CQ2y1FLI?y1BNTS OF THE AUTHORS. FEEDING IN THE WASTING DISEASES- BY EPHRAIM CUTTER, A.M., LL.D., M. I). HARVARD, 1856, AND UNIVERSITY OF PENNSYLVANIA, 1857. President American Branch Society uf Science, Letters and Art, London. Author Boylston Prize Essay for 1857, on “Under What Circumstances do the Usual Signs Furnished by Auscultation and Percussion trove Fallacious?” Corresponding Member Belgian and Italian Microscopical Societies and Gynecological Society of Boston, etc., AND JOHN ASHBURTON CUTTER, M.D., B. Sc., F. S. Sc., of New York City. Published in The Journal of the American Medical Association, July 26th, 1890 ; The Medical Bulletin, June, July and August, 1890 ; New England Medical Alonthly, August, 1890 ; Pacific Medical Journal, August, 1890 ; Southern Practi- tioner, July and August, 1890, and Virginia Medical Monthly, June and July, 1890. FEEDING IN THE WASTING DISEASES. i. Illustrative Case. — (See Transactions American Medical Association, 1880, pp. 333-408, case 7.) August 28, 1877, M. H. S., fisherman, Lanesville (Cape Ann, Mass.), aged 33 years. Father died of phthisis. Mother living; been sick two months. He states that he took cold and went out fishing. Was exposed and took more cold ; except two attacks of typhoid fever, was perfectly well before. General appearance bad. Cough is constant and severe. Nohsemop- tyses. No dyspnoea except on going up stairs. Severe pain in shoulders. Appetite poor. Bow- els regular. Has lost flesh and strength. Night sweats copious. Pulse weak. Hands shake badly. Physical Signs.—Dulness on percussion and crackling over right upper third front and lower third back ; feeble inspiration, almost flat on per- cussion; no crackling, but the respiratory murmur was heard underneath. Inspection of the blood revealed spores and spore collects in abundance. Fibrin filaments thickened. Red corpuscles adhes- ive, sticky, irregularly massed, pale in color. Mr. S. went upon the treatment with quinine. It was his intention to come up from the Cape again, but he was unable to do so, and despite the means used, he died not long after. Remarks.—At the time it did not seem to the writer that his case was hopeless. Still, his his- tory teaches that one must not trust too much to first appearance. It is a disadvantage to see a patient only once. It was reported that he faithfully used the diet. It is well, however, to compare the case with some of the very sick ones that were cured as noted in series 3 ; the lesson taught is simply that the physician should never refuse to take a case, and should never be too free in his promises of recovery. b. Cases that were on partial diet; were too irresolute ; had bad surroundings, financial, cli- matic, etc., twelve. Illustrative.—(See case 1, loc. cit.), widow, aged 43 years, small sized, thin, anxious and nervous. Asthmatic complication, old abscesses of the mediastinum, diarrhoea, dyspepsia, sleep- lessness, severe cough, dulness on percussion with constant crepitant rales over both upper thirds A Report presented to the Committee oj Dietetics of the Amer- ican Medical Association at its Forty-first Annual Meeting, 1S90. First Section—Tuberculosis Pulmonalis, One flundred Cases. Second Section.—The Fatty and Fibroid Degen- erations, Fifty cases. Third Section.—Male Neurasthenia, Fifty Cases. The following is an abstract: FIRST SECTION—STATISTICS OF ONE HUNDRED CASES OF CONSUMPTION TREATED BY FOOD PLANS TO BE HEREAFTER DESCRIBED. Resume. Series 1. Non-arrests, twenty-one cases. a. Cases that were not improved, nine. b. Cases that were on partial diet, or were too irresolute, or had bad surroundings, financial, climatic, etc., twelve. Series 2. Partial arrests, thirty-nine cases. a. Cases that followed the treatment faith- fully, nineteen. b. Cases that did not follow the treatment faithfully, nine. c. Cases that had bad surroundings, that died of pneumonia, etc., eleven. Series 3. Permanent arrests, forty cases. a. Tuberculosis, thirty-two cases. b. Pretuberculosis, eight cases. In 1880, the senior writer presented to the American Medical Association, an article entitled, “The Salisbury Plans in Consumption,” with the full text of seventy cases. To-day we come be- fore you not to laud or condemn Dr. Salisbury, but to simply give you in the concrete, what has been brought before us in our daily work with consumption of the lungs, as we have attacked the disease believing it to be first and last a food disease, climate and other causes being entirely secondary, and therefore this contribution will be of the more value to this Committee of Dietetics. SERIES I.—NON-ARRESTS, TWENTY-ONE CASES. a. Cases that were not improved, nine. 1 FEEDING IN THE WASTING DISEASES front. Great dyspnoea at times. Abnormal val- vular sounds of the heart. No albumen in urine. Altogether the most distressed and suf- fering case of consumption I had seen for some time. The effect of the animal diet, baths of mineral acids, and quinine, was to relieve, in a measure, the night sweats and abdominal pains. But the appetite turned against the animal food and it would often be rejected by vomiting. She was obliged then to carry out the regime only partially, particularly as she laid all her bad feel- ings, distresses and sickness to her food or med- icine, and never to her disease. She suffered also greatly from prolapsus of the uterus, aggravated by the severe coughing. This case was not re- lieved by the special treatment recommended. The weakness of mind and body, induced by the presence of organic disease in the thoracic and abdominal viscera, was too great to be reached by perhaps any treatment. Indeed, just here it may be stated that no pretention is made toward cure of any but one-third of the cases j1 but to insure that proportion it is necessary to have the treatment strictly carried out. The present case was one in which there was really no hope and only adopted as ‘ ‘A drowning man catches at a straw.” It is thought best here to give simply the bad and good cases together, and let the reader judge for himself of the value of the data thus derived. SERIES II.—PARTIAE ARRESTS, THIRTY-NINE CASES. a. Cases that followed the treatment faith- fully, nineteen. Illustrative Case.—(See No. 21, loc. cit.) Mr. W., aged 60, in 1874 had been consumptive for two years; his occupation was that of an over- seer of an umber paint mill. He had with a cough, marks of increasing debility, as loss of flesh, animation and courage. There were marked dulness on percussion, crepitant and sonorous rales over the upper part of both lungs; the blood also presented fibrin filaments and spores. It is some years since he has lived upon animal food diet; his wife has faithfully pre- pared the choicest meats for him, and what is more has encouraged him in pursuing the un- common diet. The case was rather unpromising at first, owing to its long standing and extent of tubercle infiltration. He is, however (1876), comparatively well. Cough is hardly perceptable. The physical signs are still to be detected, but with less marked characteristics. He attends to his business as usual. Says he expected to die, in which expectation the community shared. The blood shows great diminution in the foreign admixtures. 1879, still living but very feeble. In October he died. Temporary Arrests. b. Cases that did not follow the treatment faithfully, nine. Illustrative Case.—(See case 23, loc. eit.) Miss C., aged 22, residence Cape Cod. Seen July, 1875; ainenorrhoea, cardiac trouble, dulness on percussion in upper part of both lungs, expira- tory rales in same location. Blood was full of evidence of disease as shown by the enlarged white corpuscles, the spores and fibrin filaments ; she had been under the hypophosphites of lime and soda. She was put upon the strict diet and mineral acid baths, and was removed to New Hampshire. She was thin in flesh and unable to walk an eighth of a mile from prostration under the necessary effort. For the next three months was not herself thoroughly convinced of the util- ity of the measures now proposed, still her friends were, and by means of their influence she ad- hered closely to diet and baths. Immediately there was an improvement in the cough, in flesh and strength which continued. She walked two miles readily. Returned home for a visit in No- vember. Here the diet was abandoned, ate every- thing she liked and took medicines. Remained at home four weeks. She ran rapidly down, lin- gering till she felt “She could not live two days.” Returning to New Hampshire she improved but little. Remained there till April, 1876, when being very much worse, she returned home to die. Died in 1878. This case shows the power of the system to resist the disease, even when not fol- lowing up the treatment; this resistance ought to be more relied on. c. Cases that had bad surroundings ; that died of pneumonia, etc., eleven cases. Illustrative Case.