Hypocarnivory

GOUT.

BY W. H. DRAPER, M.D.

DIET.—The prevention of the accumulation of azotized matters in the [p. 128]blood involves, first, a consideration of the question of the diet appropriate to the gouty dyscrasia. The almost uniform counsel upon this point of all the authorities from Sydenham to the present time is, that albuminous foods should be sparingly allowed in the diet of the gouty patient, and that vegetable foods, especially the farinaceous, should constitute the principal aliment. This counsel is based upon the theory that uric acid is the offending substance, and, this being the outcome of a nitrogenous diet, the nitrogenous element in diet must be reduced. My own observation has led me to believe that while this may be a legitimate deduction from the uric-acid theory of gout, it is not supported by the results of clinical experience. If there is one signal peculiarity in the digestive derangements of gouty persons, it is their limited power to digest the carbohydrates, the sugars and starches. In whatever form these foods are used, they are more commonly the source of the dyspeptic troubles of sufferers from gout than the albuminous foods. They provoke the acid and flatulent dyspepsia which so generally precedes the explosion of the gouty paroxysm; and it must have attracted the attention of every observer who has studied the dyspeptic disorders of sufferers from inherited gout, who have sought to control their unhappy heritage by abstemious habits, that these disorders are especially provoked by over-indulgence in saccharine and amylaceous foods.

It is not possible to explain satisfactorily why the lithæmic condition should be induced by the carbonaceous aliments, but we believe there can be no question as to the fact. If, as modern physiological investigations tend to show, the liver is the organ in which urea as well as glycogen is formed, it may be that the overtaxing of its functions manifests itself more readily in the conversion of the albuminous than in that of the carbonaceous foods; or it is possible that the carbonaceous foods are destined chiefly for the evolution of mechanical energy, and that when this destiny is not fulfilled through indolence and imperfect oxygen-supply, they escape complete combustion, and so vitiate the blood. But whatever may be the cause of this anomaly, the clinical fact remains that in gouty persons the conversion of the azotized foods is more complete with a minimum of carbohydrates than it is with an excess of them—in other words, that one of the best means of avoiding an accumulation of lithates in the blood is to diminish the carbohydrates rather than the azotized foods.

The diet which a considerable experience has led me to adopt in the treatment of the gouty dyscrasia is very similar to that which glycosuria requires. The exclusion of the carbohydrates is of course not so strict. Abstinence from all the fermented preparations of alcohol is perhaps the most important restriction, on account of the unfermented dextrin and sugar which they contain. This restriction accords with the common experience respecting the part which wine and beer play as predisposing causes of the gouty disease and as occasional exciting causes of gouty lesions.

Next to the fermented liquors, the use of saccharine food in the diet of gouty persons needs to be restricted. This limitation also is one which common experience confirms. Sweet foods cannot be said to be as provocative of the dyspeptic derangements of the lithæmic subjects as wine and beer, but they are certainly often responsible for the formation of [p. 129]the dyscrasia and for perpetuating many most distressing ailments. Their more or less strict prohibition may constitute the essential point of treatment not only in controlling the progress of the constitutional vice, but in subduing some of the most rebellious lesions. It is important to observe that this prohibition sometimes involves abstinence from sweet and subacid fruits, in the raw as well as in the preserved state. Paroxysms of articular gout have been known to follow indulgence in strawberries, apples, watermelons, and grapes, and the cutaneous and mucous irritations which follow even the most moderate use of these fruits in some gouty persons are certainly not uncommon.

Next in order to the saccharine foods as the source of indigestion in gouty persons come the amylaceous aliments. These constitute, necessarily, so large an element in ordinary diet that the limitation of them in the dietary of gouty persons applies, in the majority of cases, only to their excessive use. This excessive use, however, is often observed. There is a popular prejudice in favor of this class of foods, and a corresponding prejudice against the too free indulgence in animal foods. The purely starchy aliments, such as potatoes and the preparations of corn and rice, and even those which contain a considerable portion of gluten, like wheat, oatmeal, and barley, often provoke in gouty subjects a great deal of mischievous and painful indigestion. This feeble capacity for the digestion of farinaceous foods is most frequently observed in the children of gouty parents, and especially in persons inclined to obesity, and in those whose occupations are sedentary and whose lives are passed for the most part in-doors, and they are least common in those whom necessity or pleasure leads to much active muscular exercise in the open air.

