n ANB <3HARLES REiNHAR!^ MD. Shiffin^Ne^ Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924059209746 CORNELL UNIVERSITY LIBRARY 3 1924 059 209 746 DIET -* ^' ^ ^ AND THE MAXIMUM • DURATION °^ LIFE BY CHARLES REINHARDT, M.D. AUTHOR OF LIFE IN AN OPEN AIR SANATORIUM. THE HANDBOOK OF THE OPEN AIR TREATMENT. THE CONSUMPTIVE POOR OF ENGLAND. 120 YEARS OF LIFE. THE BOOK OF THE SOUR MILK TREATMENT. &c. PRICE ONE SHILLING NET. THE LONDON PUBLICITY COMPANY, LTD., 379, Strand, W.C. 'His days shall be an hundred and twenty years. Genesis 6. 3. TABLE OF CONTENTS. Chap. I. Diet and the Maximum Duration Life PAGE. OF • • 5 II. Lactic Bacterium Therapy . . 20 III. Food . . 24 IV. Fruitarianism, Vegetarianism, and the Mixed Diet 30 V. The Calorie 34 VI. Facts about Foods 39 VII. Fish 45 VIII. Milk and its Products, and eggs 51 IX. About Vegetable Foods 61 X. Bread 64 XI. Pulses, Tubers, and Green Vegetables 69 XII. Beverages 75 XIII. Food in Infancy 81 XIV. Food in Disease . . 83 XV. Feeding in Obesity 90 XVI. How to Grow Fat 96 XVII. Dietetic Systems 100 XVIII. Conclusion 106 " There is no wealth Bat life. ' — Ruskin. *' Success is largely a. matter of survivorship," — OSLER. DIET AND THE MAXIMUM DURATION OF LIFE. CHAPTER I. Recent researches have led to the estab- Ushment of the fact, to the satisfaction of the medical profession of the whole civilised world, that the chief cause of the infirmities of old age, as well as of a large proportion of the diseases of adult life, is the process known as " auto-intoxication," or self-poison- ing. This poisoning of our own bodies is due to putrefaction taking place in the large intestine, which in turn is the result of de- composition of food material set up by germs or microbes which infest the bowel, and which flourish most where bowel cleanliness least obtains. The dual problem, therefore, of maintaining health and postponing the evils of old age resolves itself into the ques- tion as to how intestinal putrefaction may be O DIET AND THE MAXIMUM averted or prevented — or, in other words, how the bowel may be kept clean. Cleanli- ness is admittedly next to godliness ; but cleanliness, to be complete, must not merely be skin cleanliness, but must extend to the mouth, the stomach, the bowels and the blood, and, having gone so far, it will natur- ally reach the mind and the morals. Clean- liness of mind and body are interdependent. Real cleanliness is true godliness. Dirt, dis- ease, decrepitude, and death are, indeed, near relations. The solution of the problem is to be found in what may fitly be termed " the scientific diet," for it is only by the scientific application of the principles of dietetics that the intestinal flora, or the bacteria which inhabit the bowel, can be so modified as to eliminate the excessive production of toxins or poisons. Nor can any hard and fast rule be laid down which shall be applicable to all cases, since nothing is more variable than the individual's powers of digestion, especially amongst those who, owing to illness, error or misfortune, deviate from the normal in matters of alimentation. DURATION OF LIFE. 7 It is true that certain general principles may be stated, careful observation of which will enable almost everyone to obtain and preserve digestive health ; but there must always be a residue of cases in which no success can be obtained unless and until the actual chemico-physiological defects are ascertained and corrected. Until compara- tively recent times the application of such methods as are here indicated was aU but an impossibility, for the study of dietetics was pure empiricism, or at best an art depen- dent upon the ordinary and fallible sources of information, observation and experience, with- out any available means of checking the validity of the theories upon which it rested. The art of dietetics shared with many other departments of medicine this empiricism or want of conformity to any known rules of exact science, and this fact goes far to ex- plain the comparative indifference of the average physician to the subject. There is no chair of dietetics in the medical schools and universities ; medical students are not taught even its elementary principles, 8 DIET AND THE MAXIMUM and the ordinary practising medical man sel- dom displays any readiness to prescribe in strict detail a special dietary, and probably, if asked to show a little practical knowledge of the subject — say, for instance, by describ- ing the best method of cooking a cheese souffle or an omelette aux fines herbes, or, better stiU, by actually performing such a simple culinary process, — an accomplishment which every doctor should possess — he would not hesitate to confess his ignorance, or even to express some disdain for such kitchen knowledge. This state of things is to a great extent explained by the fact that until lately there was little or nothing of the exact science about dietetics ; recent developments, how- ever, have changed this, and everything now points to the rapid transformation of the old empirical art of dietetics into the correspond- ing science — a change which may be com- pared to the evolution of astronomy from Astrology, or the birth of chemistry from its mother Alchemy. The ordinary reader will ask what has hap- pened of late years to so completely alter DURATION OF LIFE. 9 the character of our knowledge of dietetics, and the simple answer is that important discoveries have been made both as to the chemistry of food and the chemistry of the human body, and more especially in relation to the causes and effects of putrefactive pro- cesses which take place in the large intestine. One of the first references to auto-intoxi- cation was made in 1868 by Senator, since when the subject has attracted the attention of many investigators, amongst whom may be mentioned Bouchard, whose work on the subject is well known. To Professor Combe, of Lausanne, is attributed the merit of having reduced to practice the theories of his prede- cessors. He published in 1907 a work of great usefulness under the title, " L'auto- Intoxication Intestinal " ; but so long ago as 1896, in Brussels, I heard Professor Romme- laire. President of the University, and chief physician to the Hospital of St. Peter, expound views identical with those which have since met with such complete acceptance. During that year I spent six months in post-graduate study in Professor Rommelaire's wards, 10 DIET AND THE MAXIMUM where it was obvious that in theory and practice he had anticipated not only the modern views respecting intestinal putrefac- tion and auto-intoxication, but also some of the remedies which were unknown in Eng- land, at least, at that time, but which have since gradually been recognised here as weU as elsewhere upon the Continent. I shall always remember the surprise, almost amounting to dismay, expressed on the faces of the little band of British physicians who accompanied the Professor on his daily rounds — surprise and anxiety sometimes reflected upon the face of the patient — when the mysterious letters " D. A." were inscribed upon the treatment sheet of a newly-admitted sufferer. At first we did not realise the significance of these letters, but presently it was explained that they stood for " Diet Absolu," or, in plain English, diet consisting of absolutely nothing at all but water. Patients who were ad- mitted to the hospital suffering from any of the very numerous ailments due to disordered digestion, or to over-indulgence in food or drink, and even those whose sufferings were DURATION OF LIFE. II perhaps less obviously due to such causes, were given a course of " Diet Absolu " as a preliminary to any other treatment that might be indicated. The effect of this, explained Professor Rommelaire, was to give the diges- tive system almost complete physiological rest ; and often this sufficed to bring about a speedy and permanent cure withovit re- course to any medicinal treatment whatever. During my residence in Brussels I came in contact with much illness, and it happened that one day I found myself feeling far from well, and I was somewhat alarmed to find that I was in a high fever, with a pulse run- ning at 120 beats to the minute, and an almost insupportable headache. The doctor at once diagnosed my case as due to " auto- intoxication " — which, as I was an abstainer had no connection with alcohol — and he re- commended five days of rest in bed on " Diet Absolu." During the first few hours I felt the deprivation somewhat, but the frequent sips of hot water which were permitted gave me some consolation. On the second day I felt some desire for food, but on the third 12 DIET AND THE MAXIMUM and fourth I was indifferent to the sound of the dinner gong, which I heard ringing in the hall of my hotel without feehng a single pang of envy ; and when, on the fifth day, I was told that in a few hours I might be allowed a little nourishment, I did not display any very marked signs of excitement. I made a rapid recovery, and to this day I remember the satisfaction I felt when I returned to a normal dietary with an invigorated digestion and some little leeway to make up. This was my first acquaintance with the theories of auto-intoxication, which were fully expounded to me at a time when I was in a state, both mental and physical, in which I was well calculated to be interested in them. When it was once recognised that the presence of putrefactive conditions in the bowel gives rise to the productions of poisons which are absorbed by the blood, and that the result of the circulation of such poisons is to produce all manner of illnesses and diseases both local and general, ranging from skin diseases such as eczema, to gout, and from headache to senile decay, efforts were DURATION OF LIFE, I3 made to combat the intestinal uncleanliness by many varieties of method. It is true that from the earUest times the habit of taking occasional purgative medicines has been recommended as a means of preserving health and youth, and that the explanation of such beneficial results as they may lead to is the expulsion of poisons which would otherwise to some extent have been absorbed. It is also true that in many countries such as Russia, Turkey, Greece, Egypt and Arabia, but more particularly in Bulgaria, Roumania and Hungary, the practice of taking soured milk in the forms of Maya, Yoghourt, Kephyr, Koumiss, etc., has been a national habit for ages, and that in addition to the dietetic qualities of curdled milk it possesses pro- perties which, render it in effect an intestinal antiseptic, but these remedies were used empirically and with very little knowledge on the part of those who used or administered them of the means by which they produced their beneficial effects. The special branch of bacterium therapy by which it is sought to cleanse the bowel of putrefactive germs by 14 DIET AND THE MAXIMUM introducing a colony of harmless or beneficent ones, which is known as the Sour-milk treatment, is associated in the general mind with the name of Metchnikoff, who did much to popularise it by his publication " Pro- longation de la Vie," but it is only fair to point out that in 1887 Escherich recom- mended precisely similar treatment, whilst at the Congress of Wiesbaden in 1898 Quincke proposed to combat harmful or pathogenic microbes in the intestine " by taking advan- tage of the antagonism of others which are themselves entirely harmless to the human body." Although this volume is devoted to the subject of diet and food generally in relation to length of life, it will be necessary to make many references to lactic bacterium therapy, or the Sour-milk treatment ; such allusions, however, will be made en passant, and will not provide a complete consideration of the subject which I have dealt with more fully in " 120 Years of Life,"* to which readers especially interested in that branch of food • izo Years of Life. 3rd edition. London Publicity Co., Ltd., 370, Strand. W.C. IS. . . J ». , DURATION OF LIFE. 15 therapy are referred. My object here is to discuss the advantages and disadvantages of various foods for those who would preserve robust health for the longest possible time. It must not be supposed that one who wishes to advance the cause of dietetics both for the preservation of health and the cure of disease is necessarily a food faddist ; on the contrary the food faddist is often an ill-informed individual who has only a very limited outlook and a very partial knowledge of a tiny department of the subject of diet- etics. It sometimes happens that a man possessing a smattering of physiological in- formation takes up a fad in matters of food, either because of a fancied or real improve- ment in his own health under some special regimen — and he judges all temperaments and constitutions by his own — or perhaps upon sentimental or humanitarian grounds, or it may be out of sheer quackery. In either case he announces himself as a specialist in dietetics and proceeds to advo- cate some particular food fad which a certain number of innocent dupes will try, probably l6 DIET AND THE MAXIMUM to their own undoing. The special diet recommended may be one