—(See case 27, loc. cit.) In October, 1874, Mrs. , a woman with a very young child, that especially cried by night and kept its mother awake, was very pale and thin, coughing severely and raising largely. There was diminished resonance on percussion and crackling throughout the upper third of "light lung. _ She adopted the diet and acid baths. In four months the cough was very slight. The physical signs diminished. Her softened lung tissue dried up. The appearance improved so much that a casual observer would have called her well. All the time she suckled her infant. Owing to the hard times she was obliged to re- linquish her diet and would not accept it as a gift. Immediately she began to fail and died in the course of six months. The improvement in health kept pace exactly with the imposed diet. When she ate bread the cough returned ; the ex- pectoration was copious. The night sweats re- appeared. This shows markedly the relation of animal food to consumption. It is well worth knowing, for if these things “are done in the green tree what may be done in the dry ?” SERIES III.—ARRESTS MORE PERMANENT IN CHARACTER AND MIGHT BE TERMED CURES IE OCCURRING IN OTHER DISEASES. a. Tubercular, thirty-two. 1 This was 1880, now we think that more can be cured. 2 FEEDING IN THE WASTING DISEASES. b. Pretubercular, eight. Illustrative Case.—(See case No. 53, loc. cit.) Mrs. Wall, Cleveland, Ohio, June 21, 1877. Present condition : Suckling a four months’ child. Active and doing her own housework. Eooks like a person in ordinary health. Coughs occasionally. No sputa. A good sized, rather flat-chested woman thirty-five years of age. Chest: Dulness on percussion and cavernous respiration over left upper third back. Dulness over the whole left back. Elsewhere normal. Blood: In- spection showed normal looking blood. Red cor- puscles not massed ; are distinct, well defined, rouleauxed, no fibrin or mycelial filaments ; white corpuscles not enlarged. This report is more interesting when taken in connection with the following history : In Feb- ruary 1865, Mrs. Wall had been sick in bed four months with the last stages of consumption. She was emaciated to a skeleton; weight, sixty pounds; usual weight one hundred and thirty pounds. Her physicians, who were regularly educated and skillful men, pronounced her left lung “gone”—that is, riddled with tubercle that had softened and broken down in such a manner that the pulmonary substance was removed ; had become useless and of course they gave a decid- edly fatal prognosis. There was at this time a great caving in or flattening of the anteropos- terior diameter of the chest due to atmospheric pressure conjoined with loss of lung substance. At this time she came under Dr. Salisbury’s care. The patient’s mother caused the treatment to be faithfully and assiduously followed out. . Im- provement slowly followed. In four months’ time she was able to be out of doors and visit the city. After a time she resumed her profession as school teacher and taught successfully for four years. Five years ago she married and has borne three children, all healthy and vigorous. She likes her meat diet best, lives on it and works hard. The physical signs adduced show the marks of the ruin wrought in her lung and also show the tremendous power of food in managing or in affecting the course of organic pulmo- nary disease even in its third and hopeless stage. This history reads like fiction. November, 1888, we heard from her that she had continued in good health. A beef eater. Illustrative Case.— ( Unpublished. ) — 1882. Young man. Cavities in both lungs. Heart en- larged. Emaciated as badly as preceding case. Profuse haemoptyses. Elastic and inelastic lung fibers in sputa. Blood, tubercular. Was treated very carefully on these plans. Was cured, i. e. his cough ceased ; the lungs healed ; the heart regained its normal size ; he took on flesh and strength ; went through Yale college; was grad- uated with honors. Is well and was seen by us May, 1890. Pretubcrcular Cases Treated that May Come Under This Head. Illustrative Case.—(See case 65, loc. cit.) In April, 1876, a young man eighteen and one-half years, complained of feeling weak and listless. He had nocturnal and morning cough, with slight expectoration. He was pale, thin, and losing flesh. Consumption was hereditary on both sides of the family. There were no physical signs of pulmonic lesion. Inspection of the blood micro- scopically disclosed abundant signs of mischief, such as : Fibrin filaments were marked in char- acter ; spores and spore collections; mycelial fila- ments ; white corpuscles much enlarged and too numerous ; corpuscles, thin, flabby, pale, sticky, outlines not cleanly cut, aggregated. These taken together with the history and the rational signs, induced a diagnosis of the pretubercular stage. Under the use of acid baths and strict diet, the sanguineous and other signs began to disappear, so that in a year he was enabled to proceed to Germany and study music. He has been a beef eater, i. e. eats more of it than people usually do ; alive and well, 1890. Rationale. 1. Tuberculosis is a systemic and not a local disease primarily. 2. Tuberculosis is a diseased condition or state due to the presence of yeast in the blood with its fermentative products. 3. The yeast is introduced into the blood through the alimentary canal from starch and sugar in excess, and in a state of fermentation. 4. The physical micrographical conditions found in the blood of tubercular cases constitute the peculiar morphology so often alluded to. The main features are as follows: a. Spores of vinegar yeast. b. Spore collects. c. Fibrin filaments unusually large and prom- inent. d. Enlarged massal white corpuscles. This enlargement proceeding from the white corpuscles being unusually fertile niduses of the vegetation, called entophytal, similar examples of which abound in algae. e. Deprivation of the red discs of their coat- ing of neurine, thus rendering them sticky, ad- hesive and singularly inclined to aggregate them- selves in confused masses. At the same time they lose their color, their clean-cut outlines and are diminished in number relatively and abso- lutely. f. Thrombi formed of the fibrin filaments ; of the corpuscles ; of the spore collects. g. All of the foregoing have been photograph- ed with Tolies’ objectives, from the one-fourth to his one-seventy-fifth. 5. The vegetation may exist in a latent state. 6. It may be transmitted from parent to child 3 FEEDING IN THE WASTING DISEASES. in the milk, but the greater point of interest is in the tuberculous diathesis, produced by the same feeding in families for generations. 7. The morphology of the blood is commonly present some time during one year before organic disease. In other words, there is a new physical sign of the pretubercular state; the senior writer has a monograph on that subject alone, illustrat- ed with many microphotographs. 8. Food, then, is the agent of tremendous power that causes tuberculosis. 9. The treatment is based on the idea of re- moving the cause by ridding the blood of the presence of the yeast and its fermentative pro- ducts by a process of starvation. 10. Tubercle is a secondary product—a result from embolism caused by the minute thrombi of fibrin filaments— of the massal corpuscles and of the spore collects, and also from mechanical and chemical effects of the embolism on the nutri- tion. 11. The breaking down of the tissues comes from a necrosis caused by this overloading of them with the products of fermentation. 12. The yeast is also found in the alimentary canal, on the skin, in the sputum, etc. 13. Flour has been raised into bread by the de- iecta of third stage consumptives. 14. The progress of the case is best watched and studied in the morphology of the blood. The spores are diminished, the filaments remov- ed. The enlarged massal white corpuscles are reduced in size to normal proportions; the red discs acquire their normal color, covering, and clean outlines; the fibrin filaments are hardly vis- ible. Thus the red discs dispose themselves in the normal manner, the more perfectly as the cure proceeds. Any deviation in the regimen is indicated by the increase of the abnormal mor- phological elements in the blood. As the blood improves, usually the general symptoms improve, pari passu. We have often witnessed, under treatment, the disappearance of rales of all kinds, night-sweats, emaciation, the reduction of the heart to normal size and frequency of beats, sim- ply because of taking away the load it had to carry, when the blood was filled with emboli and was ropy and sticky. 15. This diagnosis by blood examinations does not exclude ordinary physical explorations; it supplements them; we find that the ordinary idea of this diagnosis in the profession is that hsemology is like urinology, and all that is nec- essary, is to take specimens of blood, just as we do urine, and base all our diagnosis of tubercu- losis on such examinations. The very sugges- tion of this demonstrates how far the proposer is from having a true idea of the subject; the evi- dence must be collected with the least possible interval of time between the removal of the blood from its stream to the stage of the micro- scope; the capillary circulation is to be used, not the venus or the arterial; take blood from the radial or ulnar side of the forearm, by slight puncture with scarificator or scalpel; do not prick the end of the finger ; the student must study the morphology of the skin as well as that of the blood. 