Tilden says: "A fast must not be continued when the patient is suffering greatly, it matters not in what way. * * *

"Some patients will start without food and within a week they are very sick--sick because of great enervation. They have been overstimulated so long that when the stimulating food is removed they soon evolve a severe prostration. Most intelligent people know how much the inebriate suffers when he is compelled to go through delirium tremens. Delirium tremens is the acme of prostration. People who are tremendously prostrate or enervated, from years of overstimulation from food, do not suffer just the same as the inebriate but they suffer, many of them, just as greatly. A good many will become very sick at the stomach and vomit almost unceasingly. This must be avoided. When such a patient starts on a fast, the physician must recognize the coming symptoms, and break the fast by giving a small amount of fruit. As soon as the symptoms of irritation have subsided, the fast will be resumed, until other symptoms indicate that the system is suffering too greatly from the effect of going without food, when a little fruit may be given for two or three days, and sometimes a week. The fast can then be resumed; but, as soon as the patient begins to show the appearance of suffering, and the haggard state begins to develop, feeding must be resumed."

He says that "little by little, such cases can be piloted into perfect health." I give Dr. Tilden's plan for what it is worth. It is my own plan not to break a fast while there is vomiting. I have broken fasts when there is great prostration and resumed the fast after strength has been recovered.

The remedy for delirium tremens is not more whiskey. Just so the remedy for the great prostration caused by long-continued food drunkenness is not more food. If we would not give a dose of morphine to the morphine addict who suffers when deprived of his morphine, or the coffee addict a cup of coffee to "relieve" her headache, why should we give the food drunkard more food to relieve his suffering? With all due respect to Dr. Tilden, whose experience with fasting was very great, I do not find this plan essential or helpful, except in a very few cases.

Tilden also urges daily enemas and lavages. He says: "the bowels should be looked after from the day the fast is started until it is ended. A retention of excretions will poison and make the patient very sick, and there is a possibility of his becoming so prostrated from the effect of the poison absorbed that he will die. Nausea and vomiting following fasting are a very good indication that there is too much absorption taking place. Then the bowels must be moved by enemas, or whatever is proper to do, until they are thoroughly cleaned out."

My experience does not bear this out. I have seen more vomiting and nausea in cases that received daily enemas than in those who have received no enemas at all. Nor have I seen prostration and death as a result of absorption of retained excretions. Indeed, it seems clear to me that absorption does not occur.

Tilden also says: "But fasting must not be continued if the patient begins to present a haggard appearance or if nausea and efforts at vomiting develop. When a patient under a fast begins to show a depressed state and haggard look and the tissues begin to droop down, and a decided discomfort begins to manifest, feeding must be resumed and the patient must be brought back to a reasonable state of comfort. Then fasting can be resumed; or if it is not thought best to go without food entirely, then the patient may be put on a small amount of fruit for a week or more. It requires a great deal of skill to assist nature back to a normal state when the health has been outraged almost to the point of dissolution. Fasting is not a remedy that should be trusted in the hands of laymen, nor in the hands of ignorant professional men. Putting such a remedy as fasting into the hands of laymen, to be applied to sick people, is equivalent to putting an insane man to work in a barber shop, especially if the barber's hallucinations are on the order of homicidal mania."

We are not convinced that laymen cannot make excellent use of fasting in minor troubles and the less advanced pathologies; but we are sure that Tilden's warning should be heeded by those who suffer with advanced stages of pathology.