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 Reference Library 
 
 Given by 
 
AIE, FOOD AND EXEHCISES. 
 
AIR, 
 FOOD AND EXERCISES 
 
 AN ESSAY 
 
 ON THE PEBDISPOSING CAUSES OF DISEASE. 
 
 BY 
 
 A. RABAGLIATI, M.A., M.D., F.E.C.S., Edin., 
 
 HONORARY GYNECOLOGIST, AND LATE SENIOR HONORARY SURGEON, BRADFORD 
 ROYAL INFIRMARY ; CONSULTING SURGEON TO BINGLEY HOSPITAL, TO 
 BRADFORD CHILDREN'S HOSPITAL, AND TO THE BRADFORD 
 HOME FOR CANCER AND INCURABLES. 
 
 THIRD EDITION, 
 
 GEBATLY ENLAEGED AND ALMOST ENTIRELY EB-WEITTEN. 
 
 NEW TOEK: 
 WILLIAM WOOD AND COMPANY 
 
 MGMIV. 
 
Digitized by tine Internet Arciiive 
 
 in 2010 witii funding from 
 
 Open Knowledge Commons 
 
 http://www.archive.org/details/airfoodexercisesOOraba 
 
PREFACE. 
 
 T HOPE that the chief proposition of this essay 
 has been made so plain that I need say but 
 httle in the way of preface. A critic of the 
 first edition said that it was written for the public, 
 as distinguished from the medical profession. I 
 thought I detected a certain (or uncertain) air of 
 reproach in his tone, as if he meant distantly to 
 insinuate a suggestion of unprofessionalism in the 
 behaviour of a doctor who should write for the 
 public. As a fact, the first edition was written, so 
 far as I know, for the medical profession. It 
 appeared as a series of articles in the Scalpel, a 
 journal read only by the medical profession. No 
 doubt after its separate publication, the public 
 read the essay eagerly, the first edition being 
 exhausted before a single medical criticism had 
 appeared. The second edition was as rapidly 
 cleared out ; and no doubt another edition or 
 two might have been disposed of. But I 
 was not quite satisfied to go on with the 
 work in the form which it had in 1896. In 
 the original preface I had suggested that I 
 might amplify my observations if the essay was 
 received favourably. But in the intermediate 
 
vi. PREFACE, 
 
 period between the publication of the second 
 edition and any new one, I thought I ought to 
 appeal to the medical profession directly and solely, 
 before appealing to the public in a matter in which 
 both the profession and the public are most deeply 
 interested, and which seems to me indeed to be 
 of the most vital importance to both. Accordingly 
 I wrote in 1901 a book entitled "Aphorisms, 
 Definitions, Reflections and Paradoxes : Medical, 
 Surgical, and Dietetic." This being sent to various 
 medical journals, elicited a few reviews, some 
 depreciatory, and some highly laudatory ; but on 
 the whole the book fell flat, some critics even 
 hinting that the language was too technical, a 
 rather curious criticism of a book addressed and 
 dedicated to a learned profession. This being so, 
 I had to consider what I should do. It is rather a 
 fine point to say what a medical man ought to do 
 when he is not attached to a medical school, and 
 yet feels that he has something very important 
 to say on professional subjects. The direct appeal 
 that I made to the medical profession fell on deaf 
 ears. A few private letters of a more or less 
 appreciative kind did not seem to me a sufficient 
 answer to the question I addressed to my colleagues 
 — How is it that when we know as physiologists 
 that there is twice or thrice as much lymph in the 
 body as there is of blood, no use whatever is made 
 of this fact in medical practice ? This overplus of 
 lymph collected in the connective tissue of the 
 body appears to me to be the basis on which the 
 
PBEFACE. vii. 
 
 great mass of disease is built. It appears to me to 
 be of the very utmost consequence as regards the 
 causation, the treatment, and the prevention of 
 disease. And my colleagues having as a body 
 ignored the question (although a few of them seem 
 to have been greatly and effectively interested in 
 it) I have felt myself compelled, in view of the 
 shortness of life and of the probability that I 
 cannot in the nature of things expect to have 
 many more opportunities of addressing either my 
 colleagues or the public, to appeal at once to as 
 wide an audience as I can. This book is, then, 
 written frankly for the public, in the hope that its 
 perusal may simplify and clarify their ideas upon 
 the subject of disease, and that, by having their 
 attention directed to its chief cause, as I conceive 
 it, they may be enabled to considerably increase the 
 length of efficient and healthy life, as also to obtain 
 some amount of relief from the calamities which, 
 in spite of all the advances of medicine and 
 surgery, they still are called upon to endure. 
 
 A. K 
 
 Bbadfoed, 
 
 December, 1903. 
 
TABLE OF CONTENTS. 
 
 "^AGE 1 : Inteodugtion. Meaning of the word Medicine. 
 *-» Prevention of Disease. Cure. Prevention implies know- 
 ledge of causes ; cure not. P. 2 : Treatment implies three things 
 usually — rest, medicine, alteration of food. P. 3 : Prevention 
 at present applied only to fevers, but applicable to all diseases. 
 Do fevers depend on wrong feeding or bad air ? Opinion of 
 Moses. Means for prevention dependent on the opinions we 
 hold. P. 4 : Is feeding or respiration the more important 
 physiologically ? P. 6 : Medicine a difficult pursuit ; proved 
 by differences in view among experts. Pp. 7-9 : As in other 
 departments of knowledge, better medical theories will replace 
 worse ones. P. 9 : When medical experts differ, reason and 
 judgment must decide. But other experts differ from their 
 colleagues as much or more than doctors. P. 10 : A difficulty 
 in medicine is caused by the large number of diBcases with 
 which she has to deal. P. 11 : Why one part is affected 
 rather than another. Least resistance. Pp. 12, 13 : Scientific 
 explanations unsatisfactory, and often may involve circular 
 reasoning. Medicine deals with states of the organism ; 
 another reason for her obscurity. P. 14 : Order and light in 
 medicine to be obtained by study of circulation of blood and 
 lymph. P. 15 : Eegions of science in which medicine has 
 advanced. Difficulty from the personal equation. P. 16 : 
 Difficulty from unwillingness of men to exercise self-restraint. 
 P. 17 : And from fear on the part of doctors to say unpleasant 
 things. Pp. 18-20 : Can we define health ? Attempts at 
 definition. 
 
 Pages 21-52 : Chaptee I., Present State and Past Progress. 
 of Medicine. Pp. 21-3 : Too much surgery ; unscientific and 
 
X. TABLE OF CONTENTS. 
 
 iiaphysiological and arrogant mental attitude of some surgeons. 
 Removal of the appendix vermiformis. P. 23 : Must attend 
 to causes if we wish to prevent, e.g., return of tumours after 
 removal. P. 24 : Causes of simple tumour and of cancer the 
 same. P. 25 : Surgery, though more successful than formerly, 
 has done very little to lengthen general duration of life. 
 Medicine (including hygiene') has done much more. Pp. 26-8 : 
 Gains to life effected by medicine. Pp. 28-31 : Special gains 
 in reduction of fever and consumption. Pp. 32-6 : Analysis 
 of gains in duration of life, effected chiefly by attention to air 
 supply. P. 37 : In writer's opinion, effects of food greater 
 than effects of air. Pp. 37-41 : Contributory causes of gains 
 by medicine. Diminution of the birth-rate. Going on in all 
 European countries, and probably also in America. How it 
 -acts. Pp. 42-4 : Analysis of effects of low birth-rate. Facts 
 relating thereto. Differences between birth-rates in towns 
 quite near to one another. P. 44 : Low birth-rate lowers 
 death-rate. P. 45 : Great mortality among infants and 
 children. Opinions of medical officers of health as to causes 
 of this. Wrong feeding a potent cause. P. 47 : How a low 
 birth-rate lowers the death-rate. A low birth-rate also lowers 
 fever mortality. How. P. 48 : Mortality of infants under 
 one year old has not improved in recent years. P. 49 : If 
 children survive five years of age, why should they not live to 
 old age ? P. 50 : Deaths from accident not more numerous 
 than they were. Pp. 51-2: Summary of gains; fevers and 
 consumption have been reduced about a half ; and a consider- 
 able increase has been made to life, particularly, however, at 
 the two extremes of infancy and old age. 
 
 Pages 53-68 : Chapter II., Principal Causes of Mortality. 
 P. 53 : Bronchitis the commonest cause of death. Pneumonia 
 the next commonest. Proportional numbers. P. 54 : Causes 
 of. Attributed to cold. General effect of alimentation. Heat 
 as a cause of disease. Predisposition to disease ; what it 
 means. Pp. 55-7 : Predisposition to disease greatly alterable, 
 •especially by dietetic measures. P. 57 : Proportional number 
 
TABLE OF CONTENTS. xi. 
 
 of Phthisis and tubercular diseases. P. 58 : Diseases of 
 circulation, including apoplexy. "Old age" as a cause of 
 mortality. P. 59 : Cancer as a cause. Cancer a disease of 
 over feeding. P. 61 : Mortality from diarrhoea and dysentery ; 
 essentially diseases of wrong feeding. Convulsions ; alse due 
 to wrong feeding. Pp. 62-4 : Influenza and the zymotic 
 diseases ; facts regarding ; mortality from ; causes. Pp. 64-5 : 
 Mortality from digestive diseases; probably stated much too 
 low. Pp. 65-7 : Diseases of the nervous system. Dr. Dewey 
 on physiology of nervous system in fasting. P. 68 ; Suggestion 
 that all these diseases may be in great part caused by wrong 
 alimentation. 
 
 Pages 69-81 : Chapteb III. , Causes of Mortality betweeii 
 Five and Sixty-five Years. P. 69 : From 32 to 40 per cent, of 
 all mortality under five years of age. P. 70 : Opinion of 
 medical officers of health that much of this mortality is due to 
 improper feeding ; and the probability that this cause also acts 
 at later ages. Pp. 70-1 : From 22 to 24 per cent, of all 
 mortality over 65 years of age. Therefore about 40 per cent, 
 of the total mortality occurs between five and 65 years of age, 
 or the active ages of life. Pp. 71-2 : Tuberculosis and cancer 
 the most potent causes of death at these ages. Eheumatism 
 and gout important indirect causes of death. P. 72 : Diseases 
 of circulation with apoplexy the next most numerous cause of 
 death. Nextly, diseases of respiration. P. 73 : Fourthly, 
 deaths from old age. But "old age" before 60 or 65 a 
 misnomer. Fifthly, zymotic diseases. P. 74 ; Sixthly and 
 seventhly, diseases of digestion and nervous diseases. Dietetic 
 diseases, in Eegistrar- General's terminology, a trifling cause of 
 death. But it includes alcoholism, which is evidently stated 
 much too low, deaths from alcohol being frequently set down 
 to diseases of the various organs which alcohol has affected. 
 P. 75 : But alcoholism, though an important cause of death, 
 is not nearly so important as wrong feeding. Teetotallers 
 well-meaning, but wrong in attributing many diseases to 
 alcoholism which are not due to it, but frequently occur among 
 
xii. TABLE OF CONTENTS. 
 
 teetotallers. P. 76 : "What the teetotallers have proved. 
 P. 77 : Constipation far oftener caused by bad food habits 
 than by alcohol. Pp. 77-8 : Modus operandi in which this 
 cause acts. Hov? to cure constipation. P. 78 : Skin diseases 
 frequently caused by wrong food habits. P. 79 : Many 
 teetotallers die too early from taking too many meals. Pp. 
 80-1 : Account of two brothers, one a teetotaller and the other 
 a drunkard, who yet lived the longer of the two. 
 
 Pages 82-125: Chapter IV., The Causes of Disease. 
 Three : The Proximate (swelling and shrinking), the Exciting, 
 and the Predisposing Causes. Pp. 82-83 : Organised bodies 
 occupy always probably about the same amount of space, this 
 being probably due to the large quantity of water they 
 contain. P. 84 : The proximate causes are not so much 
 causes as states. Swelling and shrinking always precede and 
 follow one another ; yet do not cause one another. Difference 
 between causation and invariable succession. P. 85 : Con- 
 traction of longitudinal elements causes contraction of 
 transverse and vice versa. P. 86 : This causes the confusion 
 of supposing that contraction causes dilatation, and dilatation, 
 contraction, and has led to opposition in the practice of 
 doctors. P. 87 : The exciting causes. P. 88 : Difficult to 
 separate the exciting from the predisp'^sing causes. Attempt 
 to do so by the writer. P. 88 : Predisposing causes are mostly 
 the relations of the body to air, food, exercises, heredity, and 
 anxiety. Influence of heredity in disease greatly exaggerated. 
 Organisation generally inherited ; disease rarely. The relations 
 of the body to food far the most important predisposing cause 
 of disease. This the main thesis of present essay. Pp. 88-9 : 
 Analysis of this thesis. Ancient divisions of treatment of 
 disease. P. 90 : How greatly improper food habits pre- 
 ponderate over other causes of disease. Pp. 91-100 : Discussion 
 of terms acute, chronic, long, short, sub-acute, and mild, as 
 applied to diseases. Acute and chronic are not logical 
 opposites. Acute the opposite of mild, not of chronic. 
 Pp. 92-3 : Retrograde proposal of Asclepiades of Prusa. 
 
TABLE OF CONTENTS. xiii. 
 
 Position and views of Hippocrates. P. 93 : Definition of 
 chronic. P. 94 : Eemittent and intermittent. Pp. 95-6 : 
 Cause of intermission and alternation in disease connected 
 with the manner of the earth's rotation and behaviour to the 
 sun. P. 97 : Life may behave differently on other planets 
 behaving differently to the sun. Pp. 97-100 : Definitions of 
 short diseases, of rather short, of very short, acute, per-acute, 
 sub-acute. P. 98 : Possible anticipation of germ theory of 
 disease by Asclepiades of Prusa. Pp. 99-100 : Views of 
 Hippocrates. P. 101 : Evidence to be adduced for view that 
 wrong feeding is the chief cause of disease : threefold, (1) 
 Disease best treated by alteration of diet ; (2) Health endures 
 so long (chiefly) as proper feeding resorted to ; and (3) Return 
 to wrong feeding re-induces disease. P. 102 : Even the fevers 
 offer no exception to this statement, but more difficult to prove 
 the thesis, because fevers usually occur but once in hfe. 
 Definition of fever and inflammation, and, p. 103 : Specific 
 inflammation. Simple inflammations may in the future be 
 shewn to be associated with growth of micro-organisms in 
 blood and tissues. P. 104 : Why so difficult to prove that 
 recurrence to wrong food habits re-induces fever. But influenza, 
 though a fever, frequently recurs. Pp. 104-5 : Cure and 
 prevention of colds, and recurring influenza in a man 38 years 
 of age. Pp. 106-7 : Cure and prevention of recurring colds, 
 and malaria lasting 30 years, by alteration in diet. Failure of 
 quinine to cure malaria. P. 108 : Law of constant causes 
 inducing periodic or intermittent effects. Pp. 109-10 : Purther 
 remarks on the case shewing that wrong feeding was the chief 
 cause of the illness, which was nevertheless attributed to 
 residence in the tropical climate. P. 110 : Although the same 
 fever does not generally recur, another one not infi-equently 
 occurs from the same predisposing causes. Pp. 111-3 : 
 Incidence and causation of fevers. Fevers have increased 
 slightly La last ten years in spite of "sanitation." Total 
 reduction ia fifty years only 50 per cent. Influenza has come 
 to stay, at least for a time. We infer, therefore, that a main 
 
iiv- TABLE OF CONTENTS. 
 
 part of the causation of fevers has been overlooked, and 
 suggest that it is improper food habits, and in particular too 
 many meals. P. 114 : Even paupers in workhouses are fed 
 too often. Changes of doubtful health value made in the fare 
 of the men of the Eoyal Navy. P. 115: Experience of 
 soldiers in Boer War, eating (practically) once a day. De 
 Quincey's statement about Eoman soldiers. Food customs of 
 imperial Eome in second century: Celsus on. Pp. 116-7: 
 Alterations in food customs according to Athenaeus, increase 
 from one or two to four or five meals. Recommendation of 
 no breakfast plan 2350 years ago. Pp. 117-20: Spread of 
 luxury foreruns decay. Comparison between imperial Rome 
 and modern London. Pp. 120-5 : Fevers alleged to be due 
 to famine. Often occasioTied no doubt by famine, but really 
 caused by previous over-feeding. Famine ought to cause 
 simple attenuation without fever. When crops fail in famine, 
 however, they are both short and bad. Diseased potato and 
 diseased rice cause respectively famine fever and plague. 
 P. 123 : Comparison between alcoholic and over-fed person. 
 Pp. 124-5 : Fevers, falling chiefly on young lives which do 
 not take alcohol, are not generally caused by alcohol, although 
 in more advanced hfe they sometimes are. 
 
 Pages 126-76 : Chapteb V., The Circulation of the Blood 
 and of the Lymph. P. 126: Less change than is generally 
 supposed has been introduced into medical practice by the 
 discovery of the circulation of the blood. The circulation of 
 the lymph has hardly been made use of at all. P. 127 : 
 Ancients thought arteries contained air. The wind pipe they 
 called arteria aspera. It divides like an artery. The best 
 ancient physicians had a good general grasp of the subject of 
 medicine. Pp. 128-9: Local diseases are mostly local 
 expressions of general states, and are therefore generally 
 best treated by treating the whole organism. P. 130 : If this 
 is not done, other and worse diseases may follow. Pp. 130-1 : 
 Ancient physicians felt the pulse, although they did not 
 understand the circulation of the blood. Pp. 131-3 : Views 
 
TABLE OF CONTENTS. xv. 
 
 of the medi£eval philosophers on this subject. MultipHcation 
 of spirits. Pp. 133-6 : Different views of the relations 
 between structure and function. The assumption by modern 
 science that structure determines function by no means proved. 
 Pp. 136-8 : Effects of the state of the blood on the state of 
 parts of the body. Affection of two organs may be accounted 
 for by the state of the blood, which is common to both, as 
 well as by the influence of one organ on another. The 
 influence of this view on the position of specialists. P. 139 : 
 Influence of the discovery of the circulation of the blood on 
 blood-letting. But blood-letting was given up for reasons 
 independent of the discovery. Pp. 140-2 : Three great facts 
 known to the ancient physicians, hundreds of years before 
 modern science had been evolved. P. 142 : Analogy between 
 study of a machine and of human organism. If we under- 
 stand the machine it is unimportant where we commence to 
 study it; but more convenient to do so in some ways than 
 others. P. 141 •- The most convenient way to study the human 
 machine is to begin with the digestive processes, because these 
 make the blood. Mastication and insalivation. Pp. 144-5 : 
 Four or five divisions of food stuffs suggested by Liebig. 
 P. 145 : Insalivation converts starch into glucose or grape 
 sugar. Pp. 146-7 : Function of gastric juice or gastric acid to 
 digest nitrogenous foods. Why we should not eat to satiety. 
 Futility of taking half an hour's rest after food. If three or 
 four hours' rest is required, we have eaten too much. Why 
 we should eat slowly. P. 148 : Chymification. P. 149-51 : 
 Action of pancreatic and biliary secretions. Lacteals and 
 thoracic duct. Effects of respiration when digestion is 
 healthy and when it is unhealthy. Connection of respiratory 
 diseases with digestion. Pp. 151-3: Connection between 
 unhealthy digestion and the occurrence of local diseases. 
 Pp. 153-5 : Portal circulation and importance of the liver in 
 the digestive processes. The liver the largest digestive viscus. 
 In the rabbit it contains 30 per cent, of the blood. Liver has 
 a very free blood supply, and differs very much in its weight 
 
xvi. TABLE OF CONTENTS. 
 
 and size at some times from what it does at others. 
 P. 155-62: Facts regarding the distribution of blood in the 
 body of a rabbit and (perhaps) also of man. About 30 per 
 cent, of blood in muscles. Significance of this. Much blood 
 required for muscular work, and therefore much food. Only 
 about 22 per cent, of blood in the organs of the circulation 
 and respiration (heart, blood-vessels, and lungs) together. 
 Therefore less in these than in the muscles, or even the liver. 
 Only a comparatively small amount of blood in the brain 
 Significance of this. Brain must not be overcharged 
 with blood. Therefore, brain- workers {i.e,, townsmen) do 
 not require a large amount of food. Circulation in the 
 brain, synchronous, not with pulsation of heart, but 
 with respiration. Termination of brain arteries in end 
 arteries, not by anastomosis. Significance of this. Connection 
 between "plain living and high thinking." The brain seems 
 to act rather through its lymph circulation than through its 
 blood circulation. But brain-lymph or fluid of ventricles (and 
 in nerve sheaths) probably secreted from blood vessels in choroid 
 plexuses. Animal spirits a physical fluid, not a metaphysical 
 conception, originally. Pp. 162-6 : The animal spirits or fluid 
 of the ventricles belongs to the same class as the lymph, which 
 is secreted to the extent of 30 or 40 pints (it is believed) from 
 the blood. The lymph is the watery part of the blood, with 
 fine particles ; and the animal spirits are a finer, subtler form 
 of lymph. Lymph is separated from the blood in the lymph 
 spaces in the connective tissue, and is collected and elaborated 
 in lymph vessels and lymph glands. The capillary vessels lie 
 between arteries and veins. Definition of arteries and veins. 
 No lymph circulation in the invertebrata. The lymph 
 circulation is an economical provision by which the blood parts 
 to the tissues with any nutrient materials not used up by 
 previous circulation in the tissues. Lymph comes from the 
 blood and goes back again into it, along ynth the chyle from 
 the digestive tract. Its purpose, therefore, is obviously 
 nutritional. Connective tissues are in layers, which separate 
 
TABLE OF CONTENTS. xvii. 
 
 from one another when the mterspaces are filled with lymph. 
 Pp. 166-170 : Effects of too frequent feeding on lymph 
 formation. Too much blood formed and too much lymph 
 secreted. Lymph spaces, lymph ducts, and lymph glands 
 over filled. The consequences are, tired because overloaded 
 muscle sheaths, nerve sheaths and bone coverings, and also 
 engorgement of lymph glands, and even suppuration of them, 
 knovni as strumous or scrophulous glands, often seen in the 
 necks of children and young persons. Or pleurisy, or white 
 swellings of joints. P. 170 : These suppurations generally 
 associated with growth of tubercle bacilli. P. 171 : But this 
 means rather engorgement with lymph from engorgement with 
 blood, from excess of food, than deUcacy of constitution. No 
 doubt the digestive powers have been exceeded. This process 
 may not indeed create the bacillus, but it attracts it. P. 172 : 
 The tubercle bacillus may be lying dormant in the body, or it 
 may be ingested with the food immediately or more remotely. 
 P. 172-5 : Analogy from manuring ground in agriculture to 
 make crops grow which either did not grow before or did not 
 thrive before, although the manure did not contain the seed 
 which springs up. Relation between organism and environ- 
 ment, plain and obvious, although it may not be possible for 
 us to say which was first. 
 
 Pages 176-219 : Chapter VI., The Paradoxes of Medicine. 
 Pp. 176-7 : Are there any pathognomic signs of under- 
 feeding ? A much more difficult question than might have 
 been supposed, because thinness and wasting and inactivity of 
 function may be, and often are, marks of over-feeding as well 
 as of underfeeding. P. 177 : Mark Twain's description of 
 functions of starving men. They were constipated and sleep- 
 less. Pp. 177-8 : But constipation and sleeplessness are 
 oftener caused by over-feeding than by under-feeding. P. 179 : 
 "Why we should not treat constipation by purgatives. P. 180 : 
 No cure by this means. P. 181 : A much constipated person 
 cures his malady in a year by restricting his diet to two 
 meals a day. Pp. 181-2 : How constipation may lead 
 
xviil TABLE OF CONTENTS. 
 
 to obstruction of the bowels and even to cancer. P. 183 : 
 The law of hereditary transmission of disease. A common 
 fallacy in discussion of. Pp. 184-6 : Probable and experi- 
 mental evidence. P. 186 : All functions diminished by too 
 much stimulus, especially by stimulus of too much food. 
 P. 187 : State of the brain-vessels in sleep. Pp. 187-9 : 
 Proportion between nutrition of longitudinal and transverse 
 elements of vessels and other parts. P. 189 : How to cure 
 sleeplessness. P. 190 : Why sleeplessness ought not to be 
 treated by hypnotics ; nor any long-continued condition by 
 drugs calculated to induce the opposite condition. P. 191 : 
 Why blood-letting fails to cure, and has been on the whole 
 given up. P. 192 : Diseases and remedies, dry and moist, hot 
 and cold, &c. P. 193 : These divisions fanciful, and yet 
 founded on substantial physiological facts. Pp. 193-4 : Second 
 paradox; that the same causes induce opposite states. P. 
 195 : How Surrey fowls are fattened for market. Dr. King 
 Chambers and starvation of over-repletion. Pp. 195-6 : 
 Wasting treated by restriction of the diet. Pp. 196-201 : 
 Diet of over-feeding. For first fortnight is a diet of great 
 restriction. P. 197 : Calorie value of. P. 198 : A misnomer 
 to call it in the first fortnight a diet of over - feeding. 
 P. 199 : Diet of over-feeding after first fortnight. Calorie 
 value of. Pp. 200-2 : May lay foundation for subsequent 
 diseases. Pp. 202-3 : Specific gravity of urine in general 
 debility. Pp. 204-5 : How patients sometimes gain weight 
 by restricting their diet. A case. P. 207 : The question, 
 although disputatious, cannot be escaped. Pp. 207-8 : 
 A great law in physiology and in medicine. Views of 
 Greeks and Latins on, and names used by them, for 
 contraction and dilatation. P. 208 : Confusion by ancients 
 of property and function. Confusion of Latins in use 
 of term solutio. P. 209 : Eelation of longitudinal and 
 transverse elements of body. Contraction of longitudinal is 
 dilatation of transverse, and vice versa. Strictum et laxum and 
 absoiytio et solutio. P. 210 : Confusion shewn by use of 
 
TABLE OF CONTENTS. xix. 
 
 phrase — Strictures et solutionis complexio, instead of strictures 
 et solutionis alternatio. How one doctor sometimes advises 
 treatment exactly the reverse of that recommended by his 
 'Colleague. P. 211 : How cold, judiciously appHed, may 
 counteract the effects of exposure to excessive cold. Double 
 action of tonics and relaxants. Actions of cold and of alcohol. 
 Pp. 211-12 : Physiological reasons for existence of rival 
 schools in medicine. Pp. 212-13 : Effects of exposure to cold 
 combated by appUcation of cold in acute illness. P. 213 : 
 Effect of long-continued exposure to moderate cold; and of 
 exposure to long-continued and moderate over-feeding. P. 
 214 : The reactionary effects cause only sub-acute or even 
 mild (but long) illnesses, P. 215 : Deficiency of function, 
 excess of function, and irregularity of function, all induced by 
 long-continued irritation. Pp. 215-16 : Canon of treatment in. 
 Excess of food far the commonest irritation ; nextly, improper 
 relations to air ; then, to exercises ; then, anxiety. Pp. 
 216-19 : Analogy of action of irritation of too much desire for 
 food acting on the body physiological, to irritation of too 
 much desire for gain acting on the body commercial. The 
 one causes feverishness and depression ; the other booms and 
 panics. 
 
 Pages 220-264: Chapter YII., The Two Medical 
 Paradoxes {continued). Pp. 220-1 : Meaning of the term 
 disease. P. 222 : Difference between functional alteration and 
 organic disease. They shade off into one another insensibly. 
 P. 223 : So do sanity and insanity. P. 224 : On the whole, 
 disease characterised by presence of exudation. In functional 
 alteration, no exudation. P. 225 : Changes of function, 
 however, probably imply slight changes of structure even if 
 undiscoverable. P. 226 : Disease usually springs fiom mal- 
 nutrition, which is generally due to excess of food. The chief 
 form it takes is congestion of connective tissue. Pp. 227-8 : 
 Meaning of termination His. Bodily organs consist of three 
 parts — the parenchyma, and the inner and outer coverings or 
 ilemmata. P. 229 ; Connection between stimulus and 
 
XX. TABLE OF CONTENTS. 
 
 function. Propositions concerning. P. 230 : Duration of 
 life when deprived of food and drink, and of air. P. 231 : 
 Proof of proposition that food-supply is the chief cause of 
 illness. Pp. 232-5 : As affecting circulation ; nutrition ; 
 respiration ; renal action ; temperature of body ; cerebration ; 
 skin function. P. 236 : Three propositions regarding the 
 relation of food to function. P. 237-41 : Efifects of poverty. 
 Even the poor eat too much and too often. Effects of too 
 much food mistaken for those of too little. The charwoman ; 
 the beggar's baby. Dr. King Chambers and starvation of 
 over-repletion. Direct and indirect starvation. P. 241 : Mr. 
 Seebohm Eowntree and poverty. Poor in York take too many 
 meals. Pp. 241-2 : Excess of function generally treated by 
 restriction of diet. Pp. 242-5 : Cases of diabetes, or excess 
 of renal functiou. Pp. 245-9 : Too great mentalisation is 
 often insanity. Cases treated by restriction of the diet. Dr. 
 Dewey's case where an insane lady fasted for 45 days and 
 became sane. P. 247 : A case known to the writer in which 
 insanity was caused by an inordinate love of sweets. P. 248 : 
 "What taking six pints of milk a day means. P. 249 : Defect 
 of function also to be treated by restriction of diet. Pp. 
 250-4 : Slowness of circulation. Cases of. Pp. 253-4 : 
 Medical experts differ in opinion from one another. Pp. 
 254-6 : Attenuation treated by restriction of diet. Explana- 
 tion of the treatment. How it acts. Pp. 256-8 : Slow 
 respiration treated by restriction. Pp. 258-9 : Defect of renal 
 function : Pp. 259-262 : Subnormal temperature treated by 
 restriction of diet. Unwillingness to submit to treatment; 
 yet temperature raised after fasting. Pp. 262-4 : Defective 
 cerebration treated by restriction of the diet. Eelation of 
 heredity to mental disturbance. Pp. 262-4 : Effects of 
 anxiety. 
 
 Pages 265-326 : Chapter VIII., The Quantity of Food 
 and the Number of Meals required by Man. P. 265 : How 
 much food is required to make and enrich the blood ? P. 
 266 : Bodily functions must be neither checked nor clogged. 
 
TABLE OF CONTENTS. xxi. 
 
 P. 257 : The no breakfast plan suggested by Hippocrates, the 
 very expression, " avapL(rTO<s, being used. Pp. 268-9 : 
 Effects of wealth and poverty, indirect and direct starvation. 
 Pp. 270-1 : A mistake to gauge the amount of food required 
 by the quantity of the egesta. The quantity of ash is pro- 
 portional to that of coal consumed. P. 271 : Inquiries 
 should be conducted over a long time, and should have relation 
 to presence of illness among men. Pp. 272-3 : Almost all 
 medical authorities agree that v^e habitually eat too much. 
 Pp. 273-5 : Experience of Oddfellows shows that men live 
 longer than before, but are oftener ill. Is this due to the 
 increase in food consumed of late years ? Pp- 275-9 : Food 
 requirements according to different authorities — Eanke, 
 Moleschott, Voit, Playfair, Atwater, &c. P. 277 : Calorie 
 value of food. Pp. 279-282 : Eequirements of physiologists 
 too high when gauged by clinical experience. Pp. 282-3 : Dr. 
 Haig's views. P. 283 : Experience of Cornaro. Pp. 283-4 : 
 And of Addison, his biographer. How we say and do not do. 
 P. 284 : Food ingestion in infirmaries too great. Quantity of 
 bread. Effects of too much food in causing depression. Pp. 
 285-7 : How fasting may undo depressing effects of too much 
 food. Pp. 287-8 : Eight ounces of mixed food is a subsistence 
 diet for the lightest forms of work. Impossible to use 4f lbs. 
 of food daily in any circumstances without danger. Pp. 
 288-90 : Eequirements of the nursing-mother, and of men in 
 the Eoyal Navy. Pp. 290-1 : Fasting first increases and then 
 diminishes the numbers of the blood corpuscles. How. Pp. 
 291-2 : Accumulation of reserves in body, and over-accumula- 
 tion. Pp. 292-4 : The English soldiers who died at Aldershot 
 after eight hours' deprivation of food did not die of starvation. 
 What they probably did die of. Probable unwisdom of 
 proposed preventative. P. 294 : Moderation the only rule ; 
 attempt to define moderation in food. P. 295 : Death 
 attributed to almost all causes but the real one of over-feeding. 
 P. 296 : "What the Medical Council or the Municipal Councils 
 might do. Pp. 297-303 : Length of time required for digestion 
 
xxu. TABLE OF CONTENTS, 
 
 of food much longer than commonly supposed, or than time 
 required by St. Martin's stomach. Time differs very much 
 in different occupations and circumstances. Keasons for 
 recommending dissiteism and even monositeism. Good effects 
 of these practices. Pp. 303-4 : Even children v^ell fed on two 
 meals a day. A child fed for 15 months on one daily meal 
 increased her v^eight 10 lbs. P. 304 : Did she have too much 
 food ? Pp. 304-7 : Dr. Haddon's views and those of the 
 physiologists. A closer agreement ought to be possible. P. 
 308 : The duty of medical adviser ends when he has declared 
 the law. Pp. 308-11 : Why we are tired some hours after 
 eating. Uric acid, &c. Pp. 311-12 : If stimulants are taken 
 should they be taken with food? Pp. 312-4: Why we 
 often wake tired in the morning ? Why do we sleep too little 
 or too much, or irregularly ? P. 314 : Initis. Pp. 315-17 : 
 Hysteria, being an affection of connective tissue, may be 
 accompanied by effusion of serum on the brain, coma and 
 death. Eelation to rheumatic fever, pleurisy, synovitis, &c. 
 Pp. 317-18 : Eecurring headaches, neuralgias, &c., proper 
 advice for : restrict diet. Pp. 318-20 : A case so treated and 
 cured after many failures. Eelation to insanity. P. 321 : 
 Severe mutilating operations generally unnecessary, and futile. 
 Pp. 321-3 : Poliosis. Women should eat, not little and often, 
 but little and seldom, if they wish to become more resistant, 
 and get rid of peliosis. P. 323-6 : General conclusions as to 
 quantities of food and time for taking it. An ounce of mixed 
 diet daily for every 10 lbs. of body weight required by the 
 townsman, who works his brain rather than his muscles. 
 Salisbury diet. Views of Mrs. Eichards, and Forster of 
 Munich. Persons should never eat oftener than thrice daily, 
 and most persons would be better to do so twice. Two to 
 three pints of water required daily. 
 
 Pages 327-51 : Chapteb IX., Heredity in Disease. 
 P. 327 : Frequency of transmission of disease greatly 
 exaggerated. Pp. 327-8 : Case reported by distinguished 
 medical writer does not prove his suggestion at all. P. 329 : 
 
TABLE OF CONTENTS. xxiii. 
 
 Organisation transmitted. Disease not, or very seldom. Law 
 of transmission. Enquiry into causation essential to under- 
 standing of the law. P. 330 : Burden of proof is on those 
 who allege heredity of disease. Experience from consumption 
 in British Army. A narrow chest transmitted generally; 
 consumption very seldom. P. 331 : Cancer may run in 
 famiUes because different generations live similarly and induce 
 it. P. 332 : If disease is transmitted it ought to appear early 
 in life. But the cause even of high infant mortality is 
 probably environment rather than inheritance. Opinion of 
 medical officers of health. P. 333 : Eesistance a quality of 
 organisation. Liability to disease different from subjection to 
 it. P. 334 : Predisposition is inverse resistance. P. 335 : 
 If the subjection to infectious disease is in our own hands, 
 we should be ashamed to take influenza, and we should 
 even feel it a disgrace to take influenza with pneumonia, 
 since in this case we shall almost certainly for a long 
 time previously have over-indulged our appetite. P. 336 : 
 Anxiety a contributory cause, and very occasionally, perhaps 
 the chief cause of disease; but such anxiety would have 
 to be very great and very unusual. P. 337 : Freedom 
 from disease rather dependent on self-government than 
 on fate or ancestors. Pp. 337-42 : Constitution ; diathesis ; 
 atavism or heredity. Suggested definitions of these terms. 
 P. 338 ; Constitution always changing. Environment is 
 the sum of the circumstances acting on the constitution. 
 P. 339 : How we modify our environment. Constitution and 
 environment act and react on one another. P. 340 : Heredity 
 or atavism is fixed and unchangeable. P. 341 : Physical life, 
 like spiritual life, is the play of the changing on the fixed, of 
 the temporal on the eternal. P. 341 : Definition of diathesis. 
 Pp. 342-5 ; Ancient views on transmission. Organisation and 
 disease mixed up and confused. P. 343 : What is transmitted 
 in epilepsy ; unstable nervous organisation, and not disease ; 
 and what is transmitted in other diseases. P. 344 : Is special 
 susceptibility to take infectious fevers transmitted ? No. 
 
xxiv. TABLE OF CONTENTS. 
 
 Kesistance varies, no doubt ; but susceptibility depends mainly 
 on management. P. 345 : How Hippocrates anticipated the 
 pan-genesis of Darwin. Pp. 346-7 : Appalling case of trans- 
 mission of drunkard's liver. But this very exceptional. If 
 common, humanity could not survive. Pp. 347-8 : Difficulty 
 of distinguishing organisation from disease. Of the same 
 kind as that of distinguishing any contraries, as, e.g., day 
 from night. A difficulty more theoretical than practical. Pp. 
 348-51 : Parents not likely to transmit to children diseases 
 they did not themselves manifest till many years after birth of 
 children. 
 
 Pp. 352-80 : Chapter X. The Feeding of Children. 
 P. 352 : The principle of moderation in food applicable to 
 children also. Children, like adults, are often fed both too 
 often and too much. Anxiety not a cause of children's 
 ailments, or hardly so. P. 353 : Overfeeding the chief cause 
 of children's digestive troubles, colds and fevers. P. 354 : 
 Milk the proper food of infancy. Comparison between human 
 and bovine milk P. 365 : How to replace the one by the 
 other. Strength of food should advance with age. P. 356 : 
 Capacity of stomach at different ages. Pp. 356-7 : Ancient 
 and modem practices as to feeding infants. Number of meals 
 proper to them. Eelation of feeding to growth. Increase of 
 growth in first year of life amounts to about half an ounce a 
 day ; but extra food given is usually much beyond what is 
 proper. P. 359 : Illness among children far oftener caused 
 by too much food than by too little. Alternation of neglect 
 and over-indulgence. Pp. 360-1 : Growth of children from 
 second to fifth year ; intermittent rather than continuous. 
 Professor Holt on loss of weight in children's illnesses. Even 
 the beggar's baby is too often fed and too much. Pp. 362-3 r 
 Increase of weight from five to sixteen years; from 4 to 
 6 lbs. a year ; but the extra food given to growing children 
 is usually far beyond their requirements. Pp. 363-5 : The 
 same causes act on expectant mother and frequently make her 
 ill, though illness is attributed to many other causes. P. 365 : 
 
TABLE OF CONTENTS. xxv. 
 
 Feeding of children determines the healthy growth of 
 nervous system as well as other parts of the body. Interest 
 of this. P. 366 : Necessity of early inculcation of self- 
 restraint. P. 367 : Effects of feeding on constitution of fluids 
 of brain-ventricles or the animal spirits of the ancient writers. 
 Why children's breath is often offensive in early morning. P. 
 368 : Feeding of school children. Three daily meals, at 
 most, sufficient. P. 369 : No solid food should be taken at 
 the forenoon interval. Fevers and infection. Effects of 
 infection greatly exaggerated. P. 370 : If children develope 
 fevers through very slight infection, their state rather than the 
 infection is the cause. Over-fed body, and over-manured soil, 
 grow fever and weeds respectively. Pp. 370-2 : Details of a 
 case where a delicate child was over-fed. Dissiteism recom- 
 mended after recovery. Pp. 373-5 : Difficulties from prejudice 
 and from wrong use of words. The strengthening and the 
 lowering treatment, and the competition between Mr. Pilgrim 
 and Mr. Pratt in Milby. A diet of port wine and bark is 
 really a very restricted diet. What purging, blistering and 
 bleeding can do and what they can not do. What is 
 a stimulating diet ? P. 376 : Signs of health in children. 
 Dr. Dewey's suggestions for feeding school children. Writer's 
 suggestions. P. 378 : Trissiteism not unsuitable ; but writer 
 prefers dissiteism. P. 379 : But dissiteism might at least 
 be adopted from 21 or 25 to 55 ; after which monositeism 
 is safest. Pp. 379-80 : Life passes insensibly from infancy 
 to childhood, adolescence, maturity and old age, which last 
 bears abstinence well and over-feeding badly. 
 
 Pages 381-434 : Chapteb XI. On Cancer. P. 381 : 
 Cancer only one of many diseases which are one in causation, 
 treatment and prevention. P. 382 : Cancer, if incurable, 
 easily preventible theoretically. Panic to be deprecated. 
 Cancer not one of the largest causes of mortality. Pp. 383-7 : 
 Not necessary to raise a million pounds sterling in order to 
 reduce the incidence of cancer mortality. Even if cancer 
 proved to be due to micro-organisms, the problem of 
 
xxvi. TABLE OF CONTENTS. 
 
 prevention would still be the same. Laboratory results of 
 diagnostic and of classification value ; but for treatment ? or 
 prevention ? almost none. P. 384 : Analogy from diphtheria. 
 P. 385 : Growth of a micro-organism comparatively unim- 
 portant ; while the state of body that harbours it is of the 
 utmost consequence. P. 386-7 : The true answer to inquiry 
 into causation, and, therefore, of prevention of cancer, is to 
 be got from physiology and bed-side observation. Let us use 
 our eyes first and the microscope afterwards. Pp. 387-8 : Way 
 in which a million pounds sterling might be used, so as to 
 settle the causes of cancer. Would the millionaires agree? 
 Pp. 388-9: The King and cancer. P. 389: Predisposing 
 causes of cancer obvious. P. 390 : Cure practically 
 impossible ; prevention easy. P. 391 : Increase of mortality 
 from cancer on the whole real. P. 392 : Complete prevention 
 not to be expected ; but ^raciicaZ prevention. P. 393 : "Once 
 cancerous always cancerous." Operation alone a futile means 
 of cure. Added to altered mode of living, might be hopeful. 
 Pp. 394-6 : Effects of causes slowly modifying the organism 
 during many years cannot be overcome by operation alone. It is 
 impossible. Effects of recurring devastation cannot be undone ; 
 but appreciation of their causes may prevent their recurrence. 
 P. 396 : Definition of cancer and sarcoma. P. 397 : They 
 are hypertrophies or overgrowths. What is by far the most 
 likely cause of overgrowth ? Over-nutrition, that is, over- 
 feeding. P. 398: "Infection from without." Food intro- 
 duced from without alters the body so as to render it 
 susceptible. Pp. 398-9 : Importance of connective-tissue- 
 congestion. Eelation therefore of cancer to rheumatism or 
 initis. Disease being one, initis is the one. Restricting the 
 diet will reUeve fatigue of initis, and prevent the onset of 
 cancer. Pp. 400-1 : How materials enter the blood. Four 
 ways. Is cancer inhaled or breathed in ? Not likely, though 
 not impossible. Reasons for thinking so. Pp. 402-5 : Is 
 cancer introduced through cracks in the skin or mucous 
 surfaces ? Not impossible, but not likely. Lip cancer. 
 
TABLE OF CONTENTS. xxvii. 
 
 P. 403 : Does smoking introduce it ? Irritates, but does not 
 introduce. Cancer due to a blow. The injury does not 
 introduce it. Cannot do so, any more than bicycle injury can 
 introduce gout. P. 404 : Occasion and cause. Inoculation 
 of cancer. Not a practical risk, though not theoretically 
 impossible. Pp. 405-10 : Is cancer transmitted from 
 ancestors ? No. P. 406 : Cancer very uncommon in 
 childhood. If appearing (as it does) later in life, far more 
 likely to be acquired. Do parents transmit what they have 
 not themselves got ? P. 407 : Predisposition : what ? 
 Organisation and disease. P. 408 : Propositions about 
 transmission of disease. P. 409 : Facts about incidence of 
 cancer in childhood. P. 410 : and later life. The causes of 
 cancer, whatever they are, increase as age advances. Pp. 410- 
 31. Cancer is introduced through the digestion. "We eat it. 
 P. 410 : The age incidence of cancer goes to prove this view. 
 Wrong alimentation gains power as age advances. In early 
 life irritation reacts by intolerance into fever and acute 
 inflammation ; in later life by tolerance into depression, and 
 then into mild and slow disease, with intercurrent subacute or 
 acute exacerbations. P. 411 : Irritation and tolerance, with 
 depression, found sometimes even in childhood. The 
 depression stage is the best time to treat chronic disease, and 
 80 to prevent the onset of fatal disease. P. 412 : How cancer 
 becomes more prevalent as age advaDces. P. 412 : Cancer in 
 dogs and pigs. P. 413 : Why cancer affects women more 
 than men. Habit the cause rather than sex. But the 
 preponderance of the proportion among women to cancer, as 
 compared with men, is diminishing. Why ? Because the 
 habits of the sexes are approximating in character to one 
 another. Pp. 414-5 : Comparison of habits of women with 
 those of men. Pp. 416-7 : Women eat oftener than men. 
 The kinds of food they like. P. 417 : Food habits of boys and 
 girls much the same as one another. Cause of frequent illnesses 
 of domestic servants. Pp. 418-9 : Comparison between food and 
 work-habits of men and women continued. P. 419 : Indefinite 
 
xxviii. TABLE OF CONTENTS. 
 
 postponement of illness is equivalent to its prevention. 
 General habits of to-day deteriorate health ; but bad food 
 habits a most important cause. Pp. 420-3 : Cases of cancer 
 apparently caused by too frequent feeding (pollaki-siteism). 
 Habits affect vs^ell-to-do and ill-to-do women. P. 423 : Great 
 increase in consumption of sugar. Bread and jam, a whole- 
 some food once a day, but five times a day is deadly. P. 424 : 
 Eegularity of life good ; but regularity in wrong-living is 
 deadly. Pp. 424-6 : Misery a contributory cause of cancer. 
 But cancer spares neither poor nor rich, miserable nor happy. 
 Effects of anxiety on men and women. P. 426 : Alleged 
 influence of cancer houses. Fallacy of this statement. The 
 food-habits of the tenants should be investigated. P. 427 : 
 Damp, swampy districts, and alcohol may sometimes be 
 contributory causes. Pp. 428-9 : Cancer might easily be 
 reduced and prevented. Increasing weight of authority that 
 it is a food-disease. Pp. 429-30 : Dr. Braithwaite's views as 
 to excess of salt being a cause of cancer. P. 431 : Mr. 
 Giimpel's criticism and view supported by the author. Salt in 
 the blood. Pp. 432-4 : Advice as to means of preventing 
 cancer, the same as that intended to prevent other diseases. 
 The strength and the weakness of this view. 
 
 Pages 435-522 : Chapter XII. General Observations ; 
 and Cases illustrative of the Causation and Cure of Disease 
 by Diet. P. 436 : Too much food the chief cause of 
 disease. A knowledge of causes necessary for prevention ; 
 and our belief in alleged causation corroborated by ability 
 to prevent. P. 437 : Some medical advisers will probably 
 always be necessary. Pp. 438-9 : Prophasiology and 
 etiology. Prophasiology a part of etiology. P. 440 : A 
 practical question more than a theoretical one. Food as a 
 cause of disease much greater than alcohol. P. 441 : Indiges- 
 tion the first step in the production of illness. Pp. 441-2 : 
 Two great lines of evolution of disease, one culminating in 
 cancer, the other in tuberculosis. P. 442 : Etymology of 
 scrofula. P. 443 : Two definitions of tuberculosis compared. 
 
TABLE OF CONTENTS. xxix. 
 
 Quite impossible morally, and almost impossible physically, 
 *' to keep away from infection." Pp. 444-5 : Causation and 
 cure of bronchitis by diet. Pp. 445:6 : Asthma best treated 
 by restriction of diet. Medical men have long taught this 
 view. Pp. 447-9 : Temporary confusion in writer's mind 
 between poly-amylism and poly-siteism. Pp. 449-52 : History 
 of a case of bronchitis. Its relation to rheumatism or initis 
 and varicosity of veins. P. 452 : Further considerations on 
 this case. P. 453 : Dissiteism would probably have been 
 better than trissiteism for it. Cure of repeated broncho- 
 pneumonia and influenza by diet. Pp. 453-4 : Also of colds 
 and malarial ague by the same. P. 454 : Eemarkable cure of 
 old lady of 72. Dogma : Bronchitis is caused by excess of 
 food. P. 455 : Inference from this dogma : Bronchitis pre- 
 ventible by diet (between five and 65 years of age). P. 456 : 
 New hope for humanity from this dogma. Pp. 456-7 : Letter 
 from America detailing cure of asthma by diet. P. 458 : 
 Uses of exercises for the body. Quantity of fluid required. 
 Eecurrent bronchitis ending in fatal pneumonia caused by 
 wrong dietary. Teetotalism did not save the patient. Pp. 
 460-1 : Pneumonia also caused by wrong dietary, and there- 
 fore preventible by proper dietary. P. 462 : Another fatal but 
 probably preventible case. P. 463 : Medical scientist can only 
 declare the law. Eheumatism and gout. Etymology of 
 rheumatism. P. 464 : Eheumatism is congestion of connective 
 tissue. P. 465 : Clinical relations of rheumatism. Best 
 treatment of. P. 466 : Suggested alteration of name to initis. 
 Etymology of gout. P. 467 : How we eat rheumatism and 
 gout. Eestriction of diet often cures rheumatism. Pp. 
 467-8 : A case. Pp. 468-71 : Another case, hereditary in 
 conventional sense, but not really so. P. 371 : Anasmia 
 or triphthsemia or catatribaemia, due to over-feeding, and 
 tractable by restriction of diet. P. 472 : Many wasting 
 diseases should be treated by restriction. Law of con- 
 stant causation and intermittent or periodic effects. Or, 
 P. 473 : Causes acting at short intervals produce effects 
 
XXX. TABLE OF CONTENTS. 
 
 at longer intervals. P. 473 : Canon of treatment arising 
 from this law. The ancient view sound, that we should 
 treat periodic affections in the intervals rather than in 
 the attacks. P. 474 : Periodic aflfections are on the way 
 to becoming chronic. But chronic illness is not always 
 equally present. What recurring headaches lead to. 
 Pp. 474-5 : A case. How it might have been better treated. 
 P. 476 : Other causes, like damp, &c. , may be contributory to 
 rheumatism. Pp. 476-7 : Connection between causes of 
 ovarian tumour and bilious attacks. A patient advised to 
 become monositeous after removal of an ovarian tumour. 
 This the best means to prevent future illness. P. 478 : 
 Futility of treating periodic illnesses by palliatives. Pp. 478-80 : 
 Case of cure of recurring illness without the intervention of 
 the medical expert. Pp. 480-2 : Eecurring affections of the 
 skin, as erysipelas of the face, cured by restriction of diet. 
 Eationale of. P. 482 : Erysipelas a specific inflammation, 
 associated with growth of micro-organisms, and allied to the 
 fevers. Suggestion therefore that the fevers also are to be 
 prevented by proper diet. P. 484 : Too great redness and too 
 great pallour of the skin. Causes of Anaemia. Overgrowth 
 of circular fibres of vessels in. P. 485 : Same causes which 
 produce redness of erysipelas produce pallour of anaemia. 
 Also constipation and diarrhoea. P. 486 : How therefore to 
 be treated. Pp. 486-8 : Case of Pruritus ani. Proof of its 
 causation, and eflSciency of treatment. Pp. 489-90 : Is 
 further proof possible ? Pp. 490-3 : Sycosis menti or tinea 
 barbae, tractable by diet. Theory of treatment. Significance 
 of existence of parasitic diseases and of fevers, not particular, 
 but general. Pp. 493-4 : Skin function, like others, may 
 shew excess, defect, or irregularity. Pp, 494-502 : Ulceration 
 due, like other conditions, to two opposite causes, starvation 
 and plethora. P. 495 : The callous ulcer caused by over- 
 feeding. P. 496 : Good effects of fasting in callous ulcer. 
 Treatment of ulceration of stomach. P. 497 : Of scrofulous 
 ulceration ; juvenile and senile cases. Pp. 498-502 : Ulceration, 
 
TABLE OF CONTENTS. xxxi. 
 
 probably of large intestine, cured by restriction of the diet. 
 Eationale of the treatment. Evidence probable, not 
 demonstrative. Pp. 502-4 : Dilatation of the pupils. How 
 caused. Sometimes accompanied by slow pulse. Can often 
 be modified by restriction of diet. Pp. 504-7 : Epilepsy and 
 its treatment. Transverse elements of pupils are irritated. 
 P. 507 : Defects of vision and dietary causes. P. 508 : 
 Dilatation of pupils often an important sign of illness. 
 Nature gives us desires. It is for us to govern them. P. 509 : 
 Only a few seem willing to attempt this. But a minority of 
 medical men in every generation has always taught it. 
 Pp. 511-6 : Writer's view illustrated from history of well 
 known literary character. The cause of her ailments was too 
 many meals. Pp. 516-20 : All diseases probably more 
 amenable to dietary than to any other form of treatment. 
 P. 520 : Too much surgery. P. 521 : No panacea for human 
 suffering. But moderation the chief means to diminish it. 
 
 Pp. 623-37 : Chapter XIII. Exercises. P. 523 : Are 
 exercises necessary to health ? Opinions of authorities. 
 P. 624 : Exercises cannot undo persistent and long-continued 
 effects of over-feeding. P. 626 : Heavy exercise should be 
 entered on gradually. Pp. 526-7 : Women and exercises^ 
 Three drawbacks in the lives of women. Pp. 527-9 : Exercises 
 among the ancients. Celsus. Active and passive exercises. 
 Pp. 529-30 : Baths in ancient times. P. 630 : Sound ancient 
 view as to relation of exercise to digestion. Pp. 530 : Kinds 
 of exercises. P. 532 : Effects on lymph- circulation. Should 
 not be overdone. P. 633 ; Well-balanced mind avoids 
 extremes of rush and torpor. Pp. 534-5 : Some publications 
 on exercises. Pp. 636-7 : Exercises should be taken when 
 digestion is not going on. Better twice than once a day. 
 
INTRODUCTION. 
 
 rj^EDICINE, connected, as the word is, with 
 the Latin verb mederi, to heal, may be 
 defined as the theory and art of managing the sick, 
 of restoring them to health, and of preventing the 
 occurrence or recurrence of illness. It is evident 
 that the last branch of medicine named, that which 
 is occupied with the prevention of illness, is one of 
 late growth ; and, as a historical fact, it has come 
 into existence only of late years. I am not aware 
 that the idea of preventing illness entered into the 
 minds of the classic Greek and Latin writers on 
 medicine at all. With cure, on the other hand, of 
 diseases which had already arisen, they occupied 
 themselves greatly, just as we do now. In the 
 opinion of the writer of this essay, very little has 
 been done in the domain of the prevention of illness 
 and of disease, compared with what may be expected 
 to be done in the future, and with what may be 
 done now. Evidently, before preventive medicine 
 can attain any great measure of success, we must 
 know what the causes of disease and of illness 
 are. To treat disease, it is not necessary to know 
 much, or, in fact, almost anything of its causes. 
 At least, long before it occurs to us to inquire as to 
 its causes we adopt almost instinctively a method 
 of treatment, and, if the disease is at aU severe, 
 
 A 
 
that method usually involves the three practical 
 points of* putting the patient at rest in bed, of 
 giving him medicine in some form or other, and of 
 altering his diet, since we seem to feel that we 
 cannot feed him in sickness as he has been 
 accustomed to be fed in health. Nature herself 
 indeed points the way to us in this matter, for, if 
 the patient is very ill, or even moderately so, he 
 is naturally unable to be up, and his appetite is 
 generally entirely absent, or at least much impaired. 
 This is so at least in those cases of illness in which 
 feverishness is present, that is, those in which the 
 pulse is quickened and the temperature is elevated, 
 as in fever, and inflammation, and severe injury. 
 But if after a time it occurs to us that perhaps it 
 might have been possible to avoid the fever, to 
 prevent the inflammation, or to escape the injury, it 
 is plain that we must first know what are the causes 
 of these different conditions of body before we can 
 offer advice as to how they may be prevented in the 
 future either in the case of the given patient or of 
 others. As to the last named condition, that of the 
 injury, it will at once occur to every one that to 
 avoid or to prevent a recurrence of that will offer 
 the simplest case of the application of preventive 
 medicine, since it is comparatively easy to see 
 whether knife, or industrial tool, or warlike arms, or 
 accidental fall have caused the condition ; and 
 prevention will resolve itself therefore into the one 
 piece of advice to be more careful in the future. 
 As to the fever and the inflammation, the problem 
 
is much more complicated, and it is more com- 
 plicated still as regards the occurrence of such a 
 condition as tumour-growth ; but it is evident that 
 the means recommended by the medical adviser, by 
 the adoption of which these evils are to be escaped, 
 will differ according to the view which he takes of 
 their causation. In point of fact, as regards the 
 incidence of fevers only, has much thought been 
 expended on their causation, while even as to this 
 opinions are divided into two great classes, one 
 holding with the modern sanitarians that of all the 
 causes of disease, and particularly of all the causes 
 of fever, vitiation of air is far the most important, 
 while the other holds, as Moses did at Kibroth 
 Hattaava, that improper feeding is the cause of 
 fevers, and that if the Israelites gathered and con- 
 sumed quails in excess for two days and a night, it 
 was no wonder that plague should break out among 
 them, and that it should be necessary to bury 
 at Kibroth Hattaava those of them that lusted. 
 Evidently the advice calculated to prevent the 
 outbreak of the pestilence that stalketh in darkness 
 or of the destruction that wasteth at noon-day ; 
 the advice given as to how we are to prevent 
 scarlet fever or typhoid or influenza, will differ 
 according to the different views we may take as to 
 the causation of these affections. On the former 
 view much attention will be directed to the opening 
 of windows so as to obtain the freest ventilation, 
 and to supplying abundant cubic space to each 
 person, so as to prevent overcrowding; on the latter 
 
 A2 
 
we shall devote much attention to the quantity and 
 quality of the food (and drink) taken, and to the 
 amount of time that should elapse between each 
 meal. 
 
 As a preliminary to the consideration of the 
 question whether it is more likely that bad vitiated 
 air or wrong feeding is the more potent cause of the 
 incidence of fever, let us consider which of these 
 two great sets of physiological processes most 
 alters a man. A man emits as much carbonic 
 acid gas through his respiration as would suffice 
 to supply about half a pound of carbon daily 
 were it to be chemically separated from the 
 carbonic acid gas. This is a large amount, and 
 bears quite a considerable proportion to his body 
 weight of say 140 lbs., or about •/ per cent. 
 But if he takes what is generally considered the 
 quite moderate allowance of 2 lbs. of food daily, it 
 is evident that he consumes his own weight of food 
 in 70 days, or a little over two months ; while if he 
 takes 3 lbs. of food daily, the quantity recom- 
 mended by Dr. King Chambers for the nursing 
 mother, he consumes his own weight of food in 
 46 days. Some physiologists contemplate with 
 equanimity the consumption of 5 lbs. weight of 
 food daily, and at this rate a man would eat his 
 own weight in 28 days. I hope to say something 
 later regarding the very extensive quantities of 
 fluid which in various forms pass into and out of 
 the blood daily ; but, referring now to food alone, as 
 distinguished from water, I think I am justified in 
 
saying that a priori, so to say, and on the general 
 merits of the question, it is more likely that a man's 
 body should be modified by food than by air. Of 
 course there are many other changes effected by the 
 respiration than the mere emission of half a pound 
 of carbon daily. Other organic materials, not to 
 mention a quite considerable amount of watery 
 vapour, are given forth by the lungs, but the total 
 amount of change in the body effected by the 
 respiration is very much less than the amount 
 effected by the digestion and assimilation of food 
 and water in the body. Whoever, therefore, should 
 argue that food is probably a greater agent in 
 producing health or disease in the body than air, 
 founds his opinion on substantial facts of this kind ; 
 and, at any rate, no inherent improbability attaches 
 to his contention. 
 
 As to other affections of the body besides 
 the fevers, the inflanmiations, for instance, and 
 particularly as to the occurrence of tumour-growths, 
 it will probably be admitted that scarcely anyone 
 thinks of methods of preventing them, almost every 
 one tending to look upon these conditions as part of 
 the inevitable order of Nature. Let us hope that 
 another view will project itself on our minds before 
 we finish our consideration of the subject, so that 
 some means of preventing these evils that now 
 afflict humanity may arise before our imagination, 
 and offer itself to our practical grasp. At present, 
 however, I fear it must be admitted that any one 
 who hints that perhaps more study of the causes of 
 
the inflammations and tumour growths might enable 
 us to suggest methods by which they might be 
 prevented, and, especially if in order to this end, 
 he suggests that it is necessary to exercise a certain 
 amount of self-restraint, is apt to have his judgment 
 questioned as that of a visionary. 
 
 It seems to be evident that medicine, although 
 appealing to almost every human being with 
 fascinating and even absorbing interest, must be a 
 subject which presents many and great difficulties. 
 The differences of opinion and view between different 
 medical experts, regarding the subject matter with 
 which they deal, offer one of the most striking 
 proofs of this. Before any department of human 
 affairs can be said to be understood, the facts con- 
 cerning it must be clearly stated, they must be 
 marshalled in a more or less complete manner, the 
 law or laws of them, or, at least, their natural order 
 declared, and their causes displayed. When these 
 things have been done, and particularly when the 
 prediction has been ventured on, and verified, as to 
 when and in what circumstances the facts will arise 
 or appear on the one hand ; and, on the other, 
 by what means their existence or onset may be 
 prevented, then the phenomena may be said to 
 have been scientifically or philosophically arranged, 
 verified and declared. And when, or if, these things 
 shall have been accomplished in Medicine, obviously 
 there can be no differences of opinion or view 
 between different medical experts ; at least, no 
 fundamental contradiction of view, although, of 
 
course, there may be, and must be, as in all other 
 branches of science, some or even considerable 
 differences of opinion as to less or more. For in 
 medicine, as in all other domains of knowledge, the 
 phenomena dealt with, while they do not differ in 
 kind, as between case and case, do differ very 
 materially indeed in quantity or amount. The best 
 theory is that which best harmonizes with and 
 accounts for the facts. And it is interesting to 
 observe how, as science has advanced in other 
 departments of knowledge, better theories have 
 supplanted worse ones, since, as knowledge of 
 medicine advances, the same thing will no doubt 
 be observed, one department of knowledge being 
 governed by the same principles as obtain in other 
 departments of inquiry into the constitution and 
 course of nature. An illustration from the history 
 of astronomy may perhaps be allowable here to 
 shew the similarity of the lines of inquiry into the 
 course of nature in all directions. The theory 
 which seems so natural to a dweller on the earth 
 that at first and for a long time no one would think 
 of questioning it, that the earth is of very great 
 size,, that it is at the centre of the universe, and 
 that the sun, moon, planets and fixed stars are 
 revolving round it, does account for a number of 
 astronomical facts ; it is only when it is found that 
 it does not account for or explain a large number of 
 other facts, and that indeed it is quite incompatible 
 with and opposed to them, that we are compelled to 
 discard it in favour of one which supposes the sun 
 
to be more or less fixed, if not in space, at least in 
 relation to his own sphere of action, and that the 
 planets and their satellites, our own small earth 
 included, revolve around him. But just as, say, six 
 passengers in one compartment of a railway carriage 
 may change their places frequently within the limits 
 of the compartment at the same time that the train 
 may be carrying them all rapidly to their destina- 
 tion, so we recognise that the sun, with all his 
 attendant planets and their satellites, may be 
 moving onward, and that even rapidly, to some 
 unknown point in space. The wider theory sup- 
 plants the narrower one because it explains more 
 of the facts. It may in turn be destined to be 
 supplanted by one still wider if it shall be found 
 that some astronomical facts are not explained by 
 the theory ; but in the meantime all astronomical 
 experts accept the theory as far as it goes, and 
 none are to be found who oppose it. The facts of 
 medical science, however, are much more compli- 
 cated and obscure than are those of astronomy 
 (albeit to work out the complete inter-actions of 
 even three bodies obeying the law of gravitation 
 transcends, it is said, the highest powers of mathe- 
 matics, how much more an indefinite number of 
 such bodies ?) at least they probably are so, since it 
 is not uncommon to find medical experts differing 
 fundamentally in their views as to the causation of 
 certain conditions, and, therefore, opposing one 
 another in their recommendations as to treatment. 
 I refer particularly to the facts of depression or of 
 
defect or deficiency of function, as, e.g.^ lowering 
 of the temperature of the body, slowing of the 
 pulse, &c., of which some account will have to be 
 given later. Some medical experts attribute these 
 conditions to causes the exact opposite of those 
 alleged by others to be the causes. In this 
 particular, however, it must be said, the public are 
 hard to please. If doctors agree, the public are apt 
 to attribute their agreement to professional or class 
 feeling ; while, if they differ, they are apt to ask — 
 who shall decide ? The answer, however, when or 
 if this unfortunate state of things occurs, is, I 
 should like to say, just this. The public must 
 decide ; each man for himself must decide ; reason 
 and judgment must decide. The duty of the 
 public, in a condition of opinion so unfortunate as 
 this, is to receive the different views, to ask for the 
 reasons given in support of each, to weigh them up 
 as far as judgment and reason can do so, asking, if 
 necessary, for help from other persons accustomed 
 to weigh evidence in general, in order to be able to 
 decide which of the opposing views is correct ; and 
 to act accordingly. Differences of opinion, after 
 all, are not confined to medical experts. It is 
 doubtful if they differ from one another as often or 
 as widely as lawyers or politicians or statesmen or 
 divines. Emotion sways and excites men in their 
 efforts to settle differences in all of these directions ; 
 but nothing and no expert opinion can relieve the 
 individual man from the need to exercise his judg- 
 ment, his reason, and his conscience, in face of 
 
10 
 
 contradictory advice tendered to him regarding the 
 interests of those entrusted to his care, and whom 
 he may feel to be dearer to him than his own life. 
 
 A very noticeable and noteworthy aspect of 
 the diflBculties, and even the chaotic disorder of the 
 facts with which medicine has to deal, appears 
 when we think of the widely different conditions 
 with which she has to occupy herself. I mentioned 
 fever, inflammation, tumour-growth and injury a 
 little while ago as examples of different classes of 
 disease. It will be necessary to offer definitions of 
 these different conditions later, so as to separate 
 them from one another, if it be possible to do so, 
 and, therefore, to be able to say what we mean 
 when we say that one person has a fever, and 
 another is suffering from inflammation, as also to 
 say how these states of body are to be prevented. 
 But before we reach this attempt at definition, and 
 of clearing up of confusion, we are met by the 
 difficulty that the inflammations themselves are 
 exceedingly numerous — they are co-extensive, in 
 fact, with every organ and even with every tissue 
 of the body — and that no reason appears at the 
 outset why one person should suffer from inflamma- 
 tion of the throat or tonsillitis, as it is called, 
 another from inflammation of the lung or pneumonia, 
 while still another should have inflammation of the 
 stomach or gastritis, and so on through the very 
 numerous list of the inflammations. The explana- 
 tion given by scientific medicine of the reason why 
 these different conditions occur in different persons 
 
11 
 
 or in the same persons at different times is not 
 altogether satisfactory, albeit it is all that has been 
 5'et given, and apparently all that ever can be given 
 to us. It is this. One person is said to have 
 tonsillitis rather than pneumonia because the throat 
 was the weaker place rather than the lung, while 
 another has pneumonia rather than tonsillitis because 
 the lung was weaker or had a lower resistance 
 than the throat. It was the direction of his least 
 resistance, as the expression is. But if we come to 
 inquire why or how it is the direction of least 
 resistance, it is not always possible to get or to give 
 an answer. Very often it is said to be because of a 
 previous occurrence of that affection in the body. 
 A person is subject to recurring attacks of tonsillitis, 
 each of which weakens the part and makes it more 
 susceptible to subsequent attacks. The insufficiency 
 of this explanation, however, appears when we 
 reflect that we have to account also for the 
 occurrence of the first attack. In this, as in all 
 other attempts made by the human mind at scientific 
 accuracy and explanation, we are very apt to become 
 involved in a process of circular reasoning. Thus 
 we say the tonsil was the direction of his least 
 resistance ; it was his weakest organ or place ; and, 
 therefore, he got tonsillitis. And we also say that 
 the existence of the tonsillitis (rather than of 
 pneumonia, for instance) is a proof that the tonsil 
 was the direction of his least resistance. We 
 account for the low (or least) resistance by the 
 tonsillitis, and we account for the tonsillitis by the 
 
12 
 
 low (or least) resistance. The same difficulty meets 
 us in other directions in scientific inquiry. We say, 
 for example (I confine myself to medical illustra- 
 tions, although I might have found them anywhere 
 and everywhere in other departments, as philosophy, 
 theology, morals, sociology, &c.), a man, his father, 
 and his grandfather, all suffered from bronchitis 
 because the family were delicate, and we advance as 
 the reason why we say the family is delicate, the 
 fact of the occurrence of the bronchitis in three 
 generations of the stock. The truth seems to be that 
 scientific explanations, so called, cannot explain 
 anything, and themselves in turn demand explana- 
 tion. To say that a man had tonsillitis rather than 
 pneumonia because the tonsil was the direction of 
 his least resistance, is more high-sounding and 
 pretentious than really explanatory, but it is all the 
 explanation which, as a rule, it is competent for us 
 to offer. As has been said, the difficulty is of the 
 same kind as confronts us in other departments 
 of knowledge. In the science of grammar, for 
 instance, or of language, if we want to know the 
 meaning of the word acute, and look it up in a 
 dictionary, we shall find among other synonyms the 
 word sharp given as an equivalent ; and if we look 
 up the word sharp we shall find among other 
 synonyms the word acute as an equivalent. We 
 can never get beyond our limitations in our 
 attempted enquiries into nature, and it is hopeless 
 to attempt to do so. A man cannot jump out of his 
 own skin or get away from his own shadow in 
 
13 
 
 sunlight. The brighter the sunhght the more 
 noticeable the shadow. In the obscurity of night 
 there is no shadow at all. If an acute critic 
 suggests that in my attempt to clear up obscurity 
 I am myself guilty of a similar course of circular 
 reasoning in using such terms as synonym and 
 equivalent, he may be correct ; but indeed to some 
 extent I fear it is impossible to avoid it. 
 
 The obscurity and complication of the facts 
 with which she has to deal may, therefore, well be 
 advanced as a reason why medicine has not yet 
 made such an amount of scientific advance as will 
 be necessary before she becomes, with her body of 
 rules, formulated for the guidance of humanity to 
 health, a light to the path and a lamp to the eyes. 
 This obscurity is indeed further darkened by the 
 fact that she deals with conditions and states of the 
 body or organism rather than with the organism 
 itself. Almost before the physician has formulated 
 a definite conception of what he means by the 
 organism or body, in health ; before he has had 
 time to do so, he finds himself attempting to under- 
 stand various alterations or changes in its states, 
 which alterations he terms disease, and which, as 
 they are the subject matter of his art, he finds 
 himself compelled to define for himself, and also to 
 clearly expound to others. And, in order that he 
 may be able to do this, it is plain that he must 
 make a long and wide excursus into the wanderjahre 
 of the collection of facts, before he can settle down 
 into the lehrjahre of the methodised order and 
 
14 
 
 arrangements of his facts. When or if, however, 
 the physician can succeed in doing this, when he 
 sees the order and the laws of his facts, the appUca- 
 tion of discovered laws to new facts must result in 
 greater simplification of the facts, in the diminution 
 of their obscurity, and in the conversion of difficulty, 
 disorder and darkness into perspicuity, method, 
 order and light. It is, it seems to me, through a 
 study specially of the blood and lymph, through 
 examination of the mode of their formation, of 
 their uses and functions, and of their conveyance to 
 and their circulation in every one of the tissues of 
 the body, that this order and methodised arrange- 
 ment are to be introduced. By this means the 
 chaos of the incidence of disease in the body is to 
 be reduced to order, and the seeming impossibility 
 of understanding how one person should have sore 
 throat, another headache, another bronchitis, another 
 pneumonia, another rheumatism, another inflamma- 
 tion of the heart, and so on through a catalogue of 
 diseases that seems interminable — the same person 
 may at different times of life suffer from any or all 
 of these affections, and from a large number more — 
 it is through a study of the circulation of the blood 
 and lymph that these disorders are to be understood 
 and the laws of their incidence seen. For, truly, 
 as soon as it is perceived that the same blood goes 
 everywhere in the body, and when it is seen that if 
 the blood is properly and healthily made, it will 
 nourish properly every organ and tissue of the 
 body, while, if it is not healthily or properly made, 
 
15 
 
 it cannot do so, and must, therefore, instead of 
 carrying health to them, convey disease ; and when, 
 lastly, a little observation and reflection have been 
 given to the mode of formation and repair of the 
 blood, then it is that chaos is replaced by order, 
 confusion by simplicity, and darkness by light. 
 
 Medicine has, however, already made much 
 scientific advance. In the whole of anatomy her 
 method is scientific, and in much of physiology, 
 pathology, and the principles of therapeutics, 
 though scarcely in pharmacology. The methods are 
 also scientific in subsidiary domains like chemistry. 
 Bacon's dictum regarding medicine that it has been 
 magis elahorata quani amplificata, rather laboured 
 than advanced, is, if it cannot be said to be totally 
 untrue, at least much less true than when he said it. 
 But there is one other great reason for medicine's 
 failure to make so great an advance into the 
 scientific arena as we might have expected, a reason 
 which she shares with some other departments of 
 enquiry, and which is apt equally to complicate 
 their investigation, viz., what has been called the 
 difficulty of the personal equation. Phenomena 
 which ought to appear the same seem often to difier 
 very much indeed when manifested by this, that 
 or the other person or organism, just as in sociology 
 or in politics phenomena are often very different 
 when manifested by this, that or the other 
 personality, or by this, that or the other difierent 
 nationality. Physiological and medical phenomena 
 are not like mathematical facts, in which we can 
 
16 
 
 discard variables like the widths of lines, and the 
 magnitudes of points, without seriously vitiating 
 our conclusions. In medicine, the analagous 
 variables have much more weight and influence, 
 and if we attempt to discard them, as in mathe- 
 matics we may the width of our lines and the 
 magnitude of our points, we shall find our con- 
 clusions seriously vitiated and interfered with. 
 
 There is even a special form of the personal 
 equation which is more apt to disturb the judg- 
 ment and the equanimity of the medical man 
 than that of the representative of almost any 
 other calling, unless indeed it be the pastor and 
 preacher, and that is the unwillingness manifested 
 by the average human being to seriously con- 
 sider any advice which involves the giving up of 
 any personal gratification or which contemplates 
 in any form the idea of self-restraint or self- 
 government. Now it is very frequently the case 
 that the medical man is called upon to point out 
 that some form of self-indulgence is the cause of 
 the ailments, and particularly of the recurring 
 ailments, from which patients suffer. In this case 
 he feels it to be his duty to say what he has to say, 
 but is afraid how it will be received, and often 
 indeed feels that saying it may lead to a breach 
 between himself and his client, a contingency which 
 he is on all grounds anxious to avoid. It will be 
 felt perhaps how very delicate the position becomes 
 if, for instance, a mother is not excercising a wise 
 government over her children's food-habits, and if 
 
17 
 
 in consequence the children's health is suffering. It 
 might be thought perhaps that mothers would be 
 only too happy to know what would prevent their 
 children's illnesses, and would, therefore, be only 
 too glad to do anything to obviate them. But a 
 great many considerations arise to prevent their 
 taking: such a course, mosth' of a social nature, and 
 coming through channels which it is very difficult to 
 control. And, of course, at bottom there is great 
 dislike to imposing limits either to our own gratifi- 
 cation or to that of our children. Then again, 
 other exponents of medical views may not have 
 such strong opinions, and for these and many other 
 reasons which perhaps are as well unexpressed, the 
 happy relations which it is so desirable, if possible, 
 to maintain between adviser and client are apt to 
 come to an end ; and this however tactfully the 
 unpleasant advice has been offered, and however 
 well the unpalatable pill has been gilded. Perhaps 
 these difficulties are as great in other walks of life. 
 Each person gets to know them in his own depart- 
 ment. It does not seem possible to go through life 
 very smoothly, however careful one may be to avoid 
 causes of offence. Still each must judge for himself 
 how far he ought to go in attempting to hold the 
 balance even between a tactful desire to please and 
 a compulsion laid on him to interpret the facts and 
 the law of the facts truly as far as in him lies. 
 
 The variabilities in the phenomena with which 
 medicine has to occupy herself, the obscurities and 
 the indefiniteness of them become greater rather 
 
18 
 
 than less when we come to consider more closely 
 what medicine is. Medicine is a science, or it may 
 come to be a science of conditions, of the conditions 
 of the human body in disease. An extension of 
 the domain to cover the field of animal medicine, 
 and, still further, to cover the field of orgajiic 
 medicine, that is, the medicine of organic or 
 organised things (animal and plant), would very 
 greatly widen its scope. It would, that is, greatly 
 widen it as regards details, though as to principles 
 this might be doubted. However, with this we 
 need not at present concern ourselves. It is 
 sufficiently difficult and confusing to deal with the 
 disease-conditions of the human body, as these 
 pass by gradations almost insensible from conditions 
 of health to those of disease. Disease being any 
 and every departure from health, the question at 
 once is forced on us for consideration — What is 
 health ? Can we define health ? There have been 
 many definitions or descriptions of health, none of 
 them theoretically perfect, yet practically of good 
 service in clearing the mind of confusion. If, for 
 example, we say that health is the normal, easy 
 and painless balance between the organism and its 
 environment, and that disease is any departure 
 therefrom, we have a practical definition, though by 
 no means a theoretically good one, of health and 
 disease respectively ; since the question at once 
 arises what a normal balance is, and the settlement 
 of this and similar questions reaUy involves the 
 definition of what health is, so that we find 
 
19 
 
 ourselves unconsciously begging the question and 
 moving in a circle. 
 
 The reader will think of Mr. Herbert Spencer's 
 definition of life, that it is " the continuous adjust- 
 ment of internal relations to external relations," 
 and will ask if this statement is a simplification of 
 his ideas of life, or otherwise. What we want in a 
 definition is something that will make the idea or 
 the thing easier, simpler than it was before. If, we 
 say, trying to get a practical working definition 
 that disease is any and every condition in which the 
 doctor is sent for, we are forced at once to reflect 
 that the doctor is not always summoned when 
 disease sets in, and also that persons are not always 
 ill when they summon the doctor, since they may 
 want a certificate that they are well, or a statement 
 from him that they are fit to join the army or navy, 
 or, for example, that they are safely insurable, or 
 that they are able to perform this, that or the other 
 piece of work. The truth is, it is almost impossible 
 to give a definition of health, and, therefore, of 
 disease, which is any departure therefrom, without 
 introducing by paraphrase, if not explicitly, the 
 very word or idea which we wish to define. To 
 say, for instance, that health is organisation in 
 normal, easy and painless action, sounds well until 
 we ask what is ' ' normal action," and when we 
 attempt to answer this question we find that normal 
 action and health is much the same thing, so that 
 our high sounding definition seems in the end to 
 come to the statement that health is health, 
 
 B2 
 
20 
 
 which, though undoubtedly true, is by no means 
 instructive. If instead of a definition we attempt 
 a description of health, and say that an organism is 
 healthy when the pulse is not below say 60 a 
 minute, nor above 90, when the temperature stands 
 at about 98 '4° F. or 37° C. , when the respiration 
 varies from 14 to 20 a minute, when the bowels act 
 once a day, and 40 to 60 ounces of water are passed 
 daily by the kidneys, all these functions being 
 easily and painlessly performed ; and so on, through 
 all the functions of the body (and, it might have 
 been added, of the mind also), we soon realise that 
 the idea of health, simple as we thought it on 
 commencing our study, is a very complicated aifair 
 indeed, and that our ideas concerning it, instead of 
 becoming more and more simple, become, if not 
 more and more obscure, yet at least more and more 
 extended. Without, therefore, assuming more for 
 our definition of health than it is reasonable to claim 
 for it, and without attaching too much importance 
 to our attempts at description, since our limits of 
 variation may easily be exceeded without departure 
 from health, we must leave attempts at definition 
 and description and pass on to the consideration of 
 the subject of health and its co-relative disease. 
 
 'rJ^S^ii^V^?^^^ 
 
21 
 
 CHAPTEE I. 
 
 The Problem stated. The present state of 
 Medicine and Surgery, and their progress 
 in the past. 
 
 TN current literature, professional and lay, we 
 are continually being told of the progress of 
 medicine and surgery. I shall have to say some- 
 thing from time to time in the course of these 
 observations regarding the latter, although my 
 remarks are mainly confined to medicine. I think 
 there is too much surgery performed in England 
 and the world at present. There can be no doubt 
 that many diseased conditions, which it is now the 
 custom, and which it has been increasingly the 
 custom for some time past, to treat surgically, 
 might be, and much more satisfactorily, treated 
 medically, that is, by medical, and particularly 
 by dietetic management. The cry of " operate, 
 operate," is becoming too loud, and people are 
 stretching out in too marked a manner mute hands 
 appealing to surgery for help, and are tending to 
 expect too much from surgical operations. When a 
 surgeon takes upon himself to say that a natural 
 structure is " obsolete and out of date," suggesting, 
 by implication at least, that all might yet be well if 
 
22 
 
 he were called in to remove it by surgical operation, 
 his mental attitude, as well as the language in 
 which he expresses it, strikes us as with a jar. 
 And when he goes on to say "it is safe to predict 
 that in the intestine of the man of the future 
 there will be no such structure (as the vermiform 
 appendix) found hanging from the caecum," one is 
 inclined to say, it is unwise to prophesy unless you 
 know. But if one is going to venture on prophecy, 
 it is certainly clever to predict that something will 
 occur or will not occur at a period of time so remote 
 that neither the prophet nor any of his hearers 
 will be here to see the prophecy verified, or to be 
 disturbed if it is not verified. The prophet who 
 predicted the end of the present dispensation in 20 
 years gave his auditors a much better chance. 
 They could verify the truth or otherwise of the 
 prediction. But although this particular prophecy 
 cannot be verified in any reasonable time, a simple 
 sum in proportion rises to the mind on reading rash 
 and arrogant statements of this kind, viz., this: if 
 5,000 years (or 50,000 or more years, for it seems 
 not impossible that men may have been on this 
 planet for even that length of time) have not 
 sufficed to abolish the vermiform appendix of the 
 caecum, what likelihood is there that it will evolve 
 to nothing in 1000 years hence, or 2000 or 3000 
 years ? It does seem a pity that men so able and 
 so knowing had not been entrusted with the 
 making of man and of the world on which he was 
 to dwell. They could have done the work so much 
 
23 
 
 "better. And what a number of useful hints have 
 been lost because they were not consulted when the 
 thankless task of fashioning them was in course of 
 being accomplished. A structure rich in lymphoid 
 elements has probably a useful part to play in the 
 economy, and it would be far more useful to poor 
 and suffering humanity, though possibly less imme- 
 diately beneficial to the prophets, to advise it how 
 to keep the appendix vermiformis and other parts 
 sound and healthy than to proceed to remove them 
 in the way that is now so freely proposed and 
 carried out. Even after the appendix is removed, 
 the ^caecum or other parts of the intestine may 
 become inflamed, and the appendix-less patient may 
 still suffer from inflammation of the caecum or of 
 the bowel, from peri-typhlitis or enteritis. Are we 
 to excise the caecum in order to prevent typhlitis or 
 peri-typhlitis ? or the bowel, in order to prevent 
 enteritis ? Or would it be wise to amputate the 
 head in order to prevent neuralgia of the face ? 
 
 Obviously, if the causes which lead to the 
 formation of some growth or abnormality in the 
 body, or to some local inflammation in it, are 
 allowed to go on acting after the inflanunation has 
 •subsided, or after the growth or abnormality has 
 been removed, either a recurrence of the growth or 
 
 *NoTE. — Caecum is the Latin for blind, the Greek equivalent 
 being tv^Xov. The name is given to that part of the 
 bowel where the large intestine commences as a cul de sac 
 or blind part, that is, with no passage through at that 
 place. The appendix vermiformis springs from this part. 
 
24 
 
 abnormality, or, when that is not possible, some 
 other abnormality or diseased condition must be 
 expected to occur in the body. Many instances of 
 this have come under my observation, as they 
 must have done under the observation of every 
 experienced practitioner. A patient who gets sore 
 throat, for example, or bronchitis, may, and not 
 infrequently does, get another and another attack of 
 the same affection, if, when the inflammation has 
 been subdued by treatment, nothing is said to him 
 as to the causes which led to his successive attacks. 
 The well-known fact that the removal of a simple 
 ovarian tumour is frequently followed some years 
 afterwards by the formation of cancer about the 
 stump of the simple tumour, is a striking corrobora- 
 tion of the truth of this view, as it also suggests to 
 our minds that the causes of simple tumour and of 
 malignant or cancerous tumour are probably the 
 same, and that the long continuance of the action 
 of the causes of simple tumour-growth leads in 
 time to the production of cancerous growth. In 
 any case, every experienced surgeon must have 
 heard from time to time the statement — " I am 
 much disappointed with the result of my opera- 
 tion." Surgery has its sphere, no doubt, and a 
 very great one, but it seems at present to be 
 overdone. But I do not wish to enter into any 
 considerations of this sort. I do not deny, I rather 
 re-echo, the assertion that, where operations are 
 necessary, they are much safer in the performance 
 and much more curative in their results than they 
 
25 
 
 used to be. Nevertheless, and notwithstanding the 
 brilliancy and striking character from time to time 
 of the results of surgery, it has not done much for 
 the lengthening of the life of the people. Com- 
 pared with the results achieved by medicine^ 
 meaning by that name not only pharmaceutical but 
 also sanitary and hygienic measures, the results of 
 surgery have been in the aggregate very small 
 indeed, As to medicine, however, what has been 
 the result? In the year 1838 the Eegistrar-General 
 began to compile his figures for England and Wales, 
 and in the years 1838-40 the death-rate for the 
 country was 22-33 per 1000 per annum. In the 
 years 1898-1900 (60 years after) the death-rate 
 averaged 18 per 1000 per annum, a fall of about 20 
 per cent. It would be a crude inference from these 
 figures to assume, dividing 1000 by the ratio per 
 thousand per annum, that the average duration of 
 life for these sets of years had been forty-four and 
 three-quarter years for the first period, and no less 
 than fifty-five and a half years for the second. 
 Nevertheless, the expectation of life is now con- 
 siderably greater in England and Wales than it 
 was when the Registrar-General began to compile 
 his figures. A very interesting set of tables has 
 been published in the supplement to the forty-fifth 
 annual report of that official, from which it will be 
 advisable to extract a few facts. It would take too 
 long a time and occupy too much space to deal 
 completely with the information contained in this 
 and previous reports ; but it appears if we compare 
 
26 
 
 the expectation of life at birth at different periods of 
 time in England, that a very considerable improve- 
 ment has been effected. Thus in the 16 years, 
 1838-54, the expectation of life at birth for males 
 was 39*91 years. In the 10 years, 1871-80, how- 
 ever, it had risen to 41 "35 years, and in 1881-90 it 
 reached 43*66 years. For females the corresponding 
 expectations were: — For 1838-54, 41*85 years; for 
 1871-80, 44-62 years; and for 1881-90, no less than 
 47 "18 years. If we were to assume, which is not 
 the case,* that the numbers of males and females 
 were equal, this would mean an increase in 1881-90 
 over 1838-54, to the average duration of life, of 
 about four and a half years. If this number were 
 multiplied by 32|^ millions, the estimated population 
 of England and Wales in 1900 (supposing the 
 improvement still to hold), no less a sum would be 
 reached than 145,125,000 years of life as added 
 to the life-time of the generation now living in 
 England and Wales, as compared with the conditions 
 obtaining in 1838-54. For the United Kingdom 
 the corresponding addition would be no less than 
 180,000,000 years of life. Numbers like this strike 
 the imagination with some of the surprise excited 
 by the figures dealt with in astronomical enquiries ; 
 but so far as can be seen, they seem fairly to 
 represent the gross increase, medical and surgical, 
 made in the last 60 years in the life duration of the 
 people of this country. If similar gains have been 
 
 *NoTE. — In 1881-90, out of a million children born, 485,527 were males, 
 and 514,473 females. 
 
27 
 
 effected (as to some extent they have) in other 
 countries, the life gains to humanity, made by a 
 diminished mortahty, must be very great indeed. 
 Beside numbers Hke these, even the addition of 
 30,000 years of life, which a great ovariotomist 
 recently claimed that he had made through his own 
 personal instrumentality to the life-time of his day 
 and generation (great as it undoubtedly is as the 
 influence of one man, now happily imitated by many 
 others), pales into insignificance. It illustrates the 
 different figures dealt with by medicine and surgery 
 respectively. When the surgeon speaks of adding 
 thousands of years of life to his generation, the 
 physician (as represented by hygiene and sanitation) 
 speaks of millions. The millions no doubt include 
 the thousands, but the total result goes to show 
 that, great as the influence of improved surgery 
 has been, it has been comparatively small as com- 
 pared with that of improved medicine, speaking of 
 it in its widest sense. And further, sanitation is 
 without drawback, which surgery is not. For, in 
 considering the improvement effected by the latter, 
 we are compelled to remember that at least some 
 lives have been shortened where surgical operations 
 have ended fatally ; since it cannot be contended 
 that all the lives cut short by surgical operations 
 would have been terminated so soon had the patients 
 been left alone. It will never be known to what 
 figures such losses would amount ; but whatever 
 they are, they ought to be deducted from the gross 
 addition made to human life by surgery. On the 
 
28 
 
 other hand, all that is added to human life by 
 sanitation is pure gain — we must hold with 
 Socrates that 6 yStos /Stwros, ' ' life is worth living " 
 — for I think I need not now and here discuss 
 the question, already settled, whether, in saving 
 the weaklings, sanitation can in any sense be 
 said to have deteriorated the race. Assuming 
 that as settled, the question remains in what 
 forms the gains have been effected. I hope to 
 consider the increase in the duration of life at 
 different age periods later. In the meantime, it 
 may be said that the gains on the large scale in the 
 last 50 or 60 years have been mainly two. We 
 have very much diminished the mortality from the 
 fevers, or what are known as the zymotic diseases, 
 and we have very much diminished the mortality 
 from consumption. In the five years, 1850-4, the 
 mortality from the fevers amounted to 5'^34 per 
 million per annum on the average. In the five 
 years, 1875-9, it had fallen to 3911 per million per 
 annum. In 1871-80 the average mortality from the 
 zymotic diseases in England and Wales was at the 
 rate of 3724 per million per annum. In the five 
 years, 1881-5, it averaged 2797; in 1886-90 it was 
 2506; in the decennium 1881-90 it averaged 2656. 
 In 1891-5 it was 2747. The average of 1889 to 
 1898 was at the rate of 2663 per million per 
 annum, the rate in 1897 being 2811. The rate has 
 been rather upwards in the last few years. The 
 decennium, 1889-1898, has shewn no less mortality 
 from this cause than the decennium ending in 1890 ; 
 
29 
 
 it is, in fact, rather higher if anything ; but the 
 rate in the decennium ending 1898 has been less 
 than that of the five years ending 1854 by no less 
 than about one-half, or 49 per cent. Why this is, 
 is an interesting question, which I propose to 
 discuss later. 
 
 In the case of consumption, the mortality in 
 the five years, 1850-54, was at the rate of 2811 per 
 million per annum. This had fallen to 2130 per 
 million per annum in the five years 1875-9. In 
 1881-5 the mortality was at the rate of 1830 per 
 million per annum; in 1886-90, it was 1635; in 
 1891-5, it was 1461 ; and in 1896-1900 it was 1321 
 per million per annum ; so that the fall in the 
 mortality from consumption in England and Wales 
 since 1850-4 has been no less than 53 per cent., or 
 considerably over one half. And both in the case 
 of the fevers and in that of consumption the gain 
 to the health of the community must be considered 
 most satisfactory, more so perhaps in the case of 
 consumption than in that of the fevers, since the 
 fall in consumption appears to be still steadily 
 progressing, while that from fevers has been some- 
 what checked. It may also be noted in passing as 
 regards consumption, that the diminution in its 
 mortality had begun steadily to progress long 
 before any special crusade against it had been 
 instituted, and that, good as that crusade is, and 
 laudable in its attempted results, we must be careful 
 of attributing to it efiects beyond those to which it 
 may be fairly entitled. 
 
30 
 
 Besides these gains to the health of the people, 
 known to have accrued during the registration 
 period, there are others of a very satisfactory 
 character. The following table, copied from the 
 report of the Registrar- General for England and 
 Wales for 1900, will shew, for those who are 
 interested in such inquiries, the diminution which 
 has been occurring in the mortality of the people 
 since 1838, when the Registrar. General first began 
 to compile his figures : — 
 
31 
 
 ENGLAND AND "WALES.— Annual Death-rates at Twelve Age-periods in 
 Groups of Years, 1838-1900. — Males and Females. 
 
 Pebiod. 
 
 AGES. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 All 
 
 Ages 
 
 0- 
 
 1 
 1 
 
 5— 
 
 10— 
 
 15— 
 
 20- 
 
 25— 
 
 35— 
 
 45— 
 
 55— 
 
 65— 
 
 75— 
 
 85 
 
 and 
 
 upwards. 
 
 1838 ■) 
 
 DEATHS TO 1000 LIVING. 
 
 MALES. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 to [ 
 
 221 
 
 683 
 
 7-1 
 
 40 
 
 56 
 
 76 
 
 90 
 
 12-8 
 
 19-0 
 
 33-5 
 
 681 
 
 147-6 
 
 308-8 
 
 1900 ) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1841-50 
 
 231 
 
 71-2 
 
 9-2 
 
 5-1 
 
 7-1 
 
 9-5 
 
 9-9 
 
 12-9 
 
 18-2 
 
 31-8 
 
 67-5 
 
 143-3 
 
 .312-3 
 
 1851-60 
 
 23-1 
 
 727 
 
 8-5 
 
 4-9 
 
 67 
 
 8-8 
 
 9-6 
 
 12-5 
 
 18-0 
 
 31-0 
 
 65 "5 
 
 1467 
 
 308-2 
 
 1861-70 
 
 237 
 
 73-5 
 
 8-2 
 
 4-5 
 
 6-2 
 
 8-5 
 
 9-9 
 
 13-5 
 
 19-2 
 
 331 
 
 67-1 
 
 147-2 
 
 315-0 
 
 1871-80 
 
 227 
 
 68-5 
 
 67 
 
 37 
 
 5-3 
 
 7-4 
 
 9-4 
 
 13-8 
 
 20-1 
 
 .34-9 
 
 697 
 
 150-8 
 
 3-27-4 
 
 1881-90 
 
 20-3 
 
 61-6 
 
 5-4 
 
 3-0 
 
 4-3 
 
 57 
 
 7-8 
 
 12-4 
 
 19-4 
 
 347 
 
 70-4 
 
 146-6 
 
 305-8 
 
 1891-1900 
 
 19-3 
 
 60-8 
 
 4-2 
 
 2-4 
 
 3-8 
 
 5-2 
 
 7-0 
 
 11-9 
 
 19-4 
 
 35-8 
 
 69-0 
 
 1470 
 
 285-1 
 
 1841-45 
 
 22-2 
 
 687 
 
 8-8 
 
 4-8 
 
 6-8 
 
 9-0 
 
 9-4 
 
 12-2 
 
 17-2 
 
 30-3 
 
 65-5 
 
 143-7 
 
 305-1 
 
 1846-50 
 
 24-1 
 
 7-38 
 
 9-5 
 
 5-4 
 
 7-3 
 
 10-0 
 
 10-5 
 
 13-6 
 
 19-2 
 
 33-2 
 
 69-5 
 
 1530 
 
 319-5 
 
 1851-55 
 
 23-5 
 
 73-9 
 
 8-8 
 
 51 
 
 7-0 
 
 9-2 
 
 100 
 
 12-9 
 
 18-6 
 
 31-5 
 
 66-6 
 
 150-8 
 
 311'0 
 
 1856-60 
 
 22-6 
 
 71-5 
 
 8-3 
 
 4-6 
 
 6-4 
 
 8-4 
 
 9-2 
 
 12-2 
 
 17-4 
 
 30-4 
 
 64-3 
 
 142-6 
 
 305-4 
 
 1861-65 
 
 237 
 
 74-0 
 
 8-5 
 
 47 
 
 6-4 
 
 87 
 
 97 
 
 13.2 
 
 18-9 
 
 32-8 
 
 66-3 
 
 145-8 
 
 316-4 
 
 1866-70 
 
 237 
 
 72-9 
 
 7-9 
 
 4-3 
 
 60 
 
 8-3 
 
 101 
 
 13-8 
 
 19-6 
 
 33-5 
 
 678 
 
 148-7 
 
 313-6 
 
 1871-75 
 
 23-3 
 
 69-9 
 
 7-1 
 
 4-0 
 
 57 
 
 8-1 
 
 100 
 
 14-3 
 
 20-3 
 
 34-8 
 
 70-0 
 
 149-5 
 
 323-3 
 
 1876-80 
 
 22-1 
 
 670 
 
 6-3 
 
 3-4 
 
 49 
 
 67 
 
 87 
 
 13-4 
 
 19-8 
 
 34-9 
 
 69-4 
 
 152-2 
 
 331-6 
 
 1881-85 
 
 20-5 
 
 61-3 
 
 5-8 
 
 3-2 
 
 4-5 
 
 60 
 
 8-2 
 
 12-8 
 
 19-3 
 
 34-2 
 
 687 
 
 145-4 
 
 297-8 
 
 1886-90 
 
 20-0 
 
 61-9 
 
 4-9 
 
 2-8 
 
 4-1 
 
 5-5 
 
 7-4 
 
 12-0 
 
 19-4 
 
 35-2 
 
 721 
 
 147-9 
 
 313-8 
 
 1891-95 
 
 19-8 
 
 62-0 
 
 4-5 
 
 2-5 
 
 40 
 
 5-3 
 
 7-2 
 
 12-1 
 
 19-8 
 
 36-3 
 
 71-8 
 
 149-7 
 
 290-1 
 
 1896-1900 
 1838 •) 
 
 18-8 
 
 59-6 
 
 3-8 
 
 2-2 
 
 3-5 
 
 51 
 
 67 
 
 117 
 
 19-0 
 
 35-3 
 
 66-2 
 
 144-3 
 
 280-2 
 
 FEMALES. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 to f 
 
 200 
 
 58-4 
 
 69 
 
 41 
 
 60 
 
 7-2 
 
 8-8 
 
 ire 
 
 15-5 
 
 28-2 
 
 59-9 
 
 133-9 
 
 282-1 
 
 1900 ) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1841-50 
 
 21-6 
 
 61-1 
 
 8-9 
 
 5-4 
 
 7-9 
 
 9-1 
 
 10-6 
 
 12-9 
 
 16-1 
 
 28-4 
 
 60-9 
 
 135-9 
 
 293-3 
 
 1851-60 
 
 21-4 
 
 630 
 
 8-4 
 
 5-1 
 
 7-4 
 
 8-6 
 
 10-0 
 
 12-2 
 
 15-3 
 
 27-1 
 
 58-9 
 
 134-5 
 
 288-9 
 
 1861-70 
 
 21-4 
 
 637 
 
 7-8 
 
 4-5 
 
 67 
 
 8-0 
 
 97 
 
 12-1 
 
 15-6 
 
 27-9 
 
 59-1 
 
 134-9 
 
 285-1 
 
 1871-80 
 
 20-1 
 
 58-4 
 
 6-3 
 
 37 
 
 5-5 
 
 6-8 
 
 8.6 
 
 il-6 
 
 15-6 
 
 287 
 
 61-0 
 
 135-4 
 
 296-4 
 
 1881-90 
 
 18-1 
 
 52-0 
 
 5-3 
 
 3-1 
 
 4-4 
 
 5-5 
 
 74 
 
 10-6 
 
 15-1 
 
 28-5 
 
 60-4 
 
 130-6 
 
 270-8 
 
 1891-1900 
 
 17-1 
 
 50-9 
 
 4-2 
 
 3-5 
 
 37 
 
 4-6 
 
 6-3 
 
 9-9 
 
 14-9 
 
 29-0 
 
 60-0 
 
 133-5 
 
 259-6 
 
 1841-45 
 
 20-6 
 
 58-6 
 
 8-6 
 
 5-2 
 
 77 
 
 8-6 
 
 9-9 
 
 12-2 
 
 15-1 
 
 27-2 
 
 59-1 
 
 131-8 
 
 288-6 
 
 1846-50 
 
 22-6 
 
 637 
 
 9-2 
 
 57 
 
 8-1 
 
 9-6 
 
 11-2 
 
 137 
 
 17-0 
 
 297 
 
 62 8 
 
 140-1 
 
 297-9 
 
 1851-55 
 
 21-8 
 
 63-8 
 
 8-5 
 
 5-3 
 
 7-8 
 
 8-9 
 
 10-3 
 
 12-6 
 
 15-8 
 
 27-8 
 
 59-6 
 
 1371 
 
 292-0 
 
 185&-60 
 
 21-0 
 
 62-3 
 
 8-3 
 
 4-8 
 
 7-1 
 
 8-2 
 
 9-6 
 
 11-9 
 
 14-8 
 
 26-5 
 
 58-1 
 
 131-9 
 
 285-8 
 
 1861-65 
 
 21-5 
 
 64-1 
 
 8-3 
 
 4-8 
 
 6-9 
 
 8-2 
 
 9-8 
 
 12-1 
 
 15-5 
 
 27-9 
 
 59-1 
 
 133-7 
 
 287-7 
 
 1866-70 
 
 21-2 
 
 63-3 
 
 7-4 
 
 4-3 
 
 6-4 
 
 7-8 
 
 9-6 
 
 12-1 
 
 15-8 
 
 27-9 
 
 59-1 
 
 1361 
 
 282-4 
 
 1871-75 
 
 207 
 
 60-0 
 
 6-6 
 
 4-0 
 
 5-9 
 
 7-4 
 
 9-2 
 
 120 
 
 15-9 
 
 287 
 
 61-2 
 
 135-3 
 
 293-8 
 
 1876-80 
 
 19-5 
 
 56'8 
 
 5-9 
 
 3-5 
 
 5-0 
 
 6-2 
 
 8-0 
 
 11-2 
 
 15-4 
 
 28-6 
 
 60-8 
 
 135'4 
 
 299-0 
 
 1881-85 
 
 18-3 
 
 51-9 
 
 57 
 
 3-5 
 
 47 
 
 5-9 
 
 7-9 
 
 11-0 
 
 15-2 
 
 28-1 
 
 59-0 
 
 128-9 
 
 265-4 
 
 1866-90 
 
 17-8 
 
 52-0 
 
 4-9 
 
 2-9 
 
 4-1 
 
 5-2 
 
 6-9 
 
 10-3 
 
 15-0 
 
 28-8 
 
 617 
 
 132-3 
 
 276-2 
 
 1891-95 
 
 177 
 
 51-9 
 
 4-5 
 
 27 
 
 40 
 
 4-9 
 
 67 
 
 10-3 
 
 15-3 
 
 29-8 
 
 627 
 
 135-8 
 
 263-2 
 
 1896-1900 
 
 16-6 
 
 49-9 
 
 3-9 
 
 2-3 
 
 3-3 
 
 4-3 
 
 5-9 
 
 9-6 
 
 14-5 
 
 28-1 
 
 57-4 
 
 131-2 
 
 255-9 
 
32 
 
 The analysis of these figures in detail would 
 probably weary and confuse most readers, who will 
 from personal examination of the table find much 
 to interest and instruct, and that in a better way 
 than any analyst can do it for them. But the 
 following few observations may be made. First as 
 regards females, with the exception of the age 
 periods 55-65 and 65-75, the mortality is less in 
 1891-1900 than it was on the average of the years 
 1838-1900, the whole period for which the figures 
 have been kept. Thus we find that the general 
 mortality at all ages had fallen from 20 per 1000 
 per annum to 17*1 per 1000 in 1891-1900. From 
 0-5 years it had fallen from 58*4 per 1000 to 50*9. 
 From 5-10 years of age it fell from 6*9 to 4 "2. 
 From 10-15 years of age it fell from 4*1 to 2*5. 
 From 15-20 years of age it tell trom 6*0 to 3'7. 
 From 20-25 years of age it tell from 7 '2 to 4*6, 
 From 25-35 years of age it fell from 8*2 to 6 "3. 
 From 35-45 years of age it fell from 11*6 to 9*9. 
 From 45-55 years of age it fell from 15*5 to 14*9. 
 From 75-85 years of age it fell from 133*9 to 133-5. 
 And from 85 and upwards it fell from 282*1, the 
 average mortality over the whole period, to 259*6 
 in 1891-1900. In the age-periods alone 55-65 and 
 65-75 did the mortality rise, being in 1838-1900 
 28*2 per 1000 from 55-65, and 29 for the ten years 
 ending in 1900, while from 65-75 the figures were 
 for 1838-1900 59*9, and in 1891-1900, 60 per 1000 
 per annum. This means that with these exceptions 
 the average expectation of life has been raised for 
 
33 
 
 the whole of the female part of the population of 
 England during that long period of time ; and this 
 is certainly a very gratifying and satisfactory state 
 of things, and one for which sanitation and medical 
 progress may reasonably take credit. Among males 
 the same general improvement has taken place, but 
 with differences not quite so satisfactory as regards 
 results. We find, for example, increased mortahty 
 among males for the three age-groups, 45-55, 55-65, 
 and 65-75, in the later and shorter period, as 
 compared with the average of the longer one. The 
 reader can see for himself that at age-period 45-55 
 the average mortality of males for 1838-1900 w^as 
 19 per 1000 per annum. For 1891-1900 it was 
 19 '4 per 1000 per annum. At age-period 55-65 
 the mortality was at the rate of 33 "5 per 1000 per 
 annum for 1838-1900, and 35-8 for 1891-1900; 
 and at age-period 65-75 it was 68*1 for 1838-1900, 
 as compared with 69 for 1891-1900. On the whole, 
 however, both for males and females, the improve- 
 ment has been very satisfactory and gratifying. 
 Some other interesting facts arise to the student of 
 these figures. At every age-period nearly, the 
 mortality of males is greater than that of females 
 at the corresponding age-periods. Thus from 0-5 
 years of age, from 5-10 years, and at every age- 
 period except from 10-15 and from 15-20 years of 
 age, the mortality of males is greater than that of 
 females. At 10-15 years of age, however, and also 
 at 15-20 years, the mortality of females living at 
 those ages is greater than it is for males. Thus for 
 c 
 
u 
 
 1838-1900 the male mortality was 4 per 1000 from 
 10-15 years, and 5 "6 per 1000 from 15-20 years of 
 age, while the corresponding female mortality was 
 4'1 per 1000 and 6 per 1000. For the ten years, 
 1891-1900, the same holds true for the age-period 
 10-15, for which the male mortality was 2*4 per 
 1000 and the female 2*5 per 1000 ; but it does not 
 hold good for age-period 15-20 years, for the male 
 mortality was at the rate of 3*8 per 1000 per annum, 
 while the female was 3*7. The explanation of these 
 disparities raises very interesting questions, but has 
 not been wholly effected. Certain broad facts rise 
 before the student of these figures. While, for 
 instance, except at the age-periods already men- 
 tioned, the expectation of life is on the whole better 
 in 1891-1900 than it was either on the average 
 of 1838-1900 or in the ten years 1841-50, the 
 improvement is much more noticeable in the early 
 life-periods than it has been either in old age or in 
 the middle or working periods of life. In the case 
 of males from 25 to 45 years there has been some 
 improvement in the expectation of life, which 
 means probably also greater vigour at these ages to 
 do the work of life, but, even at the best, the 
 improvement has not been very great. From 45-75 
 the mortality is really a little greater in 1891-1900 
 than it was either over the average of the years 
 1838-1900, or than it was in the years 1841-50. 
 Only from 75 onwards, when the work of life 
 is over, has the expectation of life at the more 
 advanced ages been increased. We ought to be 
 
35 
 
 thankful for the improvement which has been 
 effected, but, when it is all summed up, it is not 
 yet so great as we had hoped, or as perhaps the 
 prevailing optimism in the literature of the subject 
 had led us to expect. The net result appears 
 to be, in the case of males, that while in very 
 early life, when work is yet in promise rather than 
 performance, the expectation of life has been very 
 considerably increased; that while in extreme old 
 age, when the work of life is over, and when those 
 who have lived well and have been fortunate may 
 sit down to enjoy the fruits of their labours, the 
 expectation of life has also been increased ; in the 
 middle or active periods of life, when the burden 
 and heat of the day have to be borne, either the 
 expectation of life has been only very little increased 
 (ages 25-45), or it has been even somewhat 
 diminished (45-75). Similar conclusions arise from 
 a study of the results when lustra or quinquennia 
 rather than decades are compared with one another, 
 and with the av^erage results extending over the 
 whole period from 1838-1900. The reader will 
 do well to make these comparisons for himself. 
 Nothing can well afford a better bird's eye view, so 
 to call it, of the changes (not all progressive, 
 unfortunately, as regards the public interest) and 
 improvements which have taken place in the public 
 health since 1838, than the careful and prolonged 
 study of such a table. We are at a great advantage 
 as compared with our predecessors in the possession 
 of such figures, since it makes our information, if 
 
 C2 
 
36 
 
 not accurate, at least much more approximately 
 accurate than any which our ancestors possessed. 
 They were obliged to trust to general impressions, 
 while we can adduce comparative figures ; and an 
 intelligent attempt to realise on the part of each 
 for himself what has been going on, coupled with 
 the appreciation of the fact that the risks of males 
 from overwork, accidents, anxiety, and the competi- 
 tion and struggle of life generally, are considerably 
 greater than they are among females (who yet have 
 their own special risks and troubles, no doubt), will 
 do far more to enable the student to understand 
 the general question of the improvement or other- 
 wise in life than any other method of study. 
 