16. There are other diseases in which the nor- mal blood morphology is changed, to-wit: rheu- matism, cystinsemia, syphilis, ague, etc. 17. This rationale explains the cough, where it is not due to local irritation in the air- passages, such as hypersemiae, ulcers, infiltrations, reflex irritations, to the presence of carbonic acid gas in excess ; sometimes it is wonderful how dimin- ishing the fermentation does away with the cough. 18. This rationale explains haemorrhages as the result of local action of the vegetation on the glue tissues, the connective tissues being softened, disintegrated and broken down by the products of fermentative changes. 19. It explains the night-sweats as due to the interstitial necrosis of tissues thus throwing more work on the skin; hence the injunction to take good care of the skin, and help the lungs while they are being healed. 20. The emaciation and loss of flesh and strength are only the results of the great tissue destruction going on. 21. The sputum must be studied for lung fi- bers, for the various crystals that are found in asthmatic conditions and also the gravel, granu- lar and encysted. 22. Old fashioned or fibrous consumption is due to holding of the yeast products in the stom- ach, to the gradual paralysis of the lungs, with the consequent hyperplasia of the connective tis- sues, and to the deposit of gravel in this hyper- plasia of the fibrous tissues; in this condition the blood morphology is not so much altered ; the diagnosis must be made on general grounds; the treatment is practically the same, however. 23. The condition of the liver and kidneys can be determined by watching the urine; it should be tested at least twice a week and kept at a spe- cific gravity of 1015 to 1020, free from bile, odor or deposit. 24. Physiologists say that man cannot live on beef alone; the chemist says that beef contains all of the elements found in the tissues of the human body. We say, that in cases of consump- tion, Bright’s disease, uterine fibroids, etc., where the special case has indicated a rigid diet of beef, such a dietary has been ordered and some of the patients have lived on it alone for four years: thus the dictum of the physiologist is upset. 25. It has been sneeringly said that all that was needed if the ideas here given as to consump- tion are true, that a man prescribe beef and hot water; yet the senior writer had his sou study 4 FEEDING IN THE WASTING DISEASES. Fig. 4.—Microphotograph, t*5o in. objective, Tolies. E. Cutter, 1876. Fibrin filaments in tuberculous blood. Fig. 5.—Sticky, ropy and adhesive blood, tuberculous. 1-16 in. objective, Tolies. E. Cutter, 1876. Fig. 6.—Three enlarged white blood corpuscles, the fourth ruptured with spores vinegar yeast. 1-75 inch objective, Tolies. First ever taken; byDr.Ephraim Cutter and G. B. Harriman, D.D.S., of Boston, 1876 Fig. 5. Fig. 3. Copyrighted, 1889 and 1890, by Ephraim Cutter Alt rights reserved. Fig. 4. Fig. 2. Fig. i.—Microphotograph, 1-50 inch objective, Tolies. E. Cutter, 1876. Healthy blood. Fig. 2.—Microphotograph, 1-16 in. objective, Tolies. E. Cutter, 1883. Healthy blood. Fig. 3.—Microphotograph, 1-16 in. Tolies objective. 1876. Tuberculous blood under treatment showing improvement anti attempt to rouleaux rightly. Fig. I. Fig. 6. 5 FEEDING IN THE WASTING DISEASES. the general sciences four years, medicine four more, and special cases three more years, before he was willing to leave his practice in his care ; the art of treating chronic disease, even by posi- tive food plans and judicious medication, is an extremely hard one to acquire. 26. Air is food. Yet consumptives have been cured in the rawest and dampest climates, and so many times that we must go behind the old idea that climate was the only cause of consumption ; granted that bad climate helps to cause the dis- ease, and so also will worry, trouble, grief, assist toward death; the sending of patients away from home comforts to die elsewhere is not the thing to be advised. If home comforts, good air and the proper food can be combined, by all means do it. This is written with the knowledge that pul- monary disease has been arrested by climate. But our aim is to cure the cases wherever they are, because many cannot afford to change their climate or live the remainder of their lives in the Adirondacks or Colorado. 27. Remove from the atmosphere of the patien. all doubters, sneerers and those that argue, but never cure; agnostics and nihilists, not content with helping no one, they will endeavor to pull down your work. More permanent arrests could have been secured of these one hundred cases if the patient had been left alone. 28. While encouraging the patient at all times and in all emergencies, give him to understand what he is fighting; that he must not waste his nerve forces by needless thought and worry, but to hold on persistently and wait for nature to do the work; each case is a law unto itself; this can be seen by the study of the cases herein record- ed ; we are finite; death is certain; no man will ever cure 100 per cent, of his cases, may we say of any disease. 29. If all will take hold firmly, at least 50 per cent, of tubercular cases can be cured, judging from our own clinical experience. Now that consumption is called a curable disease, the great load is lifted off and much more will be accom- plished. 30. All cases of pretuberculosis ought to be cured, because here is a condition where there has been no destruction of tissue; this is where the exception to section 28 comes in, if, the prac- titioner will diagnosticate the condition, treat scientifically, and the patient obey orders. 31. All physicians who say these plans are foolishness, and who treat their cases by mor- phine, maltine and whiskey, we ask for publica- tion of cases and the percentage of cures. 32. The diagnosis of tuberculosis by blood examination, often negatively points out the seat of trouble to be in the heart or uterus, or perhaps some other organ; also, cases of uterine disease complicated with tuberculosis should not be al- lowed to go untreated, but in making examina- tion, the physician must go over the whole field, and find out all of the disease; some of the cases in this series, years ago, would have been bene- fited if their uterine disease had been treated; granted the cause is systemic, for bad food is an etiological factor of uterine diseases, while treat- ing systemically, use all of the modern means to attack the local pelvic troubles. 33. If men complain and say this dietary is too rigid, we will only reply that the cases have de- manded it, and will be very thankful when con- sumption can be cured by more pleasant means than we have employed. 34. Lastly, as to Koch: In 1876 all of the morphology of consumptive blood was photo- graphed with Tolies’ objectives to the highest power, his one seventy-fifth. These microphoto- graphs have been exhibited here and abroad, and we find none that equal them ; this is written ad- visedly. Bacteriology is but an extremely small portion of the micrological world. Such algologists and phytologists as Professor Paulus F. Reinsch, of Erlangen, and Dr. Fr. Ecklund, physician of the first class of the Royal Navy, Sweden, endorse this work as covering a much larger field than bacteriology does. If the proof was to be placed entirely on the results, then bacteriology must hold its head in shame, as no cures have been effected by it; but we are willing to controvert Koch on scientific grounds, and maintain the po- sition that he has told but one-half the story; that botanists have been fighting for years as to whether bacteria were simply babies of the fuller fledged vegetations ; that the bacillus was photo- graphed in 1876; that the ability to diagnosticate pretuberculosis and tuberculosis by blood exami- nations, and the means thus afforded of watching the cases, are worth immeasurably more than the diagnosis of consumption when the disease is ap- parent to all.2 SECOND SECTION—THE FATTY AND FIBROID DEGENERATIONS. 1. Bright’s disease, twenty cases. 2. Fibroid tumors, eighteen cases. 3. Cancer, twelve cases. SERIES I.—BRIGHT’S DISEASE, TWENTY CASES. We do not consider any case full-fledged Bright’s disease unless there are in the urine albumen, casts and fatty epithelia. We are continually getting cases which may have any one or two of these three signs. Such cases are hovering on the border line of health and well-marked disease, and are very amenable to treatment. Such wavering from health would oftener be detected if physicians would make more thorough examinations of the urine. Tak- 2 We are ready to demonstrate, by microphotographs, facts as to the relations of the bacteria to alcoholic and acetic acid plants. 6 FEEDING IN THE WASTING DISEASES. ing six specimens from six consecutive days, it is wonderful to see the variance from day to day. The following is an abstract: Cases that would have been diagnosticated earlier if they had been more fully examined. 