After this acid soil has grown almost from infancy through the stage of fatigue, then there is a sufficient accumulation to permit of the growth of disease germs, and disease in some form is waiting in the offing for just the right opportunity to implant itself and grow, necessitating a cataclysm of some sort to right things before function can resume normally.

Acute illnesses of all sorts would be a very salubrious affair if they completely burned up and threw off all the accumulated wastes of the body, but the system has become habituated to so much of this handicap that after the excess is reduced to a little below the usual the body can again resume, and starts off again with still much accumulated waste matter that forms a nucleus for still further accumulations through our faulty habits of eating, and we begin again rebuilding the very same state that compelled this readjustment, and that will compel another and still another till our tolerance rises higher and higher, and we carry eventually a degree of waste that allows of a semblance of function in spite of this.

And so with each year we have added to this stored acid waste, carried at an increasing output of vitality to maintain it, till we age under it. And now appears this third member of the attacking party, old age.

Not every one reaches this stage, for many have succumbed to the first and second of the four horsemen, as witness the four hundred thousand who never see the tenth year of life, the two hundred thousand that never see the end of the second year, and the many hundred thousand that never live to grow up, or that die before old age appears.

There are those who resist for many years, developing all the evidences of the decrepitude that marks the advance of this third horseman, because they have escaped the organic breakdown that fails before the attack of disease.

These continue to function after a manner till they reach perhaps complete helplessness, perhaps bearing many scars from encounters with the first and second horsemen, yet continuing to live and carry on.

These are the wounded in the battle of life, the ones who swell the ranks of the pensioners of the world, carried at a great expense to the producing element, a liability, never an asset.

How easily all these futile encounters could have been obviated, by a realization of the predisposing causes, the repairing of all the little leaks before they became great leaks!

The thing to watch is the first evidence of fatigue, for the first of the four horsemen is already on the attack and if he can be repulsed there will be no opening for the second.

Nature makes no mistakes in her indications, so when fatigue appears it means rest not only from physical and mental work, but from the internal causes that always produce this state of fatigue. Stop the accumulation that is making this state, and by so doing repair the little leak.

The very first day that fatigue shows, unaccounted for by unusual work of either mental or physical sort, the first day that is ushered in by this sense of languor or inertia, get busy, do something, take stock of the present state, and if you are wise you will know that in the rather immediate past something has been eaten, many things perhaps, that have resulted in an uneliminated collection of waste matter, and to add to this is to prepare the way for the second horseman.

Take plenty of active exercise, or stop all intake of food, or both, till this enervated state passes and again you feel peppy and spry.

At first, these evidences of autointoxication pass off rather easily, as they are not deep, of course, but as time goes on a tolerance develops, just as to the use of tobacco or alcohol, and the system carries ever increasing amounts, till its ability to adapt itself longer to this increasing task of maintaining an equilibrium is finally surpassed, and it fails to adapt itself longer, and then decline comes rapidly.

This is age, no matter what the number of years expressed by this state, for age is not time but condition.

Thus is the way opened for the fourth horseman, who waits patiently for this opportunity.

When the body can no longer adapt itself to the increasing flood of toxins, when it begins to fail under this, occupying more and more of its vitality in the vain effort to readjust itself, then this fourth horseman seizes any favorable opportunity to attack, and the end comes, often quickly, often after a struggle that refuses to capitulate till every resource of the reserves has been completely exhausted, and we say such a person had wonderful vitality.

Death is awful to contemplate in any form, but is more awful when it is resisted to the very last ounce of vitality, when nature rebels strenuously to the giving up of its fortresses.

Our best friend, perhaps, has been pursuing his usual activities today, tomorrow we learn that he is very ill, next day he is gone, and we say: "Why, yesterday he was the picture of health."

He was not well yesterday, no matter how he appeared, for death does not come without favorable opportunity, this being the last battle.

Our friend was creating for years a soil that was sure to furnish material for just this denouement, yet he no doubt felt well, or as well as usual, and he would never have believed that death was so near.

