The aetiology of arterio-sclerosis is varied. In many cases it is traceable to toxaemias, as lead poisoning, gout, chronic alcoholism, or syphilis. In other cases it accompanies autointoxication from deficient elimination of waste, as in chronic interstitial nephritis. In a very large number of cases it appears to be the result of severe mental or physical strain. In my wards in Bellevue Hospital, filled with representatives of the hardest working labouring classes - longshoremen, diggers, foundrymen, truckmen, etc. - it is the exception to find a man past thirty-five years of age who does not present an advanced grade of it. There is some doubt as to the influence of diet as a causative factor, but it is probably at least a contributing factor, and the results of dietetic treatment are often beneficial. The question of fluid restriction must be decided upon the merit of each case, rather than by rule. Much fluid taken into an empty stomach, being promptly absorbed, tends to raise arterial tension and tax a heart already working against greatly increased arterial resistance, thereby accelerating cardiac hypertrophy.

In cases complicated with cardiac dilatation or myocarditis, it is desirable to restrict fluids as much as possible in order to lessen the weight of fluid that an enfeebled heart, already working against great arterial resistance, is obliged to pump through the circulation. On the other hand, too little fluid ingested lessens renal activity and the excretion of waste, and should be avoided whenever interstitial nephritis or renal inadequacy exists. Tobacco should be much restricted, and fried foods, much fat, and any indigestible foods should be prohibited.

The dietetic treatment of arterio-sclerosis should be substantially the same as that of lithaemia, with such common-sense modifications as the patient's social position may dictate. It is futile to tell a day laborer to lie down and rest before or after his meals, but it is possible to keep his elimination. of waste products active through catharsis and diuresis, and to regulate his diet, while it may be possible to induce him to drink water occasionally, in lieu of poor beer and worse whisky.

In those cases in which renal inadequacy is a pronounced feature it will be well to put the patient upon a milk diet for several weeks. In general a non-stimulating diet is requisite, with a minimum of butcher's meat, and no strong condiments, richly cooked dishes, or alcohol should be allowed. If too much red meat be eaten the extractives irritate the vascular system and increase arterial tension. According to Pabst, although white meats contain less proteid than red, they are alike in the quantity of extractives present, hence a diet largely vegetarian is to be recommended in this condition.