The fats are as a rule easily digested by gouty dyspeptics. This is a fortunate circumstance, for the reason that in the anæmia which is frequently one of the consequences of chronic gout the fatty foods are of inestimable value. In cases of persistent and rebellious lithæmia an exclusively milk diet constitutes a precious resource.

The succulent vegetables, such as tomatoes, cucumbers, cauliflower, cabbage, and the different varieties of salads, constitute for the gouty as well as the diabetic subject agreeable and wholesome additions to a diet from which the starchy and saccharine vegetables have to be largely excluded.

XLV. SOME OF THE DISEASES PRODUCED BY TOO EXCLUSIVE FEEDING UPON AMYLACEOUS AND SACCHARINE FOODS AND FRUITS, WITH THE DIET TO BE USED FOR THEIR CURE. 

Vegetable Dyspepsia, or the first Stage of Consumption. 

This arises from the too exchisive and long-continued use of vegetable or amylaceous and saccharine foods and fruits, or either of them. The stomach is the first organ to suffer. In man this organ is mainly designed for digesting lean meats. It may be called a purely carnivorous organ. It requires lean meats to excite a normal quantity of healthy secretions in its glandular follicles for digestion, and the healthy excitation of these secretions stimulates the muscular fibres to maintain those normal downward peristaltic movements which are necessary for physiological digestion and transmission. The stomach does not digest amylaceous and saccharine foods, fruits and fats. These are digested by the secretions that are poured out into the duodenum by the liver, pancreas, and glands of Lieberkuhn and Bruner. Hence the too exclusive and long-continued use of vegetable, and especially amylaceous and saccharine food, fills the stomach with materials which do not stimulate it even enough to pass them along to where they are digested, in consequence of which they lie so long in this organ that fermentative processes supervene little by little, and we have the stomach filled with carbonic acid gas, sugar, alcohol, acid and alcoholic and acid yeast plants. These products of fermentation soon begin to paralyze the follicles and muscular walls of the stomach, so that it becomes flabby and baggy, and will hold an unusual amount of trashy foods and fluids. The organ has been turned into a veritable sour " yeast pot," and we have the first stage of the disease known as vegetable dyspepsia of the stomach, or the first stage of consumption. 

In this stage of the disease, the stomach is almost constantly distended mth gas, which is only partiafly relieved by the frequent sour eructations. 

Yeast plants are rapidly developed in the organ, and every particle of vegetable food which is taken in immediately begins to ferment, —the stomach being converted into an apparatus for manufacturing beer, alcohol, vinegar and carbonic acid gas. This carbonic acid gas soon begins to paralyze the gastric nerves, and the follicles of the mucous membranes of the organ commence to pour out a stringy viscid mucus, in considerable quantities. This, together with the partial paralysis, produces a relaxed, dilated state of the blood-vessels, so that a congestion (with a low state of vitality) results. The epithelial surfaces and connective tissue layer beneath them, then begin to mcrease in thickness, and if this process and state continue long enough, we have a gastric fibroid which may terminate ni scirrhus of the organ. If, however, the person is fairly active, so as to shake the food out of the stomach into the duodenum and small bowels, or if the pyloric valve becomes sufadently paralyzed to remain open, so that the food and hquids flow into the small bowels soon after being swallowed, then danger of gastric thickening is lessened : the patient feels much more comfortable and thinks he is greatly improved. The disease, however, is no better. It has simply changed its base of action and is transferred from the stomach to the small bowels. This is the second and most dangerous stage, bemg vegetable dyspepsia of the small bowels. 

The exercise, habits of living, eating and dnnkmg may be such as to detain the disease in this stage a long whfle. There is then great danger of the passage of Mycoderma spores (and the products developed by their multipHcation) into the blood stream. Should this occur, we are in the second or transmissive stage of Consumption. In this stage of the disease, the bowels are more or less constipated. Generally speaking, the more constipated they are, the greater the danger. 

