The attitude of the patient himself also determines to a great extent the prognosis. Some men, especially those who have always enjoyed good health, turn a deaf ear to warnings and instead of ordering their lives according to the advice of the physician, persist in going their own way in the hope that the luck that has always been with them will continue to stand at their elbows. Neither firmness nor pleadings avail with some men. The only salve for the conscience of the physician is that he has done his best to steer the patient away from the shoals and breakers. In others who realize their condition and take advantage of the advice given as to the regulation of their lives, the prognosis is generally favorable. To sum up the chapter in a few words, I should say: Always remember that the patient is a human being; study his habits and character and mode of life; look at him as a whole; take everything into consideration, and give always a guarded prognosis. CHAPTER XII PROPHYLAXIS Arteriosclerosis comes to almost every one who lives out his allotted time of life. As has been noted within, many diseases and many habits of life are conducive to the early appearance of arterial degeneration. Decay and degeneration of the tissues are necessary concomitants of advancing years and none of us can escape growing old. From the period of adolescence certain of the tissues are commencing a retrograde metamorphosis, and hand in hand with this goes the deposit of fibrous tissue which later may become calcified. The arterial tissue is no exception to this rule, and we have already shown that certain changes normally take place as the individual grows older, changes which are arteriosclerotic in type and are quite like those caused in younger people by many of the etiologic factors of the disease. We are absolutely dependent upon the integrity of our hearts and blood vessels for the maintenance of activity and span of life. Respiration may cease and be carried on artificially for many hours while the heart continues to beat. Even the heart has been massaged and the individual has been brought back to life after its pulsations have ceased, but such cases are few in number. We can not live without the heart beat and the prophylaxis of arteriosclerosis consists in the adjustment of our lives to our environment, so that we may get the maximum amount of work accomplished with the minimum amount of wear and tear on the blood vessels. The struggle for existence is keen. Competition in every profession or trade is exceedingly acute, so much so that to rise to the head in any branch of human activity requires exceptional powers of mind. Among those who are entered in this keen competition, the fittest only can survive for any period of time. The weaklings are bound to succumb. A scion of healthy stock will stand the wear and tear far better than will the progeny of diseased parentage.