 If now we come to inquire how it is that these 
 gains have been effected, the answer is obvious. 
 These changes and improvements are the result of 
 the sanitary efforts of the present and of the last 
 generation. We have expended vast sums in 
 improving (sometimes even in creating) drainage 
 and sewage, in abolishing cellar-dwellings, diminish- 
 ing over-crowding, opening up and widening narrow 
 streets, opening public parks and recreation grounds, 
 and generally iu efforts to purify the air and abate 
 nuisances ; and we have obtained vast benefits as 
 measured by the figures just stated. Following 
 the statement of a great sanitarian, we have 
 believed and have shaped our general national 
 hygienic policy on the statement that " Statistical 
 inquiries prove beyond a doubt that of the causes 
 of death which are usually in action, impurity of 
 
37 
 
 the air is the most important." As will abundantly 
 appear in the sequel, this statement seems to me to 
 be far too sweeping. It appears to me, indeed, 
 quite impossible to accept it. Vitiation of air is no 
 doubt a very important cause of illness and of 
 death, but it is not by any means the most 
 important, being second, and a long way second, 
 to errors of diet. Whatever be its rank, however, 
 as a cause affecting health, there can be no doubt 
 that attention to the improvement of the air 
 breathed has had a very great influence on the 
 public health. Generally speaking, the effects 
 having been mainly two, viz., the diminution of 
 the incidence and of the mortality from the fevers 
 and those from consumption, the general effect has 
 been very much to benefit life at the earlier ages, 
 and to diminish sickness and mortality during child- 
 hood and youth, since the effects of the zymotic 
 diseases and of consumption are mainly felt at early 
 ages, the large majority of these diseases occurring 
 under 25 years of age. 
 
 There have been, however, at work on the 
 health of the community other contributory causes 
 besides those making for the improvement of the 
 respired air. By failing to realise the importance of 
 these, we are apt, erroneously, to attribute to sanita- 
 tion effects due to other causes, so exaggerating the 
 importance of sanitation, which, however, requires 
 no fictitious aids to add to its consequence. Among 
 these is the diminution which has taken place, and 
 which appears to be still going on, in the birth-rate. 
 
38 
 
 The birth-rate rises and falls under the operation of 
 various causes connected with the prosperity or 
 otherwise of the people ; but, speaking broadly, the 
 birth-rate of England and Wales was at about 3 4 '2 
 or 34 "3 per 1000 per annum 50 years ago, and is 
 under 29 per 1000 now, a fall of about 14 or 15 per 
 cent. This is no isolated fact affecting the United 
 Kingdom or England and Wales only. The table 
 inserted on p. 41 from the report of the Registrar- 
 General for England and Wales for 1900 shews that 
 the diminution of the birth-rate is going on in 
 all European countries without exception, even 
 Norway and Sweden shewing the fall, although not 
 to the same extent as is seen elsewhere. This is a 
 fact of the utmost significance, and must, I think, 
 be considered as coincident with great economic and 
 moral changes in the character of peoples. We in 
 this country have been accustomed to point to a 
 low birth-rate as a mark of a people unexpansive, 
 not given to colonisation, and somewhat contracted 
 in their methods of behaviour and intellectual 
 outlook. It is not necessary to offer any opinion 
 on such views. Very much may be said in defence, 
 as in criticism, of a high birth-rate on the one hand 
 and of a low one on the other. The physician and 
 hygienist is happily not called upon to defend or 
 blame, it being sufficient if he notes the changes 
 which are occurring among the peoples whose health 
 he is considering, and their influence upon it. The 
 noteworthy fact is that the process of lowering the 
 birth-rate is general. In France, it will be observed, 
 
39 
 
 the birth-rate was in 1900 actually lower than the 
 death-rate, a fact which obtains in no other European 
 country, and is not even approximated to in any 
 except Ireland, whose latest returns make the birth- 
 rate 22 7 per 1000 and the death-rate 19*6. It is 
 impossible, I think, to suppose that a tendency 
 which is seen in every European country is not of 
 grave moral significance, and I shall dismiss this 
 aspect of the question with one observation. If a 
 diminishing birth-rate is, as we imagine it to be, 
 a mark of decadence, or at least of want of pro- 
 gressiveness, as we continually assume in comparing 
 our own country with France, for example, it is to 
 be noted that we are persistently approximating to 
 the French custom in this particular. So are all 
 European countries. In America, we are told — but 
 I do not know what the truth may be in this 
 matter — that but for foreign immigration the 
 numbers of the people would not be kept up, let 
 alone increased, by the excess of births over deaths. 
 It would probably be a very narrow view to assume 
 that these simultaneous changes are an imitation of 
 the French system. It is far more likely that the 
 causes are much more general than that, and that 
 they are to be found in changes in the economic 
 and moral conditions of the various peoples con- 
 cerned. From this (probably the correct) point 
 of view, the diminution in the birth-rates in the 
 various civilised countries ought rather to be 
 viewed, like the sequence of day on night, as 
 concomitant or successive effects of a common cause 
 
40 
 
 or common causes, than as causes and efiects of one 
 another. It is our business to note what are the 
 effects on the health of nations of a process which 
 is so general and so wide-spread, that there is not a 
 single European country in which a considerable fall 
 in the birth-rate has not occurred in the last 25 
 years. 
 
41 
 
 IHrths and Deaths per 1000 of the Poptilation, in the United Eingdom 
 and in Other European States. 
 
 
 (Tabulated from returns 
 
 furnished by the authorities of the various 
 
 States.) 
 
 
 
 Year. 
 
 
 q 
 
 ■< . 
 
 aj 
 c 
 
 a 
 
 < 
 
 H 
 O 
 
 < 
 
 m 
 
 l-l 
 
 s 
 
 s 
 
 ft 
 
 o 
 
 a 
 
 w 
 
 < 
 
 H 
 to 
 
 < 
 
 o 
 
 a 
 
 o 
 
 2w 
 
 IBS 
 
 ■< 
 
 CO 
 
 a 
 
 0H 
 
 O 
 Z. 
 
 K 
 H 
 
 p 
 3 
 fa 
 
 H 
 o 
 
 
 M 
 
 Average 
 
 in the 
 
 26 years 
 
 Births per 1000 Living. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1875-99 
 1875 ... 
 
 31 •! 
 
 32-3 
 
 32-2 
 
 23-8 
 
 31-3 
 
 30 -V 
 
 28-/ 
 31-2 
 
 38'0 
 
 42-9 
 
 28-9 
 
 3V-2 
 
 3V-V 
 
 34-2 
 
 30-1 
 32-5 
 
 23-7 
 
 35-6* 
 
 36-6 
 
 33-9 
 
 35-4 
 
 .35-2 
 
 26-1 
 
 ,31-9 
 
 31-2 
 
 39-9 
 
 45-0 
 
 32-0 
 
 40-6 
 
 40-7 
 
 36-6 
 
 25-9 
 
 ? 
 
 37-7 
 
 1876 ... 
 
 34-8 
 
 36-3 
 
 .35-6 
 
 26-4 
 
 32-6 
 
 31-8 
 
 30-8 
 
 40-0 
 
 46-3 
 
 33-0 
 
 40-9 
 
 40-7 
 
 37-1 
 
 33-2 
 
 26-2 
 
 •) 
 
 39-2 
 
 1877 ... 
 
 34-4 
 
 3ri-0 
 
 .35-3 
 
 26-2 
 
 31-8 
 
 31-8 
 
 31-1 
 
 38-7 
 
 43-6 
 
 32-3 
 
 40-0 
 
 39-9 
 
 36-6 
 
 32-3 
 
 25-5 
 
 ? 
 
 37-0 
 
 1878 ... 
 
 34-0 
 
 35-6 
 
 34-9 
 
 25-1 
 
 31-7 
 
 31-1 
 
 29-8 
 
 ,38-6 
 
 43-1 
 
 31-6 
 
 38-9 
 
 38-7 
 
 36-1 
 
 31-5 
 
 25.2 
 
 9 
 
 36-2 
 
 1879 ... 
 
 33-3 
 
 34-7 
 
 34.3 
 
 25-2 
 
 32-0 
 
 32-0 
 
 30-5 
 
 39-2 
 
 45-8 
 
 30-8 
 
 38-9 
 
 39-0 
 
 36-7 
 
 31 -5 
 
 25-1 
 
 ? 
 
 37-8 
 
 1880 ... 
 
 32-7 
 
 34-2 
 
 33-6 
 
 24-7 
 
 31-8 
 
 30-7 
 
 29-4 
 
 38-0 
 
 42-8 
 
 29-8 
 
 37-6 
 
 37-8 
 
 35-5 
 
 31-1 
 
 24-6 
 
 •) 
 
 33-9 
 
 1881 ... 
 
 32-5 
 
 33-9 
 
 33-7 
 
 24-5 
 
 32-3 
 
 30-0 
 
 29-1 
 
 37-7 
 
 42-9 
 
 30-0 
 
 37-0 
 
 37-0 
 
 35-0 
 
 31-4 
 
 24-9 
 
 1 
 
 38-0 
 
 1882 ... 
 
 32-3 
 
 33-8 
 
 33-5 
 
 24-0 
 
 32-4 
 
 30-9 
 
 29-4 
 
 39-1 
 
 43-8 
 
 29-1 
 
 37-2 
 
 37-6 
 
 35-3 
 
 31-2 
 
 24-8 
 
 •> 
 
 37-0 
 
 1883 ... 
 
 32-0 
 
 33 -.5 
 
 32-8 
 
 23-5 
 
 3T8 
 
 30-9 
 
 28-9 
 
 38-2 
 
 44-8 
 
 28-8 
 
 36-6 
 
 37-1 
 
 34-3 
 
 30.5 
 
 24-8 
 
 9 
 
 37-1 
 
 1884 ... 
 
 32-2 
 
 33-6 
 
 33-7 
 
 23-9 
 
 33-4 
 
 31-0 
 
 30-0 
 
 38-7 
 
 45-6 
 
 28-5 
 
 37-2 
 
 37-6 
 
 34-9 
 
 30-5 
 
 34-7 
 
 V 
 
 38-9 
 
 1885 ... 
 
 .SI -6 
 
 ,S2.9 
 
 32-7 
 
 23-5 
 
 32-6 
 
 31-3 
 
 29-4 
 
 37-6 
 
 44-8 
 
 28-0 
 
 37-0 
 
 37-7 
 
 .34-4 
 
 29-9 
 
 24-3 
 
 9 
 
 38-4 
 
 1886 ... 
 
 31-5 
 
 32-8 
 
 32-9 
 
 23-2 
 
 32-6 
 
 30-9 
 
 29-8 
 
 38-0 
 
 45-6 
 
 28-0 
 
 37-0 
 
 37-7 
 
 34-6 
 
 29-6 
 
 23-9 
 
 ? 
 
 36-8 
 
 1887 .. 
 
 30-7 
 
 31-9 
 
 31-7 
 
 23-1 
 
 32-0 
 
 30-8 
 
 29-7 
 
 38-2 
 
 44-2 
 
 28-0 
 
 36-9 
 
 37-7 
 
 33-7 
 
 29-4 
 
 23-5 
 
 9 
 
 38-8 
 
 1888 ... 
 
 30-1 
 
 31-2 
 
 .3T3 
 
 22-8 
 
 3T7 
 
 30-8 
 
 28-8 
 
 37-9 
 
 43-8 
 
 27-8 
 
 36-6 
 
 37-4 
 
 33-7 
 
 29-1 
 
 23-1 
 
 36-6 
 
 37-4 
 
 1889 ... 
 
 30.0 
 
 ,Sl-2 
 
 30-9 
 
 22-7 
 
 3T3 
 
 29-7 
 
 27-7 
 
 37-9 
 
 42-7 
 
 27-6 
 
 36-4 
 
 37-1 
 
 33-2 
 
 29.6 
 
 23-0 
 
 3fi-7 
 
 38-1 
 
 1890 ... 
 
 29-2 
 
 30-2 
 
 30-4 
 
 22-3 
 
 30-6 
 
 30-3 
 
 28-0 
 
 36-7 
 
 40-3 
 
 26-4 
 
 35-7 
 
 36-6 
 
 32-9 
 
 28-7 
 
 21-8 
 
 34-8 
 
 35-7 
 
 1891 ... 
 
 30-4 
 
 3T4 
 
 3T2 
 
 23-1 
 
 30-9 
 
 30-9 
 
 28-3 
 
 37-0 
 
 42-3 
 
 27-8 
 
 .37-0 
 
 37-7 
 
 33-7 
 
 29-6 
 
 22-6 
 
 35-8 
 
 37-0 
 
 1892 ... 
 
 29-5 
 
 30-4 
 
 30-7 
 
 22-5 
 
 29-5 
 
 29-6 
 
 27-0 
 
 36-2 
 
 40-4 
 
 27-4 
 
 35-7 
 
 36-3 
 
 32-0 
 
 28-9 
 
 22-3 
 
 36-4 
 
 36-1 
 
 1893 ... 
 
 29-8 
 
 30-7 
 
 30-8 
 
 23-0 
 
 30-5 
 
 30-7 
 
 27-4 
 
 37-9 
 
 42-6 
 
 27-7 
 
 36-8 
 
 37-5 
 
 33-8 
 
 29-5 
 
 22-3 
 
 36-1 
 
 36-4 
 
 1894 ... 
 
 28-8 
 
 29-6 
 
 29-9 
 
 22-9 
 
 30-1 
 
 29-8 
 
 27-1 
 
 36-7 
 
 41-5 
 
 27-1 
 
 35-9 
 
 .36-6 
 
 32-7 
 
 29-0 
 
 22-3 
 
 .35-3 
 
 35-4 
 
 1895 ... 
 
 29-4 
 
 30-2 
 
 30-0 
 
 23-2 
 
 30-0 
 
 30-6 
 
 27-5 
 
 38-1 
 
 41-9 
 
 27-1 
 
 36-1 
 
 36-9 
 
 32-8 
 
 28-5 
 
 21-7 
 
 35-4 
 
 34-7 
 
 1896 ... 
 
 29-0 
 
 29-6 
 
 30-4 
 
 23-6 
 
 30-3 
 
 30-4 
 
 27-2 
 
 38-0 
 
 40-5 
 
 27-9 
 
 36-3 
 
 36-9 
 
 32-7 
 
 29-0 
 
 22-5 
 
 .36-3 
 
 34-7 
 
 1897 ... 
 
 28-9 
 
 29-5 
 
 30-0 
 
 23-5 
 
 29-7 
 
 30-0 
 
 26-7 
 
 37-5 
 
 40-3 
 
 28-1 
 
 36-0 
 
 .36-5 
 
 .32-5 
 
 29-0 
 
 22-3 
 
 34-6 
 
 34-6 
 
 1898 ... 
 
 28-7 
 
 29-3 
 
 30-1 
 
 23-2 
 
 30-2 
 
 30-3 
 
 27-1 
 
 36-2 
 
 37-7 
 
 38-4 
 
 36-1 
 
 36-7 
 
 31-9 
 
 28-6 
 
 21-8 
 
 33-8 
 
 33-4 
 
 1899 ... 
 
 28-5 
 
 29-1 
 
 29-8 
 
 22-9 
 
 29-8 
 
 30-9 
 
 26-4 
 
 37-1 
 
 39-3 
 
 28-9 
 
 35-8 
 
 36-3 
 
 32-0 
 
 28-8 
 
 21-9 
 
 ,34-8 
 
 33-8 
 
 1900 ... 
 
 28-2 
 
 28-7 
 
 29-6 
 
 22-7 
 
 29-8 
 
 30-1 
 
 26-9 
 
 
 39-3 
 
 28-6 
 
 35-6 
 
 36-1 
 
 31-5 
 
 28-9 
 
 21-4 
 
 34-4 
 
 32-9 
 
 Average 
 
 Deaths pe 
 
 R 1000 LiVIN . 
 
 in the 
 
 
 
 25 years 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1875-99 
 
 19-1 
 22-1 
 
 19-3 
 
 19-4 
 
 18-1 
 
 18-6 
 
 16-7 
 
 17-1 
 20-3 
 
 28-8 
 
 32-7 
 
 20-8 
 
 24-4 
 
 23-9 
 26-6 
 
 20-6 
 
 20-3 
 
 22-0 
 
 30-4* 
 
 26-7 
 
 1875 ... 
 
 22-7 
 
 23-3 
 
 18-5 
 
 21-0 
 
 18-8 
 
 30-0 
 
 .37-0 
 
 24-2 
 
 27-6 
 
 25-6 
 
 22-7 
 
 23-0 
 
 9 
 
 .30-7 
 
 1876 ... 
 
 20-4 
 
 20-9 
 
 20-9 
 
 17-3 
 
 19-7 
 
 18-0 
 
 19-6 
 
 29-8 
 
 .35-9 
 
 24-3 
 
 26-3 
 
 25-4 
 
 23-5 
 
 21-9 
 
 22-6 
 
 ? 
 
 28-8 
 
 1877 ... 
 
 19-9 
 
 20-3 
 
 20-6 
 
 17-5 
 
 18-7 
 
 16-9 
 
 18-7 
 
 31-6 
 
 36-6 
 
 23-6 
 
 26-4 
 
 25-6 
 
 22-2 
 
 21-1 
 
 2T6 
 
 9 
 
 28-3 
 
 1878 ... 
 
 21-1 
 
 21-6 
 
 21-2 
 
 18-6 
 
 18-5 
 
 15-8 
 
 18-1 
 
 31-6 
 
 37-4 
 
 23-5 
 
 ?.6-2 
 
 25-8 
 
 23-0 
 
 21-5 
 
 22-5 
 
 9 
 
 29-1 
 
 1879 ... 
 
 20-5 
 
 20-7 
 
 20-0 
 
 19-6 
 
 19-8 
 
 15-0 
 
 16-9 
 
 29-9 
 
 .35-7 
 
 22-7 
 
 2.') -6 
 
 24-7 
 
 22-5 
 
 21-9 
 
 22-5 
 
 ? 
 
 29-8 
 
 1880 ... 
 
 au-4 
 
 20-5 
 
 20-6 
 
 19-8 
 
 20-4 
 
 15-9 
 
 18-1 
 
 29-8 
 
 37-2 
 
 22-0 
 
 26-0 
 
 25-5 
 
 23-5 
 
 22-3 
 
 22-9 
 
 9 
 
 30-8 
 
 1881 ... 
 
 18-7 
 
 18-9 
 
 19-3 
 
 17-5 
 
 18-3 
 
 16-8 
 
 17-7 
 
 30-6 
 
 34-4 
 
 22-6 
 
 25-5 
 
 24-9 
 
 21-5 
 
 20-9 
 
 22-0 
 
 9 
 
 27-6 
 
 1882 ... 
 
 19-3 
 
 19-6 
 
 19-4 
 
 17-3 
 
 19-3 
 
 18-4 
 
 17-4 
 
 30-8 
 
 35-3 
 
 22-2 
 
 25-7 
 
 25-4 
 
 20-7 
 
 20-2 
 
 22.2 
 
 9 
 
 27-5 
 
 1883 ... 
 
 19-6 
 
 19-6 
 
 20-2 
 
 19-2 
 
 18-4 
 
 17-1 
 
 17-3 
 
 ,30-1 
 
 32-2 
 
 20.6 
 
 25-9 
 
 25-6 
 
 21 -8 
 
 20-8 
 
 22-2 
 
 ? 
 
 27-5 
 
 1884 ... 
 
 19-4 
 
 19-7 
 
 19-6 
 
 i7-5 
 
 18-4 
 
 16-4 
 
 17-5 
 
 29-4 
 
 .31-0 
 
 20-4 
 
 26-0 
 
 25-7 
 
 22-2 
 
 20-9 
 
 22-6 
 
 9 
 
 26-8 
 
 1885 ... 
 
 19-1 
 
 19-2 
 
 19-3 
 
 18-4 
 
 17-9 
 
 16-5 
 
 17-8 
 
 .30-1 
 
 .3T8 
 
 21-4 
 
 25-7 
 
 25-4 
 
 2T0 
 
 20-1 
 
 22-0 
 
 ? 
 
 26-9 
 
 1886 ... 
 
 19-2 
 
 19-5 
 
 18-9 
 
 17-8 
 
 18-2 
 
 16-1 
 
 16-6 
 
 29-4 
 
 .3T7 
 
 20-8 
 
 26-2 
 
 26-1 
 
 21-8 
 
 21 1 
 
 22-5 
 
 ? 
 
 28-6 
 
 1887 ... 
 
 19-0 
 
 19-1 
 
 19-0 
 
 18-2 
 
 18.3 
 
 16-0 
 
 16-1 
 
 28-9 
 
 ,33-8 
 
 20-3 
 
 24-2 
 
 23-8 
 
 19-7 
 
 19-3 
 
 22-0 
 
 ? 
 
 27-9 
 
 1888 ... 
 
 18-1 
 
 18-1 
 
 18-0 
 
 17-9 
 
 19-7 
 
 16-9 
 
 16-0 
 
 29-2 
 
 32-0 
 
 20-0 
 
 23-7 
 
 22-8 
 
 20-4 
 
 20-1 
 
 21-9 
 
 30-3 
 
 27-4 
 
 1889 ... 
 
 18-1 
 
 18-2 
 
 18-4 
 
 17-4 
 
 18-6 
 
 17-4 
 
 16-0 
 
 27-3 
 
 29-9 
 
 20-0 
 
 23-7 
 
 23 '2 
 
 20-1 
 
 19-1 
 
 20-7 
 
 30-9 
 
 25-5 
 
 1890 ... 
 
 19-4 
 
 19-5 
 
 19-7 
 
 18-2 
 
 19-0 
 
 17-9 
 
 17-1 
 
 29-4 
 
 32-4 
 
 20-8 
 
 24-4 
 
 24-0 
 
 20-5 
 
 20-6 
 
 22-8 
 
 .32-7 
 
 26-2 
 
 1891 ... 
 
 20-0 
 
 20-2 
 
 20-7 
 
 ]8-4 
 
 20-0 
 
 17-5 
 
 16-8 
 
 28-2 
 
 33-1 
 
 20-4 
 
 23-4 
 
 22-9 
 
 20-7 
 
 21-0 
 
 22-9 
 
 .32-0 
 
 26-0 
 
 1892 ... 
 
 19-0 
 
 19-0 
 
 18-5 
 
 19-4 
 
 19-4 
 
 17-8 
 
 17-9 
 
 28-8 
 
 35-1 
 
 18-8 
 
 24-1 
 
 23-4 
 
 21-0 
 
 21-8 
 
 22-8 
 
 31 -3 
 
 26-1 
 
 1893 ... 
 
 19-0 
 
 19-1 
 
 19-3 
 
 17-9 
 
 18-8 
 
 16-3 
 
 16-8 
 
 27-2 
 
 31-2 
 
 19-9 
 
 24-6 
 
 24-2 
 
 19-2 
 
 20-3 
 
 22-5 
 
 30-3 
 
 25-1 
 
 1894 ... 
 
 16-8 
 
 16-6 
 
 IV -1 
 
 18-2 
 
 17-4 
 
 16-9 
 
 l(J-4 
 
 27-8 
 
 30-5 
 
 19-9 
 
 22-3 
 
 21-8 
 
 18-5 
 
 18-6 
 
 2T2 
 
 ,31-1 
 
 24-9 
 
 1895 ... 
 
 18 -V 
 
 18 -V 
 
 19-4 
 
 18-4 
 
 16-8 
 
 15-7 
 
 15-2 
 
 27-7 
 
 29-7 
 
 19-] 
 
 22-1 
 
 21-8 
 
 18-6 
 
 19-5 
 
 22-2 
 
 29-4 
 
 25-0 
 
 1896 ... 
 
 17-0 
 
 IV -0 
 
 16-6 
 
 16-6 
 
 15-6 
 
 15-2 
 
 15-6 
 
 26-4 
 
 2,S-9 
 
 17-7 
 
 20-8 
 
 20-7 
 
 17-2 
 
 17-5 
 
 20-0 
 
 29-9 
 
 24 
 
 1897 ... 
 
 17-6 
 
 IV -4 
 
 18-4 
 
 18-4 
 
 16-5 
 
 15-3 
 
 15-4 
 
 25-6 
 
 28-5 
 
 17-6 
 
 2T3 
 
 20-9 
 
 16-9 
 
 17-2 
 
 19-6 
 
 28-8 
 
 21-9 
 
 1898 ... 
 
 IV -6 
 
 17-5 
 
 18-0 
 
 18-1 
 
 15-5 
 
 15-3 
 
 15-1 
 
 24-9 
 
 28-0 
 
 182 
 
 20-5 
 
 20-0 
 
 17-0 
 
 17-6 
 
 20-9 
 
 28-6 
 
 22-9 
 
 1899 ... 
 
 18-2 
 
 18-2 
 
 18-1 
 
 17-6 
 
 17-3 
 
 16-9 
 
 17-7 
 
 25-4 
 
 27-2 
 
 17-6 
 
 2Tfi 
 
 21-4 
 
 17-1 
 
 18-8 
 
 21-1 
 
 29-3 
 
 21-8 
 
 1900 ... 
 
 18-4 
 
 18-2 
 
 18-5 
 
 19-6 
 
 16-9 
 
 15-8 
 
 16-8 
 
 — 
 
 26-9 
 
 19-3 
 
 22-1 
 
 21-8 
 
 17-8 
 
 19-3 
 
 21-9 
 
 29-4 
 
 28-7 
 
 '■ Average of 12 years— 1888-! 
 
 wmm 
 
 ^MHaWdHaUlin 
 
42 
 
 There is one great fact, however, brought out 
 prominently by a study, however brief, of this 
 table. High birth-rates as a rule accompany high 
 death-rates, and low birth-rates low death-rates ; 
 and to a large extent these are cause and effect of 
 one another. In Austria and Hungary the birth- 
 rates, though falling, are still higher than in any 
 other European country (37 and 39 per 1000), and 
 their death-rates are also the highest (25*4 and 27'2 
 in 1899). The statistics of Spain form an exception, 
 but apparently the figures are not so full or accurate 
 as for other European countries. And the reason 
 why birth-rates and death-rates are not only 
 casually, but also causally connected, is this. 
 There is unfortunately a very large mortality pro- 
 portionately at the early ages of life. Of 1,000,000 
 male children born over the average of the ten 
 years 1881-90, only 760,167 would be found sur- 
 viving at the end of five years or under five years 
 of age. For females the number sm^viving would 
 be 791,973. Boughly speaking, about one-fourth of 
 the children born die in the fii'st five years of life. 
 In the first year of life, out of 1,000,000 males born 
 161,036, or 161 per 1000, died over the average of 
 the ten years 1881-90. For female children the 
 corresponding number was found to be 131,126, or 
 131 per 1000. Now a lowered and a lowering 
 birth-rate, such as we see to have been going on 
 over a number of years past, means that a smaller 
 proportion of the population are alive at the more 
 fatal ages than when the birth-rate was higher. 
 
43 
 
 And this being so, a lowered birth-rate implies a 
 lowered death-rate, even if no sanitary improve- 
 ments take place in the condition of the people. 
 When, therefore, we compare, as we often have 
 occasion to do, the hygienic and sanitary conditions 
 of one set of people with another, or, say, the health 
 conditions of one town with another, we shall be 
 omitting a very important factor if we do not take 
 account of differences in the birth-rate of the 
 towns. For the curious thing is that there often 
 exist such differences even in towns quite near to 
 one another. The fall in the birth-rate has been, as 
 we have seen, continuous in England and Wales for 
 many years past. But this fall, though applying 
 generally to the country and to the United Kingdom, 
 is much more accentuated in some places and in 
 some parts of the country, and notably in some of 
 the boroughs, than others. This is more marked in 
 the West Riding of Yorkshire, e. g. , than in London. 
 In Bradford the birth-rate is the lowest, and that 
 by a good deal, of all the large towns (with popula- 
 tions of 200,000 and over) in the United Kingdom ; 
 and its birth-rate has been persistently falling for a 
 long time. Thus in 1881 it was 33 per 1000; in 
 1885 it was 29; in 1891 it was 28'6; in 1895 it 
 was 26 '6 ; in 1900 it was 24*6 ; and in 1901 it was 
 28 "1. In Leeds, only nine miles away, the birth-rate 
 in 1901 was 30 per 1000; in Sheffield, 33-1; in Hull, 
 33*3 ; and in Newcastle, 32-1. All these towns 
 have populations of over 200,000, and Bradford's 
 birth-rate is considerably lower than that of any 
 
44 
 
 of them. Only in Halifax and Huddersfield, of 
 Yorkshire towns, each with populations of about 
 100,000, is the birth-rate lower than in Bradford, 
 being 22*5 and 22*7 in 1901 respectively. In 
 London in the same year it was 29, while the 
 average of thirty-two provincial English towns was 
 29 "8. The low birth-rates of some of the West 
 Riding of Yorkshire manufacturing towns of late 
 years is a curious and interesting fact. 
 
 A low birth-rate implies a low death-rate, and 
 a high birth-rate implies a high death-rate. It 
 might be argued, and probably with truth, that 
 more care would have prevented a large proportion 
 of the deaths that occur among infants and young 
 children. Even with a low birth-rate, in some 
 places the infant mortality is high. In Bradford in 
 the ten years ending in 1900 the death-rate of 
 infants under one year of age averaged 171 out of 
 every 1000 born, and, as we have seen, the birth- 
 rate is very low. Whatever the causes of this 
 may be, wheresoever a low birth-rate and a high 
 infantile mortality rate coincide, that portion of the 
 population has laid on it the burden of accounting 
 for the coincidence, and of shewing that it is not 
 due to negligence. It is quite compatible with the 
 view taken by the writer of this essay that the 
 most important cause of mortality in general is 
 wrong feeding, to note what Dr. Arnold Evans, 
 the Medical Officer of Health for Bradford, says 
 regarding the high infantile mortality in that city. 
 "The high infantile mortality," he says in his report 
 
45 
 
 for 1901, "is not to any great extent the result of 
 the employment of women in factory work, but I 
 am sure it is largely contributed to by a wide-spread 
 ignorance of the management and feeding of infants 
 among the working classes. In the returns pre- 
 pared by the Inspector, such expressions as ' fed by 
 breast for two months, and afterwards on Quaker 
 Oats and lime water,' or ' pobbies,' are not uncom- 
 mon ; some infants were fed on all kinds of malted 
 food, and one infant, which died at the age of ten 
 months, and commenced life on humanised milk, was 
 afterwards fed on ' Marshall's Malted Food, Scott's 
 Emulsion, and brandy and cream,' and towards its 
 end on 'veal and tea.'" In order to meet this 
 deplorable state of things he recommends the 
 establishment of " municipal milk depots, where 
 humanised milk may be obtained in amounts suit- 
 able for infants of various ages, and as cheaply as 
 it can be produced." Information as to the proper 
 methods of feeding infants, and the quantities and 
 times for administration of their food, would also 
 be greatly for the benefit of the public health, since 
 even suitable food may be administered too often or 
 too seldom. As a rule, however, it must be 
 admitted, when all has been done, that the rearing 
 of young children, like the rearing of young 
 animals of all sorts, is a task accompanied by many 
 difficulties, and even when much and continuous 
 care has been exercised, some amount of failure is 
 apt to be experienced. No doubt, many sensible 
 and careful and well advised mothers rear all their 
 
46 
 
 children, but we are struck with the reflection that 
 some or many others must be careless, ignorant or 
 incapable, or through economic or other causes may 
 find the task beyond them, when we realise that 
 about a quarter of all the children born in this 
 country die before they are five years of age. In 
 England and Wales in 1900, 209,960 deaths out of 
 a total of 587,830 occurred among children under 
 five years of age. That was about 36 per cent. In 
 many years two-fifths or 40 per cent, of the total 
 mortality has been returned as occurring among 
 children under five years of age. In 1893, for 
 instance, 569,958 deaths occurred in England and 
 Wales, and of these 216,833, or very nearly two- 
 fifths or 40 per cent., occurred among children under 
 five years of age. As in many of the towns the 
 proportion is the same, we can see how important an 
 influence such a fact must exert on the general 
 mortality returns. But about 25 per cent, of all 
 the children born die before they are five years of 
 age. If, therefore, a smaller number of children are 
 born into the world than formerly (and that is the 
 meaning of a low birth-rate), obviously there will 
 be a smaller number of the population living to 
 afibrd so high a mortality, and, therefore, the 
 general mortality rate will prove lower, not only 
 because of general improvement in the public 
 health, but also because a smaller proportion of the 
 population are living at what may be termed the 
 very fatal ages. An illustration will make this 
 clear. Suppose a town of 200,000 inhabitants has 
 
47 
 
 a birth-rate of 30 per 1000, whereas formerly it had 
 a birth-rate of 35. Obviously 6000 children will be 
 born where 7000 used to be ; that is, 1000 fewer 
 children will be living in that town under the new 
 birth-rate than under the old one during a given 
 year. Now suppose that one-fifth of the children 
 born died under one year old (which rate, I regret 
 to say, is not only reached but even occasionally 
 exceeded in some of our large towns), then 1200 
 children would die, as against 1400, had the former 
 birth-rate been maintained. This would reduce the 
 deaths by 200 in a year, or 1 per 1000 per annum 
 in a population of 200,000, a diminution quite 
 sufficiently marked to seem to justify the statement 
 that that town was at a higher level of health than 
 others. 
 
 Another point should not be lost sight of A 
 large proportion of all the cases of fever that occur, 
 a large proportion of the zymotic diseases as they 
 are called, happen among children under five years 
 of age — a large number of cases of measles, 
 scarlatina, diphtheria, diarrhoea, &c. Now, as under 
 a lower birth-rate a smaller number of persons 
 specially susceptible to these ailments are living at 
 a given time, it follows that fewer of these cases 
 will occur, and therefore that a lowered birth- 
 rate lowers not only the general mortality as we 
 have seen, but that it lowers also the zymotic or 
 fever mortality. But the lowering of the zymotic 
 mortality is almost by every writer pointed to as 
 marking the general sanitary advance of the 
 
48 
 
 country. From the considerations advanced, how- 
 ever, it is apparent that this is not necessarily so, 
 that a mere diminution of mortahty is not in itself 
 necessarily a mark of improvement in the public 
 health, that a mere diminution even in the mortality 
 from fever may be capable of other explanation, 
 and that many corrections may have to be made 
 before we are in a position to estimate justly the 
 state of the public health as shewn in the mortality 
 returns of the Registrar-General or in those of local 
 Medical Officers of Health. 
 
 For some reason, not apparent on the surface, 
 the mortality among infants under one year of age 
 has not improved as compared with the mortality at 
 other ages in recent years. Comparing the ten 
 years 1881-90 with 1871-80, we find the mortality 
 for male infants under one year was 161,036 per 
 million, or 161 per 1000, in 1881-90, as compared 
 with 158 per 1000 in 1871-80. For females the 
 corresponding numbers were 131 in 1881-90, as 
 against 129 in 1871-80. For 1900 the infant 
 mortality in England and Wales for both sexes 
 was 154 per 1000. Various suggestions occur to 
 account for this somewhat remarkable fact. Under 
 five years of age, on the other hand, the improve- 
 ment has been considerable, whether we compare 
 1881-90 with 1871-80 or with the average of the 
 years 1838-54. For females the mortality under 
 five years of age was :— For 1881-90, 208 per 1000 ; 
 for 1871-80, 224 ; and for 1838-54, 236. For males 
 the rates were 240, 253 and 263 respectively, 
 
49 
 
 shewing a progressive diminution of mortality since 
 registration began in England and Wales. 
 
 We have seen that 209,960 out of 587,830, or 
 about 36 per cent., of the deaths which occurred in 
 England and Wales in 1900, were of children under 
 five years of age. On the other hand, 142,496 
 deaths, or about 24 per cent., occurred among 
 persons over 65 years of age. That leaves 235,374 
 deaths, or about 40 per cent., as the number and 
 proportion of deaths which occurred between five 
 and 65 years of age. I take this number as it 
 gives the proportion of deaths which occurred at 
 ■what may be considered the active or working 
 period of hfe. The nuiiiber of the active popula- 
 tion is indeed not so large as this, for before 15-20 
 years we can scarcely reckon school children among 
 the active working members of the community. 
 But from five to fifteen years of age mortality is 
 very low, and so I have for convenience taken the 
 40 per cent, of mortality which occurs between five 
 and 65 years of age into consideration as a whole. 
 Of what did these 235,374 persons die ? Of course 
 a preliminary question is why did they die at all ? 
 If children pass through the dangers which beset 
 them under five years of age, why should they not 
 reach old age ? Why at least should they not over- 
 pass 65 years, if it is too much to hope that they 
 should reach the three score years and ten usually 
 considered as the term of human life ? It is for 
 medicine to say why. Of course some accidents 
 must be expected to occur. We cannot hope that 
 
 D 
 
60 
 
 the whole population over five years of age should 
 reach old age or even 65 years of age, although to 
 take 65 years instead of 70 is to make easier the 
 problem of medicine by five years of life. Let us 
 assume that for various reasons, delicacy, for 
 example, accident, and, in one word, unsuitability 
 of environment, 20 per cent, or one-fifth of these 
 235,274 persons should fail to reach the age even 
 of 65 years. That would still leave 188,300 deaths 
 as occurring in England and Wales in 1900 between 
 five and 65 years of age, who might reasonably 
 have been expected to reach it. As to accident 
 itself as a cause of mortality we do not find that it 
 is an increasing factor. Legislation has been active 
 in this direction as well as in others in defence of 
 public health ; and in compulsory fencing of 
 machinery, defence from dangerous places, com- 
 pensation for injury sustained in the prosecution 
 of daily occupations, and in other ways, has taken 
 what steps it could in the way of preventing death 
 from accident and violence. I do not know that 
 much stress need be laid on the figures, and there is 
 no need to do so ; but so far as can be made out 
 there is no increase of mortality under the heading 
 of accident among the people of England. Thus 
 the deaths returned as from accident in 1868 were 
 in the proportion of 30,867 to 1,000,000 deaths from 
 all causes, while in 1893, a quarter of a century 
 afterwards, they were at the rate of 29,615 to 
 1,000,000 deaths from all causes. In 1900 the 
 proportion was 30,567. There is no increase of 
 
51 
 
 mortalitv from this cause. From 1866-70 the 
 deaths from accident or neghgence were at the rate 
 of 677"8 per miUion Hving ; in 1876-80 the rate was 
 630-4; in 1886-90 it was 543-8; and in 1896-1900 
 it was 557 "8. Still, if death from accident and 
 violence is not increasing, but if anything diminish- 
 ing in the country (and after all accident is a 
 comparatively small cause of mortality), it will be 
 interesting to inquire what are the principal causes 
 of mortality in the population, especially at the 
 middle or active portion of life. This I propose to 
 do in the next chapter. Meantime, if we attempt 
 to sum up the results of improved medicine and 
 surgery since the year 1838, when the Registrar- 
 General began to compile the figures for England 
 and Wales, they appear to be the following. The 
 fevers or zymotic diseases have fallen to about one 
 half, and consumption by more than one half in 
 their incidence and mortality during that time. 
 These two great and very satisfactory results are 
 aided, however, by a considerable fall in the birth- 
 rate, and the three factors account for a diminution 
 in the general death-rate of about 20 per cent, 
 since 1838. The expectation of life has risen in the 
 case of males from 39*91 years to 43*66 years, and 
 in the case of females from 41*85 years to no less 
 than 47*18 years, and an immense number of years 
 of life amounting to many millions have been added 
 to the population in each generation. The addition, 
 however, has been made rather at the two extremes 
 of Ufe, children under 20, and old persons over 65, 
 
 D2 
 
52 
 
 having benefitted much more than those Hving 
 between 25 and 65 years of age. The expectation 
 of Ufe has been raised in the case of females at all 
 ages except from about 65-75, and for males except 
 from 45 to 75 years of age ; rather important 
 exceptions, however. Keeping these changes and 
 improvements in our minds, we shall be better able 
 to estimate their causes, after examining the causes 
 of mortality from five to 65 years of age, as is now 
 to be done. 
 
63 
 
 CHAPTEE II. 
 
 The Principal Causes of Mortality in England 
 and Wales. 
 
 TN 1900, in England and Wales, the most frequent 
 cause of death, taking the whole population at 
 all ages, was bronchitis. It accounted for 54,580 
 deaths out of the 587,830 occurring in that year. 
 This is no unusual proportion, as, year after year, 
 bronchitis heads the list among the causes of 
 mortality. In 1899 bronchitis accounted for 51,206 
 deaths; in 1898, for 46,261; and so on. If we 
 calculate the proportion of deaths occurring from 
 this cause to a million deaths from all causes, we 
 shall find that in 1900 bronchitis accounted for 
 mortality in the proportion of 92,850 deaths out of 
 each million that occurred. This is usually called 
 the proportional number, and it may be well to 
 make use of this expression. The next commonest 
 cause of death is pneumonia or inflammation of the 
 lungs ; single pneumonia when only one lung is 
 inflamed, double when both are affected. The 
 number of deaths that occurred from pneumonia in 
 England and Wales in 1900 was 44,300, and the 
 proportional number was 75,362. Between them, 
 these two diseases accounted for at the rate of 
 
54 
 
 168,212 deaths out of every million of deaths that 
 occurred. These diseases are generally said to be 
 due to cold. No doubt exposure to cold is very 
 often the immediate exciting cause of them. But 
 there is very strong reason to believe — and I hope 
 to be able to adduce probable if not even demon- 
 strative evidence to this effect — that not only 
 these diseases, but many others also, have their 
 predisposing causes in errors of diet. " How few 
 diseases," says Professor Stewart in his Manual of 
 Physiology, " are not in some degree alimentary." 
 As to the opinion, however, that bronchitis and 
 pneumonia are due to exposure of the body to cold, 
 it must be said that these affections are not by any 
 means experienced only in cold weather. Patients 
 often suffer from severe attacks of them also in 
 summer. The true statement regarding the effects 
 of heat and cold in inducing these diseases would 
 be, I suppose, that, in those predisposed to them, 
 cold is often the exciting cause, and so is heat, but 
 that without the predisposition neither cold nor 
 heat, at least in the moderate amounts of them 
 experienced in ordinary life in England, would 
 induce them. Humanity is intended and fitted to 
 endure without damage moderate changes both in 
 heat and cold. And predisposition to disease — - 
 what is that ? Predisposition is inverse resistance ; 
 it is weakness ; and it can, I think, in the large 
 majority of cases, be defined in terms of the 
 influence on the economy of air, food, and exercises 
 or movements. What is meant bv that statement 
 
55 
 
 is this. If the economy is treated by a proper 
 amount of food, neither too Httle nor too much ; if 
 the air suppHed to it is moderately pure and 
 abundant ; and if exercises or movements of the 
 body are properly followed, neither over-exercise nor 
 under-exercise being indulged in, then the predis- 
 position of the body to disease will be found to be 
 greatly lessened, or otherwise the resistance to 
 disease will be greatly increased. If, on the other 
 hand, the body has either too much food or too 
 little ; if the air breathed is impure and in excess 
 or deficiency ; and if the muscular movements used 
 are too few or too many, then the predisposition of 
 the body to disease will be found to be greatly 
 increased, or otherwise its resistance will be greatly 
 diminished. Predisposition is inverse resistance ; 
 the greater the predisposition the less the resistance, 
 and the less the predisposition the greater the 
 resistance to outside influences. Heat and cold are 
 of course relative terms. If heat is assumed to be 
 the positive condition, then cold is only a less 
 amount of heat, so that exposure to heat and cold 
 only means, when we think about it, exposure to 
 more heat or to less heat. It might be thought 
 that " cold " might be defined as a degree of heat 
 less than the normal temperature of the body ; but 
 if this were so, then we should be obliged to say 
 that, in the English climate at all events, the 
 weather is almost always cold, because the tempera- 
 ture of the air is very rarely indeed so high as 
 98*4°F. In hydropathic establishments, and in some 
 
56 
 
 of the literature appertaining thereto, the term 
 " cold " is applied to water of a temperature of 
 60°¥. or less. We are quite unable to alter our 
 climate ; we may have a change of climate, indeed, 
 that is a few of us can, very few comparatively ; 
 but we are sometimes well, and, on the other hand, 
 sometimes ill, in all kinds of weather, so that it is 
 not the weather only which affects us, a more 
 important factor being the state we are in, or the 
 predisposition of the body to disease. But to say 
 that a man was specially predisposed to any disease, to 
 bronchitis, for example, or pneumonia, is equivalent 
 to saying that his resistance was so low that an 
 amount of exposure less than would have been 
 necessary in the case of another man sufficed to 
 induce in him an attack of bronchitis or of 
 pneumonia. But in reference to this, the important 
 point to get into our minds, and to keep there, 
 is that predisposition can be altered by changes 
 effected between the organism and its environment, 
 and particularly by alterations in the food habits. 
 No doubt alterations of the environment in other 
 particulars also have their influence. It is well- 
 known that through accustoming oneself to cool 
 baths, to open windows, and to moderate and well 
 regulated exercises, the resistance of the body to 
 disease can be greatly increased, or, in other words, 
 that its predisposition to disease can be greatly 
 lessened. But while this is so, no doubt, the 
 chief means by which predisposition to disease 
 can be lessened seems to consist in a proper 
 
57 
 
 arrangement of the dietary, so that neither too 
 much nor too Httle is taken. How much that 
 is, and how often it ought to be administered, 
 attempts will be made to state later. Meantime, it 
 should be stated that, as has been said long ago, the 
 quantity and kinds of food, and the proper times 
 for taking it, cannot be stated to a nicety (ets 
 oLKpL^etrjv, to use the expression of Hippocrates), 
 and the quantity proper to be taken depends on 
 several qualifying circumstances. 
 
 After bronchitis and pneumonia, the cause of 
 mortality shewing the next highest proportional 
 number is phthisis or consumption of the lungs, 
 whose proportional number is 73,128 for the year 
 1900. It may be contended that to this ought 
 to be added the proportional numbers of other 
 forms of tubercular disease, so that we may realise 
 the full importance of this cause of mortality. If 
 this were done, and if the proportional number of 
 tabes mesenterica, or consumption of the bowels 
 (10,166), and of tubercular meningitis, or consump- 
 tion of the brain, as it is often popularly called 
 (10,879), and also the proportional number of 
 what the Registrar- General calls " other forms of 
 tuberculosis" (10,112), were added, the proportional 
 number of tuberculosis in general would stand at 
 the very high figure of 104,285, or over one-tenth 
 of the total mortality. Of course, if this were done, 
 it would be necessary to take the proportional 
 number, say, of the whole of the respiratory 
 diseases in order to have a fair comparison 
 
58 
 
 of the mortality due respectively to tubercular 
 and to simple respiratory diseases. In this case, 
 tuberculosis, accounting for 104,285 deaths out of 
 a million from all causes, would be compared with 
 182,355 caused by respiratory diseases. Diseases of 
 the circulation again account for 93,857 deaths out 
 of every million that happen. To this, however, I 
 think the proportional number of apoplexy ought to 
 be added, because, although apoplexy shews itself 
 chiefly in nervous phenomena such as paralysis and 
 coma, still it is essentially dependent on degenera- 
 tion and rupture of vessels, changes in whose 
 condition really belong to diseases of the circulatory 
 apparatus. This number, 32,509, if added to, the 
 proportional number of diseases of the circulation, 
 would raise the latter to 126,366, a very high figure 
 indeed. 
 
 Of " old age " as a cause of mortality, the 
 proportional number (next highest on the list) is 
 54,056 for the year 1900. In a community quite 
 healthy, or even approximating to that condition, 
 this cause of mortality ought to be very much 
 higher. It is, in fact, a task for medicine to explain 
 why only about 5^ per cent, of the total mortality 
 is due to old age. We ought to have a very much 
 higher proportion. As to the influences of food and 
 feeding on the attainment of old age, a considerable 
 amount of evidence ought to be available. If, at 
 least, we can connect the causation of some of the 
 diseases already named, and which often prevent the 
 onset of " old age " — if we can connect those 
 
59 
 
 diseases or any of them with improper feeding, we 
 shall incidentally shew the connection between 
 proper feeding and the attainment of old age. 
 Respiratory diseases, it appears to me, diseases of 
 the circulation, and tubercular diseases, all seem 
 directly connected with mal-nutrition ; and I hope to 
 adduce evidence in support of this view in the 
 sequel. 
 
 Next after old age, as a cause of mortaUty, 
 comes cancer, whose proportional number is 45,457 
 for 1900 in England and Wales. I dwell at some 
 length on cancer in a later part of this essay, and 
 therefore need not do more here than say what I 
 have no doubt at all is the simple truth, viz., that 
 from first to last, from its commencement in 
 indigestion, loss of teeth, anaemia (triphthsemia, or 
 catatribsemia rather), pallour, fatigue, rheumatism, 
 and constipation, to its later manifestations in 
 epithelial and connective tissue overgrowth with its 
 limited molecular caries, or more general necrosis, or 
 molecular or general death of larger parts of the body 
 and their elimination or exfoliation with offensive 
 putrefying odour into the outer world, and finally 
 to its culmination in hsemorrhage or the effusion of 
 inamense quantities of usually bloody serum into 
 the body with or without the development of micro- 
 organisms ; from first to last cancer is a disease of 
 mal-assimilation of food, and that mal-assimilation 
 is caused not by too little but by too much food, 
 and particularly by too frequent feeding. When this 
 process has gone on for many years, it is, as a rule, 
 
60 
 
 impossible that cure can be effected. We might as 
 well ask that the effects of a devastation should be 
 undone, that the drowned in a flood should be 
 brought to life again, or the victims of La Souffrifere 
 or Mont Pelee should be requickened. Prevention 
 might have been easy and simple had steps been 
 taken at the proper time, but when that time has 
 been allowed to go by, cure is impossible. The 
 medical profession cannot, nor can any body of men, 
 clerical or lay, accept the role which the public are 
 too apt by implication or avowal to present to them, 
 viz., to relieve humanity from the effects of their 
 action without altering their habits. Not in this 
 way is power over nature attained ; and if we refuse 
 to put some necessary restraint on ourselves when we 
 have still the power and opportunity to do so, we shall 
 certainly find it vain to stretch out hands too late 
 in mute appeal to surgery or medicine, demanding 
 that they should cure the incurable or re- vivify the 
 dead. This explanation may not perhaps account 
 for all the cases of this sort that are met with in the 
 practice of medicine ; a certain small proportion will 
 still perhaps be inexplicable, are there always must 
 be anomalies and exceptions to every rule ; but if 
 nine-tenths of the cases, or nineteen-twentieths of 
 them, are so accounted for, and if an alteration in 
 our habits should enable us to prevent so large a 
 proportion of incurable diseases, we might reason- 
 ably say that we had solved the dreadful problem of 
 the prevention of cancer. That this is within our 
 reach I have no doubt. Cure may be practically 
 
61 
 
 impossible (for what is the good of talking of cure 
 when the most we can do is to save say one, two or 
 three per cent, of the cases?), but prevention is easy 
 and simple. 
 
 Diarrhoea and dysentery, whose proportional 
 number for 1900 in England and Wales was 38,984, 
 are next on the list of the causes of mortality. These 
 are diseases markedly dependent on improper feeding. 
 I should take it that this is a case in which there will 
 be little or no difference of opinion among experts, 
 not, of course, to the view that improper feeding is 
 the only cause of the incidence of and the mortality 
 from those affections, but certainly that it is much 
 the most important one. Diarrhoea is a large cause 
 of mortality among infants. In 1900, of the 
 22,916 deaths attributed in England and Wales to 
 diarrhoea and dysentery, 20,542, or about ten- 
 elevenths, or, say 90 per cent., occurred among 
 children under five years of age ; and it is the 
 opinion of medical officers of health that a very 
 large proportion of mfant mortality is due to 
 improper feeding. I think I need hardly quote 
 authorities to prove a statement regarding the 
 truth of a view so generally held as this. 
 
 Convulsions, whose proportional number for 
 1900 is 31,475, comes next on the list. This 
 affection occurs almost entirely among infants. Of 
 18,502 deaths attributed to this cause in the year 
 mentioned, 18,344, practically all of them, occurred 
 among children under jSve years of age. By 
 common consent these diseases are often attributed 
 
62 
 
 to errors of diet. Convulsions often appear in the 
 course of an attack of diarrhcea or of some other 
 acute illness, and many of them can be connected 
 with errors of diet. 
 
 We next come on influenza with a proportional 
 number of 27,636 deaths to a million from all 
 causes, measles with 21,622, whooping cough 19,507, 
 and diphtheria 15,897. These all belong to the 
 group of zymotic diseases, whose proportional number 
 (exclusive of cholera, diarrhoea, &c.) amounted to 
 101,600 in 1900, one of the very largest groups of 
 causes of mortality. Further on in this essay I 
 adduce (Chap. IV. ) what seems reasonable evidence to 
 shew that these diseases are probably also somewhat 
 dependent on wrong feeding, although it is customary 
 to attribute them almost wholly to vitiated air. I 
 do not deny, however, that the latter is also an 
 important cause of the fevers. I also shew that for 
 ten years past the fevers or zymotic diseases have 
 not diminished in England and Wales, although we 
 certainly have not intermitted our efibrts towards 
 the obtaining of better sanitation in the restricted 
 sense of that term. For the three years 1890, 1891 
 and 1892, the proportional numbers of the zymotic 
 diseases in England and Wales were 130,200, 
 133,960, and 146,579 respectively. In 1897 the 
 proportional number was 148,908. In 1898 it was 
 158,343, and in 1899 it was 154,450. The pro- 
 portional numbers are higher at the end of the ten 
 years than they were in the beginning of the period. 
 It appears either that we are in course of exhausting 
 
63 
 
 the benefit which we may expect to receive from 
 sanitation in the restricted form in which alone it is 
 customary, unfortunately, to use the term, or that 
 we have overlooked a main or important part of the 
 cause of the z3niiotic diseases. I beheve myself 
 that weight must be attached to both of these 
 suggestions. It is certainly strange that if fevers 
 are dependent on bad air and overcrowding, &c., 
 they should not only not continue to fall in 
 frequency in response to our continuous efforts to 
 improve conditions in these respects, but that their 
 proportional number should actually increase. I 
 have little doubt that an important factor in 
 their causation has been overlooked, and I have 
 equally little doubt that that factor is the food 
 habits of the people, the too frequent and too 
 abundant meals which they habitually ingest both 
 into themselves and their children. When Sydenham 
 suggested, at the time of the English revolution, 
 that fevers came e mscerihus terrarum^ out of the 
 bowels of the earth, it might have been suggested 
 to him that perhaps a main part of the cause arose 
 e visceribus hominum, out of the over-loaded diges- 
 tion of men. The idea is not so unlikely as might 
 have been thought. It is not even new. The sanitary 
 genius of Moses was not bound down by the notion 
 that plague depended upon bad aii% for, as we have 
 seen, he attributed the attack that his people sustained 
 from that zymotic disease, to the quails which they 
 stood up and gathered during a whole day and a 
 night and all the next day, and which no doubt 
 
64 
 
 they ate in great excess. But after burying his 
 dead at Kibroth-hattaavah, and apparently beUeving 
 that the ground and the air were infected with the 
 pestilence, he moved his camp also to Hazeroth, so 
 taking steps to get rid of the double cause of 
 improper feeding and infection of land and air. If 
 modern sanitarians would follow this sagacious and 
 broad-minded example, they would no doubt find 
 that instead of the zymotic diseases gaining on 
 them in spite of their efforts, they would have the 
 satisfaction of seeing that their sanitary efforts were 
 prevailing against the zymotic diseases. And, I 
 think, if they were dealing with the whole of their 
 causation, and not with a part of it only, they would 
 find that they could so advise the people as that they 
 might get rid not of the half only of the number 
 and mcidence of these diseases, but of a proportion 
 somewhere between three-quarters and nine-tenths. 
 Under specious phrases like the progress of science 
 and the like, we seem far too ready complacently to 
 assume that we know everything while the people 
 who went before us knew nothing ; but the assump- 
 tion is not always true in either direction. 
 
 To diseases of the digestive system, more par- 
 ticularly diseases of the mouth, stomach, intestines, 
 liver, spleen, lymphatics, &c., the proportional 
 number of some 61,801 deaths were attributed in 
 1900 in England and Wales ; and if to these the 
 proportional number of deaths due to diseases of the 
 kidneys and to Bright's disease — some 21,200 — be 
 added, we reach the large proportional number of 
 
65 
 
 83,000 as that of the diseases of the digestive 
 system. If we take a wider view of things, no 
 doubt — and this is in one word the thesis of the 
 present essay — diseases directly or indirectly 
 attributable to the digestive system are very much 
 more numerous than this ; but this is the 
 proportional number given by the Registrar general 
 as applying to England and Wales for the year 
 1900 ; and it forms about a twelfth of the total 
 mortality. 
 
 The only remaining important group of diseases 
 to which mortality is attributable is diseases of the 
 nervous system. It is a little difficult to gauge 
 its value or to state its proportional number for 
 various reasons. Its proportional number includes 
 apoplexy, for instance, in the Registrar-General's 
 return, but I have already said that I think 
 apoplexy (accounting for a proportional number 
 of 32,509 deaths in 1900) would be better classified 
 under diseases of the vessels, since it is rupture of 
 the arteries which is the main cause of apoplexy; 
 and the brain softening and degeneration following 
 are consequences of this and of the softening 
 changes which occur in the blood-clot effused on to 
 the surface or into the substance of the brain or 
 other parts of the nervous system. The nervous 
 system, in fact, being the organ of the controlling 
 power in the body, has a very high measure of 
 vitality, as if it were the intention of nature to 
 preserve it to the last extremity. In death from 
 direct starvation, for example, while other parts of 
 
 E 
 
66 
 
 the economy lose great parts of their weight, the 
 nervous system scarcely wastes at all. The 
 significance of this, though not the existence of it, 
 has been in a manner discovered by Dr. Dewey, of 
 Meadville, Pennsylvania, who quotes from Dr. 
 Burney Yeo statements, which he has entitled 
 "Nature's Bill of Fare for the Sick." Besides 
 quoting it in the text of his book, " The True 
 Science of Living," Dr. Dewey places it in capital 
 letters in the frontispiece of his book. He shews 
 that in illness, when we are using up the materials 
 accumulated in our bodies (and the same is true 
 in death due to direct starvation, as when sailors, 
 e.g., are confined in a boat without food) we may 
 use as much as 91 per cent, of our fat (practically 
 all of it), that of muscle we may use as much as 
 30 per cent., that the spleen, a blood-making gland, 
 may waste to the extent of 63 per cent., the liver 
 as much as 56 per cent., and the blood itself be 
 absorbed to the extent of 17 per cent, of its total 
 amount. That in these circumstances the brain 
 and nerve centres scarcely waste at all is surely a 
 most significant fact, and is closely related to 
 another of scarcely less importance, viz., that the 
 nervous system is not particularly liable to suffer 
 from direct disease of its proper substance. It is 
 its vessels which become diseased, and, by their 
 rupture, indirectly destroy its controlling power ; 
 or it is its fibrous coverings which become 
 infiltrated with gouty or rheumatic exadation, and 
 so lead to defect of its functions, to excess of its 
 
67 
 
 functions, or to such irregularity of its ftinctional 
 power as compels us often to send persons to 
 asylums where they can receive more care than 
 it is possible for them to obtain at home. 
 Considerations of the same kind incline me to think 
 that even " hemiplegia and brain paralysis," to 
 which the Registrar- General attributes a pro- 
 portional number of mortality in 1900 of 10,384, 
 ought to be also relegated to the diseases of the 
 vessels of the brain, that is, to diseases of the 
 circulation. However, I have still retained it 
 among diseases of the nervous system, and I find 
 that in this case, but deducting the proportional 
 number of apoplexy (32,509), of convulsions, which 
 is mostly a disease of infancy due to improper 
 feeding (31,475), and of laryngismus stridulus, also 
 a disease of infancy and early childhood, and 
 mostly, I think, catarrhal, and due also to wrong 
 feeding (742), there remains 47,917 as the 
 proportional number of the mortality attributed by 
 the Registrar- General to diseases of the nervous 
 system for England and Wales for the year 1900. 
 The causes enumerated, then, bronchitis, pneumonia 
 and respiratory diseases in general, consumption of 
 the lungs and other forms of tuberculosis, diseases 
 of the circulation, cancer, convulsions, the zymotic 
 diseases, diseases of the digestive system, including 
 diseases of the kidneys and Bright's disease, and 
 diseases of the brain and nervous system, account 
 for the bulk of the causes of mortality among the 
 population of England at all ages. If it can be 
 
 E2 
 
68 
 
 shewn, or if good reason can be advanced for the 
 opinion, that these causes of mortality and disease 
 are more aggravated by improper food habits than 
 by any other means, and if, therefore, more 
 improvement can be effected in the incidence of 
 these diseases on humanity by alteration of the 
 food habits of the people than in any other way, or 
 even if it can be shewn to be probable that such 
 alterations in food habits would be likely to 
 diminish the virulence and power of these causes of 
 disease and mortality, the task which I have set 
 before myself in this essay will have been 
 accomplished. For then it will have been 
 incidentally shewn that a great part of the causes 
 of the evils from which we suffer is diminishable by 
 our own exertions, and can be reduced by better 
 management of ourselves. 
 
 We have not yet, however, received the answer 
 to our question — what are the chief causes of 
 mortality among the active portion of the 
 population living between the ages of 5 and 65 
 years ? I am sorry to have to beg the reader's 
 attention still to what he may consider details of 
 dry arithmetic, but if I do so for yet a little while, 
 it is because I am afraid I cannot put the problem 
 before him in any easier or simpler way. Happily 
 the study already given to the causes of mortality 
 in general among the English population has 
 rendered examination of the causes of mortality 
 between ages 5 and 65 years by so much easier, and 
 our next chapter, therefore, will be a short one. 
 
69 
 
 CHAPTEE III. 
 
 The Principal Causes of Mortality in England 
 and Wales between the Ages of Five and 
 Sixty-five Years. 
 
 FN the year 1900 there were in England and 
 Wales, as has already been said, 587,830 deaths, 
 and of these 209,960, or over 35 per cent, occurred 
 among children under five years of age. This is a 
 large proportion of the mortality, but it is not at 
 all an unusual one. If anything, indeed, it is lower 
 than usual. In 1893, for instance, there occurred 
 in England and Wales 569,958 deaths, and of these 
 216,833, or about 40 per cent., took place among 
 children under five years of age. Year after year 
 it is the same, from one third to two fifths of all 
 the deaths that occur in the country happening 
 under five years of age. In our towns it is the 
 same. In 1901 4,701 deaths were registered in 
 Bradford, and of these 1,512, or 32 per cent., 
 occurred among children under five years of age. 
 There being thus about 32 to 40 per cent, of the 
 total mortality under five years of age, that 
 proportion of the mortality may be left out of 
 account. As to the causes of that mortality, 
 
70 
 
 however, my general argument is not weakened but 
 strengthened, it being the opinion of medical 
 officers of health that a great part of its cause is 
 improper feeding. If this is so under five years of 
 age, and as no noticeable break or gap occurs 
 between the modes of management of children 
 under five years of age and those over that age, 
 or at subsequent ages, it is probable that mortality 
 is induced by the action of similar causes at all 
 ages, and therefore that the view which attributes 
 a large proportion of the mortality at more 
 advanced ages to wrong feeding is prima facie at 
 least not improbable. Let us now look at the 
 mortality at the other extreme of life. I have 
 taken 65 years and not 70 as the point from which 
 to examine the mortality because it is an easier 
 problem for medicine to prolong life to 65 than 70, 
 although I do not for a moment suggest that we 
 ought to let 65 years of age form the limit of our 
 ambition. If medicine succeeded in raising the 
 age at death to 65 years, her ambitions would very 
 soon rise to 70 and beyond. Meantime it seems 
 hopeless to talk about such a thing, so very little 
 has yet been done towards increasing life at the 
 active and useful ages. In 1900, then, there died 
 in England and Wales 142,496 persons over 65 
 years of age out of the 587,830 deaths occurring 
 that year. That was about 24 per cent., and this 
 forms year after year about the proportion of the 
 population who reach not 70 years of age, but 65. 
 In the towns again it is the same. In 1901, out of 
 
71 
 
 the 4,701 deaths registered in Bradford, 1,038, or 
 22 per cent., attained the age of 65 years or 
 upwards. On the assumption that life is worth 
 hving, this does not seem to me a satisfactory- 
 result. Further, if life could be prolonged in health 
 and activity and interest, the objection frequently 
 felt by persons who hve long, to the solitude 
 experienced by them in the loss of their friends 
 would not count for so much, since the same causes 
 which might lead to the prolongation of their life 
 would lead to the longevity of their friends. 
 Deducting, then, the 209,960 deaths under five 
 years along with the 142,496 which occurred over 
 65, there remain 235,374 deaths to be accounted for 
 between five and 65 years of age — which we may 
 term the deaths at the active stages of life. From 
 what causes did these deaths occur ? In the order 
 of their frequency, and therefore of their 
 importance, we gather from the Registrar-General 
 that they are the following : — 
 
 1. The most numerous group is that 
 attributed by the Registrar- General to con- 
 stitutional diseases which includes consumption 
 of the lungs and other forms of tuberculosis, cancer, 
 and rheumatism. This group accounts for 71,004 
 deaths out of the 235,374 to be accounted for. 
 Practically it is tuberculosis and cancer which are 
 to be considered, for the former accounted for 
 48,931 deaths between five and 65 years of age, 
 and the latter for 17,026. Rheumatism and gout 
 were not directly large causes of mortality, 
 
72 
 
 although it would be very unwise to infer from this 
 that these are unimportant diseases. Both 
 rheumatism and gout are very important and very 
 dangerous conditions of body indeed, but they are 
 so far more in relation to what they mean and to 
 the evils which they portend as about to ensue in 
 the body, than in themselves. This quality is 
 shewed by other diseases besides rheumatism and 
 gout, and is, indeed, a characteristic of many of 
 the minor ailments, especially, for instance, 
 indigestion, in which nearly all, or at least a very 
 large proportion of diseases have their origin. 
 
 2. The next most important cause of death 
 between five and 65 years of age is diseases of the 
 circulation, I ought to say that I have added the 
 deaths caused by apoplexy to those attributed by 
 the Registrar- General to diseases of the circulation 
 for reasons mentioned in the previous chapter, and 
 have therefore removed the deaths due to apoplexy 
 from those attributed to diseases of the nervous 
 system. Diseases of the circulation, then, and 
 apoplexy account for 40,332 deaths out of the 
 285,374 in question. Apoplexy alone accounted for 
 19,110 of these deaths, so important a cause of 
 mortality is it. 
 
 3. The next largest cause of mortality at 
 these active ages of life is diseases of the 
 respiration, which account for 36,321 deaths. Of 
 these bronchitis and pneumonia together accounted 
 for 31,383 deaths, so that the deaths due to other 
 diseases of the respiratory system are comparatively 
 
73 
 
 unimportant. Diseases of the respiration are, 
 among persons living at the active ages of Hfe, as 
 well as among the population in general at all 
 ages, a very important cause of mortality. 
 
 4. The next most important cause of death, 
 according to the Registrar- General, is " old age," 
 which accounts for 31,146 deaths under 65 years of 
 age. I have already said that all would like to see 
 this cause of death greatly increased, and to see 
 life lived as it ought to be, till it determined in 
 decay of nature rather than in succumbing to 
 disease. " Old age," in fact, under 65 years of age, 
 and particularly under 60 or less, would appear 
 to be a misnomer. If persons succumb to ' ' old 
 age" at such ages, it is likely, on the face of it, that 
 they have in some way mismanaged themselves, so 
 as to make themselves old before their time, and it 
 will be well before making any other inquiry to try 
 to see whether a main cause of this is not over- 
 filling of the body with food and drink, so clogging 
 its actions and bringing its powers to a stand- 
 still. 
 
 5. The cause next in importance of mortality 
 between five and 65 years of age in England in 
 1900 was the zymotic diseases. We saw how very 
 important a cause of death this set of diseases is 
 among the whole population at all ages ; and now 
 we find that between five and 65 years of age it 
 accounts for 29,766 deaths out of the 235,374 
 to be accounted for. This would give a pro- 
 portional number of 126,000 out of a million deaths 
 
74 
 
 from all causes, or about an eighth of the total 
 mortality. 
 
 6. The next most important cause of death 
 between five and 65 years of age is the diseases of 
 the digestive system, which in 1900 accounted for 
 14,638 deaths out of the 235,374 which occurred in 
 England and Wales in that year. This is still a 
 large proportion, although if the arguments on 
 which I have relied are sound, this number, large 
 as it is, by no means represents the number of 
 deaths due to disorders of the digestion. As it is, 
 however, it represents a proportional number of 
 62,000 out of a million deaths from all causes. 
 
 7. Lastly, deducting apoplexy (a very im- 
 portant cause of death, as has been shewn), diseases 
 of the nervous system accounted for 8503 deaths 
 out of the 235,374 between five and 65 years in 
 England in 1900. 
 
 From these seven causes of death, we find that 
 231,710 deaths are accounted for, out of the 235,374 
 in question in England and Wales in 1900, so that 
 the remainder, due to parasitic diseases, dietetic 
 diseases, &c., is very trifling. The class of dietetic 
 diseases, I may say, however, includes the deaths 
 from chronic alcoholism and delirium tremens, and is 
 put at the too low figure of 3638 at all ages for 
 Ensfland in 1900. As chronic alcoholism causes 
 disease in various organs, as the liver, kidneys, lungs, 
 heart, brain, and, in fact, in almost all organs, deaths 
 that ought to be set down to alcoholism are far more 
 frequently referred to diseases of those organs, so 
 
75 
 
 that the Registrar- General's returns are no guide, 
 and do not even offer an approximation to the 
 number or proportion of deaths due to this cause. 
 It is quite natural, of course, that relatives should 
 not like to have the deaths of their friends put 
 down to alcoholism, but their unwillingness to let 
 this be done must not be allowed to blind us to the 
 real facts of the case. Chronic alcoholism no doubt 
 accounts for a frightful amount of mortality in 
 England if the truth could be known ; and no 
 doubt also it is a most shocking cause of death, 
 since no other cause equally lowers the power of the 
 intellect in the government of men and women, 
 sears their conscience and blunts their sense of 
 refinement, or shuts their heart to the claims of 
 those dependent on them. Bad as alcoholism is in 
 these respects, however, and terrible in so many 
 ways, it is not by a long way so potent a cause of 
 mortality or of disease as improper feeding ; and I 
 cannot help thinking that if the teetotallers, instead 
 of confining their attention to the evil effects of 
 alcoholic drink alone, had widened the scope of 
 their inquiries and extended them to the effects of 
 intemperance in the use of food also, they would 
 have effected much more good than they have 
 yet succeeded in doing. There are passages in the 
 writings of well-known medical writers on the evil 
 effects of alcohol, referring a long succession of 
 bodily evils to the effects of alcoholism, every one 
 of which I have seen, and that not once, but over 
 and over again, occurring in the life history of 
 
76 
 
 teetotallers who were perfectly sincere in their state- 
 ment that they abstained entirely from alcoholic 
 drink. I am very sorry to say this, because 
 I recognise to the full the good intentions of 
 teetotallers and their sincere desire to benefit their 
 kind in the best and highest ways, by inculcating 
 on them the need for self control, and by shewing 
 them how to achieve it. And I have endorsed the 
 practice of the teetotallers by being one myself for 
 years, so that I know of what I speak. No doubt 
 they have shewn that alcohol is not necessary to 
 persons in health, and that long and active and 
 useful life is attainable without its use, while I 
 think they have shewn also that childhood and 
 youth are better without it. But nothing is gained 
 by exaggeration, or by attributing to one cause 
 what is often due to another, as, for instance, in 
 the following passage, in which a distinguished 
 physician said that "it is the prevalence of beer 
 and spirit drinking, and consequent liver-clogging, 
 which accounts for the widespread use and countless 
 forms of patent pills such as Cockle's, Morison's, 
 Holloway's, and others. These are taken by 
 millions every week, and people find that if they 
 do not take them they become bilious and unwell." 
 And then he goes on to suggest that the chief 
 reason for all this constipation and clogging, so very 
 deleterious to the system, I freely admit, is caused 
 by " gin-drinker's liver." But while this is some- 
 times a cause of the constipation which drives 
 people foolishly to take aperients, by which, 
 
77 
 
 nevertheless, they cannot cure it, surely it is not 
 the only cause or the chief cause. It is impossible 
 that constipation, so prevalent a condition in young 
 and old and in middle-aged, and in all sorts and 
 conditions of men and women, can be due to alcohol 
 as its commonest cause' It is not compatible with 
 common experience to say so. Thousands of the 
 young women, for example, suffering in this way 
 never take alcohol at all ; and what it is due to far 
 more than to anything else is excess not in alcohol 
 but in food, and particularly to the widespread 
 habit of taking too many meals. The modus 
 operandi also of this habit and its consequences are 
 quite plain. Too much chyle gets into the blood 
 through over-feeding. The excess of nutritive 
 material so introduced must be used somehow, and 
 by means of it the muscular fibres of the bowel, 
 and particularly the transverse or circular fibres, 
 become overgrown or hypertrophied. The effect of 
 this is to make these overgrown fibres contract too 
 tightly, especially as the stimulus of too much 
 nutritive material in the blood is still kept up by 
 over-feeding. In this way the firm contraction of 
 these fibres narrows the lumen or channel of the 
 bowel, and prevents its contents from passing; or 
 otherwise, we may say, causes constipation, and 
 when some sort of action does occur, it causes 
 the evacuation of those small knotty motions so 
 common in this condition. Let the constipated 
 young person, who is constantly taking sugar and 
 spice and chocolates between her meals, give up 
 
78 
 
 this pernicious habit ; let her or him who is in the 
 habit of taking four daily meals, try the effect of 
 three for three months, and the probability is that 
 he will be somewhat less constipated. If this does 
 not cure him, however, let him take two daily meals 
 for six months, and he will probably become regular, 
 especially if he will take frumitty and cooked fruit 
 at one of his meals, and the well boiled onion or 
 fresh lettuce, tomatoes, &c., at the other. But if 
 this is insufficient to put him right (but it will fail 
 very seldom indeed) he will almost certainly become 
 so on one daily meal. Alcohol is sometimes, no 
 doubt, a cause of constipation, but sometimes, on 
 the other hand, a little beer has the opposite effect 
 — not that I recommend its use for that purpose, 
 because I think the purpose can be better effected 
 in the way suggested — but far the commonest 
 cause of constipation is not alcohol but too much 
 food. 
 
 The same statements are true, the necessary 
 name-changes being made, as regards skin eruptions, 
 which another medical authority attributes to 
 alcohol. I do not deny that alcohol may cause 
 acne and eczsema, for instance, that is, that beer 
 may cause and that it often does cause spots and 
 redness of the face and nose ; but the large majority 
 of the cases I have seen, occurring as they do in 
 young women, who are greatly distressed by them, 
 or in middle-aged women, many of whom do not 
 touch beer or stout at all, much less brandy or other 
 spirits, have been caused not by alcohol but by too 
 
79 
 
 much starch and sugar in the diet, and these skin 
 affections are really very easily treated by diminish- 
 ing the number of meals taken and by restricting 
 the use of these articles of food. I have seen many 
 teetotallers die early, say between 50 and 60 years 
 of age, not from their teetotalism at all, certainly 
 not, but from wrong dieting of themselves, and 
 particularly from taking too many meals. In fact, 
 my experience leads me to say that teetotallers, as 
 a rule, err in this way more than moderate drinkers, 
 and having been deeply impressed by the truly 
 shocking and degrading and demoralising effects of 
 alcoholic drinking (let no one say I minimise these in 
 the least, for I do not) have exaggerated its 
 importance and extent, and so have attributed to 
 alcohol many effects which are not due to it at all 
 but to wrong feeding. Will any doctor seriously 
 contend that say one glass of sherry or Madeira, 
 taken at lunch, and one small whiskey taken at 
 bed-time, in those cases where it suits — will any 
 doctor seriously contend that such an amount of 
 alcohol taken daily will shorten the life of the 
 average man by a day ? I do not believe it will, 
 although at the same time I fully admit that it is 
 not necessary to life or health, and although for my 
 own part I quite expect to hve to term without it. 
 The moral and social grounds for abstinence from 
 alcohol may lead persons justly to become teetotal 
 themselves, and to inculcate total abstinence on 
 other people — this style of argumentation attracts 
 me very much, I must say — but we must be careful 
 
80 
 
 not to transcend the bounds of truth and evidence 
 even for a good cause, and we must also sanely 
 attempt to attribute the effects of excess in all 
 directions to their true causes, and to consider 
 judicially the effects of too much food as well as of 
 too much alcoholic drink. 
 
 Many strange things happen in life in the 
 observation of those who notice what they see. I 
 knew, for example, two brothers, one of whom 
 lived to 75 years of age, the other attaining the 
 age of 84. The former was a sober, righteous, and 
 godly man, the centre of a numerous family of 
 nephews and nieces, who looked to him as to a 
 pattern for the help which young people so often 
 need, and which he was able and willing to give. 
 He died of a dilated, flabby, weak heart, brought 
 on, I believe, partly by anxiety, but chiefly because 
 he did not understand digestion, and because he 
 ingested into his blood, habitually, more food than 
 he required. The brother was such a rascal, and 
 had so little command over himself that for 40 
 years he never went to bed sober, if he could go 
 drunk. He was a pleasant, smiling, agreeable man 
 to strangers, and when I saw him, at 83 years of 
 age, he was as straight as a dart, and as nimble as a 
 lamplighter. Yet, when he died the next year, so 
 awful had been his family's experience of his vagaries, 
 and so great the shame he had put them to, that 
 his own daughter went down on her knees to thank 
 God when she heard of his death. This was an 
 exceptional case, no doubt. I may mention that 
 
81 
 
 the longer lived brother, although he drank so 
 hard, was a very spare eater. But how wrong it 
 would be of me if I were to advise people, because 
 this man lived in spite of his habits, that they 
 should go and do likewise. And yet, would it be 
 any more untrue to nature, or any less dis- 
 proportionate to reality, than was, for example, the 
 language of a compeer of my own, a medical man, 
 who practised his profession for over 30 years, and 
 who, all through his professional life, spoke of 
 alcohol as " the accursed thing," advising all to 
 abstain totally from it under peril of eternal loss ? 
 Or, to take another example. Many medical men 
 believe that much damage is done, and many fatal 
 illnesses are brought on by an excess of starch and 
 sugar in the diet. But do we value their judgment 
 if they advise total abstinence from these articles 
 of food ? Or at least is it not more rational of 
 them if they advise, not complete abstinence, but 
 such moderation as conduces to life, and health, and 
 usefulness ? The effects of the use and abuse of 
 alcohol and of foods (and, I may add, of other 
 things), may differ greatly in detail, but our 
 attitude in respect of them must, it seems to me, be 
 in principle always to remember that moderation is 
 the only rule which never fails us. 
 
 ':>'^^^^?5<5^ 
 
82 
 
 CHAPTER IV. 
 
 The Causes of Disease or the Causes of the 
 Causes of Death. Preliminary. 
 
 rnOETALITY, being attributed to the diseases 
 already named, or death being caused by 
 them, an inquiry into the causes of these diseases 
 may be otherwise considered as an inquiry into the 
 causes of the causes of death. Death is, of course, 
 the natural termination of life, but death ought to 
 oc(iur by a slow wearing out of the natural powers 
 of the body. It very rarely does so ; it occurs not 
 from old age but from disease, for the most part. 
 Now the causes of disease are usually considered 
 under three divisions, termed respectively the 
 predisposing, the exciting, and the proximate 
 causes. The proximate causes of disease are two, 
 and two only, viz. : shrinking and swelling, or 
 contraction and dilatation. Organised bodies, like 
 unorganised, have the power or quality of 
 contracting or shrinking, and also of dilating, or 
 swelling, or expanding, under the action of certain 
 stimuli, but there is probably this difference 
 between them, that unorganised bodies may 
 actually shrink into smaller compass, so as to 
 occupy less space at some times than others, under 
 
83 
 
 the contracting action ; while organised bodies, if 
 they contract or shrink in one direction, usually 
 expand or swell in another, so that it is doubtful if 
 they occupy less space at one moment than at 
 another. (Of course organised bodies grow and 
 develope, and again shrink and become attenuated 
 and old, so that at different periods of their lives 
 they occupy very different amounts of space ; but 
 the question at present is whether they occupy more 
 or less space under the actions of contraction and 
 dilatation, respectively, at very short intervals of 
 time, as, e.g. , iron does under the action of heat and 
 cold). Usually, when an organised body, as the 
 earth-worm, for example, shrinks in one direction, 
 say its longitudinal direction, or in its length, it 
 swells or expands or dilates in another direction, in 
 its width, for instance ; so that the space it occupies 
 at any two shortly separated intervals of time is 
 nearly if not quite the same. This property it 
 probably owes to the water which always forms a 
 large proportion of the structure of organised 
 bodies, water being for practical purposes incom- 
 pressible. A fact of this kind seems to have 
 greatly impressed early inquirers into the 
 constitution of nature, one of them, as is well 
 known, having held that water (or moisture as we 
 now term it), is the ultimate element from which 
 all things are formed and to which they all return. 
 Certainly without moisture life, as we know it, 
 does not occur. The proximate causes, then, being 
 swelling and shrinking (and the ancients knew 
 
 F2 
 
84 
 
 them under a great many different names, 
 especially the Greeks, see Chap. VI. — the Latins 
 called them strictum et laxum), it appears that 
 these so-called causes are not really causes so much 
 as states. These two causes or states have this 
 peculiarity when manifested in organised bodies, 
 that, whichever of them appears first in the animal 
 economy, is always followed by its opposite ; 
 shrinking by swelling and swelling by shrinking, 
 contraction by dilatation and dilatation by con- 
 traction. If a muscular fibre, for instance, 
 contracts, it in course of time expands, and, after 
 expanding, it again contracts. These properties 
 depend on the constitution of the organised body, 
 or on the constitution of the part of it undei* 
 consideration ; but we shall not be betrayed into 
 the fallacy of supposing that contraction is the 
 cause of swelling, although it always precedes it, 
 nor yet that swelling in turn is the cause of 
 contraction for the same reason, if we remember 
 that day always precedes night and night day, 
 although day is not the cause of night nor night 
 the cause of day. These offer also a good instance 
 of the fact that invariable succession is not the 
 same thing as causation. Nevertheless, when we 
 find one thing invariably preceding another, we 
 may assume that there is some causal nexus, 
 although it almost always takes the form that the 
 two phenomena are successive effects of a common 
 cause, although they are not cause and effect of one 
 another. Day and night, for example, although 
 
85 
 
 they are not cause and effect of one another, are 
 successive effects of a common cause, namely, the 
 rotation of the earth on its axis, and its behaviour 
 to the sun. So the succession of swelling on 
 shrinking and vice versa, may be considered best as 
 successive effects of a common cause, namely, the 
 constitution of the tissues of organised bodies. 
 
 There is another phase of the relation between 
 swelling and shrinking which should not be 
 overlooked, for failure to appreciate its significance 
 has led to the greatest confusion in medicine, and 
 is probably doing so to-day, notwithstanding all 
 the advance which is alleged to have been made in 
 the art. It is this. The structure of many parts 
 of organised bodies, of the arteries, for example, 
 which generally convey the aerated or arterial 
 blood ; of the intestines and of other parts ; is in two 
 layers of contractile structures, one of which goes 
 along the length of the structure, and the other 
 across its width. These are called respectively the 
 longitudinal and the transverse fibres (or circular, 
 sometimes). Now it is evident that contraction of 
 the longitudinal fibres must cause dilatation of the 
 transverse fibres, and that, on the other hand, 
 contraction of the transverse fibres must cause 
 dilatation of the longitudinal. In other words, 
 contraction in the length of a vessel, or shortening 
 it, widens its width, while contraction or narrowing 
 of its width lengthens its length. When it is 
 added that these two sets of fibres may be under 
 the control of two different sets of nerves, and that 
 
86 
 
 not infrequently the one set of nerves stimulates 
 its fibres to contraction immediately after the other 
 set has ceased to stimulate its own, it is evident 
 how complicated may be the actions resulting from 
 the successive action of two sets of structures 
 acting in the body. Shortly, the complication is 
 apt to create this amount of confusion in the 
 observations of an inquirer that (1) contraction 
 appears to cause dilatation and dilatation appears 
 to cause contraction, and (2) that stimulation of one 
 set of nerves appears to have the same effect as 
 absence of stimulation or loss of control by 
 another. That is to say, in both of these 
 directions, actions may appear to produce effects 
 exactly the opposite of those which they do 
 exert. It is a little away from our subject at the 
 present moment, but perhaps an example may 
 illustrate better than a statement what is wished 
 to be conveyed ; and I may say, therefore, that 
 contraction of fibres may either contract or dilate 
 the pupil of the eye, and that parahsis of one of 
 its nerves of supply may cause the same dilatation 
 as is produced by stimulation of another. This 
 complication and difficulty also arises in the attempt 
 to understand the actions of many other parts of 
 the body, and may lead us astray in studying 
 respiration, cardiac action, intestinal action, sleep, 
 thinking, and possibly, indeed, any and all 
 functions. Even a poor imagination may perceive 
 how entirely opposite must be recommendations as 
 to treatment according to the mode in which 
 
87 
 
 various changes in function are produced, or (and 
 this is where the difficulty comes in, in practice), 
 according to the possibly differing views of different 
 advisers as to their mode of production, Evidently 
 if a condition is caused by paralysis or loss of power 
 in one set of nerves, its treatment mu^ be by 
 attempting to strengthen the same ; but if, on the 
 other hand, it is caused by over- stimulation of 
 another set, equally clear is it that the object of 
 treatment ought to be to remove some of the excess 
 of action. On the former view the action must be 
 tonic, bracing, strengthening ; on the latter it must 
 be lowering, relaxing, weakening. There can be no 
 doubt that much difficulty enters here into medical 
 practice, but I should like to add that the difficulty 
 is by no means confined to medicine ; commercial, 
 social and ethical relations presenting frequently 
 the same difficulties. 
 
 Simple as they are, the discussion of the 
 proximate causes or states has led us further than 
 we expected, and has opened up a field much wider 
 and more difficult than we supposed. The exciting 
 causes will hardly detain us long. These are such 
 influences as heat, wetness, dryness, calm, wind, 
 storm, and so on ; also organic micro-organisms, 
 spores, germs and organic particles ; and, lastly, 
 violence of various kinds. The effects of the last 
 are dealt with by the surgeon ; those of the others 
 by the physician for the most part. It is very 
 difficult to differentiate by exclusive characteristics 
 the exciting causes from the predisposing, with 
 
88 
 
 which I must deal directly ; but probably as good a 
 means of differentiation as any would be to say 
 that while the exciting causes act once or seldom, 
 the predisposing act often or for a long period of 
 time. An attempt to distinguish the one set of 
 causes from the other shews that causes which are 
 considered to be exciting from one point of view 
 may become predisposing from another. For 
 instance, getting one's feet wet on a given occasion, 
 or being in a wind, may be the exciting cause of 
 an attack of inflammation of the lungs or of 
 bronchitis ; but being more or less continually 
 exposed to the effects of damp or draughts may act as 
 a predisposing cause to some long-continued illness. 
 The predisposing causes of disease are for the 
 most part the relations of the body to air, to food, 
 and to exercises, with perhaps the influences of 
 anxiety and of heredity added. I shall hope to say 
 something about the last later, and shall dismiss it 
 for the present with the remark that as a cause of 
 disease (though not of organisation, which is greatly 
 determined by it) I believe its influence has been 
 greatly exaggerated both by medical men and by 
 the general public. And I go on to say that of 
 the other predisposing causes of disease by far 
 the most important is the relations of the body to 
 food. This statement is really the main thesis of 
 this essay. This thesis may be analysed into the 
 following statements. First, if human beings were 
 to arrange properly the quantity and quality of the 
 food which they take, and also the times at which 
 
89 
 
 they take it, they would suffer much less from 
 disease and illness than they do now. Second, even 
 after disease has occurred or has broken out, the 
 best means to combat it and to restore the body to 
 health is by an alteration in the diet. From which 
 it follows, thirdly, that the best and most important 
 means to keep a man in the health which by the 
 supposition he has re-attained, is to prescribe for 
 him a proper amount and quality of food, and 
 suitable times of taking it for the future. 
 
 A great Latin medical writer, it is well known, 
 divided methods of treatment into three divisions, 
 treatment by diet {victus), by medicines {medica- 
 menta), and by surgery (manus). And he might 
 have added, I venture to suggest, that, with the 
 exception of a few diseased conditions which mtist 
 be treated by surgery, those diseases which cannot 
 be treated by diet or by diet combined with 
 exercises, which for the moment he forgot, ca.n 
 hardly be ejB&ciently treated at all. 
 
 These positions must not be understood. It is 
 not contended that the relations of the body to 
 food are the only causes of disease. It is most 
 freely admitted that there are other causes. No 
 sensible man would deny or would wish to deny 
 that the relation of the body to air or respiration is 
 a very important cause of health on the one hand, 
 and of disease on the other. Nor would he fail to 
 attribute an important influence to the effects of 
 exercise on the body. Among the exciting causes 
 of disease, again, long exposure to cold or to heat. 
 
90 
 
 or to fatigue, or to anxiety, as to many of* the 
 other exciting causes, must and does exert a very 
 powerful influence for good or evil on health or 
 disease. But after all these admissions are made, 
 and due allowance made for the undoubted effect of 
 these other causes in affecting the body for good 
 and ill, the statement still seems to the writer to 
 hold good that by far the most potent cause of 
 disease, the cause compared with which all the rest 
 pale into insignificance, is the predisposing cause of 
 improper food supply, either as to quality or 
 quantity, or both. How greatly this cause pre- 
 ponderates it is difficult to say, but the writer is of 
 opinion, for reasons which will appear abundantly 
 in the sequel, that it would probably be no 
 exaggeration to say that proper or improper 
 relations between the body and food are as great 
 and important causes of health and disease as all 
 other causes put together. The precise proportion, 
 however, by which this cause preponderates over 
 the others is immaterial to the argument, which 
 alleges, on the other hand, that it is by far the 
 most important cause, but by no means that it is 
 the only one. A man may undoubtedly be worried 
 to death, may be broken down by sorrow and 
 anxiety, and his life and spirit worn down by 
 this cause, however properly he may manage his 
 digestion and food arrangements. And, on the 
 other hand, so may he be chilled or destroyed by 
 excessive and long continued cold or heat, or 
 exposure, or overwork. 
 
91 
 
 This will probably be the best place in which 
 to introduce some ideas which we must consider 
 sooner or later, regarding the division of diseases 
 into acute and chronic. Under the action of such 
 an exciting cause as exposure to cold, or wetness, 
 or wind, a person is very apt to have a feverish 
 attack, or an attack of inflammation, as it is 
 called, in some organ or part. When this happens 
 the temperature usually is found to rise above the 
 normal standard of 98*4° F. (37° C), and the pulse 
 is generally found beating at a higher rate than the 
 60-90 beats a minute, which we laid down as the 
 usual limits of health. The increase of the pulse- 
 rate, and the elevation of the temperature are the 
 signs, or some of them, by which nowadays we 
 measure the acuteness or severity of an illness. 
 Formerly it was not so. The ancient physicians 
 did not measure temperature, although they put 
 their hands on patients' bodies to feel if they were 
 hot ; nor do they seem to have counted the pulse, 
 although they examined the pulse carefully, and 
 attached great importance to its changes, and this 
 notwithstanding that they did not realise or under- 
 stand the circulation of the blood and lymph. The 
 severity or acuteness of a disease seems to depend 
 on two things ; first, the amount or quantity of the 
 exciting cause, the amount of the cold, or wind, or 
 wetness, etc, , to which a person may be exposed ; 
 and second, the strength or weakness of the 
 patient. We should now say that the severity of 
 an illness or its acuteness, as well as the length of 
 
92 
 its duration, are proportional to the quantity of 
 the cause in action, and that it is inversely as the 
 resistance of the person acted upon, or (what comes 
 to the same thing) proportional to his weakness or 
 his predisposition to disease. An acute disease is 
 generally a rather short-lived one, while milder 
 diseases are generally longer in duration ; and 
 hence it is customary to classify diseases into acute 
 or severe on the one hand, and into chronic on the 
 other. It is, however, many years since I have 
 been attempting to draw attention to the fact 
 which I must emphasize again, that acute and 
 chronic are not logical opposites. Acute, in fact, is 
 opposed, not to chronic, but to mild ; and between 
 acute and mild there may be, and often is, inserted 
 an intermediate group or class of diseases, viz., the 
 sub-acute', while beyond the acute diseases it is 
 not infrequently necessary to distinguish those 
 which are extremely severe, or per-acute* as they 
 have been termed. Chronic, on the other hand, is 
 the opposite, not of acute, but of short. The 
 division of diseases into acute and chronic was 
 introduced by Asclepiades of Prusa, who, after he 
 went to Rome, became the medical adviser of 
 Cicero. He was not a doctor, properly speaking, at 
 all (of the rank, for instance, of Celsus or Galen) 
 but a philosopher or dialectician. His contribution 
 to medicine, of this very division of diseases into 
 acute and chronic, as also his distinction between 
 
 * The term ultra-acute, suggested recently, seems to have been proposed in 
 ignorance of the existence of the much better and time-honoured 
 term per-acute . 
 
93 
 
 category and prosagory, as well as his ideas 
 regarding the oyKoi (Latin, Unci) or hooked atoms, 
 a possible anticipation of the modern doctrine of 
 microbes, and of the part they may be supposed to 
 play in the causation of disease, all bear the impress 
 rather of the philosopher than the practical 
 physician. His division of diseases into acute 
 and chronic, however, has been most unfortunate, 
 and offers one of the most interesting instances of 
 an alleged reform being really a retrogression, 
 because it can be shewn that Hippocrates, hundreds 
 of years before, had spoken of diseases as being 
 mild {rrpaeis) and severe or acute (o^et?) and had 
 also spoken of diseases as being short {/Spaxel'? or 
 6XLyo-)(p6vLOL) and /ong (ttoXv^ovlol or yjpovioi or 
 [MaKpol), so keeping things which were distinct in 
 fact, clear and distinct in his mind and in language. 
 And yet the so-called reform of Asclepiades has 
 held its own ever since his time, displacing the 
 more logical ideas of Hippocrates in this particular. 
 In Latin the word lentus is often used of the 
 chronic diseases. As lentus means tenacious, hence 
 slow, sluggish, hence lasting, and as long diseases 
 are generally somewhat mild, there has been no 
 relief to the ambiguity, derived from the use of 
 Latin terminology, such e.g., as the use of the 
 word mitis for mild or slight would have given us. 
 
 Chronic means long continued, and the term 
 has been applied to any diseased state of the 
 organism lasting for twenty-eight days or longer. 
 To lengthen its application or definition to diseases 
 
94 
 
 lasting three months would, I think, be better, 
 because a few cases of what is called acute disease 
 last as long as three months (some even more), e.g., 
 some cases of typhoid fever, which certainly go on 
 occasionally for six, nine, or twelve weeks, or longer ; 
 or cases of rheumatic fever. No doubt chronic 
 diseases are generally mild, but frequently they are 
 not so, being sub-acute or acute, or even per-acute 
 (in accordance with the definitions immediately 
 to be given to these terms), while more often they 
 are alternately mild at some periods of their course, 
 and acute or sub-acute, or per-acute at others. Or 
 they may be intermittent or recurrent ; that is, 
 they may cease entirely for a time, during which 
 the patient gets quite well, and then they may 
 recur. Again, disease, without entirely ceasing, 
 may improve considerably, becoming milder for a 
 time, and then become more severe again ; in which 
 case it is termed remittent rather than intermittent. 
 But when disease settles down on a patient, or, as it 
 may be better expressed, when the patient is always 
 ill, for as long (I propose) as not less than three 
 months at a time, then his disease is termed chronic. 
 Even in this last case, however, when patients are 
 always ill, they are not equally ill at all times, for, 
 if the case is watched closely, it will always be 
 found that the patient is worse at some times and 
 not so ill again at others. We may otherwise 
 express this state by saying that a patient is 
 recurrently or intermittently ill, and, by and bye, 
 that he is remittently ill, before he becomes 
 
95 
 
 chronically ill. The cause of this alternation 
 between being better and worse or between being 
 ill and again not so ill, is a very interesting 
 one. I believe it depends on the manner of the 
 rotation of the earth on which we live, and its 
 behaviour to the sun ; for that arrangement implies 
 that our earth, in revolving on its axis, projects 
 now this side and then that to the sun, so that 
 in the former case it is day on one part of the 
 planet and night on the other, and in the course of 
 twelve hours or so these relations are reversed. 
 Now, when it is day, on a certain part of the 
 planet, all organic things on that part are shrunk 
 and ready for action like a spring compressed which 
 is ready to uncoil as the day goes on ; till, when 
 night comes on, they are swollen like an uncoiled 
 spring and go to sleep, during which time the 
 spring becomes shrunk again, or compressed, as it 
 were, and is ready on another day to translate its 
 uncoiling into the doing of physical and mental 
 work. The effect of this arrangement is to produce 
 the intermittent work or action as distinguished 
 from constant or continuous action, which is so 
 characteristic of everything that occurs on this 
 planet, that all action is intermittent and even what 
 seems to be continuous action, translates itself 
 always into a rapid succession of intermittent 
 actions. Hence the alterations of pulse-rate and 
 temperature which we observe, not only in disease 
 but even in health to some extent ; and hence also 
 those alternations which invariably occur in all the 
 
96 
 
 relations of man to his environment, traceable, as 
 they are, in politics, commerce, and philosophy, and 
 which determine the behaviour even of the ultimate 
 elements of protoplasm, so that they are seen, 
 whether by the naked eye or under the microscope, 
 to be in constant alternation of swelling on the one 
 hand and shrinking on the other. Even inorganic 
 phenomena manifest this characteristic, and the 
 very tide rises and falls in an intermittent and not 
 in a continuous way, alternately rising and falling 
 as it flows, and falling and rising as it ebbs. It is 
 an interesting speculation, and one not wholly 
 unpractical, to inquii'e what would be the effect on 
 life and on phenomena on a planet which should 
 behave differently to the sun, as the moon, for 
 instance, behaves to the earth, rotating on its axis, 
 indeed, but in such a way as to keep always the 
 same face to the sun. Obviously there would be 
 everlasting day on one side of such a planet, and 
 everlasting night on the opposite one ; and the 
 effect on Hfe and on every action occurring on that 
 planet would probably be very different indeed 
 from what occurs on our earth. It seems as if the 
 diagrammatic representation of life in this latter 
 case would be, not as with us, a zig-zag line repre- 
 senting a rise and fall, thus — 
 
 but would be, on the contrary, represented by a 
 
97 
 
 point which widens into a line, the hne widening to 
 its broadest place, after which it would begin to 
 become narrower and narrower till it ended in a 
 point again, thus — 
 
 and probably^ the action of life on such a planet 
 would be continuous, and not intermittent as on 
 ours, beginning with slight actions, which would 
 become stronger and stronger, till they culminated 
 at the central point in the double cone, after which 
 they would generally diminish, but still in a con- 
 tinuously lessening manner, till they finally ended 
 in a point as they began. 
 
 But however this may be, and to return to our 
 consideration of acute and chronic, when we reflect 
 that chronic diseases are severe enough, or acute 
 enough to kill patients, we seem to realise better 
 the confusion which exists in our minds in thinking 
 about them. Chronic being, then, the opposite, 
 not of acute, but of short or brief, we can define a 
 short, or brief, or brachy-chronic disease {vov(To<i 
 fipa)(yxpo^i^o^> or morbus brevis), as one lasting, I 
 would suggest, not longer than three months. If 
 it lasted longer than this, it would be chronic 
 (vovcros ^6vL0<i, or Trokxxxpovio's, or jxaKpb^s, morbus 
 longus or chronicus). Then a rather short disease 
 (i/ov<Tos ^pa)(y)(f>ovL(oTepa, or morbus brevior) would 
 be defined as one lasting 14 days or so ; while a very 
 
98 
 
 short disease {vov(ro<; ^paxyxpovLtoTara, or morbus 
 brevissimus), would be one which lasted from two 
 to seven days. A disease lasting one day has often 
 been termed ephemeral (j/ovcro? i^rjixepios, or morbus 
 dturnus). Diseases which recurred, on the other 
 hand, at daily intervals, or at intervals of two or of 
 three days, were called, respectively, quotidian, 
 tertian, and quartan diseases. In the opinion of 
 Asclepiades of Prusa, the differences in the length 
 of the duration of these last diseases were determined 
 by differences in the sizes of the oy/cot, or unci, 
 or hooked atoms co-existing with them, a doctrine 
 which, as has been said, may be considered anticipa- 
 tory 1800 years ago, of the germ theory of disease, 
 of which we have heard so much of late years. 
 
 Acute or severe diseases {vovaoi 6^el<s, or morbi 
 acuti), on the other hand, may be defined as those 
 in which the pulse-rate reaches, say, 120 or 130 a 
 minute, and the temperature, say 102*5° to 104° F. 
 
 Peracute diseases (vovcroL o^vrdrai or vTrepo$ei<;, 
 or morbi per acuti), are those in which the pulse 
 reaches 130 a minute or over, and the temperature 
 is over 104° F. (Sometimes the temperature does 
 not rise in these diseases, being kept down by 
 failure or inability of the body to react, or by too 
 great shock.) In mild diseases {yovcroi Trpaets, or 
 morbi mites or lenti), the pulse is not more rapid 
 than about 100 a minute, and the temperature not 
 above 99-5° or 100° F. 
 
 Acuteness of disease, therefore, depending on 
 its severity and not on the length of its duration, 
 
99 
 
 its opposite is mildness, not length of duration. 
 And a subdivision might be made, and often is 
 made, between acute and mild diseases, of the 
 subacute diseases (vovo-ol vno^eis, or morbi 
 subacuti), in which the pulse-rate will be about 110 
 to 120, and the temperature between 100° and 102° 
 F., or so. 
 