entirely suitable to a certain condition of ill-health, just as the Salisbury diet consisting of undercooked meat and hot water might as a temporary expedient prove extremely beneficial in the case of a person who by abuse of sugai, alcohol and carbohydrates, or from some other cause had for the time being lost the ability to digest starch ; but when recom- mended indiscriminately, regardless of the actual state of health of the person to whom it is prescribed, the results of a faddist's dietary may be nothing less ihan disastrous. Some persons may thrive upon a diet of nuts and uncooked cereals, whilst another may find positive starvation in such a regimen. We must clearly distinguish between the old Empirical school of dietetics ; the tenets of the faddists ; and the school of scientific dietetics. The object of the last being to recommend to the healthy those foods which supply the actual requirements of the body in Nitrogen, Carbohydrate, Hydrocarbon, salts and water in proper proportion, without undue waste. DURATION OF LIFE. I7 and in a form calculated to produce a minimum of intestinal putrefaction ; and also to advise such methods of cooking and such thoroughness of mastication as shall conduce to the complete assimilation of the food material without throwing any injurious strain upon the digestive functions ; and in the case of invalids, dyspeptics, and sufferers from definite diseases, to ascertain as far as may be possible the actual defect in the machinery of digestion, and to regulate the diet accordingly. In order to achieve the latter it is often essential to make an examination of a specimen of the faeces and urine. The con- nection between the urine and the processes of digestion may not be obvious to the ordinary reader, but a few words will explain it. Intestinal putrefaction produces poisonous matters in the colon or large intestine ; these toxins are absorbed by the blood and after producing evil consequences upon all the vital organs, including the heart, liver, pancreas, brain and the nervous system generally, they have to be discharged either through the skin, in which case they may set up eczema, or l8 DIET AND THE MAXIMUM through the kidneys, and in all cases to a considerable extent by the latter channel. It has been ascertained that the presence in the urine of Ethereal Sulphates (Sulpho con- jugate Ethers) demonstrates the presence of putrefactive processes in the bowel, and the proportion of these aromatic bodies, which are practically absent in normal urine, gives an accurate index of the amount of such morbid processes as may be taking place. An increase in the urinary ammonia, though this may be produced by local conditions such as cystitis or inflammation of the bladder, is in the absence of such local disorder, an in- dication of abnormal putrefaction in the bowel. The decomposition of nitrogenous food material in the intestine gives rise to the production of phenol, indol, scatol, and gaseous bodies, the presence of which can be accur- ately ascertained. To attempt to treat a severe case of intestinal disorder without mak- ing an examination of the urine and faeces is as unscientific as " Christian Science," which would treat a patient at a distance DURATION OF LIFE. I9 without diagnosis or knowledge of the dis- order. Both these methods may occasion- ally produce good results, but they are not scientific. 20 DIET AND THE MAXIMUM CHAPTER II. Lactic Bacterium Therapy. It will be convenient at this point to say a few words about the Sour-milk treatment, which after flourishing from time immemorial in South East of Europe has found its way to the North, where its intrinsic merits must render it a beneficial and a permanent insti- tution. Though curdled milk was used in Biblical days in Palestine, and in the Balkan Peninsula since the remotest times, the theory as to the physiochemistry of its action is, as already pointed out, quite of recent origin. It depends upon the simple fact that disease-producing and putrefaction-causing germs which are apt to infest the bowel can only grow and thrive in an alkaline medium, whereas the bacillus acidi lactici prefers and creates an acid environment, since it is the special property of this beneficent germ to transform sugar into lactic-acid. Sour-milk contains lactic acid and the lactic-acid-pro- ducing bacilli, the only difference between ordinary milk that has gone sour " of its DURATION OF LIFE. 21 own accord " in England, and Bulgarian Sour-milk being that the lactic bacillus native in Bulgaria (which may be imported to England in a culture) is larger, stronger, and more resistant than its cousin which is " wild " or indigenous in our own country. The British bacilli are apt to be digested and destroyed before they reach the lower bowel, those from the Balkans survive the passage through the stomach and small intestine, and establish themselves as a colony in the large bowel, crowding out the harmful bacilli and cleansing the colon as no other food, medi- cine, or medicinal procedure can cleanse it, and rendering the bowel contents destructive to pathogenic or disease-producing germs. The best form in which to take the treat- ment is the actual Sour-milk, which may be purchased ready made or manufactured at home ; in the latter case the Veronelle appli- ance* is the simplest and best, and in the for- mer it is necessary to exercise extreme care in choosing a firm from whom to obtain supplies. A recent examination of fifty specimens, made • Sold by Clay, Paget, Ltd., 71, Ebury Street, London, S.W. 22 DIET AND THE MAXIMUM by the pathologist of one of the large London hospitals led to the disquieting discovery that only two were bacteriologically satis- factory. The " Uga " made by Messrs. Clay, Paget (71, Ebury Street, S.W.), is not only in every sense reliable, but is so much more attractive in flavour and consistency than any other Sour-milk that I have tried, that it may be unhesitatingly recommended as the best. The same may be said of the " Uga Cream Cheese," which presents in semi-solid form the actual Sour-milk in full activity. Powders, tablets and dry preparations alleged to contain the bacilli should be avoided as uncertain, unreliable and entirely unsatis- factory. The connection between the regular use of Sour-milk and the prolongation of life will be clear from what has already been said. The evils and infirmities common in advanced life are due to a hardening of the arteries and nervous tissues, and to degeneration of the blood vessels and nerves, all of which are produced or hastened by the poisons absorbed from the bowel. DURATION OF LIFE. 23 If we can check the production of such poisons, health and vigour may be maintained for many a long year beyond the limit which is supposed to mark the alloted span. The only satisfactory method by which intestinal putrefaction, which is the source of these poisons, may be effectually prevented in the scientific regulation of the diet, and in this the use of lactic ferments or Soured-milk is an important factor. 24 DIET AND THE MAXIMUM CHAPTER III. Pood. The main objects of food are to repair the waste which is constantly taking place in the body, and to provide for the production of heat and energy. The repairing process, or substitution of new cells for the old and worn out ones, and the building up of new tissue, is achieved by means of proteid or nitrogenous foods alone, excepting so far as water and mineral matters, stjch as lime, iron, phosphorus, &c., may be concerned in such processes. Energy and heat are chiefly produced from carbohydrates (sugar and starch) and hydrocarbons (fats and oils), but proteids may also provide heat and energy, and the other two classes of foods, though they cannot under any circumstances entirely replace proteids, may act as " proteid sparers," that is to say that when they are supplied in requisite quantity, the body makes less demand upon the proteid foods, which it employs more exclusively for repairing waste, and less for producing heat and energy. It is assumed that the reader is aware that DURATION OF LIFE. 25 proteid foods are those which owe their nutri- tive properties to nitrogen, and that they are to be found in meat, white of egg, milk (casein), and also in vegetables and wheat (legumen and gluten), whilst carbohydrates include sugary, starchy and farinaceous foods generally, and hydrocarbons consist of animal and vegetable fats, oils, butter, &c. It will be clear that many foods contain all the food elements requisite for supporting life ; for instance milk contains proteid in the form of casein, hydrocarbon or fat in the form of cream which may be churned into butter, carbohydrate in the form of lactose or milk sugar, and in addition there is the whey in which water and various mineral salts are to be found, but then milk is the only substance produced by nature for food purposes alone and it is not to be wondered at that in making one solitary food she would have made one that is perfect. Perhaps it is not sufficiently often realised that of all the foods upon which we depend milk is the only one which at some period of our life is an essential, and that no other food can be regarded as 26 DIET AND THE MAXIMUM absolutely indispensable. In fact no other food is obtainable, excepting by a process which in a sense consists of robbery. We rob the hen when we take her egg for food, and we are apt to forget that when we eat an egg we are devouring a potential chick. Wheat is the seed of a grass, and, as bread is the staff of life, there is truth in the statement that aU flesh is grass. Meat consists of the muscles and other parts of the bodies of animals, which were obviously intended to serve the purposes of their original owners rather than our own. The potato consists of reserve of food stored by the plant in the spring for its own use later on. Apples and other fruits are pro- duced for the purpose of providing for a continuation of their own race rather than to support ours. Milk then, which serves no other purpose but that of a food, is complete in that it contains all the ingredients needed to support life, and, as far as infants and the aged are concerned, in such proportions as are most desirable as regards nutritive economy. DURATION OF LIFE. 27 The art of the dietetian consists in supply- ing food in the requisite proportions of proteid, carbohydrate and hydrocarbon, in a digestible form, avoiding undue excess of any one ingredient, whilst in particular providing against proteid starvation. Excess of pro- teid, more especially proteid of animal origin such as meat, leads to intestinal putrefac- tion, and consequently to gout, plethora, and arterio-sclerosis or degeneration of the arteries, and these bring on all the evils and infirmities of old age, therefore the excessive consumption of meat should be avoided by all who value life and health. On the other hand proteid starvation leads to debihty, lack of resisting power, and both bodily and mental inefficiency. Excess of carbohydrates and hydrocarbons is apt to lead to obesity, and it is to be remembered that, excepting in extremely rare instances of disease to which reference will be made later, obseity always indicates that an excess of food beyond the body's require- ments has been consumed. 28 DIET AND THE MAXIMUM A really small eater, or one whose diet is scientifically adapted to his requirements, cannot become unduly fat. An insufficiency of the starches and fats may prove serious in the case of children, but adults do not suffer marked ill effects provided that an abund- ance of proteid is consumed, since the latter, as already explained, can serve its own special purposes of tissue construction, and also pro- duce heat and energy as well. It was stated above that the main objects of food are the repair of waste tissue, and the provision of material for the generation of energy and heat, but foods are adminis- tered with other objects as well. Many foods have very low nutritive value, but are selected because of their refreshing, stimu- lating, appetising, or medicinal qualities. Others may have these properties or some of them, and yet be possessed of the highest degree of nourishing power ; as instances of the first may be mentioned fruits, such as grapes and oranges, beverages such as tea and coffee, and alcoholic drinks, and bitters and other appetisers. Perhaps the best DURATION OF LIFE. 29 instance of the second class is " Uga " or Bulgarian Sour-milk, which is a veritable food medicine. 