Meatritionist

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.

Important as the hot water treatment is, the meat diet is far more so. The Salisbury treatment may be said to consist of two factors : first, the practice of taking a large amount of hot water on an empty stomach ; and second, confining the patient to lean flesh, preferably beef, minced or scraped to thoroughly break down and as far as possible remove the connective tissue. The leg or ham of beef — that portion usually sold as round or buttock steak — is the part preferred. It is recommended in the case of very delicate stomachs that the fat, gristle, and like parts be removed, and that the lean flesh be run through a meat-chopper two or three times to insure a thorough breaking down of the connective tissue. This minced meat should be loosely made up into round balls from half an inch to an inch or more in thickness, and three or four inches in diameter. Let a frying-pan be made very hot, and the meat balls placed in it, shaking the frying-pan to keep the meat from burning; when the surface has been browned, turn the ball over, cover- ing the frying-pan to keep in the steam, and set it back where the meat will cook gently but continuously. It should be cooked until all the red color has disappeared. A small portion of salt, and when desired a very little pepper, may be added. All persons taking this treatment who are not too stout are advised to add fresh butter to the meat ; and when the butter is salted no further addition of salt is necessary. When preferred, the meat cakes can be placed on a common grill or broiler, turning the grill often until the red has disappeared from the center of the balls. 

Mrs. Stuart prefers a preparation of stewed meat, as follows : In preparing beef for a Salisbury steak, a considerable portion of valuable meat must be discarded. This is utilized by slow and long boiling until the value of the meat is extracted in soup. Then to one and a half pounds of the minced meat add about a pint of the meat soup, which has first been allowed to cool and the fat removed. Add a little salt and pepper, and stew over a gentle fire until the redness of the meat has disappeared. It will be found that it is not necessary to boil the meat; boiling dissipates some of the valuable elements, and distinctly damages it, but it can be thoroughly cooked without boiling. Many people prefer this method of cooking to the broiled cakes, and it affords a variety to those who care for it. 

Most persons reading these directions for the first time will think at once that such a diet would be very repulsive and cloying to the appetite. Surprising as it may seem, a majority of those who confine themselves to this food come to relish it greatly, and not particularly to miss the lack of bread or other usual foods. It has long been known that hunger is the best sauce ; and when an adequate food is furnished to a hungry man, the food is relished, digested, assimilated, and passed off, leaving the system with a good appetite when the time comes for more food. 

It will be found by all persons who try this diet that it is not difficult if they resolutely abstain from the use of all other foods. If, however, they indulge themselves at the outset by tasting, in what may seem to be trifling quantities, other and accustomed kinds of food, the appetite for the beef is very likely to vanish, and the patient will find considerable difficulty in sticking to it. Fortunately, for all those not obese and who are not taking this diet largely for effecting a reduction of their weight, it is not necessary to be wholly confined, as Dr. Salisbury recommends, to the minced beef. We have found that all the conditions that may be obtained from a strict adherence to the beef and hot water regime are obtained by the addition of some food-fruits to this diet. These fruits may be dates, stewed figs, prunes, raisins, sultanas, and — when thoroughly ripe and of good quality before drying — peaches or apricots. If too much of this fruit be eaten it will cause acidity and flatulence ; on the other hand, if those persons confining themselves to the Salisbury diet will gradually add such food-fruits, they will find a distinctly better relish with the meals, the removal of more or less longing that is inevitable with those who are eating only the meat, and a greatly improved tendency toward the removal of constipation. 

At the same time, it must be borne in mind that to some patients there appears to be nothing so easily digested, that at the same time gives anything like so much nourishment and vitality, as the pulp of lean meat; and if the addition of fruits even when made cautiously produces flatulence, heartburn, or other evidences that there is fermentation instead of digestion, to such very weak stomachs it is best to rely for the time upon beef alone, and until the stomach is so far restored that such fruits may be safely added. 

