In speaking of the relations of war, famine and pestilence we stated that the cause of pestilence following famine was partly the lessened resistance to infection which occurs in the underfed. It is now possible to go a step further, and assert that it is nitrogen starvation which is the main factor in reducing resistance in many of these epidemics. The "great white plague," for instance, which we have shown to be so very prevalent as soon as a certain density of population is reached, is now known to be in great part a result of nitrogen starvation, very rare in the well fed, but exceedingly common in the starved, whether the starvation be due to money privation or indigestion or disease, or due to an alcoholism which interfered with nitrogen nutrition. It rages among the underfed poor of all parts of the earth, Malays, Indians, Americans, etc., and one of the chief means of cure is forced feeding of nitrogen - the patients being literally stuffed full of animal food to the limit of their digestive powers. Like beri-beri, it attacks only those in a condition of physiological poverty.

Woods Hutchinson* has shown from post mortem records made in zoological gardens, that, as a rule, with some exceptions, vegetable feeders are twelve-fold more susceptible to tuberculosis than the meat eaters. As the latter presumably ingest more nitrogen than vegetable feeders, we are justified in suspecting that the increased nitrogen nourishes the tissue protoplasm to a state of almost immunity from attack. Moreover, foxes and rats upon a carnivorous diet are nearly immune, but a vegetable diet makes them more than twice as susceptible, though fat and apparently thriving. Likewise, calves rarely contract tuberculosis when fed exclusively on milk, even when fed from tuberculous cows. The carnivorous new world monkeys contract the disease very rarely, and though it is common among the vegetarian old world species, the latter are preserved in greater numbers by the addition of more nitrogen, even beef tea, which is now a part of the regular diet of anthropoids. It has recently been found the men with large hearts and conjested lungs rarely contract tuberculosis, but the feeble heart and large lungs of the tuberculous have been noted for many years. These physical conditions indicate an arrest of development. The typical phthisical chest is round or barrel shape, narrow but increased from front and back - the condition of childhood. The small heart is equally an arrest of development, and both can be due to defective nitrogen nutrition, though it is also due, in part at least, to defective vitality of the ovum itself. For instance, the disease shows a tendency to attack the offspring of the aged, who, by the way, are notoriously poor breeders. In addition, the statistics rather indicate that the exhaustion of much childbearing is also a factor - the later children being generally feebler than the first, as every family physician knows, though there are exceptions *

* Medical Record, August 24, 1901.

Since nitrogen starvation and the great white plague are the two modern descendants of the famines and the great black plagues of past ages, the relationship of these two modern conditions to overpopulation and to each other must be enlarged upon.

Raw-meat diet in tuberculosis was investigated by Hericourt and Richet, in 1900, and adopted at the Woodburn Sanitarium as a routine diet. Philip and Galbraith have written on the subject, and shown that by its easy assimilation and power to repair wastes it was specially valuable in this as well as other wasting diseases.* Dr. A. W. Martin, Medical Officer of Health for Gorton, England, has been quoted by the Manchester Guardian * as having noticed the fact that the tuberculous have commonly neglected the fatty foods and consumed inordinate amounts of starch, thereby producing a depraved condition of nutrition in which tubercle bacilli flourish. They often have a disgust for animal foods. Doctor Lannelongus, of Paris, has shown that deficiency of nitrogen food markedly shortens the life of infected guinea pigs. Dr. H. Edwin Lewis * has asserted that tuberculosis is based upon a deficient nutrition of the cells, and that is the reason it so frequently follows starvation, pregnancy, diabetes, indigestion, bad air, worry, and other causes of defective metabolism, though we must remember that there may be an essential defect as the basis of both the malnutrition and susceptibility. Nevertheless, he found much benefit by giving pancreatic extract to the tuberculous. It decreased the free fat and sugar in the blood.

* Of one hundred cases of tuberculosis:

44 were the

1st, 2nd, or 3rd born

12 " "

4th bom

8 " "

5th "

9 " "

6th "

10 " "

7th "

4 " "

8th "

3 " "

9th "

4 " "

10th "

4 " "

1lth "

2 " " :

12th "

We can now understand why tuberculosis should so often attack the diabetic. In this condition the pancreas is often, if not generally, at fault. It is either ineffective through nervous disturbances or is organically diseased and unable to produce those ferments which oxidize our sugars to alcohol and lower chemical forms. Hence, the free sugar floats in the blood and is excreted by the kidneys as a foreign substance. But the pancreas also is the mainstay in digesting fats and proteids intimately mixed up in the foods. Consequently, the diabetic cannot get enough nitrogen food, and in addition they burn up their nitrogen tissues. They are typical cases of nitrogen starvation and woefully subject to tuberculosis. In addition to all this, it is a well-known fact that whooping cough leaves the child so depraved that tuberculosis is often the outcome months later. Indeed, it is a more fatal disease than scarlet fever. Dr. Chas. E. Page § stated that twenty-five per cent. of those who recover from typhoid or pneumonia subsequently die of tuberculosis.

* British Medical Journal, May 27, 1905. * American Medicine, October 21, 1905. * American Medicine, August 12, 1905. § Medical Record, December 23, 1905.