Autointoxication; or, Intestinal toxemia : Kellogg, John Harvey, 1852-1943 : Free Download & Streaming : Internet Archive Spoiler: PoetryThis book is interesting and surprisingly comprehensive. Was written by John Kellogg, you all must know him and that he had a vegetarian orientation -- for good reason if you consider the motives, some of which were explained in this book. But keep this in mind because he might exaggerate sometimes. 1919 was the date of publication. He is in favor of acidifying the intestines with an abundance of lactose or plant fibers. Things have evolved since then and many things that you'll read will be conflicting with what you read from Ray. Given that his work was refined through experimentation, it has its merits and deserves some attention. Instead of dismissing the parts that conflict, consider why they worked and if there is a better way of doing it to get a similar or better effect. It touches on many crucial points: - why keeping the intestines moving vigorously and emptying completely is so important - why an excess of animal proteid is not good - why a mixed diet tends to not be the best option for recovery - why acids in the colon are way milder in terms of negative effects than the products of microbial action on proteids - why exercise is important and even weak people should avoid being sedentary - why the appearance of the tongue is indicative of immunocompetence and strength - why sometimes a fruit-only diet is needed to give a rest for the body - why laxatives substances are harmful in the long-term - why diseases/infections tend to start in the gut - why starches should not be feared - why potatoes don't provide enough fiber to replace lactose - why a plant-based diet is superior - why it might be a good idea to buy thick pieces of meat, slice and discart all the exposed parts - why lowering the vitality encourages the growth of putrefactive organisms - why a little milk can be worse than none at all - why fasting might give a rest but can be risky for chronic infections, being definitely not the best solution - why charcoal can be a useful tool to evaluate intestinal function - why a lot of fat is just as bad as an excess of proteid in the diet - why only one bowel movement a day is not enough and ideally 3-4 - why fibers are necessary, especially if the intestines are on the sluggish side - why pboysters might be a risky food - why milk isn't suitable as a staple for adults but can be extremely therapeutic temporarily - why some attemps to employ milk and fruit fail - why milk from Holstein cows is different than Jersey's - why a period of avoidance of animal proteid altogether might be needed - why "milk must be eaten, not swallowed as a beverage", requiring proper.. mastication (of course applying to all foods) - why pasteurization can be detrimental - why rice and potato are also safe and have therapeutic value, the concern with them being not providing enough fiber for a mixed diet - why thyroid dysfunction is associated with chronic poisoning from the intestines Don't mind the silly of the modifications (such as this), it was too much to copy and highlight, so I had to make it entertaining less stressful somehow. Throughout the book he often mentions Élie Metchnikoff with admiration. Metchnikoff observed that certain animals can get away with eating even rotten food as long as it doesn't remain longer than what's needed to extract the majority of nutrition. In a sense, the lower the vitality, the closer you are to a being corpse that's decaying and reintegrating back to nature through the action of bacteria. #louvreofthedarkness Some members pick pieces of the sustainable system that Ray has developed for him thinking it will have the same effect on them. The book might address some of these issues. Hopefully it adds something refreshing. In my opinion, this has a great relevance for forum members since you can only consider fibers optional if your intestines move extremely fast, because in such situation you're inadvertenly supplying fermentable carbs, so a little is enough to prevent any significant microbial action. If it doesn't, it's not the best idea to leave them out because it will shape the gut composition to the worse. In other words, it's better to have an acidified intestine, than a putrefying one. Consider this: high-protein, refined carbs, little vegetables, sedentary life and style, vit of D and deficiency, etc. It isn't much different than the habits of the population in general. All in all, the main take-home message from this book is that if the body is discharging the remnants of active digestion vigorously and fast enough without much effort, it means that things are on the right direction: "The normal intestinal rhythm is three or four [complete] bowel movements daily, or at least one movement after each meal." In my opinion it reads better with the browser's Reader. ----- "Very few surgeons are yet convinced that the elimination of the colon from human beings would be an improvement on the Creator's handiword; and it is a notorious fact that most of those who have submitted themselves to short-circuiting and even more radical surgical operations for relief of intestinal stasis, sooner or later, usually within a year after the operation, find themselves suffering from the same distressing symptoms for the relief of which they consented to submit themselves to a mutilating surgical procedure." "Especial prominence is given to the "milch regimen" and the "fruit regimen," because these two have been found most efficient. Various other useful and efficient regimens have been worked out and are occasionally used. Although a milch diet has been recognized as a therapeutic measure, and employed in the treatment of various acute and chronic maladies since the time of Hippocrates, its use in this manner even at the present time has been largely, if not altogether, empirical. The rationale of its use has not been understood, and hence it is not surprising that this exceedingly valuable curative means has been little appreciated. The same may be said in relation to the grape and other fruit cures, which from the most ancient times have been more or less in vogue, especially in certain countries. Thanks to the labors of Pavlov, Pasteur, Tissier, Metchnikoff and various other physiologists and bacteriologists there has been developed within recent years the necessary scientific data upon which to base a sound rationaly for the "milch regimen," and "fruit regimen" and various other special regimens, and to perfect exact and efficient methods for the employment of these physiologic and remarkably efficient methods of dealing with a class of disorders which have baffled the most persevering efforts alike of internists and surgeons." "While useful in other ways, both the milch regimen and the fruit regimen are chiefly valuable as means for changing the intestinal flora. The failure to recognize this fact and to make the modifications usually necessary for accomplishing this result is the chief cause of the frequent failures which have attended the employment of the milch diet and the fruit diet and which have caused conservative practitioners to hesitate to make use of these physiologic and often brilliantly successful remedies." "Pigments of various sorts are produced by certain species of bacteria. Some of these are highly toxic. Deposits of these pigments in the skin produce so-called "liver spots," dinginess and bad complexion. One of the most common of these is brenzcatechin which according to Combe is formed from animal proteid in the intestine, but not from vegetable proteid." "One of the most notable facts is that most bacteria refuse to grow in the presence of acids. This is particularly true of disease-producing bacteria. A few bactaeria are able to resist acids. These are the organisms that give rise to fermentations, such as the souring of milch and the fermentation of solutions of sugar in the formation of vinegar. The products of bacterial work are always poisonous to the organism by which they are produced. This fact limits the degree of acidity that can be produced by any particular organism. The B. Bulgaricus is remarkable in possessing greater resistance to acids than any other micro-organism known. It will endure a concentration of acids as high as four per cent, whereas few other organisms can resist a concentration much greater than one per cent. This organism will continue to grow in a solution that contains thirty times the amount of acid which will stop the growth of Welch's bacillus, an organism which produces foul gases in the intestine. It is chiefly because of its acid-forming activity that the B. Bulgaricus is able to render special service in efforts to change the intestinal flora, as will be shown later." "many bacteria thrive best when supplied with a culture media containing an abundance of nitrogenous substances in some form. These organisms in turn give rise to a destructive change that in organic substances is commonly known as putrefaction. Instead of acids, this class of bacteria produce ammonia, ptomains, skatol, indol, phenol, or carbolic acid, and other highly poisonous substances, among which are tox-albumins, which closely resemble and sometimes exceed in virulence the venoms of the most poisonous reptiles." "in general, proteins of animal origin are attacked twice as readily by putrefactive organisms as are proteins of vegetable origin. This is of great importance and agrees with the observation made by Combe many years ago, that brenzcatechin, a highly poisonous pigment that causes pigmentation of the skin (so-called "liver spots) is produced only by the action of bacteria upon animal proteid." "The decomposition of organic matter is not a simple process. There are two classes of substances, those which ferment, carbohydrates, and those which decay, proteids. The two classes of bacteria, those that feed on sugar, causing fermentation, and those that decompose proteid, causing decay, work together; but the fermentation process starts first because this class of organisms grows most rapidly. Even in meat there is sufficient sugar to start fermentation process, and so the first symptom of decay in meat is souring. After the sugar is used up, the acids are destroyed by germs that feed on them. At the same time, process of putrefaction is slowly starting through the growth of the bacteria that feed on protein. Soon the acids disappear, ammonia takes their place, and the odors of putrefaction appear." "Vegetable foods contain sugars, starches and dextrines, substances which ferment, and so when undergoing decay do not in general give rise to the obnoxious and poisonous gases and other substances which accompany the decay of animal tissues. Milk likewise ferments because of the large amount of sugar which it contains. Eggs and meat do not ferment but undergo putrefaction giving rise to highly offensive and poisonous products. This is because of the absence of sugar. Eggs or meat place in a strong solution of sugar will not decay. Sugar is thus a preservative." "It is difficult to find a spot on the earth's surface where bacteria do not abound. They are most abundant in the air of crowded cities, but also are found in the air of mid-ocean. The air of high mountain tops is comparatively free from bacteria as also the air of the Artic regions. Even the sea wasser near the poles contains few microbes. Bacteria grow with great rapidity in the warm moist climate of the tropics, but fortunately their development in hot countries is greatly hindered by the disinfecting effects of the actinic rays of the tropical sun." It's not uncommon for people that are used to temperate climates to travel to tropical places and pick up infections during the stay. It's also common to find people that live long living on mountain tops, one of the factors is chronic infections for sure. "Many of the species of bactaeria found in the mouth are also found in the stomach. Fortunately the stomach is protected by the gastric juice, which is a powerful disinfectant so long as it contains the normal amount of hydrochloric acid. The normal stomach always contains enough gastric acid to protect it. The diseased stomach, however, often lacks this important means of defense. When this is the case, the bacteria of the mouth easily pass through the stomach and establish themselves in the intestine, where they find conditions more favorable for their growth and development, especially in the colon." "Bacteria are so constantly present everywhere that the wonder is, not that the intestine becomes infected, but that the body is not more quickly and more often overwhelmed by these parasitic enemies of life. The air we breathe, often the water we drink and the food we eat, swarm with bacteri or their spores. Through the medium of unwholesome food and various errors and accidents, the alimentary canal becomes infected with putrefactive organisms and other poison-forming and disease-producing microbes. The most virulent and active of these are naturally introduced in connection with animal proteid. Stale eggs, oysters, and especially smoked or salted fish, "prime beef," game, certain varities of cheese, commercial cow's milk and butter are common sources through which the so-called "wild bacteria" are introduced into the body. Many persons can distinctly trace the beginning of years of suffering from conditions dependent upon intestinal toxemia to an acute poisoning from canned fish, "over ripe" game, cold storage eggs, or sausage." "The development of toxemia is especially favored by habitual constipation. When delay occurs in the movement of the intestinal contents, carbohydrates are entirely absorbed; as a result, the acid-forming bacteria which normally protect the intestine against the wild or poison-forming bacteria are starved and soon die. Cooked food yields much more readily to bacterial action than does uncooked food." Cooked foods are safer when flavored with safe fats and spices. "The fact that in many cases of extreme constipation the fecal matters have very little odor is not evidence of the absence of putrefaction, but rather is evidence that the putrescible material has been exhausted and the putrefaction products absorbed. It is only necessary in such cases to give the patient a laxative to find in the loathsome smilling stools that result abundant evidence of the active putrefaction taking place in the upper portion of the colon." "The introduction of "wild" bacteria into the intestinal tract alone will not give rise to chronic intestinal toxemia. The protective forces of the body are capable of dealing with infections of this kind so long as the bodily functions remain normal. In a person with normal secretions and with a colon that empties itself with the normal intestinal rhythm, evactuating its content three times a day, wild bacteria would not be able to obtain a foothold. The few bacteria introduced, if not destroyed in the stomach or captured by the myriads of leukocytes that they would meet during transit of the alimentary tract, would be dismissed from the body before they had an opportunity to develop in any considerable numbers by colonizing in the folds or pouches of the colon." "The poison-forming organisms always find in the colon an abundance of protein the form of mucus. In the residues of internal secretions, as well as unabsorbed food proteins, these organisms grow luxuriantly, so that in the course of years a considerable variety of putrefactive and other mischief-making organisms are accumulated. Every new infection makes a new contribution of injurious organisms that become domiciled in the intestine and continually flood the tissues with their virulent products, some of which are highly active in most minute quantities." "According to Spence, urobilin (formed by the putrefaction of bile) must be included with skatol, indol, phenol, cresol and other poisonous products of intestinal putrefaction." "The studies of Tissier and Metchnikoff and numerous others have demonstrated that bacteria are not essential to animal life, notwithstanding the fact that they are commonly found present in the intestines of animals. The presence of bacteria, in other words, is in a sense accidental and in no way essential to life." "It is true, as already pointed out, that the intestine is invaded by acid-forming bacteria within a few hours after bith. But this seems to be a defensive arrangement that has been developed for the purpose of protecting the young organism against the destructive effects of putrefactive organisms that otherwise would quickly take possession of the whole digestive tract." "Metchnikoff has long maintained that the colon bacilli are not helpful, but in the highest degree harmful, producing, through their pernicious influence, hardening of the arteries, premature old age, and numerous degenerative disorders of the heart, liver, kidneys, and other vital organs." "Certain animals, as has been pointed out by Metchnikoff, are naturally free from bacteria." ""In the normal stools of healthy infants," according to Czerny and Steinitz, "sugar is either absent, or only present in very small amount" (Wegscheider, Uffelmann, Blauberg). It must not, however, be concluded from this fact that sugar is completely or almost completely absorbed. According to our present knowledge a certain, by no means negligible, amount is decomposed by the fermenting agencies in the intestine, and escapes absorption. The products of its decomposition serve to maintain the acid reaction of the intestinal contents, which for their part, secure a normal bacterial growth and normal peristalsis of the intestine." "bacteria are constantly entering the circulation from the intestine. The blood of the portal vein always contains bacteria, especially after meals, when absorption is most active. In the passage of blood through the liver most of these bacteria are destroyed or passed out in the bile, so that they do not in large numbers pass into the general circulation, except when taken in unusual numbers, or when the liver has become crippled and so no longer able to perform its defensive work. Bacteria are often found in the urine in great numbers, having been eliminated from the blood by the kidneys after having escaped removal by the liver. The gall-bladder often becomes an incubating chamber for bacteria. Gallstones are the result of the action of bacteria. Typhoid bacilli have been found in the gall-bladder many years after recovery from an attack of the fever." "The liver, as already explained, combats bacteria by destroying and eliminating them. It also destroys to some extent the bacterial poisons that get through the mucous membrane. Certain poisons, (such as skatol, indol, and phenol) are distoxicated by combination with sulphuric or acetic acid. Glycuronic acid is also formed from sugar or glycogen, and is used for the same purpose. It is doubtless for this reason that a good store of glycogen in the liver is essential to insure its efficient functioning as a poison-destroying organ. Glycogen is formed from carbohydrates. A liberal supply of carbohydrates is thus essential to maintain body resistance. Roger maintained that