1. 1883, woman, 30. Called tuberculosis; blood normal; urine albuminous, and contained casts and fatty epithelia ; sputum copious. Bright’s disease lungs and kidneys; not treated. The urine had not been examined before in this case. 2. Man, aged 50, 1885. Bright’s and diabetes. Disease had not been detected. Treatment of no avail ; too late. 3. March, 1885. Called nervous prostration by a homoeopath. When urine was examined later by senior writer, disease found to be Bright’s. Treatment by her cousin of no avail, though a Harvard graduate and thoroughly equipped; again too late. Deaths. 4. The late Dr. Elsberg. Bright’s disease of lungs and kidneys. Great improvement. Death on resumption of old modes of life. 5. Bright’s disea.se of kidneys and lungs. Im- provement. Death from handling his own case, thus eating wrongly, overworking and allowing himself to be poisoned by sewer gas. 6. March, 1889; woman, 50. Bright’s disease lungs and kidneys. Death September from pneu- monia. Disease somewhat arrested. 7. Bright’s disease of kidneys; 1885, man, 50. Convulsions like that of a puerpera. Chloroform to neck. Urine cleared up by diet. Took cold from riding in open carriage. Death from bron- chitis. 8. Man, 50; October, 1885. Bright’s disease kidneys; nearly blind. Case improved ; very nervous; services discharged; death in a few months. In Progress. 9. Man, 60; 1886. Bright’s disease kidneys. Great amelioration of pains and improvement of urine. April, 1890, disease returning, and will probably die if work is not given up at which he labors constantly. 10. Woman, 40; 1883. Bright’s disease kid- neys. No improvement till she came into our family. Then followed diet, and urine cleared up. Disease has returned, though alive April, 1890. Not on treatment. Cases cured; that is, that are well April, 1890, with kid- neys acting rightly. n. Man, aged 46; January, 1886. Bright’s disease kidneys, cirrhosis of liver and enlarged heart. Considered absolutely hopeless.3 12. 1880. Acute fatty degeneration kidneys, placenta and cerebral blood vessels. Has since borne two more children. 13. Woman, aged 35 ; October, 1885. Not as serious as some of the cases. 14. Woman, aged 25; 1886. Unusual large number of casts and fatty epithelia in urine. 15. Woman, middle-aged ; 1887. Had decided to transfuse blood. Well April, 1886. 16. 1879. Man, aged 60. 17. 1881. Man, aged 60. 18. 1884. Man, aged 24. 19. Girl, 13; 1884. Scarlatina; menses ap- peared when eruption was at its height. Two years to get well. 20. Woman, 46; 1886. Fibrous consumption, Bright’s disease kidneys and small fibroid tumor of womb. Tumor gone, cough gone, urine nor- mal, April, 1890. SERIES II.—FIBROID TUMORS, EIGHTEEN CASES. The following is an abstract: Tumors Held in Statu Quo. Three cases. The first: Immense abdominal fibroid, woman aged 60. Shall soon apply gal- vanism by deep abdominal puncture. Second: Small tumor; would go away, prob- ably, if woman would allow herself to rest. Third : Earge abdominal tumor, which did not diminish till galvanism was applied by abdominal puncture, though diet helped her very much Tumors Reduced and Patients Made Comfortable. Five cases, all uterine ; four, large tumors ; the fifth, smaller and back of uterus. All greatly improved ; tumors arrested and reduced. These would be called a cure if done by the Apostoli method of giving galvanism ; (which method, by the way, was employed by the senior writer in his first operation in 1871). Tumors That Disappeared. Ten cases. Seven, uterine fibroids ; four, large abdominal tumors ; three cases of smaller abdomi- nal and pelvic tumors. One case of tumor of the breast; one of fibroid of the stomach ; one of tumor of the neck which might be called tuberculous. SERIES III.—CANCER, TWELVE CASES. The following is an abstract: 1. Cancer of the face, so called by eminent men in the American Medical Association at the Phil- adelphia meeting, 1847. Treatment by knife and caustic had only made disease return and sore more ugly. Diet of bread and milk removed tu- mor and healed sore. 2. Tumor of scapula as large as a pint bowl. In the practice of the late Dr. Amos Twitchell, case 1 of this series. Diet of bread and an in- fusion of water dock. Disappearance of tumor. 3. Attendant, E. Cutter. Woman, 40; uncle dead of cancer ; her case, cancer of womb. Dis- appearance of growths by rigid diet of beef. 4. E. Cutter, attendant. Woman, aged 50. 3 The result is understood to be according to the reading of the heading. 7 FEEDING IN THE WASTING DISEASES. Cervix enlarged laterally to sides of pelvis; rough and bleeding ; opium eater. Rigid diet; iodoform locally. Great improvement. Death on discon- tinuance of treatment and resumption of opium. 5. E. Cutter, consultant. Cancer of carpal bones and axillary glands; 1882 ; said to be hope- less by attending physicians. Amputation at middle third of forearm ; animal food diet. Alive 1890. Disease in axilla quiescent. 6. E. Cutter, attendant. Woman, 35. Cancer of womb. Improvement and arrest of disease. Discontinuance of treatment; death. 7. Woman. Attendant, E. Cutter. Sister case 6. Knobbed enlargements of os and cervix uteri. Strict diet; disappearance of tumors ; alive eight years later. 8. E. Cutter, attendant. Cancer of womb ; dis- charged from hospital to die of that disease, 1882. Reduction and disappearance of disease by diet. Well April, 1890. 9. Attendant, E. Cutter. Woman, 40. Four tumors back of womb. Valvular disease heart. Tumors disappeared by rigid diet of beef; this in 1876. Woman alive and well April, 1890. Her father had died of cancer of stomach.1 10. Attendant, E. Cutter. Disease in both breasts. Tumors diminished in size by diet. Caught cold from exposure ; pleurisy; cancer cells found in fluid aspirated from chest; death. 11. Man, aged 60. E. and J. A. Cutter, attend- ants latter part of illness. Cancer of larynx. Tracheotomy had been done; wore tube; suffered much pain. Wished to try food treatment. Did little good, as he could eat but little, and that finally fed to him through a catheter in fluid form. ' Eiterally starved to death. A man of great heroism, the late Dr. Wm. S. Hurlocke, of Philadelphia. 12. E. Cutter, attendant. Woman, 40; 1881; vomitus composed of a black grumous fluid; tumors of womb and stomach. Relieved and in fair health April, 1890. Rationale. We would have liked to have presented more of our cases of Bright’s disease, tumors and can- cer ; but space does not permit. A few words must be given as to our ideas in attacking these cases mainly by food. The word nephritis gives us little light as to the real causes of Bright’s disease. We would say as to our belief, that the disease is commonly an expression of a systemic condition; either a fatty or a fibroid degeneration. That the fatty may be acute or chronic ; the fibroid most always chronic. Some have thought because they found ganglia fattily degenerated that the renal disease was the sequence. But we ask what was the cause of the ganglionic degeneration ? The answer is: In the food eaten, in the air breathed, in the modes of life, the clothing worn, the amount (too much or too little) taken' of exercise ; our ways of thought, of carrying on our business; whether we are intemperate, etc. In these long continued and steadily acting causes is to be found the explanation—and until the causes of disease are understood, few men will treat them intelligently and successfully. The cases that we have treated have been stud- ied as far as we were able, on all sides; we wished to know all that could be found out about the patient’s life. This may seem too simple, but gentlemen, concrete things, not abstract, cause disease. But to be more particular, let us con- sider the food part of the question. Starch and sugar contain but three chemical elements; yet they make up a large part of the diet of many. The old saying is that “ you cannot get blood out of a stone.” Certainly phosphorus and ni- trogen, to say no more, cannot be made out of carbon, hydrogen or oxygen ; so on the side of chemistry alone, if a man or woman will persist in feeding on starch and sugar, they must not expect nature to break her laws and change her elements into others. But, the excessive feeding of starch and sugar will in time produce the carbonic acid, and later on acetic acid fermentations in the alimentary tract. Carbonic acid gas is a poison, it paralyzes and kills men and animals when breathed; yet how many live with their stomachs bloated with this gas, wonder why they have heartburn, and their families mourn when they drop suddenly in the street from heart paralysis due to this same gas ; or they keep on their way, living in spite of their vicious feeding, and the long continued paralysis may result in a fibrous degeneration of the lungs, the stomach, the liver, the kidneys or the spinal cord; or nature, instead of building fibrous tissue under this slow-going paralysis (for it is well to remember that nature does her best always), will lay in fat in these tissues and keep the bulk of them intact as long as she can. A man on treatment for locomotor ataxy was much improved. Meeting a friend on Fifth Ave- nue, he said : ‘‘I want to go into Delmonico’s and eat a big dinner; will it hurt me?” His friend was a physician, but knew nothing about his treatment; he however said ‘‘It will not hurt The man followed his advice, filled him- self up with fermenting and fermentable food, with the result that the ataxia came back imme- diately—why, because the spinal cord was tem- porarily paralyzed by the carbonic acid gas. The same thing we have seen within a year in the case of a boy on treatment for the same trouble ; his fond mother let him have ice-cream and a big dinner, and his legs were almost immediately paralyzed. April, 1890, this boy is as bright and lively as most any of his age. * For full account of these nine preceding cases see Albany Medical Annals, July and August, 1887, “ Diet in Cancer,” E- Cutter. 