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IT may be that some day it will be found that rheumatism is due to a specific germ. According to our present knowledge, however, it seems more likely that it is the result of a general poisoning of the system; a clogging of the body machinery by waste matter and poisons. This aspect of the disease we discussed last month.

Rheumatism is largely preventable. In fact it is easier to prevent than to cure. In order to keep free from rheumatism, we must avoid all those things which contribute to its cause. These are poisoning of the body by its own waste products, the presence of septic foci, and a local factor such as an injury or exposure to damp and cold.

To put this in a more positive form, if we wish to keep free from rheumatism we shall adopt a cleansing diet of fruits, grains, nuts, and vegetables. We shall avoid flesh in all its forms and alcohol, tea, and coffee. All these are poisons and they injure the delicate organs whose duty it is to keep the body free from impurities. We shall also drink two or three glasses of pure water on rising, between meals, and before letiring. Frequent bathing, too, will tend to keep the pores of the body free from impurities and functioning well.

BOWEL HYGIENE

If constipation is present, as it frequently is, this must be overcome at once. Chronic inactivity of the bowels means that the whole machinery of the body is clogged and unable to function properly. Careful dieting, water drinking, abdominal massage, and general exercises should cure all such cases. Diet is most important and includes the use of liberal quantities of fresh fruits, especially the laxative ones such as figs and prunes, and the use of wholemeal bread and green vegetables.

In addition to these points, we shall have the mouth, ear, nose, and throat examined twice a year to make sure that these cavities are quite healthy. The mouth probably is the most likely one to become diseased and careful daily attention must be given to oral hygiene.

Lastly, clothing is very important in preventing rheumatism. The whole body should be sensibly clothed, leaving no part unduly exposed. Special attention should be given to the neck, legs, and feet. Women would do well to be guided by sense rather than fashion as frequently the latter exacts so high a toll from its slaves.

In those who are subject to rheumatism, flannel will be the best material to wear next to the skin. Very often a flannel binder worn round the waist will prevent lumbago. This is very simple and is certainly worth a trial during the winter months in those subject to this complaint.

Do not underclothe or overclothe as both are bad. The latter encourages perspiration and subsequent chill.

SIGNS AND SYMPTOMS

Chronic rheumatism most commonly attacks the joints. Frequently one of the large joints is affected, but sometimes several small ones, such as those of the hands and feet, are involved.

Pain is a very prominent feature and as a rule this is accompanied by a certain amount of swelling. The tenderness is worse at night and at the approach of bad weather. The stiffness which is always present in severe cases is improved by exercise.

Cases of rheumatism very often have a history of dyspepsia.

The prognosis of rheumatism, once it is established, is not good as regards a permanent cure. It is, however, not a very fatal disease but it is responsible for much crippling and deformity. When continued for a long time, the general health
may become impaired.

TREATMENT

The number of so-called cures for rheumatism is legion, which proves, so far, that there is no specific treatment for this complaint. Much may be done, however, to relieve the suffering and many cases can be cured altogether. One thing to remember is that the disease comes on slowly as the result of many years of faulty living. Therefore we cannot expect to effect a cure in a short space of time. Treatment, to be of any value, must be persevered with, often for many months.

The internal treatment includes strict attention to the diet. Avoid flesh-foods, tea, coffee, and alcohol and use salt sparingly. Be sure to get the stomach healthy and functioning well. This is done by obeying the laws of diet and digestion. Fresh fruits and vegetables should be eaten freely. The vegetables should either be steamed to conserve all their salts or the water in which they are boiled should be used for the making of gravies. It ising freely. This, together with copious water drinking, will help to eliminate from the body much of the poisonous waste matter which is causing the trouble. In fact, much of the benefit derived from treatment at various spas is due, we believe, to the amount of water taken rather than to the actual salts which it contains.

VALUE OF HEAT

..Then we have the external treatment. This is very important, and we will consider first what we can do locally. The application of heat in the form of hot fomentations, hot bran bags, hot baths, etc., followed by inunction with “iodex and methyl salicylate ointment” is the best in most cases. Antiphlogistine, a preparation obtained at any chemist’s, is also excellent and is really a form of prolonged fomentation. Liniments, such as compound liniment of camphor, are often useful, but here it is probably the friction rather than the liniment that gives relief.

When the joint is not being treated, it should be covered with moist wool followed by a piece of oiled silk and a large piece of dry wool. For rheumatism of the hands, sleeping gloves, sometimes filled with hot bran, are comforting.

Extremes of temperature should be avoided, flannel should be worn next to the skin, and the affected joint should be protected by an extra) covering. The tendency to deformity must be resisted by movement and exercise.

GENERAL TREATMENT

Then lastly we have the general external treatment. This is chiefly concerned with eliminative methods to assist the internal treatment. Such measures are the wet sheet pack, the hot vapour bath, the Turkish bath, the alkaline bath (sodium carbonate, 4 ozs. to a full bath),, and the pine bath (extract of pine, 3 ozs.).
Electricity is useful in some cases, and very often the greatest benefit seems to be derived by having the current applied while in the bath. Should the patient be running a temperature, it is best for him to have rest in bed, especially if the temperature is 100 deg. Fahr.

All septic foci must, of course, be cleared up. No treatment will do much good so long as we are absorbing poisons day by day from an unhealthy mouth or diseased tonsils.

The joint affected by rheumatism should be kept moving, and ten minutes should be set aside twice a day for special exercise.

Not many people are able to leave home and give ‘Up work to go abroad, but for those who are able to do so, the climates of southern Europe, California, and Egypt will be found most suitable.

