Arteriosclerosis is a condition which mostly affects those who have passed life's meridian, although it may develop in those of earlier age. There are several causes predisposing to the condition, but probably the most prominent in point of number of victims is the habits of daily life. It is practically a disease belonging to civilization, more especially to modern civilization, although we lack data to decide whether it exists in savage life. There are a few other diseases which undoubtedly predispose to this condition, such as gout, rheumatism, acute infectious diseases, and to a certain extent syphilis, although there is serious doubt if arteriosclerosis and syphilitic endarteritis have so very much in common. Probably in advance of all other causes comes disobedience of the laws of hygiene. As a rule the patient has since the age of twenty-five or thereabouts led a sedentary life with almost no active exercise, and has continued the diet of days when he was active and quite likely athletic; as times got easy with him he even added more articles to his bill of fare, eating sweets and butcher's meats more than before because he liked them and could afford it. Alcoholic stimulants are usually credited with being a frequent cause, but observations made in Europe seem to indicate that its influence has been overestimated in this relation, however much trouble they may have caused in other directions. There is not much evidence that the tendency is inherited. More men than women are afflicted.

The symptomatology varies somewhat according as the chief trouble is general, or more or less focal, and as to the stage of the disease when the case is first seen. As a rule the physician is first consulted for some one or more of the sequelæ or secondary symptoms or those of focal sclerosis. Probably the most uniform and constant symptom is vertigo; this is most likely to be present during the day-time, or rather while sitting or standing erect, being relieved on lying down. This change is probably the result of

*Read before the Bosten Homeopathic Medical Society. November 11, 1909.

change in the hemostatic pressure in the cerebral vessels and is most prominent in the cerebral type. Also in this type there is often a mental slowness, not at first noticed by the patient, or if noticed not acknowledged, any little difficulty of this nature being attributed to an attack of indigestion. At first the person may seem not to have heard a question asked, but a careful observation will show that there is a lack of quick comprehension. When once aroused the mind may work regularly, and even for some time improve in its activity; herein it differs from the mental weakness of neurasthenia where the mental weakness is quite directly in proportion to the duration of the effort. This mental torpor increases by giving a physical stupor; the patient sleeps a great deal during the day, but is apt to be a poor sleeper at night-this again is probably the result of position. Digestive trouble of greater or less severity has usually appeared by this time. Whether or not this is the result of disordered nervous control, or is more direct in its origin, it is the common symptom which first brings the patient to one, and is a most perplexing symptom as affecting diagnosis. There is the accumulation of gas in the abdomen, the distress either before or after eating, the constipation, coated tongue, all of which are common to neurasthenia, hysteria, and other morbid conditions, and which, if one is not on guard, do not suggest arteriosclerosis. The radials, or temporals, or both, may or may not be found stiff (always using two fingers, preferably one finger of each hand). In the early stage this may be only a diminished compressability; in most cases the blood pressure is high.

I would here caution you against placing too much reliance on the sphygmomanometer. In the hands of anyone but an expert it seems to be endowed with more possibilities for mistakes than any other diagnostic instrument; I certainly prefer my fingers. For many years the tortuosity of the temporals was considered a reliable measure of the condition of the arteries, this is not now esteemed so highly.

In the treatment of this disease there must at the outset be some variation depending upon the urgency of focal symptoms. The first demand in treatment, no matter whether the sclerosis is general or focal, is to control and limit the diet. Nearly all the patients have been for a long time, and are still, taking more proteid food than they can physiologically dispose of, and this is very likely an important factor in the origin of the trouble, certainly in its continuance. For a time beef, mutton, lamb, and veal should be practically prohibited; clear soup may be allowed in moderation as it does not contain much beside flavoring anyway, but the flavoring should not be stimulating spices. Fruit of the citrus group may safely be taken early in the day, but always without sugar: in point of fact sugar should not be used at all until improvement is well established. Alcoholic stimulants are prohibited where it is safe, which is not always nor in all stages, for there are patients who have for years been in the habit of taking wine in moderate

quantities with their dinner; they might be in just such a condition. that a sudden cessation would be unfavorable, therefore it should be removed gradually, and the lighter wines substituted for stronger beverages; the wines of Moselle and the Rhine are the least injurious. Intestinal and gastric fermentation are present in the majority of all cases, and very much help to perpetuate the main trouble by their toxic products. Aside from the usual selected. remedy I have seen much good follow the use of buttermilk, or what is still better, the milk prepared from "Lactone" tablets. The proper preparation of this requires some little care on the part of the housewife. When the kidneys are involved there is a strong temptation to put the patient on an exclusive milk diet, but this is not always good policy as milk carries a large percentage of lime salts, and this is one of the things we wish to avoid. In my sclerotic cases I always limit even buttermilk to one pint a day for the reason mentioned.

A large proportion of sclerotics are, or have been, heavy smokers, and this of course must be attended to. I suspect the insomnia may be made worse by sleeping in ill-ventilated rooms, particularly those cases where the insomnia is in the first hours of the night; I fancy that in some cases tent life would be generally useful. We have seen that the greater number of these individuals have been leading a sedentary life for at least a dozen years, and know that they suffer from insufficient exercise; exercise they must have, but how much? This is a more important question than it seems. A man who has once been active but for fifteen or more years has led a sedentary life, has a muscular system which has undergone deterioration from which it cannot readily recover after the age of fifty, and any unwise effort to develop muscular tissue carries with it some danger to the heart or vessels; exercise should therefore begin in a small way, and never be carried to the extreme limit in elderly men. The amount of water taken should be abundant, but not excessive. It is of importance that it be pure and taken in small draughts, as irrigation of the stomach may temporarily increase the blood pressure.

As to remedies in our materia medica those applying directly to sclerosis are not many, but secondary results multiply them materially. For systemic sclerosis in those who are old enough to be entitled to the disease, nothing fits the case better than that "old man's remedy." secale. Both from its symptomatology and from its known action on the circulation in the brain and cord it seems to be well adapted; at advanced age the central nervous system feels the strain and causes symptoms akin to secale. For sclerosis earlier in life, general in extent, and mostly due to actual transgression instead of original sin, there is no drug better than chloride of gold and sodium; this has the advantage of being equally applicable for the basic condition, and for the consequent errors in metabolism which continue and aggravate the original condition. It is so often the case that a serious state of the kid