30 DIET AND THE MAXIMUM CHAPTER IV. Fruitarianism, Vegetarianism and the Mixed Diet. It will have been observed that, beyond a caution as to the grave evils of excessive meat-eating, no word has yet been said as to the various dietary schemes which are so often vaunted as panaceas for all digestive iUs. This is not a sentimental work, nor a treatise on humanitarianism, but an effort to point out the nearest approach to the perfect way in diet. No one can doubt the fact that, if other things were equal, it would be plea- santer to feel that our food was procurable without the necessity for taking the Uves of our fellow-animals ; but these other things are not equal by any means, and though in certain climatic zones life may be supported and efficiency maintained upon an exclusively vegetarian regimen, especially amongst those devoted to pastoral pursuits, in our own climate and in the conditions of life which obtain here, and with the heredity of the mixed feeder behind us, it is certain that the DURATION OF LIFE. 3I average individual cannot obtain the maxi- mum of health or display the highest efficiency upon an exclusively fruitarian or vegetarian dietary. It is possible to certain individuals to live without animal food, and most of us could abjure the use of flesh without great inconvenience or loss of health or vigour, more especially if such animal foods as are obtained without actual slaughter, including milk and its products — Uga, cheese, butter, cream — eggs and honey, were permitted. But, when all is said, the fact remains that man, when resident in temperate zones, is a mixed feeder, as the dweller in the Arctic regions, where animal food is practically the only kind available, is almost exclusively carnivorous, and the peasant in the tropics, who labours for a mere pittance in the rice fields, is a vegetarian. It is true that the vegetable kingdom can supply the proteid which is the chief food element for which the animal kingdom is raided ; but, as will be seen when the various foods are dealt with separately, there is a greater expenditure of energy in obtaining proteid nutriment from 32 DIET AND THE MAXIMUM vegetable foods than from animal sources, and even the best human digestion fails to extract the whole sum of nutriment present in such substances. On the other hand, in meat we have in a readily digestible and almost completely assimilable form the actual chemical equivalent of the tissues we wish to repair and replace ; and in other animal products, such as eggs, and milk we have foods which can be more quickly and more thoroughly transformed into living tissue, or translated into heat and energy, than can foods of vegetable origin. In fact, the vege- table kingdom elaborates materials derived from the soil, the atmosphere and water, into complex substances, which the human body can further adapt to its own requirements ; but, in choosing animal foods, man takes materials which have been carried many stages further in the direction of the cells of his own body. The animal has accom- phshed what otherwise man would have had to do for himself at considerable expense as to digestion, assimilation and metabolism. DURATION OF LIFE. 33 No one who has had extended experience of the subject can doubt that, if strict vege- tarianism and fruitarianism were rendered compulsory in England, there would follow a grave deterioration in the health and effi- ciency, both mental and physical, of the people, and it is probable that the nation would suffer severely in the struggle for existence and supremacy. Nothing said here, however, qualifies or alters the writer's view that an incalculable amount of illness and suffering is caused by the over-use or abuse of animal foods, and more especially of meat. The experience of ages has taught man- kind that those who live in temperate climates thrive best upon a mixed diet, and neither theoretical reasonings nor the aspirations of humanitarianism will compete successfully with ingrained instinct ; but the application of reason and knowledge enable the enlightened to make such selection as will remove defects which ignorance and indifference, not to say gluttony, have pro- duced. 34 DIET AND THE MAXIMUM CHAPTER V. The Calorie. When reading books upon diet, one often meets the word " Calorie," and to the lay reader it is sometimes a little confusing to find the value of a food estimated in calories, unless he is quite familiar with the signifi- cance of that term. The Calorie is the standard physiological measure of a food, and may be compared to the foot rule or the pound weight in other departments of calculation. The Calorie is, strictly speaking, the stan- dard of heat production, being the amount of heat required to raise a kilogram of water one degree centigrade. Experiments have proved that of the three classes of food, proteids and carbohydrates each produce about four calories for every gramme consumed, whilst hydrocarbons or fat produce about nine. It has further been ascertained that a healthy man, doing a fair amount of muscular work, requires 3,500 calories daUy. If he DURATION OF LIFE. 35 takes more, it is practically certain that he fails to metabolise it, and that waste ashes will be floating in his circulation and putre- factive processes will be taking place in his bowel ; whereas, if he secures less than 3,000 calories, unless he be leading an inactive or sedentary life, he wiU be draining his strength and drawing upon his own tissues, with the result that he will have no reserve of resist- ance to enable him to deal with any special strain or emergency, and therefore he will fall an easy prey to disease. It may be necessary from time to time to refer to the Caloric value of a food ; but as far as possible in these pages more familiar measures and indications of quantity will be employed. In the meanwhile it will suffice to mention the value in calories of one pound each of some common foods, the figures in brackets representing the caloric value. Butter (3,500), cheese (2,000), beef (600), potatoes (350), apples (220). It will be clear that, though beef has a lower caloric value than butter, it is because, though beef is more nourishing, being nearly all proteid, it 36 DIET AND THE MAXIMUM is not SO good a heat producer as fat, of which butter is composed. It has been indicated above that the average diet should provide between 3,000 and 3,500 calories, but the food requirements of individuals vary greatly according to the amount of work habitually performed. Thus, a clerk working in an office, and doing little muscular labour, might get along very well with 2,500 calories, whereas a blacksmith or a navvy might require 5,000 or even more. Expressed in terms of nitrogen and carbon, a fairly liberal diet for an ordinary English- man who habitually performs a moderate amount of muscular labour would include twenty-one grammes of nitrogen and three hundred and thirty grammes of carbon, a gramme being the equivalent of about fifteen grains. But these figures show the actual weight of the carbon or nitrogen consumed, whereas foods are so composed that the presence of water and accessory ingredients renders them much more weighty and bulky than the figures would suggest ; therefore, we may translate the ordinary dietary into DURATION OF LIFE. 37 terms of the three food bases above referred to ; when we find that a dietary yielding 3,500 calories may consist of 125 grammes of pro- teid, 75 grammes of fat, and 500 grammes of carbohydrate. Or, in terms of ordinary foods, it may be set out as follows : — Lean meat half a pound, fat a quarter of a pound, potatoes one pound, milk half a pint, cheese two ounces, and eggs two of average size. Such a dietary is all that is needed to keep an ordinary individual in full vigour ; and when we think how very much more the average well-to-do person consumes — simply because so many live largely to eat, since the process is pleasurable, instead of eating in order to live well — we have no reason to wonder at the vast number of diseases which arise from over-feeding, or from the con- sumption of an ill-balanced diet — that is, of a diet excessive in some directions, whilst perhaps actually deficient in others. I re- cently visited a charitable institution where several thousands of young people of both sexes are being educated, and, after noticing the well-nourished condition of the inmates, 38 DIET AND THE MAXIMUM I ascertained that the diet allowed for girls of fourteen to seventeen, which it is to be remembered is a growing age, consisted of nothing more than 17 oz. of bread, 5 oz. of meat, 8 oz. of potatoes, i oz. of cheese, f oz. of butter, and about if pints of cocoa or milk. The breakfast consisted of a pint of cocoa, 7 oz. of bread, and | oz. of butter ; the dinner of 5 oz. of meat, 3 oz. bread, 5 oz. potatoes ; and the supper of 7 oz. of bread, I oz. of cheese, and f of a pint of milk and water. It wiU be conceded that this is not a very liberal dietary, but experience proves that it is an adequate one. DURATION OF LIFE. 39 CHAPTER VI. Facts about Foods. Later on in the book general rules will be given as to diet both in health and disease, but in the meantime it will be of interest to consider very briefly the ordinary constituents of the mixed diet of an Englishman, pointing out those foods which are wholesome, those which must be taken only with caution, and those which tend to promote undesirable bowel conditions, and which must therefore be avoided altogether or taken only in the strictest moderation. Hints will also be offered which will show that many foods, though chemically possessed of the necessary nutritive ingredients, are for one reason or another to be discounted. For instance, certain nuts, when considered only in respect of chemical composition, appear to be most valuable foods ; but when considered physio- logically, owing to indigestibility, due to the presence of cellulose and an excess of oil, and on account of the fact that a consider- able proportion of their proteid contents is not assimilated, but passes through the 40 DIET AND THE MAXIMUM human alimentary system unabsorbed, they compare unfavourably with other foods, less rich in proteid, but capable of complete digestion and absorption. Poods of Animal Origin— Meat. Lean meat such as beef contains about i8 per cent, of proteid, 75 per cent, of water, and about ij per cent, each of " extractives " and ash. There is also some amount of gela- tine and fat. Meat represents chemically the very tissues which proteid food is intended to replace, moreover meat is eminently digest- ible and is dealt with mainly in the stomach, though it throws comparatively little demand upon the mechanical powers of that organ, being readily soluble in the gastric juice. Taken in strictly moderate quantities, there- fore, meat is a good and a wholesome food, but if taken in excess it leads directly to intestinal putrefaction, and to all the train of ill effects which inevitably follow. The ordinary healthy person requires, as already stated, 125 grammes of proteid daily, but this should not all be derived from animal DURATION OF LIFE. 4I sources, on the contrary it is best that rather more than two-thirds of the proteid con- sumed should be of vegetable origin. This would leave rather less than one-third to be derived from the animal kingdom, and about 33 grammes may advantageously be supplied by meat. From this it follows that from six to eight ounces of meat is the maximum which should be consumed, or in plain lan- guage two ordinary platefuls, an ordinary helping of meat consisting as a rule of about four ounces. If this limit is not overstepped there will be no undue residue of nitrogenous food in the bowel to be broken up by the action of putrefactive micro-organisms. Those who take a sufficiency of animal proteid in other forms such as milk, cheese, fish, Uga, Sour- milk or Uga Cream Cheese, may very advan- tageously diminish the allowance of meat or suspend it altogether for a time. In fact if those who from humanitarian reasons or otherwise object to eat the flesh of slaugh- tered animals, would take sufficiency of animal proteid, say for instance in the form of Sour-milk (Uga), or Uga Cream Cheese, 42 DIET AND THE MAXIMUM they would be able to dispense with meat without any disadvantage whatever. On the other hand, those who rely upon the products of the vegetable kingdom ex- clusively for their proteid supplies are almost sure to suffer a gradual deterioration of tissue with a corresponding diminution of energy. The flavours of meats are largely due to the " extractives " which alone give to meat and meat essences such stimulating proper- ties as they possess. The extractives are not nourishing, and a person fed upon any of the ordinary fluid extracts of meat so largely advertised and upon nothing else, would die of starvation in a very short time. The effect of cooking meat is to reduce the proportion of water which it contains ; thus a pound of cooked meat is equivalent in nourishment to a pound and a quarter of raw meat. Cooking renders meat more palatable and less offensive to the aesthetic senses, but it does not render it more digestible in spite of the popular opinion to the contrary. Now, with vegetables the effect of cooking is DURATION OF LIFE. 43 very different, for the digestibility of most vegetable products is greatly enhanced by cooking, and the amount of water which they contain is largely increased during the process. It has already been said that meat is one of the most digestible of solid foods when not taken in excess, and experiments show that it is almost entirely absorbed, leaving little residue. When taken in such quantities as can be completely digested it does not in the least degree lead to gout or the formation