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JAMA 100 Years Ago
November 3, 2004


Author Affiliations

JAMA 100 Years Ago Section Editor: Jennifer Reiling, Assistant Editor.

JAMA. 2004;292(17):2162. doi:10.1001/jama.292.17.2162-a

A discussion of the subject is not proposed; only the recording of a note and a suggestion. The recent literature indicating some probability of the supreme etiologic rôle of hyperfunction of the adrenals in the production of arteriosclerosis has opened a wide field of physiologic and pathologic research. In addition to the experimental work necessary exactly to establish the causative relation of the adrenals to arterial disease, it is exceedingly desirable to have careful clinical observation of the early cases of arteriosclerosis. In no other line of work do physicians have the opportunity to observe the beginnings of any arterial disease as that which comes to the examiner for life insurance. He it is, almost solely, who every now and then has the chance carefully to examine arterial sclerosis in young men, and at its first stage. At this time it is usually overlooked by the examiner, because up to the present most physicians do not look for it except in those of advanced years. The observant examiner knows this to be a faulty practice, as it is by no means infrequent to find slight thickening of the radials and temporals in men under 35 years of age. Therefore, it is urged that examiners look more particularly for this condition, make all possible history and notes of the case, and then, if practicable, advise the applicant’s physician of the existing condition, with the suggestion that the case be followed up and studied as closely as possible for a long period of time. Without doubt, the general adoption of this method by careful workers would add greatly to our knowledge of the early clinical course and associations of arteriosclerosis. In any event, the appearance of the adrenal hypothesis bids fair rapidly to throw some real light on the thus far extremely dark problem of the etiology of vascular sclerosis. While we make this suggestion specifically to this disease, it should apply to many others. The physician who is an examiner for life insurance has a peculiar advantage over others; he has the opportunity of examining the well man, the man who is supposed to be healthy. The earnest student will often run across a case in which he may detect a possible beginning of a chronic disease, and by a hint to the family physician a continuous study of its development may be carried on.