the bile modifies poison-forming bacteria so that they are unable to produce toxins. It is also known that the bile prevents the growth of many harmful bacteria, although it does not actually destroy them. It was noted, however, by Roger, that the bile increases the toxicity of bacterial poisons which have already been produced." "Years ago, Roger, the brilliant pupil of Bouchard, showed that the liver cells destroy poisons brought to it in the blood. Some poisons are actually burned up by oxidation; others are distoxicated and rendered harmless. "Lauder Brunton showed that the liver destroys the toxin of diphtheria, and Dixon and Lee showed that the tolerance to tobacco shown by smokers is due to the fact that the liver destroys the nicotine." If the liver possessed an unlimited capacity, the use of tobacco could do no harm. But its protective power is limited. When the limit is reached, the smoker begins to note ill effects." "Other poison-destroying organs are the thyroid gland, probably the lymphatic glands, and especially the suprarenal capsules. An important special function of the last named glands is to destroy cetain poisonous pigments which are produced in the putrefaction of animal proteins in the intestine. The kidneys and the skin eliminate germs probably in much greater numbers than is generally supposed. It is on this account that attention must be given to the excretions of the skin and the kidneys, in cases of typhoid fever, as well as the stools to prevent infection." "Nature(r) has provided a remarkable means of defense against the bacteria and bacterial poisons developed in the food residues found in the colon by placing at the junction of the small intestine with the colon a check valve so ingeniously contrived that nothing that has once passed into the colon can get back into the small intestine. Even gas, as well as solids and liquids, is effectively confined to the colon. This is necessary for the reason that the colon is better prepared to deal with germs and their poisons than is the small intestine. Absorption from the colon takes place very slowly. Not more than one-twentieth as much fluid is absorbed from the colon as from the small intestine. Adolph of Schimdt called attention years ago to the relation of ileac stasis to intestinal toxemia. Schmidt remarked that putrefaction in the colon did not give rise to the presence of indican in the urine in any considerable quantity, and that the presence of much indican in the urine was due to the reflux of putrefactive material from the colon into the small intestine through an incompetent ileocecal valve. The study of the clinical histories of some hundreds of cases in which Dr. J. and T. Case has proved the ileocecal valve to be incompetent by x-ray examination has convinced me of the accuracy of Schmidt's observation, which is all the more remarkable, since at the time his statement was made the x-ray means of diagnosis of incompetency of the ileocecal valve had not yet been developed. It seems probable that in practically all cases of intense intestinal toxemia, the ileocecal valve is incompetent." "The influence of the poisoning-destroying glands in protecting the body was well demonstrated by a modification of [an] experiment, in which Carrel applied the juice of thyroid gland or spleen of a very young animal to the growing tissue [living tissue in media, lab experiment]. The effect was most astounding. The rate of growth was stimulated to such a degree that the tissue increased in twenty-four hours to forty times its original bulk. Carrel was thus enabled by the use of thyroid juice, not only to prevent the degenerative influence of the tissue poisons shown in the gradual slowing of growth and finally death, but to produce an opposite effect; increasing the rate of growth and apparently making it possible to continue his experiment in the artificial growing of living tissues for an indefinite period." "Lecithin and phosphorated fat found in the yolk of eggs is decomposed by the bacteria of the colon into cholin and other poisons. Ammonia, always present with putrefaction, produces disease of the liver. In experiments upon animals, ammonia caused degeneration and hardening of the liver. Many of the products of digestion are converted into poisons by putrefactive bacteria. Tyrosine (an amino-acid, a product of digestion) is converted into tyramine, a highly poisonous substance. Tryptophane and arginine (amino-acids) are converted into poisons, indol and skatol. Sepsin, a poison so virulent that a minute dose administered to a large dog caused death in a few hours, is found in putrid meat and is always found in the colons of meat eaters. Barger and Walpole demonstrated two pressure-raising poisons produced from sepsin by putrefaction. Tyramine is found in old cheese, in which it is produced by bacterial action. It is also produced in the colon." "Carrots may be advantageously used in a regimen that has for its purpose the changing of intestinal flora. Bertrand found that when rabbits were fed on potatoes, the urine contained indican, while the urine was free from indican when the animals were fed on carrots. The colon bacilli were more numerous in the colons of potato-fed rabbits. Bertrand thought that the greater amount of putrefaction in the potato-fed rabbits was due to the fact that there was less acid fermentation because less sugar was present. I was also noted that starch-digesting bacteria were present in smaller quantities in the stools of potato-fed rabbits. This experiment shows the value of raw starch as found in green vegetables in reforming the intestinal flora." "Mantle, Consulting Physician to Halifax Royal Infirmary, agreed with Sir Bertrand Dawson in the belief that colitis, as well as gastritis and catarrh of the duodenum, may be due to infection from the vermiform appendix, and that catarrhal inflammation of the appendix and the colon may be carried upward to the stomach and duodenum. The gall-bladder may be infected from either direction. The most common origin of intestinal toxemia is catarrhal inflammation of the colon due to chronic constipation. That many people seem to be well, even though they suffer from constipation, is due to the fact that the natural defenses of the body are in their cases not yet broken down. Toxins do not readily find their way into the circulation until after the mucous membrane becomes abraded, or ulcerated, as the result of chronic infection." "Sir Lauder Bronton said, "The Bacillus coli seems to have a special power of producing fatigue toxins, and many people in whose intestines it exists in great abundance suffer from constant weariness and a feeling of fatigue."" ""Rheumatoid arthritis and other joint symptoms may arise from poisons absorbed from the intestinal mucous membrane. The joints are especially susceptible to certain poisons." (Mantle)." "[..]Dr. Mellanby mentions especially the powerful poisons, para-hydroxyphenylethylamine (the amine of tyrosine), iso-amylamine (the amine of leucine), and betthatisnotdiokine-imidazolethylamine (the amine of histidine)." "Dr. Alfred C. Jordan, an eminent roentgenologist, said, "In many subjects of intestinal stasis I find marked radiographic evidence of atheroma of the aorta at an unusually early age--another instance of the havoc wrought on the tissues by intestinal poisons."" "Dr. J. F. Briscoe, in discussing the subject from the standpoint of the specialist in mental diseases, remarked, "Who has not seen a prodigious evacuation of the bowels at the hands of the physician terminate a case of insanity, and on the other hand, has not observed the skill of the surgeon unfold the mechanical obstruction that has led to the deadly consequences of intestinal putrefaction." "It is obvious that constipation is only a link in the series of causes and consequences arising from the disturbed abdominal viscera, and on the mental side encourages and accentuates such symptoms as apathy, mania--nay [?], suicide; while on the bodily side it produces very marked emaciation, rheumatism, cachexia, and a long string of diseases." Said Dr. Lennox Wainwright, Hon. Physician to St. Michael's Medical Aid, and Physician to the Society for the Prevention of Cruelty to Children, "I am quite sure of this, that the mental effect of many patients of prolonged intestinal toxemia is such as to make them almost demented, and I believe that if many of our asylums were invaded by a good, sound clinical physician who would approach the subject without preconceived idea, in many cases supposed to by hopeless, the melancholia and hypochondria would yield to common-sense treatment and reduce the number of insane people."" "The toilette of the digestive system has always been a difficult problem of solution. The state of the tongue may be a good index of intestinal health, and a foul condition of the breath speaks volumes of what may be suspected lower down, although the patient may not be constipated." "Said Dr. H. Douglas Wilson, "Diseases of the locomotor system not uncommonly find their origin in chronic intestinal auto-intoxication. It is a more than probable cause in some cases of rheumatoid arthritis, and of prime importance in gout, especially of the acute type. In quite a number of cases I have seen efficient lavage of the colon cut short an attack of this disease where previously all the more usual methods of treatment had failed to bring or maintain relief." "Fibrositis, too, may find its origin in absorption of toxins from the digestive apparatus, and this is now recognized by many authorities as a direct cause of this painful and troublesome affection."" "Dr. H. D. Rolleston remarked, "Doctor Vaughan Harley suggests that the idiosyncrasy of some persons to eggs, which is now commonly quoted as an example of anaphylaxis, is due to the cleavage of lecithin into cholin, which may eventually yield the poisonous body neurin. In this connection I may mention that a medical man with neurasthenic symptoms and a belief during the morning that he was ruined, recovered after he left off taking an egg for breakfast."" "Said Dr. Frederick Langmead, "On very good grounds, tetany is thought by many to be produced by toxins generated in the alimentary canal." "In rheumatoid arthritis, we have a condition probably in many cases due to alimentary intoxication; in this condition, overgrowth of the thyroid is apt to occur, and tetany, a symptom of ineffective functioning of the thyroid gland, is also found. Moreover, rheumatoid arthritis is occasionally distinctly benefited by the administration of thyroid extract." "The last three cases of myxedema that I have had under observation have all shown, together with severe oral sepsis and very offensive motions, anemia of the pernicious form that Dr. William Hunter has for so many years ascribed to lesions in the alimentary tract. If the thyroid undergoes enlargement to combat toxemia, it is reasonable to suppose that relieving it of part of its burden may cause a simple goiter to shrink; this, of course, cannot be expected if adenomata or cysts are present."" "it is not the organization of the great intestine that has failed, but that our modern dietary sets a task for which it is not adapted." "Dr. Murray Leslie, Senior Physician to the.. Prince of Wales' Hospital, said, "I was particularly interested in Mr. Rowell's reference to cases of intestinal stasis associated with thyroid enlargement, and in which the gland diminished in size on removal of the stasis, in one case as the result of administration of liquid paraffin." "I believe strongly in the importance of diminishing the intake of animals proteids, and there is a great deal of truth in Professor Keith's contention that the colon is more of a misused than a useless structure, owing to the extraordinary change that has taken place in the diet of man in civilized countries. I agree with Metchnikoff in thinking that the simpler food of uncivilized races may be best, and that it would be true progress to abandon much of the modern cuisine and to go back to the simple dishes of our forefathers. "It is the excessive cleavage of animal proteids that is so harmful. In my experience, intestinal stasis is much commoner in private than in hospital practice, and I attribute this fact to injudicious diet on the part of the better classes. The substitution of a two-meal diet for the three-meal diet of today would be a great advantage."" "Mr. Mummery, Surgeon to St. Mark's Hospital referred to intestinal toxemia the symptoms resulting when the function of the liver fails (hepatism), as also the symptoms of uremia which occur when the kidneys become inefficient. He remarked: "Some of the most interesting and important cases of auto-toxemia are those in which there are associated joint lesions of the nature of semi-acute or chronic arthritis. I believe that many of the cases of crippling arthritis that we see from time to time are due to poisons formed in the large bowel. I have seen several cases in which arthritis, both of the chronic and semi-acute variety, was associated with stasis and toxemia."" "Sir Bertrand Dawson, M. and D., Physician in Ordinary to H. M. the King, Physician to the London Hospital, and one of the leading physicians of Great Britain said, "Although the terms 'alimentary toxemia' and 'intestinal stasis' are open to criticism, they convey to out minds a definite clinical picture. The sallow, dirty complexion, the inelastic skin, the dusky lips and nails, the dirty tongue, evil-smelling breath, constant abdominal discomfort of one kind and another, the doughy inelastic abdomen, cold extremities, the physical and mental depression, are among the prominent features. That such a condition may be produced by colon block and statis, is, I think, clear."" "Dr. A. F. Hertz, Physician of Nervous Diseases to Guy's Hospital, gave as the classical symptoms of intestinal toxemia, "extreme emaciation, extensive pigmentation, evil-smelling sweat, and cold extremities"." "Arbuthnot Lane, the eminent surgeon of Guy's Hospital, attributes to intestinal toxemia inflammation of bile ducts and of the gall-bladder, gall-stones, inflammation of the pancreas, duodenal spasm of the pylorus, cirrhosis of the liver and Diokine's disease. Lane even goes so far as to say that "the gynecologists may also be regarded as a product of intestinal stasis." He enumerates the following conditions as due to intestinal toxemia: "Wrinkles, atrophy of the skin, pigmentation of the skin, browning of the eyelids, also the skin about the eyes, the axillae, the abdomen, cyanosis, coldness of the hands and feet, sweating of the hands and feet, livid skin, roughness and dryness of the skin, wasting of the muscles, general musculas weakness, curvature of the spine, wasting of the abdominal muscles, prolapse of the viscera, weakness of the heart, degeneration of the aorta, dilated heart, melancholia, imbecility, headache, symptoms resembling brain tumor, epilepsy, diseased conditions of the mammary gland--a nodulated condition, induration, cystic degeneration and later cancer--goiter, adenoids, enlarged tonsils--the result of lowered vital resistance, pyorrhea, endometritis, uterine cancer, various disease of the eye and baldness. In certain persons increased growth of the fine hairs covering the general surface of the body, tuberculosis, rheumatoid arthritis, Still's disease."" Doesn't sound too bad "Dr. H. G. Adamson, Physician in Charge of Skin Department to St. Bartholomew's Hospital, stated, "There are many skin eruptions--psoriasis, lichen, planus, pemphigus [?], scleroderma, pityriasis rosea, alopecia areata, lupus erythematosus and others--which certainly definite entities, and almost obviously due to some specific cause of the nature of which, however, we are as yet ignorant. There are circumstances which rendered it very improbable that these eruptions are due to the local presence of micro-organisms, and the only alternative seems to be to regard them as due to toxins. The most likely source of such toxins seemed to be the alimentary canal." "Said Dr. W. Knowsley Sigley, "A too generous diet often plays an important part in some cases, especially in eczema, acne and psoriasis, and a change to a more or less vegetarian one will often bring about a cure. In some patients a diet of rice and water, in others a pure milk diet, will often clear up an old-standing and very obstinate skin lesion, especially if of an inflammatory or irritable type. "The treatment of a large number of general skin eruptions resolves itself into the scientific treatment of chronic constipation. "It is not the frequency of evacuation that is of importance but the quantity, that is to say, that the contents of the large bowel are systematically completely removed, and that there is not an ever-increasing residue left behind. In other words, it is necessary to be sure that the patient is not passing today what he ought to have got rid of a week, or perhaps a month ago." "Dr. James Galloway, Senior Physician of Charing Cross Hospital, holds that intestinal toxemia is capable of producing nearly all forms of skin disease. Among others, lupus, erythematosis, dilation of the vessels of the skin, also purpura and pigmentation of the skin and especially the following: A yellow tint due to urobilin, jaundice noted in cases of anemia, hemachromatosis, in which the skin acquires a mahogany brown or slate black color [tut], a red brown tint noted in anemia, cirrhosis of the liver and enlargement of the spleen, and other pigmentation produced by methemoglobinemia [?] and sulphoglobinemia [?]