of uric acid, it is only when taken in excess that the results of the disintegration of such excess produce many dangerous toxins, including uric acid. Some forms of meat are digested more quickly than others, though this depends somewhat upon personal peculiarities of the eater : for instance, some persons can digest beef more readily than mutton, but as a general rule mutton is considered the more digestible of the two. Chicken, game, sweet- 44 DIET AND THE MAXIMUM bread and tripe are exceedingly digestible, whereas veal, pork and bacon require longer time in the stomach for the process of diges- tion to be completed. Fat, whether of animal origin or otherwise, is not digested in the stomach, but passes into the duodenum, to be dealt with there. Owing to the tendency for decomposition of a very deleterious kind to take place in animal foods, they should be always taken only when fresh, and it is a safe rule to avoid sausages, meat pies, and other concoctions of uncertain composition. DURATION OF LIFE. 45 CHAPTER VII. Fish. The nutritive ingredients of fish, as of meat, are proteid and fat. Like the flesh of animals, that also of fish, is almost completely absorbed in the process of digestion, very little residue being left. The digestibility of fish, however, is rather more variable than that of the ordi- nary meats, depending partly upon the amount of oil, which is abundant in salmon (12 per cent.), eel (15 per cent.), and mackerel (9 per cent.), and partly upon the texture of the fibres of the muscles of the various fishes. Cod is apt to prove comparatively difficult of digestion owing to toughness of the fibres ; this is even more pronounced in the claw muscles of lobsters. Salted and " cured " fish is apt to resist digestion for a considerable time. Sole, plaice, brill, halibut, whiting, and the white and non-fatty fishes generally, are very digestible. Fish is less nutritious than meat in that there is a much larger proportion of water, amounting in plaice to nearly 80 per cent., and the proportion of proteid is also smaller than that contained in meat. 46 DIET AND THE MAXIMUM Oysters are peculiar as a form of animal food in which proteid, fat and carbohydrate are all present, the latter being in the form of glycogen or " animal starch," whichis con- tained in the liver of the mollusc. Oysters are readily digestible, and to some tastes very agreeable ; but their nutritive value is small — in fact, they contain nearly go per cent, of water. Turtle Soup. The turtle is not, strictly speaking, a fish, but rather an amphibious reptile. Its fat is used to prepare turtle soup, which is an over- rated delicacy that would hardly find a place on the dinner-table were it not for the high price which it commands. The " f at " of the turtle, chemically speaking, is gelatine, and its nutritive value is not great. There is a con- siderable amount of very reprehensible cruelty in the turtle traffic, as in that of worn-out horses, respecting which so much is heard. In the case of the turtle, however, the public has not yet been enlightened. When travelling from the West Indies, on more DURATION OF LIFE. 47 than one occasion I have seen the handling of turtles carried out in a fashion which made me wish that the attention of some body such as the R.S.P.C.A. could be called to the matter. The poor creatures are thrown into the hold or on to the deck of the vessel so roughly that sometimes their very solid and tough shells are cracked ; and, to prevent their escape, their front limbs are pierced and tied together by the natives, who seem to have no concern for their sufferings ; from time to time the hose is turned upon them to supply them with sea water, beyond which, so far as I could ascertain, they receive no food. Many die during the voyages, for they are not brought direct from their native place to this country ; and others that do not die often become diseased. The dead ones are sometimes found to have been suffering from tumours and other repulsive disorders which would give the gourmet some twinges of dis- comfort if he knew the truth. It is to be hoped that the facts wiU become so well known that the demand will cease, and that the cruel traffic will come to an end. From the point of 48 DIET AND THE MAXIMUM view of the dietetian, at least, there would be no loss. Mock Turtle consists of the gelatinous matter obtained from the scalp of the calf. About Soups Generally. As foods, soups are not to be taken seriously — that is to say, from the standpoint of nutri- ment. Clear soups seldom contain more than two per cent, of solid matter, and only a trace of proteid — as foods, therefore, they rank very low indeed ; but as they contain the extrac- tives, or stimulating and flavouring agents of meat, they can and do act as adjuvants to food by promoting the flow of the digestive juices, and also they excite appetite ; and as both these phenomena are essential to com- plete digestion, the use of a small quantity of clear soup at the commencement of a meal can be justified. There are conditions of digestive impairment, however, in which soups should be forbidden. Thick soups owe their nourishing properties to added materials such as starchy or farinaceous flours, or to lentils, or peas, or macaroni (which contain proteid), DURATION OF LIFE. 49 grated cheese, bread, potato, etc. ; but such soups are not an ideal form for the administra- tion of nourishment, as they introduce food substances into the stomach without masti- cation, and therefore without the very desirable admixture with the saliva. This can be compensated for to some extent by taking such soups only in small quantities, and together with rusks or hard bread, which should be thoroughly masticated. Those in health should take soup only spar- ingly, whilst invalids and dyspeptics should only take it in such quantities and conditions as may be recommended in their special circumstances. It has already been said that meat extracts contain hardly any real nourishment, and this applies even to the best of beef teas. In the case of certain advertised meat essences it is claimed that they contain aU the nutritive elements of meat, including the nitrogenous or proteid constituents. Careful examination proves that the proportion of these ingredients is inconsiderable. The only satisfactory plan 50 DIET AND THE MAXIMUM by which the meat proteid can be obtained in beef tea or meat essences is by the addi- tion of dried meat powder after the beef tea or essence has been prepared. DURATION OF LIFE. 51 CHAPTER VIII. Milk and its Products, and Eggs. It has already been pointed out that milk is the one and only substance provided by nature for food and for no other purpose. The importance of milk and its derivatives is so great that one could easily use up the whole of the space available in a volume Uke the present one, and yet only succeed in saying a fraction of the interesting and significant things bearing upon the subject. It will be necessary, therefore, in order to keep within the available space, to be content with summarising some of the more salient information relating to the uses of milk and its preparations. Milk is an emulsion consisting of casein (proteid), fat (cream), carbohydrates in the form of milk sugar (lactose), certain mineral constituents, and water. There is also some amount of citric acid, chiefly in the form of citrate of lime. Milk when excreted is sterile, that is to say free from living germs, and it is obvious that 52 DIET AND THE MAXIMUM under natural circumstances milk passes directly into the alimentary system of the young of the mammal by which it is produced and therefore runs no risk of contamination. Under the circumstances of modern life, however, in which the milk intended by nature for the nourishment of the calf is used for that of human beings, it is inevitable that it must be kept, and subjected to various processes, all of which require time ; and as milk is a complete nitrogenous food upon which germs as well as animals thrive it is not wonderful that milk as actually brought to table or used for food is as a rule very highly charged with germ life. Fortunately, the germs which thrive best in milk produce lactic acid and are themselves harmless to human beings, whereas the acid is unfavour- able to the growth of harmful or disease- producing germs. Composition of Good Milk. Good milk should not contain more than 88 per cent, of water at most, and the other important ingredients should be as follows : — DURATION OF LIFE. 53 Fat 4 per cent., sugar 4^ per cent., and proteid 2 J per cent., the final i per cent, being made up of mineral matter, etc. Fresh milk also contains " enzymes " which are of importance and which are destroyed by boiling. The loss of these is a drawback in the case of boiled milk and of condensed or preserved milk preparations, in the manufacture of which destructive heat is employed. Milk is regarded as a liquid and its adminis- tration to invalids is spoken of as " fluid diet," but in point of fact when used as a food, milk is for practical purposes a solid, since upon entering the stomach the gastric juice at once coagulates the casein and renders the whole milk at least semi-soUd. For this reason milk should always be administered in small quantities or sips, and not drunk as a beverage; otherwise large masses are formed, the digestion of which is slow. Nature teaches us that milk should be ingested slowly and that the process should be accompanied by action of lingual and labial muscles and those of deglutition. The Bulgarian peasants, who 54 DIET AND THE MAXIMUM live on Sour-milk and hard rye bread, never attempt to drink the former, which indeed is far too solid for this to be convenient even if possible, rather do they eat it with their rye bread, which, when fresh is somewhat gluti- nous, and when dry sufi&ciently hard to compel mastication, so that in either case the Sour- milk is eaten and not drunk. Some persons try to drink Bulgarian Sour- milk and even dilute it with fresh milk or water for this purpose, but here they make a serious mistake. A well-known firm of dietetic specialists,* recognising the need for a special form of food with which to take Uga or Sour-milk, have devised two preparations of great merit for this purpose. The one is called the Bulgan Biscuit, and it is the equivalent of the Bulgarian rye bread in its fresher stage, being highly charged with proteid. These biscuits with Uga and Uga Cream Cheese constitute a complete diet which may be temporarily adopted with the greatest possible advantage by those who, owing to digestive * Messrs, Callard & Co., J^, Regent Street, London, W, DURATION OF LIFE. 55 derangements and intestinal disorders, may be advised to give the alimentary organs as nearly as possible a complete physiological rest. The second consists of the Rouman rusks, prepared with milk and milk sugar in a manner which like dry rye bread compels mastication, whilst supplying the necessary carbohydrate from which abundant supplies of lactic acid are produced in the alimentary system. Milk is a nourishing and digestible food, especially when not taken in such quantity that large curds are formed in the stomach. The process of souring milk by means of Bulgarian lactic acid producing bacilli renders the casein more soluble, and therefore it is true to say that the food value of milk is en- hanced thereby. The practice of mixing some other liquid with milk, as for instance lime water, barley water, or soda water, tends to render it more digestible by preventing the formation of solid clots in the stomach. The same result is also attained by eating solid food with milk. 56 DIET AND THE MAXIMUM The advantages of this have just been pointed out in the case of Sour-milk. Cream, Butter and Cheese. Cream consists chiefly of the fat which has risen to the surface of milk left to stand, or which has been abstracted by means of a mechanical separator, and yet cream is by no means all fat, as butter may be said to be, for in cream all the other constituents of milk, namely casein, whey, salts and milk sugar are present. In the process of churn- ing by which butter is prepared these are separated from the pure fat and discharged as butter milk. Devonshire cream is obtained by heating milk short of boiling point in pans, by which process the cream rises quickly. Less of the other milk constitutents are found in the clotted cream, and in particular there is much less of the lactose or milk sugar, and for this reason Devonshire clotted cream is more suitable for diabetics than ordinary cream. In the light of recent knowledge one of the most important of food preparations DURATION OF LIFE. 57 derived from milk is the Bulgarian Sour- milk to which reference has already been made. Full particulars as to the manufacture of this health-giving food will be found in the companion volume " 120 Years of Life," but it may be mentioned here that the Sour-milk is readily prepared by adding a culture of the lactic-acid-producing germs, or a portion of Sour-milk already prepared from such a cul- ture, to milk previously boiled and allowed to cool to the body temperature (98 °F) and kept at that degree of warmth for about ten hours. Cheese consists of the casein of milk, which has been clotted either by the use of rennet or by a process of souring, the clot is subjected to pressure to remove the whey, and is then allowed to ripen, a process depen- dent upon bacterial action, to which is due the special flavour of different brands of cheese. Sour Milk Cheese. The question has frequently been asked of late whether cheese is a satisfactory form in which to administer the Sour-milk treatment. 