SO 
hospitals and putting them in charge of doctors who chew and smoke. but 
by teaching the people the necessity, the importance, of clean air. 
The ills of civilization call for more civilization. The man who is con- 
stantly seen with a cigar in his mouth or whose clothes reek with tobacco 
surely does not represent the highest type. The people have suffered much 
at the hands of the tobacco using doctor, usually a robust individual who 
uses tobacco because he gets ease. He does not understand the ills of his 
patients, and so they apply elsewhere; as a consequence he has all sorts of 
competitors. There are all sorts of isms and pathies, with new ones spring- 
ing up. 
Here should come a review of several papers relating to high blood pres- 
sure, a very interesting subject, especially in the light of coniosis. What 
causes a rise in blood pressure, and how can it be reduced? Why do seemingly 
robust men drop off suddenly and prematurely? ] have at times discussed 
these things with physicians who smoke and who in their ignorance advised 
me also to smoke or to become accustomed to bad air conditions, to become 
acclimated, or, to put it in still another way, to develop an antitoxin, an 
antitoxin that will enable one to live under unsanitary conditions. 
A physician constantly speaks of Case Reports.* In the course of time 
some of my own short case reports have developed into biographies. They 
cover a series of years. At first one may be greatly in doubt as to inter- 
preting facts, but in time one sees the reason. For instance, I have in mind 
a physician who for a number of years practised in a small country town; he 
made long drives; he had perfect health; he did not use tobacco nor alcohol, 
had no desire for either. Then he removed to the heart of a medium sized 
city, that means he exchanged good air for bad air. He began to feel bad; 
the symptoms of dust infection appeared, finally to such an extent that he 
was almost disabled. I advised him to get out; others advised him to stay 
and become accustomed, become adapted. We use the term adaptation to 
a great extent, but if you look at it properly adaptation comes about in the 
race, phylogenctically, not ontogenetically. The unadapted are constantly 
killed off. This doctor concluded to follow the advice of the many rather 
than of the one. In time he did develop an ‘‘anti-toxin.”” He even took 
*To quote illustrative case reports in a short paper is not satisfactory; one cannot 
go into details and there is a danger of a reader drawing wrong conclusions in the 
absence of details. Often brief case reports are worse than none, and one may hesitate 
to give any at all. 