Nuts

The Nutritive Value of Nuts
THE food chemist, accustomed to deal with edible products in terms of quantity and proportions,— in calories and grains of protein, fat, and carbohydrate,— has long given to the various nuts a prominent place among concentrated foods. From his analytic standpoint theymay even surpass such recognizedly valuable foods as meats, eggs, and cereals in their concentration of nutrients. Although nuts and products made from them have been used by man the world over as adjuvants to his usual diet, they have only lately obtained a larger recognition in relation to the dietary. The failure to eat nuts more extensively is doubtless due in part, as Cajori pointed out some time ago, to their reputation for indigestibility, and to the discomfort that may occur after eating them at the close of a heavy meal.

Scientific studies have not justified the reputation for the indigestibility of nuts that has become somewhat traditional. Experiments that were conducted by Cajori at Yale emphasized anew what has long been contended by Jaffa, of California, namely, that nuts are valuable foods, judged by their behavior in digestion and metabolism. They point out that if nuts are eaten properly and used in the diet as eggs, meat, and other foods rich in protein are eaten, they behave quite as well in the body as do the ordinary staple articles of food. Particularly when nuts are finely comminuted by proper mastication, or are consumed in the finely divided form of nut pastes or nut ” butters,” there can be no complaint about the proper utilization of the product. The question of texture, of the avoidance of hard, impermeable particles of any food substance concerns the culinary or physiologic manipulation of the material rather than its chemical make-up. In other words, it can usually be corrected by proper preparatory procedures; one need merely contrast raw almonds with almond ” milk ” by way of illustration.

But the nuts have something more than mere digestibility to recommend them. Their protein is, in general, of a superior quality. The production of good growth is a test for biologic ” completeness ” of a protein. In experiments just conducted at Yale University, Cajori has secured very satisfactory growrth over long periods in animals on diets in which the almond, English walnut, filbert, and pine nut, respectively, furnished the essential source of protein in the ration. These proteins afford the necessary nitrogenous complexes for the elaboration of milk in the same species. From a study of the relation of diet to milk production in women, Hoobler pointed out, not long ago, that as a rule animal proteins are more efficient than vegetable proteins for the elaboration of human milk. However, nut proteins were an exception to this generalization in that diets containing almonds, English walnuts, pecans, and peanut butter as a source of protein, proved to be as suitable for milk production as diets that furnished protein from animal
sources.

This is not the limit of commendation. Nowadays, adequate nutrition is also discussed with reference to vitamins in the diet, since these dietary essentials apparently cannot be synthesized by the animal organism. According to Cajori, normal growth can be secured when rats are fed on otherwise adequate diet containing the almond, English walnut, black walnut, Brazil nut, chestnut, or pecan as the sole source of water-soluble vitamine. Animals that have declined on a diet devoid of water-soluble vitamine promptly recover when the almond, English walnut, filbert, hickory nut, pine nut, chestnut, or pecan is introduced in the diet. These observations indicate that nuts are sources of abundant quantities of water-soluble (B) vitamine. Evidence of the sort here reviewed need not be assumed to justify propaganda for any exclusive system of diet. We do not argue for a race of nutarians or vegetarians or any other fad of the extremists. The latest information as to the nutritive virtues of commonly used nuts can only be welcomed, particularly by those who, like diabetics, rely on these food products, most of which are poor in digestible carbohydrates but rich in proteins and fats, to enlarge the variety of a limited regimen. Furthermore, the nuts are logical dietary supplements to many foods, like the cereals, roots, tubers, and fruits. There’s a reason as we now have learned.—Journal A. M. A., Oct. 30, 1920.

MY BACK IS KILLING me, Dr. Charles, M and your secretary says it will be two weeks before she can give me an appointment.  Isn’t there anything I can do? I can’t work for more than a few minutes at a time, and my boss says I can’t come back to the office until I get this thing fixed.” The attitude of wavering hope and pain were apparent in both tone and word as her voice came over the telephone, and my desire to help was aroused. “I’m comfortable only when I’m lying down on my side with my knees up,” she continued. ”Just where is your pain?” I asked. “It’s about three or four inches below the small of my back and off to one side near my hip,” she replied. “I know I should have called before.
I’ve been having trouble ever since vacation when we drove about 2,500 miles. I got a little stiff, but I thought it would go away in a short time, and when it didn’t—well, I had my back adjusted several times. It seemed to help for a while, but the past few days my back has gotten worse, and I even have a dumb, numb feeling in my left leg.” “Do you have pain down your leg?” I interrupted. “Yes!” “How far down does it go?” “Well, I don’t know,” she paused in reflection, “but now that I think of it, I’m sure it goes clear down to my ankle. But the worst spot seems to be outside the calf of my leg. It’s terrible when I try to get out of an easy chair; I have to use my hands to let myself down or lift myself up. Isn’t there
anything you can do?” The plaintive search for relief came through strongly. “Do you have pain down your leg?” I interor strain?” I asked. “I never sneeze, but it sure hurts to cough. And it seems I’ve been more constipated lately,
and my back hurts worse when I have a bowel movement and have to strain.”Apparently my continued questioning had given the impression that I was reluctant to see her immediately, “Karen, I’m sorry I can’t see you right away; I have an office full of patients and surgery in an hour. But I will give you some suggestions. If you do not improve I may have to hospitalize you.”

“But I .don’t want to go to the hospital,” she interrupted. “Can’t you just give me a pill or something so I can go back to work?” Yes, I thought. We all seek the easy way out, but I answered aloud, “I’m sorry there is no magic potion to cure a bad back; it will take time and patience, and perhaps even hospitalization with the eventual need of surgery if you continue to be so disabled that you can’t work.” ”I’ll do anything—even go to the hospital, if it will make me better. But not surgery! I’ve heard that surgery doesn’t always help, and some people are even made worse. Anything but surgery! I’m scared of that.”

