The amount of food necessary for bare subsistence has been pretty accurately determined. During the siege of Paris the 6 daily ration was at one time reduced to less than ten ounces of bread and one ounce of meat daily. Dr. Edward Smith ascertained that the daily amount of food barely sufficient to maintain life among the factory operatives must contain 2·84 ounces of nitrogenous matter, and 19·25 ounces of carbonaceous. Pettenkofer and Voit give, as the necessary amount of food required by an adult when at work, 5·22 ounces of nitrogenous and 22·38 of carbonaceous matter. Letheby furnishes the following table as the result of his investigations on this point:

Nitrogenous,                 Carbonaceous,

Daily diet for                                                                                                 ozs.                                ozs.

The ration of the United States soldiers imprisoned at Andersonville consisted of one third pound of bacon and one pound and a quarter of unbolted corn-meal. This amount and quality of food were insufficient to maintain the bodily functions in a healthy state, and hence vast numbers died of scorbutus, diarrhoea and dysentery, and hospital gan-grene. From these data we are enabled to form an estimate of the amount and kind of food necessary to maintain life in those cases of disease in which it is desirable to apply the method of denutrition.

Physiological Effects of Insufficient Food

Intestinal uneasiness, more or less pain, borborygmi, and a feeling of hunger, are among the first symptoms of an insufficient supply of food. The secretions of the intestinal canal diminish, digestion becomes difficult, and constipation results. The respiratory movements are diminished in frequency and volume, and the exhalation of carbonic acid notably declines. According to Dr. Edward Smith, while under an ordinary diet the daily excretion of carbonic acid amounts to thirty-four ounces, under an almost complete abstinence it falls in twenty-four hours to twenty-two ounces. The blood suffers a notable diminution in its amount; the quantity of water augments, and the number of blood-globules greatly diminishes. Meanwhile the blood loses its plasticity, and a tendency to haemorrhagic extravasations is developed. The urinary secretion also lessens in amount; the urea and uric acid diminish, but the hip-puric acid rather increases; the chlorides after some days almost disappear, but the sulphuric and the phosphoric acids persist. As a result of the very obvious decline in the function of assimilation, the temperature of the body falls some degrees below the normal. The functions of the nervous centers undergo a marked derangement. Giddiness, vertigo, hallucinations, ensue, and are coincident with a fatty degeneration of the cells of the gray matter. The subcutaneous fat disappears; the muscles lose a considerable part of their substance. The muscular substance of the heart diminishes proportionally. The bones do not suffer much loss. The extreme degree of loss attainable with safety is from 40 to 50 per cent of the average weight.

Therapy

Diminution in the gross amount of aliment and a rearrangement of its constituents are of the first importance in the treatment of obesity. The tendency to obesity may be hereditary or acquired. In the former it is cured with difficulty; in the latter a suitable regimen will accomplish much. The fat accumulates under the skin, in the visceral cavities, and in the interstices of organs. Two doctrines have been held by physiologists with regard to the mode of production of fat in the organism: one, that the fat received in the food is simply stored up; the other, that it is also produced by the transformation of some of the other constituents of the food. If the first theory contained the whole truth, it would be necessary only in the treatment of obesity to withdraw from the patient's aliment all fatty substances; but it is found in practice that this is insufficient, and that fat is created out of the starchy and saccharine elements of the food. Hence it is necessary in the treatment of corpulence to interdict not only fats, but the starches and sugar. This was the method of Hippocrates; but it has been revived in our generation by Mr. Banting, and is now usually called Bantingism. As a guide to this method of treatment I quote the rules of Mr. Banting:

"For breakfast, at 9 a. m., I take five or six ounces of beef, mutton, kidneys, broiled fish, or cold meat of any kind except pork or veal; a large cup of tea or coffee, without milk or sugar; a little biscuit or one ounce of dry toast; making together six ounces of solid and nine of liquid. For dinner, at 2 p. m., five or six ounces of any fish except salmon, herring, or eels; any meat except pork or veal; any vegetable except potato, parsnip, beet, turnip, or carrot; one ounce of dry toast; fruit out of a pudding not sweetened; any kind of poultry or game,, and two or three glasses of good claret, sherry, or madeira—champagne, port, and beer, forbidden; making together ten or twelve ounces solid and ten liquid. For tea, at 6 p. m., two or three ounces of cooked fruit, a rusk or two, and a cup of tea without milk or sugar; making together two to four ounces solid and nine liquid. For supper, at 9 p. m., three or four ounces of meat or fish, similar to dinner,, with a glass or two of claret or sherry and water, making together four ounces solid and seven liquid."

Sugar, Mr. Banting finds, is one of the most active of fat-forming foods. His method consists in the avoidance of sugar, fat, and farinaceous substances—in fact, all roots or vegetables grown underground. Although this system was pursued by Mr. Banting with success, it can not always be persisted in without danger. The dietary is wanting in the amount both of carbonaceous and nitrogenous constituents necessary to the healthy action of the organism. Therapeutically it is adapted to the end in view—the denutrition of the body; but it is, physiologically considered, unsafe to be long persisted in, because insufficient for the work of the body.