The rationale of the beef and hot water treatment is easily understood; that of the hot water is already given. Health depends upon nourishment; a food may be rich in all the elements of nutrition, and yet be valueless to a person either because it is of itself unfitted to human digestion, or because the digestion of such person has been weakened by wrong habits, or by heredity, or by both, and is thus rendered unable to get nourishment from such ill-adapted food. All persons out of health, and all whose digestion is weak, and whose nervous system has been overstrained — and this classification includes vast numbers, a great majority in civilization — are in need of a food which will give greatest nourishment for the least expenditure of vital force. The lean meat of our domestic animals, and of some kinds of game, and especially that of beef, answers this demand in a remarkable degree. A good quality of beef or mutton, roasted or broiled, to the average stomach will be found quite easy of digestion, and is more conveniently obtained than the minced meat, though flesh that has been well chopped or minced has its connective tissue largely destroyed, and this connective tissue offers the chief obstacle in the way of digestion. This can also be broken down by continuous cooking for hours in succession. A simple method of accomplishing this is to put the meat into a covered tin or copper vessel, and place this in a large stewing vessel. Insert a piece of brick, coal or like substance between the bottom of the vessel containing the meat and the bottom of the stewpan or boiler; fill with water that will surround the inside vessel but not enter it; cover also the larger vessel, bring it to a boil, and keep it gently boiling for about five hours. No water is to be placed in the vessel containing the meat; and it will be found after long cooking that the connective tissue is substantially destroyed, the meat is exceedingly tender, its juices are all retained, and many of the advantages secured that result from mincing the beef. A good way of cooking such meat, also, is to boil in an ordinary boiler with but little water until thoroughly done — from four to six hours. In whatever way meat is cooked, skin, gristle, and indigestible lumps must not be eaten; these substances are very difficult to digest, and must be avoided. 

If this food be taken only in such quantities as the needs of the system demand, it will be found to be less liable to fermentation than most foods, and persons troubled with flatulence or any other evidence of a weakened state of the stomach and bowels will find this food especially favourable to the recovery of strength and vigorous digestive power. 

All persons who are at all corpulent, having more adipose tissue or fat than is natural, will find this diet of special value; and all such will do well to exclude, until they are reduced to a normal weight, the fat portions of the meat, and refrain from the use of butter or sweet fruits. A continuous exclusive diet of lean beef in quantities barely sufficient for the needs of the systern, with the addition of stewed tomatoes or spinach and a moderate amount of lettuce and like salads, is sure to reduce almost any obese person to their normal weight. When such weight is reached, butter and oil may be gradually added to the dietary, and also the food fruits. One great advantage of a diet composed of a moderate amount of animal flesh, as beef and mutton, and a considerable portion of the food-fruits — dates, figs, prunes, sultanas, apples, etc. — is that these fruits are distinctly aperient, and overcome the tendency to constipation which is quite sure to be induced by an exclusive meat diet. When for any reason these fruits are excluded from the dietary, recourse must be had to a mild aperient. A leading symptom by which to differentiate between health and illness is the color and appearance of the skin. Persons accustomed to a free use of cereals and starchy vegetables, when out of health are quite apt to have a pale or anaemic color, and a rough and blotchy skin. All such persons who will adopt the diet herein recommended will be gratified to see in a few weeks' time improvement in their complexion. A pink, healthy hue takes the place of the pale color, and the skin becomes soft and pliable. Many persons in middle life have more or less accumulations of dandruff in the head and hair, which is sometimes so plentiful as to need brush- ing from the clothes several times a day. This condition is frequently changed by the adoption of this diet, and sometimes entirely overcome.

It is written on a letterhead: “J. H. Romig, M.D., 115 East Columbia, Colorado Springs, Colo. ... 1948 ...” and signed, in ink, “J. H. Romig, M.D.” In the first part of this paper he speaks of himself in the third person:

“When Dr, J. H. Romig went to the Bering Sea region of Alaska, in the year 1896, he found the Eskimos living according to tradition, ideology, and diet, the same as they had lived for hundreds of years before.” He gives the general impression of average good health and considerable longevity. He describes their houses and housekeeping and tells that during winter most of the men spend much of their time at what whites have called club houses or bath houses, the native karrigi or kadjigi.

“The women brought the largest meal of the day to their husbands, fathers, and sons. The food was in a wooden dish ... mostly game and fish ... Dried smoked salmon was much used, and other dried fish. Seal and fish oil was much in demand and was a necessity; no one could be well without fats. Their food was cooked mostly by boiling, and was rather rare; they ate as well, especially in winter, raw frozen fish and raw meat. They kept some wild cranberries for the favored dish of akutok — made [of lean meat and] of seal or fish oil mixed with warm tallow, sprinkled with cranberries, stirred, and hardened with a little snow.