8 FEEDING IN THE WASTING DISEASES. The various fibroid tumors are also instances of degeneration. Nature is doing her best, but she cannot lay down healthy tissues, so she builds with the poorest, to wit, the fibrous tissue. If this is not so, gentlemen, why did our cases re- cover? Granted we kept them quiet (when we could) and used every medical means our humble knowledge permitted us to prescribe; yet the main idea, and held to firmly, was that these were dis- eases of nutrition and must be attacked on that ground. Cancer. A woman of fine mind was attacked by two tumors in her 60th year, one just anterior to the right ear, the other below the right breast. By careful attention to diet, so that she lived plainly, by the use of alcohol baths, and by keeping her life in as even a tenor as possible, she lived till she was over 90, and then died of her disease which was called cancer. The tumor on the head had extended to the external angle of the eye; the tumor on the breast killed her. A boy aet. 10 years, an orphan, picked up a precarious living setting up tenpins in a billiard alley ; he was beaten with one and thrown out; the disease (fungus haematoides) commenced ; when found, he was on the railroad track. The town authorities supported him as a pauper, and the disease before his death took in a great part of his body. A woman carried for thirteen years a large ab- dominal multilobular, subperitoneal and pelvic fibroid. One early spring she was compelled to move into a house situated in marshy lands which had not been used during the winter. She took cold, was overworked, and the disease changed into cancer, attacked the bladder and caused death. A young man of 30, who had lived a riotous life, died in great agony from no known cause. Post-mortem showed at least one hundred tumors in the peritoneal cavity, on the bowels, liver and other organs. The disease had invaded the ver- tebrae and the lungs. This man had money enough to buy good food but used the wrong. A woman, aet. 35, was deserted by her husband. She sued for divorce and finally won her suit. In the meantime cancer appeared in the womb ; the disease was arrested and held back for two years, but finally caused death. In 1887 (Alba7iy Medical Annals, July and Au- gust), the senior writer defined cancer to be “ Tis- sue under Mob Law; ” “ Tissue Rioting. ’ ’ Tissue that the body systemic cannot govern, and hence the reversion to embryonic types and the fright- ful results sometimes seen in this overthrow of the law of the body systemic. The blood, i. e. in our work, which extends over many years, does not show morphologically any causes; in the end it is impoverished and corpuscles changed, but we must say with all can- dor that we do not consider that cancer is a blood disease but a tissue disease. This is confounding perhaps our present ideas, but disease has many phases and vve must not look on these matters from one side alone. You may call if you please the cases that re- covered not cancer; but the fact remains, that they were very sick people before the treatment and are not now. Let this committee take this idea, that cancer is tissue under mob law, and then attack it under all of the chances offered to pro- mote the nutrition, and the members report in another year, the results. We could give you more cases, those under treatment at the present time. One case where the right breast had been removed; the disease returned, it was burnt out with cautery and finally came under our care last August, with a sore 4 inches long, 4 inches wide and 1 inch deep, pouring out the most filthy and stinking discharge. April, 1890, this woman is still alive ; the sore is smaller, the discharge less. The treatment has been a rigid diet of chopped broiled beef, the application of tannic acid and quinine ointment to the sore ; these ap- plications agreeing better than anything else. Haemorrhage is now not frequent. Still, her chances of recovery are very small. May, dis- ease increasing. We leave this part of our subject till treatment is considered. THIRD SECTION—NEURASTHENIA IN MALES. Where often the patients objectively appear like co?isu?nptives—occurring amongst business me7i and stude?its, a7id is due to iniproperfeeding. We had intended giving statistics of fifty cases, but our report has grown to too large proportions to give these cases. A preliminary report on this subject was pre- sented to the Richmond Medical and Surgical Society, January 23, 1890, by the senior writer, and published in the Virghiia Medical Monthly for February, 1890:' Some thirty years ago the writer was secretary of the Middlesex (Mass.) East District Medical Society, and, on being requested by me to do so, one of the members, Dr. , kindly stated his case to the Society, and asked for opinions and treatment. It dealt entirely with neu- rotic symptoms, which varied from time to time, and showed a lack of nerve force without any organic dis- ease, which could be detected. The case was a poser; no expression of opinion nor of treatment could be drawn from the members. The doctor himself was a bright, careful, intelligent observer; and his relation showed that he had skillfully treated himself up to the then present state of knowledge. After a series of cases had been worked up for several years, on which this paper is based, Dr. ’s case oc- curred to mind, and he gratified me by sending, at my request, seven one-ounce bottles of morning urine voided on seven successive days. These specimens, when sub- jected to physical exploration, showed the presence of a protoplasmic or colloid discharge, which, in other cases, had been to me a sufficient evidence of one cause of male neurasthenia, and which it is proposed to explain. Morphological Evidence.—This physical sign is found in the morphology of the urine. (See “The Clinical Mor- 9 FEEDING IN THE WASTING DISEASES. phologies,” E. Cutter, New York, 1888, p. 45.) It is not that observers have not noticed this discharge ; they have, still they have regarded it of no pathological sig- nificance. Where we differ from them is that we do re- gard it as a valuable diagnostic sign of male neuras- thenia. The way this difference of view came about was as follows: Since 1880 we have made a practice of study- ing the morphology of the urine of patients, sometimes daily for weeks and months. But coming upon neurotic cases, in which this colloid discharge was the only appre- ciable lesion, and finding that when such cases were treated and the catarrhal condition was removed, they always improved, and so long as the patient would fol- low out directions, the improvement continued, the senior writer was led to take the position here given, and I feel convinced that this complaint is a very common one, occurring often in old and young business men and students who are apparently well, save that their complaints of irritability, pains, sometimes excruciating, making them express them- selves in terms which appear, to those most interested about them, whimsical, nonsensical, or, as we used to say in our boyhood, “hypoey.” And I might remark here that I now think that, if these cases I knew in my boyhood, and were known to the whole community in which they dwelt as “hypoey,” could have had the ben- efit of what is now understood, they would have passed from the opprobria which rested upon them by proving that there was a physical foundation for their condition, just as the women who had the same term applied to them in those days would have been relieved by finding some gynecological disease. JVhat to Look For.