58 DIET AND THE MAXIMUM The correct reply to this question is that the actual Sour-milk itself is the most efficient form in which to provide the lactic bacilli, but that of substitutes for this the cheese form is the best, in that it is moist and therefore the bacilli can live for a considerable time in a condition of unimpaired activity, which they cannot be relied upon to do in tablets, powders or confections ; moreover the dose which can be given in a moist cheese is much larger than is possible in a chocolate cream, but the cheese should be a fresh Sour-milk cheese, and not a ripened rennet prepared curd. The Uga Cream Cheese which actually represents the Sour-milk deprived of surplus whey by a special process, is a most efficient adjunct to and even a good substitute for the actual Sour-milk. Moreover, it is as pleasant as the best of cream cheeses and extremely nourishing, and being practically sugar-free, may be given to diabetics with advantage. Ordinary ripened cheeses, including Ched- dar, Stilton, Cheshire, Gruyere, etc., are extremely nourishing, but they present their proteid in such a concentrated form that they DURATION OF LIFE. 59 are apt to prove difficult of digestion, more especially when taken in addition to a full diet. When used as the staple item of food and well masticated with dry bread or rusks or hard biscuits they may be digested with more ease. A pound of cheese represents the casein and fat of a gallon of milk and produces 2,000 calories of energy. Cheese contains, weight for weight, more than twice the nourishment contained in lean beef, and three times the energy-producing value. Eggs. Eggs are clearly a typical form of animal food. They are referred to in an earlier page as potential chickens, into which they can be transformed simply by the agency of warmth and time. They therefore can have no place in the dietary of a strict vegetarian, though generally an important item in the non-flesh dietary of the lenten fast, or even of the Humanitarian feeder. An average hen's egg weighs about two ounces, a little over half is represented by 6o DIET AND THE MAXIMUM the white, a third by the yolk, and the remainder by the shell. The white consists of pure albumen or proteid, whilst the yolk is even more nourish- ing, having, in addition to proteid, fat, phos- phorus and mineral matter of a complex nature. An egg represents about 70 calories of energy and is equal in nourishment to about one and a half ounces of meat or four ounces of milk. Eggs are almost completely absorbed in the intestine, leaving very little residue. DURATION OF LIFE. 6l CHAPTER IX. About Vegetable Foods. The vegetable kingdom is the chief source of the carbohydrates which are so important an element in our food, whereas the animal kingdom provides little else beyond proteid and fat. Vegetables, however, contain pro- teid and fat as well as carbohydrates, there- fore the vegetable kingdom provides aU the essentials of life, though not always in the most accessible and digestible or most com- pletely assimilable forms. Vegetable foods are for the most part bulky in proportion to their nutriment ; for instance, a cabbage con- tains more water than the same weight of milk, its solidity being due to the skeleton of cellulose which is not digestible and which accounts for its bulk. Vegetables are not digested in the stomach but in the intestines, and yet they impose considerable labour upon the stomach, especially when not completely titurated by mastication, as that organ has to reduce to fluid form all the foods of what- ever kind that enter it as solids. Were the habit of thorough mastication habitual, the 62 DIET AND THE MAXIMUM stomach would be relieved of much work which it finds itself compelled to perform, and in the performance of which it not in. frequently breaks down. However complete and thorough stomach digestion may be, and however efficient the digestive power of the intestines, no human being is possessed of the power to absorb and assimilate the whole of the vegetable food consumed. Turnips always leave an undigested residue of at least a fifth of the dry substance which they contain, cabbage leaves 15 per cent., potatoes II per cent. ; or if we look at it in another way we find the inability of the human diges- tion to cope with the nutriment supplied by the vegetable kingdom even more strikingly illustrated when we consider the waste of proteid which always follows the consump- tion of vegetable foods as compared with those of animal origin. When we eat meat, always assuming that it is not taken in excess, we actually assimilate 98 per cent, of the proteid, whereas in the case of peas we only absorb 83 per cent, of the proteid, with potatoes the loss is still more marked, DURATION OF LIFE. 63 for 32 per cent, of the proteid is wasted, and of lentils only 60 per cent, is absorbed. It will thus be seen that in attempting to live upon an exclusively vegetarian regime, we give the digestive organs a great deal of fruitless work, and we waste energy and food material. When we derive our proteid from animal sources a considerable proportion of the work of elaborating the simpler product of the soil and atmosphere into the complex cells of the human body has been carried out for us, and thus we are left with a surplus of energy which is available for those activities of thought, organisation and enterprise for which the human race is unique upon earth. There is a true division of labour between the cow chewing the cud and giving her whole energy to the digestion of grass and the provision of highly elaborated food in the form of milk or flesh, and the human being who, taking advantage of such preliminary labour, is able to spare himself digestive effort and to employ his energies for higher things. 64 DIET AND THE MAXIMUM CHAPTER X. Bread. Bread has already been described as the product of the fruit or seed of a cultivated grass. In the earhest days man discovered that grain, which when dry is hard and indigestible, was improved by being ground into flour. Next it was made into a kind of unleavened bread by the simple method of mixing the flour with water and baking it. This process still survives in the manufacture of the ship biscuit, which is hard almost as stone. The problem of rendering bread soft and light was next solved by the discovery that fermentation would produce gas which would cause the dough to " rise." The effect of leaven or yeast upon the dough is to fill it with small bubbles of gas with the result that in an ordinary loaf no less than two-thirds of the bulk consists of gas or air and of the remainder over a third is water, over a half carbohydrate ; and about 6 per cent, proteid. When bread becomes stale it loses some of its free water both by evaporation and by DURATION OF LIFE. 65 combination of the moisture with gluten and starch. Stale bread may be " refreshed " by- being placed in a hot oven for a few minutes. This will release the moisture from the starch and gluten and there will again be some amount of free water in the bread which gives it " freshness." Chemically speaking, this question of water is the only difference between fresh and stale bread, but this is a very important consideration, for it accounts for the well known indigestibility of freshly made bread, which is simply due to the fact that it is soft , tenacious and elastic, and is generally swallowed without efficient masti- cation and admixture with the saliva, with the consequence that the gastric juice cannot get ready access to the balls of dough which ferment from within. Stale bread, on the other hand, compels mastication, without which it cannot be swallowed in comfort. Fresh bread would be as digestible as stale if the habit of thorough mastication were universal. Toast, the crust of bread, and rusks all compel mastication, and in addition some of their starch has been converted into 66 DIET AND THE MAXIMUM dextrin, which is soluble, whereas uncon- verted starch is not digested by the gastric juice, but must wait tiU it reaches the intes- tines. This accounts for the fact that many who find fresh bread indigestible can take toasted bread or rusks without experiencing discomfort. The advantage of brown over white has often been discussed and sometimes with more zeal than knowledge. A very white bread may contain too much starch and too Uttle proteid, for in excessive refining the germ and bran are rejected. A badly made brown bread may, however, be less nourishing than a white bread pre- pared from good flour, and it may contain an excess of cellulose and a considerable propor- tion of indigestible and mechanically irritant particles. A good brown bread, that is, one made from whole-meal flour well milled, is the most nourishing kind of bread, but it is unwise to accept all brown loaves as superior to white. When eating bread, thorough mastication is of more importance than when eating other foods. Meat, for instan'ce, may be swallowed unmasticated with less ill effect DURATION OF LIFE. 67 than bread. Of all the cereals wheat makes the best bread, being well supplied with gluten. Rye comes next to wheat as a bread maker. It is rich in gluten and the bread prepared from it is moist and solid. It is preferred to wheat bread by the inhabitants of many of the Continental Countries, and with sour milk it forms the staple diet of the peasants in Bulgaria and the other countries of South Eastern Europe. Oats are more nourishing than the other cereals, being richer in proteids, and fat. Oats do not make good bread owing to the lack of gluten. Oatcakes, however, simply made by mixing oatflour and water, are extremely nourishing. Rice is the chief source of starch, contain- ing as much as 75 per cent, of this carbohy- drate, but compared with the other cereals it is poor in proteid and fat. Mixed with eggs and milk, in the form of milk pudding, it be- comes an extremely nourishing food, as the eggs and milk supply the food elements in which starch is deficient. Rice when cooked is readily digested and very completely 68 DIET AND THE MAXIMUM absorbed. Rice alone is by no means a satis- factory forra of food, but when its deficiencies are compensated for by the employment of other foods rich in nitrogen, it is extremely valuable. Some persons have difficulty in digesting starch, or can only do so when administered in small quantities ; for such persons rice is not a suitable food. DURATION OF LIFE. 69 CHAPTER XL Pulses, Tubers, and Green Vegetables. Peas, beans and lentils are known as the pulses. They are rich in proteid, fat and carbohydrate. The proteid is in the form of legumen. They are not easily digested by the stomach and their comparative bulk renders them an unsatisfactory form of food when certain disorders of the stomach are present, but when properly prepared by cooking and taken in appropriate quantity they are very well digested in the intestines and prove very nourishing. Roots and tubers, of which the most widely used is the potato, are an important source of starch. This group includes carrots, turnips, parsnips, artichokes, and others, all of which are unduly provided with indigestible cellu- lose, which renders them difficult of digestion by those whose alimentary organs are not vigorous, moreover they are bulky in propor- tion to the nutriment contained, and a con- siderable part of the nourishment which they possess cannot be assimilated by the human 70 DIET AND THE MAXIMUM body. It is a curious and interesting fact that the most nourishing part of the potato is contained in the rind and the part imme- diately within it, both of which are generally discarded when the potato is peeled. The usual method of cooking the potato has this further disadvantage, that much of the proteid and mineral constituents are dis- solved out in the water. The best method is, obviously, to cook the potato in its jacket, and the second best is to steam rather than boil it when peeled, so as to prevent the loss of the soluble material. Potatoes are not suited to form the chief food of man. They are unduly bulky and lacking in proteid and fat. The Irish peasant who regards them as his principal food is apt to suffer from dilatation of the stomach and intestines and from deficient nourishment of the bodily tissues. Green vegetables are valuable chiefly for the salts which they contain, rather than for their nutriment. When cooked they consist mainly of water (go to 98 per cent.) contained in a skeleton or frame work of cellulose, JURATION OF LIFE. 7I which latter is indigestible. They must be eaten with caution by those who suffer from any dilatation