necessary to healthy persons, and 
 most of them would be better without it. 
 Many diseases of the liver, the kidneys, the 
 brain, the blood-vessels (arterio-sclerosis) and 
 other organs are, no doubt, produced by the 
 abuse of alcohol ; many promising lives are 
 destroyed by it ; it is the most frequent cause 
 
ii2 The Prolongation of Life 
 
 of crime and of the ruin, not only of the drinkers 
 themselves, but of their families and their pro- 
 geny. It is, as Lord Brougham said, " the 
 mother of want and the nurse of crime "; it is 
 the greatest of all preventable evils affecting the 
 public health. A large percentage of epileptics, 
 imbeciles, idiots, criminals, persons suffering 
 from weak and early loss of memory and other 
 mental deficiencies, melancholia, &c., is the 
 progeny of intemperate persons. The mind is 
 perverted by it, the love of home and family 
 and the sense of veracity and morality are 
 destroyed. The great and early mortality 
 amongst public-house keepers is well known, 
 and is so general amongst all those who are 
 engaged in the liquor traffic that insurance 
 offices either decline their lives, or take them 
 only exceptionally, and then only at very high 
 premiums. The records of insurance offices 
 further show that the lives of total abstainers 
 are longer than those of non-abstainers. Quite 
 recently Sir T. P. Whitaker [138], in a carefully 
 arranged paper read before the Life Assurance 
 Medical Officers' Association (on January 6, 
 1904), has shown that, other things being 
 equal, " the abstainers from alcoholic beverages 
 have a much lower mortality than the 
 
Alcohol 113 
 
 non-abstainers and the general average lives in- 
 cluding abstainers and non-abstainers/' It is 
 important to notice that in this statement the 
 term " non-abstainers " includes only mode- 
 rate drinkers, for the intemperate are alto- 
 gether excluded from life assurance. Sir T. P. 
 Whitaker is fully entitled to the infer- 
 ence that abstinence from alcoholic beverages 
 is conducive to health and longevity. The 
 tendency to dipsomania, to alcoholism in 
 general, and to all its painful effects on mind 
 and body is distinctly inheritable, and the de- 
 scendants of inebriate parents ought, therefore, 
 entirely to abstain from alcoholic stimulants. 
 Many people assert that alcohol assists the diges- 
 tion ; but this is the case only in exceptional 
 instances, and even in these, better means of 
 cure, dietetic, hygienic, and pharmaceutical, can 
 be substituted, without the danger of acquiring 
 the habit of taking larger instead of the originally 
 recommended small quantities. 
 
 Alcohol is also regarded by some men of 
 science as a valuable article of food, as an econo- 
 miser of albuminous substances, but in truth it 
 possesses this virtue only in a very small degree, 
 and the injurious effects infinitely outweigh this 
 slight and exceptional advantage. Alcohol has 
 
H4 The Prolongation of Life 
 
 further been praised as a producer of warmth ; 
 but its warming effect is only transitory and 
 is followed by the opposite, even by death on 
 long, cold journeys. 
 
 The regular use of alcoholic stimulants by 
 young persons is especially dangerous, and ought 
 to be counteracted at school as well as at home, 
 since it stunts complete development and leads 
 often to the habit of taking in adult life more 
 than is conducive to happiness and a healthy old 
 age, and in not a few to excessive drinking 
 and to all its deleterious effects on mind and 
 morals. 
 
 Alcohol, like other poisons, can be used as 
 a medicine temporarily in various states of ex- 
 haustion ; on this point I cannot fully enter 
 at present, but I must state that it has been 
 greatly abused in the last century, and that even 
 now it is often too indiscriminately and too 
 loosely recommended. Above all things the 
 exact quantity ought to be mentioned, the times 
 when it is to be taken and how long it is to 
 be continued, for otherwise the inclination to 
 take too much and to continue it for many 
 months and years may be fostered and the habit 
 of drinking to excess* may v be created. At the 
 and of exhausting diseases, such as severe enteric 
 
Alcohol 115 
 
 fever, influenza, bronchitis, &c., when the 
 nutrition of the heart has been much impaired, 
 the pulse has become very rapid and weak, 
 small doses of alcoholic stimulants frequently 
 repeated are sometimes necessary and most 
 beneficial, but such cases form the exception, 
 not the rule ; and the allowance of alcoholic 
 stimulants must be withdrawn as soon as the 
 necessity ceases. It may here also be pointed 
 out that the arrangement which still exists in 
 some hospitals, convalescent homes, and sana- 
 toria, to give a certain amount of alcoholic 
 stimulants as part of the daily diet, is repre- 
 hensible, and that the use of alcohol in such 
 institutions ought to be restricted to those for 
 whom it is really necessary. 
 
 It is the habit with some persons of judging 
 the influence of alcoholic stimulants on the 
 constitution merely by the amount of alcohol 
 which they contain. This, however, is not 
 correct. The other constituents of these bever- 
 ages ought likewise to be taken into considera- 
 tion. The fermentation of the malt and sugar 
 by which the alcohol is produced is in many 
 liquids combined with the production of other 
 substances. The so-called " spirits " of which 
 brandy, whisky and gin are the ordinary types, 
 
n6 The Prolongation of Life 
 
 most nearly approach in their influence on the 
 body that of pure diluted alcohol ; but they also 
 contain various by-products of fermentation, 
 and occasionally other additions which produce 
 special effects. They are almost free from 
 acidity and are through this more easily borne 
 by many persons than wines ; but it is important 
 that they should be well seasoned, and recom- 
 mended only with the safeguard, previously 
 mentioned [p. 113]. The different kinds of 
 wine contain, in addition to alcohol, varying 
 quantities of sugar, vegetable acids, ethers, 
 essential oils, extractives, mineral matters, car- 
 bonic acids, &c., on which the effects of wine 
 on the organism depend. It is impossible to 
 enter adequately on this large subject. Alcoholic 
 fluids containing a considerable amount of sugar, 
 dextrin, hop extract, albuminous matter, salts, 
 vegetable acids, and free carbonic acid and other 
 substances, such as the different kinds of beer, 
 have not the same effects on the digestive organs, 
 the nervous system and the organs of circulation 
 as fluids which are more or less pure, more or 
 less diluted solutions of alcohol, such as those 
 just mentioned. Beer, owing partly to the 
 purin bodies which it contains (Walker -Hall 
 [127]), disposes persons who take it regularly 
 
Alcohol 117 
 
 to rheumatic and gouty complaints, and by 
 the saccharine substances to stoutness and the 
 disadvantages and dangers attending it. The 
 difference in the composition of different 
 kinds of beer and in their action on the body 
 is considerable. 
 
 Professor Baeumler [9] further directs atten- 
 tion to the fact that persons consuming large 
 quantities of beer mechanically overtax their 
 blood-vessels by keeping them in a state of dis- 
 tension, which gradually leads to disease of the 
 small arteries and later on also of the heart, the 
 work of which becomes additionally more and 
 more increased by the morbid state of the 
 blood-vessels. My own experience amply 
 corroborates Baeumler 's view. Between 1850 
 and 1870 many young Germans engaged in the 
 sugar-baking trade in the East End of London, 
 came to the German Hospital suffering from 
 various diseases, due partly to the excessive heat 
 to which they were exposed from morning till 
 night, partly and even more commonly so to 
 the almost incredible amount of small beer 
 (eight to twelve gallons per day) which they 
 took to quench their thirst ; dilatation of the 
 heart and hydraemia very frequently occurred, 
 and in one man, scarcely 30 years of age, 
 
ii8 The Prolongation of Life 
 
 extensive atheroma of arteries, especially those 
 of the brain. Ebstein in his excellent treatise 
 on the prolongation of life [33] likewise points 
 out the injuriousness of excessive beer-drinking. 
 
 Sometimes we succeed in combating the 
 alcoholic habit by substituting for the usual 
 alcoholic stimulants non-alcoholic beverages, such 
 as non-alcoholic beer, lemonade, ginger beer, 
 soda water, effervescing mineral waters, non- 
 alcoholic grape juice, other fruit juices and 
 fruit syrups with water. The rough cider, too, 
 though not quite free from alcohol, may be 
 taken by many persons in fair health, in limited 
 quantities, without harm. 
 
 In some men I have been able to diminish 
 the craving for alcoholic stimulants by greatly 
 reducing flesh foods, especially salt foods and 
 salt itself; in others by abstinence from tobacco. 
 Again, in others by inducing them to take no 
 fluid at all at meals, but to wait till an hour after 
 meals, when they were less inclined to drink, 
 sometimes forgot it altogether and gradually 
 lost the habit of regularly taking stimulants. 
 
 A very prevalent idea with regard to alcohol 
 is that it is most useful to aged people, in fact, 
 that " wine is the milk of old people," that it 
 does for them what milk does for children. 
 
Misuse of the Term "Moderation" 119 
 
 This doctrine is not in harmony with careful 
 observation and is dangerous, in so far as it 
 induces some old people to take alcohol in 
 rather large quantities with injurious effects ; 
 almost all old people who have been accustomed 
 in their younger days to much wine, and have 
 taken it without apparent harm, find out for 
 themselves that they cannot any longer take 
 the same quantity without suffering for it. 
 
 Alcohol habitually taken in any large quantity 
 injures, in most persons, the arteries and capil- 
 laries, the brain cells and nerve-fibres. It is 
 well known that alcohol interferes with the 
 cell-growth, especially in the liver, and partly 
 through this, deteriorates the metabolism and 
 the transformation of the purin bodies into urea. 
 It diminishes the resisting power of the organ- 
 ism against chills, microbes and other causes of 
 disease, and this resisting power is one of the 
 great agents in the prolongation of life, and 
 ought to be strengthened in every possible way, 
 not weakened as it is by alcohol. We hear 
 often that alcohol is not injurious if taken only 
 in moderation, but it is the interpretation of this 
 term which is fraught with so much danger. 
 Many persons consider themselves moderate, if 
 they never become drunk ; some take five or 
 
1 20 The Prolongation of Life 
 
 six glasses of sherry or port in the twenty-four 
 hours, or two to three pints of beer, or three or 
 four glasses of brandy or whisky, and consider 
 themselves moderate. This is a very dangerous 
 kind of moderation to the majority of people. 
 An occasional, but rare, inebriation with inter- 
 mediate abstemiousnsss is much less injurious 
 than the regular use of the amount of stimulants 
 just mentioned. Most persons who take more 
 alcohol than is compatible with their health 
 do not feel any disadvantage from it for months 
 and even years, and often not till actual changes 
 in the heart and blood-vessels, or in the nervous 
 system, have been produced. The slow and 
 insidious manner in which the regular drinking of 
 so-called moderate, but in reality immoderate^ quan- 
 tities acts, is one of the causes of the frequency and 
 danger of this error. The fourth part of the 
 quantity mentioned above is what we could call 
 moderation, permissible to the majority of per- 
 sons. It is a common fallacy to think that 
 alcohol by its action on the brain enables the 
 mind to work more quickly, and the body to 
 undergo greater fatigue. Sir Victor Horsley 
 [56] has forcibly shown that there is no 
 foundation whatever for this view, and refers 
 to Professor Kraepelin's scientific experiments, 
 
Alcohol and Neurotic Affections 121 
 
 proving that alcohol even in small quantities 
 interferes with the highest functions of the 
 brain, that it abrogates the controlling power 
 of the brain and cerebellum. The increased 
 action of the brain which is produced in some 
 persons by alcohol is only of very short duration, 
 and is rapidly followed by impaired and deranged 
 action. Another fallacy is that alcohol enables 
 man to undertake a larger amount of physical 
 work. I have repeatedly asked a number of 
 men engaged in physical labour, and from an 
 overwhelming majority of intelligent labourers I 
 have received the answer that they can do more 
 and better work witho.ut than with alcohol. 
 I have received a similar answer from great 
 wrestlers, quite in accordance with Dr. Mehler's 
 researches on this subject [74], and in my long 
 continued intercourse with Alpine climbers, the 
 experience, with scarcely any exception was, 
 that alcohol did not increase, but impaired 
 their power of climbing ; and almost all my 
 companions in the Alps gave up the use of 
 wine and stimulants altogether, excepting in the 
 smallest quantities, and this only after the day's 
 work. I have stated above the quantity which 
 may be considered as moderate, and which has a 
 beneficial action on some old people in certain 
 
122 The Prolongation of Life 
 
 morbid affections, for instance, chronic bron- 
 chitis, as Dr. Savill [109] found in the aged 
 inmates of a workhouse infirmary. Here, again, 
 habit is to be consulted, and old persons accus- 
 tomed for many years to a certain, originally 
 unnecessary, amount of alcohol ought not to be 
 deprived of it all at once, but only by degrees. 
 For a careful consideration of the question of 
 alcohol I refer to the chapter on stimulants in 
 Sir Lauder Brunton's volume on " Disorders of 
 Assimilation," &c. [14]. 
 
 It is well known that alcohol exercises on 
 some persons a much more injurious action than 
 on others. It would lead too far to enter fully 
 into this subject ; but I must allude to its con- 
 nection with neurotic affections, especially 
 epilepsy, dipsomania and neurasthenia. Alcohol 
 is frequently the cause of epilepsy, and it 
 greatly aggravates the disease when it already 
 exists ; it ought to be entirely abstained from 
 by persons affected with, or hereditarily dis- 
 posed to this disease. The same is the case 
 with dipsomania, which is in many cases of 
 epileptic nature. The connection of alcohol 
 with neurasthenia is more complicated ; in the 
 majority of cases of neurasthenia in which I 
 have observed it combined with abuse of 
 
Alcohol and Neurasthenia 123 
 
 alcohol, other injurious influences were present 
 besides alcohol, especially excessive smoking, 
 continued mental worry and mental over-exer- 
 tion, particularly when of an unsuccessful 
 nature. Persons under the influence of worry, 
 or unsuccessful work, often endeavour to re- 
 move their depression by alcoholic stimulants, 
 which for the moment drown the sense of 
 trouble and have an exhilarating effect, but are 
 mostly followed next day by greater depression, 
 the feeling of hopelessness, and diminished power 
 of working. Stimulants ought never to be 
 resorted to under such circumstances ; change 
 of place and temporary cessation of work, if 
 they are possible, and especially open-air exer- 
 cise, are infinitely more promising, while alcohol 
 ought to be entirely, or almost entirely, avoided. 
 Persons with small amounts of albumin in 
 the urine, combined with signs of arterio- 
 sclerosis, can mostly by great restriction in 
 alcohol and meat prolong their lives consider- 
 ably. I have had under my observation many 
 such persons for ten and twenty years and 
 more who enjoyed almost perfect health while 
 they lived entirely on milk, vegetables, bread, 
 light puddings and fruit. The majority of 
 them, however, are disinclined to do so, and 
 
124 The Prolongation of Life 
 
 are inclined to misinterpret the advice of their 
 doctors, if not given precisely, in favour of their 
 own inclinations. It has repeatedly occurred 
 to me, that when I told such persons that 
 great restriction was necessary, they answered 
 that Doctor X. considered such restriction quite 
 unnecessary, that he said they were perfectly 
 safe with only " a few glasses " of wine at lunch 
 and dinner, and a moderate quantity of meat. 
 They felt perfect security after this advice, and 
 took their " few glasses," and died within two 
 or three years, while they might have lived 
 much longer with abstinence from alcohol and 
 great restriction in meat food. Their feeling 
 of " security " always reminded me strongly of 
 the words of Hecate in " Macbeth," which 
 are so often applicable in life : 
 
 " And you all know, security 
 Is mortal's greatest enemy." 
 