." "Mr Ernest Clarke stated: "Although not generally recognized, the eye, as a matter of fact, is an organ that registers in a very delicate manner certain conditions of the system, and amongst these conditions intestinal toxemia is markedly one."" "hardening of the lens may be delayed by the absence of, and accelerated by the presence of, certain poisons in the system, and intestinal toxemia takes a very high place in the list." "[..]I think I have said enough to prove that premature hardening of the lens is a very constant sequela of intestinal stasis, and this is a very useful and easily ascertained index." "Changes in the arteries of the brain have been produced in monkeys to which small doses of paracresol have been administered daily during several months. Experiments conducted by Metchnikoff and his students showed that hardening of the arteries may be produced in guinea pigs and rabbits by giving the animals daily small doses of indol and phenol. Bouchard showed that an extract prepared from feces possessed highly toxic effects. He also noted that the feces of a person living on a mixed diet are twice as toxic as those of a person living on a non-flesh diet. Herter showed that an extract of the feces of a carnivorous animal produces deadly effects when injected into the bodies of small animals while similar extracts of the feces of herbivorous animals do not." "Adolph Schmidt, one of the leading internists of Europe, thus describes the effects of intestinal toxemia: "Most of the symptoms that clearly result from the effects of intestinal decomposition are displayed by the nervous system. They are of the most varied kind. At one end of the series there is simple headache; at the other come, convulsions and collapse. The more usual forms may be considered under the headings: (a) the general phenomena observed in cases of severe constipation; (b) epilepsy or eclampsia; and (c) psychoses. The general phenomena observed in cases of severe constipation include the nervous symptoms seen in chronic habitual constipation--felings of being out of sorts, lassitude, headhache, giddiness, neuralgia, ill-humor, and so on." "The colon bacillus, as pointed out by Metchnikoff, is an active poison producer under the conditions that are always present in the colons of persons suffering from intestinal toxemia. It is true that the colon bacillus is an acid-forming organism, as pointed out by Bienstock, but it has been clearly shown by Metchnikoff and his followers that this is true only when the organism is well supplied with carbohydrates. These are present if at all only in minute quantities in the feces of persons suffering from intestinal toxemia." "Is is doubtless true, as pointed out by Distaso and others, that the chief sources of toxins from which the body suffers are not the toxins that are set free during the life of the micro-organisms, but rather the endo-toxins that are liberated after the death of the organisms. The tremendous potency of these endo-toxins is well shown reaction produced by the injection of a few drops of autovaccine, which consists simply of heat-killed bacteria culture, and the toxines derived from a few million bacteria. When injected beneath the skin, a vaccine often gives rise to very marked rigor followed by a high fever lasting several hours, with numerous pronounced systemic disturbances. Is is evident that the quantity of these poisons derived from the small number of bacteria injected is many times less than that which we know to be daily produced in the human intestine. The chief reason that fatal effects do not ordinarily occur is to be found in the protection afforded by the intestinal mucous membrane and other organs of defense. The venom of a snake does no harm when brought in contact with the intact skin, but a very minute amount of venom introduced underneath the skin gives rise to distressing and often fatal consequences. So long as the mucous membrane of the intestine remains intact, it is able to filter out these poisonous substances. When, however, the mucous membrane is inflamed or eroded, this defense is broken down and the poisons gain access to the circulation. This fact explains many of the nervous and other distressing symptoms that accompany colitis, and also various anaphylactic phenomena associated with intestinal toxemia, among which may be mentioned urticaria and various other skin eruptions, asthma and migraine. It is evident, then, that if the number of bacteria produced in the intestines each twenty-four hours can be materially lessened, distinct progress will be made in combating intestinal toxemia." "To change the intestinal flora is not an easy matter. It is necessary to do something more than to simply introduce a few acid-forming bacteria. [Criticizing Metchnikoff's idea of probiotics] The soil must be changed. If we continue to put into the alimentary canal material of a sort that encourages the growth of putrefactive organisms, this class of micro-organisms will continue to be the dominant flora of the intestine. But even a change of soil is not sufficient. Several measures must be employed in conjunction to successfully change the intestinal flora. These are: 1. A diet that will produce in the intestine a media unfavorable for the growth of putrefactive and pathogenic organisms. 2. Increased activity of the colon. 3. The introduction into the intestine of large quantities of acid-forming or protective bactaeria. The intestinal flora may be favorably influenced by any one of these three measures, but for definite and rapid change of the flora, all three of the methods must be employed simultaneously." "Is is a matter of common observation that carbohydrates (starches and sugars) ferment, while proteids putrefy. Although both changes are due to bacterial action, there is a most important difference between the classes of micro-organisms involved in the two processes. The organisms that give rise to fermentation produce simple acids--chiefly lactic or acetic acid--that are harmful only in very large quantities. In the minute quantity in which they can be produced in the intestine they are usually entire harmless [?]. On the other hand, the microbes that give rise to putrefaction produce deadly poisons and toxins, a long list of which have been already mentioned, while there are doubtless many others not yet known [!]. Bacteria, like other plants, require soils favorable for their development. It is evident that the most effective way of suppressing the growth of poison-forming, putrefaction-producing organisms in the intestine is to reduce to a minimum the amount of proteid in the diet. The marked difference in the character of the stools of a vegetable-eating animal, like the sheep, and a carnivorous animal, like Travis, is clear evidence of the influence of a high protein diet in promoting putrefactive changes in the intestine. The same difference is observed between the stools of a flesh-eating man and those of a flesh abstainer. When meat and eggs are eaten freely, considerable of the proteids escape digestion and find their way into the colon, and there undergo putrefactive changes. If, on the other hand, the diet is reduced to a minimum amount of proteid, and the residues that reach the colon are small in quantity, the putrefactive changes are slight and the number of bacteria with their toxins and endo-toxins is notably lessened. By a change of diet it is not only possible to change the bacterial inhabitants of the intestine, but to change the action, and even nature and influence of the colon bacillus and its congeners so that they no longer produce pernicious effects, but actually become a means of protection and defense. In other words, the wild bacteria that, in various ways, as already pointed out, find their way into the human intestine and give rise to putrefaction and other bacterial changes whereby poisons in large quantities are produced, may be changed. The researches of Kendall showed beyond question that these poison-forming bacteria cease to produce poisons when they are adequately supplied with carbohydrates of the kind that they can utilize. Kendall found that even most virulent disease-producing bacteria, like the diphtheria bacillus, in the presence of sugar cease to produce toxins. The same is found to be true of the colon bacillus and various other bacteria that grow in the human intestine--with one or two comparatively unimportant exceptions. How to get the required amount of carbohydrates into the colon is the problem. Sugar and cooked starch are so quickly digested and so completely absorbed in the small intestine that it is by no means easy to get this element into the colon. Raw starch digests less quickly and milk sugar is more slowly absorbed than other sugars. Practically only two carbohydrates can be made to reach the colon without undergoing digestion and absorption--raw starch and milk sugar. Raw starch digests so slowly that when taken in more than very minute quantities a considerable portion will reach the colon and there be acted upon by amylolytic bactaeria, which are always present; sugar is produced, supplying to the colon bacillus and other harmful bacteria the material necessary for changing the action of these organisms, so that they become protective instead of destructive through the harmless acids which they produce. Sugar of milk in considerable quantities in connection with means for stimulating intestinal activity may also be made to reach the colon because of the great slowness with which it is digested and absorbed in adults. Milk sugar remains four times as long in the alimentary canal as does malt sugar. By means of the "milk regimen," which will be described later, it is possible to introduce lactose or milk sugar into the colon in almost any desired quantity. When the colon is thus supplied with carbohydrates, fermentation takes the place of putrefaction and the acids produced not only prevent the development of poisons, but also act as normal stimulants to the colon, encouraging frequent and normal emptying of the colon." "To prevent misapprehension it should be here stated that the ordinary "milk diet," so called, is not an efficient method of introducing lactose into the colon, although it is probable that the increased quantity of lactose that finds its way into the colon in connection with the milk diet is one of the principal means of securing the beneficial results sometimes secured by milk feeding. We shall describe a practical method of using milk, the "Milch regimen," by means of which surprisingly good results have been obtained." "Lactose, or milk sugar, is the most slowly absorbed of the sugars. It remains in the intestine four times as long as does dextrose, or maltose, that is the sugars formed in fruit juices and that formed by the digestion of starch. By feeding a portion of the starch in an imperfectly cooked condition, the desired end may be accomplished, since raw or partially cooked starch is digested very slowly and hence may reach the colon before absorption. It has been shown by Distaso and others as well as Rettger that some of the colon bacteria are amylolytic, that is, are able to convert starch into sugar, and so can supply to the colon bacilli and other organisms the sugar they need to change their action into acid-formers, so that they will cease to produce indol, skatol and other toxins, ptomains, ammonia and other poisons which are found in putrid stools. In the fruit regimen, half a pound of milk sugar is given daily, the amount Rettger found necessary for producing the change of the colon flora. With the fruit regimen, the colon is kept empty and a sufficient amount of starch and fruit sugar reaches the colon to produce the needed acid fermentation. It is often advantageous to add to the regimen four to six ounces daily of lactose or a mixture of lactose and maltose." "The multiplication of bacteria in the intestine is more actively encouraged by stasis or stagnation of the intestinal contents than by any other factor aside from an excessive amount of protein in the diet. A most important means of lessening the multiplication of bacteria in the intestine is the acceleration of the food materials along the intestinal tract. Delay of intestinal contents at any point along the twenty-seven feet of small and large intestine is quickly followed by the development of active bacterial changes." "Normally the stomach becomes empty in about four hours after the beginning of a meal and the small intestine discharges the last remainders of the meal into the large intestine four hours later. In other words, the process of digesting and absorbing a meal normally occupies about eight hours. Three of four hours later the undigested residues of foodstuffs, mixed with excretory substances derived from the liver and intestinal mucous membrane, in a perfectly normal person may be discharged from the body. Under such circumstances the opportunity for putrefactive changes is so slight that the bacteria developed are comparatively few, and the amount of poisons produced is exceedingly small. In carnivorous animals the time required for the transit of foodstuffs through the alimentary canal is much shorter." "Some animals, such as the eagle, which live on an exclusively flesh diet, nevertheless live to great age because of the extreme shortness of the intestinal tube, which affords no opportunity for stasis and hence little chance for putrefactive changes." [Humans:] "It must be clearly understood, however, that by increased frequency of bowel movement is meant, not simply one bowel movement a day, but at least three full bowel evacuations. In many cases it is desirable that as many as four evacuations should be secured. The normal rhythm of bowel movement is three evacuations daily, or a bowel movement after each meal. Briefly stated, my reasons for this belief are these: In healthy infants the bowels usually move soon after feeding. The same is true of healthy animals and active healthy boys and girls who are fed upon a natural diet that is sufficiently bulky to produce normal peristalsis. Among primitive people the bowels move after every meal. Three evacuations are generally the habit. This fact was ascertained by a questionnaire sent out to several hundred medical missionaries stationed among people of the most primitive types. Doctor Sheppard, an experienced practitioner of Aintab, Turkey, says, "Among the Turks, three bowel movements a day is the universal habit. When a Turk's bowels move less than three times a day, he consults a physician." Dr. William Arbuthnot Lane told the writer that he was once consulted by a member of the Turkish Embassy in London for relief of constipation because his bowels moved only once a day, and he stated that he found his vital stamina was very greatly diminished when his bowels moved less than three times a day. A Bushman said to a missionary doctor whom he consulted for relief, "Doctor, I am horribly constipated; my bowels move only once a day." The chimpanzees and other big apes in zoological gardens move their bowels four to six times daily." "Hundreds of persons who have come under the write's observation and have been induced to adopt necessary measures for securing three bowel movements daily, have experienced notable improvement in health and the disappearance of headaches, languor, sleeplessness, loss of appetite, coated tongue, foul breath and a great variety of other symptoms that form the familiar clinical picture of intestinal toxemia." "Since the process of digestion and absorption is normally completed in eight hours, no reason whatever can be assigned for the retention of the unusable remainders and waste matters that contribute nothing to the welfare of the body and may become a source of infinite mischief through putrefactive changes while waiting for delayed evacuation." "Food is a natural laxative. When food is taken into the stomach, peristaltic waves begin passing along the organ, from above downward at the rate of three to five waves a minute. The peristaltic waves do not stop at the pylorus but continue along the whole length of the intestine, so that the taking of food stimulates the movements in the colon. According to the observations of Hertz, Case, and others, the contents of the colon are pushed forward four times as rapidly during the taking of a meal as when the stomach is empty." "The writer has met a number of unusually healthy persons who attributed their remarkable health and vigor at an advanced age to the fact that all their lives they had had the habit of moving the bowels three times a day." "It is usually quite easy by the methodical use of simple means to acquire the habit of three bowel movements daily and the results of this practice have always been found to be beneficial and in no way harmful. The method is quite simple. It is only necessary to supply the proper amount of bulk and lubrication required in each individual case. For giving to the diet a proper amount of bulk, Nature(r) has provided only a single food substance. This is cellulose [plant fiber]. Animal foods of all sorts are practically all completely digestible. Little or no residue is left in the digestion of meat for the reason that meat represents material that has once passed through the process of digestion in the digestive organs of an animal and hence is capable of undergoing complete digestion when exposed to the proper digestive juices. Cellulose is the one substance found in foodstuff that is not digestible in the human alimentary canal, although in certain animals, particularly herbivorous animals, nature has made provision for the digestion of cellulose. Cellulose is found in larger or smaller quantities in practically all vegetable foods. In some instances it is found in larger quantities than in others. The cellulose content of our foods varies greatly. In fruits and fresh vegetables cellulose is found in a newly formed state in which it is very easily broken up, and it is on this account less valuable as bulk-producing material. It is easily acted upon by bacteria and broken up into gases resembling illuminating gas. The bran of cereals represents an older form of cellulose in which it has been transformed into wood and which is resistant to bacteria. Agar-agar represents a peculiar form of cellulose known as "hemi-cellulose" which is soluble in boiling water. This is also indigestible. All forms of cellulose are useful in giving bulk to the intestinal contents; but bran and agar-agar, known also as "Japanese isinglass," are the most valuable of all. For efficient stimulation of the intestine it is necessary to take with the food daily from two-thirds of an ounce to one or two ounces of cellulose. This indigestible material or roughage should not be taken at a single dose, but should be taken at each meal in such a way that it will be thoroughly mixed with the various other food substances so that it vvill be equally distributed along the intestine. Care must be taken that the requisite amount of cellulose is taken at every meal without exception. The omission to supply the necessary bulk for one single meal may give rise to stasis, the ill effects of which may last for several days." "In addition to increasing the bulk of the food, lubrication is often required." "Examination of the bowels and rectum generally shows, in cases of chronic constipation, a dryness of the mucous membrane." "The importance of studying crap of young infants has been long recognized. With this fact in mind it is very surprising indeed that the stools of adults are seldom inspected by either the physician or the patient. The physician inquires, perhaps, whether the bowels are regular. If the patient replies, "Yes, my bowels move every day," no further inquiry is considered necessary. As a matter of fact, a thorough examination of the stools is just as important for adults as for infants." "In some persons the fecal residues are greatly reduced in amount. This condition some authorities refer to as greedy colon and attribute to "too good digestion." This explanation can hardly be accepted. It is impossible for digestion to be too good. The amount of the fecal residue is reduced because of the presence in the intestine of bactaeria that destroy cellulose, the element that normally makes up the greater bulk of feces." "Very finely ground charcoal--or better, bone black--may be used instead of carmine. A teaspoonful of this should be taken dissolved in a little water or milch. Stewed huckleberries or raspberries may also serve as a marker. This test is a highly important one and gives most valuable information respecting the activity of the intestine. In certain cases the color appears promptly the afternoon of the same day it is taken, but continues to appear for a couple of days, showing that the unusable food remnants and the body wastes accompanying