“Now, Karen,” I reassured her, “we’ll cross the surgery bridge when we get there. For now, do you have anyone at home to care for you? Our beds at the hospital are at a premium, and I can’t get you in there for several days.” ”Well, yes-s-s. My sister-in-law and her kids are here from across the country, and I’m sure she’d be happy to help me out.” ”Fine. First of all, I want you to come by my office and get some X-rays of your back. After I’ve checked them I’ll be in a better position to determine what is wrong and to outline an appropriate programme for you.” Next morning her X-rays were lying on my desk. As I looked them over some possible causes for her pain were evident. When Karen telephoned
to get her report I said, “There are several things I want you to do. So please get a piece of paper and write them down. ”First. Come by my office, and my nurse will give you a little booklet of back exercises and show you how to do the ones I have marked. Do only the marked ones. If any exercise hurts, hold off until I.get a chance to examine you. I’ll work you into my appointment schedule as soon as possible. ”Second. If your bed is soft or has a tendency to sag at all, have your husband place a sheet of 5/8-inch plywood under the mattress; your bed needs to be quite firm.

“Third. Because your physical activity will be decreased, cut the amount of food you’re eating by at least one third, and you’U do better if you eat a light diet. Emphasize fruits and vegetables. ”Fourth. Increase your fluid intake by taking a couple of glasses of water regularly, one-half to one hour before each meal. This habit, along with the change in diet, will probably eliminate your problem with constipation.
“Fifth. Initially I want you to go to bed with a doubled-up pillow behind your knees. You may walk to the bathroom and I want you to take a short walk once daily outdoors. This will help to prevent the profound weakness that some people experience when at complete bed rest. If your pain is intolerable you may have to postpone walking. ”Sixth. Take a good alternating hot and cold shower, with five to eight minutes hot and fifteen to twenty seconds full cold, repeating five or six times.

For some an ice pack to the low back will many times relieve pain.

“I’d like to see you in four days. If you do not feel better within a day or so, please call me, and I’ll either change your programme or see you sooner if your symptoms suggest I should.” Four days later, after her examination was completed, I sat down with her to discuss the problem. All three lines of evidence, vher history, her X-rays, and her physical condition, supported the diagnosis of a “slipped disc,” or “ruptured disc,” as it has become known to the nonmedical world. It is one of the commonest causes of back trouble hi twentyfive-to fifty-year-olds.

This problem usually begins with an intermittent low backache of some years’ duration which is aggravated by heavy work, lifting, or prolonged, unusual posture, such as bending over for long periods of time. The pain does not at first involve the leg and is usually relieved by rest. This suggests an incompetent disc. Microscopic study and biochemical analysis reveal abnormalities that cause some loss of normal elasticity and shock-absorbing qualities, so that the joints between vertebrae begin to act as weight bearers instead of simple glide restrictors to prevent excess motion. As abuse continues, changes increase, the joint membranes and lining thicken, and the surface of the joint cartilage becomes softer and erodes. Finally bony spurs may appear on the vertebrae, and spaces between the vertebrae narrow, putting pressure on the nerves which leave the spinal cord at that point. This accounts
for the later appearance of pain in the leg. These problems develop over a number of years, rather than weeks or even months.

Diseased discs sometimes result from the strains of certain occupations or sports. Overhead-crane operators have more frequent trouble with the discs between the lower vertebrae of their necks than do men of the same age engaged in other occupations. Disc disease in the neck in teen-agers and youth is commonly seen among wrestlers, due incidentally, I believe, to “bridging” to avoid being pinned. Fifty per cent of a wrestling team I examined, including the coach, had symptoms of premature disc protrusion and ageing, and some of these men had X-ray evidence of break-down of their lowest three discs, similar to those seen in the lower neck. Regular exercise is important in both preventing disc disease and treating it after the first acute stage is over, because it can tremendously increase the blood supply to the muscles, ligaments, and joint structures.

Here are a few of the many causes of low back pain that are not a result of ruptured disc.

Chronic back strain. It is sometimes difficult for a physician to differentiate chronic back strain from early degeneration of the disc. The pain is from strained ligaments, weak muscles, and stiffness of the joint capsule. Hoeing, weeding, and many other activities which are done only occasionally and which keep the body in unaccustomed positions for long periods of time cause this type of backache. Treatment includes actively moving the back as far as possible in every direction and eliminating stressful positions, such as standing at the sink for hours, or, as typists and students know, sitting at a desk for hours with neck bent over copy material. Frequently standing up and deliberately moving the back, neck, and arms into positions opposite to those in which they have been held will bring relief.

Sponylolysis and spondylolisthesis. These are two similar bony defects in which a part of a vertebra begins to erode or where one vertebra slips forward over the one below it. Some suffer no pain, while others do. Eskimos paddling their kyaks or sitting on the floor with their legs straight out infront of them frequently develop this problem. The combination of heredity and improper posture starts the low back pain. Later the pain may extend down the legs. The treatment is the same as outlined for Karen. Occasionally surgery is necessary.

Transitional vertebra. This is a birth defect in which a vertebra is doing double duty by acting as a portion of the pelvis in its lower half and as part of the spine in its upper half. Treatment is again much the same except that surgery is usually highly successful. I really believe that it is the best in the long run.