 Sir Isambard Owen has given a careful 
 analysis of the results of the Collective In- 
 vestigation Returns, comprising 4,284 persons, 
 and shows that the average duration of life 
 was greatest in the total abstainers and very 
 moderate drinkers, and that only few hard 
 drinkers were amongst the long-lived (British 
 Medical Journal ^ June 23, 1888, p. 1312). 
 
Excessive Tea Drinking 125 
 
 Before leaving the subject of alcohol, it may 
 be useful again to allude to the erroneous idea 
 entertained by many persons when giving up 
 the use of alcohol, that they may eat as much 
 as they like, and may drink at meals as much 
 common water or " table waters " as they desire. 
 This' misconception is, as I have already said, 
 fraught with great danger, leading, as it does, 
 in many cases to obesity, in others to weakness 
 of the heart, to degeneration of the blood-vessels 
 (arterio-sclerosis) , to dropsy, to gout, and in all 
 to premature death ; the effect is much more 
 injurious than the moderate use of alcohol at 
 meals. 
 
 IX. TEA, COFFEE, COCOA. 
 
 Amongst the food accessories, tea is regarded 
 by the majority of people as an agreeable, use- 
 ful and harmless stimulant. When taken in 
 moderate quantity and strength it exercises a 
 pleasant effect on the nervous system, especially 
 in physical or mental fatigue, and is not 
 injurious to the majority ; but in some persons, 
 particularly amongst those affected with dyspep- 
 sia and heart weakness, it produces development 
 of gas and through this distension of the 
 
126 The Prolongation of Life 
 
 stomach and disturbance of the heart and the 
 nervous system. The habit, which exists especi- 
 ally amongst some of the poorer classes, to take 
 three to five meals of strong tea and this generally 
 not infused but boiled, with inadequate food, 
 is no doubt injurious ; it causes deterioration of 
 the digestive organs, imperfect nutrition of the 
 heart, degeneration of the small blood-vessels, 
 anaemia, malnutrition of the whole body, and 
 lowering of the nervous system, as occasionally 
 shown by trembling of the hands and arms, 
 effects which in most persons develop them- 
 selves only slowly. The change which many 
 people have made especially amongst the labour- 
 ing classes, in substituting tea and bread or 
 potatoes for porridge and milk has exercised 
 injurious effects, and must be strongly con- 
 demned. I have repeatedly seen alarming 
 symptoms in the functions of the nervous 
 system and the heart amongst children, pro- 
 duced entirely by the regular use of strong tea, 
 symptoms which disappeared in the course of a 
 few weeks after the removal of strong tea from 
 the diet list, in favour of milk foods. The slow 
 and insidious action of tea renders the abuse 
 more common. The fact that tea, especially 
 strong tea, retards digestion, renders the habit 
 
Tea Less Dangerous than Alcohol 127 
 
 of taking it as part of the principal meals 
 (high teas] to some people rather injurious. 
 When, however, great authorities condemn tea 
 entirely as a poison, and class it together with 
 the eating of large quantities of meat or the 
 immoderate consumption of alcoholic stimulants 
 as a most potent producer of gout and diseases 
 of the heart and blood-vessels, and of the 
 nervous system, we are not prepared to accept 
 their view, provided the consumption of it is 
 moderate and the making of it judicious. It 
 is true that the tea-leaves (Haig [48 and 49] 
 and Hutchison [59]) contain a certain amount 
 of purin (methyl-purin) , but if the quantity of 
 tea consumed during twenty-four hours does not 
 exceed the infusion of 40 to 80 grains, and if it 
 is not allowed to stand long, it can scarcely be 
 regarded as a serious danger, barring a small 
 number of exceptional persons. We have not 
 seen much real gout amongst great tea drinkers 
 if they were at the same time moderate with 
 regard to meat and alcohol. Tea, Sir Wm. 
 Roberts says, is an inhibitor of salivary diges- 
 tion, probably through the tannin contained in 
 it [103]. Black teas agree with most persons 
 better than green teas, and good qualities of 
 Chinese teas better than Indian teas in the same 
 
128 The Prolongation of Life 
 
 quantity. The latter ought to be taken at all 
 events in smaller quantities than the former, or 
 mixed with them in the proportion of one part 
 of Indian to two or three of Chinese. Tea 
 ought not to be boiled, but only infused with 
 boiling water, and the infusion ought not to 
 stand longer than one or two to four minutes, or 
 at the outside, five. Strong tea, especially when 
 taken on an empty stomach, causes irritation of 
 the mucous membrane of the stomach ; but this 
 disadvantage is avoided by the addition of one 
 part of milk to two or three of tea. The habit of 
 taking a cup of tea an hour or two hours before 
 breakfast is beneficial to persons who wake very 
 early, or do some work before breakfast, but the 
 tea ought to be weak and mixed with milk. 
 Taken in this way it sustains the nervous system 
 and aids the removal of waste products ; but a 
 tumbler full of hot water is to many quite as 
 beneficial or even more so, and to vigorous 
 gouty people, cold water is preferable. Those 
 who condemn tea do not seem to consider that 
 many persons who take tea as a stimulant save 
 themselves through this from the abuse of 
 alcoholic stimulants, which is infinitely more 
 injurious than even rather excessive tea drink- 
 ing. We may further add that the Japanese 
 
Coffee 129 
 
 take tea four or five times a day, and certainly 
 are not as much injured by this habit as many 
 Europeans are by alcohol. Finally, we must 
 not forget that the abuse of alcohol deranges 
 the moral condition of the mind and is the most 
 frequent cause of crime, which no one can say 
 of tea drinking, by which at all events only the 
 tea-drinker himself is injured and not others. 
 
 Coffee contains, in addition to caffein, which 
 has the same properties of thein, a volatile oil 
 developed by the process of roasting, some cellu- 
 lose and extractive material (Parkes [96], Koenig 
 [67] and Hutchison [59]). The infusion acts 
 on most people in the same way as tea, but in 
 some cases it causes indigestion and tendency 
 to piles when they take it habitually, while they 
 can take tea without harm. Many, on the 
 other hand, of those in whom tea produces flatu- 
 lence and faintness, bear coffee quite well. 
 Coffee likewise has an inhibitory effect on 
 stomach digestion, and strong black coffee after 
 meals ought therefore to be avoided by dyspep- 
 tics with slow digestion. Parkes had a high 
 opinion of the value of coffee for soldiers under- 
 going fatigue, and in severe Alpine climbing I 
 have found coffee, on others as well as myself, 
 rather more effective than tea, although the 
 9 
 
130 The Prolongation of Life 
 
 latter is likewise very useful. This effect is due 
 principally to the caffein and partly to the 
 volatile oil which stimulate the brain as well as 
 the heart. The relief of fatigue and exhaustion 
 which is produced by coffee and tea is, how- 
 ever, due to some degree at all events, to the 
 vehicle in which they are taken, viz., hot or cold 
 water, with or without milk ; for caffein when 
 taken alone in doses of one or several grains by 
 my companions and myself in long mountain 
 tours had never as strong an effect on us 
 as a good cup of tea or coffee, especially when 
 taken hot. The fact that hot water alone under 
 such circumstances removes much of the sense 
 of fatigue, shows that the fluid has a great share 
 in the action of one or two cups of tea or coffee. 
 It is the fluid part which clears the tissues from 
 the waste products. Kola, had more effect than 
 caffein alone, but not so much as hot coffee 
 or tea. 
 
 This property, however, of enabling persons 
 to bear extra fatigue, which tea shares with 
 coffee, leads occasionally into danger. We have 
 repeatedly observed that under their influence 
 not only physical, but also, and perhaps more 
 frequently, mental over-exertion was persisted 
 in for weeks and months, until it led to exhaus- 
 
Cocoa 1 3 1 
 
 tion of the nervous system, which sometimes 
 lasted through life. Working for scholarships, 
 for instance, and for competitive examinations, 
 has in this way caused sometimes sad failures in 
 life. 
 
 To the use of coffee similar objections are 
 being made as to that of tea, with regard to uric 
 acid and troubles connected with it. It is im- 
 possible for me properly to discuss them here ; 
 but I may say that my line of argument would 
 be about the same as that on tea, and my advice 
 is, likewise, moderation. The habit of German 
 ladies of taking much coffee in the afternoon has 
 often been mentioned as a cause of many of their 
 troubles, though probably the rich and sweet 
 cakes taken with the coffee have something to 
 answer for. 
 
 Cocoa (Hutchison [59]) is different in com- 
 position and action from either tea or coffee, 
 although theobromin is chemically almost 
 identical with thein and caffein. The beans 
 contain a large proportion of fat, in addition to 
 other non-nitrogenous and nitrogenous sub- 
 stances. The cocoa prepared from cocoa shells 
 and nibs is better borne by most persons than 
 that prepared from the finely powdered kernel, 
 which disagrees with some on account of the 
 
132 The Prolongation of Life 
 
 large amount of fat. The ordinary chocolate 
 is mostly mixed with much sugar, which is a 
 disadvantage to some dyspeptics. Cocoa and 
 chocolate are much more articles of food than 
 tea and coffee, and have great sustaining power 
 in fatiguing climbs and other exertions. To 
 many persons the use of cocoa is preferable to 
 that of strong tea and coffee provided they can 
 digest the fat contained in cocoa, or take it 
 prepared from cocoa nibs. As cocoa is mostly 
 taken with much milk, it becomes a real meal. 
 An instructive chapter on tea, coffee and cocoa 
 is contributed to the " Book of Health," by Sir 
 Lauder Brunton, whose views are also given in 
 his " Disorders of Assimilation and Digestion " 
 
 [H]. 
 
 We are often asked whether to give the pre- 
 ference to tea or coffee or cocoa in daily use. 
 It is as impossible to give a general answer, as 
 it is with ordinary articles of food. The per- 
 sonal element must mostly guide us. Where 
 tea produces flatulence, and disorders of the 
 action of the heart, or trembling, or sleepless- 
 ness, it must either be avoided entirely or 
 greatly restricted, and coffee or cocoa may be 
 substituted, whichever agrees best. Many per- 
 sons bear all three equally well, and can suit 
 
Excessive Smoking 133 
 
 their taste or convenience. The rule of modera- 
 tion applies to these food accessories as much 
 as to the ordinary articles of food. There are 
 a few exceptional persons who cannot take 
 either coffee or tea or cocoa, and must be satis- 
 fied at breakfast with milk or porridge or similiar 
 dishes or water. 
 
 X. TOBACCO. 
 
 Tobacco is to many persons a means of enjoy- 
 ment and is well borne by them if they take 
 it with great moderation, for instance, only one 
 medium-sized cigar after dinner or three to four 
 cigarettes or one or two small pipes in the 
 twenty-four hours ; it soothes nervous irrita- 
 bility, and often makes men look more conten- 
 tedly on their work and troubles. Some persons 
 have an unlimited tolerance of tobacco, and seem 
 not to be injured by immoderate smoking. On 
 the other hand, excessive smoking is decidedly 
 injurious to the majority of people by affecting 
 the heart, the small blood-vessels, the digestion, 
 the nervous system, and the throat. In many 
 cases diminution of the amount of smoking, or 
 taking a milder kind of tobacco, remedies the bad 
 effects; in some, however, the use of tobacco has 
 
134 The Prolongation of Life 
 
 to be given up entirely. Smoking with an empty 
 stomach is more injurious than smoking after 
 meals. Boys and girls, before they are grown 
 up, ought not to be permitted to smoke, as 
 it prevents perfect development. There are 
 good observers, amongst them Professor Lazarus, 
 of Berlin, who regard excessive smoking as one 
 of the principal causes of arterio-sclerosis, and 
 when we consider the effect of tobacco on the 
 heart in some people, it appears natural that 
 the smaller blood-vessels are likewise injuriously 
 influenced by it. Sir Lauder Brunton states 
 that Boveri and Rickett produced atheroma in 
 animals by intravascular injections of nicotine. 
 In this connection we may refer also to a 
 paper by Dr. Michels and Dr. Parkes Weber 
 " On Arteritis Obliterans " [79 and 130]. The 
 patients were Russian and Roumanian Jews, 
 between 30 and 40 years of age, who were 
 free from other morbid complications, but 
 had in common : (i) that they smoked every 
 day many cigarettes ; (2) that they had poor 
 food, in quality, and probably insufficient in 
 quantity ; and (3) that they consumed a large 
 quantity of strong tea. It is to the immoderate 
 smoking that I am inclined to attribute the 
 disease of the arteries, though possibly one of 
 
Opium Smoking 135 
 
 the other points, viz., abuse of strong tea, may 
 have produced a predisposition. I may add, 
 however, that tea can probably be excluded, as 
 Professor Israel, of Berlin, has communicated 
 other cases of this disease occurring in Eastern 
 Jews in the prime of life, who lived in Eastern 
 Europe, where tea-drinking is not the custom 
 amongst the poorer classes. 
 
 I scarcely need here mention the smoking of 
 opium^ since it is indulged in only quite excep- 
 tionally in Europe and America. It is generally 
 acknowledged to be a most injurious habit 
 which lowers the smoker physically as well as 
 mentally and morally. 
 
 Snuff is out of fashion at present ; but to 
 some people suffering from chronic catarrh of 
 the nose, with insufficient secretion of mucus, 
 a pinch, taken once or twice a day, is useful 
 by increasing the discharge and rendering the 
 breathing through the nose more easy, and also 
 by maintaining to a certain degree the sense 
 of srnell ; it seems to act by its stimulation as 
 a species of gymnastics on the capillaries of the 
 Schneiderian membrane. Many old doctors 
 maintained that snuff-taking was a good practice 
 against some forms of frontal headache and blear- 
 eyes, and this not without reason. 
 
136 The Prolongation of Life 
 
 XL ACTION OF THE BOWELS. 
 
