sition, and that he must present a pleasing appearance and perform his duties satisfactorily. He found it extremely difficult to adapt himself to the new routine of life, especially to institutional restrictions, the close association with young individuals, and the better care of his person. It required the combined effort of pleading by his family, goading and encouragement of the more thoughtful of his associates and the ridicule of the more frivolous ones to induce him to take better care of himself and make a pleasing appearance. After a visit to the Turkish bath, the barber and the manicurist, and donning a new suit, he was delighted with the change in his appearance, but being shy and diffident, he was afraid others would consider him giddy or might ascribe his action to unworthy motives.

The favorable comments of everyone who knew him encouraged him, and he was determined to continue to take better care of himself. Flattery by the Flattery by the younger associates, which is often a more powerful argument than reason or threats, spurred him in this and in other directions. He took part in their discussions at the dining table, and when he found that he could not sustain his arguments in favor of old ways and customs against their arguments in favor of the new order and progressive ways, he adopted their views, and in this way he became imbued with a new spirit. He took part in social affairs, and despite the stiffness of his joints he took dancing lessons. The stiffness gradually wore off and he became a fair dancer. Encouraged by an athletic instructor he took up mild athletics, and in a few months was able to exercise on parallel bars, flying rings, climbing poles, etc., and in the field he took part in boys'

En

sports, playing baseball, basketball and running races with them. He was now determined to regain and retain the spirit of youth. Removal of his beard and care of the skin and a generally pleased and animated expression changed his facial appearance, and today he would be taken for a man of forty or forty-five. A pair of shoulder braces forces his shoulders back, and this with the constant mental admonition to 'brace up' keeps him in an erect attitude. His gait is brisk, movements active, and he deports himself as a young man. A few months ago he took part in a foot race with trained athletes. Mentally alert, his conversation has become animated and interesting, and where formerly his mind was centered on his special scientific investigations and literary work, now he takes an interest in almost everything that is of public interest, taking liberal, even radical views in politics and economics, social matters, art, science, etc. He is still interested in his own field, but it is no longer the all-absorbing interest; it has become a hobby, no longer a life work. An examination made now for the purpose of comparing his present condition with his condition two years ago shows the following: Weight 160, general appearance healthy. The sallowness has given way to a healthy flush, the skin clear and slightly tanned. Body erect, movements active, energetic, attitude and gait those of an active man of 35 or 40. The expression is bright and cheerful and animated, but becoming serious and thoughtful when discussing the subject of his former scientific work. He is mentally alert, able to maintain prolonged attention and mental concentration. His writing is again clear, a comparison of letters written today with let ters written shortly before his break

down two years ago showing a remarkable improvement in his handwriting, in continuity of ideas and reasoning ability. He does little literary work now, only when he is in a writing mood, but then he will write for hours, ideas coming as fast as they did formerly. For several years before his breakdown his writings dealt almost exclusively with his scientific work. Now he seldom writes on this subject, but deals with a variety of other subjects, including short stories, sociological subjects, accounts of travels,

etc.

He is energetic and sociable, seeking companions among both sexes, is a member of several medical, social and fraternal organizations, taking an active part in their discussions and affairs. Virility has been restored partly thru the use of aphrodisiacs, partly thru stimulation of the emotions as a result of close association with young persons. The physical examination showed systolic pressure of 145, diastolic 110, pulse 70, strong full, but vessels hard; respiration 18, normal. Heart hypertrophied, with an occasional diastolic murmur at the base. Pleuritic friction sounds but no rales. The enteroptosis disappeared after wearing an abdominal supporter for a few months, and this also relieved. to some extent the gastroptosis. There is no clapotage at present. The abdominal muscles appear to be firmer and there. is less abdominal fat. This is probably due to the gymnastic exercises which he kept up faithfully almost daily for over a year, and to the same cause can be ascribed the firmer muscles of the arms and legs, which were formerly soft and flabby.

The circulation is greatly improved, the hands and feet being now warm and having a healthy flush, and while the

veins in the hands and in the lower limbs are still prominent the varicosities have disappeared. The disappearance of the varicosities is probably due in part to the improved circulation, in part to gentle massage over the varicosed areas, continued for several months. It was found that after he had been in the hot room of the Turkish bath for a few minutes the veins were not as prominent as before. The rubber was instructed to gently massage the legs instead of kneading the muscles forcibly, and some of the smaller varixes disappeared under this treatment, some disappearing after the first bath. The face is fuller and the wrinkles on the forehead, which, together with the strained, pre-occupied expression and wasted muscles and fat, gave the face its aged appearance, have almost entirely disappeared. Of the objective manifes tations of age, which were present two years ago, the bald head and graying hair, the scrawny neck, wasted buttocks, thin hands and filled veins, and wasted intercostal muscles remain. Of the subjective manifestations he says he still notices some signs of ageing, such as poor memory, anosmia, presbyacusia, presbyopia, dyspnea and palpitation upon exertion, as when running up stairs, and occasional cramps in the legs after a brisk walk. Having become more alert, the presbyacusia has become less noticeable and glasses have relieved the presbyopia. He is also more attentive to conversation and all sensory impressions, and he can retain names and numbers better than before, altho he has still difficulty in recalling names and numbers that he had used before his breakdown and not since. He has become optimistic, hopeful and cheerful, takes an interest in the affairs of the day, and in almost everything that is of general interest.