 Diseases which are severe, or acute, or per- 
 acute, are generally also short, because the human 
 body cannot bear very severe suffering for any 
 great length of time without either relief or death ; 
 and this has no doubt been the chief determining 
 consideration which has led in men's minds to the 
 confusion in classification into the acute and chronic 
 diseases. I said that Hippocrates was much clearer 
 in his ideas on this subject, and in his use of 
 language regarding it, than was his successor 
 Asclepiades of Prusa ; and this is true. But even 
 Hippocrates was not always quite clear on the 
 point, and in one of his aphorisms, he says, that 
 acute diseases can be judged or determined (by the 
 observer) in fourteen days — a most unfortunate 
 expression, as it happens, since it has been supposed 
 to mean that he defined acute diseases as those that 
 last fourteen days, so justifying that confusion 
 between severity and length of duration in diseases 
 which has obtained for so long a time. The words 
 of Hippocrates are, ra o^ea raiv vocnqfidTOiv iv 
 TecrcrapecTKaLSeKa rjfjLepyjo-Lv KpiveTai. Here a good 
 deal may turn on the meaning we attach to the 
 word KpLverai. It seems, however, clear that 
 
 G2 
 
100 
 
 what Hippocrates did mean was, not that acute 
 diseases were those that last fourteen days, but 
 this, that in fourteen days the observer will 
 generally be able to determine what sort of disease 
 his patient is suffering from, and what the issue is 
 likely to be ; whether the illness is likely to be 
 long or short, and also whether it is likely to be 
 fatal or otherwise. These propositions are true 
 enough ; and, in fact, we can usually form opinions 
 on these points before even fourteen days have 
 elapsed from the commencement of the illness we 
 may be treating. But while we must admit that 
 Hippocrates was not always quite clear in his 
 language regarding acute and mild diseases on 
 the one hand, nor as to short and long ones on the 
 other (see, for instance, a passage in Trepl Kpia-luiv, 
 where he says that diseases Kplvovrai up till the 
 sixtieth day, after which they become chronic), 
 his confusion was never so dark as that of the 
 so-called reformer who came after him, and who 
 misled his successors in turn. The remarks made, 
 and the descriptions suggested for mild and acute, 
 and lon^ and short conditions will, it is hoped, show 
 how a disease may, in its course, be now acute, and 
 then mild, and again sub -acute, and that these 
 conditions have no necessary connection with the 
 length of its duration ; and they will, I hope, 
 therefore, have proved that the division of diseases 
 into acute and chronic is not a logical one, and that 
 it ought, therefore, to be superseded by one more 
 in accordance with the order of nature. 
 
101 
 
 I hope to be able to adduce evidence which 
 offers a reasonable amount of proof for the correct- 
 ness of the view I put forward that wrong feeding 
 is the chief or paramount cause of disease, both 
 acute or mild on the one hand, and chronic or brief 
 on the other. This evidence should be capable of 
 receiving corroboration in three directions. First, 
 it is easy to shew that all diseases are most easily 
 treated by alteration of the diet. This statement 
 will hardly be disputed. By common consent it is 
 true, and common practice bears it out. In fact, 
 alteration of the diet, and almost always, or at 
 least very frequently, restriction of the diet, is 
 nature's method of cure. Certainly in all acute 
 diseases this is so much the case that restriction of 
 the diet, and often, indeed, entire abstinence from 
 food, is the treatment adopted by nature. In these 
 diseases she flings the patient into bed with a furred 
 tongue, or dry and brown tongue and mouth, with 
 complete inability to take any food, and very often 
 also complete refusal to take it, or to digest and 
 assimilate it, if, in spite of her clear indications, it 
 is taken. Second, it can be shewn in most cases 
 that, this disinclination to take food persisting for a 
 time, the patient recovers, and remains well so long 
 as he continues to take proper quantities of food at 
 proper times. Thirdly, it will be shewn in so many 
 cases as to raise a reasonable presumption that it is 
 the rule in the body, that disease is re-induced in 
 those cases in which return is made again to those 
 methods of feeding which made the patient ill 
 
102 
 
 before. I do not myself believe that the fevers 
 which are generally supposed to be caused by bad 
 or vitiated air ofter any exception to this statement. 
 I think that the chief predisposing cause of them, 
 as, e.g., of measles, scarlatina, diphtheria, typhoid 
 fever, influenza, and the rest, is improper feeding, and 
 chiefly over-feeding. It is true that it is difficult 
 to shew this in the case of the continued fevers, 
 because, as a rule, these diseases occur only once in 
 life. Although they seem to me to occur offcener 
 than once in life, more frequently than is commonly 
 believed — how often do we find patients having 
 more than one attack of measles or scarlet fever 
 (scarlatina), for instance — I admit that recurrence 
 is exceptional, and that as a rule they occur only 
 once. This is not true, however, of influenza, which 
 is properly classed among the fevers. The definition 
 which I should ofler of the zymotic diseases (^u/aog>, 
 = I leaven or make to ferment), or of the fevers 
 (ferveo — I burn) is that they are febrile diseases 
 known or believed to be associated with the 
 presence and growth of micro-organisms in the 
 blood or tissues of the body. Inflammations, on 
 the other hand (flamma — a flame), might be 
 defined as febrile diseases not known to be associated 
 with the presence and growth of such micro- 
 organisms. Some inflammations, it is true, are 
 believed to be associated, or are suspected to be 
 associated, with the presence and growth of micro- 
 organisms in the body. Some forms of pneumonia, 
 for instance, or inflammation of the lungs, are 
 
103 
 
 now known to be so associated ; while lately, as 
 regards acute rheumatism, or rheumatic fever, as it 
 is more frequently called, the same suggestion has 
 been made, or the same suspicion entertained. 
 Such inflammations are often termed specific 
 inflammations, and of them it may be said that 
 medical opinion is tending towards including and 
 classifying them among the fevers. But at present 
 we may say that the specific inflammations form a 
 group of diseases between the fevers and the simple 
 inflammations. As regards these last diseases, 
 indeed, the simple inflammations, I should not be 
 greatly surprised if it should be found before long, 
 as the knowledge of the life history of the 
 numerous micro-organisms becomes more thoroughly 
 known, that more and more of the inflammations 
 will be found to be associated with the growth in 
 the body of some forms of micro-organisms. In 
 this case the distinction between the fevers and the 
 inflammations would tend to become obHterated. 
 Up to the present time, however, this association of 
 the growth of micro-organisms has not been shewn 
 in the case of the simple inflammations, such, for 
 instance, as bronchitis, simple broncho-pneumonia, 
 or in such afiections as inflammation of the heart, 
 stomach, liver or kidneys, and, therefore, the 
 distinction between the fevers and the inflamma- 
 tions still holds good. And further, the clinical 
 distinction between the fevers and the inflammations, 
 that the former appear only once in life while the 
 latter may and often do occur again and again, 
 
104 
 
 holds true in the main. It is, therefore, very 
 diflficult to prove the third part of our argument in 
 the case of the fevers, viz., that a recurrence to 
 those modes of feeding which induced them at first 
 will re-induce them. In the case of influenza, 
 however, this difficulty does not occur. Influenza 
 belongs to the fevers, because the micro-organism 
 associated with its occurrence in the body, has been 
 cultivated and developed again and again. I have 
 no doubt at all that the chief predisposing cause of 
 influenza is wrong feeding and too frequent feeding ; 
 and the kind of evidence which I ofier for the 
 holding of this opinion is represented by cases like 
 the following. A man about 38 years of age 
 consulted me for frequently recurring attacks of 
 broncho-pneumonia, or severe feverish colds, as they 
 are popularly termed, and mentioned also that he 
 had had influenza in three consecutive years. He 
 ofiered to go to South Africa or anywhere where I 
 might think he would have a better chance of 
 living a healthy life, if only he could be rid of his 
 crippling attacks of illness. I told him that he 
 might go to South Africa if he liked, but that, in 
 my opinion, he could get well in Bradford if he 
 would take a little trouble. Further, I said that if 
 he did go to South Africa, and if he got rid of his 
 severe and recurring colds there, and if he did not 
 in the meantime alter his ways, and particularly his 
 food habits (there was no suggestion of alcoholism 
 in the case, the man being, if not a teetotaller, very 
 temperate), the colds would infallibly be replaced 
 
105 
 
 by some other form of illness, rheumatism, e.g.^ or 
 gout, or perhaps by the onset of some disease 
 generally attributed to the South African climate. 
 In short, I told him that it mattered far less where 
 he lived than hoiso. I advised him to cut down his 
 food, which he evidently was not assimilatiug, and 
 in particular to take two meals daily in place of 
 three, and I suggested that he should diminish his 
 bread. The effect of these changes has been most 
 beneficial. After one other broncho - pneumonic 
 attack, whose effect was most salutary to him, as it 
 helped to rid his body of the accumulation of effete 
 and unassimilated stuff which was stored up within 
 it, he has remained now free of his old ' ' colds " for 
 about four years ; and he has not had influenza 
 since. As these advantages were confidently pre- 
 dicted to him as consequences which would ensue 
 on the alteration of his food habits, and as they 
 have accrued to him accordingly on his effecting 
 that alteration, I have no doubt that his colds and 
 his influenzas were dependent on the wrong feeding 
 to which he used to be subject. If this is so, we 
 have a recurring inflammation, and also a fever, put 
 an end to by alteration of the diet, and particularly 
 by restriction of the diet. If the man has any 
 doubt of the sequence of cause and effect in the 
 case, he has only to return to his former way of 
 living ; which, if he did, I have no doubt that in a 
 few weeks he would get another attack of broncho- 
 pneumonia, and, no doubt, after some time longer, 
 would again find himself suffering from influenza. 
 
106 
 
 But I do not recommend that this experiment 
 should be made, although I have no doubt (neither 
 has my patient, to whom the whole matter has been 
 a great surprise) what the result would be if it 
 were. The same experience occurred to me in 
 treating a patient who had suffered for many years 
 from a succession of bronchitic and asthmatic 
 attacks. He had lived in the West Indies for some 
 years, some thirty years before the time to which I 
 am now referring. While there he had suffered 
 greatly from malarial fever, ' ' fever and ague, " as 
 it was termed there, and so profoundly had his 
 organism become modified that he never took one 
 of his many and continually recurring colds without 
 suffering also from an attack of ague. Being 
 advised to restrict his diet in order to get rid of 
 his bronchitis and asthma, and having done as he 
 was advised, he made a complete recovery, not only 
 from the bronchitis and asthma, but also from 
 chronic rheumatism, from which he used to suffer, 
 as well as recurring attacks of herpes, or watery 
 blisters, on his lips, mouth and tongue. And, still 
 further, to the surprise both of the doctor and of 
 the patient, he has not now had an attack of ague 
 for over ten years. It really does seem marvellous 
 that so marked and so gratifying a result as this 
 could occur after about fifty years of age, and after 
 the body had suffered for so long a time as thirty 
 years ; but so it was. That patient would be very 
 ill-advised if he were to carry scepticism as to 
 whether his recovery depended on the treatment, so 
 
107 
 
 far as to have recourse again to the mode of feeding 
 which made him so ill before. Nevertheless, if he 
 were to do so, I have no doubt that he would soon 
 again begin to suffer from herpes of the lips, from 
 rheumatism, from bronchitis and asthma, and, by 
 and bye, even from recurring ague. But as malarial 
 fever and ague is technically a fever, here is another 
 case in which an alteration of the food habits and 
 restriction of the diet have cured and prevented 
 the recurrence both of inflammations and of fever. 
 
 I can imagine some reader here saying to 
 himself, why was not quinine administered to 
 this patient "to break the periodicity of his 
 attacks ? " It is well known, I hear him mentally 
 adding, that quinine is specific, and a sovereign 
 remedy in intermittent fever. Alas for the 
 suggestion — quinine was administered, and that in 
 large doses. Often had he been cinchonised while 
 in the West Indies by the quinine which he took. 
 On one occasion he took 120 grains of quinine in 
 three weeks, but without any noticeable effect on 
 his intermittent fever. Then he was recommended 
 to take arsenic, which did him good for a time, but 
 the attacks recurred, because the causes of the 
 attacks, viz., improper feeding, continued to act. 
 It is easy to see this now, but no one had the ghost 
 of an idea of it then. It had never occurred to 
 anyone interested in the case that food had 
 anything to do with it, and the illness was 
 attributed wholly to the West Indian climate. 
 Nevertheless, it is plain now, on looking back, that 
 
108 
 
 it had everything to do with it, and that a cause 
 acting constantly, or at least at very short intervals 
 of time (three or four or more times a day), shewed 
 its effects in intermittent or periodic attacks of ague, 
 separated from one another by longer intervals of 
 time. This is in perfect accordance with the law 
 elsewhere stated that constant causes acting on the 
 economy shew their influence, not in constant, but in 
 periodic effects. If the reader is interested in this 
 case, I will mention one or two other incidents in it. 
 After quinine had failed to improve the patient at 
 all, and when, notwithstanding the administration 
 of arsenic, the attacks still recurred, much benefit 
 was obtained by an early morning shower-bath, 
 given in the primitive way of emptying a large 
 calabash full of water, left in the open air all night, 
 over the head and shoulders and back of the 
 patient. It was guilelessly believed that the water 
 was more efficacious for having been left out 
 all night ; but obviously it was the cold shower 
 bath which did the good, and a bath fitted up in 
 the house, if there had been a bath-room in the 
 house, would have had the same or more effect. 
 By and bye, however, this also lost its effect, and 
 the malarial attacks returned, no noticeable and 
 permanent improvement being apparent until the 
 patient left the tropical country for a temperate 
 one. Even then, however, and for 30 years 
 afterwards, an attack of ague came on again with 
 every cold. The only question remaining on one's 
 mind now in respect of this case is the following : — 
 
109 
 
 Would, it may be asked, a change of diet in the 
 tropical country itself, given moderately sanitary 
 conditions present, would such a change of diet, 
 say two meals a day, to an extent of not more than 
 12 ozs. a day, without a change of climate, have 
 cured the patient ? For my part, I believe it 
 would. Opinions will differ about this. It is a 
 hypothetical question which can never be translated 
 into terms of actual experiment for the given case, 
 although there are no doubt now many thousands of 
 similar cases going on among Europeans living in 
 tropical countries, to whom such a narrative may be 
 of the very greatest interest. If my opinion is 
 sound, they might save themselves much suffering, 
 much trouble, and much money. The development 
 of rheumatism, bronchitis, and asthma, in the 
 temperate climate, shewed how superficial was the 
 change that relieved the patient (though it did not 
 cure him) of the recurring malarial attacks, and 
 shews also, to all who wish to see it, that the chief 
 cause of all the ailments, tropical and temperate, was 
 improper feeding. I, at least, have no doubt that 
 this man ate his diseases, that he ate his malaria, 
 his rheumatism, his bronchitis, and his asthma, of 
 all of which, even after 50 years of age (that is the 
 surprising thing) he was able to get rid on 
 changing his diet. No doubt he was bitten by 
 mosquitoes, but the question is, would their bites 
 have done him much harm if he had been properly 
 fed ? And at any rate they did not bite him for 
 the 30 years after he left the tropics, and yet he 
 
110 
 
 continued to have malaria for that length of time, 
 and I do not doubt would have gone on having it 
 still (if he had lived) if he had not altered his diet. 
 Neither have I the slightest doubt that the other 
 patient got rid of his broncho-pneumonias and his 
 influenzas by the same means. 
 
 In the usual case, when one of the continued 
 fevers is taken, scarlet fever, for instance, which 
 does not as a rule occur more than once in life, it is 
 difficult, as I have said, to see the effects of the 
 continuance of long acting causes, like prolonged 
 improper feeding. What usually happens is, either 
 that some inflammation, or an attack of some other 
 fever, follows as the effect of long acting or of the 
 frequently repeated causes. The person who has 
 had scarlet fever before does not, as a rule, take 
 scarlet fever again (he does so sometimes, however), 
 but he has, say, an attack of diphtheria, or of 
 measles, perhaps, or typhoid fever, or perhaps a 
 severe " feverish cold " ; and so the causal nexus is 
 not seen. As the disease is called by a difierent 
 name in each case, and as, further, it is attributed 
 to such exciting causes as infection, exposure to 
 cold, damp, fatigue, &c., the connection of each 
 attack with the predisposing cause of improper 
 feeding, and with the bad, unresisting state of body 
 so induced, is not seen, or is overlooked. Yet all 
 the while, the occurrence of the severe feverish cold, 
 or of the measles, or of the broncho-pneumonia, 
 was, or might have been, as much the efiect of 
 long-continued improper feeding, as the original 
 
Ill 
 
 attack of scarlatina, or other so-called infectious 
 fever was. 
 
 As was said in the last chapter, it is commonly 
 
 beHeved that the fevers are caused, not by improper 
 
 feeding, but by breathing bad or vitiated air ; and 
 
 on this doctrine the whole of the modern practice 
 
 regarding the prevention of the fevers has been 
 
 based. Having suggested before that I was not 
 
 altogether satisfied with the truth of this doctrine, 
 
 I now proceed to give some more of the reasons 
 
 which lead me to disbelieve in its correctness. 
 
 Attention to air and to supplying an abundance of 
 
 pure air is an excellent measure, and has had a 
 
 great influence in preventing the incidence of fevers, 
 
 as it has had also in limiting their spread. In 
 
 point of fact, it has diminished fevers by from 40 to 
 
 50 per cent, in the last forty or fifty years. But if 
 
 bad air had been the whole of the cause, or the 
 
 main part of the cause, of fevers, supplying good 
 
 air would probably have diminished fevers by more 
 
 than 40 or 50 per cent. When, for instance, the 
 
 chief cause of bronchitis is known and is eliminated 
 
 (except, of course, in those cases where organic 
 
 change has gone so far as to have rendered recovery 
 
 impossible), not only is the bronchitis cured, but 
 
 its recurrence is prevented. If we had been acting 
 
 on the whole of the cause of fevers we ought to 
 
 have diminished them by 80 or 90 per cent. 
 
 Besides this, under a free supply of good air, 
 
 influenza (which is a fever, for the micro-organism 
 
 associated with it is known and cultivated) has come 
 
112 
 
 among the English people, and has annually attacked 
 them since 1890 or so. It is plain, therefore, that 
 bad air is not the main cause of influenza, although 
 it may be a contributory cause, and that of an 
 important character. Another reason for thinking 
 that bad air has had too much importance attached 
 to it as a cause of fevers is that during the past ten 
 years no appreciable diminution in the incidence or 
 mortality from fevers has been effected in England 
 and Wales. This statement may appear ex- 
 travagant to those who have had in their minds 
 only the great reduction which has taken place in 
 the incidence and mortality from the infectious 
 fevers or the zymotic diseases during the last two 
 generations. The following facts, therefore, on 
 which this statement is made, will be of interest. 
 In the five years, 1876-80, the death rate from 
 zymotic disease in England and Wales was 3*823 
 per 1000; in 1881-5 it was 2*804 per 1000; in 
 1886-90 it was 2*502 per 1000 ; in 1891-5 it was 
 2*747 per 1000 ; and in 1896-99 it was 2*678 per 
 1000. It will be seen that the zymotic mortality 
 was less in 1886-90, before influenza appeared, than 
 it was in 1891-5 or 1896-99. About the time of 
 the Crimean War, the death rate from the zymotic 
 diseases was about 5*240 per 1000 per annum. 
 Since that time the fall has been very marked ; 
 but in the last ten years there has been a slight 
 increase instead of a diminution. It seems as if we 
 had exhausted the benefit in this respect which we 
 are likely to get from improved sanitation, so far, 
 
113 
 
 that is, as improved air is concerned. In 1890 
 influenza caused 4523 deaths in England and 
 Wales; in 1891, 16,686; and in 1895, 12,880 
 deaths. In 1896-7-8-9 and 1900 the numbers were 
 3753, 6088, 10,405, 12,417, and 16,245, respectively. 
 In attempting, therefore, to come to a con- 
 clusion regarding the causes of the fevers or 
 zymotic diseases, these three reasons make us 
 hesitate to accept the prevailing opinion that 
 breathing bad or vitiated air is the most important. 
 (1) The reduction of fever has only been from 
 about 40 to 50 per cent, in about 50 years ; (2) 
 during the last ten years there has been no 
 reduction in the mortality from fevers at all ; and 
 (3) during the last ten years influenza has come, 
 apparently to stay. No intermission has taken 
 place in our sanitary efforts during that period. 
 On the contrary, our sanitary authorities are 
 carrying out, with the loyal co-operation of the 
 people, and even, it may be said, under instruc- 
 tions from them, vast sanitary works, whose 
 total cost must be little, if at all, short of the 
 amount of the National Debt of this country. 
 The results are not satisfactory — certainly not so 
 satisfactory as they ought to be ; and my suggestion 
 is, Has not a main part of the cause of these 
 epidemic diseases been overlooked ? I suggest that 
 this is so, and that what has been overlooked is the 
 increased frequency of meals, which is so character- 
 istic of our time. The three meals a day which 
 used to be sufficient for us are no longer so. Even 
 
 H 
 
114 
 
 our paupers, breakfasting at 8-0 or 8-30, have a 
 lunch of bread and cheese, men and women aUke, at 
 10-30 or 11 a.m., and dine at 12-30. It is quite 
 impossible that the food taken at 8-0 a.m. can be 
 digested at 10-30 or 11-0; and it is equally 
 impossible that that taken at 10-30 can be digested 
 at 12-30 or 1-0 p.m. There is no time for it. Even 
 when breakfast is taken at 8-0, digestion is so slow 
 in many cases that the food is not digested — 
 frequently it has not left the stomach — at 12-30 
 or 1-0. But even if this is not very frequently the 
 case, and if, therefore, it is reasonable to take a 
 second meal four or four-and-a-half hours after the 
 first, it is quite certain that food taken at 10-30 is 
 not digested at 12-30 or 1-0. There is no time for 
 it to be so. Nothing, therefore, could be less wise, 
 physiologically, than the interpolation of this super- 
 numerary meal, and the interpolation is a very 
 striking instance of carrying out into practice the 
 unsound doctrines which are current on this subject 
 at the present time. One wonders where the 
 physiological advisers of the Local Government 
 Board were, or what they were thinking about, 
 when this course was adopted at the public expense. 
 The same course in principle has been followed in 
 arranging the diet of our sailors in the Navy, 
 although there is no proof that they were under-fed 
 or too seldom fed before. One must only hope that 
 their fighting powers will not be impaired by the 
 new regime, and that there will be no more sickness 
 among them than before. The experience of the 
 
115 
 
 Boer War in South Africa was to the effect that our 
 men, after having a cup of coffee and a biscuit 
 about four in the morning, marched or rode there- 
 after till about four in the afternoon, when they 
 halted and had a meal, that completing the tale of 
 their food for 24 hours, and that on this diet they 
 were active and well. These men were in the early 
 flush of life and activity, and were also doing 
 active work. If they could thrive on these food 
 arrangements, how unnecessary must it be con- 
 sidered to allow more numerous meals to paupers 
 leading for the most part an inactive or little active 
 life. It is no reproach to the paupers that they 
 should be inactive at the age which many of them 
 have reached, but still it must be remembered that 
 in inactivity less food is required than when persons 
 are younger and performing more active duties. 
 The experience of the Boman soldiers, who were 
 called upon to do anything and to go anywhere, was 
 very similar to that of our men in South Africa, for 
 de Quincey tells us that they ate once a day. The 
 habit of taking food once a day must have been a 
 recognised one among some of the population of 
 imperial Home, for we find Celsus recommending, in 
 the second century of the Christian era, the taking 
 of two meals rather than one. '^ Bis die potius/' 
 he says, " quam seniel cihum caper e." Still we 
 should hardly be justified in inferring that it 
 was anything like a universal custom in imperial 
 Rome to eat once a day, or even twice, for we find 
 from Athenaeus, perhaps 50-100 years after the time 
 
 H2 
 
116 
 
 of Celsus, that the custom had quietly altered, aud 
 that it had become usual to take, as we are doing 
 now, four or five meals a day. These were named 
 oLKpaTia-fia (early breakfast), apicrrov (perhaps similar 
 to what we call lunch, although the term is often 
 applied to breakfast), icnrepLa-fxa (an afternoon 
 meal), and SeuTrvov (supper). Under the influence 
 of the spread of wealth, just as is happening in 
 this country now (it is not, it seems to me, the 
 poverty of England, it is its wealth which is our 
 danger — it is, I mean, the foolish use we are making 
 of our wealth and its bad distribution), food customs 
 gradually altered in the ancient world. The time 
 had long gone by, and, more important still, the 
 human outlook had greatly altered since the time 
 when, about 500 years before Christ, Hippocrates 
 describes the practice of what was then the Ancient 
 Medicine, and in reference to which he gives his 
 own personal opinion that it is immaterial whether 
 a man eats once a day or twice. We seem to have 
 it suggested to us that at that time it was a 
 common custom to do either one or the other. In 
 other places in his writings, it is true, Hippocrates 
 refers to customs involving the taking of more 
 frequent meals, so that there was evidently no fixed 
 rule among the Greek peoples among whom he 
 practised. It is, however, interesting to note that 
 those among ourselves who have been so profoundly 
 shocked by the suggestion recently resuscitated 
 among us, that it is often wise to abstain from the 
 meal called breakfast (or rather postpone it, for that 
 
117 
 
 is the meaning of taking the first meal at 12 or one 
 o'clock — it is a postponement, not an omission of 
 the breaking-of-the-fast), might, if they chose to 
 think or to read a little, find that many thousands 
 of the inhabitants of this planet have lived long 
 and happily and usefully on even one meal a day, 
 as well as on two. A piece of advice offered by 
 Hippocrates to his countrymen, some time before 
 they successfully opposed the Persian invasion of 
 Greece by Xerxes, was to the effect that, if a man 
 found himself not very well, he should abstain from 
 breakfast, at least if the weather was hot. At this 
 season, the physiological instinct of the physician 
 told him from his clinical experience, although he 
 had no chemical ideas to guide him, chemistry up 
 to that time being only an alchemist's dream, that 
 a man required less food then than he did in cold 
 weather. Let the man, says Hippocrates, go 
 without his breakfast (dvaptaTos fikv Stayero)), if it 
 is summer time. 
 
 It is no part of the physician's duty to 
 trench on the sphere of the moralist or spiritual 
 adviser; but if a proper view of the processes 
 of nature is taken by each in his own sphere, 
 it is remarkable how similar is its course seen 
 to be in all departments ; and it is impossible 
 to avoid being struck by the observation that, as 
 great and numerous banquets and other forms of 
 sensuous indulgence have become prominent, so 
 have the nations pursuing that course of conduct 
 decayed. What has happened before will certainly 
 
118 
 
 occur again ; and any nation which pursues 
 pleasure, wealth, and sensual gratification too 
 keenly, will certainly begin to decay and perish. 
 In this respect, as in every other, moderation is the 
 only fixed and the only unfailing rule. If the 
 Roman habit came to be to take jeiitaculum, 
 prandium, and coenam, breakfast, dinner, and supper, 
 as we now call them, we know that at former times, 
 as Celsus hints to us, the Komans lived on fewer 
 meals than three ; and, unfortunately, we also know 
 that, as wealth increased among them, so did 
 luxury, and that luxury translated itself among 
 them as one of its forms into the taking of more 
 and more meals, of a more and more elaborate sort, 
 and that the habits accompanying this mode of 
 living coincided in the most marked manner with 
 national decay. It has often seemed as if a very 
 striking parallel might be drawn between the 
 Rome of, say, 200 to 350 A.D., and the London of 
 to-day. " Rome," says Athenaeus, writing prob- 
 ably about 250 A.D., "may fairly be called the 
 nation of the world. And he will not be far out 
 who pronounces the city of the Romans an 
 epitome of the whole earth ; for in it you may see 
 every other city arranged collectively, and many 
 also separately; for instance, there you may see 
 the golden city of the Alexandrians, the beautiful 
 metropolis of Antioch, the surpassing beauty of 
 Nicomadia, and besides all these, that most 
 glorious of all the cities which Jupiter has ever 
 displayed, I mean Athens. And not only one 
 
119 
 
 day, but all the days in an entire year, would be 
 too short for a man who should attempt to 
 enumerate all the cities which might be enumerated 
 as discernible in that uranopolis of the Bomans, 
 the city of Rome, so numerous are they. For, 
 indeed, some entire nations are settled there, 
 as the Cappadocians, the Scythians, the people of 
 Pontus, and many others." How can one fail to 
 be struck by the similarity between the state of 
 things here described as obtaining in Bome at that 
 time, and that obtaining in London to-day ? 
 Substitute modern cities arranged collectively and 
 separately for the ancient ones named by 
 Athenaeus ; substitute the thousands of Frenchmen 
 in London from gay and volatile Paris, the 
 thousands of Italians from ancient and stately 
 Bome, the thousands of Germans, harsh of speech 
 and full of enterprise, from our neighbouring 
 Teutonic land, and we have a picture of the 
 uranopolis of London very like the uranopolis of 
 ancient Bome. And if we add to the picture the 
 Jews in England, probably not less numerous than 
 the whole of the race resident in Palestine in her 
 most palmy days, and picture, besides, the 
 representatives of Australia, Canada, and New 
 Zealand, the refined and subtle Indian, and the 
 patient and artistic Chinese, not to speak of 
 representatives of the still uncivilised South African 
 peoples, our imagination must be poor and 
 unmovable indeed if we do not see a likeness 
 between ancient Bome and the modern commercial 
 
120 
 
 capital of the world. And if, in spite of ourselves, 
 we proceed to inquire whether the causes that 
 subverted the one are not again in action, tending 
 to dethrone the other, and if we feel ourselves 
 compelled to reflect that even in despite of 
 Christianity, the absence of slavery, at least in 
 name, and the existence of free political institutions ; 
 the spread of luxury and the unrestrained worship 
 of wealth and pleasure are becoming very apparent 
 in the London of to-day, we are compelled to pause 
 and consider. There is no doubt plenty of grit in 
 England yet — there are more than seven thousand 
 men who have not bowed the knee to Baal in this 
 matter — but the general tendency towards ex- 
 travagance and luxury, who can fail to be struck by 
 it, or who can refrain from asking to what it may 
 lead ? Panem et Circenses, said the Roman 
 proletariat ; food and amusement for nothing. Are 
 not these parallelled, if faintly, by heavy receipts 
 of gate money at sports, by demands for houses 
 without payment or equivalent contributions in 
 labour, by demands for old age pensions towards 
 which no contributions are to be made by the 
 recipients, the while that charities are languishing 
 for lack of support, while art and literature are 
 being neglected, and education can be recommended 
 and defended only for the commercial advantages 
 which it is expected to bring ? 
 
 The reader may here say to himself: well, but 
 are not visitations of epidemic disease also well 
 known sometimes to be due, not to over-feeding. 
 
121 
 
 but to under-feeding? Not to plethora, but to 
 starvation ? Was not the relapsing fever epidemic 
 in Ireland, in 1848, and the typhus fever that 
 accompanied it, as also the Indian recent epidemic 
 of plague, due to the failure of the potato crop in 
 Ireland, and to the failure of the rice crop in India ? 
 Yes, I admit that they were, but I think that one 
 or two qualifications ought to be made, which I 
 will proceed to do directly. First of all, however, 
 let us note this. I say that moderation is the only 
 fixed and the only unfailing rule of living ; and in 
 the case of food supply to people living in towns, I 
 attempt to more or less define moderation (an 
 indefinable and indefinite thing, of course), as 
 lying between 12 and 24 ozs. of ordinary diet of 
 wholesome quality a day, taken preferably at two 
 meals, eight hours or so apart from one another. 
 I do not consider starvation as moderation. 
 Starvation is as much below moderation as plethora 
 and too frequent eating is above it. Neither is 
 good. Neither, secondly, do I say that starvation 
 cannot cause fever. I think it can, especially if 
 people have been too well fed before. This is the 
 first qualification which I think ought to be made 
 when I admit that starvation also may cause fever. 
 Because, if people were in a quite healthy state 
 before, that is, if they had been moderately fed, 
 neither by too much nor by too little, I believe 
 that the efiects of starvation would be not to cause 
 fever, nor the feverish state, but to slowly wear 
 them down with a slowly progressive diminution of 
 
122 
 
 strength. Fever and feverishness are, I believe, 
 re-actions from this condition, and are due, not so 
 much to the starvation, as to the fact that for a 
 long time previously their bodies and blood had 
 been loaded with waste unassimilated materials 
 derived from an excess of (even wholesome) food. 
 The fever and feverishness are occasioned no 
 doubt by the fasting, but not caused by it. This 
 means, of course, when we come to analyse it, as 
 has been before said, that the starvation is part of 
 the cause of the fever, but that the chief part of 
 the cause is the state that our bodies are in when 
 the fast is compulsorily forced on us. So that I 
 have come to accept the conclusion (I do so for 
 myself, at least, which, if it does not prove my 
 wisdom, proves, at least, my good faith), that if we 
 cannot fast without fever, it is because we have 
 been previously improperly fed ; and in my own 
 case I should accept the verdict, unquestioningly, 
 that it was because for some considerable time 
 previously I had been over -fed. But although 
 admitting in this qualified sense that starvation 
 may cause a visitation even of epidemic disease, 
 this admission does not hinder me from asserting 
 that, as a rule, epidemics are in fact caused far 
 more frequently by over-feeding than by starvation. 
 There is, however, another and a more 
 important qualification which I would make 
 regarding the admission that starvation may cause 
 epidemic disease, and that is this. It seems to me 
 to have been too much overlooked. When crops 
 
123 
 
 fail, so as to cause famine, they seldom fail utterly, 
 but they are short and had. The potato in Ireland, 
 and the rice in India, were not only short, but they 
 were also diseased. I think that shortage and 
 badness of crops may well be admitted to account 
 for the presence of epidemic disease among a people 
 said or thought to be suffering from starvation pure 
 and simple, when mere shortage might not have 
 been sufficient to account for it. 
 
 These are in brief the reasons, or some of them, 
 why I cannot accept or feel satisfied with the 
 prevaihng opinion that bad air is the chief cause of 
 the fevers. I might corroborate this opinion by 
 other well known facts. When a person who is 
 taking too much alcohol makes up his mind to pull 
 up and cease taking it, he frequently suffers very 
 much at first, and for several weeks, after getting 
 on to a better way of living. He institutes a fast 
 from alcohol, and it distresses him greatly. 
 Obviously, his distress is occasioned by his 
 abstinence from alcohol, that is, his abstinence is 
 a part of the cause of his distress, but the chief 
 part of the cause is not the abstinence, but the fact 
 that for a long time previously he was in the habit 
 of taking too much. And if, on account of his 
 distress, which is no doubt real enough, and not at 
 all imaginary, he should throw up his good 
 resolutions, and say that total abstinence did not 
 suit him, he would not only be very unwise, and 
 very unreasonable, but he would in addition be in 
 the perilous way of running the risk of forfeiting 
 
124 
 
 whatever chance he might have had of recovering 
 his health, and of overcoming his bad habits. And 
 so with the person who finds himself sufiering from 
 a fever, due, as he may suppose, to too little food. 
 It is not the fast, but the previous over-feeding, 
 from which he is really suffering, and which is the 
 most potent cause of his attack. The reference to 
 alcohol may perhaps justify my going on to say 
 that while alcohol, in those who take too much of it, 
 may be a cause, and a potent one, of epidemic 
 disease, it seldom accounts for the onset of the 
 Fevers in this country. These affections, measles, 
 scarlatina, diphtheria, chicken pox, &c,, are mainly 
 rife among children, who, as a rule, take no alcohol 
 at all. No doubt, however, epidemics, like 
 influenza, typhus, small pox, &c., which are apt to 
 attack older people, may to some extent be caused 
 by the excess of alcohol in which too many of our 
 grown people indulge. And perhaps I may be 
 pardoned if I add that persons who are advised to 
 restrict their diet in order that they may get rid of 
 ailments from which they may have long suffered, 
 either mild and long - continued ailments, or 
 recurring attacks of a more severe or acute 
 character, not infrequently suffer severely at first, 
 and even for a long time after commencing a better 
 way of living. Their bodies at once begin to 
 eliminate the unassimilated stuff that is in them, a 
 process which is as trying in its way, and brought 
 about quite in the same way as the distress of the 
 alcoholic who becomes a total abstainer. The 
 
125 
 
 over-eater who adopts restriction (a class to which 
 I fear most of us belong, though we do not hke to 
 admit it), finds himself greatly distressed by his 
 new mode of life ; but how very unwise it is of him 
 or her, if, as so many unfortunately do, he makes up 
 his mind that this plan will not suit him, and if, 
 because, for example, he does not sleep for a night 
 or two, or otherwise feels a disagreeable aching 
 void, he throws the whole thing up, and returns to 
 his three-hourly meals, and to heavy and late 
 suppers. We see the folly of this clearly enough in 
 the case of the alcoholic, but the folly of the other 
 person, though quite as great, does not, un- 
 fortunately, strike us so strongly. 
 
126 
 
 CHAPTER V. 
 
 Some observations on the Circulation of the 
 Blood and of the Lymph, as bearing 
 particularly on the question of Food Supply 
 to the body. 
 
 TT7HE circulation of the blood, although so much 
 has been heard of it since it was discovered by 
 Harvey, the physician to King Charles the First 
 (1578-1657), does not appear to me to have received 
 the amount of attention, or, perhaps I should rather 
 say, the sort of attention which it deserves. One's 
 first impulse, no doubt, is to say, offhand, that it 
 has revolutionised the practice of medicine and 
 surgery ; but I do not know that this statement 
 can be truthfully made. Some mechanical improve- 
 ments have no doubt been introduced into surgery, 
 as, eg. J the tying of arteries in various places to 
 cure diseases in the course of these vessels, or the 
 removal or obliteration of veins for diseases of their 
 coats, since the general course of the circulation of 
 the blood has become known ; but the general 
 practice of medicine has scarcely been altered at 
 all, and any changes in it which have been 
 effected have been introduced through considerations 
 independent of our views upon the circulation of 
 
127 
 
 the blood and lymph. It may help us to realise 
 this better if we reflect that hundreds of years 
 before the circulation of the blood and lymph 
 became recognised as an established fact (yes, 
 hundreds of years before — I had almost said 
 thousands of years before — 1400 years, at least), 
 physicians were in the habit of feeling the pulse 
 when they visited their patients. They thought, 
 no doubt, that they were feeling the vein and not 
 the artery, which last they believed to contain air 
 and not blood (although in one passage Galen, who 
 died A.D. 200, seems to say that the artery con- 
 tained blood and not air). The very name artery 
 means air-container {^aer = air), and the ancients 
 believed, so far as their somewhat vague notions can 
 be made out, that the arteries were somehow the 
 finer divisions of the wind-pipe, which they knew 
 to contain air, and which they called arteria 
 aspera, or the rough, hard air-container, so contra- 
 distinguishing it from the ordinary or softer vessels, 
 which they, named veins. This was an easy mistake 
 to make, or, at least, not so unlikely as we might 
 have supposed, because, if we trace the wind-pipe 
 into the lungs, we find it breaking up into branches 
 which we now call bronchi^ and these again into 
 finer and finer ones, which we call bronchia ; and 
 we also find the same division and breaking up 
 characterise the behaviour of the pulmonary artery 
 as it finds its way into the lung-tissue, the finest 
 branches of it accompanying and being somewhat 
 easily mistaken for the finest divisions of the 
 
128 
 
 trachea, bronchi, and bronchia. But although the 
 ancient physicians of Greece and Kome could not be 
 said to know much about the circulation of the 
 blood, that ignorance cannot be said to have 
 mihtated much against their success as practitioners 
 in the treatment of the sick. If we were to ask, 
 indeed, in what respects they were worse practi- 
 tioners than we are to-day, it would be difl&cult to 
 reply satisfactorily. They had, or, at least, the 
 best of them had, a general grasp of their subject, 
 of its theory, and of the consequent art of medicine, 
 which, with all our science, it were much to be 
 wished many of us possessed now. The best of 
 them knew, for instance, and were greatly impressed 
 by the fact, that the body was one organic whole, 
 and that, therefore, its diseases were one ; that 
 they were departures from normal conditions ; that, 
 therefore, it was more or less accidental whether 
 this, that or the other member or part of the 
 body suffered, since its sufferings were almost always 
 local marks of general disorder, or, as we might say 
 now (and as in fact some do say), most local diseases 
 are the local expression of general states ; and that, 
 for their successful treatment, therefore, it is not 
 and cannot be enough to confine our attention and 
 efforts to the organ or part affected, but that if any 
 real or permanent benefit is to be achieved, we must 
 treat the organism as a whole. We may note in 
 this connection what Coelius Aurelianus, writing in 
 the earlier part of the Christian era, said, in 
 discussing what part of the body was at fault when 
 
129 
 
 phrenitis, as he called it, was present. After saying 
 that some said it was the head, others that it 
 was the brain, and others that it was the membranes 
 of the brain, he delivers himself of this reflection, 
 profoundly philosophical as it seems to me, and 
 exemplifying a point of view and a grasp too 
 seldom attained to-day by our too highly scientific 
 practitioners : Nos igitur commtmiter totum corpus 
 
 pati accipimus sedplus pati dicimus caput. 
 
 " I therefore am of opinion that all the parts of the 
 body suffer in common, but that the head suffers 
 most of all." As if he had said, what is profoundly 
 true : ' ' Most local ailments are only local expressions 
 of general states." The specialist is by implication 
 here relegated to his proper place, and is informed, 
 if he has wit enough to read the lesson presented 
 to him, that it is not sufficient to remove an ovarian 
 tumour, e.g., and that if nothing is said at the same 
 time or subsequently as to the causes which induced 
 it, a positive damage may be done to the woman, 
 who may, therefore, while considering herself cured, 
 proceed to manufacture one on the other side, or 
 may find herself in a few years suffering from 
 cancer in the stump of the previous one. Or the 
 child who has tonsils removed, and adenoids cleared 
 away, may and certainly will subsequently suffer 
 from colds, bronchitis, broncho-pneumonia, and the 
 like, and by and bye probably from rheumatism or 
 rheumatic fever, &c., unless at the same time or 
 subsequently to the operation, his mother is advised 
 to treat him differently from the way in which she 
 
130 
 
 treated him before. For, if she does not, a worse 
 thing may happen to him in the future, and so the 
 operation which was intended to benefit may 
 eventuate in damage and not in good. Evidently 
 the same causes which enlarged the tonsils and 
 caused the adenoid growths on the soft palate and 
 nose will, if they are allowed to go on, tend to 
 make the child ill again either in the same or in 
 some other way. Or the middle-aged woman, who 
 has a chronic discharge from her nose, may get it 
 stopped, indeed, by having her nose cauterised by a 
 platinum wire made white hot by the electric 
 current, only to find herself in a few months 
 suffering from cancer of the breast, which, being in 
 turn removed, eventuates in cancer of the liver, for 
 which there is no relief These illustrations are, I 
 may say, by no means imaginary, but are drawn 
 from experience of cases in practice. 
 
 To return now to the question of the cir- 
 culation of the blood, and the influence which its 
 discovery has had on practice, let us listen to this 
 statement of Celsus, the great Latin physician, who 
 wrote and practised in the second century of the 
 Christian era. In his De medicina he makes the 
 following interesting observations. " On the other 
 hand, very often the sun, a bath, exercise, fear, 
 anger, or any other emotion of the mind, 
 accelerates the pulsations {concitat venas\ so that 
 when a physician first comes in, the solicitude of 
 the patient, doubtful and apprehensive respecting 
 what opinion the physician may have of his case, is 
 
131 
 
 of itself sufficient cause to excite the pulse. For 
 this reason it is the part of a skilful physician, not 
 to seize the patient's arm immediately as he enters 
 the chamber, but let him sit down first, with a 
 cheerful countenance, and enquire how he finds 
 himself, and if he seems alarmed, soothe him with 
 some plausible observations ; then he may apply his 
 hand to the body" (feel the pulse). "But how 
 easily might a thousand other incidents excite the 
 veins " (heart's action and pulse) ' ' as well as the 
 sight of a physician ! " (Celsus III., 6). 
 
 This passage is very interesting, and has long 
 been held to be so. It shews us how practically 
 useful a physician might be, even although he did 
 not know the course of the circulation of the blood, 
 and had no proper appreciation of its facts and of 
 its meanings ; and it brings conspicuously before us 
 the fact that the ancient physician, hundreds of 
 years before the discovery of the circulation 
 of blood, still felt his patient's pulse in order to 
 judge of the condition he was in, and knew, 
 further, that the state of the pulse might be 
 affected by many things and circumstances, for 
 which, therefore, due allowance had to be made, if 
 he wished to properly appreciate his patient's state. 
 Galen's views on the pulse are also well known. 
 
 The mediaeval physician, as well as the ancient 
 one, also felt the patient's pulse, but on the whole 
 a more metaphysical attitude of mind characterised 
 him than that found in his more ancient 
 predecessor. The reader may perhaps pardon a 
 
 12 
 
132 
 
 short digression, although I have no wish to make 
 this a historical essay on medicine. But by intro- 
 ducing a few words regarding Dante's physiological 
 ideas, we can, I think, perceive both the strength 
 and the weakness of the mediaeval mind. In the 
 Vita nuova the following interesting passage occurs. 
 When at about the end of his ninth year Dante first 
 saw his Beatrice, at about the beginning of her ninth 
 year, after describing her dress, which was of a 
 most noble colour, a subdued and goodly crimson, 
 he goes on to say — and this shews us by implication 
 and also in fact, the physiology of the fourteenth 
 century of the Christian era — " At that moment, 
 I say most truly, that the spirit of life, which hath 
 its dwelling in the secretest chamber of the heart, 
 began to tremble so violently, the least pulses of my 
 body shook therewith ; and in trembling it said 
 these words : Ecce deus fortior me qui veniens 
 dominahitur mihi} At that moment the animate 
 spirit, which dwelleth in the lofty chamber whither 
 all the senses carry their perceptions, was filled 
 with wonder, and, speaking more especially unto 
 the spirits of the eyes, said these words : Apparuit 
 jam beatitudo vestra} At that moment the 
 natural spirit, which dweUeth there where our 
 nourishment is administered, began to weep, and, 
 in weeping, said these words : Hen 7niser ! quia 
 frequenter impeditus ero deinceps. "^ 
 
 1. Here is a deity stronger than I ; who, coming, shall rule over me. 
 
 2. Your beatitude hath now been made manifest unto you. 
 
 3. Woe is me ! for that often I shall be disturbed from this time forth. 
 
133 
 
 Now these three spirits, the spirit of life 
 associated with the circulation ; the spirit of the 
 anima, or the animate spirit, associated with the 
 brain and nervous system; and the natural (or 
 regetative or animal) spirit, associated with the 
 digestive system — these three spirits formed one 
 threefold chain among many threefold chains to be 
 found in Dante's poems ; and what perhaps strikes 
 us most forcibly about them to-day is that they 
 were metaphysical or philosophical in character, 
 rather than scientific, although in this last 
 connection each different spirit was associated with 
 a different physical part and structure in the body. 
 And we are also, I think, struck by the reflection 
 that there seems to be an unnecessary number 
 or multiplication of them. But let not the 
 modern thinker too hastily imagine that he has 
 advanced so very far in comparison with Dante's 
 conception; for although to a great extent he has 
 chosen to give these mediaeval notions the go-bye, 
 or to ignore them, he has not got rid of, and he cannot 
 get rid of the fundamental conceptions underlying 
 them, seeing that he, too, speaks of life, and vitality, 
 and vital principle, and digestive power, and of 
 mind and soul. Without espousing any view, or 
 doing more than indicating the one which appears 
 to me to be the most reasonable and the most 
 comprehensive, I should just like to set down here 
 once for all, and shortly, the three or four lines of 
 thought which the human mind tends to pursue in 
 dealing with structure and function. Plainly they 
 
134 
 
 vary together. When structure is sound, function 
 is healthy, and when unsound, unhealthy. Hence 
 the view generally adopted by modern science that 
 structure determines function, that, for example, 
 the structure of the liver determines the secretion 
 of bile. From this to the view that environment 
 determines organisation, and even that matter 
 determines mind, that the thing determines the 
 thought, there is no long step. But, obviously, 
 there is no more warrant for this view than there is 
 for the other one that function determines 
 structure, that organisation determines environment, 
 that mind determines matter, and that the thought 
 determines the thing. This is the second view, 
 held by some philosophers, who find themselves in 
 disagreement, not, indeed, with the material results 
 of science, but with her logic. Obviously, as 
 function and structure vary simultaneously, and 
 co-ordinately, it does not matter, as far as physical 
 results are concerned, which view we adopt. Then 
 there is a third view, that the thought is the thing. 
 And indeed there is more to be said for this view 
 than perhaps appears at first sight. For if it is 
 impossible for us to know what a thing may be in 
 itself, so to say, and out of all relations to other 
 things and to other intelligences, to us our thought 
 of a thing is the thing itself. What we think it to 
 be, that it is to us for the moment. The first 
 explanation of things is material ; the second is 
 idealistic ; the third is pantheistic, or may be 
 thought to lead to pantheism. And there is a 
 
135 
 
 fourth possibility which is this : that thought and 
 thing form at each moment a new combination and 
 a new compound creature, which begins anew its 
 investigation of outside nature, so that we are 
 always becomitig, but never are. The problem of 
 creation always has transcended and apparently 
 always will transcend the wit of man ; and we are 
 face to face with it here in the inquiry whether 
 function or structure was first. Who shall say 
 whether day or night was first, or hght or 
 darkness ? But it is not nececssary for us to solve 
 the question, since day always succeeds night, and 
 night, day. So structure and function move and 
 change simultaneously and concomitantly. I have 
 just said that whichever view we adopt, the facts 
 remain the same. If we accept the fourth 
 explanation of organic phenomena, or even the 
 third, as the most likely and reasonable, I am not 
 quite sure that this statement is true ; but as the 
 question has now become philosophical or theo- 
 logical, it would be obviously improper to pursue it 
 further in a disquisition on medicine. Changes in 
 function and structm-e, however, may, it is evident, 
 be concomitant or successive effects of a common 
 cause (like the alternations of day and night), as 
 well as cause and effect of one another. All I want 
 to show is that the questions raised by the 
 mediaeval mind, as by the ancient mind, are still 
 with us, and that the calm assumption of modern 
 science, that structure determines function, that 
 matter determines mind, that the thing is before 
 
136 
 
 the thought, may be utterly denied by an enquirer 
 into the course of nature, wbo is as humble, as 
 patient and painstaking, as unbiassed, as un- 
 prejudiced, as free from the influence of the personal 
 equation as it is possible for mortal man to be. 
 These considerations will again come before us 
 in examining food supply, as they have been 
 already raised by the causation of fevers, 
 and the inquiring reader may find himself 
 forced to raise them also on other occasions. In 
 fact, whether soluble or not, these questions are 
 continually arising, both in medicine and in life, and 
 seem to exercise a fascination on the human mind. 
 
 The practical bearing, however, of these con- 
 siderations on the circulation of the blood and 
 lymph is considerable. As the blood goes every- 
 where in the body, it is obviously a matter more or 
 less of accident which part of the body is afiected. 
 If the blood is sound, the parts of the body will be 
 sound also, that is, in the absence of some more or 
 less accidental cause, which may have for the 
 moment disturbed any given part. But in this case 
 the local irritation will soon be remedied by the 
 powers of nature, by the circulation in the part of 
 sound and healthy blood, and very soon all traces of 
 the irritation will be gone ; or at least the irritation 
 will be in proportion to the magnitude of the 
 exciting cause, the resistance of the part being 
 great because of the soundness and wholesomeness 
 of the blood, and the suffering, therefore, caused by 
 the irritant comparatively slight. But let the blood 
 
137 
 
 be unsound, loaded, let us say, with effete products 
 — it is manifest that in this case the effects of the 
 same irritant as before may and will be much 
 greater; and the part affected, as also the whole 
 organism, will be likely, nay, certain, to suffer much 
 more than if the blood had been healthy. This 
 would be seen in the case of a wound of the arm or 
 leg, for instance, the suffering being proportionate 
 to the magnitude of the injury and inversely as the 
 healthiness of the blood, or proportionately to its 
 unhealthiness. If, now, a person is exposed to a 
 draft or cold or wind or damp, the same thing will 
 be likely to happen. His weakest part will be 
 affected, his lung or liver or stomach or eye, as it 
 may chance ; but the suffering will as before be 
 proportionate to the magnitude of the exposure and 
 to the unhealthiness of the blood (or inversely as 
 its soundness or healthiness), all of which con- 
 siderations shew that local affections or local 
 inflammations are far more serious as being the 
 marks of the general state of the blood, than they 
 are as being affections of this or that or the other 
 part. In fact, it is an accident whether the man 
 exposed to the exciting cause, suffers in one 
 part of his body or in another, and the same 
 general lines of treatment which are proper 
 and suitable for the one will be proper and 
 suitable for the other. Also, if two organs are 
 affected, say, e.g., an internal organ and the muscles 
 of the back, it is evidently much more likely that 
 both the affections are caused chiefly by the state 
 
138 
 
 of the blood that goes to both, than that the 
 internal inflammation causes the pain in the 
 back-muscles, or than that the affection of the 
 back - muscles causes the inflammation of the 
 internal organ. The bearing of these considera- 
 tions on practice, simple though they are, is 
 considerable. Sometimes, too often indeed, we 
 are advised that treatment, say, of an internal 
 organ will cure the muscles of the back, whereas it 
 would be quite as rational to expect to cure an 
 internal inflammation by treating the back-muscles 
 (driving needles into them, for example). But by 
 treating the blood, by altering its condition, it will 
 be rational to expect to cure both. In fact, both 
 sets of effects are concomitant or successive effects 
 of a common cause, and not cause and effect of one 
 another. Further, also, a pair of " specialists " are 
 not required for the management of that patient. 
 He or she is, in fact, better without them, as, if 
 they were narrow-minded specialists, the treatment 
 of the one would conflict with the suggestions of 
 the other ; while if they were broad-minded and 
 judicial, they would both advise the same general 
 line of treatment. The view, however, which we 
 take of the condition of the patient, and, conse- 
 quently, the treatment we recommend for him is 
 precisely analagous to the third or fourth view 
 mentioned above respecting the relation of structure 
 to function, and may, I hope, justify to the reader 
 my introduction of these apparently outside and 
 irrelevant considerations. 
 
139 
 
 Besides feeling the pulse, I may also remind 
 the reader that, centuries before the discovery of 
 the circulation of the blood (and lymph) it was 
 customary among doctors to resort to blood-letting, 
 and to leeching, as well as to blistering, for the 
 relief and cure of diseases — and yet one would have 
 thought, a priori, that at least the two former of 
 these methods depended directly upon the discovery 
 of the circulation of the blood, and would appear 
 useless and inept without it. The great reason, 
 indeed, why blood-letting has been to so large an 
 extent given up is not, in my opinion, because the 
 discovery of the circulation militated against it — on 
 the contrary, it justified and encouraged it, if 
 anything — but because it came to be recognised 
 that removal of a quantity, say a pint, of blood, 
 while it might to that extent remove some of the 
 materies morbi of disease, could have no influence 
 on the rest of the blood in the body, and could, 
 therefore, do nothing towards removing the 
 materies morhi or materies morhorum, from the 
 remaining 10, or 11, or 12, or 13 pints of blood in 
 the body. At least this is the consideration which 
 ought to have determined the cessation of blood- 
 letting. But, in point of fact, it was not even this 
 which did so determine it, but a feeling that men's 
 bodies were weakened by the process. We are too 
 apt, it seems to me, in considering the present state 
 of knowledge, and comparing it with that of past 
 generations, to imagine that we know a great deal 
 more than our predecessors. No doubt there are 
 
140 
 
 whole domains of knowledge within the power, 
 more or less, of men of the present day, which 
 were not even dreamed of in past times. 
 Chemistry, biology, physiology and pathology, e.g., 
 did not exist in their present form in the times of 
 Hippocrates, or Celsus, or Galen. And yet, as to 
 conduct, or as to the medical management of 
 illness, it is doubtful whether we are much in 
 advance of our predecessors. We are at least, I feel 
 sure, not so much in advance of them as we so 
 often and so complacently suppose. The role of 
 the progress of science is, after all, not so much, or 
 at least not so much as we suppose, to point out 
 new methods of inquiry into the constitution and 
 course of nature, as it is to corroborate, by the use 
 of newer and more accurate methods, what we may 
 see and perceive by means of the proper use of the 
 senses. I have already mentioned the feeling of 
 the pulse and the instruction obtained from it by 
 men who knew nothing of the circulation of the 
 blood and lymph, and I will now mention one or 
 two other ideas known to the ancient physicians, so 
 that we may be able the better to gauge the truth 
 of what I am saying. The most ancient obser- 
 vation, perhaps, in medicine, was to the effect that 
 we cannot feed the sick as we feed the well ; and 
 Hippocrates, writing, say 450 B.C., mentions this 
 as an observation of the physicians who were 
 " ancient " in his day, that is, as an observation 
 made by men living 1000 or 1500 years B.C. 
 If this be considered an observation, so trite that 
 
141 
 
 no one could fail to notice it, what shall we say to 
 the observation of Hippocrates himself, already- 
 mentioned on page 117, that less food is 
 required in hot weather than in cold ? This 
 seems to me a remarkable observation to be 
 made by a man who lived many centuries 
 before chemistry or combustion, or the relations 
 between heat and oxidation, or between heat and 
 physiological or physical energy had been dreamed 
 of. But he saw, and correctly saw, by observation, 
 what was only demonstrated, or let us say, what 
 had new experimental light thrown on it many 
 generations later. The last point I will mention 
 at present is perhaps the most important of all, 
 and it is an observation of Hippocrates to the 
 effect that people ought to be fed in proportion and 
 in relation to the work they have to do. We must 
 inquire, he says, " whether the food has been too 
 much for the work to be done, or the work too 
 great for the food, or whether they have been 
 proportionate one to the other. For according as 
 one exceeds the other, diseases set in, while from 
 their equality with one another, health arises." 
 Although there has been so much " advance " 
 in chemistry, physics, biology, physiology, and 
 pathology, I think my friend Dr. Dewey is justified 
 in his question, whether the sons of medicine have 
 ever given to the world physiology of equal or 
 greater importance in these nineteen hundred years 
 since Christ ? And I repeat that these three 
 observations (with others I could mention), tend to 
 
142 
 
 induce and corroborate the view that as regards the 
 conduct of medicine, the progress of science goes to 
 strengthen us in forming conclusions, which, by 
 the unaided but candid use of the senses, we could 
 observe and know without her. 
 
 As bearing on the circulation of the blood and 
 lymph and its relation to food-supply, certain 
 fundamental considerations arise to the inquirer. 
 As a circle has neither beginning nor end, or as it 
 may be viewed, if we are so minded, as all beginning 
 or all end ; so in studying a round or circle of 
 organic processes, all mutually connected with one 
 another, it is immaterial at what process or point in 
 the circle we commence our study — we shall return 
 to that point or process again. Nevertheless, there 
 are some ways, and some points of view, from which 
 more instruction will be obtained from the study 
 of the mechanism than if it is approached in other 
 ways. In the case of a steam engine driving looms 
 or wool-combing machines, it is immaterial whether 
 we commence our study of its action at the shaft, 
 which, by its attachment to the crank, turns 
 gearing which turns leather bands, causing the 
 back and forward movement of the looms and the 
 to-and-fro movement of the shuttles, or whether 
 we commence our study at some other point. 
 Through bands and driving wheel and eccentric, 
 through piston and cylinder and boiler and the fire, 
 which is the source of the motion of the machine 
 and of the mill, we come back to the point from 
 which we started. But it is more illuminating and 
 
143 
 
 instructive to begin with the fire, and proceed to 
 examine boiler, cylinder, piston, &c., than in other 
 ways ; or even to commence with the pump which 
 sends the water into the boiler. 
 
 The analagous method by which the organic 
 processes of the body are to be examined in order 
 that the animal machine may be understood, and 
 the best work provided by it, is through a study of 
 the digestive processes ; and, therefore, a very short 
 account of these processes must be inserted here, in 
 order to draw attention to them a little more at 
 length, and so that we may be better able to under- 
 stand and appreciate the reasons for the advice to 
 be offered regarding the times and quantities of 
 meals. This account, though popular, must be 
 correct, so far as it goes, but will not, of course, be 
 so elaborate as if it formed part of a technical 
 course of physiology. At the same time, it should 
 be sufficient to enable us to understand the round 
 or circle of the bodily mechanism. First, then, the 
 food, being taken into the mouth, undergoes the 
 action of mastication by the teeth, whose function 
 is mainly one of mechanical trituration. At the 
 same time (and the better will this be effected, the 
 more completely is that mastication or trituration 
 and grinding by the teeth performed), the food 
 ought to be slowly and well mixed with saliva in 
 the mouth, coming from the salivary glands. Foods 
 have been divided, since the time of Liebig, the 
 great physiological chemist, who died in 1872, into 
 four great classes, according to their chemical 
 
144 
 
 composition. (1) Those foods which contain nitrogen, 
 and are called proteids or nitrogenous foods. The 
 most important examples of this class are such 
 foods as meat and flesh of all sorts, fish, eggs, milk, 
 cheese, the cereal grains, and pulses belonging to 
 the pea and bean tribe. (2) The group of foods 
 represented by sugar, arrowroot, sago, tapioca, 
 &c., and called non-nitrogenous or carboniferous or 
 carbonaceous. The latter names are, however, 
 bad, since the nitrogenous foods also contain a 
 carboniferous part. With the division, however, of 
 foods into nitrogenous and non-nitrogenous, no fault 
 can be found, although the notions of Liebig have 
 been considerably modified by subsequent inquiries 
 as to the parts played by the difierent kinds of food 
 in the economy. The non-nitrogenous foods have 
 been divided into two groups, first, the sugars and 
 starches already referred to, and secondly, the fats 
 (oil, butter, cream and fat), which form the third 
 division of food stuffs. The first division of foods, 
 the nitrogenous, are alone capable of repairing 
 completely the waste of the body-flesh or muscle, 
 since it contains nitrogen in its composition. But 
 although the carboniferous or carbonaceous foods 
 contain no nitrogen, the nitrogenous foods contain 
 considerable quantities of carboniferous stuff, and 
 are therefore capable of performing all the functions 
 in the body which can be performed by the non- 
 nitrogenous foods, with the power of building up 
 again the nitrogen- containing tissues in addition. 
 The great function which the non-nitrogenous 
 
145 
 
 foods perform in the body is that of maintaining 
 the body-heat, and this they do both by the sugar 
 and starch group and by the fats, but the latter, as 
 we see from the use made of them by denizens of 
 very cold regions like the Arctic and Antarctic 
 regions, have greater power in maintaining bodily 
 heat than sugars and starches. The fourth division 
 of food-stuffs is the mineral portion made of salts 
 of alkalies for the most part, as compounds of 
 potash, soda, lime, and common salt, with smaller 
 quantities of sulphur, &c., entering into their 
 composition. Lastly, and so important is it that 
 we may consider it as forming a fifth division of 
 food stuffs, water enters largely into the composi- 
 tion, and forms from two-thirds to three-fourths 
 both of the foods used in the body and of the 
 body itself 
 
 Now the saliva coming from the salivary 
 glands in the mouth, and being there well mixed 
 with the food, has little or no action on the proteid 
 or nitrogenous part of the food proper, has little or 
 no action, e.g., on fish, flesh, fowl, or eggs or cheese ; 
 but exerts, on the other hand, a very considerable 
 effect on the non-nitrogenous starches and also on 
 the non-nitrogenous portion of nitrogenous foods — of 
 bread, for instance, or of rice — the starch of which 
 it converts into grape sugar. Starch must be 
 converted into grape sugar before it can be used in 
 the economy, so that the need for good chewing 
 and for efficient mixing with saliva becomes more 
 apparent from this consideration. The food, being 
 J 
 
146 
 
 now ready for swallowing, is passed along the 
 
 gullet (which exerts comparatively little action on 
 
 it) into the stomach. There it is met by the gastric 
 
 juice, considerable quantities of which (from a pint 
 
 to two pints) are secreted into the stomach from its 
 
 walls, each time that food is taken. The gastric 
 
 juice is sometimes called the gastric acid because it 
 
 has an acid reaction, while the reaction of the saliva 
 
 is alkaline. A proper appreciation of the fact that 
 
 so much gastric juice as two pints is poured out 
 
 when a meal is taken, is highly important in 
 
 determining the quantity of food that ought to be 
 
 taken at a meal. The children of a past generation 
 
 — the advice is not so common now as it was then, 
 
 nor so common as it ought to be — were advised to 
 
 stop eating before they felt that they had had as 
 
 much as they could take, or before, as the phrase 
 
 was, they felt full. Now this was very wise advice, 
 
 for if we go on, either children or adults, eating till 
 
 our stomachs are full, how are we to make room for 
 
 the pint or the quart of extra material when gastric 
 
 juice to that amount has been poured into the 
 
 stomach ? But we must make room for this extra 
 
 quantity of material, because the presence of 
 
 gastric juice is absolutely necessary if food is to 
 
 undergo gastric digestion and to be converted into 
 
 chyme. There can be no doubt, indeed, that the too 
 
 widespread habit of eating to satiety, even if it is 
 
 not carried quite to fulness, is, after the necessary 
 
 amount of gastric acid has been added to the 
 
 stomach contents, the chief cause of that feeling of 
 
147 
 
 distress and weight or pressure which is so apt to 
 be felt by all of us from half an hour to two or 
 three [hours after eating a hearty meal. Taking a 
 less amount of food would have allowed more room 
 for the necessary gastric acid, and would have 
 prevented the feeling of weight and heaviness. 
 The fact also incidentally alluded to that digestion 
 in the stomach goes on for hours, shews, by the 
 way, how futile is the advice sometimes given to us 
 that we should lie down for say half an hour after 
 taking a meal. In half an hour, or even an hour, 
 the digestion of a townsman or townswoman has 
 reached only its initial stages, and if it is necessary 
 to lie down half an hour or an hour after eating, it 
 is because we have taken more at the meal than 
 was good for us. To suggest that we should lie 
 down for three or four hours after eating would 
 probably meet the case ; but to do this would be to 
 behave like a boa-constrictor, and would be to raise 
 eating into the "chief labour of life," while no 
 amount of physiological rest after food consumption 
 could ever undo the evil effects of over-ingestion ot 
 food, especially if that process were frequently 
 repeated. 
 
 Another practical conclusion of the utmost 
 consequence, besides the one just come to, that we 
 ought to stop eating before satiety is reached, is 
 that we ought to eat slowly. This is so obvious 
 that it ought almost to be unnecessary to state it ; 
 for if saliva is to act on the starchy portions of our 
 food, it must be well mixed with the food in order 
 
 J2 
 
148 
 
 to do so, and this can be effected only by 
 thoroughly chewing the food as it is taken. Very 
 many persons, perhaps even a majority of us, make 
 the great mistake of eating too quickly, and so of 
 failing to masticate and triturate properly the food 
 we take. Eating slowly is in fact a help against 
 the error of eating to satiety, because we have 
 more time to appreciate the state of fulness that 
 the stomach gets into after ordinary eating, and so 
 we are helped by slow eating to stop before we 
 have taken too much. The simple device of 
 chewing each morsel of food taken, say twenty 
 or thirty times (some have said even forty times), 
 before swallowing it, would greatly help towards 
 forming the habit of slow eating ; and this in turn, 
 as it would greatly aid digestion and assimilation, 
 blood-making, and tissue nutrition, would have the 
 most potent influence on the maintenance of health 
 and the prevention of illness. 
 
 The gastric juice or gastric acid acts specially 
 on such nitrogenous foods as meat, fowls, fish and 
 cheese, and, helped of course by the preceding 
 action of the saliva, and by the rolling action 
 exerted by the muscular walls of the stomach 
 itself, converts the whole contents of the meal into 
 a grey grumous fluid mass called chyme. Not yet, 
 however, is the food ready for absorption. It has 
 to be passed out of the stomach into the small 
 intestine ; and immediately on its reaching this 
 part of the digestive tract, it meets with the 
 secretion from the pancreas and that from the liver. 
 
149 
 
 These secretions have again an alkaHne reaction. 
 The former finishes the digestion of any starch 
 which may have escaped the action of the saHva in 
 the mouth, converting it into a state fit for 
 absorption, either directly into the blood, or 
 indirectly to the same destination by means of the 
 intestinal villi. These last structures are found in 
 the small intestine, and contain each a small lacteal 
 vessel, whose mouth opens and absorbs some particles 
 of chyle. These particles are passed on by the 
 lacteal vessels, and find their way into the thoracic 
 duct, in the way to be immediately described. The 
 action or influence of the bile from the liver on the 
 other hand is mainly to prevent putrefaction in the 
 highly unstable contents of the digestive tract, and 
 to complete the digestion of particles of fat, butter, 
 cream, &c., and fit them for being mixed with the 
 contents of the small intestines, the chyle. This 
 chyle is completely elaborated and rendered ready 
 for absorption on meeting with the alkaline 
 secretion from the small intestine itself Entering 
 the venous blood from the small intestines, it is 
 carried by the portal vein to the liver, while some 
 of the chyle-particles enter the lacteals and thoracic 
 duct, being emptied by it directly into the venous 
 blood at the root of the left side of the neck. This 
 venous blood, if we follow it in its course, will be 
 found, by means of the superior or descending 
 vena cava, to be carried to the right side of the 
 heart. How much of the chyle finds its way by 
 means of the portal vein to the liver, and how 
 
150 
 
 much by means of the lacteals and thoracic duct to 
 the superior vena cava, does not seem to be quite 
 known. In any case, that which goes to the liver 
 after being laid out there by means of its very 
 extensive circulation, and after having some very 
 important changes effected in it, finds its way back 
 again by the hepatic vein into the general venous 
 circulation, so that in time all the chyle is emptied 
 into the venous blood, either directly by means of 
 the thoracic duct, or indirectly through the portal 
 circulation. Being carried in these ways to the 
 right side of the heart, the blood, dark and venous, 
 and loaded with the carbonic acid gas and other 
 products of oxidation, which it has received from 
 the tissues as it was passing through them, is 
 carried by the pulmonary artery to the lungs right 
 and left. There it gives up its carbonic acid gas or 
 carbon-dioxide, and takes in oxygen from the 
 inspired air, changing coincidently its colour from 
 crimson-black to scarlet. There ought to be no 
 oxidation or combustion in the lungs according to 
 the laboratory physiologists, a mere passing of 
 carbon-dioxide from the venous blood taking place, 
 accompanied by the entrance of oxygen from the 
 air. But when, from the blood containing too 
 much material in it from unused food, an 
 exudation from the blood has taken place into the 
 mucous membrane lining the lungs, or into the 
 substance of the lungs itself, it may happen that 
 oxidation and excess of combustion does occur here 
 as in any other inflamed place in the body. When 
 
161 
 
 this is so, noj doubt the limits of health have been 
 transcended, and disease has set in. Physiology 
 has begun to shade off into pathology. But this is 
 unfortunately far too commonly the case, pul- 
 monary affections or diseases of the respiration 
 being among the very commonest affections of the 
 body. The figures in Chapters II. to IV., 
 regarding the incidence of disease, show how 
 common they are. 
 
 By the pulmonary veins, which therefore 
 contain arterial blood, the oxygenated and 
 depurated blood is carried back from the lungs to 
 the left side of the heart, thence to be distributed 
 all over the body for its nourishment, for its waste- 
 repair, and for building up its strength. We see 
 from this short summary how the function of food 
 is to make blood and to enrich the blood, and how 
 it is the function of blood to nourish the body. 
 It is only therefore by ellipsis that we can speak of 
 the function of food as being to nourish the body, to 
 repair its waste, and to build up its tissue. The food 
 does all these things, but not directly or immediately, 
 since it does them mediately or indirectly through 
 the blood. And in the attempt to understand the 
 diseases and ailments of the body it is absolutely 
 necessary that we should keep these steps of the 
 processes of nutrition and of digestion separate in 
 our minds. By means of this consideration also we 
 can introduce order into the study of medicine and 
 of diseases, and so substitute simplicity for chaos 
 and confusion. The multiplicity of diseases, for 
 
152 
 
 instance, the immense number of them which come 
 under our notice, either because we ourselves or our 
 friends or acquaintances are suffering from them, 
 are apt to fill us with despair as to the possibility 
 of our ever being able to understand them or see 
 their causal connection. But let us once get into 
 our minds the facts that the blood goes 
 everywhere all over the body, and that the blood 
 is made by changes which through the digestive 
 processes are effected in the food, and then how 
 simple do these apparently complicated diseases 
 become. For if the blood goes everywhere all over 
 the body, then it may nourish the various parts 
 properly, if it is itself in good condition, that is, if 
 digestion or assimilation has been properly effected, 
 and if the proper quantities and qualities of 
 material have been poured into it ; while, on the 
 other hand, it may fail, and will fail to nourish the 
 various parts properly, if it is itself not in good 
 condition, that is, if digestion or assimilation has 
 not been properly effected. In the former case the 
 various tissues will be so properly nourished that 
 they will be healthy ; and so, as they are acting 
 normalty and painlessly in reference to their various 
 functions in the body, and in relation to one 
 another, we remain unconscious of their very 
 existence, feeling only the general pleasurable 
 sensation of health and well-being. But if, on the 
 other hand, the blood going to the various bodily 
 tissues has not been property made by the digestive 
 processes ; if, for example, as often happens, it is 
 
153 
 
 loaded with badly assimilated materials, we can 
 easily understand how it may deposit in any of the 
 various tissues some of its ill-formed material, and 
 how this, by disturbing the exercise of the various 
 functions and the relations of these functions to 
 one another, may translate itself into pain and 
 discomfort, and may give us an unpleasant 
 consciousness of the existence of parts and organs, 
 which knowledge we might otherwise have been 
 enabled to escape. In this way we may suffer from 
 bronchitis, or pneumonia, or pleuritis (pleurisy), 
 according as the ill-made and waste-laden blood 
 deposits an exudation into the mucous membrane 
 lining the lungs, into the lung tissue itself, or into 
 the pleura or serous membrane covering the lungs. 
 And in the same way any and every organ and 
 tissue of the body may be affected, the names of the 
 affections of different parts being as various as 
 the different tissues and organs themselves, while 
 their various symptoms differ from one another 
 according to the very various functions of the 
 different parts affected. 
 
 I have already referred shortly to the portal 
 circulation, and with one or two words more our 
 sketch of the blood-making processes may be 
 completed. The blood-vessels which come from the 
 stomach (where probably some absorption of chyme 
 takes place, although the mass of it passes on 
 through the duodenum into the small intestine), 
 those blood-vessels which come from the small 
 intestine, filled with the products of digestion 
 
154 
 
 there, that is, with the chyle ; as well as the blood- 
 vessels which come from the spleen and pancreas, 
 join together to form the portal vein, as it is 
 called, because it is found at the gate-way or 
 door- way ( porta = gate or door) so to term it, of 
 the liver. The portal vein carries its contents 
 received from these four most important viscera, the 
 stomach, the small intestine, the spleen and the 
 pancreas, to the liver, which is the largest digestive 
 viscus and one of the most important organs of the 
 body. This organ, which weighs about four pounds 
 when out of the body, is said by physiologists to 
 contain, on occasions, about 29 or 30 per cent, of 
 the blood contained in the body of a rabbit. By 
 generalisation, this proportion is supposed to obtain 
 in the case of other mammals and man. Whether 
 it does so in this proportion or not does not really 
 very much matter. What does matter is that the 
 liver receives through the portal circulation an 
 immense quantity of blood. It is indeed difficult 
 to believe that in man the quantity of blood 
 received by the liver can reach so high a 
 proportion as 30 per cent, at any one time, since 
 this would imply that three or four pints out of the 
 twelve to fourteen pints of blood contained in 
 the body would be in the liver at one time. As, 
 out of the body, the liver weighs about four 
 pounds, the addition of three and a half or four 
 pints of blood would increase its weight to about 
 double ; and although no doubt the liver differs 
 from itself immensely in weight, according to the 
 
155 
 
 different states of digestion, it is not easy to 
 believe that from time to time it actually doubles 
 in weight. That it varies very much indeed at 
 different times is no doubt true, and is all that 
 need concern us. And whoever properly appreciates 
 this fact will be able to rate at its proper value the 
 statement, for example, of a patient, who said that 
 his doctor had been able to reduce the width of his 
 liver by about an inch since beginning his 
 attendance on him. If he had told us the 
 comparative times of digestion at which the 
 measurements were made, we should have been 
 better able to judge the value of the statement ; 
 but that an empty or comparatively empty liver 
 should be reduced by an inch when it had been 
 overgrown or hypertrophied by that amount, is a 
 statement which would require to be supported by 
 a good deal of evidence before it was accepted. 
 
 While I am on this subject let me mention 
 some other statements of the physiologists 
 regarding the facts of the distribution of the blood 
 in the body. These facts, let me repeat, are taken 
 from the rabbit, and what amount of weight ought 
 to be attached to them when applied to the 
 circulation in man must be carefully considered. 
 The muscles, they say, contain about 30 per cent, 
 of the blood also. If this is true for man, then we 
 should have about four pints of our blood in the 
 muscles. I think we have quite that proportion. 
 On the enveloping membranes of the muscles, 
 blood-vessels are carried freely, as also on the 
 
166 
 
 finer forms of envelopes which surround bundles 
 of muscular fibres, down through still finer and 
 finer processes, till we finally reach the finest 
 coverings of all, or the sarco-lerama, as it is called, 
 enveloping the ultimate muscle-elements. On all 
 of these, arteries finer and smaller according to the 
 increasing refinement of the enveloping membranes, 
 are carried till they are lost in the very finest 
 sarco-lemmatous processes, where, however, lymph- 
 spaces are not absent. It can therefore readily be 
 believed that four pints of blood or more are 
 distributed to the muscles of the human body. 
 And the significance of this seems to be very 
 great. The muscles are the active agents of the 
 body, or the agents through which the active 
 powers of motion, locomotion, and work are 
 performed. It is likely, therefore, that they will 
 require a large supply of blood, in order that their 
 active work may be possible ; and whether this 
 supply amounts to 30 per cent, of the whole of the 
 blood or not, it is evident that the supply of blood 
 to the muscles is free and abundant. 
 
 Continuing our examination of the blood 
 distribution in such an animal as the rabbit, we 
 come upon other very interesting facts. The heart 
 and great blood vessels, the great arteries and veins 
 of the body, with the addition of the lungs, do not, 
 say the physiologists, contain more than 22 per 
 cent, of the total volume of the blood. This is 
 very curious when we reflect that we are in the 
 habit of thinking of the heart and vessels as the 
 
157 
 
 organs of the circulation par excellence. If this 
 proportion holds in the case of man, only about 
 three pints of blood out of his fourteen, or only 
 2*6 pints out of a total of twelve pints, will be 
 contained in the heart, blood vessels and lungs at 
 any given time. That is to say, the blood-contents 
 of the organs of circulation and of respiration 
 added together do not reach the amount contained 
 either in the liver or in the muscles (assuming, of 
 course, what is not certain, that what is true in the 
 rabbit obtains also in the case of man). 
 
 The physiological significance of these facts 
 must be very great, and we may reasonably draw 
 these inferences . — (1) The liver exerts an enormous 
 influence on the blood-making processes ; (2) The 
 muscles play a great part in the blood - using 
 processes. In order that they may do the work of 
 the body they require a large blood supply, which, 
 if they are active, they call upon the food to supply. 
 And, no doubt, the greater the muscular activity of 
 the body, the larger wiU be the amount of blood in 
 the first place, and of food in the second, which 
 they will require. On the other hand, the less the 
 bodily activity, and the lighter the muscular work 
 done, the less blood do the muscles require, and, 
 therefore, the less food. Now let us set beside 
 these facts another one also vouched for by the 
 physiologists. The brain, they say, of a rabbit, 
 and its spinal cord together, the governing and 
 controlling structures, ordering and willing so far 
 as a rabbit can govern movements, can order and 
 
158 
 
 can will, can think and can feel, the cerebro- spinal 
 nervous system contains only about 1 '5 per cent, of 
 the blood within it at any given time. If this is 
 true of man, his brain will contain about one-fifth 
 of a pint of blood out of the twelve or fourteen 
 pints contained in his whole body. It may be said 
 that probably the brain of a man is better supplied 
 with blood in proportion than is the brain of a 
 rabbit ; and this does not seem to me an unreason- 
 able idea, considering what very different work a 
 man's brain performs from that done by a rabbit's. 
 But if the human brain is twice as well supplied 
 with blood in proportion as a rabbit's, this would 
 only give two-fifths of a pint of blood in the human 
 brain, as compared with three or four in the 
 muscles ; while, if the human brain contains even 
 5 per cent, of the blood, as compared with 1'5 per 
 cent, in the rabbit, this would only amount to from 
 three-fifths to seven-tenths of a pint of blood. 
 Even then, on a rather high and free computation, 
 we seem to be driven to infer that the brain does 
 not require a large amount of blood for the conduct 
 of its operations, while the requirements of the 
 muscles are very considerable, in order that they 
 may perform their work, at the same time that the 
 requirements of the liver for the purposes of 
 digestion and assimilation of food are very great 
 also. The supply of blood, therefore, seems to 
 require to be large in order that the lower functions, 
 so to call them, of the body, the functions of 
 locomotion and of digestion, should be well per- 
 
169 
 
 formed; but in order to the performance of the 
 higher functions of cerebral activity, ordering, 
 feehng, perceiving, judging, thinking, reflecting, 
 and willing, not nearly so much blood seems to be 
 required. This is a rather remarkable conclusion to 
 come to, but I think it is a sound one ; and there 
 are some very remarkable physiological facts which 
 point in the same direction, and appear to bear it 
 out. For instance, it is surely a very remarkable 
 fact that although the blood supply all over the 
 body, and in all its parts, except the brain, is and 
 remains under the government and control of the 
 heart, it is not so in the brain ; but the blood supply 
 of the brain passes under a different government 
 whenever the internal carotid artery enters the 
 lacerated opening in the temporal bone in order to 
 pass in to supply the brain. Whereas in the 
 common carotid artery in the neck, before the 
 internal carotid artery branches off for the supply 
 of the brain, and whereas in the external carotid 
 artery going to the face and even to the brain 
 membranes, and in all the other arteries of the body 
 wherever they are distributed, the circulation is and 
 remains sjmchronous with the pulsations of the 
 heart, that is, heaving at the rate of from 60 to 90 
 times a minute, the motion of the blood in the 
 vessels of the brain itself is synchronous not with 
 the heart's pulsations, but with the respiration, i.e., 
 it heaves and throbs and moves only at the rate of 
 from 13 to 17 or 18 times a minute. The full 
 significance of this remarkable arrangement does 
 
160 
 
 not seem to be appreciated, but it appears to me 
 not unlikely that it is partly at least because the 
 brain does not require a very large amount of blood 
 supply in order that it may perform its functions 
 well, and that, in fact, it is rather hampered, than 
 otherwise, and hindered if a very large supply of 
 this fluid is sent to it. Another fact seeming td 
 point in the same direction, is that the arteries in 
 the brain end as end arteries, each to its own small 
 portion of cerebral substance, and do not anastomose 
 with other fine arterial endings, going to neigh- 
 bouring parts, as other arteries do in other parts of 
 the body. The object of this may be to ensure that 
 if by chance a fine cerebral vessel becomes blocked, 
 the disease and the impairment of vitality and 
 power consequent on this condition may be confined 
 to its own portion of cerebral substance and be 
 prevented from spreading to other portions of the 
 brain. But the fact, so far as it goes, seems to 
 have for its object, or, at least, for its effect, the 
 limiting of blood supply to the brain. Now as 
 blood is made from food, this seems to mean that 
 persons who use their brain largely should not take 
 much food lest they should make too much 
 blood, which, finding its way in too great volume to 
 the brain, might cloud and interfere with the finer 
 and subtler working of that governing and con- 
 trolling and thinking and feeling organ. This 
 seems to be a remarkable vindication by physiology 
 and anatomy, of the correctness of insight of the 
 poet who sang that there was a close connection 
 
161 
 
 between "plain living and high thinking." The 
 finer functions of the brain, indeed, do not seem to 
 be performed through the blood supply so much as 
 secondarily they seem to be associated with the 
 formation and with the state or quality of the fine 
 lymph which is found in all the brain cavities or 
 ventricles, as they are called. This fine, subtle, 
 clear, spirituous fluid exists to a considerable extent, 
 especially in the large lateral ventricles in the 
 anterior parts of the brain, as well as in the smaller 
 third ventricle, and has set apart for its production 
 a special arrangement of blood vessels known as the 
 choroid plexuses. (There is a choroid plexus even in 
 the fourth ventricle.) These choroid plexuses are 
 collections of blood vessels carried on prolongations 
 of the finest brain membranes, and from them 
 seems to be secreted the fine spirituous fluid, which 
 used to be called by older writers animal spirits, 
 and which they appear to have thought to be the 
 medium through which the higher powers of the 
 brain were conducted. As this fine fluid or animal 
 spirit (the animal spirit or animal spirits we see to 
 be fundamentally a physical fluid, although in 
 mediaeval and modern language the expression 
 seems never to be used in this sense, but always in 
 a metaphysical or psychical or spiritual sense) is 
 found in all the cavities of the brain, as it flows 
 between the membranes of the brain, moistening 
 and lubricating them ; and as it passes even 
 between the membranes or sheaths of the nerves 
 ^also, which pass out from the brain and spinal cord, 
 
162 
 
 we may be quite certain that the function of a 
 fluid so widely distributed must be an important 
 one, and no doubt it plays a great and important 
 part in acting as a medium to hold intact the nexus 
 between the brain cells and the more or less remote 
 parts of the body, which in so remarkable a way 
 recognise the authority of the brain, and respond to 
 its commands. 
 
 But it is now time to consider more thoroughly 
 the nature, and character, and origin, and relations 
 of this fine spirituous fluid having this peculiar and 
 interesting relation to the brain and nervous 
 system. It belongs no doubt to the same class of 
 secretions as are found all over the body, under the 
 name of lymph, and may be considered as a finer 
 form of the same, distilled, so to say, or secreted 
 from the choroid plexuses in the brain. How 
 important the lymph is, finer and coarser, will be 
 apparent when we reflect that, although the exact 
 quantity of it in the body is not known, it amounts 
 in the aggregate to probably not less than thirty or 
 forty pints. It is in fact not unlikely that occasion- 
 ally, or even frequently, more than this quantity is 
 present in the body of an average sized man, who 
 has, on the other hand, only twelve, or thirteen, 
 or fourteen pints of blood. This fact of itself 
 invests the lymph and its circulation with great 
 importance. Let us try to realise more clearly what 
 the lymph is. It is the watery or clear fluid basis 
 of the blood, uncoloured, or very slightly coloured, 
 and it contains also a considerable number of 
 
163 
 
 corpuscles, some not larger than very small pin-point 
 granular masses, and some a little larger, some not 
 unlike in size to the corpuscles of the blood, though 
 not coloured red like them. It is collected in 
 interstices that exist between the layers of the 
 tissues of muscle sheaths. There are spaces also in 
 the very substance of connective tissue, like muscle 
 sheaths, nerve sheaths, periosteum, sarco lemma, 
 neuri lennna, &c., &c., and in these spaces, some- 
 times lined by very fine layers of membrane, called 
 endothelium, the lymph, or watery part of the blood, 
 collects. From these interstices, in the substance 
 of the connective tissue, and from the spaces 
 between its layers, the lymph is conveyed away by 
 channels which, gradually becoming lined, form 
 lymphatic ducts and lymphatic vessels, which 
 conduct away the lymph collected in this way, and 
 take it to structures, called lymphatic glands, of 
 which more detailed mention must immediately be 
 made. Meantime, we must bear in mind that the 
 lymph is itself collected from the blood after the 
 blood has been carried to the various structures of 
 the body, in order that it may nourish them. The 
 arteries which convey the blood to these various 
 structures (the definition of an artery is that it is a 
 vessel which conveys hlood from the heart, while a 
 vein is a vessel which conveys blood to it), break up 
 into finer and finer branches, until they end in 
 capillaries, wide enough only to convey one blood 
 corpuscle at once. The blood corpuscles, conveyed 
 in this way, find themselves in relation with the 
 
 K2 
 
164 
 
 ultimate cells of the tissues, being separated from 
 them only by a layer of the finest membrane, 
 through which nutritional changes pass between the 
 blood corpuscles and the tissues, these changes 
 having the efiect of building up, repairing, 
 strengthening and vivifying the tissues so as to fit 
 each different form for the performance of its own 
 special function. But after these nutritional 
 changes have been effected, and after the blood has 
 parted with its nutritive materials to the tissues, 
 something is still left over, and this something is 
 picked up in the form of lymph, as above described, 
 and finds its way first into lymph spaces, and then 
 into lymph ducts, to be carried further into the 
 body, where we must now follow it. The lymph 
 ducts go in the vertebrata (there is no lymph 
 circulation in invertebrata, we are told — the true 
 inwardness of which fact is of intense interest) to 
 the lymphatic glands, which are found in numerous 
 places in the body, particularly at the sides of the 
 neck, in the arm pits, and in the groins, as well as 
 in many internal parts, as the roots of the lungs, 
 intestines, &c. Entering these lymphatic glands, 
 they coil about in an intricate manner in their 
 interior, and an important elaboration of the lymph 
 must occur, because after it has passed through 
 these glands, it is found to contain many more 
 corpuscles, generally also larger corpuscles than it 
 contained before it entered the glands. In some 
 cases the lymph passes through as many as two or 
 three of these glands before it joins the thoracic 
 
165 
 
 duct. For it is important to bear in mind that 
 the lymph is carried into the thoracic duct. Now 
 as the thoracic duct contains the particles of chyle 
 which have been absorbed by the viUi and lacteals 
 of the small intestines, and as the contents of the 
 thoracic duct itself are poured into the large vein 
 at the root of the left side of the neck, for the 
 purpose of being mixed with the blood, in order to 
 enrich the blood and enable it to perform its 
 function of nourishing the tissues of the body, 
 and repairing their waste, it is evident that the 
 lymph also assists in these important processes. 
 The lymphatic vessels, therefore, may be considered 
 as existing for the purpose, or at least chiefly for 
 the purpose of collecting, and so of getting used 
 over again any constituents of the blood whose 
 powers have not been wholly used up in the 
 nutritive processes. The lymphatic vessels are a 
 part Hterally of the economy of nature, which will 
 not allow, so to say, if she can avoid it, any waste 
 to take place in the body. Any nutritive materials, 
 whose powers have not been completely exhausted, 
 are re-collected by these vessels, and carried by 
 them to join the thoracic duct charged with the 
 products of digestion, so that, after being 
 elaborated by the glands, they may be used again 
 in the body without waste. The flat or expanded 
 structures, in which the lymph spaces and the lymph 
 vessels arise, form investments and supports for 
 most of the organs of the body. They are called 
 fibrous tissues, according as they form investments. 
 
166 
 
 or sheaths, or supports for muscles, nerves, bones, 
 and the outside of joints ; or serous membranes, 
 according as they form investments and supports 
 for organs like the lungs, liver, intestines, heart, 
 the inside of joints and of internal organs 
 generally. Their structure, although seemingly 
 made of one layer of fibrous or serous tissue, really 
 consists of several or many layers, as can be easily 
 seen when, through inflammation, or congestion, or 
 engorgement with lymph, the layers have been 
 somewhat separated from one another. In between 
 these layers, and in interspaces which are scarcely 
 visible in the substance of the individual layers 
 themselves, the lymphatic system of vessels begin, 
 and these interspaces become filled with the watery 
 part of the blood, containing also white granular 
 and corpuscular particles, after it has been squeezed 
 out of the organs, and particularly when it has 
 been squeezed out of the muscles, after the blood 
 has parted with some of its nutrient materials for 
 the life and energy-supply of those organs. 
 
 Now in order better to appreciate the part 
 played by this arrangement, let us attempt to 
 realise what the efiect of too frequent feeding will 
 and must be in the body. When this interest- 
 ing arrangement has come into operation, some 
 hours after food has been taken, and when the 
 lymphatic vessels are engaged in picking up 
 this watery and corpuscular part of the blood 
 for re-use in the body, let us suppose that the 
 person in question has meantime taken another 
 
167 
 
 meal. There is the most unmistakable evidence 
 present from time to time by which it can be 
 demonstrated that, when persons are engaged in 
 performing the light duties of town life, food has 
 not left the stomach for five or six hours (frequently- 
 much more than five or six hours), after it has been 
 taken. Even after it leaves the stomach, let us 
 remember that some considerable time longer must 
 elapse before, having reached the small intestine, it 
 has been taken up into the blood in the form of chyle 
 by the thoracic duct, or by the portal vein. Now 
 let us suppose that in a case which requires five or 
 six hours for gastric or stomach digestion to be 
 completed, a new meal is taken in four hours after 
 the previous one. Let us suppose that a person 
 who breakfasts at 9 o'clock takes dinner or lunch at 
 12-30 ; or, since digestion is probably more rapid in 
 the forenoon than it is later in the day, let us ask 
 ourselves what will happen if a person who has had 
 lunch at 1-0 or 1-30 takes afternoon tea, and cake, 
 and bread and butter, at 4-30 or 5-0. Plainly 
 before one meal has left the stomach (not to speak 
 of the small intestine), another one is ingested 
 some hours before any need for it can possibly have 
 arisen in the economy. Evidently, therefore, 
 before digestion of the previous meal has been 
 completed, the digestion of the next will have to 
 be begun, and more gastric juice will have to be 
 poured out into the stomach, before the previous 
 contents have been properly dealt with. In fact, 
 digestion will be going on at two different stages in 
 
168 
 
 the same stomach at the same time. Now if even 
 it be admitted that this might conceivably happen 
 once or twice without doing much damage (but 
 even once or twice is once or twice too often), it is 
 quite obvious that the repetition of the process must 
 be most deleterious. Besides the fact that 
 digestion is going on at two different stages in the 
 same stomach at the same time, and that all the 
 other digestive processes are apt to be simul- 
 taneously disarranged by the same or similar 
 causes, we must consider the changes effected by 
 the same causes in the lymph circulation. 
 Obviously too much lymph must be finding its way 
 into the blood through the thoracic duct. Before 
 one supply has been properly elaborated and mixed 
 with the blood current, another supply is on the 
 way. This must interfere with proper assimilation 
 m the first place, and in the next must lead to 
 overloading of the blood with excess of nutritive 
 material. Then, nextly, where such too rich blood 
 has been carried to the muscles to keep up the heat 
 of the body, and to enable them to perform 
 mechanical work, there will be a larger over-plus in 
 the form of lymph to be absorbed by the lymph 
 spaces, and to be thence passed on to the lymphatic 
 trunks, by them to be carried to the lymphatic 
 glands for further elaboration, before the contents 
 pass on to be poured through the thoracic duct 
 back again into the venous blood. The lymphatic 
 vessels, let us suppose, do this work well. They 
 rid the blood of material which is unused, and pass 
 
169 
 
 it on for re-use in the economy, But long before 
 they have succeeded in doing this, another supply 
 of lymph and chyle has entered the thoracic duct 
 and the portal vein, and from these has been poured 
 into the blood. The blood carries it all over the 
 body, and particularly to the muscles, for conversion 
 into heat and into mechanical work. The same 
 round re-commences, the same overwork is thrown 
 on to the lymph spaces, and the lymph vessels, and 
 the lymphatic glands. The muscles become heavy 
 and achy, and the person feels languid and unable 
 or unwilling to move, and low and weak, not from 
 taking too little food, but from taking it too 
 often and too much. Nevertheless, she feels weak, 
 and further finds herself relieved for a short 
 time by taking more food, the heat of hot tea 
 (which is accompanied by bread and butter or 
 cakes) stimulating the digestion to assimilate some 
 of the unused stufi" in the digestive tract and in 
 the blood, while unfortunately the efforts of the 
 lymphatic system to relieve the blood are rendered 
 nugatory by the perpetual re-ingestion continually 
 going on, at too short intervals, of food in 
 excess of the requirements of the body. Obviously 
 the economical arrangements of nature may be 
 opposed or thwarted by unphysiological manage- 
 ment. Before the lymphatics have had time to 
 collect the lymph, more materials for lymph 
 formation have been ingested into the body. The 
 new digestive processes occur too soon. Too much 
 material finds its way into the blood, and, especially 
 
170 
 
 if this arrangement is repeated frequently and at 
 
 too short intervals, it is evident that the lymph 
 
 spaces may become blocked, and that the lymphatic 
 
 glands may become congested and inflamed. When 
 
 the congestion and inflammation proceed further, 
 
 pus-formation or suppuration occurs, and in this 
 
 way we can easily account for those enlargements of 
 
 the glands and for those disfiguring suppurations 
 
 and abscesses in the neck which often occur 
 
 among the people, and especially among the 
 
 children, of this country. In the same way, and 
 
 from the same causes, the lymph spaces in a serous 
 
 membrane like the pleura or that lining the interior 
 
 of such a joint as the knee, may become over-filled 
 
 with lymph, and so an attack of pleurisy or pleuritis 
 
 may ensue, or a white swelling, as it is called, may 
 
 occur in the knee joint of a child. If these are 
 
 theoretical ways in which such diseased conditions 
 
 may arise, I have no doubt that they are also in 
 
 most instances the practical ways in which they do 
 
 arise. A curious thing is that in the diseases I 
 
 have mentioned, the tubercle bacillus is very often 
 
 found to be concomitantly developed in the blood 
 
 and tissues, and, these diseases being then shewn 
 
 to be of a tubercular character, are looked upon 
 
 further as signs or marks of delicacy of constitution, 
 
 as the phrase is, in those who sufier from them. It is 
 
 doubtful, however, or more than doubtful, whether 
 
 this is a just view. It depends on the definition 
 
 we give to the term constitution, or what we mean 
 
 by it. If by constitution we mean resistance, then 
 
171 
 
 it would not be inept or unsuitable to use the term 
 as meaning simply that the child in question had a 
 somewhat low digestive resistance, and that in this 
 sense he had a weak constitution. But if we mean 
 (as we generally seem to do) that the original 
 powers of the person were too weak, that somehow 
 or other and from the very first his stamina was 
 poor and low, and much below the average, it is 
 more than doubtful whether we are justified in 
 using the term constitution in this sense ; and for 
 my part I think it is a wrong and unjustifiable use 
 to make of it. The question of constitution and its 
 definition will come up for discussion later. Mean- 
 time, let it be stated that it is not suggested that 
 the lymphatic derangements described have created 
 the tubercle bacillus. This would probably be 
 impossible, or, at all events, a most unlikely thing 
 to happen, neither man nor his body, nor the body 
 of any other organism, plant, or animal, being able 
 to create anything. But it does not seem at all 
 impossible, or even unlikely, that, if the tubercle 
 bacillus were in the body, it might be attracted by 
 the increased activity going on in those lymph- 
 engorged parts ; and that it might there set up its 
 characteristic actions. Most of us contain in our 
 bodies, most probably, numbers of these bacilli (and 
 numbers of other sorts also), but so long as we are 
 healthy we oxidise them off and take no harm, or 
 perhaps they lie dormant for a time and then die. 
 If ingested into the body by being, for example, 
 eaten in meat or swallowed in milk, we can easily 
 
172 
 
 imagine them lying dormant in the body so long as 
 it is healthy ; but when excess of activity has 
 occurred in any part through the lymph engorge- 
 ment referred to, we can suppose them finding their 
 way to that part, developing and multiplying there, 
 because they find the pabulum suitable for their 
 growth, and so from that place they may find 
 their way all over the body ; and, setting up their 
 characteristic actions, may in this way destroy the 
 body. If this suggestion seems far-fetched to any 
 reader of these remarks, let me remind him of what 
 takes place in agriculture when we treat with basic 
 slag grass land producing no clover, or, at least, so 
 little that it escapes our notice. For some years 
 after grass land has been treated in this way, fine 
 crops of clover are grown where no notable amount 
 of clover grew before, and not only so, but the 
 weight of the grass crop is very much increased. 
 Now the basic slagr did not contain the clover seed. 
 Being manufactured in the process of making iron, 
 it was white hot at one stage of the process of its 
 production, and nothing living could survive such a 
 condition. Unless, therefore, the clover seed had 
 been added to the basic slag at some time after its 
 production, it could not possibly contain any ; and, 
 of course, we know very well that this was not 
 done. The clover seed must, therefore, have been 
 in the ground, or it could not have grown. In 
 some way, therefore, the addition of the basic slag, 
 while not containing the clover, modified the 
 conditions of the soil and caused to thrive the 
 
173 
 
 clover which, perhaps, before, managed to live some 
 sort of a weak life, being possibly kept , down 
 though not destroyed by the grasses among which 
 it grew, until the addition of the basic slag some- 
 how altered its environment and made it thrive. 
 The precise form of the explanation is immaterial 
 to the argument. What is material is that the 
 addition of a manure not containing clover seed made 
 clover grow where it was practically unknown before. 
 There might be other explanations as to how this 
 occurred. But however this may be, who does 
 not see the close analogy between the facts of 
 clover production in this way and the causing to 
 thrive, in the body of man or animals, the hostile 
 micro-organisms of the tubercle bacillus ? That in 
 the case of the agricultural experiment we wished 
 the seed to thrive, and that in the case of the 
 tubercle bacillus we did not, is beside the argument, 
 which is on the other hand to this effect, that when 
 we alter the soil (by manuring land, or feeding the 
 animal body, as the case may be), we alter the 
 conditions or the environment, ^and so organisms 
 spring up which did not formerly do so, or if they 
 did spring up before, did not come to the matui'ity 
 of development which they subsequently attained. 
 To account for the original origin of the tubercle 
 bacillus, or of any other organism, is part of the 
 problem of creation, and transcends the wit of man ; 
 but to account for the presence of the tubercle 
 bacillus in any given place may or may not be 
 difficult, and as it generally lies within the powers 
 
174 
 
 of human investigation and explanation, may 
 profitably occupy us. To decide whether organism 
 or environment was first, to say whether the hen or 
 the egg was first, whether day was before night or 
 night before day, to declare whether structure was 
 before function or function was before structure, 
 are problems which transcend the powers of 
 human faculty. It is not, however, essential to 
 our happiness or comfort in this wonderful and 
 practically infinite universe, extending beyond the 
 utmost stretch of our imagination in all conceivable 
 directions, that we should be able to solve these 
 mysterious questions. It is enough for us that we 
 should see that organism and environment are 
 co-ordinated and co-related, that as the one alters 
 so does the other, that as the other alters so does 
 the one, to see that hen and egg and egg and hen 
 follow one another in invariable sequence, and 
 evidently have done so for an indefinite time in the 
 past, as we may assume that they will continue to 
 do so for an indefinite length of time to come ; that 
 similarly day and night follow one another in 
 invariable succession, and form part of the 
 arrangements of the universe, so far as we 
 have to do with it ; and that structure is co- 
 ordinated with function and function with structure 
 in such a way that, as one alters, so does the 
 other in a corresponding manner. In the same 
 way we may perceive that the tubercle bacillus 
 tends to grow in tissues, whose activity is 
 heightened by the long continuance of inflammatory 
 
175 
 
 blood congestion and lymph congestion in them, 
 whatever may have been the original way in which 
 its existence may have been brought about ; and 
 this knowledge carries with it, or may carry with 
 it, the practical conclusion that we may be able to 
 prevent the growth of that and other micro- 
 organisms in our bodies, if we see to it that these 
 bodies, besides being properly treated as regards 
 air and exercises, have also their food nutrition 
 properly managed, by being supplied with neither 
 too much food nor too little, and by being fed 
 neither too often nor too seldom, in conformity 
 with the work and the kind of work which they 
 are called upon to do. 
 
 I have in this chapter set forth the anatomical 
 and physiological facts of the circulation of the 
 blood and lymph, which seem to have a bearing on 
 the advice offered in these pages, at any rate to the 
 average townsman and townswoman, that they 
 should rather tend to restrict than to increase their 
 diet. I deal here rather with the theory on which 
 the advice is founded. Later, and particularly in 
 Chapter VIII. , the subject is dealt with more from 
 the practical standpoint. Until he reaches that 
 Chapter, therefore, the reader will perhaps be kind 
 enough to let the subject rest, and turn itself over 
 quietly in his mind ; and, meantime, I pass on to 
 the consideration of the two great medical 
 paradoxes. 
 
176 
 
 CHAPTER VI. 
 
 Some of the Paradoxes of Medicine. 
 
 T DO not know that I can introduce the considera- 
 tion of this interesting and important part of 
 my subject, or perhaps help to clear up, as I hope 
 to do, some of its puzzling confusion, better than by 
 relating the following occurrence. A lady, who 
 is much interested in medical questions, asked 
 me recently this question: "Can you give me," 
 said she, "any unequivocal sign, doctor, of under- 
 feeding ? any one unequivocal sign by which I may 
 know that either myself or my children are 
 under-fed ? " On hearing such a question the first 
 idea that occurs to one is, how simple is the 
 question and how easy the answer. Thinness, for 
 instance, wasting, attenuation, general depression, 
 languor, lowness of temperature, slowness of pulse, 
 inactivity of function, weakness — all these one 
 would think to be marks so obvious of under- 
 feeding as to cause surprise that the question was 
 asked at all. But, in point of fact, the answer to 
 the question is so dijQ&cult — at least it proved to be 
 so for me — that I was obliged to reply, " I cannot 
 mention any unequivocal, or as it might be called, 
 pathognomonic, sign of under-feeding." For the 
 
177 
 
 curious and even paradoxical thing is that all the 
 signs mentioned — the thinness, the wasting, the 
 lowness, the inactivity, the languor — while they may 
 sometimes, no doubt, be marks of under-feeding, 
 and occasionally are so, may also be, and, in fact, 
 when met with in practice, most commonly are, 
 marks or signs, not of under-feeding, but of 
 over-feeding. When men are exposed in a boat 
 after the wreck of their ship, for many days, with 
 only a few days' provisions on board, we know 
 that when saved they will be thin, wasted and 
 attenuated, that they will be weak, that their 
 pulse may be slow (or quick), their temperature 
 probably low, and their bodily functions generally 
 in abeyance. Mark Twain has described to us, 
 from the layman's standpoint, in his essay " How I 
 made my debut as a literary person," how there had 
 been no action of the bowels for twenty and 
 thirty days in the case of men subjected to these 
 conditions. In one case, he tells us, the duration of 
 the constipation, including a period of time after 
 the man was saved, was no less than forty-four 
 days. "Sleep, also," he says, "came to be rare, 
 but the men did very well without it." In one 
 stretch, the captain did not sleep for twenty-one 
 days and nights. The functions of intestinal action 
 and of sleep were in abeyance, or absent, for a 
 very long time. 
 