“On this diet the people were strong, and did not get scurvy ... the did not have gastric ulcer, cancer, diabetes, malaria, or typhoid fever, or the common diseases of childhood known so well among the whites. For the most part they were a happy, carefree people ...

“With the advent of gold discovery, government schools and missions, and the high price of furs, came a new era ... They were able to buy white men's food and clothing, neither of which fitted their real need. The children were sent to school and learned white man's ways ...

“These people have changed from the old way, to eating pancakes with syrup and canned goods from the store. The children have poor teeth now, as well as the older ones. They have white man's epidemics, and neither the home nor the food that once was good for them ...

“The Government is now doing much to cover up and ease these changes in native life ... It is with regret that we can see the slow passing of these once hardy people ...”

ABOUT seven years ago I saw two patients, one suffering from severe chronic gouty arthritis and the other from recurrent uric acid calculi, in both of whom, after all routine treatment had failed, cure was effected by the so-called " Salisbury" treatment, prescribed and directed by a lady. Taking for many weeks nothing but red meat and hot water, these patients certainly made wonderful improvement, which, in spite of a gradual return to an ordinary dietary, persists to this day. It seemed to me that this treatment possessed some element of usefulness, but that it ought neither to be used indiscriminately nor without medical guidance. The only English book on the subject, which quickly obtained and still has a large circulation among the laity, was written in a tone and spirit which did not encourage the medical profession to give this method a thorough trial; but the patients whom I had tried in vain to help, and for whom I had sought the best special advice without good result, were so evidently benefited that I have since then given this diet a careful trial, more especially during the last three and a half years, when I have been afforded in Buxton exceptional opportunities for selecting suitable cases for its use and for watching its effects. The indefatigable and painstaking work of Dr. Alexander Haig and the careful and ingenious experiments of Dr. A. P. Luff, which latter, placed before us in the recent Goulstonian Lectures,” have excited so much interest, indicate that the red meats or their salts are in themselves harmful to the gouty. Having for the last three years been working on the subject of auto-poisoning in relation to the causation of out, some forms of rheumatoid arthritis, and allied ailments, had been led to doubt whether that is so, or whether it is not the admixture of food of other classes with the red meat which causes complex chemical changes leading to the formation (whether in the blood, tissues, or kindeys) of an excessive quantity of uric acid. The able and suggestive work of Dr. Lauder Brunton has done much to stimulate medical opinion on this subject, and has given us a better understanding regarding the chemical changes which take place during digestion and their clinical significance; while the researches of Gautier and Bouchard have added to our knowledge of “the self-poisoning of the individual."

The course of treatment, which lasts from four to twelve weeks in its strict form, is as follows—subject, of course, to such modifications as the condition of the patients and their progress demand. The bowels having been thoroughly relieved the patient begins to drink from three to five pints of hot water daily; the temperature of this should be from 100° to 120°F.; a little lemon juice may be added, and it should be drunk in sips. One pint should be taken at least one hour before each meal, and the same quantity at bedtime. The food should consist at first of beefsteak from which all fat, gristle, and connective tissue have been removed; this should be thoroughly minced, a little water being added, and then warmed through with gentle heat until it becomes brown in colour and perfectly soft and smooth; it can be eaten thus or else made up into cakes and cooked on the grill. On the minced meat may be put the poached whites of from two to four eggs per day. The only bread allowed is a half slice, cut very thin, and thoroughly torrified in the oven, with each meal. A little salt or pepper may be added to the meat, or a little mustard freshly mixed with lemon juice. As the treatment progresses a little of the steak may be given grilled, or a lean mutton chop; very little or no fluid should be given with the food. The quantity of the meat given is from one pound to four pounds in the twenty-four hours. During the latter part of the treatment a grilled cod-steak is often ordered Alcohol should be avoided; if absolutely necessary a little good whisky with cold water may be given with food; or a cup of weak tea with a slice of lemon, or a cup of black coffee may be taken. The immediate results experienced are a feeling of hunger and a difficulty in drinking so much hot water; these difficulties soon disappear, although the feeling of “emptiness” due to the stoppage of the carbohydrates often persists. There is also a marked diminution of the abdominal girth and a more or less rapid loss of flesh, especially in those who are fat and flabby; but walking is much easier and the breathing is often greatly relieved. The urine at first is often scanty and loaded with urates, which indicates either the necessity for adding some freshly prepared citrate of potash to the hot water given in the early morning and late evening, or else an increase in the quantity of water drunk. The bowels become constipated, the motions being scanty and dark coloured. An aperient is often necessary. After the first two or three weeks the patient begins to feel weak and easily tired, and it is wise at this stage to limit the amount of exercise taken, substituting in some cases a little massage; but before the conclusion of the course the strength returns, and stout patients especially feel the benefit of the diminished weight.