—In a case of male neurasthenia, which comes to you with a long story of aches, pains, weakness, and sufferings which appear so momentous that you wonder how the sufferer could be alive, and of having want of confidence in the medical profession to discover the seat of his complaint or to relieve him. Usually there is a degree of self-confidence and positive- ness of statement in his own conviction, which reminds us of the same qualities we find in our better-halves. You look the case all over carefully ; no lesion is found to explain such a great departure from normal innerva- tion. You examine the urine ; it appears clear, amber- colored, of good specific gravity, normal in odor, and all that is seen if you allow it to stand over night, is a light protoplasmic cloud, occupying, sometimes, the wdiole of the lower half of the vial. Or if in graduate glass meas- ure, the cloud will swing halfway between top and bottom of urine. You cannot tell by the naked eye the charac- ters of this discharge. It is put pnder the microscope, and the deposit is not made up of triple phosphates or urates ; but if you use (as you had better use), a one-inch objective—which must be a good one, and the best are none too good—you will find, if the case is a typical one, collections ®f gluey (colloid), viscid matter, with no extra amount of mucous corpuscles or mucous epithelial cells, moulded in shapes like Indian clubs, varying in color from white to a brown ; then, if you look further, skeins of colloid matter, curled up in fanciful shapes, some- times separated into single filaments, and sometimes fill- ing the field so full of the Hogarth lines of beauty that you cannot help expressing your surprise, perhaps to the discomfort of your anxious patient. Besides this, the discharge is sometimes diffused through the urine in a light, fleecy, unorganized cloud, which is sometimes dif- ficult to recognize, unless one is familiar with the pro- toplasmic studies. Although these three forms are some- times found together, still they are often found separate, so that, in enumerating them, we speak, first, of the pro- toplasmic ; second, of skeins; third, of Indian clubs. Next, you should examine seven successive specimens of seven days, i. e., one of each day, the first urine voided on rising. It has not seemed justifiable, in chronic cases, to base the diagnosis on one examination. For example, spermatozoa may be normally discharged once or twice a month, and if you happen to get a specimen on the day of that normal discharge, it will be unwise to jump into the conclusion that the case is one of spermatorrhoea. Spermatorrhoea, according to my experience of thirty- six years, is a rare disease, and the diagnosis of it is not complete unless the forms are found very much oftener than the normal discharge. I may be wrong, but I do not consider the finding of the colloid secretion in one specimen evidence enough ; it must be found in a majority of the discharges for the days of the week. When you study urine daily, you will find that it varies very much. For example, in the cases in question I have been very much surprised to find them alternating on some days with albumen, casts of the kidney tubes and fatty epithelia, which I regard as a diagnostic of Bright’s disease. In both neurasthenia and Bright’s disease of the kidneys there is more or less paralysis of the parts involved. Some regard the fatty degener- ation as a means of staying the effects of the pa- ralysis. In other words, that the destruction of the tissue would proceed more rapidly were it not for the fatty degeneration. Still the neurotic symptoms differ. In simple Bright’s disease of the kidneys there is little pain, and when it oc- curs it comes from rheumatism, and even the neurasthenia which is found sometimes along with the Bright’s. The subject is not fully worked up in this aspect and hence I cannot speak so confidently, but it is a very interesting matter for consideration why the loss of albumen should not cause pain, when the colloid and perhaps albu- minoid discharges which are found in the com- plaint under discussion assuredly does. One thing is certain, that neurasthenics thrive in the open air, and are worse in indoor air. A clergy- man with this trouble said he would be all right if he worked on a farm outdoors, but he wanted to use his brains in his work. A diet substan- tially what is lined out below cured him so that he now works indoors and has recovered from impotency. But air is food. There is as much difference between fresh and foul air, as between fresh meat and old. As to the Importance of this Form of Neurasthenia.— When first acquainted with this disease, I knew it was hard to bear, but did not think it was dangerous; but I have had patients die with it, and the autopsies showed no sufficient cause of death. The manner of going out was with a sudden failure of the heart as if there was not enough nerve force to run it; so I am led to take a more serious prognosis. The patients may live, like Dr. , for thirty years, and though he considers that his life has been prolonged by the disease, because it has made him careful where he would have been careless, I believe there is danger, especially as the urine will alter- nate with albuminuria, fatty epithelia, aud renal casts as before noted. This complaint is not due to sexual abuse, i. e., as a sole cause; it is a food disease. The catarrh is mainly from the ducts of the prostate and spermatic glands. 10 FEEDING IN THE WASTING DISEASES. APPENDIX. TVide of One Hundred (\5e5 of TubercuIosE PuImonUL Series I.—Non-Arrests—Twenty-one Cases. A.—Cases that were not improved—nine in number. No. Date. Sex. Age. Publication . Condition when Placed on The ATM ENT. Remarks. I. See illustrative case, p. i, col. i., a. II. Man. Middle-aged. Case 2. Loc. cit. Father of case XLIII. Not so much disease as in son. Death in a few weeks. III. Woman, 35. Case 4. Loc. cit. Advanced disease. Three years’ standing. Digestion improved. Diet relished but of no avail; died in a few weeks. IV. 1873. Boy 19. Case 8. Loc. cit. Acute tuberculosis and per- itonitis. Blood morphology of tuberculosis. Treatment of no avail. Di- agnosis confirmed by post- mortem. V. 1873. Woman, 55. Case 1 5. Loc. cit. Aphonia. Larynx infiltrated, thickened and inflamed. Vocal cords swollen, ash colored and stiff. Tuberculous blood mor phology. Chest emaciated, flattened. Coarse and fine rales and cavernous respiration at apices. Symptoms relieved. Death in nine months. VI. 1889. Girl, 22. Unpublished. Tuberculous blood. Crack- ling through right lung front and back, and upper third left lung. Asthma. Diarrhoea. Night sweats. Copious expect- oration. Lung fibers in spu- tum. Slight amelioration of symp- toms. Death in two months. VII. 1887. Man, 22. Unpublished. Tuberculous blood. Much disease in lungs. Plans followed out faithful- ly. Death. VIII. 1886. Girl. Unpublished. Tuberculous blood. Treatment carried out faith- fully. Of no avail. IX. Woman. Unpublished. Tuberculous blood. Cavity in apex of each lung. Had uterine disease which she would not have treated ; retarded case; death. Series I.—Non-arrests. Cases that were on partial diet; were too irresolute ; had bad surroundings, financial, elunatic, &c. Twelve in number. X. See illustrative case, p. i., col. 2., b. 12 FEEDING IN THE WASTING DISEASES No. Date. Sex. Age. Publication. Condition when Placed on Treatment. Remarks, XI. 1879. Dr. , 72* Case 3. Loc. cit. Tuberculosis, as diagnosti- cated by Dr. H. I. Bowditch. Partial treatment. Was im- proved. Death in three months. XII. Man, 40. Case 5. Loc. cit. Grave general symptoms. Local disease in lungs not so well marked. Followed up treatment fee- bly. Death in few months. XIII. Woman. Case 6. Loc. cit. Advanced tuberculosis of both lungs; great weakness, prostration and impaired mor- ale. Night sweats. Followed up treatment faint- ly. Died in a few weeks. XIV. 1877. Woman, 34. Case 9. Loc. cit. Acute tuberculosis in the puerperal state. Hemoptyses before and after labor. Disease in upper third right lung. Blood morphology tubercu- lous. Patient poor and house dark and damp. Died in two weeks. Life perhaps might have been saved if there had been a sanitarium to treat her case in. XV. April, 1877. Irish girl, 17. Case 10. Loc. cit. Undersized, pale, thin, feeble, downcast. Cough; cop- ious expectoration; loss of flesh and strength. Blood tu- berculous. Diet had been main- ly flour, potatoes and tea. Did not follow up treatment closely; was improved but died in October, 1877. XVI. 1877. Dr. , 37. Case 11. Loc. cit. Tuberculous blood. Dis- ease right upper third front and back. Throat inflamed throughout. Throat treated with solution liq. per sulphate iron and glycerine, equal parts. Lived on New England rum and cream; some improvement and then gradual increase of dis- ease, and death in three months. The blood was not improved by this dietary. XVII. 1873. Woman. Case 12. Loc. cit. Early stages of disease. Throat inflamed. Had bad surroundings as to finances and did not follow out treatment. Retrograded and died. XVIII. 1874. Girl; daughter, case XVII. Loc. cit. Case 13. Tuberculous blood. Disease started in lungs. Not seen again; ordered on diet which was not follow- ed out. Death in six months. XIX. 1876. Irishwoman. Case 14. Loc. cit. Tuberculous blood. Disease in right lung. Treatment not followed out. Death. XX. 1875. Man. Case. 16. Loc. cit. Marble-worker. Vocal cords thickened and ulcerated. Ary- tenoid cartilages enlarged. Blood tubercular. Disease at apices of both lungs. On strict diet for a month. Wife sick in bed. Becoming discouraged gave up treatment altogether. Died. XXL 1874. Woman. Middle-aged. Case 17. Loc. cit. Been called consumptive for years. Farmer’s wife and a hard worker. Advanced tu- berculosis. Blood tubercular. Partial diet. Great deal of medicine. Perhaps would have been saved if treated earlier. 