 Now there could be no doubt what the cause 
 was in these cases. The cause was direct starvation, 
 so long- continued, and with consequences so marked, 
 
178 
 
 that, had it gone on for only a little longer time, the 
 men must have died. And consequently, after the 
 men had been saved, the obvious treatment for 
 them, the only rational thing to do, was to have 
 recourse to cautious and, of course, not too suddenly 
 increased administration of food. And this would 
 have to be continued, as, in fact, it was continued, 
 until the men gradually returned to normal and 
 healthy food habits, properly proportioned to the 
 work which they had to perform. All this is perfectly 
 plain and obvious to the meanest comprehension. 
 But we should make the greatest mistake if we were 
 to assume that because attenuation, constipation 
 and sleeplessness were in these cases caused un- 
 doubtedly by too little food for a long continuance 
 of time, they are always so caused. And if, acting 
 on this view, we were to recommend a patient 
 suffering in these ways to increase his food, we 
 should or we might find his attenuation getting 
 worse and his constipation and insomnia increasing. 
 Constipation is inactivity of intestinal function, and 
 it may be brought about in two opposite ways, or 
 from two contrary causes, by deficiency of food and 
 by excess of food. In the one case constipation is 
 induced for two reasons, first, because there is 
 nothing to pass — the intestines have no contents, 
 they are quite empty — and second, because, if there 
 were anything to pass, there is no strength to void 
 it. But in the other case, constipation or intestinal 
 inactivity sets in because, there being too much 
 to pass, the intestines become dry and plugged. 
 
179 
 
 Obviously, while the treatment proper to the first 
 form of constipation is to cautiously increase the 
 diet till we get the man on to proper food habits 
 (when his constipation will begin to disappear), the 
 treatment proper to the second form of constipation 
 is to cautiously restrict the diet in the way 
 described in Chapter III. The first form of 
 constipation is caused by direct starvation, and 
 by the direct weakness which it brings on, but 
 the second by causes just the opposite of this; 
 and I have already described the modus operandi 
 in which it comes about. Reflection on the 
 causes of the condition also shews the futility of 
 treating such a state by purgatives. These only 
 irritate the bowel, causing an increase of watery 
 discharge from it by increased stimulation and 
 irritation ; but when these subside, unless other 
 measures are meantime taken, and particularly 
 unless the diet is restricted, the constipation is not 
 and cannot be relieved. In fact, it is apt to become 
 aggravated, because the irritation of over-action or 
 over-secretion, set up by the purgative, is apt to be 
 followed by a corresponding diminution of activity, 
 or by under-secretion, which makes the original 
 trouble worse. Unless the person so suffering 
 consents to restrict his diet — and, unfortunately, 
 too few persons are advised to do this, or, if advised, 
 unfortunately refuse to do it, so persistent and so 
 widespread and prevalent are wrong ideas on the 
 subject — he cannot get rid of his trouble. And 
 hence we see those frequently recurring cases in 
 
 L2 
 
180 
 
 which persons have recourse to the use of purgatives 
 for many years without being able to obtain relief 
 from their misery. Instances have occurred within 
 my knowledge in which patients have taken aperients 
 every day for 25 years, and even longer, without 
 succeeding in obtaining cure of their ailment. It is, 
 I confess, a standing puzzle and mystery to me how 
 this state of things can continue. One sees persons 
 capable, in other directions of life, of grappling with 
 difficulties, and of adapting suitable means to the 
 end of ridding them of their troubles ; but in a 
 case like this it is not so. Day after day the 
 difficulty recurs, the constipation shews no sign of 
 yielding to the means adopted for its relief. In 
 order to meet this, perhaps the purgative is 
 changed, cascara is replaced by liquorice powder, 
 or one form of patent pill by another, or one 
 mineral water by another, Hunyadi Janos by hitter 
 wasser or Friederichshalle ; or the dose is increased. 
 A patient once told me that, beginning with one 
 pill, which had a decided effect, he soon found it 
 necessary to take two, then three, and then 
 four, and so on, until at the time I saw him he 
 was sometimes taking as many as eighteen, and 
 occasionally even this dose had no effect. This had 
 been going on for fourteen years. How any sensible 
 man or woman fails to discover, after say six 
 months, that there is no relief to be got in this 
 way, and how it is that he still persists in futile 
 efforts of this kind, is a puzzle to me. In any 
 other direction in life, he would, when he found one 
 
181 
 
 means fail, try another, but in this he goes on in 
 the most fataHstic way with the same means, 
 or with means of the same kind, although time 
 after time he finds his remedies fail ; or, if he 
 obtains temporary relief, the evil soon recurs, 
 even perhaps in an aggravated form. The patient 
 above referred to told me a year after our 
 interview that he had only once taken a dose of an 
 aperient medicine during the preceding twelve 
 months, changes in the diet having effectively cured 
 the constipation, which no aperients could do more 
 than temporarily relieve. But this patient did not 
 hesitate, when advised to do so, to reduce his meals 
 to two a day, and to make some changes in the 
 quality of his diet. 
 
 How serious this condition may become, 
 however, and how serious in point of fact it often 
 does become, may be seen, among other instances, in 
 the case of cancer of the bowel, supervening from 
 this cause, the overgrowth of the muscular fibre at 
 some particular point in the bowel becoming greater 
 and greater, until at last it becomes so great that it 
 contracts so tightly as to prevent any contents from 
 passing, and an attack of intestinal obstruction sets 
 in, which puts the patient into the greatest danger, 
 and may even cost him his life. Even if he 
 survives one such attack, the causes still continuing, 
 and too much nutritive material continuing to find 
 its way into the blood, and thence to be conveyed 
 to the bowel itself, another attack is sure to occur, 
 followed by another and still another. In the end 
 
182 
 
 what is called malignant disease, and what is at 
 least incurable disease, sets in. The overgrowth, 
 though general over the whole bowel, is usually 
 much more pronounced at one point or place than at 
 the rest, and from this place an aggressive or 
 invasive action sets in in the surrounding tissues, 
 and indeed in the whole intestines, involving them 
 in similar action, so that, even if the chief place 
 afiected is cut out or exised, and if the patient 
 survives the operation, other parts have been for a 
 long time steadily prepared for taking on a similar 
 action, they may take it on accordingly, and cure for 
 that person may become impossible. People some- 
 times say that constipation causes cancer. What 
 has been said explains what they mean ; but 
 obviously a truer and sounder statement would be, 
 not that constipation causes cancer, but that the 
 causes of constipation are frequently also the causes 
 of cancer. On both views, of course, the practical 
 inference would have been drawn that if the consti- 
 pation had been cured, the cancer would not have 
 occurred ; but on the former view, the futile plan of 
 attempting to cure the constipation by administering 
 purgatives, would probably have been had recourse 
 to, while on the other view, the much better and 
 much more hopeful plan would have been adopted of 
 restricting the diet. The discussion of the causes of 
 constipation has led to a short digression as to how 
 constipation is often connected with incurable 
 disease, like cancer ; but the statement I wish to 
 emphasize, and which I think I have proved by 
 
183 
 
 probable evidence, the best sort of evidence which 
 can be brought to bear on the case, is that opposite 
 causes acting on the body may and do induce the 
 same effect. Constipation, obstinate and lasting as 
 we have seen (illuminating and rendering much 
 more instructive the layman Mark Twain's perfectly 
 correct description), for as long as 44 days, may 
 arise from too little food ; and it may also be caused, 
 as in fact it far more commonly is, by too much. 
 
 It is not quite relevant to the phase of the 
 subject under discussion, perhaps, but this seems 
 nevertheless a suitable place to introduce another 
 consideration bearing on this subject. The person 
 referred to as having taken all those pills told me 
 that his mother had died of cancer. From inquiry 
 it appeared that it had come on with prolonged and 
 recurring attacks of constipation, which it had been 
 fruitlessly attempted to relieve by administering 
 purgatives. Now suppose that my patient had also 
 gone on in the same way ; suppose that he had 
 persisted in attempts to cure his constipation by 
 efforts which, in the nature of things, could not 
 have been successful, and supposing that as a 
 consequence he had got cancer also — well, we 
 should have been apt to say that cancer was 
 hereditary in that family. And yet no more would 
 have been proved than that, like causes having 
 acted on like organisms for two generations, like 
 results had been produced. Organisation is trans- 
 mitted, no doubt, but disease hardly or very rarely 
 indeed. And in the case supposed there would 
 
184 
 
 have been no more proof of the hereditary 
 transmission of cancer than there would be for the 
 belief that death by gunshot wound or rifle bullet 
 is hereditary in a family because son, father, and 
 grandfather, having been mihtary officers, were, 
 one after the other, shot in action. If the son of 
 the last becomes a wool merchant, the probabilities 
 are that he will die in his bed. And if my patient 
 treats his constipation differently from the way in 
 which his mother treated hers, there is no reason 
 why he should have cancer like her. 
 
 I have said that probable evidence is the best 
 sort of evidence that can be brought to bear in 
 cases of this sort. The reader may demur to this, 
 and may ask for experimental evidence. Well, 
 what better experiment could be devised than the 
 experiment of civilised nature, as it may be termed, 
 of starving men in a boat for many days, if we 
 want to find out one of the causes of constipation ? 
 And, on the other hand, what better experiment can 
 we desire as to the causes of the ordinary and common 
 form of constipation than watching the effects of 
 the food habits of ourselves and our friends ? But if 
 minds are so constituted as to be dissatisfied with 
 this kind of evidence, let them, if they are so 
 minded, and if they can get persons to submit to 
 the experiments, subject their friends (or, better 
 still, themselves), to a long course of fasting on the 
 one hand, and to a long course of too frequent and 
 too abundant feeding on the other. Constipation 
 will arise in both experiments. They will find that 
 
185 
 
 opposite causes induce (apparently) the same state. 
 Let them weigh, and measure, and time the 
 quantities of food administered, let them note its 
 qualities and kinds as well. Then they will be able 
 to conclude that certain quantities of food of certain 
 kinds, administered at certain times, will, as 
 a rule, and within certain limits, induce constipation, 
 but that the powers of resistance of different 
 individuals, and of the same individuals in different 
 circumstances, will vary very much in the 
 manifestation of the effect. The net result will be 
 the view that the quantity and quality of food, and 
 the times of its administration which will induce 
 constipation, cannot be stated to a nicety, but that, 
 on the whole, frequent and abundant feeding tends 
 to induce it. In fact, the evidence to be obtained 
 from the artificial experiment will coincide with 
 that from the natural experiment or experiment of 
 nature, which, if we had carefully and, as far as 
 possible, accurately observed it, would have led us 
 to the same conclusion. And a general rule would 
 arise, the same as observation has already led to, 
 viz., that the quantity, and quality, and frequency 
 with which foods would have to be administered in 
 order to induce constipation cannot indeed be stated 
 to a nicety, but that taking it too much and too 
 often is a very potent cause. And of course from 
 this rule would arise the same canons of treatment, 
 the practical conclusions, the things we care most 
 about, the canons which have already been stated. 
 The results of experimental evidence will harmonise 
 
186 
 
 with and corroborate the conclusions of natural 
 evidence, but both are really experimental if 
 properly viewed. 
 
 But we may go a great deal further than this. 
 Not only is constipation induced by two opposite 
 sets of causes by too little and by too much ; so 
 are all conditions in which functions come to 
 be in abeyance. Mark Twain tells us how the 
 captain in charge of the boat for those 43 days did 
 not sleep for 21 days and nights. In fact, through 
 direct starvation, he lost the power to sleep. But 
 how unwise to conclude from this natural 
 experiment, so to call it, that the commonest way 
 in which sleeplessness or insomnia is brought about 
 is by taking too little food, and taking it too 
 seldom. The commonest form of insomnia is, on 
 the other hand, caused by taking food too often 
 and too much. The explanation of the modus 
 operandi^ in which the same result (I use 
 opposite in the sense of contrary^ not of con- 
 tradictory, i.e., as marking differences of quantity 
 and frequency, as to more or less, but not as 
 marking differences as to kind or essence — which 
 would be termed contradictory. Day and night, 
 heat and cold, e.g., are contraries of one another, 
 but motion and rest — if there is such a thing as 
 absolute rest — would be contradictories), is brought 
 about by these two opposite conditions, may be 
 difficult, and different opinions may be held about 
 it. I think the explanation is the following, and 
 that it is the same in principle as the explanation 
 
187 
 
 already given of the induction of constipation by 
 the two opposite causes of too much and too little. 
 In order that sleep may be induced the circulation 
 of the blood (and of the lymph) in the brain must 
 be moderate and proportional. But the function of 
 food is to make blood and lymph, and through 
 proper stimulus of nerves to control their cir- 
 culation. When men are directly starved for many 
 days, so that they threaten to die from direct 
 starvation, they, of course, use up the nutritive 
 powers of their blood. Blood too poor in nutritive 
 materials is sent again and again to the brain and 
 other organs. In normal circumstances this blood 
 stimulates the coats of the arteries to contract and 
 help in assisting the passage of the blood along the 
 arteries, and also keeps these coats in proper tone. 
 In normal circumstances, it seems to me, that 
 through the action of the trophic or vasomotor 
 nerves the normal tone is maintained in these coats, 
 as also a normal proportion between the action of 
 the longitudinal and the transverse or circular coats 
 of the arteries. In health I think the arteries are 
 contracted in sleep, while the veins are dilated ; but 
 contraction is kept up by over-stimulation of the 
 circular coats as compared with the longitudinal 
 coats. Normally I think healthy balance between 
 these two, results in rather more stimulation of 
 transverse than of longitudinal elements. * It may 
 
 • The same relation obtaining between the longitudinal and transverse 
 muscular fibres of the bladder and bowels respectively, leads to the 
 prevention of unpleasant accidents in their corresponding functions. 
 
188 
 
 possibly be that, while both the longitudinal and 
 
 the transverse elements are under the control of 
 
 the nervous system, the transverse coats are rather 
 
 under the control of the sjnnpathetic system of 
 
 nerves, while the longitudinal are rather under 
 
 the government of the cerebro-spinal system. If 
 
 so, this would account for the well-known fact that 
 
 too much excitement or too much anxiety causes a 
 
 feeling of throbbing in the head, and prevents 
 
 sleep. By the suggestion made, or in accordance 
 
 with it; excitement, and anxiety, and mentalisation, 
 
 or cerebration in general, tend rather to stimulate 
 
 the longitudinal elements of arteries, and so, by 
 
 contracting them, to shorten and widen or dilate 
 
 the vessels, and so, by over filling them with blood, 
 
 and hence by supplying too much blood to the 
 
 brain to keep it awake, and prevent sleep. Too 
 
 much food often has the same effect, If the effects 
 
 of over feeding continue, a compensatory action is 
 
 set up, and the transverse coats of vessels increase 
 
 in size or they hypethoply, as if in order to 
 
 overcome the overplus of stimulation of the 
 
 longitudinal elements. And, in fact, we find in 
 
 gout and other states of over feeding, great increase 
 
 in these circular or transverse coats, so that, in 
 
 some cases, they contract so tightly as scarcely to 
 
 allow the blood to pass at all. In this case their 
 
 action must be to induce a sort of obstipation or 
 
 constipation of the brain vessels, just as the 
 
 corresponding state already referred to in the bowel 
 
 narrows its lumen so much as to allow nothing or 
 
189 
 
 hardly anything to pass, and so to cause con- 
 stipation of the bowels from excess of food. But 
 in the opposite condition, that of direct starvation, 
 acting for a very long time, the blood has parted 
 with so much of its nutrient material that it cannot 
 stimulate the coats to act at all ; and so, as in the 
 analogous case in the bowel, whereas we saw there 
 was nothing to pass, and no strength to void it if 
 there had been, in this case the powers of the brain 
 and nervous system are so weak through the 
 impoverishment of the blood supply that the 
 nervous system is unable to sleep. Here is, 
 therefore, another function, that of sleep, which 
 disappears under starvation, and disappears also 
 under the long continued action of too much food, 
 and this, be it observed, even if the explanation I 
 have suggested of the modus operandi is incorrect. 
 In any case, the practical conclusion that we 
 come to is that the ordinary form of insomnia 
 ought to be treated by cautious restriction of the 
 diet. If a man is sleepless on four meals a day, let 
 him try three for a while ; if this is insufficient to 
 make him sleep, let him take two ; or, if two are 
 still too many, let him try one daily meal. But as 
 we cannot wait so easily for the arrival of sleep as 
 we can for the action of the bowels in prolonged 
 constipation, an admirable device for procuring 
 sleep is often found to be either starvation or a very 
 restricted diet, a glass of milk, e.g., morning and 
 evening, or a cup of cocoa made with milk, with a 
 basin of soup with, say, a slice of bread, in the 
 
190 
 
 middle of the day. This diet is in most cases 
 effective in inducing sleep in ten, or twelve, or 
 fourteen, or twenty days. If at the commencement 
 of treatment we think it right to administer a 
 sleeping draught once or twice, it is only in order 
 that we may be able soon to cease its administra- 
 tion ; for, bad as are the effects of administering 
 purgatives to cure obstinate constipation, much 
 more damaging and much more to be deprecated is 
 the too common practice of attempting to procure 
 sleep by means of frequently repeating the 
 administration of hypnotics. I hope, in fact, that 
 the reader is beginning to be prepared for the 
 statement that he is a poor physician (whatever 
 be his legalised medical qualifications) who shall 
 attempt to cure constipation by purgatives and sleep- 
 lessness by the administration of hypnotics. But 
 not only so ; I hope he will be beginning to see that 
 the statement may be generalised, and that he will 
 perceive how poor is that form of medical practice 
 in general which shall attempt to combat any 
 long - continued condition in the body by the 
 administration of remedies calculated to induce 
 the opposite state — which shall attempt, e.g., to 
 cure long - continued diarrhoea by administering 
 astringents, lowness or depression by administer- 
 ing stimulants, and stimulation or excitement by 
 depressants, excess of acidity by the administra- 
 tion of alkalies, or excess of alkalinity by the 
 administration of acids. These conditions may 
 possibly be combatable in this way if they are not 
 
191 
 
 of long standing, for the sufficient reason that in 
 this case they tend to get well of themselves, and 
 even without treatment ; but if they have existed 
 for some time, such treatment is quite faulty, and 
 persistence in it cannot eventuate in the cure of the 
 patient, unless the causes of the irritation are also 
 at the same time reduced, the usual translation of 
 which is that the diet ought to be restricted. Of 
 course, if the irritant were lying in the digestive 
 tract, administering a purgative might succeed in 
 removing it ; but if it were in the blood, no such 
 means could succeed in doing so. Hence the futility 
 of administering purgatives even where patients 
 are plainly and avowedly suffering from the long 
 continued effects of over -feeding. A purgative 
 cannot remove the cause from the blood, though 
 it may succeed in doing so in the case where some 
 irritating material is lying in the stomach or 
 intestines. The same indeed is true of blood-letting, 
 for which, however, there is really something more 
 to be said, for bleeding, while it may succeed in 
 removing a portion of the materies morbi in the 
 blood, can, after all, remove only say half a pint or a 
 pint of blood, while the quality of the blood which 
 remains is unaltered, and must continue to exert its 
 deleterious influence on the economy ; and, if the 
 over-feeding which led to the blood containing too 
 much nutrient material in it is continued after the 
 bleeding, what can we expect except that the 
 continuance of the causes will re-induce the old 
 effects? For this reason, among others, bleeding 
 
192 
 
 has been practically given up by medical men. Let 
 us hope that we shall soon see the evil effects of 
 purgatives and hypnotics as clearly. While insomnia 
 due to over-feeding must, therefore, be treated by 
 restriction of the diet, that form which is due to 
 direct starvation, the form from which Mark Twain's 
 men were suffering, must be treated by cautious 
 feeding and cautious increase of the diet. 
 
 The ancient writers on medicine used to say 
 that diseases were hot and cold or moist and diy, 
 and that the indication for treatment was, therefore, 
 to oppose dry by moist and moist by dry, to oppose 
 hot by cold and cold by hot. Stated in these ways 
 these terms seem fanciful, as, in fact, frequently 
 was the treatment adopted in conformity with 
 them, remedies being likewise divided into dry and 
 moist and hot and cold. But if we translate these 
 terms into the scientific language of to-day, we 
 shall see that they were perhaps not so fanciful as 
 we had supposed, or, at least, that solid facts 
 underlay them. For, undoubtedly, in some diseased 
 conditions, although the ancient physicians could 
 not measure it, the temperature of the body is too 
 high, and in others it is too low, and the physician 
 often enough attempts to diminish too high a 
 temperature, say, by putting an evaporating or 
 cooling application on the head, or even by 
 administering (though this is generally not so wise 
 a measure) a remedy whose effect is to lower 
 temperature. To elevate too low a temperatm*e, 
 which is almost always caused by too much food, is a 
 
193 
 
 much more difficult thing, and to attempt to do this 
 by stimulants, for example, is to end in failure, the 
 only sound methods of doing so being through 
 restriction of the diet and by recommending 
 exercises with or without the use of baths. But 
 reflection shews that though it might have been 
 fanciful to speak of hot and cold diseases, it is not 
 at all so, but is, on the contrary, highly practical to 
 speak of those with a temperature above natural 
 and those with too low a temperature. Likewise, 
 moist and dry in disease are often described nowadays 
 by the words, too dry and burning a skin, or one 
 too moist and sweating ; and physicians to-day 
 frequently recommend, at least, as temporary 
 measures of treatment, sudorifics, e.g., to make 
 the skin act ; or they recommend the body to be 
 sponged over with say tepid applications of weak 
 vinegar solutions to check sweating ; or even 
 administer remedies with that intention. Of course 
 it is much sounder and better practice to inquire 
 what made the temperature too high or too low, 
 what made the skin too dry or too moist, and to 
 take remedial measures in accordance with our 
 conclusions, than to rest contented with opposing 
 moist by dry, or hot by cold. 
 
 These reflections have, however, brought us in 
 sight of our second great paradox in medicine, 
 which is that the same causes often induce opposite 
 states in the body. The first, of course, was that 
 opposite causes induce the same state. Under the 
 second paradox we find statements of this sort : 
 
 M 
 
194 
 
 the causes of constipation and of diarrhoea are 
 often the same, viz., excess of stimulus, the chief 
 form of which is excess of food. The causes of 
 feverishness or elevation of temperature, and of 
 depression with too low a temperature, are often 
 the same, viz., wrong food habits; so with the 
 causes of too great dryness and of too great 
 moisture of the skin ; so with the causes of too 
 heavy sleep and too little sleep — they are often the 
 same. And of course it follows, if this is so, that 
 the treatment of these various and opposite 
 conditions must frequently be the same, the great 
 remedy being restriction of the diet. Much con- 
 sideration and much patience is required before 
 assent is given to this general proposition that the 
 correct treatment of opposite states is the same. 
 At first sight, in fact, it seems impossible that it 
 can be true. To recommend an obese person to 
 restrict his diet or his drink may seem quite 
 rational and in accordance with common sense and 
 common experience. But to say to a thin, wasted, 
 weak and attenuated person, " you must restrict 
 your diet in order to get rid of your thinness, your 
 wasting, your attenuation, your weakness ; " this, 
 it must be admitted, does sound foolish and 
 unnatural. Nevertheless, it is so often true, and so 
 often helpful to the patient to offer him this 
 seemingly parodoxical advice, that we must consider 
 and patiently discuss it for a while, because 
 unquestionably, he who does not understand it can 
 have no correct view of medicine and medical 
 
195 
 
 practice, and will, in consequence, fail to cure a 
 large proportion of patients, whose ailments, 
 nevertheless, are curable if the treatment is 
 properly set about. But we shall find, if we allow 
 ourselves to observe a little, and to reflect on what 
 we do observe, much corroboration of this view. 
 Breeders of fowls, for example, and fatteners of 
 fowls for the market know that if animals are over- 
 fed they become thin and wasted, and fall off in 
 weight. The mode in which Sussex and Surrey 
 fowls are fattened for market is said to be the 
 following. For about a fortnight they are confined 
 in coops and suppHed with as much corn as they 
 can eat. After about that length of time, their 
 appetite falls off, whereupon, for another fortnight 
 or so, they are artificially fed with soft food, inserted 
 into their gizzards with a squirt several times a day. 
 They have then reached their highest weight, and 
 it is found that they must then be sent to market, 
 if the owners are to make the best profit out of 
 them, because, if they are not, they then, or soon, 
 begin to fall off in weight, to become thin and 
 attenuated from over-feeding. The first effect of 
 over-feeding is greatly to increase the weight, but 
 the second as markedly to diminish it. The same 
 cause, viz., over-feeding, does induce opposite states, 
 viz., too great stoutness and too great thinness. 
 The thinness which follows over-feeding was called 
 by Dr. King Chambers the starvation of over- 
 repletion. It is quite evident that a sound way to 
 overcome it is and often must be to restrict the diet. 
 
 M 2 
 
196 
 
 But it is not difficult to see how this may be so, 
 because, in fact, people themselves will often come 
 to doctors with the statement : " My food does not 
 seem to be doing me any good, doctor." And the 
 doctor has frequently to reply, " You will get more 
 benefit out of it if you take less of it." No doubt 
 this state of thinness and wasting is often treated 
 by over-feeding, and apparently with good results, 
 at least for a time, patients improving very much 
 under seclusion and over-feeding, as it is called. 
 But do not let us be led away by words. Let us 
 see what this diet by " over-feeding " really is. 
 Here is an account of the diet of one of these cases, 
 variously termed hysteria, neurasthenia and anaemia, 
 in which patients are thin, low and weak, and in 
 which they are treated by over-feeding. 
 
 " Patient kept in bed ; rising only to relieve 
 calls of nature. 
 
 " First day : one quart of milk in divided 
 doses every three hours. 
 
 " Second day : cup of coffee on awakening. 
 Two quarts of milk in divided doses every two 
 hours. Aloetic pill at night. 
 
 " Third to sixth day : same diet. 
 " Seventh, eight and ninth days : same diet, 
 with a pint of raw soup in three portions (the soup 
 is made by treating raw beef with strong hydro- 
 chloric acid). 
 
 " Tenth day : 7 a.m., coffee; 7-30 a.m., half a 
 pint of milk ; 10 a.m., 12 noon, 2, 4, 6, and 10 p.m., 
 ditto; soup at 11 a.m., 5 and 9 p.m. 
 
197 
 
 " Fourteenth day : egg and bread and butter 
 added. 
 
 "Sixteenth day : dmner added and iron." 
 But in what sense is this diet a generous diet ? 
 It is not generous at all. It is a spare diet, yes, 
 and a very spare diet. A quart of milk in the first 
 24 hours, and nothing else, surely that is a very 
 restricted diet. In calories, it comes to about 600, 
 while the fasting man, as we shall see in Chap. VIII., 
 on the authority of a distinguished physiologist, 
 requires, or at least produces, 2303 calories. But 
 the first day is only the introduction. Let us see 
 the next stage. From the second to the sixth days 
 double this quantity of milk was administered, and 
 nothing else. But 1200 calories, the amount of 
 energy obtainable from this diet, is yet only a little 
 more than half of that given out by the starving 
 man, and about half of that emitted by the physician 
 or the ofiicial, as we shall see in due time. Up 
 to the present point, therefore, this diet of over- 
 feeding is only about half of a starvation diet. 
 From the seventh to the ninth days a pint of raw 
 soup was added, i.e., a pint of soup into which the 
 juice of a pound of raw beef had been strained. This 
 would not and did not contain much of the nutritive 
 matter of the beef, but if we were to admit that it 
 contained all the nutritive value of a pound of 
 beef, and were to add 1000 calories as representing 
 the energy value, we should still find that our 
 so-called over-feeding diet amounted to only 2200 
 calories of energy value, which is even yet less than 
 
198 
 
 the amount demanded by the starving man. But 
 it would be a gross exaggeration to suppose or 
 estimate that a pint of raw soup, made in the way 
 described, contained an3rthing near 1000 calories. 
 I really think that 100 calories would be nearer the 
 energy value of a pint of raw soup made in this 
 way. We come, therefore, after what I think is a 
 very fair and quite impartial examination of a diet 
 of " over-feeding," to the conclusion that for the 
 first fortnight it is a diet of restriction, and even of 
 great restriction. I quite agree, nay, I strenuously 
 assert that the principle of treatment by restriction 
 is correct ; but one must emphatically protest against 
 its being called a generous diet or a diet of over- 
 feeding. The patient's body is being called upon 
 during that fortnight to part with its surplus 
 stores, those surplus stores which made the patient 
 weak, thin and attenuated, because they were in 
 excess. This will be appreciated better if it is 
 realised that the urine passed in these circumstances 
 has often a specific gravity as high as 1030 in place 
 of 1010. A most excellent canon of treatment, in 
 fact, for these cases is to go on with the greatly 
 restricted diet until the specific gravity of the urine 
 falls to 1010, after which cautious increase of the 
 diet may be ordered, especially if in the meantime 
 the very low bodily temperature generally found in 
 these cases has shewn signs of rising. In four to 
 six weeks or so in my experience, these two facts 
 begin to shew, when I generally get patients on to 
 one solid meal a day, and continue that for some 
 
199 
 
 time, and uDtil they are ready for more, and until 
 they demand more. 
 
 But let us pursue the account of the over- 
 feeding diet, which, for the first fortnight, is, as we 
 have seen, a diet of starvation. 
 
 " Nineteenth day : The entire diet was as 
 follows : — 7-0 a.m., coffee. 8-0 a.m., iron and malt 
 extract ; breakfast, consisting of a chop, bread and 
 butter, a tumblerful and a half of milk. 11-0 a.m., 
 soup. 2-0 p.m., iron and malt ; dinner of anything 
 liked, with six ounces of Burgundy or dry 
 champagne, and at end one or two tumblers of 
 milk. 4-0 p.m., soup. 7-0 p.m., malt iron, bread 
 and butter, usually some fruit, and two glasses of 
 milk. 9-0 p.m., soup. 10-0 p.m., aloetic pill." I 
 have had some lifl&culty in calculating the calorie 
 value of this diet. I am sure it is too much, and 
 that after the patient had been on so restricted a 
 diet for the first fortnight it would have been better 
 to go on as on the sixteenth day, with dinner added 
 to the starvation diet, when the patient would have 
 had sufficient food, and would not have required the 
 aloetic pill at bed time. On a sufficient diet, 
 neither too much nor too little, the bowels regulate 
 themselves, and no aperients are required. If, on 
 the other hand, aperients are required, we may 
 be sure that the food administered is either too 
 much or too little. So far, however, as I can make 
 out, the diet represents about 3445 grand calories in 
 value, made up as follows. The bread given is not 
 quantified, but I have assumed that 4 ozs. were 
 
200 
 
 given at 8-0 a.m. and 7-0 p.m., and 2 ozs. at dinner, 
 that is, 10 ozs. in all. This is more, let me say 
 here, than the average woman can continue to take 
 without getting indigestion, colds, rheumatism, &c. 
 She may of course, however, take this amount daily 
 for some time without suffering in these ways, for as 
 long perhaps as the " over-feeding " diet lasts, 
 though what a misnomer " over-feeding " is in the 
 first fortnight of the diet we have seen. 
 
 7-0 a.m., cup of coffee. There is no calorie 
 value in this, or almost none. Its use in the body 
 is, however, great, as it stimulates the body to draw 
 on its own reserves and to use up some of them. 
 The increase of temperature which generally follows 
 the administration of a cup of hot coffee is a proof 
 of this. I have known the temperature of the 
 body to be raised by one or two degrees F. for an 
 hour or longer by such a dose of coffee. Half a 
 pound or half a pint of hot coffee solution at 
 110° F. could not possibly raise the temperature of 
 a woman weighing about 100 lbs., through one or 
 two degrees F. in temperature. It is a physical and 
 mechanical impossibility. But it may and easily 
 does so by stimulating the body to oxidise some 
 of its own surplus stores lying unused, and to some 
 extent clogging the body ; and so it performs a 
 very useful part in the economy. 
 
 8-0 a.m., breakfast. 4 ozs. of bread = 276 
 calories, and 4 ozs. of chops uncooked = 3 ozs. 
 cooked = say 120 calories, and milk = 225 calories, 
 butter, 1 oz. = 208 calories. 
 
201 
 
 11-0 a.m., soup. This contains little or no 
 calorie value, acting in much the same way as the 
 hot coffee does, and stimulating the better digestion 
 of the breakfast so as to prepare the stomach for 
 dinner at two. But let us say that half a pint of 
 soup contains 65 calories (perhaps 50 calories would 
 be nearer the mark). 
 
 2-0 p.m., ordinary dinner. Suppose this to 
 weigh two to two and a half pounds of mixed diet 
 as it comes to the table, made up say of 4 ozs. of 
 meat = 196 calories; 2 oz. of bread =138 calories ; 
 } lb. of potatoes = 270 calories ; cooked fruit, 1 lb. 
 calorie value, say 200 calories ; 1 oz. of cheese 
 = 125 calories ; 1 oz. of butter = 208 calories; two 
 tumbler sful of milk = 300 calories. 
 
 4-0 p.m., soup = 65 calories. 
 
 7-0 p.m., bread, 4 ozs. = 276 calories ; butter, 
 1 oz. = 208 calories ; fruit, say 200 calories ; two 
 glasses of milk = 300 calories. 
 
 9-0 p.m., soup = 65 calories. 
 
 The total estimated calorie value of this diet 
 comes therefore to about 3445 calories. I have not 
 been able to do more than guess at the calorie 
 value of the fruit, which, it is well known as to 
 many kinds of it, consists of about 90 per cent, of 
 water ; but I have estimated the calorie value of a 
 pound of it as about equal to 3 ozs. of bread. 
 This specimen of diet of over-feeding, taken from 
 Professor Davis's Dietotherapy, can scarcely be 
 termed a very excessive diet, representing in calorie 
 value barely more than half as much again as the 
 
202 
 
 energy lost daily by the starving man, but with 
 the patient in bed is probably a good deal more 
 than was required. For one thing, the need for 
 administering an aperient at bed time is itself a 
 suggestion in this sense. But this specimen of a 
 diet of over-feeding is much less than is administered 
 in some cases in which patients are heavily fed 
 every two or three hours during the day, and in 
 which much larger quantities of food, representing 
 a much higher and, it must be held, quite un- 
 necessary and very undesirable quantity of calorie 
 value, are given. Even if apparently well borne at 
 the time (but many patients rebel greatly when 
 undergoing the treatment), it is difficult to avoid 
 the conclusion that later it must lead to the 
 occurrence of gout, rheumatism, colds, headaches, 
 or other ailments in patients so treated, especially 
 as the treatment itself offers a tacit suggestion that 
 the patient should go on afterwards living more or 
 less under the idea that heavy feeding is a main 
 means towards maintenance of health and strength. 
 The explanation of the high specific gravity of 
 the urine formerly referred to is simple, on the 
 theory that the body and its circulation, the blood 
 and the lymph spaces, are loaded with unused 
 material accumulated within them, and on the view 
 that, under restriction of the diet, the body begins 
 to use them up, and to eliminate them ; but it is 
 difficult to explain it on any other theory. In fact, 
 if we examine we shall find that the urine passed 
 by persons in the state of neurasthenia, ovarian 
 
203 
 
 neuralgia, hysteria, general debility, and wasting 
 without feverishness, for the treatment of which 
 recourse is generally had to what is called over- 
 feeding, differs from time to time very much in 
 specific gravity. Sometimes a large quantity of 
 urine looking very much like pure water is passed. 
 This, on examination, proves to have a very low 
 specific gravity, say of 1004 or 1006, and to 
 contain very few chemical salts. At other times, 
 and more often, the urine is found to be of the 
 high specific gravity of 1030 or 1032, formerly 
 described. When this occurs under restriction of 
 diet, and before over - feeding is commenced, a 
 possible explanation might be that the body is 
 living on itself, that it is using up its own materials, 
 and that the high specific gravity is caused by the 
 presence in the urine of the products of the 
 oxidation of the tissues of the body. If this were 
 so, however, to any great extent, feverishness, or 
 elevation of temperature, with quickening of pulse, 
 might be expected to be present. As a rule, 
 however, neither of these conditions is present, the 
 temperature being generally considerably too low 
 (96° or 97° F., e.g., in place of 98-4° R), while the 
 pulse is not quickened. Still, the body must to 
 some extent be considered to be living on itself 
 during the treatment, because, during restriction, it 
 is not being suppHed, as we have seen, with sufficient 
 food for the long continued maintenance of life ; and 
 we are corroborated in this view by the fact, fre- 
 quently observed, that women treated in this way 
 
204 
 
 may increase their weight at the same time that 
 their food is diminished. This has occurred frequently 
 in my practice, and, among other cases, in that of a 
 young woman, twenty-six years of age, who had 
 been ill for three years with dyspepsia and anaemia, 
 and had been unable to follow her occupation for 
 two years. For the first four weeks of treatment 
 she took a tumblerful of milk mixed with an equal 
 quantity of boiling water morning and evening, and 
 about half a pint of mutton - or chicken - soup in 
 the middle of the day, and nothing else. She was 
 not confined to bed, but went about all the time. 
 For the next five weeks she had the same allowance 
 of milk morning and evening, or she took hot barley 
 water in place of the hot water. For dinner she 
 had half a pint of any soup with some green 
 vegetables in it, well cooked, as sprouts, cauliflower, 
 or celery, or cucumber, and some Parmesan cheese 
 dredged over it. The solid constituents of her diet 
 did not weigh more than eight ounces, and green 
 vegetables contain, it is well known, about 90 per 
 cent, of water in their composition. Nevertheless, 
 on this diet, she got entirely rid of her dyspepsia, 
 no longer vomited the bitter stuff she formerly did, 
 and, to a great extent, got rid of her anaemia ; her 
 friends complimenting her on her improved 
 appearance. More strange it is to add that on this 
 diet she gained one and a half pound in weight in 
 three weeks. No doubt she drew on the over- 
 accumulation of reserves in her body for some of the 
 supplies on which she lived during the time, for it 
 
205 
 
 is not to be supposed that she could continue to live 
 on such a diet, especially after she shall have 
 returned to her work. And the waste, effete, 
 unused material accumulated in her body, and 
 converted under this regime into the heat and 
 energy of life, was probably replaced by water in 
 the tissues, so that she gained weight. A certain 
 amount of this replacement by water was no doubt 
 of the greatest benefit to the patient, for in anaemia 
 the tissues are so shrunk and " constipated," or 
 obstipated, and the circulation in them is so blocked, 
 that the blood cannot enter them freely. The 
 oxidation and metabolism, therefore, that ought to 
 occur in the tissues is prevented from taking place. 
 This leads to further blocking and further 
 obstipation, especially if attempts are made to 
 "feed up," as they so frequently are in this 
 affection. The first part of the treatment which 
 goes under the name of over-feeding being, 
 therefore, a restriction of the diet, so that the body 
 may be called on to eliminate the excess of material 
 accumulated within it, the next part of the 
 treatment ought to consist in getting the body on 
 to proper nourishment, and this the treatment 
 attempts to do. Of course much depends on the 
 view which we take of the facts before us. If we 
 think that the lowness, the weakness, the thinness, 
 and the low temperature are marks of under- 
 feeding, we shall order a course of gradually 
 increased feeding, or even, perhaps, for a time, 
 of over-feeding. If, on the other hand, we think 
 
206 
 
 these are the sign of plugging, blocking and 
 obstipation of the fluids and tissues of the body, we 
 shall restrict the diet. It is a curious thing to find 
 that the first fortnight of what is called over-feeding 
 is really a diet of great restriction. But whatever 
 view we take of the causation of the patient's state, 
 there is certainly a danger that in the next part of 
 the treatment the administration of food may be 
 carried so far as to over-load the blood, and lymph, 
 and tissues with excess of the products of digestion ; 
 and it is to me, I must say, more than doubtful 
 whether the greatly increased diet sometimes 
 administered, a diet much heavier than the one 
 described by Professor Davis, is either necessary or 
 desirable. It seems to me to cause loss of strength, 
 plugging, blocking, constant tendency to take 
 colds, headaches, feeling of fatigue, and other 
 ailments. Some patients even resent it while 
 feeling over-persuaded to submit to it ; and I have 
 heard complaints from such that they were simply 
 stufied like geese that are being prepared for the 
 market. 
 
 We have been led into this digression through 
 consideration of the different methods of treatment 
 that must be adopted according to the different 
 points of view from which we see the facts before 
 us, and because this seemed a suitable place in 
 which to discuss the treatment of over-feeding. 
 We must now proceed to discuss further the aspects 
 of our second paradox that the same causes induce 
 or cause the production of opposite states in the 
 
207 
 
 body. This academic discussion has the most 
 important practical bearings, as we have seen. It 
 makes to the patient all the difference between 
 recovery and failure to recover, between life and 
 death, what view we take of his ailment, because 
 on the view we take depends the course of treat- 
 ment which we recommend for him. An academic 
 discussion, therefore, on the part of the medical 
 adviser is a practical matter of life or death to 
 the patient. If the medical adviser or the reader 
 is tempted to think, he will steer clear of the 
 whole discussion, if he thinks he will give it 
 the go-bye, if love of peace and quiet tempt 
 him to withdraw and let others fight it out, 
 he must be reminded that peace is not so to be 
 obtained, that refusal to consider a question does 
 not make it non-existent, and that the question is 
 a clamant one and of the most supreme importance, 
 because his future and that of those dependent 
 on him is bound up in it. He simply must face it, 
 for there is no escape. 
 
 It is difficult to find the best way of putting 
 the results of the second medical paradox. Perhaps 
 as good a way as any to explain how constipation 
 and diarrhoea, slow pulse and quick pulse, depression 
 and fever, melancholia and excitement, with a 
 variety of other opposite conditions, are frequently 
 produced by the same causes, and particularly by 
 excess of food, is by stating the following proposi- 
 tion. ALL AGENTS WHICH AFFECT THE 
 BODY OK ANY PAKT THEREOF EXEET 
 
208 
 
 ON IT A TWO -FOLD AND CONTRARY 
 ACTION IN TIME, THE SECONDARY OR 
 REACTIVE ACTION BEING THE OPPOSITE 
 OF THE ACTIVE OR PRIMARY ONE. As we 
 
 have seen, there are only two fundamental states in 
 the body, or in parts thereof, or tissues thereof, viz. , 
 shrinking and swelling, contraction and dilatation, 
 stricturn et laxmn, as the Latins called them. 
 The Greek medical writers knew these two con- 
 ditions under many and varied names, as, e.g., 
 arovia koX poxji^ ; crTeyvov /cat poiohe<; ; crreyvwcrts 
 KoX pvcTLt; ; TOLCTL'^ Kol ^^aXacTts ; crvuaycoyyj kol 
 X^o"ts ; KeKkeiOTfJiivov koX dvecoyjxeuov ; TrvKvo)cn<; kol 
 dpaLO)(TL<S' The Latins, again, keeping, in accordance 
 with the genius of their race, rather to the simpler 
 and logical division of strictmn et laxum, than to 
 the more florid and more imaginative subtleties of 
 the Greek mind ; but finding that discharges (or as 
 we should now term them, secretions and excretions, 
 especially the latter) are given out from the body 
 during the state of laxum. or dilatation, unfor- 
 tunately introduced another term, viz., solidio, as 
 the opposite of strictiira, and then by a lapse of the 
 logical faculty came to use solutio for any condition 
 characterised by such discharges as phlegm in 
 coughing, or diarrhoea or sweating, instead of as a 
 name for the dilatation which they thought to 
 accompany them. By opposing strict ur a to solutio 
 they really mixed up property and function, since 
 stricturn et laxum are fundamental properties 
 of organised (and unorganised) bodies, while of 
 
209 
 
 strictura et solutio, the latter at least denotes a 
 functional change occurring in an organised body, 
 and, as such, ought to have been opposed not to 
 strictura but to ahsorptio or imbibitio, if there had 
 been such a word. The logical and word-saving 
 Boman became confused here, but he was right to 
 this extent that in solutio, when some material is 
 being expelled from the body, the process is accom- 
 panied, no doubt, by dilatation of the longitudinal 
 elements of tissues, but is effected by contraction 
 {strictura) of the transverse. Absorptio, on the 
 other hand, takes place only when contraction 
 {strictura) of the longitudinal elements occurs, and 
 this, as we have seen, necessarily leads to dilatation 
 (laxatio) of the transverse, the latter action causing 
 opening of the mouths of vessels, by which alone 
 absorption is possible. In strictum of the transverse 
 elements, which is, of course, accompanied by 
 laxum of the longitudinal, organised bodies, having 
 expelled their secretion or excretion, become dry ; 
 while in strictum of the longitudinal elements, 
 leading necessarily to laxum of the transverse, 
 moisture appears in organised bodies. Strictum et 
 laxum therefore are the physical or anatomical 
 ■changes which occur in tissues ; absorptio et solutio 
 are the corresponding functional changes. But as 
 the ancients, both Greek and Latin, had not 
 distinguished either between structure and function 
 on the one hand, or between the necessarily opposed 
 states of contraction of longitudinal and transverse 
 ^elements on the other, and, as lastly they did not 
 
 N 
 
210 
 
 clearly see that strictum of elements is invariably 
 in time followed by laxum of the same elements, 
 their thinking on the subject became very much 
 confused. For, when the Latins spoke of strictwce 
 et solutionis co7nplexto they plainly mixed up 
 contraction of longitudinal and contraction of 
 transverse ; whereas, had they used the term 
 alternatioj and had they spoken of stncturcs et 
 solutionis alternatio, of alternation in place of 
 combination or mixture, they would have kept to 
 simpler considerations, which would have delivered 
 them and their followers from much confusion. 
 When, however, contraction of one set of elements 
 has the same effect as dilatation and even paralysis 
 of another, things do become very complicated and 
 difficult to explain. From this point of view we 
 may perhaps somewhat understand how medical 
 expert A advises his patient in a sense diametrically 
 opposite to that recommended by his colleague B, 
 the permutations and combinations of two or three 
 pairs of opposite things being almost impossible of 
 comprehension by the average human intellect. 
 And we must to this add the consideration that a 
 vehement desire on the part of the patient to 
 escape from his misery, and a failure to discover 
 whether the misery depends on excess or deficiency, 
 or rather perhaps the conviction that it does depend 
 on too little and not on too much, is apt to force the 
 hand of the medical adviser and to compel him to 
 allow indulgences which his judgment feels are 
 beyond the line of true moderation. Our general 
 
211 
 
 proposition, therefore, translates itself into this, that 
 when an agent primarily shrinks the body it 
 secondarily swells it. Cold is such an agent, and 
 the effect of cold is such that while its primary 
 action is to shrink the tissues, its subsequent action 
 or its reaction is to swell them. Shrinking, there- 
 fore, or swelling, may either of them be the effect 
 of cold. Heat also first contracts and secondly 
 expands the body, and so either contraction or 
 swelling may be the efiect of heat. Contraction 
 of transverse elements may be considered as the 
 type of depressing action ; their dilatation, on the 
 other hand, as the type of elevating or feverish 
 action. Tonics usually act as primary shr inkers 
 and secondary swellers. Relaxants usually act as 
 primary swellers and secondary shrinkers. Ex- 
 posure to cold first braces up to action and then 
 causes swelling, fatigue, and sleep — after which we 
 are ready to begin again. Alcohol, on the other 
 hand, first reddens the face, relaxing the vessels, 
 and then shrinks them, so causing pallor, and, if 
 the action has been carried far, shrinking secondarily 
 the vessels of the brain so much as to cause a 
 headache in the morning. As a small quantity of 
 the agent which in excess did the mischief, and 
 which caused the headache as its secondary effect, 
 relieves the headache by dilating the vessels as its 
 renewed primary effect, we see how much room 
 there is for difference and even for opposition of 
 practice, and perhaps we may be able to understand 
 somewhat the reasons for the existence of rival schools 
 
 N2 
 
212 
 
 opposed in practice to one another. But a patient 
 and repeated investigation of facts, and the explana- 
 tion of the same, must unquestionably lead to greater 
 toleration by rival schools of the methods of one 
 another, and in time, perhaps, to better agreement 
 among them as to practice. How much depends on 
 the natural action of nature, and how much is to be 
 attributed to the artificial action of the remedies 
 administered, ought reasonably to be considered by 
 both sets of practitioners. The result of such 
 inquiry, and of others like it, will undoubtedly be 
 good both for the practitioners and for those on 
 whom they practise. Take the case of a navvy 
 working in a sewer with his feet all day in six 
 inches of water, perhaps foul water, and a wind 
 blowing through the sewer. The man's tissues are 
 shrunk by the application of cold and by the loss of 
 heat from his body. He shivers, and (especially 
 when there is much effete unused stuff in his body, 
 that is, when, as is mostly the case, he has not 
 assimilated all the food he has taken) he is soon found 
 to have a high temperature and quickish pulse, and 
 may be diagnosed to be suffering from pneumonia 
 or inflammation of the lungs. Cold was the 
 immediate exciting cause of this. The predisposing 
 cause was the state of the man, particularly the 
 relation of his body to the prolonged influences of 
 its food environment. But an effectual mode of 
 treatment for the man might be — it is often the 
 most effectual of all — to envelope him in a wet sheet 
 pack for an hour; to restrict his diet, so that 
 
213 
 
 he shall use up some of the unused stuff that 
 is in him ; and to renew the application of the 
 pack at intervals till his temperature and pulse 
 fall, and the exudation into the oppressed lungs 
 is resolved and eliminated from the body. Here 
 excess of exposure to cold makes a man ill, 
 and judicious exposure to moderate and quantified 
 amounts of the same agent makes him well. 
 If, now, instead of taking the case of what 
 is called acute illness, the case in which the 
 exposure to the cause acts suddenly and severely, 
 we try to imagine the slower action of the 
 cause, when it is continuing to act for a con- 
 siderable length of time, we shall get some light 
 on the subject. Suppose a person to be exposed 
 not to sudden and severe cold, but to slighter 
 amounts of it acting for longer periods. Suppose 
 also that the body is subjected to a slow but not at 
 any time excessive condition of over-feeding. So 
 slow, indeed, that the body may be made gradually 
 to be tolerant of the irritation. We can imagine 
 (what frequently happens), that slowly the body is 
 depressed, and that its powers are lowered, that the 
 pulse may fall, and the temperature may be 
 diminished, till they seem to permanently shew 
 depressed readings. If acute or sub-acute attacks 
 of illness, repeated "colds," for example, or 
 repeated attacks of influenza, supervene, as they 
 often do, the tone of the body is so much lowered, 
 it is so much depressed, and the action of the 
 depressing agents, the cold and the over-feeding, are 
 
214 
 
 so slow and gradual, that even the reaction of the 
 sub-acute attack is not great. The patient has 
 only a slight elevation of temperature, to 99° F. or 
 100° F., say, after the subsidence of which, it falls 
 down again to its former level of 96° or 97°. It 
 seems that it is quite easy in this condition to 
 mistake the effects of too much for the effects of 
 too little. This is an example of our first paradox 
 (since depression may be caused both by too 
 much and by too little), that opposite causes 
 induce the same state. But further examination 
 also shews that the depression alternating with 
 the feverishness are both effects of the same 
 causes, and therefore it shews the action of the 
 second paradox, that the same causes induce 
 opposite states. We may put this in another way, 
 and say : irritation with tolerance causes depression, 
 while irritation with intolerance causes elevation or 
 fever, or at least feverishness ; but both depression 
 and elevation, both a too low temperature and a 
 too high temperature, are the effects of long 
 continued irritation. In point of fact it is far 
 rather the long continued improper feeding, the 
 long continued excess of irritation, which is the 
 main cause both of the depression and the 
 feverishness, than the prolonged exposure to cold, 
 so that, if a person is properly fed, neither taking 
 too much on the one hand nor too little on the 
 other, he will not be put about or made ill by any 
 moderate exposure to cold such as he may 
 experience in the ordinary conditions of English or 
 
215 
 
 European life. I think, however, that I have 
 shewn not only that, in accordance with paradox I., 
 opposite causes induce the same state, but also 
 that, in accordance with paradox II., the same 
 causes induce opposite states, and that these 
 opposite states are apt to alternate with one 
 another. If we think of it we shall find that the 
 frequent alternation of depression with feverishness, 
 of too low a temperature with one too high, might 
 be, and often is, termed irregularity of action. 
 And from this it will follow that a constant or long 
 continued irritation, acting on the body, induces 
 not only deficiency of function and excess of 
 function, but also irregularity of function. And 
 from these considerations arises also the practical 
 conclusion, so important it seems to me, that in the 
 medical management of the body its importance can 
 hardly be exaggerated : If you find defect of 
 function, irregularity of function, or excess of 
 function, look for a constant cause, or at least for 
 one acting at very short intervals over a long 
 period of time. As by far the most important 
 cause is improper nutrition, and as the form which 
 this takes is far oftener over-nutrition than under- 
 nutrition, the practical conclusion that emerges is 
 this : If you find yourself suffering from defect of 
 function, from irregularity of function, or from 
 excess of function, look for a frequently acting 
 cause, and recollect that most frequently (perhaps 
 three times out of four, or five times out of six, or 
 oftener), that frequently acting cause will be found 
 
216 
 
 to be too much food. Next to that, probably, it 
 will be found that improper relations between the 
 body and air are the chief cause of illness (for illness 
 is either defect, or irregularity, or excess of function). 
 Next to the relations of the body to air, probably, 
 it will be found that those to work or occupation 
 will be important, after which a variety of other 
 causes, like anxiety and exposure to various of the 
 exciting causes of illness, will take rank, such, e.g., 
 as damp, cold, moisture, dryness, &c. 
 
 This chapter is becoming long, but the import- 
 ance of the subject is great, and there are 
 difficulties connected with it, some of which I hope 
 are now less in the mind of the reader than when 
 he began to consider them, I do not wish to 
 labour the matter further, so will close this chapter 
 with an illustration from the course of business or 
 trade. There are two conditions in which business 
 tends to be depressed, or even to come to a 
 stand-still. The first is when there are no stocks 
 on hand, for when tradesmen have nothing, they 
 can neither buy nor sell (unless, indeed, they deal 
 speculatively in things which do not exist, which 
 is not legitimate business). But the second 
 condition in which business tends to come to a 
 stand-still is when stocks are so heavy that 
 merchants are afraid to do business for fear that, 
 instead of being able to make a profit, they may 
 sustain a loss. In the former case business is 
 checked by too little, it is starved ; in the second 
 it is clogged by too much, it is suffering from the 
 
217 
 
 starvation of over-repletion. This is the first 
 paradox : opposite causes have induced the same 
 state. We have now to see in illustration of the 
 second paradox that the same causes induce 
 opposite states, how the alternation of boom 
 and panic in business is the efiect of a constant 
 and a frequently acting cause in the commercial 
 organism, just as the alternation of fever and 
 depression is the mark of such a cause in the 
 physiological organism. The cause in the one 
 case is an unrestricted desire for gain on the part 
 of the merchant. The cause in the other case is a 
 too unrestricted or ungoverned desire for food on 
 the part of the man, woman, or child. When the 
 desire for gain on the part of the merchant is 
 natural, reasonable, right, neither too great nor too 
 small, then the course of business shews moderate 
 elevations at some periods, alternating with periods 
 of less activity, or of moderate depression at others. 
 But there are no inflated booms on the one hand, 
 and no panic depressions on the other. Let, 
 however, the desire for gain be too great, dispro- 
 portionate, inordinate, and then we get cornering 
 and other devices introduced, means intended 
 to gain monopoly for ourselves while we are 
 attempting to deprive our neighbour of his fair 
 share of business and of profit. The consequences 
 of this are booms alternating with panics, inflated 
 prices, when things are not worth for life what they 
 are fetching, alternating with times when they do 
 not fetch anything like their real value to life. 
 
218 
 
 We have, therefore, excess of business — too 
 great excess — alternating with defect — too great 
 defect — and the whole marked by irregularity; 
 just as we have feverishness, depression, and 
 irregularity in the bodily functions, arising from 
 too unrestricted desire for food on the part of the 
 man. But just as we may infer from defect of 
 business, excess of business, or irregularity of 
 business, that there is a constantly or frequently 
 acting cause to account for it, and that an 
 unrestricted desire for gain is far the most likely 
 cause to account for these conditions ; so we may 
 infer from defect of function, from excess of 
 function, or from irregularity of function in the 
 physiological organism, that there is a constantly or 
 frequently acting cause to account for it, and that 
 far the most likely cause is a too unrestricted 
 desire for food on the part of the man. Here also 
 in both of these cases it appears to me that the 
 thought is before the thing, not the thing before 
 the thought, that it is the desire which, being 
 gratified, causes the irregularity, the excess, or the 
 defect of the function, pointing to the conclusion 
 to which the study of life in all its aspects seems to 
 lead, that the government of desire and a wise 
 self-restraint make things go well, and safely, and 
 properly. So then if on the one hand we see the 
 organism healthy and active in the pursuit of good, 
 which is to be shared with all its fellows, we may 
 feel assured that there has been a wise government 
 of desire, and if on the other we see commerce 
 
219 
 
 pursuing a course, not monotonous, indeed, but 
 varying within certain well marked limits, neither 
 marked by boom nor by panic ; we may also infer on 
 the part of the business community a wise and just 
 self-restraint, a well ordered thought, which has 
 translated itself into that suitable and proper 
 thing. 
 
220 
 
 CHA.PTEE VII. 
 
 Some Further Observations on the Two Great 
 Medical Paradoxes as related to Changes 
 in Function. 
 
 FS health and disease shade off into one another 
 by insensible gradations, it is often difficult 
 to say where the one ends or where the other 
 begins. Would it, for instance, be a just or normal 
 use of words to say that a man whose sleep function 
 was disturbed, was diseased, and if so, at what 
 point in sleeplessness should we say that disease set 
 in ? If a man does not sleep for, say, one night or 
 for two nights, are we justified in saying of him he 
 is diseased ? Want of ease, dis-ease in this sense, 
 he is suffering from ; but I think it will be 
 admitted that to speak of such a man as being 
 diseased would scarcely be to use the words disease 
 or diseased in their ordinary sense. Where, then, 
 is the difference between health and disease to be 
 found ? Suppose, for instance, that in place of the 
 function of sleep, we were discussing the function 
 of circulation, or of respiration, or of intestinal 
 action. If we define the function of circulation in 
 health as corresponding with a pulse rate varying 
 
221 
 
 between, say, 60 and 90 beats a minute, and if 
 we find a man with a pulse rate of 55 on the 
 one hand, or one with a pulse rate of 95 on 
 the other, are we justified in saying, on this 
 evidence alone, that either of them is diseased ? 
 Scarcely, I think. Although a healthy pulse rate 
 is generally found to coincide with a rate of not less 
 than 60, or not more than 90 a minute, still it is a 
 difficulty that, when deahng with organic affairs or 
 the phenomena of organised bodies, and especially 
 when dealing with the phenomena of organised 
 bodies so complicated as the human economy, we 
 cannot offer definitions which are true to a nicety. 
 Health shades off into disease by insensible 
 gradations, and although, as a rule, a healthy 
 pulse rate is generally found to be running 
 as stated, and a healthy respiratory rate between, 
 say, 13 and 18 a minute, and although a healthy 
 temperature is generally about 98*4° F. (37° C), 
 still we should not be justified, I think, in 
 saying — at least I think it would scarcely accord 
 with the ordinary usage of words, if we were to 
 say that a pulse rate of 55 on the one hand, or 95 
 on the other, or a respiration rate of 12 or of 20 a 
 minute, or a temperature of 97*5° F. or of 99° F. 
 were necessarily marks or proofs of disease. I 
 should at least scarcely feel justified in speaking or 
 writing in this sense, although I daresay I should 
 feel less difficulty in admitting that a condition of 
 disease were present if I observed a pulse rate as 
 low as 40 on the one hand, or as high as 120 on the 
 
222 
 
 other. Where, then, it may be asked, is the 
 difference between functional alteration and organic 
 disease ? This is rather a difficult question, 
 although no more difficult than many others which 
 call for answer in other domains of knowledge. No 
 child would confound a dog with a gooseberry bush, 
 and yet it might tax the wit and information of 
 the keenest and best stored intellect to offer such 
 definitions as would separate logically and in 
 characters all plants from all animals. The fact is 
 that animals and plants shade off into one another 
 by gradations so insensible that it is sometimes 
 very difficult, and sometimes even impossible, in 
 classifying a given specimen, to be sure to which 
 class or kingdom we ought to refer it. This kind 
 of difficulty, indeed, abounds in our study of 
 nature. Even between things so immensely apart 
 as living and dead, or organic and inorganic, how 
 difficult it is to state the differentia. Or between 
 gaseous and fluid, or between fluid and solid. 
 Practically, of course, these questions do not 
 trouble us, or not very often ; but academically it 
 must be admitted that they present very great 
 difficulties indeed. Between sane and insane again 
 the experience of our law courts, as well as 
 judgments of sensible and unbiassed persons, shew 
 how difficult it is to draw a dividing line. Insane 
 people do not necessarily do insane things ; in fact 
 they comparatively seldom do so ; but they do sane 
 things (if, indeed, one may speak of things or 
 actions as being sane or insane ?) in an insane way. 
 
223 
 
 But who shall say certainly whether a given action 
 was that of a sane or of an insane person ? Dis- 
 proportion is probably the most unfailing mark of 
 insanity, the failure to make ideas, and the actions 
 springing from them, to correspond with the 
 realities of things ; and therefore persons are said 
 to be sane or insane much rather because of the 
 ways in which they do things, than because of 
 the things themselves which they do. In fact the 
 things done by insane persons are very often things 
 which require to be done by sane persons, but 
 insane persons do them in excess, either greatly too 
 much and too vehemently, or greatly too little and 
 too casually, or they may fail to do important 
 things at all. But to decide whether a given action 
 was that of a sane or insane person, is often so 
 difficult that one expert may think it was the action 
 of a sane person, and another may think it was not. 
 Similarly with the intestinal function, which we 
 expect to act once a day. We should hardly say if 
 it missed a day on the one hand, or acted twice a 
 day on the other, that a man was diseased ; 
 although if there were inaction for a fortnight, or 
 five or six motions in a day, we might be more 
 disposed to admit that he was so. The difficulty is 
 that both of these opposite conditions may be 
 present without the person thinking himself ill 
 enough to consult a doctor, although he did not in 
 either case think that he was quite well. Perhaps, 
 however, persons look with more equanimity or 
 with less mental disturbance on the former state of 
 
224 
 
 inaction than they are disposed to do on the latter 
 state of over-activity. 
 
 These cases are instances of the well known 
 difficulty of drawing the line, a difficulty which 
 meets us in so many cases in life that each of us at 
 once thinks of many instances in which he has 
 experienced it. And in the present case, although 
 we cannot absolutely separate (can we absolutely 
 determine anything ?) between alteration of function 
 and disease, we may make an approximation to the 
 statement of the differentia ; and the test that I 
 think may be offered, practically, is that in disease 
 there is generally present some exudation from the 
 blood, or from the lymph, in some part or parts of 
 the body, while in merely functional disturbance 
 there is not. I quite admit that there are cases, 
 well recognised to be cases of disease, where no 
 such exudation can be shewn to be present, a mild 
 feverish attack, for instance, or a mild attack of 
 typhus fever, or of measles. But as shewing how 
 functional change and disease shade off into 
 one another, we have only to picture a very severe 
 case of typhus fever in which exudations take 
 place into the arm pits and groins, and result in 
 suppurations such as are sometimes seen in plague. 
 From this point of view, sleeplessness would not be 
 a mark of disease, although it would be a mark of 
 functional disturbance, unless we could shew, or 
 unless it were likely, that some exudation from the 
 blood into the parts of the nervous system, through 
 which sleep is produced, or into its connective tissue, 
 
225 
 
 were present to account for it. So with constipation, 
 or with diarrhoea ; and so with disturbance of cir- 
 culation, or of temperature, or of respiration, or of 
 any other function of the body. It may be argued 
 that no change of function occurs in the body 
 without some corresponding temporary change, say 
 of circulation or of nervous action, leading insensibly 
 to change of structure. That may be so. But so long 
 as we cannot shew, or render likely by reasoning 
 the presence of some exudation from the blood, 
 somewhere in the body, as accounting for the 
 disturbance of these functions, we use the term 
 disturbed function, or functional disturbance, rather 
 than disease. If, on the other hand, we know or 
 think that we know that there is anywhere in the 
 body some exudation to account for the disturbances, 
 then we speak of disease. I believe myself that a 
 large number of instances of functional disturbance 
 commence in changes, and generally in some 
 blockage of the lymph circulation in the capillary 
 vessels lying between veins and arteries. Very 
 soon, and often impalpably or unprovably, some 
 lymph congestion of connective tissue sets in, 
 some phase of what I have called ^Initis, and that 
 this is the beginning of the process of disease in a 
 very large proportion of cases. But, of course, if 
 anyone were to argue that, before these changes 
 occurred, some previous mal-assimilation was 
 present, some failure to assimilate nutriment, this in 
 turn being caused by unsuitability in food supply as 
 
 * See Chapter YIII. for a full account of Initis. 
 
226 
 
 regards its quantity, quality, or frequency, this 
 statement would also accord with my view. 
 Practically, I should say that disease generally or 
 almost always begins at some point in the digestive, 
 and blood making, and lymph circulation processes, 
 that is, that disease is a form of mal-nutrition. 
 And I have a general opinion formed from the 
 evidence offered throughout this essay, that the 
 particular phase of mal-nutrition which is commoner 
 than all the rest put together, or at least the most 
 common, is the mal-nutrition which comes from 
 excess of food. Then the most usual change to 
 which this excess of food gives rise is over-growth of 
 the connective tissue ; so that, if we had functional 
 change in the connective tissue of a nerve, we 
 should speak of neuralgia (vevpov = nerve, and 
 a\yos = pain), while if we had exudation present, or 
 thought we had, either in the nerve or in its sheath, 
 we should speak of neuritis or peri-neuritis. The 
 former would be functional disturbance, the latter, 
 disease. Mere sleeplessness would be functional 
 disturbance, but cerebral meningitis or cerebritis 
 itself would be disease. Palpitation, that is, 
 irregular action of the heart, would be functional 
 disturbance, so long as there was no organic change 
 in the organ ; but endo-carditis, or peri- carditis, 
 or carditis itself would be disease. And so 
 with mere constipation and mere diarrhoea as 
 contra-distinguished from enteritis or peri-enteritis 
 {peri-typhlitis, e.g., which is a rather more familiar 
 term). Perhaps I ought to explain here, for the 
 
227 
 
 information of the general reader, the meaning of 
 the termination tfis, appearing in the words 
 neuritis, cerebritis, enteritis, bronchitis, &c. The 
 termination itis is the end of a Greek feminine ad- 
 jective, meaning of or belonging to, and agreeing 
 with vocros or i/ovo-os = disease, understood. Thus 
 cerebritis would be a diseased condition of or belong- 
 ing to the cerebrum or brain ; enteritis would be a 
 diseased condition of or belonging to the evrepov or 
 bowel ; bronchitis would be a diseased condition of or 
 belonging to the bronchial mucous membrane, &c., 
 &c. , &c. The termination would always point to a 
 diseased condition of the part of the body named in 
 the beginning of the word. But as it was soon 
 seen that the commonest diseased condition of parts 
 was inflammation of the parts, the termination itis 
 has for a long time now, by general consent, come 
 to mean inflammation of the part pointed to by the 
 beginning of the name. Thus cerebritis means 
 inflammation of the cerebrum or brain, enteritis 
 means inflammation of the enteron or bowel, &c. 
 In all these conditions there is an exudation 
 temporarily efiused into the parts, and so in the 
 generality of cases the difierentia that separates 
 disease from mere functional disturbance is found to 
 be present. With one word more I may for the 
 present dismiss this discussion. The bodily organs, 
 and even the tissues, very frequently consist of 
 three parts. (1) The tissue or organ proper, its 
 interior part, so to call it, or what is sometimes 
 termed its parenchyma. (2) Its coverings, or 
 
 02 
 
228 
 
 sheaths, or envelopes, These coverings are gener- 
 ally two, the inner and the outer. The Greek term 
 for a covering being etXe/x/Aa, inflammation of the 
 €tXe/x/xa becomes eilemmatitis or ilemmatitisy and 
 hence we say diseases are parenchymatous, on the 
 one hand, when the intimate central structure of 
 the organs is inflamed, and they are eilemmatous , or 
 ilefnmatous, on the other, when the coverings are 
 inflamed. As either the inner or the outer covering 
 may be inflamed, we sometimes speak of end- 
 ilemmatous {evhov = within) and ex-ilemmatous 
 {Ik or e^ = without). An end-ilemmatous disease 
 would be represented by bronchitis or inflammation 
 of the inner lining membrane of the lungs, while 
 pleuritis or pleurisy would be the name used of 
 inflammation of their outer or serous membrane. 
 Sometimes the inflammation of the outer covering 
 is referred to by the Greek preposition irepl = around, 
 and hence, instead of ex-enteritis or exo-typhilitis, 
 we speak of peri - enteritis and peri - typhilitis, 
 meaning inflammation of the parts around the 
 rv<l?\ov or blind portion of the bowel (the Latin 
 caecum), so named because it ends in a cut de sac. 
 So much it seemed necessary to say in order to 
 clear up some points in medical terminology, 
 which seem sometimes to create confusion in the 
 minds of readers. 
 
 We can now go on to discuss a little more at 
 length the alterations of function, which appear 
 according as more or less stimulus is acting on 
 the body. From time to time it will be evident 
 
229 
 
 that function shades off into disease by insensible 
 gradations, so that it is often difficult to differentiate 
 the one from the other. But the propositions I am 
 about to make are true, it seems to me, of function 
 rather than of disease. The general proposition or 
 propositions are : — (1) In the absence of stimulus 
 there is no function ; (2) in the presence of too 
 much stimulus there is also no function ; and (3) 
 when stimulus is moderate and proportionate 
 function is normal and healthy. We saw that 
 these propositions appear to be true for the functions 
 of intestinal action and of sleep. We have now to 
 see that they can be generalised, when they will be 
 found to be true of all functions. Of course, to do 
 this completely would involve a considerable amount 
 of labour, since to prove it completely would be to 
 evolve a complete treatise on physiology, on the one 
 hand, and a complete account of the practice of 
 medicine on the other. But short of this too great 
 task, it is possible for us to get much probable 
 evidence of the truth of this generalisation. And 
 the stimulus, which, as in the case of sleep and 
 intestinal function, has an inffaence so great as to 
 cast all others into the shade, is the stimulus of 
 food supply. Other forms of stimulus are important, 
 no doubt, but this is the chief, and that by a long 
 way. It is not necessary for us to depreciate 
 the effects of air on the body, or of work, or 
 of anxiety. In some ways, indeed, the effects 
 of air-supply on the economy are more noticeable 
 than are the effects of food-supply ; for deprivation 
 
230 
 
 of air for even a few minutes brings life to an 
 end ; while the body can go on without food 
 (if, that is, it is meanwhile supplied with water) 
 for an indefinite number of weeks, according to the 
 resistance of the organism, but certainly in many 
 cases for not less than six, while some persons have 
 lived without food for eight or ten weeks and even 
 longer. I suppose this is one of the reasons why in 
 our sanitary discussions, and in our practical measures 
 founded on our sanitary ideas, so much attention 
 has been given to the effects of air supply, and so 
 little to the effects of food. I do not know for how 
 long an average person, not exposed, say, to 
 extremes of weather, can live without both food 
 and water. For how long, for instance, could an 
 average adult of 35 years of age, and in average 
 health, live, say, in a covered boat gently rocked on 
 a calm and temperate sea, if deprived of food and 
 water ? Perhaps two or three weeks ? But if 
 supplied with water and deprived of solid food, he 
 can live for six or eight or more weeks. But if 
 deprived of air (and this, however he had been fed 
 before), for not longer than a few minutes. There 
 is a very great and very marked difference. The 
 effects of work or muscular movements, again, or of 
 anxiety, are, like the effects of food, of an indefinite 
 length of duration, so that the same difficulties 
 present themselves to us in the attempt to guage 
 the effects of these as in that to shew the effects of 
 food. There is a P-reat difference then between the 
 view here stated, that food supply, the defect of it. 
 
231 
 
 the excess of it, the irregularity of it, and the good 
 or bad quahties of it, is far the most important 
 cause of alteration of function in the body (leading 
 to disease, no doubt, since function and disease 
 shade off into one another by insensible gradations) 
 — there is a great difference between this view and 
 that which should state that food supply is the only 
 predisposing cause of disease in the body. Anyone^ 
 indeed, who should attempt to argue the latter 
 view, would put himself out of court at once, 
 rendering himself unworthy to obtain a hearing. 
 My argument, then, in attempting to shew that 
 food supply is the chief cause of illness, must take 
 the form of shewing that when defect of function 
 exists, on the one hand, when excess of it exists, on 
 the other, or when irregularity of it is present, 
 these abnormalities can be made to disappear by 
 alterations in the diet better than by any other 
 means. To do this I propose to attempt to deal 
 with other functions besides those of sleep and 
 intestinal action, with which I have ah-eady dealt. 
 Let us consider (1) circulation, (2) nutrition, as 
 shewn in obesity and in attenuation, (3) respiration, 
 (4) renal action, (5) the heat function of the body, 
 or the maintenance of its temperature, and (6) 
 cerebration, or thinking, feeling, &c. In dealing 
 with all these (as also with others, which, however, 
 are not quite suitable for general discussion), it will 
 be found that the paradoxes formerly stated hold 
 good as practical conclusions, and that we may 
 say : — 
 
232 
 
 1. Circulation. Too great slowness of the 
 pulse, say a pulse of 40 a minute or even 20 a 
 minute ; too great quickness of the pulse, say up 
 to 130 or 140 a minute; and irregularity of the 
 pulse, all may and often do depend on an excess 
 of food, and all can be combated, therefore, by 
 restriction of the diet. Otherwise, we can quicken 
 a slow pulse or render regular an irregular one (that 
 is, one which is now too slow and then too quick), 
 by the same means by which we can slow a quick 
 pulse, namely, by restricting the diet. 
 
 2. Nutrition. Too great thinness and too 
 great stoutness, and the state in which persons 
 sometimes become too stout, quickly, and, again, 
 too thin, quickly (in which nutrition is irregular), 
 all may and often do depend on excess of food ; 
 and, therefore, we can often fatten too thin persons 
 and render much more regular the nutrition of 
 persons who thin and fatten alternately, at too 
 short intervals of time — we can regulate these 
 abnormalities by the same means by which we 
 reduce or thin obese persons, namely, by restricting 
 the diet. 
 
 3. Respiration. Too great slowness of respir- 
 ation (below twelve a minute, e.g.), too great 
 quickness of respiration (above twenty a minute, 
 e.g.), and irregularity of respiration, that is, the 
 state in which too great slowness at some times 
 alternates with too great rapidity at other times, 
 may and often do depend on an excess of food. 
 And, therefore, we can frequently quicken a too 
 
233 
 
 slow respiration, and regulate an irregular one, by 
 the same means universally adopted to slow a too 
 quick respiration, namely, by restricting the diet. 
 
 4. Renal action. Too scanty and loaded 
 urine, as well as too thin and too abundant 
 urination, as well as irregularity of the function, 
 when too scanty urination alternates too rapidly 
 with too abundant functioning, all may and often 
 do depend on an excess of food. From which it 
 follows that we can frequently increase a too 
 scanty urination, and regulate an irregular flow, 
 by the same means by which we can reduce a too 
 abundant flow (as, e.g., in what is termed diabetes 
 insipidus or even diabetes mellitus), viz., by 
 restricting the diet. 
 
 5. Temperature of the body. Lowness of 
 temperature in the body (a temperature of 96° F., 
 or less, e.g^., elevation of temperature in the body 
 (a temperature of 102° or 103° F., e.g^, and 
 irregularity of temperature in the body, that is, 
 the state in which a too low temperature alternates 
 at too short intervals of time with a too high 
 temperature — these three states of disturbed 
 temperature all may and often do depend on an 
 excess of food. From which it follows that we 
 can frequently elevate a too low temperature, or 
 regulate an irregular one, by the same means which 
 are almost universally adopted to reduce a too high 
 one, viz., by restricting the diet. 
 
 6. Dulness of cerebration, or mentalisation, 
 or thinking, when the person's mind is lethargic 
 
234 
 
 and sluggish, when, e.g., he tends to fall asleep 
 if he tries to think or even to read ; also too 
 great rapidity and want of continuity in thinking, 
 when he cannot keep his mind on one subject for 
 any length of time, but flies off suddenly to 
 another ; as also the condition of mind in which 
 sluggish thinking alternates too rapidly with excited 
 and perhaps flighty thinking — these three states of 
 disturbed mental function may and often do all 
 depend on an excess of food. From which it 
 follows that we can frequently quicken the thinking 
 powers in too great sluggishness, regulate them in 
 too rapid alternation of quickness and slowness of 
 thinking, and slow them when the processes are too 
 quick — we can often effect all these changes by 
 restricting the diet. 
 
 If the critic were to say, as perhaps he will 
 say, that all these changes in the various functions 
 of the body may be brought about because persons 
 are exposed to the influences of bad air, or because 
 persons are deprived of proper exercises, or because 
 they are exposed to too great anxiety, or because 
 persons have too many things to think about, or 
 because of the incidence of other causes, we ought 
 to admit all these as possible causes, or we might 
 theoretically admit them to be possible causes. But 
 practically I have no doubt at all that the influences 
 of any two of these causes put together, or even of 
 all of them, are not to be named in the same breath 
 as the influences of improper food supply. Further, 
 of the three or four possibilities of food supply, 
 
235 
 
 its excess, its defect, its irregularity, or its bad 
 quality, I have no doubt at all that excess of 
 supply, either as to quantity or frequency, or both, 
 is far the commonest way in which this cause acts. 
 So that the practical conclusion we form, whenever 
 we see alteration of function, either as to excess or 
 defect or irregularity, is this : In order to rectify 
 the excess, the defect or the irregularity, let us 
 first restrict the diet, and see what the result will 
 be. I mio;ht have added the function of the skin 
 to those already named, and might have stated as 
 to the action of this seventh function : Too great 
 dryness of the skin, when, for instance, the hands 
 feel hot and dry ; too great moisture, as when they 
 are wet, cold and clammy ; and the state in which 
 too great dryness alternates at too short intervals 
 of time with too great moisture, all may and often 
 do depend on excess of food. From which it follows 
 that we can frequently relieve too great dryness of 
 the skin, as also too great moisture, as also 
 irregularity in the manifestation of these condi- 
 tions, by restricting the diet. In reference to the 
 skin function, I will only say that more than once 
 has it occurred to me to be able to reg-ulate it by 
 the simple advice to persons suffering in any of the 
 ways named, that they should, e.g.j omit their 
 supper. 
 
 Summing up then the propositions regarding 
 the relation of food supply as a stimulus to changes 
 in function, we come to the followino- state- 
 ments : — 
 
236 
 
 1. In the absence of the stimulus of food 
 there is no function. (If organs are not supplied 
 with nutriment they cease to act). 
 
 2. In the presence of too much stimulus 
 there may also be absence of function. (If organs 
 are supplied with too much nutriment they cease 
 to act.) 
 
 3. In the presence of moderate stimulus there 
 is normal function. (If organs are supplied with 
 their proper amount of nutriment, neither too 
 much nor too little, function is normal or natural). 
 These are very different propositions, I may say, from 
 the statement that might have been made that, for 
 example, absence of function is caused by absence 
 of stimulus. I do not think we are entitled to say 
 the latter. What we are entitled to say is that 
 absence of function and absence of stimulus are 
 co-ordinated and co-related. We are not entitled 
 to say which is first — which is the cause of the 
 other — at least, not till after a long philosophical 
 inquiry, very interesting, no doubt, to some minds, 
 perhaps to all, but to enter on which, as it would 
 lead us very far on the present occasion, there is no 
 time nor opportunity for. Let me here just remind 
 the reader of what was before said as to the various 
 relations of thought and thing ; and ask him to 
 apply the same ideas to the relation of food supply 
 and function. Food supply would correspond with 
 the thing ; function with the thought. The same 
 general relations hold between food supply and 
 function as between thing and thought. 
 
237 
 
 The reader who sees the statement that excess 
 of food supply is a far commoner cause of altered 
 function than either defect, or irregularity of 
 supply, or even than bad quality of it, may find 
 himself in a difficulty. If he should whisper to 
 himself — what about poverty, then? — do the very 
 poor also eat too much and too often ? It seems to 
 me that they do. The poor, it seems to me, eat 
 poor food too often and too much, and the rich eat 
 rich food too often and too much, and they are both 
 ill. Frequent eating is nearly always of too much 
 bread, cakes, and sweets. I never met any person, 
 man or woman, who ate meat five times a day, but 
 I have met very many persons, especially women, 
 who took bread, not only five times a day, but even 
 six, seven and eight times ; and once a woman 
 came under my care who ate bread no less than ten 
 times a day. I got to know all these people 
 because they were ill — they suffered in a variety of 
 ways, from colds, headaches, &c. ; but a way in 
 which many of them suffered was in being so thin, 
 so wasted, and so attenuated, that some of them 
 were advised that they were not having enough 
 food. A lady who ate eight times a day, on 
 going to a watering place, was told : ' ' Madam, you 
 are low, you are weak, you are attenuated, and you 
 must be fed up." The advice, I suppose, was felt 
 to suit her complaint, her mental if not her bodily 
 complaint, and she got, as so many people do, the 
 advice which it was felt would suit her. A 
 servant in a common lodging house, who got up at 
 
238 
 
 4-30 in the morning, and began with her tea and 
 bread and butter then, keeping on at it all day till 
 I counted ten times that she was taking it (the 
 ordinary dinner about 1-0 p.m. was one of the 
 ten meals), she, poor thing, was advised to go 
 to bed on nothing but milk and soup diet for a 
 fortnight, after which her diet was cautiously 
 increased, until she was got on to proper food 
 habits ; and she did very well. She also was low, 
 weak, and attenuated, and she was fattened by 
 having her diet for a time greatly restricted. Her 
 condensed, and plugged, and obstipated tissues 
 were drawn on, to deliver up some of their too 
 solid constituents, those whose too close aggregation 
 made her too thin ; by this means the blood found 
 its way better to the tissues, and she improved in 
 colour and aspect under restriction, and by and bye 
 increased in weight. But although, as I say, bread, 
 and cakes, and sweets are the commonest foods 
 which are taken too often and too much, and 
 although I have never met anyone who took meat 
 even as often as five times a day, not to speak of 
 six, seven, eight or ten times, still, no doubt, if 
 anyone did so foolish a thing, we should find that 
 he suffered from some form of serious illness. 
 The principle is that too much food and too 
 frequent consumption of it is destructive to health ; 
 the accident that it is nearly always bread, cakes, 
 and sweets, rather than meat, eggs, or game, which 
 are taken in this unphysiological and unhealthy 
 way. I have no experience of the effects of the 
 
239 
 
 appalling poverty which are said to be experienced 
 in the east end of London. I do not know how 
 much of '^these effects is due to crime, vice, reckless- 
 ness, drink, and improvidence ; but, judging from 
 experience in other places, it seems as if very careful 
 elimination of these sources of sickness would have 
 to be made before the effects pure and simple of 
 insufficient feeding in causing sickness and mortality 
 could be declared with any approximation to 
 accuracy. In provincial England, at any rate, 
 whatever may be true of the capital, even the very 
 poor, as a rule, eat too often and too much ; and 
 the charwoman is made ill and has her life 
 shortened, not by insufficiency of diet, nor yet by 
 the hard work which she is always talking about, 
 but by the five meals which she thinks it necessary 
 to take in order to keep up her strength so as to 
 be able to do her work. Even the beggar's baby 
 suffers in the same way, and from the same causes, 
 viz., not too little food too seldom administered, but 
 from taking it too often and too much. For the 
 beggar's baby, which has bread and tea at eight in 
 the morning, before being taken out to beg, which 
 gets from the hand of charity a piece of bread and 
 butter at 10-30 in the morning, which is taken 
 home at 12-30 or so to dinner of bread and tea, and 
 which is again fed with the same food at four and 
 at seven before being put to bed, suffers also from a 
 succession of " colds," and often from one or more 
 of the " fevers," such as measles, scarlatina, 
 diphtheria, infantile remittent fever, or the like. 
 
240 
 
 These ailments are attributed to cold, exposure, 
 infection, etc., and it seems to occur to but few that 
 the chief predisposing cause of them is improper 
 feeding. Nevertheless, the sickly history of the 
 rich woman's child, in whose case cold is avoided 
 and exposure and infection are carefully guarded 
 against, shows that there is a common cause of the 
 illnesses both of the children of the poor and of 
 the rich, viz., improper feeding, the commonest 
 form which this takes being, not too little food 
 administered too seldom, but too much food 
 administered too often. Of course, occasionally, 
 direct starvation is a cause of mortality among 
 infants, but the instances in which, Csg., infants are 
 neglected by bad mothers are nothing like so 
 numerous as are those in which they suffer from too 
 much food injudiciously administered too often. 
 The latter cause of death often takes the form of 
 what Dr. King Chambers termed the starvation 
 of over-repletion, or, as we might term it, of 
 indirect starvation — the former is direct starvation. 
 Both indirect and direct starvation cause or may 
 cause thinness, wasting and attenuation, but 
 obviously thinness caused by indirect starvation 
 must be treated by restriction of the diet, while 
 thinness due to direct starvation must be treated by 
 cautious increase of it. The mortality among 
 infants is frightful in England and other countries. 
 How frightful may be judged when we reflect that 
 among the whole population of England and Wales 
 .about a fourth of the children die before they are 
 
241 
 
 five years of age. But, as many careful and well- 
 advised mothers rear all their children, at how great 
 a rate must the others die, to render the general 
 mortality so high ! 
 
 Mr. Seebohm E-owntree's interesting book on 
 the Poverty of York appears to me to point in 
 the same direction. His menus of the meals of the 
 poor shew bread and jam four times a day, and 
 sometimes five times a day as the staple of the 
 kinds and frequency of their food supply. This is 
 certainly in accord with what strikes me as the true 
 conclusion in the matter on the whole (there are 
 exceptions, no doubt), when I say that the poor eat 
 poor food too often and too much, and that it is a 
 common cause of their illnesses. Two meals a day, 
 one of which might well enough be the bread and 
 jam referred to (it is quite suitable for one of the 
 daily meals), and the same amount of money spent 
 on more substantial fare such as frumity with suet 
 dumplings, and some egg, or milk, or meat up to 
 the value of the three or four bread and jam meals 
 which the second meal replaces, would provide a 
 much healthier and more substantial dietary, and 
 would cost no more, would indeed, I think, cost 
 less ; so that the needs of the family whose total 
 earnings are twenty- five shillings a week or less, 
 would be met, as far, that is, as it is possib..3 to 
 meet them on such small means. 
 
 In attempting now to make good the statements 
 that both excess and defect of function, as also 
 irregularity of function, are frequently due to 
 
242 
 
 excess of food, and that these conditions can be 
 more easily treated by restriction of the diet than 
 in any other way, it is not necessary to say much 
 regarding the treatment of excess of function, for 
 this is almost invariably and by almost universal 
 consent treated in this way. A too quick pulse, too 
 rapid respiration, excessive renal action, a too high 
 temperature, obesity, and even excessive mentalisa- 
 tion, as shewn, e.g., in delirium or too great 
 talkativeness, are usually treated by restriction of 
 the diet. There may perhaps be exceptions in the 
 case of excess of renal action, and occasionally in 
 that of too great mentalisation or cerebration, but 
 the almost invariable custom regarding the others 
 is to restrict the diet. As regards excessive renal 
 action, such as we get in diabetes, when persons pass 
 an immense quantity of urine, amounting perhaps to 
 30 or 40 pints in a day, the best results can often be 
 obtained in this way. In such cases I have seen 
 the quantity brought down in a few weeks from 
 many pints to three or four in a day, and with a 
 great fall in the specific gravity, by the administra- 
 tion of milk and barley water, with mutton tea, 
 during the day, and nothing (except water) during 
 the night. One such case was that of a young 
 woman, twenty-three years of age, who was brought 
 to me by her mother, suffering from diabetes 
 (specific gravity of urine 1040), many pints of 
 urine containing large quantities of glucose being 
 daily passed. There was also some albuminuria. 
 Under a diet of half a pint of milk and barley- 
 

 243 
 
 water, equal parts, twice a day, and half a pint of 
 mutton tea in the middle of the day, continued for 
 six weeks, this young woman entirely recovered, 
 after which she was put upon two meals a day, the 
 advice being given her to take a little meat at one 
 of her meals (about four ounces), and some bread at 
 the other. Under this regime she remained well, 
 and then, feehng that she need not keep so strictly 
 to orders as before, returned to her usual three 
 meals a day. In a year from the time of her being 
 first seen she relapsed, the old diabetic condition 
 returning, and being removed by the same curative 
 regime as before. The second attack did not last so 
 long as the first one. 
 
 It will be observed that the theory on which 
 treatment in this case was conducted was that the 
 disease was due to too much food taken too often, 
 and not that it was due to too much starch and 
 sugar in the diet. The advice given, therefore, was 
 that the patient should diminish her food or restrict 
 her diet, not that she should abstain from starch 
 and sugar. I have reason to believe that, had she 
 been fed on milk, meat and eggs — which the theory 
 that her illness depended on too much starch and 
 sugar would have necessitated — she would not have 
 recovered. It is interesting that a difference of 
 view so slight as that a patient's condition depends 
 on too much food rather than on too much starch 
 and sugar, should make so much difference to the 
 prospects of recovery, that on one view she would 
 recover, and on the other not. An academic 
 
 P2 
 
2U 
 
 difference of opinion as to causation may translate 
 itself into the difference between recovery and 
 non-recovery in the sphere of treatment, or into a 
 difference, so far as the patient is concerned, 
 between Hfe and death. 
 
 A man, thirty-eight years of age, who had 
 suffered for two years from diabetes meUitus, was 
 put upon a diet of a cup of coffee for breakfast, a 
 basin of soup for dinner, and a glass of milk and 
 barley-water for supper ; and this treatment being 
 maintained for some weeks, the specific gravity of 
 the urine fell from 1040 to 1020, the glucose 
 diminished greatly, and the quantity passed was 
 much lessened. After that he was advised to take 
 one meal daily of ordinary mixed diet, with milk 
 for his evening meal, sometimes with an onion. 
 Under this diet he improved greatly, and lived for 
 several years, dying, however, in the end, of the 
 remote effects of the intemperate habits to which 
 he was formerly addicted. 
 
 In another similar case, a man improved greatly 
 for some weeks on a similar diet, and seemed to be 
 in a fair way to recover, when unfortunately the 
 love of alcoholic drink to which he had formerly 
 been addicted, overcame him, and giving way to 
 alcoholic intemperance he speedily relapsed and died. 
 On the other hand, a middle-aged man suffering 
 from diabetes mellitus at the same time as the two 
 last-mentioned persons, and who was fed, on medical 
 advice, on a diet of milk, meat and eggs, died in 
 six months of diabetic coma. The view taken of 
 
245 
 
 the causation of his illness was that it was due to 
 too much starch and sugar ; and the excess of food, 
 which was most probably the real cause, was 
 continued in a somewhat modified form, an excess 
 of mixed diet being replaced by an excess of 
 nitrogenous food, and the patient lost his life. 
 Here again a discussion, which sounds an academic 
 one only, between the merits of too much food, on 
 the one hand, and too much starch and sugar, on 
 the other, or between the general and the particular, 
 may, when translated into treatment, be fraught 
 with the issues of life or death to a patient. 
 
 In other cases I have seen great benefit from 
 the administration of half a pint of milk at 8 a.m. 
 and 4 and 8 p.m., with 4 ozs. of beef or mutton and 
 some green vegetables at 12 noon. This is of 
 course a greatly restricted diet, whether as 
 measured by its calorie value or by custom. 
 Professor Davis, whose work on the Diet Treatment 
 of Disease has already been referred to, speaks of 
 ' ' a reasonable restriction of the diet " in the 
 condition in which too much water is being passed. 
 
 Cases of too great mentalisation or cerebration 
 or of too rapid, and irregular, and flighty thinking, 
 very often find their way to asylums, and are 
 therefore not so much treated by doctors outside of 
 these establishments ; but the forced and sometimes 
 mechanical feeding which is often resorted to there 
 is of very doubtful value, and seems frequently to 
 be over-done. When patients in these places refuse 
 food, as they so often do, the proper plan, it seems 
 
246 
 
 to me, would be to wait until they come round, and 
 to refrain from interference until signs of danger to 
 life set in, which would generally be not after a few 
 days, but after the lapse of some weeks. I was 
 present on one occasion at a discussion of this 
 question, at the meeting of a medical society, at 
 which several asylum experts were also present, and 
 only one case could be cited in which a person in an 
 asylum had carried starvation to actual death. All 
 the rest had given it up after some time, and had 
 returned more or less to food. Dr. Dewey, of 
 Meadville, Pennsylvania, publishes a remarkable 
 case in which a young lady in such circumstances 
 was induced to leave an asylum and to put herself 
 under the care of a scientific man who believed, in 
 accordance with Dr. Dewey's teaching, that too 
 much food is often the chief cause of insanity. 
 Under his advice she began to fast, neither he nor 
 she knowing for how long the experiment was to be 
 allowed to continue. He meant to interfere if he 
 saw any danger of death from direct starvation. 
 He believed she was insane from indirect starvation, 
 otherwise from the effects of too much food taken 
 too often, which had so altered her blood as to 
 supply the brain badly, and so to cause the general 
 flightiness which compelled her friends to send her 
 to an asylum. The well-meant but ill-judged plan 
 of treatment there was to feed her five times a day. 
 After fasting for 45 days, during which time she 
 took, besides water, no food at all, she became 
 perfectly sane, and has since remained so, having 
 
247 
 
 returned, of course, to proper but not excessive 
 feeding, meantime. It may also be mentioned that 
 from the 24th to the 45th day of the fast she 
 walked over 100 miles. Her portrait and name are 
 published by Dr. Dewey. On looking at it, one 
 would, I think, say she was "neurotic," but neurotic 
 people may be sane or insane according to the ways 
 in Avhich their environment alters, and one of the 
 chief causes why such persons not infrequently pass 
 the border line between sanity and insanity is, I 
 beheve, through the mismanagement of their food. 
 I feel quite sure that many persons, especially 
 women, are in asylums mainly through this cause, 
 and that much of the flightiness of conduct and 
 hysteria as it is called, manifested by many women 
 in conducting the business of their lives, and that 
 of their households, and who are not in asylums, is 
 due to the same cause. I have had a most striking 
 proof of this related to me in a long letter, the 
 writer saying, after her recovery, that all the while 
 that she was behaving so strangely as to become 
 at last quite intolerable to her friends, she knew 
 what was going on and knew the cause also (for she 
 had been told what it was, viz., an inordinate 
 liking for sweets), but for a long time she could not 
 brace herself up to do without them. When at last 
 she did so, however, and restrained her abnormal 
 appetite, she again became sane and quite her 
 former amiable and reasonable self 
 
 I do not think that the very potent influences 
 of causes of this prosaic kind in disturbing mental 
 
248 
 
 equilibrium, especially in women, has received 
 anything like adequate recognition. If it were to 
 receive it, much more could be often done by 
 very simple means to restore patients to mental 
 health, and prevent the need of their being removed 
 to asylums. If this is so, we can see how insanity 
 is often brought on just as other diseases are, just 
 in the same ways often as an ordinary cold or sore 
 throat is induced, and how ridiculous it often is to 
 suppose that heredity, e.g.^ has any more influence 
 on the disturbance of mental balance than it has in 
 inducing many other ailments. Further references 
 to this point of view will be made later. For 
 the present, the important point is to notice 
 that patients shewing signs of flightiness, and 
 loquacity, and oddness in ordinary life outside of 
 asylums, can often be well treated by a milk diet, 
 and frequently do so well on it as not to require 
 removal. But a diet of two pints or three pints of 
 milk a day is a greatly restricted diet. In calories 
 it does not amount at the highest estimate to more 
 than 600 or 900 against the 2303 calories emitted 
 by the starving man. Even six pints of milk a 
 day — and to see how much this amounts to (a glass, 
 e.g., at 4, 6, 8, and 10 a.m., 12 noon and 2, 4, 6, 8, 
 and 10 p.m., 12 midnight, and 2 a.m.), let anyone 
 try to keep ujd the ordeal of taking this quantity 
 for a week, and he will find out what an intolerable 
 burden it is. But even so, six pints of milk a day 
 only amounts to 1800 calories, and the starving man 
 emits 2303 ! ! I knew a woman suffering from 
 
249 
 
 typhoid fever who died from no other cause than 
 stuffing her with milk at this rate. If she had had 
 two and a half or three pints a day she would 
 probably have recovered. I need not, I think, 
 dwell ftirther on the management of excess of 
 function. It is only another name in most cases for 
 the feverish state, and it is invariably and by 
 general consent, and quite properly, treated both 
 by medical practitioners and by the public, by 
 restriction of diet. It is true that illustrations of 
 excess of function, especially great excess, have 
 to be obtained from what is usually termed 
 disease, but this only shews, what is freely 
 admitted, that healthy function shades off into disease 
 by insensible gradations. The practice of medicine is 
 only applied physiology and applied pathology, but 
 between physiology and pathology there are only 
 the differences that are found between function and 
 disease, viz., differences of degree. The differences 
 are those which obtain, e.g., between day and 
 night, not differences of kind, or quality, or essence, 
 but of degree only — not differences between con- 
 tradictories, but only of contraries. 
 
 I am afraid I shall find much more difficulty, 
 and shall encounter much more opposition in the 
 attempt to establish the proposition that defect of 
 function must also, in the vast majority of cases 
 that come before us, be treated by restriction and 
 not by increase of the diet. Nevertheless, the 
 references already made will help us to understand 
 this part of treatment better. Of course I do not 
 
250 
 
 deny — let me repeat this — that defect of function 
 is occasionally due to direct starvation. In this 
 case it must be treated by cautious increase of food. 
 But this is a comparatively rare occurrence in 
 ordinary practice, so rare that it may practically be 
 put out of account. The great majority of cases 
 of defect of function are, on the other hand, caused 
 by excess of food (or of some other stimulus — but 
 excess of food is by far the commonest form of 
 over-stimulus), and must therefore be treated by 
 restriction. Let me deal with the various functions 
 seriatim, and in the same order as before. First as to 
 circulation. I saw a boy of ten years of age, not long 
 ago, whose pulse rate was 40 a minute, and the pulse 
 was also irregular (there was defect of function and 
 also irregularity of function). He got quite well, 
 that is, his pulse rose to 80 and became quite 
 regular on a glass of milk and barley water three 
 times a day, or rather, on half a glass of the 
 mixture given six times a day, and nothing but 
 water in the night. This treatment was continued 
 for a fortnight, when his pulse having risen to 80 
 and having become regular, he was given one meal 
 in the middle of the day, and the milk and barley 
 water continued to the exent of half a pint of the 
 mixture morning and evening. After about ten 
 days of this treatment, and when the circulation 
 had become well re-established he was given an 
 ordinary meal at tea-time, and his mother was 
 recommended to continue this diet for the boy after 
 he went back to school, that is, he was to have two 
 
251 
 
 meals a day, dinner and tea, and a glass of cold 
 milk and boiling barley-water, equal parts, in the 
 morning before he went out. Similar treatment, 
 but continued for three or four weeks in the first 
 stage, namely, half a glass of milk and barley-water, 
 equal parts, every two hours in the day, and 
 nothing but water at night, raised the pulse of 
 a man from 38 to 72 a minute. After this he was 
 treated as the boy was, by cautious increase of the 
 diet, that is, he was put first on one meal a day, and 
 after a couple of weeks on two daily meals, and 
 became quite well. It will help to avoid repetition 
 if I say here, that in both of these cases I recom- 
 mended the continuance of two meals a day, and of 
 two only, after recovery - what may be called a 
 dissiteous regime -on the following grounds. Too 
 much food taken too often appeared to be the chief 
 cause of the illness in both cases. It was necessary 
 to greatly restrict the diet in order to obtain or to 
 allow recovery, and this restriction had to be 
 carried to a point below what would have been 
 sufficient for the maintenance of life and vigour, 
 especially as all work was perforce stopped for 
 the time being. But if, after recovery, the patients 
 had been advised to return to a diet as full as that 
 on which they had previously fallen ill, it is plain 
 that they might be expected to fall ill again, either 
 in the same ways as before or in some other way. 
 In order, therefore, to avoid this evil, they were 
 both recommended in future to pursue a dissiteous 
 regime in place of the three or four meal plan 
 
252 
 
 (the trissiteous or even tetrasiteous plan) formerly 
 pursued, and the results have been very satisfactory. 
 When defect of function (in these two cases, too 
 great slowness of the pulse) shews itself from food 
 taken too often or too much, we may say that there 
 is present in the body irritation with tolerance, the 
 irritation shewing its primary effect, viz., depression 
 or shrinking. On the other hand, when a quick 
 pulse is caused by excess of food supply, we may 
 say that there is present irritation with intolerance, 
 the irritation shewing its secondary efiect, viz., 
 reaction or swelling. These tw^o states may be 
 illustrated by the behaviour of disciplined soldiers 
 in attempting to get away from danger, as compared 
 with the behaviour of an ungoverned panic-stricken 
 crowd. When a thousand soldiers attempt to go 
 too quickly through a pass which will allow only six 
 at a time to pass, they may become blocked and 
 slowly come to a standstill. But the state of 
 irritation with intolerance is like a crowd of persons 
 flying from a burning theatre, jostling one another, 
 ])locking up the doorways, and trampling on one 
 another in wild panic. If the former ofier a rather 
 helpless mark for the attack of an enemy, the latter 
 not only do this but are their own enemy, and are 
 self-destructive besides. In both cases, however, 
 the remedial indication is to diminish the numbers 
 attempting to pass, and to diminish the causes 
 that led to the block ; but there is greater need for 
 haste to act in the latter condition than in the 
 former ; and the analogue of the way in which the 
 
253 
 
 numbers attempting to pass may most certainly and 
 most safely be diminished in both conditions of the 
 body is by restricting the supplies of food which led 
 to their multipHcation or increase in the first 
 instance. If these ideas are kept in mind we easily 
 see how both contrary states must be treated in the 
 same way. Neither the boy nor the man had 
 alcoholic stimulants administered. They might 
 have had, but they did not. The essence of the 
 treatment was the restriction of the diet. There is 
 a long, low depressed state of the circulation which 
 follows influenza sometimes, in which the pulse 
 becomes very slow and sometimes irregular. This 
 also ought to be treated by the administration of 
 hot fluids and by restriction of the diet in the way 
 suggested. When it is not, but is treated by 
 increase of the diet, as it too often is, the patient 
 sometimes succumbs to the treatment, while his best 
 if not his only chance would have been from the 
 opposite method of treatment. How serious is this 
 difference of view and of treatment between different 
 medical expert^ may be imagined. I feel convinced 
 that it forms a great part of the reason for the 
 low esteem in which the medical profession is 
 frequently held by the public, a low estimation, 
 notwithstanding the laudatory things they say of 
 us when in other moods, too often justified — for if 
 the experts are not only not agreed, but are 
 actually in flagrant conflict, what confidence can be 
 placed in them ? Imagine a business expert called 
 in to advise the community how to mitigate the 
 
254 
 
 stagnation of business caused by a plethora of 
 stocks. If in such a case he should advise 
 increased manufacture so as to multiply the stocks, 
 his clients would feel that he had misapprehended 
 the problem, even if they could not quite see how. 
 But if another expert advised using up the existing 
 stocks before proceeding to manufacture new ones, 
 a long suffering public could only feel that both 
 experts could not be right, and might be driven to 
 conclude that no coniSdence could be placed in 
 either, or in the expert class as a whole. And yet 
 one of these experts would be right, and the other 
 wrong, so that the last conclusion might be very 
 unjust. 
 
 2. The function of Nutrition. The next 
 function to be considered, if we follow the former 
 order, will be that of nutrition, in the restricted 
 sense in which it may be said to cause obesity and 
 attenuation. (Of course, in a wider sense, nutrition 
 may be said to cover all the functions, and changes, 
 and metabolisms of the body). There will be 
 no difference of view that obesity must always (or 
 at least almost always ?) be treated by restriction 
 of food and drink. But attenuation, or too great 
 thinness, and emaciation — is this always or is it 
 generally to be treated by increase of food ? Let 
 us see. The young woman formerly mentioned 
 came to me suffering from indigestion, anaemia, and 
 emaciation. She had been ill for three years, and, 
 for the last two years before I saw her, had been 
 unable to follow her very light occupation of a 
 
255 
 
 paste-board box maker. (This occupation consists 
 mostly in sitting with small pieces of paste-board in 
 the hands, and allowing a triangular-shaped iron, 
 driven by power, to come down and make " corners " 
 on the paste-board. It is rather a monotonous 
 occupation, but is in no sense laborious, so that the 
 person who could not do that must have been weak 
 indeed. If ever any person required to be " fed up," 
 surely it would be a person in such a state, and, 
 indeed, this was exactly what the eight doctors she 
 had seen before had advised her — but she was not 
 better, but worse). For the first four weeks after 
 she came to see me, she took a tumblerful of milk 
 mixed with an equal quantity of boiling water, 
 morning and evening, and about half a pint of 
 mutton - or chicken - soup in the middle of the day. 
 I need not go further into particulars about this 
 case than to say that under this greatly restricted 
 diet the young woman gained 1|- lb. in weight in 
 three weeks. She was suffering from the "starvation 
 of over-repletion," and under this restricted diet 
 she gained weight. At the very most this diet 
 does not represent more than 450 calories (probably 
 300 calories is nearer its energy value), while the 
 starving man emits energy value up to 2300 
 calories. She was, therefore, under a starvation 
 diet, and under it she gained weight ! ! How ? 
 Because her tissues were too dense ; they were 
 obstipated or constipated (so was the action of her 
 bowels, which slowly rectified themselves under the 
 treatment), and the blood, which was not deficient 
 
256 
 
 at all, but in excess, could not flow to the tissues, 
 and so could not nourish them properly, and she 
 became pale and thin, and wasted and weak. 
 When, under a starvation diet, her body was 
 induced to some extent to live on itself, the tissues 
 slowly began to be less dense, the blood flowed into 
 them better and nourished them better, and, as she 
 probably replaced some of her too dense tissues 
 with water, which was not restricted, though other 
 forms of food were, she gained weight. There was 
 no difierence among the experts as to the facts. 
 The girl was anaemic, she did suffer from 
 indigestion, she was pale, and thin, and wasted. 
 But there was all the difference in the world 
 between the experts as to the interpretation of the 
 facts, and there was also the greatest difference in 
 the results of treatment founded on the different 
 and opposing views held by the experts. This kind 
 of case can be parallelled every day in practice. 
 Another illustration of increase of weight following 
 restriction of the diet will be found in the case 
 detailed in the next chapter, where a child of four 
 years of age gained 9 lbs. in weight, on a diet 
 described by physiologists as a starvation diet, 
 continued, not as in the case referred to, for a short 
 time, but for the long period of fifteen months. 
 What evidence could be more striking or more 
 convincing to the candid inquirer than this sort of 
 evidence ? Truly they who do not yield assent 
 to it will not be convinced by anything. 
 