of the stomach, which organ is apt to find considerable hard and unprofit- able labour in attempting to dissolve the fibre of the green vegetable. Vegetable marrow may sometimes be digested with comparative ease for the simple reason that when cooked it consists almost entirely of water, even to 99 per cent, or more, the remaining one per cent, not offering much resistance to the efforts of the stomach to transform all food into a liquid. Fruits are generally desired for their flavours rather than for their nutrient quali- ties. There are, however, certain food fruits such as the banana, dates, and the dried grapes. Raisins, currants and figs also are very nutritious. Unripe fruit contains more cellulose and more acid than that which is well ripened, it is therefore, less digestible and more hkely to prove irritant. The flavour fruits, such as strawberries, apples, pears, peaches, plums, etc., consist of about 90 per cent, of water, 72 DIET AND THE MAXIMUM five to ten per cent, of sugar with small pro- portions of acid, salts, cellulose, etc. The food fruits owe their nourishing properties to carbohydrate, chiefly in the form of sugar. The banana, however, contains from one to one and a half per cent, of proteid and over 20 per cent, of carbohydrate, and dried dates and figs are more than equivalent in nourish- ment to an equal weight of bread. Nuts are extremely well provided with nutriment, and, theoretically speaking, should prove, bulk for bulk, more nourishing than any form of food, but in actual practice nuts have disadvantages. They are not weU di- gested in the stomach, owing to their density, compactness, and to the preponderance of fat, and also on account of their nutritious ingre- dients being contained in a network of cellulose, the result being that a consider- able proportion of their nutriment is never assimilated. There are food " Scientists" who recommend one to live largely on nuts on account of their proteid contents, but it would be necessary to DURATION OF LIFE. 73 eat 700 walnuts daily in order to get the necessary quantity of proteid from that source alone. The almond is rich in proteid and free from starch, for which purpose it is used in the manufacture of bread for sufferers from diabetes, who cannot take starch without evil consequences. Chestnuts are the most convenient of the food nuts and are used in France as a regular item of the daily dietary by the peasants. It is said that next to the banana, the chest- nut comes first in this respect, that a given acreage of ground used for the production of chestnuts provides more food than when used for any other tree or plant. Fungi, of which the mushroom is the one most commonly used as food, are neither very satisfactory as sources of nourishment, nor are they very digestible. They contain an undue proportion of cellulose, and though nitrogenous, only a portion of the nitrogenous matter is true proteid, and only part of that is assimilable. Their chief virtue depends upon their agreeable flavours. 74 DIET AND THE MAXIMUM Reference has been made on several occa- sions in this chapter to cellulose, which forms the framework of many fruits and vegetables. It has also been mentioned that this substance is indigestible. An idea of its characteristics will be gained when one recognises that cotton- wool consists of pure cellulose. No one would regard cotton-wool as a digestible substance, or as a food at all, but some of the lower animals are able to extract nutriment even from cellulose. DURATION OF LIFE. 75 CHAPTER XII. Beverages. It is probable that many readers will expect that in a book on diet considerable space will be devoted to the discussion of drinks, but in point of fact this branch of the subject can be dealt with without much expenditure of space. Those who enjoy robust health, and who are inclined to be content with the present, and to leave the future to take care of itself, are likely to continue to please themselves as to matters of food and drink, but those who suffer from ailments of one kind or another, or who, though in possession of good health, recognise that they hold it upon sufferance, and that pleasant indulgences now, are apt to lead to evil consequences later on, wiU carefully consider the question of beverages in relation to health. It may be said at once that water is, from a physiological point of view, the ideal beverage, and that all other drinks are merely adulterations of water, the use of 76 DIET AND THE MAXIMUM which concoctions, excepting under proper restrictions, is sure to result in undesirable effects upon body or mind, or both. About 66 per cent, or two-thirds of our body weight is made up of water either in the blood or the tissues, and though most of the soUd foods which we eat contain a considerable proportion of water, it is practically essential to supplement this by means of drinking water, which should be taken in requisite quantities, and either entirely apart from, or as a part of the solid meals, as circumstances may require. Thirst is the demand made by nature for fluid, and it occurs when the volume of the blood has been diminished by means of per- spiration or through the various channels by which fluid is excreted, or when the density of the blood has become excessive. To re- adjust the balance it is essential that water should be consumed, and this may be effected partly by means of apparently solid foods, partly by miscellaneous beverages, and partly by plain water, but in each case the water is the one thing needful, and in the case of DURATION OF LIFE, ']'] beverages such as tea, cocoa, ale, wine, lemonade or ginger beer, the other ingredients are employed merely as flavours or stimulants, and they are in fact non-essential. It may be objected that certain beverages are nutrient or medicinal ; for instance, cocoa is often advertised as a valuable food, and mineral waters and certain wines are recommended for their supposed health-giving qualities. The answer to this is that fluids are not a satisfactory form in which to administer foods as such, excepting under special circumstances. It has already been explained that milk is to be regarded as a solid rather than as a fluid food, since it curdles directly it enters the stomach, and as for cocoa, which is the chief of the so-called food beverages, its food value depends chiefly upon the addition of milk and sugar and partly upon the oil and the nitro- genous elements which it contains, whilst in many prepared cocoas arrowroot or starch are blended with the cocoa. In any case the beverage known as cocoa is not a good medium for the administration of nutriment, for, as pointed out by Dr. Robert Hutchison, an 78 DIET AND THE MAXIMUM ordinary breakfast cupful of cocoa is prepared from about ten grammes (2^ spoonfuls) of cocoa, which represent forty calories of energy, and therefore a person who attempted to live on cocoa alone would have to imbibe seventy- five cupfuls daily. Natural mineral waters have their medicinal value in cases of various pathological conditions, but they are not largely used in this country by those in health excepting as dilutants of spirits. Tea, coffee and cocoa all contain alkaloids which have more or less stimulating properties, and on this account they are apt to be taken in excessive quantities, and to exert destructive effects upon the nervous health. For the same reason they meet with an exaggerated degree of condemnation and abuse from fanatics. In ordinary cases and apart from personal peculiarities or idiosyncracies they may be taken when properly prepared, and in moderate quantities, without the slightest evil consequences. Where these beverages are concerned only two conditions are to be feared, defective quality due to adulteration or improper preparation, or excess in DURATION OF LIFE. 79 quantity. The same cannot be said of alcohol, which is best left alone by all who desire long life and good health. There are conditions of health in which even alcohol may be employed, in the hands of the physician, with good results, but the safest rule for the person who values health and life, is total abstinence from alcohol. During the last few months attempts have been made to rehabilitate alcohol, and it has been suggested that those nations where it is most employed are the most progressive, and that even the children of alcoholic parents are not so liable to suffer from degenerative tendencies as the temperance advocates would have us believe. No such efforts can alter the fundamental fact that indulgence in alcohol reduces the expectation of life, dis- integrates the vital organs and leads to those diseases of the arteries, brain, liver, heart and kidneys which in themselves constitute the infirmities of premature old age or senility. Moreover, nothing is more certain than that the children of alcoholic parents are apt to inherit the dypsomanial tendency, and if 8o DIET AND THE MAXIMUM they escape this there are a number of alter- native tragedies which lie in wait for them, such as epilepsy, madness, or such a degree of nervousness as renders life a burden not only to themselves, but to those who are obliged to come into constant contact with them. Cyder, ginger beer, and other apparently inoffensive drinks often contain from two to four per cent, of alcohol, and lemonade which is free from this defect is highly charged with sugar, each bottle containing the equivalent of four ordinary lumps. DURATION OF LIFE. 8l CHAPTER XIII. Food in Infancy. As the child is the father of the man, it is of extreme importance that the foundations of long life should be well laid in infancy. It is a universally accepted and perhaps an obvious fact that there is no food more suitable for the infant than its mother's milk, but when for any reason this is not available the next best substitute is cow's milk, which should be diluted with water since the casein of the latter is in excess, and fortified by the addition of cream, and milk sugar, since these are comparatively speaking deficient in the milk of the cow. This modification of cow's milk is perfectly simple, and can be done at home by mixing one part of water or barley water to two parts of milk and adding cream and milk sugar in the proportion of a tea- spoonful of each to half a pint of the milk used. Those who prefer a modified milk ready prepared can use Paget' s milk, which has a world-wide reputation for reliabihty and 82 DIET AND THE MAXIMUM uniformity of composition, and which is supplied to several of the leading London hospitals. Proprietary infants' foods are best left alone, though certain of them being starch free, and carefully prepared, may be employed as adjuncts to milk with good results. As a rule, however, they are deficient in fat, and are quite unsuited to be used excepting with cow's milk. Some of these patent foods, however, are positively dangerous to the health and life of the child to whom they are given, and may give rise to such serious diseases as rickets, and to many grave dis- orders of digestion and nutrition. CURAtlON OK LIFE. 83 CHAPTER XIV. Pood in Disease. It is desirable so far as possible in all cases of illness or disease that the physician should prescribe the actual dietary for each individual case, but the following general principles may be outlined. Food in Fever. In dealing with the febrile state in which the body temperature is above the normal and the digestive functions are seriously dis- ordered solid food is out of the question ; nature, indeed, generally emphasises this by temporarily obliterating all trace of appetite. Nevertheless, tissue waste proceeds apace, and nourishment after a while become a necessity. Reference has already been made to the " Diet absolu " of Continental practice, and experience proves that in certain disorders complete temporary starvation or abstinence from all foods excepting pure water proves the shortest road to recovery. In other cases a return to the diet of infancy is the best course, or in other words diluted milk is the best food in fever. Sour-milk or Uga has been $4 DIET AND THE MAXIMUM employed in many cases with the happiest results, as the patient finds the slight acidity refreshing, and the digestion of this health- giving food is much more complete and easy in febrile conditions than is that of milk diluted with water or barley water. Beef teas, and broths, for reasons already ex- plained, are of little nutrient value, despite the popular impression to the contrary, though they have certain stimulant properties and may excite the dormant appetite. Food for Dyspeptics. Those who suffer from chronic indigestion have generally been guilty either consciously or otherwise of long continued or frequent breaches of the simple rules of dietetics, though indigestion may be the result of con- stitutional disease or of personal idiosyncrasy, such as the inability to secrete sufficient active pepsin, or the possession of a dilated stomach or an unusually small or a contracted pyloric outlet. As a rule, however, the victim of dyspepsia is one who habitually consumes food of unsuitable character or of improper DURATION OF LIFE. 85 