 An important matter with regard to the 
 digestive system is the action of the bowels. 
 There are great differences in this respect 
 with different persons ; many only feel well 
 if they have one or two evacuations daily, and 
 even more, and they mostly have them with- 
 out being obliged to pay any attention to the 
 nature of their food ; others have a motion 
 only every second and even third day, without 
 suffering in health. On the other hand, there 
 are many persons who have great difficulty in 
 this function ; they go for three and four days 
 and longer ; some do so without feeling incon- 
 venience, but in the majority, in course of time 
 the health is disturbed by this habitual con- 
 stipation, especially by interfering with the 
 portal circulation, by causing piles, and by 
 the absorption of ptomaines; auto-intoxication 
 manifesting itself in many ways, such as head- 
 aches, drowsiness, lassitude, unfitness for mental 
 work, some forms of neurasthenia, and of 
 chronic anaemia. Constipation may also cause 
 organic disease of the intestines ; the irrita- 
 tion which the hard faecal matters exercise 
 on the mucous membrane, especially in the 
 lower region of the bowels, from the beginning 
 
Constipation 137 
 
 of sigmoid flexure to the anus is, in some 
 persons, the probable cause of cancer. A 
 great point is to accustom the bowels to a 
 regular action at a certain time of the day, 
 a habit which ought to be cultivated from 
 childhood ; the morning, if possible, excepting 
 in persons affected with piles, to whom the 
 evacuation of the bowels at bedtime is more 
 useful, since by rest in the recumbent position 
 after the motion the lower part of the bowel 
 returns to its natural position, and the hasmor- 
 rhoidal vessels become relieved. The quantity 
 and quality of food are of great importance to 
 persons with sluggish bowels. A diet consisting 
 in a great part of flesh food, eggs, cheese and 
 farinaceous matter, is in many persons attended 
 with constipation, while the diminution of these 
 substances and the substitution of fruit and green 
 vegetables leads to regularity of the bowels. 
 The reason is that of flesh food, cheese and 
 eggs the greatest part is absorbed in the upper 
 portion of the intestines, and only a small 
 quantity remains for the formation of faeces, 
 insufficient to stimulate the peristaltic action of 
 the bowels ; while green vegetables and fruit 
 having a large proportion of vegetable cellulose, 
 which usually is not absorbed in the intestines, 
 
138 The Prolongation of Life 
 
 lead to a larger quantity of faecal matter, sufficient 
 to promote peristaltic action and regular evacua- 
 tions. With many people, however, this change 
 of diet alone is insufficient to make the bowels 
 act regularly. They require substances which 
 cause a greater amount of local mechanical 
 stimulation, such as is produced by the bran 
 of brown or whole-meal bread, in addition to 
 the fibres of green vegetables and fruit. Sir 
 Lauder Brunton explained this in a practical 
 lecture on constipation some years ago. The 
 best brown bread, in my experience, is the 
 whole-meal bread recommended by Sir Henry 
 Thompson, which is a modification of the 
 ordinary brown bread, or Graham bread ; and 
 for travelling, Spiking's or Hill's whole-meal 
 biscuits may be substituted. The best qualities 
 of Smyrna figs are likewise useful, partly no 
 doubt by the seeds they contain, but partly also 
 by the other portion of the pulp. One or two 
 fair-sized raw apples at breakfast are of great 
 assistance to many persons. Cooked fruit is less 
 active, although it is likewise useful ; a dis- 
 advantage in cooked fruit and compots is the 
 customary addition of much sugar, which ought 
 to be avoided. 
 
 Quite lately Dr. Schmidt [i 1 1] and Dr. Neville 
 
Constipation 139 
 
 Wood [142] have explained the occurrence of 
 constipation in many persons, by the peculiarity 
 of their digesting a great part of the cellulose 
 contained in the food, and through this pro- 
 ducing only a scanty amount of faecal matter. 
 To prevent this they recommend such persons 
 suffering from constipation to take once or twice 
 a day a substance which is not absorbable by the 
 intestines, and forms a coating round the food on 
 its passage through the bowels, thus preventing 
 the absorption of the cellulose and rendering at 
 the same time the faecal matter softer. Such 
 substances are fluid paraffin and agar-agar. 
 Honey regularly used at breakfast, with or 
 without butter, acts on many persons as a gentle 
 aperient, but there are others who cannot bear 
 it, as it causes with them attacks of colicky pains 
 and diarrhoea. 
 
 There are many people who think that it 
 is better to take only the nourishing parts of 
 food, which are in their opinion more digest- 
 ible, and save their digestive organs the labour 
 of extracting them ; they prefer meat extracts 
 to meat, fruit jellies to the whole fruit, the 
 finest flour to the entire wheat meal ; but this 
 is for most persons a great mistake, not only 
 on account of the reason previously given, viz., 
 
140 The Prolongation of Life 
 
 the slight stimulation caused by the vegetable 
 fibres, and other solid parts contained in the 
 coarse meal and bran, but also because the 
 stomach and intestines ought to be kept at work 
 like all other organs of the body, provided they 
 are free from ulceration, catarrhal affection ; or 
 other disease. Furthermore, the entire natural 
 substances are more useful than the extracts ; 
 the entire meat is more nourishing than ordinary 
 extracts of meat, which do not make muscle 
 though they exercise some nourishing action ; 
 the very fine white bread is rather inferior in its 
 nutritious qualities to the wheaten bread made 
 from the entire flour, the whole-meal bread or 
 any good household bread, excepting some 
 persons for whom it is necessary to avoid food 
 containing purin as much as possible, and some 
 others in whom the presence of much cellulose 
 causes the development of gases. For these 
 the finest white bread is preferable, since it is 
 almost free from purin, while the whole-meal 
 bread contains a certain amount of it. 
 
 If the arrangement of food, or the addition 
 of some lubricating matter mentioned, is not 
 sufficient to produce regular action of the 
 bowels, massage of the abdominal organs is in 
 many people a satisfactory measure, and almost 
 
Constipation 1 4 1 
 
 every individual can learn to practise this on 
 himself. Another help, and a very useful one, 
 not only with regard to the motion of the 
 bowels, is the voluntary and systematic con- 
 traction of the muscles of the abdominal wall, 
 the abdominal pressure (TZauch Presse of the 
 Germans). By slowly and thoroughly con- 
 tracting the abdominal muscles from above 
 downward fifty or sixty times, and by keeping 
 them in contraction during full and prolonged 
 expiration, not only the intestines, but also the 
 liver, the bowels, the blood-vessels, and all the 
 organs within the abdominal cavity are com- 
 pressed, the entire abdominal circulation is 
 activated, the blood squeezed out of the veins 
 and moved on towards the heart, which is 
 strengthened by the extra work which it has 
 to perform, as well as the abdominal muscles 
 themselves. A glass of hot or cold water, or 
 of some aerated table water like Seltzer or 
 Apollinaris or Giesshiibler, or a cup of weak 
 tea taken about one or two hours before break- 
 fast, has often the desired effect ; in others a 
 ride on horseback before breakfast, or a brisk 
 walk. A wet bandage round the stomach and 
 loins, worn during the night, is likewise often 
 a successful measure. If by all these aids the 
 
142 The Prolongation of Life 
 
 regular action of the bowels cannot be obtained, 
 and if the health of the individual suffers in 
 consequence, mild aperients become to some 
 persons a necessity, especially to gouty people, 
 as the tendency to imperfect removal of ex- 
 cretory matters is mostly part of their con- 
 stitution, and may lead to various deviations 
 from health, and ultimately shorten life. Many 
 people, however, always take aperients without 
 requiring them, and live in constant fear of 
 constipation a kind of hypochondriasis. They 
 ought to bear in mind what I have already 
 alluded to, that to many persons it is sufficient 
 to have a motion only every other day, and 
 even more rarely. It is further important to 
 consider that the amount and nature of food 
 and the way of taking it exercise great influence 
 on the frequency or rarity and on the abundance 
 or paucity of motions. If a large quantity of 
 food containing much insoluble vegetable fibre 
 is consumed, a greater amount of substance 
 must be evacuated by the bowels ; but if only 
 a moderate amount of food is taken, the greatest 
 part of which can be dissolved and absorbed in 
 the intestines, only a small amount remains for 
 evacuation through the stools, and the motions 
 may be less frequent and less bulky. The way 
 
The Brain and Nervous System 143 
 
 in which the food is taken exercises likewise 
 great influence ; by the process of cooking 
 the fibrous parts of the food are softened, the 
 saliva and gastric juice are allowed to act on 
 it, and absorption is promoted. Equally im- 
 portant and in some respects more so is thorough 
 mastication, by which, combined with the ad- 
 mixture of saliva in the mouth, a much larger 
 amount of nourishing material becomes absorb- 
 able and is absorbed in the intestines, a smaller 
 quantity of the original food substance remains, 
 the evacuations must be diminished in quantity 
 and need not occur every day (Dr. van Someren 
 [126] and Horace Fletcher [40]). 
 
 XII. THE NERVOUS SYSTEM. 
 
 Equally important with the organs of circula- 
 tion and digestion is the nervous system^ which, 
 we may say, governs all the other systems. 
 We must therefore prevent its degeneration as 
 long as possible ; we must nourish it and keep 
 it in action. The state of the blood-vessels 
 and the circulation are again all important. 
 Degeneration of the blood-vessels of the brain, 
 and the impairment of the brain structure and 
 functions consequent on it, form a frequent 
 cause of premature decay and death ; and the 
 
144 The Prolongation of Life 
 
 tendency to this degeneration is in many 
 families hereditary ; but this premature decay 
 is to a great degree preventable by moderation 
 in food and stimulants, by regular physical 
 exercise, and by judiciously arranged mental 
 work and occupation. I have often witnessed 
 this, and in a very striking way, in a family 
 whose male members had for several generations 
 died between 56 and 64 from apoplexy, or 
 paralysis, or other early decay of the brain. 
 Of five brothers in this family who came under 
 my observation when between 25 and 40 years 
 of age, two carried out the advice to lead an 
 active life, mentally and physically, coupled 
 with moderation in everything, and lived to 
 beyond 70 and 73 years, and died not from 
 degeneration of the brain, but from heart affec- 
 tion and pneumonia ; while the three others, 
 with less active and less temperate habits, and 
 too much sleep, died between 60 and 64 from 
 paralysis and apoplexy. I could adduce many 
 similar experiences in other families, but this 
 one may suffice. 
 
 THE BRAIN. 
 
 The brain profits like all the other organs of 
 the body by physical exercise, in so far as 
 
Mental Occupation 145 
 
 through the increased action of the heart more 
 blood is carried to it, and the nerve-cells as 
 well as the arterioles and capillaries are kept 
 in a healthy condition. Exercise, however, 
 produces another and more immediate influence 
 on the nutrition of the brain. As every volun- 
 tary movement is due to an impulse from 
 certain portions of the brain, this impulse, we 
 may assume, causes an increased afflux of blood, 
 through which the nerve-cells as well as the 
 small blood-vessels themselves are nourished and 
 kept in working condition, counteracting pre- 
 mature decay. The brain often decays from 
 want of physical exercise or mental work. We 
 have frequent opportunities of witnessing this. 
 Many men retire rather too early from business ; 
 others, especially officers in the navy or army 
 and civil servants, are obliged to do so by the 
 regulations. Amongst these men we see not 
 rarely weariness, dejection, and an inclination 
 to give up occupation and active habits, to 
 remain longer in bed, to play cards by day and 
 night, to smoke immoderately and sit longer 
 over their meals, and in consequence sickness 
 of different kinds is developed, and also pre- 
 mature decay of the brain functions. Such men 
 ought to find occupation for their brains, and 
 
 10 
 
146 The Prolongation of Life 
 
 take regular bodily exercise. They ought to 
 seek some objects of interest in art or in litera- 
 ture, in studying the habits of insects or birds, 
 in history, geography, geology, zoology, botany, 
 in gardening or agriculture, in travelling, or in 
 adopting and educating a child, and in other 
 philanthropic matters, &c. ; they ought to 
 cultivate a hobby, for instance, in collecting 
 prints, autographs, antiquities, or coins, to 
 induce them to study history, antiquity and 
 mythology ; even the collecting of postage 
 stamps, in default of something else, can be 
 used as a source of mental occupation. The 
 cultivation of a hobby ought to be commenced 
 while people are still at active work, since 
 the inclination and the aptitude to being some- 
 thing new disappears not rarely long before 60 
 or 65, when they have to retire from their 
 work. Many old people derive great benefit 
 from chess and other intellectual games, also 
 from games at cards or dominoes, especially 
 when the eyesight for reading fails, provided 
 over-excitement or passion is avoided. The 
 families or companions of old people ought 
 therefore to play with them, or otherwise 
 occupy them, instead of allowing them to go 
 to sleep for several hours during the day or the 
 
Mental Occupation Morbid Imagination 147 
 
 long evenings. Amongst the classes of people 
 who die earlier than they ought to do from 
 imperfect brain work, are some who had lived 
 a healthy life up to 50 and 60, but then began 
 to fail from want of occupation or activity. 
 I have observed this, for instance, amongst 
 farmers, who, when they ceased to be able to 
 take the long walks and rides necessary to 
 superintend their farms, allowed their work to 
 be done by their sons, indulged, however, in the 
 comparatively large amount of food to which 
 they had been accustomed, spent the greater 
 part of the day during the long winters indoors, 
 became stiff in their limbs, sleepy and indolent, 
 and died between 66 and 72. This may be 
 called a respectable age, but it is not the age 
 which they would probably have attained, if they 
 had sufficiently occupied their minds, diminished 
 the amount of food, and kept up out-of-door 
 life and exercise. Similar observations I have 
 made amongst well-to-do tradesmen and other 
 classes, to which I have already alluded. A 
 great point is to keep up variety in mental 
 occupations^ and to keep awake the interest in 
 many things so as to prevent mental torpor, 
 which is akin to ossification of cartilages or 
 arteries. 
 
14$ The Prolongation of Life 
 
 Another advantage of regular mental occupa- 
 tion is that it prevents us from turning our 
 attention too much to our own feelings and 
 failings, to our mental and physical troubles. 
 Many persons are apt to pay too much attention 
 to slight ailments, and imagine them to be the 
 beginning of serious disease and suffering, become 
 through this mentally depressed and unhappy, 
 and at last imagine that they are the subjects of 
 serious incurable disease. These morbid imagina- 
 tions sometimes give rise to real disease of mind 
 or body. The most effective remedy, preventive 
 as well as curative, of such morbid imaginings 
 and their grave effects, is constant occupation 
 combined with open-air exercise, and none of 
 the many remedies constantly advertised is 
 generally required. Great moderation in eating 
 and drinking must be added, as many forms of 
 mental depression and morbid imaginings depend 
 on dyspeptic conditions. All mental occupation 
 leads to increase of flow of blood to the brain, 
 activity of the small blood-vessels and nutrition 
 of the nerve-cells. I have already mentioned 
 Mosso's experiment (p. 27) [81]. I could 
 produce the most remarkable proofs of the in- 
 fluence of mental activity on the condition of 
 the heart, the digestion and the whole body. 
 