An inactive, sedentary life, and a great disturbance of the bowels with carbonic acid gas and other yeasty products, may early paralyze the ileo-csecal valve so far as to let the fermenting products pass readily and freely into the large bowels. The danger of having the yeast spores transmitted is then lessened by the free passage of the spores into the colon, where they go on exciting fermentation in the various fermenting foods used. This soon results in many copious, yeasty evacuations during the night or early every morning and forenoon. Sometimes there are twenty or more passages daily. The passages are light and bulky, and have but little weight. They are sour yeast. This is the third stage of Vegetable Dyspepsia or Chronic Diarrhoea, or more strictly speaking, Consumption of the Bowels. The disease, if left to itself, and if the foods producing it are kept up, may run on for months or even years. I have treated and cured cases that had been running on for from fifteen to twenty years. 

In all cases of this stage of the disease, the large bowel becomes greatly thickened, and often in severe cases is almost entirely closed up. This thickening goes on quite rapidly in the connective tissue layer, and in the epithelial lining of the bowel. The folds of the bowel soon become greatly enlarged and are elongated from a few inches to a foot or more extra in length. If the patient lives long enough, and is on a curative diet, these folds and the thickening gradually disappear by absorption, though sometimes the elongated folds slough away partially decayed. Occasionally, in severe cases, from three to four years are required to remove all traces of the disease and all thickenings of the bowel. As long as the thickenings are present, there will be more or less of a thick, jelly-like, ropy, viscid mucus, coming- away every day . or every few days or weeks, according to the condition and severity of the disease. In consumption of the bowels, the lungs almost invariably become involved before death. Checking the diarrhea with astringents —while the fermenting foods are kept up —only aggravates the disease in the end and endangers lung invasion.

Summer Complaint in Children. 

The summer diarrhoeas in children are of the same character as the so-called Chronic Diarrhoea, previously described. It is essentially a disease of unhealthy or defective feeding, and readily yields to the simplest treatment, by removing the cause and substituting food that will not ferment with yeast. As soon as green vegetables and fruit begin to appear in early summer, children live almost entirely upon this kind of food at the expense of more substantial aliments. The same symptoms and pathological lesions, in the same order, result as has been previously described under the head of chronic diarrhoea, and the disease yields readily to the same treatment. 

Influence of Army Diet in Producing Diseases of Soldiers. 

In the army there is in all the men a peculiar chronic condition of the "alimentary membranes, excited by frequent fermentation of amylaceous matters too long retained, and which condition does not run on to chronic diarrhoea unless some enervating cause — such as over-fatigue, dysentery, typhoid, bilious, remittent or intermittent fever, or other cause —debihtates the system, and further impairs the condition of the alimentary membranes. This is evidenced by the almost universal condition of the alimentary canal in apparently healthy soldiers who are shot dead in battle. (See Eng. Surg, and Med. Hist, of Crimean War.) The follicles of the large intestines are more or less enlarged and frequently disintegrated, leaving ulcers. The amylaceous, army biscuit diet of the common soldiers, besides its fermentative and carbonic acid poisoning effects, does not furnish to the system the proper proportion of ingredients for healthy alimentation and nutrition. Hence a scorbutic condition results, which renders the disease an obstinate one to treat, unless this state is recognized and particularly attended to. This explains the reasons why the vegetable acids, combined with potassa and iron, are so useful in treating this disease. Rochelle salts are admirably adapted for exciting intestinal epithelial activity, and secretion and absorption in the alimentary canal. 

Any one kind of food too long continued has a tendency to produce systemic derangements of a scorbutic type. Amylaceous matters, too exclusively used, tend to excite abnormal actions in the parent epithelial cells of the mucous surfaces and of the glands ; while any one kind of animal food, too long and too exclusively eaten, produces derangements which show themselves more strongly in skin and mouth. A too free use of oils and fatty food, and of alcoholic beverages, produces the red, blotched face, and swollen carbunculated nose, oily surface, and erythematous swelling and redness of the skin generally. 

