The importance which Trall attached to fasting in fevers may be gleaned from his statement that: "We can easily explain the seeming value of the article (Extractum Carnis was claimed to possess extraordinary efficacy in fevers) to febrile patients, and in the explanation is involved an important therapeutic principle." The explanation was that the patient was practically fasting and the important principle of care was that the fever patient should not be fed.

Without explaining why, Trall made occasional exceptions to this principle in smallpox. In this disease he advised: "Give no food save Indian or wheat-meal gruel, and not that unless the appetite calls for it. Nursing children may take the breast as usual if inclined." It need hardly be added that nursing babies are not inclined to take the breast when feverish.

There need be no fear of letting the patient fast, as there is no power to digest food and feeding does not provide nourishment for the fever patient. Whether in acute or chronic disease, in the absence of a fresh supply of food, the body appropriates its own substance for the purpose of continuing its vital activities and functions. It has large stores of nutritive materials in its bones, muscles, glands, fluids, etc., with which it can maintain essential repairs and minimum functional activities for a considerable time. Drawing only from the storehouse of its own internal treasure, it seeks to make these last as long as possible.

Writing in the Journal, September 1857, S. M. Landis, M.D., said: "In acute and inflammatory diseases no food should be used . . . Henceforth, brothers of the Hygeo-Therapeutic cause, I beseech you, one and all, to pay more attention to diet, and let splashing, dashing, exercising, etc., be of secondary importance . . . do this that drug doctors may no longer have the opportunity to cry us down by saying that our system is a mere soaking and squirting practice . . ." Landis thus lays the greatest emphasis upon the importance of the fast.

'Perhaps the man other than Jennings who placed greatest stress "upon fasting was Dr. Kittredge. In an article published in the Journal, June 1851, Kittredge says: "Nature, knowing the impossibility of quelling insurrection in one of her chief citadels (he was dealing with diseases of the liver), while there was anything to feed the fires of rebellion, wisely stops the appetite at such times, in order that the excitement may cease, knowing that flames without fuel cannot last always." His resort to pictorial language and reversion to old fallacies about disease (a rebellion and a flame) somewhat spoils his assertion about abstinence in disease, but the fact that the desire for food is cut off in acute disease is not destroyed. Writing in the Journal, January 1861, Dr. George H. Taylor said: "The coated tongue is nature's peremptory method of refusing food, which indication must be respected." In this same article he advised abstinence in headaches and dyspepsia, these latter being commonly regarded as chronic diseases.

It is important for us to understand that the absence of desire for food and the lack of digestive ability seen in acute disease is but part of the general prostration of the patient. Prostration must be viewed as a general suspension of muscular, secretory and mental function as a conservative measure. The prostration of the digestive function is as much a conservative measure as is the prostration of the superficial muscles of the body. Viewed in this light, prostration is seen to be the chief means employed by the sick organism in adjusting its activities and its intake of external requirements to its needs under the circumstances of disease.

Writing in the Journal, May 1856, Solomon Priese, M.D., stressed the fact that the indications of the prostrated digestive function should be respected by saying: "The first thing to be done when these feelings (headache, aching in the limbs, bad taste in the mouth, furred tongue and general constipation of the bowels--the leading premonitory symptoms) are experienced is to stop eating . . ." In an article in the Journal, October 1851, dealing with "Bowel Complaints," Kittredge said: "Above all, stop eating." Further, he advised: "It is within the bounds of prudence to stop eating when you have 'bowel complaint' of any kind, especially when nature stops the appetite." It is important for the reader to know that a due adherence to this simple rule will speedily end most cases of diarrhea and other forms of bowel disease. Writing on "The Hunger Cure," in the Journal, November 1851, Kittredge said: "It must be injurious to the patient and retard his recovery, if the stomach and liver are made to work, when not in a condition to labor, or the arterial system to be stimulated by ingesta when inflammation already exists.

"Now I contend that in almost all phases of diseased action, there is more or less inflammatory action, even in debility; and argue as they may, it will not do to eat, however hungry or weak, anything requiring much of any exercise in digestion, and in very many cases nothing at all. It requires great discrimination to know when to stop, when to begin, and how much to give, I know; but a man should not attempt to practice unless he has good judgment, above all things."

Recounting a case of a woman suffering with inflammation of the liver and duodenum, whom he had to fast, Kittredge gave it as his opinion that "it would have been impossible to have cured her, while she was still eating." "Accordingly," he adds, "I advised her to stop; she did so, though her appetite was 'raving;' but immediately the question arose in her mind, how long can I fast?

"It is hard to fast, as I well know, when you are hungry as a half famished bear all the time; but it is better to fast than to do worse." "This woman went seven days without tasting food of any kind, and then contrary to my advice, went to eating; but in a short time was as bad as ever.

"My rule is to keep them fasting until the tongue becomes clean and the mouth tastes properly.

"My patient's good sense told her she had acted unwisely, and she readily assented to commence again her fasting, which this time lasted about seventeen days, and she then cautiously began to eat and increased the amount till she reached a full diet; and it is now some three months or more since that time, and she has been almost a well woman, nothing has troubled her stomach since."

In bowel inflammation, Kittredge advised: "Let the stomach alone severely . . . and abstain from all food." Of typhoid he said: "Very little treatment is necessary in these cases actually, if the patient will only consent to live in obedience to common sense, by abstaining from all nutriment."

Writing in the Journal, April 1856, Kittredge said, in discussing a case of severe ophthalmia: "The first thing was to stop all the fuel that was feeding the flames in the shape of food from being supplied . . . He fasted a week, when the inflammation having abated, he began to eat lightly, and in a day or two more, insisted upon going down town; the weather being intensely cold, and when he returned, his appetite having become as keen as the wind he had been facing, he ate too much, which with undue exposure, brought on a return of symptoms similar to the first, though not so severe.