The changes due to the treatment are very marked. The swelling of the joints diminishes, the aching and soreness are greatly relieved, and the mobility is considerably in creased. The patient becomes brighter, and work, both mental and bodily, is done with pleasure instead of with trouble and effort; acidity, pyrosis, heaviness, distension, and oppressed feelings after food disappear, flatus is greatly diminished in quantity and becomes much less offensive, and the perspiration loses the disagreeable odour so frequently present in these cases. The urine becomes more copious and clearer, and does not give the reactions to nitric acid and ferric chloride mentioned later. and the oxalates and uric acid are materially decreased. The indications for the adoption of this treatment seem to me to be : (1) obstinate and refractory chronic gouty arthritis; (2) recurrent uric acid calculi; (3) frequent and intractable migraine; and (4) obstinate gouty dyspepsia. The treatment appears to be indicated more especially if any of the following symptoms are present : (a) amylaceous and intestinal dyspepsia; (b) acidity, pyrosis, and flatulence; (c) heaviness and irritability after food; (d) excessive formation of sulphuretted hydrogen in the large intestine, disagreeable smelling perspiration, and offensive breath; and the following conditions of the urine : (e) persistent lithiasis; (f) oxaluria; (q) excessive formation of indican ; (h) purple or red reaction with nitric acid; and (i) wine-red reaction with ferric chloride.

I am sure that where either damaged kidneys or a weakened heart are present exceptional care should be taken; in fact, many of these cases are quite unfit for the treatment. I do not say all, advisedly, as I have seen several cases in which both unsound kidneys and heart have been greatly relieved, but such patients require daily watching and the exhibition of great care, experience, and discretion. The above mentioned symptoms, I would venture to submit, bring us face to face with the great question of auto-poisoning. I have been greatly impressed by the sudden subsidence of severe chronic gouty arthritis in five cases. In three of these it followed what were described as “very severe bilious attacks”; and in two it came on after severe and spontaneous attacks of diarrhoea; the relief was immediate and complete, and for several weeks the patients kept better, but gradually the old symptoms began to return, and in three months after the sudden improvement they were as bad as ever. No doubt also many of us have observed how severe attacks of deltoid rheumatism of many weeks' standing have been at once removed by a mercurial purgative. These facts seem to me to point to the possibility of poisons generated in the alimentary canal setting up affections of the joints. Bouchard describes certain articular enlargements which he contends are almost always present, more or less, in cases of gastric dilatation. That a very considerable number of ptomaines, leucomaines, and toxins are formed in the ali mentary canal seems to be beyond doubt, as is also the fact that they are taken up by the blood and appear in the urine.