Salt meats produce a dry, scaly eruption upon the surface, with spongy, swollen and discolored gums ; loosened teeth, and a watery, flabby, often bloody tongue ; pains in the limbs and back resembling those of chronic rheumatism ; leaden-hued features ; offensive breath ; patches of extravasated blood in various parts of the body ; hard, contracted condition of the muscles ; stiffness of the joints ; diarrhoea and hemorrhage from mucous surfaces generally ; mental depression and indisposition to any kind of exertion. From this scorbutic condition —produced in all the men by the want of the necessary variety in their food —arises a long train of the most fatal and most obstniate diseases of the army. Among these may be mentioned chronic diarrhoea ; the so-called muscular rheumatism ; dysentery ; hospital gangrene in wounds ; tuberculosis ; fibrinous depositions iii the heart ; the clogging up of pulmonary vessels with fibrinous clots ; paralytic conditions and tendencies, and many of the diseases of the larynx, ear and eye. This condition of the system also renders it extremely subject (when exposed to the exciting cause) to typhoid, intermittent and remittent fevers. The vital powers are so depressed that the organism on light exposure to cold, is liable to be frostbitten and is strongly inclined to attacks of pneumonia and bronchitis, with diseases of the eye and ear. In short, the long list of army diseases may be traced, in great measure, to an extreme susceptibility to them, which susceptibility is produced by a want of the proper admixture of nutrient ingredients in the food of the soldier in campaigns. All authorities agree that scorbutic states arise from this cause, and no one having any experience in army diseases can fail to detect symptoms of scorbutus in almost every one of them. If they are not plainly visible in the apparently well man, they make themselves manifest in him as soon as he is placed under treatment for any disease, in the surprising benefit his system derives from the vegetable acid salts of potassa and iron, and from the free use of those articles of food of which his system has been deprived. Without this treatment almost all army diseases become obstinate to deal with, much more so than similar ones in private practice. In old cases of chronic diarrhoea, it frequently happens that the diarrhoea somewhat abates, the appetite becomes remarkably good and the patient fattens rapidly. His abdomen becomes hard and distended, it being either dropsical, tympanitic, or distended by enlarged viscera ; the whole surface becomes bloated and presents the appearance of having been affected by an excessive use of alcoholic beverages. The eyes become prominent, red and watery ; the thyroid glands become enlarged ; the heart gives marked evidence of fibrinous depositions internally (1 It has been noticed that in certain cases of heart disease tlie thyroid glands become enlarged, and the eyes prominent, watery and red. Whether there is any analogy between the condition of tlie symptom in this form of heart disease, and that productive of heart disease, chronic diarrhea, paralytic tendencies, etc. in the army, I am unable to say. I merely mention the circumstance here to draw attention in this direction.)

The foregoing descriptions of the results of continuous feeding upon one food at a time, with a view of determining what especial diseased states might be brought about by each food, in the human body, are sufficient to give a clear idea of the significance, scope and character of this painstaking work. To go through all my food experiments in detail would make this treatise far too voluminous to be read and studied, except as a work of reference. This would defeat my desire of getting it into the hands of as many students as possible in the opening of their career, directing their attention, as well as that of all earnest thinkers, whether in the profession or out of it, to the urgent necessity of dietetic reform, and to the real nature of most of our diseases, based as they are upon departure from dietetic laws indicated by the organic structure of man. 

I will state in this connection, that bread, rice, wheaten grits, hominy, tapioca, sago, potatoes, green peas, string beans, green corn, beets, turnips, squash, asparagus and the various meats, have each been fed upon exclusively and continuously by from four to six men at a time, for from seven to forty-five days. The results in all cases were recorded and tabulated as in the preceding experiments. Bread, rice, wheaten grits, hominy, sago, tapioca and potatoes have each been fed upon continuously for from forty to fortyfive days, before serious diseases and symptoms were produced. These foods are very similar in their action upon the human body, and cause like derangements and pathological states. They sustain the organism far better, and can be borne longer than any other vegetable aliment, before grave disturbances arise from their exclusive use. The diseased conditions and states finally induced by them are as follows : Flatulence, weak heart, oppressed breathing, singing in ears, dizzy head, headaches, lumbago, constipation lirst and afterwards chronic diarrhcBa ; tliickened large bowel, cold feet, numbness in extremities, and general lassitude and weakness. Were the exclusive feeding too long kept up, either consumption of the bowels, or lungs, or both may result ; or either locomotor ataxy, Bright's disease, diabetes, paresis, or fatty diseases of liver, spleen, or heart might be the final outcome. Also goitre, ovarian tumors, uterine fibroids, fibrous growths and fibrous consumption may be caused by such feeding in course of time. Green peas and string beans rank next to the seven foods above named in point of alimentary qualities. Green corn, turnips, beets and squash, cannot be subsisted upon for more than a very short period (when taken exclusively) before most unpleasant and more or less grave derangements ensue. Of all vegetables, asparagus is one of the most injurious when lived upon alone. Seven days is about as long as it would be safe to subsist upon this plant. The great efforts made by the kidneys to eliminate the asparagine, which overstimulates them, rapidly exhausts the vitality of the victim, and in a few days he is scarcely able to navigate. 