 3. Kespiration. There is a phase of the 
 
257 
 
 respiration in which the breathing becomes very- 
 slow, with long pauses in between. Instead of 
 breathing fourteen or fifteen times a minute, a 
 person will breathe only eight or even six times a 
 minute, three or four breaths taking place quickly 
 after one another, after which a long pause 
 occurs, lasting in some cases for half a minute, to be 
 followed by three or four more quick breaths, and 
 then another half-minute pause. The breathing is 
 not only slow, but irregular, though it is often, as 
 will be seen, regular in its irregularity. In this 
 condition the state of the patient is generally very 
 serious — in fact, very often this condition precedes 
 death — so that in general nothing which we can do 
 is of any avail to lift him out of his state of 
 too slow breathing. Nevertheless, under the ad- 
 ministration of hot drinks, whose aggregate calorie 
 value in twenty-four hours does not amount to 
 more than 400 or even less, this slowness and 
 irregularity of breathing sometimes quickens, and 
 becomes more regular, and patients survive for a 
 time, till another attack comes on. There will 
 probably be no difference of opinion as to the 
 treatment to be adopted for such a condition. No 
 doctor that I have ever heard of would advise 
 the administration of much food or of solid food in 
 such a condition, though he might [term the 
 frequent administration of small quantities of fluid 
 " keeping up or nourishing " his patient. It sounds 
 better to the ears of the friends to term it so. But 
 scientifically, so far as the calorie value of such a 
 Q 
 
258 
 
 diet is concerned, it is a restrictive diet, and not a 
 ' ' nourishing " one. Therefore I conclude that 
 depression of the respiratory function is treated by 
 common consent, and ought to be treated in the 
 vast majority of cases by restriction, and not 
 by increase of the diet. Of course, if slowing 
 and irregularity of the respiration had occurred 
 among Mark Twain's men exposed in the boat, 
 and if it had, therefore, been due to direct 
 starvation, as it might have been, it would have 
 been necessary to treat it by cautious increase of 
 food — but this is the uncommon or exceptional case, 
 while the other is the common one. It is hardly 
 necessary to say that too great rapidity of the 
 respiration is by universal consent and quite 
 properly treated by restriction of the diet. It is 
 in fact one of the most striking marks of the feverish 
 state, which is always treated by restriction. 
 
 4. Kenal Action. Defect of this function or 
 scanty urination usually depends on over-nutrition, 
 and ought, therefore, to be treated by restriction 
 of the diet. I think I need not dwell much on 
 this view because it is a generally accepted canon 
 of treatment that scanty urination, as it is usually a 
 mark of the feverish state, must be treated by 
 restriction of the diet. But it is a curious thing, 
 shewing how far, as yet, medical treatment is from 
 being , as it ought to be, a set of examples of applied 
 physiology, that opinions as to treatment still 
 differ, not as to defect of the renal function, but a& 
 to its excess. It is, as we have seen, quite tha 
 
259 
 
 reverse in the case of the three functions akeady 
 considered. In these there are differences of view 
 as to how deficiency ought to be treated, but none 
 as to excess. If we think about it, however, we 
 shaU see that a scanty, high coloured, and loaded 
 urine indicates a plugged or blocked renal action, 
 corresponding with the ordinary form of con- 
 stipation of the bowels, while diabetes, with or 
 without the presence of sugar (diabetes means 
 free urination, from Sta and jSaCvo), = I pass 
 through), indicates the excessive renal action which 
 corresponds with long continued diarrhoea. As 
 constipation and diarrhoea are both generally caused 
 by excess of food, and as they must both, therefore, 
 be generally treated by restriction of the diet, we 
 can the more readily see how the same canons of 
 treatment should govern the management of the 
 renal function in opposite conditions, and we can 
 the more easily understand the rationale as well as 
 the efficacy of the treatment of the cases of 
 diabetes already detailed in this chapter. 
 
 5. The Bodily Temperature. A low temper- 
 ature ought also to be generally treated by restriction 
 of the diet. No doubt in direct starvation the 
 temperature falls, and where a low bodily temper- 
 ature of say 95° or 96° F. is caused in this way, 
 it must be treated, if we have any opportunity of 
 treating it at all, by cautious increase of the diet. 
 But the commonest cause of subnormal temperature is 
 not deficiency of food, but excess of it ; and equally 
 obviously this must be treated by restriction of the 
 
 92 
 
260 
 
 diet. A great difficulty in accepting this view, a 
 difficulty so great that it seems to render the 
 defence of the view absurd to common sense, is 
 that persons suffering in this way are often thin, 
 emaciated, and attenuated by their illness, and it 
 seems ridiculous to advise restriction. In fact, 
 persons no doubt often become very angry, and 
 change their medical adviser, if he advises 
 restriction in this condition. And if they do not, 
 their friends do it for them. To meet this difficulty, 
 the medical adviser is often compelled to call his 
 method by the name of frequent and nourishing 
 feeding, and in order to seem to justify this, he orders 
 small quantities of hot stimulating fluid food (not 
 necessarily alcoholic stimulants), at short intervals 
 of time. A tablespoonful of milk and hot barley 
 water every half hour, or the same quantity or even 
 double the quantity of the same, or of hot beef tea, 
 or bovril, or some such food, taken all day long, 
 sounds as if it were a large quantity of nourishing 
 food. In point of fact it is not. It is a very 
 restricted diet. Suppose that a patient takes an 
 ounce of milk and hot barley water every half hour 
 from say 8 a.m. till 10 p.m. How much does she 
 take in a day ? Two ounces an hour for 14 hours, 
 or 28 ounces in a day. Even on the assumption 
 that the barley water is as valuable a nutrient as 
 the milk, the total calorie value of such a diet is 
 not above 450 calories (it is probably not so much 
 as that), and we have seen that the starving man 
 emits a value of 2300 calories. But people are so 
 
261 
 
 easily led by words that they dismiss the medical 
 adviser who speaks of restriction — which such a diet 
 really is — and send for him who calls the same 
 thing a " highly nourishing diet." In point of fact 
 I raised the temperature of a man who was, 
 besides, thin, emaciated, and attenuated by 
 constant vomiting, lasting for seven years, from 
 96° F. to 98*4°, by advising him to fast for 35 days. 
 On the 28th day his temperature had risen to 
 normal, and remained so. I do not think it could 
 have been raised in any other way. Neither does 
 he. He also was very angry when the suggestion 
 was made to him ; it seemed so much opposed to 
 reason and common sense ; and it was only when he 
 felt that he was dying on the other plan of frequent 
 feeding, and when he reflected that he might as 
 well die on one plan as on another, that he 
 consented to submit to treatment. I believe 
 myself that he was dying on the other plan, and 
 that the method of treatment that saved him was 
 the only one that would have done it. Or at least 
 I believe — what alone I am concerned to make out — 
 that restriction of the diet was indicated in the 
 treatment of the case. How much restriction was 
 necessary, and whether absolute starvation, except 
 for the free use of water, for five weeks was 
 necessary, must be left to the opinion of the 
 medical adviser. But the thin, emaciated man, 
 though he lost some 13 lbs. more weight during 
 the fast, not only did not die of it, but recovered ; 
 and during the time of the treatment his bodily 
 
262 
 
 temperature rose over 2° F, (I believe it rose 3" F., 
 but say over 2° F., because I wish to keep within 
 the bounds of fact). Could anything have demon- 
 strated more clearly what the cause of the man's 
 illness was, and what the cause of his subnormal 
 temperature was, than his behaviour under the 
 treatment? In seven years a man has many 
 opportunities of knowing his condition and of 
 hearing the views of different advisers. And his 
 unwillingness to submit to treatment makes him 
 all the more valuable a witness to its efficacy, after 
 he has submitted. 
 
 6. Defective Cerebration. This condition also, 
 as usually met with, is due not to too little food but 
 to too much, and generally requires restriction of 
 the diet. Of course, here also the cause may be 
 long continued and direct starvation. In this 
 unusual case it must be treated by cautious increase 
 of the diet. The history of the case alone will 
 determine which is the cause, but in ordinary 
 practice the cause is so seldom deficiency of food 
 that it may practically be left out of account. I 
 have already said something about this condition at 
 pp. 246-7, and must refer the reader to what is there 
 said, for my defence of the opinion that, the cause 
 being generally too frequent feeding and its con- 
 sequences, the condition calls for restriction of the 
 diet. I have seen some very notable cases in which 
 this was true, and in which also the opposite line of 
 treatment was very damaging to the patient. This 
 kind of case, however, as it leads so often to 
 
263 
 
 deprivation of liberty, and stirs up, besides, fierce 
 passion because of the horror, the altogether foolish 
 horror which persons have of having their friends 
 confined in asylums because of their prejudices 
 regarding heredity, cannot be so fully entered into 
 or described as some others. If it were generally 
 realised that brain irritation — both the irritation 
 with reaction or intolerance, as I have called it, and 
 the brain irritation with tolerance, which shews itself 
 in depression — is very often caused in just the same 
 ways as the taking of any other illness, then we 
 might be allowed to talk more calmly and dis- 
 passionately about it. When dealing with the 
 subject of the heredity of disease, and when 
 attempting to distinguish between the organisation 
 with its qualities, which is generally transmitted, 
 and acquired disease itself, which is generally nof 
 transmitted, I hope to return to this point. Mean- 
 time, I think it will be well to close the general 
 discussion, as also to refrain from considering 
 some other functional changes which may occur 
 to the imagination of the reader, but which are 
 unsuitable for public consideration. One point I 
 should mention about these mental conditions, viz., 
 this : both excess of cerebration and defect of it 
 (as well as irregularity) are not infrequently 
 caused by mental anxiety and stress ; while 
 wrong feeding, and especially too frequent feeding 
 frequently acts as a contributory cause. Still it 
 has to be admitted that long continued anxiety 
 alone may upset the mental balance. In fact, 
 
264 
 
 however a man or woman lives in respect of his diet, 
 he may be over-borne, and his mental balance upset, 
 by anxieties of business and of domestic and social 
 circumstances too great to withstand. Anxiety is 
 no exception to the general rule that moderation 
 is the only fixed and the only unfailing rule ; 
 but, although without the stimulus of moderate 
 anxiety, we may tend to become lethargic and 
 unwilling for exertion, still under too much pressure 
 we may lose our balance altogether, and drop into 
 melancholic depression on the one hand, or react 
 into maniacal excitement on the other. 
 
 I think, however, as the result of this long 
 discussion, that I have been able to shew the two 
 paradoxes in action, viz., first, the paradox that the 
 same causes induce opposite states in the body, and, 
 second, that opposite causes induce the same state. 
 And I think I have also shewn, or, at least, have 
 rendered it very probable, that of all causes food 
 is the most important, so that in finding ourselves, 
 called on to treat excess of function, defect of 
 function, or irregularity of function, we should 
 eliminate the eff'ects of food in causing the condition 
 before we proceed further in search of causes. Our 
 view as to causation may or may not afiect our 
 treatment of cases (although it generally does, 
 whether we know it or not), but the prevention of 
 diseases is so wholly dependent on our ideas as to« 
 causation, that it is absolutely necessary for us tO' 
 make up our minds on it if we wish to prevent 
 them. 
 
265 
 
 CHAPTER Yin. 
 
 The Quantity and Quality of Food Required by 
 Man. The Number of Meals, and the 
 Intervals of Time that Ought to Elapse 
 between Them. 
 
 T HAVE already said that the function of food is 
 to make blood, and that it is only by ellipsis 
 that the function of food can be described as being 
 to nourish the body, to supply energy to the body, 
 to maintain its structure and tissues, and to 
 provide for their repair. It does all these things, 
 no doubt, but indirectly, by supplying material to 
 form blood ; and it is directly the function of the 
 blood to do all these things, and only indirectly 
 the function of the food to do them. This being 
 so, the question before us in this chapter is how 
 much food must be daily taken into the body of an 
 average man or woman, in order that the blood 
 may be so made, and enriched, and refreshed, as to 
 suffice to nourish the body properly, and so as to 
 supply the material whose oxidation or combustion 
 may be convertible into energy or work done, and 
 to maintain the bodily heat ; as also that proper 
 maintenance and repair of the tissues may be 
 efiected. An additional question has also incident- 
 ally arisen through discussions in previous chapters, 
 
266 
 
 and we want to know also how food and blood may 
 do all these things without letting the bodily 
 functions be checked by too little on the one hand, 
 or clogged on the other by too much ; since we 
 have seen that in both of these states the bodily 
 functions are impaired and rendered inefficient, and 
 that, if either the checking or the clogging 
 processes are pushed, the bodily functions are either 
 stimulated to great excess of action, or tend to 
 come to a stand-still. A great deal of discussion 
 has always taken place around this question of food- 
 supply to the body ; and there are commonplaces in 
 inference and in observation which have naturally 
 occurred to inquirers in all times, as well to ancient 
 writers on the subject as to the modern ones, who, 
 since the time of Liebig, have considered the 
 chemical composition of food, and who, since the 
 time of Count E-umford and Joule, have been put on 
 the track of considering the mechanical equivalent 
 of heat, and its conversion, by mechanical and 
 animal machines, into physical and physiological 
 work. 
 
 I have already at pages 140-2 mentioned three 
 important observations made by the ancient Greek 
 medical authors, which have a bearing on this 
 subject, and need not repeat them here. But it 
 would obviate a good deal of needless labour if 
 persons who have proposals to make on this and 
 cognate subjects would familiarise themselves with 
 what has already been said and done in these 
 matters. Even the distinguished physician, who 
 
267 
 
 has re-introduced the no breakfast plan as a 
 practical proposal for the circumstances of to-day, 
 introduces his ideas in the following words : — " A 
 hygiene that claims to be new, and of the greatest 
 practicability, and certainly revolutionary in its 
 application, would seem to require something of its 
 origin and development, to excite the interest of 
 the intelligent reader." But, as we have seen, the 
 advice is not new and revolutionary. So far from 
 being either of these, indeed, it does not go so far 
 as the ancient writer in its recommendation, since 
 Dr. Dewey does not recommend the taking of less 
 than two daily meals generally, while the advice of 
 Hippocrates to go di^apto-ro? was offered to persons 
 who were taking apLorrov and hexTrvov only, and 
 therefore amounted to a recommendation that they 
 should be monositeous and eat once a day only. 
 There would or might be less objection to Dr. 
 Dewey's proposals on the part of critics if they had 
 taken the trouble to inquire what no less an 
 authority than the father of Greek medicine himself 
 had said on the subject, and if they realised that it 
 is only a very ancient advice resuscitated, and that 
 very much is to be said for it, which it would be 
 well for them to consider. 
 
 The reader will long before now have gathered, 
 I hope, that the writer of this essay is of opinion 
 that humanity suffers far more from being clogged 
 by too much food than it does from being checked 
 by too Httle. If there are a few people still in 
 this country who suffer from direct starvation, there 
 
268 
 
 are vastly larger numbers, he believes, who suffer 
 from the starvation of over-repletion. It is not the 
 poverty of England at the present time which is 
 doing it harm ; it is its wealth. Perhaps this is not 
 quite a fair statement ; and we ought rather to say, 
 since neither wealth nor poverty does us harm in 
 itself, that it is the use we make of either of them 
 which affects us well or ill. The present writer at 
 least believes that if the effects of over-feeding 
 were eliminated from medical practice, only a small 
 remnant of diseases would be left. What remnant ? 
 Perhaps a quarter or a third at the outside ; 
 perhaps a tenth on the least calculation. That is to 
 say, he has come to the conclusion that if people 
 generally would reform their diet — which means in 
 general terms, if they would consent to reduce their 
 diet, for he does not think that it is this, that, or 
 the other article of food that is doing damage, but 
 it is eating (and drinking) too often and too 
 much — if they would reduce their diet, young, 
 middle-aged, and old alike, the illnesses that affect 
 humanity would fall by from nine-tenths to three- 
 (juarters or two-thirds as compared with those from 
 which humanity now suffers. There would not be 
 more than a third or a fourth, perhaps not even 
 more than a tenth part of them left to trouble us. 
 The remarks made about the two great medical 
 paradoxes have, he hopes, somewhat confirmed this 
 view, and have enabled the reader to understand 
 how the attenuation due to the clogging or choking 
 by too much food can easily be mistaken, and often 
 
269 
 
 is mistaken, even by the experts, for the checking 
 which is due to too little. In other words, he 
 hopes he has somewhat cleared up the fallacy of 
 confusing the effects of direct starvation (from too 
 little food too seldom administered), with those of 
 indirect starvation (from too much food taken too 
 often). 
 
 With these conclusions in our minds, let us 
 now shortly view the present position of the 
 question of food supply to the body. An immense 
 amount of work, by very well informed and very 
 capable men, has been put into the question. Two 
 defects, however, it seems to the writer, char- 
 acterise the whole of this work. First : in order to 
 determine the quantity of food required for the 
 nourishment of the human body, the quantity of 
 the egesta from kidneys, bowels, lungs, and skin, 
 has been computed over a large number of 
 instances. It has been found that about twenty 
 grams of nitrogen, and about 300 grams of carbon 
 are eliminated daily by the body of the average 
 man ; and hence it has been computed that these 
 amounts must be supplied daily in the food 
 administered, since nothing is more certain (there 
 can indeed be no dispute about this point) than 
 that the body can create nothing, and that, if it is 
 not supplied with materials to make good its losses, 
 it must waste and consume away before its time. 
 But what if the average man is in the habit of 
 consuming more food than is good for him ? Will 
 not the egesta in this case be larger than if he 
 
270 
 
 takes only a proper amount of nutriment ? Of 
 course they will. And if from the egesta of too 
 much food habitually taken, we infer the proper 
 amount of food required to keep a man in health, 
 shall we not be apt to prescribe more for him than 
 he requires, and so, by our prescription, choke 
 the functions of his body with too much, and 
 so lower his vitality by this means ? Evidently 
 we shall. What should we think of the engineer 
 or the stoker who should gauge the quantity 
 of coal required by his engine by the quantity 
 of ash left after combustion ? Plainly the 
 quantity of ash left is directly proportional to 
 the quantity of fuel put into the furnace, and 
 also inversely as the effectiveness of the com- 
 bustion, for every stoker knows (even if he has 
 not put his knowledge into words), that he can 
 easily put his fire out by heaping on too much fuel. 
 No ; the proper inquiries for the engineer are to ask 
 how much heat he requires to provide for the 
 performance of a certain amount of mechanical 
 work, how much heat he can get out of the 
 complete oxidation of a certain weighed quantity of 
 fuel, and therefore how much fuel he requires to 
 consume before his engine can do the amount of 
 mechanical work (or of heating) required of it. 
 The questions asked by the animal physiologist and 
 by the doctors are precisely analogous ; and if they 
 gauge the amount and frequency of administration 
 of food by the quantities of carbon and of nitrogen 
 eliminated by the body, they will be very apt to 
 
271 
 
 fall into fallacies of reply just as would the 
 engineer. Now this is exactly what has happened 
 in this enquiry. When we look at the arguments 
 of the present physiological authorities on this 
 subject, the force of this fallacy becomes apparent. 
 
 Another fallacy incidental to this question has 
 been that the inquiry how much food is required by 
 the body has not been made over a long enough 
 time, and in particular that no sufficient enquiry has 
 been made whether the man remained well or 
 became ill under the administration of food. It is 
 true that in prisons and among soldiers and sailors 
 some enquiry has been made into this question, but 
 hardly any has been made into it as regards the 
 general population. But to refrain from doing this 
 is really to fall into a very great fallacy. A man or 
 woman may undoubtedly take for a day or two, or 
 for a week or two, or longer, a quantity of food 
 quite unsuitable to health, either in amount or 
 quality, without seeming to suffer much in one way 
 or another ; and yet, if he goes on doing so, may 
 suffer from illness from the continuance of its 
 effects. It seems to me, I must say, that the 
 frequent illnesses from which humanity suffers offer 
 a prima facie case for the suggestion that the way 
 in which we live is somehow unsuitable to us ; and 
 as by far the most important means by which the 
 blood and tissues are modified is through the food 
 consumed, the suspicion seems to arise in our minds 
 that all may not be well with the ways in which the 
 body is managed in regard to this. When we come 
 
272 
 
 to inquire further, and in greater detail, as to this, 
 our suspicions become confirmed, and the answer 
 seems to arise in by no means inaudible tones that 
 our food habits will require much modification if we 
 are to be or to remain well. "We habitually eat 
 more," says Professor Nathan S. Davis, of Chicago, 
 " than is needed to supply waste." All authorities 
 more or less agree in this opinion. But what the 
 writer thinks has not been sufficiently realised is 
 that habitually to eat more than is needed to supply 
 waste, translates itself and must translate itself in 
 the conduct of life, into suffering from a large 
 variety of illnesses, and that until this cause of 
 illness has been eliminated we must continue to 
 suffer in these ways, whatever our doctors do for 
 us, and however expert they may become in finding 
 remedies for the relief of ailments brought on by 
 this cause. Another consideration brought out by 
 this line of reflection is that a constant succession of 
 illnesses means early senility and early death, even 
 when patients recover from illness after illness, since 
 it cannot be denied that the body is weakened by a 
 succession of illnesses ; and that although Nature 
 is very skilful in eliminating waste effete materials 
 from the blood and tissues by the recurrence of the 
 illnesses which she inflicts on the body, still not all 
 of the materies morbi or materies morhorum is 
 eliminated each time, some remaining to clog and 
 choke up the processes of the body, so as to bring it 
 into the heaviness and ineffectiveness of old age, 
 and even to death, much before its time. And as. 
 
273 
 
 after recovery from each attack, the fornier methods 
 of living are again resorted to, and as, under the 
 plea that a larger supply of nutriment is necessary 
 to restore the strength lowered by the illness (to 
 some extent a true and just plea, but apt to be 
 greatly overdone), even more nutriment is adminis- 
 tered than before, the train of causes is efficiently 
 laid for the onset of another attack, which occurs 
 accordingly, being followed in turn by another 
 attack, and still another. It is in this way, and for 
 this reason, that, for example, we hear of persons 
 having a long succession, one after the other, of severe 
 colds, or of their having six or eight or ten, or even 
 occasionally fifteen or sixteen, or even more, attacks 
 of influenza, this condition of constantly recurring 
 illness not being confined even to the laity, but 
 occasionally affecting medical practitioners them- 
 selves. We have already seen, even although it is 
 lengthening a little, how unsatisfactorily short life 
 is for the large majority of the human race living 
 under the ordinary conditions of civilisation in a 
 settled country like England. A return of the 
 Manchester Unity of Oddfellows, recently made by 
 Mr. Alfred W. Watson, one of the actuaries of the 
 society, has brought out the general facts that the 
 duration of life is increasing among the members of 
 the society, but that it is accompanied by a larger 
 amount of sickness than formerly. The return 
 covers the years 1893-7, and comprises a much larger 
 number of years of life exposed to risk, and also a 
 much larger number of sickness-weeks than has been 
 
274 
 
 dealt with before. The general results seem to be 
 these : There has been an increased sickness among 
 members aged 17-45 years, as compared with 
 1866-70, of 21 per cent. ; between the ages of 
 45 to 65 years there is an excess of sickness equal 
 to 26 per cent. ; and from the age of 65 and over 
 there is an increase of 42 per cent. As to mortality 
 there has been an improvement as compared with 
 the results of thirty years ago. Up to 45 years of 
 age the death-rate now is only two-thirds of what 
 it was thirty years ago. This is what our general 
 examination of the subject had already led us to 
 expect. From 45 to 65 years the death-rate has 
 been found to be nine-tenths of what it formerly 
 was. At ages beyond this we find a heavier death- 
 rate. Whatever the causes of these general results 
 are, it does not seem to be very satisfactory to 
 contemplate an improvement in the duration of the 
 life of working people up to 65 years of age, when 
 it is accompanied by a considerable increase in 
 sickness. More life and more efl&cient is what we 
 want, not more life and less efiicient. Over 65 
 years of age, among this large class of workpeople, 
 both the mortality and the sickness rates are larger. 
 The improvement in early life is due, I suppose, to 
 the diminution in the fevers and in consumption 
 which have occurred in the thirty years ending in 
 1897, these being, as we have seen, diseases whose 
 incidence mainly falls in the earlier years of life. 
 The benefit has been gained, as we have seen, by 
 the attention which has been paid to the improve- 
 
275 
 
 ments effected between the body and air, and the 
 improvement holds on to a period well past middle 
 life. What the subsequent deterioration is caused 
 by is not apparent. Of course if persons live 
 longer than formerly, they must die at somewhat 
 increased rates at the later ages, since they cannot 
 go on living indefinitely. But whether this 
 accounts for the whole of the increase, I do not 
 know. Evidently, however, the increased mor- 
 tality at the later ages cannot be caused by 
 either increased hard work or increased liability to 
 accident, since the increased use of machinery has 
 tended to displace laborious hand-work by the lighter 
 work of superintending the machines which do the 
 work ; while the efforts of the legislature to prevent 
 accidents have been so far successful that there is at 
 least no increase of mortality or of sickness on this 
 score. Whether the deterioration of health at the 
 higher ages is due to the increased number of meals 
 which working people, as well as other people, are 
 now taking, is at least a question worthy of 
 consideration. 
 
 Let us now hear what different physiological 
 and other authorities say regarding the require- 
 ments of the body as to food supply. 
 
 With a body weighing 74 kilogrammes, or 
 about 1 64 pounds, Ranke found himself sufficiently 
 nourished with — 
 
 Proteids ... ... ... 100 grammes. 
 
 Fats ... ... ... 100 
 
 Carbo-hydrates ... ... 240 ,, 
 
 R2 
 
276 
 
 This he could have got from- 
 
 Proteida. Fat. Carbohydrates). 
 Grams. Grams. Grams. 
 
 Lean meat, 9 ounces, or 250 grammes, 
 
 containing ... ... ... 55 8*5 
 
 Bread, 18 ounces, 
 
 containing ... ... ... 40 7 '5 245 
 
 Butter, 2 ounces, 
 
 containing 
 
 or 500 grammes 
 or 55 grammes 
 
 55-0 
 
 Fat, 1 oz., or 28 grammes, containing 28 
 
 Total ... ... 95 99 245 
 
 or, since 18 ounces is altogether too much bread for 
 a man to eat in a day, say, nine ounces of bread and 
 one pound of rice pudding, containing one egg, and 
 say, six or seven ounces of lean meat. This is the 
 allowance for a large man. Most men weigh a 
 good deal less than this ; but even so it is about 
 30 ounces of mixed diet daily. At the same rate, 
 a man weighing 120 pounds (we are not told if 
 Ranke's weight included his clothes) or three- 
 quarters of this weight would require three-quarters 
 of this allowance of food daily. That is, 6| ounces 
 of lean meat, about 13 ounces of bread, Ij ounce of 
 butter, and J ounce of fat — i.e., about 22 ounces of 
 food as it comes to the table. 
 
 But we are not told for how long E,anke per- 
 sisted in taking this diet, and whether, for instance, 
 he had any " colds," rheumatism, bronchitis, 
 headaches, or other ailments. Most townsmen of 
 my acquaintance would suffer from dyspepsia, 
 constipation, herpes labiorum, bronchitis, rheu- 
 matism, pruritus ani — one or more of these 
 
277 
 
 affections — if they took anything like so large a 
 quantity of bread as 18 ounces daily for any length 
 of time. Nine ounces of meat is also a large 
 quantity to take daily. 
 
 The demands of Moleschott are higher than 
 those of Ranke, viz. : Proteids 120 grammes, fat 
 90 grammes, and carbo-hydrates 333 grammes. But 
 most men habitually take much more food than 
 these allowances. 
 
 It has become customary in recent years to 
 estimate diets in what is called calorie value, and 
 perhaps we ought to do so here. Food eaten 
 represents so much potential energy, capable in the 
 body, as fuel in a furnace, of being converted into 
 so much kinetic energy, which latter takes the 
 form of maintaining bodily heat, or of doing work. 
 " To determine," says Professor Davis, " the 
 amount of potential energy in food eaten, it is 
 necessary to know how much food is consumed and 
 the potential energy of food stuffs. The calorie 
 is the unit that has been fixed upon to express the 
 energy stored in food. A calorie is the amount of 
 heat required to raise one gram of water 1° C. The 
 most convenient way in which to estimate the value 
 of food stuffs is to determine how many calories a 
 given weight wiU furnish. It has been established 
 that one gram of dry proteid will furnish 4000 
 calories, the same quantity of carbohydrate 4180 
 calories, and the same quantity of fat 9400 calories. 
 With these facts known, it is easy to determine 
 the calories that any given food stuff will furnish, 
 
278 
 
 provided the percentages of proteid, fat and carbo- 
 hydrate that it contains are known. These 
 percentages must be multiplied by the figures just 
 given, and their results added, in order to 
 ascertain the number of calories in 100 grams of 
 food." This is the scientific doctrine of the day, 
 what may be called the formal statement of the 
 scientific position on the subject. Obviously it 
 requires translation into pounds or ounces of 
 ordinary mixed food as it comes to the table, and 
 proportionment to the business of life, whether 
 that of brain-worker or hand-worker, and if so, 
 whether a light hand-worker or a heavy hand- 
 worker, before it is of much use in practical life to 
 practical people. Ranke's diet aforesaid obtainable 
 from the meat, bread, butter, &c., mentioned, w^orks 
 out to about 2355 grand calories. (A grand calorie 
 is 1000 small calories, or the quantity of heat 
 required to raise 1000 grammes of water through 
 one degree Centigrade. I always state results in 
 grand calories, and to avoid the use of long figures ; 
 for 2335 grand calories would be 2,335,000 small 
 calories, a longer and probably a more confusing 
 number). Moleschott's diet works out to 2718 
 grand calories. Play fair's full health diet of 118 
 grams proteid, 50 grams fat, and 528 grams carbo- 
 hydrate, comes to 3140 grand calories. The same 
 authority makes the diet of active labourers 
 demand 155 grams proteid, 73 grams fat, and 568 
 grams carbo-hydrate, which comes to 3630 grand 
 calories. I append below a short table embodying 
 
279 
 
 the views of other authorities, so that the reader 
 may see at a glance how widely they differ on this 
 subject. 
 
 Authority. Proteids. 
 
 Fats. 
 
 Carbo-hydrates. 
 
 Calories 
 
 Voit- 
 
 -Moderate Work ... 118 
 
 55 
 
 500 
 
 3055 
 
 Do. 
 
 Hard Work ... 145 
 
 100 
 
 450 
 
 3370 
 
 Atwater —Little Exercise ... 91 
 
 91 
 
 300 
 
 2450 
 
 Do. 
 
 Light Muscular Work 100 
 
 100 
 
 350 
 
 2800 
 
 Do. 
 
 Moderate „ ,, 127 
 
 127 
 
 500 
 
 3520 
 
 Do. 
 
 Active ,, ,, 150 
 
 150 
 
 500 
 
 4060 
 
 Do. 
 
 Hard „ „ 177 
 
 250 
 
 650 
 
 5700 
 
 It appears to me — I respectfully suggest it to 
 these eminent authorities — ^that all these dietary 
 requirements are too high as measured by the test 
 as to whether the persons who take them remain 
 well for a long time, say a year or two, or longer. 
 It seems to me that all my experience says, and 
 that firmly and decidedly, that such diets make 
 people ill, at least those people who live in towns 
 and do town work. They cannot bear them without 
 suffering in a variety of ways. A patient of mine, 
 for example, suffering from a variety of ailments, 
 was advised to greatly restrict his diet in order to 
 get rid of them. He belonged to that large and 
 increasing class of the community living in towns, 
 who now form the bulk of the population of these 
 islands, and who may fairly be described as persons 
 with little muscular exercise or as doing light 
 muscular work. He suffered from dyspepsia and 
 heartburn, frequent colds, resulting in bronchitis 
 and recurrent attacks of sneezing and bronchial 
 asthma, recurring attacks of herpes of the lips. 
 
280 
 
 that is, eruptions of watery blisters on the Hps, 
 which in course of time became dry and scabbed 
 over and then cleared oft'; recurring little sores 
 similarly produced on the tongue, constipation, and 
 general rheumatism, making his back and limbs and 
 muscles ache and become tired long before the 
 reasonable and moderate exertion he made could 
 possibly account for it ; in fact, he often woke tired 
 in the morning after six or seven hours sleep ; and 
 sometimes he could not sleep till say three o'clock 
 in the morning, while sometimes he would sleep for 
 two hours, and then waking might have an attack 
 of asthma which would keep him awake not less 
 than two hours, while occasionally he could not sleep 
 at all. For this large variety of ailments, plainly 
 portending the more or less speedy onset of more 
 serious and possibly incurable disease, he was advised 
 greatly to restrict his diet. He weighed about 140 
 pounds, so that according to Ranke he required 85 
 grams proteids, 85 grams fats, and 205 grams 
 carbo-hydrates. What he did take in two meals, 
 seven or eight hours apart from one another, was 
 the following : — Lean meat, 3 ozs., or fish, 3 ozs. ; 
 bread, about 4 ozs. ; rice, about 4 ozs., uncooked 
 (4 ozs. of uncooked rice equals 1 lb. of rice 
 pudding) ; butter, about 2 ozs. ; cheese, 1 oz. to 
 2 ozs. and over ; and one egg on some days, and 
 some days no egg. This works out to about 60 
 grams proteids, 85 grams fats, and say 150 grams 
 carbo-hydrates. After losing weight a little on this 
 diet, he afterwards regained it up to about 133 lbs., 
 
281 
 
 and incidentally he got rid of every ailment he had, 
 so that from being a delicate, pale, pasty-looking 
 man, disinclined for exertion, he became", well 
 coloured, healthy-looking, and fresh and able for 
 exertion at all times of the day. I do not think 
 that Ranke's requirements are far out for the 
 average townsman doing office work or the work of 
 an active business man, or the work of a townsman 
 generally, be he professional or layman, but I think 
 even his diet errs on the side of too much rather 
 than on that of too little. It will be observed that 
 my patient's diet works out to about 1666 grand 
 calories, i.e., 60 grams proteids x 4, 85 grams of 
 fats X 9'4, and 150 grams carbo-hydrates x 4*18, 
 and this is just about two-thirds of what Ranke's 
 diet amounts to (2325). But Ranke's diet is lower 
 than Moleschott's, or than Voit's, for moderate 
 work, or even than Atwater's for little exercise, 
 while it is very much less indeed than Atwater's 
 diet for active work (4069 calories), or for hard 
 work (5700 calories). I confess that it is a severe 
 violation of my conclusion from all the observations, 
 that have forced themselves on me in a prolonged 
 experience to be asked to believe that almost any 
 man can stand for long a diet amounting to 5700 
 grand calories daily. However strong a man might 
 be who took this amount of food, and however hard 
 he worked, I do not think he could possibly oxidise 
 it off, and I feel sure that between overloading his 
 digestion and overworking his muscles he would 
 speedily fall into an incurable illness on such a 
 
282 
 
 regime. Other authorities mention enormous quan- 
 tities of food as justifiable to be taken in health, as, 
 e.g., 4| pounds of mixed diet, while even Dr. King 
 Chambers, who introduced the phrase " Starvation 
 from over - repletion,"* recommends the nursing 
 mother to take three pounds of mixed diet daily. 
 In my opinion, the ordinary townsman requires \\ 
 pounds of mixed diet daily, from that as a liberal 
 estimate down to three-quarters of a pound as a not 
 unusual one, if he wishes to be well and to keep so, 
 while a woman requires even less than this. This 
 would be my translation into the language of every 
 day life of Professor Davis's statement that " we 
 habitually eat more than is needed to supply 
 waste." We cannot go on putting into the animal 
 economy more supplies than are needed for its 
 smooth and easy and efl&cient working, without 
 rendering the working of it hard, difficult and 
 inefficient by clogging and choking it up. 
 
 Contrast with these diets Dr. Haig's Diet 
 Table II., in his little book. Diet and Food in 
 Relation to Strength and Power of Endurance. 
 Table II. is as follows : — 5 ozs. Hovis bread, 2 ozs. 
 oatmeal, 1 oz. gluten, 3 ozs. cheese ; or a total of 
 11 ounces of solid food with one pint of milk daily. 
 If the tw^o ounces of oatmeal be made into half a 
 pound of porridge, the total weight of this diet is 
 
 *NoTE. — My friend Dr Dewey has used the phrase "starvation from over- 
 feeding," not knowing of Dr. King Chambers' prior expression. Here 
 again we are forced to exclaim : How one generation discovers, how 
 its successors forget or overlook, and how we have to discover again, 
 to the great loss of our time and damage to progress ! 
 
283 
 
 17 ounces and a pint of milk ; and Dr. Haig says it 
 is enough for the average man. I think he is right ; 
 but if this is so, it at once follows that all of us 
 take too much food, for certainly none of the 
 people of my acquaintance take so little food as 
 this (except, indeed, some of those who have been 
 very ill, and have reduced their diet under medical 
 advice). 
 
 Cornaro, it is well known, lived from the age 
 of 38 years, when he suffered greatly from 
 dyspepsia and many ailments, till the age of 97, or 
 for a period of 59 years, on a diet of 12 ounces of 
 mixed food daily and 14 ounces of red wine. His 
 age at death is variously given, but was not less 
 than 97, and he himself believed it might have been 
 much more if he had not abused his constitution in 
 his youth. 
 
 In connection with Cornaro and the length of 
 time he lived, and that in good health, on a very 
 restricted diet, I cannot forbear making an obser- 
 vation. It was Addison who introduced the story 
 of Cornaro to English readers. It was he who 
 translated from the Italian the treatises which 
 Cornaro wrote on health and longevity ; and it was 
 Addison who knew, if anyone did, how longevity 
 had been attained. How did Addison behave 
 himself? After breakfasting about eight or nine in 
 the morning, he would drop into a coffee tavern 
 perhaps in the forenoon, sipping coffee and stronger 
 drinks. He would lunch about one o'clock, and 
 spend the afternoon as he spent the morning ; and 
 
284 
 
 dine (or sup) from seven to eight in the evening, 
 keeping up hilarious nights till the small hours of 
 the morning. The consequences of this were, as 
 Addison must have well known that they would be, 
 death at 49 years of age, from severe asthmatical 
 distress of breathing, and general dropsy. 
 
 In infirmaries, where, if anywhere, persons 
 ought to be properly fed, it is customary to allow 
 about 16 ounces of bread daily, besides other food, 
 to each patient. This is very much too large an 
 amount for health on the average, Anything 
 beyond from six to eight ounces of bread daily is 
 sufficient to cause in men and women doing ordinary 
 town work a variety of ailments, most of which 
 are usually attributed to " taking cold." Common 
 examples of these are watery blisters on the lips 
 and tongue, pimples and spots on the face, so 
 frequently seen in young people who are fond of 
 bread and cakes, and take them too often and too 
 much, inflammation of the windpipe and bronchial 
 tubes, inflammation of the mucous membranes of 
 the eyes and nose, sore throats, enlargements of the 
 glands of the neck, constipation (or diarrhoea 
 sometimes), and rheumatism, &c. Although the 
 remote effects of the digestion and assimilation of 
 food is to increase the strength and to build up the 
 tissues of the body, it does not seem to be generally 
 realised as it ought to be, that the immediate effect 
 is to place a labour and often a severe labour on 
 the body, and that this for a time shews itself in 
 depression of the body by using up part of its 
 
285 
 
 energy in the digestive processes. Too frequent 
 repetition of this labour in the body by the taking 
 of too many meals, especially when the amounts of 
 food taken are greater than the bodily requirements, 
 often seems to exert an influence of cumulative 
 depression, and accounts for the subnormal state of 
 the temperature, which so often precedes the onset 
 of chronic and of incurable disease, as was shewn 
 in the chapters dealing with the paradoxes of 
 medicine. And it was then also shewn how a hot 
 drink (of cojBTee, e.g.), might raise the bodily 
 temperature for an hour or two, although not itself 
 supplying material for oxidation and combustion. 
 The cup of afternoon tea often acts in the same 
 way, and its mode of action explains also the advice 
 given not to eat anything with it, since food 
 interpolated then will find lunch undigested, while 
 in turn it will not itself be digested when the 
 evening meal is taken. It cannot be wise to have 
 digestion going on at two different stages in the 
 same stomach at the same time. And if the 
 temperature of the body is subnormal from an 
 excess of material present there is all the more 
 reason to abstain from food, which, if taken, can 
 only aggravate the depression already existing, 
 after the immediate effects of the stimulation shall 
 have passed. And study of what goes on in such 
 circumstances in the body explains how fasting may 
 sometimes be of such great benefit, since fasting, by 
 inducing the organism to use up some of the 
 material accumulated in it in excess, takes 
 
286 
 
 the load off to some extent and enables the 
 organism to rise to natural, when the burden 
 clogging it in every capillary vessel and in 
 every lymph duct has been lightened. A case 
 which I treated some years ago illustrates so well 
 the points just referred to, and also raises for our 
 consideration another method of estimating the 
 quantity of food required by the body, that, 
 although I have already mentioned on p. 261 
 another feature in the case, I may be pardoned 
 for recapitulating the main facts of it here. A 
 man 47 years of age, a labourer in a foundry, 
 when he was able to work, but who had not 
 worked for over seven years at the time of which 
 I speak, submitted on my recommendation to 
 a long fast in order that he might, if possible, be 
 cured of recurrent vomiting, which had troubled 
 him for all that time. He had had much and 
 careful treatment from distinguished medical men, 
 but with little or no benefit. Except that he had 
 the whey from two pints of milk daily, he had no 
 food of any sort except water from 31st August till 
 5th October, 1898. The solids in 30 ounces of 
 whey do not at the outside amount to more than 
 two ounces (I do not myself think they amount to 
 so much), but we shall assume that the man had 
 two ounces of solid food daily during that time. 
 Now what was the weight loss of his body? It 
 amounted to 13:^ pounds in 35 days, not lost 
 continuously and equably during that time, but 
 intermittently. From the ninth to the thirteenth 
 
287 
 
 day of the fast, for instance, he lost no weight at 
 all, while from the twenty-ninth to the thirty-fifth 
 day of the fast he lost three pounds in weight. 
 But on the average the loss during the 35 days was 
 about six ounces. This, added to two ounces of 
 food taken (if it was so much), implies that the 
 man's economy used about half a pound of the 
 material of his body daily on the average to keep 
 himself alive ; and, therefore, I take it we are 
 entitled to conclude that about eight ounces daily 
 of mixed diet is suf&cient to enable a man of 130 
 pounds weight to subsist and keep himself alive if 
 he does not do any more work than my patient did, 
 that is, walk about, and help his wife in little 
 domestic duties like making beds, laying the table, 
 and washing up dishes. This loss of eight ounces 
 daily corresponds well with some other observations 
 of mine, and cannot as a subsistence diet, be con- 
 sidered unusual. For instance, a lady patient of 
 mine, suffering from rheumatism, constipation, and 
 a variety of ailments, maintained her weight for a 
 considerable period of time on eight ounces of food 
 a day, her health improving very much in almost 
 every particular during the process, including 
 the complete cure of constipation. When she 
 added two raw apples daily to this diet, as a 
 second meal, she slightly gained weight. From 
 facts like these I conclude that eight ounces of 
 mixed food daily (not, of course, eight ounces of 
 white bread, but of mixed diet) is a subsistence diet 
 for people moving about and doing no work beyond 
 
288 
 
 the lightest sorts, or such work, for instance, as a 
 sempstress does. They can just maintain their 
 weight on it. It does not seem, therefore, an 
 unreasonable inference from these facts to conclude 
 that persons could do the active but not laborious 
 work of an overlooker in a mill, of a weaver, of a 
 joiner, of a doctor, of a lawyer, or of a shopman or 
 clerk, or of a lady looking after the conduct of 
 a household, or, in fact, of the average town- 
 dweller, on an amount of food represented by the 
 addition of say six or eight ounces more. This 14 
 or 16 ounces of food brings us very near to Cornaro's 
 12 ounces, with 14 ounces of red wine, rendering 
 his estimate and practice a far more reasonable and 
 credible amount than we might have thought if 
 we had had regard only to the almost invariable 
 habit of mankind to take much more. It contrasts 
 strongly with the light or moderate diet of E-anke, 
 which would amount with the water of cooking 
 added to not less than 30 ounces. But when we 
 come to think of 4| pounds or four pounds of food, 
 it does not seem possible that in any conceivable 
 circumstances so much can be required ; and if so 
 much is taken, it is difficult to escape the conclusion 
 that the body must suffer for it in a variety of 
 ways. Next, let us consider the late Dr. King 
 Chambers' advice that the nursing mother should 
 have three pounds of ordinary food daily, and whose 
 only fear was, as he said, lest she should not 
 have enough. A baby will require from 12 ounces 
 of breast milk up to say two pints daily, according 
 
289 
 
 to age. This would involve the addition to the 
 mother's ordinary diet of say four ounces of 
 extra food. Or suppose that she took even 
 two pints of milk daily over and above her 
 normal food, that would only be 600 calories. 
 Even if her ordinary diet consisted of Ranke's 
 demand for a large man, she could not possibly be 
 made out to require more than two pounds of food, 
 so that Dr. King Chambers' demands for three 
 pounds is one which, if satisfied, must clog the 
 woman's economy and make her iU, even if she 
 added to her nursing labours that of wheeling the 
 perambulator, as many mothers do. But if her 
 ordinary diet consisted of say 16 ounces of food, 
 then her nursing diet might amount to 20 ounces, 
 or 1|- pound, or perhaps, if we are very liberal, to 
 1|- pound, just half of the amount advised by Dr. 
 King Chambers. I am quite sure that taking such 
 diets as his makes women ill. These estimates 
 differ so widely that one is surprised at the 
 difference. Why, in the E-oyal Navy, where men 
 are freely exposed to the oxidising influences of the 
 ocean air, and are besides engaged during much of 
 the time in doing laborious work, the full allowance 
 of food is about three pounds daily, viz., one pound 
 of fresh meat, half a pound of vegetables, one and 
 a quarter pound of biscuits, two ounces of chocolate, 
 a quarter of an ounce of tea, and one-eighth of a 
 pint of spirit. It is said, though I do not know 
 with how much truth, that the ordinary seaman 
 does not use so much food as this, and that, when 
 s 
 
290 
 
 left to follow his inclinations, he takes not three 
 pounds of food but 30 ounces on the daily average, 
 or about two pounds. I must say that to eat one 
 and a quarter pound of sea-biscuit daily is a task 
 that the ordinary man might well shrink from ; and 
 one shudders to think of the indigestion, constipa- 
 tion, acne, and rheumatism it must cause, when taken 
 to such an extent, and in addition to other food. 
 
 Another point of great importance and, on the 
 surface, of some considerable difficulty, becomes 
 cleared up by this line of observation and 
 reflection. The first effect of a fast is said to be to 
 increase the number of the corpuscles of the blood. 
 Now as the function of food is to make blood, and 
 as the food therefore makes the corpuscles, it seems 
 at first sight impossible to conceive how stopping or 
 greatly diminishing food supply can increase the 
 nmnber of the blood corpuscles. It ought to 
 diminish them, and in fact, in course of time, if the 
 fast is persisted in, it does diminish them. But 
 the explanation is really very simple. Most of us 
 are over-fed, and the consequence of this is that the 
 tissues are blocked or choked, because too much 
 material finds its way into the blood. This directly 
 prevents the blood-making processes from going on. 
 The process is checked because the capillary vessels, 
 the lymph spaces, the lymph ducts, and the muscular 
 coverings, and the tissue coverings, and the connec- 
 tive tissues generally, are blocked. Consequently 
 there is an accumulation of waste unused material 
 in the body. This accumulation often lowers the 
 
291 
 
 temperature and prevents and checks the accomplish- 
 ment of all the processes of the body, and, among the 
 rest, of the important process of the manufacture of 
 the blood corpuscles. But when a fast is instituted, 
 the body must live on something, and it calls up 
 into the capillary and lymph circulation minute 
 particles of tissue and of accumulations which had 
 not yet become tissue, and oxidises these in order 
 to maintain the bodily heat and energy. The 
 consequence of this is, by gradually removing the 
 block from the tissues, to allow the blood-making 
 process (and other processes also, no doubt), to 
 proceed for a time more healthily and more 
 vigorously, until in course of time — it often 
 takes a few weeks for this to happen — all the 
 unused stuff has been made use of, after which the 
 corpuscles begin to diminish. If the fast is pushed 
 to actual death, of course all functions and all 
 processes come to an end, and, long before the man 
 dies, there is no blood formation going on in his 
 body. But the explanation of the difficulty that 
 fasting should even at first increase or seem to 
 increase the number of the blood corpuscles, when 
 prolonged fasting certainly diminishes them, becomes 
 really quite easy. It depends on the economical 
 tendency of nature to accumulate reserve stocks in 
 the body, so that under any stress or strain she 
 shall be able to go on for some time even without 
 the ordinary and regular supplies of food. Inci- 
 dentally we also see how over-feeding lowers the 
 bodily temperature, and how fasting at first raises 
 
 S 2 
 
292 
 
 it to normal, and may even by reaction raise it 
 above normal, or may cause fever, after which, of 
 course, it, like the blood-making processes, falls, 
 and is checked by fasting. And we also see how it 
 is important that some reserves should always be 
 present in the body so that they can be drawn on in 
 case of need. But the great test as to whether the 
 reserves are in excess is the state of the tempera- 
 ture and of the other functions of the body, which, 
 as we have seen, are reduced by too much. They 
 are so reduced, at least, when the body is tolerant of 
 the irritation of too much, although not infrequently 
 we find the opposite condition set up by the same 
 cause, viz., irritation with intolerance or reaction, 
 when we get feverish temperature and almost all of 
 the functions heightened or elevated for a time. 
 
 This state of body explains some otherwise 
 inexplicable conditions. I have, for example, 
 referred many times in the course of these 
 observations to fasts which have lasted, not for 
 hours or days, but for many weeks ; after which, in 
 numerous cases, patients have recovered from severe 
 and long-continued illnesses. With these facts 
 before us, what are we to say of a statement that, 
 for example, English soldiers actually died (it was 
 freely said of starvation) after being exposed to the 
 fatigue of military manoeuvres for eight hours in 
 the heat of an English summer at Aldershot, and 
 after being deprived of food for eight hours ? That 
 they unfortunately died is not to be questioned; 
 but they certainly did not and could not have died 
 
293 
 
 of starvation. But if they had been over fed 
 before, or if they had taken much alcohol, then the 
 waste unassimilated stuff within them might easily 
 go into excessive combustion or oxidisation ; an 
 acute and feverish poisonous condition might be set 
 up, which might easily cause severe illness and even 
 death. And the remedy, the true remedy, would 
 be rather the inculcation of such food habits (and 
 drink habits) as would render the body healthy 
 enough and strong enough to bear easily such an 
 amount of fatigue as they might expect to have to 
 undergo at any time in actual war, than to condemn 
 the War Office and the military authorities for their 
 barbarity in not supplying the men with bovril, &c., 
 while on the march. Nevertheless, the outcry in 
 the public prints a couple of years ago took only 
 the latter form, while not one word was said in 
 condemnation of those previous habits, which, there 
 could be no doubt, led to the catastrophe. And the 
 chief trouble is that the sufferings of the soldiers, 
 and the loss of valuable lives to the country, are 
 certain to have been in vain, until we learn what 
 the causes of both were, and until we take proper 
 steps to obviate them. Because, after all, it is very 
 doubtful whether the order in future to administer 
 refreshment to soldiers on the march will have the 
 effect expected. Besides all which, of what use to 
 their country, it may be pertinently inquired, are 
 soldiers who are so weak that they cannot march 
 eight hours in warm but not tropical weather 
 without halting to take refreshment ? Would an 
 
294 
 
 enemy be so considerate as to intermit their attack 
 while our men were so employed ? 
 
 It is, then, the man with reserves in him 
 from over-feeding, whose corpuscles become more 
 numerous from fasting (for a time), and it is only 
 when the process of accumulation of reserves has 
 been carried to excess, that the condition has become 
 unhealthy. The conclusion of the whole matter is — 
 what everyone knows and admits theoretically, but 
 hardly anyone carries out into practice — that modera- 
 tion is the only fixed and the only unfailing rule. 
 Ne quid nimis. M-qhkv ayav. Nothing too much. 
 There is nothing new in this. It has been all said 
 before. And yet the translation of it is somewhat 
 new. For what is moderation? That is the question. 
 Well, moderation differs in different circumstances ; 
 but for the average man and woman living in a 
 town, that is for the average man and woman in 
 England to-day (and in most other countries, too), 
 moderation is much nearer to the amount of food 
 mentioned by Cornaro, the 12 ounces of mixed food 
 as it comes to the table, with the 14 ounces of red 
 wine, than it is to the scale, or rather the widely 
 varying scales, of some of the modern physiologists. 
 I am certain at least that this is so, if the aim of 
 medicine is to be, as I think it ought to be, to 
 increase, and lengthen, and make more vigorous for 
 active work, and also, while it lasts, less susceptible 
 to illness, the life of man on this planet. Only he 
 knows or can appreciate the discouragement caused 
 by looking on and seeing active and useful human 
 
295 
 
 organisms rendered, sometimes quickly and some- 
 times slowly, inactive and useless by being silted 
 up and choked with too much food — only he can 
 adequately appreciate the discouragement and 
 sorrow caused by the loss, one after the other, of 
 friends or acquaintances, who has been forced to 
 reflect that such loss might easily in most cases 
 have been postponed by from five to twenty years, 
 if more rational ideas had prevailed on this simple 
 subject, and if, prevailing, they had been translated 
 into the conduct and habits of everyday life. The 
 causes of death seem, to be attributed to every 
 reason but the right one. It is bronchitis, it is 
 pneumonia, it is Bright's disease, it is cancer, 
 it is tuberculosis, it is apoplexy ; but the causes of 
 these causes — who says anything about them ? 
 About the drinking (yes, we are alive to that), but 
 particularly about improper feeding as a cause of 
 the causes of too early death — how is it that we 
 are all so blind to this ? How many young lives 
 are sacrificed on the altar of over-feeding ? Well, I 
 am glad to see that our medical of&cers of health 
 are beginning to warn us of this. One is apt to be 
 accused of extravagant statements if one attempts 
 to answer this question. In time, however, the 
 labours of our medical officers of health will teU 
 in this direction. But how many wives have been 
 made widows ; how many husbands have been left 
 wifeless ; how many both wives and husbands have 
 gone to asylums, and how many children have 
 been left orphans from this cause? It were 
 
296 
 
 much to be wished that we could induce 
 our people to ask and answer these questions. 
 If only a small part of the ability so abundant 
 in life were directed to the consideration of 
 the simple questions, how much food is necessary 
 and desirable for the adequate but not excessive 
 nutrition of the body of the average man, and 
 woman, and child, and how often should that food 
 be taken ; what a harvest of information and what 
 a harvest of happiness would be reaped. If our 
 Medical Council, instead of crowding the medical 
 curriculum with more or less useless knowledge (all 
 knowledge is useful, no doubt, and I do not despise 
 any of it, but some forms of knowledge are much 
 more useful than others) about bacteria, and germs, 
 and micro-organisms, would insist on instituting a 
 chair of dietetics in every medical school ; or, 
 perhaps, better still, if our Municipal and County 
 Councils would found lectureships on this simple 
 subject, so germane to practical life ; and if the 
 occupants of such chairs iind if such lecturers would 
 tell the people what, and how, and how often they 
 should eat and drink, and what are the effects of 
 improper eating and drinking, the effects would, I 
 am sure, be such as to astonish us all by their 
 magnitude, and importance, and far-reachingness. 
 
 There are still one or two questions remaining 
 for consideration before we can complete the dis- 
 cussion of the question how often ought we, e.g., 
 to eat in order to be well, and fit for work. There 
 have been very different practices followed in this 
 
297 
 
 respect by different nations ; but a considerable 
 amount of additional knowledge has been gained 
 regarding it of late years. As to the time required 
 for the digestion of food, and as a consequence of 
 this, the number of meals which it is proper to take 
 in a day, much difference of opinion and of practice 
 prevails. It seems to me unfortunate that many of 
 the data as to the time that food remains in the 
 stomach before it is passed in a partially digested 
 form through the pylorus into the small intestine, 
 have been obtained from the experiments of Dr. 
 Beaumont on the stomach of St. Martin. St. 
 Martin was a young Canadian who, about 1830, 
 received a gun-shot wound in the stomach. This 
 healed, leaving, however, a valvular opening, by 
 means of which it was possible for Dr. Beaumont to 
 examine at various times, after food had been taken, 
 what amount of digestion had been performed ; and 
 careful observations were made by Dr. Beaumont on 
 this point. Thus, to take an instance : "At three 
 o'clock on a certain day, St. Martin dined on boiled 
 dried codfish, potatoes, parsnips, bread, and drawn 
 butter. At half-past three o'clock Dr. Beaumont 
 examined and took out a portion about half- 
 digested ; the potatoes the least so. The fish was 
 broken down into small fiJ.aments ; the bread and 
 parsnips were not to be distinguished. At four 
 o'clock, examined another portion. Very few 
 particles remained entire. Some of the few 
 potatoes were distinctly to be seen. At half-past 
 four o'clock he took out and examined another 
 
298 
 
 portion ; all completely chymified. At five o'clock, 
 stomach empty." " Dr. Beaumont constructed a 
 table shewing the times required for the digestion 
 of all usual articles of food in St. Martin's stomach, 
 and in his gastric fluid taken from the stomach. 
 Among the substances most quickly digested were 
 rice and tripe, both of which were chymified in an 
 hour ; eggs, salmon, trout, apples, and venison, were 
 digested in an hour and a half; tapioca, barley, 
 milk, liver, fish, in two hours ; turkey, lamb, 
 potatoes, pig, in two hours and a half; beef and 
 mutton required from three hours to three and a 
 half, and both were more digestible than veal ; fowls 
 were like mutton in their degree of digestibility. 
 Animal substances were, in general, converted into 
 chyme more rapidly than vegetables." I do not 
 deny or question the statement that these facts 
 were true for St. Martin's stomach ; but I am very 
 sure that whoever should infer that because they 
 were true in that particular case, they are true in 
 general in the case of the average man living in a 
 town and doing a townsman's work, would make a 
 very great mistake. The cases are not comparable. 
 We ought not to assume that the activity of 
 digestion in a young Canadian backwoodsman, 
 living an active and even laborious life in the 
 country, will be parallelled by the processes 
 occurring in the digestive apparatus of a man 
 doing office work or the work of a business man 
 in a town. Whoever should imagine that, because 
 the backwoodsman's stomach was completely empty 
 
299 
 
 in two hours, of a meal of codfish, potatoes, parsnips 
 and bread, the same rapidity might be expected in 
 a townsman, would make a disastrous mistake. 
 According to that, it would be quite justifiable to 
 eat in four hours again, that is, at seven o'clock ; 
 and this would allow two hours for the chyme to 
 become chyle, and to get into the blood and be used 
 there. Perhaps, even in this case, five hours would 
 be a better interval between meals than four, since 
 -we do not know quite how long a time the latter 
 processes require for accomplishment, and it is 
 well not to overload the digestion or to clog the 
 lymph-separating processes. But there is the most 
 unmistakeable evidence that such a meal as St. 
 Martin took is, in many cases, not out of the 
 stomach of a townsman for five or six hours after it 
 is taken ; and I have known it longer. For instance, 
 I have seen, and that not once but many times, 
 food eructated from the stomach, and in such a 
 condition as that some of the different materials of 
 the meal could be distinguished from one another, 
 quite six hours after it had been taken. Food 
 taken at two o'clock, for instance, has been seen by 
 me even as late as eight o'clock, and parsnips in 
 particular have been observed. There is a minority 
 of persons who eructate their food for hours after 
 they eat it, performing a process not very unlike the 
 chewing of the cud in herbivorous animals ; and I 
 have had more than one such person under observa- 
 tion for long periods of time, so that I know that in 
 such persons it is the rule that stomach digestion 
 
300 
 
 requires, not two hours, as in St. Martin's case, nor 
 even three or four hours, but five or six hours, or 
 even longer in some cases. 01 course, I do not 
 mean that no food leaves the stomach for the 
 intestines under this length of time. The fatigue, 
 sudden sometimes, which is so noticeable three or 
 four hours after a full meal, whose explanation is 
 given later, shews that some of the food must do so, 
 but in such persons, not infrequently the whole of 
 the food taken at a meal such as dinner, has not left 
 the stomach for quite five or six hours, or even 
 longer. In pathological conditions the time is often 
 much longer than this. I have known food to be in 
 the stomach for as long as 48 hours ; in fact, some 
 sorts of foods, as, for instance, the cocoanut, which is 
 not only indigestible, but irritant to the stomach, 
 not infrequently require this length of time for 
 removal. The mushroom, again, which, though 
 indigestible is not irritant, but bland, not infre- 
 quently lies in the stomach for 24 hours even in 
 normal circumstances ; and I have known a cup of 
 cocoa lie for 36 hours in atony of the stomach, a 
 condition of disease, of course ; but the facts as to 
 the cocoanut and the nmshroom are natural and 
 physiological and normal in many instances. I saw 
 on one occasion in a patient with slow digestion (it 
 is true the salad had rather too much vinegar in it), 
 a salad which had been eaten at 7-30 p.m., vomited 
 in exactly the state in which it had been eaten, so 
 far as appearances went, at five o'clock next morning, 
 or say nine and a half hours after it had been 
 
301 
 
 taken. The curious thing was, and I beheve that 
 this is not at all an uncommon occurrence, that all 
 the other articles of food taken at 7-30 appeared to 
 have left the stomach, since none of them were 
 recognised. It appears to me from this and other 
 like experiences, that the stomach has the power of 
 selecting what it can digest, of digesting it, and of 
 passing it through the pylorus into the small 
 intestine, while it retains within its walls other and 
 undigested, and perhaps we may say, also, indigest- 
 ible, foods. But if, as in the previous case, we add 
 three hours as the time required for food which has 
 left the stomach to get into the blood, so as to be 
 used there for purposes of nutrition, and if we take 
 even the shorter period of five hours as that 
 required for complete chymification by the stomach, 
 persons whose digestion is so slow as this ought not 
 to eat again for at least eight hours after their 
 previous meal was taken ; and I believe that even a 
 longer interval is often demanded if health is to be 
 maintained. Such persons might eat, e.g., at eight 
 a.m. and four or five p.m., and would generally be 
 well nourished on two meals a day. In fact, I have 
 often recommended men, whose digestion is so slow 
 as this (and it is a much commoner case than is 
 usually supposed), to eat not even twice a day, but 
 once only, so as to let the digestion of one meal be 
 completely effected, both its primary digestion in 
 the stomach and intestines, and the secondary 
 digestion or lymph assimilation in the tissues, 
 before the next one is taken. I have also to 
 
302 
 
 add that in the cases in which this advice has 
 been accepted and acted upon, much benefit 
 has accrued to health and vigour in almost 
 every instance. I have recommended this course 
 at all adult ages, up to 86 even, and with great 
 benefit. I have not prohibited a hot drink of tea, 
 coffee or cocoa twice a day in addition, but have 
 preferred that it should be taken without any bread, 
 or perhaps with half an ounce only. An interesting 
 and somewhat curious thing in reference to tea and 
 cofiee in this connection has been the fact that 
 while persons living on the ordinary three or four 
 daily meals have alleged that they could not take 
 tea or coifee after five p.m. without lying awake 
 till three or four in the morning ; after they have 
 gone on to one daily meal the same persons can 
 sleep soundly on tea or coffee taken as late as eight 
 or nine or even ten p.m. Similar interesting and 
 curious facts have appeared in regard to other 
 articles of food. Thus many persons think they 
 cannot take cheese because of its disagreeing with 
 them, or because it constipates them when they live 
 on three or four daily meals. But the same persons, 
 on becoming monositeous, or taking only one daily 
 meal, have found that they could quite well take 
 an ounce or even two ounces of cheese, without 
 discomfort, and, more remarkable still, have thought 
 that, in place of causing constipation, it helped the 
 action of the bowels. This kind of experience it is 
 which has gone towards forming in my mind the 
 conclusion that it is not this, that, or the other 
 
303 
 
 article of diet which makes us well or ill, but that 
 health or discomfort depends rather on how much 
 we take, and how often we take our food. 
 
 While I am on this subject, I perhaps ought to 
 mention that although the recommendation to eat 
 once a day only has for the most part in my 
 practice been offered to persons after middle life, as 
 being most suitable to the condition of those whose 
 bodily frames have been fully grown, and often, 
 indeed, over-grown, it has not been altogether 
 confined to them. I have often recommended 
 children to eat twice a day, and always with 
 advantage ; and in one case I recommended the 
 mother of a child of four years, who was suffering 
 from a tuberculous disease of the knee joint, with 
 suppuration in the joint and necrosis (or limited 
 death) of the thigh bone, to let her have only one 
 meal a day ; and that with the best results. I 
 ought to say that the child had also a glass of 
 milk each morning and each evening, but no solid 
 food at either of these times. Milk is, no doubt, 
 food, but the number of calories represented by 
 a glass of it is only about 140, so that the two 
 glasses represented about 280 calories. According 
 to the latest authorities, a child of four years of 
 age ought to have such a quantity of food as will 
 produce 1200 to 1400 calories daily, so that 280 
 calories represent only a very small proportion of 
 this. The child to whom I refer had only as much 
 food as would produce at most 850 calories when 
 converted into energy in the body, and probably 
 
304 
 
 800, or even less, more nearly represented the 
 amount which she did have. Nevertheless, on this 
 diet, which, according to the authorities, was a 
 restricted diet, or even a starvation diet, but which 
 proved to be nothing of the kind, the child grew 
 nearly ten pounds avoirdupois in weight in fifteen 
 months ; her bowels, which had been constipated, 
 became perfectly regular ; and the suppuration in 
 her knee joint was entirely healed. Could anything 
 shew more strikingly than this case that the quantity 
 of food recommended by the physiologists working 
 in laboratories is much greater than is required by a 
 child in actual or real life ? Among a large number 
 of criticisms which the publication of this case 
 called forth, most of them, strange to say, laudatory 
 (but general opinion is, I think, fast altering on this 
 subject, and people are at least not so intolerant 
 and contemptuous as they used to be, and that not 
 long ago, of views such as I am here advocating), I 
 received one from a medical friend of over 30 years' 
 standing in the profession, and he suggested that I 
 had given the child not too little but too much ! ! 
 I had myself hinted in my pamphlet on the subject, 
 that, much as I had restricted the child's diet, who 
 had had little more than half of what the latest 
 authority said she ought to have had (and this 
 treatment had been continued for fifteen months), 1 
 doubted if I had restricted it sufiiciently. Dr. 
 Haddon wrote to say that in his opinion I had given 
 her more than she required. I must say that I 
 agree with him, but if this is a correct view, how 
 
305 
 
 flagrantly out must be the physiological authorities 
 who recommend so very much more. The difierence 
 between us is not as to a little less or a little more, 
 but it is a difl'erence of two to one, or even perhaps 
 three to one. Well might Hippocrates say that 
 the issue could not be determined to a nicety. 
 Apparently it cannot be determined at all — but this 
 is absurd. One of the estimates must be so far 
 away from nature as to be wrong. Which is it? 
 Day and night no doubt shade off into one another 
 by insensible gradations, so that at a given point of 
 time it is diJBScult to know whether it is day or 
 night. But for all that, the ordinary man and the 
 ordinary child has no practical difficulty in distin- 
 guishing between the light of day and the darkness 
 of night, and doctors and physiologists (for the 
 practice of medicine is or ought to be — I repeat 
 it — only applied physiology, and pathology is 
 only disordered physiology, or at least is mainly 
 so) ought to be able to come nearer to a 
 practical conclusion as to whether a child ought 
 to have for health as much food as is represented 
 by 1400 grand calories, or only by as much as 
 800 or 700 or 600 or 500 a day. It is said 
 of the great Hippocrates himself that he entirely 
 failed to please all parties. No sensible or self- 
 respecting man would try. On one occasion, being 
 accused, however, by one party, of feeding patients 
 to death, and, by another, of starving them to 
 death, he made no reply, but allowed the one 
 criticism to answer the other. The medical man 
 
306 
 
 who to-day attempts to hit the golden mean of 
 moderation between too much and too little, will 
 probably fail to please either party, one of whom 
 will be apt to say one thing of him, and the other 
 the opposite ; but he may take comfort in the 
 reflection that he finds himself in the good company 
 of those who in the past have attempted the same 
 task ; and he may also anticipate that, in the 
 future, the history of his eiforts, and perhaps his 
 failures, will comfort the heart and cheer the 
 courage of successors who will find themselves 
 attempting the same arduous enterprise. I think 
 in this matter that Dr. Haddon is much more nearly 
 correct than some of the physiological authorities, 
 and the great majority of the medical profession, 
 who, afraid seemingly to verify things for them- 
 selves, so slavishly follow their lead. The happy 
 issue of this case under the treatment adopted, a 
 treatment which I have used not only in juvenile 
 struma, but also, and that much more than once, in 
 senile struma also, has confirmed me in the view I 
 have often expressed, that the most successful 
 treatment of tubercular disease is that founded on 
 the view that its management is analogous to the 
 di-ainage of marshy land in agriculture. More 
 water is getting into the ground than is flowing 
 out, and the problem is, for a time, and until 
 proper drainage has been efiected, to allow more to 
 get out than flows in, after which time proper 
 drainage must be resorted to. In white swelling of 
 the knee or other joints, a precisely analogous 
 
I 307 
 
 problem presents itself for solution, for much more 
 lymph is finding its way into the joint structures 
 than is flowing out, and the problem therefore is, 
 and must be for a time, and until a proper balance 
 has been effected, to allow more lymph to get out 
 than flows in, after which time proper feeding 
 must be resorted to. If this view is in collision 
 with the present orthodox opinion, fostered and 
 supported by that love of indulgence, and of 
 luxury, and of short-lived pleasure, which is so 
 characteristic of our time, the orthodox opinion 
 that cases of tuberculosis ought to be stuffed 
 or over-fed, I can only regret that such evidence 
 as I have has forced me to a different conclusion. 
 The serious question, fraught with the issues of 
 life and death, and of maiming or soundness 
 to our patients, is, which view is nearer to the 
 truth. I may say that the mother of the child 
 in question, finding the results so satisfactory 
 in one child, and finding that an elder sister, 
 though three years older, weighed only two 
 pounds more than the younger one, and finding 
 that, although not ill, she looked pale and 
 anaemic (triphthgemic or catatrib^mic, rpCfieiv = to 
 rub or waste) of her own accord has put the elder 
 child on to the same lines of treatment as the 
 younger one. I cannot doubt what the result 
 will be. The elder, also, will get a better colour 
 and gain weight. The law having been pointed out 
 and declared by the medical interpreter of nature, 
 all that the patient has to do is to attempt to obey 
 
 T2 
 
308 
 
 it, and the more nearly he can do so, the better 
 health and vigour will he enjoy. If any hitch 
 arises or if any difficulty occurs, the medical expert 
 may again be consulted ; but his proper function 
 must in that case again be to clearly point out the 
 scope of the law and clear up any misconceptions in 
 its interpretation. All that the doctor can do is to 
 declare the law ; all that the patient can do is to 
 obey it ; and the more nearly the patient succeeds 
 in doing this, the less and less necessary does 
 the medical expert become. If we know the 
 formula by which the law of gravitation acts on a 
 falling body, we do not need a mathamatician or a 
 physical expert to make its application in any given 
 case. With some knowledge of arithmetic we can 
 do that for ourselves. 
 
 The complaint which patients not infrequently 
 make to their doctor, of feeling tired several hours 
 after taking a meal, may now be shortly considered. 
 If, for instance, they dine at half past one or two 
 o'clock, they feel very tired, and sometimes rather 
 suddenly so, especially if the meal has been a 
 somewhat full and large one, about five or six 
 o'clock. How is this they ask ? Well, the explan- 
 ation is very simple. In three or four hours after 
 eating, digestion has made some progress towards 
 effectiveness. Chyle from the food has begun to be 
 poured into the blood. If the chyle so poured into 
 the blood bears too large a proportion to the total 
 volume of the blood, the in-rush is too great, and 
 when the blood, laden in this way with too much 
 
309 
 
 chyle from the thoracic duct, finds its way to the 
 muscles, which, as we saw before, may contain some 
 30 per cent, of the blood in them, they become 
 rather suddenly loaded with too much material, and 
 being oppressed with this, they cry out as if 
 fatigued. Especially will this be so, if, the meal 
 having been a large one, it has not been very 
 perfectly assimilated. The chyle in this case will 
 have been imperfectly elaborated, and the blood 
 therefore imperfectly made. The blood, finding 
 itself loaded with imperfectly assimilated stuff from 
 the food, will begin to get rid of it into the muscle 
 sheaths; and the lymph spaces, being somewhat 
 choked with excess of lymph, and particularly with 
 excess of lymph from imperfectly assimilated food 
 stuff, the lymph vessels will not carry away the 
 lymph plasma sufficiently quickly, and, as a certain 
 amount of swelling will therefore occur, the person 
 will feel tired. Neither the muscles nor their 
 sheaths will work smoothly or easily, and the 
 sensation of fatigue is really caused mainly because 
 the muscles are loaded with bad blood containing 
 ptomaines and other unassimilated materials. The 
 blood is said to contain uric acid. No doubt it 
 often does, but it is very unlikely that uric acid is 
 the only poison carried by the blood to the tissues 
 in such circumstances. No doubt other materials 
 besides uric acid are present, some of them known 
 to chemists as, e.g.j lactic acid, and very probably 
 others as yet unknown. In fact, uric acid stands 
 mainly as a symbol or sign of imperfectly oxidised 
 
310 
 
 and imperfectly assimilated products of digestion, 
 and it is these in their totality or aggregate which 
 poison and fatigue the muscles and the whole 
 locomotor mechanism. But the blood received its 
 excess of material, too much in volume in pro- 
 portion to its total capacity, and ill-assimilated 
 besides, from the thoracic duct. The thoracic duct 
 in turn received its contents from the chyle of the 
 small intestine. (The contents of the thoracic duct 
 have sometimes been described as the lymph from 
 the villi of the small intestine. This terminology 
 is illuminating, and instructive of it makes us think 
 of the meaning of the purposes which lymph 
 performs in the body). The small intestine in its 
 turn received its contents from the stomach through 
 the pylorus ; and the stomach in its turn received 
 its contents by the oesophagus or gullet, which 
 conducted the food often far too quickly, and far 
 too imperfectly masticated, from the mouth. The 
 whole processes of digestion thus hanging together, 
 and being dependent, step by step, and each step 
 on the step immediately preceding it, too much 
 fatigue after eating, whether an hour after, or three 
 or four hours after, which is a far commoner experi- 
 ence, calls out to us rather (if our ears are attuned 
 to listen) to masticate properly and to eat less, than 
 to lie down for an hour after eating, or to lie down 
 for two hours, or say three or four hours after food. 
 And when at 5 or 6 o'clock a cup of afternoon 
 tea is taken, the stimulus it gives is so marked as 
 to be an almost universal experience, whose good 
 
311 
 
 effects, if people would but make the experiment, 
 would be as beneficially experienced, and much 
 more safely, without any solid food being added 
 with it. 
 
 I fear I shall get on to very controversial 
 ground in what I am going to say next. I do not 
 recommend the taking of alcoholic stimulants at 
 all ; but if they are taken, I recommend the 
 average man to take only as much alcohol as would 
 be represented by one small glass of whiskey twice a 
 day. More than this transcends the bounds of mod- 
 eration. But now if he is going to take it, say at 
 five in the afternoon, or at eleven in the forenoon 
 (not so suitable a time, I think), if he is going to 
 take it, ought he to eat with it ? Well, I think 
 not. Why should he eat at either of those times ? 
 He does not require food at 5 p.m. if he has had 
 lunch at from 1 to 2 o'clock ; and if he does not 
 take his first meal till 12 or 1 o'clock, he still ought 
 not to eat at 11, because whatever he eats then will 
 certainly not be digested when he has his meal at 
 12, or 1, or 1-30. The same reasons which justify 
 the advice not to eat with afternoon tea compel 
 one, therefore, to offer the advice that if a person 
 is going to take alcohol either at 11 a.m., or 5 or 
 6 p.m., he should refrain from eating at those times. 
 It seems to be thought that if a man eats at the 
 same time that he takes alcohol, the food will 
 prevent the alcohol from doing his stomach so much 
 harm as if he takes it alone. I think, however, 
 that this reasoning is fallacious, and that the habit 
 
312 
 
 of too frequent eating, which such practices 
 confirm, does an immense amount of damage by 
 keeping up continual demands for work on the part 
 of the digestive organs. If, therefore, a man does 
 take a little alcohol at either of those times (which 
 I do not recommend him to do) I think he ought not 
 on any account to eat at those times. And if his 
 second ounce of whiskey is taken at bed-time, as it 
 so often is, I for the same reason advise him not to 
 eat biscuits or any other food at that time. 
 Frequent eating and frequent alcoholic drinking 
 are two very bad things, but it is certainly more 
 dangerous for a man or woman to do both 
 together than it is to do one alone. 
 
 Another question which patients often put to 
 their doctors is this : Why do we, they will say, 
 wake tired in the morning after six, seven, or eight 
 hours' sleep? The answer to this question need 
 not detain us long. We wake tired in the morning 
 because too much material has been finding its way 
 into the blood from the digestion, and because during 
 the quiet of sleep the blood has taken the opportunity 
 to drop in the connective tissue that excess of 
 material which was oppressing it. As the connective 
 tissue forms the coverings of the muscles, bones, joints 
 and nerves, the consequence is that the whole loco- 
 motor system is in such circumstances over-loaded, 
 so that whenever we begin to move we are tired. 
 
 o 
 
 During sleep I believe the veins are dilated, and 
 the arteries contracted. The longitudinal elements 
 of the former vessels are stimulated more than their 
 
313 
 
 transverse elements, while the transverse elements 
 of the arteries are contracted rather more than the 
 longitudinal. (When the reverse of this occurs, i.e.^ 
 when the arteries are dilated, the person is sleep- 
 less). The veins being thus in sleep dilated and 
 full of blood, which is, besides, moving rather 
 sluggishly, the blood has every facility of getting 
 rid of any material it may contain in excess. 
 Another form of the question often is : Why do we 
 sleep for say two hours, then wake, and find 
 ourselves unable to sleep again for say two or three 
 hours, or perhaps not at all ; or perhaps we fall 
 asleep just when we ought to be getting up? And 
 yet another form of the question may be : How is 
 it that we cannot sleep till three, four, or five in the 
 morning ? And still another form of the question 
 may be : Why do we sleep too heavily ? After the 
 discussions in Chapters VI. and YII. we can readily 
 understand that defect of the function of sleep, 
 irregularity of that function and excess of it, are 
 all due to the same cause, viz., that we are eating 
 too much or too often, or that we are eating too 
 much and too often. I do not know if my explana- 
 tion of the respective state of the veins and 
 arteries in sleep is correct or not, although I think 
 it is. I consulted an eminent physiologist on the 
 point, and he said it was a very difficult question to 
 answer. But it does not really matter whether the 
 precise explanation offered is the correct one. 
 What does matter is that during sleep the blood 
 does part to the connective tissue with materials 
 
314 
 
 which it coutains beyond its needs, and that this 
 physiological fact accounts for the feeling of fatigue 
 which many persons experience on waking in the 
 morning. The connective tissue is what we may 
 call the dumping ground of the blood ; it is the 
 safest or the least hurtful place in which waste 
 products can be deposited, for if they were not 
 deposited in the ilemmatous parts of organs, they 
 might be dropped into the parenchymatous portions, 
 in which case, instead of being tired simply, we 
 might get an attack of pneumonia. As the muscle 
 sheaths, the bone coverings, or periosteum, the 
 joint ligaments, and the nerve sheaths, as also the 
 brain-and cord-membranes are all made of this 
 connective tissue, all the locomotor system is 
 oppressed and weighted by being thus made the 
 dumping ground of the blood, and therefore when- 
 ever one moves after waking in the morning, one 
 feels and must feel tired. There is really inflam- 
 mation or at least congestion all over the body, for the 
 connective-tissue is found practically everywhere in 
 the body. No wonder, therefore, that the body is 
 tired. Every movement is clogged, and the patient 
 feels as if she could not drag one leg behind the 
 other. I have suggested that this condition should 
 be called Initis, from the Greek \a, Latin vis = 
 strength. Homer used the word Iviov, as did also 
 Hippocrates, of the strong, firm elastic tissue at the 
 nape of the neck, the same which, immensely 
 strengthened in the horse, for example, enables it to 
 carry its heavy load almost at right angles to its 
 
315 
 
 body (or take the elephant as even a more striking 
 example), seemingly without getting tired or 
 knowing even that it has such a heavy weight 
 to carry. Even in man, however, the tissue is 
 strong ; and a marked sign of advancing age and of 
 danger to life is noticed when this strong tissue 
 begins to get weak, and the head begins to shake 
 or tremble on the neck. Old persons seldom last 
 more than two years, I have observed, after 
 beginning to manifest this sign. Sometimes the 
 affection of the connective tissue in young people is 
 called hysteria, sometimes neurastheniaj sometimes 
 neuralgia, and sometimes women (for it is oftenest 
 observed in them) are reproached with being able 
 to avoid complaining if they would ; and sometimes, 
 I regret to say, are recommended to undergo many 
 and varied mutilating and other operations on 
 account of it, which operations do not and cannot 
 cure them, A further stage of initis, or inflamma- 
 tion of the connective tissue, as it is the further 
 stage of all other inflammations, is effusion of fluid, 
 sometimes into joints, when it is called synovitis, or 
 if many joints are affected, rheumatic fever ; or if 
 the effusion takes place into the pleura, it is called 
 pleurisy; or if into the peritoneum, it is called 
 peritonitis ; or if into the brain membranes it causes 
 coma, or unconsciousness, with dilated pupils, and 
 perhaps death. It is quite true that these very 
 serious developments occur only rarely, but they 
 do occur often enough to make practitioners wary, 
 and the older a doctor gets the less lightly does he 
 
314 
 
 which it coutains beyond its needs, and that this 
 physiological fact accounts for the feeling of fatigue 
 which many persons experience on waking in the 
 morning. The connective tissue is what we may 
 call the dumping ground of the blood ; it is the 
 safest or the least hurtful place in which waste 
 products can be deposited, for if they were not 
 deposited in the ilemmatous parts of organs, they 
 might be dropped into the parenchymatous portions, 
 in which case, instead of being tired simply, we 
 might get an attack of pneumonia. As the muscle 
 sheaths, the bone coverings, or periosteum, the 
 joint ligaments, and the nerve sheaths, as also the 
 brain-and cord-membranes are all made of this 
 connective tissue, all the locomotor system is 
 oppressed and weighted by being thus made the 
 dumping ground of the blood, and therefore when- 
 ever one moves after waking in the morning, one 
 feels and must feel tired. There is really inflam- 
 mation or at least congestion all over the body, for the 
 connective-tissue is found practically everywhere in 
 the body. No wonder, therefore, that the body is 
 tired. Every movement is clogged, and the patient 
 feels as if she could not drag one leg behind the 
 other. I have suggested that this condition should 
 be called Initis, from the Greek tcr, Latin vis = 
 strength. Homer used the word Iviov, as did also 
 Hippocrates, of the strong, firm elastic tissue at the 
 nape of the neck, the same which, immensely 
 strengthened in the horse, for example, enables it to 
 carry its heavy load almost at right angles to its 
 
315 
 
 body (or take the elephant as even a more striking 
 example), seemingly without getting tired or 
 knowing even that it has such a heavy weight 
 to carry. Even in man, however, the tissue is 
 strong ; and a marked sign of advancing age and of 
 danger to life is noticed when this strong tissue 
 begins to get weak, and the head begins to shake 
 or tremble on the neck. Old persons seldom last 
 more than two years, I have observed, after 
 beginning to manifest this sign. Sometimes the 
 affection of the connective tissue in young people is 
 called hysteriuj sometimes neurastheniaj sometimes 
 neuralgia, and sometimes women (for it is oftenest 
 observed in them) are reproached with being able 
 to avoid complaining if they would ; and sometimes, 
 I regret to say, are recommended to undergo many 
 and varied mutilating and other operations on 
 account of it, which operations do not and cannot 
 cure them, A further stage of initis, or inflamma- 
 tion of the connective tissue, as it is the further 
 stage of all other inflammations, is effusion of fluid, 
 sometimes into joints, when it is called synovitisj or 
 if many joints are affected, rheumatic fever ; or if 
 the effusion takes place into the pleura, it is called 
 pleurisy ; or if into the peritoneum, it is called 
 peritonitis ; or if into the brain membranes it causes 
 coma, or unconsciousness, with dilated pupils, and 
 perhaps death. It is quite true that these very 
 serious developments occur only rarely, but they 
 do occur often enough to make practitioners wary, 
 and the older a doctor gets the less lightly does he 
 
316 
 
 tend to treat those so-called hysterical affections, 
 even although very few seem to have made out the 
 pathology of them ; for every experienced doctor 
 must once or oftener have been compelled to see a 
 calamitous issue to cases of this kind. And if he 
 has spoken slightingly of the case, and has 
 suggested, for instance, that the young woman 
 should have water poured from a jug on her upper 
 lip between her nose and mouth, so as that by 
 preventing her from breathing properly she may be 
 roused out of her " hysterical " state, and if she 
 should unhappily become comatose and die, his 
 credit is severely diminished and justly impaired, 
 and the value of his advice to the friends not to 
 make too much of the ailment, and " not to be too 
 sympathetic," is severely called in question. For 
 the curious thing about these cases is their 
 variability. Sometimes the women who suffer in 
 this way are now quite well, and then again, and 
 that in a short time, very ill. Alterations in the 
 circulation of the blood, and particularly, I think, 
 of the lymph, alterations which may and do occur 
 suddenly and extensively and unexpectedly, make 
 the women now very ill when connective-tissue- 
 lymph-congestion occurs, and in a short time they 
 seem to be much better again, when connective- 
 tissue-lymph-relief occurs ; and the alternation of 
 these processes taking place at short intervals of 
 time, gives to the disease that erratic character 
 which has led to so many mistakes being made 
 about it. It seems to me to be a very simple thing 
 
317 
 
 to understand it, and, understanding it, to treat 
 and cure. Unhappily, the advice which is good 
 for it goes against popular, and, worse still, against 
 professional opinion, so that on all sides, from 
 s^nnpathetic and well - meaning but injudicious 
 friends on the one hand, and because the medical 
 profession do not always seem to have clear ideas 
 regarding either the nature of the affection or its 
 cure on the other, the patient is dissuaded from 
 taking the advice to restrict her diet, which, never- 
 theless, is the only advice (that and gentle and 
 cautiously increased exercises) that can do her any 
 good. Pain between the shoulders (the muscles of 
 the back being sore and tender) and in other parts 
 of the body, and what is very badly called anaemia 
 or chlorosis, are frequently concomitant conditions. 
 Also, as we saw before, we find constipation present, 
 which is too frequently treated as if it were the 
 substantive affection, whereas, in fact, it is a con- 
 comitant condition, due, as we then saw, to the 
 same plugging or blocking of the lymph circulation 
 in the intestine, which, when it exists in the brain- 
 connective-tissue, causes all the flightiness and 
 disorder of mind and body which characterise this 
 very grave and by no means imaginary complaint. 
 Recurring headaches, megrim, neuralgias, &c., &c., 
 also often characterise it, very diJfficult to understand 
 when improperly viewed, and yet so simple and so 
 easy to treat and to cure when one can manage to 
 persuade patients, and particularly to persuade their 
 friends, to allow to be used the only means that are 
 
318 
 
 suitable for them. lu some cases iDdigestion is the 
 most prominent sign, and it is happy when this is 
 so, for then there is some chance that the patient 
 and her friends will submit to treatment ; and also 
 the medical adviser has his attention perforce 
 directed to the real cause of the ailment, which 
 manifests itself in so many and varied and protean 
 forms and symptoms. Cases of this kind are the 
 despair at once of the public and of the medical 
 profession, and yet they are easily treated when 
 properly handled. Such a case I saw recently 
 in a young woman (like all my colleagues I have 
 seen scores, perhaps hundreds, of them — they 
 are very common indeed), and handled with 
 perfect success, by persuading her relatives to 
 allow her to be submitted to a much restricted diet 
 for a fortnight, that is to say, the whey from one 
 pint of milk daily, after which, for another 
 fortnight, she was put on one meal a day, and 
 recommended to have exercises first once and then 
 twice a day ; and for the third fortnight she was 
 allowed two meals a day, the first at 12 noon, and 
 the second at 7 p.m. I also ordered a large linseed 
 meal poultice to be put over the abdomen for an hour 
 morning and evening at first, and afterwards in the 
 evening only. The girl, who had been ill for years, 
 was entirely reasonable herself, and having suffered 
 so much and so long, was only too glad to submit 
 to any treatment likely to benefit her. It was the 
 dyspeptic form of hysteria (or, as I prefer to call it, 
 initis), from which she sufiered. She vomited 
 
319 
 
 everything she took, or almost everything, and was 
 thin, pale, emaciated, and anaemic (triphthsemic) ; 
 she was suffering, in fact, from indirect starvation, 
 the proper treatment of which is, at first, 
 restriction of the diet, as we have seen, and then 
 cautiously increased feeding as the patient can 
 bear it. It is really one of the simplest things 
 to understand and to treat if only it is properly 
 viewed, but, when improperly viewed, one of the 
 miost difficult and the most intractable. But, in 
 one word, the common error concerning it is the 
 mistaking of indirect for direct starvation, and the 
 treating, therefore, by increase of food what ought 
 to be treated by restriction. It is a very serious 
 error, which even experts sometimes fall into. 
 When the head is very much affected in some of 
 these cases, the connective tissue about the brain 
 being much irritated, patients not infrequently lose 
 the balance of their minds and reason, and even 
 have to be put under care. Unreasonableness, 
 flightiness, uncertainty of disposition, a mixture of 
 amiability and perversity, and a curiously subtle 
 power to excuse and defend eccentricity, and to 
 make the worse appear the better reason, char- 
 acterise the mental condition of persons suffering in 
 this way ; added to which is often found a morbid 
 desire to nurse and even create grievances, some of 
 the women seeming never to be happy unless they 
 have a grievance. Sometimes love is said to make 
 them go wrong, sometimes religion. The fact is, 
 they are so disturbed that anything would or- 
 
320 
 
 might have upset the balance. Love or reUgion 
 may be the occasion, no doubt, but the condition of* 
 the nutrition is the main cause. The connective 
 tissue inside the head has become congested from 
 improper nutrition, and has irritated the brain cells, 
 preventing their healthy action. I mention this 
 here particularly because so much good can often be 
 done in such cases by restriction of the diet. I 
 have already mentioned the case of a lady who 
 recovered rapidly when she braced herself up to 
 follow the advice given her ,to stop the inordinate 
 quantities of sweets which she had been in the 
 habit of taking. And I have also referred at some 
 length to Dr. Dewey's case, in which a lady fasted 
 for 45 days, so restoring herself to perfect sanity. 
 These cases emphasize the question asked by Dr. 
 Dewey, whether we might not anticipate better 
 results than we now obtain if we treated insanity 
 more frequently by restriction of the diet. Cer- 
 tainly no patients could be so thoroughly controlled 
 as patients in asylums, and it would always be easy 
 to interfere if there seemed to be any danger to life 
 from direct starvation. Sometimes, no doubt, the 
 connective tissue in other parts of the body, as, for 
 instance, the pelvis, is inflamed also in these initio 
 affections. It is natural that it should be. The 
 same blood goes everywhere in the body, and, being 
 badly made and loaded with unused stuff, may 
 deposit this stuff, or some of it, in the connective 
 tissue, wherever connective tissue exists, and 
 therefore in the pelvis, causing various adhesions 
 
321 
 
 and inflammations of the organs in this region of 
 the body, or even sometimes going on to suppur- 
 ation. But even such adhesions do not justify 
 naany of the surgical operations which are 
 performed for their rehef, and certainly do not 
 justify the mutilating operations on women which 
 are so common nowadays. The medical manage- 
 ment referred to will nearly always in young 
 women succeed in removing these adhesions, 
 displacements, &c., if patients wiU be patient and 
 intelligent as to their causation. And if operation 
 is necessary, it is very seldom indeed that removal 
 of organs is called for, especially as such removal 
 too often fails to cure the complaints from which 
 patients suffer. Evidently, unless something is 
 said as to causation, the same processes must go on 
 in the body, and must result in disease somewhere 
 else, even if the particularly distressed part has 
 been removed. 
 
 One other condition found in many of these 
 initio cases I must not omit to mention, viz., the 
 tendency often shewn to bruise easily. On the 
 slightest occasion, as, for example, if they happen 
 to knock against a piece of furniture, or if they 
 sustain some very slight injury, and sometimes even 
 when no history of injury can be made out, women 
 will shew large black or blue bruises on various 
 parts of their bodies. Sometimes, if a friend lays 
 a hand upon them, takes hold of an arm, for 
 example, the finger marks may appear next day. 
 This condition was well known to the ancient 
 u 
 
322 
 
 writers on medicine, and the Greeks called it 
 peliosis or pelidnosis (TreXtos = black and blue, 
 livid), but I am not aware what explanation they 
 gave of it, or if they gave any. It is evidently 
 due to excessive weakness or to a very low degree 
 of resistance in the connective tissue of the body, 
 the coats of the finest blood-vessels being so weak 
 as to become lacerated on sustaining the slightest 
 injury or tension. Kupturing, they cause extrava- 
 sation of a minute amount of blood into the cuUular 
 tissue of the body ; and it is the changes undergone 
 by this blood in the course of its re-absorption 
 which cause the discoloration and lividity referred 
 to. But what is the cause of the excessive weak- 
 ness of the connective tissue which makes it give 
 way so readily ? Well, the cause is the one we 
 have so often seen in action, mal-nutrition ; which, 
 in nearly all cases, means over- nutrition of the 
 connective tissue, and congestion of the blood and 
 lymph circulation by the ingestion of (generally) 
 small meals, too frequently repeated. This condi- 
 tion often coincides with the somewhat flighty and 
 irregular mental condition to which I have already 
 referred ; and, indeed, women so improperly nourished 
 not injfrequently convert injuries sustained in the 
 trivial ways described into proofs of cruelty, and 
 shew them as evidence in accusations of ill-treatment. 
 To advise persons suffering in this way to eat, not 
 little and often, but little and seldom, if they want 
 to be well in the comparatively inactive life which 
 many of them lead, sounds, I have often been made 
 
323 
 
 to feel, like adding insult to injury, but is, never- 
 theless, I regret to say, the only advice which can 
 do them any good. The exercises which one might 
 otherwise be disposed to recommend, they not 
 infrequently cannot bear ; in fact, such movements 
 might only increase the evil, and the only thing left 
 is that they should be advised to restrict their diet. 
 The conclusions, then, which seem reasonable 
 from the evidence and considerations advanced in 
 this chapter regarding the quantities and qualities 
 of food suitable for the average man and woman, 
 especially those dwelling in towns, are the following. 
 The average townsman requires a quantity of from 
 three-quarters of a pound to a pound and a half 
 daily of mixed food as it comes to the table. The 
 average townswoman requires a little less. About 
 one ounce of food a day for every ten pounds of 
 body weight, or, perhaps, in the case of growing 
 children, every eight pounds of body weight, seems 
 to be enough and not too much. According to this 
 scale, a man weighing 140 pounds would require 
 about 14 ounces of mixed food daily, and a man of 
 12 stones rather more than a pound avoirdupois. 
 As to quality we require a mixed diet of proteids, 
 fats, carbo-hydrates, and mineral matters ; but 
 whether we should get our proteids from animals 
 or vegetables may reasonably be left to each 
 person's judgment and (perhaps) conscience. The 
 moral arguments against the slaughter of somewhat 
 noble animals for food have always seemed to me 
 stronger than the scientific ones. The man who 
 
 U2 
 
324 
 
 allows himself to think about the question usually 
 inclines to take less and less meat. At one time, 
 thinking that an excess of starch in the diet was 
 the chief cause of illness, I inclined to too much 
 diminution of the starch, and was therefore driven 
 to the use of meat instead. For persons suffering 
 from the effects of over ingestion of starch and 
 sugar, the Salisbury diet of meat and hot water is 
 no doubt often very useful ; but its chief use, after 
 all, I believe, is that it restricts the diet. To take 
 four ounces of beef three times a day is a great 
 reduction of food from taking two pounds or three 
 pounds avoirdupois of mixed diet, the taking of 
 which makes so many of us ill. But when we see 
 that although it happens to have been, as an 
 accident, starch and sugar which has made us ill, 
 the real and essential cause has been too much food 
 taken too often, we also see that it was an accident 
 only, and that the reduction of our mixed diet to 
 four or five ounces taken three times a day, with or 
 without the washing out by hot water, would 
 equally have enabled us to recover. It is easy, in 
 these as in other matters, to mistake the accident 
 for the property, to mistake too much starch and 
 sugar for too much food, and, therefore, to recom- 
 mend as a remedy the cessation of the former 
 instead of a wise and cautious restriction of the 
 latter. And, indeed, in the conflict of opinion and 
 practice, there is some excuse for going wrong, or for 
 failing to see all the bearings of the problem at 
 first. A man who should take, for instance, three 
 
325 
 
 pounds of beef daily, as some persons do, would 
 probably soon find that he was taking too much 
 food. As to calorie value, however, even three 
 pounds of lean beef daily is only equal to about 
 2000 grand calories, or perhaps somewhat less. 
 According to Mrs. Richards, a mere subsistence 
 ration amounts to 2000 calories. On the other 
 hand, Forster found that a lawyer at Munich 
 consumed as much food as would supply 2400 
 calories, and a physician at the same place 2830 
 calories ; while Banke found that a university 
 professor at the same place, with very little 
 exercise, consumed as much food as would produce 
 2325 calories. These figures appear to me to go in 
 the direction of corroborating what I said before as 
 to the relation between plain living and high 
 thinking, as also the physiological facts regarding 
 the circulation in the brain and muscles respectively. 
 Then, lastly, as to times of eating, we conclude 
 that no one ought to eat oftener than three times 
 daily, say at 8-0 a.m., and 1-0 and 7-0 p.m. ; that 
 in many, if not in most cases, it is better to eat 
 twice than even three times, say at 12-0 noon and 
 7-0 p.m., or at 9-0 a.m. and 6-0 p.m., if more 
 convenient (in the latter case, a cup of hot cocoa 
 or coffee about 1-0, with no solid food, would 
 provide a good physiological stimulus) ; that to eat 
 twice a day is suitable even for growing children, 
 of whom, however, more will be said in a subsequent 
 chapter ; and, lastly, that in many cases it is better 
 for the townsman to eat once a day only, rather 
 
326 
 
 than thrice, or even than twice. In the last case, 
 the best time for eating is about mid-day, or say 
 from 12-0 noon to 1-30 or 2-0 p.m. ; and a cup of 
 tea or cofiee may fitly be taken morning and evening 
 besides, without any accompaniments ; or, instead of 
 the evening tea, a glass of milk with or without the 
 addition of an equal quantity of hot water or of 
 barley water. The total quantity of fluids required 
 by the average townsman appears to be from two to 
 three pints daily. We get rid of about two and a 
 half pints of water from the kidneys daily, and about 
 another pint of water from the skin and lungs, but 
 we appear to manufacture water inside the economy 
 by combining the hydrogen of the food with the 
 oxygen of the inspired air (water = HgO), but to 
 what extent we do this has not been accurately 
 determined. 
 
327 
 
 CHAPTER IX. 
 
 On Heredity in Disease. 
 
 TT appears to me that the frequency with which 
 disease is transmitted is greatly exaggerated in 
 common estimation ; that is, I think that disease is 
 comparatively seldom transmitted, while it seems, 
 from what I hear, that the opinion is very generally 
 held that it is often or very often transmitted. 
 True, it is very difficult to get a clear idea as to 
 what doctrine on this subject is generally favoured 
 by the medical profession, and therefore by the 
 public, who, on the whole, take their opinions on 
 trust from them. But let us take a case or two 
 from medical literature to shew what seems to be 
 the common doctrine. A distinguished medical 
 writer instances as a proof of the hereditary trans- 
 mission of disease the following case. He has so 
 little doubt, apparently, on the point, that he 
 assumes, or seems to assume, that the mere 
 statement of his case proves his theory of trans- 
 mission. A lady of 45 years of age appears in his 
 consulting room suffering from psoriasis, which is a 
 dry, scaly, often reddish coloured or grey and 
 reddish coloured form of skin affection. He is a 
 good note taker, and has a good memory, and so 
 
328 
 
 when, twenty or so years after, the daughter of 
 that lady, now at the same age as her mother was 
 twenty years before, appears in the same consulting 
 room, suffering from an affection precisely similar, 
 he is greatly struck, and turning to his notes and 
 comparing the two sets of skin eruption, finds them 
 to be identical, or almost identical. And, as I have 
 said, the mere statement that the same or a similar 
 skin affection has appeared in mother and daughter 
 at similar ages seems to him (as to most other 
 people also, if one may judge from the fact that no 
 one has ventured to call the theory in question), to 
 justify him in instancing the succession of cases as 
 a clear proof of the hereditary transmission of 
 disease. But is it? Where is the proof? Let me 
 put my view of the case before we go further. 
 I do not question the facts, which is a great 
 comfort, since the issue between the two views is 
 thus narrowed and limited, and much verbal dis- 
 cussion and disputation is avoided. I contend that 
 organisation is transmitted, but disease not, or so 
 rarely that we may as a practical theory or 
 conclusion throw it out of account. Now let us 
 look at the question for a little. Suppose that a 
 man, and his father, and his grandfather have been 
 soldiers, and that one after another at say 20 years' 
 interval, they were each shot in action ; should we 
 expect anyone to agree with us in the suggestion 
 that death by gun-shot wound or rifle bullet was 
 hereditary in that family ? And if the son of our 
 last soldier became a grocer, are not the probabilities 
 
329 
 
 great that he would die in his bed ? It will be 
 said, " Oh, that is quite different. Everyone can see 
 th at it was the circumstances of life, the occupation, 
 the calling, the environment, which caused the 
 three successive deaths in three different generations ; 
 but, in the cases of psoriasis quoted, there is no 
 proof that this was so." It certainly seems very 
 remarkable at the first blush that the psoriasis 
 should appear in mother and daughter at the same 
 age. I will now, however, state my theory in order 
 that it may be seen side by side with the other, and 
 (I suppose) the commoner view. Organisation is 
 transmitted ; disease not, or very seldom. Being 
 translated, this means that : like causes acting on 
 like organisms in successive generations (or in the 
 same generation) induce like effects. Before I 
 admit that the disease psoriasis was transmitted, 
 I must know what the causes of psoriasis are (I 
 know what the cause of being killed in battle, is) 
 and then I must know (1) whether the mother was 
 subjected to the action of those causes — whether, 
 for example (for I think this is the chief cause), she 
 took too many meals, too much bread, cakes, 
 sweets, and puddings, but generally too much food ; 
 and (2) whether in her turn the daughter did the 
 same. If they did, then I see no proof of the 
 hereditary transmission of the disease, but I do see 
 proof of my theory that too much food (essentially) 
 too much bread, cakes, puddings, and sugar 
 (accidentally) was the cause of the psoriasis first 
 in the mother and then in the daughter. The 
 
330 
 
 burden of proof of the hereditary transmission of 
 disease is on the man who alleges its existence, 
 not on him who objects to it. But I do not care 
 about this. I am quite willing, so strong is my 
 case, to assume the burden of proof Take the 
 case of consumption or of cancer. Consumption 
 has been reduced in the British Army from 12 per 
 1000 per annum to 1*2 per 1000 per annum since 
 the time of the Crimean war. The commission 
 which sat upon the subject found that consumption 
 was much more rife in the line regiments who had 
 only 350 cubic feet of space allowed per man in 
 barracks than among the guards who had 500 cubic 
 feet of space per man allowed ; so they recom- 
 mended that the line regiments should be allowed 
 500 cubic feet of space per man also. But I never 
 heard that they recommended that careful enquiry 
 should be made into the family history of recruits 
 for the army, and that those recruits should be 
 rejected whose families gave a history of the 
 presence of consumption. No doubt they insisted 
 on chest measurements being taken, but that was 
 done also before the question of how to prevent 
 consumption in the army, or how to diminish it 
 was discussed. A narrow chest is a condition 
 of organisation, and it may be and is trans- 
 mitted, but whether it will take on consumption 
 is a question of environment. It is quite a 
 question whether a man whose chest measures say 
 only 28 inches in circumference, instead of 34 or 36 
 inches, ought to be admitted into the army at all. 
 