the same are too long retained. This slow disappearance of the color after a prompt appearance is probably indicative of a dilated condition of some portion of the colon. It is usually the right half of the colon that is dilated. This condition is often associated with pains in the region of the appendix. The reason for the delay may be either extreme dilatation or a pouched condition of the cecum, or adhesions of the cecum interfering with the contraction movements by which it pushes its contents into the ascending colon. When the color is slow in appearing--that is, when it does not appear until twenty-four or thirty-six hours instead of appearing the same day it is taken--the cause is very likely to be rectal constipation, a condition in which the lower bowel, and even the rectum may be so clogged with accumulated and hardened fecal matters as to produce mechanical obstruction to bowel movement. The delay may also be caused by colitis, a condition that usually affects the left half or descending portion of the colon. The irritation produced by colitis causes the bowel to contract so that the passage of material along the canal is hindered. This causes an accumulation in the cecum and right half of the colon, a condition usually accompanied by the formation of large quantities of gas with discomfort from distention due to gas accumulation. Slow disappearance of the color may be due to incompetency of the ileocecal valve. When this condition exists, the food residues do not advance with the normal promptness and regularity, but oscillate back and forth between the colon and small intestine. X-ray observations have clearly shown this. The small intestine may become empty as the result of the vigorous intestinal activity that accompanies digestion. The next day, however, although no food may have been taken in the meantime, several feet of the small intestine may be filled with putrefying material that has backed up from the colon. In such cases there is usually obstruction in the left half of the colon, which may be due to colitis or rectal constipation, or may be caused by prolapse and adhesion or incarceration of the pelvic colon. The slow disappearance of the color may also be due to obstruction at the outlet of the stomach. This condition is often accompanied by great dilatation of the stomach. In such cases, twenty-four hours or even longer may be required for the complete discharge of the coloring matter from the stomach. This, of course, will cause delay in both the appearance and disappearance of the color as observed by examination of the stools." "In modern of the times the use of milk as an exclusive diet was brought to the attention of the profession by Philip Karell, of St. Petersburg, physician to the Emperor of Russia. A paper written by this sagacious physician was translated by Carrick, at that time physician to the British Embassy at St. Petersburg, and was published in this country in 1870. Karell was perhaps the first to systematize the use of milk to insist upon its use in small doses. He made use of the remedy especially in the treatment of obesity and dropsy, though he commended it as a valuable remedy in many other chronic diseases. On this account, he employed small quantities, generally not exceeding three or four pints daily, the object being to reduce flesh or to promote the absorption of dropsical fluids. He did, however, recognize the fact that it was somehow through its influence upon the alimentary canal that the beneficial effects of milk were impressed upon the body. He said, "I have, after fruitlessly trying all sorts of remedies in many chronic and obstinate diseases, at last succeeded in thoroughly bringing the alimentary canal, that seat of so many diseases, under my control. I did this by administering milch according to a new method." The writer desires especially to emphasize the fact that the chief beneficial effects derived from the milk regimen are due to its influence upon the alimentary canal; in other words, as will be shown later, to its influence in changing the intestinal flora." "Although many persons experienced considerable benefit from the regular use of cultures of the lactic acid-forming organisms, the results were on the whole very disappointing. The good effects produced were not sufficiently regular or pronounced to maintain the confidence in this new therapeutic agent that had been inspired by Metchnikoff. The theory was most plausible and fascinating but the results were more frequently intangible than otherwise. The idea developed by Tissier and Metchnikoff that the intestinal flora must be changed for the purpose of getting rid of the chronic intestinal poisoning, which lies at the foundation of the majority of chronic diseases, was, however, too rational and practical a notion to be abandoned." "After many hundreds of more or less successful, but not altogether satisfactory, attempts to solve this interesting problem, the simple and successful methods which are outlined in subsequent chapters of this buch were at last hit upon and gradually perfected. Among the changes accomplished by the methods herein outlined, are the following: 1. The pernicious poison-forming and disease-producing bacteria, the "wild" bacteria of Herter, are made to disappear, or at least are so greatly reduced in numbers that they cease to exercise a pernicious influence. 2. The putrefactive and other "wild" bacteria, that under ordinary conditions produce in the colon and lower part of the small intestine great quantities of highly virulent poisons, which work enormous mischief in the body, under the new conditions established by the regime described in subsequent chapters, cease to produce poisons and produce harmless acids, chiefly lactic and acetic acids instead. In other words, the "wild," mischief-making bacteria are tamed or domesticated [: idi], and behave like friendly organisms, assuming a protective action essentially the same as that of the Bacillus Bulgaricus and other lactic acid-forming organisms. 3. A further change that is effected is the substition of organisms of a positive beneficial character for the "wild" and pernicious bacteria which throng the intestine in conditions of toxemia and overwhelm the body with noxious products." "That is, the pernicious bacteria which render the change of flora necessary are by the methods here presented: 1. Eliminated or greatly diminished. 2. So changed that their action becomes beneficial instead of pernicious. 3. Displaced by vigorous strains of friendly organisms, the B. acidophilus, B. bifidus and B. Bulgaricus." "To achieve the best results it is a good plan to place the patient under preliminary treatment for a few days before beginning the milk regimen. During this period, the length of which may vary from two to ten days, special efforts should be made to get the patient's bowels operating freely. The bowels should be made to move three or four times a day." "If necessary, an enema at 85o to 75oF may be administered daily for a time until normal action begins." "In many cases, especially when the tongue is much coated and when other evidences of pronounced intestinal toxemia are present, the "fruit regimen" may be employed with great advantage as a preliminary to the "milch regimen." The writer has found this plan of greatest service. After three to five days of fruit regimen the milk regimen is instituted." "Cow's milk is not a natural food for grown-ups, either humanoid or bovine. Milk is deficient in iron, and contains an excess of proteid and lime. Cow's milch disagrees with many persons, children as well as adults. It is certainly by no means an ideal food for adults. Yet many persons are marvelously benefited by its temporary use when proper precautions are taken. The first essential is that the milk should be taken in large amount, so large as greatly to excess the needs of the body, and thus fill the alimentary canal with material which will promote the growth of friendly bactaeria. A second essential is that the milk shall be taken often. A half pint every half hour is the usual plan. This makes it possible to take into the stomach the five or six quarts of fluid for one day's ration. It is also important to maintain a constant stream of fresh material passing along the alimentary canal, so that a considerable portion may reach the colon undigested and unabsorbed. It is especially important that a sufficient amount of milk sugar should reach the colon unabsorbed to maintain in the colon a state of acid fermentation, thereby preventing putrefaction and changing the intestinal flora. This is, indeed, in many cases, the chief benefit derived from the milk diet. An important fact pointed out by Magnus-Levy is that "the absorption of the various forms of sugar in the intestine proceeds with unequal velocity. This observation, which has been made repeatedly on animals Weinland has found to hold good for man (Nagano); maltose and dextrose disappeared completely in one hour whereas only 26 per cent of milk sugar, present originally in equal quantity and in the same concentration as the maltose and dextrose, was absorbed during the same period." To encourage the acid fermentation in the colon, it is well to give at each alternate feeding yogurt buttermilch in place of sweet milk; or equal parts of sweet milk and milk soured by the Bulgarian ferment may be taken at each feeding. It is still better to give with each glass of milch a half ounce of a mixed culture of B. Bulgaricus and B. Travisicus." "Milk ferments but does not putrefy. This fact has been established by Hirschler, Rivighi, Schmitz, Eisenstadt, and many other observers. That fact that milk also "arrests or diminishes intestinal putrefaction accounts for its absence in milk diet" (Czerny). As a matter of fact, however, milk may encourage putrefaction if constipation coexists. This is due to the fact that undigested curds remain in the colon after the sugar of milk has been wholly absorbed, so that its protective influence in supporting acid fermentation is lost." "Feedings being at 7:00 am and end at 7:30 pm--twenty-five feedings in all. At 10:00 am and 4:00 pm the milk is omitted and a meal of fruit is taken instead. The purpose of this is to encourage bowel activity, since very free and frequent bowel movement is essential to success. The disappointing results often encountered in the use of the milk diet are chiefly due to the constipation, which is likely to be produced in many persons, the natural result of which is intestinal toxemia and an aggravation of the very symptoms from which relief is sought. Two ounces of sterilized wheat bran or an ounce and a half of agar-agar should be taken daily in half ounce doses, preferably at 7:00 am, 11:00 am, 3:00 pm and 7:00 pm feedings." "When the period of exclusive milk feeding is ended, a laxative and stricly antitoxic diet must be adopted. It should be remembered that the chief advantages of the milk regimen as a means of changing the intestinal flora lie 1. in the large amount of milk sugar that by this means is carried into the colon and there, fermenting, produces lactic acid and so prevents the growth of the putrefactive bacteria; 2. in the frequent bowel actions induced. The soft curds, undigested and unabsorbed, by their bulk as well as by their acidity stimulate peristalsis to such a degree as to cause several bowel of movements daily." "In cases in which mechanical obstacles to bowel action exist, such as incompetency of the ileocecal valve, or adhesions of the pelvic colon, constipation may constinue in spite of the largest quantities of milk that can be taken. In such cases, the sugar of milk is wholly absorbed, leaving the milk curds to putrefy in the colon. The most intense toxemia may result. The writer has met a number of cases of this sort. This is the chief cause of the disatrous failure of the ordinary "milch cure" in many cases. By a free use of bran and paraffin [: idi], combined with the abdominal fomentation and the wet-girdle, success may be attained even in these difficult cases by persevering effort. The colon should be emptied twice daily by the enema. When colitis is present, the warm enema (90o-100oF) should be used; in other cases the cool enema (85o-70oF) is preferable. When the bowels begin to move naturally and the stools are no longer putrid, the enema should be used at bedtime only. This should be continued until the tongue becomes clean. The bowels should move four or five times a day. If for any reason proper bowel action cannot be secured, the "milch regimen" must be suspended at once." "If the patient is emaciated so that a gain in flesh is one of the objects of treatment, complete rest should be maintained during the first week; not necessarily in bed, but on a cot, or in a wheel chair a part of the time if more agreeable. During the resting period the patient should take a few deep breaths four or five minutes every hour when awake to counteract the ill effects of lying in bed. The patient should not lie always in the same position. When lying on the back, a cushion should be placed at the small of the back. Sand bags are useful as "props." The old style of "rest cure," instituted by S. Weir Mitchell, was defective in that it did not provide systematic and graduated exercise. It made patients obese, but not strong. (Zuntz.) Graduated exercise should be begun after the first week (see page 292). [!] The patient must spend every possible moment out of doors, day and night." "The amount of milch taken daily must depend upon the capacity of the patient. It is clearly necessary to take fully double the amount of milk actually needed for nourishment. The ratio to body weight is about one and one-half ounces of milk to each pound of body weight." "The total food value in calories of the full regimen (6 qts.) is not far from 4 and 0 and 0 and 0 calories, of which one-half is fat, one-fourth casein and one-fourth milk sugar; that is, 2000 calories of fat, 1000 of proteid, and 1000 of carbohydrates. The fat and milk sugar are more completely utilized than the casein. The body can store up almost any amount of sugar and fat in the form of adipose tissue and glycogen [?], but only a very limited amount of proteid. This is especially true while the patient remains in a state of rest. Proteid can not be retained unless it is utilized by entering into the composition of the living tissues of the body--the glands, the nerves, blood and muscles. Not more than two hundred to three hundred calories per day can be used for this purpose, so that several hundred calories of casein must be lost in the stools. The loss is not complete, however, for the soft, slightly acid curds have a highly beneficial effect upon the diseased surfaces of the colon, suppressing the growth of pernicious bacteria, and gathering them up and sweeping them away by stimulating intestinal activity." "Cases are, indeed, very rare in which the milk regimen can not be employed with success, even though the patient's former experience may have been such as to justify the expectation of failure. The only cases, in fact, in which the milk regimen is positively contra-indicated, are those in which the individual has been sensitized to milk proteid. The milk regimen differs from ordinary milk feeding, especially in the following perticulars:1. It is a thoroughly systematized method. In ordinary "milk feeding," it is a common practice with physicians to say to the patient, "Take all the milk you can at meals and between meals." That is, the milk is simply added to the ordinary bill of fare. This method occasionally succeeds fairly well in securing a gain in weight when this is the chief object sought, but no infrequently, perhaps in a majority of cases, the patient soon finds his digestion upset. Appetite disappears, the bowels become inactive, the tongue coated, and pronounced symptoms of intestinal toxemia appear. When milk is taken in this desultory manner, it is likely to promote rather than to combat putrefaction in the colon. In cases in which a normal or excessive amount of free hydrochloric acid is produced by the stomach, large tough curds are likely to be formed, which finding their way into the colon furnish a favorable medium for the development of the putrefactive organisms that abound in this part of the alimentary canal. This is particularly likely to occur if the milk is taken between meals for then it enters the stomach at a time when large amount of highly acid gastric juice is present, a condition favorable to the production of large indigestible curds. The increase of intestinal putrefaction increases the constipation and resulting toxemia that destroys the appetite and gives rise to malaise, headache, and other distressing symptoms. Thousands of persons have learned from experience that milk, when taken in connection with other foods, produces the disagreeable symptoms above noted. When taken in sufficient quantity and as an exclusive article of the diet, these symptoms do not appear, for the following reasons: (a) The quantity of milk taken is so great that the lime and casein present neutralize the acid of the gastric juice and diminish the intensity of the action of the rennin, so that the curds formed are soft and friable and easily broken up. (b) When milk is taken in connection with an ordinary diet, the quantity is so small and its movements along the intestine so slow that the milk sugar present is all absorbed before it reaches the colon. Thus, the undigested curds present are not protected from the action of putrefactive bacteria, but are left to undergo decomposition. When taken in the quantity prescribed by the milk regimen, the whole alimentary canal is flushed with milk in which the lactic acid fermentation begins before the colon is reached, and the movement toward the colon is so rapid that a considerable part of the large amount of milk sugar taken reaches the colon. The twelve pounds of milk usually taken by the patient in the milk regimen contain about half a pound of milk sugar. A sufficient amount of this will reach the colon to maintain acid fermentation by which the growth of the putrefactive organisms is prevented. Bienstock, Tissier, and Martelly have shown that when sugar is present to the extent of one per cent, the growth of putrefactive bacteria is prevented, provided acid-forming bactaeria are also present. Careful chemical analysis of the stools of patients taking the milk regimen shows the presence of sugar to the extent of one per cent. In a case in which a fistulous opening existed in the intestine just above the ileocecal valve, the amount of lactose found present in the intestinal contents with patient taking the milk regimen was nearly five per cent. That is, the food residues of the small intestine which were just ready to enter the colon contained an amount of sugar amply sufficient to protect the contents of the colon against the action of putrefactive bacteria. 2. The frequency with which the milk is administered plays a highly important part in the success of the milk regimen. Each time the milk is taken, a new impetus is given to the peristaltic activity of the stomach and the intestine. Fresh food entering the stomach sets up active peristalsis the whole length of the alimentary canal. This serves an important purpose in getting a sufficient quantity of lactose into the colon to support the active growth of the acid-forming bacteria.  