Tension low back syndrome. Several weeks ago I saw Erma, who was suffering from low back pain. Her symptoms improved with improving relationships both at home and at work, so you would not have recognized her as the same woman. When she lost her job her old symptoms of pain sprang into full bloom. Both light touch and deep pressure provoked intense pain. But when she secured new employment her financial problems improved, as did her back.

Constitutional  problems. Various kinds may cause low back pain as a major symptom. Here are a few of these.

Constipation can mimic a ruptured disc. The cure is rather simple.

Pregnant women more than six months along may frequently show signs of a pseudo-ruptured disc. Delivery cures their back pain. Meanwhile, a back support, such as a surgical corset, appropriate exercises, weight control, and elastic hose are all she needs.

Some women suffer low back pain similar to that of a ruptured disc before their monthly periods. With menstruation comes complete relief. Endometriosis also affects only women. It is an overgrowth of certain cells lining the womb and may cause symptoms like that of a ruptured disc. Pain comes and goes in cycles, depending on their ovarian hormones. Treatment consists of hormone therapy or, if necessary, removal of the womb. A corset or other back support is usually not helpful. Pelvic tumours, including cancers, may imitate a ruptured disc. One patient came to me with a strange gait and a nontypical disclike pain running down his hip and leg. Examination showed cancer of the prostate gland, which had spread to his pelvic bones. He improved with hormone treatment and surgery. If you sometimes have back pain a prompt change in your health habits may improve your back. If your aching back continues see your doctor for an evaluation of your problem.

skin diseases

WITH reference to their causes, the various diseases and abnormal conditions of the skin may be divided into ten classes, as outlined below:

1. Those resulting from, and constituting a part of, general systemic diseases. In this class are included the skin eruptions of syphilis, smallpox, scarlet fever, measles, typhoid fever, typhus fever, chicken-pox, and diabetes. In the last-named disease the skin disorders do not always assume the definite form, but frequently the patient is afflicted with boils, carbuncles, eczema, or pruritus (itching of the skin).

2. Those having their origin in disorders of digestion, intestinal auto-infection, and constipation. Here may be mentioned urticaria or hives, herpes simplex, psoriasis, acne, blackheads, dandruff, some cases of pruritus, and many cases of eczema.

3. Disorders of the skin caused by a poor quality of food, insufficient nourishment, or overeating; or by uncleanliness or other unhygienic conditions. Common of this class are acne, blackheads, boils, psoriasis, erysipelas, and ecthyma.

4. Those which are the result of some primary abnormal condition of the blood. The greenish-yellow tint of chlorosis and the lemon-yellow tint of pernicious anemia are examples of this class. In many persons there is a uric acid diathesis or predisposition, and an increase of uric acid in the blood, which is a frequent cause of eczema.

5. Affections of the skin resulting from functional or organic disorders of the nerves. Herpes zoster, or shingles, is an important member of this class. Others which frequently arise from the same cause are herpes simplex, urticaria or hives, lichen, and eczema.

6. Those which have their origin in disease of some special organ or organs, as disease of the kidneys, liver, or reproductive organs. Bright’s disease of the kidneys frequently causes a pasty white, sallow, or brownish color of the skin, and is often a cause of pruritus or eczema. In many cases diseases of the liver and gall bladder are accompanied by pruritus and jaundice. Acne and blackheads sometimes result from disorders of the reproductive organs.

7. Skin eruptions from various drugs taken internally. Many drugs, when taken in large doses or long continued, especially when they are eliminated largely through the skin, cause skin eruptions in persons who are peculiarly susceptible to their influence.

8. Skin disorders resulting from external irritants of a chemical, thermal, or mechanical nature. Common examples of this class are erythema intertrigo or chafing; chilblain from frostbite; burns, irritation or injuries of the skin from irritating or caustic gases or liquids, as chlorine gas, ammonia, formaldehyde, bromine, strong acids or alkalies; and poisoning of the skin by poison ivy or poison oak.

9. Skin affections resulting from animal or vegetable parasites. Some of t h e skin diseasesdue to animal parasites are scabies, or itch, caused by the itch mite; pediculosis, or lousiness from the presence of lice; and trombidiosis, caused by the red chigger. Among those resulting from the presence and activity of microscopic vegetable parasites known as bacteria, are erysipelas, sycosis of the bearded region, tuberculosis of the skin, and leprosy. Two of the skin diseases caused by a microscopic fungus growth are favus and ringworm.

10. Disorders of the skin resulting from unknown or little-understood causes.

In this class belong prurigo, a chronic skin disease beginning in infancy or early life; lupus erythematosus, usually limited to the face, and occurring most frequently in women; scleroderma, or a hardening and stiffening of the skin; ichthyosis, or fishskin disease; leucoderma, or abnormal whiteness of the skin in patches; freckles; and the so-called liver spots.

Here also may be mentioned the disorders of the sweat glands, giving rise to excessive or offensive sweating, suppression of the sweat, colored sweat, bloody sw.eat, and prickly heat. In many cases, diseases of the skin are the result of two or more of the above-named causes acting in combination. When one considers the variety of causes and the difficulty in diagnosing the various skin disorders, it will be readily understood that while cleanliness, proper diet, relief of constipation, outdoor exercise, and general hygienic measures are of great importance, the treatment of the majority of skin diseases should be under the direction of one who has made a special study of the subject.

The cause, when discoverable, should, of course, always be removed if possible. In addition to the removal of the cause and the adoption of hygienic measures, in most cases external applications and sometimes internal medicines are required to bring about a prompt and successful cure.

