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W

hen the Norwegian Red Cross Journal was born in 1921, its parents silently hoped that it might some day earn its own living. It has done so from birth. On its first birthday there was a balance of kr. 3,688. A year later the balance in its favour was kr. 4,624. For the third year, 1923, the balance was kr. 7,088. The parents of this infant prodigy hope for a balance of kr. 10,000 for 1924. There is nothing succeeds like success, and we are sure the good parents will not be disappointed. We have counted 141 advertisements in the number before us (No 4, 1924), and beg to congratulate both the advertisers and the manager of the Journal on having discovered each other, to the benefit of all parties.

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The great scourges of mankind, tuberculosis, syphilis, cancer and infant mortality, are not the only evils which demand the attention of the health worker. There are unfortunately many other diseases, less striking in their manifestations, but none the less serious both on account of the gravity of their effects and the great number of people they affect. The insidiousness of their onset is no reason for neglecting them, it should be rather a reason for taking precautions and trying to combat them through prevention. Arteriosclerosis should be considered in the first rank of such diseases. It is a disease which is not widely known by the general public, but which nevertheless strikes almost everybody and is only too often one of the main causes of premature old age, decay and death.

It is a disease of all times and all peoples, and according to Professor Guicart in his study on medicine in the time of the Pharaohs (1), which was inspired by the work of Sir Armand Rufer, the Egyptologist: "Arteriosclerosis, generally considered as a disease which is becoming more prevalent as time goes on, was just as rife at the time of the XXIst dynasty, that is about 1,000 B. C., as it is to-day. As a matter of fact, out of 24 mummies examined for this disease, 6 were found to be intact, 5 showed only slight alterations, but 13 showed important lesions, particularly a more or less diffuse calcification of the aorta, and sometimes an actual ossification of the arteries. Moreover an observation of the heads of mummies preserved in museums will show that certain of them have tortuous temporal arteries, even in the case of relatively young men. We can

(1) La Médecine au temps des Pharaons. La Biologie Médicale, Novembre 1922.

see from this that atheroma existed even in early antiquity. We may well ask what was the cause, for we must eliminate tobacco, which the Egyptians did not know, and syphilis, of which we have not been able with any certainty to find the least trace in ancient Egypt. We can hardly throw the blame on meat, for the diet of the Egyptians was largely vegetarian. There remains alcohol; we know, as a matter of fact, that they used beer and wine, and we shall even see that they had no scruples about becoming intoxicated on the occasion of banquets; they were never, however, considered as great drinkers. Rufer states that he made a post-mortem examination of 800 pilgrims returning from Mecca, and he asserts that arterial lesions were as frequent and manifested themselves as early in abstainers as in regular drinkers.

Without insisting now on the causes of arteriosclerosis, to which we shall come back presently, we are going to try to give not a scientific and absolutely accurate definition of the disease, but some idea of what it involves.

Generally speaking, we may say that arteriosclerosis is due to the aging of the arteries, the walls of the arteries becoming infiltrated with calcium salts, thus losing their elasticity. The objection will perhaps be raised that it does not seem important whether the arteries are hard or flexible, and that the blood flows just as well in the one case as in the other. This is a serious mistake, and we might recall the classic example of the rubber pipe and the glass pipe. It is obvious that the former is the one which keeps the flow of the liquid perfectly regulated, especially when it is propelled by successive waves, as in the case of the blood which is sent through the system by the beating of the heart. The importance of arterial soundness, particularly as to elasticity, is so great that according to a popular saying "we are as old as our arteries." The blood is the nourishing and regenerating fluid which provides the material necessary for the preservation and growth of the tissues. In a case of arteriosclerosis the flow of blood is insufticient and the organs suffer two harmful results : in the first place they are not properly regenerated, and in the second place waste products, which are normally carried away by the blood, do not find sufficient outlet, but remain to poison the organism.