The experiments upon meat feeding showed that meats, and especially beef and mutton, can be subsisted upon without resulting in diseased states, for a much longer time than can the best vegetable products under the same conditions. The reason of this is that the first organ of the digestive apparatus — the stomach — is a meat-digesting organ. I have had patients afflicted with grave diseases, thrive and become perfectly well upon beef. Many of them have continued this as an exclusive diet from three to four years, before bringing breads and vegetables into their diet list. Good, fresh beef and mutton stand at the head of all aliments as foods promotive of human health.

Eggs, fish, pork, veal, chickens, turkeys and game come in merely as side dishes : they may be subsisted upon singly tor a limited time without bad results. All of these, however, if continued alone for too long a time, or if eaten in undue proportion constantly, may eventually produce meat dyspepsia, and various scorbutic conditions which are disagreeable and sometimes difficult to handle, and may result fatally. In meat dyspepsia there is more or less distress, oppression and load about the stomach, with usually a ball in the throat, and the " gulping of wind " that tastes like "rotten eggs " (Sulphuretted Hydrogen). With these symptoms there is frequently much sickness and weakness, with loss of appetite and great heat and bewilderment in the head. In treating this form of dyspepsia, all food by the mouth has to be discontinued, and nourishment given by the rectum till the stomach can be thoroughly washed out and disinfected. Then feeding by the mouth is carefully begun by giving a very small quantity of pulp of beef and bread foods at first, gradually increasing them as digestion improves.

At this point, however, it may be well to mention that the standard amount of proteid matter taken, in the construction of all these tables, was 130 grammes — 4.5 ounces. Moleschott's original diet-table contained only 120 grammes or (4.2 ounces), but as almost all observers agree quite closely as to the amount of proteid material necessary to be used, and also as to the results obtained from its oxidization, the same quantity was used in all instances that a more exact comparison might be established. The chief difference of dispute, however, is in relation to the relative value of the fats and carbohydrates, and particularly in reference to the latter compounds. 

In trying to develop out of a purely vegetable diet, anything like the same amount of working power for the system that is obtainable by the use of Porter's or Moleschott's diet, almost double the amount of proteid had to be taken with the proportionate rise in the fat and starch as is contained in the vegetable chosen. 

To produce the same amount of work by using a vegetable diet necessitates the outlay of a much larger amount of oxygen, and the production and handling by the glandular structures of the body of an excessive amount of the nitrogenous excrementitious elements. These facts illustrate quite conclusively the manner in which the damage to the system is brought about by indulging too freely, or living exclusively upon a cereal or vegetable compound. 

The vegetable proteid in these tables is further given an undue advantage, to which it is not justly entitled, by crediting it with the same atomic formula as that possessed by an animal proteid ; since the nitrogenous element found in plant-life contains a much larger number of nitrogen atoms, and consequently requires more vital force and oxygen to digest and assimilate it. This naturally decreases rather than improves the nutritive value of the proteid compound of vegetable origin. 

An average of a compound fat molecule is taken as the working standard in all these tables. 

Attention is also directed to a probable error in the rating of the heat-producing power of the carbohydrate. It is & commonly stated, that the comparative oxygenating capacity of a carbohydrate and fat is as one to two and one-half, but by their chemical atomicities, it is as one to thirteen, or thirteen and one-half in favor of the fat. 