BESIDES air and water, both of which are of prime importance to the maintenance of life and health, the living bodyalso requires for its sustenance a certain amount of more or less solid matter, which we term food. Dr. Robert Hutchison defines food as ” anything which, when taken into the body, is capable either of repairing its waste or of furnishing it with material from which to produce heat or nervous and muscular work.”

As yet we don’t seem to have found an infallible system of diet suitable alike for all ages and conditions of life. The stomachs and livers of people appear to differ as much as their noses, and there is some truth in the saying that ” one man’s food is another man’s poison.” Nevertheless, there are certain axiomatic, guiding principles with regard to our daily food which we can lay down without appearing to be unduly arbitrary or dogmatic. It is a fact that the simpler and plainer the system of diet, the less difficulty there is in adapting it to large classes of individuals.

The Human Engine.

The body has long since been described as a living machine, a sort of combined furnace and engine in one. Like the engine, it requires fuel for the production of steam with which to drive it, and a certain small but none the less necessary amount of building and repair material with which to maintain its upkeep, and prevent it from going to pieces through deterioration: The food we eat furnishes both fuel and repair substance, and must be looked upon, along with air and water, as one of the supreme supporters of life. Good food is a natural stimulant, a real tonic, which only benefits and ne er leaves behind in its wake any after effects of a depressing and harmful nature.

Two Classes of Food.

We have, then, two great classes of food serving the two requirements of the human machine. First, there are tissue builders or tissue repairers, the chief being the nitrogenous element of our food, that is, the proteins, such as the white of an egg, the curds of milk, the gluten of wheat and other flours, and the legumin of the pulses. During growth the body requires a larger proportion of these foods to provide both for building new tissue and repair of the old tissues, but after maturity has been reached, only an amount sufficient to make good the daily wear and tear of life is necessary.

I. Building and Repair Food.
a. Proteins, including albuminoids.
b. Salts or mineral matter.
c. Water.

The second great class is composed of the fuel foods and includes proteins because they are also capable of furnishing a moiety of fuel for the supply of heat and energy.

II. Fuel or Energy Foods,
a. Starches and sugars.
b. Fats,
c. Proteins.

Tissue- Builders.

As in the case of the locomotive or any other engine, the metal, that is, the building material, is of supreme importance. If the machine were not kept in repair, it would soon fall to pieces and become use less ; so with the human machine. Protein matter is of ” pre eminent” importance, because without it life could not exist. It is the only food capable of building new tissues and making good the losses which are continually taking place. If all the protein matter were removed from the food a person would die sooner on such a diet than if no food at all were taken. It is possible to live on proteins and fat alone, as witnessed by the Pampas Indians of the Argentine and Patagonia, but, of course, it is not desirable or wise to select such an exclusive diet.

The amount of repair food required by the average adult is comparatively small, certainly less than ten per cent of the total intake.  A growing child would require a larger proportion, and should therefore not be stinted in diet.

Fuel Foods.

The best fuel foods consist of starch, sugar, and fats,and these may be looked upon as the real work and heat producers of the human body. Liebig, the famous physiologist, believedthat proteins were the chief sources of muscular energy, but this has now been shown to beacomplete fallacy. He also believed that carbonaceous foods, that is, sugar, starch, and fat, were merely capable of producing heat, but no other form of energy. This too is a fallacy. Nevertheless, the vast majority of people to day, judging from their habits, still seem to be influenced by the erroneous teaching of Lsibig, and the consequence is that they take altogether too large an amount of repair food. This surplus of building material which is not required for the repair of the body becomes a sort of clinker in the human furnace, and causes irritation of one kind or another, and gives rise to various discomforts and probably also diseases, including cancer.

The great bulk of the food undergoes combustion in the body for the purpose offurnishing heat to maintain
a certain fixed temperature of 98 5° Fahr. This is the normal heat of the body, and only a slight variation of a few degrees above or below this natural temperature causes more or less dangerous disturbances. Fuel foods furnish all forms of energy, muscular, nervous or chemical, as well as heat.

Every form of tissue activity, whether it is the contraction of muscle fibre, the sending of nerve impulses, or the manufacture of secretions or excretions, is always accompanied by the production of hear. It was once thought that the burning processes whereby heat is produced took place only in the blood, but now we know that the fires of the human furnace exist everywhere throughout the tissues and organs of the body, including the blood, and that the chief purpose of the blood as far as heat is concerned is to equalize the temperature throughout the human system.

Hutchison tells us that ” life and heat are inseparable,” and it is a fact that any serious interference with the normal temperature of the body is accompanied by grave or even fatal consequences.

From this brief glance at the composition of our daily food we may conclude that ninety per cent or more of it consists of sugar in the natural state as we find it in various fruits, such as grapes and bananas, and vegetables, such as sugar cane and sugar-beet; or in the form of starch, as found so abundantly in cereals, rice, potatoes, and chestnuts, and which in theprocess of digestion is changed into sugar ; and fats such as butter, cream, and vegetable oils like olive oil and cocoanut oil; and only a small proportion, something less than ten per cent, of the more solid building material is required for the maintenance of a healthy human machine.

Foods Rich in Protein

IT has been shown  conclusively that on the average more  protein is  consumed than the  body  needs.  We  know  that,  provided  the  proteins  are  ” adequate,”  or  balanced, that is,  capable  of being built up  into  such  proteins  as  the  body  needs, one  gram  protein  per kilogram  of  body  weight  is  amply  sufficient  to  supply  the  needs  of  the body.  The  rapidly  growing  baby  receives  no  more  than  this  in  its milk — the  food perfectly adapted  for its nutrition  and  growth.  But  adult man, under  the  theory  that  the  proteins  are  the  essential  foods,  has  so  arranged  the dietary,  when  the  purse  will  stand  it,  that  the  meal  is  largely  protein.  This results,  of  course,  from  the  custom  of  making  meats  such  a  large  portion  of the  menu.