3. Peristaltic activity is increased with the "milk regimen" and decreased with the ordinary "milk diet." When used in the ordinary way, milk is generally found to be constipating. Some persons note laxative effects from the use of buttermilk, although this is not uniformly the case. Raw milch, and especially boiled milch, is almost universally regarded as constipating. There are two reasons for this: (1) When milk is well digested, no residue is left behind to stimulate peristaltic activity. (2) It is not well digested, the curds that pass into the colon produce putrefaction with the production of ammonia and other putrefaction products, the effect of which is to paralyze the colon and produce constipation. The older writes on the milk diet call attention to the fact that patients taking the milk cure were constipated, and even referred to the constipation as a good indication. Some modern advocates of the milk diet have expressed the same view. This is a grave error and this is an important point in which the "milk regimen" differs from the so-called "milk cure." One writer even goes so far as to recommend that the "call" for evacuation of the bowels should be resisted and postponed so as to secure a large movement the next day. Nothing could be more absurd. One bowel movement a day is constipation. The bowels should always move three times a day, and a person on the "milk regimen" should have at least four bowel movements daily. A steady stream of sour milk must pour along the intestinal canal. In this way, the old flora or "meat bacilli" (Herter) and other "wild" bacteria, may be driven out and the new beneficent, acid-forming flora may be established.  Especial care must be taken so to manage the milk regimen as to secure a very decided increase of peristaltic activity. It is by this means alone that the necessary carbohydrate (milk sugar) may be made to reach the colon, a condition essential for changing the intestinal flora. Increased peristalsis is also one of the most important measures for securing a change of the intestinal flora by preventing stasis or stagnation of the intestinal contents, which, more than any other condition, promotes putrefactive changes. In exceptionally favorable cases, the administration of a glassful of milk every half hour will produce a sufficient degree of intestinal activity to accomplish the desired end; but in a large majority of the cases in which the milk regimen may be of service, such obstinate constipation exists that it is necessary to employ additional means for securing the necessary degree of intestinal activity. In these cases, incompetency of the ileocecal valve, a spastic condition of the distal colon, adhesions of the pelvic colon or some of the several forms of rectal constipation--any of these conditions, or a combination of several, may be present.  It is only by this thorough flushing and scourging of the intestine that the pernicious putrefactive organisms can be drive out and the beneficent ferments established. The colon must be constantly flooded with fermenting carbohydrate. [The faster it moves, the lesser is needed to obtain the same result.] 4. It has been found decidedly advantageous to allow the patient two meals of fresh fruit, one in the forenoon, the other in the afternoon--at 10 am, and 4 pm. The usual glass of milk is omitted and the patient is allowed to take, instead, fruit of any kind for which he may have a fancy. Fresh fruits are, however, decidedly preferable, particularly strawberries and juicy fruits of all sorts. Great care must be taken to masticate the fruit very thoroughly. Lettuce and celery may be added to the fruit meal without disadvantage in most cases. These foods require almost no digestive activity, while they supply vegetable acids, together with carbohydrates, which aid in establishing the acid-forming bacteria in the colon, as well as vitamines, iron, and various salts that promote the patient's nutrition. The alkaline salts furnished by fruits are particularly valuable to combat the slight tendency of the milk regimen to disturb the equilibrium of the body fluids as regards the exact balance of acids and bases. Another advantage of the "milk regimen" depends upon the fact that casein is a form of proteid of which the body can make use with a very high degree of economy. "Caspari found both in the dog and man a greater nitrogen retention after addition of casein to the diet than after a corresponding amount of flesh" (Milroy)." "When a gain in flesh is one of the chief objects desired to be attained by the use of the milk regimen, the patient should take very little or no exercise during the first week. It is not necessary that the patient should stay in bed as some have insisted. It is only important that he should avoid active exercise. Even moderate exercise may increase metabolism from twenty-five to fifty per cent. The energy thus consumed in muscular activity diverts a definite amount of nutritive material which has been digested and absorbed, and consumes instead of storing it. The patient should not walk about or engage in occupation of any kind, and should avoid even light work. Generally, the patient may read, chat, and entertain himself, and may be entertained with music and in other ways, but should avoid violent excitement of all sorts and should sleep as much as possible." "It is well-known that there is a marked difference in the quality of milk furnished by different breeds of cattle. Cattle of the Holstein breed furnish a milk containing a moderate amount of fat, while Jersey cattle furnish a milk in which the fat content is very much larger. Microscopic examination of the two varieties of the milk show also that there is a difference in the fat globules, the globules in Holstein milk being much finer. There has been much discussion as to which of these two varieties of milk is best adapted to milk feeding of infants and invalids. It seems to be pretty well settled among those who have had considerable experience in milk feeding that an excess of fat is decidedly injurious, lessening digestibility and encouraging intestinal putrefaction. It is important also to remember that in employing the milk regimen for the purpose of changing the intestinal flora, the milk sugar is an element of primary importance since it constitutes the food of the acid-forming organisms, the re-establishment of which in the colon is necessary for a change of the intestinal flora. The Holstein milch contains a liberal supply of sugar, and the smaller amount of fat is a decided advantage. For many years, the only milk employed for table use in the feeding of patients in the institution under the write's supervision has been supplied by a fine herd of Holstein cattle and produced under the conditions required for certified milk. Too much emphasis can not be put upon the importance of avoiding miscellaneous feeding in connection with the milk regimen. Fruits may be used to advantage, for reasons given elsewhere, while in most cases even lettuce and celery may be employed to advantage." "Miscellaneous foodstuffs, particularly meat and eggs, must be carefully avoided, not only on account of the excess of proteid, which their use involves, but, in the case of meat, on account of the stimulating effect of meat upon the gastric glands. Pavlov demonstrated that the use of meat excites the acid-forming glands of the stomach to a very high degree, the result being the production of a highly acid gastric juice. The reason for this is that the meat requires a highly acid gastric juice for its disinfection and digestion. Milk, on the other hand, requires a gastric juice with a low degree of acidity. Consequently, these two articles of food are naturally incompatible, and there is something more than a mere ceremonial significance in the ancient law of the Hebrew race, which for many thousands of years has required strict adherence to the rule that eating of meat and milk or milk products at the same meal should be strictly prohibited. Even at the present time an orthodox Jew stricly abstains from eating milk in any form when flesh foods form a part of the bill-of-fare. Nothing could be more opposed to plain physiologic principles than the recommendation of certain advocates of the rest cure that large quantities of beefsteak and eggs should be combined with the use of milk. Recent very careful studies of the dietetic properties of raw eggs have shown that the raw white of eggs is not only very indigestible but that it hinders the digestion by absorbing pepsin." "The mouth should be cleansed by rinsing well with water after each feeding. It is well also to rinse the mouth several times a day with cinnamon wasser. This may be easily prepared. Put into a pint bottle a tablespoonful of calcined magnesia. Add to this two teaspoonfuls of cinnamon essence. Fill the bottle half full of water and shake vigorously two or three minutes. Then fill the bottle with water and mix, and it is ready for use. Shake each time before using. A weak solution of peroxide of hydrogen [didn't change a thing here] is also highly valuable for mouth disinfection. When proper care is taken to keep the mouth clean, the milk regimen greatly promotes the health of the teeth. Pyorrhea, if not too far advanced, will sometimes disappear after two or three weeks of milk regimen. Decay of the teeth has been shown to be, in part at least, the result of a deficiency of lime in the saliva. The milk not only itself contains lime in abundance, but replenishes the body's stores of lime and so increases the amount of lime in the saliva. When the teeth are constantly bathed with a saliva which is rich in lime salts, the decay already started is arrested and new foci of decay do not appear." "Feeble patients who can not exercise should have automatic exercise after the first week. Those who are able to do so, should walk a definite distance daily--the first day, twenty rods; the next, forty rods; the next day, eighty rods; so increasing the distance each day up to three or four miles. The full distance need not be walked at one time. Not on any account must the patient be allowed to become greatly fatigued. Swimming and various special exercises and exercises upon the inclined plane are of special value. An electric light bath may be given daily with advantage. Sweating should continue only three or four minutes and should be followed by a cold towel rub or a cold shower and massage." "The tongue becomes clean, breath sweet, the stools are no longer offensive, and usually have a yellow color and little odor or a slightly sour odor. This change is generally observed within a week or ten days, and even sooner when the bowels move very freely. The skin clears, the blood improves, the patient gains in flesh, often a pound a day, and the old depression, headache, mental dullness, and other miseries are replaced by a sense of energy and well-being. The transformation of the patient from a poor, emaciated, despairing invalid to a plump, rosy-cheeked, bright, forceful person, ultra-pimp is often so rapid as to seem almost miraculous. This rejuvenating process sometimes continues for two or three months if the regimen is faithfully carried on and modified to meet the patient's changing needs." "Taking the milk too rapidly is a frequent cause of gastric disturbance. It is of the highest importance that the milk should be taken slowly as directed. It may be slowly sipped with a strong suction action, or better still, it may be drown through a straw. Experiment shows that when milk is taken in this way, the amount of saliva mixed with it is several times as great as that when it is swallowed as one ordinarily drinks wasser. Milk should never be taken as a beverage. It must be taken as a calf or an infant takes it, with a sucking movement, which insures proper insalivation. Milk requires a liberal admixture of saliva to insure normal digestion." "In some cases, it is found necessary to take the milk warm instead of cold, or at a temperature near that of the body, say 102 to 105 degrees. When taken at this temperature, the stomach seems to relax more readily to accomodate the milk. When taken cold, a certain sensation of fullness in the stomach due to failure of the stomach to relax sometimes leads the patient to protest that the stomach is already full and can not receive more. This sensation usually disappears at once when the milk is taken warm. In heating the milk, case should be taken not to raise the temperature above 115 to 120 degrees. A higher temperature is likely to injure the vitamines, which are highly essential to the most favorable results. A convenient way of heating the milk is to place the bottle containing it in a basin of hot wasser, covering the whole with flannel. A small electric heater, which may be placed in the bottle or in a tumbler containing the milk is a great convenience." "In certain cases in which the stomach is sensitive to fats, it is found advantageous to give skimmed instead of full milk or milk from which a part of the cream has been removed. Similar results may be obtained by diluting the milk with water and adding milk sugar. For example, the milk and water may be mixed in equal quantities and the milk sugar added in the proportion of two ounces of milk sugar to a quart of the mixture." "Patients sometimes complain of inability to take milk because of the formation of quantities of gas that distend the bowels and produce discomfort. The cause of this is stasis. The intestinal contents are delayed in some part of the alimentary tract and as a result of the stagnation, fermentation with the formation of gases occurs. The worst cases are those in which incompetency of the ileocecal valve exists. This condition is usually associated with prolapse, with adhesion of the pelvic colon or a spastic condition of the descending colon, or both these conditions together. In many cases there is in addition a sacculated state of the cecum, the so-called movable cecum of Wilhms or adhesions of the cecum. The gas accumulation is in both the colon and the small intestine when the ileocecal valve has become incompetent. The gases naturally force their way back into the small intestine and the distension of the abdomen is most pronounced in the region of the umbilicus." "In certain cases the tongue becomes thickly coated a few days after the beginning of the milk regimen. The appearance of the tongue may be white, brown or yellow. The surface is usually moist. The breath is sometimes fetid and has a strong fecal odor. In these cases the cause of the coating of the tongue is usually stasis in the colon and putrefaction with the consequent absorption of toxins. In the majority of cases there is an incompetent condition of the ileocecal valve, resulting in the backing up of fecal matters into the small intestine, where putrefaction poisons present are readily absorbed. The coated condition of the tongue is due to the fact that when the blood is charged with toxins, the resistance of the blood and other fluids is lowered, the saliva loses its power to inhibit the growth of micro-organisms, and the mouth becomes an incubating chamber in which molds and bacteria of various sorts grow luxuriantly. When the bowels become active, moving three to five times a day, the tongue soon clears off. The colon should be cleansed by enema once or twice a daily. When the tongue is coated at the beginning, which is not infrequently the case, it should be gotten clean or nearly so by a course of fruit regimen for a few days before beginning the milk regimen. When the tongue becomes clean or nearly so, the breath sweet, and the stools comparatively free from odor, the patient is ready for the milk regimen. In some cases it is best to interrupt the milk regimen and put the patient on a fruit regimen for a few days until the tongue clears, then resume the milk. If the patient is put upon a milk regimen without having the preliminary fruit regimen, he is much more likely to suffer inconvenience from the use of milk and frequently nausea, vomiting and constipation occur; the patient gets discouraged and gives up the attempt. This rarely occurs when the patient is properly prepared by means of the fruit regimen, which lessens the putrefactive flora and gets the bowels moving." "Perhaps the most frequent and the most serious obstacle in the way of milk feeding is constipation. If milk is taken in small quantity, constipation is certain to result. It is only by taking milk in quantities sufficiently great to furnish a large residue of undigested curds that constipation may be avoided. In fact, in cases in which the colon is greatly crippled by adhesions, dilatation of the cecum, incompetency of the ileocecal valve, prolapse and incarceration or adhesions of the pelvic colon, or a spastic condition of the descending colon, it is often impossible to secure proper activity of the bowels by the use of milk alone. It is unwise in such cases to resort to laxatives, such as saline mineral water or other aperients. These drugs largely counteract the beneficial effects of the milk regimen and should never be employed." "Constipation may best be overcome by the use of substances which afford bulk without presenting to the digestive organs elements which require digestive work. Cellulose, convenient in the form of agar-agar or bran, is the element provided by Nature for this purpose. Lubrication is required in most cases in which chronic constipation has long existed, for the reason that the intestine has ceased to produce the normal quantity of lubrcating mucus." "A vast multitude of invalids and semi-invalids have suffered great damage through an undue fear of injury from the use of starchy foods. Many physicians as well as patients have entertained the idea that a farinaceous diet may give rise to acidosis, rheumatism, and a long train of ills. Nothing could be more contrary to the truth. Starch is of all the food principles the one least likely to become a source of disease or injury. Starch is, of all foodstuffs, the most easily digestible, the most easily assimilable, and the most easily and completely oxidized or burned in the body. The products of its combustion are simply water and carbon dioxide, a gas. The carbon dioxide escapes through the lungs with greatest facility. Starch is converted into sugar in the process of digestion, and thus becomes the chief fuel element of the body. Every heart beat, every muscular movement, is possible only through the consumption of sugar." "The views held by some of the older medical writers respecting the possible injury from a diet containing much starch have been shown by authoritative physiologic researches to be wholly unfounded." "Voluntary fasting probably originated as a religious performance. It was prescribed as penance, or was undertaken for the purpose of encouraging a state of spiritual elevation. In modern times, fasting has been, at various times, greatly extolled as a panacea for nearly all chronic disorders. It has been