A most important discovery was made by Gautier in 1885, when he found that poisonous alkaloids were continuously being formed in healthy men and animals by decomposition in the intestinal canal during the process of digestion or in the blood and tissues generally by the metabolism which occurs during the functional activities of life. It seems to me that if we have either an excessive formation or a deficient elimination of these toxic products we get a con dition of self-poisoning, which may be either slight and transient, severe and lasting, or, what I believe to be more common still, a daily storage of small quantities of noxious matter which gradually undermines the health, leads to deterioration of the nervous system, and disturbance of the nutrition of some or all of the structures of the body; and it seems likely that vital action is much more quickly interfered with through the accumulation of waste products within the organs than by any want of nutriment of the organs themselves. Aitken, writing on gout and rheumatism, says: “They are such diseases as become developed under the influence of agents generated within the body itself through the continuous exercise of its functions in the daily course of nutrition, development, or growth.” That marked symptoms of poisoning do not more frequently occur is due to the physiological processes continually going on in our bodies: (a) the elimination of the poisons by the kidneys, liver, skin, lungs, and the lining mem brane of the bowels; and (b) their destruction by oxygenation, the leucomaines being burned up in the blood. That the urine contains toxic products was made clear by the researches of Mr. Reginald Harrison, our esteemed President, concerring so-called “catheter fever” when he gave his adhesion to the following important conclusions: (1) In health alkaloids exist in the living subject; (2) these arise in the intestinal canal through the action of putrefactive intestinal organisms; (3) the alkaloids of normal urine represent a practical part of these alkaloids absorbed by the intestinal mucous membrane and excreted by the kidneys; and (4) diseases augmenting intestinal alkaloids augment in consequence the urinary. Dr. Lauder Brunton suggests that one set of poisons is probably allied to uric acid, and includes guanidine, methyl-guanidine, xanthine, and other derivatives of urea. A very interesting statement has been made that while the greatest part of the products of albuminous waste is in health secreted by man in the form of urea with very little uric acid, in disturbance of nutrition (as by self poisoning, affections of the nervous system, &c.) the quantity of uric acid is enormously increased. It has also been suggested that as pyrocatechin, a body of the aromatic series frequently found in urine, is known to have a poisonous action on the spinal cord it may probably interfere with the joint centres, an thus set up reflex trouble in the articulations. To those who entertain the opinion, so generally held, that the various toxins are formed from the decomposition of animal food it will not be at all clear how a meat dietary, even with the aid of hot water, can alter this condition ; but Brunton and Macfadyen have shown that “the same bacteria which form a peptonising enzyme on proteid soil can also produce a diastatic enzyme on carbohydrate soil”; and, further, that “the same bacilli, when grown in starch paste instead of in gelatin or in beef-tea, produced a different ferment, which would convert starch into sugar, but which would not act upon gelatin.” Bouchard, again, strongly condemns bread, with the exception of the outer crust, on the ground that the process of baking, although it has interrupted the fermentation, has not stopped it altogether, and that this fermentation re-appears when moisture and temperature are again favourable to it, and from this are formed acetic and butyric acids, leucin, tyrosin, and phenol in large and poisonous quantities. The difficulties of a mixed diet of meat and carbo-hydrates in the gouty state are that the latter are so much more easily oxidised, and are therefore more readily consumed in the system than the albuminous compounds, and thus prevent the disintegration and oxidation of the latter; and also that vegetable albumin less easily undergoes disintegration than animal albumin. In gout disintegrative changes in the albuminates are arrested, and insufficiently oxidized substances remain in the blood; and in this connexion it is of importance to note that under a diet of animal food more oxygen is retained in the system than when starchy foods are taken in excess. The microbes subsisting on starchy food, milk, and cheese may be got rid of by a purely meat diet and vice versá, the offending microbes being starved out.