Kellogg  and  Taylor,  in  ” The  Pood  Problem,”  have  given  in  plain language at  least  two  reasons  why  an  excess  protein  consumption  is  a  disadvantage.  To quote:

” If more  protein  is  ingested  [eaten]  than  is  required  to  maintain  growth,  wear  and  tear,  and  upkeep,  it is destroyed  in  the  body.  The  body  does  not  store  it  in  the sense  that the  body  stores  fat.  No  matter  how  great the  excess  of  protein  beyond  the needs  of  the  body,  the  needless  protein  is  destroyed,  and  end-products  appear  in  the urine.  Now,  since  protein  is  an  expensive  form  of  food  to  produce  in  nature,  and, therefore,  expensive  in  the  market,  we  ought  to  reduce  the  ingestion  of  protein  to somewhere  near  the  point  of  need.  Protein  consumed  in  excess  of  the  tissue  needs becomes  a  mere  fuel,  but  a  very  expensive  form  of  fuel,  and  one  that  possesses  in addition  a  residue  to  be  eliminated  in  the  urine.  The  difference  between  sugar  and protein  as  fuel  may  be  compared  to  the  difference  between  crude  oil  and  coal.  Sugar burns completely  and leaves no ash;  protein burns incompletely  and  leaves  an  ash,  and this  ash  must  be  eliminated,  imposing  upon  the kidneys  a  useless  labor,  comparable  to removing  ashes  from  a  grate.  Certainly  no  engineer  would  use  a  coal  with  ashes  if he could for the same price or a smaller price use an ashless  fuel;  and whenever  protein is  consumed  in  excess  of  the  tissue  needs,  it  amounts  to  selecting  deliberately  a  fuel with  a  large  ash  instead  of  a  fuel  with  no  ash.”

This thought is certainly worth  some  consideration by those  who  think their menu must be built up largely of roasts and steaks and other meat  dishes.  These foods  are  expensive  both  from a money viewpoint,  and  from  a  health  viewpoint. It is  the  liver  and  kidneys  that  have  to  do  the  extra  work  of  disposing  of  the excess  portion,  and who  knows  to  what  extent  these  excesses  are  responsible  for the kidney and liver diseases  that take  off the  well-to-do  shortly  after the  prime of life ?  It is the ” good eaters “— the apparently robust, successful men of affairs, who  are  liable  to  this  early  death,  while  the  spare  eaters  may  outlive  them  for decades.  One  thing  the  life  insurance  statistics  have taught  us,  namely,  that the  man  a  little  ” underweight “— that  is,  under  the  average  weight — has  a better chance for long life than one who is a little ” overweight; ” and the greater the overweight the greater the  difference in  favor  of  the  one who is just short of the average.

Because  we  have  had  the  money  to  pay  for  it,  we  as  a  people  have  allowed  ourselves  to  yield  to  the  pleasures  of  the table,  both  as to  the  quality  of  protein  and as to the total intake, to that extent that it shows  up in the insurance  statis­tics.  We  should  let  the  lessons  of  the  present  food  crisis  sink  so  deeply  into  our  minds  that  we  as  individuals  will  eat  for  efficiency  and  long  life,  rather than  for mere  pleasure.

MUCH is being said of late about con­servation. An important phase of conservation is that of the teeth or dental hygiene. Un­doubtedly bad teeth are an economic waste. This even the most casual observer must admit.

To illustrate: If the grate bars of your stove are too far apart, or if some are broken and missing, the unburned fuel drops through and you have a fuel waste. More fuel is being used than is necessary. This same proposition holds good and with equal force in the human body.There should be received into the stomach food, properly prepared, and easy of digestion, and insufficient quantity to maintain life and health and energy without waste. If some teeth are missing or have cavities in them that are sen­sitive when food is pressed upon them, or if the mouth is sore from diseased gums, and the food is swallowed before it is thoroughly masticated, much of this food (fuel) is wasted. The wasted food, however, is of small consequence compared to other things that result.

The stomach has no machinery for breaking up half-masticated food; hence fermentation follows, instead of digestion. And finally, when much of this mass is absorbed into the blood stream, this stream of life becomes verily a stream of death.

No one would think of feeding a baby im­pure milk, spoiled eggs, or moldy bread,— at least, one would not expect the child to grow strong upon such a diet,— and yet it would be just as unreasonable to put umnasticated food into the stomach and expect it to furnish the body with a strong, health-giving flow of blood. If one is fully determined to contribute so heavily to the high cost of living, he would bet­ter take the prepared food to the sewer and throw it in. The stomach and the whole body will at least escape the evil consequences of poorly masticated food.

Let us go back just a little. If your grate bars are too wide or broken, you remedy this, because you have been wasting fuel. You put in new grates or place the bars closer together. This is common sense. If you are wasting fuel fed to the human body through defective grate bars (the teeth), the remedy is equally appar­ent,— supply the missing teeth and repair the ones you have, or get a new set that will work.

ADVANTAGES OF CLEAN TEETH

The advantages of having clean teeth are at least two, economic and esthetic. The economic
value is this: The mouth, warm and moist, is a first-class incubator. Food particles lodging about the teeth are subject to the action of the heat and saliva of the mouth. This starts the process of fermentation. Lactic acid is formed, and lies in close contact with the teeth, gradu­ally softening the tooth surfaces. This causes a roughening, and thus produces a surface more favorable for the lodgment of food materials. The process of acid formation is now greatly enhanced, a decided breaking-down of the tooth structure follows, and a cavity is the result. So the advantages of keeping the teeth free from these food deposits become self-evident. A clean tooth cannot decay; hence less dental bills.