13 feeding in the WASTING DISEASES. No. Date. Sex. Age. Publication. Condition when Placeo on Treatment. j_ Remarks, Series II.—Partial Arrests. Thirty-nine Cases. A.—Cases that follotved the treatment faithfully—nineteen. XXII. See illustrative case, p. 2, col. I, a. XXIII. Man. Case 18. Loc. cit. Severe pulmonary hemor- rhage. Dulness on percussion and crackling over left upper third front; emaciation; cough and night sweats. Would not take cod liver oil, then, as now a standard remedy; ate pound and a half of butter a day; restored to duties and lived twelve years. Death from profuse hemor- rage. Post-mortem showed lung healed—three cavities— on right side and some new disease in the left lung. XXIV. Woman, 24. Case 20. Loc. cit. Primipara; disease right upper third front; after labor, suffered with prolapsed ovary, which caused much reflex pain. Blood tuberculous. Treatment of pelvic disease successful. Restored to health. Lost sight of. XXV. 1876. Man, 27. Case 22, Loc. cit. Chest flattened; coughs all night. Sweats; debility; dys- pepsia, enteralgia and gastral- gia. Insomnia. Gone to bed to die. Strict diet and no medicines stopped cough in three days. Improved and returned to work as plumber; was drench- ed by water from a burst pipe ; contracted pneumonia; was placed again on strict diet, but never recovered from shock. Death. XXVI. 1878. Man, 65. Case 25. Loc. cit. Cough; expectoration ; loss of flesh and strength; abnormal heart sounds; night sweats ; dullness on percussion, expir- atory crackling, left upper third front; tuberculous blood. Strict diet, returned to busi- ness in a year: Died in 1878 with cardiac symptoms. XXVII. 1876. Man, 30. Case 28. Loc. cit. Tuberculous blood ; distort- ed chest; severe cough ; pro- fuse hemoptyses; disease in both lungs; weight, 65 pounds. Gained 20 pounds in four weeks; followed diet more or less closely for a year; disease arrested for a time; a man of great courage and should have been treated earlier and saved. XXVIII. 1877. Girl, 17. Case 30. Loc. cit. Throat inflamed ; chest thin; case as to blood and lungs be- tween pretuberculosis and tu- berculosis. Splenic enlarge- ment. Local treatment to throat. Milk diet. Do not know final result. Case was improved. XXIX. 1877. Man, 33. Case 34. Loc. cit. Laryngeal inflammation. Car- diac hypertrophy. Tubercu- lar blood; disease left lung; dyspnoea. Prognosis doubt- ful. Local treatment for throat. Milk diet. Later some leeway as to food. Case reported well 1879. 14 FEEDING IN THE WASTING DISEASES No, Date. Sex. Age. Publication. Condition when Placed on Treatment. Remarks, XXX. 1877. Irishman. Case 35. Loc. cit. Disease upper part of both lungs. Tuberculous blood. One month later, left upper third, tympanitic percussion, metallic tinkling, splashing on succussion. Lower thirds flat. Respiratory murmer absent. On strict diet. Did not ex- pect him to recover from pneumothorax, but lung heal- ed over and man died several years later of other trouble. XXXI. Young lady. 1873. Case 36. Loc. cit. Disease in both lungs; left lower third almost hepatized. Blood tuberculous. Died in 1875. Improved while at home and on strict diet; visited, ate wrongly; disease lighted up again. XXXII. 1874. Brother case XXXI. Case 37. Loc. cit. Been sick four years. Lived out of doors; depressed in mind, as he was not earning money. Case improved. Was able to work as a clerk in a harbor steamer. Died, 1880. XXXIII. 1876. Man. Case 38. Loc. cit. Violent hemoptyses. Dis- ease in both lungs; not afraid to die. Took cod liver oil besides the general plan here laid down. Jan. 1877, blood and lungs much better. Living in Tennesee, October, 1879. XXXIV. Frenchwoman. Middle-aged. Case 39. Loc. cit. Disease right upper third. Tubercular blood. Strict diet closely followed. Well at last accounts. XXXV. 1874. Woman, 24. Case 40. Loc. cit. Dyspnoea; hypertrophy of heart. Disease apices of both lungs; had given up school teaching to die. Tubercular blood. Adhered closely to diet. Local treatment for throat. Was able to return to her teaching; overworked ; disease returned; profuse hemoptyses; death. XXXVI. 1874. Man, 21. Case 42. Loc. cit. Marked diseased apices of both lungs; an unpromising case. Improved and went to Cali- fornia. Died there. XXXVII. 1877. Woman, 36. Case 43. Loc. cit. Blood tuberculous. Laryn- gitis. Uterus anteverted. Dis- ease left upper third front. Unlike majority of cases did not treat uterus; case im- proved but finally retrograded and died. XXXVIII. 1886. Woman, 24. Case unpublished. Disease in both lungs. Arrested for two years Died March, 1889. XXXIX. 1887. Man, age 24. Unpublished. Disease in both lungs as diagnosticated by his physi- cians. Not seen by us. Improvement and disease arrested for two years. XL. Man. Unpublished. Considerable disease. Arrested temporarily. Series II.—Temporary Arrests.—Continued. B.—Cases that did not follow the treatment faithfully—nine. XLI. See illustrative case, p. 2, col. i and 2, b. 15 FEEDING IN THE WASTING DISEASES. No. Date. Sex. Age. Publication. Condition when Placed on Treatment. Remarks. XLII. Woman, 30. case 19. Loc. cit. Between pretuberculosis and tuberculosis. Attention dismissed early, and case died in six months. XLIII. 1874. Youth, 21. Case 24. Loc. cit. Advanced tuberculosis; diet had been mainly flour. Great improvement under strict animal food diet. Re- turned to work. Resumed former diet; died in 1876. XLIV. Man, 50. Case 26. Loc. cit. Left upper third chest, cav- ernous respirations and am- phoric tinkling; elsewhere crackling and diminished res- piration. Rigid diet. Much improved. Appetite returned and ate anything desired ; death. m XLV. 1875. Man, 43. Case 31. Loc. cit. Malaria and abdominal tu- mor, i860; cured. 1875,work- ed too hard, and lung and throat trouble came on. Improved while on treat- ment ; not encouraged by wife; gave it up and died, 1876. XLVI. Woman, 29. Case 32. Loc. cit. Pretuberculosis. Under strain and grief, ran into tuber- culosis. Was improved while under close observation and followed treatment; finally said she would eat what she pleased; did so and died. XLVII. 1877. Woman, 34. Case 33. Loc. cit. Asthmatic. Disease in right lung. Arytenoid cartilages inflamed. Disease arrested. Went from observation and gave up treatment. XLVIII. 1880. Man, 54. Unpublished. Heart enlarged. Angina pectoris. 1886, lungs becom- ing affected with great deal of disease. 1880, heart reduced to nor- mal size by diet. Would not follow diet when lungs became affected and died, 1889. XLIX. 1887. Woman, 46. Unpublished. Disease in both lungs. Asth- matic. Heart enlarged. Improved while following treatment closely. But could not control appetite and would steal food ; died 1889. Series II.—Temporary Arrests.—Concluded. C.—Cases that had bad surroundings; that died of pneumonia, &c.—eleven. L. See illustrative case, p. 2., col. 2., c. LI. 1876. Woman, 33. Case 19. Loc. cit. Lived in a damp, musty house. Caught severe cold. Disease upper third front. Tubercular blood. Throat much inflamed. Improved. Passed from under my care. Disease re- turned. Treated by Homoe- opathy. Death. LII. 1876. Woman. Middle-aged. Case 41. Loc. cit. Disease left lung; Cough. Expectoration. Hemoptyses. Did well while senior writer supplied her with beef. On his moving away from that town, supply ceased; case died. LI11. 1882. Man, 24. Unpublished. Small cavities in both lungs; disease arrested for two years. Died of pneumonia. 16 FEEDING IN THE WASTING DISEASES. No. Date. Sex. Ace. Publication. Condition when Placed on Treatment. Remarks. LIV. 1883. Man, 26. Unpublished. Cavity in right lung. Disease arrested for a year. Cough stopped. Died of pneu- monia caused by exposure in a rain storm. LV. 1887. Man, 64. Disease upper third left Improved. Died o*f pneu- Unpublished. lung. monia. LVI. 1887. Girl, 22. Unpublished. Cavity left lung. Arrested for a year. Dis- graced socially by a certain crime committed. Disease re- sumed its sway; death. LVII. 1887. Man, 50. Unpublished. Disease in both lungs. Arrested for a year. Died of pneumonia; family refused the services of a trained nurse. LVIII. 1887. Man. Unpublished. Disease in both lungs. Arrested ; death from pneu- monia. LIX. Man. 1887. Unpublished. Considerable disease. Arrested for two years. Died of pneumonia. LX. Man. Unpublished. Disease right lung. Arrested for one year. Died of pneumonia. It may be said that we were not very successful in our treatment of pneumonia complicated with tuberculosis. The complication is a grave one, and is usually the result of carelessness; still, many recover; we have seen cases of tuberculosis under treatment who had gotten the blood in good condition, and on contracting pneumonia, almost always pull through ; one diffi- culty is in not treating the cases early enough, i. e., not arresting the congestion. But if the blood is full of emboli of yeast and fibrin filaments and massed corpuscles, there is a great plenty of quick work to be done to relieve the engorged lung and help the heart ; each case needs its own treatment; pneumonitis in those (jailed well is a more fatal disease than it ought to be, as the laity have been educated into such a dread of it, that when pneumonia is pronounced, they are apt to give up all hope; antipyrin and the newspapers killed many of the cases that died during the late epidemic. Series III.