That such an error exists in the computations in Moleschott's standard is sustained by a comparative study of the atomicities of the food-stuffs used in both Porter's and Moleschott's diet tables, and of the amount of oxygen required for complete oxidization in both instances. In the former, or Porter's proteid and fat diet table, a little more oxygen is needed than is necessary in Moleschott's mixed diet* yet it is claimed that in the latter instance 393,170 kilogramme-metres or 54,358 more foot pounds of work is produced. This, however, is directly opposed by the smaller quantity of oxygen used in the oxidization processes. When this error in work, produced out of the carbohydrates in Moleschott's diet, is corrected in accordance with the difference in atomicity and the amount of oxygen used between the fat molecule and the carbohydrate molecule represented as glucose, and a computation is made in accord with the correction, a slight difference in work produced when living on a Moleschott's or Porter's diet, is found to exist. The increase in work produced, however, is now found to exist in connection with Porter's diet and is in accord with the larger amount of oxygen used, which makes atomicity, oxygen used, and work produced correspond, while the reverse was stated in the calculations formerly made in connection with Moleschott's diet. 

If this error be true, as it appears to be, the profession have been sadly misguided in all their attempts in the construction of diet tables starting with Moleschott as their standard. 

On the other side, if these chemical and physiological laws be true, as based upon the atomicity of the proximate principles, by carefully considering the percentage composition of each food product to be used, exact results can be obtained. Another point to which attention is called by Dr. Porter is this, that the factors 1.812 and 3.841, which are used in computing the kilogramme-metres in Table VIII., are taken from Frankland — Philosophical Magazine XXXII., and are those which are generally quoted in all scientific works upon physiological chemistry and upon diet. 

In studying the proximate principles, however, by the atomicities, and considering the amount of oxygen required to completely transform a fat molecule into its final products of excretion water and carbon dioxide and a proteid molecule into its final products of excretion — urea, uric acid, kreatinine, carbon dioxide, water, etc. — it is found that only eighteen (18) more oxygen elements are used in the complete oxidization of the fat than in that of the proteid molecule. The computed amount of work performed by the oxidization of the fat molecule is found to be 530 foot pounds as compared to 250 foot pounds for the complete oxidization of the proteid molecule. This makes the eighteen (18) more elements of oxygen used in transforming the fat molecule result in the production of 280 more foot pounds of work than is obtained from the eighteen less used in the proteid. 

From this a decided discrepancy is quite evident between the results obtainable by former calculations and those based upon our modern chemical atomicities. 

However, for an illustrative and comparative study of the working power obtainable from the use of the various food-stuffs, this table is still of great value, as the same figures are used in each and all the calculations. 

As these same factors, 1.812 and 3.841, appear in all the modern scientific works, they were retained in the arrangement of this table, but not without appreciating and calling attention to this discrepancy when the computation is based upon the atomicities of the food elements used, the amount of oxygen required, and the results obtained. 

Again, it must be remembered that the proteids are not directly transformed into their final products, but undergo a series of intermediate changes, all of which require the use of oxygen and must of necessity yield more or less heat and energy, so that all our estimates are approximate. 

When upon Moleschott's diet with the proteid substances raised to the common standard of 130 grammes and the carbohydrates rated in accord with the correction previously noted, it requires 36,115 oxygen elements to produce 678,270 kilogramme-metres or 93,773 foot pounds of work. 

When upon Porter's diet of proteid and fat, it requires 38,415 oxygen elements to produce 734,890 kilogrammemetres or 101,602 foot pounds of work. When upon a purely vegetable diet that will yield anything like the requisite amount of work that can be obtained by using Moleschott's or Porter's diet, it requires 47,191 oxygen elements to produce 742,018 kilogramme-metres or 102,587 foot pounds of work. 

To obtain the 63,748 more kilogramme-metres or 8,814 foot pounds of work out of the vegetable diet as compared with Moleschott's diet, it requires the expenditure of 11,076 more oxygen elements. 

To obtain the 7,128 more kilogramme-metres or 985 foot pounds of work out of the vegetable diet as compared with Porter's diet, it requires the expenditure of 8,776 more oxygen elements. The vegetable diet in both instances yielding an excessive amount of nitrogenous excretory matter, carbon dioxide, and water. 

A careful study of Table II. and VII., and Porter's diet in Table VIII., proves beyond a question of doubt that upon an exclusive diet of our ordinary average meat alone very nearly the required proportions of the proteids or CHNOS compounds and of the fat or CHO element can be established. 