TARTAB DEPOSITS

Next to food deposits allowed to remain around the teeth, tartar deposits are most in­jurious. Such deposits, of course, like the food deposits, are due to carelessness in cleaning the teeth. These deposits, consisting largely of lime, by attaching to the tooth at the edge of the gum, act as foreign bodies, and become sources of constant irritation. If allowed to remain and increase in area, they will cause the gum margin to become inflamed and sore. The teeth also become sore and inflamed and finally loosen, and if not attended to speedily, are soon past repair. Tartar is the chief favoring cause of one of the worst of dental diseases — pyorrhea. Pyorrhea is to the teeth and gums what cancer is to the general system. It is curable only in its incipient stage.

ESTHETIC VALUE OP TEETH

As I write, there lies upon my desk a set of recently extracted teeth. These teeth are most repulsive, even to a dentist. Great, heavy de­posits of greenish-gray tartar reach from re­ceded necks to the very cutting edges of the teeth. The lingual or palatal surfaces are black as jet from tobacco smoke. Their odor is in­ describable. Altogether they are exceedingly offensive. However, they are not badly de­cayed. A characteristic of teeth affected by pyorrhea is that they are never badly broken down. These teeth are strong and long rooted, and would be in the mouth today if it were not for one thing — dirt.

One look at a set of uncared-for teeth, with their tartar stains and their cavities, their unhealthy gums and their fetid odor; then one look at a row of clean, pretty teeth, with their healthy gums and untainted odor — these pearls in ruby settings,— just one look at each will demonstrate the value of esthetic principles in the care and preservation of teeth. It has been said that ” dirty teeth will slander the whitest character.” This is not a very nice way of put­ting it, but comes somewhat near the truth. Dr. Oliver Wendell Holmes stated the case well when he said: “The dental profession has estab­lished and prolonged the reign of beauty. It has added to the charm of social intercourse. It has lent perfection to the strains of elo­quence, and has taken from old age its most unwelcome feature.”

THE air we breathe is not taken directly into the lungs, but must pass through a series of special tubes known as respiratory system (see illustration) which nature has provided for this particular purpose. Taking the respiratory system in order from the outside they are as follows :—

The nostrils or nose.
Posterior nares.
Pharynx or the back part of the mouth.
The glottis.
The larynx or voice-box.
The trachea or wind-pipe.
The right and left bronchus.
The large and small bronchial tubes.
The bronchioles.
Finally, the air cells of the lungs.

Respiratory System

The Nose.

Besides serving the purpose of ornament, which is of no little inportance, the nose has two distinct duties to perform: first, it is the organ of smell; and second, it is an essential part of the breathing apparatus. Nature intended that we should always breathe through the nose.

There are at least three good reasons why we should breathe through the nose. Firstly, because the nose is provided with hairs at its external opening, which serve the purpose of straining the air, and excluding the larger particles of dust. Its internal membrane is also lined by countless millions of exceedingly fine, delicate, microscopic hairs called cilia, which serve to arrest the smaller particles of dust, and vigorously sweep them outwards.

Secondly, the air is properly moistened by being brought into contact with the wet surfaces of the mucous membrane, and is thus prepared for its entrance to the delicate lung cells. This moistening process is of considerable importance, and cannot take place properly unless the air has passed through the nose.

Thirdly, the cold air from the outside is warmed on passing through the sinuous passages of the nose, thus preventing any chill of the sensitive bronchial tubes andair cells.

Although it is far less harmful to exhale through the mouth than to inspire, still, proper breathing, both inspiration and expiration, would take place through the nose.

The Pharynx.

The term, pharynx, is a Greek word, and means throat. At the upper part of the pharynx, immediately behind the posterior nares or back of the nose, is to be found a small gland, which is sometimes called the pharyngeal tonsil. This gland is composed of the same tissue as the tonsils, and with colds and other infections becomes inflamed, and swells like the tonsils, and may even become permanently enlarged. In proportion as the gland swells there is direct interference with the passage of the air to and fro. Sometimes during an acute attack the interference of one or both sides may be complete, so that one is obliged to breathe through the mouth. When this condition persists or when the enlarged gland actually interferes more or less with the passage of the air, the condition is known as adenoids. In many cases simple palliative measures, such as the inhalation of suitable lotions, and particularly a determined effort to avoid mouth respiration, breathing only through the nose, is sufficient to ensure a cure. Sometimes in the case of children the obstruction is so large and so serious that the diseased portion of the gland has to be forcibly removed by the surgeon, a very simple and at the same time safe operation.

The Glottis and the Larynx.

In the pharynx the food and air have a common passage, but from this point on the air passes through a small opening into the voice-box, and from thence it possesses a set of breathing tubes set apart for its sole use. The opening, known as the glottis, is protected by a lid or sort of trap-door, which closes when fluid or food is swallowed, and opens to let air in and out. If, owing to a combination of laughing and eating a particle of fluid or food gets into the larynx, there is at once a violent coughing to expel these foreign particles which cause intense irritation, and if they were not expelled might do serious damage.

Stretched across the lower part of the larynx are two more or less tense, thin, fibrous membranes, known as vocal cords. The voice is produced by the passage of the air causing these cords to vibrate, and the pitch of the voice depends upon their tenseness. When the voice is pitched in a low key the cords are comparatively loose, but when the pitch is raised there is. a corresponding tightening.

The Trachea and Tubes.