SERIOUS CONSEQUENCES

It is clear, then, that a defect which at first glance is commonplace and almost insignificant, is the cause of very serious consequences. Dr. Jarroway of New York has compiled statistics which show that out of 100 arterio

sclerosis patients, 29 die of cardiac insufficiency,

36 of renal insufficiency and 14 of cerebral hæmorrhage, not counting the various complications not mentioned here, such as angina pectoris, acute cædema of the lungs, etc. The importance of arteriosclerosis, inasmuch as it is the cause of other diseases, should not, therefore, be overlooked, and we were not exaggerating when we said at the beginning of this article that it was one of the most important causes of death.

It is interesting to have some definite ideas on the subject, and to know the principal causes leading to this disease as well as the means of combating it and particularly of avoiding it. If it is necessary to fight against the disease when it is clearly manifested in a patient, it is perhaps still more important to do so as soon as it is suspected in a person still apparently in the best of health. In this study we shall follow the excellent book which Dr. Scheffler has just published on the subject (2), and which we should like to see very widely read. It is a clear and detailed treatise

(2) Prophylaxie et traitement de l'artério-sclérose, by Dr. Scheffler (Encyclopédie illustrée des actualités scientifiques). 1923. Paris. Librairie Aristide Quillet.

on arteriosclerosis, and the reader will get a real insight into the subject without being confronted with explanations of too scientific a nature. Symptoms, diagnosis and prognosis are considered according to the most modern ideas, and the book contains what is still more valuable, a programme for prevention and treatment which should be of the greatest service.

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The most important cause of arteriosclerosis is old age. This may seem at first glance to be the most difficult to avoid, but it is a fact that if we take the necessary health precautions, it is possible to delay the appearance of lesions of the arterial system, and thus prolong our lives. The principal precaution to be taken in this connexion is to avoid all causes of intoxication of the organism. Among these we might mention lead, alcohol, tobacco, and a defective diet. We shall not speak of lead poisoning, for lead does not play an important part among the poisons which affect human beings except in particular cases (painters, workmen in lead mines, etc) although Dr. Scheffler thinks that lead water conduits may in the long run constitute an appreciable cause of poisoning. Alcohol is frequent, more serious, and also more avoidable cause tea and coffee must be added if taken in excess. Tobacco must also be used in moderation, for its action, although less deadly than that of alcohol, is also detrimental. But the most important cause of arteriosclerosis is certainly defective diet. The immoderate use of meat should be condemned particularly. It is well known that a meat diet produces poisons in the organism which are more difficult to eliminate in proportion to the quantities in which they are present. In addition to these intoxications of a dietary origin, there are others more general, among which must be classed brain work when it is not accompanied by sufficient physical exercise, muscular fatigue and infectious diseases, particularly acute articular rheumatism.

We shall pass briefly over the symptoms of arteriosclerosis although they are a very interesting study, for, particularly at first, they

are very difficult to discern and interpret. Often only the doctor can make an early diagnosis of the disease, and that is one of the principal reasons why all health workers advocate an annual medical examination as one of the most important rules for keeping in good health. This examination, which at first sight may seem unnecessary, is, as a matter of fact, extremely important in order to ensure prevention of disease. A regular and frequent medical examination of every individual is necessary, just as the regular supervision of elevators, aeroplanes, locomotives, etc, is necessary. The more complex an organism is, the more mechanism it possesses, and its operation is correspondingly more delicate and its control more necessary. What machine could be more complex than the human machine, and why should the annual regulation of this machine seeni unnecessary? Among the infallible symptoms of arteriosclerosis we must mention first of all increase of arterial pressure and of the quantity of urea in the blood, which indicate the commencement of renal insufficiency and incipient intoxication of the organism But, as we have just said, only the doctor can detect the presence of these symptoms, for special apparatus requiring very delicate handling must be used.