331 
 
 The probabilites are that he will take on con- 
 sumption if submitted to the hardships of a 
 campaign, but that is a question of organisation 
 and resistance. No doubt his resistance will be 
 lower (other things being equal) than that of the 
 fuller chested man. And if it had so happened, 
 as very likely it might, that consumption was 
 abundant in the narrow chested man's family, one 
 may easily get a false impression regarding the 
 transmission of disease, and may think that disease 
 is transmitted, when in reality it is not disease 
 which is transmitted, but the organisation, which, 
 having a low resistance, is apt to take it on. So 
 with cancer. Many families shew numerous cases 
 of cancer occurring in successive generations. 
 But cancer mainly is due to too many meals ; 
 and if the children of cancerous parents, eating 
 four or five meals a day, would confine them- 
 selves to two meals, or, in rare cases, to one a 
 day, there would soon be much less cancer to 
 chronicle than there is now. Organisation is 
 transmitted; not disease, or at least very rarely. 
 But talking of cancer, or even of the psoriasis with 
 which we started, raises another consideration, 
 which appears to me to have received far too little 
 examination. Is it not likely, if disease is trans- 
 mitted, that it will appear early in life ? It seems 
 as if it should. If children inherit disease from 
 their parents, should not inherited disease appear in 
 infancy or childhood, since the nearer that children 
 are to their parents the more prone they ought to 
 
332 
 
 be to suffer from their parents' diseases ? For my 
 part I cannot get away from this conclusion ; and 
 so far as the evidence goes why should I wish to get 
 away from it ? Is not a clear conception of the 
 facts the first thing we ought to aim at? and a 
 sound theory to account for all the facts the next 
 thing ? It has, in fact, often seemed to me that 
 perhaps the great mortality in the first year of life, 
 and even in the first five years of life, may be 
 partly due to a considerable amount of inheritance 
 of disease. However, our medical ofiicers of health 
 appear to think, and I agree with them, that even 
 here the chief cause of mortality is wrong feeding, 
 and not inherited disease. Still, inherited disease 
 may be a part of the cause of the high mortality of 
 early life. Or we may put it : perhaps it is not 
 even inherited disease which is the cause of the 
 high infant mortality ; it may be simply extra 
 predisposition to it. I should like to say a word 
 here about predisposition to disease. So far as I 
 can see, predisposition is neither more nor less than 
 weakness, or, as it may be better to say, it is 
 inverse resistance. Now resistance is a quality of 
 organic or organised matter (as it is, of course, of 
 inorganic matter also), and if organisation is 
 inherited, the qualities of organisation must be 
 inherited also ; and therefore predisposition to 
 disease, that is, a less amount of resistance than 
 usual to the causes, which, acting on the organism, 
 and especially on the young organism, disorder it 
 or produce disease (it is better to say, throw the 
 
333 
 
 organism into disease, or cause the organism to 
 become diseased), will be inherited also. It is well 
 known that we all have very varying amounts of 
 resistance, not only to causes which produce disease, 
 but to influences outside and inside us, which 
 produce all sorts of modifications in us. From this 
 point of view we are all predisposed to every 
 human characteristic ; but we are not equally 
 predisposed to each characteristic. To confine our 
 consideration to the matter under discussion, we are 
 all predisposed to the fevers, to inflammations, to 
 rheumatism, gout, tubercle, cancer, and all other 
 human diseases. Indeed, we may go further and 
 say, we are predisposed not only to all these human 
 diseases, but to the diseases of animal organisation 
 in general ; since the lower animals also suffer from 
 all these diseases. So that, from our inheriting 
 that general form of organisation which we share 
 with animals (and even with plants), we inherit 
 predisposition to all the disorders to which organ- 
 isation is subject ; while from inheriting the special 
 form of organisation we caU human, we are liable 
 to every human disease and ailment. We are 
 liable to all human ailments, but (except in a very 
 few instances — I do not deny inheritance of 
 disease — I have seen it, but it is very rare), it 
 depends on how we manage ourselves, and in help- 
 less early life it depends on how our parents or 
 guardians manage us, whether we shall be subject 
 to diseases or not. To say that this, that, or the 
 other disease is not known in our family, or that a 
 
334 
 
 given disease is particularly rife in our family, is 
 only to say that the influences making for its 
 production were not or were great among the 
 members of our family on the one hand ; or on the 
 other, that our family's resistance to these 
 influences was or was not great, or was or was not 
 greater than that of other families. In examina- 
 tions for life insurance many companies ask a 
 question like this : is your family particularly 
 prone to any form of inherited disease, to 
 rheumatism, gout, cancer, or tubercle, or other 
 disease known (?) to be hereditary ? And the 
 answer is generally : none of these diseases are 
 known in my family ; but in point of fact all 
 diseases are known in all families, but in some more 
 and in some less. It is not only in mental and 
 moral regions that one may say Homo sum et nihil 
 humanum alienum a me puto ; but this is chiefly 
 because like causes acting on like organisms in 
 succeeding generations induce like effects. Predis- 
 position is therefore inverse resistance. It seems a 
 mere play upon words to say that no one can suffer 
 from any disease who had not the predisposition to 
 do so ; and yet a great writer has delivered himself 
 of this truism as regards the acquisition of physical 
 characteristics. If the resistance of the organism 
 to the poison of influenza (or to any other influence) 
 is great, then predisposition is small or slight. If, 
 on the other hand, predisposition is strong, then 
 resistance is slight. Predisposition and resistance 
 seem to be inversely as one another, the greater the 
 
335 
 
 one the less the other, and the less the one the 
 greater the other. If health is maintained by- 
 proper management in respect particularly of 
 proper relations between the body and air, food and 
 exercises, then the economy will be able to oxidise 
 off and to resist without illness a much larger 
 amount of the poison of influenza than if the air 
 we breathe is foul, the food we consume is unsuit- 
 able, either in amount or quality, and the exercises 
 or movements we perform are insufficient or not 
 properly methodised. If health is at a standard 
 sufficiently high as regards these conditions, it 
 seems as if the poison of influenza would or might 
 have no effect on us at all. Of course, any one 
 who has been compelled by reflection and evidence 
 to adopt this view regarding the susceptibility to 
 influenza or other infectious diseases, would not 
 hesitate, if he were himself attacked, to admit that 
 he felt somewhat humiliated, since he would feel 
 that he had not been able to live up to his 
 own principles. If, on the other hand, he were 
 attacked by influenza with complications, like 
 pneumonia, or the long depressed condition which 
 sometimes follow it, ending in consumption or 
 organic heart disease, he might even feel disgraced, 
 since he would know that in both of these 
 conditions he had been improperly fed, and, 
 especially in the case of influenza occurring 
 with complications, he had been for a long time 
 previously to getting it, over-fed. I might lik& 
 to stipulate for the absence of very severe and 
 
336 
 
 very long continued anxiety as a predisposing 
 cause in this case ; but the amount of anxiety to 
 which I refer would have to be very great indeed, 
 such, for instance, as befel Job when messengers 
 announced to him in quick succession the loss of his 
 oxen, and asses, and the servants who were tending 
 them, his camels and their attendants, nay the 
 destruction even of his dwelling-house besides ; or, 
 as has occurred more than once in modern business 
 life, when a man has lost goods, and credit, and 
 friends, and when even his family have not escaped 
 from sickness and death. And if, when a man's 
 health suffered from these causes we could conceive 
 it possible that even his wife should turn against 
 him, his anxieties would be so great as probably to 
 make him ill, however properly he had managed his 
 air, food, and exercises. But such combinations of 
 misfortune are rare indeed, and are comparable 
 rather with the effect of volcanic eruptions, or 
 earthquakes, or tidal waves, which, though they do 
 occur sometimes in the physical history of our 
 earth, are so rare as to account for only a small 
 part of the evils from which, on the whole, we 
 suffer. By establishing proper relations between 
 the body and air, food, and exercises, but par- 
 ticularly between the body and food, we may get, it 
 seems to me, into such a condition as not to fear 
 the pestilence that stalketh in darkess, nor the 
 destruction that wasteth at noon-day. Neither we 
 nor our households need have any terror or fear of 
 them. And the state of freedom from the 
 
337 
 
 apprehension of infection to which one person or one 
 household may attain, may be attained by all. It 
 is not necessarily the strongest persons, but often 
 the most delicate ; it is not those whose original 
 predisposition or inverse resistance or weakness is 
 least, but often it is rather those whose predis- 
 position and weakness is greatest who seem most 
 easily influenced by the kind of arguments here 
 advanced to aim at the practices of self-restraint 
 and self-government here suggested, with the 
 freedom from care, and anxiety, and disease, which 
 these practices bring in their train. I do no more 
 here than make the barest reference to the moral 
 implicates of these suggestions, or the bearings 
 they have on life in all its manifold aspects. These 
 may perhaps be elaborated and amplified by others 
 more competent to deal with them. I confine 
 myself to pointing out the bearing they have, if 
 correct, on the avoidance of suffering, on the 
 number of early deaths their carrying out might 
 prevent, on the diminution of the number of 
 widows, widowers, and orphans they might effect, 
 and on the clearing from our minds of those unjust 
 aspersions, and of the cant and self-complacency 
 which blames our ancestors or our fate for evils 
 which, to a great extent, we inflict on ourselves. 
 
 Intimately connected with the term predisposi- 
 tion are three other terms frequently used by 
 medical writers and speakers, viz., constitution, 
 diathesis, and heredity or atavism. To these 
 we ought to devote a little consideration. I 
 
338 
 
 propose to use these words in senses perhaps a little 
 different from those in which they are commonly 
 used — as commonly used, they are often convertible 
 or synonymous with one another — but I do so 
 because it is well to limit the sense in which words 
 are used so as to attain clearness of ideas regarding 
 them, and also because in the present case there are 
 three natural divisions of life to which the three 
 words in question can be easily confined, so that 
 this desirable clearness can be attained. By con- 
 stitution, then, I mean to denote the state of the 
 human organism from the moment of birth to 
 death. Constitution, from this standpoint, being 
 the resultant at any and every moment of the 
 interaction between the organism or economy and 
 its environment, that is (mainly) between the 
 economy and its air, food and exercises ; it follows 
 that the constitution can be, and is, slowly changed 
 as the relations of the organism to these three 
 things (mainly) or generally as its relations to its 
 environment alter and change. The environment is 
 the sum of the circumstances affecting the organism 
 from birth till the moment under consideration. A 
 complete account of the environment would be a com- 
 plete history of the relations between the organism 
 and its surroundings from birth till the moment 
 under consideration ; but while it is evident that an 
 account or history so complete as that is unattain- 
 able, the general effect of the surroundings upon an 
 organism can be observed well enough, and the 
 influence of the more important of them can also be 
 
339 
 
 observed. But constitution, it is evident from these 
 considerations, must be always flowing, mobile, 
 changing, as the circumstances of the environment 
 change, flow and alter. Every action or experience 
 in the body must have its influence on the constitu- 
 tion, which is incessantly changing ; and, as any 
 given body is capable only of a certain number of 
 changes before it ends or dies, each action must 
 have its effect in hastening that termination. But 
 it is not possible to estimate the effect of one 
 action, and still less to measure it with any 
 approximation to accuracy. All we know is that its 
 influence must be incorporated in the constitution. 
 But the effects of long-continued mal-assimilation 
 are plain enough, not only theoretically but practic- 
 ally, and their influence in hastening the termination 
 of life is often quite clear. Ailments, small and 
 great, make their appearance, as we have seen, and 
 very few constitutions come to an end from simple 
 old age. 
 
 I think perhaps I ought to draw attention 
 here to the influence we may exert in modify- 
 ing or altering our environment. It seems to 
 me as if not enough attention was generally 
 given to this point. We seem to assume too 
 readily that environment is a set of conditions out- 
 side of our power and influence, as if environment 
 influenced us rather than we it. But both are true. 
 Environment acts and reacts on us, no doubt ; but 
 we in turn act and react on it. If it is true, within 
 certain limits, that environment makes us, it is also 
 
 V2 
 
340 
 
 true that we may make and that we do make our 
 environment. In the moral sphere it depends 
 greatly what use we turn our trials to, what effect 
 they have upon us ; but I do not speak of that. It 
 is true also in the lower physical plane ; and by the 
 proper and moderate use of the great natural 
 environing factors of air, food and exercises, the 
 quantities and relations of which are very greatly 
 in our own power, we can modify for good, and the 
 building up of a healthy resistance to all forms of 
 disease, the organism which we inherit and possess. 
 Heredity or atavism is the state of the organism 
 as determined by the ancestors. Whatever this 
 may be (and a very complicated subject and com- 
 plicated condition it evidently is), it is plain that, 
 unlike constitution, which is always changing, 
 heredity is fixed and determined. Our ancestors 
 have come and gone. They have lived their lives, 
 and transmitted their organisation, with its qualities, 
 whatever they are. Our heredity or atavism, 
 transmitted by them (mingled with the diathesis 
 immediately to be defined), and from them received 
 by us, is fixed and determined. What it was and 
 is, that it remains. Nothing can alter it. The 
 heredity of a human being determines humanity. 
 That of an ox bovinity. That of a fox vulpinity. 
 That of a dog caninity, &c. A human being, an 
 ox, a dog, or a fox, however, will live healthily or 
 otherwise, rather in accordance with the circum- 
 stances of their respective environments than in 
 regard of the state of their ancestors ; rather in 
 
341 
 
 regard of their own changing constitution than of 
 their heredity. But, while the heredity in general 
 of human beings determines humanity, the heredity 
 in special of a particular human being determines 
 the special hereditary characteristics of that human 
 being. As, however, these hereditary character- 
 istics, or characteristics received through inheritance, 
 are determined by ancestors who have come and 
 gone, it is evident that their influence, whatever it 
 is, is fixed and determined, and cannot be altered. 
 Such characteristics as size, colour of hair and eyes, 
 and even gait and handwriting, dependent on shape 
 and form of hands and of the nervous mechanism 
 through which it is governed, are all hereditary 
 characteristics, and maintain themselves, as we see, 
 from generation to generation. And the evolution 
 of the changing, mobile, fluctuating constitution 
 through the fixed and now changeless heredity is 
 like the moral relations of life, which may be 
 described as the play of the temporal on the 
 eternal, as the movement of that which is for a day 
 on that which is for ever, an analogy which I do 
 not elaborate any further. 
 
 Lastly, there is a third condition or period of 
 history in the life of the organism, namely, its 
 intra-uterine history. To this it is proposed to 
 confine the term or name, diathesis. It is evident, 
 if this definition or limitation be accepted, that 
 diathesis is a state intermediate between heredity 
 on the one hand and constitution on the other ; and 
 further, that diathesis, like heredity, but unlike 
 
342 
 
 constitution, is fixed and determined. If it be 
 objected that the proposal to limit these three 
 commonly used words to these particular senses is 
 somewhat arbitary, the reply must be : there are 
 three great natural periods in the history of organic 
 beings, and these three words seem naturally to fit, 
 or can be made to fit, or suit, each word one of the 
 natural periods. And whoever is unwilling to accept 
 these definitions ought to be prepared with the 
 suggestion of better ones. 
 
 With these ideas in our minds, it may be well 
 to try to see further into what is transmitted or 
 inherited. A very ancient writer delivered himself 
 of the following views. " If, then," he says, " bald 
 persons arise from bald persons, and blue-eyed 
 persons from blue-eyed persons, and squint-eyed 
 persons from squint-eyed persons as a rule, and 
 as the same rule holds good as regards other forms, 
 why may not long-headed persons be produced 
 from long-headed ones ? " And again, speaking of 
 epilepsy, which the priests had called the sacred 
 disease, contending that if they cured it they 
 must be considered the representatives on earth of 
 divine power, while if they did not cure it, who 
 could, they said, wonder that they failed since it 
 was a sacred disease ? contending against and 
 opposmg this doctrine, he says : " For if from 
 phlegmy persons phlegmy arise, and from bilious 
 persons bilious are generated, and from phthisical 
 persons phthisical, and from spleeny persons 
 spleeny " (those who sufier from affections of the 
 
343 
 
 spleen, a blood-making gland), " why may not those 
 parents who suffer from epilepsy transmit it like- 
 wise to their descendants ? " These passages 
 are very interesting, as shewing the ancient view 
 of the heredity of disease. It appears to me 
 that they mix up in the most delightful and 
 the most unconscious and confusing way the 
 transmission of organisation and the transmission of 
 disease. We should admit to-day that blue-eyed 
 persons have as a rule blue-eyed children, and 
 (physically) long-headed persons long-headed chil- 
 dren. We might or might not admit that bald 
 persons have bald children. In fact most children 
 are born with hair, which they soon lose as a rule, 
 becoming quite bald ; after which the hair grows 
 again, fair in the case of those descended from 
 fair-haired ancestors, and dark in the case of those 
 descended from dark-haired ancestors. And we 
 might or might not admit that squints were 
 transmitted ; while we should probably think that, 
 not epilepsy, but the unstable organisation of 
 nervous system, which easily takes it on, was 
 transmitted — at least this would be my view. But 
 we should all (I suppose) deny that phlegms or 
 catarrhs were generally transmitted, that bilious- 
 ness comes down from ancestors, that consumption 
 is transmitted, and affections of the spleen. At 
 least I do not know, but I suppose we should. It is 
 very difficult to get at the mind of the medical 
 profession on this subject, if, indeed, it has made up 
 its mind. Some time ago I was treating as more or 
 
344 
 
 less ridiculous the idea that special susceptibility to 
 take fevers ran in families, or contending at any 
 rate that only resistance as a quality of organisation 
 was transmitted ; when a distinguished physician 
 wrote to say he did not at all agree with me, and 
 that he felt convinced that some families shewed 
 much more predisposition to take fevers than did 
 others. If this means anything more than that 
 resistance is greater or less in different persons, and 
 in different families, to the causes which induce 
 fevers, I confess I do not know what it does mean ; 
 but in that sense I quite agree with him. As, 
 however, he combated my view, I suppose he must 
 have meant something more. What I meant then, 
 however, and mean now, is this. I must admit, of 
 course, that varying degrees of resistance to the 
 causes which induce epidemic and other disease, are 
 transmitted. This is a commonplace of observation, 
 and is only to say, what everyone knows, that 
 infants come into the world with varying degrees of 
 strength. But, every minute that life lasts, we 
 begin to alter our original strength or weakness, or 
 our predispostion, by the ways in which we live, or 
 in which our parents or guardians make us live ; by 
 the care or carelessness, or the wisdom or folly with 
 which they treat us. And so it comes about that 
 in a comparatively short time we alter, or have 
 altered for us, and that to a very considerable 
 extent, the predisposition to disease, or otherwise 
 the weakness of resistance against it with which 
 we started life. And obviously this is more and 
 
345 
 
 more our own doing as we go on in life to form our 
 own habits, and to gradually go on into delicacy or 
 strength of constitution, and manifest (what we 
 really therefore make for ourselves), more or less 
 readiness to be attacked by epidemic or other 
 disease. This is only an illustration of what was 
 said before, that constitution is always flowing, 
 mobile, changing, coincidently with changes in the 
 circumstances or environment to which we are 
 subjected, or to which we subject ourselves. 
 
 A phrase, by the way, which our ancient 
 authority makes use of, and that twice, once in 
 each of the passages which I have translated from 
 him — o yap y6vo<5 iravToxoOev ep-yerai — reminds us 
 very much, or rather may be said to anticipate, in 
 a somewhat remarkable manner, Charles Darwin's 
 theory of pan-genesis, especially as in his second 
 statement he adds the words rov crcofxaTo? ; and we 
 seem to see the organic body throwing off its 
 gemmules from all parts. 
 
 Discussion of such a subject as this might 
 easily fill a treatise ; so I will only go on to say 
 briefly one or two words more about it. The view 
 I am advocating seems to me on the whole to take 
 more and more of the influences that determine the 
 course of life out of the hands, so to say, of fate or 
 necessity, and to shew more and more how much 
 we have in our own power. I did not adopt it 
 because of this feature at all ; but having come to 
 it for other reasons, I found that it did lend support 
 to the more hopeful view. I once saw the liver of 
 
346 
 
 a child of eight years of age, which shewed all the 
 features of gin drinkers' liver, of what is known as 
 the hob-nail liver, although the child had never 
 tasted gin at all ; but his father was a drunkard. 
 An appalling fact of this kind fills the mind with 
 awe, as we seem to see the sins of the father 
 visited on the child ; and it is facts of this kind 
 which prevent one from denying that disease is 
 sometimes transmitted. But how rare this is after 
 all. In thirty years no other case like it has come 
 under my observation. No doubt at all, if one's 
 eyes had been opened, more such cases might have 
 been observed ; but even then I believe they would 
 have been few, and certainly the evidence does not 
 warrant any other conclusion than this, that the 
 vast majority of the children of diseased parents, 
 even of drunkards, are born healthy. This view is 
 in keeping with the latest expert opinion on the 
 subject, that acquired characteristics are not 
 transmitted, that is, that they are not often trans- 
 mitted, although it is equally plain that they are 
 transmitted sometimes ; indeed, if they were not, I 
 do not see how evolution could be possible. But 
 that it is not the rule that they are transmitted, 
 but quite the contrary, is shewn not only by direct 
 observation, as we have seen, but also from this 
 theoretical reflection that, if they were, the race 
 must long before now have been swept away from 
 off the face of the earth, since not only we, but all 
 our fathers, have broken, and that not once, but 
 repeatedly, the laws of life and health. 
 
347 
 
 It may be said that it is not always possible to 
 distinguish between the organisation which, I say, 
 is, as a rule, transmitted, and the disease, which, I 
 contend, is not or not often. This is true, no doubt. 
 Organisation and disease shade off into one another 
 by a large variety of gradations, so subtle that it 
 is very difficult, if not impossible, to say where 
 organisation leaves off and disease begins. A 
 defective structure of the heart valves, for instance, 
 would be an example of imperfect organisation, and 
 might be transmitted. If it were, the moment 
 that such valves began to act, it might be quite 
 impossible to distinguish between the defective 
 organisation which caused imperfect circulation of 
 the blood, and the nutritional signs of that 
 imperfect circulation. But this is a kind of 
 difficulty which, as we before saw, is continually 
 being m.et with in our study of nature ; and we 
 have seen instances of it before in the attempt to 
 separate day from night, heat from cold, and, in 
 fact, all contraries from one another. The poet, 
 indeed, revels in the illustration of such subtle 
 gradations, and much poetry and a good deal of 
 philosophy turns on it. The idea is well illustrated 
 in such a quotation as that 
 
 " Day in a breathless passion kissed dark Night, 
 And neither spoke. And in that kiss Day died." 
 
 The idea would have been equally well expressed 
 if night had been made to kiss the day, or the hot 
 the cold, or the dry the moist, or any other opposite 
 its contrary ; and yet this does not prevent us 
 
348 
 
 from being able to make practically workable 
 demarcations of day from night, of hot from cold, of 
 dry from moist, nor of organisation and its healthy 
 functioning from diseased functioning. A good 
 idea of what is transmitted and what is not, might, 
 it has frequently seemed to me, be obtained from 
 the attempt to answer the question : how is it that 
 every baby born into the world comes in with the 
 soles of its feet a great deal thicker than the tops 
 or dorsa of its feet, and yet is born without corns ? 
 If a long succession of walking ancestors, each 
 using in paws and feet the under parts of the feet 
 to walk on — if this long succession of walking 
 ancestors determined the former, why not the 
 latter also ? And the only answer that occurs to 
 me is that it seems to be because the long line of 
 walking ancestors, whose habits brought about the 
 former, was a much longer procession than of the 
 ancestors whose feet were pressed in tight boots and 
 shoes. But if this is the correct answer, then it is 
 evident that characteristics acquired in an indefinite 
 number of previous generations must in course of 
 long ages be transmitted ; but in what generation 
 the characteristic in question began to be trans- 
 mitted, it is exceedingly difficult and even impossible 
 to say. 
 
 Another question arising out of the views 
 advanced here is this. We can see it arising in the 
 cases of psoriasis with which we started, and in the 
 attempt to answer the question whether cancer is 
 transmitted. If the mother and daughter who had 
 
the psoriasis were each of them 45 years of age 
 before they shewed the psoriasis, and if the mother 
 was 25 years oP age when her daughter was born, 
 is it hkely that the mother transmitted to the 
 daughter a disease which she did not herself have 
 till 20 years after her daughter was born ? This 
 does not appear to me likely, I must say. Or take 
 the case of a mother and a daughter, both having 
 cancer say at 55 years of age. A precisely similar 
 question arises. If the mother was 25 at her 
 daughter's birth, is it likely that she should have 
 transmitted to the daughter a disease which she did 
 not herself manifest until 30 years after her 
 daughter's birth ? This does not seem likely. But 
 if, on the other hand, we can shew that improper 
 feeding, or any other breach of the laws of healthy 
 life, caused the psoriasis or the cancer in the mother, 
 and that, in the course of 20 or 30 years, similar 
 improper methods of feeding (or any other causes) 
 caused psoriasis or cancer in the daughter, then we 
 have efficient causes to account for the facts without 
 having recourse to the suggestion of hereditary 
 transmission to account for it. We have to answer 
 the question : whether is it more likely that 
 something done or left undone by the mothers 20 or 
 30 years or more before the daughters were born 
 is the cause of the psoriasis or of the cancer, or 
 whether is it more likely that something caused 
 these diseases which the daughters themselves did 
 between their birth and the 45 or 55 years which 
 elapsed before the psoriasis or the cancer shewed 
 
350 
 
 itself? As a question of probability, surely no one 
 would deny that the latter is far more likely, as it 
 also seems to me to be that If the diseases were 
 really transmitted they would probably have 
 appeared in early childhood, when the influences 
 of the parents on their children must have been 
 much stronger than we can suppose them to have 
 been at a later date. This is not a mere academic 
 question. It has the most important practical 
 bearings. We are continually being pressed with 
 questions and suggestions of this sort. Children 
 whose parents are suffering or who have died of 
 what is believed to be hereditary disease, come from 
 time to time to their medical adviser to ask his 
 opinion on this question : Am I likely or certain to 
 suffer as my mother or my father has suffered ? Or 
 they are more or less depressed by the suggestion 
 that they are more or less certain to suffer. If the 
 medical adviser can conscientiously reassure them 
 on such an important issue, much will be gained. 
 If he can say : You have your mother's organisa- 
 tion, no doubt, but it depends on how you manage 
 that organisation whether you in turn suffer from 
 her disease ; the affair is in your own hands ; avoid 
 the causes which made her ill, and you need not 
 suffer — if the medical adviser can say this, as it 
 seems to me he can, what a load is taken off the 
 daughter's mind or the son's mind ; and what a load 
 is also taken off the mind of the medical adviser. 
 The mere removal of the apprehension may be, and 
 I believe often is, a contributory cause in preventing 
 
351 
 
 the onset of the disease which the child fears ; and 
 although I did not adopt my view of heredity in 
 disease in order to be a suggester of hope rather 
 than a prophet of evil, I feel very glad indeed that 
 the opinion to which I have come from the evidence 
 (as I think and believe) carries with it this sugges- 
 tion of hopefulness, as it carries with it the advice 
 that if we avoid the causes of our ancestors' 
 diseases, we shall most probably not suffer from 
 them. Of course, we must wear out and we must 
 die of something, but we ought to die worn out, 
 and of old age, not of disease. And, at least, it 
 makes the most tremendous difference to our 
 families whether we die, say at 55, or live to 70, 
 since in the latter case we have the opportunity 
 allowed us to help them in their entrance upon life, 
 and in the former we disappear just about the 
 time when our presence and influence would be of 
 most use. 
 
352 
 
 CHAPTER X. 
 
 On the Feeding of Children. 
 
 TT7HE inquiry into the heredity of disease, 
 resulting, as it has done, in the general 
 conclusions that it is organisation which is inherited 
 rather than disease, and that the general law of 
 heredity is that like causes acting on like organisms 
 in succeeding generations induce like effects — that 
 inquiry seems naturally to lead up to some obser- 
 vations on the feeding and management of children. 
 These observations need not be numerous, because 
 the principles which apply to the feeding of adults 
 apply also to children, and may be summed up in 
 the one word moderation. Too frequent and too 
 abundant feeding unfortunately obtains in the case 
 of children as well as in the case of grown persons. 
 Before I deal with this, however, and with what 
 the reader has probably mentally observed to 
 herself — how can the principles be the same when 
 the child is growing, while the adult is fully 
 grown ? — I should like to say just a word or two on 
 another point. I have several times said that I 
 thought that anxiety must be reckoned among the 
 predisposing causes of illness. Well, in the case of 
 children, this cause is almost entirely absent. If 
 
353 
 
 children are destitute (in a sense all children are 
 destitute, being paupers, as it were, and dependent 
 on the love and charity either of their own 
 parents or relatives, or on that of strangers), they 
 are taken charge of almost always by some one, and 
 seem to accept the inevitable in their lot in the 
 most matter of fact way, without murmuring, or 
 repining, and with little of that anxiety which is 
 one of the causes of illness, and of the aggravation 
 of illness among grown people. This cause being, 
 therefore, almost wholly eliminated, the problem of 
 managing children's ailments, and of maintaining 
 them in health, is by so much more easy and 
 hopeful. But in them, as among adults, one of the 
 chief, if not the chief cause of illness is also errors 
 of diet. And, more than this, I believe that the 
 chief cause (after making what allowance is 
 necessary for hereditary disease — a larger amount 
 probably than obtains in the case of adults), of 
 disease among children is not only errors of diet, 
 but that the particular form which those errors of 
 diet take is too frequent and too abundant feeding. 
 From the cradle to the grave this cause seems to 
 aflSiict us. Even the poor suffer from it, for what is 
 commoner among all classes of the population than 
 to feed infants too frequently, every two hours for 
 example, or every time they cry ; and how common 
 are digestive ailments in consequence of this, as 
 shewn by the presence of flatulence, colicky pain, 
 constipation or diarrhaea ; or the occurrence of 
 some of the continued fevers ; or of bronchitis or 
 w 
 
356 
 
 months, 6 ounces ; at twelve months, 9 ounces ; and 
 at eighteen months, 12 ounces ; but in early life the 
 digestion effected in the stomach is almost nil, the 
 stomach acting much more as a reservoir than a 
 digestive organ, and passing its contents rapidly 
 through into the intestine, where practically all the 
 digestion has to be effected. The number of feeds 
 necessary for infants varies very much according to 
 the different views of the different experts, and it is 
 very interesting to compare different practices with 
 one another. In ancient times it seems to have 
 been the practice to feed much seldomer than now. 
 For instance, Oribasius (B.C. 403 — 326) says : ^'Puer 
 nuper in lucem editus, melle primuni nutriatur^' (is 
 this the source or authority for the custom followed 
 yet by so many old women of thrusting a piece of 
 butter and sugar into the mouth of the newly born 
 child?) ''deinde lacte bis in die vel ad summum terT 
 Milk twice a day or three times at the outside, that 
 was Oribasius's prescription for the feeding of 
 infants. And Paulus Aegineta, about 1000 years 
 afterwards (Circa 625 A.D.), almost slavishly 
 follows him, for he says : " Primuni alimentum 
 recenter nato infanti mel exhibere oportet ; postea 
 vero lac praebere bis in die aut ad summum ter. 
 . . . Sufficit autem biennium lacte nutrire ; deinde 
 ad cibos transgredi.'" The infant was to be fed 
 with milk twice a day or thrice at the outside, and 
 the milk was to be continued for two years, at the 
 end of which time a change was to be made to 
 other foods. How different and how much better a 
 
357 
 
 plan was this than the modern habit of feeding 
 babies every hour and a half or every two hours, or 
 than that which obtains so much of filling them up 
 with starchy foods which their digestive apparatus 
 is unable to cope with. No wonder that from 160 
 to 200 infants should perish in the first year out of 
 every 1000 born. Even if we think that two or 
 three meals a day are too few for infants, four are 
 in most cases quite enough, say about 8 a.m., 12 
 noon, and 4 and 8 p.m., with one feed in the night. 
 And no starchy food at all is required or should be 
 given for at least the first nine months of life, after 
 which it should be given only once a day, milk 
 being used at the other diets. 
 
 I think I ought now to say something about 
 the growth of children in reference to feeding. 
 The fact that a child is growing makes, no doubt, 
 an important difference in comparing its feeding 
 problem with that of a full grown adult. But to 
 how much does this amount ? A baby weighing 
 say 7 lbs. at birth loses, as a rule, nearly a pound 
 in weight in the first three days, after which it 
 gains on the whole steadily (though sometimes in 
 the intermittent way which, as we have more than 
 once seen, characterises the movement of organic 
 phenomena on this planet), till, in twenty days, it 
 will weigh nearly 8 lbs. ; at the end of a month 
 about 8J lbs. ; at the end of two months about 
 10|- lbs. ; at the end of three months about 12 J lbs. ; 
 at the end of six months about 16 lbs. ; and at the 
 end of the first year of life about 20 lbs. In one 
 
358 
 
 sense the gain is immense, because a baby weighs at 
 the end of a year nearly three times its weight at 
 birth, and this must no doubt mean great develop- 
 mental activity in every part of the growing body. 
 I dare say that this great nutritional activity and 
 the changes it implies form a main part of the 
 cause of the great mortality experienced in the first 
 year of life ; and probably to this must be added 
 some amount of hereditary weakness or occasionally, 
 inherited disease. But in another sense the gain in 
 weight from 7 to 20 lbs. is only a gain of 13 lbs. in 
 a year. This again is about a pound a month, or 
 about half an ounce a day on the average. We 
 may, however, suppose that some overplus of food 
 ought to be ingested into the growing body, over 
 and above absolute necessity, and we may, therefore, 
 in response to this demand (a reasonable one I 
 think), say that we ought to supply as much food 
 as will afford one ounce a-day or even one and half 
 ounce in addition to that required for subsistence. 
 I do not know how this will strike the reader, but I 
 think she will say that the requirement is a good 
 deal less than she expected it to be. Considering the 
 composition of milk and of body-tissues respectively, 
 this demand for growth amounts to say three or 
 four ounces of milk daily in addition to what is 
 required for subsistence. What I suggest is, that, 
 under the demand for food for increase of growth, 
 a demand vague, and because vague, usually much 
 in excess of requirements, a great deal more food is 
 given to babies, in order to meet this growth-demand, 
 
359 
 
 than the three or four ounces of extra milk which 
 they require for this purpose. The consequence of 
 this is a great deal of mal-assimilation of food 
 or of indigestion, shewing itself in flatulence, pain, 
 griping, constipation or diarrhoea, or in disturbed 
 and irregular sleep, and in various "colds," and 
 tongue — mouth — or throat — troubles. Mothers, and 
 especially young mothers, are so anxious to do well 
 by their babies, that they do too much for them ; 
 they overdo, and the children sufler. Of course 
 children are sometimes neglected, but this is a much 
 rarer form of error than the other ; albeit that it 
 shocks us very much in those comparatively rare 
 cases in which it occurs. Perhaps a mixture of 
 neglect and of over-indulgence is the commonest 
 form of error in the treatment of infants, too 
 long intervals between meals at one period of time 
 being attempted to be made up by too frequent 
 feedings at another. But this form of error is often 
 fatal ; and it really would be better if, by any 
 chance, baby, who ought to have been fed in four 
 hours, has had to wait six, to give it its food 
 then, and to wait the full four hours next time, than 
 to feed say in two hours again, or even in three, in 
 order to make up for the previous omission. Clear 
 ideas, then, regarding growth, its rate, and its 
 amount, would vastly help us in managing the 
 nutrition of infants, and would tend to prevent 
 the over-feeding and the too frequent feeding which 
 are so common a cause of illness and of mortality 
 among them. While I am considering this subject, 
 
360 
 
 I should like to add some similar considerations 
 regarding the nutrition of growing children, say at 
 ages beyond the first year. A growing boy or girl, 
 we are constantly hearing, ought to be well fed. 
 Yes ; so they ought ; but how well ought they to be 
 fed? That is the question. Comparatively few 
 observations have been published upon the weight 
 of children from the second to the fifth year of life. 
 But from 372 observations made by Professor Holt, 
 of New York, it appears that the gain in weight is 
 about six pounds during the second year, about four 
 and a half during the third year, and about four 
 pounds during the fourth year. During this period 
 the gain is rarely steady even in the second year. 
 With most children it is slowest, or the weight is 
 stationary, in the summer months, while the most 
 rapid increase is usually seen in the autumn. 
 Throughout this period girls gain in about the same 
 ratio as boys, but remain on the average nearly one 
 pound lighter. * * During almost every illness, no 
 matter of what character," says Professor Holt, 
 ' ' the gain in weight ceases, and usually there is a 
 loss, the rapidity and extent of which are somewhat 
 proportionate to the severity of the attack ; but it 
 is always much more rapid in diseases of the 
 digestive tract than in any other form of illness." 
 The reader who has entered into the spirit of the 
 observations characterising this essay, will have no 
 difficulty in seeing how these remarks coincide with 
 it, or in perceiving that I look upon the rapid loss 
 of weight in children's illnesses as generally caused 
 
361 
 
 by the too rapid accumulation in their blood and 
 tissues of ill-assimilated food stufi, converted into 
 ill-made body stuft'. This ill-made body stuff is apt 
 on exposure to a variety of the ills of life, to cold, 
 wetness, wind, damp, or fatigue, which, do as we 
 will, cannot always be prevented, to die, break down 
 with excessive combustion or fever, and require to 
 be eliminated from the body. If we translate this 
 statement into the language with which we are now 
 familiar, we may say, that exposure of infants to 
 the exciting causes of cold, wet, damp, fatigue, &c. , 
 is apt to have very hurtful influences on their 
 health, but that these hurtful influences are apt to 
 be much aggravated if in addition they have been 
 subjected to the action of the predisposing cause of 
 wrong feeding, and, as is so commonly the case, of 
 over-feeding, that is, of too frequent or too 
 abundant feeding. The principle, therefore, which 
 determines the occurrence of the large majority of 
 the diseases from which infants and children suffer 
 is just the same as that which causes their 
 occurrence in grown persons, viz., wrong feeding, 
 the considerations advanced regarding normal 
 increase of weight in infants exactly and strongly 
 corroborating this view. Even the beggar's baby, 
 as has been already said, is under the same 
 influences ; too frequent feeding, and that generally 
 with improper sorts of food (particularly starchy 
 foods) being the chief cause of its illnesses. 
 
 As regards the increase of weight beyond 
 the age of five years, the following table from 
 
362 
 
 Bowditch, referring to American children, will shew 
 at a glance the facts. The height and circumference 
 of the head and chest increase proportionately to 
 the increase in weight, but I have not inserted 
 them in the table. 
 
 Weight op Childben from Five to Sixteen Yeabs 
 
 
 
 OF Age. 
 
 
 Age 
 
 5 yej 
 
 Boys. 
 Pounds. Kilos. 
 
 irs ... 41-2 18-71 
 
 Girls. 
 
 Pounds. Kilos. 
 
 39-8 18-06 
 
 6 , 
 
 ... 45-1 
 
 20-48 
 
 43-8 19-87 
 
 7 , 
 
 ... 49-5 
 
 22-44 
 
 48 21-78 
 
 8 , 
 
 ... 54-5 
 
 24-70 
 
 52-9 24-01 
 
 9 , 
 
 ... 60-0 
 
 26-58 
 
 57-5 26-10 
 
 10 , 
 
 ... 66-6 
 
 30-22 
 
 64-1 29-07 
 
 11 , 
 
 ... 72-4 
 
 32-83 
 
 70-3 31-87 
 
 12 , 
 
 ... 79-8 
 
 35-21 
 
 81-4 36-90 
 
 13 , 
 
 ... 88-3 
 
 40-04 
 
 91-2 41-36 
 
 14 , 
 
 ... 99-3 
 
 45-03 
 
 . 100-3 45-50 
 
 15 , 
 
 ... 110-8 
 
 50-26 
 
 . 108-4 49-17 
 
 16 , 
 
 ... 123-7 
 
 56-09 
 
 . 113-0 51-24 
 
 The slowest gain is from the fifth to the eighth 
 year, when it is about four pounds a year. From 
 the eighth to the eleventh year it rises to about six 
 pounds a year. Up to the eleventh year the two 
 sexes gain in about the same ratio. From the 
 eleventh to the thirteenth year the girls gain much 
 more rapidly, passing the boys for the first time, 
 and maintaining this lead until the fifteenth year, 
 when again the boys pass them. But the rate of 
 increase for boys and girls alike emphasises the 
 truth of the considerations I have advanced 
 regarding the need for feeding for growth, and 
 
363 
 
 the comparatively small amount of extra food 
 required on this account. As a fact, growing boys 
 and girls are frequently supplied, not with half an 
 ounce of extra food daily to allow them to grow, 
 nor with an ounce, or even two, three or four 
 ounces, but, on the ground that they are growing, 
 are not infrequently provided with an extra half 
 pound of food three times a day ; and, in conse- 
 quence, most disastrous results not infrequently 
 occur. 
 
 I might say here, in a parenthesis, as it were, 
 that exactly the same principles determine or ought 
 to determine the kind of advice that ought to be 
 offered to the expectant mother, so often advised 
 and even besought by her friends to " eat for two." 
 As in nine months there is brought forth a product 
 weighing altogether about nine pounds, the problem 
 of properly feeding her is very similar to that of 
 feeding the growing boy or girl, and amounts to an 
 extra quantity of between half an ounce and an 
 ounce a day. Even if the gross weight at birth 
 were 18 pounds (and it occasionally approximates 
 to this weight), the extra necessity of food-supply 
 would only amount to about an ounce a day. But 
 the vaguest ideas being current as to this necessity, 
 well-meaning but injudicious friends press upon her 
 the advice to perhaps interpolate an extra meal or 
 even two in the day, and to increase her normal 
 food supplies besides, so that in order to meet a 
 necessity of an extra supply of an ounce, or say 
 two ounces, of food daily, perhaps an extra one and 
 
364 
 
 a half pounds avoirdupois may be ingested and 
 consumed. The consequences of this only those 
 know or can appreciate whose business it is to bear 
 on their shoulders the responsibility for disasters 
 occurring at parturition — disasters of the most 
 calamitous kind, which always evoke, as they ought 
 to do, the widest spread sympathy, too often 
 accompanied by execrations of nurse and doctor, 
 who did or did not do this, that or the other trifle, 
 the doing or not doing of which led, in common 
 opinion, to the calamitous occurrence. It is not the 
 lighting or not lighting of the fire at a given 
 moment, nor is it the opening or not opening of a 
 window or of a door, causing a draft on the one 
 hand or too much stufiiness on the other ; nor yet 
 is it the bringing of a certain meal five minutes 
 after its proper time — it is not any of these trifles 
 which does the mischief, although all things ought 
 to be done, no doubt, decently and in order ; but 
 it is the improper habits of the patient herself, and 
 particularly the unsuitability of her food habits, 
 before her confinement, which is the main cause of 
 her disasters. The exciting causes named may 
 indeed be the occasion of the calamity — they may 
 be a part or a small part of the cause ; but the 
 cause, or the main part of it, without whose 
 existence the slight or exciting causes would have 
 been powerless for evil, is the state of the patient 
 herself, brought about by the action of causes so 
 simple as to be within the observing power of 
 the meanest intellect, and yet, perhaps for 
 
365 
 
 that very reason, overlooked or ignored by 
 almost all. 
 
 If we keep in mind the principles which ought 
 to guide us, we shall have little dijficulty in 
 answering the question so often put to us, how often 
 do children require to be fed ? I have already dealt 
 with infancy. After two years of age a child ought 
 to be got on to three meals daily without any inter- 
 polation of extra meals, without addition of 
 chocolates, spice, cakes, &c., if we wish it to be 
 well, and to exemplify and maintain those 
 characteristics which seem to make the period of 
 from two to four years of age the very acme and 
 perfection of childhood. Nothing probably is more 
 interesting and attractive in the whole range of 
 human experience than to watch the opening of 
 childhood's faculties at this age, to hear the early 
 attempts at connected speech, as nerve cells in the 
 brain become connected with one another so as to 
 form the mechanism through which the growing 
 powers of mind can be better and better exercised. 
 Equally interesting is it to watch the development 
 of the moral and spiritual and the emotional nature, 
 as by leaps and bounds in an intermittent, but, on 
 the whole, progressive way, it opens up before us ; 
 similar changes in the posterior parts of the brain 
 taking place, so as to allow of the manifestation of 
 these qualities, and of remembering, judging, &c., 
 as took place in the anterior portions to allow of 
 feeling and perception. But if these faculties are to 
 grow and develope from early promise to maturer 
 
366 
 
 fulfilment, how important it is that from the earliest 
 age the necessity of self-government should be put 
 before the child, how necessary that it should be 
 taught that, while learning its needs from the 
 impulses of nature and of desire, it should early 
 learn to put restraint and government upon them. 
 And until this is possible, how necessary that 
 parents and guardians, who stand to children in the 
 same relation as divine providence to children of a 
 larger growth, how necessary for them to make the 
 conditions as suitable, and natural, and healthy as 
 possible. The same considerations obtain and 
 ought to weigh with us in feeding the growing and 
 developing cerebral organism as obtain in the case 
 of the nutrition of older persons ; only this is, if 
 possible, more important in the case of children so 
 delicate and so tender. If, for example, they have 
 a great love of sweets, this should be gratified — 
 it was not implanted in them by nature for 
 nothing — but it should be gratified in moderation, 
 say by giving one or two of the coveted edibles at 
 meal times, and not between meals, so that they 
 shall be digested and properly assimilated with the 
 food, and not go to form subidiary meals. For, if 
 they do the last, how can the blood fail to be loaded 
 with waste and effete, or, at least, with ill- 
 made and imperfectly assimilated food stuffs ? And 
 when this is so, how can we expect that the blood 
 will either nourish the body properly or secrete the 
 fine spirituous fluid l3^ng in the ventricles of the 
 brain, and between the membranes of the brain and 
 
367 
 
 spinal cord, so that the functions of these governing 
 and controlling parts of the body shall not fail of 
 their high place and power ? Will not that fine 
 spirituous fluid tend in such circumstances to 
 become thick, cloudy, and grumous, and so to spoil 
 the development and growth of those very faculties 
 whose proper growth is of so great consequence to 
 their possessors, and of interest so intense to 
 on-lookers ? That there must be something wrong 
 in the way in which children are generally fed will 
 be apparent to whoever calls to mind and reflects 
 upon her experience on seeing her child in the early 
 morning, and on discovering from the morning kiss 
 how unpleasant (not to use a stronger term) is the 
 child's breath. It ought not to be so, but the 
 breath is too often faint and mal-odorous in place of 
 sweet and fragrant. This must mean mal-assimila- 
 tion of food, and mal-assimilation of food must, in 
 turn, result in imperfect formation of bodily and 
 cerebral tissue, in other words, in improper growth 
 of the child's tender body and brain, and in marked 
 instability of tissue, which is therefore far proner 
 than it ought to be to break down with excess of 
 combustion and oxidation, and to induce one of 
 those inflammatory or febrile attacks which are so 
 characteristic of childhood. 
 
 I will not say any more about the interest and 
 even fascination which characterise the growth of 
 body and mind in early life ; nor will I say anything 
 more about the gravity of the responsibility 
 undertaken by parents in the rearing and education 
 
368 
 
 of their children. Truly, when we come to reflect 
 upon it, we are driven to exclaim : " who is 
 sufficient for these things ? " But I will, coming 
 down again to the lower physical and organic basis 
 on which the higher qualities are founded, and 
 through which they work, consider a little further 
 the number of meals proper to childhood, and how 
 best to meet the indications of physiology and of 
 nature in the circumstances of modern civilisation 
 in towns. I do hope I may carry medical opinion 
 with me in the view I am enunciating. I do know 
 that some able medical authorities agree with me 
 in thinking that three meals a day are sufficient for 
 children in all circumstances, and that in no case, 
 therefore, should the practice be resorted to of 
 providing them with more. If, for instance, 
 children of from five to fifteen years of age 
 breakfast at eight, go to school at nine, and dine at 
 12-30 or one, they should in my view not be 
 encouraged or even allowed to eat anything at the 
 ten minutes' break during school hours at 11 p.m. 
 At the most, they might have a glass of milk and 
 hot water, equal parts, at that time, although I 
 really think a glass of water alone would be 
 better for them, since it would stimulate the 
 stomach, and the digestive organs generally, to 
 finish the digestion of breakfast before dinner was 
 due. The digestive organs would thus have more 
 rest, the blood-making processes would be better 
 performed, and fewer causes of " colds " and 
 feverish attacks would be present in the body and 
 
369 
 
 blood ; while dinner at its proper time would be 
 better enjoyed and better assimilated. As to the 
 habit, not uncommonly indulged in, of taking tarts 
 and milk at eleven o'clock, it is a pernicious custom, 
 which I am quite sure ought to be abolished. It 
 leads to many colds and many illnesses, fevers 
 among the rest, the causes of which are apt, as we 
 have already often seen, to be attributed to cold, 
 wetness, fatigue, &c., on the one hand, and to that 
 bugbear of modern life, " infection," on the other. 
 If only parents and the public generally could be 
 induced to see that when small amounts of exposure 
 to cold, rain, wind, and the like, give children 
 " colds," and that when small and often scarcely 
 discoverable amounts of exposure to infection give 
 them "fevers," the predisposing conditions as to 
 feeding ought to be carefully considered and 
 examined, how much benefit might be obtained. 
 Sometimes, it seems to me, the " infection " is 
 boldly invented, when a "fever" has to be 
 accounted for. A child, for instance, is, say, six 
 months in hospital when it developes scarlatina or 
 diphtheria. At once infection is looked for. 
 A visitor, it is said, must have brought the 
 infection. This is assumed as an unquestionable 
 axiom. Careful inquiry is made. Someone who 
 visited the child is proved, or is suspected 
 to have been in communication with someone 
 who has had scarlatina or diphtheria, and in 
 this obscure and subtle way the infection, it is 
 inferred, has been introduced into the ward. The 
 
370 
 
 idea that the child might have developed the fever 
 because say a germ or two of the infecting cause 
 was swallowed in milk or eaten in food, and, finding 
 in the over-fed body a suitable nidus or soil, took to 
 growing in the blood or tissues, is never considered. 
 Nor is it considered, as it ought to be, that 
 if a cause so slight as the vague exposure to 
 infection on the one hand, or the introduction into 
 the organism of a germ or two on the other, 
 suffices to give a child a fever, the cause, or its 
 main part, ought to be looked for, not in the 
 introduction of the germ, but in the predisposition 
 of the soil, that is, the state of the blood and 
 tissues of the child, to stimulate its growth. Of 
 course, I do not suggest that the germ was created 
 by the suitability of the soil to favour its growth. 
 The germ was not created by the soil, but it was, I 
 believe, attracted by it. Or the germ may have 
 been lying dormant in the soil (that is, the body), 
 and, finding a suitable pabulum in its wrongly fed 
 state, or over-manured state, took to growing in it. 
 Now this is no imaginary case. I saw not long ago 
 a little girl, five years of age, pale, thin, delicate, 
 refined, and her mother told me that the child 
 could not eat. " She only picks," she said, " like a 
 dickey bird." And quite recently the child had 
 had typhoid fever — at least, so it was said — and a 
 doctor had attended her for it. Whether the child 
 had typhoid fever or not, it was well that that 
 opinion was formed and acted upon, because, as is 
 well known, the best treatment for that condition is. 
 
371 
 
 an exclusive milk diet for several weeks, three, say, 
 to six, and sometimes nine, and very occasionally 
 even twelve. If only the milk is kept down to 
 small amounts, say to a pint or so a day, diluted 
 with hot water so as to make it easier of assimila- 
 tion, and to let it be administered at the comfortable 
 and convenient temperature of about 70° F., with 
 perhaps half a pint of mutton tea or chicken tea in 
 addition in the 24 hours — if anything is wanted 
 in the night, water is best, for the stomach 
 and digestive organs require rest as well as the 
 other parts of the body — nothing but good can 
 result. The child in question had been treated in 
 this way, and had in due course recovered, her 
 appetite returning in a more healthy way than 
 before the illness. By and bye, however, the 
 delicate and refined little thing began to want less 
 food, and the mother became alarmed. In order to 
 make up for a poor breakfast, she served the child 
 with lunch at 10-30 a.m. of bread and milk, a 
 wholesome food enough, but given at the wrong 
 time, especially as the child was expected to eat 
 dinner at one. Naturally enough the dinner meal 
 was refused, or a mere pretence was made to eat it. 
 The mother being again alarmed lest the child 
 should die of starvation, had some more food served 
 at four o'clock, and again at six. The child was 
 having not too little done for her but too much. 
 Injudiciously, but well meaningly, no doubt, she 
 was having too many meals forced on to her, and 
 the consequence was that her digestion became 
 
 X2 
 
372 
 
 entirely upset and deranged, her tongue became 
 furred and dirty, and her appetite almost wholly 
 disappeared. I recommended that she should be 
 put to bed and fed as if she had typhoid fever. I 
 did not say she had typhoid fever, because I did not 
 think she had ; but I put her to bed and recom- 
 mended poultices or compresses to her stomach 
 regularly for an hour, twice a day, with a cool 
 evaporating lotion to the head at the same time, 
 and suggested giving not more than a pint of milk 
 well diluted with water, and nothing else, in the 24 
 hours, and going on with this until the child began 
 to call out for something to eat. This she did in 
 about a fortnight, when, her tongue being clean 
 enough to make it seem right, she had some dinner 
 given her. The milk was continued as before, 
 morning and evening, and the dinner was continued 
 for several more days. After this, the child had a 
 little bread with her milk about six o'clock, and soon 
 became quite well, with a reasonable appetite for 
 her dinner between twelve and one, and for her 
 " tea " between five and six p.m. As she was a 
 delicate child, with a low resistance to digestive 
 labour, I recommended continuing this, really a 
 two-meal-a-day plan, for some time ; and said I 
 thought it would be well if this course were 
 adhered to for the future. Sometimes mothers are 
 convinced by this sort of reasoning, and sometimes 
 not. For some reason (perhaps because general 
 medical opinion, and particularly the prejudices of 
 friends, are violently opposed to it) it is sometimes 
 
373 
 
 very difficult to persuade them to continue in this 
 way, even although one can point to the facts that 
 the child is doing well, plays with energy, and has 
 a better colour, and more regular intestinal action, 
 and that she wakes also with a sweeter breath in 
 the morning, and also that she is gaining weight. 
 Notwithstanding these clear evidences that things 
 are going on quite well, in some cases mothers will 
 not be convinced that they ought to let well alone. 
 They begin again with the 10-30 meal "to keep the 
 child's strength up, and to allow for growth," and 
 they begin the day with breakfast at eight or 8-30 
 besides. In not a few cases, after one had been 
 able to persuade the mother into rational ways of 
 feeding children, grandmother has appeared on the 
 scene and has sternly forbidden the continuance of 
 the "pining process." Occasionally even the father 
 has assumed this responsibility. Opinion is divided, 
 as it was in Middlemarch, we are told, between Dr. 
 Wrench and "the strengthening treatment," on the 
 one hand, and Toller and " the lowering system," on 
 the other ; or we are reminded of the competition in 
 Milby between Mr. Pilgrim and Mr. Pratt, " the 
 latter of whom elegantly referred all diseases to 
 debility, and, with a proper contempt for symp- 
 tomatic treatment, went to the root of the matter 
 with port wine and bark ; while Pilgrim was 
 persuaded that the evil principle in the human 
 system was plethora, and he made war against it 
 with cupping, blistering and cathartics." The 
 present writer humbly agrees with Mr. Pilgrim 
 
374 
 
 in his view, though not in his practice ; faihng to 
 see how cathartics can clear plethora out of the 
 blood and tissues, although, as they have some 
 influence on the stomach and bowels, they might 
 conceivably clear obstructions out of these, so 
 ridding the system of the materies morbi, if it had 
 not been for the other fact that, long before, the 
 peccant matter had been passed from these organs 
 and had found its way into the blood. On the 
 other hand, Mr. Pilgrim's other sheet-anchors of 
 blistering and cupping, while they might con- 
 ceivably remove effete plethoric material from a 
 small portion of the blood, or even remove some 
 of that vital fluid itself, and along with it its 
 deleterious accompaniments, could not, it seems to 
 the present writer, exert any effect at all on the 
 rest of the circulating medium, which would still 
 continue to flow, loaded with its ill-made and 
 unused stuff, to poison the tissues of the body. By 
 restricting the diet, however, to a point under (for 
 a time) what is required for the maintenance of the 
 body in health, all these desirable ends may be 
 attained, the non-introduction of new material 
 compelling the organism to use up what is already 
 in it, to the great benefit of all the actors and 
 elements concerned in the problem. But in Milby, 
 as in the rest of the civilised world, it is apt to be 
 " the strengthening treatment " which commands 
 the favour of a not too discerning or too closely 
 reasoning popular opinion. " Port wine and bark," 
 indeed, acting as stimulants, while they do not 
 
375 
 
 supply the materials for oxidisation and combustion 
 required by the body, might have an influence 
 which neither Mr. Pilgrim nor Mr. Pratt, nor any 
 of their respective supporters or partisans had ever 
 considered, and might even be acting favourably 
 in ways unsuspected either by the supporters 
 or by the leaders themselves. A diet, in fact, 
 of port wine and bark, or of alcohol in any form, 
 or such a diet, in addition, say, to a pint of milk, 
 and of soup daily, such as is not infrequently 
 prescribed for patients sufiering from various forms 
 of fever and debility, is really a restricted diet, 
 although it is called a stimulating one. Measured 
 in food calories, it will amount to perhaps 300 or 
 400 food calories, as against the 2300 or so emitted 
 by the starving man, or by the physician or the 
 professor, or the literary man or woman, whose 
 food requirements are so very low, as we have seen. 
 And yet, such slaves are we to words, that a diet 
 amounting in food value to only a fractional part 
 of even the ounce of food- weight required daily for 
 every ten pounds of body- weight, on the lowest 
 computation, for the nourishment and enrichment 
 of the blood, is thought of by us, if only we call it 
 " a stimulating diet," as one in excess, and not as it 
 really is, in deficiency. 
 
 But to return to the feeding of children ; it is 
 in many cases quite in vain to reason about the 
 am.ount by which a child grows in a year, and to 
 say how much extra food is required for this 
 purpose ; and equally useless to point to the various 
 
376 
 
 marks of improvement, and to shew that he is 
 gaining weight. The quantity of food which ought 
 to be given to a growing child is too apt to be 
 settled by prejudice rather than by reason ; and it 
 is not often that parents can be induced to listen to 
 the arguments which convinced the mother of the 
 tuberculous child of four years, formerly referred 
 to, who was cured of her necrosis of the thigh bone, 
 and white swelling of the knee joint, on one meal a 
 day and a glass of milk night and morning, and 
 who gained nearly ten pounds in weight on this 
 diet continued for fifteen months. That the two- 
 meals-a-day plan, recommended by Dr. Dewey, is 
 suitable for town-bred children in England, there 
 can be little doubt. He proposes that children 
 should go to school at say eight a.m., and stay there 
 till ten, returning home then for breakfast. He 
 points out that, their organisms not being troubled 
 with the labour of digestion, their intellects and 
 perceptions would be keen to take in and to remem- 
 ber the instruction they received. At ten he thinks 
 they should go home to breakfast. At eleven they 
 might return to school. I would suggest that they 
 should be encouraged to play under cover if the 
 weather is bad, and that in good weather they 
 should be taken out into the country, if necessary a 
 short distance by rail in the case of large towns, to 
 study nature under the general superintendence of 
 teachers, who should go with them and shew them 
 animals, birds, plants, and rocks, in a conversational 
 way, interfering no further with their libert}'' of free 
 
377 
 
 movement than might be necessary to preserve 
 order and prevent destruction or damage to 
 property. At one or two p.m. they should be back 
 in school, where for two or three hours more they 
 might, by the help of books and maps, follow up 
 the studies which they had practically, and almost 
 without knowing it, begun in the fields and in the 
 country. The scientific and orderly arrangement 
 of knowledge, begun practically through eyes, ears, 
 and fingers, might be elaborated and carried on by 
 the help of books, &c. The stomach and digestive 
 viscera, having done their work, the brain would 
 not be distracted by having to superintend digestive 
 labour, and would again, therefore, be almost as 
 keen and receptive of instruction as it was from 
 eight to ten a.m. In these two stretches of two 
 hours each, young children would probably learn as 
 much as they are capable of assimilating. Older 
 children might have two stretches of three hours 
 each, or perhaps one of three hours and one of two. 
 At four they should go home to dinner of varied 
 and mixed diet, and at six, seven, eight, or nine, 
 they might go to bed, according to age. These 
 seem very suitable arrangements to make children 
 happy and healthy, as well as to educate them. 
 The numbers of children of school age, about a 
 sixth of the total population, say 50,000 in a town 
 with 300,000 inhabitants, are numerous enough to 
 demand arrangements suitable for their life, and 
 health, and happiness, and instruction; and there 
 would, it seems to me, be little difficulty in 
 
378 
 
 adapting the business arrangements of the parents 
 so as to make them suit all parties. But if this is 
 thought too revolutionary a measure, there is 
 nothing to hinder the present arrangements about 
 breakfast and dinner, at eight and 12-30 or one, 
 respectively, to be continued, and that the children 
 should have either a glass of milk at 5-30 or six, or 
 that and some bread, so that they should have in no 
 case more than three meals daily. The occurrence 
 of illness might reasonably be made the test as to 
 whether any further change should be made. As 
 disease is more often induced by wrong feeding, and 
 by too frequent feeding, than by any other cause, 
 and as this is as true for children as it is for grown 
 persons, the occurrence of illness should in most 
 cases be met by restriction of the diet, and this 
 could best be effected by omitting either the 
 morning or the evening meal, and substituting for 
 it say a glass of milk. In these cases where a 
 three-meal-a-day plan (it would be shorter to say a 
 trissiteous plan) suited, we could follow the good 
 conservative rule to let well alone ; but in no case 
 do children require to be fed oftener than three 
 times a day. I do not, however, even in the case 
 of children, conceal my own preference for the 
 two-meal-a-day plan (or the dissiteous plan), thinking 
 that they would be healthier on two meals a day 
 than on three. If, however, they took three meals 
 daily, this plan might be continued till the age of 
 21, or possibly till 25, after which, I think the two- 
 meal regime should be resorted to, say till the age 
 
379 
 
 of 50, or perhaps 55 years. After this, I believe, in 
 the majority of cases, one moderate meal of mixed 
 diet, taken some time between twelve noon and 
 two p.m,, would be the healthiest plan. This could 
 be continued to advanced age, say 75-80. After 
 that age, many aged persons I have known have 
 seemed to think that they obtain the best health 
 results if they take a very little food three or four 
 times a day ; and one ought to be careful of 
 recommending a line of treatment contrary to the 
 views of those whose experience entitles them to 
 know. True, the persons whom we meet who have 
 attained advanced age, have seldom done so on a 
 two-meal-a-day plan, or on a one-meal-a-day plan. 
 It might be otherwise if they had. They have 
 generally, however, done so on a somewhat 
 abstemious diet, as Cornaro's case so markedly 
 exemplified. There are, no doubt, exceptions to 
 every rule, and one finds a few aged persons who 
 have eaten freely all their lives, just as one 
 occasionally finds also persons taking alcohoHc drink 
 freely and still surviving to old age. But these 
 cases do not form the majority, and, when they are 
 found, one is disposed to ask the question, how much 
 better might they not have been if they had kept 
 better within the bounds of moderation. That old 
 people bear abstinence well is a very ancient 
 observation, followed in the next sentence by the 
 statement that they bear over-feeding badly, or, as 
 the ancient writer put it, seeing the paradox which 
 has occupied us so long in a former part of this 
 
380 
 
 essay, they waste or consume away by much (yno 
 fxev yap Tro\\(i)v airoa- ^ivvvvr ai). And as there is 
 no strict line of demarcation between infancy and 
 childhood, nor between childhood and adolescence> 
 and maturity, and elderliness, and old age, each age 
 insensibly leading on to the one beyond it, 
 temperance and restraint in the use of food seem to 
 be the best means to be followed by humanity at 
 all its stages of progress from the cradle to the 
 grave, if life is to be healthy, happy, and useful. 
 
381 
 
 CHAPTER XL 
 
 On Cancer. 
 
 T HAVE thought it well to introduce a chapter 
 on cancer, because it is occupying a large 
 amount of public attention at the present time. 
 Perhaps I ought not to say that it occupies a large 
 amount of public attention. I ought rather, I 
 think, to say that it is causing a large amount of 
 public panic. I wish cancer did occupy a larger 
 share of public attention, because I have come to 
 think, and the reader who has cared to accompany 
 me so far will be prepared for the statement, that 
 cancer is not a diseased condition of body to be 
 considered by itself; but, on the other hand, being 
 only one of a large number of diseases that 
 overtake humanity, and obeying the same laws as 
 other diseases, it is induced by similar causes, 
 and, like them, though not often cured, to a very 
 large extent it is obviable or preventible, and 
 this by the simplest means. I share the general 
 opinion of the greatest of medical writers, as the 
 reader will have observed, that disease is, on the 
 whole, one ; and I venture to translate this opinion 
 practically into the view that on the whole the 
 causes of disease, of all diseases, are the same, and, 
 
382 
 
 therefore, that the means, if not of curing, at any 
 rate of preventing cancer, are the same as the 
 means of preventing other diseases. Therefore, 
 also, I beHeve that proper attention to air, food 
 and exercises would do as much for us in preventing 
 cancer as it would or could do for us in the case of 
 other diseases. It seems to me a very simple 
 matter ; theoretically, I mean, for practically it 
 involves the problem of self government, it involves 
 a certain amount of self restraint ; and no one who 
 thinks about that, or studies his own nature, can 
 fail to perceive that that (while it is the main 
 problem in life) is at once the simplest and yet the 
 most difficult of all problems. Panic is, however, 
 the least favourable attitude of mind in which to 
 approach the consideration of any subject. I 
 deprecate panic in the consideration of this one. 
 In the number of deaths which it causes, cancer is 
 not even one of the most important of the diseases 
 to which humanity succumbs. If we consider the 
 effects of the fevers, of consumption, and of cancer, 
 on the people of England, we may roughly say that 
 fevers cause four deaths for every one caused by 
 cancer, and that consumption causes two for every 
 one of cancer. That is to say, cancer causes only 
 half of the mortality caused by consumption, and 
 only one quarter of the mortality caused by the 
 fevers. But we have on the whole greatly 
 diminished the incidence and the mortality both of 
 the fevers and of consumption ; and there is, 
 therefore, on the face of it, no reason to fear that 
 
383 
 
 we shall be able to do the same for cancer. I have 
 not the slightest doubt of this myself. Neither do 
 I think that it is necessary for us to raise either a 
 million pounds sterHng or a hundred thousand 
 pounds in order to do this. Any results to be 
 obtained by expensive laboratory work, by micro- 
 scopic and bacteriological inquiry, seem to me more 
 or less useless, practically, or from the point of view 
 of the causation and prevention of cancer, which 
 are the only really important aspects of the 
 question. Such inquiries are academically interest- 
 ing, no doubt ; and all kinds of knowledge, I freely 
 admit, mutually illuminate one another. But 
 when laboratory results are obtained, divorced, as 
 they too often are, from every day life, all the use 
 that can be made of them will be to corroborate the 
 conclusions which we much more simply and much 
 less expensively draw from the occurrences, from 
 the facts, and from the observations we may make 
 from every day life. They can, at any rate, never, 
 without subverting the true order of nature, be 
 made to supersede the latter. A striking illustra- 
 tion, I think, of the truth of this view may be 
 obtained from the history of another disease. 
 Diphtheria is now believed to be caused by the 
 growth in the body of a certain micro-organism, 
 the Klebs-Loffler bacillus. (The view I would put 
 before the reader is that diphtheria is caused not by 
 the bacillus, but by the state of the body which 
 makes the bacillus flourish.) Our health authori- 
 ties, therefore, following out logically the view they 
 
384 
 
 hold as to the causation of diphtheria, provide 
 practitioners with tubes, &c., in which to collect 
 material from the throats of patients suffering from 
 this disease, and kindly examine them for us at a 
 public laboratory, free of charge. They seem by 
 their attitude almost to wish to compel us to treat 
 the bacillus by injections of serum, and in a manner 
 to force the hands of experienced practitioners to 
 this mode of treatment, as if they thought that it is 
 the disease which is to be treated, or the bacillus 
 and not the suffering patient — but I shall let this 
 consideration pass. Now what happens ? This, 
 among other things. The doctor gets a case, takes 
 a swab from the throat, sends it to the laboratory, 
 and, in due course, gets a report that it swarms with 
 bacteria of the most deadly sort. All the while, 
 however, there are no symptoms in his patient 
 which cause him the slightest anxiety. Then he 
 has another case, or his colleague has, at the same 
 time ; and on this case the report is that the 
 diphtheria bacillus is only doubtfully present — yet 
 the patient dies in spite of serum injections and the 
 most approved modes of treatment. (Very possibly 
 the patient's blood and tissues were in too bad and 
 depraved a condition to allow the bacillus to grow ? 
 I suggest, in fact, that we have not yet learned how 
 much importance or how little we ought to attach 
 to our recent bacteriological discoveries). These 
 are not imaginary cases ; they occur every day 
 when diphtheria is abundant. What inferences are 
 we to draw from them ? Why this inference, 
 
385 
 
 among others, that the presence or otherwise of the 
 diphtheria bacillus is comparatively unimportant ; 
 and that on the other hand the totality of the 
 symptoms and the general condition of the patient 
 are of the utmost consequence. That is to say, 
 that the laboratory inquiries are not nearly so 
 important as the clinical history and conditions of 
 patients, and that they must be corrected by the 
 latter. The same conclusions, I have not the least 
 doubt, will be arrived at regarding cancer ; and 
 after the expenditure, not of a hundred thousand 
 pounds, but of a million pounds, we shall not 
 discover anything useful in the prevention and 
 treatment of the disease in this way that we might 
 not have discovered far more simply from clinical 
 and practical observation. For note ; the laboratory 
 investigation throws no light on the conditions in 
 the body which make the diphtheria bacilli grow or 
 fail to grow. Nor will any amount of microscopic, 
 and laboratory, and bacteriological investigation 
 into cancer be likely ever to tell us what causes 
 make it occur in the body — while, on the other 
 hand, a very little practical and bed-side investiga- 
 tion gives us a speedy answer to the question. At 
 least I think it does. And it is at least reasonable 
 to ask inquirers to attempt to answer the question 
 in this way before they make demands for funds, 
 the proper application of which they have not 
 sufficiently considered. Some light on the question 
 whether cancer is accompanied by the growth 
 in the body of a micro-organism or micro- 
 
 Y 
 
386 
 
 organisms might be shed by this method of 
 investigation. And if the micro-organism proved 
 to be always the same one in cancer, more light 
 might, no doubt, be obtained as to the diagnosis of 
 the disease. But of what value would improved 
 diagnosis be? Of a scientific or classification 
 value, no doubt it would be ; but of practical 
 value, none, or next to none. What we want 
 to know is, what causes acting on the organism 
 favour the production of the diseased state, be 
 it connected with the growth of micro-organisms 
 or not ? And what conditions, on the other hand, 
 are unfavourable to it ? In short, what causes it, 
 and what, therefore, will prevent it ? Now these 
 questions are physiological and clinical ; and 
 we already, I think, possess all the knowledge that 
 we require to answer these important questions. 
 And to give an answer at once and shortly ; it may 
 safely be said that health and soundness of the 
 body render it an unsuitable site for the growth of 
 micro-organisms, while unhealthiness and unsound- 
 ness, on the other hand, render it suitable for such 
 growth. And healthiness and soundness of body 
 are to be obtained by maintaining proper relations 
 between the body and its environment, and 
 particularly by suitable relations between it and air, 
 food, and exercises. And if, on the other hand, 
 unsuitable relations between the body and air, food, 
 and exercises, have subsisted for say 20, or 25, or 
 30 years, not all the knowledge conceivable, or to 
 be attained after the expenditure of any amount of 
 
387 
 
 time and labour, and of any conceivable amount of 
 money, into the natural history of micro-organisms, 
 will enable us to undo the evil effects of wrong 
 living carried on for so long a period of time. Let 
 us at least look at the facts presented to our 
 clinical observation, of the habits of the people who 
 suffer from cancer, before we ask for money to 
 enable us to institute expensive laboratory in- 
 quiries — let us use our eyes before we inquire with 
 the microscope — and if, after that, we wish to draw 
 on the millionaires, or if they are willing to be 
 drawn upon, by all means let them be invited to 
 hand over their money. 
 
 A use to which a sum of a million pounds 
 might be put in order to investigate the causes of 
 cancer might be the following. I fear the donors of 
 it would not consent to a use so simple, but I have 
 more fear for the demanders than for the donors. 
 It would not be very easy to carry it out perhaps. 
 What I would suggest is that a large number of 
 townspeople at all ages, say 10,000, should be fed five 
 times a day, say at eight and eleven a.m., and two 
 five, and eight p.m., on bread and jam for a genera- 
 tion. Let at the same time a similar number of 
 people, similarly circumstanced, be fed twice a day 
 only, on ordinary mixed food, to the amount of not 
 more than 16 ounces avoirdupois a day, and let the 
 diseases and illnesses of these two groups of people 
 be compared and tabulated every five years for a 
 generation. I know in which group the largest 
 number of cases of cancer would occur. And I 
 
 Y 2 
 
388 
 
 also know in which group the largest number of 
 cases of other sorts of disease (yes, including 
 consumption and the fevers), would occur. At the 
 end of the time we should all know it also ; that is, 
 if we wished to know it. But as this experiment is 
 really being made all the time, is it not better to 
 use our observing faculties to see what is going on, 
 without troubling our millionaires to part with their 
 money, or our caretakers to take all the trouble that 
 would be involved in making such an experiment, 
 necessary as it would be to carry it on over a very 
 long time ? 
 
 No doubt cancer differs both from the fevers 
 and from consumption in this respect that it claims 
 its victims mainly among the mature, among the 
 fathers and mothers of families, among those whose 
 presence has come to be most important to their 
 families, and so to the community ; while fever and 
 consumption deal with those whose lives are yet for 
 the most part in promise, rather than fulfilment. 
 This increases the importance of cancer in a way 
 which the number of its victims does not justify. 
 It was no doubt because he felt this consideration 
 weighing upon him that the King, on the 25th 
 July, 1901, in welcoming to London the Congress 
 which met there for the purpose of studying 
 tuberculosis, and mitigating its effects, after some 
 sympathetic words regarding the objects of that 
 Congress, went on to say : — 
 
 " There is still one other terrible disease which 
 has, up to now, baffled the scientific and medical 
 
389 
 
 world, and that is cancer. God grant that, before 
 long, you may be able to find a cure for it, or check 
 its course. I think that to him who makes the 
 discovery, a statue should be erected in all the 
 capitals of the world." 
 
 The candidate for that statue is still to be 
 discovered, if, that is, the finding of a cure for 
 cancer is to be the only cause for which the statue 
 is to be erected. If, however, checking of the 
 course of cancer is to be considered worthy of 
 the erection of a statue in all the capitals of the 
 world, that is quite a different matter. To check 
 the course of cancer would not be difficult if the 
 cause or causes were known, for by obviating its 
 causes, the disease could be prevented ; and 
 prevention would be the most efPectual means of 
 checking its course. That at least the predisposing 
 causes of cancer are known is a matter of conviction 
 with the writer of this essay, and he thinks that 
 this conclusion will be shared by candid readers, 
 after consideration of the evidence, the probable 
 evidence, which has weighed with him. 
 
 After what has been said already regarding 
 predisposing and exciting causes, and the differences 
 between them, I need not weary the reader by 
 recapitulation. As it is the predisposing causes 
 which are important, it is to them that our 
 attention must be directed. The suggestion is that 
 by acting in certain directions, which are easily 
 within our own power and control, we might be able 
 to prevent the incidence of a large proportion of 
 
390 
 
 the cancer which now afflicts us. Cure of cancer, 
 after it has once occurred in the body, is a very- 
 different affair from prevention. Prevention may 
 be easy ; cure impossible, or practically impossible. 
 These are, in fact, the conclusions which I wish to 
 set before the reader. 
 
 A preliminary word may, however, be permissible 
 regarding prevention, in general, of cancer, and of 
 other diseases. However well the causes of disease 
 may be known, and however well we may grapple 
 with them, or strive to prevent their action, it is 
 scarcely to be hoped that we shall ever absolutely 
 prevent the occurrence of their effects. The 
 complete prevention of cancer is not to be looked 
 for. There will always be anomalies for which we 
 shall be unable to account, always some cases which 
 it will be impossible to avoid. Some unknown and 
 probably undiscoverable causes in the history of 
 various individuals, or in their ancestry, some 
 instances of the unknown " personal equation " will 
 arise, which will make it impossible for us to 
 prevent occasional cases of this disease. Cancer 
 does not differ from other diseases in this respect. 
 The fevers, for example, and consumption are held 
 to be preventible diseases ; but they have not been 
 prevented, although their incidence and mortality 
 have been considerably diminished ; and although I 
 think that much more might be done in this 
 direction than has yet taken place, if we were 
 somewhat to enlarge our conception of the 
 causation of these diseases beyond the view which 
 
391 
 
 attributes them to bad air and over-crowding, still 
 I do not expect that we shall ever entirely put an 
 end to either of these plagues of humanity. 
 Already consumption has fallen as a cause of 
 mortality from 2800 per million per annum, at 
 which point it stood at the time of the Crimean 
 war, to 1325 per million ; and no doubt it will fall 
 still further, but it will be Utopian to expect that it 
 will ever entirely cease from among us. Some 
 cases, I suppose, always will occur, as they always 
 have occurred in the past, in the long history of the 
 relations between the organism and its enviroment, 
 for it is improbable that even if we knew quite all 
 the causes of our illnesses, we should ever be able 
 to entirely obviate their action or neutralise their 
 effects. The same considerations must govern us in 
 the case of cancer. A diminution by one half 
 would be a great achievement. A reduction by 75 
 or 80 per cent, might, almost without straining of 
 language, be called practical prevention. In the 
 decennium, 1861-70, there died of cancer in 
 England and Wales a proportion of people amount- 
 ing to 384 per million per annum persons living. In 
 1871-80 the proportion had risen to 468 per million 
 per annum. In 1881-90 the number was 589, and 
 the ratio is still rising. In the five years, 1891-5, 
 the ratio, for instance, was 712, and in the four 
 years, 1896-9, the latest date for which figures are 
 available, it has risen to 795, an increase of more 
 than double, if we compare it with 1861-70. It is 
 not necessary here to consider the question whether 
 
392 
 
 the whole of this great and alarming rise is real, or 
 whether it is only partially so. Allowing for 
 whatever part of the increase can be accounted for 
 by better diagnostic power and better naming of 
 diseases, it still does not seem possible to escape the 
 conclusion that this disease has increased steadily 
 as a cause of death for the last forty years. Now 
 while the writer does not look for anything like 
 complete prevention, he does not see any reason 
 why it should not be reduced again to the rate at 
 which it stood say in 1861-5 (368 per million per 
 annum), or even why it might not be reduced still 
 further than the rate then obtaining. 
 
 The first question, then, which we have to 
 discuss, is this : Is the discovery of a cure for 
 cancer an object likely to be achieved, a goal 
 possible of attainment ? To the question put in 
 this form the writer's answer is negative. The 
 search for the cure or for a cure for cancer is not a 
 hopeful role to follow. It is in fact an object 
 impossible of attainment, or at least so unlikely to 
 be attained as to render the search for its attain- 
 ment futile. We may as well spare our pains. 
 The writer's view is that when cancer has set in, 
 when the body physical has become cancerous or 
 affected with cancer, the organism has become so 
 profoundly modified in an unhealthy direction that 
 to hope or work for cure is to hope or work for that 
 whose attainment is impossible. Perhaps he ought 
 not to use the word impossible. It is not necessary 
 to contend that no case of cancer has ever been 
 
393 
 
 cured. That would be to go beyond the evidence. 
 Occasionally, though very rarely indeed, probably 
 persons affected with cancer have been cured, or at 
 least have recovered. But the view of the writer 
 is that cancer has been so rarely cured that it is far 
 nearer the truth to say of the organism — once 
 cancerous always cancerous — than to say that it is 
 likely to be helpful or profitable for us to embark 
 on a voyage of discovery to obtain a cure for this 
 disease. Instead of impossible the writer would 
 prefer the expression practically unattainable. 
 Impossible raises metaphysical or super-sensible or 
 ultra-scientific considerations (which considerations, 
 however, we cannot help raising from time to time, 
 however difficult their solution may be), and these 
 would be shewn to be inadmissible if but one case 
 of cancer had been proved to be cured — a possibility 
 which, as he says, the writer is not concerned to 
 deny. It is not what is abstractly possible that 
 will profitably occupy our attention and our efforts, 
 but what is likely to be practically attainable in the 
 light of our knowledge of causes, and of that which 
 has hitherto been attained. The writer's view is 
 that " once cancerous always cancerous " is a 
 position of mind and fact far nearer the truth 
 than that the discovery of a cure for cancer is 
 likely to be made. Certainly if operation is to be 
 persisted in for the eradication or obviation of the 
 effects of this malady, some addition will have to 
 be made to this method of dealing with it, some 
 advice concurrently given which shall enable the 
 
394 
 
 patient to get outside of the action of those causes 
 which have induced the disease in the first instance, 
 and whose obviation may enable him to prevent the 
 recurrence, which, though sometimes delayed for 
 many years, and very rarely, perhaps, obviated 
 altogether, takes place in the large majority of 
 cases in from six months to four years. If 
 operation alone is more or less futile in curing 
 cancer, perhaps operation coupled with the advice 
 to live differently in future might have some chance 
 of effecting a cure ? When His Most Gracious 
 Majesty made to the scientific men assembled in his 
 capital the suggestion referred to, he no doubt 
 spoke out of a full heart, which was still lamenting 
 the death of a younger brother from that disease, 
 and at the same time was looking hopelessly 
 forward to the certainty, which has been unfor- 
 tunately too sadly realised, that an elder sister was 
 about to succumb to the same malady. Without 
 discussing what is theoretically possible, the 
 experience of the royal families of England and 
 Germany emphasises the futility of the treatment 
 of cancer in the present state of knowledge, for if 
 these powerful families could not command the 
 means of cure, it may well be asked — who could ? 
 In the writer's view, the causes of failure to find a 
 cure were and are inherent in the nature of the 
 case, and the fact that the best skill available, 
 medical and surgical, failed to save the patients, 
 was no accident of the situation, but an ultimate 
 factor to be dealt with in at least the great 
 
395 
 
 majority of cases where changes have advanced 
 so far in the organism as to result in the formation 
 of the cancerous state. It will be seen, therefore, 
 that, for reasons which he believes will strengthen 
 as his argument proceeds, the writer thinks that 
 the search for a cure for cancer is not a hopeful 
 object of research ; and, in fact, he believes it to be 
 practically impossible of attainment. He is no 
 candidate for the statue to be erected in all the 
 capitals of the world. If through a flaw in the 
 bank of a great reservoir the confined waters had 
 burst their bonds, had devastated the neighbouring 
 country, had destroyed growing crops, had drowned 
 cattle, swept away houses, and carried to long 
 distances the corpses of their occupants, it would 
 be obviously futile to suggest the erecting of a 
 statue to whosoever should cure the efiects of the 
 devastation, since indeed the effects would be 
 incurable. Nothing ever would or could restore 
 the crops, the houses, the cattle, or the men. But 
 it would be hopeful — and if the erection of a statue 
 in all the capitals were considered a fit reward for 
 the service, the candidate for the statue might 
 easily be forthcoming — it would be hopeful to 
 mquire how the devastation occurred, where the 
 flaws in the banks were, and by repairing and 
 strengthening the weak place or places, to prevent 
 a recurrence of the evil whose effects unfortunately 
 it would be too late to remove or undo. Especially 
 would this be so if not one but several devastations 
 had successively occurred, for no donbt proper 
 
396 
 
 arrangements would prevent such recurrences in the 
 future. The parallel between the effects of such a 
 devastation, or such a succession of devastations, 
 and the ravages of cancer, appears to the writer to 
 be very complete. To cure it appears to him 
 almost as hopeless as to attempt to undo the effects 
 of the devastation. The proper aim and role of 
 medicine is not to attempt to undo effects without 
 reference to causes, although unfortunately we too 
 often act as if we thought it was. Her true role 
 really is, by discovering the causes of the maladies 
 from which we suffer, to prevent the effects by 
 removing the organism outside of the sphere of 
 action of the causes. In fact, the enlargement of 
 the sphere of preventive medicine is a much more 
 hopeful object of attainment to true medical science 
 than the discovery of cures. Cures are effected by 
 nature, and the chief function of the medical 
 adviser is to interfere as little as possible with the 
 beneficent means of cure adopted by nature. 
 
 By cancer, the writer means chiefly carcinoma 
 or epithelioma, an overgrowth of epithelial or 
 superficial structures, two or more epithelial cells 
 appearing instead of one. This condition, when 
 once it has commenced, goes on to more and more, 
 constantly spreading, ulcerating, or fungating by 
 advance and recession, the advance, however, 
 unfortunately preponderating, till in time the 
 disease destroys the life of the person suffering 
 from it. As to sarcoma, as distinguished from 
 carcinoma, the most illuminating idea, in my 
 
397 
 
 opinion, is the view that sarcoma is merely cancer of 
 the connective tissue. This idea simplifies the 
 problem very much, since on this view cancer of 
 epithelium is a special form of hypertrophy of 
 the epithelial tissues, and sarcoma is cancer of 
 connective tissue. So that cancer and sarcoma 
 are probably both due to the action of the same 
 causes on different tissues ; and the investigation or 
 study of the one is the same, mutatis mutandis, as 
 the investigation or study of the other. But to call 
 carcinoma or sarcoma a hypertrophy or overgrowth 
 is to endorse the writer's view that they are an 
 overgrowth due to over-nutrition. And no doubt 
 cancer and sarcoma are hypertrophies or over- 
 growths. In the one case there is a large increase 
 in the amount and number of the epithelial cells, 
 the appearance of two or more epithelial cells 
 where only only one ought normally to be ; in the 
 other case there is a large increase in the number of 
 connective tissue corpuscles. Perhaps, on the 
 same lines, colloid cancer might be considered a 
 h3rpertrophy of the mucoid cells, and encephaloid 
 cancer of some other forms of cells ? Parasitic cells 
 might or might not appear among these cells, 
 according as it happened. But the essence of the 
 disease on this view is the hypertrophy ; the 
 occurrence of parasites the accident. Now the 
 question is, what is the chief predisposing cause of 
 overgrowth? Well, what can be the cause except 
 an excess of materials in the blood ? And if so, 
 whence came the excess of material which is poured 
 
398 
 
 out of the blood in the form of the cancerous 
 exudation ? What source can there be but the 
 environment of the organism ? And of all the 
 facts of environment, what so likely to be the chief 
 cause of change in the body as the food ? 
 
 A recent writer on cancer, in advocating the 
 infection theory from without, says that "no 
 alleged cause can possibly be accepted which is not 
 universally applicable, and infection from without is 
 the only suggested cause which will satisfactorily 
 account for every case of cancer." Well, this is not 
 incompatible with my view that over-feeding is the 
 predisposing cause of cancer, because it is even more 
 ' ' universally applicable " than infection, and because 
 the over-fed state of the organism is an efficient 
 cause in making infectious diseases grow in the 
 body as noxious weeds grow in the soil, from over- 
 manuring of the ground ; and certainly over- 
 feeding is introduced "from without." 
 
 As regards sarcoma and the view that it is a 
 connective-tissue-cancer, how illuminating and how 
 important become the remarks formerly made, that 
 this same connective tissue is the first great place 
 or part in the body where the products of an excess 
 of food materials, finding their way into the blood, 
 are primarily deposited. We called the connective 
 tissue the great dumping ground of the blood, the 
 place which was, so to say, chosen by the blood 
 as the least hurtful place or site in which to lay 
 down any excess of material which it might be 
 carrying, and for which it had no use. Under the 
 
399 
 
 name of initis, we shewed how connective-tissue- 
 congestion was the basis of such states as neurosis, 
 hysteria, rheumatism, gout, &c. And we further 
 shewed that the next stage after initic congestion 
 was effusion, as e.g., into joints, or into the 
 origins, or insertions of tendons about joints, or into 
 such cavities as the pleura or peritoneum, or the 
 membranes or meninges of the brain. Now we see 
 that when connective-tissue-h3rpertrophy or over- 
 growth takes place in any particular part of 
 the body, sarcoma may occur, and from these 
 facts becomes more apparent the connection 
 between diseases so very different (at first sight) 
 from one another as sarcoma and the diseases just 
 named. From which considerations a corroboration 
 arises of the view that disease is essentially one, 
 with many different phases or aspects, a view which 
 has been held in the past by some of the greatest 
 thinkers and writers on medicine Changes in 
 connective-tissue-cells form the one common factor 
 uniting these so various diseased states ; and 
 changes of this sort are brought about by changes 
 in nutrition, that is, in the feeding of the body. It 
 is food supply, therefore, which is the chief factor 
 in inducing health or disease in the body, and to 
 alterations in this (and usually to restrictions) must 
 we look if we are to do anything towards relief of 
 the fatigue that accompanies initis, or towards 
 the prevention or diminution of the hypertrophy 
 that characterises sarcoma and epithelioma. 
 
 It may be well to inquire here, since cancer 
 
400 
 
 and sarcoma seem to be made out of an excess 
 of material finding its way into the blood, what are 
 the chief ways by which such a process is likely to 
 occur, how, in fact, any excess of material or, 
 indeed, how any material at all may find its way 
 into the blood. There seem to be three or perhaps 
 four channels through which such entrance may be 
 efi*ected. (a) Foreign matter may enter the 
 economy through the respiration ; it may be 
 inhaled or breathed in. (b) It may be inoculated, 
 or it may find its way in through some crack in the 
 skin, or in a mucous surface, (c) It may be 
 introduced through the ancestors, (d) It may 
 enter through the mouth ; it may be swallowed 
 with food or drink ; or, an excess of food, being 
 ingested into the digestive tract, may cause some 
 form of disease, and may require to be eliminated 
 in some way. To take these different methods in 
 order, shortly, let us inquire, is it likely that cancer 
 is breathed or inhaled into the system ? Is it 
 likely that some germ, for instance, lighting upon 
 our clothes, may be inhaled as impalpable dust, and 
 do its deadly work after its reception into the 
 economy ? This is a possible mode of the 
 introduction, no doubt. There are other affections 
 whose introduction into the economy is believed to 
 be, at least sometimes, effected in this way ; 
 whooping cough, for example, consumjDtion, and 
 others. But is it likely that carcinoma is intro- 
 duced in this way ? The writer thinks not. 
 Affections so introduced, or rather, bodily con- 
 
401 
 
 ditions so induced (for disease is not so much an 
 entity superinduced on the body, or added to it, as 
 a state of body somehow induced, a departure from 
 health), generally run a rapid course, extending 
 over a few days or weeks, and accompanied by 
 notable feverishness. Neither of these facts is 
 characteristic of cancer, whose onset is usually 
 insidious, and its course slow and unaccompanied by 
 feverishness. In fact, so far from the temperature 
 being raised in cancer, it is usually sub-normal for 
 years before the onset of carcinoma, only rising 
 above normal as intercurrent inflammatory attacks 
 occur. And the temperature appears to be sub- 
 normal, because the presence of the effete materials 
 in the blood and tissues, which induce the diseased 
 condition, lower vitality and crush down the 
 powers of the organism, like a horse overburdened 
 under the load which it is carrying. Another 
 objection, not of great weight, perhaps, in itself, 
 but helping as a contributory consideration to 
 induce a negative answer to the question whether 
 cancer is introduced through the respiration 
 is, that if it were so introduced, we should 
 expect cancer to affect the respiratory tract 
 more than it does. But although cancer does 
 affect the lungs sometimes, it does so far too 
 seldom to make it seem probable that the diseased 
 condition is produced in this way. Even if it does, 
 however, or if it did, all the considerations formerly 
 noticed regarding the mutual relations or reciprocity 
 of soil and seed would still remain and hold good ; 
 z 
 
402 
 
 so that as regards prevention of such a possible 
 mode of infection, the measures proposed would bear 
 relation chiefly to the germ on the one hand, or 
 chiefly to the state of the person on the other, 
 according to the importance one attached to 
 either of these factors. On the one view, we 
 should advise the person to avoid and keep 
 clear of infection ; on the other, to get his body 
 into such a state that if a cancer germ or two did 
 light on him, he would take no harm from it. It 
 will, I hope, now be abundantly evident which of 
 these two views I should take.. 
 
 (b) Is it likely next that cancer is introduced 
 into the economy, or that the economy becomes 
 cancerous by inoculation through a crack in the 
 skin, or by endosmosis or absorption through the 
 skin or other bodily surface ? If so, should we not 
 be able to point to the spot at which the inoculation 
 was effected, and to prove the onset of the disease 
 in this manner, as also to detail its further 
 progress ? The evidence that cancer is introducible 
 in this way will be dealt with immediately. At 
 present all that need be said is that it is not a 
 very likely mode of cancer origin, although it 
 certainly cannot be pronounced to be an impossible 
 one. 
 
 It may appear to some that lip cancer, or 
 epithelioma of the lip, so frequently associated 
 with the smoking habit, that it is rare indeed to 
 find it in non-smokers (I have only once seen it in 
 a woman, and she smoked) afibrds a case in point, 
 
403 
 
 where the cancerous germ is or may be introduced 
 into the blood, through a crack in the lip. But 
 another explanation is possible, and quite as 
 reasonable, if not more so, viz., that the smoking 
 acts only as an irritant to the lip, the excess of 
 activity thereby induced to the part causing an 
 increased flow of blood thereto, the blood depositing 
 therefore at that spot by preference some of the 
 waste or unused material which it had in it in 
 excess, so forming the .epitheliomatous growth. 
 There is no evidence that the tobacco introduced 
 the particulate matter which caused the epithelioma, 
 any more than that the basic slag formerly referred 
 to introduced the clover seed, or that the railway 
 cutting introduced the seeds of the new flora, after- 
 wards found in the district. It is, however, quite 
 reasonable to suggest, and, I may add, it is a 
 sufficient explanation, that the irritation, by 
 heightening vascular activity, acted in the way 
 supposed. There are numerous other analogies 
 to bear out this view. For instance, the 
 occurrence of cancer is often attributed to a 
 blow ; but no one suggests that, for example, a 
 blow from a child's arm, causing cancer in the 
 mother's breast, actually introduced a cancer germ 
 at the time. Such a thing is highly improbable, 
 and indeed practically impossible. Then again, 
 take this case which actually occurred in my 
 experience. An old gentleman of 87 years of age, 
 was knocked down by a bicycle, and the injury was 
 followed by an attack of gout. The obvious 
 
 22 
 
404 
 
 explanation of both of these cases (and It is quite 
 a sufficient one), is that the blow followed by- 
 cancer, and the bicycle injury followed by gout, 
 were in both cases the occasion indeed of the 
 malady, but they were not the cause (7r/oo<I>ao-t9 ovk 
 aiTLa, to use the words of Hippocrates), the cause 
 being the state of the patient's blood in both cases, 
 loaded as it no doubt was by the presence of waste 
 unassimilated materials. Otherwise we may say 
 the injury was no doubt part of the cause, but only 
 a small part, the chief part being the state of the 
 patient's blood and tissues. 
 
 I ought, however, to discuss another phase of 
 this question before leaving it. Experimental 
 inoculation of cancer appears to have been success- 
 fully performed in the lower animals. Watery 
 emulsions of materials taken from cancerous 
 growths, on being injected into the veins of dogs, 
 have been followed in course of time by the appear- 
 ance of cancerous growths in the lungs. Well, I can 
 admit the success of these and similar experiments 
 without any damage to my theory that over-feeding 
 is the chief predisposing cause of cancer, because I 
 do not deny that, after cancer has been produced in 
 the body, it may spread by infection from a given 
 site. But I wish to point out that cancer in fact 
 never does come in the human subject from 
 inoculation, except in one or two very rare and not 
 quite certain cases, in which surgeons may have 
 inoculated themselves. I must say that such a risk 
 in operating troubles me very little. I should think 
 
405 
 
 that the state of the operator's health had more to 
 do with such a mode of origin than the inoculation 
 which was alleged to cause it. And, besides, our 
 problem is to account for the original origin oP 
 cancer and sarcoma, rather than to say how it may- 
 behave and how it may infect the body after it has 
 begun to grow. 
 
 (c) Has carcinoma been transmitted from 
 ancestors ? Is it being so transmitted now ? Is it 
 a hereditary disease ? If this were so, should we 
 not find cancer running in families more than we 
 do ? And should we not also find cancer appearing 
 oftener than we do in the childhood of the children 
 of those who have themselves suffered from the 
 disease ? But there is no evidence of this. Even 
 if it were so (and I have already discussed this 
 question in dealing with the general subject of 
 the heredity of disease) and if the children of 
 persons suffering from cancer were themselves 
 cancerous, it would not follow that the disease was 
 transmitted, because it might have been, and 
 probably, in fact, would have been the similarity of 
 environment in parent and children, the similarity of 
 the conditions to which both were subjected, which 
 induced the affection in all the cases. Where, 
 however, is the proof of the hereditary transmission 
 of carcinoma, when in so many cases grown up 
 descendants die of quite different affections ? of 
 pneumonia, for example, of infectious fevers, or in 
 advanced life ? I need not repeat what I said 
 before in dealing with the general question. I wiU 
 
406 
 
 just remind the reader that the occurrence of cancer 
 in childhood is very rare indeed, while we should 
 expect it to be common in childhood if it were 
 hereditarily transmitted, since young children are 
 nearer to their parents than they are later, and may 
 therefore be expected to be more affected than 
 afterwards by inherited conditions. But if cancer 
 appears after 50 years of age in the descendants of 
 those persons who may have suffered from cancer, 
 we shall have to answer to ourselves this question : 
 whether is it more likely that a disease, appearing 
 after half a century of life, or more, has been 
 transmitted from ancestors ; or, is it more likely 
 that it has been acquired, that is, produced 
 by some condition in the environment of the 
 persons who suffered from it ? By some habits of 
 their own, in fact ? Put in this way, there can be 
 but one answer to the question, viz. : it is far more 
 likely that it has been acquired. In the case again 
 of parents suffering from cancer, and whose children 
 may also suffer from the disease, other con- 
 siderations arise. In many instances the parents 
 did not acquire the disease till long after the birth 
 of their children. Children may be born when 
 their parents are 35 or 40 years of age, and when 
 the parents were quite healthy, so far as could be 
 known. But at 55 or 60 years of age, when the 
 children were 20 years old, or so, the parents, let us 
 suppose, develope cancer. Is it likely that in such 
 circumstances parents will transmit to their offspring 
 an affection which they did not themselves suffer 
 
407 
 
 from for 20 years after their children were born? 
 There is surely no evidence for this, on the face of 
 it, unlikely view. It will be said, they transmitted, 
 not the disease, but the predisposition to it. But 
 what is the meaning of predisposition ? Pre- 
 disposition means inverse resistance ; it means that 
 the children in such circumstances took on cancer 
 more readily than other and ordinary children 
 would have done. But the proof of this is very 
 hazy and very vague. The theory is started to 
 account for a set of facts, of which a far more 
 likely explanation is at hand, viz. : that similar 
 conditions of environment induced the diseased 
 conditions in the parents, and many years after- 
 wards in the children. The ancestors were not to 
 blame. They transmitted to their children the 
 same sound constitution which they themselves 
 possessed at the time of the birth of their children. 
 They did not then suffer from cancer. How could 
 they then transmit that which they did not 
 themselves have or possess ? Obviously this phase 
 of the question only requires to be stated in order 
 to be answered in the negative. 
 
 But further. If parents suffer from cancer at 
 the time of the birth of their children, and if the 
 children suffer in turn from cancer, but not till after 
 they are 50 years of age, is there any proof of the 
 transmission of cancer in this case ? Very little. 
 Organisation is transmitted, indeed, and any human 
 being may take on any human condition or disease, 
 as every human being is predisposed to every 
 
408 
 
 human ailment ; but as to the Inheritance of disease, 
 what is the proof or evidence for that ? Sometimes, 
 indeed, though very rarely, disease does seem to be 
 transmitted, as when a family-disease appears in 
 the children at birth, or immediately after it, and 
 before the causes which generally induce it have 
 had time to act and to bring it on. But how rarely 
 does this occur. No doubt when it does happen, it 
 is a very striking fact, and one which makes a deep 
 impression on our minds. As, however, I have 
 already dealt with the general question of the 
 hereditary transmission of disease in the chapter on 
 heredity, I will not go further into it now, 
 contenting myself with the statement of my two or 
 three contentions, (l) that although disease seems 
 sometimes to be transmitted from ancestors to 
 offspring, this very rarely happens ; (2) that as a 
 rule organisation is transmitted and disease not ; 
 and (3) that the chief law of heredity in disease 
 (and in cancer, therefore, as a form of disease), is 
 this : that like causes acting on like organisms in 
 succeeding generations induce like effects. 
 
 To see now as an actual fact what probability 
 there is of cancer being transmitted or inherited, 
 let us consider the following statements. Of the 
 20,358 persons who died of cancer in England and 
 Wales in 1892, only 103 were under five years of 
 age. Of the 21,135 who died of this disease in 
 1893, only 94 were under five years of age. Of the 
 21,442 persons who died of it in 1894, only 103 
 were under five years of age ; while of the 22,945 
 
409 
 
 who died in 1895, and of the 23,521 who succumbed 
 in 1896, only 115 and 110 respectively were under 
 the age of five years. That is to say, out of the 
 109,396 persons who died in England and Wales of 
 cancer in the quinquennium of 1892-6, only 525 or 
 •48 per cent., not quite one in two hundred, were 
 under five years of age. Surely if cancer were a 
 hereditary aflection, a larger proportion than this 
 of cases of the disease would have occurred in early 
 life, since children, being nearer to their parents 
 than they become later in life, would be more likely 
 to manifest congenital characteristics. If, however, 
 the causes inducing cancer take some time to act, 
 and if the affection is acquired and not hereditary, 
 we can see how it should become, as in fact it does, 
 increasingly fatal as age advances, that is, in pro- 
 portion as the causes which induce it have longer 
 and longer time to act. If, then, it does not seem 
 very likely that cancer is inhaled into the economy 
 by the entrance of some germ through the 
 respiratory tract ; if there does not seem much 
 likelihood that it enters the body by being absorbed 
 through the skin ; or if the fact that so few cases 
 occur in infancy discredits the theory of its 
 hereditary transmission, are there any other 
 suppositions open to us ? Seemingly, the causes of 
 cancer, whatever they are, take time to act. As 
 has been said, deaths from cancer are increasingly 
 numerous as age advances. In 1900, for instance, 
 which shewed the same characteristics as are seen 
 in other years, there were only 502 deaths from 
 
410 
 
 cancer under 25 years of age out of the 26,721 
 deaths from cancer in that year. From 25-35 years 
 of age, 737 deaths occurred. Between 35 and 45 
 years of age, 2551 deaths occun'ed from cancer ; 
 between 45 and 55, 5501 deaths occurred from 
 cancer; between 55 and 65, 7745 deaths occurred; 
 and between 65 and 75, 6631 deaths occurred. 
 That is to say, the causes of cancer, whatever they 
 are, increase as Hfe advances, reaching their 
 culmination in the middle period of life after 45 
 years of age, and between that time and 75. 
 
 [d) The fact that (practically) cancer is not a 
 children's disease has insensibly brought the inquiry 
 up to the fourth way in which foreign material 
 may find its way into the blood, viz., through the 
 digestion. Does cancer enter the system through 
 the digestion ? The facts regarding the age- 
 incidence of cancer appear to me to be susceptible 
 of a very simple explanation, as do most, if 
 not all of the other facts regarding the incidence of 
 the disease. Children appear to me not to suffer 
 from cancer (practically, of course, for we have seen 
 that a few cases occur) because they have not had 
 time by their food habits to induce it ; while it 
 increases as age advances to the middle period, 
 because the wrong feeding which, I suggest, is at 
 the bottom of it, and is the chief cause of it, is 
 a cause which goes on gaining power as age 
 advances. In childhood and early life, irritation 
 of the organism is accompanied by intolerance, and 
 therefore we find so violent a reaction from the 
 
411 
 
 over-feeding of children that the infectious fevers 
 and inflammations, sudden and fierce, and very 
 often of short duration, are the characteristics of 
 childhood. Up to middle age this cause goes on 
 increasing. But as the bodily tissues harden and 
 become more resistant with advancing time, they 
 bear irritation better ; irritation is accompanied by 
 tolerance, and so we find the diseases affecting this 
 period of life less fierce than in early life. The 
 bodily temperature, instead of reacting, as in 
 childhood it mostly does, into elevation above 
 natural, is frequently characterised by depression 
 below natural ; and so one of the chief characteristics 
 of the pre-cancerous stage is the existence of a 
 subnormal temperature. Even in childhood this 
 condition is less uncommon than is believed. It 
 very often precedes the onset of tubercle, say of a 
 joint like the knee, or of some other part. But in 
 middle life this condition is much more common, 
 as it is even in adolescence. The organism being 
 weighed down and oppressed by the excessive load 
 it is being compelled to carry, and the tissues 
 being somewhat resistant, it does not intolerantly 
 react against the irritation into high fever, but 
 on the other hand is simply depressed by 
 it. This is the time to treat the condition by 
 restriction of the diet, in order to reduce the 
 irritation, although, unfortunately, the opposite 
 advice is too commonly given, viz., that the patient 
 should be fed up in order to elevate his temperature. 
 Then the reasons why cancer becomes less common 
 
412 
 
 over 65 years of age are simply these. Persons by 
 that time have learned how to live. Those who 
 have not learned, or who would not learn, have 
 been swept away by some of the chronic, or by 
 some of the acute illnesses ; and nextly, of course, 
 by the time 65 years has been reached, only a small 
 proportion of those who started life together now 
 survive, so that the numbers of those capable of 
 suffering from cancer must be much reduced. On 
 the other hand, of those who do survive at 65 years 
 of age, a large proportion suffer from cancer, owing 
 mainly, I think, to the wrong methods of living so 
 much in vogue. 
 