—Arrests more permanent in character, and might re termed cures IF OCCURRING IN OTHER DISEASES. A.— Tubercular—thirty-two. B. —Pretubercular—eight. LXI. See p. 3, col. 1. Mrs. Wall’s case. LXII. See p. 3, col. 1. Young Man’s case. LXIII. Case 44. Woman, 20. 1865. Loc. cit. Cough, expectoration; wast- ing of flesh ; loss of appetite ; dullness on percussion and crackling right upper third front. Predisposed to tuber- culosis. Animal food diet repulsive, but she was encouraged by her relatives. Was cured and re- mains so, 1878 ; thirteen years. LXIV. Case 45. Man, Dec. 1862. Loc. cit. Diagnosis, double pleurisy and tubercle—so made by the late Dr. Benj. Cutter. Medi- cation did little if any good. Was ordered to have killed a fat hog which he owned and to eat it. This was done; man not seen again till 1878 ; then alive and well. 17 FEEDING IN THE WASTING DISEASES. No. Date. Sex. Age. Publication. Condition when Placed on Treatment. Remarks, LXV. Girl, 16. 1878. Case 46. Loc. cit. Sister dead of tubercle. Blood tubercular; disease right upper third front. Placed on rigid diet. Was cured and remained so, 1880. LXVI. Case 47. Woman. 1872. Loc. cit. Cough, emaciation, copious expectoration; dullness on per- cussion and expiratory crack- ling well marked over left up- per third. Followed treatment faith- fully and was rewarded by restoration to health. LXVII. Case 48. Girl, 24. 1875. Loc. cit. Right upper third front and back dullness on percussion ; crepitant rales and tubular res- piration. Tuberculous blood. Diagnosis of tubercle given by late Dr. William F. Stevens, of Stoneham, Mass. Lung healed by diet. Has been troubled by a uterine fibroid, and pelvic abscess but pulmonary disease in abey- ance. LXVIII. Case 49. Man. 1873. Loc. cit. Copious hemoptyses. Lung breaking down. Heart’s action controlled with veratrum ; alcohol to outside of chest. Rest; strict diet. Cure. LXIX. Case 50. Woman. 1873. Loc. cit. Hard-working woman. Ema- ciation ; cough ; disease upper part right lung. Blood tuber- culous. 1877 in quite good condition. 1889, no cough; dry rales right lung; has to work hard; troubled with uterine disease. LXX. Woman, 34. 1877. Case 51. Loc. cit. 1866, Dr. Buzzell of N. Y. sent her to Wales to recover from hemoptysis, cough and copious expectoration by diet of mutton, milk and moun- tain air. Result desired in 1886 achiev- ed. 1877, blood pretubercu- lar; was run down; placed on diet and cured. Seen 1890, well. LXXI. Case 52. German, 32. 1877. Loc. cit. Disease, right lung. Abject feebleness. No appetite. Feared tubercle. Night sweats. Gallon of milk a day. Case made rapid progress to health. LXXII. Case 54. Girl, 18. 1877. Loc. cit. Disease lower part of left lung. Blood tuberculous. Was dieted faithfully and cured. LXXIII. Case 55. Irishman. 1876. Loc. cit. Tubercle diagnosticated by other physicians, upper thirds both lungs. Blood tubercu- lous. Was cured. LXXIV. Case 56. Girl, 16. 1875. Loc. cit. Sister dead of tubercle. Dis- ease upper portion left lung. Partial diet on which she recovered. LXXV. Case 51. Woman, 38. 1877. Loc. cit. Blood tuberculous. Throat inflamed. Pharynx inflamed. Cough; some expectoration. Lung not much affected. Was pulled out of her con- dition and is living, 1890. LXXVI. Case 58. Woman. 1873. Loc. cit. Disease upper part left lung. Restored to health by par- tial diet. Treated for uterine disease, 1874. 1880, well. LXXVII. Man, 50. 1874. Case 59. Loc. cit. Disease left upper third front. Strict diet. Cured of tuber- cle and asthma. Remains so, 1880. FEEDING IN THE WASTING DISEASES. No. Date. Sex. Ace. Publication. Condition when Placed on Treatment. Remarks. LXXVIII. Irish boy, 17. Case 60. Loc. cit. Tuberculous blood. Acute tuberculosis right upper third front. Diet followed out faithfully, Cure. LXXIX. Woman, 34. 1871. Case 61. Loc. cit. Chronic cough; expector- ation, disease not well marked as yet in lungs. Blood tuber- culous. Remained well under treat- ment till 1888, and return of trouble; was again dieted with success. LXXX. Girl, 20. 1878. Case 62. Loc. cit. Chronic cough ; free expec- toration ; night sweats ; pallor; weakness; chest first stages of disease ; blood tuberculous. Cured and remains so. 1880. LXXXI. Woman. 1871. Case 63. Loc. cit. Blood tuberculous. Disease right upper third front; cough; severe hemoptysis. Family consumptive ; pharynx inflam- ed, especially patch on poster- ior pillar palate. Health restored, 1877. Cop- ious hemoptysis after excite- ment; heart laboring too much, 1878; uterine disease, restored blood to its tubercular condi- tion; treated energetically and remains well, 1880. LXXXII. Girl, 17. 1875. Case 64. Loc. cit. Severe hemoptysis. Cough; lungs not much diseased ; heart enlarged ; blood tuber- culous and syphilitic. Cure. LXXXIII. Woman, 35. 1881. Unpublished. Cavity upper part of left lung. Was cured positively and died of pneumonia, 1885. LXXXIV. Girl, 20. 1886. Unpublished. Hemoptysis. Lung fibers in sputum ; blood tuberculous. Cured and remains so, 1890. LXXXV. Woman, 50. 1887. Unpublished LXXXVI. Woman. 1881. Unpublished. Disease base right lung. Breath fetid. Heart enlarged. Crackling and cavernous respiration upper third right lung; inelastic fiber in sputum. Retroversion uterus. Is called a trophy, but may yet go under in her slavish at- tention to household duties. 1890. Cured. Wore Cutter Stem Pessary. Died 18890! typhoid fever ; lung remained healed. LXXXVII. Woman, 48. 1886. Unpublished. Lung fibers in sputum. Gravel of lungs. Asthma. Tuberculous blood. Albumen, fatty epithelia and casts in urine. Small fibroid tumor of womb, anteversion and ante- flexion. A tough case. Cured of renal and pulmonary troubles; tumor disappeared under diet. Wore Cutter Stem Pessary to California via Isthmus of Pana- ma. Comparatively well as a valetudinarian. 1890. LXXXVIII. Woman, 38. 1885. Unpublished. LXXXIX. Girl, 20. 1885. Unpublished. Disease in both lungs. Uter- ine disease. Disease upper third left lung. Lung fibers in sputum. Uterine disease. Cured of lung lesion, and fairly well 1890. Cured ; remains so, 1889. XC. Man, 40. 1882. Unpublished. Cavities in both lungs. Profuse hemoptyses. Night sweats. Said to be absolutely incurable. Cured and remained so for two years. Have lost track of him. 19 FEEDING IN THE WASTING DISEASES. No. Date. Sex. Age. Publication. Condition when Placed on Treatment. Remarks, XCI. Man, 60. Jan. 1889. Unpublished. Disease in both lungs. Promptly arrested and pa- tient satisfied after three months of treatment. XCII. Woman, 26. 1887. Va. Med. Monthly, Dec. 1888, and Sep. 1889. Disease through middle of left lung and at apex. Uterine disease. Hemoptyses. Lung fibers in sputum. Disease arrested and patient died Aug. 1889, from the re- sults of a meningitis and bowel lesion of fibroid thickening. B.—Pretubcrcular cases treated that may come under tins head. XCIII. See p. 3, col. 2. XCIV. Physician, 45. 1877. Case 66. Loc. cit. Takes cold easily. Ulcer- ated sore throat. Weak and debilitated; loss of flesh; cough and expectoration. Slight diminished resonance on percussion, diminished re- spiratory murmur, strong ex- piratory murmur, upper right front. Blood tuberculous. Dieted but not very faith- fully. In 1880, well. XCV. Man, 24. 1876. Case 67. Loc. cit. Father dead of tubercle and sister dying. He had lost flesh, strength and voice. Pale and anaemic. No lung lesion. Blood pretubercular. Treatment resulted in re- moval of blood morphology of disease. Is well. XCVI. Woman, 24. 1877. Case 68. Loc. cit. Phthisis hereditary. En- larged lymphatic glands. Uterine disease. Diminished respiratory murmur through- out the right lung. Pretuber- cular blood. Milk diet. Blood became normal. Glands nearly disap- peared. XCVII. Woman, 30. 1877. Case 69. Loc. cit. Small fibroid tumor Oi womb. Menorrhagia; blood pretuber- cular. Blood restored to health and tumor disappeared under diet influences. XCVIII. Girl, 21. 1877. Case 70. Loc. cit. Feeble respiration right lung. Blood pretubercular. Debility; cough; uterine dis- ease. Pyrophosphate of iron. Strict diet. Rest. Entire re- covery. XCIX. Woman, 25. June 1888. Va. Med. Monthly, Dec. 1888. Mother and brother dead of tuberculosis. Weight, 248. Red corpuscles pale in color and sticky. White corpuscles enlarged with spores of vinegar yeast. Spore collects in serum spaces. Also crystals of cys- tine. P"atty heart. Dieted for six months. Weight 150 lbs. Calls herself well March, 1890. C. Man, 60. 1878. Unpublished. Heavy cough. Brother dead of tuberculosis. Corpus- cles massed. Yeast and fibrin filaments present. Dieted and cured. Lived in Japan several years. Well, March 1890. Diet principally beef and bread. Lives in the South in winter; is a hard worker in his profession. The Arts ton, Broadway and Fifty-fifth street, New York. 20