The primary indication that the fast is to be broken is the return of hunger; all the other indications which I have enumerated are secondary. Often one or more of these secondary signs are absent when hunger returns, but one should not refrain from breaking the fast when there is an unmistakable demand for food, merely because the tongue, for example, is not clean. Inasmuch as all the signs do not invariably appear in each case, do not hesitate to break the fast when hunger returns.

In general I agree with Carrington that "natural hunger, and that alone should indicate the terminus of the fast; when the fast is ready to be broken. * * * The artificial breaking of the fast; the taking of food in the absence of real hunger, for the reason that the ignorant attendant thinks the patient has 'fasted long enough,' is an abomination, and an outrage upon the system which cannot be too strongly deprecated." Most fasts are broken too soon; that is, before the work of renovation is completed.

The care that must be exercised in breaking a fast is in proportion to the length of the fast and to the general condition of the fasting individual. The approved plan is to break the fast on liquid food, using for this purpose fruit juice, or tomato juice, or watermelon juice, or vegetable broths. Fruit juice--usually orange juice--is used most often.

Orange juice, grapefruit juice, or fresh tomato juice are excellent with which to break a fast. Watermelon juice or the juice of the fresh pineapple or of fresh grapes may also be used. A half a glass may be given at the start. After an hour, another half glass may be given. Juice may be given every hour the first day. The second day a whole glass of juice every two hours may be employed. On the third and fourth days give the whole orange or grapefruit and on the fifth day other foods may be added. Large meals should not be attempted in less than a week. These instructions are for the long fast. A short fast requires less care in breaking and is usually followed for several days by an eliminating diet.

There is a tendency on the part of the faster to overeat, not alone because he is hungry, but also because he is desirous of regaining his weight. His friends also urge him to eat. Sinclair truly says: "A person at the end of a (long) fast is an agitating sight to his neighbors, and their one impulse is to get a 'square meal' into him as quickly as possible."

Almost any food may be employed in breaking a fast, although greater care must be exercised if the concentrated types of food are employed for this purpose. There are individual factors that must receive attention. Sinclair tells of breaking a fast on a large, thoroughly ripe Japanese persimmon, and says that "it doubled me up with the most alarming cramps." A friend of his had the same experience from the juice of an orange; "but he was a man with whom acid fruits had always disagreed." The tendency of the long fast is to remove these digestive shortcomings, but it is not always completely successful, and this is especially so where the fast has not been carried to completion.

A few fallacies about breaking a fast deserve attention. Dr. Kritzer says: "In breaking a long fast it is wise to consult the patient's wishes as to the particular food desired for the first meal. Any food wished for should be granted--even if it is meat, ice cream, chocolate or any other food outside of the fruit and vegetable kingdom.

"In this instance the patient's appetite is fully reliable and the food thus craved may supply an essential need. Should such a request be denied, the patient's improvement may be retarded."

It is true that a long fast tends to restore taste and food desires to a more healthful condition and render them more reliable; but many patients crave the foods they have previously been in the habit of consuming. These reversions to the old habit-cravings are distinctly not to be respected on any specious notion that the foods "craved" supply some essential need. It is a common experience to see a faster crave, at the end of a fast, the foods he has always eaten. Fed differently and given a second fast, he craves at the end of the second fast, the foods he had following the first fast.

There are no food elements in chocolate that cannot be supplied by other foods and one would be foolish to permit his patient to return to his disease building diet. I saw two fasts broken on chocolate and I don't care to see it done again; neither do I care to see a fast broken on ice cream.

If we assume that the "patient's appetite is fully reliable after a long fast," there is no reason why we should limit the satisfaction of his desires to the first meal. We may permit him to follow the lead of his appetite at every meal and have all the chocolate and ice cream he desires. Not only should we permit him to have the food his appetite calls for, but, we should also permit him to have as much as his appetite calls for. Yet we all know that this cannot be done. A man breaks a long fast on bread and meat sandwiches and is dead in twenty-four hours. His appetite simply was not reliable.

In breaking a fast it is always wiser to play safe and use tried and tested methods and follow this up with an adequate diet and not go off after wild theories and funny notions.

Dr. Kritzer also says: "It is best to break a fast at five o'clock in the afternoon, thus the patient has an opportunity of thoroughly digesting his meal before retiring. It also affords the digestive organs a considerable rest between the first and second meals."

There is no time of day that is best for breaking a fast. There is no reason why the meal should be thoroughly digested before retiring. If the fast is properly broken, there will be no need for twelve to fourteen hours of rest for the stomach, between the first meal and the second. The second dose of orange juice may be given one hour after the first, instead of a day later. I would not hesitate to break a fast at midnight, or at any time upon the return of hunger. If the fast is broken before the return of hunger, it may be broken at any hour during the day. Ritualistic feeding following the fast, is no more necessary than at other times. Let us employ our intelligence.