The only defect in the perfection of Table VII. and VIII. is found in the saline column, which contains much more mineral matter than perfect physiological laws indicate are required. This excess in saline or inorganic compounds, however, appears to be true in all kinds of food products — that is, if the proportion of salts in the milk is taken as the guide for a working basis. The reason for looking upon the amount of salts in the milk as the guide to the maximum quantity required is based upon the fact that during the infant period of life, where milk forms the only source of food supply, bone formation is most rapidly progressing, and the amount of mineral matter needed by the system is at its height and much larger than at any other period of life. The bones continue to grow and become fully and perfectly developed with the ordinary quantity of mineral matter contained in the milk. 

Physiology also teaches that a little less than one ounce of mineral salts are required daily by the system, but in all the tables given, except the one containing milk alone, the amount of salts is fully up to or more than an ounce. 

The only great objection that can be raised to an exclusive meat diet is the lack of variety, but that is quite easily adjusted by varying the kinds of meat used. The perfection of the proportionate composition of the proximate principles when using a meat diet, the smaller liability to imbibe an excessive quantity of any one kind and the little danger that there is of taking an excess of the CHO or stimulating and non-nutritious compounds, clearly establishes the fact that in meat we approach the nearest to an ideal food. 

If attention is turned for a single moment to the lower orders of the animal kingdom, it is quite apparent that the most supple and intensely powerful organisms are found among the carnivora only. This tends to substantiate the high utility of the meat diet. Another interesting point is the almost universal absence of tuberculosis among meat-eating animals, while the vegetable-feeding class are specially prone to suffer from this fatal malady. 

CHAPTER XVIL THE IMMORALITY OF FLESH-EATING. 

In these days of vegetarianism and theosophy a phy- sician is often met with objection on the part of patients to a diet of flesh, which objection will usually be found to be based on the conviction — a growing one through-out civilization — that it is wrong to slaughter animals, and therefore wrong to use their flesh as food. What- ever may be the ultimate decision of humanity in regard to this question, at the present time it is not infrequently a very serious one to the physician. A patient comes to him much out of health, earnestly desiring to follow the necessary course and practice the necessary self-denial to gain health, and the physician is fully impressed that the patient's digestive apparatus and general system is in such condition that flesh is well-nigh indispensable in a dietary system that will restore the patient to health, — under such circumstances this question will be found of grave importance. 

What constitutes morality in diet ? Manifestly, many animals are intended by nature to live upon other animals. To our apprehension the intention of nature, when it can be ascertained, authoritatively disposes of this matter. If it could be shown, as many physicians believe, that man is by nature omnivorous, and designed to eat flesh among other foods, this would be a conclu- sive demonstration that it was right for him to eat flesh. If, as we believe, nature intended man should subsist upon sweet fruits and nuts, there is not only no license for flesh-eating, but the reverse, — there is presumptive evidence that it is wrong to eat flesh. Physiological law must be the court of last resort in which to try this question. 

Vegetarians and others scruple at the purchase of a beef-steak on the ground that the money so expended encourages the butcher in the slaughter of the animal, and thereby identifies the one who expends the money with the slaughter. If this reason be given in earnest it should be binding, and its logic followed under all circumstances. While it is true that the purchase of a pound of beef identifies the purchaser with the slaughter of the animal, the purchase of a dozen eggs or a quart of milk as clearly identifies the purchaser with the slaughter of animals; for the reason that the laws governing the production of agricultural products are such that the farmer cannot profitably produce milk or eggs except he sell for slaughter some of the cocks and male calves, as well as those animals that have passed the productive period. True, there is no particular animal slain to produce a given quart of milk or a dozen of eggs, as there is in the production of a pound of beef-steak; but the sin is not in the slaughter of a given animal, but in the slaughter of animals, and it must therefore be acknowledged that animals are as surely slaughtered for the production of milk and eggs as for the production of beef-steak. And hence, since this is a question of ethics, we may as well be honest while dealing with it; and if an ethical student honestly refrains from the purchase of flesh because it identifies him with the slaughter of animals, there is no escaping, if he be logical and ethical, from the obligation to refuse also to purchase milk and eggs. This law applies as well to wool and leather, and to everything made from these materials; because, as before shown, agriculture is at present so conducted that the farmer cannot profitably produce wool and leather unless he sells the flesh of animals to be used as food. 