quantity, and it has to be remembered that continued insufficiency in any of the essential items of the physiological diet will lead to dyspeptic troubles just as will habitual excess. It is surprising to observe in how many cases digestive health may be restored by the simple method of discarding the ordinary varied dietary for a while and living for a few weeks upon little else beyond Sour-milk and a nitrogenous biscuit, gradually returning to the usual regimen when digestive vigour has been regained. It is impossible to prescribe too simple a diet during the active stages of dyspepsia, and those who by unpleasant experience know themselves to be subject to digestive disorders should always live frugally and in particular avoid the following : — Forbidden Foods for Dyspeptics. New bread, muffins, crumpets, buttered toast, pastry and sweets ; hard, long fibred meats, veal, pork and beef ; sauces, curries, pickles and condiments ; all fried or re- cooked meats ; aU salted, cured, tinned, preserved and highly seasoned fish and meat ; 86 DIET AND THE MAXIMUM sausages, liver, kidneys, duck, goose, and eels ; green vegetables generally, save in small quantities for those whom they are known to suit ; soups and broths, except in small quantity ; foods generally which leave a large residue, or which are in their nature irritating (discard seeds, kernels, rinds, skins, and stalks) ; acid or unripe fruits, sour wines ; tea with meat and otherwise, unless of moderate strength and freshly infused ; coffee, chocolate, lemonade and ginger beer. On the other hand a sufficiently liberal diet may be chosen from the following list : — Fish of any kind (boiled) (except mackerel, salmon, crab, lobster, anchovies and eel) ; chicken, lamb, mutton, beef (roasted), well boiled ham and bacon (never fried) ; eggs, poached or lightly boiled ; tripe, sweetbread, calf's head ; dry toast, carefully prepared, or (better) plain rusks, stale bread ; other fari- naceous foods with caution and in moderation only ; potatoes (with caution), spinach, green vegetables generally, in small quantities only ; celery (cooked), French beans, vegetable DURATION OF LIFE. 87 marrow ; fruit (without pips, core or skin) in small quantities ; milk plain, butter in moderation ; Sour-milk ; hot or cold water ; tea, freshly made, not strong ; coffee in moderate quantity and not strong ; thin cocoa. The importance of thorough mastication either as a means of preserving digestive health or of regaining it when temporarily lost, cannot well be over-estimated. The Dietary in Gout. Gout is almost entirely the result of an unsuitable diet ; in fact, it may be said that the two chief causes of this painful and dangerous condition are intestinal putrefac- tion and the poisons engendered thereby and the long continued abuse of alcohol. The following are forbidden : — Fats and rich foods, re-cooked foods, sauces, rich gravies and made dishes ; the harder or richer meats, pork or veal ; smoked, dried, or pickled fish, beef, or other meat ; pastry, jellies, sugar ; meat essences and strong soups ; rhubarb, gooseberries, straw- berries (except in strict moderation) ; mullet, 88 DIET AND THE MAXIMUM mackerel, salmon, herring, eel, lobster, crab, duck, goose, hare, mushrooms, truffles, pickles and spices ; preserved fruits ; ale, porter, stout, port, champagne. Burgundy, sherry, Madeira, and all liqueurs. The diet should be chosen from the fol- lowing : — Fresh meats with exceptions mentioned above ; fish (with exceptions named) ; eggs in moderation, lightly boiled or poached ; meats (those of the lighter and whiter kinds) in great moderation ; rice, sago, and tapioca ; fresh ripe fruits (with exceptions named) ; vegetable soups, toast or stale bread, or Rouman rusks, potatoes, salads, celery (cooked) and green vegetables ; milk, skimmed, diluted, with soda Vichy, or Seltzer water. Sour-milk and Uga Cream Cheese ; China tea, freshly infused and not strong ; coffee, which should be taken in moderation, and not at night ; cocoa. It should be remembered that gout is a constitutional disorder with local manifesta- tions, but that its cause is the presence in the blood of uric acid which is apt to be deposited DURATION OF LIFE. 89 in the joints and muscles in the form of urate of soda. To cure gout, therefore, two things are necessary, to stop the production of the poisonous acid and to eliminate or discharge from the system that which is already present. The dietary methods here recommended will do the former and the latter may be effected or encouraged by promoting the activities of the skin. It is for this reason that the baths at Harrogate, Droitwich, Luchon, Llandrindod Wells and elsewhere are visited by so many thousands of gouty sufferers each year. A similar remedy for home use is well known under the name of the Anturic Bath. The frequent use of such a bath is to be recommended to those who suffer from gout, as being one of the most efficient adjuncts to the dietetic treatment. 90 DIET AND THE MAXIMUM CHAPTER XV. Feeding in Obesity. It has already been indicated in these pages that in the great majority of instances undue fatness is due to an excess of food habitually consumed. In fact, obesity is nearly always the result of an excessive intake of food, generally associated with an inadequate ex- penditure of energy. The average person requires daily from 2,500 to 3,000 calories of energy-producing foods, but if he consumes the equivalent of 3,500 or 4,000 calories, and leads an inactive life, he is almost sure to become the subject of disease or of obesity ; and the latter, as a rule, is a stage on the way towards the former. It is said that there are a few in- stances in which, owing to a lack of vitality of the cells of the tissues or other obscure cause, even small eaters accumulate adipose tissue, but these cases a,re not often met with, and upon careful enquiry it often transpires that obese patients who believe themselves to be small eaters prove to have been mistaken when DURATION OF LIFE. 9I the actual weight and quantity of the foods consumed are ascertained. Obese patients are apt to be sceptical as to the chances of a permanent cure of their condition by means of diet and exercise, and to prefer the less irksome but delusive and dangerous method of drugs and patent remedies, but it may be stated here with absolute certainty that there is no medicine or drug which can safely reduce fatness in the absence of proper regulation of the diet and of the daily habits as to exercise ; and that when these are attended to do no drug is neces- sary, for it is a matter of equal certainty that obesity can be cured by a scientific reduction in the quantity of the various foods consumed accompanied by a prudent increase of the expenditure of energy. Before undertaking any drastic modification of the diet and the habits of life it is well for obese persons to seek the advice of a physician as to the actual reductions which should be made, and also to make sure that no serious diseases of the heart, liver or kidneys which 92 DIET AND THE MAXIMUM SO often accompany excessive adiposity may be overlooked ; but once the restricted diet is agreed upon it should be adhered to faith- fully, and if necessary by means of weights and measures, lest the appetite and inclination of the moment may lead to involuntary excesses which would render the treatment a complete failure. According to the severity of the case the physician will decide to reduce the number of calories from the 3,000 which is the usual minimum of such sufferers before treatment, to 2,000 or even less, and he will indicate to what extent the diminution is to be made at the expense of the fats and carbohydrates respectively. The Banting System. Of all the various well-known systems of diet for obesity, that practised by William Banting in his own case in 1862 is, perhaps, the one most commonly referred to, in fact the adoption of a temporary starvation diet has come to be known by the term " Banting." DURATION OF LIFE. 93 William Banting was so fat that life became, in more senses than one, a burden to him. He could not lace his own boots, nor when upright could he see his feet at all, and he was so unwieldy that he dared not descend his own staircase excepting backwards, and with the assistance of a handrail. He had consulted various medical men in vain, and had adopted what he considered to be a very bland and innocent diet which consisted for the most part of bread, milk, butter, sugar and potatoes. These very items, however, he was advised by Dr. Harvey, were least suited to his condition, and he was recommended to abjure them altogether, and also to limit the quantities of the remaining foods to such an extent that the following diet table repre- sents all he was allowed, and upon this regimen he lost over two and a half stones in weight within nine months, or about a pound each week. Afterwards he wrote the following remark- able sentence : "I can conscientiously assert that I never lived so well as under the new plan of dietary." 94 DIET AND THE MAXIMUM Banting' s Diet. Breakfast. A plateful or small helping (not to exceed five ounces) of meat. A large cup of freshly made weak tea, one ounce of toast or rusk or dry biscuit. Dinner. A plate of meat of any kind, or fish, (not to exceed six ounces), 5 ounces of any vegetable excepting potato, 4 oz. of stewed fruit, 3 glasses of light wine. Tea. Two rusks, 3 ounces of fresh ripe or stewed fruit, a cup of tea. Supper. 4 ounces of meat, or fish, 3 or 4 small rusks, a glass of wine. Such a diet as Banting's when modified to suit individual circumstances will seldom fail to reduce obesity ; the chief disadvantage being the comparative preponderance of nitrogenous foods, which are apt to strain the kidneys, especially when these organs are in any way defective. The other well-known dietary systems for obesity are not dissimilar in principle to Banting's, but differ in detail, as follows : — Van Noorden splits up the food into eight small meals taken at short intervals during DURATION OF LIFE. 95 the day and he restricts the fats more than the carbohydrates. Ebstein follows Banting's method, but gives more fat and less proteid. Hirchfield's diet is not unlike Ebstein' s, and may be outlined as follows : — Breakfast. 2 oz. stale bread, toast or rusk, and a cup of plain tea or coffee (no sugar or milk). Early Lunch. 2 eggs hghtly boiled or raw. Dinner. 4 oz. of soup containing 2 oz. of rice, 8 oz. lean meat. Afternoon. Black coffee or plain tea (with- out sugar or milk). Supper. 2 oz. of cream cheese, 4 oz. bread, ^ oz. of butter. It is always desirable when treating obesity and, indeed, in most cases of alimentary impairment, to diminish the amovmt of fluid taken with food, but to allow water in moder- ate quantities apart from food. 96 DIET AND THE MAXIMUM CHAPTER XVI. How to Grow Fat. I do not propose to devote much space to the answer to this question, since leanness in itself is seldom a disadvantage, nor does it shorten life ; on the contrary, obesity is seldom compatible with the maximum duration of life. There are four conditions, however, in which efforts should be made to increase the weight and general nourishment of the body, (i) During convalescence after illness ; {2) in certain nervous disorders, especially that known as neurasthenia ; (3) in wasting diseases such as consumption ; {4) in emaciation due to insuf&cient or improper feeding. In order to " lay on fat " two things are necessary : there should be an increase in the food consumed, and especially in the hydro- carbons and carbohydrates, and there should be a diminution in the output of energy, therefore it is that in a sanatorium where patients rest and are well fed a marked increase in weight is almost universal. In the DURATION OF LIFE. 97 year 1900 I was acting as physician to an open-air sanatorium in Oxfordshire, to which the editor of the Hospital newspaper sent down his special commissioner to inspect the institution and report upon the methods of the open-air treatment, then a novelty in this country. There were at that time twelve patients in the sanatorium, and after careful enquiry the commissioner was able to report that the average increase in weight during the week previous to his visit was no less than three pounds per patient. [The Hospital, December 15th, 1900). This week was, perhaps, exceptional, but in very many cases I was able to observe an increase of weight amounting in a few months to two stones or more. This result being due not only to the dietary, but to the physical, mental, and moral rest commonly found during residence in an institution and to freedom from harassing employment. The Weir-Mitchell treatment depends for its success upon similar considerations. Patients are kept at rest in bed, they receive no letters or visits from friends, and they are gS DIET AND THE MAXIMUM well fed and subjected to frequent massage, and in practically every case there is a great increase in body weight and often such increase is permanent. Recently certain food-medicines have been devised and widely recommended, the basis" of which is casein or milk powder and glycero- phosphate of soda. These seem not only to be efficient as foods but to promote the assimilation of other foods as well, and in cases of neurasthenia they are undoubtedly of value. Perhaps the best of these is known as Phosphova, which is prepared by the original makers of dried milk powders (Casein Ltd., of Battersea, S.W.) ; it consists of the dried powder of milk, eggs and malt, blended with the tonic glycero-phosphate. This pre- paration has the merit of agreeable flavour and being made without the application of destructive heat, or sterilisation, the enzymes resident in the fresh foods are not destroyed. Diet in Diabetes. It would be out of place in a volume like the present one to discuss in detail the dietary DURATION OF LIFE. 99 requisite in cases of serious diseases such as diabetes, renal disease, cardiac disorders, etc., but speaking in general terms it may be said that the diabetic patient must avoid starchy foods, sugar and carbohydrates generally, or ' take them in extremely small quantities only. The food must consist chiefly of proteid (meat, fish and eggs), fat (butter, cream, cream cheese,* salad oil, fat meat, etc.), and green vegetable with gluten or almond bread. It is obvious, however, that sufferers from diabetes and other grave constitutional dis- orders must necessarily place themelves under the care of a physician who will supervise the dietary. Under these circumstances, even in cases in which complete recovery is impos- sible, life and comfort may be prolonged and much suffering obviated. * Careful analysis of the Uga cream cheese already mentioned as prepared from sour milk by Clay, Paget, Ltd., 71, Ebury Street, shows it to be practically sugar free. It is therefore an extremely suitable form of food in diabetes. It is palatable and nutritious, and presents the therapeutic advantages of the sour milk treatment in a form convenient for administration. 