I would now ask the question whether, from the foregoing facts and theories, it is possible to suggest any scientifically satisfying reason for using this dietary. And in reply I would submit that meat taken as suggested is easily and readily digested; that the process of digestion is more com plete and perfect, and is almost entirely free both from the processes of fermentation and putrefaction, and from the toxic products thereof; and also that there is a more complete oxidation of the food taken, and therefore less waste and morbid material remaining in the system. Whatever poison does remain is more promptly eliminated by diuretics than by any other means, and no diuretic is more efficient than a free supply of water, especially when taken into a comparatively empty stomach. The exceptional power of water as an eliminator has been well shown by the researches of Sanquirico into the lethal doses of various drugs. There can be no doubt also that water has a direct flushing effect on the stomach, kidneys, and liver. It has been suggested to me that, while a very much improved condition of the general health might be brought about by the stimulating effects of a diet of red meat, the uric acid in the system would be driven into the joints to their great detriment, and that when this diet was discontinued most serious relapse would occur, the last state of the patient being much worse than the first. I have watched this point most carefully, and in a number of cases I have gradually brought the patient down from a meat diet to a carefully arranged mixed dietary, and in eight cases still further to the meat-free dietary recommended by Dr. Alexander Haig, without any such result being observed. Had space permitted I should like to have submitted the detailed notes of cases of chronic gout and recurrent renal calculi treated by this method. In some respects the latter cases are the more interesting, for in spite of the continuous taking of solvents they were, up to the time of taking this dietary, frequently passing uric acid calculi. With the exception of a few small stones passed shortly after the commencement of the treatment (in less than half the cases only) no further formation took place, although the use of all solvents was discontinued. My experience of the sc-called “Salisbury” dietary has led me to form the following conclusions, which I venture to submit for consideration and criticism: (1) that a certain number of cases of chronic gouty arthritis, recurrent uric acid calculi, and gouty dyspepsia, with fermentative changes, which have proved refractory to ordinary methods of treat ment and dietary, may be treated by means of an exclusively red meat dietary, plus hot water drinking, with excellent results; (2) that this method of treatment is irksome and trying, and as, unless it is carried out strictly in the first instance, it is apt to do harm it should only be used in those cases where other methods have failed or are thought likely to do so; (3) that the cases require careful selection and close medical supervision, the details being modified according to the needs of each individual patient; (4) that those who suffer from persistent albuminuria or organic heart disease are in most instances unfit for this treatment— when, however, it is prescribed for them its course should be watched daily; (5) that certain cases of chronic gouty arthritis which fail to improve while on a mixed diet recover equally well whether on this dietary or on the meat-free dietary suggested by Dr. Alexander Haig; (6) that it is of the utmost importance that no addition, however small, of carbohydrates, saccharine matters, or fruit be made to the dietary during the first few weeks of treatment, very slight acts of carelessness in this respect having often caused disappointment and failure; and (7) that used with due care and discretion this method is a most efficient, and sometimes even a brilliant, addition to our therapeutic resources, but that it is only necessary in some 3 or 4 per cent of gouty cases treated. 

Buxton.

THE VALUE OF AN EXCLUSIVE RED MEAT DIET IN CERTAIN CASES OF CHRONIC GOUT."
To the -Editors of THE LANCET.

SIRS,-Mr. William Armstrong’s paper under this heading in The Lancet of July 3rd has shown the good that can be done by sometimes using what on the face of it appears to be a theoretically wrong diet. Reasoning as the writer does on the subject of auto-intoxication the diet has much in its favour; its results are good in his practice.

Speaking of children in whom the uric acid diathesis is sometimes very marked, I will give a case in my own practice which supports the assimilation theory. A child at two days old passed a quantity of red urine which alarmed the nurse, so much so that she saved me a specimen which on being tested was found to contain pure uric acid crystals. This urine was constantly being passed by the child, who screamed a great deal, had flatulence and sickness, and seemed very miserable altogether. The mother's milk was rich in cream, but turned acid rapidly. Careful dieting of the mother had no effect on the child for good. I found eventually that no milks would agree, so I abandoned milk and put the child on mutton juice. This agreed perfectly, the crying and sickness ceased, the general aspect of the child changed for the better, and the uric acid ceased to be marked after twenty-four hours of mutton-juice feeding. I gradually brought the feeding back to a sterilised cream mixture; the child is now well and taking food without difficulty. Curiously enough the family history of this infant reads like a list of Spa patients--viz., paternal grandmother has rheumatoid arthritis; the father has passed quantities of uric acid calculi; the mother has what Sir Willoughby Wade would call gouty neuritis accompanied by acid dyspepsia.

When Dr. Eustace Smith introduced meat-juice feeding he saw the wonderful way in which the albumin was assimilated, and I am quit econvinced that it is in cases of uric acid diathesis that milk-mixed carbohydrate-diets often disagree. Beef-tea I never give to children, as I only see harm from its use. In several other cases of children unable to digest milk well I have noted uric acid, but the family history is not so marked. When one considers that sugar, which is almost harmless in itself, can (as Sir Dyce Duckwork has pointed out) by setting up fermentation produce flatulence and acidity, it is obvious that carbohydrates may retard stomach digestion by acting as diluents alone, as well as by improperly fermenting and throwing the whole digestive tract out of gear by sending into the duedenum a fermenting mass, the toxins of which are absorbed--veritable taskmasters to an overworked system. Sir William Roberts has called attention to the value of mixed diets, and they certainly are more comfortable than the single red meat and water or vegetarian; but in the special cases mentioned by Mr. Armstrong the microbes must be mastered. 

I am, Sirs, yours faithfully,

Lennox Wainwright, M.D. Brux., &c. 

Folkestone, July 19th, 1897