Looking at the matter in this light, almost all of us will be found in a situation demanding compromise. If a delicate patient be allowed eggs, milk, and its products, and the patient is able to digest these foods, so far as physiological needs are concerned there is no serious difficulty in refraining from the use of flesh as food; but if these ethical students hew to the line, have the courage of their convictions, accept the logic of their position, and refrain from the use of animal products altogether, there will be a breakdown very soon. There are a few isolated cases where individuals have lived upon bread and fruit to the exclusion of animal products, but such cases are rare, and usually end in disaster. 

We are, after all, in a practical world, and must bring common sense to bear upon the solution of practical problems. The subject of the natural food of man will be found treated somewhat at length in Part III. In this chapter it is designed only to point out some of the difficulties that inevitably supervene upon an attempt to live a consistent life, and at the same time refuse to use flesh on the ground that such use identifies the eater with the slaughter of animals. There seems to us good ground for the belief that fruit and nuts constituted the food of primitive man, and are the diet intended by nature for him. Remember, primitive man was not engaged in the competitive strife incident to modern life ; the prolonged hours of labour and excessive toil that are necessary to success in competitive pursuits in these times were not incidental to that life. Undoubtedly an individual with robust digestive powers, who is not called upon to expend more vitality than is natural and healthful, will have no difficulty whatever in being adequately nourished on raw fruits and nuts. When, however, a denizen of a modern city, obliged to work long hours and perform excessive toil, can only succeed in such endeavors by a diet that will give him the greatest amount of nourishment for the least amount of digestive strain, it will be found that the flesh of animals usually constitutes a goodly portion of such diet. It may be said to be a pre-digested food, and one that requires the minimum expenditure of vital force for the production of the maximum amount of nutrition. However earnest a student of ethics may be, however such a student may desire to live an ideal life, if he finds himself so circumstanced that a wife and family are dependent upon his exertions for a livelihood, and if it be necessary, in order adequately to sustain him in his work, that he shall have resort to a diet in which the flesh of animals is an important factor, there is no escape, in our opinion, from the inevitable conclusion that it is his duty to adopt that diet which enables him to meet best the obligations resting upon him. 

An invalid with no family to support, and with independent means, may nevertheless find himself in a similar situation with regard to the problem of flesh-eating. We have found many persons whose inherited vitality was small at the outset, and whose course of life had been such as to greatly weaken the digestive powers, and who when they came to us were in such a state of prostration as to require, like the competitive worker, the greatest amount of nourishment for the least amount of digestive strain ; and yet such persons have duties in life to perform, and are not privileged knowingly to pursue any course that necessarily abbreviates their life or diminishes their usefulness. The conviction is clear to us that the plain duty of persons so circumstanced is to use that diet which will best contribute to a restoration of their digestive powers and the development of a fair share of vital energy. When this result has been reached, these persons may easily be able to dispense with flesh food and even animal products, and to obtain satisfactory results from a diet of fruit and nuts. 

A true physician must make every effort to overcome the illness of his patients, and to put them on the road to a recovery of health. To our mind there is, in the solution of this problem, a clear path for the ethical student to follow. We believe that health is man's birthright, and that it becomes his bounden duty to use all efforts within his power to obtain and maintain it. We believe that sickness is a sin; that it unfits the victim for his duties in life ; that through illness our life becomes a misery to ourselves, and a burden to our fellows ; and where this result is voluntarily incurred it becomes a shame and a disgrace. Manifestly the body is intended for the use of the spirit, and its value depends upon its adaptability for such use. In the ratio that the body is liable to be invaded by disease is its usefulness impaired. The old saying, "a sound mind in a sound body," is the outcome of a perception of this truth. The saying that cleanliness is next to godliness is based upon the perception that cleanliness is necessary for the health of the body, and that the health of the body is necessary for the due expression of a godly life. When this truth is adequately understood it will be seen by the vegetarian, the theosophist, and the ethical student that health is the first requisite ; that it becomes a religious duty to create and conserve this condition, and that whatever diet, exercise, vocation, or course in life is calculated to develop the greatest degree of health is the one that our highest duty commands us to follow. In short, the favorite maxim of one of Britain's most famous statesmen might wisely be taken for the guiding principle of all : Sanitas omnia sanitas.