It may be that Dr. Hare has stumbled across the explanation of the great value of moderation in diet, and in any case he has emphasised the valuable therapeutical influence of an important dietetic procedure. Many modifications of the system exist, but all alike ascribe their beneficial results to the diminution of toxaemia. One of the latest additions to the list is that of Dr. Ernest Young, who advocates an exclusive protein diet with hot water, in digestive disorders. He prescribes three meals of 2 ounces of minced meat, gradually and cautiously increased to 6, 8, or even 10 ounces, with the usual pint of hot water four times a day. He is careful to emphasise the fact that the diet must be regarded as a therapeutic measure only, an abnormal diet, helpful in restoring an abnormal condition of the digestion to the normal. When this has been achieved he advises that a mixed diet be resumed with as little delay as possible. This is judicious counsel when we realise that 6 ounces of lean meat per day has only an energy value of less than 300 calories, and even 30 ounces is well under 1,400 calories. Young recognises the objection to mixing carbohydrates and proteins in cases of dyspepsia, and suggests that in resuming the ordinary diet it is advisable to prescribe one entire meal of starchy foods in place of one of the meat meals.

Some of the treatments for obesity are characterised by an almost entire absence of carbohydrates. Towers Smith employed the following method. For fourteen days the diet was confined to rumpsteak, codfish, and as much as six pints of hot water per day. To obviate the possibility of dyspepsia the meat was made into an essence, as follows: Four pounds of lean beef were cut into pieces about an inch square and placed in a close-fitting, air-tight jar. This was placed in a pan of boiling water and allowed to simmer for six hours. The juice of the meat thus obtained was passed through a sieve and mixed with 4 ounces of the fibrin, which had been pulverised in a mortar. This was divided into four parts and administered daily. For the next twenty-one days the quantity of water was reduced to four pints, some vegetables and other kinds of meat were allowed; at the end of this time, and for thirty-one days more, the water was further reduced to two pints, and toast and biscuits permitted.

Saundby's modification of the Salisbury diet consists of 12 ounces of minced mutton, served as collops, divided into three or four meals, followed two hours later by half a pint of hot water. This is continued for two or three days, during which the patient is kept at rest, and is extraordinarily successful in curing certain forms of dyspepsia.

The practice of zomotherapy, although distinguished by an entire absence of carbohydrates - except such small quantities as may be present in the form of glycogen - can hardly be included among dietetic methods allied to Hare's, as its use is founded on the principle that the muscle serum is possessed of antitoxic properties.

I had recently under my care a patient suffering from severe insomnia, in whom the only method of obtaining a few hours' sleep consisted in subsisting on the following apparently repulsive self-imposed diet: three meals per day, each consisting of 3 ounces of raw meat, 3 ounces of toast, and 2 ounces of butter. The slightest contravention of this regimen - even a departure so slight as the cooking of the meat - was invariably punished by renewed inability to sleep.

In contrast with the low-protein system and the two fleshless dietetic systems we have discussed, Hare does not recommend his diet as anything but a therapeutic measure, although he urges sufferers from the paroxysmal neuroses, migraine, asthma, epilepsy, etc, to approximate as closely as possible to a diet with a reduced intake of carbonaceous material. He is so particular in this regard that he impresses them with the disastrous possibilities residing in even two or three lumps of sugar, half an ounce of butter, a slice of bread, and he has been able to attribute an attack of migraine to the addition of only one of these items. He also emphatically urges the institution of means such as exercise, exposure to cold, diminution of sleep, and abundance of fresh air, with the object of increasing combustion. Some cases, of course, fail to respond to such a course of treatment, and a distinct proportion of such cases is what he categorises as prepotent. This term he uses to signify a class of case in which the fuel in the blood is discharged even when not present there in excess, in contradistinction to those he calls postpotent, where the conflagration only takes place when the fuel is in excess. In this latter class, while the temporary effects are unpleasant, the final result is beneficial, whereas in the former the results all round are disastrous and malnutrition ensues.

Reference must be made to his book for the best methods of recognising these cases and the therapeutic measures counselled. It is worthy of note that in many cases of malnutrition, forced feeding, with, of course, supervision of exercise and abundance of sleep - all factors contributing to the establishment of hyperpyraemia - is productive of the most brilliant curative results, although it is seldom that such cases are subjects of paroxysmal neuroses. The explanation of course is, that along with increased supply of pyraemic material, time has been given for the excretion of the accumulated excess of toxins, whilst no more fresh poisons have been formed than are capable of being excreted during the day, and so the metabolic functions have been stimulated to a point capable of dealing with the extra nutriment. The removal of the toxaemia, however, is here the factor of most importance, and it is astonishing to witness the daily regeneration of neurotic patients who have for years suffered from dyspepsia and constipation, and to note that confinement to bed is not inconsistent with a free and regular daily evacuation of the bowels. Such patients can tolerate with ease the temporary increase in the supply of protein, but I am hardly prepared to admit with Hare that the protein allowance in standard diets is inadequate, although, on the other hand, a more liberal protein ration in adolescence is essential to healthy adult life.

My own experience goes to show that cases of migraine and epilepsy make more assured progress towards recovery on a purin-free diet than on the diet recommended by Hare, although, when epileptics tend to grow stout, as they have a tendency to do on such a diet, they are in great danger of an attack. In their case excess of food, especially of animal food, is always bad. Cases of asthma, on the other hand, are better suited with a diet such as is suggested by Hare, the last meal being always a light one, and being partaken of not later than 6 p.m.