He says the profound change in his mode of life and his new associations have brought out and developed traits and characteristics which have been suppressed since his youth; that he is in fact leading a new life, the life of a young man. Some of the physical changes in the two years are as marked as some of the objective and subjective changes. The most important is the general physical improvement due to the improved circulation. This was brought about mainly thru outdoor life and exercise, regular hours and attention to the excretory functions; also to the improvement in respiration brought about by the wearing of shoulder braces, the open air and the mental admonition to 'brace up.' Undoubtedly the vitiated blood played some part in producing the mental sluggishness which existed before the breakdown two years ago. The mental change was due mainly to the forced association with young persons who were able to break down his reserve and diffidence and impress upon him their own youthful spirit and enthusiasm. When this was done and the association became habitual new emotions and sentiments were aroused, and these led to new desires and ambitions. Vanity or pride in appearance, the most difficult yet most important factor in producing the sense of rejuvenescence in the aged, was thus aroused, and created in turn the desire to appear youthful and to act accordingly, and instilled the spirit of youth. Thruout this whole process the man kept constantly in mind his years and the necessity for observing the rules of health if he would not relapse into his former state. With the exception of the aphrodisiacs of which he took but few doses, he has taken no drugs since his recovery from the breakdown two years

ago. He is regular in his habits, sleeps seven hours a day, enjoys three meals a day, a light breakfast, a light lunch and a heavy dinner, has a regular bowel movement at the same hour every morning and has no aches or any other distressing symptoms, aside from the dyspnea and palpitation upon excessive exertion. A few months ago he passed a rigid life insurance examination, the examiner assuring him he could find no trace of heart murmur, or any other unfavorable feature.

This case is not unique, except perhaps in the profound changes that have followed the line of treatment I have advocated for years in dealing with the aged. I have seen similar changes, but not so marked, in cases of men and women in the seventh and eighth decades of life. In some cases there was no thought of rejuvenescence, the change in the mode of life having been made to prevent a recurrence of mental and physical breakdown. In other cases the object was, primarily or incidentally, temporary rejuvenescence. A man, now 84 years of age, was ten years decrepit mentally and physically. He married a woman of 27 who had been his housekeeper for several years. Thru his association with her and her young friends he became stimulated mentally and again took an interest in life. Flattery aroused his vanity, and he made efforts to present a pleasing appearance and appear spry and active. In a few weeks after his marriage he had changed so completely in appearance, mentality and behavior that his relatives, who had taken steps to have him adjudged insane, thereby making the marriage void, refrained from further action. He is now active and energetic, makes minor repairs about the house, goes out collecting his rents,

and takes an active interest in current affairs.

I have reported the one case in detail to show what can be accomplished with the aged and prematurely aged thru exercise, change in the mode of life and association with the young. To bring

tion or prolonged depression or nonobservance of the rules of health will lead to rapid, irreparable decrepitude and death.

IN MAY

co-operation of the individual, who must be made to understand that either ex

travagance or neglect, too rapid stimula

By

I. L. NASCHER, M.D.

By

By

By

By

NOTE

A NEW CAMP DISEASE OF THE LARYNX: 'PNEUMOCOCCUS ULCERATIVE LARYN

GITIS'

MAJOR FREDERICK D. OWSLEY, M. C., U. S. ARMY

(Abstract of article published in Survey of Head Surgery, in the Office of the Surgeon General)

During my service at Camp Travis, Texas, during the winter of 1917 and 1918, I observed a form of laryngitis undescribed in the literature, and reported 120 cases to the surgeon general in April, 1918.

This is a laryngitis showing ulceration of the vocal cords in the initial stage of the disease. The laryngeal picture at the onset is that of a bilateral ulceration of the mucosa, usually symmetrically opposed patches on the anterior third of the cords, just back of the anterior commissure, elliptical in shape, from 5 to 7 millimeters long.

Eighty-five per cent. showed these characteristics and location, 15 per cent. were diffuse ulcerations along the free border of the cords from the anterior commissure to the vocal processes of the arytenoids.

In forty cases I was able to obtain laryngeal smears from which to have cultures made. These showed the pneumococcus as the constant and predominant organism. The streptococcus, staphylococcus and micrococcus catarrhalis were present in some and absent in others. Four cultures showed pure in others. pneumococcus.

These cases occurred during a heavy pneumonia epidemic, but in no instance. were they associated with that disease, or did they show temperature or other constitutional systoms.

Symptoms. Complete loss of voice. where the ulcerations were anterior and circumscribed. Hoarseness, where the ulcerations were diffuse along the free border of the cords. Severe attacks of paroxysmal coughing were usually pres

ent.

These cases had been considered as simple laryngitis by the regimental surgeons, and many were of several months' standing when first seen. The aphonia remained persistent so long as the ulcerations remained, and in many instances the aphonia persisted for from several weeks to several months after the ulcerations had disappeared.

Diagnosis. The laryngeal picture. determines the diagnosis when differen