Influence of Joy and of Grief 149 
 
 I cannot resist mentioning a very striking case 
 which I had the opportunity of watching from 
 day to day, as the subject was an intimate friend 
 of mine. A man of great energy and intelli- 
 gence, who was the leading spirit in a well- 
 known hospital, began to get languid and to 
 lose his interest in his work at the age of 
 76. The action of his heart became weak and 
 very irregular, he lost the expression of in- 
 telligence peculiar to him, the saliva ran con- 
 stantly from his mouth, and a viscid and acrid 
 fluid from his swollen eyes ; the action of the 
 bowels and the bladder became extremely 
 sluggish ; oedema of the legs, and at last effusion 
 into the pleural cavities, developed themselves 
 in his eighty-second year, when suddenly the 
 arrangements which he had created at the hos- 
 pital were in danger of being overturned. This 
 caused violent excitement in him ; he began at 
 first to dictate and soon to write letters, he held 
 meetings, and succeeded in saving his arrange- 
 ments and his influence. Marvellous was the 
 improvement manifesting itself from day to day 
 without any medicine. The pleural effusion 
 and oedema disappeared, the heart became 
 almost regular, the eyes and mouth returned to 
 their natural conditions, the puffiness of the face 
 
150 The Prolongation of Life 
 
 subsided, and the intelligent expression came 
 back. He remained in this improved con- 
 dition over a year, when he died of pneumonia, 
 from a deleterious meteorological change, or 
 influenza. It was the work of the brain and 
 the joy at his success which caused this astonish- 
 ing improvement. Wonderful is the effect of 
 success, and equally so that of joy ; it shows 
 the immense power of the mental condition over 
 the whole organism. The opposite conditions 
 of the mind, such as grief and loss of hope, cause 
 in some people the greatest mental and physical 
 depression, total indifference for their surround- 
 ings, combined with at first functional, after- 
 wards organic changes, especially dilatation of 
 the heart, and death from what may truly be 
 called a "broken heart" Diminished respiration, 
 weakening of the action of the heart, and im- 
 perfect supply of blood to the brain, probably 
 have a great share in these conditions of de- 
 pression. Sometimes, but not always, we are 
 able to produce a favourable turning in such 
 cases by awakening an interest in near relatives 
 or friends, or by some other powerful mental 
 influence, which is followed by arousing the 
 depressed functions of the brain, the heart, and 
 the rest of the body. Of many cases of this 
 
Influence of Strong Sympathy 1 5 1 
 
 kind which have occurred to me, I will narrate 
 only one : A lady, 70 years of age, lost suddenly 
 from acute disease her husband, a very distin- 
 guished physician, whom she had adored, and 
 with whom she had shared every pleasure and 
 every sorrow throughout their long and happy 
 union. She was highly cultivated, very active, 
 and took a lively interest in all her surroundings. 
 Immediately after the unexpected death of her 
 husband she became mentally depressed and 
 perfectly helpless, while formerly she had been 
 full of resources. The condition might be called 
 " mental paralysis" or acute melancholia. It 
 was almost impossible to induce her to take 
 food, she nearly always sat in a corner of the 
 room with her head bent down, frequently 
 sighing, and took scarcely any notice of the 
 members of her family, of whom she had 
 always been very fond. Within less than three 
 weeks the heart, which had been quite sound, 
 had become dilated, the pulse had become weak 
 and irregular, and a loud systolic mitral bruit 
 had developed. The legs had become oede- 
 matous. The intellectual and sympathetic 
 physiognomy had turned into an expression of 
 apathy and almost stupor. This state con- 
 tinued and increased for some weeks ; she 
 
152 The Prolongation of Life 
 
 became greatly emaciated and was expected 
 shortly to die, when as a last experiment an ur- 
 gent message was sent to her from a daughter 
 who had not been able to leave her bed for 
 several years, and had entirely depended on her. 
 The daughter implored her to see her once more 
 before she died ; the mother was carried to 
 her, and her maternal interest and affection 
 were roused by the daughter's helplessness and 
 grief and attachment. She took some food and 
 stimulant while with her, and revived from 
 that moment, was daily carried to this invalid 
 daughter, whose joy at her mother's arrival 
 seemed to act as a powerful stimulus on the 
 latter, who gradually regained also her interest 
 in other members of the family. The aged 
 lady recovered her general health in the course 
 of three months, although the heart remained 
 somewhat dilated and irregular ; she became 
 again the centre and soul of her large family, 
 and retained her faculties until her death, in 
 her eighty-sixth year. 
 
 Equally injurious as grief and sorrow is 
 worry, by which the equanimity is destroyed, 
 and the joyful performance of the daily work 
 and duty is rendered impossible. Worry is 
 doubly injurious if caused by one's own faults, 
 
To Counteract the Effects of Grief and Anxiety 153 
 
 cither of commission or of omission. The 
 habit of some persons to make worries is most 
 injurious, and ought to be counteracted from 
 an early period by all possible means. 
 
 It may not be quite easy to explain the 
 physical mode of action of happiness and allied 
 mental conditions on the one side, and dejection 
 and unhappiness on the other, but if we consider 
 the immediate effects which in most persons 
 emotions produce in the action of the heart and 
 blood-vessels, it becomes more intelligible. The 
 palpitation of the heart and the flushing of the 
 face under the influence of anger, joy, or shame, 
 the paleness and feeling of coldness and shivering 
 from fear, grief and anguish, clearly show the 
 intimate connection between mind and heart, 
 which is so constant that both words are, in 
 common language, often used in the same sense. 
 Both happiness and unhappiness act on the heart 
 and circulation, and the vaso-motor system, 
 the former stimulating, the latter depressing, but 
 the mind is no doubt first influenced, and through 
 it the respiration and the entire circulation from 
 the heart to the smallest blood-vessels. On 
 watching persons under despondency and grief, 
 I have often found their breathing superficial and 
 irregular, interrupted occasionally by a sigh, and 
 
154 The Prolongation of Life 
 
 their pulse weaker, sometimes irregular and less 
 frequent from imperfect action of heart, while 
 under the influence of joyful news the breathing 
 became regular and deeper, and the pulse fuller 
 and regular, rising within half an hour or less 
 from 50 to 70 and 75, its habitual rate of fre- 
 quency. Evidently the centre of the pneumo- 
 gastric nerve is influenced by these opposite 
 forms of emotion. It is often impossible to 
 remove sorrow, grief, mental anxiety, and de- 
 pression by friendly encouragement, but we 
 must endeavour under such circumstances to 
 counteract these injurious agencies by physical 
 means. Exercise, active or passive (in car- 
 riage or bath-chair), in the open air is one of 
 the most powerful agencies, and rarely fails 
 gradually to exert its beneficial influence. 
 
 There can be no doubt that pleasure is often 
 a source of happiness^ but it is by no means iden- 
 tical with happiness, and the habit of hunting 
 after pleasure is a frequent source of unhappi- 
 ness, and ultimately even of illness. The seeking 
 of pleasure must, therefore, be limited in a judi- 
 cious manner, and pleasures which are lasting 
 must be preferred to pleasures of an exciting, 
 momentary, or transitory nature. A different 
 matter from pleasure is cheerfulness^ and in 
 
Selfishness 155 
 
 order to promote cheerfulness we must culti- 
 vate contentedness with the circumstances in 
 which we are placed. It is, further, of great 
 importance to educate the sense of duty with 
 regard to one's position in life and to one's 
 surroundings. A person who does his duty and > 
 through this, is satisfied with himself, in other 
 words, has a good conscience^ is, other matters 
 being satisfactory, happy, and even if the cir- 
 stances are not to his liking, he is able to keep 
 his equanimity, to bear them well, and to make 
 the best of the situation. On the other hand, 
 a man who has reason to be dissatisfied with 
 himself, or has a bad conscience, is unhappy, 
 looks at the circumstances surrounding him in a 
 mistrusting and despondent manner, and is less 
 able to extricate himself out of a difficulty ; he 
 often becomes depressed, his resisting power is 
 lowered, and he is easily attacked by disease. 
 The sense of duty ought, therefore, to be cul- 
 tivated from an early age through life. The 
 head of the family, for instance, who neg- 
 lects the happiness of his wife and the train- 
 ing of his children for his personal enjoyment, 
 and a wife who shirks her duty of bearing 
 children and of nursing them for frivolous 
 motives, fine clothes and social excitement, often 
 
156 The Prolongation of Life 
 
 prepare for themselves worry, disease and pre- 
 mature death. In several instances of my 
 experience it has happened that parents who, 
 in the earlier years of their married lives had, 
 by their own will, limited, for their con- 
 venience, their progeny to one child, lost this 
 only child after it had grown up. It had 
 been the bond of union between them and 
 the centre of their happiness. The death of 
 this only child caused them the greatest un- 
 happiness ; in one case deep melancholy of the 
 wife, in another estrangement between husband 
 and wife for the remainder of their lives, in 
 another suicide. Again and again Goethe's 
 words came before my mind : 
 
 " Denn alle Schuld raecht sich auf Erden." 
 (" For vengeance follows on the guilty deed.") 
 
 Free translation. 
 
 although not all " guilty deeds " are guilty in 
 the eye of the law. 
 
 On the other hand, those who bear sacrifices 
 for home and family, for the alleviation and 
 improvement of the condition of the sick and 
 helpless with whom they come in contact, earn 
 mental satisfaction and happiness, which act like 
 sunshine on the whole body, and thus become 
 means of prolongation of life and of a happy old 
 
Cultivate Thoroughness, Avoid Haste 157 
 
 age. A further point of self -education connected 
 with the sense of duty is the restraint of our 
 passions ; not only must we check our anger 
 if any thing displeases us, but we must also con- 
 quer undue ambition, 1 vanity, avarice, jealousy, 
 illicit sexual desires, which often become, as 
 you know, the cause of bodily and mental 
 disease, premature death, or " miserable " old 
 age. Another part of self-education is the duty 
 of combating self-indulgence with regard to food, 
 drink, sexual pleasures and to idleness. Self- 
 indulgence leads to moral and physical weakness, 
 want of resisting power to disease, and mental 
 depression. 
 
 We also must endeavour to promote cheer- 
 fulness by the arrangement of our whole manner 
 of living, as far as lies in our power, without 
 neglecting our duty. We must endeavour to 
 cultivate the sense of beauty for Nature and art ; 
 much can be done in this way, for instance, by 
 
 1 "Ambition" is not to be absolutely condemned; a 
 certain amount of ambition is to many persons useful 
 as a stimulant to learning and progress, it is almost 
 needful to the soldier ; but " undue ambition " often leads 
 to injustice towards others and to crime. 
 
 " I charge thee, fling away ambition : 
 By that sin fell the angels/' 
 
 " King Henry VIII., Act III." 
 
158 The Prolongation of Life 
 
 flowers, by pictures and drawings, a home, in 
 cottages, public schools, hospitals and sick rooms. 
 
 " A thing of beauty is a joy for ever." 
 
 We must cultivate restfulness, equanimity, and 
 thoroughness, and must avoid too great multi- 
 fariousness of work which leads to haste and 
 hurry. Habits of haste and hurry prevent 
 mental satisfaction, over-excite the heart, and 
 gradually injure its nutrition and structure (dila- 
 tation with or without hypertrophy). While 
 well-regulated work, adapted to the powers, 
 strengthens the brain and heart, ill-regulated 
 or ambitious work, exceeding the mental 
 power, deranges the brain and heart, and often 
 leads to premature breakdown in either the one 
 or the other or in both. Unfortunately such 
 misjudgment of one's powers is not rarely the 
 cause of failure in life. 
 
 A potent enemy of cheerfulness is nervousness^ 
 which shows itself in many different ways, and 
 must be fought with all means in our power, 
 especially by judicious reasoning and regular 
 occupation combined with open-air life. 
 
 A further powerful agent in health matters is 
 the will. We must develop it from youth and 
 cultivate it throughout life. An effective influ- 
 
Develop a Strong Will 159 
 
 ence in this respect is exercised by our en- 
 deavouring to carry out in our daily life what 
 we think good for us and right towards others 
 in great as well as in small matters. We have 
 mentioned already Dr. Austin's remarks on the 
 advantages of severe climbing tours in strength- 
 ening our will, but our persevering in our daily 
 walks even in disagreeable weather, is one of 
 the many instances in this direction, and the 
 practice of moderation in sensual enjoyment is 
 another. A large proportion of those whose 
 lives I have been able to prolong, exercised 
 their strong will in carrying out the precepts 
 which I gave them, although they appeared 
 to them at first tedious and difficult. I 'will 
 not decay early^ they said, I will maintain my 
 powers and faculties as long as possible. And 
 not only is a strong will a great aid in attain- 
 ing longevity by maintaining health and pre- 
 venting disease, but it is also a powerful agent 
 in overcoming disease. This is generally 
 acknowledged with regard to pulmonary tuber- 
 culosis, but I have also seen many, and amongst 
 them some marvellous cases, in other diseases. 
 A man, for instance, above 60, who had suffered 
 for more than eighteen months from a weak and 
 dilated heart, from cirrhosis of the liver, oedema 
 
1 60 The Prolongation of Life 
 
 of the legs, and ascites, and had been tapped 
 seven times, was scarcely ever free from pain 
 and from a sense of exhaustion ; he was justly 
 refused by a Life Assurance Society, and was 
 told that his chances of recovery were doubtful. 
 At first he was much depressed by this pessi- 
 mistic prognosis, but on the following day, after 
 having thoroughly considered his position with 
 me, he said that he must live on account of his 
 large family, that he would not die and would 
 do everything in his power to prevent death. 
 He tried, and fairly succeeded in disregarding 
 pain, he began to carry out all our rules, however 
 difficult it was to him, with regard to food, 
 open-air life, different kinds of exercise, and 
 change of climate ; he regained his health 
 within two years and remained well up to a 
 considerable age. Even in children the will 
 exercises sometimes a remarkable influence on 
 the course of disease. Thus I still see before 
 me a pale and breathless child of 7 years of age 
 who had pleuro-pneumonia, and was suspected 
 of having tubercles in the lungs. After a con- 
 sultation between three physicians the mother 
 had been told that there was only a very slight 
 chance of recovery. When I afterwards came 
 into the sick room, I found the mother unable 
 
Prevention of Mental Diseases 161 
 
 to suppress her tears, and the child almost 
 breathless, exclaiming : " Don't cry, mummy 
 dear, I shall get well again, I will not die." 
 An improvement set in almost from that hour ; 
 slight at first, it became more decided after 
 some days, leading gradually to perfect recovery. 
 This child gained with advancing years many 
 other advantages from a strong will. Such 
 occurrences, I know, may be regarded as coin- 
 cidences only, and not as due to the will ; but 
 as I have observed several cases of a similar 
 nature, I am convinced that the will of the 
 patient has had a great share in the successful 
 issue. The will is, indeed, a great power in 
 disease as well as in other events of life. 
 