used chiefly by certain irregular practitioners in an empirical way, and sometimes, it must be confessed, with a considerable degree of apparent benefit." "Various professional fasters as well as fasting animals have since that time been studied by physiologists in different parts of the world. The uniform testimony of these expert observers has been that the withholding of food does not exercise the prompt control over intestinal putrefactions that might be expected. It is true that under ordinary conditions, putrescible food remnants furnish material for promoting an abundant development of putrefaction organisms in the colon. On the other hand, food is not the only source of putrescible material in the colon. The bile, intestinal mucus and other intestinal secretions that are constantly poured into the alimentary canal furnish a sufficient amount of putrescible material to maintain a luxuriant putrefactive flora. When these materials are promptly discharged from the body, however, there is not sufficient time for the development of the putrefactive process, which requires much more time than is needed for the development of the fermentative process to which carbohydrates are subject. In fast, however, there is almost complete inactivity of the intestine. Food is the natural excitant of peristaltic activity. Whenever food is taken into the stomach, active contraction waves begin at once, traversing the stomach at the rate of three to five a minute, and passing along down the whole alimentary tract. When food is withheld, these movements cease, the biliary and other excretions accumulate and undergo putrefaction; the poisons are absorbed; the tongue becomes coated; the breath foul; the urine is loaded with the products of putrefaction and all the evidences of intestinal autointoxication become intensified. In the case of the faster Cetti, observed by Lehmann, the first stool after the beginning of the fast occurred on the ninth day. The amount of phenol, a putrefaction product, found in the urine had increased in the meantime to nearly five times the amount present at the beginning of the fast. The condition of the urine was the same as that which is usually observed in cases of obstruction from peritonitis or other causes, the result of the paralyzed condition of the bowel due to complete abstinence from food. Examinations of the urine of Succi, the famous Italian faster, made by Apollo and Solard by Bouchard's method showed its toxicity to be greatly increased. Mr. Horace Fletcher, who fasted seventeen days, found at the end of that time the evidences of autointoxication so aggravated that he was compelled to terminate the fast. Some years ago a man who had fasted for three weeks consulted the writer on the twenty-first day of his fast. He had begun the fast for the purpose of getting rid of a foul tongue, a bad breath and various disorders which were clearly the result of chronic intestinal toxemia. He was disappointed in finding that all his symptoms had become worse instead of better. His tongue was very heavily coated, his breath very foul, he was sleepless and greatly depressed and nervous. On inquiry it appeared that his bowels had not moved once during the entire three weeks. In answer to the question when his bowels moved last, he remarked, "I took an enema the day before I began my fast and I have eaten nothing since; of course my bowels have not moved as there is nothing to be moved." A saline laxative was administered at once and within twenty-four hours the patient had several large and horribly smelling stools and was greatly relieved. Needless to say this patient was cured of his desire to fast. Some who have taken very long fasts maintain that if the fast is continued long enough, the tongue after a time clears off, appetite returns and a very great physical and mental renovation is experienced. Possibly in such cases the enormous number of putrefactive bacteria retained in the body undergoing digestion and absorption may produce an effect similar to that following the use of bacterial vaccines, conferring a temporary immunity, such as one sees in the convalescence of typhoid fever and some other intestinal infections. But this favorable result is uncertain and a number of cases have been reported in which patients have died while waiting for the tongue to clear and the appetite to return. It is probable that in the most favorable cases the benefit derived from prolonged fasting is obtained at the expense of more or less permanent injury to important vital organs, and that great and unnecessary risk of serious vital damage is incurred. Starvation suspends the secretion of the digestive juices. "The secretion of salive diminished in acute starvation even when water was taken ad libitum. Thus, Succi, on the seventh day of his fast, only produced as much saliva by the movements of his jaws in three hours as under ordinary circumstances is secreted in five minutes" (Von Noorden). In fasting, the stools are highly putrid and "similar in appearance to the feces passed when the diet is mainly composed of meat" (Von Noorden). Says the same author, "The blood atrophies." Statkewitsch studied the effects of fasting in a large number of animals--cats, dogs, rabbits, pigeons, frogs, lizards, and other animals--and found that after prolonged fasting the cells of the heart, liver, muscles, kidneys, pancreas and other glands were the seat of degenerative processes. These processes were most marked in the muscles and the glands. Zander found evidences od degeneration of the heart muscles in pigeons after fasting eight to twelve days. Gaglio found cloudy swelling of the muscles, granular and fatty degeneration of the liver in fasting frogs." "So long as life continues, the fasting animal body continues to consume energy although at a reduced rate. The energy output of the body during fasting is three-fifths to three-fourths the ordinary output. In the absence of the usual source of energy, food, the body feeds upon itself. The body is consumed at the rate of about one-eightieth of its weight each day. The stores of fat are first drawn upon, then the muscles, glands and other structures are consumed to keep the fires of the body burning. The heart muscles and some other organs may lose as much as one-half their weight. This process of degeneration may be carried so far that the body can not recuperate itself. According to the London Lancet, the professional faster, Succi, although only thirty-eight years of age, had the appearance of a very aged person; not only his face but his entire body was covered with deep wrinkles. His muscles were so atrophied and degenerated that he looked like a skeleton and had the appearance of a person suffering from incipient marasmus." "[..]It is evident that to submit such a person to an ordeal by which he would lose thirty or forty pounds in weight, involving the destruction of half his muscular structures and nearly an equal proportion of many of the most important vital organs, for the purpose of eliminating three of four pounds of waste materials that may be easily gotten rid of otherwise is, in the highest degree, irrational. It is like setting a house on fire or half tearing it down to get rid of a dead rat in a closet. There are much easier, safer and more efficient means of getting rid of accumulated body wastes. And so, while admitting that good, even remarkable results are sometimes obtained by prolonged fasting, the writer feels no hesitancy in condemning this practice as an unnecessary drastic, unsafe and dangerous method of combating conditions which are clearly due to intestinal toxemia. All the good results obtainable by fasting may be much more easily, safely and efficiently secured by the rational employment of the "fruit regimen" and the "milk regimen" as recommended in this work." "Sugar (chiefly derived from the digestion of starch) is the fuel of the body. Fat, the other fuel element of the food, must be burned with sugar to make it available. Burned alone it produces incompletely oxidized and poisonous products, resulting in a highly dangerous condition: acidosis. Fats and proteids (albuminous elements) promote putrefaction in the colon and load the body with waste and poisonous products. Carbohydrates ferment, and the acids formed combat putrefaction. It is thus evident that all the benefits to be derived from fasting as a means of blood and tissue purification are more certainly attainable by the elimination of fats and proteid only, than by abstinence from all food. The "fruit regimen" is a fat-proteid fast. It secures all the benefits of fasting and avoids all the dangers and inconveniences of abstinence. More than this, the fruit regimen keeps the bowels open and trains them into the normal rhythm of activity. The over-distended cecum contracts. The spastic descending colon relaxes. The liver and kidneys, no longer owataxed, rapidly clear the blood of waste matters and toxins, and a feeling of well-being and "fitness" is experienced which is an index to the rejuvenating processes which are in progress in the blood and tissues." "That a diet from which animal proteids is wholly excluded is safe and competent is attested by all modern physiologists. Says Prof. D. Spence, in Von Noorden's monumental work on metabolism, "The old question as to whether the proteid of vegetable origin is in respect of value as a food-stuff equal to that of animal origin--whether omnivorous man, like the herbivora, could with impunity draw his entire supply of proteid from the vegetable kingdom alone, is in principle one which is already decided for us through the practice of those people who live exclusively on vegetable foods. Physiological investigation can therefore only supply the evidence that it is indeed true that the vegetable-albuminous substances as they occur in nature are equal in nutritive value to an equivalent quantity of proteid of animal origin."" "Professor Milroy [Von Noorden's "Metabolism"] thus incidentally at once endorses and commends the low-proteid diet as a means of prolonging life and increasing efficiency: "To arrive at a diet rich in energizing material and poor in proteid, one that may also offer variety and be sufficient for the bodily requirements, is the endeavor of the scientists." "However, such a doctrine will not attract too many admirers, or at least will not bring them in as adherents, for the majority of men, even with the tempting prospect of prolongation of life, or at least rejuvenation, prefer to enjoy the comforts of life" and die prematurely." "But another element is necessary for the best results. Soon after Metchnikoff called attention to the fact that the colon produces indol, skatol and other highly deleterious substances capable of setting up degenerative changes in the body when absorbed into the blood stream, Bienstock called attention to the fact that the colon bacillus is also capable of producing lactic acid and other acid products. So while Metchnikoff condemned the colon bacillus as a cause of premature senility through the poisonous products of the putrefactive processes set up by it, Bienstock extolled the colon bacillus as an organism friendly to human life on account of the fermentation of carbohydrates caused by it. A vvarm controversy was for years waged between the followers of Metchnikoff and those who followed Bienstock. These divergent views were finally reconciled by Kendall, who as the result of a highly interesting research discovered that nearly all the micro-organisms found in the colon, as well as many other pathogenic organisms, including the diphtheria bacillus, undergo complete change of character in the presence of carbohydrates and set up fermentative rather than putrefactive changes, and produce only harmless acids instead of the virulent poisons, ptomaines and toxins that they produce when grown in a culture rich in proteid. These various observations made evident the important fact that the intestinal flora may be changed in two ways: first, by suppressing the growth of putrefactive organisms, and second, by changing the character, or at least the mode of activity of the colon organisms, without actually getting rid of the micro-organisms themselves. To effect this remarkable change by which the virulent poison-forming organisms are converted into harmless acid-formers, it is only necessary to supply the bacteria growing in the colon with an abundance of available carbohydrate." "The starch that thus escapes digestion is, of course, lost to the body as nutriment, but in supplying food to the billions of hungry colon bacilli that inhabit the lower segment of the intestine, it performs a protective function[.]" "One more point to be noted in relation to the antitoxic diet is the avoidance of an excess of animal fats. Animal fats in large amount promote intestinal putrefaction. This fact was pointed out by Combe." "The interval between meals should be sufficient to afford the stomach an opportunity for rest. The gastric glands exhaust their energy by long continued activity and need rest. But this is not all. The stomach requires disinfection after each meal. If no time is allowed for this, infection is likely to occur. The need for rest for disinfection has been very clearly shown in the feeding of young children by Czerny and Steinitz (Von Noorden's "Metabolism"). The principles laid down by them in the following paragraph apply equally well to adults: "As the power of human milk to combine with HCl is less than that of undiluted cow's milk, so the antiseptic power of the stomach contents of the naturally fed child is greater than that of the artificially fed. Moreowa, the system of three to four hour pauses between meals, especially advocated by Czerny, is supported by this fact. For since in the case of healthy, naturally-fed children, free HCl appears in the gastric contents at the earliest in one and a quarter hours, and in the case of artificially-fed children first in two hours, a thorough disinfection cannot be attained without allowing a considerable interval. If this is not inserted between two meals, the stomach has not the time to disinfect its contents, and the way is thrown open to all possible invasions. Besides, Czerny and Wachsmuth have also drawn attention to this defect, and have attempted to explain by its means the higher mortality of artificially fed children (often 20 to 1)." The emptying time of the stomach in healthy adults is four and one-half hours. Allowing an hour for rest and disinfection, the interval between meals for the average healthy person should be not less than five and a half hours from the beginning of one meal to the beginning of the next. Observing this rule, it is impossible to eat more than two substantial meals in a day without encroaching upon the sleeping hours. Nothing is more unphysiologic than to go to bed soon after eating a hearty meal. This is one of the most prolific causes of insomnia." "In the majority of persons suffering from chronic intestinal toxemia, the carmine test meal appears first only at the end of twenty-five hours or longer and will disappear only after the lapse of forty-eight or more hours. Not infrequently, the color will be still observed after three days and in one case under the writer's observation the carmine was last seen at the end of one hundred and forty-two hours or nearly six days from the time it was taken. Observations show that in persons suffering from constipation, even in latent form, there is a very great accumulation of material in the intestinal tract. It is evident, for example, that in a case in which the color does not make its appearance until at the end of twenty-four hours or longer, there is accumulating during the the intervening period the residues of the several meals taken during this time together with the bile and other excretions, which have during the same time been excreted into the intestine. Much larger accumulations occur in cases in which a still lower motility is observed. When the color is long disappearing, it is evident that the bowel never empties itself, but always retains larger or smaller fractions of the meals taken during several days. The writer has noted several cases in which the carmine reappeared after once having appeared and disappeared. In one case, an interval of twenty-four hours elapsed between the first disappearance and the second. This might easily occur in a case with a greatly distended cecum, an uncolored meal passing over an accumulation of colored material in the cecal pouch and appearing first." "Increased frequency and completeness of bowel movement is nearly as essential for the restoration of a normal condition of the intestinal flora as regulation of the diet. The normal intestinal rhythm is three or four bowel movements daily, or at least one movement after each meal. The chimpanzee and other of the larger apes move their bowels three or four times daily. I was informed by the animal keeper of the London Zoo that the large apes in that great collection uniformly move their bowels four times a day. The small monkeys have more frequent bowel movements. They eat constantly. The keeper of the big chimpanzee at the Washington (D. and C.) zoo states that five or six bowel movements daily is the rule with his big apes. Doctor Hornaday, Superintendent of the Bronx Zoological Garden, informs me that the large monkeys in his collection move their bowels three times a day. By correspondence with many missionary doctors practicing among primitive people in Africa and other foreign countries, I have learned that the bowel habits of people living in a wild or primitive state are identical to those of higher apes." "The average American of the citizen, however, consider himself a model of regularity and physical rectitude if he has one bowel movement daily without the use of drugs or pills. Nevertheless, it is no exaggeration to say that the average adult American is suffering from intestinal toxemia. Women suffer more than men as a result of sedentary life and wrong habits of dress. It is difficult to find an adult woman who does not show more or less indication of chronic toxemia, though probably the majority, if charged with being intoxicated, would protest vigorously, if perhaps with less frankness than was shown by a woman who consulted the author some years ago. When told that she had autointoxication, she showed much indignation and exclaimed very vehemently, "You are mistaken, sir; I am not intoxicated. I have not taken a drop since night before last. I confess that I do usually take a toddy at night to make me sleep but I took none last night." The lady was not comforted when we explained to her that the intoxication from which she was suffering was even worse than alcoholic intoxication because continuous, whereas alcoholic intoxication is usually intermittent. The effects of intestinal toxemia are on the whole, in the writer's opinion, quite as bad as those of alcoholic intoxication in its ordinary manifestations. When the bowels move thoroughly three times a day or after each meal, or better still, four times a day, once after each meal and on retiring or immediately on rising in the morning, the time during which the unused