100 DIET AND THE MAXIMUM CHAPTER XVII. Dietetic Systems. The Salisbury Diet. — Reference has al- ready been made to this, which consists of the temporary adoption of a diet of lean minced beef and hot water. As a habitual dietary in this country it is quite impracticable, but as a temporary expedient in cases of dyspepsia with an inability to digest starch and sugar its value is extreme, and can hardly be over- estimated. Its employment demands careful supervision, as it throws unusual work upon the kidneys. The Purin-free Dietary has been recommended by Alexander Haig and others as being little short of a dietetic panacea. Purin bodies are supposed to give rise to uric acid and to be responsible therefore for gout, rheumatism, neuralgia, headaches, and, if we believe the most enthusiastic advocates of the anti-purin system, crime and ill-temper as well. Purins are supposed to reside in meat, eggs, tea, coffee, and the pulses, and, therefore. DURATION OF LIFE. lOI the chief foods left to the purin-free dietist are nuts and cheese. I am of opinion that such restriction is both unnecessary and harmful, and that when proper moderation is observed there is no objection to the purin containing foods. The Uncooked Food System. — This emanates from America, and is also known as the Sun-cooked food system. Its devotees avoid meat and animal foods generally, and subsist upon cereals dried in the sun and milled more or less incompletely, olives, dates, and fruits, cocoanuts, pine kernels, and other vegetable products. Milk, cheese, and cream are not disallowed. This is a system which has its attractive side. It is pleasant to think of living upon the proceeds of the orchard, garden and fields without the need for destroying animal hfe, and the foods recommended are prepared for table with the minimum of effort, and therefore the housewife enjoys unusual leisure ; but, physiologically speaking, the uncooked food system has many drawbacks. The coarse, unfired breads 102 DIET AND THE MAXIMUM and biscuits require the digestive powers of a horse rather than those of the average human being, and much of the actual nutri- ment which these foods contain, cannot be extracted by the human digestive machinery, but passes through the aUmentary organs unabsorbed. I have seen patients who have endeavoured to live upon uncooked foods whose tongues and general appearance give evidence of chronic gastric catarrh and deficient general nourishment. Nevertheless, certain sufferers from former excessive alimen- tation may find in the temporary adoption of the frugal regimen of the fruits and sun- cooked cereals, not a little improvement in their digestive health. The Fletcher System. This consists of complete and thorough mastication of all food consumed. Every mouthful must be positively reduced to fluid form before being swallowed. Gladstone recommended 32 bites for each mouthful, but Fletcher advises between one and two hun- dred, and if this is faithfully carried out DURATION OF LIFE. IO3 Fletcher is, comparatively speaking, indifferent as to the kind of food consumed, provided that it is of wholesome and moderately frugal character. No one with any knowledge of physiology can doubt the wisdom of " Flet- cherising," or in other words of performing the office of mastication thoroughly. This habit promotes the flow and activity of the salivary juice, which partially digests the starches in the food ; and when the food mass, well mingled with the saliva, reaches the stomach the flow of the gastric juice is thereby promoted, and the whole cycle of digestive activity is encouraged. Food bolted, however, delays digestion and sets up gaseous fermentation ; moreover, the digestive juices cannot readily penetrate solid masses of food, and yet the stomach when acting normally will not allow such solid particles to pass through the pylorus into the duodenum, and therefore there is an almost inevitable dead- lock, which leads to dyspepsia, dilatation of the stomach, and even graver evils. Thorough mastication, therefore, is to be heartily commended as a preUminary to and 104 I'lET AND THE MAXIMUM a notable encourager of complete stomachic and intestinal digestion, for just as the bolus of food well mingled with the alkaline saliva, is the best stimulant to the peptic glands of the stomach, so in turn the well titurated contents of the stomach promote the duodenal digestion and the flow of the bile and pan- creatic juice, all of which functions and organs are hampered by the ingestion of masses of unmasticated foods. The objection sometimes raised that dogs and carniverous animals bolt their food greedily, and that we should take them as nature's pattern, is not really applicable to the human mixed feeder. If man lived on flesh alone mastication and mouth digestion would be of comparatively little importance, for the gastric juice can dissolve and disintegrate large masses of meat, but when starchy and mixed foods are consumed mouth digestion and thorough mastication are of supreme importance. Moreover, they discourage gluttony and lead to an appreciation of flavour which confers many advantages upon those who practice them. And in particular those who efficiently DURATION OF LIFE. I05 masticate all foods, so as never to allow any solid to enter the stomach as such, are not only as a rule immune from dyspepsia, but also comparatively speaking from intestinal putrefaction as well, and therefore they escape much of the auto-intoxication which leads to premature senihty. I06 DIET AND THE MAXIMUM CHAPTER XVIII. Conclusion. The importance of the regulation of diet as a means of securing the maximum duration of human hfe cannot be over-estimated. Metchnikoff , who places the probable limit of individual life at 120, in which, by the way, he was anticipated by the Scriptures (see Genesis, chapter vi., verse 3) says that " The duration of the life of men may be consider- ably increased ; it would be true progress to go back to the simple dishes of our ancestors." Sir Henry Thomson stated that he had " Come to the conclusion that more than half the disease that embitters life is due to avoidable errors of diet," whilst Sir James Crichton Browne says, " This question of food is one of primary importance, far more than education." Maeterlink tells us that " In truth all our justice, morality, aU our thought and feelings derive from three or four primordial necessities, whereof the principal one is food." And the British Medical Journal says " The study of dietetics should be looked upon as very nearly if not quite as DURATION OF LIFE. I07 important as the study of Therapeutics." As far back as the EHzabethan age Bacon was dividing medicine into three branches, of which the first was the prolongation of life, the other two relating to the preservation of health and the cure of disease. It is in- teresting to notice the order in which Bacon arranged these three departments of the physician's art. In the foregoing pages I have attempted, in brief outline, to indicate the means by which regulation of the diet may be employed to secure for each of us the maximum duration of life. It will have been made clear that the chief object of such dietary care is the pre- vention of intestinal putrefaction and the consequent self-poisoning, which by leading to deterioration of the arteries, nerves, and brain, prematurely encourage the infirmities of senility. This object is to be attained by strict frugality, thorough mastication and the judicious employment of certain health pre- serving foods, of which Bulgarian Sour-milk is the most notable. I have recently re- visited Southern Europe, where, in 1895, I first 108 DIET AND THE MAXIMUM DURATION OF LIFE. became acquainted with Yoghourt. I have taken some trouble to interview persons who have been famiUar with and have habitually consumed this Sour-milk for very many years, and I have failed to hear of any instance in which any but good results have followed its regular employment. Statements have recently been made to the effect that the injudicious use of Sour-milk may give rise to rheumatism. It is probable that the injudicious use or abuse of anything whatever may lead to unpleasant conse- quences, but so far as my own experience goes I have never known a case in which properly prepared Sour-milk was taken without good results following, more especially when those principles of moderation, frugality and judi- cious selection, as advocated in these pages, have been observed. INDEX. Alcohol . . Ale Animal Foods Arrowroot Auto-intoxication 79 n 40 n 5,9 Bacillus Acidi Lactici 20 Bacon . . . . 44, 86 Bacteria 6 Banana 71 Banting System . . 92 Barley Water . . . . 55 Beans 69 Beef Extracts . . 42 Beef Tea 42 Beer 77 Beverages . . 28, 75 Biscuits (Bulgan) . . 54 Bouchard . . . . 9 Bowel Cleanliness . . 6 Bread 64 Brussels 9 Bulgan Biscuits . . 54 Bulkiness of Foods 61, 69 Butter 56 Cabbage 62 Calorie 34 Callard's Rouman Rusks 55 Carbohydrate . . 16, 24 Carrots 69 Casein .. .. 51,98 Cellulose . . . . 71, 74 Cereals 67 Cheese .. .. 56,58 PAGE Chicken 43 Childhood .. .. 81 Cider 80 Climate and Food . . 30 Cocoa 77 Coffee 78 Combe (Professor) . . 9 Cooking 42 Cow's Milk .. 25,51 Cream 56 Cixrrants 71 Dates 71 Diabetes 98 Diet absolu . . . . 10 Dietaries 86, 88, 94, 95, 100 Dietetics 7 DigestibiUty . . 39, 40 Digestion.. .. 17,32 Dilatation of Stomach . . . . 70 Disease 83 Dyspepsia (food in) 84 Ebstein Diet . . . . 95 Eggs 51,59 Energy 24 Extractives . . . . 42 Facts about Foods. , 39 Faeces . . . . 17, 18 Fat 24, 96 Fat (how to grow) . . 96 Fermentation . . 103 Fever Diet . . . . 83 Figs . , 71 INDEX- Fish Flavour Fruits Fletcher's System Flour . . . . Fruitarianism Fruits . . . . Fungi Gastric Juice . . Germ of Wheat Germs Ginger Beer . . Gluten . . Gout Green Vegetables Haig's Diet Hirchfield's Diet Infant Diet Intestine . . Kephyr Koumiss 45 71 102 64 30 28 73 103 66 5>52 77 25>67 87 69 100 95 81 5 13 13 Lactic Bacterium Therapy . . 14, 20, 57 Lime Water . . . . 55 Meals 38 Meat . . . . 40, 62 Melabolism . . . . 32 Metchnikoff . . . . 14 Milk .. .. 25,51 Minerals in Food . . 24 Mineral Waters . . 78 Mixed Diet . . . . 30 Mock Turtle .. .. 48 - conid. FACE Mutton 43 Nitrogen . . . . 24, 25 Nuts 72 Oatmeal 67 Oats 67 Obesity . . . . 27, 90 Omelettes . . . . 8 Oysters 46 Paget'sMilk .. .. 81 Phosphates . . . . 98 Potatoes . . . . 62, 70 Prolongation de la Vie 14 Proteid 24 Pulses 69 Purin Bodies . . . . 100 Purin Free Diet . . 100 Rest . . . . 96, 97 Rice 67 Rommelaire (Pro- fessor) 9, II Rouman Rusks . . 55 Rusks 65 Rye Bread . . . . 67 Salisbury Treat- ment . . . . 16, 100 Sausages 44 Senator 9 Ship Biscuits . . . . 64 Soups 48 Sour-Milk . . 20, 57 Stale Bread . . . . 64 Starch 67 Starvation Diet . . 94 INDEX FAGS Stomach 6i Sugar . . 25, 51, 56 Tapioca 88 Tea 77 Thirst 76 Tissue Builders . . 24 Tripe 44 Tubers 69 Turnips 62 Turtle 46 Uga 22 Uga Cream Cheese . . 22 Unripe Fruit . . . . 71 - contd. PAGE Vegetables . . 61, 70 Vegetarianism . . 30 Wasting Diseases . . 96 Water 75 Weir Mitchell Treat- ment 97 Wheat 26 Whey .. 25,56,57,58 Wholemeal Bread . . 66 Wine (Alcohol) 79,94 Work 36 Yoghourt .. 13,108 Yolk of Egg .. .. 60 Shiths' lyp., HottOD i^treet, £.0., and Fleet Works, Bt. Albans. iWS.