 These considerations bring us to the borders 
 of mental diseases^ which often, though not 
 always, shorten life. In many cases there is a 
 hereditary tendency, but this can mostly be 
 counteracted successfully by promoting the 
 general health, by strengthening the balance 
 of the mind, by healthy occupation and exercise, 
 by enlightened mental surroundings, by great 
 moderation, by cultivating contentedness, and 
 by governing the passions, while at the same 
 time all exciting causes must be kept off as far 
 as possible. While I write this a very suggestive 
 
 ii 
 
1 62 The Prolongation of Life 
 
 paper by Sir Samuel Wilks comes before 
 me, " On the Correction of Hereditary 
 Tendencies" (Lancet^ October, 1903, p. 1151). 
 He occupied himself with the hereditary 
 tendency to vice, but his suggestions apply also 
 to other forms of mental irregularities ; he espe- 
 cially points out as means of cure, change of 
 mental surroundings, from the houses of vicious 
 parents or relatives to healthy surroundings or 
 schools, where the qualities of self-respect, in- 
 tegrity, independence, and a just dealing with 
 others are brought out. Lord Bacon, in his 
 " Advancement of Learning," speaks of par- 
 ticular remedies " which learning doth minister 
 to all the diseases of the mind." 
 
 Before leaving the mental condition and the 
 influence of mental work, I must again express 
 my conviction against the doctrine that under 
 ordinary conditions work wears out the organs 
 sooner than idleness or great restriction in work. 
 It certainly is wrong with regard to healthy 
 brains, if the work is well arranged and is 
 not " overwork." Judiciously arranged mental 
 work in itself, with fair intervals of rest, does 
 not wear out but strengthens the brain in the 
 same way as the power of the heart and the 
 blood-vessels and muscles is maintained by ade- 
 
Vary Mental Occupation 163 
 
 quate physical exercise. When Sir William 
 Cowers [47] in a lecture "full of wisdom" 
 on the nervous system in old age, speaks of 
 the necessity of rest in old age, he evidently 
 does not mean to prohibit regular mental occu- 
 pation, but only " overwork." The mental 
 faculties ought to be exercised during the 
 greater part of the day and the whole year, 
 holidays included, but there ought to be a 
 change in the nature of the work, so that one 
 sphere is in a comparative state of rest while the 
 other is employed. Dr. Pollock [101] says very 
 well : " Sameness begets weariness, causes the 
 mind to grow old and accelerates bodily decay." 
 In the majority of people who practise their 
 mental faculties judiciously, these are retained 
 longer in fair energy than the functions of the 
 muscular and digestive systems ; perhaps, as Sir 
 Crichton-Browne points outs [28 and 29], be- 
 cause the frontal lobes on which they depend, 
 attain their highest development later in life. 
 We find, at all events, statesmen, judges, orators, 
 doing almost their best work after 50 and 60. 
 We have fortunately many instances of great 
 brain-workers attaining considerable ages and 
 maintaining their faculties to the end, in science, 
 in arts, in politics, in the law and divinity, and 
 
164 The Prolongation of Life 
 
 also in medicine. Hufeland himself, although 
 he rather supports the wearing-out theory, was a 
 hard worker, and lived to 74. Cicero says " the 
 intellectual powers remain in the old, provided 
 study and application are kept up, and old age 
 need not be inactive, indolent and drowsy." We 
 have striking instances in painters, in Giovanni 
 Bellini, in Titian, Franz Hals, and in Sidney 
 Cooper ; we have amongst other brain-workers, 
 Sophocles, who is said to have written tragedies 
 at 90 and more, Plato, Galen, Cato (Censorious), 
 Cicero, Michael Angelo, Heberden, Wesley, 
 John Howard, Benjamin Franklin, Goethe, 
 Samuel Rogers, Chevreuil, Victor Hugo, Kant, 
 Voltaire, Sir Henry Holland, the physician, 
 Sir Moses Montefiore, the philanthropist ; 
 William I. of Germany, Moltke, Bismarck, Dr. 
 Holyoke, an American physician (died at the 
 age of 100) ; Manzoni, Leopold von Ranke, 
 Mommsen, Gladstone, Lord Masham, the great 
 inventor in modern industries ; Mrs. Elizabeth 
 Hanbury, Mrs. Neave, of Guernsey, Madam 
 Viardot, the celebrated singer ; Sir Henry Pit- 
 man, the Emeritus Registrar of our own College, 
 who is alive at 99 ; Tolstoi has passed 85 ; Sir 
 Manuel Garcia, the inventor of the laryngo- 
 scope, who celebrated his hundredth birthday 
 
Exercise the Intellect in Old Age 165 
 
 in the early part of 1905 ; Baron de Waldeck, 
 who died in Paris in 1875, a g e d IO 9 > Elise 
 Averdieck, of Hamburg, who died in her hun- 
 dredth year, after a most active and useful life 
 as a teacher and deaconess, and many others who 
 contributed through this to the pleasure and 
 benefit of others and probably to their own 
 longevity. We have, on the other hand, good 
 reason to assume that neglect of the mental 
 faculties, idleness, excessive amount of sleep, lead 
 to premature decay of the brain functions and to 
 shortening of life. What we said of the mus- 
 cular and circulatory systems applies with still 
 greater force to the brain, viz., that few people 
 only die of mental overwork, compared to the 
 large number of those who shorten their lives 
 by over-rest. There are, we all know, cases 
 of real over-exertion of the mental faculties, 
 and through this injury to health and life, but 
 these are comparatively rare ; and amongst 
 them are many of misdirected brain-work, of 
 persons who undertake tasks which are beyond 
 their powers. 
 
 We need not conceal from ourselves that we 
 do not retain in old age the same rapidity and 
 force of thought, and the same memory which 
 we enjoyed in youth and manhood ; but we 
 
1 66 The Prolongation of Life 
 
 must not allow ourselves to become depressed 
 by this or to give up mental work. We must 
 endeavour to retain our mental equanimity and 
 do as much useful work as we can by which 
 that feeling of contentedness is produced which 
 exercises the most beneficial influence on the 
 whole organism. Nothing is more injurious 
 to old persons than the idea that they are use- 
 less, that they cannot any more do anything 
 either for themselves or for others, and that they 
 must die soon. I have often seen people of 
 advanced age rapidly decaying, when through 
 some unhappy influence they allowed themselves 
 to be seized by such an idea ; but I have also 
 had repeatedly the happiness to see such despair- 
 ing persons recover strength and activity and 
 happiness, when we succeeded in reawakening 
 self-confidence and hope. This fact cannot be 
 strongly enough impressed on the aged them- 
 selves and on the friends surrounding them. 
 I may refer to the case mentioned at p. 149. 
 Pessimism is always to be condemned ; it is 
 depressing and prevents our making the best of 
 our position. It is quite right to acquire a full 
 insight into the dangers and disadvantages of 
 our condition, but we must at the same time 
 diligently search for the means to remove or at 
 
Useful Work in Old Age 167 
 
 all events to mitigate them. We are not in 
 favour of blind optimism, but of realism, and 
 this realism not rarely leads to victory. 
 
 Many people seem to have been startled by 
 a statement in Professor Osier's Valedictory 
 Address at Johns Hopkins University [93] about 
 the comparative uselessness of men above 60, 
 and that all the effective and vitalizing work of 
 the world is done between 25 and 40. His 
 partly jocose remarks seem to have been mis- 
 interpreted. I understand Osier's remarks much 
 in the same way as Sir Samuel Wilks does in 
 his philosophical article " De Senectute " [142]. 
 He thinks that the principal activity, we may 
 call it the creative period, ceases in the middle 
 of life, viz., about 50, that, however, judgment 
 and ability to do useful work may last to much 
 more advanced life. To use the words of Sir 
 Samuel Wilks : Men (older than 50) "may still 
 continue to take their appropriate share in the 
 affairs of life. The work which they then do 
 need not be original and new, implying a reten- 
 tion of the same mental activity as they had 
 previously possessed, but rather the turning to 
 account the knowledge which they had pre- 
 viously gained, and so utilizing their experiences 
 for the benefit of others as did the Nestors of 
 old" (Lancet^ 1905, vol. ii., p. 1606). 
 
1 68 The Prolongation of Life 
 
 XIII. SLEEP. 
 
 Under the head of the nervous system we 
 must pay some attention to sleep, that most 
 wonderful function of our organism. Dr. G. 
 Oliver points out that during sleep the 
 arterial pressure falls, the venous rises, and that 
 the tissues are irrigated with lymph, which 
 leads to their restoration and nutrition. The 
 amount of sleep required differs very much in 
 different people and at different ages, and even 
 in the same persons at different times and 
 under different circumstances. Children and 
 young persons at school require much more 
 than adults. Sleep promotes with them nutri- 
 tion and growth ; it is to them the " great 
 nourisher in life's feast/' Most adults do not 
 require more than five and a half to seven 
 hours, but some take nine hours and over. 
 Much depends on the nature of occupation and 
 on habit, and there are in this matter, too, good 
 and bad habits. Sleeping for one or many months 
 too little, say under five or six hours in children 
 between 8 and 14 years of age, and four hours 
 in adults, causes in many persons impairment ot 
 digestion, sanguification and nutrition, emacia- 
 tion, anaemia, mental irritability, neuralgia, and 
 other troubles of the nervous system. This is 
 
Children require much Sleep [69 
 
 easily understood when we take Oliver's expe- 
 rience just mentioned into consideration, from 
 which we see that too little sleep gives not time 
 enough for the process of nutrition of the 
 tissues. Oliver's experience also shows why 
 during active growth much more sleep is 
 required than in the later stages of life, when 
 the body is thoroughly developed, and why the 
 curtailing of sleep in children and growing 
 persons is so much more injurious than in 
 adult life. Dr. T. D. Acland has quite lately 
 judiciously discussed this subject [IA] The 
 habit of sleeping too little is, however, less 
 frequent than that of sleeping too much. 
 There are some hard brain-workers who 
 never sleep more than five hours and even 
 less, and enjoy good health with this small 
 amount up to old age, if they live otherwise 
 correctly. There are many persons who worry 
 themselves if they sleep less than seven hours 
 and if they wake several times during the night. 
 They mostly do themselves more harm by 
 worrying about the supposed too short hours 
 of sleep, than by the small amount of sleep they 
 get ; and if they can be persuaded that they are 
 not injured by the shorter hours, that rest in bed 
 by itself leads to restoration of the body, they 
 
i/o The Prolongation of Life 
 
 mostly begin to sleep better. Other persons on 
 waking during the night, immediately turn 
 their thoughts to their occupations or worries, 
 and as everything looks blacker during the 
 night than in broad daylight, they dread this 
 so much that they take alcoholic drinks or 
 sleeping drugs either on going to bed or during 
 the night as soon as they wake up. This is a 
 very bad habit and ought never to be resorted 
 to excepting under the well-considered advice 
 of the doctor. The frequent use of anodynes 
 and sleeping remedies (narcotics, hypnotics, 
 soporiferous substances) weakens the heart, the 
 nervous system, often also the digestion and the 
 resisting power. Among the means frequently 
 used is a dose of alcohol (Cognac, whisky, rum) 
 at bedtime or on waking during the night. 
 Although we are aware that a small quantity 
 of alcohol, say a dessertspoonful or a table- 
 spoonful of whisky or Cognac in as much milk 
 or water often produces sleep, it ought never to 
 be allowed to become a habit, and its use ought 
 to be restricted to rare exceptions like that of 
 other somnorifics, such as chloral and opiates. 
 The tendency to sleep badly can often be corrected 
 by taking a slight meal on going to bed, or on 
 waking during the night, such as milk, a plain 
 
Sleep 1 7 1 
 
 biscuit, or some light farinaceous food, but not 
 alcohol. In some persons a late dinner or supper 
 or an injudicious article of food, or coffee or tea 
 at a late hour, form the causes of imperfect sleep, 
 and must be avoided. In other persons, insuf- 
 ficient bodily exercise is the cause ; in others 
 exciting mental work at late hours. In every case 
 one must endeavour to find out the cause and try 
 to remove it. In some cases a warm bath at bed- 
 time, in others a cold bath, and again in others 
 a wet bandage round the stomach, furnish good 
 remedies against imperfect sleep. Much sleep, 
 viz., over eight hours I speak here of adults 
 is mostly more injurious than too little, especially 
 in persons of full habits, by causing diminu- 
 tion of nervous energy, or degeneration of the 
 small arteries or capillaries of the brain, and in 
 consequence apoplexy or premature decay of 
 mental faculties. Dr. Oliver's experience just 
 quoted explains this deterioration, which is 
 often manifested by the appearance of plethora 
 and by obesity. Immanuel Kant, who was not 
 only a great philosopher but had also very 
 judicious views about health and most matters 
 of life, says that much sleep exhausts the energy 
 and shortens life [63]. 
 
 Sir John Sinclair [114], in his excellent and 
 
i 72 The Prolongation of Life 
 
 most diligently compiled work says : ' : It is 
 proper to add, that nothing is more pernicious 
 than too much sleep. It brings on a sluggish- 
 ness and dulness of all the animal functions, 
 and materially tends to weaken the body. It 
 blunts and destroys the senses, and renders both 
 the body and the mind unfit for action. From 
 the slowness of the circulation which it occa- 
 sions, there necessarily follows great corpulency, 
 a bloated habit of body, and a tendency to dropsy, 
 lethargy, apoplexy, and other disorders." 
 
 The time for sleep is the night, and sleep 
 during the day, which is so necessary for infants, 
 ought not to be indulged in by healthy persons 
 in middle life and only very moderately by 
 old people, barring exceptions, as for instance 
 after illness, or exhausting work. It is a bad 
 habit to transform the night into day and the 
 day into night, to do mental or social work after 
 midnight and to sleep in the morning until 
 9 or 10 and even later. With few exceptions 
 the long-lived reported on and analyzed by the 
 " Collective Investigation Committee " (Hum- 
 phry, " Old Age ") rose early and went to bed 
 early, and my own observations are entirely in 
 accordance with this. 
 