Pneumonia, apoplexy, heart failure, thrombosis, septic infections-- these are the things that take an apparently strong man off in what may appear to be the prime of life, but not one of these things comes like a bolt out of a clear sky.

They only appear to do so because we do not see these evidences of acid accumulation till the accident has happened.

Just as the writer, twenty-four years ago last winter, was insulted when he was denied an insurance policy without conditions, for he thought himself almost the acme of health.

Then a little sprint for a train dilated his heart, and he knew for the first time that he had a blood pressure, no doubt one that had been forming for a number of years from an increasing viscoscity of the fluid due to retention of much debris of gluey character.

If he had died during this sprint, if the heart had ruptured instead . of partially dilating, his friends would all have said the same things, have expressed the same surprise, as when a strong man in his apparent strength is called suddenly anywhere.

It was only a careful analysis of his condition and the possible predisposing causes at that time that opened his eyes to these things, and it has been his observation ever since that death is never sudden: only the final yielding is sudden.

So if the little leaks are repaired the great will all take care of themselves.

The May 26th, 1928, issue of the Journal of the American Medical Association carries thirty-five obituaries of physicians who had passed on since the last issue, six lived only to the seventy year mark, when one is supposed to have earned the right to die by any means he may choose.

The other twenty-nine passed out from the following causes: yellow fever at 51, intestinal obstruction at 52, cerebral hemorrhage (apoplexy) at 48, septic arthritis at 58, duodenal ulcer at 54, myocarditis and chronic nephritis at 54, gunshot wound by patient at 36, septicemia following mastoid operation at 28, spinal meningitis at 40, angina pectoris at 55, cerebral hemorrhage at 61, carcinoma of the throat at 57, disease of coronary artery at 50, cerebral hemorrhage, chronic nephritis and myocarditis at 62, diabetes at 66, cerebral hemorrhage at 63, arterio-sclerosis and acute dilatation of the heart at 62, transverse myelitis following influenza at 40, angina pectoris at 65, died in hospital at 38, meningitis at 26, chronic bronchiectasis at 67, intestinal obstruction at 62, cerebral embolism at 63, cerebral hemorrhage at 61, suddenly of heart disease (suddenly?) at 29, same at 59, paralysis at 58, pneumonia at 59.

One week's mortality record for the physicians of the country, the very same diseases they return as causes of death in others!

Are these causes understood, or were these men deliberate suicides?

The average life of physicians is a little lower than for the other class of professional lives, and why?

Surely there must be something that is daily overlooked in our study of disease, else these things could not go on in a profession whose whole business is the very thing of watching for disease and doing something for it when it appears.

There's just the point, for they do not see the little leaks but wait for the flood, the completed pathology, the finished diseased condition, something that can be classified and named and treated as an entity, a something concrete that something concrete may be devised to control.

Too late, for the little leak has become a great rush of water before it was recognized.

If you were out on the lake in a boat and it suddenly sprung a leak, what would you do?

If you would look back you would perhaps remember that for some time the bottom of the boat had been showing water, but you paid no attention to this so long as the boat continued to float well on top of the water as do other boats, and others seeing this would not know to warn you.

Now would you seize the bailer and go to work to unload the water without looking for the leak?

This might keep you afloat for some time, but it would mean that unless you continually kept on bailing the water would continue to rise in the boat, which would continue to sink lower and lower, functioning less and less as a boat is supposed to function, and when you were exhausted bailing you would sink, for the leak would still continue to admit water.

The sensible thing to do first is to inspect the boat thoroughly and to calk every little leak before launching out; then if a leak developed, stop everything and calk this; then the bailing could proceed with some hope of a radical cure of the condition.

And so twenty-nine of the thirty-five physicians who passed out in a week died of neglected leaks, at least all except gunshot wound, and this was administered by a disgruntled patient who perhaps laid to the door of this physician some blame for a death in his family from what he considered this physician's mistake or carelessness.

Surely we are overlooking something in our studies of disease. We are failing to see the little leaks, and we would do better to spend more thought and study and experiment on the soil that furnishes the beginnings of disease.