 It is said that among domestic animals, dogs 
 suffer from cancer to a considerable extent, while 
 pigs scarcely suffer at all. If this is the fact (I do 
 not myself know, but I am told it is so) a likely 
 suggestion, germane to what has been just said, 
 occurs to account for it. Dogs are kept till they 
 grow old, while pigs are as a rule slaughtered 
 young. The former, therefore, have time to con- 
 tinue the action of the causes which induce cancer, 
 while the latter have not. If, however, pigs lived 
 to old age, I think it likely that, from their greedy 
 and unclean food-habits, they would develop cancer 
 quite as much or more than dogs — unless, indeed, 
 they are immune to cancer, as some animals are 
 to some diseases ; but I do not think this likely in 
 the present instance. 
 
 But to continue our inquiry into the causes of 
 cancer as connected with the food habits of the 
 
413 
 
 people. The next point which arises is that the 
 causes, whatever they are, affect women more than 
 they do men. In the years 1896-1900, 126,206 
 persons died of cancer in England and Wales ; and 
 of these 49,533 were males, and 76,673 females. 
 The males were to the females in the proportion of 
 two to 3*1. There were almost exactly half as 
 many more women as men. But it is found that 
 the proportion of males who die of cancer now, as 
 compared with females a generation ago, is greater 
 than it used to be. In the three years 1860-2, 
 there died 6536 males of cancer, as against 14,963 
 females, which gives a proportion of two males to 
 every 4*6 females. In the two years 1868-9, the 
 numbers were 5676 females and 12,578 females, or 
 in the proportion of two males for every 4*4 females. 
 The proportion of males was smaller than it is now, 
 and we desire, if possible, to find out the reason of 
 that. First of all, we might ask the question, why 
 should women suffer from cancer at a greater ratio 
 than men ? Is it because of sex or because of 
 habit ? The writer believes that the cause is rather 
 habit than sex, as will be said later. But the 
 present question is this : Seeing that women, for 
 whatever reasons, suffer from cancer more than 
 men, how is it that the preponderance of 
 the proportion of female cancer is diminishing ? 
 Probably, the writer suggests, because the habits of 
 men are approximating more in character to those 
 of women than was formerly the case. And indeed 
 this seems to be so. The habits of the English 
 
4U 
 
 race are altering, and rapidly. Under the com- 
 mercial and industrial policy pursued by the people 
 of the United Kingdom for the last hundi'ed years 
 (free trade was only an incident in that policy), the 
 English race is being more and more congregated in 
 towns, and there is much less difference than there 
 used to be in the habits and occupations of the two 
 sexes. It is not now as it used to be, when women 
 performed the indoor occupations of life, and men 
 did the more laborious out of door work. Both 
 sexes are now doing indoor work, and, more 
 important than that, are falling quickly into 
 similar general habits, and more particularly into 
 similar food habits. If women still perform the 
 duties appertaining to the home, many of them 
 also perform work strictly comparable with the 
 lighter occupation now followed by men in offices, 
 warehouses, manufactories, and mills, and women 
 also work in mills, shops and offices much more than 
 they used to do, so that in many respects the habits 
 of the lives led by the two sexes are identical. 
 Men still, of course, do the out of door work of 
 railway building, road making, sewerage, drainage, 
 waterworks, iron production in all its branches, and 
 heavy works of all kinds ; but there has been a 
 very great diminution of late years in the number of 
 men employed upon the land. It is to be hoped that 
 this is a passing phase of things, but unquestionably 
 for many years, the land of the country being more 
 and more laid down in grass, and the habits of men 
 and women becoming more alike, fewer and fewer men 
 
415 
 
 have been employed upon its cultivation. When, 
 therefore, the habits of the two sexes so much 
 approximate to one another as regards occupation 
 and food habits as has been the case of late years, 
 it is not surprising that they should be found to 
 be approximating to one another as regards the 
 diseases from which they suffer. Neither sex now 
 works very hard. Under the influence of a rapidly 
 extending humanitarianism, legislation has been 
 very active for some years in shortening the hours 
 of labour in industrial work. But the work of 
 women — what may be termed their natural work at 
 home — is longer continued and more monotonous, 
 and can be much less easily controlled than can that 
 of men. Their work at home with the children, 
 superintending and often performing with their own 
 hands multifarious household duties which can 
 hardly be regulated, and which never seem to come 
 to an end, is certainly trying, and often even 
 laborious, if in nothing else, then in respect at least 
 of the very long hours over which it is extended, 
 much longer for the most part than in the case of 
 men. Add to this that the introduction of 
 machinery has greatly lightened the work of men, 
 and has so far approximated it in character to that 
 done by women, a greater similarity now obtaining 
 between the kinds of work done by the two sexes 
 than used to be the case ; and we shall see some 
 considerable reason to understand how the diseases 
 of the sexes may resemble one another. 
 
 But there is one notable respect in which the 
 
416 
 
 habits of women differ from those of men. They 
 eat oftener. They do not eat more, probably, than 
 men, but they eat oftener. It is not uncommon to 
 find them breakfasting about 8 a.m., having some 
 lunch of tea and bread and butter at 10-30 or 
 11 a.m., having dinner about 12-30 or one, tea at 
 4-30, and supper at 8 or 9 p.m. Further, if the 
 kind of food they take is inquired into, it is found 
 to consist (besides the chocolates and sweets which 
 women seem to be constantly taking), largely of tea 
 and bread and butter, mostly white bread, from 
 which some of the natural constituents have been 
 removed, rather than brown. In fact, at each of 
 the five meals (or four, if the forenoon lunch is 
 omitted), bread is eaten, very often with jam. 
 Food is taken too often, and the kind of food is 
 mostly bread and sugar. It must be very unusual 
 to find anyone, man or woman, who eats meat five 
 times a day, or even four times a day. To take 
 meat even three times a day is rather uncommon, 
 and I have never yet met man or woman who took 
 it oftener. If meat were taken as often as bread, 
 five times a day, or four times a day, no doubt it 
 would set up other forms of illness. It is an 
 interesting and also a very serious question, whether 
 the frequent slight ailments of women, their head- 
 aches, their back-aches, neuralgias^ rheumatism, 
 frequent colds, and influenzas, are not in great 
 part to be attributed to their food habits. Many of 
 their ailments seem to be due to habit rather than 
 to sex. How frequently and for how long they 
 
417 
 
 suffer from dyspepsia, and indigestion, and heart- 
 burn ; and what a large proportion even of the 
 younger ones have lost their teeth from this cause. 
 Very often, indeed, even the first set of teeth in 
 children are soft and decaying, and no sooner does 
 the second set of teeth appear than they are found 
 to be decaying also. There is even comparatively 
 little difference between the sexes in this respect, 
 and the little boy, as well as the little girl, is apt 
 to awake, as indeed they do, early in the morning, 
 with the breath offensive and the mouth fetid from 
 indigestion commencing thus early in life. Formerly 
 the habits of the sexes diverged somewhat early in 
 life. Boys went to work in the fields, while the 
 girls stayed at home or went into service. On the 
 whole the boys, and afterwards the young men, did 
 harder and more laborious work than the girls, and 
 afterwards the young women. And, besides this, 
 the boys and youths, coming home at regular stated 
 times for meals, kept on the whole freer from 
 indigestion than the girls who, remaining at home 
 and feeding at other people's cost, got into the way 
 of taking more meals and at shorter intervals than 
 the members of the other sex. The same causes 
 acting now in the case of domestic servants are the 
 chief factors in producing the frequent (I had 
 almost said constant) illnesses suffered by this 
 portion of the community, and attributed by them 
 to any and every cause but the real one. Nowadays, 
 however, both sexes go to school, and after 11 or 12 
 years of age, to the factory, and their habits are 
 
 AA 
 
418 
 
 almost precisely similar. When adult life is 
 reached, and particularly after marriage, the habits 
 may diverge again a good deal for some years ; but 
 very often both the man and the woman live 
 similarly, perform the same duties, and follow the 
 same avocations. And, in respect of health and 
 sickness, the same kinds of illnesses appear to 
 overtake them. But after the arrival of children, 
 the kinds of work done by the sexes are again 
 separate, and the women, staying at home to mind 
 the children and the house (although in too many 
 cases women's work is not so natural as this) fall 
 into habits somewhat different from the men, and, 
 finding themselves frequently suffering from 
 indigestion, have recourse to frequent small meals 
 of bread and tea, which no doubt often relieve 
 them immediately, but mediately or remotely are 
 too apt to aggravate the dyspepsia they were taken 
 to relieve. After a period, longer or shorter, of 
 experiences of this sort, and after suffering from a 
 variety of ailments like those referred to, or 
 perhaps quite as often from the frequent recurrence 
 of some single ailment, like headache, or neuralgia, 
 or influenza, or "bilious attacks," or rheumatism, 
 or a constant feeling of fatigue, they fall into 
 long continued or chronic ill-health, and after some 
 years are found to be suffering from cancer. If the 
 other and more trifling ailments had been properly 
 grappled with ; if in particular longer intervals had 
 been allowed between the meals, the indigestion 
 and mal-assimilation, having been prevented by this 
 
419 
 
 means, and if the food products in their fermenting 
 and ill-digested condition had been prevented from 
 entering the blood and poisoning it, no doubt the 
 occurrence of later and graver disease would either 
 have been obviated or postponed. The indefinite 
 postponement of illness is equivalent to its preven- 
 tion. No doubt some sort of illness is bound to 
 overtake humanity, however physiologically or 
 rationally it lives, for we can hardly reach the 
 perfection of health ; but the more rationally we live, 
 the fewer of these illnesses will be our portion. On 
 the other hand, the general anxiousness of the times 
 in which we live, and the interpolation of large 
 numbers of small meals, habits afiecting all classes 
 of society, and afiecting men to a larger extent 
 now than formerly — all these causes are having a 
 marked influence on our population, and are acting 
 as serious deteriorators of health, and among other 
 things, there can be little doubt, leading to the 
 large increase of cancer. How this condition of 
 things is brought about by improper feeding, and 
 how the products of assimilation and of mal- 
 assimilation of food are carried by the thoracic duct 
 into the venous blood-current, I need not here 
 repeat, it being sufficient to refer the reader to 
 what has already been said on this subject in 
 Chapter Y. I may, however, add here (and it will, 
 I think, help to shew that the view I am advocating 
 is not theoretic only, but has a real and even grim 
 existence as an actual fact), some experiences I 
 detailed formerly regarding the causes of cancer. I 
 
 AA2 
 
420 
 
 saw, for instance, in the Bradford Royal Infirmary, a 
 woman, aged 42 years, "suffering from a large 
 infiltrating malignant growth from lips of cervix 
 uteri." (House-surgeon's note.) I had never seen 
 the woman before. There was no doubt about the 
 diagnosis ; but I said to the resident medical officer ; 
 " You will find, if you inquire, that that woman has 
 lived largely on carbonaceous food." Now one has 
 to be very sure of one's position before making such 
 an observation to a critical young professional man, 
 who would in the nature of things be glad to gain 
 an advantage over a senior by proving that he was 
 in the wrong. Had I been wrong, no doubt I 
 should have heard more about it. However, my 
 young friend inquired, and ingenuously wrote the 
 following note, which I read on my next visit : — 
 " Patient is fond of bread ; never eats potatoes ; 
 eats rice; never liked meat; bad teeth." I saw 
 with Dr. H. a man, set 56, suffering from cancer of 
 rectum. His diet had been bread and butter and 
 tea for breakfast, sometimes oatmeal porridge. 
 Dinner : meat, potatoes, bread, and rice, sago, or 
 tapioca pudding, often Yorkshire pudding. Tea : 
 bread and butter and tea. Supper : oatmeal 
 porridge. The whole diet here is starchy, except 
 the small piece of meat (viz. : two or three ozs. ) at 
 dinner. That starchy food, taken over a course of 
 years, had fermented in his digestive tract — how 
 often these suff'erers say they have had a "poor 
 stomach " — had poisoned his blood, loading it with 
 waste matters, and had, I have no doubt, led to the 
 
421 
 
 production of the cancer. In any case, four daily 
 meals, even if they had not consisted to such an 
 extent of carbonaceous materials, would have been 
 at least one, and perhaps two, too many ; and 
 would probably have led to illness and to early 
 death, whatever materials they had been com- 
 posed of 
 
 I asked the matron of our small cancer hospital 
 to give at random the diet of the first three cancer 
 cases she chose to question. Here is the result. 
 
 1. "Mrs. B., eet 55. Breakfast, 7-30: tea, 
 bread, bacon or egg. 11-30 : Cheese, bread, beer. 
 1-30 : Meat, potatoes, vegetables " (green ? A. B.), 
 " milk or Yorkshire pudding. 5-30 : Tea, bread, 
 butter. 10 : Meat and bread." Note that this 
 woman had five meals a day. She had bacon or 
 egg for breakfast, and meat twice daily, which is 
 unusual. But she had bread four times a day, and 
 if Yorkshire pudding be counted (it is really the 
 same thing as bread) five times. But she lived to 
 55, and, I have no doubt, might have survived to 
 65 if she had had sense to keep to three meals, like, 
 say, her breakfast, dinner, and tea, with proper 
 intervals between them. 
 
 2. "Mrs. S., set 69. 8 a.m. : Tea, bread, 
 bacon or egg. No lunch. 12-30 : Meat, potatoes, 
 sometimes vegetables " (green ? A. R. ), " and potted 
 meat. 4-30 : Bread, butter, tea, and remains of 
 dinner. 10 p.m. : Potatoes, milk, or porridge." 
 I have not much to say about this case. The 
 woman survived to 69, and it may be said she had 
 
422 
 
 lived her day, and must be expected to die of 
 something. I incline to think that, had she had 
 one meal after dinner in place of two, she would 
 have been healthier, and would probably have lived 
 longer. But I give the case as I got it. 
 
 3. "Miss R, aet 44. 8 a.m. : Tea, bread and 
 butter. No lunch. 12-30 : Potted meat and bread 
 taken at the mill. 4 : Bread and the remains of 
 dinner. 7 : Tea, bread and butter. 9-30 : Bread 
 and beer." Bread here was taken five times a day, 
 and once with beer. As bread takes five hours to 
 digest, often longer, let any one imagine the state 
 of fermentation that that poor woman's digestive 
 tract must have been in day after day, for say 
 twenty years, with " tea " following dinner in three 
 and a half hours, another ' ' tea " following the first 
 in three hours more, and a third " tea " following 
 the second in two and a half hours. The only 
 meal which was allowed any approach to a reason- 
 able time for its digestion was breakfast ; and 
 dinner followed that in four and a half hours, while 
 five and a half hours would have been much better. 
 No wonder the poor thing did not survive beyond 
 44 or 45 years. 
 
 These are cases of women in the humbler 
 walks of life. But their well-to-do sisters are 
 doing the same thing in a difierent way. One of 
 them told me some time ago that she had tea and 
 cake, or tea and bread and butter, at no less than 
 three different houses in one afternoon, and all 
 within two hours, or even an hour and a half of one 
 
423 
 
 another. Well for her if the attack of indigestion 
 which ensued on that series of indiscretions shall 
 teach her more sense, and help her to prevent the 
 irreparable damage which, in one form or other, 
 probably enough the onset of cancer, is certain to 
 ensue if she persists in so insane a course. And 
 yet, how many women are living ' like this ! 
 
 The statistics of the Board of Trade regarding 
 the immense increase in the quantity of sugar 
 imported into this country in recent years, appear 
 to me to support the view I advocate regarding the 
 causation of cancer. Of course, too much stress 
 must not be laid upon them, because much of the 
 imported sugar is used in the manufacture of 
 articles again exported. Nevertheless, I have a 
 general impression, corroborated by several con- 
 siderations, that our people are consuming much 
 more sugar in various forms than they did. Bread 
 and jam, as we saw before, is one of the cheapest 
 forms of food ; but while bread and jam, taken 
 once a day, may be quite wholesome, bread and 
 jam taken four or five times a day is a sickly and 
 even deadly diet. 
 
 Here is another case of cancer. " Mrs. L., set 
 50. Breakfast, 8 a.m. : bread and butter and tea. 
 Dinner, 12 : meat, potatoes, Yorkshire pudding, rice 
 pudding, bread. 4-30 p.m. : bread, butter, tea. 
 8 p.m. : bread, butter, stout, or quaker oats, or 
 oatmeal porridge." The perpetual fermentation 
 of food so induced resulted in the production 
 of a malignant ulceration of the mouth of the 
 
424 
 
 uterus. Cases of this kind could be multiplied 
 indefinitely, and they afford the kind of evidence 
 (which any one who chooses can verify for 
 himself) which has led me to the general con- 
 clusion that too many meals, and especially 
 when they contain too large a proportion of the 
 carbonaceous and fermenting foods, form a main 
 part of the predisposing cause of cancer. And as 
 the habits of men are now approximating more and 
 more to those of women, in the materials and in the 
 number of their meals, they are falling victims to 
 the same terrible scourge. Sometimes one is almost 
 reproached, on being compelled to come to the 
 horrible conclusion that it is cancer from which a 
 patient is suffering, to hear him say : " Well, but I 
 have lived so regularly." Yes, they have lived 
 regularly, but regularly in a wrong or physio- 
 logically unsound or vicious way. What can this 
 result in but disease and early death ? 
 
 But if these are the most important and the 
 most potent causes of cancer, no doubt others are 
 contributory. One special form of female cancer is 
 called morbus miserice. Some poor women (not 
 always, unfortunately, poor only In material 
 wealth, although this form of cancer is commonest 
 among the conventionally poor) being joined to 
 husbands who are careless, or negligent, or 
 inconsiderate, or brutal, and who squander their 
 earnings, or who are perhaps too idle to have any, 
 suffer in quiet and uncomplaining ways untold 
 miseries lasting over years. Wives who are better 
 
425 
 
 off can often defend themselves by finding resources 
 in other directions than those of domestic duty ; 
 and in the pursuit of pleasure, or perhaps in works 
 of philanthrophy, or of religion, solace themselves 
 for the loss of the domestic happiness which they 
 have given up everything to obtain. But the very 
 poor have no such resources. Compelled, perhaps, 
 to go out charring in order to find food for their 
 children as well as themselves, or even for idle and 
 dissolute husbands, and happiness being entirely 
 unknown to them, some of these women are found 
 early to develope a special form of cancer, termed 
 in such cases the disease of misery. No doubt, 
 some proportion of cancer may be contributed to in 
 this way, especially as the food habits of such poor 
 women are generally those which have just been 
 described, I doubt, however, if any very large 
 proportion of the cases are caused wholly or in part 
 in this way. Cancer, at any rate, although it deals 
 desolation among the poor, does not spare the rich ; 
 and in the case of most of the latter, as well as 
 of most of the middle-class women, it would be out 
 of place to speak of the cancer that occurs among 
 them as a morbus miser ice. As regards anxiety, 
 again, as a cause or a contributory cause of cancer, 
 it is not easy to point to much evidence. Both 
 sexes suffer from the anxieties to which humanity 
 is subject, and each sex, no doubt, has its own 
 special troubles. If, however, one might venture to 
 hazard an opinion, men seem to suffer from anxiety 
 rather more than women, many of whom, happily 
 
426 
 
 for themselves, appear to accept their troubles 
 rather in the spirit in which children meet theirs, in 
 a matter-of-fact way and uncomplainingly, as if 
 they belonged to the nature of things and to the 
 inevitable. Men, on the other hand, are more apt 
 to chafe, and fret, and grumble, appearing also less 
 able to derive comfort from the consolations of 
 religion, which act as such a calmative to the 
 women. Suicide, at any rate, is much less common, 
 as is the despair which leads to it, among women 
 than among men. It does not, therefore, seem easy 
 to say how far anxiety enters into the causation of 
 cancer. That it is often a contributory cause I do 
 not doubt. 
 
 Some other conditions have been said to induce 
 cancer. Some evidence has lately been brought 
 forward regarding what have been called cancer 
 houses, it being alleged that, in some houses, tenant 
 after tenant has succumbed to this disease, A 
 great fallacy here seems to be that, even if this is 
 so, no special inquiry has been directed into the 
 habits of the successive residents who suffered in 
 these ways. Obviously, much, almost everything 
 in fact, depends on this inquiry. By convention 
 most of us live after the prevailing fashion of the 
 time : we live as the majority live ; and if the 
 habits of the majority are unhealthy, it may well be 
 the case that a succession of tenants occupying a 
 particular house, being at an age suitable for the 
 development of cancer, might have so lived as to 
 induce it ; or the effects of the causes acting in 
 
427 
 
 the previous parts of their Hves might have 
 culminated during the periods of their tenancies, 
 the occupation of the house being quite accidental, 
 while the influence of the habits of the tenants 
 was the all important factor. 
 
 It has also been said that low-lying districts, 
 wet and swampy, help in inducing cancer in their 
 residents. This is quite probable. Damp is a 
 contributory cause of most illnesses ; and it may be 
 admitted to be a contributory cause of cancer 
 also without any damage to the theory that far and 
 away the most important cause is wrong living, and 
 particularly the dyspepsia that is induced by the 
 taking over a long period of time of too frequent 
 meals. Alcohol does not seem to have much 
 influence in the causation of cancer. At least, m.en 
 take alcohol to a much greater extent than women ; 
 and men do not even yet suffer from cancer so much 
 as women. At the most the influence of alcohol 
 might be admitted as a contributory cause of 
 cancer. Damp and alcohol no doubt aggravate 
 such illnesses as bronchitis, pneumonia, and 
 rheumatism, and yet we find many cases of each of 
 these diseases among teetotallers, where, at any 
 rate, one of these causes cannot be an efficient 
 factor. 
 
 Such being, then, the predisposing causes and 
 such being some of the exciting and contributory 
 causes of cancer, and since so little prospect remains 
 of effecting a cure when the disease has become 
 established, the great question of prevention rises 
 
428 
 
 before us. It has been said that prevention is easy, 
 and in the sense already explained this statement 
 may be repeated, it being remembered that what is 
 meant is that not theoretical but practical preven- 
 tion, that is, a very considerable diminution of 
 cancer, can easily be attained. As much, I have no 
 doubt, or more, might be effected towards the 
 prevention of cancer as has already been effected 
 towards the prevention of consumption and the 
 fevers, both of which, as we have seen, cause 
 many more deaths than cancer. Cancer might 
 easily be reduced by 40 or 50 per cent, from 
 causing a mortality of 700 per million per 
 annum down to 425 or 350. If the causation is 
 known, the question of prevention becomes quite 
 simple. If taking too many meals is the main 
 cause of cancer, taking fewer meals ought to have 
 some influence in preventing it, and so in checking 
 its course. I may say here that since I first stated 
 the opinion that such was the chief cause of cancer, 
 a great change has become evident in medical views. 
 A clever medical critic of the first edition of Air, 
 Food, and Excercises, "smiled " when he referred to 
 it — I was going to say discussed it — but he did 
 not discuss it. He only " smiled." Now, Dr. 
 Braithwaite says in so many words that cancer is 
 caused by too much food. So does Sir W. Mitchell 
 Banks, who thinks, however, that meat is the chief 
 cause. It may be so in the cases which have come 
 under his notice ; but that is not my experience, for 
 I have found a very large number, in fact the great 
 
429 
 
 majority of the women whom. I have interrogated 
 on the subject, say that they did not hke meat and 
 did not indulge in it much. But whether it is meat 
 or bread is an accident. The principle is that too 
 much food is the cause, the chief cause, I mean ; 
 and in that opinion we are at one. I hope, 
 therefore, that the critic will cease to smile, and 
 will preferably consider with candour a view which 
 has some weight of authority regarding the 
 causation of a disease from which the people are 
 suffering and dying in thousands every year even in 
 our own country, and in millions over the whole of 
 the known world ; and which none of us can cure. 
 A smiling professional critic and a suffering and 
 dying people is not a spectacle which commends 
 itself' to my sense of fitness. 
 
 Dr. Braithwaite's statement regarding over- 
 feeding as being a cause of cancer is introduced, by 
 the way, in a pamphlet which he has written to 
 shew that an excess of salt in the diet is the chief 
 cause of the disease. I have read the pamphlet 
 twice, and the argument appears, I regret to say, 
 weak in the extreme. His theory is that " excess 
 of salt in the diet is one of four factors which cause 
 the disease." But he does not define what is 
 " excess of salt." He is not even certain in his own 
 mind, for he remarks : "It is a debatable question 
 whether the salt must be in great excess." The 
 idea that salt was the ' ' essential factor " originated 
 in his mind by noticing that cancer of the uterus 
 was seldom or never met with among Jewesses. 
 
430 
 
 But the British Medical Journal says in the number 
 of 5th October, 1901 : " As a matter of fact cancer 
 is extremely and increasingly prevalent among the 
 Jews," So the fact is denied. Then he states that 
 excessive meat eating is a cause of cancer (which 
 no doubt it may be), and then he goes on to assume 
 that excess of meat means an excess of salt (which 
 it may or may not do). Now it does not follow 
 that those who take much meat take also much salt, 
 and it does not follow, either, that the flesh eaten 
 contains much salt, because the flesh of young 
 animals does not, as a rule. 
 
 "The second point," he continues, "which led 
 me to the idea about salt is much more certain, and 
 it is this : In vomiting from cancer of the stomach, 
 Vander Yelden found that there is almost always 
 no free hydrochloric acid in the vomit, whereas in 
 all other forms of vomiting it is present. Hydro- 
 chloric acid is derived from salt, so that there 
 appears to be some connection between salt and the 
 disease." But surely if this argument proved 
 anything it would go to shew that absence of salt 
 and not excess of it might be a cause of cancer. 
 There seems indeed to be a good deal of force in 
 the arguments of Mr. C. Godfrey Gitmpel that 
 deficiency of salt and not excess of it is a potent 
 cause of cancer. He has saved me the labour of 
 criticising the opposite view, and indeed I have 
 quoted him rather than expressed in my own words 
 the opposition to Dr. Braithwaite's view, which was 
 stirred up in my mind by reading his pamphlet. 
 
431 
 
 Mr. Gllmpers case for the defect of salt as a cause of 
 cancer, is so strong that it seems to me it must be 
 admitted as to a certain extent proved. I still, how- 
 ever, think that excess of food is the chief factor, and 
 that the accidental form which this takes is usually 
 an excess of starch and sugar. The taste for these 
 foods is usually accompanied by a distaste for salt, 
 and I think usually by the habit of taking little or 
 none. I think, therefore, from this consideration, 
 and from a general review of the whole question, 
 that we ought to consider deficiency of salt as a 
 contributory cause, and probably an important 
 contributory cause of cancer. Mr. Gtimpel quotes 
 the statements of physiologists that the blood 
 CBnnot exist with less than 2 '5 parts of salt in 
 1000 parts, and that it contains from this proportion 
 up to six parts per 1000 in varying conditions. 
 In order to keep the blood healthy, therefore, I 
 am disposed to recommend those who wish to 
 be free from cancer (and other diseases) by 
 simple means, to take a cupful of water morning 
 and evening, containing a pinch of salt in each, 
 just enough to make the water pleasant. A salt- 
 spoonful of salt also in the morning coflPee is a very 
 palatable addition, much pleasanter, when one gets 
 used to it, than sugar. By this means one may 
 prevent the too great diminution of salt in the 
 blood, and the too great tendency to putrefactive 
 change which such a diminution may imply, and so 
 prevent some of the conditions which favour the 
 growth of cancer. 
 
432 
 
 If, then, as I think, and as I have attempted 
 to shew, too much food Is the cause of cancer, if 
 taking too many meals is the cause, if eating too 
 much meat is the cause, or if too much bread and 
 too much sugar is the cause, combined with too 
 Httle salt, let us advise the people to take less food, 
 to take fewer meals, to take less meat, or to take 
 less bread and sugar. Plainly there is sufficient 
 agreement among; authorities to enable us to concur 
 in offering certain advice to the people. I need not 
 repeat here the statements made in a previous 
 chapter, regarding the time required for digestion, 
 or regarding the intervals which ought to elapse 
 between meals. I think I may say, without fear of 
 contradiction, that two meals a day is sufficient for 
 most people, and especially that they are sufficient 
 for townspeople, who now form the large majority 
 of our population. My advice, therefore, to those 
 townspeople who wish to avoid cancer is to eat a 
 mixed diet not oftener than twice a day, at say 
 seven or eight hours' interval, to eat, for instance, 
 at 9 a.m. and 4 or 5 p.m., or at 12 noon and 7 or 
 8 p.m., according to the circumstances of their 
 lives. And if in quantity they do not exceed 
 about two pints of fluid a day, and about one ounce 
 daily of food for every ten pounds avoirdupois 
 of their body weight, or say, perhaps, one and 
 a half ounce, I am sure there would soon be 
 much less cancer to chronicle in our midst. The 
 hot drink morning and evening, say with a small 
 pinch of salt in it to make it pleasant, and to add 
 
433 
 
 to the blood a necessary ingredient, would be a 
 suitable part of the diet, and would act in the 
 way formerly suggested. It will be noticed that 
 this advice is very much the same as that given for 
 the preservation of health generally. It is the 
 simplicity of the advice that is at once its strength 
 perhaps and its weakness. It is its strength 
 because it is in keeping with the view that 
 disease is one in all its varied and various phases, 
 and that its chief cause is mal-assimilation of 
 food from the ingestion of it too often and too 
 much. And it is its weakness because people 
 expect to be recommended to do some great 
 thing, some obscure thing, some difficult thing, 
 in order to be freed from a disease hitherto so 
 obscure in their minds as cancer ; and because 
 they are apt to be impatient when they are advised 
 simply to eat twice a day, or once a day, after the 
 age of say 55 years. Also they do not like the 
 suggestion that they are or have been too fond of 
 the pleasures of the table. But common sense and 
 candour ought to be great enough to overcome 
 these objections. Self-restraint and self-government 
 are not sufficiently commended to our favourable 
 consideration at the present time. I think it would 
 be well for us if we thought more of them ; and on 
 the evidence, as it presents itself to me, I cannot 
 fail to press this advice with what energy I can 
 muster, feeling, as I do so strongly, how much 
 benefit we might as a people reap from following it, 
 how much suffering we might prevent, how much 
 
 BB 
 
434 
 
 happiness we might attain, both for ourselves and 
 for our households, and how much more useful and 
 complete as well as more happy we might make 
 our lives. KaXov yap to adXov /cat ^ cXtti? 
 fieydXr). For fair is the prize and great the hope 
 of attaining it. 
 
435 
 
 CHAPTER XII. 
 
 Some General Observations; and some Cases 
 illustrative of the General Conclusion of 
 the Writer regarding the Chief Cause of 
 Disease in general, and of its Cure by 
 Diet. 
 
 T HAVE now said in principle pretty nearly 
 all I have to say regarding the causation, 
 or the chief cause (for causes are always 
 multiple, and the causes of disease form no 
 exception to this rule), of the great mass of 
 diseases which afflict humanity. In detail, of 
 course, each case of disease is unique to the person 
 aifected by it ; but the medical man, while he feels 
 that patients very often shew a certain amount of 
 resentment at having their cases referred to a class, 
 or in being classified themselves, and while he 
 would, perhaps, if he could, much prefer to let 
 them continue to magnify their own importance by 
 encouraging them to think that such a case as 
 theirs was never known before, is not unfortunately 
 always able to do so, and insensibly refers the case, 
 both as to its causation and classification, to one of 
 several groups which he has in his mind. In fact, 
 
 BB2 
 
436 
 
 if he did not or could not do so, there would be no 
 possibility of science or of philosophy in medicine. 
 In this chapter I propose to make some general 
 remarks, and to offer some observations which the 
 reader will, I hope, be more or less prepared for, 
 since the general idea underlying them must by 
 this time be familiar to him. And, besides these 
 general remarks, I have thought that it would be 
 useful to detail some further instances of the 
 application to the treatment of disease of the main 
 proposition laid down. That proposition is, that 
 disease is far oftener due to mal-assimilation of food 
 than to any other one cause, and that, of the 
 various forms of mal-assimilation of food, excess of 
 consumption of good food is a far commoner cause 
 of disease than either deficiency or badness of food. 
 The description of some additional cases in which 
 the application of this proposition or principle has 
 not only cured long-continued or recurrent illnesses, 
 but has also prevented their recurrence, will be of 
 interest to the reader, and, still more, of value to 
 sufferers. For, as has been said now more than 
 once, while a knowledge of causes may not enter 
 one's mind, or may not be necessary in the treat- 
 ment of illness, such knowledge is absolutely 
 necessary to prevention. And further, if the 
 application of theories as to causation enables us 
 to prevent the recurrence of a given illness, 
 especially if a patient has often suffered from it 
 before, our very success acts as a piece of additional 
 evidence for the truth of the theory, which, on 
 
437 
 
 general principles, and as a deduction from our 
 observations, we had been led to adopt. The 
 interest of the public is no doubt summed up in the 
 statement that prevention is better than cure. For 
 the doctor, on the other hand, cure is much better 
 than prevention. A trader is glad when the prices 
 of commodities rise ; the public when they fall. 
 Yet a wise trader often manages to reconcile his 
 own with the public interest by the avoidance of 
 cornering and other measures calculated to unduly 
 conflict with it. As to the prevention of disease, 
 the medical man, I fear, has no chance of ever 
 making himself unnecessary. Do as we will, and 
 interpret nature and her laws as we may, there will 
 always, I am afraid, be a residue of illness which 
 our efforts will fail to prevent ; although I have no 
 doubt that the residue would be much smaller if 
 the methods of prevention proposed were more 
 likely to obtain not only public sanction, but active 
 public support. The clergy and the lawyers are in 
 much the same condition. The numbers of the 
 persons filling both of these honourable professions 
 might be greatly diminished with advantage both 
 to the pubHc and to themselves ; but there does not 
 seem to be any immediate prospect of this result 
 being attained, since the methods of self-control 
 and of the pursuit of justice, by which alone such a 
 diminution could be attained, do not attract the 
 majority, but only a small minority of mankind. 
 If, however, a medical man can do anything in the 
 direction of advising people how to hve so as to 
 
438 
 
 prevent disease, he will have achieved something 
 worth attaining ; and at all times the medical 
 profession has advised its clients up to its lights in 
 this direction, as indeed most notably have the 
 clergy, and to some extent even the lawyers. 
 
 Under the terms, predisposing causes and 
 exciting causes, as also under the notions of cause 
 and occasion (atrta and 7r/3o<^acrt9, as Hippocrates 
 has it), I have dealt with these ideas to some 
 extent already. What is called Etiology, or 
 Aetiology, that is, causation, is too often in 
 medicine nothing more than a Prophasiology, i.e , 
 the so-called causes of disease are very frequently 
 only its occasions. Perhaps a few more instances 
 of the kind of cases which justify this statement 
 may be useful here. A young man will come to 
 the doctor, say, with a number of suppurating 
 pimples on the side of his neck, just under the 
 angle of the jaw, and will say that friction by the 
 collar-edge has been the cause of these. Or he may 
 perhaps have one large similar suppurating point 
 (a boil), or, if older, even such a place with three 
 different heads on the back of his neck (a 
 carbuncle), just where a stud has been pressing 
 and rubbing it. Or a person may suffer from corns 
 on the toes, which he may attribute to the pressure 
 of too tight boots ; or he may suffer from chilblains, 
 which he attributes to frosty weather. Or a 
 woman may have a cancerous growth develope in 
 her breast through a slight blow accidentally given 
 her by her own child, all unconscious and even 
 
439 
 
 incapable of understanding the damage he was 
 doing. And I have already mentioned the case of 
 an old gentleman of 87 years of age, who, being 
 knocked down by a bicyclist, suffered from an 
 attack of gout. Now all these alleged causes are 
 instances of prophasiology rather than of etiology 
 — they are samples of occasions rather than causes ; 
 they are instances of exciting causes rather than of 
 predisposing causes — instances of the action of 
 recent causes acting only once or seldom, rather 
 than of the action of remote causes acting 
 frequently and with cumulative effect. 
 
 Of course, all these alleged causes were part 
 oi the real causes, for without these particular 
 prophasiologies, none of the illnesses mentioned 
 would have occurred just when, and where, and 
 how they did. Without the fraying and rubbing 
 of the collar or stud, neither the pimples nor the 
 carbuncle would have occurred just then and there, 
 although, no doubt, any other slight cause or 
 occasion might have set them up. Without the 
 frosty weather the chill-blains would, or might 
 probably, not have appeared just then. Without 
 the tight boots there would probably have been no 
 corns ; without the blow cancer would probably 
 not have occurred just where and when it did ; and 
 without the bicycle injury there might have been 
 no attack of gout at that time. The reader must 
 not suppose that this is a mere theoretic or academic 
 discussion without any practical consequences, or 
 that its consideration is like the school - men's 
 
440 
 
 question, " How many archangels could dance on the 
 edge of a razor, or on the point of a needle ? " It 
 is on the contrary full of the grimmest practical 
 consequences. Without the predisposition none of 
 these prophasiologies could have been converted 
 into aetiologies ; none of these occasions could have 
 been the causes of the illnesses more or less serious 
 which followed on them. And to a very much 
 larger extent than is commonly thought, we make 
 our own predisposition ; that is the important 
 matter. It is not the rubbing by the collar ; it is 
 not the frost ; it is not the tight boots ; it is not 
 the blow ; it is not the bicycle accident ; but it is 
 in aU these cases (as in a thousand others which 
 will occur to the reader — I could multiply them 
 indefinitely, and, in fact, might never be done) the 
 way in which these different people have lived 
 before these events occurred, and it is in particular 
 their previous food habits more than anything else, 
 which have been the real causes why they suffered 
 from their illnesses. If we did not all of us load our 
 blood, and overload our blood, and that habitually, 
 with more food and drink than we require, the 
 slight causes mentioned above would have failed 
 to induce the illnesses mentioned. And I emphasize 
 food more than drink, not, as I have said before, 
 because I think alcoholic drink an unimportant 
 cause of iUness, but because I know food to be so 
 much more important a cause, that while on the 
 whole only comparatively few of us suffer from the 
 effects of too much alcoholic drink, nearly all of us, 
 
441 
 
 without exception, suffer from an excess of food. 
 The way in which the foundation then is laid in 
 the hody for the occurrence of these illnesses from 
 causes so slight is the way in which disease begins 
 in the body, that is its first step is usually 
 indigestion in some form. And, beginning with 
 indigestion, which is nearly always, or at least, very 
 often, caused by too many meals taken too close 
 together in time, many varieties of illness are 
 apt to occur. It will be useful to examine these 
 a little more. There seem to be two great lines 
 of the development or evolution of disease. In one, 
 the sequence of events is indigestion, heart-burn, 
 acidity, the occurrence of watery blebs or blisters 
 on the lips or tongue, sore throat (tonsillitis), acne 
 of the skin, rheumatism (initis, I have ventured to 
 call it — congestion of connective tissue, generally 
 lymph - congestion rather than blood- congestion), 
 constipation, bronchitis and broncho-pneumonia, 
 pneumonia itself, scanty high-coloured urination 
 often accompanied by a heavy deposit on standing, 
 insomnia, eczema, and apoplexy or cancer. In the 
 other we have indigestion, fulness and weight after 
 eating, faintness, relieved immediately by frequent 
 eating, and remotely aggravated by the same, 
 enlargement of glands in the neck, the watery blebs 
 on the lips mentioned above, free urination without 
 deposit or precipitate, tendency to free perspiration 
 or sweating, the occurrence perhaps of disease in 
 a joint such as the knee, hip, elbow or ankle, 
 anaemia (triphthsemia, or catatribsemia rather it 
 
442 
 
 should be called), pallour and attenuation, feeling of 
 general or frequent fatigue, peliosis, or proneness 
 to become black and blue on receipt of very slight 
 or unremembered injuries, flushing, followed by cold- 
 ness, clamminess of hands, rheumatism, diarrhoea, 
 pleurisy and tuberculosis. Of course, these groups 
 of illnesses, one culminating in cancer, and the other 
 in tuberculosis, are not definitely demarcated off 
 from one another ; but still, I think, perhaps, are 
 more or less fairly defined. However, the important 
 thing is that they both commence with indigestion, 
 and the inference therefore rises before our minds that 
 if this could but be dealt with, all the other evils, 
 or most of them at least, could be obviated. Let 
 us look for a little longer at the course of things. 
 The function of food being to make blood ; w^hen 
 indigestion occurs, the blood is furnished with 
 ill-made, ill-digested stuff. Some of this gets 
 stopped at the capillary circulation, or at the 
 lymph spaces beyond, the consequence being that 
 the lymph ducts and lymph glands become inflamed 
 and may even suppurate, causing those so-called 
 scrophulous affections so common among children 
 and young persons. The word scrophula, or 
 scrofula, is itself interesting, and of somewhat 
 doubtful etymology. <iK6pohov or ^K6po(f)ov is the 
 Greek name for a species of onion^ which the 
 enlarged glands of the neck were fancifully 
 thought to resemble. By the omission of 
 the o, the word got altered to crKpo^ov, hence 
 aKp6(f)vXov, and hence scrofula came to be that 
 
443 
 
 form of disease in which the glands of the neck 
 become enlarged and infiltrated, as if onions were 
 dotted along it. Of late years it has been found 
 that the tubercle-bacillus is constantly or at least 
 very often associated with the suppuration which 
 so frequently accompanies such gland inflammation ; 
 and hence the modern view of tuberculosis is that 
 it "is an infectious disease due to the presence in 
 some part of the body of the bacillus tuberculosis. ' 
 I do not think this is a proper statement or 
 definition, and think that it would have been better 
 to define tuberculosis as that state of the body 
 which favours the growth in it or in some part of it 
 of the bacillus tuberculosis. We all, it seems to 
 me, so ubiquitous are the germs of tubercle, have 
 them in us, we are swallowing them in milk and 
 meat, and inhaling them in the form of dried 
 sputum all the time. We cannot avoid doing so if 
 we are to mix with our fellows, and do the work we 
 were intended to do in life. It is all very well to 
 take all the means we can to avoid infection, or "to 
 keep away from it," as we are so often recommended 
 to do. But evidently beyond a certain (or un- 
 certain) point it is not possible to do this. How 
 can a husband keep away from his wife if she has an 
 infectious illness ? How can a wife keep away from 
 her husband, or still more, how can a mother and 
 father keep away from the children in such circum- 
 stances ? Is it even morally right that they should 
 do so ? Or should a man desert his friend in such 
 circumstances ? Is it not rather cowardly to do so ? 
 
444 
 
 In the case of parents, or at least of mothers, it is 
 hopeless (as a rule) to inculcate or expect it. And 
 when it seems possible by proper living to get into 
 such a state of body and mind as that we need not 
 fear the pestilence that stalketh in darkness, nor 
 the destruction that wasteth at noonday, is it not 
 far more to the purpose for the medical profession 
 to attempt to educate the public and shew them 
 how to make themselves immune to infection, than 
 to fill them with the fear and terror which induces 
 them to try to "keep away from it?" Of course 
 there is reason in all things, and I am not 
 advocating recklessness in the exposure of ourselves 
 to infection, although I do think the present 
 attitude of the public in reference thereto is often 
 craven and cowardly. A little more consideration 
 of the subject, and a little more attempt to put 
 government and restraint upon ourselves and on our 
 appetites, would soon bring about a much healthier 
 and happier and more courageous public opinion on 
 this subject of infection. 
 
 As regards the cure of particular diseases by 
 diet, one of the first conclusions to which I came 
 was that bronchitis, as it appeared specially to be 
 caused by errors in diet, was particularly amenable 
 to this form of treatment. This was at that time 
 rather a revolutionary idea to my mind, because I 
 had thought, in common with all the world, I 
 suppose, that bronchitis and broncho-pneumonia, at 
 least, were forms of " taking cold," and were due to 
 the action of " cold " for the most part, to exposure 
 
445 
 
 to wind, cold, wetness, ''drafts," &c. Indeed, it 
 seemed likely a priori, so to say, that bronchitis 
 would be due to the action of cold air inspired, or 
 wet air, or " draft," since the function of the lungs 
 is performed through inspiration and expiration, and 
 any disturbance of the balance of health in those 
 organs would very likely be attributable to some 
 change occurring between the body and its relation 
 to air. An upset of digestion, on the other hand, 
 naight perhaps be readily enough attributable to 
 some error in diet, because the function of digestion 
 is to deal with food and to convert it into blood and 
 lymph. This, I take it, was the form taken by the 
 unconscious reasoning adopted by one's mind, or 
 would have been, if the process had been put into 
 conscious thought. However, there was this 
 amount of possibility that this newly suggested 
 mode of causation might be the real one that I 
 was taught as a student, and medical men had 
 for two generations expounded the idea that 
 asthma at any rate was caused to some extent by 
 errors in diet ; and if asthma, why not bronchitis 
 also ? After all, asthma is only a special form of 
 bronchitis, the form in which as a rule some 
 spasmodic contraction takes place in the transverse 
 muscular fibres of the bronchial tubes, preventing 
 the patient from getting rid of the air which he has 
 forcibly inspired, and which, remaining in his air- 
 cells loaded with carbonic acid and other effete 
 materials, which ought to be eliminated from the body, 
 poisons the patient more or less, and leads through 
 
446 
 
 the continually repeated and forcible inspirations to 
 dilatation of his air-cells, and to other disease- 
 changes in the breathing organs. The patient 
 thinks that he cannot get air to breathe, while in 
 point of fact he cannot get rid of the air he has 
 breathed. He continues making rapidly repeated 
 forcible inspirations, while he ought to be making 
 long and repeated expirations, so as to rid his 
 respiratory apparatus of the waste-laden air which 
 is oppressing him so sorely. But in treating 
 asthma, my teachers and the medical profession 
 generally had repeatedly recommended that patients 
 should at least abstain from taking supper, and the 
 good effects of pursuing this line of treatment were 
 generally admitted. I did not at that time know 
 (say 20 to 25 years ago, for it was not yesterday 
 that more or less vaguely this idea of the supreme 
 influence of food in causing disease began to possess 
 my mind), I did not then know that the best way 
 to treat severe asthma is to put the patient either 
 on nothing (to make him fast), or on say a pint of 
 milk mixed with water each 24 hours, with perhaps 
 half a pint of mutton tea or chicken tea, and to 
 keep him to this for 10, 12, 14, 16, or 20, or even 
 more days, until his breathing becomes sufficiently 
 easy to allow him to lie down, after which, cautious 
 increase of the diet may be allowed. From for- 
 bidding supper, however, in the treatment of asthma, 
 a quite accepted method of treatment, to diminishing 
 food in other forms of bronchitis was not, or ought not 
 to have been, a very difficult step. It was, however, 
 
447 
 
 in fact, rather diJfficult. Having suffered very much 
 from bronchitis and frequently recurring colds in 
 my own person, and having also suffered from 
 asthma so severely as to be unable to lie down for 
 nights together, and having also had change of air 
 prescribed w'thout much or without more than very 
 temporary benefit, I felt that something else ought 
 to be done, and I thought also that in the nature of 
 things and on general principles, it ought to be 
 possible to do something for a man about 40 years 
 of age, who, if not robust, had yet always been fit 
 for any work that had come his way. About this 
 time I read Dr. Salisbury's book, and was by it, I 
 think to some extent confused in mind between the 
 effects of too much food and of too much starch 
 and sugar in causing disease, and particularly in 
 causing bronchitis. As is well known. Dr. Salisbury 
 recommends a diet of beef and hot water in the 
 cure of this and other diseases, and contends that 
 persons can live indefinitely on beef and water alone 
 without the need of any other food. In my case 
 the effects were good so far as the relief to the 
 asthma and the bronchitis was concerned, and even 
 the rheumatism from which I had suffered (and 
 which was, I now know, only another phase or form 
 in which the poisoning of my blood by too much 
 food expressed itself), improved greatly also. But 
 it was some time before I saw that the relief 
 experienced from these ailments was not positively 
 due to the beef I was living on so much as it was 
 negatively due to the diminution of my food, which, 
 
448 
 
 in following the suggestions of his book, I had 
 unconsciously made. For I by no means took the 
 same quantity of beef that I had formerly taken of 
 food in mixed meals, repeated three, four, or five 
 times a day, as had been my habit. In fact, 
 4 ozs. of beef taken three times a day is a very 
 restricted diet, and it was the restriction of the 
 diet, I now see, which did me good ; and I believe I 
 should have received as much benefit by a re- 
 striction to 4 ozs. of ordinary mixed food three times 
 a day, or to 6 ozs. of the same twice a day, as I got 
 from the beef and hot water ; and I believe further 
 that I should not have experienced the distressing 
 weakness which stopping all starch and sugar 
 induced in me for a long time afterwards. Studying 
 Dr. Salisbury's work and following its precepts did 
 much good ; but it unfortunately for a time 
 confused in one's mind the essentially bad efiects of 
 taking too much food (polysiteism and pollaki- 
 siteism) with the accidentally bad efiects of taking 
 too much starch and sugar (poly-amylism and 
 poly-glycism, and poUaki-amylism and pollaki- 
 glycism). But the confusion did not last long, for 
 it speedily appeared that to recommend say 3 lbs. of 
 beef to be taken in a day would be as great an 
 error as to recommend 3 or 4 lbs. weight of mixed 
 diet, as some physiologists calmly do now. Three 
 pounds weight of beef taken daily is too much food 
 for the average man, and must translate itself into 
 some form of illness, just as much as ingesting 3 or 
 4 lbs. weight of ordinary mixed diet must do, the 
 
449 
 
 only difference being that too much meat would 
 probably cause one sort of illness (gout, ^.^. ?) while 
 too much mixed diet, and particularly, as in the 
 general case, too much starch and sugar, would 
 probably cause illness of some other sort (bronchitis, 
 e.g., or asthma ?) 
 
 These being the ideas in my mind, I had 
 naturally, in the course of practice, many opportu- 
 nities of putting them to practical tests. In the 
 first edition of Air, Foodj and Exercises, I described 
 the case of a well-built woman, 52 years of age, who 
 came to me, saying she had suffered for twelve 
 years from what her medical advisers called bronchitis 
 and asthma. She said the attacks were very 
 severe, and were coming on at continually diminish- 
 ing intervals, and with continually increasing 
 severity. Attacks which used to be three or four 
 months apart were appearing at eight weeks' and 
 six weeks', and even three or four weeks' intervals, 
 and she was becoming worse and worse. The 
 question was, could anything be done for her ? 
 This seemed an unpromising problem to attempt to 
 solve in the case of a woman no longer young, who 
 had suffered for so long a time. She was not very 
 ill, however, at the time, as she was able to present 
 herself for treatment. On examination she was 
 found to have catarrh of the larynx, trachea and 
 bronchial tubes, there being sibilus and rhonchus 
 audible ; and I thought that there were some 
 evidences also of emphysaema or over- distention of 
 the air-cells in the lungs. The question was, what 
 cc 
 
450 
 
 were the causes of the recurring attacks ? Unless 
 the action of these causes could be obviated, other 
 attacks would certainly take place. On inquiry, 
 however, it was quite plain what the causes 
 were. Bread and butter and tea for breakfast at 
 8 a.m. ; meat, potatoes, Yorkshire pudding, rice 
 pudding or jam pudding, with bread, for dinner at 
 1-0 ; tea, with bread, butter, and jam at 4-30 or 5 ; 
 and bread and milk or boiled oatmeal for supper at 
 8-0, constituted the woman's ordinary diet, and, in 
 my opinion, accounted sufficiently for her attacks. 
 At any rate, considering that she was taking far 
 more carbonaceous food than she was assimilating, 
 and believing that the laryngo-tracheo-bronchial 
 mucous membrane was congested and irritated by 
 the deposition or precipitation into it from the 
 blood of some of the surplus material which had 
 found its way into the blood by such excess, I 
 advised an alteration of the diet to three meals a 
 day, and that she should take bread only twice, and 
 jam and sugar not at all. If she wanted any 
 supper she was to have simply a glass of milk, not 
 bread and milk, nor any oatmeal porridge. She 
 came at weekly mtervals for a few weeks. It was 
 a little difficult to keep her confidence, because two 
 or three of her previous medical advisers had said 
 that the food taken had no influence on the 
 bronchitis. However, she persevered, losing weight 
 under the treatment, but losing also the congestion 
 of her pulmonary mucous membrane. After the 
 lapse of about five weeks she informed me that. 
 
451 
 
 judging from her former experience, she might expect 
 to have a new attack ; " but," she added, " I am not 
 going to have one." She has not had any severe 
 attack of bronchitis since. So much for the history 
 of this case up till the publication of the first edition 
 of this book. On May 8th, 1902, this woman, 
 then 63 years of age, came to me suffering from 
 rheumatism of both knees, or well marked initis as I 
 have called it, also from varicose veins in the legs 
 and thighs. The bronchitis, she told me, was 
 much better, and would be better still, she said, if 
 she "minded her diet" as I advised her, but she 
 said she got tired of it, &c. (unfortunately, humanity 
 does get tired of self-control). This rheumatic and 
 varicose condition has replaced the bronchitis, or it 
 has supervened on it ; but she has not required 
 medical advice between November, 1893, and May, 
 1902. Arthritis, of right knee joint particularly, 
 and periostitis of the right tibia with varicosity, 
 have supervened on the bronchitis for which she 
 consulted me about ten years before. I point out 
 here that this sequence of ailments corroborates the 
 general view I have been driven to take by the 
 evidence, that disease is one (in this re-discovery I 
 find I have been anticipated by Hippocrates, and the 
 greatest of the early medical writers— how, indeed, 
 could it be otherwise ?) and also that bronchitis and 
 rheumatism {initts or congestion of connective 
 tissue) are different phases of the same thing, viz. , 
 an excess of material finding its way into the blood, 
 mainly from indigestion, 
 cc 2 
 
452 
 
 Let us look at this case a little longer. In 
 itself, of course, it is not much. It does not 
 concern the life of a king or noble or merchant 
 prince, but the principles underlying the sufferings 
 of a working woman are the same exactly as 
 determine the health or otherwise of all these 
 important personages. It may be held that the 
 history of the case proves nothing ; that the 
 recovery was a coincidence ; and that the woman 
 would have recovered, whatever she had done and 
 whatever food she had taken. I do not, however, 
 take this view. In view of the facts that she was 
 not young, that she had suffered for so many years 
 (no less than about a quarter of her life), and that 
 the opinion that an excess (specially) of carbonaceous 
 foods getting into the blood through the digestion 
 produced material which was deposited as an 
 inflammatory exudation in the pulmonary mucous 
 membrane, is a physiologically correct opinion, and 
 therefore that the excess of these foods was the 
 main cause of the bronchitis — in view of all these 
 considerations, I am compelled to the conclusion 
 that the recovery was no mere coincidence, but was 
 really the effect of the treatment. The critic may 
 say — well, the bronchitis was cured, but the patient 
 became rheumatic (she was somewhat rheumatic 
 before, however), she was not much better, on the 
 whole, as she changed one ailment for another. To 
 this I should reply that she required no further 
 medical treatment for ten years, and that at 63 
 years of age one may expect to suffer from 
 
453 
 
 something. But I freely admit the force of the 
 suggestion, which, I daresay, occurs to the reader as 
 well as to the critic, viz., that it would probably 
 have been better to advise her to take two meals 
 daily rather than three. I quite think so myself, 
 and the good effects of this advice in other similar 
 cases makes me feel pretty confident on this point. 
 I do not know if she would have been willing to 
 follow the advice even if I had offered it. However, 
 much further experience of the good effects of this 
 advice has strongly confirmed my conviction of its 
 value. I have already, at pp. 104-5, &c., related 
 the case of a middle-aged man who put an end to 
 the repeated attacks of broncho-pneumonia from 
 which he had sufiered by altering his diet. But 
 another very interesting point in this man's case is 
 that, whereas for several years consecutively he had 
 had an attack of influenza in the spring, for some 
 years past he has ceased to have such attacks ; so 
 that I have had the good fortune to prevent the 
 recurrence of successive attacks of simple inflam- 
 mation (broncho-pneumonia), and also of "fever" 
 (influenza), by inducing a man to adopt the simple 
 course of reducing the number of his meals from 
 three or four to two daily. I have already 
 mentioned the case of a man who had a long 
 succession of colds, and also a succession of attacks 
 of ague extending over thirty years, from the time 
 of his leaving the West Indies, where he suffered 
 greatly from malaria, but who for ten or twelve 
 years now has neither had a bad cold nor a single 
 
454 
 
 attack of ague, and this by the simple remedy of 
 eating twice, and sometimes once, a day. Here, 
 again, not only have inflammatory attacks of 
 broncho-pneumonia been entirely prevented for 
 many years, but also a fever like ague or malaria. 
 But I think the most remarkable case I have ever 
 had is the following : — An old lady of 72, feeble, 
 thin, and attenuated, had suffered so much from 
 repeated attacks of broncho-pneumonia that for 
 twenty years she had been confined to her house, 
 except that during the warmest weather in summer 
 she sometimes ventured to walk for perhaps ten 
 minutes at a time in front of her house in the sun. 
 By following the simple advice of reducing her food 
 to two small meals, one about 12 noon and one 
 about 7 p.m. (both together not amounting to 
 12 ozs. of mixed diet daily), this old lady, two 
 years after I had seen her, was able to visit friends 
 at Clayton and Bingley, although for over twenty 
 years she had been unable to venture on such a 
 thing. I must say I was myself greatly impressed 
 by the results of treatment in this case, much 
 more effective and much more striking than I had 
 ventured to hope for. This treatment is so valuable 
 and so certain in bronchitis and broncho-pneumonia, 
 and the evidence in favour of its efficacy is so strong, 
 that I venture now to lay down the dogmatic 
 position that the chief predisposing cause of 
 bronchitis is an excess of food, and that in most 
 cases the special form of the excess consists of such 
 foods as bread, potatoes, puddings, and sugar. Of 
 
455 
 
 course it does not follow that in order to get rid of 
 bronchitis we ought to cease to take such foods, but 
 it does certainly follow that we ought to diminish 
 them. But bronchitis accounts for about a tenth of 
 the total mortality of this country ; and, therefore, 
 the inference is that one-tenth part of all the fatal 
 illness in England and Wales to-day is amenable to 
 hopeful treatment ; and further, that by proper 
 dietetic management, bronchitis is preventible. 
 This opinion is, of course, one fraught with very 
 serious and very important consequences. If, 
 however, we are in the presence of a physiologico- 
 pathological law of the human organism, the 
 principle can be put into operation by others. If it 
 is, I make bold to venture the prediction that the 
 law will be vindicated, and that bronchitis will not 
 only be cured by the inculcation of a suitable diet 
 and regimen, but that it will also be found possible 
 by similar means to prevent it ; to prevent it, that 
 is, as a rule (for I suppose there must always be 
 individual exceptions) between the ages of five and 
 sixty-five years. I look on the case in which 
 bronchitis of twenty years' standing was cured after 
 seventy-two as too exceptional to allow us to 
 expect so good a result at that time of life as a 
 general rule — although this general view ought not 
 to make one refrain from suggesting rational and 
 possibly helpful treatment at any age, however 
 advanced. The facts already mentioned that " old 
 people bear abstinence weU, and that they bear 
 over-feeding badly," fill the medical adviser with 
 
456 
 
 new hope in attempting to prolong the lives and 
 
 relieve the suflerings of the aged. 
 
 I do not know how the narration of the 
 
 following will strike the reader. The writer lives 
 
 in Joplin, Mo., U.S.A. I have never seen either 
 
 him or the acquaintance whose case he describes, 
 
 and it is not likely that I ever shall see either of 
 
 them, and as there are no relations between us 
 
 except those of inacquaiutance, reasonableness and 
 
 goodwill, I think all other motives for making 
 
 the narration may be put out of account. After 
 
 stating that the writer of the letter to me had 
 
 "read repeatedly and with very great benefit to 
 
 himself" my first edition of "Air, Food and 
 
 Exercises," and asking some questions about the 
 
 new edition of the same, he continues : — 
 
 ' ' If you will pardon me, I will give you a little incident 
 showing the good your book did to another, and no doubt has 
 been the means of prolonging a life. About one year ago I 
 met a gentleman in Sumpter, State of Oregon, U.S.A., who 
 complained of asthma, saying he had not been able for ten 
 years to sleep in the ordinary position, but slept, bolstered up, 
 sitting almost upright in his bed, not being able to lie down, 
 on account of choking so much as to prevent sleep. Eemem- 
 bering your book, I ventured to inquire if he ate a good deal, 
 and especially of carboniferous foods, and he replied in the 
 afl&rmative. Having your book with me at the time, I offered 
 to lend it to him, if he wished, and he gladly assented. As 
 he told me, he read it through six times, realising that it fit 
 his case exactly, and he at once put it into practice, and 
 reduced his meals from three to two a day, and with immediate 
 benefits of the most marked kind. He is over 60 years of 
 age, and is a well educated man, and a mining engineer, and 
 so has a good knowledge of chemistry, having devoted some 
 30 years to a study of the chemistry of rocks, metals, fuels, 
 
457 
 
 and water, but never a thought did he ever before give to the 
 chemistry of foods. Like a flash, he says, he realised the 
 force of your position, and began to eat sparingly of carbona- 
 ceous foods. Within two weeks he lost, to his delight, some 
 ten pounds of flesh, and found he could lie down and sleep 
 like others, and soundly, and he was as happy a man as I 
 ever saw. 
 
 In telling his friends about his wonderful cure, he often 
 used the following words — 'Now I feel like a bird, and can 
 sleep Hke a child.' His temperate life generally helped him 
 to a quick recovery. Perhaps the good results from your book 
 were never expressed in the short and original way he did. 
 His name is E. Sanderson Smith, Sumpter, Oregon. No 
 relation of me. 
 
 For myself, I generally omit breakfasts, and eat but little 
 of foods largely carboniferous, and derive much good thereby. 
 
 As so many on this side advocate free drinking of pure 
 water, whether thirsty or not, I have been drinking three or 
 four pints of water daily, but not during meals, though j 
 seldom or never was really thirsty at the times. 
 
 I see that Dr. Dewey, in his late little pamphlet, takes 
 very decided stands on that point, advising that no water be 
 taken unless actually thirsty, and thirst should be confined to 
 the three sources he mentions. 
 
 Do you wish to express an opinion on the question of 
 drinking water ? 
 
 Also, Dr. Dewey rather goes against special exercises. 
 However, from experience, I am strongly inchned to take the 
 view you do as to exercise. 
 
 Not many of us will agree with him on the subject of 
 bathing the body, though his plan of omitting the morning 
 meal, and his clear exposition of the harm and danger of 
 eating to excess in any event, has done good to hundreds, and 
 I suppose thousands, and has clearly prolonged very many 
 lives, as, indeed, no doubt your work has done. 
 
 "With best wishes for your happiness and continued 
 success, 
 
 I remain, 
 
 Very truly yours, 
 
 S. M. SMITH." 
 
458 
 
 As I say, I do not know how the narration in 
 this letter will strike the reader ; but I hope at 
 least he will not grudge me the satisfaction I have 
 felt in reading it. As to the points about water- 
 drinking which Mr. Smith raises, I have already 
 considered them. I think about two and a half to 
 three pints of fluid taken daily is the gauge of 
 moderation for the average townsman ; and while I 
 agree with Erasistratus (B.C. 300), that exercises 
 are not necessary to health and life, believing that 
 the movements supplied by the ordinary business of 
 life are physiologically sufficient for that purpose, I 
 think that these statements are true only for that 
 small minority of persons who do not take too much 
 food. For the majority, therefore, I still recom- 
 mend the use of moderate exercises, especially for 
 10, 15, or 20 minutes in the act of dressing in the 
 morning. They help to keep the body supple, 
 young and active, and they render us more active 
 and fit for the prosecution of the work of the day. 
 
 In the following case, chronic bronchitis, lasting 
 for many years, led on to a severe attack of pneu- 
 monia, to which the patient speedily succumbed ; 
 but the causes of the bronchitis and of the 
 pneumonia plainly were the same as in the cases 
 just related. Some years ago I saw in consultation 
 a stout man, 54 years of age. The patient had 
 suffered for years from what his wife called asthma 
 and bronchitis, the symptoms being a more or less 
 constant cough, with whistling sounds to be heard 
 in the breathing, and increase of the cough when 
 
459 
 
 he hurried or undertook exertion. The man was a 
 teetotaller (how often, as I have said before, are 
 effects, which are really due to wrong eating, 
 attributed to alcohol. They could not at least be 
 so attributed in the case of a life -long teetotaller). 
 As I say, when the family doctor and myself saw 
 the man together, he had most severe and extensive 
 pneumonia, and the doctor had justly given an 
 almost hopeless prognosis, too speedily verified, in 
 fact. Now what had this man's diet been for many 
 years ? I asked the question of his wife, and she 
 told me as follows : — He was in the habit af taking 
 tea and bread and butter for breakfast at 8 a.m. 
 At dinner (12-30) he would have meat, Yorkshire 
 pudding, bread, and rice pudding. He had 
 abstained from potatoes for some time, because 
 he thought them watery, and that they tended to 
 puff or blow him up, and make him fatter than he 
 was. (Note here how the man made the mistake 
 of thinking that it was potatoes, rather than too 
 much food, taken too often, that made him ill. He 
 stopped potatoes, but continued to take bread four 
 times a day. In point of fact, it is not generally 
 this, that or the other article of diet that makes us 
 ill, but it is too much food of any kind taken at too 
 short intervals of time. We saw the same principle 
 in action when dealing with cancer, and the reader 
 will see that the causes of bronchitis and of cancer 
 — as, indeed, of most, if not all other illnesses — are 
 the same.) Tea at 6 p.m., of bread and butter and 
 tea. Supper, 9 p.m., oatmeal porridge. The plain 
 
460 
 
 causes of the chronic bronchitis and of the pneu- 
 monia which supervened on it, were the four meals 
 eaten every day, bread being taken at every one of 
 them (for the oatmeal at supper has much the same 
 composition as wheatmeal), the Yorkshire pudding, 
 and the rice, which formed practically the whole of 
 the diet. Bread twice a day is enough for most 
 townsmen, if they wish to keep well ; and I have 
 no doubt that three meals a day would have been 
 much better for this man than four ; while, if he 
 had taken two meals daily, the probability is great 
 that he would have been living now, without the 
 help of doctors. It was not his teetotalism which 
 killed him, not at all ; but on the other hand it 
 failed to save him, as it has in my experience failed 
 to save a large number of other persons who 
 persistently have ingested into their bodies more 
 food than they could assimilate, or oftener than was 
 proper. 
 
 So much for the dietetic management of those 
 who suffer from bronchitis, asthma, and broncho- 
 pneumonia. As to pneumonia itself now causing a 
 calamitous mortality among the people, I have no 
 doubt at all that it is due to the same causes as the 
 affections just named. It is not, however, quite so 
 easy to prove this, because pneumonia seems to 
 attack people suddenly, when they are in the midst 
 of robust health. It has, in fact, seemed true often 
 that pneumonia is an affection of the strong (not 
 always, of course, for delicate persons often suffer 
 from it also, and it often enough ends life after a 
 
461 
 
 succession of illnesses of other kinds). In many 
 instances, however, persons attacked by pneumonia 
 have had no previous illness at all for years. I 
 remember very well a gentleman who told me he 
 did not know he had a stomach, or a liver, or a 
 heart, or lungs, or any organ, because none of them 
 troubled him. Being so strongly made, he lived 
 freely, and indulged in the pleasures of the table. 
 I cannot doubt that this was the reason why he was 
 struck down as by a bolt from the blue by an attack 
 of pneumonia, to which he succumbed on the fifth 
 day, his sorrowing family being deprived of his help 
 just when they needed it most, and he himself of 
 life at about fifty years of age. Recollections of 
 this kind crowd upon the medical man as time goes 
 on, and seem to emphasise his determination to 
 draw attention to the effects of free living — effects 
 which, when they have been persisted in for some 
 time, are often irremediable, but which at an earlier 
 stage could so easily have been prevented. Had he 
 taken two reasonable meals a day, I believe that 
 man would have been living now, and I believe he 
 was strong enough to have resisted it, even had he 
 taken at each of them rather more than he required. 
 Of course I do not recommend this ; but still many 
 of us have so great a resistance that even when we 
 over-tax our powers considerably (of course it must 
 not be greatly overdone) we still live long and have 
 good health, 
 
 Other recollections fill one's memory, and 
 compel relation in order that, if possible, men and 
 
462 
 
 women may be warned in time of the calamities 
 which, although we attribute them to fate or other 
 inexplicable " dealings of an inscrutable Provi- 
 dence," are most commonly brought upon us by 
 ourselves. A heavy man, about forty-seven years 
 of age, in the very prime and vigour of life, 
 consulted me on account of a liability to " take 
 cold" frequently without suJBScient cause. I 
 pointed out to him the causes of this, viz., that he 
 was ingesting into his body more food than he 
 required to maintain him in health and strength, 
 punctuating my opinion by drawing attention to 
 the facts that he had indigestion, and that he was 
 too heavy for his age and size. He did not like the 
 advice I gave him, and after coming back once or 
 twice, ceased to return. In six months I saw his 
 death announced from acute pneumonia. I quite 
 believe that when the last illness overtook him, it 
 was too late to save him. I do not suppose any 
 other doctors could have done any better for him 
 than those who were called in. But I am equally 
 certain .in my mind that if, six months before his 
 death, when he came to see me, he had begun and 
 had afterwards continued to follow the advice I 
 gave him, he would, after suffering at first, perhaps, 
 from an aggravation of his " colds," &c., have 
 begun to recover from them, that he would have 
 gradually thrown them off, and that the calamitous 
 illness which made his wife a widow and his 
 children fatherless would not have occurred, or if it 
 did, that it would not have terminated fatally. 
 
463 
 
 The medical man, like any other scientific man, does 
 not make the law ; if he did, he might be tempted 
 perhaps from a weak sentimentality to make it less 
 stringent, though I do not for a moment think that 
 that would be a good thing ; but the scientific 
 man's duty is to declare the law, the responsibility 
 then resting with other people whether they will 
 obey it or not, or whether they will recognise it or 
 not. Whatever they do, however, and whether 
 they ignorantly or knowingly disobey it or obey it, 
 the effects are inevitable, and no amount of protest 
 or of frantic appeal to be saved from the conse- 
 quences of disobedience are of any avail whatever. 
 
 As to rheumatism and gout, very much evidence 
 has accumulated in my experience to justify me in 
 saying that I am satisfied that both of them are due 
 to the persistent ingestion of food into the body 
 over and above its requirements. I have already 
 remarked upon the name rheumatism, and given the 
 reasons for the suggestion that we should displace it 
 in favour of the term or name initis, in order to get 
 rid of the obscurity attaching to it. I wish only to 
 add here a word or two about the derivation of the 
 terms rheumatism and gout, so as to complete what 
 has to be said about them. Rheumatism comes 
 from the Greek pevfxa = a stream, and the name 
 was applied to the pain which succeeds on the 
 stopping (generally the sudden stopping) of a 
 watery discharge or stream of watery matter from 
 e. g. , the head. To this day the term rheum is used 
 by some elderly people of a watery discharge from_ 
 
464 
 
 the eyes. As the watery discharge comes from the 
 lymph and blood, and as the blood gets its materials 
 from the food, the name is not a bad one ; but my 
 reason for wanting to be rid of it is because it has 
 long ceased to have that meaning, and because it is 
 used of so large a variety of conditions, that those 
 who use it attach no definite meaning to it. 
 Rheumatism is no doubt primarily congestion of 
 connective tissue, or inflammation of it, which is a 
 further stage • of congestion. The next stage is 
 effusion, effusion either of a solid or of a fluid 
 exudation, which exudation, however, is the 
 succeeding stage of all inflammations. Wherever 
 connective tissue is found in the body, it may be 
 congested or inflamed ; and as connective tissue 
 forms the coverings of muscles, nerves, and bones, 
 and as it forms also the ligaments about joints, as 
 also much of the tissue under the skin, rheumatism 
 may arise whenever connective tissue in any of 
 these very widely different parts of the body is 
 inflamed. Tendons also are made of connective 
 tissue, and hence tenonitis, or inflammation of 
 tendons is a form of rheumatism. Other forms are 
 neuralgia, muscular rheumatism, periostitis, shewing 
 themselves in general aching, or varied symptoms, 
 according as the connective tissue of the nerves, of 
 the muscles, or of the bones is affected ; and of 
 course the ligaments of joints may be inflamed 
 when we get the joint inflammation or arthritis, 
 which some authorities say is the only real 
 rheumatism. I do not agree with this view at all, 
 
465 
 
 because, wherever connective tissue is, it may be 
 inflamed, and inflammation of connective tissue is 
 rheumatism. Connective tissue is found also to a 
 considerable extent about the brain (as well as 
 forming the sheaths, &c., of nerves), and hence 
 many phases of mind-disturbance are associated 
 with its congestion, the flightiness, e.g., uncertainty, 
 irritability, unreasonableness, depression, excite- 
 ment, and so on, with various phases of intellectual 
 and moral perversion and perversity, which, as I 
 have already dealt with them in Chapter VIII., I 
 need not here recapitulate. The feeling of " sinking " 
 which the women describe who sufier in this way, 
 and the far too frequently repeated small meals 
 with which they attempt to relieve it, reminds one 
 forcibly of the craving for alcohol described by the 
 alcoholic, which he in turn attempts to relieve by 
 small and frequently repeated nips or drams. In 
 both sets of cases the immediate eflects of in- 
 dulgence in small and frequently repeated meals 
 and in small quantities of alcohol are to relieve the 
 sinking and the craving, and in both the remote 
 effects are most disastrous. In both sets of con- 
 ditions the best method of treatment is abstinence 
 from alcoholic drinks on the one hand, and from food 
 on the other, at least for a considerable length of 
 time ; but the latter advice is as yet very seldom 
 given, and still seldomer acted upon. However, as 
 I have dealt with the matter already, I will not 
 dwell upon it now. It has obviously come on again 
 for discussion from our consideration of the term 
 
 DD 
 
466 
 
 and disease rheumatism, whose definition I take to 
 be congestion and inflammation of connective tissue, 
 and which I therefore consider to be synonymous 
 with initis. (Syndesmitis, from orvi/8ecr/xetv = to 
 bind, would really be the best name, but unfortun- 
 ately this name is not available, because it has 
 already been appropriated to inflammation of the 
 ligaments of joints, which is, of course, one form of 
 connective tissue. One may add a new name to 
 Science, but to attempt to divert a name already in 
 use to a meaning diflerent from that to which it has 
 already been appropriated, even when the suggested 
 change is an unquestionable improvement, only leads 
 to confusion.) The term gout, again, is connected 
 with the Latin gutta = a drop, and both 
 rheumatism and gout were therefore considered by 
 the older writers to be defluxions from the blood. 
 This, indeed, they are, or at least they are either 
 fluid defluxions from it or solid exudations from it, 
 so that the older ideas regarding these aff'ections 
 were quite correct, and if we remember that the 
 blood gets its materials from the food, we have a 
 perfectly correct idea of both. Fundamentally, the 
 ancient idea regarding both rheumatism and gout 
 that they were caused by the deposition from the 
 blood of materials present in it in excess was quite 
 sound. Modern investigations have shewn that 
 uric acid or some of its compounds is a common 
 form that this exudation takes, but they have not 
 altered the principle underlying the ancient notion. 
 In rheumatism many joints are afiected, the knees. 
 
467 
 
 ankles, elbows, shoulders, jaws, and many smaller 
 joints in the fingers and toes, the toe nails (and 
 even the finger nails sometimes) being often 
 distorted and overgrown. (How, it may here be 
 asked, should this be, unless the blood, containing 
 more material than it requires, converts its excess 
 into overgrowth ?) Gout, on the other hand, is 
 used of the disease in which one joint, that at the 
 ball of the great toe, is specially affected. The 
 important thing, however, to remember is that the 
 blood contains nothing which it has not received, 
 and that the source par excellence, the source com- 
 pared with which all others are comparatively 
 unimportant, from which the blood obtains the 
 materials contained in it, is the food. In fact we eat 
 gout and we eat rheumatism in the sense in which 
 Sir Thomas Browne said that " we eat our bodies on 
 our trenchers," and " devour ourselves," viz., we 
 manufacture our diseases, and rheumatism and gout 
 among them, out of an excess of food. 
 
 To shew that restriction of the diet often cures 
 rheumatism, take the following cases, which could 
 be greatly multiplied. A lady, aged 30, had 
 suff'ered very severely from chronic rheumatoid 
 arthritis for seven years. She had stiffening, 
 swelling and distortion of her fingers and wrists, 
 much pain and stiffness in the back of the head 
 and neck (an affection literally of the Iviov, or 
 strong tissue at the nape of the neck), and she had 
 also a large fluid effusion into one knee joint. For 
 this I recommended her to eat once a day (to be 
 
 DD2 
 
468 
 
 monositeous), and to take a very small meal then. 
 She did so for about three years, and under this 
 treatment she improved greatly in health, the 
 rheumatoid arthritis ceased to spread, the extensive 
 effusion into the right knee-joint was absorbed and 
 disappeared, and the pain and stiffness in the back 
 of the neck were greatly diminished. The diet was 
 often weighed, and consisted of seven, eight or nine 
 ounces of mixed food daily, a much less quantity 
 than is generally taken or than is usually required. 
 More strange is it to add that on this diet she 
 gained four pounds in weight in about three years. 
 
 In another case a man had suffered inter- 
 mittently for years from recurring attacks of 
 rheumatism, which affected his muscles rather than 
 his joints ; that is, he would find the great muscles 
 of the back, or of the thigh, or of the leg, 
 painful and sore as if from over-exertion, although 
 without adequate cause of that kind ; or if he had 
 to hurry to catch a train, for instance, he would 
 find the muscles of the calf or of the front of the 
 leg stiff and sore for perhaps a week afterwards. 
 Sometimes he would find himself suffering from a 
 " crick " in the neck, so that he could not move his 
 head freely from side to side, and if he wanted to 
 look round would have to move his whole body in 
 the slow deliberate way adopted by those persons 
 who suffer from disease of the spinal column. 
 In addition, he suffered from stiffness and aching 
 about the fore-arms and about the elbow-joints, and 
 sometimes about the shoulder-joints. One of the 
 
469 
 
 ways in which such conditions resulted was a 
 feeling of great fatigue on making small exertion. 
 For instance, on making such small exertion as is 
 involved in carving the meat at dinner for the 
 family, the aching of the arms would be so con- 
 siderable, and the feeling of fatigue so great, that 
 he would have to drop the knife and fork for a few 
 moments until rest enabled him to go on again. 
 Obviously, so sHght an exertion could not possibly 
 be the adequate cause of such fatigue. And, 
 generally speaking, the alleged cause obviously 
 never was more than the occasion of the annoying 
 feeling of fatigue and of being " overdone." These 
 symptoms would come on somewhat suddenly and 
 painfully, and after lasting for a longer or a shorter 
 time, would pass off again with as little apparent 
 cause for the rehef as there seemed to be for the 
 attacks. From the age of 30 up to about 50 years 
 these attacks annoyed him, though without ever 
 being severe enough to lay him up, or not for more 
 than a day or so at a time ; but the attacks were 
 getting worse. A point in the case was that when 
 about 50 years of age his mother had had an attack 
 of chronic rheumatism, as it was called, which 
 confined her to bed for several months, although it 
 had not hindered her fi?om afterwards attaining 
 advanced life. Here seemed then to be a case of 
 hereditary rheumatism in the conventional sense. 
 The reader, will, however, now be prepared to view 
 the rheumatism in mother and son as brought on by 
 similar causes acting on similar organisms in two 
 
470 
 
 generations rather than as cases of inherited disease, 
 since the man did not begin to suffer until he was 
 grown up ; and also from the sequel of the case, 
 which was this, that when under medical advice he 
 reduced his meals from three, four or five a day to 
 two, and subsequently to one, he was able slowly 
 to get rid of all his troubles, to walk and move and 
 run freely, and to suffer only at very greatly 
 lengthened intervals from his recurring muscular 
 stiffnesses and pains, which, when they did come, 
 were less and less severe, and finally wore off. The 
 mother had had to slowly learn the same lesson 
 also, and although she never did recover to the 
 same extent as her son, still she was able to live in 
 comparative comfort to over 80 years of age. But 
 so far from the disease being hereditary, the 
 evidence was simply to the effect that both mother 
 and son took more food and more meals than were 
 good for them, and having similar constitutions or 
 organisations (for organisation is inherited, though 
 disease very rarely is), suffered in similar ways ; 
 also, when the causes were diminished, that is, 
 when the excess of food was diminished, both 
 mother and son recovered somewhat, the former a 
 little, and the latter practically completely. As to 
 the second part of the proof that a recurrence to 
 the action of the same causes re-induces the same 
 conditions of body, I have no doubt at all that if 
 either the lady first mentioned, who suffered from 
 rheumatoid arthritis, or the man, should return to 
 their former way of living, they would find their 
 
471 
 
 disease in both cases aggravated. But I do not 
 recommend either of them to have recourse to such 
 an experiment. 
 
 The same considerations enable us to under- 
 stand many or even most other diseases ; and 
 management founded upon our proper understanding 
 of them enables us to effectually deal with them. I 
 have already (p. 318) mentioned anaemia, which 
 ought to be named triphthsemia or catatribaemia, 
 as has been said. It is not want of blood (anaemia) 
 from which anaemic patients suffer, but it is loading 
 of their blood with an excess of material or of 
 waste matter, which is the real malady. As the 
 chief source of this is excess of food, the chief means 
 of relief and cure is and must be restriction of the 
 diet ; and hence the young woman who had seen 
 eight doctors without relief was greatly benefited, 
 and in a few months cured by the diminution of her 
 food, her blood being allowed to flow better to her 
 too solid tissues, as the obstruction to its passage 
 was slowly removed. I need not repeat what has 
 already been said, nor detail what I hope the 
 imagination of readers will easily fill in each for 
 himself. The young anaemic woman was thin, pale, 
 bloodless-looking, and wasted because her blood 
 and tissues were checked or obstipated by unused 
 stuff which had entered her blood from the 
 digestion, and therefore relief was to be expected, 
 and in fact was obtained only by restriction, the 
 opposite method in the hands of eight different 
 doctors having failed to relieve her, or to do 
 
472 
 
 anything but aggravate her misery. Many or even 
 most other affections which thin and waste and 
 lower the physique of patients must be treated in 
 the same way. Neuralgia, megrim or migraine, and 
 sick headaches, for example, are other examples of 
 similarly caused diseases, which must, therefore, be 
 similarly treated. These diseases are recurrent or 
 periodic, as is well known. Patients get an attack 
 of neuralgia or of megrim, or of sick headache (a 
 bilious attack, as it is often called), and then they 
 recover and go on for a while till another attack 
 occurs ; and if one has not in one's mind the 
 organic law that constant causes acting on the 
 organism shew themselves not in constant but in 
 periodic or intermittent attacks, one is very apt to 
 be deceived as to the causation of these attacks, and 
 to imagine, as in fact patients do, that it was that 
 draft or that fatigue, or that crowded room with its 
 bad air, or that exposure to wet or cold, which 
 caused the attack, and not the wrong food habits of 
 the sufferer which were the real cause. We 
 confound the occasion with the cause or mistake the 
 exciting for the predisposing cause. The proper 
 translation or application of the law, in fact, is 
 this ; Do we find ourselves suffering from a recurring 
 affection of any kind, then we ought to search for a 
 constant cause ; and in the large majority of cases 
 that cause will be found to be wrong food habits. 
 A better statement of the law would be (since 
 organic actions are not so much constant as inter- 
 mittent) that causes acting at short intervals of 
 
473 
 
 time shew themselves in effects which appear at 
 longer intervals of time. Food, for instance, taken 
 wrongly four or five times a day at intervals of 
 three or four hours, day after day and week after 
 week, causes effects which appear at longer intervals 
 of time, headaches, e.^. or neuralgic attacks, or 
 " bilious attacks," occurring at intervals of weeks or 
 even months apart. And the application of the law 
 is this : Do we find ourselves suffering from such 
 attacks, then we should alter our habits, and 
 particularly our food habits — i.e., we ought to 
 lengthen the intervals between our meals. This is 
 the meaning of the statement of the ancient writers 
 on medicine, of Galen, for example, when he said 
 that recurring affections are to be treated in the 
 intervals rather than during the attacks. As 
 epitomised by Andreas Lacuna Secobiensis, he says 
 administramus remedia, quum morbus non adest 
 sed futurus timetur (we administer our remedies not 
 when the attack of the disease is on, but when we 
 have reason to believe that it is impending). In 
 his own interesting words he says : — etSe aKy^r}^ 
 7rapov(Trj<s voarjjjLoiTcov ovk eial Kaipoi TbiV^orjBiqiiaTOiV, 
 Koi jxr) ovTO)v voarjfxaTOJV etcrt Kaipol ^orjdyjfxaTCJV, 
 <f)av€pov, OTL OVK eTTivoia fiovov dXXa /cat vTrocrracnv 
 hia^epovdiv. (For it is evident that the times of 
 the occurrence of the paroxysms of (recurring) 
 diseases are not the proper occasions for the 
 administration of remedies, but that, on the other 
 hand, the times for favourably affecting (recurrent) 
 diseases are the intervals when they are not present. 
 
474 
 
 since opportunities for treatment differ not only in 
 our view of disease, but in its own nature. ) We 
 can, in fact, do little except to attempt to palliate 
 or relieve an attack of neuralgia or sick headache 
 or "biliousness," or of recurring bronchitis or 
 broncho-pneumonia when it is on, but we can do 
 much to prevent subsequent attacks, to lengthen 
 the intervals between attacks, and to render the 
 attacks less severe, when or if they do occur. But 
 recurring attacks tend to become, and are on the 
 way to becoming, chronic or long continued, and the 
 chief way in which we ought to handle chronic 
 illness also is to alter the habits, and particularly 
 the food habits. For even chronic illnesses, that is, 
 illnesses which are always present, are not always 
 equally present, or are not present always in equal 
 degree or extent. Like the recurring affections 
 from which they are developed, they have their 
 periods of exacerbation and of recession, they are 
 better and worse. And they often go on to or 
 pass into other affections, or what seem to be other 
 forms of disease. Recurring sick headaches or 
 bilious attacks frequently, for example, lead on to 
 attacks of chronic rheumatism or to the formation 
 of some bony or other tumour or growth, which 
 could have been prevented had the patient been 
 advised earlier how to deal with the sick headaches 
 in the intervals between the attacks. A woman, 
 for instance, whom I saw for recurring sick head- 
 aches many years ago, and whom I was able, by the 
 administration of medicine, greatly to relieve from 
 
475 
 
 the severity and frequency of her attacks, sent for 
 me some years afterwards on account of the onset of 
 inflammation, pain, sweUing, and stifiness of the 
 joints of her fingers, of the nature of rheumatoid 
 arthritis ; and some years after that time I saw her 
 again for an incurable bony tumour of her pelvic 
 bones, a form of cancer no doubt. Twenty-five 
 years ago, when I first saw this woman, I was not 
 so profoundly impressed as I am now by the power 
 of food to cause health and to cause illness, nor did I 
 then know how much more helpful I might have been 
 to that patient than in fact I was. If I were to see 
 her now for the first time, I should strongly impress 
 on her the advisabihty of eating twice a day, and 
 twice only (she is a teetotaller, so that here again the 
 cause is not alcoholic drink) up to say fifty years of 
 age, and once daily after that age ; so that the 
 cause of the evils, which I did not then foresee, but 
 which I now know to have been wrong living, 
 might not continue to act, and so that she might, 
 escaping both her rheumatoid arthritis and her 
 incurable pelvic disease, have settled down into a 
 serene, painless, and placid old age. Perhaps she 
 might not have taken the advice ; but, however this 
 might have been, I at least should have been able 
 to feel that I had warned her beforehand of what 
 was impending, and so have afforded her the 
 opportunity of escaping, if she wished, from the 
 evils before her. So much in the way of evidence 
 to shew that gouty and rheumatic affections depend 
 upon wrong food habits more than upon any other 
 
476 
 
 single cause ; that their cure and amehoration, 
 therefore, depend rather upon restriction of the diet 
 than upon any other single measure; and that 
 recurrence to former food habits is the most potent 
 influence in re-inducing the former disease- 
 conditions. Of course other causes may be con- 
 tributory to the induction of rheumatism or gout. 
 Damp, wet subsoil, for instance, and bad drainage 
 may be subsidiary causes, and therefore some 
 improvement and amelioration may be obtainable by 
 removal to a drier soil (from clay to sand, for 
 instance) and to better and drier climatic conditions ; 
 but, on the other hand, much improvement and 
 even cure are often obtainable without having 
 recourse to these costly adjuvants, beyond the reach 
 of the means of many sufferers, by the simple device 
 of restricting the diet. 
 
 As to the cure of recurring ailments, like sick- 
 headaches, bilious attacks, and the like, and the 
 relation of these affections to ailments so wholly 
 different apparently, as, for instance, tumour- 
 growths, take the following case. A woman aged 
 thirty had a large ovarian tumour which it was 
 necessary to remove by operation. She also suffered 
 from dyspepsia, anaemia, and recurring sick-head- 
 aches, and '* bilious attacks," which would confine 
 her to bed helplessly for a day or two at a time at 
 weekly intervals or so. After I had removed the 
 tumour, and had so obtained her increased 
 confidence and that of her husband and family, I 
 advised her to eat once a day, and once a day only, 
 
477 
 
 in order to prevent the formation of* some other 
 tumour or morbid growth in the body, as also to 
 obviate the recurrence of her indigestion, her 
 anaemia, her sick-headaches, and her bihous attacks. 
 The effect of this advice was immediate in the great 
 amelioration of all her symptoms ; and now at the 
 close of about a year after the institution of these 
 changes, or I ought to say of this one small change 
 in her mode of living, she has no dyspepsia, she is 
 reheved of her constipation, and has no more than 
 a suggestion from time to time of her former sick- 
 headaches and bilious attacks, and has never been 
 laid up for a day by the enemies which used so to 
 annoy and worry her. That continuance in this 
 way of living, besides ridding her of present 
 ailments, will be the best means also of preventing 
 the onset of other diseases, like the chronic 
 rheumatism, the rheumatoid arthritis, or the bony 
 growth suffered from by the other woman referred 
 to, as also that it will probably afford the best 
 protection against the formation of some other 
 malignant growth in the body, and against the 
 occurrence in the stump of the removed ovary, of 
 some cancerous growth, I have and can have no 
 doubt. And if there is any self-restraint required, 
 or suflering endured by voluntary submission to 
 such restriction, it may reasonably be contended 
 that these inconveniences are much less and much 
 more easily borne than the compulsory restraint, 
 and confinement, and suffering, and annoyance 
 inflicted by nature as the penalty for breach of her 
 
478 
 
 laws. The nexus between cause and effect does not 
 seem to me to be at all difficult to see ; but whether 
 we see it or whether we do not, the penalty comes 
 inevitably for any breach of nature's laws. And 
 conversely, when we find ourselves suffering from 
 any recurring ailment, we ought to inquire whether 
 we are not in some simple and plain way breaking 
 some natural law, and whether by the means of 
 treatment we are adopting for it, by the use, e.g^^ 
 of an aperient, or of hypodermic injection of 
 morphia, or of antipyrin, phenacetin, phenalgin, or 
 other drug, we are not simply palliating and mask- 
 ing symptoms, which would disappear of themselves 
 if our ideas of treatment were to go back to the 
 digestive causes of our sufierings. In very few 
 cases, indeed, would such a line of treatment fail of 
 affording relief When it did we might perhaps 
 begin to institute inquiries further back still, and 
 see if some hereditary predisposition were not at 
 the foundation of our suffering — which, if it were 
 so, would raise considerations which I will not 
 pursue further at present. 
 
 Another case in which recurring sick-headaches 
 were cured by changes in the diet recently came 
 under my notice, and I mention it here because it 
 illustrates how the law can be put in action without 
 the intervention of the medical expert at all, just as 
 any other law of nature can be in any other 
 department of nature when the law is known. A 
 young lady, 22 years of age, recently told me this 
 interesting story. She suffered, she said, from the 
 
479 
 
 age of ten or twelve years from recurring sick- 
 headaches, sometimes accompanied by severe 
 vomiting, which would compel her to betake herself 
 helplessly to bed for a day or perhaps two days at a 
 time, during which time she could take no food at 
 all. These attacks continued up to within two 
 years of the time when I met her, that is, up to 
 20 years of age. About that time, partly through 
 reading one of Dr. Dewey's books, and partly 
 through other reasons, she adopted, and that in 
 spite of the ridicule of some of her young friends, a 
 dissiteous regime, in place of the trissiteous or 
 tetrasiteous course which she had formerly followed. 
 Almost from the very first, she said, she had 
 experienced benefit, and in a few months she was 
 quite cured, by taking no more than two daily 
 meals, of headaches which had annoyed her for not 
 less than eight or ten years. When I saw her she 
 was nursing her little brother, and, as he was very 
 ill indeed, her duties compelled very close waiting 
 upon him. As she could not leave his room to take 
 any exercise in the open air, she thought she ought 
 to become for the time being monositeous, that is, 
 that she ought to eat only once a day ; and at the 
 time of which I speak she had been doing this for a 
 fortnight, a course in which I encouraged her to 
 persevere as long as the circumstances lasted which 
 led her to adopt the plan. Of course the original 
 suggestion of dissiteism, or the later one of mono- 
 siteism, was not mine at all. She had heard of the 
 law that sick-headaches were due to too many meals ; 
 
i80 
 
 she applied the law and got cured. The suggestion 
 subsequently of monositeism to meet her temporary- 
 deprivation of exercise was also of her own making, 
 on the very reasonable ground that as there was 
 so much less expenditure of physical and kinetic 
 energy, there was the less reason to ingest so much 
 potential energy into the body, as before, in the 
 form of food ; and her rosy, plump, and healthy 
 appearance appeared to me to completely justify 
 her application of the law. 
 
 The same principles underlie the causation of all 
 recurring afiections of the animal economy. What 
 the tissue or organ which is affected may be is an 
 accident. We have seen how the law applies to 
 affections of the bronchial mucous membrane, and of 
 the lung tissue, to rheumatic affections, and in cases 
 of sick-headaches. But affections of any and every 
 part come under the same law. For instance, here 
 is a case of skin affection which was successfully 
 treated by dietetic management. A young woman, 
 who had suffered for many years from recurring 
 attacks of erysipelas of the face, and who for many 
 months before I saw her had been prevented by her 
 illness from following her occupation as a weaver, 
 and whose face was distorted almost beyond 
 recognition by repeated attacks of her malady, was 
 informed that her diet, consisting largely of bread, 
 potatoes, puddings, and sugar, was the chief 
 predisposing cause of her recurring illnesses. (The 
 essence of the cause was too much food ; the 
 accident was too much starch and sugar.) She was 
 
481 
 
 advised, therefore, to eat bread only once a day, and 
 then not more than four ounces, and to have for 
 dinner, if she could get it, three or four ounces of 
 any meat, with some lettuce or other green vege- 
 table. She was also advised to diminish greatly her 
 puddings and sugar. She did so, and very soon the 
 attacks of erysipelas began to come less frequently 
 and with diminishing severity, and in the course of 
 a few months she became very much better. As 
 she had improved so much she after a time thought 
 that she need not be so particular about her diet, 
 but might do as other persons of her acquaintance 
 did. (It is almost always a puzzle to patients when 
 they are told that so-and-so is the cause of their 
 illness, to answer the question, why is it, then, that 
 the same causes do not make their friends and 
 acquaintances ill in the same way as themselves. 
 "If," they say, "I am made ill by bread and 
 puddings, why are not A.B. and CD., whose habits 
 I know very well, and who take even more of these 
 foods than I do ? Why are they not made ill in the 
 same way ? " The answer that different persons 
 have different resistances to these things, and to 
 the physiological labour required for their digestion 
 and assimilation, does not seem to satisfy them. It 
 is, perhaps, not a very satisfactory explanation, 
 although it is all the explanation which we can 
 give.) My patient, at least, thought she might do 
 as her friends and acquaintances did, and after 
 recovery took more of these foods than she had 
 been advised to take. The erysipelas faciei 
 
 EE 
 
482 
 
 recrudesced, after which she made no more 
 experiments, but, restricting herself to what she 
 had been advised, remained well. The proof that 
 the alleged cause of the erysipelas was in such a 
 case the real cause requires no additional confirma- 
 tion. 
 
 The successful treatment of erysipelas of the face 
 by alteration of the diet raises another interesting 
 question besides merely that of the treatment 
 and successful prevention of a recurring inflam- 
 mation. Erysipelas has been shewn to be associated 
 with (the conunon view would be that it is caused 
 by, but I have already frequently given reasons for 
 dissenting from this interpretation of the facts) the 
 growth of a micro-organism in the blood and tissues. 
 This being so, erysipelas asserts its relationship to 
 the fevers, whose course is associated with the 
 growth of these micro-organisms, and not merely of 
 an inflammation whose course is not known to be 
 so associated. Whether the micro-organism is 
 a coccus, as in this instance, according to Fehleisen, 
 it is, or a bacillus, makes no more than an accidental 
 and unimportant difierence. On this view, if 
 erysipelas is not a fever, it is at least a *' specific 
 inflammation." At any rate it is not a simple 
 inflammation. But whether we view it as a fever 
 or as a specific inflanamation, the very interesting 
 and very important fact stands out that the 
 presence of the microbe does not render the disease 
 any less amenable to dietetic treatment than if it 
 had been a simple inflanomation which was not 
 
483 
 
 associated with the growth of micro-organisms at 
 all. However the coccus entered the system, it 
 thrives in tissues that are over-fed, particularly as 
 it happens with bread and starchy stuffs, although 
 the kind of food may be (?) an accident. And this 
 being so, whenever the over-manuring of the soil is 
 reduced to what is fitting and proper, the disease 
 dies down, or rather, and as I much prefer to say, the 
 body (that is the soil) returns to a condition which 
 renders it unsuitable for the continued growth of 
 the coccus, the coccus dies down and the patient 
 recovers. The whole question of the management 
 of fevers is raised by this simple issue, and it is on 
 evidence of this kind, and on this kind of reasoning 
 among others, that my opinion is founded that in 
 the management of the fevers more attention should 
 be devoted to dietetic conditions, and that dietetic 
 conditions should be considered by the medical 
 adviser more than questions merely as to air-supply 
 and overcrowding and infection. Until we deal 
 with food-supply, I do not think we ever shall 
 effectually deal with fevers (or with consumption). 
 I have just to add the single word that erysipelas is 
 an affection so infectious when once it has started, 
 that surgeons have the most wholesome horror of 
 allowing it to be near wounds, since they know that 
 its presence is very apt to set up blood-poisoning in 
 their patients. Even in this case, however, some- 
 thing, nay, very much, will depend on how the 
 patients suffering from wounds have been fed — 
 although, of course, I freely admit the duty of the 
 
 EE 2 
 
484 
 
 surgeon to keep his patient clear from all sources of 
 infection as far as he can. These facts, however, 
 seem to me to be very instructive as to the causes, 
 the origin, the spread and the treatment of specific 
 inflammations, and their relations to fevers. 
 
 In erysipelas the skin is red, even very red. 
 Redness, in fact, and erysipelas mean much the same 
 thing. Pain, redness, heat, and swelling are the 
 cardinal symptoms and signs of inflammation, and 
 erysipelas is inflammation of the skin (and con- 
 nective tissue beneath it), and as it is accompanied 
 by the growth of a micro-organism, it is a " specific 
 inflammation " of the skin. Now the redness ot the 
 skin being attributed to an excess of food, and being 
 treated by restriction of the diet, it may seem 
 somewhat strange to attribute the extreme pallour 
 which we find in anaemia {triphthcemia or 
 catatrihcemia) to the same cause, viz., an excess of 
 food, and generally an excess of starch and sugar, 
 I hope, however, that the reader is now accustomed 
 to the idea that defect and excess of function are 
 often due to the same cause. I should, however, 
 like to add a word or two here to shew how excess 
 of food so frequently acts in causing the pallour of 
 anaemia. In anaemia the muscular fibres of the 
 vessels, and particularly their transverse or circular 
 fibres, are first hypertrophied, as it is called, or 
 overgrown. When they are overgrown, they tend 
 to go into contraction, and the efiect of this being 
 to diminish the calibre of the vessels, less blood gets 
 into it, and pallour of the skin, if the vessels in 
 
485 
 
 question are skin-vessels, results. But the muscular 
 fibres of the vessels become hypertrophied because 
 the blood contains in it more material than it 
 requires for the effective nourishment of the tissues. 
 The pallour or anaemia is therefore a direct effect of 
 the over-nutrition of the fibres which automatically 
 act so as by cutting off the blood- supply to diminish 
 their over-growth. But inasmuch as relaxation 
 always follows contraction, and is further apt to be 
 proportional to it, the greater the contraction the 
 greater the subsequent dilatation, the same causes 
 which primarily produce the pallour of anaemia 
 secondarily produce the over-redness of erysipelas ; 
 and by observation and interpretation of these 
 processes we see how the same cause, viz. an excess 
 of nutritive material in the blood, produces both of 
 these opposite states. The same reasoning enables 
 us to understand, when the necessary name changes 
 are made, how over-nutrition by causing hypertrophy 
 of the transverse muscular fibres of the bowel may 
 induce constipation, and then when dilatation 
 follows, may induce diarrhoea. And the practical 
 conclusion, of supreme importance to right treat- 
 ment, follows, that in order to cure the pallour of 
 anaemia and also the too great redness of erysipelas, we 
 must restrict the diet ; while it also follows that in 
 order to cure constipation and its opposite, diarrhoea, 
 we must restrict the diet likewise. These opposite 
 conditions are not usually found both to be present 
 in the same person at near periods of time — they 
 cannot, of course, both be present in the same 
 
i86 
 
 person at the same time — hence our rule or canon 
 of treatment generally takes the form of compelling 
 us to treat pallour in A by the same means by 
 which we treat over-redness or erysipelas in B, 
 viz., by restriction of the diet. And the same 
 considerations apply, mutatis mutandis, to the 
 treatment of constipation and diarrhoea. Never- 
 theless, as even in the same person anaemia may be 
 present at one stage of illness and erysipelas at 
 another, and the same being true of constipation 
 and diarrhoea, it follows, or may follow, that we may 
 have to treat even in the same person, at somewhat 
 longish intervals of time, opposite states in the same 
 way, viz., by restriction of the diet. 
 
 Other skin affections which are due to over 
 nutrition, and particularly to over ingestion into the 
 economy of starch and sugar (not necessarily, be it 
 always remembered, unwholesome food), are eczaema 
 and pruritus, or excessive itchiness of the skin. A 
 very annoying form of this latter affection is 
 frequently experienced at that part of the skin 
 which lies close to the orifice of the bowel and is 
 called pruritus ani. In this affection patients 
 scratch themselves till they bleed, doing it often 
 even in their sleep, and waking themselves up in 
 great misery. Many remedies have been suggested 
 for its relief, and some of them are useful ; but the 
 great remedy is restriction of the diet, and usually 
 restriction of the carbonaceous elements in the diet. 
 I detailed a case in the first edition of this essay, 
 and I repeat it here. A stout woman, aged 41, who 
 
487 
 
 had suffered from this complaint for a long time, 
 presented herself as an out-patient at the Bradford 
 Infirmary in August, 1896. She had suffered from 
 time to time, for no less than seventeen years from 
 the intolerable itching which characterises this 
 affection, and had sought advice and assistance from 
 several quarters, though without obtaining relief 
 She used to suffer from diarrhoea (due, no doubt, to 
 fermentation of carbonaceous food) but this had 
 subsided of itself before she came under my care. 
 She had been subject also to attacks of "influenza 
 colds " from time to time, that is, had attacks of 
 sneezing with cough, but had never been laid up 
 with bronchitis proper. When I saw her she had 
 very disturbed nights, on account of the itching, 
 which made her scratch herself in her sleep, some- 
 times till blood was drawn. By the simple advice 
 of recommending her to take bread only once a day, 
 and greatly diminishing other forms of carbonaceous 
 foods, I was able entirely to relieve this long- 
 standing ailment, so that in about five weeks from 
 the time of her coming under treatment she was 
 able to sleep right through the night. In another 
 fortnight all the eczsematous spots (I suppose 
 pruritus ani really is eczaema ?) had healed. 
 
 There now occurred a rather remarkable 
 incident. For some time I lost sight of the patient, 
 who absented herself from the out-patient room 
 from the end of December, 1896, tiU February, 
 1897, when she was nearly as bad as ever again. 
 What was the reason of this relapse ? She told me 
 
488 
 
 she had had a miscarriage, and had been obliged to 
 consult a medical man. He had put her on the 
 conventional treatment usually adopted in that 
 condition, ordering her to live on gruel, bread and 
 milk, rice and milk, &c. The increase of starch 
 taken brought back the itching, and she was obliged 
 to make her way back to the Infirmary as soon as 
 possible to obtain relief again, in which she was 
 not disappointed. Here, then, is a case in which 
 a medical man — first, alleges that the main cause of 
 an ailment lasting for seventeen years is wrong 
 eating (and particularly that it is eating too much 
 bread and carbonaceous food) ; second, in which he 
 therefore recommends that bread be taken only once 
 a day. Thirdly, the patient recovers, or practically 
 recovers (she was not perfectly well) on taking his 
 advice. Fourthly, she is compelled to put herself 
 under advice for another ailment ; and for the 
 management of that ailment is recommended to live 
 on the kind of food which was alleged to be the 
 main predisposing cause of her first ailment. 
 Fifthly, the first ailment returns in accordance with 
 the original statement. Sixthly, the ailment again 
 disappears when she again follows the original 
 advice. I do not know what more clinical evidence 
 could be demanded by the most sceptical in the way 
 of a demonstration as to what the causes of the 
 ailment were. The logical methods of agreement 
 and difference combine to demonstrate that the 
 main predisposing cause of pruritus ani is wrong 
 eating, and in particular that it is the consumption 
 
489 
 
 in excess of starchy food. She suffers from the 
 aihnent when she takes the food, and she ceases to 
 suffer when she ceases to take it ; or rather (since 
 it is not abstinence but moderation which is 
 inculcated by nature) when she sufficiently 
 diminishes it. Now this conclusion does not apply 
 to this case only, but to practically all cases where 
 the experiment is made. The conclusion that the 
 alleged cause is really the main cause has become 
 firmly fixed in my mind, and has indeed the force of 
 a law of nature or of human organisation. And, 
 of course, anyone can for himself put the law into 
 action when appropriate circumstances arise. 
 