food residues remain in the colon is too short to allow for the development of advanced putrefaction processes; and if the diet is of proper character, low in proteid, rich in carbohydrate, supplied with a reasonable amount of starch in its native state, the stools soon cease to show marked evidence of decomposition; the strong ammoniacal, putrid or rancid odors disappear, the stool has either a faint sweetish or slightly sour odor, and the black or dark brown color [tut] gives place to an orange or yellow color." "In persons who are fairly normal, these changes may be brought about very quickly by regulation of the diet and a voluntary effort to move the bowels after each meal; but in persons who have been chronically constipated for years, other measures are necessary. Means must be employed to combat chronic constipation systematically and continuously. It is not proper, however, to resort to the habitual use of laxative drugs, such as castol pboyl, cascara sagrada [This is the second time someone experienced warns against its use], senna, etc. Salines and even laxative mineral wassers must be avoided. All of these things do harm. They invariably aggravate the spastic condition of the descending colon almost always present. Laxative drugs also produce an exaggeration of the anti-peristaltic movements, which begin in the transerve colon and travel backward toward the cecum. These movements are natural during digestion but do not interfere with the periodical movement of the intestinal contents. Colitis, rectal constipation and especially the use of laxative drugs greatly exaggerate this anti-peristaltic action, and so increase the tendency to stasis in the cecum and the ascending part of the colon. It appears to be more than probable that this exaggerated anti-peristalsis set up by mechanical obstacles to normal bowel function existing in the distal colon is the chief cause of dilatation of the cecum and incompetency of the ileocecal valve, which is brought about by the owa-distention of the cecum." "In the great majority of cases of constipation, even very obstinate cases, in which a natural movement of the bowels has not occurred in many years, the difficulty may be quickly overcome by increasing the bulk of the food intake and by adding a lubricant in the form of paraffin oil [: idi]. The modern diet in civilized countries is by far too highly concentrated. The human intestine is adapted to a bulky diet. The average bill of fare leaves practically no residue after the digestive process is completed. This fault may be easily corrected by the addition of sterilized wheat bran in sufficient amount and by the free use of fresh fruits and green vegetables. For normal persons living on a biologic diet, bran would not be necessary, but persons who have been for years constipated have crippled colons, the colon is dilated and elongated, its muscular walls are weakened by long continued owa-distention, and the mechanical stimulus furnished by a very bulky dietary addition is essential. Such colons are also crippled by degeneration of the glands that normally furnish an abundance of lubricating mucus. This is particularly true in cases in which the appendix is diseased or has been removed but is also true in practically all cases of chronic constipation. This  deficiency may be compensated for by the use of paraffin oil [: nailbiting], which acts purely in a mechanical way, lubricating the intestinal wall so as to facilitate the onward movement of the colon contents. One or two tablespoonfuls of bran and one-half ounce to two ounces of paraffin oil taken at every meal will usually secure three or four bowel movements daily. The bran should be mixed through the meal. The paraffin oil should be taken a short time before the meal. Neither the oil nor the bran act as laxatives in the ordinary sense. They do not irritate the bowel. The bran stimulates the bowel not by irritation, but by a sort of titillation, hastening peristalsis in both the small intestine and the colon, and by hurrying on the unused residues of each meal, leaving no opportunity for the development of putrefactive changes. Bran also excites the intestine to action by distending it, and by the same means stimulates the activity of the glands which furnish the digestive fluids." Are you still here? "The common practice of combining raw eggs with milch is highly objectionable. The observations of Vernon and others have clearly shown that raw white of eggs is not well digested in the human alimentary canal. The undigested albumen greatly promotes putrefaction in the colon and hence does much harm. Yolks are less objectionable but not needed." "If the bowels do not move three times a day, prompt measures should be taken to make them do so. Without being aware of the fact, all persons whose bowels move only once a day are constipated. Proper of the tests show that with many persons the waste matters discharged have been lying in the colon undergoing putrefaction for several days so that every bowel movement is a belated movement. The offensive materials that are discharged today should have been discharged yesterday, the day before, or even several days before. Cases are sometimes observed in which, although the bowels move regularly, the movements are always several days in arrears. Modern physiologic observations have proven that the unusable remnants of each meal and accompanying wastes should be discharged within twelve to twenty-five hours after the meal is eaten. The following suggestions have been thoroughly tested in the treatment of many thousands of persons suffering from constipation, and have been found to be effective. 1. The bowels normally move three or four times daily. Eating starts up active movements of the intestine, which naturally lead to a bowel movement after each meal. In the majority of persons, a bowel movement occurs soon after rising in the morning. With many persons, a bowel movement occurs just before going to bed. Frequent bowel movement which occurs naturally is not weakening, but wonderfully promotes vigor, endurance, appetite, digestion, and all that pertains to good health. 2. An effort should be made to move the bowels on rising, soon after breakfast, after each meal and on retiring, whether there is or is not a "call" for bowel movement, and at any other time when a slight "call" is experienced. A persevering effort should be made to secure at least three movements daily and at regular times. 3. Meals must be regular in time and amount of food taken. Food is the physiologic laxative. A scanty meal, or the omission of a meal, means the interruption of the intestinal rhythm--omission of a movement, or an incomplete movement. Fasting, a scanty diet (milk, gruels, broths), a diet chiely consisting of such foods as potatoes, rice, meat, eggs, white bread, tea, coffee, and condiments, are constipating. Something should be eaten at the regular meal time if only fruit or bran and paraffin. 4. The importance of bulk or undigested residue as an aid to intestinal activity is well shown by the facts pointed out by Spence who tells us that "herbivorous animals, like the rabbit, die when fed on food which leaves no residue. Adult human beings are not so constructed that they can exist on diets which leave no residues. The importance of these foods residues is emphasized in the term 'intestinal scourers' that has been given to them. The carnivores, too, do not dispense with them willingly; just as they devour bones, so do the graminivorous birds that swallow sand, feathers, and the like." (Von Noorden's "Metabolism.") Cellulose (the indigestible part of vegetable foods) is the only element that can increase the bulk of the feces in man. The average person requires about an ounce of cellulose daily. In cases of chronic constipation a larger amount is required. A convenient form of cellulose is sterilized bran. Ordinary bran contains much dirt and abounds in vermin. Specially prepared or sterilized bran is now obtainable everywhere and may be used in combination with otameal and other cereals. An excellent breakfast food may be prepared by mixing one-third bran and two-thirds oatmeal, cornmeal or other cereal. Such a mixture will be ready to eat after five minutes' cooking. Longer cooking is unnecessary and detrimental. Agar-agar or Japenese gelatin, another form of cellulose, is a very efficient laxative. In its commercial form, it is inconvenient for use. It may be obtained in sterilized and convenient form ready for use. 5. Agar-agar aids bowel action by preventing drying and hardening of the intestinal contents and filling the intestine sufficiently to stimulate it to action. The physiologists have discovered that the intestine possesses a peculiar kind of sensibility known as "muscle sense." When the intestine is stretched, the muscle sense is stimulated and the intestine is thus made to act. 6. The bowel requires lubrication. Normally a peculiar mucus secreted by the appendix and the colon furnishes sufficient lubrication. When the appendix or the colon have become diseased by long continued constipation oder colitis, the glands are destroyed and the normal mucus is not produced in sufficient quantity to properly lubricate the bowel. [Something about paraffin oil left out] 7. Green vegetables (excepting the potato) contains much cellulose. This is especially true of beet root, turnip, parsnip, spinach, cabbage, brussels of sprouts, and lettuce. 8. Exercise promotes bowel action, especially walking, horseback riding, calisthenics and such special exercises as trunk bending, leg raising, and deep breathing. Exercises and deep breathing movements taken on the inclined table are especially helpful and should be practiced several times daily. 9. Various other means are highly beneficial, such as massage of the colon, vibration and kneading of the abdomen. In special cases, applications of electricity to the abdominal muscles, the rectum, the pelvic colon, and other internal applications render great service. 10. In cases in which the abdominal muscles are relaxed, and the colon and other portions of the intestine are prolapsed, an efficient abdominal supporter should be worn either permanently or until the abdominal muscles have become strong enough to hold the viscera in position. 11. Drugs of all kinds must be avoided. They do not cure, and do much harm when repeatedly used. There is no such thing as a harmless laxative drug. Mineral wassers and saline laxative pills are harmful, and produce enteritis and colitis sooner or later, and destroy the mucous membrane and so encourage autointoxication by opening the way for absorption of poisons. 12. The squatting position secured by using a raised foot-rest in front of the closet seat is a great aid to bowel movement , especially in cases in which the abdominal muscles are relaxed, a condition most common in chronic constipation. 13. In cases in which the measures above indicated do not secure prompt relief from constipation, an x and ray examination by aid of the bismuth meal should be made. By this means a minute inspection of every part of the intestine is possible. In many cases "kinks," folds, contractions, adhesions, displacements, and other impediments to normal bowel action are found, which may be corrected by the application of appropriate measures. Such an examination should be made in all cases of unusually obstinate constipation." "While [cases that don't regulate activity by those means] are comparatively rare, the number is sufficiently large to deserve attention. In by far the great majority, perhaps nine-tenths of all the cases of obstinate constipation, the seat of the trouble, as shown by both clinical observations and x and ray studies, may be definitely located in the rectum, at least in the last two segments of the large intestine, the rectum and the pelvic of the colon. [Details left out] The warm enema added to the other measures suggested in foregoing pages and in the author's work, "Colon Hygiene," vvill rarely fail to keep the colon sufficiently well-cleared to prevent toxemia. Colon massage (deep digital), and sleeping on the left side are also useful measures." "In general, the following measures will be found of substantial benefit in connection with the milch regimen:" - Baths - Massages More details in the buch. "After the first week the patient should begin methodical and carefully graduated muscular exercise. The amount of work done must, of course, depend upon the patient's strength." "At first, the walking should be at a very leisurely rate, not exceeding two miles an hour. As the strength increases, the rate may be gradually increased until the pace reaches the rate of three miles an hour. This amount of exercise will not so greatly increase the consumption of food as to materially lessen the rate of gainz, and may, in fact, increase the appetite and the rate of assimilation sufficiently to actually increase the gainz in weight. A matter of much greater importance is that by means of exercise, the growth of the muscular tissue will be encouraged so that the increase in weight will not be due simply to the accumulation of fat, but will include a growth in the muscular structures, a much more permanent and useful gain that the mere addition of reserve tissue in the form of fat." "Breathing exercises, when properly taken, render the greatest service in promoting the movement of the milk from the stomach into the intestine, in encouraging bowel action and in promoting the absorption and circulation of the digested foods." Diokine and others that might be interested in breathing exercises: page 290 "The older physicians of the last century gave great attention to the tongue and associated its various appearances with certain disorders of the liver, such as "biliousness," and torpidity, and a variety of gastric disorders. The opinion prevailed very widely at one time that a coated tongue indicated a deficient secretion of gastric juice and a clean red tongue the opposite condition; but the introduction of the Ewald test meal showed that a coated tongue was even more frequent in cases of hyperhydrochloria than in cases of hypohydrochloria. As more accurate means of diagnosis have been developed in the study of gastric disorders, it has become more and more clearly apparent that no very close relation exists between disease of the stomach and tongue coatings." "The tongue, having been discredited as an indicator of gastric disease, has come to be neglected and treated as a matter of having little if any significance. This has been true especially since Duran pointed out that a coated condition of the tongue is found in eighty-five per cent of all cases of disease, and since Mueller and Fuchs showed (1898-1900) that sixty-two per cent of apparently healthy people have coated tongues. A microscopic and bacteriological examination of the coating of the tongue shows it to be made up of epithelial cells, molds, yeasts and bactaeria. A potato culture medium inoculated with material gathered from a heavily coated tongue is in a few days covered with a luxuriant growth of molds, yeasts, and bactaeria. A great variety of organisms may be sorted out and among them are found the colon bacillus, the gas-forming bacillus of Welch, and various species of streptococci, pus-forming organisms, many of which are possessed of a high degree of virulence, and which may give rise to pneumonia, rheumatism, and other systemic diseases, to say nothing of pyorrhea, dental caries, and various other oral disorders. Before we can begin to understand the significance of the coated tongue, we must know how the tongue becomes coated. Why is not the tongue always coated? The bactaeria, mold and yeasts which are found in the "coating" are always being taken into the mouth with the breath and the food. Certain kinds of food, particularly cheese, milk, and meats of all sorts, are swarming with bacteria. [He provided some impressive numbers; while cooking kills microbes, the toxins still remain.] Ordinary street dust consist largely of bacteria. The mouth daily receives many millions of these parasistic organisms. Why do they develop as shown by the coating of the tongue in some persons or at some times and not in all persons and at all times? The answer is simply zyzz: under perfectly normal conditions, bacteria may enter the mouth, but they cannot establish themselves and grow there. The healthy salive is able to prevent the growth of germs. This property of the saliva derives from the blood. It is a part of the remarkable provision made by Nature(r) by which the body defends itself against attacks of its microscopic enemies. The living cells and tissues of the body are endowed with power to defend themselves against bactaeria. Bacteria introduced into the blood quickly disappear. They are combated by the opsonins and bacteriolysins, the white cells of the blood, the macrophags. The lymph and other fluids possess the same power to destroy germs and prevent their growth. The healthy mouth is constantly bathed with the saliva which, when it enters the mouth, is not a mere solution of digestive ferments, but is a living fluid containing myriads of cells which are capable of capturing and destroying bacteria in great numbers. This living fluid, teeming with macrophags, bathes every oral surface, the teeth, gums, tongue, fauces, findings its way into every nook and cranny of the mouth so that no part can escape its cleansing and disinfecting influence. In order that the salive shall be efficient, it is necessary that the blood from which it is formed shall be in a normal condition with high resisting power. [It's a 1919 book] If any condition is present which lowers the reistance of the blood, this fact may be revealed in the loss of the germ-destroying and inhibiting power of the saliva. When the resistance of the saliva is lowered, there is no hindrance to the growth of these parasites, or so-called "coating," appears upon the tongue. The true significance of a coated tongue, then, is not indigestion, but lowered vital resistance. It is for this reason that, as one medical writer says, "most sick individuals have a coated tongue. This symptom indicates that there is something wrong in the economy." And the something wrong is lowered vital resistance. The cause of this lowering of vital resistance is a flooding of the body with poisons in amount greater than it is able to destroy and remove promptly. The source of the poisons may be various. They may be derived from typhoid or pneumonia germs, or some other acute infetion. There can be no doubt, however, that the most common and hence most important source of these resistance-destroying poisons is the bacteria in the colon. In the colon of a constipated person, putrefactive bacteria are constantly producing in great quantities highly active poisons, among best known of which are indol, skatol, phenol (carbolic acid) and ammonia. A portion of these poisons is fixed by the intestinal mucous membrane; another portion is detoxicated by the liver; but when large amounts are produced during a long period, these protecting devices fail and poisons then accumulate in the blood. In consequence, the blood cells are poisoned, the