 At the risk of being blamed by those who 
 
Sleep 173 
 
 maintain that a certain number of hours of sleep, 
 say six to eight, is absolutely necessary, and that 
 it must be taken by day if it cannot be taken 
 at night, I may say that I have always recom- 
 mended men of work, physical or mental, to 
 rise at the same early hour, even if they had 
 gone to bed later than usual, or had not slept 
 well. There are, I need not say, a few neces- 
 sary exceptions to this rule, such as men in the 
 House of Commons, if the sittings last till 2 or 
 3 or 4 a.m., or medical men who have spent 
 the greater part of the night at the bedside of a 
 patient, or delicate ladies who have been, owing 
 to our bad habits, at dances till long after mid- 
 night, or workers on morning newspapers. It is 
 at present in England the habit of most men occu- 
 pied with literary work to do it during the late 
 evening hours ; they say that they cannot collect 
 their thoughts and bring them into proper shape 
 in the morning, but can do so in the late hours 
 of the evening, and better and better during the 
 small hours of the morning. I acknowledge 
 that it is so, but I maintain that this is only the 
 consequence of a bad habit, and that for those 
 who accustom themselves to it, the morning 
 work is the best, and that this is also more in 
 accordance with the laws of health. Many 
 
174 The Prolongation of Life 
 
 people, it is true, cannot work well for several 
 hours in the early morning with an empty 
 stomach ; but by taking a cup of milk, or of 
 weak tea with milk and with a piece of bread 
 or a biscuit, they can do their mental work, or 
 take early walks with great advantage. John 
 Wesley, the well-known divine, it is stated, rose 
 for sixty years every morning at 4 o'clock, and 
 never slept more than six hours. I could give 
 numerous instances of great mental workers who 
 from an early period of life were in the habit 
 of rising always between 5 and 6 o'clock, even 
 if they had been obliged to remain up till after 
 midnight once or twice a week, and who lived 
 and retained their .working power in spite of 
 these short hours of sleep to the age of 75 to 
 80, and even longer. Several judges of my 
 acquaintance, while on duty, rise at 4 or 5 and 
 prepare themselves for their work ; and one of 
 them is now alive, though lately retired, and 
 enjoys good health at 88. 1 
 
 refers to Lord Brampton who died in 1907, at 
 the age of 90, after a very short illness, and was living 
 when the above was written. 
 
Action of the Daily Bath 175 
 
 XIV. THE SKIN. 
 
 An important organ, by which the general 
 health and the duration of life are influenced, 
 is the skin, one of the various functions of which 
 is the removal of excretory matters. This func- 
 tion, which it performs jointly with other organs, 
 is apt to become defective in old people. The 
 skin of old people is mostly drier than in earlier 
 life, partly no doubt from the obliteration of 
 some of the capillaries. All active exercises 
 help in keeping up the circulation in, and the 
 functions of, the skin, but one of the most 
 powerful means is the bath. Many persons with 
 an active circulation can use cold baths from 
 early life to very old age ; others with poor 
 reaction, especially weakly rheumatic subjects, 
 do better with a hot bath ; again, others begin 
 best with a hot bath and then let in cold 
 water and sluice themselves, head included, 
 thoroughly with cold water, or take a cold 
 shower bath at the end. By exposing the skin 
 and its blood-vessels to an alternation of heat 
 and cold, we enable them to react more quickly 
 to alternations of external temperature and thus 
 prevent chills. The hot bath has, in addition 
 to its local effects, an immediate influence on the 
 
176 The Prolongation of Life 
 
 distribution of blood through the different parts 
 of the body. The heat of the water attracts a 
 large amount of blood to the skin, and diminishes 
 the amount contained in the internal organs. 
 It ought, therefore, not to be taken soon after 
 a principal meal, when the stomach requires a 
 larger amount of blood. This influence on the 
 distribution of blood the hot water bath shares 
 with the hot air bath, the vapour bath and 
 the electric bath. The active rubbing and 
 drying with a rough towel after the bath does 
 not only dry and massage the skin, but obliges 
 the bather to make many movements with 
 the arms and the muscles of the trunk which 
 he would not do otherwise. Thus the bath 
 acts as a kind of gymnastics to the skin 
 itself and induces also gymnastics of the arms. 
 The bath, either cold from the beginning, or 
 first hot and then cold, helps to preserve 
 the elasticity of the blood-vessels of the skin, 
 strengthens the heart, and also assists in main- 
 taining the energy of the nervous system, 
 including even the character, by the shock 
 which it applies to the whole body, and the 
 resolution required to take the cold bath in cold 
 weather. The Japanese have a very high 
 opinion of the usefulness of the daily bath ; we 
 
Air Bath 177 
 
 are informed by travellers in Japan that every 
 hamlet has its public baths, hot and cold, the 
 former generally preferred. 
 
 With the ordinary bath we can conveniently 
 combine an air bath by keeping the body un- 
 covered for several minutes after the drying and 
 rubbing process has been finished, while the 
 skin is in a state of turger or glow. This 
 exposure of the whole body to the action of the 
 air increases the tonic influence of the bath. 
 Various gymnastic exercises can be advan- 
 tageously combined with this air bath after the 
 water bath. The air bath alone during half an 
 hour and even several hours, if used with judg- 
 ment, improves the condition of the skin, and 
 through it the nervous system and the metabolism. 
 Those who have time and opportunity can, in 
 addition, take a sun bath^ the action of which is 
 allied to the hot air bath, by exposing the naked 
 or nearly naked body during half an hour and 
 longer to the active rays of the sun. The light 
 and heat of the sun, however, exercise a more 
 powerful influence than the hot air bath or 
 ordinary air bath alone on the general meta- 
 bolism, which is especially beneficial in chronic 
 rheumatic ailments. The cures with electric light 
 baths, and hot sand baths are based on similar 
 
 12 
 
i/8 The Prolongation of Life 
 
 principles. It is easily understood that the air 
 bath alone without heat abstracts warmth from 
 the body according to the external temperature 
 and the degree of movement of the air, and that 
 the duration of the air bath must be regulated 
 according to these circumstances and the condi- 
 tion of the individual. The latter remark 
 applies also to the sun bath, the electric bath, 
 and all kinds of baths. 
 
 A kind of local air bath is supplied by walk- 
 ing and driving whenever possible with the 
 head uncovered. Many chills which are fre- 
 quently caused by cold draughts on the head 
 are through this avoided. The founder of the 
 Bluecoat School deserves praise for the judicious 
 law to keep the heads of the boys uncovered in 
 all weathers. 
 
 If a full bath cannot be managed, a hip bath 
 combined with sluicing the head thoroughly 
 with cold water may be substituted as second 
 best ; and if this, too, is impossible, the 
 whole body ought to be rubbed thoroughly 
 with a wet towel once or twice a day for 
 some minutes, and the head bathed with tepid 
 or cold water and afterwards thoroughly rubbed 
 dry. 
 
 For good advice on the cultivation of the 
 
The Hair 179 
 
 skin and hair we may refer to Sir Malcolm 
 Morris in the "Book of Health " [80]. 
 
 In connection with the skin we must say a 
 few words about the hair^ which is not a mere 
 appendix or ornament, but also an organ of 
 protection. The hair undergoes, with the 
 advance of age, considerable changes, which are 
 especially noticeable in the hair of the head, 
 including the beard, and which Metchnikoff 
 ascribes to the action of the makrophages. 
 There is a wide difference in different persons 
 with regard to the quantity and nature of the 
 hair and the changes occurring in it during 
 life. There are whole families in the members 
 of which the hair begins to turn grey already 
 at 20 or soon after, while in other families the 
 hair retains its original colour up to 60 or 70 
 or even 80 or the end of life. Similar is the 
 difference with regard to the loss of hair which 
 commences in some families before 25, while 
 members of other families retain their hair up 
 to the most advanced age. The mere change 
 of colour in itself exercises, especially when it 
 is due to a family peculiarity, no influence on 
 health, but it is sometimes connected with per- 
 manent or transitory changes in more vital parts 
 of the body ; the rapid change from the natural 
 
1 80 The Prolongation of Life 
 
 colour to greyness or whiteness, when it is not 
 the effect of acute disease, is not rarely caused 
 by a deterioration of the whole constitution, 
 and thus requires the serious attention of the 
 doctor. 
 
 The loss of hair renders some people more 
 liable to the injurious effects of sudden changes 
 of temperature, draughts, &c. In many instances 
 we are able to prevent or at all events to slacken 
 the process of loss of hair, and to some degree 
 also the change of colour, by always keeping the 
 head cool and mostly uncovered, and sponging 
 it regularly with cold water ; but a still more 
 beneficial influence is exercised by daily massage 
 of the head^ which ought to consist not in mere 
 rubbing of the hair and skin of the head, but 
 in actively and rapidly moving the scalp to and 
 from the bone, combined with a certain amount 
 of pressure. By this kind of massage the nutri- 
 tion of the entire skin is promoted, including 
 the nerves, the capillaries, the rete mucosum, 
 the hair follicles, the sudoriparous and sebiparous 
 glands. This massage, when properly carried out, 
 exercises also a beneficial influence, though per- 
 haps only to a slight degree, on the nutrition of 
 the skull itself, and may thus somewhat counter- 
 act the tendency to atrophy of the parietal 
 
The Thyroid and Parathyroid Glands 181 
 
 walls. We have further succeeded in many 
 persons not only in preventing the loss of hair, 
 but also in checking certain forms of headache 
 by this daily massage of the scalp, which may 
 conveniently be practised after or before the 
 bathing of the head. 
 
 XV. IMPORTANCE OF THE GLANDULAR ORGANS. 
 
 Considerable additions to our knowledge have 
 been made during the last twenty-five years by 
 the attention paid to the functions of various 
 glandular organs^ and especially the so-called 
 ductless glands. What we know as yet is still 
 very imperfect, but clinical observation and ex- 
 periment have already clearly demonstrated that 
 these organs exercise vast influence on the 
 development, on the metabolism, and on 
 the health of the whole organism. This 
 is particularly the case with the thyroid 
 and parathyroid glands. The diseases and the 
 extirpation of these organs produce remarkable 
 changes in the whole body, especially in 
 the functions of the nervous, circulatory and 
 cutaneous systems. As some morbid symptoms 
 observed in old age seem to depend on patho- 
 logical changes in these glands (Horsley [54 
 and 55], Ewald [35 and 36], Lorand [72] and 
 
1 82 The Prolongation of Life 
 
 others) we must endeavour to maintain them 
 as long as possible in an effective state and avoid 
 their atrophy. This consideration, and espe- 
 cially Kocher's observations on the removal of 
 goitre, led me to begin many years ago regu- 
 larly to massage my own thyroid and para- 
 thyroid glands, together with the larynx and the 
 anterior part of the neck (the latter with the 
 intention to maintain a healthy condition of the 
 blood-vessels and nerves of this region), and to 
 advise many of my patients to do so. This 
 practice, I think, has been attended with distinct 
 benefit in several cases which had manifested 
 symptoms akin to those of myxoedema, such as 
 puffiness of the face and hands, rapid falling out 
 of hair, great dryness of the skin and mental 
 hebetude. The massage of the thyroid and 
 parathyroid region was gradually followed by 
 the disappearance of these symptoms, and this 
 without the assistance of thyroid extract. The 
 involuntary muscular twitchings of the face and 
 neck and actual convulsions which occur in 
 some old people may possibly be due to senile 
 changes in the parathyroid glands, and these, 
 too, I have seen checked more or less by 
 massage of the laryngeal region. 
 
 We are not able to massage all the lymphatic 
 
The Thyroid and Parathyroid Glands 183 
 
 and other glands of the body as thoroughly as 
 the thyroid and parathyroid, because most of 
 the others do not lie so near to the surface. 
 The glands situated in the abdominal cavity 
 the mesenteric glands, the spleen, the liver, the 
 pancreas, the kidneys and suprarenal glands 
 can to some degree be influenced by massage of 
 the abdomen, but not sufficiently. Some bene- 
 ficial influence also is effected by the walking 
 exercises, by the regular practice of abdominal 
 pressure (p. 141), and also by the respiratory 
 movements which have been previously men- 
 tioned, when combined with thorough com- 
 pression of the abdomen. More amenable to 
 this mechanical treatment are the parotid and 
 the submaxillary glands, which in some persons 
 of advanced age lose their natural energy and 
 secrete a viscid fluid instead of healthy saliva. 
 
 As the human organism is one whole, in 
 which every single organ is more or less inti- 
 mately connected with the rest, the health of 
 the whole organism depends to some degree 
 on that of every single part. Each single part 
 ought, therefore, to be attended to for the 
 benefit of the whole. It is, however, not in 
 our power to do this efficiently. Thus the 
 special senses which exercise great influence on 
 
184 The Prolongation of Life 
 
 the brain by the impressions which they 
 convey to it, are apt to decay with advancing 
 years, and our power to prevent this is very 
 limited. By carrying out the rules for main- 
 taining the energy of the circulation and 
 nutrition of every single part of the body 
 and preventing diseases, we exercise also some 
 beneficial influence on the special senses ; but 
 still they are apt to become old and blunted. 
 Massage of the eyes, the ears, and the nose 
 can do a certain amount of good, mostly that 
 of the eyes ; and by using them judiciously 
 and avoiding overstraining them, we can pro- 
 long the energy of their functions and thus 
 prevent, or at all events postpone, one of the 
 greatest inconveniences naturally connected with 
 old age. 
 
 XVI. PREVENTION OF DISEASE. 
 
 I have said before that prevention of disease is 
 one of the means of prolonging life (p. 1 8 and 
 p. 93). A frequent source of disease is infec- 
 tion. This is generally known, but the duty of 
 avoiding exposure to infection is often neglected, 
 even by most intelligent persons. I cannot enter 
 here on the duty of the State and of the com- 
 munity to combat the spreading of infectious 
 
Prevent Infection 185 
 
 diseases ; this is being more and more recog- 
 nized and acted upon, but also every single in- 
 dividual ought to consider it his duty not to 
 expose himself to infection, and, if himself in- 
 fected, to avoid every possibility of carrying 
 infection to others. Sir Lauder Brunton, in his 
 interesting and suggestive address on "Longevity 
 and the Means of Attaining It" [15], justly 
 directs attention to the great infectiousness of 
 common colds and the duty of evading as far 
 as possible the communication of them to 
 others, especially to those who are weak either 
 from disease or from old age ; for a so-called 
 common cold, which most people consider a 
 trifling matter, may under such circumstances 
 become the cause of death. I have myself seen 
 this from a common cold, and more frequently 
 from influenza, which had been regarded as a 
 small matter. Sir Lauder Brunton also points 
 out the duty of disinfecting oneself after contact 
 with cases of infectious disease, before visiting 
 others, especially weak or diseased people. 
 
 One of the most important measures towards 
 the prevention of disease and of injurious habits, 
 and also towards promoting healthful influences, 
 is education. We all must hail the steps which 
 are being taken in schools to promote a general 
 
1 86 The Prolongation of Life 
 
 knowledge of hygienic influences such as food, 
 exercise, and good air, but we must add to 
 them the duty of imparting some elementary 
 knowledge about prevention of disease and of 
 spreading infectious diseases. A most necessary 
 point in education is the teaching of temper- 
 ance, especially with regard to the consump- 
 tion of alcoholic beverages, and the fearful 
 consequences of intemperance, not only to the 
 intemperate person himself but to the happiness 
 and health of his family and the tendency to 
 commission of crime. 
 