 There is, however, a further line of evidence 
 possible, in order to prove this conclusion up to the 
 hilt. If, as I suggest, starch and sugar is the cause 
 oi pruritus ani, how does starch and sugar cause it ? 
 Perhaps by carrying into the stomach and thence 
 into the intestines, and thence again into the blood, 
 some spore or seed which grows by preference at 
 the orifice of the bowel ? Might it not be possible 
 to demonstrate the existence of this spore first in 
 the starch granules of the food, and second, in the 
 blood? Such spores when in small numbers are 
 no doubt destroyed by the digestive juices, but it is 
 conceivable that, if ingested in too large numbers, 
 that is, when too much of the food containing them 
 is consumed, they may escape digestion, and find 
 their way into the blood, and so be carried to their 
 favourite site. Of course this is a mere suggestion, 
 but it does not seem at all an impossible means by 
 
490 
 
 which the disease may be conveyed, although there 
 is no proof up to the present time that pruritus ajti 
 depends upon bacteriological growth at all. 
 
 Cases of this kind could be multiplied to 
 weariness. Indeed some critics seem to complain 
 of the nauseousness of the proof of the dependence 
 of disease on wrong eating. But what can one do ? 
 If one says that such is the case, and that the 
 taking of too much food is the chief predisposing 
 cause of the large majority of the ailments to 
 which humanity is subject, one is asked for proof. 
 It is a perfectly reasonable request, and ought to be 
 met. But when it is met, it is rather unfair that 
 one should be twitted with the reproach that the 
 proof is excessive and wearisome. 
 
 Sycosis. A very chronic and intractable form of 
 skin disease is one which attacks the chin and cheeks 
 and upper lip in men, and is often said to be induced 
 by the use of dirty instruments at barbers' shops. 
 It is called acne mentagra (acne of the chin), or 
 sycosis mentij and consists of a number of pustular 
 points, suppurating, itching, and unsightly, affecting 
 the chin or upper lip or cheeks. It is of two forms, 
 and is known to be due to the growth of a parasite, 
 either the Tinea Barbae or the Staphylococcus 
 aureus et alhus. This is the authoritative state- 
 ment, although I regret to be unable to accept it in 
 this form from what I am about to add. I think it 
 is a much truer statement to say that the disease 
 is known to be associated with the growth 
 and development of the Tinea Barbae or the 
 
491 
 
 staphylococcus aureus et albus, than to say it is 
 due to it. The treatment recommended is usually 
 painful and long, and consists in epillating or 
 removing the affected hairs with pincers, and in 
 the free application of germicide ointments, &c., &c., 
 and the treatment is admitted to be " unsatis- 
 factory." I am sorry to add what I have to say, 
 because it seems to conflict so much with ordinary 
 views ; but I find this one of the easiest affections 
 to treat, and one which does not require any long 
 time either, not longer than say eight or ten weeks, 
 if the simple plan is had recourse to of restricting the 
 diet. A young man, who suffered long and greatly 
 from this affection of the skin and cheeks, affecting 
 the hair follicles of beard and whiskers, was easily 
 and painlessly cured by the simple device of 
 stopping his breakfast, otherwise, by putting him 
 on two meals a day. I thought the case so 
 interesting that I asked the youth to report himself 
 to a senior colleague of mine, a former hospital 
 surgeon, who corroborated the diagnosis and con- 
 curred in admitting the efficacy of the treatment. 
 The rationale is again quite simple. There is no 
 difficulty about it. Too abundant eating does not 
 (probably) cause or create the growth of the 
 parasite which is associated with the disease 
 (although the spores of it may be swallowed in 
 food or drink, and, being ingested in great excess, 
 may escape or elude the activity of the digestive 
 juices). But, however the parasite got into the 
 economy, there it is ; and the question is whether 
 
492 
 
 is It better (a) to attack it directly by attempting 
 to extract it or weed it out, so to say ; or (b) to kill 
 it by making the soil in which it grows unsuitable 
 to harbour it ? As I believe the disease to consist 
 not by any means so much in the presence of the 
 parasite as in the state or condition of the soil in 
 which it grows, that is to say, the state of the body 
 and tissues, it follows that our efforts at treatment 
 ought to take the line not of up- rooting the 
 parasite, but in attempts to render the body 
 unsuitable to harbour it. The line of treatment is 
 determined by the analogy so often referred to now 
 that an over-fed body is like an over-manured soil, 
 and as the latter tends to grow noxious weeds, so 
 the former tends to harbour the growth of parasites. 
 Make the soil sound by proper drainage and proper 
 manuring, and suitable crops will be produced ; 
 make the body healthy by proper feeding, and 
 drain away impurities by restriction of the diet, so 
 that any excess of pabulum shall be used by the 
 body, oxidised and converted into the heat and 
 motion of life ; and then the parasite, finding the 
 conditions no longer suitable for it, will die, acne 
 spots will heal, and diseases like sycosis menti will 
 disappear. The reader will not fail to see that the 
 principles underlying the management of this 
 affection are exactly the same as those already 
 discussed when we were considering the nature of 
 fever and of tuberculosis. Well might Asclepiades 
 of Prusa, the medical adviser of Cicero say, Mr) 
 o TTvpeTo^, dXXa to nvperelv, non fehris sed 
 
493 
 
 fehricitare — "the important things for doctor and 
 patient to consider and weigh are not whether the 
 patient has scarlet fever, or diphtheria, or influenza, 
 or small-pox, but the fact that he has a fever at aU." 
 And he might have added, as he would no doubt 
 have added had he lived to-day ; the important 
 thing to be considered by him who has sycosis 
 menti, or by the doctor who would treat him 
 skilfully, so as to prevent, for instance, the dis- 
 figuring keloid which is so apt to mark the face of 
 those in whom the disease has run an unchecked 
 course, is not that sycosis is caused by a parasite, but 
 that a parasite of any kind should be thriving in 
 the body at all. And even if a man thinks he got 
 or caught his sycosis at the barber's, it will be well 
 for him to inquire how it happened that so small a 
 cause induced in him so loathsome an affection ; as 
 also to inquire how he may most readily in future 
 make himself immune to such influences. 
 
 I ought to add, before leaving the subject of 
 the skin and skin affections, that the skin behaves 
 as other tissues and parts of the body do, and that 
 the circulation in it is disturbed in the three 
 directions of excess of circulation, of defect of 
 circulation, and of irregularity of circulation, by 
 excess of irritation, the commonest form of which is 
 excess of food. The reader will therefore be 
 prepared to draw for himself the conclusion that if 
 the skin is too moist on the one hand, or too dry on 
 the other, if it is too hot or too cold, or if too much 
 moisture alternates too rapidly with too much 
 
494 
 
 dryness, or too much hotness with too much 
 coldness, we should in all cases look for a constant 
 irritation ; and nine times out of ten, or at least 
 three times out of four, we shall find that that 
 constant or frequently acting irritation is too 
 abundant or too frequent feeding. Even loss of 
 hair, as shewing such congestion of skin as cuts off 
 its own blood supply, so killing the hair follicles, 
 has often to be treated by restriction of the diet. 
 The occurrence of keloid or the white shiny state 
 of skin left hke the scar of a burn after sycosis has 
 been cured by destructive inflammation, shews the 
 condition of skin to which in some cases complete 
 and permanent loss of hair is due. 
 
 As I have been referring to the skin and hair, 
 perhaps this will be the best place in which to treat 
 of ulceration. The term ulceration is applied to 
 death of a portion of any surface of the body, and 
 most usually to death of a portion of the outer 
 surface of the body or skin, although, of course, it 
 may refer to death of a portion of an inner surface, 
 as the mucous membrane, lining the intestines or 
 stomach or lungs. Wherever it is found, the same 
 principles underlie both the mode of its occurrence, 
 and, therefore, its proper treatment. Ulceration, 
 like most (or all ?) other diseases, may be due to 
 one of two opposite causes, starvation and plethora, 
 or, as we have now learned to call them, direct and 
 indirect starvation. The former form we very 
 rarely see, although we often think we see it. But 
 if an animal is literally starved to death, it suffers 
 
495 
 
 from various forms of ulceration before it expires. 
 It may suffer from ulceration of the skin, of the eye 
 (sloughing of the cornea), or of some mucous 
 surface. Of course, this form of ulceration must 
 be treated by cautious increase of the diet, and if, 
 for example, men had been exposed in a boat fifty 
 days with ten days provisions on board ; or if 
 miners, being entombed by accident for a similar 
 length of time, were found to be suffering from 
 various forms of ulceration, it would be necessary to 
 cautiously feed them with an increasing amount of 
 nutriment in order to cure it. But how rarely do 
 we see this. One of the commonest forms of 
 ulceration is the callous ulcer, as it is called, very 
 often appearing as a large ulcerated surface on the 
 leg, surrounded by a raised thickened mass of 
 connective tissue an inch or two inches broad, and 
 an apparent three-eighths of an inch thick, and 
 very often accompanied by thickening of the vein- 
 coats also. These last, as they are weakened and 
 inelastic as well as thickened, are very apt to give 
 way and cause dangerous haemorrhage, as is well 
 known, in this kind of ulcer. The thickening of 
 connective tissues and of the vein-coats is very well 
 calculated to suggest to the mind of the reflective 
 observer what the real cause of the disease is, for 
 how can thickening or over-growth arise without 
 over-nutrition ? or, at least, what cause is so likely 
 to produce it as over-feeding ? Accordingly it is 
 found that restriction of the diet has a very 
 beneficial influence on this form of disease. Very 
 
496 
 
 few callous ulcers of the leg indeed, with or without 
 the accompaniment of varicosity of the veins, 
 would fail to be greatly benefited, and many would 
 be cured, by a fast of six weeks or so. A woman 
 of 63 years of age whom I treated in this way, or 
 by putting her on a pint of milk and half a pint of 
 mutton- or beef-tea daily for six weeks (a greatly 
 restricted diet, of course) was so much benefited 
 that her ulcer of the leg of many years standing 
 has never since that time given her any serious 
 trouble. There is, in fact, nothing original in such 
 a method of treatment, although it is not so often 
 recommended as it ought to be, for in ulcer of the 
 stomach patients are either put on a very little thin 
 barley water or on say an ounce of milk and water 
 every hour or every two hours during the day, and 
 on a little water if they are thirsty during the 
 night. But an ounce of milk and water every hour 
 from eight in the morning till nine at night is only 
 14 half-ounces, or seven ounces, of milk in 24 hours, 
 less than half a pint; and even 14 ounces of milk 
 if undiluted milk were ordered (but if this were so 
 it would probably be ordered not every hour but 
 every two hours) would be a very restricted diet, 
 which might, even without much strain on 
 language, be called a starvation diet. Yet it is 
 an excellent diet for ulceration of the stomach, 
 and is very often prescribed by medical men. The 
 same treatment is not so often resorted to for 
 callous ulcer ; but obviously the causes of its 
 formation are the same, and it ought, therefore, to 
 
497 
 
 be amenable to the same treatment, as in fact it is 
 found to be by whoever has the courage to put it to 
 the test. The reader may perhaps demur to the 
 treatment of strumous or scrofulous ulceration by 
 this means, but I have already mentioned the case 
 of a child of four years old in whom I treated a 
 strumous ulceration and suppuration of the knee by 
 a greatly restricted diet, and this with perfect 
 success, the child gaining about 10 lbs. in weight in 
 the course of 15 months. This was a case of 
 juvenile struma. Senile struma is also, I am 
 convinced, much more amenable to a treatment by 
 restriction than to the treatment usually recom- 
 mended for it, viz., increase of the diet, as the 
 following case will shew. A gentleman of 58 years 
 of age, who, to use popular language, might be 
 described as being riddled with strumous ulceration, 
 affecting his back, groin, leg and arm, and who had 
 undergone surgical treatment at the hands of a 
 most distinguished surgeon without much, if any, 
 benefit to his ulceration, had his wounds healed and 
 his system strengthened by restricting his diet to 
 practically one meal a day, continued for over a 
 year. Another man, in the prime of life, who 
 suffered year after year from suppuration of the 
 glands of his neck, was entirely cured, and that 
 without recurrence, by two meals a day. This last 
 was a fine well-made man, about 5 ft. 10 ins. in 
 height, and weighing about 186 lbs., who might 
 therefore be supposed, and generally is supposed, to 
 require a quantity of food larger than the average, 
 
 FF 
 
498 
 
 in order to keep up his frame and strength. Never- 
 theless, by reducing his usual three daily meals, 
 and occasionally four, down to two a day, his 
 ulceration was quite healed, and has not recurred. 
 
 The following case is illustrative of the 
 beneficial action of the same principles. It was 
 a case of (probably) ulceration of the large 
 intestine. A woman, 54 years of age, ansemic, 
 and whose appearance suggested even the idea that 
 she might be suffering from pernicious anaemia, or 
 some other possibly malignant affection, came into 
 the Bradford Royal Infirmary suffering from 
 frequently recurring loss of blood per rectum. The 
 quantities lost amounted to about eight ounces at a 
 time, dark liquid blood for the most part, with a 
 few clots. The site of the bleeding could not be 
 discovered. She had been under treatment for 
 some time, but, beyond a diagnosis of ulceration, 
 of probably the large intestine, a diagnosis which I 
 believe to have been perfectly correct, nothing 
 further could be said about it, and she had not 
 improved. The source of the haemorrhage might 
 have been in the rectum, although the finger could 
 not detect it, but probably was higher up in the 
 colon. Of course it might have been higher up 
 still in the ileum. In any case, here was 
 haemorrhage recurring in a thin, wasted, attenuated 
 woman, and, evidently, unless it was checked, it 
 must prove too much for the patient. To cut down 
 on the bowel, first opening the abdomen and then 
 the gut, on the chance of finding the spot from 
 
499 
 
 which the hsemorrhage came, and of excising the 
 ulcer, if one was found, seemed a very haphazard 
 proceeding. If the surgeon failed in one place, he 
 would have to stitch up his opening, and proceed to 
 another attempt to find the bleeding-point. If his 
 second attempt failed, he would have to make a 
 third, a fourth, a fifth, and even an indefinite 
 number of attempts to find the source of the 
 haemorrhage along a portion of bowel measuring 
 eight feet long, even if it was in the large intestine, 
 which was by no means certain. There can be little 
 doubt that such a set of proceedings would have 
 most probably cost the patient her life. Although, 
 therefore, she came into hospital for operation, I 
 refused to operate. The sequel is very interesting. 
 Under a diet of half a pint of milk twice a day, 
 and a little soup in the middle of the day, continued 
 for six weeks, this patient made a gradual and 
 finally a complete recovery. The quantity of blood 
 lost fell at about the third week of treatment to 
 six ounces, later to four ounces, later to about two 
 ounces, and finally ceased. The intervals at which 
 the bleedings occurred gradually lengthening 
 between the attacks as the quantity of the 
 haemorrhage diminished, plainly showed also that 
 the ulceration was gradually healing ; and although 
 we did not see the process going on, and did not 
 even know exactly where it was, it was very easy 
 to compare the healing of external ulceration which 
 one had often seen, with the steps of the process 
 which were occurring somewhere in the bowel, and 
 
500 
 
 I do not now believe that our imagination was 
 incompatible with the facts. The patient was 
 recommended to eat only twice a day for the rest 
 of her life, and when she left the hospital was quite 
 well, the gray, ashy colour of her face being con- 
 siderably improved. No doubt, if she does as she 
 has been advised, or, if necessary, eats only once a 
 day, she will recover even more than she has yet 
 done. 
 
 The result of this case confirms me in the 
 general view that ulceration is caused by starvation 
 of tissue due to previous hypertrophy, and that 
 hypertrophy, wherever found, is generally due to 
 over-feeding. Of course, ulceration may be due to 
 direct starvation, but this happens so rarely in 
 civilised life, that we may practically throw it out 
 of account. Practically it is almost always due to 
 indirect starvation, not to direct. A sensible doctor 
 will inquire which of the two opposite causes is at 
 work, and will act accordingly, treating the efi'ects 
 of direct starvation by cautious increase, and those 
 of indirect starvation by cautious restriction of the 
 diet. The explanation of the mode or method of 
 causation determines the mode or method of treat- 
 ment, and seems to me to have been the same, in the 
 case detailed, as has been described now more than 
 once. The essential cause was too frequent and too 
 abundant feeding (pollaki-siteism and poly-siteism). 
 The accidental cause was too much bread and butter 
 and tea, which formed the main part of the diet 
 (pollaki-amylism and poly-amylism). Through too 
 
501 
 
 frequent and too abundant feeding, first over- 
 nutrition and then starvation through blocking of 
 its circulation, took place at some unknown point in 
 the gut. Ulceration followed, which opened a vessel 
 or vessels, so causing the haemorrhage. Under 
 restriction of the diet, the exudation into the 
 surrounding tissues was gradually removed, and the 
 circulation in the place, wherever it was, gradually 
 became re-estabhshed. By this means the ulcera- 
 tion was healed and the bleeding ceased, the 
 gradual diminution of the quantities of blood 
 thrown out coinciding with lengthening of the 
 intervals between the attacks. For let us look at 
 the argument. If too abundant feeding, and in 
 women too frequent feeding (for how often do 
 women eat because they are ' ' faint " — not much at 
 a time, but a little food and often !), is the cause of 
 hypertrophy and exudation ; if the exudation has a 
 low vitahty and dies, leaving a raw place, otherwise 
 an ulcer — if these things are so, then it follows that 
 restriction of the diet, or even starvation, will 
 gradually remove the blocking of the circulation, 
 which is only another name for exudation. In the 
 case in question, restriction of the diet was followed 
 by healing of the ulceration, or was, at least, 
 followed by cessation of the haemorrhage, which 
 was probably due to ulceration. Will not any 
 sensible man, who realises the force of the steps of 
 this argument, and who realises besides the happy 
 results of the treatment founded on the argument, 
 be confirmed in his belief of the soundness of his 
 
502 
 
 general conclusion, and be induced, therefore, to put 
 into operation a similar chain of argument, should 
 any similar case again come before him, and to 
 follow it up by similar treatment ? It is probable 
 evidence, no doubt, not demonstrative, but it is the 
 kind of evidence on which we act in conducting the 
 practical business of life, and is quite sufficient for 
 the successful conduct of that business by sensible 
 persons. In accordance with such evidence juries 
 and judges give verdicts which, if they are wrong 
 occasionally, are usually correct, and give, on the 
 whole, satisfaction to the public. 
 
 The uncertainty and flightiness of mental 
 condition which so often accompanies the lymph 
 congestion of the connective tissue of the brain and 
 nervous system, and which, when aggravated, not 
 infrequently sends women to asylums, is often 
 accompanied by a sign on which I wish to say a few 
 words. I mean dilatation of the pupils. Dilatation 
 (like all ? other signs) may be due to two opposite 
 states, to stimulation of one set of nerves, the 
 cranial, or to paralysis of another, the sympathetic. 
 When a person becomes comatose with a serous 
 effusion on the brain, his pupils are usually widely 
 dilated. That is because both sets of nerves, the 
 cranial and the sympathetic, but particularly the 
 latter, are paralysed or have lost their power, The 
 transverse elements of the pupils are governed by 
 a cranial nerve (the third), while the circular fibres 
 are under the control of the sympathetic. Stimu- 
 lation of the former, therefore, dilates the pupil, 
 
503 
 
 while stimulation of the latter contracts it ; and of 
 course, complete paralysis of both, by relaxing both, 
 causes the dilatation that threatens, if it does not 
 necessitate death. Now in the flighty and uncertain 
 state of mind to which I am referring — it is often 
 called brain-fag — when the connective tissue of the 
 brain is congested with lymph (when cerebral initis 
 is present), there is also very often present initis of 
 the third cranial nerve, and hence over-stimulation 
 of the same, and of the fibres in the iris which it 
 supplies, with consequent dilatation of the pupils. 
 Sometimes this expresses itself in headache rather 
 than in mental disturbance, but however brought 
 about, excessive pupil dilatation ought to attract 
 our attention, as it is a sign that there is too much 
 lymph about the base of the brain, too much lymph 
 depending on too much or too rich blood, and too 
 rich blood depending on too much food. Sometimes, 
 indeed, this condition leads to defects of vision in 
 young people, the proper remedy for which is rather 
 to recommend a restriction of the diet, than to try 
 to find spectacles which will overcome the defect. 
 I have several times in fact been able to overcome 
 visual defects, especially in children, by altering 
 their diet, the visual defect being rather the local 
 manifestation of a general condition than the 
 substantive affection. In children the sign often 
 accompanies a too slow pulse (48 or 50, e.g.), and 
 both the slowness of the pulse and the dilatation of 
 the pupils are to be met by restriction of the diet, 
 as in fact both have been caused by excess of food. 
 
504 
 
 In young neurotic women also we frequently find 
 dilatation of the pupils, although the pulse may not 
 be disturbed, or, if it is, it may be too quick rather 
 than too slow. The sign is not so often found in 
 men, although the slow pulse often is. I can only 
 explain this by saying that, as a rule, men have a 
 greater resistance than either women or children, 
 although no one knows better than I that this is no 
 explanation, and that it is merely a statement of 
 the fact in another form. However, I think it is a 
 fact. What, however, I wish to draw attention to 
 is the highly important practical conclusion that 
 dilatation of the pupils (whether accompanied or 
 not by the changes in the pulse rate referred to) is 
 best combated and ought to be combated by 
 restriction of the diet. And I have to add that in 
 a few weeks (two to six, for unfortunately it takes 
 a rather long time), under a restricted diet say of a 
 pint of milk daily, divided into small quantities at 
 intervals, these dilated pupils can be restored to 
 their normal state. I could give cases in which 
 this sort of management has been quite successful, 
 but space forbids. 
 
 There is, however, an important disease in 
 which this sign of over-dilatation of the pupils is 
 frequently present, on which I wish to say a few 
 words, and that is epilepsy. I have seen first and 
 last a good many cases of epilepsy, and have come 
 to have a strong opinion that its causes also are 
 chiefly wrong feeding, and particularly too abundant 
 feeding, acting upon a low resistance to digestive 
 
506 
 
 labour. It is very difficult, no doubt, to prove the 
 truth of this view or of any view, in the case of 
 epilepsy, for this reason : Epilepsy has a very 
 varying and variable periodicity. In some cases the 
 epileptic fits come frequently, one or two or three 
 (for they often occur in " bouts " or sets) taking 
 place every few days. More often they are 
 separated from one another by weeks, sometimes 
 by months, not infrequently by years. And the 
 next fact is that the occurrence of the fits is not 
 regular. If there have been two or three sets in 
 one week, or in a month, it does not at aU follow 
 that there will be a like number in the next 
 succeeding week or month ; and the same statement 
 is true for longer periods of time, months, for 
 example, or years. Now if the last fit or set of fits 
 occurred six months ago, or a year ago, and if the 
 times of the occurrence of the fits are not regular, 
 how are we to know or to judge what the effects of 
 our treatment have been ? If a longer interval 
 than formerly occurs under treatment, it may have 
 been because the fits were not going to return in 
 any case, and the longer interval of freedom may 
 not, therefore, be due to our treatment, but to 
 Nature. No doubt it was chiefly for this reason 
 that the ancients called epilepsy the sacred disease, 
 and allowed the priests, rather than the physicians, 
 to deal with it, allowing their claim to be divine 
 agents if they seemed to be successful, and if the 
 patient seemed to recover; and if they failed, 
 attributing the failure to the belief that the disease 
 
506 
 
 was a sacred one and in the hands of the gods only, 
 who in this case would not allow it to be cured. 
 The same kind of reasoning led others of the 
 ancients to think that the disease was due to the 
 patient being possessed by devils, and that only 
 those could cure it who had the power to cast the 
 devils out. It is certainly a little curious to find 
 that the remedies of fasting and prayer were 
 greatly valued in managing epilepsy, because, 
 certainly so far as I have seen, far and away the 
 best remedy consists of a careful restriction of the 
 diet, while the mental calm implied in the act of 
 submission which prayer involves is a great 
 adjuvant to the cure. And the mode in which 
 the remedy acts is plain enough. The connective- 
 tissue of the brain being congested with lymph, 
 restriction of the diet compels the body to draw on 
 the over - accumulation of its resources, and to 
 convert them gradually into the heat and motion 
 of life, the consequences being gradual, or rather 
 intermittent, relief to the irritation which caused 
 both the dilatation of the pupils and also the 
 explosions of the fits. The transverse elements of 
 the pupils are, in fact, in a state of cramp, as it 
 were, which is slowly or intermittently relieved, 
 just as cramp in the legs can be relieved by cautious 
 diminution of the diet. For these reasons, and 
 following out this suggestion in treatment, I have 
 for many years now advised restriction of the diet 
 in epilepsy to two meals daily, and sometimes to 
 one ; and in acute cases have recommended further 
 
507 
 
 and great restriction to a pint or a pint and a half 
 of milk daily for a considerable period of time, 
 some weeks, for example, and that with excellent 
 results, so far at least as results can be guaged in a 
 condition which is so irregular in its exacerbations 
 and recessions. Especially are these results good 
 in the case of children, although older persons are 
 also often very amenable to the same line of 
 treatment. Fasting, in fact, seems to be of very 
 great efficacy in the treatment of epilepsy, the 
 rationale of its action being what I have attempted 
 to make clear to the reader. 
 
 As has been said, dilatation of the pupils is 
 seen in many other conditions besides epilepsy. 
 " Neurotic," or what I have called " initio " women, 
 full of all sorts of ailments, often manifest it, and 
 children also, who sometimes concomitantly manifest 
 defects of vision. It sounds absurd and far fetched, 
 until we see its rationale, to say that defects of 
 vision can be remedied by alterations of the diet ; 
 but I have literally seen this brought about in more 
 than one case, having been able to correct short- 
 sightedness in children, for example, by restricting 
 the diet, and this without the use of glasses, when 
 the cause of the defect was pointed to by Nature 
 by over-dilatation of the pupils through over- 
 stimulation of brain and nerves, by excess of food in 
 the way detailed. When, by diminishing the food, 
 irritation and over-stimulation were reduced, the 
 over-dilatation of the pupils was reduced also, 
 and the accompanying defects of vision relieved. 
 
508 
 
 Over - dilatation of the pupils, one or both, is, 
 in fact, a sign of such significance that we can 
 often, by paying attention to it, foresee and so 
 sometimes prevent the onset of an attack of 
 inflammation of the brain (cerebritis or meningitis) 
 in children or young people, and by a timely 
 restriction of the diet save and prevent damage to 
 young lives. 
 
 The considerations advanced in this essay, 
 the view that most of our diseases are brought 
 upon ourselves by our own folly, by too great 
 gratification of our appetites, and the consequent 
 inference, so often verified by proof, that most 
 of our diseases are tractable by restriction of the 
 diet, have come to exercise a kind of fascination 
 on my mind. And other considerations suggest 
 themselves also to one's mind, conclusions, for 
 example, as to the uniformity of nature, and the 
 order and government of the scheme of things 
 under which we live, which, though somewhat out 
 of place in an essay on medicine, are yet of the 
 deepest and even most entrancing human interest. 
 Nature has given us, for example, with a bountiful 
 hand, a large variety of good things to enjoy. On 
 the other hand she has endowed us with the desire 
 to enjoy them ; but she has left us to discover by 
 observation and experiment what are the effects of 
 free indulgence and of restraint. And it is lor each 
 of us to say what he will do, how far he will go, and 
 what amount of government he will attempt to put 
 upon himself during his progress through life to 
 
509 
 
 death — an infinitely greater consideration than the 
 far commoner one, how much influence he may hope 
 to have over his fellows. But these considerations 
 and the analogous one that thinkers have held that 
 all our knowledge is always a mean between two 
 extremes, neither of which is possible, must be left 
 aside by the medical man, who yet is at all points 
 compelled to conclude that neither ascetic abstinence 
 nor florid (nor yet anaemic, nor tripthaemic) plethora 
 is healthy ; if, that is, as seems to be the case, the 
 aim of medicine ought to be to make life fit for the 
 active work whose performance itself brings happi- 
 ness and helps to render life free from disease. 
 
 On the other hand, a certain amount of 
 depression is apt to arise when one reflects that 
 comparatively few appear to see so simple a way 
 out of their troubles, as that to be got through 
 control of our appetites, and that of those few, only 
 a small minority seem willing to put their discovery 
 into practice. In every generation, however, a 
 minority of medical men have apparently said 
 much the same thing as the present writer. A 
 most remarkable instance, as we have seen, is 
 Hippocrates in the ancient world. We may also 
 instance Celsus, who said, potius bis quam semel 
 in die edere, for although he thought it better 
 to eat twice a day than once, he certainly did not 
 countenance the four or five daily meals which, as 
 we have seen, characterised the daily life of the 
 Boman citizens in the days of the wealth and 
 luxury which preceded and caused their decline. 
 
510 
 
 In the time of the English revolution also, the 
 great Sydenham tells us how he fed a gouty man on 
 milk and whey (serum lactis) for a year ; and just 
 before the present time Dr. King Chambers spoke 
 of the starvation of over-repletion, to be translated 
 into yet more idiomatic and expressive language, 
 when Dr. Dewey speaks of the starvation of over- 
 feeding. In his day, Sir Andrew Clarke was called 
 the starving doctor ; and it would be invidious to 
 mention the names of a few living physicians who 
 make like deliverances. How will the view, the 
 view expounded and defended and illustrated (may 
 I say proved ?) in this essay — how will it fare in the 
 future ? Will it be accepted or rejected ? Or will 
 it, perhaps, be accepted as a general proposition, or 
 as a proposition generally true, but only to receive 
 practical rejection when the attempt is made to 
 apply it to any particular case ? It is so easy to 
 see the general law, but to fail to see its application 
 to our own case. Better, it seems to me, would it 
 be to denounce it out and out than to accept it in 
 a half-hearted and insincere way. I have often 
 thought what an interesting essay might be written 
 on the medical history of great men, and how it 
 might be shewn that their food habits determined 
 not only their longevity, but many of their moral 
 qualities also. But this task would be too great 
 for the termination of our exposition, although, 
 perhaps, it would be as interesting as any other 
 part of it. I have already mentioned the great 
 man who wrote the vision of Mirza, as a striking 
 
611 
 
 instance of those who say and do not do. 
 But many others probably do not have the 
 opportunity of knowing what he knew, and so of 
 shewing whether they would be willing or not to 
 obey the law in their own case. Illustrations of the 
 lamentable efiects of ignorance of the law abound in 
 our Hterature to all those who have an eye to read 
 and see them; and a noteworthy instance is afforded 
 by the medical history of a well-known literary 
 character of the truth of the statement that too 
 frequent and too abundant feeding cannot be borne 
 by average humanity without continually recurring 
 illness and premature death. Of course, if the law 
 is the law, and not a mere figment of the imagina- 
 tion, it will be found to cover all cases belonging to 
 its own order, and when exceptions occur, some 
 peculiarity in the circumstances must be looked for 
 to account for them. This Hterary character has 
 been depicted from her own letters most fully for 
 our instruction, and it appears that from somewhat 
 early days she suffered from recurring headaches. 
 At a very tender age, we are told, she suffered 
 greatly from cold, and found difficulty in getting 
 near the fire at school in winter to become 
 thoroughly warmed, owing to the circle of girls 
 forming round too narrow a fireplace. The 
 biographer is not a physiologist, but describes in 
 wonderful detail, although nearly always by 
 reference rather than description, the ailments from 
 which his subject suffered. The incident relating 
 to the fire occurred at five or six years of age. If 
 
5ia 
 
 only the feeliug of cold had been met by judicious 
 exercises and a wise regulation of the diet, in place 
 of the futile attempt to get near the fire, if the 
 oxy-uri-chaemia causing the feeling had been treated 
 in place of the feeling itself, how different might 
 not the result have been ! For the idea of the 
 child's father was the conventional, and perhaps 
 natural, one, till modified by fuller knowledge, that 
 a child's strength was to be promoted by increase of 
 food, since we find that at about thirteen years of 
 age, at her next school, "^a source of great interest 
 to the girls, and of envy to those who lived further 
 from home, was the weekly cart which brought 
 the child new-laid eggs and other delightful 
 produce of her father's farm" — these new-laid 
 eggs and delightful produce of the farm being, no 
 doubt, taken as extras in addition to the already, 
 probably, quite sufficient school fare. By the time 
 the child was nineteen or twenty her headaches 
 were in full swing, frequent references being made 
 to them. Thus, at twenty years of age, she speaks 
 of hardly knowing herself, owing to the insup- 
 pressible rising of her animal spirits, "on a 
 deliverance from sick headache." Evidently she 
 suffered from recurring sick headaches. If only she 
 had been told that when persons suffer from 
 recurring ailments they should look for a constant 
 cause, or a frequently acting cause ! Had this been 
 done she would have had the option of choosing 
 whether she would accept the unpleasantness of 
 putting upon herself a certain amount of restraint, 
 
513 
 
 or of going on in the old way and suffering from 
 the recurring ailments. She would have had the 
 opportunity and responsibility of choosing whether 
 she would belong to those who know or to those 
 who do not want to know. This heroine was 
 exceptionally gifted — most exceptionally so — and 
 saw, therefore, though without stating it, or perhaps 
 without realising its significance, that alternation 
 which always goes on, and always must go on, in 
 the body as to strictum and laxum, rao-ts and 
 yaX(L(Ti^. ' ' Have you not," she says, " alternating 
 seasons of mental stagnation and activity ? " More 
 mental power and less in the waking state, that is 
 natural and healthy; but "stagnation and activity" 
 have transcended the limits of health, and are as 
 morbid or unhealthy as panic and boom in business 
 or as depression and fever in the body. The 
 ill-health goes on, for at twenty-seven years of age 
 she speaks of a cold and headache as being doubly 
 intolerable ; and at thirty she has headaches and 
 backaches. At the same age she is suffering "as 
 acutely as ever I did in my life." But a little 
 further on, and at the same age, when she had gone 
 abroad, we have described to us, though all uncon- 
 sciously, the chief predisposing cause of these 
 ailments and delicate states, which were thought to 
 be the effects of hard work, of anxiety, of " exposure 
 to cold," of a bad, miserable, foggy climate, etc., in 
 a way which is so instructive that it must be quoted. 
 " I breakfast in my own room at half-past eight, 
 lunch at half-past twelve, and dine at four or a 
 
 GG 
 
614 
 
 little after, and take tea at eight." If one had 
 been in search of a plan to induce ill-health and 
 early death, one would have adopted that of break- 
 fasting, lunching, dining, and having tea within 
 eleven and a half hours of one another. If anything 
 additional were wanting to destroy life, it would 
 have been what some persons of my acquaintance 
 do, viz., to have some milk and fruit brought up to 
 their bedrooms, in case they should feel " faint " in 
 the night, or to make a point, as some of them have 
 done, of rousing the maid in the night to heat milk 
 or make tea and bread-and-butter for them. In 
 another place she tells us that she is becoming so 
 thin as to be approximating to length without 
 breadth ! Was that due to under-feeding ? Is it 
 likely that a person taking four meals a day would 
 sufter from direct starvation ? How is it possible ? 
 Was it not, rather, the starvation of over- 
 repletion, the attenuation of excess ? No doubt it 
 was. And the proper indication would have been 
 to diminish or restrict the diet, not to increase it. 
 The action of the predisdosing cause continues. We 
 find her describing herself as suffering from constant 
 colds. No sooner is one passing ofi by its stuffy 
 stage than another is beginning with its wet one. 
 Writing to a friend, she unwittingly informs us of 
 the cause of this also. " You know our habits," she 
 says ; " lunch at half-past one, walk from two to 
 four, and dinner at five." How could any person 
 hope to be well who followed such pollaki-siteous 
 habits ? Headache succeeded headache, cold 
 
515 
 
 succeeded cold, backache and rheumatism tormented 
 the patient ; and constant change of air and scene, 
 with frequent runs to the Continent, were adopted 
 to get rid of ailments which were not due to climate 
 at all, but to wrong living. And as the causes 
 continued their action, how could the effects cease ? 
 But why say more ? Alas ! that noble life came to 
 an end at sixty-one years of age from disease of the 
 kidneys, intercurrent attacks of headache and of 
 rheumatism sadly interfering with work ; and the 
 world was deprived of the maturer sagacities which 
 would no doubt have flowed from her pen as her age 
 advanced. Had she overcome the physical weak- 
 nesses of humanity, she would have become even 
 purer and more ennobled, reflecting in advanced age 
 most clearly the transforming light as from a 
 mountain-peak, ascending ever higher and nearer to 
 the heavenly source of knowledge and inspiration. 
 The hard work, the anxiety, the cold forbidding 
 weather, the fog, and the other drawbacks of an 
 English climate (the healthiest, probably, under 
 heaven, notwithstanding), would have failed to 
 destroy the life so early, had the foundation of it, 
 the nutrition, been put on a proper basis. And how 
 simple the remedy ! Breakfast at half-past eight 
 and dinner at four or a little after, with the omission 
 of the lunch and the meal at eight (though a cup of 
 tea alone might then have been taken if desired), 
 such a plan would have interfered with no one's 
 comfort, would have reduced labour to others and 
 not increased it, would have led to the disappearance 
 
 GG 2 
 
516 
 
 of the headaches, the backaches, the colds and the 
 rheumatism, and would have postponed probably for 
 twenty years the onset of the kidney disease which 
 so prematurely ended the life. Persons are so apt 
 to say that they eat too little at a time to allow 
 them to adopt such a plan, just as if they could not 
 trust to Nature to see that they have enough, and 
 forgetting or being apparently unwilling to see that 
 the demands of the body are much less than their 
 preconceptions declare, and that fine literary work 
 or pressure of anxious business is certainly not to be 
 met by poly-siteism and pollaki-siteism. How many 
 literary lives of the finest order and how many 
 business lives of the highest calibre have been 
 destroyed in this way twenty, thirty, forty years 
 before their time, and how many delicate and refined 
 mothers have left their children motherless from the 
 same cause ! 
 
 I have now mentioned a considerable number 
 of kinds of disease which afiect humanity that are 
 amenable to dietetic treatment, that can be pre- 
 vented by proper modes of living, and particularly 
 by proper dietetic modes of living, and that can be 
 cured, if they have not advanced too far, by proper 
 dietetic measures. I have shewn that these con- 
 siderations are true for bronchitis, for broncho- 
 pneumonia, for asthma, and for pneumonia ; for 
 rheumatism and gout ; for neurosis and hysteria, and 
 brain-fag, neuralgia, and even many fonns of insanity ; 
 for the fevers and the specific inflammations, like 
 erysipelas of the face, and sycosis of the chin and 
 
517 
 
 cheeks ; for senile and juvenile struma and scrofula ; 
 for ulceration and for other forms of disease. I have 
 shewn that the cause or the main cause of all these 
 various forms of disease being improper feeding, 
 they can all be prevented and even cured by having 
 recourse to proper feeding. And the curious and 
 simple consideration has been forced on our attention 
 that the particular form of improper feeding, which 
 is causing so many of our diseases, is not too little 
 food, but too much. So that the cure in all cases, 
 or at least in so large a majority of cases as 
 practically to amount to all (say two- thirds to nine- 
 tenths of all cases of illness), is not to increase but 
 to restrict the diet. Still more curiously and more 
 simply does it seem to arise from what has been 
 said that if we were to feed our children and 
 ourselves, living in towns, on two daily meals, to 
 the extent of say an ounce of mixed diet daily for 
 each ten pounds of our body weight, or perhaps in 
 the case of the children an ounce daily to each 
 eight pounds of their body weight, we should 
 obtain on the average very much better health than 
 we do now. Do we suffer from recurring attacks 
 of bronchitis, broncho-pneumonia, pneumonia, or 
 asthma, then let us see what dissiteism, to the 
 amount of about a pound of mixed diet daily will 
 do for us. Do our children keep taking colds, or 
 catching fevers, getting enlarged tonsils, or 
 adenoids in the nose ? Let us see what we can do 
 for them, after their recovery on a fluid diet, by 
 putting them on two daily meals, consisting of say 
 
518 
 
 an ounce of mixed diet daily for each eight pounds 
 of their body weight, or on three meals at the 
 outside. Are they suffering from juvenile struma, 
 or are the seniors among us suffering from senile 
 struma ? Let us put them on two daily meals, and 
 the seniors even on one, and they will recover from 
 these serious evils more quickly and more safely 
 than if treated by any other means. Or do we find 
 ourselves suffering from specific inflammations, like 
 erysipelas of the face, whether associated or not 
 with the growth of micro-organisms in the blood 
 and tissues of our bodies ? Let us see what effect 
 two daily meals will have on us and our ailments, 
 the quantity of our food being regulated as 
 suggested. After 50 years of age, let us reflect 
 that we are safer with one meal than with two, that 
 monositeism is better for us than even dissiteism, 
 but that it is at least much safer than tris-siteism or 
 tetra-siteism, and still more than any larger number 
 of meals. Do we find ourselves suffering from 
 ulceration anywhere in the body, between the toes, 
 for instance, or on the face, or in any part of the skin, 
 or from eczsema ? Let us see what the effects of the 
 same treatment will be, with perhaps some sooth- 
 ing topical application to the affected part. Truly 
 the re-discovery that disease is one, one in causation 
 and one, therefore, in treatment, one also in the 
 means to be adopted for the prevention of its very 
 various phases and forms, this re-discovery is at last 
 put to simple and very practical and efiicient use. 
 The question, in fact, arises : are there any diseases 
 
519 
 
 to which these principles are not applicable ? We 
 saw, as regards cancer, not, indeed, that we may- 
 have much prospect of cure in cancer from, 
 dissiteism or monositeism, or even a-siteism, but that 
 under fasting and starvation its pain is much 
 diminished and its suffering assuaged ; while by a 
 proper system of dieting there is the strongest 
 reason to believe that this terrible scourge could 
 be prevented from attacking humanity, and from 
 sweeping away its most useful members in the very 
 culmination and acme of their activity and powers. 
 Are there any diseases to which the same principles 
 are not applicable ? I do not know of any. 
 The considerations advanced in former chapters, 
 dealing with the alterations of function, and 
 shewing how health and disease shade off into one 
 another by insensible gradations, also shewed that 
 diseases of the heart, of the circulation, of the brain, 
 of the respiration, of the nerves, of the intestines 
 and of the kidneys, are all due to changes in 
 nutrition, and depend more on digestion, and there- 
 fore on food supply, than on any other one cause, 
 and probably more than on all other causes put 
 together. What other diseases are there which are 
 not amenable to this consideration ? Appendicitis ? 
 The diagnosis is too pat in most cases. It is not 
 the appendix which is inflamed in so many of these 
 cases, so much as the caecum or typhlon, that is, the 
 part of the bowel to which the appendix is attached. 
 We have generally to do with a peri-typhilitis, or an 
 enteritis, or inflammation of the bowel, rather than 
 
520 
 
 with appendicitis. And not infrequently in what is 
 called appendicitis, the connective tissue of the 
 pelvis and of the muscles of the abdomen is inflamed 
 also, the suffering child wincing like the neurotic 
 or hysterical woman, so called, when you press him 
 even lightly on any of these widely distributed 
 tissues. Are we to remove the typhlon or the 
 csecum or the gut itself to cure inflammation of the 
 bowel ? Or the connective tissue or muscles of the 
 abdomen to cure appendicitis ? Are we to amputate 
 the head in order to cure neuralgia of the face ? 
 Are we to consider that the highest aim of 
 medicine and surgery is to remove organs and 
 structures with which nature has endowed us ? or 
 is it rather to advise us how to live, so that we may 
 be able to retain them in a sound and healthy 
 condition ? Truly the advances of surgery in this 
 generation have been great. But is there not too 
 much surgery ? What if much of it could have 
 been made unnecessary, and what if much 
 impending surgery for the future may be rendered 
 unnecessary by proper methods of living ? Would 
 not that be much better than boasting of what we 
 are able to achieve in the way of removing organs 
 and parts from these wonderful bodies of ours ? 
 If the duration of life has been increased, how is it 
 that the sickness is greater than it was ? Is it not 
 because in our worship of wealth and luxury we 
 have forgotten moderation, and are over-looking 
 the necessity of exercising that amount of self- 
 restraint and government, without which we fail in 
 
521 
 
 the noblest aims of humanity ? Yes, it is hard for 
 the children to have to face this question. I freely 
 admit it. Their elders do not find it easy, but 
 sooner or later all of us have to face it. But truly 
 the penalty for breach of the laws of nature is not 
 averted by any frantic appeal of ours, from the 
 tender young or feeble old ; nor can it even be made 
 to fall, much though we might desire it, only on the 
 mature and on those who are or ought to be most 
 able to bear it. Therefore, it seems to me, even 
 the children must be taught, and that early, what 
 is the nature of the law and of the government 
 (merciful and gracious as it seems to me) under 
 which we live. And if instruction is thus early 
 imparted, the feeble old will not be called upon 
 to bear anything more than their strength will 
 allow. 
 
 Now I daresay it will be easy to bring ridicule 
 to bear on what has been said. It will be repre- 
 sented that monositeism and dissiteism are held up 
 as a panacea for all the ills of humanity. I know 
 as well as any omniscient critic that there is no 
 panacea against suffering. Do what we will or 
 may, there will always be a great deal of it. That 
 also has its lessons, with which I do not pretend to 
 deal. But if any man can tell us what better 
 remedy (even if there is no panacea) there is for 
 the evils of life than moderation in all things, 
 whether in work or rest, in food or drink, in joy 
 or sorrow, in egoism or altruism, he will do 
 well to declare it. And if he can offer a better 
 
522 
 
 approximation than mine towards the definition of 
 what moderation is, no one will be readier than I to 
 consider and adopt it. 
 
523 
 
 CHAPTEE XIII. 
 
 The Effect of Exercises on the Body. 
 
 T HAVE said very little hitherto, beyond the 
 reference made in discussing Mr. Smith's letter 
 in the last chapter, on the effects of exercises on the 
 human body. By implication, indeed, I have said a 
 good deal, or at least the reader has been left to 
 infer a good deal. Dr. Dewey, with the fine 
 medical insight that characterises him, thinks that 
 exercises are not particularly indicated for the 
 preservation of health, in this agreeing with some 
 ancient authorities, notably Erasistratus, who said 
 much the same thing. I have already mentioned 
 my own agreement with both of these authorities, 
 provided that people in general took no more food 
 than they require in order to keep the body in 
 health and efficiency. But as most, and in fact 
 nearly all of us do fall into the latter mistake, I 
 still agree with the majority of the ancient and 
 modern physicians in recommending moderate 
 exercises to be taken, especially in the act of 
 dressing in the morning, in order to keep the body 
 supple, young and active, and in order to render 
 ourselves more efficient for the work of the day. 
 But I think I ought to enter a caveat about their 
 
524 
 
 use. For if a man persistently over-fills his blood 
 and connective tissues with material ingested 
 greatly in excess of his requirements, he will find 
 himself sufiering particularly in two disadvantageous 
 ways. In the first place, he will find himself very 
 much disinclined for exercises, and secondly, when 
 he takes them, they will seem to tire him instead of 
 freshening him. He may even do himself harm by 
 them, especially if they are violent or severe, or too 
 long continued or too suddenly entered upon. I do 
 not, for example, think it is at all a wise thing for a 
 man engaged for weeks or months in somewhat 
 sedentary business pursuits, to go out for a long 
 day's shooting, involving heavy exercise or laborious 
 tramping over rough ground. If he has been 
 over-working his digestion for a long time, and if he 
 then adds to his overwrought organism the labour 
 of action and sustained exercises, to which he has 
 been for long unaccustomed, he will simply damage 
 himself, because he will be over-working his body in 
 two directions. He might possibly be able to 
 sustain the labour of one of these (though of 
 course even that would not be wise), but the 
 combination of the two will be almost certainly 
 harmful. The efiects are a little like those of both 
 eating and drinking too much. It is most unwise 
 to do either, but to do both together is certainly 
 more damaging than to do one alone. And so with 
 exercises and over-feeding or over-drinking. The 
 business man, therefore, who wants to go shooting, 
 had better take say a couple of hours' exercise of 
 
526 
 
 that sort the first day, and go for a forenoon or an 
 afternoon on the two or three next succeeding days, 
 before he ventures on spending the whole day in 
 work to which for a long time he has been un- 
 accustomed. And the same general rule ought to 
 govern the taking of any kind of exercise, as riding, 
 bicycling, cricketing, football, &c., it ought to be 
 entered on gently, and gradually increased. There 
 can be no doubt at all that much damage has often 
 been done by neglect of this rule. Of course, for 
 the countryman, accustomed to ride or to do heavy 
 manual labour, the same precautions would not be 
 necessary. But I am advising townsmen for the 
 most part ; or coimtry people, who, although they 
 may live in the country, are yet occupied in what 
 may be considered as townsmen's work ; and it is 
 these whom I have in my mind, as indeed they form 
 the large majority of the people of England (and 
 most other civilised lands) to-day. 
 
 The subject of exercise has hardly, I think, 
 received adequate consideration. True, the public 
 school education of England has always laid great 
 stress on the value of games and exercises, the 
 influences of which have been most beneficial on 
 the health of her boys and young meiL But until 
 comparatively recent times this means of develop- 
 ment has been almost wholly neglected in the case 
 of girls. With them, as with grown up women, 
 it used to be assumed that the performance of 
 the business of life would provide sufficient 
 exercise for the various muscles of the body. At 
 
526 
 
 least, nothing was so common, when exercises 
 were recommended for young or old, as for the 
 medical man to be told, " Oh, I am moving about 
 from morning till night. I cannot require exercise. 
 If an3i:hing, I have too much. " But the muscular 
 movements involved in the performance of the 
 business of life are very often monotonous, and 
 involve the performance over and over again of the 
 same, and that a limited number of movements or 
 of exercises. Take, for instance, the life of the 
 woman doing domestic work. Her occupation is 
 varied enough, certainly. To be one's own cook 
 and housemaid, and charwoman, and nurse, and 
 laundress, all at once, at short and alternating 
 intervals, seems to imply the need of making a 
 large variety of movements. And yet, even with 
 all these, certain muscles hardly get exercised at 
 all. How stiff many of the women, so occupied 
 all day long and day after day, become in the 
 muscles of the back, for instance, is well-known to 
 those who have to advise them. Of course some of 
 these conditions, as well as the peliosis from which 
 so many women suffer, are due, as has been said so 
 often, to the wrong food habits in which so many 
 of them indulge. Still some of the effects are 
 attributable to confinement indoors, and to the 
 absence of methodised exercises. In fact, such 
 women suffer from three great hurtful conditions — 
 too frequent eating, absence of fresh air, and want 
 of methodised exercises. We have seen how the 
 first cause over-fills the connective tissues of the 
 
527 
 
 body with lymph and lymph-corpuscles ; and it 
 is easy, therefore, to see how, before this has 
 culminated in its effects by acting over a very long 
 time, these effects can be combated at least to 
 some extent by well devised exercises, since these 
 stimulate the circulation and lead to the oxidation 
 and combustion of some of the unused stuff* 
 accumulated in the body. It is an interesting 
 thing, also, that the performance of methodised 
 movements for ten, fifteen, or twenty minutes, 
 twice a day, not only does not add to the fatigue 
 of persons so occupied, but positively diminishes it. 
 and enables them to do their daily work better. It 
 is better to rest a little after these movements ; but 
 if, for instance, they have been taken in the 
 morning, finishing the act of dressing usually gives 
 aU the rest required, and, after a drink of hot 
 coffee or tea, one is stimulated for the vigorous 
 entrance on the work of the day, which will be 
 done effectively, as, like a spring compressed and 
 gradually uncoiling, the body gradually gives out 
 the energy received by sleep and from the food of 
 the day before, in the form of heat and work done. 
 Few persons are so occupied that they cannot spare 
 the time required for such exercises. What sort of 
 exercises ? The ancients appear to have used two 
 main sorts, what they called gestatioj and what was 
 called exercitatio ; or what we should now term 
 passive and active movements. On the whole, a 
 good deal of importance seems to have been 
 attached to exercises by the Roman physicians. I 
 
528 
 
 do not suppose for a moment that their advice 
 would be followed by the mass of the people. The 
 social condition of the population would act as an 
 effectual barrier to that, as unfortunately it still 
 does to a great extent to the mass of the people of 
 our own day. But we find Celsus writing after this 
 fashion. '* He whom either domestic or civil duties 
 have occupied during the day ought to set apart 
 some time for the care of his body (curationi cer ports 
 suij, and his first care is exercise (exercitatio) , 
 which ought always to precede food. And exercise 
 ought to be more elaborate (amplior) in the case of 
 him who has worked little and has been well 
 supplied with food " (bene concoxit — it is really 
 surprising how much these ancient physicians knew) 
 " while it should be less in the case of those 
 fatigued with labour, and who may have digested 
 less." 
 
 As to passive movements, " the most gentle 
 gestation," says Celsus, "is that of a ship, either in 
 a harbour or a river ; the more violent is on the 
 high sea or in a suspension couch {lecticd) ; more 
 violent still is that of a carriage. And indeed each 
 of these may be either intensified or rendered more 
 gentle. If there be none of these things within a 
 man's reach, a bed ought to be suspended and 
 moved from side to side. If there be not even 
 that, a prop is to be put under one foot, and by this 
 fulcrum the head is to be propelled backwards and 
 forwards by the hand." 
 
 A rather strange, but certainly interesting 
 
529 
 
 picture, this, of the passive movements which were 
 prescribed for patients in the second century of the 
 Christian era ! It is to be hoped that they were 
 beneficial. The active exercises were, on the other 
 hand, " reading aloud {clara lectio), the use of arms, 
 the ball. Running and walking are," he says, 
 " very convenient exercises ; the latter of which 
 would be more advantageous if not on a plane, 
 since the body may be exercised better by an 
 ascending and descending variety, unless it be very 
 weak. And it is better in the open air than in a 
 portico ; better in a shade formed by walls and 
 shrubberies than that which is under a roof ; a 
 straight walk is better than a winding. But 
 incipient perspiration ought generally to terminate 
 the exercise, or at least lassitude short of fatigue, 
 and even in this, itself, it ought to be sometimes 
 more, sometimes less. And, indeed, there ought to 
 be no fixed rule {nee certa esse lex) nor immoderate 
 labour in these exercises, in imitation of the 
 athletes. Unction very properly follows these 
 exercises sometimes, either in the sun or before the 
 fire ; at another time a bath, but in a chamber 
 
 as high, light, and spacious as possible 
 
 After these things it is necessary to rest a 
 little." 
 
 The elaboration of the bath also is well known 
 to have reached some perfection amiong the Romans, 
 with its tepidarium, calidarium, and laconicum, its 
 solium, piscina, and frigidarium ; besides the 
 adjuncts of the aquarium or reservoir, vasarium, or 
 
 HH 
 
530 
 
 place for holding the vessels where the water 
 was heated ; and the hypocaustum or stove. 
 
 If we set aside the somewhat fanciful arrange- 
 ments and advice as to passive movements 
 {gestatio), I think we must admit that the ancient 
 physician who recommended the arrangement for 
 active movements [exercitaiio) knew well in this 
 matter, as in so many others that he wrote 
 about, what he was talking of, and gave good 
 advice. He may not have known anything about 
 oxidation, or about the accumulation of various 
 waste products in the connective tissues of the 
 body. Still less could he have named those 
 products ; but his juxta-position of digestion (con- 
 coquere), with movements [gestatio and exercitatio), 
 and his clear perception of their interdependence 
 and relations to one another, mark him out as 
 possessing the insight required by the accomplished 
 physician of all times. It is the same man who 
 formerly compelled our admiration when dealing 
 with the pulse and with the allowances which ought 
 to be made for changes occurring in its rate and 
 rhythm, and that, many hundreds of years before 
 the discovery of the circulation of the blood. 
 
 As to the exercises themselves, the reader may 
 ask, of what sort they should be. They should be 
 arranged so as to move in a methodic manner all 
 the muscles, not, as is too often the case, to move 
 some muscles to the exclusion of the rest. Games 
 are, of course, most useful for this purpose. The 
 games ought to be such as are not too violent. For 
 
531 
 
 young people, of course, more freedom and rapidity 
 of movement, and more exertion are allowable than 
 for middle-aged or elderly persons. Cricket, which 
 involves both the action of running, and the many 
 movements of throwing, catching, striking, and 
 finding the ball, is, of course, an admirably 
 contrived set of exercises. Football also might 
 perhaps be so, if it could be relieved of its present 
 drawbacks. A game which involves wrestling and 
 struggling so fierce as to wrench, and strain, and 
 sprain muscles and ligaments, fracture collar bones, 
 shoulder blades, ribs and legs, and do other grievous 
 bodily injury, may be a good game and a well 
 devised exercise in itself, but it is in need of reform. 
 Lawn tennis also is a very good game, its few 
 drawbacks being comparatively easily overcome. 
 Golf seems to be in all ways a most admirable 
 game ; and no doubt there are others, as billiards, 
 &c., which are suitable. Walking the deck on 
 shipboard has a fascination for many people, 
 providing exercise in the open air with the least 
 possible fatigue, and having the advantage that it 
 can be stopped at any moment that fatigue is felt, 
 and can be as readily resumed. Walking, running, 
 leaping, fencing, boxing, the use of the rings and 
 parallel bars, and the various movements involved 
 in the use of arms, are all useful, and of much 
 benefit to those who can indulge in them. Mention 
 should also be made of the bicycle and tricycle 
 now so much in vogue. No doubt, most valu- 
 able exercises can be obtained by their means, 
 
 HH 2 
 
532 
 
 particularly by women, whose lymph and blood 
 circulation can often be stirred up in such a way as 
 to materially improve many of those chronic initic 
 invalids, whose cases are at once the despair of the 
 medical profession, and the cause of so much distress 
 and despondency to patients' friends. No doubt it 
 is in wrong food habits, and in the absence of exercises 
 that the causes of these depressing ailments are to 
 be found ; and the bicycle offers a means of 
 supplying a useful form of the one necessity, while 
 by stimulating the digestive powers to greater 
 activity, it will also help to supply the other aid to 
 healthy life. Of course all good things must be 
 used in moderation. Already there are whispers of 
 the overuse of this form of exercise (as from time 
 to time there are also of others). It is devoutly to 
 be hoped that abuse of a form of exercise, very 
 good in itself, may not justify, or seem to justify, 
 a denunciation, which, even if merited by cases of 
 abuse, will be likely to restrict its proper use. 
 There is everything to recommend the prescription 
 of the use of bicycle exercises (and this applies also 
 to all exercises), for such lengths of time as patients 
 can bear, whether for half an hour, or an hour, or 
 two hours, according to the needs of the particular 
 case. The marks of a well balanced mind are that 
 we should use things which are helful to life in a 
 more or less equal and equable manner, with 
 variations of less and more, indeed, according to the 
 varying circumstances of the moment, and accord- 
 ing to the varying needs of life. But, on the other 
 
633 
 
 hand, we should avoid those extremes of rush and 
 torpor, of too excited use alternating with unmerited 
 neglect, of too enthusiastic recommendation and 
 too vehement denunciation, which are the character- 
 istics of want of balance in the mind of the 
 individual, of the community, or of the medical 
 profession. 
 
 All these modes of exercise, however, require 
 much time^ and many of them involve more expense 
 than can be afiorded by the average man and 
 woman. Happily the board schools now train both 
 boys and girls in movements and exercises admirably 
 adapted to health. In later life, most men and 
 women soon find that the main object of life is not 
 amusement, but work ; and it too often seems more 
 or less of a satire to advise those who are ill to 
 resort to out-door exercises. However admirable 
 the advice is in itself, it is too often impossible to 
 follow it ; and indeed, had it been possible to adopt 
 and adhere to it, the patients might in many cases 
 have escaped being ill at all. But there are few 
 persons so poor, or so much occupied, as to be 
 unable to afford to give five, ten, fifteen, or twenty 
 or thirty minutes to methodised movements twice a 
 day, movements devised for the exercise of all the 
 muscles of the upper limbs, of the head and neck, 
 of the ribs and trunk, of the abdomen, of the 
 flanks, of the thighs and legs. And everyone who 
 wishes can suspend a pair of rings from a beam in 
 the roof, or can use light dumb bells (they need not 
 weigh more than two pounds each), or clubs, even 
 
534 
 
 if he cannot find time or means to visit a 
 gymnasium regularly, Of course the society found 
 at a gymnasium adds a healthful stimulus to life, 
 and may be recommended to all who can make the 
 opportunity to visit one. For those whose time is 
 limited, or who for other reasons cannot use 
 gymnastic instruction, nothing could be better than 
 to read the little book, say, of Dr. Schreber 
 (Leipzig, Fleischer — it has lately been translated by 
 Day, of Norwich) entitled "Aerztliche Zimmer- 
 gymnastik." This little gymnastic instructor, 
 "made in Germany, " in its 25th edition, when I 
 last saw it (the last edition consisting of 10,000 
 copies), gives wood-cuts of a large number of 
 muscular movements and bodily positions, most 
 admirably devised, and as pictorially instructive to 
 those who cannot read German as to those who can. 
 It says much for the sound sense of our German 
 friends that there should be among them so great a 
 demand for so useful a book, and offers an example 
 which all would do well to follow, both in this 
 country and elsewhere. I might also mention the 
 chart published by Professor Dowd, of New York, 
 as offering an excellent pictorial exhibition of useful 
 movements. 
 
 There are also other valuable guides to 
 methodised exercises. Especially does attention 
 seem to have been bestowed on these in the United 
 States of America. The foundation of such 
 literature in modern times is, of course, the Swedish 
 system inaugurated by Ling. But as a development 
 
535 
 
 •on this we have the handbook of school gymnastics, 
 by Baron Nils Posse (Lee and Shepard, Boston), a 
 small but well arranged set of progressive exercises 
 for children. Then there is the physical culture of 
 Louise Preece (C. W. Bardeen, Syracuse, N.Y.), 
 which deals not only with systematic exercises and 
 movements, but also to a considerable extent with 
 the expression of the emotions by gesture. And a 
 Httle book by Edwin Checkley, entitled " A Natural 
 Method of Physical Training" (London : 24, 
 Bedford Street ; Strand ; and New York : 27, West 
 Twenty- third Street ; G. F. Putnam's Sons), ought 
 to be mentioned. Then there are ' ' Sound Bodies 
 for our Boys and Girls," by William Blaikie 
 (London : Sampson Low, Marston and Co.), and 
 " Modern Gymnastic Exercises," by A. Alexander, 
 F.B.G.S., both of them very good books. All of 
 these works give valuable information regarding 
 exercises, and the methods of performing them, and 
 may be consulted with advantage. And no doubt 
 there are others, as Sandow's and Whiteley's 
 Exercisers, which are also useful. 
 
 With these representations before one, it is 
 possible to avoid the verbal descriptions which 
 would take up so much space, and which would not 
 then be so clear as the wood-cuts themselves. And 
 I can go on, therefore, to say, respecting muscular 
 movements, that the best time to take them is 
 before a meal, as Celsus says, or immediately after, 
 before digestion has fairly begun ; otherwise it is 
 not wise to take them say a couple of hours 
 
536 
 
 after food, as then digestion is in full swing, and 
 the economy ought not, so to say, to have its 
 attention disturbed when engaged in the digestive 
 process. Four or five hours after a meal, on the 
 other hand, or an hour or so before the next one, 
 is a suitable time, as the movements, especially if 
 aided by the drinking of half a pint of water, 
 stimulate vitality, increase oxidation, improve the 
 power and rapidity of the circulation for the time, 
 and stimulate the digestive viscera to complete the 
 digestion of the previous meal. Another thing 
 which these movements effect is, by stimulating the 
 power and rapidity of the capillary circulation, to 
 prevent the deposition in the connective tissue of 
 those waste products which are apt to be filtered 
 out of the blood at that period of digestion, and 
 even to remove them if such deposition has already 
 occurred. In this way, neuralgias, " brain-fag," 
 rheumatisms, &c., tend to be prevented, and even 
 cured. The best time for the taking of exercises 
 seems, therefore, to be in the morning, in the act of 
 dressing. The proper use of them may involve the 
 getting up in the morning twenty or thirty minutes 
 sooner than usual, not a bad suggestion for any of 
 us. I think movements may with advantage be 
 had recourse to once again in the course of the day, 
 at some convenient time, as the organism does not 
 seem to retain the impress of actions of this sort 
 for more than twelve hours. Of course once a day 
 is better than not at all ; but to parody the words 
 of Celsus about food, it seems to me that it is 
 
537 
 
 better to have exercises twice than once a day, 
 potius his die quam semel exercitationem capere. 
 If this be admitted, the best time for the second 
 set of exercises will be about four, or five, or six 
 o'clock, according as people have more leisure time. 
 The well-to-do have often a toilet to perform at that 
 time, and a cup of afternoon tea taken then will 
 stimulate and aid the ejffect of the exercises. The 
 workpeople return from work about the later hour, 
 and have their evening meal afterwards. If the bath 
 has been taken in the morning, there is no need for 
 another then ; but if not, and if there is leisure for 
 for it, the addition of a bath to the afternoon 
 exercises will add to their refreshing influences, and 
 to the feeling of ease, lightness, and freshness 
 which they induce. 
 
Index of Words, Proper Names, Subjects, and 
 Etymology of Words not explained in the 
 text. 
 
 PBSTINENCE. And alcohol, 123 ; well borne by old 
 persons, 379 ; ill-borne by children, 379, 455, 465 ; 
 and plethora, 509. 
 Accident. And principle, 238 ; and essence, 480 ; as a 
 
 cause of death, 49-50. 
 Acid. Uric, 309 ; carbonic, 4 ; gastric, 146. 
 Acne, 78. 
 Action. Defective, excessive, irregular, 215 et seq. See 
 
 Dilatation and Contraction ; also Function. 
 Activity. And stagnation, 513. 
 Acute. Of disease, 91 et seq. 
 Addison, 283, 510. 
 Adenoids, 129. 
 Aeginetus (Paulus), 356. 
 Aetiology or Etiology. Causation, 439. From ama = cause, 
 
 and Xoyo5 = description. 
 Africa (South), 104-5. 
 Age. Periods, 33 ; old, 58. 
 Ague. And diet, 453. 
 Aim. Of Medicine, 396. 
 
 Air. Bad, and fever, 111 ei seq. ; deprivation of, 230. 
 Alexander, 535. 
 Alcohol. Alcoholism, 74-81, 311 ; and abstinence, 123 ; and 
 
 food, 312, 440 ; a relaxant, 211. 
 
540 
 
 Alderehot, 293. 
 
 Alimentary. Disease, 54. 
 
 Aliemaiio vel Complexio, 210. 
 
 Amylism. See Poly-amylism. From d privative = and fxyXri 
 = mill. Meaning is, that portion of cereal grain not 
 ground in the mill ; starch. 
 
 Anaemia. From d privative and alfxa = blood = bloodless- 
 ness. Case of, 204-5, 256, 471 et seq ; pernicious, 498. 
 
 Ancient views. Of heredity, 342 et seq ; on feeding infants, 
 356 ; physicians, what they knew, 140-2. 
 
 Animal, animals, animal spirits, 161 ; physical and meta- 
 physical, 162 et seq ; slaughter of, 323 ; domestic and 
 cancer, 412. 
 
 Anxiety. And Job, 336 ; and children, 352 et seq ; and sex 
 and cancer, 425 et seq ; and influenza, 337. 
 
 Apoplexy. From aTTO = from, and ttXtJ^lo- = stroke or 
 blow ; classification of, 72. 
 
 Appendix, appendicitis, 22, 519. 
 
 kpicnov, AvdpLO'TO^. Breakfast, breakfastless ; no break- 
 fast plan not new, 267. 
 
 Arteries. From aprrjpiaL ; connected with aiqp = air ; term 
 applied to arteries going from the heart, because after 
 death they were always found empty, and supposed 
 therefore in life to be full of air, 127 ; pulmonary, 150 ; 
 of brain, 160 ; definition of, 163 ; coats of, 187. 
 
 Arthritis. From "XpBpov = socket of joint, 451. 
 
 Asclepiades of Prusa, 92, 99, 492. 
 
 Asthma. From '^AcrOfxa = panting breath, or breath simply ; 
 means difficult breathing ; cause and cure, 445 et seq. 
 
 Astronomy, 7. 
 
 Asylums, 246-7. 
 
 Atavism. See Heredity. 
 
 Athenaeus, 116, 118. 
 
 Atwater, 279 et seq. 
 
541 
 
 B. 
 
 Baby, beggar's, 239 ; rich woman's, 240 ; feeding of, 288. 
 
 Bacillus. Tuberculosis, and excess of lymph, 171 ; probably 
 in most persons, 171 ; of diphtheria, 384 ; and causation, 
 433, 482. 
 
 Bacon, 15. 
 
 Balanced mind, well, 532. 
 
 Banks, Sir W. M., 428. 
 
 Banquets, numerous. Effects of, 117 et seq. 
 
 Basic slag. And clover, 172-3. 
 
 Baths. Among Eomans, 529 ; component parts of Boman 
 baths, 529-30. 
 
 Beaumont, Dr., 297 et seq. Beef, and hot water, 447-8. 
 
 Beggar's baby, 239, 361. Bicycle, 531. 
 
 Birth-rates, 39-48. Blaikie, 535. Bleeding, blood-letting, 139. 
 
 Blood. Circulation of, 139 et seq ; distribution of, 155-62 ; 
 Made from food, 151 ; nourishes body, 151 ; goes every- 
 where in body, 152 ; blood in brain not under government 
 of heart, 159 ; corpuscles, 163 et seq, 191 ; and fasting, 
 290-2 ; dumping ground of 314 ; foreign matter in, 400 
 ei seq. 
 
 Boa-constrictor, 147. Body, living on itself, 203. 
 
 Boer war, food of soldiers in, 115. Boxing, 531. 
 
 Boom, and panic, 217 et seq, 513. Bracing, 87. 
 
 Brain. Paralysis, 67 ; fag, 503, 536 ; blood in and in spinal 
 cord, 158 ; circulation, government of, 159 ; action of, 
 hindered by too much blood, 160. 
 
 Braithwaifce, Dr., 428-30. 
 
 Bread. Given in excess, 200 ; illnesses, caused by, 200 ; in 
 infirmaries, 284. 
 
 Breakfast. No breakfast plan not new, 267. 
 
 Brief, of disease, 97 et seq. British Army, and consumption, 
 330-1. 
 
 Bronchi, bronchia, bronchitis, 53, 72, 127 ; name, 228 ; caused 
 and cured by diet, 444-60 ; dogma on, 454. 
 
542 
 
 Broncho-pneumonia, 105 ; and diet, 453. 
 
 Bruising, 321-3; see peliosis. Bumey Yeo, Dr,, 66. 
 
 Business, course of, and medicine, 216-9. 
 
 C. 
 
 Caecum, or blind gut, so called by Latin name ; Greek, 
 TV(f)\ov, because it ends in a cul de sac, 23, 228. 
 
 Caelius Aurelianus, 128. 
 
 Calories, 197 ; and milk, 248, 277 et seq ; 304 et seq. 
 
 Cancer. Mortality from, 59-61, 71 ; and constipation, 181-2 ; 
 hereditary? 391 et seq, 183-4, 381-434; causes of, 381; 
 preventible, 383 ; and panic, 382 ; and laboratary experi- 
 ments, 383 et seq ; and food, 387 et seq ; and the King, 
 389 et seq ; incurable, 395 et seq ; from without, 398 ; 
 and bodily temperature, 401 ; and injury, 403, 438 ; and 
 heredity, 405 et seq, 519 ; and children, 409 ; and 
 domestic animals, 412 ; and sex, 414 et seq ; once can- 
 cerous always cancerous, 393 ; and women, 420 et seq ; 
 and regular living, 424 ; and misery, 424 ; and poverty, 
 424 ; and anxiety, 425 et seq ; and low-lying districts, 
 426 ; and salt, 429 et seq ; and Jews, 429-30 ; reducible 
 and preventible, 433 et seq ; evolution of, 441. 
 
 Carbon, carbonic acid, 4, 269. 
 
 Carbonaceous or carboniferous foods, 144. 
 
 Carditis, 226. 
 
 Catatribsemia. From Kara = down or intensely, and Tpifieiv 
 =: to rub or waste, and alfxa = blood ; the condition in 
 which the blood is loaded with waste products, 307, 472 ; 
 see anaemia, triphthsemia. 
 
 Category, 93. 
 
 Causation. And bacillus tuberculosis, 443 ; and constant 
 association, 443 ; see day and night, also micro-organisms. 
 
 Causes. Of disease, 53-125 ; and occasion, 320-1, 122, 438 
 et seq ; essential and accidental, 324 ; contributory, 37, 
 82, 125 ; proximate, exciting and predisposing, 82 ; of 
 fevers and influenza, 111 et seq; same causes induce 
 
543 
 
 opposite states, 216-9 ; constant, effects intermittent, 472 
 ei seg ; of psoriasis, 329 ; and prevention of disease, 1^ 
 436 et seq. 
 
 Celsus, 92, 115 ; on circulation of blood, 130-1 ; practice of, 
 140, 509, 528, 535-6. 
 
 Cerebration. And food, 233 ; too great, 245 ; defective, 262-4. 
 
 Chambers, Dr. King, 195, 240, 282, 288 et seq ; 510. 
 
 Changing and fixed, 341. 
 
 Chewing, see Mastication. Checked and clogged, 266-7. 
 
 Checkley, 535. 
 
 Child, children. Eating once a day, 303 et seq ; feeding of, 
 352-80; and hereditary disease, 406-10 (see also 
 heredity) ; and anxiety, 352 ; and errors of diet, 353 ; 
 ancient views of feeding of, 356 ; mortality of, 357 ; 
 growth of, 357 et seg; neglect and over indulgence of, 
 359 ; interest of, 365 et seq ; and love of sweets, 366 ; 
 from five to fifteen years of age, 368 et seq ; and fevers, 369 
 et seq ; and schools, 377 et seq ; and cancer, 409 ; and 
 food, 410 et seq. 
 
 Chill-blains, 438. 
 
 Choked. With too much food, 295. 
 
 Choroid plexuses, 161. 
 
 Chronic. Of disease, 92 et seq. 
 
 Chyle, 149. Chyme, 148. 
 
 Cicero, 92, 492. Circle, without beginning or end, 142. 
 
 Circular. Reasoning, 11 ; fibres, 85. 
 
 Circulation. Diseases of, 58 ; when discovered, 126 ; changeEf 
 in practice from discovery of, 126 ; of blood and lymph, 
 practical bearings of, 136-8, 154 ei seq ; and food, 232 ; in 
 sleep, 313. 
 
 Clarke, Sir A., 511. Climate, 56. 
 
 Clogged and checked, 266-7. Clover and basic slag, 172-3. 
 
 Clubs, for exercise, 533. 
 
 Coats of arteries, longitudinal and transverse, 187-92. 
 
 Coccus of erysipelas, 482. 
 
544 
 
 Cold, 54-5 ; and hot, 192. Colds and food, 273. 
 
 Complexio vel alternatio, 210. 
 
 Connective tissue, 226, et passim ; see Initis, 312 ; dumping 
 
 ground of blood, 399, 451, 314 et seq. 
 Conscious of unhealthy organs, 153. 
 Constipation. And alcohol, 76-7 ; pathology of, 77, 210 ; 
 
 cure of, 78 ; from starvation, 177 ; from over-feeding, 
 
 178 et seq ; and purgatives, 180 ; and cancer, 181-2 ; 
 
 hereditary? 183-4; and diarrhoea, 194. 
 Constitution, 337-9. 
 Consumption, 29, 57-8 : in British Army, 330-1 ; evolution of, 
 
 441. 
 Contracting or shrinking, 82 et seq. 
 Contrary and contradictory, 186, 249, 347. 
 Contributory causes, 37-9. 
 Convulsions, 61. 
 Cornaro, 283 et seq, 379. 
 Corns, 438. 
 
 Corpuscles, see blood and lymph. 
 Council, medical, municipal, 296. 
 Country man, 525. 
 Create. Body cannot create, 269. 
 Creation transcends wit of man, 135, 173. 
 Crick in neck, 468. Cricket, 531. 
 Crops, bad, and short, 123. 
 Cure and prevention, 437. 
 
 D. 
 
 Damp. And cancer, 427 ; and rheumatism ; a contributory 
 
 cause of illnesses, 427. 
 Dante. Physiological ideas of, 132-3. 
 Darwin, Charles. Anticipation of theory of pan-genesis (from 
 
 TToiJ^ = all or everything, and ytvofiai = I become), 370 
 
 et seq. 
 Davis, Professor, 201, 206, 245, 272, 277. 
 Day and night, 305. 
 
545 
 
 Death-rates, see Mortality. 
 
 AeiTTVov, 267. 
 
 Defects, visual, 503 et seq. 
 
 Definition. Of health, 18-20 ; of disease, 18, 220 ; of arteries, 
 163. 
 
 Delicate child and food, 370 et seq. 
 
 Delirium tremens, 74. 
 
 Depression, 8. 
 
 Deprivation, of air, food, &c., 230. 
 
 Desire. For gain, for food, 216-9 ; and self-restraint, 508 
 et seq. 
 
 Dewey, Dr., 66, 141, 246-7, 320, 457, 510, 523. 
 
 Diabetes. Cases of, 242-5 ; theory of treatment of, 243 ; 
 Professor Davis on, 245. 
 
 Diarrhoea and dysentery. Mortality from, 61 ; and constipa- 
 tion, 194. 
 
 Diathesis, 341 et seq. 
 
 Diet, see food. Eestriction of, theory of, 175 ; in opposite 
 states, 194 et seq ; in excess of function, 242-9 ; in defect 
 of function, 249-54 ; in slow pulse, 250-1 ; in attenua- 
 tion, 254-6 ; in anaemia, 256 ; in defective respiration, 
 256-8 ; in defective renal action, 258-9 ; in too low 
 temperature of body, 259-62 ; in defective cerebration, 
 262-4 ; and disease, case of, 279 et seq ; in insanity, 320 ; 
 full diet, 278 ; subsistence diet, 287 et seq ; errors of, in 
 children, 353, 353 ; the chief cause of disease, 436 ; 
 cause of bronchitis and asthma, 444-60 ; and broncho- 
 pneumonia, 453 ; and pneumonia, 460 et seq ; and 
 rheumatism, and gout, 463-71 ; and skin-diseases, 480 et 
 seq ; and micro-organisms, 483 ; and pruritus and 
 eczaema, 486 et seq ; and ulceration, 494 et seq ; and 
 scrofulous ulceration. 497 et seq ; and malaria and ague, 
 453. 
 
 Difference of opinion among medical experts, 9. 
 
 Difficulties of medicine, 86-7. 
 II 
 
546 
 
 Digestion. Digestive processes, 143-66 ; time required for, 
 147, 167 et seg ; a labour, 284 ; at two stages in the same 
 stomach at same time, 285 : slow, 301 ; and exercises, 
 528, 536. 
 
 Dilatation. Or swelling, 82 et seq, 210 ; of pupils, 502 et seq. 
 
 Disease, diseases. Alimentary, 54 ; causes of, 68, 82 ; one, 
 128, 451, 526 ; departure from normal, 128 ; and food, 
 141, 231 et seg; 279 et seg, 435, 522 ; transmitted, rarely, 
 183, 331 ; respiratory, 53-7, 72, 151 ; tubercular, 58, 
 494 ; circulatory, 58, 72 ; digestive, 64, 74, 226 ; nervous, 
 85 ; starvational, 66 ; local and general, 136-8 ; hot and 
 cold, moist and dry, 192 ; immense number ol, 152 ; and 
 functional change, 220 et seg ; and health, 220 ; accom- 
 panied by exudation, 224 ; heredity of, 327-51 ; of 
 literary character, 511-6 ; in families, 333 et seg ; caused 
 chiefly by diet, 101, 436, 516 et seg. 
 
 Disgrace. And influenza with complications, 335. 
 
 Dissiteism. For etymology, see siteism, sitia, 251 ; as cure 
 of disease, 435-522 ; starvation diet ? 496 ; and visual 
 defects, 503 et seg ; 479. 
 
 Dogma. And bronchitis and asthma, 454. 
 
 Dowd, 534. 
 
 Duct, thoracic, 150-165. 
 
 Dulness, mental, 233-4. 
 
 Duration of life, 26, 273. 
 
 Drainage. Of land, 306-7 ; of lymph, 306. 
 
 Dry and moist, 192. 
 
 E. 
 
 Eating. To satiety, 146 ; slowly, 147 ; frequently, 237 ; once 
 a day, 302 et seg ; times of, 325 ; see Food and Diet. 
 
 Economy of Nature, 165. 
 
 Bgesta, 271, Eczaema, 487. 
 
 Eilemma, or Ilemma, etXe/i^a. A covering, 228. 
 
 Element. "Water, 83. 
 
 Emphysema, 449. A Greek word adopted. 'E/xc^vcny/aa = 
 inflation or over-distension (of air-cells). 
 
547 
 
 End-eilemmatons, 228. 
 
 Energy and food, 266. 
 
 Enteritis, 23, 226. 
 
 Environment And organism, 174 ; and heredity, 183, 339 
 
 et seg. 
 Epidemics. Of disease, 124. From e77t = upon, and 
 
 SrjfJLOS = the land, and hence the people who Hved on it. 
 Epilepsy, 604-7|; the sacred disease, 605. 
 Equation. Personal, 15. Erasistratus, 523. 
 Eructate food, 299. Erysipelas, 480 et seq. E/avtrtTreXacr 
 
 from ipvOpoq = red, and TreXXa = sMn. 
 Essence and accident. Essential and accidental, 480. 
 Etimation, low, of medical profession, 253. 
 Eternal and temporal, 341. Evans, Dr. A., 44. 
 Evidence. Probable and demonstrative, 184. 
 Evolution. Of cancer and tuberculosis, 441. 
 Exciting causes of disease, 87-8. Ex-enteritis, 228. 
 Ex-ilemmatous, 228. 
 Exercises, In peliosis, 323 ; effects of, 523-37 ; and 
 
 digestion, 628-36. 
 Exercitatio, 527. Expectant mother, 363 et seq. 
 Exo-typhhtis, 228. 
 Expectation of life, 26-36. 
 Experiment. Natural and artificial, 184. 
 Exudation in disease, 153-224. 
 
 F. 
 
 Face. Erysipelas of, 480 et seq ; family disease, 333 et seq. 
 
 Fasting. How beneficial, 285 ; raises too low temperature, 
 285 ; and loss of weight, 286 et seq ; and blood- 
 corpuscles, 290-2 ; for weeks, 292 ; and insanity, 320 ; 
 in epilepsy, 505. 
 
 Fatigue after eating, 300, 308-9, 312. Fats, 145. 
 
 Feeding. Of infants, 45, 288 ; wrong feeding the chief 
 cause of disease, 101 ; of children, 352-80 ; see Food. 
 
 Fehleisen, 482. Fencing, 531. 
 II 2 
 
548 
 
 Fever and ague, 106 ; and quinine, 107. 
 
 Feverish cold, 110. 
 
 Fevers, 2. Causes of, 3, 64. And food, 102. And bad air, 
 111 et seq. And starvation, 120 et seq. And infection, 
 369. 
 
 Fibres. Longitudinal and transverse, 85, 484 et seq. Eelation 
 to constipation and anaemia, 77. 
 
 Fixed and changing, 341. 
 
 Fluids required, 326. See alchohol. 
 
 Food. Amount taken, 4, 57 ; a cause of disease, 68, 90, 231 
 et seq, 271 ; kinds of, 143 ; nitrogenous and carbon- 
 aceous, 144; over- ingestion of, M7 ; makes blood, 151, 
 265 : and function, 236 ; and insanity, 246-7 ; how 
 much required, 265-326, 323, 448 ; and energy, 266 ; and 
 physiology, 275 et seq ; too much, 272, 448 ; of royal 
 navy, 289 et seq; and "colds" and influenza, 273; eructation 
 of, 299; fatigue after, 299, 309, 312; and alcohol, 311; 
 flesh off 323 ; and cancer, 387 et seq ; as cause and cure of 
 disease, 435-522; see diet. 
 
 Football, 531. Foreign matter in blood, 400 et seq. 
 
 Forster, 325. 
 
 Full diet, 278. 
 
 Function. Defect of, 9 ; defective, excessive, irregular, 215 
 et seq ; and structure, 134-6 ; and property, 208 et seq ; 
 and disease, 220 et seq ; and stimulus, 228 et seq ; propo- 
 sitions regarding, 236 ; and food supply, 236 ; excess and 
 defect of, treatment of, 242 et seq ; of food, to make 
 blood, 265; to nourish the body, 265 ; checked and 
 clogged ; of skin, changes in feeding of, 493-4. 
 
 G. 
 
 Galen, 92, 127, 473 ; on pulse, 131. 
 
 Games, 525 et seq. 
 
 Gastric juice or acid, 146. 
 
 Gesiatio, 527. Gin-drinker's liver, 346. 
 
 Gout, 72 ; and injury, 403. 
 
549 
 
 Gravitation. Law of, 309. 
 
 Greeks. And opposites, 208. 
 
 Giimpel (Godfrey), 430-1. 
 
 Gun-shot wound, 328. 
 
 Haddon, Dr., 304-6. Haigh, Dr., 282. 
 
 Harvey, Dr., 126. 
 
 Headaches. And diet, 479 et seg. 
 
 Health. And disease, 220 ; definition of, 18-20. 
 
 Heart. Quantity of blood in, 156. 
 
 Heat, 54-5 ; mechanical equivalent of, 266 ; and fuel, 270. 
 
 Hemiplegia, 67. (From e)u,i = half and Trkiqyrj = a blow 
 
 or stroke. Used of the condition in which one half of 
 
 the body is struck or paralysed. ) 
 Heredity of disease, 327-51 ; law of, 329 ; definition of, 340-1 ; 
 
 ancient views on, 242 et seq ; of rheumatism, 469 et seq. 
 Hippocrates, 99, 100, 116-7, 140-1, 305, 451, 509. 
 Holt, Professor, 360. 
 Hot and cold, 192-3, 235. 
 Humiliation. And Influenza, 325. 
 Hysteria, 315 ; see initis. (From varepov = uterus = womhi- 
 
 ness, therefore. An absurd name for a disease, which 
 
 men may manifest as well as women. As used, it is 
 
 synonymous with flightiness, irregularity of mentalisation, 
 
 &c.) 
 
 I. 
 
 Indies, West, 106-7, 453. 
 
 Infant mortality, 49-9, 24 ; feeding, 45, 288, 354 et seq ; see 
 
 children. 
 Infection. And fevers, 369, 403 ; keeping away from, 443. 
 Infirmaries and bread, 2 ; numerous, 10, 102 ei seg ; recurrence 
 
 of, 105 ; Stages of, 464 ; specific, 484. 
 Influenza. Mortahty from, 62-4 ; recurrence of, 104 ; causes 
 
 of, 112 ei seq ; and food, 273 ; and humiliation and 
 
 disgrace, 335 ; and infection, 443-4. 
 Inheritance ; see heredity. 
 
550 
 
 Ingesta, 270. 
 
 Initis. •|;(From tcr = vis = strength. The word therefore 
 means affection — generally inflammation — of strong or 
 connective^tissue), 225 : relation to other diseases, 314 
 et seq, 451 ; see rheumatism. 
 
 Injury, 2 ; and gout and cancer, 403. 
 
 Insane. Insanity, 222, 247 ei seq, 320. 
 
 Insomnia]; see sleeplessness. 
 
 Intermittent. Of disease, 94, 472 et seq. 
 
 Intestinal villi, 149. 
 
 Intestines, 149, 153, 498 et seq. 
 
 Itis. Termination ; meaning of 227. 
 
 J. 
 
 Jews. And^cancer, 429-30. 
 
 Job, 337. Joule, 266. Juries, 502. 
 
 K. 
 
 Kibroth-Hattaava, 3. 
 
 King and cancer, 389 et seq. 
 
 h. 
 
 Laboratory experiments, 385 et seq. 
 
 Labour of digestion, 284. 
 
 Lacteals, 150-65. 
 
 Land. Drainage of, 306-7. 
 
 Laryngismus stridulus, 67. 
 
 Latins. Names of, for opposite states, 207-8. 
 
 Laxum et strictum, 208 et seq. 
 
 Law. Of opposite states, 207-8 ; of gravitation, 308 ; of 
 
 heredity in disease, 328 ; declared by medical or other 
 
 interpreter of nature, 308. 
 Leaping, 531. 
 Liable, And subject, 333. 
 Liebig, 143-4, 266. 
 Life. Expectation of, duration of, 26, 273 ; worth living, 28 ; 
 
 early in, 333. 
 
551 
 
 Line. Drawing the, 224. Ling, 534. 
 
 Lip cancer, 403. 
 
 Liver, 148, 150 ; alteration in size of, 154-5 ; empty, fuU, 155-7. 
 
 Living. Plain, and high thinking, 161. 
 
 London and Eome. Parallel between, 118-20. 
 
 Long. Of disease, 97. 
 
 Loss of weight in fasting, 286 et seq. 
 
 Lungs, 150 ; blood in, 156. 
 
 Lymph. In brain, 161 ei seq ; what ? ; comes from blood, 
 
 163 ; spaces, 164 st seq ; and economy of nature, 165 ; 
 
 overplus of, 168 et seq ; and tubercle-bacillus, 172 et seq ; 
 
 corpuscles, 163 ; drainage, 307, 317 et seq. 
 Lymphatic glands, 163 et seq. 
 
 M. 
 
 Malarial fever, 106-9 ; and over-feeding, 109, 453. 
 
 Martin, Saint, 297 et seq. 
 
 Mastication, 143, 145, 148. Materies morbi, 272. 
 
 Meals. Number of, 113 et seq ; of paupers, 114 ; of soldiers, 
 114 ; of Eomans, 115-6, 509, 515 ; in navy, 114 ; once a 
 day, 497 ; see food, feeding, and children. 
 
 Mechanism. Bodily, 133. Medical council, 295. 
 
 Medicine, 1, 6 ; difficulties of, 13 ; chaos and simplicity of, 
 151 ; paradoxes of, 176-264 ; rival schools in, 212 ; and 
 business ; parallel between, 216-9 ; aim of, 396. 
 
 Membranes. Serous and other, 166. 
 
 Mentalisation ; see cerebration. 
 
 Micro-organisms. And disease ; and laboratory experiments, 
 385 ; see bacillus, coccus. 
 
 Middlemarch, 373. Milby, 373. 
 
 Mild. Of disease, 92 et seq. 
 
 Milk. And calories, 248, 304 et seq ; for infants, 354 ; com- 
 position of. 354 ; human and bovine, 354 et seq ; 
 laboratories, 355. 
 
 Millionaires, 385 et seq. 
 
 Moderation. The only rule, 81, 294, 522 ; in alcohol, 311. 
 
552 
 
 Moist and dry, 192. Moleschott, 277 et seq. 
 
 Monositeous ; see siteism, 468, 479 
 
 Morbtis misericB, 424 et seq. 
 
 Mortality. Zymotic, 28-81 ; from consumption, 29, 37 ; 
 
 infant, 48, 240 ; under five years, 69 ; over 65 years, 70 ; 
 
 groups of, 71-5 ; old age, 73 ; from alcohol, 74-81. 
 Moses. And fevers, 3 ; mosquito bites ; and malaria, 109. 
 Mothers. And infants, 240-1 ; nursing, 289 et seq ; expectant, 
 
 363-5 ; prejudices of, 373 et seq. 
 Movements. Passive and active, 530. 
 Municipal Councils, 295. 
 Muscles. Of back, and internal affections, 139; blood in, 
 
 155 ; for motion and v?ork, 156 ; membranes, 166. 
 
 N. 
 
 Nature. Indications from, for treatment of disease, 101. 
 
 Navy. Eoyal, 298. Navvy, in a sewer, 212. 
 
 Neuralgia. Neurosis, 226, 317 et seq ; see initis. 
 
 Neuritis, 226. Night and day, 305. 
 
 Nils-posse, 535. 
 
 Nitrogen. Nitrogenous foods, 144, 269. 
 
 Non-nitrogenous foods, 145. 
 
 Number. Proportional, 53 et seq. 
 
 Nutrition. And food, 232, 254 et seq. 
 
 O. 
 
 Occasion. And cause, 122, 320. 
 
 Oddfellows. Sickness among, 273 et seq. 
 
 Old-age, 58-73. 
 
 Opposite. And contrary and contradictory, 186, 195. 
 
 Opposition. In treatment, 190-193. 
 
 Organ, organs. Interactions between, 137 ; healthy and 
 
 unhealthy, 152-3, 
 Organisation. Transmitted, 183. See heredity. 
 Oribasius, 356. 
 
553 
 
 Over-feeding. Effects of, 166 et seq ; signs of, 177 et seq ; and 
 constipation, 178 et seq ; increases and diminishes weight, 
 195 ; treatment by over-feeding, vyhat it really is, 196- 
 219 ; apt to cause illness later, 202, 206 ; lowers powers, 
 213 ; causes over-growth, 397 ; and under-feeding, 514. 
 
 Over-growth. Cause of, 397. 
 
 Over-work. In two directions, 524-5. 
 
 P. 
 
 Panacea, 521. 
 Pancreas, 148. 
 Pan-genesis (from Trd.J' = all or every part ; and yivofxaL = I 
 
 become, meaning that the new creature becomes, or is 
 
 formed by gemmules coming from every part of the 
 
 parents), 345. 
 Panic. And boom, 216-9, 513. 
 Paradoxes of medicine, 176-264. 
 Paralysis, 210. 
 
 Parasite. And treatment, 492-3. Parenchyma, 227. 
 Pathology. And physiology, 151. 
 Peace. Not obtainable by surrender, 207. 
 Peliosis or pehdnosis, 322. 
 Per-acute, 92. 
 Peri-carditis (Trepl = around ; used of the structure which 
 
 surrounds an organ ; in this case the heart ^ KapSta^ 
 
 and signifying inflammation of the membrane surrounding 
 
 the heart, or the peri-cardium), 226, 228. 
 Peri-enteritis, 226, 228 (inflammation of the serous membrane 
 
 and connective tissue surrounding the bowel). 
 Peri-neuritis (inflammation of the sheath or covering of a 
 
 nerve, vevpov = sinew, or nerve ; but the latter not till 
 
 Galen's time), 226. 
 Peri-typhilitis (nepl and TV<f)Xov, inflammation of the parts 
 
 surrounding the ccecum), 23, 226. 
 Pernicious anaemia, 498. 
 Philosophical. View determining treatment, 138. 
 
554 
 
 Phreaitis, 129 {(f>pr]v = midrifif ; heace the seat of courage ; 
 
 hence the organ of courage, or later, of wit or sense ; 
 
 hence phrenitis came to mean inflammation of the brain). 
 Phthisis (f>dC(TL^, (from <f>OL(ti or <^9ivoi = I waste) ; see 
 
 consumption. 
 Pigs, and cancer, 412. Pilgrim, Mr., and Mr. Pratt, 373. 
 Pills. Cockles', Morrison's, HoUoway's, 76 ; see constipation. 
 Plethora, 121. Plexus, choroid, 161. 
 Pneumonia, 53, 212 ; and diet, 460 et seq. 
 Pollaki-amylism, 448 (nokXaKLcr = often, and amylism ; 
 
 taking starchy food too often). 
 Poly-amylism, 448 {iroXva- = much ; and djxvXov ; see 
 
 amylism). 
 Pollaki-siteism. 516 (7roX\a/cto' and siteism, which see). 
 Poly-siteism, 516. 
 Poor, eat too often, 237, 353. 
 Portal vein, 149, 153-4. 
 Poverty, 237 et seq. 
 Predisposing causes of disease, 88-9. 
 Predisposition, 54-5 ; and resistance, 334 et seq ; made by 
 
 ourselves, 440. 
 Preece, 535. 
 Prevention. Of disease, 1-4 ; of cancer, 390 et seq ; and 
 
 causation, 436 ; and cure, 437. 
 Principle and accident, 238. 
 Proof, wearisome, 490. 
 Property and function, 208 et seq. 
 Prophasiology, 438. 
 Prophecy, 22. 
 
 Proportional number, 53 et seq. 
 Prosagory, 93. 
 
 Pruritus. Eelation to diet, 486 et seq. 
 Psoriasis, 327 et seq ; causes of, 329. 
 Pulmonary artery, 150 ; veins, 151. 
 
 Pulse. And ancient physicians, 127, 130-1 ; and blood- 
 letting, 339. 
 Purgatives. Uselessness of, in constipation, 180 ; kinds of, 180. 
 
555 
 Q. 
 
 Quinine in malaria, 107. 
 
 E. 
 
 Eanke, 275 et seq, 325. Reading aloud, 529. 
 
 Reasoning, Circular, 11-13. 
 
 Recurrent. Disease, 472 et seq ; headaches, 479. 
 
 Registrar- General, 25. 
 
 Regular living. In wrong way, 424. 
 
 Relapsing fever, 121. Relaxant, 211. Relaxing, 87. 
 
 Remittent, 94, Renal action, and food, 233, 258-9. 
 
 Reservoir, 384. 
 
 Resistance. Low, 11, 56; and predisposition, 54-5, 534. 
 
 Respiration. And food, 232, 256-8. 
 
 Respiratory diseases, 53 et seq, 72. 
 
 Rest, after eating, 147. Restraint, 508 et seq. 
 
 Restriction of diet. Theory of, 175 : in opposite states, 487 ; 
 
 in ulceration, 496. 
 Rheumatism, 71 ; caused by diet, 463-71 ; etymology of, 463 ; 
 
 what it is, 464 ; see initis. 
 Rich eat too often and too much, 237. Richards, Mrs., 325. 
 Rome. Roman soldiers, 115 et seq ; and London, parallel 
 
 between, 118-20. 
 Rotation. Of earth, 95 ; of moon, 96. 
 Eowntree, Mr. Seebohm, 289. Rumford, Count, 266. 
 Running, 529. Rush and torpor, 533. 
 
 S. 
 
 Saint Martin, 297 et seq. Salisbury, Dr., 447-8. 
 
 Saliva, salivary glands, 145. 
 
 Salt. And cancer, 429 et seq. 
 
 Sane, 222. Sanitary, sanitation, 27, 36. 
 
 Sarco-lemma, 156. Sarcoma, 396, 398, 
 
 Satiety, eating to, 146-7. Schools, and children, 377 et seq. 
 
 Schreber, 634. 
 
 Scrofula. Etymology of, 442. Scrofulous ulceration, 497. 
 
556 
 
 Secobiensis, Andreas Lacuna, 473. 
 
 Seed, and soil, 172-3, 403. Self-restraint, 433, 477. 
 
 Sex. And cancer, 414 ; and habit, 414 et seg ; and suicide* 
 426 ; and religion, 426, 
 
 Short. Of disease, 92 ei seg. 
 
 Shrinking and swelling, 96 et seq, 208, 513. 
 
 Sinking. Feeling of, 465. 
 
 Siteism, or Sitia. The taking of food (from crtro? = 
 wheat or corn ; used, of bread ; hence monositeism or 
 monositia, eating once a day from fxovoq ; monophageism 
 or monophagia is used of eating alone, some persons 
 being both monositeous and monophageous ; hence dis- 
 siteism or dissitia, trissiteism or trissitia, tetrasiteism or 
 tetrasitia, pentasiteism or pentasitia, hectasiteism or 
 hectasitia, octositeism or octositia, and decasiteism or 
 decasitia, for eating two, three, four, jfive, six, eight or 
 ten times a day ; pollaki-siteism or poUaki-sitia, and 
 poly-siteism or poly-sitia, the act of eating too often, 
 TToXXct/cicr, or too much, ttoKvs ; oligaki-siteism or 
 oligaki-sitia, and oligo-siteism or oligo-sitia, the act of 
 eating too seldom, oXtyct/ctcr = seldom, or only now and 
 then ; and too little, oXtyo? = little or small). 
 
 Skin eruptions. And alcohol, 78 ; and diet, 480 et seq ; hot, 
 dry, moist, cold, &c., 192-3: 235. 
 
 Slag. Basic, 172-3. 
 
 Sleep. Sleeplessness ; and starvation, 177 ; from opposite 
 causes, 186-7 ; and disease, 224 ; and circulation. 413 ; 
 treatment of, 169. 
 
 Slow. Eating. 147 ; digestion, 301. 
 
 Smith, letter of, 456-7, 523. 
 
 Soil. And seed, 172-3, 403. 
 
 Soldiers. And gun-shot wound, 328 ; in a narrow pass, 252 ; 
 and death from starvation, 293-4. 
 
 Solutio, 208 et seq. 
 
 Specialism. Specialist, 129. 
 
 Spencer, Herbert, 19. 
 
557 
 
 Spirits. Animate or nervous, vital or sanguineous, animal or 
 
 digestive, 132-4, 161. 
 Spring. Compressed and uncoiled, 95. 
 Stagnation and activity, 513. 
 Staphylococcus aureus et albxs, 490 et seq. (From (rTa(f)v\.rj 
 
 = a bunch of grapes, and kokkos =^ a rounded kernel, 
 meaning a micro-organism with a rounded enlargement 
 like a grape). 
 
 Starch and disease, 81 ; in foods, 145. 
 
 Starvation, 293 ; and fevers, 120 et seq ; effects of, 121 et seq ; 
 and sleep, 177 ; direct, 179 ; and indirect, 267-9 ; of 
 over-repletion or over-feeding, 195, 240, 282 ; starvation 
 diet, 197 : death of soldiers from, 293-4 ; and ulceration, 
 496 et seq. 
 
 Steam engine, 142-3. 
 
 Stewart, Professor, 54. 
 
 Stimulus. And function, 228 et seq, 229, 236. 
 
 Stomach. Capacity of, 355 et seq. 
 
 Strictum et laxum, 208 et seq. 513. 
 
 Structure and function. Four views on relation of, 134-6. 
 
 Struma. Senile and juvenile, 497. 
 
 Sub-acute, 92. 
 
 Subject. And liable, 333. 
 
 Subnormal temperature. And fasting, 286 et seq ; subsistence 
 diet, 287 et seq. 
 
 Suffering, 521. Sugar. Function of, in food, 146. 
 
 Surgery. Too much, 21, 321 ; safer than before, 24-5, 520. 
 
 Surrey and Sussex fowls, 195 et seq. 
 
 Swallowing, 146. Swedish Ling, 534. 
 
 Swelling ; see shrinking. Sycosis, 490. 
 
 Sydenham, 63, 510. Syndesmitis, 466. 
 
 T. 
 
 Tao-ts KoX XaXaort? (stretching and slackening), 208, 513, 
 Tea. Afternoon, 285, 310. 
 
558 
 
 Temperature of body, high and low, 192 ; and hot drink, 200 ; 
 low temperature, how caused, 214 et seq ; and food, 233, 
 259-62 ; low temperature raised by fasting, 286 ei seq ; 
 low temperature before cancer appears, 401. 
 
 Temporal. And eternal, 341. 
 
 Tenonitis, 464. (Inflammation of a tendon from reivav = to 
 stretch, because a tendon stretches from attachment in 
 muscle to attachment in bone. Tao"t9 = stretching, is 
 from the same root). 
 
 Thing. And thought, relation between, 134, 236. 
 
 Thinking. High, and plain living, 161. 
 
 Thoracic duct, 150, 165, 210. 
 
 Thought. And thing, 134, 236. 
 
 Tinea harha, 490 et ssq. 
 
 Tired. After meals ; see fatigue. 
 
 Tissue. See connective. Toller, Dr., 373. 
 
 Tonic, 87, 211. Tonsils removed, 129-30. 
 
 Torpor. And rush, 533. 
 
 Total abstinence from alcohol, 123 et seq. 
 
 Townsmen, 525, 
 
 Transmitted. Of disease, 338-50 ; see heredity. 
 
 Treatment. Method of, 2 ; by diet, medicine, and surgery, 
 89; and philosophic view, 139; strengthening and 
 lowering, 87 ; by opposition, poor treatment, 190 ; by 
 less amount of the exciting cause, 202-3. 
 
 Tricycle, 531. 
 
 Triphthaemia. [Tpl^eiv = to waste or rub, and alixa = 
 blood ; meaning, therefore, loading of the blood with 
 waste products) ; see anaemia, catatribaemia. 
 
 Tuberculosis, 57 ; evolution of, 441 ; see consumption and 
 phthisis. 
 
 Twain, Mark, 177. 
 
 Typhlitis. Tv(j)\ov, 23. 
 
559 
 
 U. 
 
 Ulcer. Ulceration, 494 et seq ; scrophnlous or strtimous, 497 ; 
 
 callous, 495 ; of bowel 499 et seq ; and direct starvation, 
 
 500. 
 Unconscious of healthy organs, 152. 
 Under-feeding. Signs of, 176 et seq. 
 Uric acid, 309. 
 Urine, 198-203. 
 
 V. 
 
 Vein. Portal, 149 ; hepatic, 150 ; pulmonary, 161 ; definition 
 
 of, 163 ; vena cava, 149. 
 Verdicts, 502. Villi, 149- Visual defects, 403 et seq. 
 Voit, 279. 
 
 W. 
 
 Walking, 529. War office, 293. 
 
 Water, 83 ; deprivation of, 230. Watson, A. W., 273. 
 
 Weakening, 87. 
 
 Weight. Feeling of, after eating, 147 ; loss of, in fasting, 286 
 
 et seq ; growth of, in children, 352 et seq. 
 Women. And domestic work, 526-7 ; eat too often, 416 etseq ; 
 
 and illness, 417 et seq. 
 Work. Domestic, 526-7. Wrench Dr., 373. 
 
 X. Y. Z. 
 
 Xerxes, 117. York. Poverty, 241. 
 XaXacrts. See Tacrts. 
 Zig-zag action, 96. 
 
 Zymotic mortahty, 28 ; diseases, 73 et seq ; and air and food, 
 112 g/ seq. 
 
ERRATA. 
 
 P. 80. Line 14. For pattern, read father. 
 
 P. 89. Line 11 from bottom. For understood, read misunder- 
 stood. 
 
 P. 182. Line 9. For exised, read excised. 
 
 P. 188. Line 11 from bottom. For hypethoply, read 
 hypertrophy 
 
 The scholar will also please to excuse one or two errors in 
 accents on Gresk words, which it proved too late to correct, 
 and to which no further reference is made. 
 
 Toothtlls Limited, Printers, Drewton. Street tnd Godwin Street, Bradford. 
 
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