HOW TO AVOID ARTERIOSCLEROSIS

drink too much wine; to cut down the quantity of meat; and to do without an evening meal altogether. It is also necessary to avoid overwork, intellectual as well as physical, noting particularly that a sedentary life, when it is not balanced by sufficient physical exercise, leads to arteriosclerosis and consequently to premature old age since it obstructs the elimination of toxic substances. That is why it is necessary to insist on the danger unconsciously run by many people whose duties keep them in one position most of the day. These arteriosclerosis candidates should know that they must balance their sedentary life by sports and exercises, or at least by long walks out of working hours. There is no question of going in for sport immoderately, for in the case of people of forty or fifty with no athletic training, the cure would be worse than the disease. Physical exercise is necessary, but it should be moderate, progressive, and adapted to each individual temperament. Moreover, even in offices and workshops it is often possible to improve hygienic conditions by better ventilation and supervision of the position of the workers, etc.

There are many other ways of helping in the elimination of the toxins which accumulate in the organism. Among the most noteworthy, both because of their simplicity and their effectiveness, we will mention gymnastic exercises, particularly those which involve movements of the arms and trunk early in the morning before an open window. It is an excellent way of beginning the day, if care is taken to accompany the physical exercises with deep breathing. Hydrotherapy in its various forms, cold washes, cold and tepid shower 1. Cut down the number of toxic substances baths, and tepid baths tend to improve the reaching the organism. respiratory system and encourage cutaneous respiration. Rest and sleep must not be forgotten. The latter is of supreme importance.

How, then, can arteriosclerosis be avoided and how can its development be arrested? In considering the causes of this disease, we have shown briefly the principal means of avoiding it Dr. Scheffler summarizes them very aptly in three sentences :

2. Keep the toxic substances as much as possible from developing in the organism. 3. Encourage the elimination of toxic sub- Physiologists have shown that during sleep the stances from the organism.

To obey the first principle, we must remember that it is necessary to avoid lead poisoning if possible; to abstain from alcohol and to a certain extent from tea and coffee; not to

conductibility of the nerve fibres is greatly diminished, and the result is a rest for the nerve cells which renews them and rids them of toxins and prepares them for work again. What is true for the nervous system is no less

so for the other parts of the organism, and everybody knows the feeling of well-being that takes possession of one after a good night's sleep in a properly aired room.

The prevention of arteriosclerosis, therefore, depends on the strictest possible observance

of the general rules of hygiene. This is a very interesting conclusion, since through teaching these rules and putting them into practice we accomplish a doubly useful work, the aim of which is to live better and live long

er.

<<The Junior Red Cross is the bond between children of all countries». This poster, which was drawn by a New Zealand Junior, won the prize in a poster competition organized in connexion with the Health Week.

The School-Girl Way in Belgium

The pupils of the Péruwelz Secondary School for Girls (Belgium) have actually belonged to the Junior Red Cross only for a few months. But for a long time they have been doing deeds of kindness and helpfulness, prompted by the same spirit that actuates the Juniors in their work. They have sent Father Christmas calling on poor children, laden with clothing and toys and sweets, the money for which they earned themselves. They have made little garments for very tiny babies and sent them to the "Milk Centre" to be distributed; they have knitted all kinds of woollen things for children from three to six years old, and recently gave a big party in the school-yard, when the delighted children received their gifts. On "tag" and "flower" days, these persevering little girls have been all over the town, getting money for various charities. And of course they raised a subscription for the child victims of the Russian famine. Last, but not least, they took an active part in the Japanese earthquake relief. The dainty lady on the opposite page graced a calendar designed and painted by these clever girls and sold with paper chrysanthemums and nosegays of natural flowers in cafés, cinemas, and other public places.

This is all told in a charming way by Mademoiselle Ida Laurent in a letter to some American Juniors, enclosing one of the Japanese calendars. We are sorry all cannot see the exquisite colouring of the picture, but at any rate it gives a very fair idea of the work these enterprising girls are doing.

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