 Amongst the important matters into which 
 I am unable properly to enter is the clothing^ 
 which ought to cover the body without being 
 too tight, and ought to be varied according 
 to the different meteorological conditions. It is 
 essential to the maintenance of health, especi- 
 ally in very young children, old people, and all 
 those whose vitality is lowered, to keep the 
 skin warm ; to the neglect of this rule 
 many illnesses must be attributed. This is 
 shown by every-day experience, and explained 
 by Pasteur's experiments on fowls in relation 
 to anthrax (p. 191). The clothing, however, 
 ought not only to keep the body warm, but 
 it ought to be arranged in such a way that 
 
Clothing 187 
 
 it allows free movement to every part of the 
 body, that it does not by pressure hinder the 
 action of the organs of the chest and abdomen, 
 as tight and badly arranged corsets do, or of the 
 feet by badly fitting boots, or of the veins of the 
 legs as is done by tight garters, or of those 
 of neck and face by tight collars, &c. Sir 
 Frederick Treves has given valuable advice 
 in his article " On the Influence of Dress on 
 Health" in the "Book of Health " [123]. 
 
 An equally and even more important subject 
 is the house or the rooms we live in, which 
 ought to be light, airy, and well ventilated, and 
 ought to have a sunny aspect (cf. p. 19, footnote). 
 On this we may refer to an article by Sir Shirley 
 Murphy, "Health at Home ' : [82], contained 
 likewise in the " Book of Health." 
 
 Of great influence on the condition of the 
 body is climate. This vast subject, too, 'we 
 cannot adequately discuss. We must mention, 
 however, that a regular " change " for six to eight 
 weeks every year from one part of the country 
 to another, or to the seaside, or to the Con- 
 tinent, to different elevations above the sea, is 
 a great help to mind and body, and through 
 this, a powerful agent in the prolongation of 
 life. The exact choice depends on the condi- 
 
1 88 The Prolongation of Life 
 
 tion of the individual ; but a necessary con- 
 dition in this choice ought to be that the 
 locality selected enables the aged person to be 
 long in the open air and to take regular exer- 
 cise. On some persons a stay at the seaside, 
 or yachting, or a longer sea voyage, exercises 
 the best influence ; on others a stay in a warm 
 and dry climate, such as Egypt ; on others a 
 stay in mountainons districts at various eleva- 
 tions, combined with moderate climbing ; for 
 others, again, travel from one place of interest 
 to another is preferable to a long stay at the 
 same place. 
 
 Travelling is, in fact, a great promoter ot 
 longevity, especially by preventing premature 
 senile decay. I am inclined to ascribe the 
 benefit of travelling partly to the circumstance 
 that the traveller is forced to change more or 
 less his habits while travelling ; partly to the 
 influence on the mind, to the diversion of his 
 thoughts from himself and the daily worries 
 to new things and matters of general interest. 
 
 Old people whose mental activity begins to 
 be stagnant ought to go to localities where their 
 attention is stimulated by art, by history, by 
 scenery, and by the manners of the people, such 
 as Egypt, Rome, Naples, Palermo, Florence, 
 
Climates for the Aged \ 89 
 
 Venice, Athens, Constantinople, Vienna, Munich, 
 Berlin, Paris, &c., provided judicious care is 
 taken to avoid chills and other injurious in- 
 fluences, and provided a moderate amount of 
 resisting power is left. 
 
 It ought to go without saying that in travel- 
 ling it is necessary to avoid draughts and dust 
 in railway carriages ; and that at most foreign 
 places one has to be on one's guard against the 
 risks of infection from drinking water, from 
 food, and from unhealthy habitations. 
 
 With increasing years the resisting power 
 of the organism decreases, in some more and 
 in others less, in some earlier, in others later. 
 While in youth and in the prime of life the 
 cold, the dampness, the high winds, the fogs 
 and mists are fairly well borne, they cause in 
 many old people, especially those who neglect 
 regular open-air exercise, and also in persons 
 weakened through acute disease (such as in- 
 fluenza, rheumatic fever, pneumonia, &c.), 
 catarrh, bronchitis, rheumatism, mental depres- 
 sion and other ailments, and through these lead 
 to premature senile decay and death. Warm- 
 ing the dwelling-rooms, the passages of the 
 house, the water-closets, and adopting warmer 
 clothing are useful, but are often insufficient to 
 
190 The Prolongation of Life 
 
 counteract the inclemencies ; it is therefore pru- 
 dent for many of those who have lost much 
 of their resisting power, to spend the colder 
 months in milder climates, where their accomo- 
 dating powers are less tried, such as the south 
 and south-west of England and Ireland, and still 
 more so the Riviera, especially the drier, the 
 more quiet and more elevated region of Grasse, 
 where, owing to the greater dryness of the air 
 and the large proportion of sunshine, chronic 
 rheumatism, a frequent trouble of the aged, is 
 much relieved, where the appetite, the inclination 
 and power to take active exercise are increased, 
 and through this the muscular and circulatory 
 system are maintained in a fairly vigorous con- 
 dition ; Venie shares to some degree these 
 advantages. In the south-west of France, 
 Pau and Arcachon have advantages, while 
 Biarritz is rather too windy for the aged. In 
 Spain, Malaga offers a fairly high temperature. 
 Egypt, Algiers, Madeira, Teneriffe, and Corfu 
 can only be recommended to those who, in spite 
 of advanced years, have remained good travellers, 
 and especially good sailors. The large amount of 
 sunshine in some of these localities, the longer 
 duration of daylight during the winter months, 
 and the flowers, cheer the mind and render it 
 
Injuriousness of Cold 191 
 
 more hopeful, and hope and cheerfulness exer- 
 cise, we repeat, a most beneficial influence on 
 the whole body. The first Lord Brougham 
 showed his wisdom in this matter by spending 
 the winters of his later life at Cannes, where he 
 enjoyed much better health and prolonged his 
 life considerably. 
 
 With regard to the injuriousness of cold^ i.e.^ 
 low temperature of the air, slight, when com- 
 bined with stillness of air, but great when 
 combined with wind, Sir Lauder Brunton 
 directs attention [16] to an ingenious experi- 
 ment by Pasteur, " who discovered that fowls, 
 the natural temperature of whose body is 
 nearly 104 F., are immune from anthrax, but 
 if they are made to stand with their legs in 
 cold water until their temperature is suffi- 
 ciently lowered, they become susceptible to 
 the disease." We know that we often carry 
 with us in the mouth, in the nose, and in 
 other parts of the body, the germs of diseases, 
 without becoming infected by these diseases 
 while we are in robust health, but when 
 our vitality is lowered by exposure to cold, 
 we become apt to take the disease. Our 
 experience of every day shows this especially 
 with regard to pneumonia, influenza so-called 
 
The Prolongation of Life 
 
 " colds," &c. Pasteur's experiments clearly give 
 the explanation. To pneumonia the aged are 
 especially liable, and this disease is often fatal, 
 and the anti-pneumonia serums are often with- 
 out avail. 
 
 XVII. RECAPITULATION. 
 
 There are some other subjects which deserve 
 discussion, but I have already transgressed the 
 limits of time, and I trust that if the suggestions 
 I have ventured to make are acted upon, with 
 adaptation to the different conditions of persons 
 and surroundings, the life of the individual will 
 be prolonged, and that in the course of genera- 
 tions a habit of living judiciously will be created 
 and transmitted from parents to children, and 
 that the duration of human life will gradually 
 be raised in a much larger number of cases to 
 its normal term, viz., about 100 years ; and I 
 further hope with Sir Crichton-Browne, Pro- 
 fessor Metchnikoff, Sir Lauder Brunton and 
 others that not only the duration of life will 
 be extended, but that also its usefulness will 
 be prolonged, its happiness increased and ter- 
 minated by old age and death without suffering. 
 
 I will close this discourse by summing up 
 some of the most important points more fully 
 discussed before : 
 
Recapitulation 193 
 
 (1) To maintain the vigour of all the organs, 
 the general vitality and resisting power of the 
 body by regular daily walks, rides, respiratory 
 and other exercises. 
 
 (2) To practise moderation in eating, drink- 
 ing, and all bodily enjoyment. 
 
 (3) To endeavour to obtain abundance of 
 pure air in the house, and to spend three or 
 four or as many hours as possible every day in 
 the open air. 
 
 (4) To counteract the inherited tendencies to 
 various diseases. 
 
 (5) To create, as far as possible, the habit of 
 going early to bed, and of rising early, and to 
 restrict the hours of sleep, in adult life, to six, 
 or seven, or exceptionally eight. 
 
 (6) To promote a healthy condition of the 
 skin by daily baths or ablutions. 
 
 (7) To keep the mental faculties in regular 
 occupation by appropriate work. 
 
 (8) To cultivate sympathy, equanimity, con- 
 tentedness, cheerfulness and hopefulness, and the 
 great power of the will towards pursuing the 
 path of duty and controlling anger, vanity, envy, 
 jealousy, and all other passions. 
 
194 
 
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ig6 On Means for the Prolongation of Life 
 
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2O2 On Means for the Prolongation of Life 
 
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203 
 
 INDEX. 
 
 PAGE 
 
 Abdominal pressure 141,183 
 
 Abernethy, diet and regimen 83 
 
 Acland, T. C., on sleep 169 
 
 Aged persons, their manner of living 83 
 
 Ages, great, of patriarchs and others 5 
 
 Air, purity of the, influence on health and longevity ... 18, 19, 43 
 
 Air-bath 37, 176 
 
 Alcohol, abstinence from ill ff, 122 
 
 and alcoholic beverages, a frequent cause of crime and 
 
 many diseases t ... in ff, 122 
 
 misuse of the term " moderation " 119, 120 
 
 in relation to mental and physical work 120 ff 
 
 neurotic affections 121 
 
 ,, old age ,. ... 118 
 
 as a medicine 114,121,122 
 
 sleep producer 170 
 
 Alcoholism inheritable ... 113 
 
 Allbutt, Sir Clifford, blood-pressure increased in old age ... 93 
 
 prevention of apoplexy 22 
 
 pathological anatomy and clinical symp- 
 
 toms of old age ... ... ... ... 3 
 
 Allchin, Sir W. H., excess of food 89 
 
 Ambition 157 
 
 Anaemia, occasionally in great meat consumers 76 
 
 Angling ... 56 
 
 Animal foods 59 
 
 great moderation in 93 
 
 Aperients, abuse of 141 
 
 Apoplexy, prevention of ... ... ... ... ... 22, 94 
 
 Arcachon a health resort for the aged 189 
 
 Arms, exercise of 35, 49 
 
 Arrowroot ... 69 
 
 Arterio-sclerosis from alcoholic stimulants 119 
 
 ,, ,, superabundant food 93 
 
2O4 On Means for the Prolongation of Life 
 
 PAGE 
 
 Arteriosclerosis from tobacco 133 
 
 ,, prevention of 29, 93 
 
 Arteritis obliterans 134 
 
 Asparagus 71 
 
 Atrophy, senile 24, 25 
 
 means to counteract it 25 
 
 Austin, E. K., the influence of climbing on the will 46 
 
 Bacon, Lord, influence of learning on diseases of the mind ... 161 
 
 Baeumler, Prof., arterio-sclerosis 76,117 
 
 injurious effects of excessive beer drinking ... 117 
 
 Balfour, G. W., on senile heart 3 
 
 Barley 69 
 
 Bath, beneficial effects of the daily 175 ff 
 
 different kinds of 177 
 
 Beans 69 
 
 Beauty, sense of 157 
 
 Beddoes, on the use of sanatogen 65 
 
 Beer, injurious effects of excessive drinking of 117 
 
 Biscuits 68 
 
 Blood-pressure increased 93 
 
 Blood-vessels, their importance for longevity 25,28 
 
 strengthened by exercise 26,28,46 
 
 Body-weight in old age ... ... ... ... ... ... 94 
 
 Bowels, action of 136 ff 
 
 Brain, nutrition of 27, 144 ff 
 
 Brain-workers and old age 163 ff 
 
 Bread, wholemeal and fine ... , 66 ff 
 
 Breathing deeply, habit of 52 
 
 exercises 47 ff 
 
 Broken heart from grief and loss of hope 150 
 
 Brown bread 67, 138 
 
 Brunton, Sir Lauder, mode of action and effects of muscular 
 
 exercise 26 ff 
 
 advantages of moderation 77 
 
 on mastication ... ... ... ... 98 
 
 alcohol 122 
 
 tea, coffee and cocoa 132 
 
 ,, the duty to avoid spreading infection ... 185 
 
 ,, the influence of low temperature ... 191 
 
Index 205 
 
 PAGE 
 
 Butter ... ... ... 63 
 
 Buttermilk 63 
 
 Caffeine 129 ff 
 
 Campbell, Dr. Harry, on mastication 98 
 
 respiratory exercises in the treatment of 
 
 disease 48 ff 
 
 Cannes as a health resort 191 
 
 Causes of death in parents, their importance on longevity ... 17 
 
 Cellulose 65 
 
 Centenarians 6 
 
 Cereals 66 ff 
 
 Change of air and place 187 
 
 work ... 147, 163 
 
 Cheerfulness, its beneficial influence 154,157 
 
 Cheese 64 
 
 Chestnuts 70 
 
 Cheyne, Dr. G., food in old age 93 
 
 Chittenden, nutrition 82, 89 
 
 Chocolate 131 
 
 Cicero, u De Senectute" 4 
 
 Circulatory system, influence of exercise on the 26 ff, 46 
 
 Climate, change of 39, 187 
 
 influence of, on the aged 189 ff 
 
 Climbing and alcohol 121 
 
 tours... ... ... ... 44 ff 
 
 Clothing 186 
 
 Cocoa and chocolate 131 
 
 Coffee, its effects 129 
 
 Cold weather, injurious influence on old and delicate persons 189 ff 
 Collective Investigation Committee of British Medical Associa- 
 tion 82 
 