The wind-pipe is for all practical purposes an enlarged bronchial tube. It is a circular tube of about five or six inches in length, and about three-quarters of an inch’ in diameter. It is composed of fourteen or fifteen C-shaped,. incomplete rings. The open portion, which is behind, is bridged over by a muscular and fibrous tissue. This softer tissue lies against the meat-pipe, and in<no way hinders the swallowing of food, as the firm, cartilaginous rings would. At the bottom of the trachea it divides into two large tubes, the right and left bronchi. These tubes subdivide again for the three lobes of the right lung, and the two lobes of the left lung. The large bronchial tubes rapidly divide and sub-divide until very soon the tubes are so small that they can scarcely be. seen without the aid of a magnifying glass. The larger tubes are always maintained in an open condition by the presence of crescents or pieces of gristle.

Finally the air passes into the air cells, proper, where it is relieved of a certain amount of oxygen, about twenty-five percent, and in return receives an equivalent amount of carbonic acid gas.

THE subject of the vegetarian regime is dealt with at some length in a chapter of an excellent volume, ” Dietand Dietetics ” by Prof. A. Gautier, of Paris. The book has been edited and translated by A. J. Rice-Oxley, M.A., M.D., and is published by A. Constable & Co., Ltd. From this book we have taken the liberty of culling the following paragraphs dealing with the advantages of vegetarianism. Next month we shall present an analysis of the disadvantages of the reform diet, and thus give our readers the benefit of both sides of the question, as viewed by this eminent French physician.

“According to J. Sinclair, the Hindoo pattamars, carriers of despatches, who only eat rice, run every day, passing from one town to another, twenty leagues at least, and continue thus for weeks. Russian agriculturists who live on vegetables,black bread, milk and garlic, work sixteen to eighteen hours per day, and their strength is said often to exceed that of the American sailors (Bremner and Howland). The Norwegian peasants scarcely know of animal alimentation ; they cover, however, whilst accompanying the carriages of tourists, from three to four leagues, running without stopping. Modern Egyptian workmen and boatmen, who from time immemorial have fed almost exclusively on melons, onions, broad beans, lentils,dates, and maize have remarkable muscular strength (Lane and Catherwood). The miners of South America, very sober workmen, who do not eat meat, carry on their shoulders weights of 200 pounds, with which they mount twelve times a day, on an average, vertical ladders 60 to 80 metres high (F. Head, L. Playfair, and Darwin). According to H. Ranke, the woodcutters of Upper Bavaria feed almost exclusively on flour (1,000 to 1,200 grms. per day) cooked with hog’s lard (90 grms.) without eggs or cheese; on Sundays only they have a little pork. They do, however, an enormous amount of work. The Turkish soldier is extraordinarily abstemious; he only drinks water or lemonade, feeds on pilaff of rice and figs, and scarcely touches meat. We know that his vigour is remarkable and his courage indomitable. The street porters of Salonica and Constantinople, who are fed in the same way, are of proverbial strength. Hence the saying: ‘As strong as a Turk.’

” I add that I have known very intelligent people, men and women, who, having become vegetarians from principle or for hygienic reasons after having formerly eaten flesh like every one else, have told me that they have done admirably with absolute abstinence from the point of view of their strength and of their health.

“Vegetarianism is then an acceptable, sufficient, and even useful practice in some cases, but we must know its disadvantages as well as its advantages.

“The advantages are those which result from temperance: by this method of alimentation the tendency to arthritic, gouty, or rheumatic diathesis, to neurasthenia, etc., disappears or is weakened ; the character becomes supple and the mind seems to enjoy more rest and perhaps acuteness.
” I have shown (p. 376) what the influence of meat food is on the character of animals. As to the action of a vegetarian diet on the intelligence, here is the opinion of two celebrated men who were keen observers of themselves.

Writing to his friend Firmus, who gave up the Pythagorean doctrine to eat meat, the philosopher Porphyry says :—

It is not amongst the eaters of simple and vegetable foods, but amongst the eaters  of flesh that assassins, tyrants, and thieves are met with. … I cannot believe that your change of diet is due to reasons of health, for you yourself have constantly affirmed that vegetable diet is much more suitable than any other, not only to giveperfect health, but even a philosophic and balanced judgment, as a long experience had taught you.’

And Seneca, who, preoccupied with the same considerations, had slowly adopted vegetarianism, writes (Epistol., 108):
‘ Struck by such arguments, I also have given up the use of the flesh of animals, and at the end of a year my new habits have become not only easy to me, but delicious ; and it even seems to me that my intellectual aptitudes have been more and more developed.’ “

MOST people are acquainted with the splendid laxative properties of the fig, and consequently know the value of homemade syrup of figs in combating constipation. But some may not relish the intense sweetness of the fig syrup, and therefore find it unpleasant to take. For such we would recommend fig tea as used at the Caterham Sanitarium. The matron has given us the following directions for making it: Get a pound of plain stewing figs which usually cost 3d. or 4d.; wash them thoroughly in warm water; then cut them into small cubes about the size of a large pea, and roast them in the oven until they are a dark brown colour and quite hard and crisp. Take a tablespoonful or more of these, according to the strength desired in the tea, and, placing them in a basin, pour over them a pint of boiling water, and let it stand for three or four minutes; or heat the cubes in a basin of water, boiling them from two to five minutes. The tea thus obtained is pleasant to taste, especially if it is not too strong, and, if served with cream, makes an appetizing drink, which most people would find no difficulty in taking. A cup or two of fig tea may be taken in the morning half an hour before breakfast. It has a mild effect upon the bowels, making it a useful remedy for correcting sluggish bowels.