vital fluid is changed, its resistance is lowered, and every fluid derived from it, including the salive, is likewise changed. With these facts before us, it is not difficult to understand why eighty-five per cent of all sick people have coated tongues and that sixty per cent or more people apparently in good health have coated tongues. The constipation to which this condition is nearly always due is almost universal among civilized people. The injurious effects of constipation are not always evident at first. So long as the natural defenses against these germ poisons remain intact, the blood is kept free from them and ill effects do not appear. But sooner or later these wonderful protective mechanisms become impaired and then the bodily resistance is rapidly lowered, the tongue becomes coated more and more, and a long train of mischief begins which ends in high blood pressure, hardening of the arteries, premature senility, Diokine's disease of the kidneys, and various other degenerative changes. The close association of a coated tongue with constipation has long been recognized. The old-fashioned doctors of the last century applied the term "Podophyllum tongue" to the well-known yellow or brown-coated tongue associated with the condition popularly designated as "biliousness" under the supposition that a disturbance of the biliary function is indicated. The "liver torpidity" which the yellow or brown coat was supposed to indicate was trated by the doctors of the last generation by doses of calomel and salts, but this treatment was only temporarily successful, for the calomel did nothing more than to partially disinfect the colon and so lessen the amount of poisons produced. And repeated use of the drug made matters worse by producing irritation and lowered resistance of the mucous membrane of the colon, resulting in chronic colitis. In this condition, the filtering power of the intestine is largely lost so that the absorption of toxins is increased and the mucous membrane also doubtless loses its power to retain indican and other toxins and thus the toxemia is increased. Much may be said also about the ill-efects of repeated doses of calomel upon the liver and other organs." "From the foregoing it is evident that for practical purposes we may consider a thick persistent coating of the tongue to be an indicator of toxemia due to intestinal stasis or stagnation. In most cases, there will be found delay not only in the colon but in the small intestine as well. The cure is to be found in the suppression of intestinal putrefactions which are the source of the poisons. This cannot be done by antiseptics, by cathartics, or by active drugs of any sort. These methods have been tried for centuries and are acknowledged to be inefficient. The only radical cure is to be found in so changing or reforming the intestinal flora that putrefactions will cease and thus the normal resistance of the blood and vital fluids may be restored." "Constipation encourages the growth of infectious bacteria. When sufficiently numerous and virulent, these give rise to colitis. Colitis, if sufficiently intense, gives rise to adhesions, kinks, and diverticuli. These conditions still further aggravate the constipation, toxemia, colitis, and the owa-distention of the right half of the colon. As a result, the ileocecal valve is made incompetent, infectious fecal matter is forced back into the small intestine, infections travel upward to the duodenum, the gall-bladder, the pancreas and even the stomach, and thus multiply more and more conditions that create or aggravate intestinal toxemia." "Metchnikoff placed the whole world under obligation to him for all time in his discovery that the flora of the human intestine needs changing. He pointed out one means of accomplishing this life and health-saving change. He succumbed prematurely himself, perhaps because he failed to recognize the most efficient, obvious and practical of all means of combating intestinal putrefaction, namely, intestinal activity." "The sugar of milk is a special product adapted to the needs of the body, far superior to cane sugar and free from the unwholesome properties of the products of the sugar cane. It is found nowhere else in nature except in the milk of animals. Milk sugar is slowly digested and is absorbed only one-fourth as rapidly as malt sugar. This enables it more easily to reach the lower intestine where it is converted into lactic acid and so prevents the putrefaction to which modern science has trace a great number of the maladies of both infants and adults. It is due to the presence of lactose that milk sours, while meat putrefies. Nearly ten years ago, I placed in a jar of buttermilk a raw beefsteak to which no antiseptic of any sort had been added. The beefsteak is still intact, thanks to the antiputrefactive properties of milch sugar and the acid-forming bacteria it feeds. The reason for this antiputrefactive property of milk was discovered by Kendall of Harvard, who a few years ago demonstrated that in the presence of sugar, even highly active putrefactive organisms produce harmless acids instead of noxious toxins and ferments. This is certainly a most beneficent provision of nature whereby the normal food of the young infant is kept in a wholesome state while undergoing the processes of digestion and absorption in the intestine. In the caseid of milch is found material for growth and repair, and in a form favorable for prompt and complete digestion and assimilation. There are also other proteids in milk which serve the same purpose." "Cow's milk is also rich in salts, containing four times as much of these mineral elements as does mother's milk. Milk is particularly rich in lime. A pint of milch contains 11 to 16 grains of lime, more than is found in a pint of lime wasser. Note the contrast in this regard between milk and beefsteak, or flesh food of any sort. Meat supplies only half a grain of lime to the pound, although containing twice as large an amount of solids as does milk." "Milk contains certain digestive enzymes or ferments, galactose, oxidase, and reductase which aid the processes of digestion. It is important to note, however, that this is true only of fresh milk which has not been sterilized by boiling. These useful ferments, like the subtle vitamines, are destroyed by heat. This may be easily shown by a simple experiment known as Storch's test for heated (boiled) milk. Shake five c. c. of the milk in a test tube with one drop of 2 per cent hydrogen peroxide and two drops of 2 per cent sol. paraphenaleine-diamin. If the milk has not been heated, a dark violet color appears at once, but if it has been pasteurized or boiled, no color appears." "Milk should be alive, or at least uncooked. Pasteurizing, that is, heating to a temperatue of 158 degrees F, destroys the antibodies of milk. When the milk is hearted to a temperature of 176oF the digestive ferments which it contains are destroyed. The boiling of milk modifies in a harmful way nearly all its ingedients and considerably reduces its nutritive value. Rats fed on boiled milk grow to only half their normal size. Scurvy sooner or later appears in babies exclusively fed on pasteurized or boiled milch. The subtle alchemy by which milk is prepared in the laboratory of Nature is upset by the crude process of cooking. Boiled milk will sustain the life of rats but it will not enable them to grow to full development, and reproduction fails altogether. Science is teaching us every of the day that the fine adjustments and adaptations of nature cannot be safely ignored. We are gradually learning through the loss of millions of lives which have perished through our ignorance that the foodstuffs which nature designer for our use are not the haphazard products of wild and incoherent forces, but are wrought out by a subtle and infinite wisdom which fits them to our needs so perfectly as to transcend our highest knowledge and defy the profoundest analysis." [#louvre] "Another matter of much significance which must be borne in mind in relation to pasteurized milk is the rather surprising fact that, if not handled with care, pasteurized milk is likely to develop within a short time more bacteria and bacteria of a more dangerous type than are found in ordinary raw milk. The reason for this is that most of the bactaeria found in ordinary raw milk are of the acid-forming sort; that is, they are of the kind that are commonly known as buttermilk or sour milk germs, so-called friendly or protective germs. So long as these bacteria are dominant, the growth of putrefactive germs in the milk is prevented. These acid-forming germs are destroyed by the pasteurizing process, but the spore-forming putrefactive organisms are not destroyed and hence grow with greater facility in milk which has been pasteurized than in milk which has not been pasteurized. It is evident that pasteurization does not solve the milk problem. When scientifically done, pasteurization does mitigate some of the evils associated with unclean milk but the only true solution for the problem is clean milk." "Milk must be eaten, not swallowed as a beverage. It must be chewed. All foods need to be masticated. The calf and the nursing infant chew the milk which they draw from the maternal font. The movements of the jaws and the sucking movements executed by an infant in nursing induce an abundant flow of saliva which, mixing with the milk, properly dilutes it, and to a high degree promotes its digestion. Milk when swallowed rapidly as a beverage is likely to form in the stomach large and hard curds, which are very slowly digested. Many persons who suffer from taking milk in this way imagine themselves unable to take milk and so abandon its use. I remember a man to whom I had recommended the liberal use of milch. He protested that he was absolutely unable to use it at all and state that on the last occasion on which he had taken milk, he had nearly lost his life. A few hours after hastily swallowing several glasses of milk, he experienced a sensation of suffocation, was then nauseated and on attempting to vomit, experienced a choking sensation. On reaching his finger down his throat he felt a mass which he seized and to his astonishment drew out a rope of milk nearly a yard in length. The milk had formed in his stomach one large, hard curd which he was certainly very fortunate in being able to get rid of so easily. The famous English surgeon, Dr. Lawson Tait, told me of a case in which he was obliged to perform a surgical operation to remove a similar mass of curds which had lodged low down the intestine. Milk should be sipped slowly and with a sucking movement or taken through a straw so as to secure liberal admixture of saliva. By this means, the formation of hard, indigestible curds may be prevented. Milk must be taken in right quantities and in right combinations. It cannot be denied that milk digests better when taken by itself or in very simple combinations than when mixed with a large variety of other foodstuffs. In some instances, also, a large quantity of milk is more easily digestible than a small quantity. When the stomach produces a large amount of highly acid gastric juice, as is usually the case with persons who have been accustomed to a hearty meat diet, the curds formed when a small amount of milk is taken will be large and tough, whereas if a larger amount it taken, the curds formed will be smaller and softer. Hence, the proper remedy in many cases in which a person complains that he cannot take milk, is to take more milk.  As already remarked, the taking of milk with meat is perhaps the worst of all dietetic combinations. The reason for this was made clear by Pavlov, the eminent St. Petersburg physiologist, who showed that meat requires a highly acid gastric juice for its digestion and that the stomach produces this sort of juice when meat is eaten, while milk demands a juice low in acid. When milk is largely used as a nutrient, the balance of the diet should consist chiefly of fruits and vegetables for the reason that milk contains an excess of lime and is deficient in potash and soda, which are necessary for perfect human of nutrition. The last named elements are abundant in fruits and vegetables, particularly in the potato which is also very rich in salts of potash. A diet consisting exclusively of milk and cereals is less satisfactory. Such diet often gives rise to scurvy in infants. Cereals are deficient in alkaline elements which are needed to neutralize the acid products developed in the body. In the use of milk, it is well to remember, also, especially when it is freely taken, that one may easily by this means ingest an excess of fats. The milk of certain breeds of dairy cattle is exceedingly rich in fat. The use of such milk in some persons, and especially in infants and young children gives rise to symptoms which are sometimes denominated biliousness, but which are not directly connected with the liver, being due to putrefactive changes set up in the intestine by the presence of excess of fat. Breeders of dairy cattle have labored to produce strains of milch [??? - To my surprise, it was written like that in the book, what a lame joke] cows which produce milk containing a large amount of fat because they are more profitable, but for table use, milk containing a smaller proportion of fat is much to be preferred. It may be on this account, as suggested by Rosenau, that the milk produced by the Holstein cow is much better adapted to the human stomach than is that of breeds which produce milk containing a much larger proportion of butter-fat." "Another point to which attention should be called in the interest of both infants and invalids is the fact that certain persons become sensitized to milk as well as to other forms of proteid, and to a person who is sensitized, even the smallest amount of milk gives rise to highly poisonous and even fatal symptoms." "The milk should be given first in small quantities, a teaspoonful in a half glass of water, the proportion being gradually increased until the proper dilution is reached. The same method should be pursued with individuals who have learned by experience that unpleasant symptoms are noted after the use of milk. The adult or infant who is sensitized to milk may be cured by the administration of milk in graduated proportions, beginning with extremely small doses." "For many years the writer has realized the great value of rice in certain pathological conditions. In the Southern States, particularly Louisiana, an exclusive rice diet for a few days is the popular remedy for indigestion due to over-indulgence of the appetite. Dr. H. D. Bulkley, the famous skin and cancer specialist of New York City, has for many years recommended a rice diet as almost a specific for eczema and certain other forms of skin disease. In the writer's experience, rice is a most valuable food remedy in conditions in which there is marked irritation of the buccal or gastric mucous membranes. A study of the composition of ordinary polished rice shows it to be chiefly composed of carbohydrate, a starch consisting of very small granules which are easily broken up by cooking and are very readily digested. The proteid content of rice is small, only nine per cent, but the proteid is of unusual value, much superior to that of other cereals." "When cooked in such a way as to break up the individual grains, rice forms a very smooth, emollient purée or gruel which is so bland and unirritating it produces no smarting or other unpleasant sensation when brought in contact with raw surfaces, as does almost all other vegetable foodstuffs because of acids, potash salts or other irritating substances present. For rice feeding, very little salt should be added in the cooking, and no other seasoning. The rice may be served simply boiled or steamed, or in the forum of a purée or gruel, or as dry toasted flakes. Care must be taken to cook the rice very thoroughly, an hour at least, and in general the cooking grain should be well-stirred so as to reduce it to a smooth, soft consistency." "It must also be remembered that rice is almost wholly lacking in iron and lime. For this reason it must be supplemented with purées of greens in cases in which the rice feeding is long continued." "Professor Hindhede of Copenhagen has for years been making experiments with potato feeding. In a letter received some years ago from Horace Fletcher, who was at that time at Copenhagen, the writer first learned of  potato experiments in some of which Mr. Fletcher served as a subject. He stated in the letter referred to that he had at that time lived wholly upon potatoes with the addition of a little butter, for six weeks and found himself in fine physical condition. The writer later learned from Professor Hindhede of experiments upon other persons covering two years or more in which no food but potatoes had been taken with the exception of butter or some other form of fat. A few months ago, Professor Hindhede informed the writer of another experiment conducted by him in which a young man had maintained vigorous health for twenty-three months while living on a diet consisting wholly of potatoes, bread, greens, the potatoes being the chief staple. No fat whatever or other food substance had been taken during a period of nearly two years. ["Some white potatoes, so-called, contain enough carotene that could provide the requirement of vitamin A"] An eminent European surgeon has recently published a research of extended observations in the use of the potato as an exclusive article of diet, particularly in cases of renal disease, in which good results were attained. A gruel made from potato flour may be used in cases in which it is desirable to tax the digestive organs as little as possible while at the same time introducing a large quantity of alkaline salts to combat the tendency to acidosis which may be present. Potato gruel cannot be used as a substitute for rice gruel for the reason that it lacks the bland, emollient character of rice, probably on account of the large quantity of alkaline salts present." "Autointoxication: the cause of goiter in pigs Marine has shown (Journal of Biological Chemistry, Feb. 1918) that constipation and the resulting intestinal putrefaction produce the goiter changes noted in sows that give birth to hairless pigs, and that the disease may be cured by a proper diet and relief of constipation. Changes like those found in myxoedema were noted in the affected animals. Enlargement of the gland is attributed by this author and others to the presence of putrefaction products in the blood by which the gland is owastimulated and which cause it to seek to increase its detoxicating capacity by overgrowth." -- The Influence Of Intestinal Bacteria Upon The Thyroid Gland (1923) -- Ray Peat "Starches and indigestible fibers have been tested on various animals, from horses to rats and practically all of the fibers that are used as food additives carrageenan and guar gum, various other gums, oat bran and even some of the semi-synthetic things, Metamucil, agar and psyllium, all have been identified as carcinogens for the intestine and possibly other organs and getting those out quickly before they support bacterial growth."