 Common colds, infectiousness 185 
 
 Conscience 155 
 
 Constipation ... ... ... ... ... ... ... ... 136 
 
 Contentedness of mind 155,172 
 
 Cooking, importance of 100 ff 
 
 Cornaro, L., of Venice, about the small amount of food required 78, 82 
 
 Cream 63 
 
 Crichton-Browne, Sir J., development of the brain 163 
 
2o6 On Means for the Prolongation of Life 
 
 PAGE 
 
 Crichton-Browne, Sir J., prolongation of usefulness of life ... 191 
 
 Crimes frequent amongst drinkers 112 
 
 Cycling 55 
 
 Death not always easy after a "merry life" 13 
 
 early, combating hereditary tendency to 17 
 
 ,, from old age 24 
 
 Deep breathing 52 
 
 Diet in old age 93 
 
 restricted, good results of, cases 89 ff 
 
 strict rules suiting everybody impossible 74 
 
 Digestive system, influence on longevity 58 ff 
 
 Dipsomania ... ... ... ... ... ... ... ... 17 
 
 Disease, prevention of 18^94,184,185 
 
 Draughts 19 
 
 Drinkers often become criminals 112 
 
 Drinking at meals 97 
 
 water 95,96 
 
 Duckworth, Sir Dyce, on diet 89 
 
 Duration of human life 5, 191 
 
 Duty, sense of 155 
 
 Early rising 10 
 
 Ebstein on great moderation in old age 94 
 
 injuriousness of excessive beer drinking 118 
 
 Education 2, 185 
 
 Eggs 61 
 
 Environments, influence of 8 
 
 Epilepsy, connection with alcohol 122 
 
 Equanimity 158 
 
 Eucasin 65 
 
 Ewald, Professor, relation of the thyroid gland to senility ... 181 
 
 prolongation of life 5 
 
 Exercise of all the organs 25,26,28 
 
 physiology of muscular 28 
 
 walking , 30 
 
 of the arms ... 36 
 
 ,, left arm 37 
 
 different forms of 54 ff 
 
 static or tension 57 
 
Index 207 
 
 PAGE 
 
 Exhaustion to be avoided 35 
 
 Fallacy of relying too much on heredity 14 
 
 , about the quantity of food required 79 
 
 , alcohol in old age 118,119 
 
 ,, and mental and physical work ... 120,121 
 
 ,, body-weight in old age 94 
 
 Family history, importance of studying the causes of death in 
 
 families ... ... ... ... ... ... ... ... 17 
 
 Fencing 56 
 
 Fish as an article of food 61 
 
 Flesh food 59 ff 
 
 Fletcher, Horace, on mastication 98 
 
 amount of food required 89 
 
 Food, different kinds of 58 ff 
 
 necessity of adapting rules to each individual ... 74, 75, 85 
 average amount required by healthy adults ... 89 ff, 104 ff 
 
 amount to be diminished in old age 93 
 
 as palatable as possible 102 
 
 number of meals ... ... ... ... ... .., no 
 
 Foster, Sir Michael, on overfeeding 77 
 
 Fruit 73 
 
 Gardening 57 
 
 Gin 115 
 
 Glandular organs, ductless glands ... ... ... ... ... 181 
 
 Goethe, quotations 86, 156 
 
 old age of 164 
 
 Golf 56 
 
 Cowers, Sir W., over-work and rest in old age - 163 
 
 Graham bread 67, 138 
 
 Granola 68 
 
 Grapejuice 117 
 
 Grasse as a health resort in old age 180 
 
 Great age, some distinguished men who have attained it ... 190 
 
 Greece, longevity in 8 
 
 Green vegetables ... 70 ff 
 
 Grief and depression, injurious influence on the body 150 
 
 Gymnastic exercises combined with respiratory exercises ... 49 
 
208 On Means for the Prolongation of Life 
 
 PAGE 
 
 Gymnastic exercises of different kinds 54 ff 
 
 Habit of deep breathing to be cultivated 52 
 
 ,, to walk fast or slowly, to undergo great exertion 34 ff 
 
 Habits of long-lived people 83 
 
 Haig, Dr. A., on Diet 86 
 
 on tea and meat ... ... ... ... ... 127 
 
 Hair, management of the, changes of colour, loss of 179 
 
 Happiness 154 
 
 Haste, injurious influence of 154 
 
 Health resorts for the aged 189 
 
 Heart, vigour of, in connection with longevity 14 
 
 ,, influence of climbing tours on the 46 
 
 "broken" 150 
 
 kept healthy by work 28 ff 
 
 Heredity in relation to longevity 13 ff 
 
 the tendency to long life to be cultivated 16 
 
 to early death to be counteracted 17, 20 ff 
 
 Hirschfeld on food 61 
 
 Hope 12 
 
 Horsley, Sir Victor, on the relation of the thyroid gland to senility 1 8 1 
 
 injurious effects of alcohol 120 
 
 House, the I9> 187 
 
 Humphry, Professor G., analysis of Committee of Investigation 82 
 
 Hurry, injurious effects of 158 
 
 Hutchison, Dr. R., on food 59> 77 
 
 overfeeding 78 
 
 on tea, coffee and cocoa 126 ff 
 
 Hygiene of the skin 175 ff 
 
 Hypnotics to be avoided ... 170 
 
 Imagination, morbid ... ... ... ... 148 
 
 Infant mortality ... ... ... I 
 
 Infection 18, 184 
 
 to avoid spreading it ... ... ... ... > ^4 
 
 Japanese, great moderation of 81 
 
 Jenner, E., vaccination I 
 
 Jews, their longevity 9 
 
 Joy, influence on the functions of the body 15 
 
Index 209 
 
 PAGE 
 
 Kant, Immanuel, on sleep 171 
 
 Keith, Dr. George, about food 82,108 
 
 Koch, pathogenic microbes ... ... ... ... ... ... i 
 
 Kocher, Professor, on the thyroid gland 182 
 
 Koenig, T., on coffee 129 
 
 Kola 130 
 
 Kraepelin, E., on alcohol 120 
 
 Lankester, Sir Ray, comparative longevity 4 
 
 Lazarus, Professor, on smoking 134 
 
 Legumin and leguminous vegetables ... ... ... ... 69 
 
 Lentils 69 
 
 Life, natural term of 5 ff, 191 
 
 Ling's Swedish gymnastics 54 
 
 Lister, Lord, pathogenic microbes i 
 
 Longevity in different countries ... 8 
 
 influenced by environments 8 
 
 Long life, habits of promoting long life not so difficult ... 10, n 
 
 ,, tendency, how to create it 10 
 
 Long-lived persons, their mode of living ... ... ... ... 10 
 
 maintaining mental vitality 164 
 
 Lorant, Dr. A., on senility in connection with the thyroid gland 181 
 
 Ludwig, physiology of muscular exercise ... ... ... ... 26 ff 
 
 Maize 69 
 
 Makrophages, their relation to'senile decay 25, 179 
 
 Margarine 64 
 
 Massage of the head 180 
 
 thyroid and parathyroid glands 182 
 
 eyes, ears, &c ... 184 
 
 Mastication, great importance of 98 ff 
 
 Meat, great moderation in ... 76 ff 
 
 "not necessary" 88 
 
 Mehler, influence of alcohol on wrestlers 121 
 
 Mental depression, effects of. 150 ff 
 
 diseases and deviations, prevention of 161 
 
 occupation, beneficial effect of 144 ff 
 
 variety of 147 
 
 ,, overwork ... ... ... ... ... ... >.. 162 
 
 vitality in old age 164 ft 
 
 H 
 
2io On Means for the Prolongation of Life 
 
 PAGE 
 
 Mental paralysis 151 
 
 Metchnikoff, senile decay 3*25,179 
 
 longevity in the Balkans ... 9 
 
 ,, on milk 62 
 
 i, prevention of syphilis 18 
 
 simple food 103 
 
 Michels, Dr. E., "arteritis obliterans," probably from tobacco... 134 
 
 Microbes, pathogenic I 
 
 Military training 55 
 
 Milk 6iff 
 
 Milk bacillus 62 
 
 Mind, necessity of its occupation ... ... ... ... ...144 ff 
 
 great influence over all functions of the body, instances of 148 ff 
 
 Mineral constituents of food 59 
 
 Mode of life of long-lived persons 10 ff 
 
 Moderate drinkers 112,119 
 
 Moderation in food ... ... ... ... ... ... 75, 79, 193 
 
 Moltke's rule of living 38 
 
 Morris, Sir Malcolm, on the management of the skin 179 
 
 Mosso, on the brain 27,148 
 
 Murphy, Sir Shirley, the house 187 
 
 Muscular exercise, mode of action 26 ff 
 
 system nourished by exercise 27,32 
 
 Myxoedema-like symptoms in old age 182 
 
 Narcotics 170 
 
 Natural term of life 5 
 
 Nerve-cells, their nutrition ... ... ... ... ... ... 27 
 
 Nervous system, important influence of 143 ff 
 
 Nervousness ... ... ... ... ... ... ... ... 158 
 
 Neurasthenia and alcohol 122 
 
 Noorden, Professor C. von, foodstuffs 58, 59, 60 
 
 ,, restriction of food in old age ... 94 
 Nutrose 64 
 
 Oats 68 
 
 Occupation, importance of, for health 145 ff 
 
 Oertel, clinical symptoms of old age 3 
 
 graduated uphill exercise , 37 
 
 Old age no intolerable burden 12 
 
Index 2 1 1 
 
 PAGE 
 
 Old age, with conservation of energy ... ... ... ... 170 
 
 ., death from 24 
 
 ., and alcohol 118 
 
 climate... ... 9, 39, 187 ff 
 
 Oliver, G., muscular exercises 26, 29 
 
 ,, static exercises 57 
 
 ., fluid exchange between blood and tissues ... 29, 32, 57 
 
 ., ., sleep, restorer of nutrition 168 
 
 Onions 71 
 
 Open-air life, importance of 43,44 
 
 Opium smoking 135 
 
 Osier, Professor, mental changes in old age 167 
 
 Over-exertion 42, 47 
 
 Over-work, mental 162,165 
 
 Over-feeding 75 
 
 Over-rest 42 
 
 Owen, Sir Isambard, analysis of the collective investigation 
 
 results as to influence of alcohol on longevity ... 82, 124 
 
 Paralysis, mental 151 
 
 Parathyroid gland 181 
 
 Parkes, E. A., on coffee and tea 129 ff 
 
 Pasteur, pathogenic microbes ... i 
 
 experiment on fowls with regard to anthrax 190 
 
 Pau, a health resort for the aged 190 
 
 Peas 69 
 
 Pel, Dr. P. K., the art of living a healthy and happy life ... 2 
 
 Pessimism ... ... ... ... ... ... ... ... 166 
 
 Pflueger, pathogenic microbes i 
 
 Phagocytes 25 
 
 Physical education 2 
 
 Plasmon 64 
 
 Pleasure 154 
 
 Polenta 69 
 
 Pollock, James E., usefulness of change of work 163 
 
 Potatoes 71 
 
 Preservation of milk 62 
 
 Prevention of disease 18 ff, 94, 184, 185 
 
 Pulses, their nutritive value 69 
 
 Pure air, importance of 1 8, 19, 43 
 
2 r 2 On Means for the Prolongation of Life 
 
 PAGE 
 
 Quantity of food 104 ff 
 
 Race influence on longevity .., 9 
 
 "Resisting power" increased by physical education 2 
 
 increased by long walks 43 
 
 living in the open air ... 19, 43, 44 
 
 respiratory exercise ... 53,54,55 
 
 impaired by excessive quantities of alcohol 119 
 
 one of the great factors of longevity ... 43 
 
 decreases in old age 189 
 
 Respiratory exercises, their effect on the circulation, on the 
 
 chest walls and lungs 47 ff 
 
 Rice 69 
 
 Rising early ... ... ... ... ... ... ... ... 10 
 
 Riviera, the, a climate for the aged 190 
 
 Roberts, William, digestion and diet 131 
 
 Roots 71,72 
 
 Rules for the prolongation of life 11 
 
 Rye and rye bread 65,66 
 
 Sago 69 
 
 Salad 74 
 
 Salt, culinary, and other salts 94 
 
 ,, beef 102 
 
 Sanatogen 64 
 
 Sandow's exercises 55 
 
 Satisfaction and dissatisfaction with oneself 154 
 
 Savill, T. D., changes from old age 3*24 
 
 alcohol as a medicine 122 
 
 Schmidt, on constipation ... ... ... ... ... ... 138 
 
 Sealy, Dr. G. S., lighter meals 79, 80 
 
 Self-education 157 
 
 indulgence 13, 157 
 
 control 13 
 
 Selfishness 155 
 
 Senile atrophy, the cause of death 24 
 
 Sense of duty, cultivation of 154 
 
 Senses, special 183 
 
 Shakespeare, quotations from 12,123,156,162 
 
 Shelters, their necessity at all health resorts 39, 44 
 
Index 213 
 
 PAGE 
 
 Sinclair, Sir G., on sleep ... ... ... ... ... ... 171 
 
 Skim milk ... ... ... ... ... ... ... ... 63 
 
 Skin, attention to the 175 
 
 Sleep, amount required varying 168 
 
 Sleeping drugs to be avoided 164 
 
 Smoking, injurious effect on some persons 133 flf 
 
 Snuff, its action 134 ff 
 
 Sour milk 62 
 
 Sparkling waters 96 
 
 Spirits 115 
 
 Starvation diet, erroneously called 76 
 
 Static exercises 57 
 
 Stewing '102 
 
 Streber's exercises 55 
 
 Success, influence on health... ... ... ... ... ... 150 
 
 Sugar 73 
 
 Sun-bath 177 
 
 Swedish gymnastics 54 
 
 Table waters 96 
 
 Tapioka 69 
 
 Tatham, Dr., centenarians in England 6 
 
 Tea, its effects 125 ff 
 
 Teeth, necessity of attending to 99 
 
 Temperance and intemperance, see Alcoholic Beverages. 
 Temperature, low, injurious influence on the aged ... ... 191 
 
 Temple, Sir William, regimen 83 
 
 Tension exercise 57 
 
 Thorn, W., human longevity 6 
 
 Thompson, Sir Henry, diet 77, 82, 93 
 
 Thoroughness 157 
 
 Thyroid gland 181 ff 
 
 Tobacco, its injurious effects 133 
 
 Travelling, influence on health ... ... ... ... ... 188 
 
 Treves, Sir Frederick, on alcohol = in 
 
 clothing 187 
 
 "Turnen" 55 
 
 Van Someren, Dr. E. H., on mastication 98 
 
 15 
 
214 On Means for the Prolongation of Life 
 
 PAGE 
 
 Vegetable foods 65 
 
 Vegetarians 84 
 
 Walker-Hall, purin bodies in beer 116 
 
 Walking exercise, mode of action 30 
 
 ,, amount of 33 
 
 graduated uphill 37 
 
 hard, to be avoided after meals 38 
 
 in all weathers 38 
 
 pace of ... 34 
 
 days of long walks 39 
 
 tours or climbing tours 44 ff 
 
 " without an object " 44 
 
 Waste products, removal of 30,41,46 
 
 Water drinking, excessive, at meals 96 
 
 importance of pure drinking ... 95 
 
 Watson's experiments on rats 76 
 
 " Wearing-out " theory 23,42 
 
 Weber, Dr. F. Parkes, arteritis obliterans, probably from tobacco 134 
 
 ,, pathological anatomy of old age 3,24 
 
 Weekly long walk 39 
 
 Weight of body, decrease in old age 94 
 
 Whisky , 115 
 
 Whitaker, Sir T. P., mortality amongst total abstainers compared 
 
 with that of non-abstainers from alcoholic beverages ... 112 
 
 Wholemeal bread 66, 67, 138 
 
 Wilks, Sir Samuel, correction of hereditary tendencies 162 
 
 mental changes in old age 4, 167 
 
 Will, the, its influence on health and prolongation of life ... 158 ff 
 
 Wine 116 
 
 Wood, Neville, on constipation 138 
 
 Work, at night or in the morning 173, 174 
 
 mental, beneficial effect of 143, 144, 147 
 
 Worry, injurious effect of 152 
 
 Wrestlers and alcohol 121 
 
 Yeo, Dr. Burney, about food 82 
 
 Young, T. E., on centenarians 6 
 
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