The most complete study of the phenomena of fasting in this country with which I am acquainted was conducted by Dr. E. P. Cathcart on Victor Beaute, a German professional starving man or "hungerkunstler." The fast lasted for fourteen days, and the following is an epitome of its effects. The tongue was fairly clean throughout. The loss of weight amounted to .85 gram per cent. daily; but the loss of strength was not notable, as Beaute was able to carry two 56 pound weights at arm's-length for some distance on the last day of the fast. The pulse dropped on an average 15 per minute, the respiration rate was unaltered, the temperature became slightly subnormal, and the blood-pressure was lowered from 120 to 88 mm. Hg. The urine was reduced in quantity and its specific gravity lowered. Analysis showed that the total nitrogen was steadily reduced to the end of the fast, and the quantity of urea fell proportionately. A steady rise of the ammonia nitrogen, compared with the percentage of the total nitrogen, was observed until the eighth day, and thereafter a steady fall.

The uric acid was fairly regular in its output, though it was slightly diminished in quantity as compared with the period before the fast. In contrast with this the total purins rose consistently till the close of the fast. There was a steady fall in the quantity of creatinin, and for the first time in such analysis creatin was discovered, although it gradually became reduced in quantity. There was a steady fall in the quantity of chlorides and phosphates, but a distinct retention of the latter was noticed after the completion of the fast. The total sulphur, inorganic sulphates, and ethereal sulphates steadily fell in quantity, whereas the neutral sulphur, whilst reduced, maintained a fairly regular output. The acidity fell the first day, rose the next two days, and thereafter declined steadily till the end of the fast. The calcium and magnesium both diminished, but the magnesium in greater proportion than the calcium, the ratio before the fast being Ca: Mg:: 2: 1 - during the fast, Ca: Mg:: 3:1.

Before the fast more sodium was excreted than potassium, but during the fast the situation was reversed, the ratio of excretion on the third day being K: Na:: 1.5: 1, and on the seventh day K: Na:: 7:1, but after the fast the normal condition of affairs was restored. Acetone and aceto-acetic acid both appeared in the urine during the fast, but disappeared after its completion.

Additional observations were made in the same case by Dr. R J. Charteris, chiefly with reference to the blood changes. He noted that although Beauts slept quite soundly he was troubled with dreams in which he was feasting at a banquet of various delectable comestibles. He suffered much from cold, and was quite unable to keep warm. As the fast proceeded the pulse became slower, softer, and weaker, and the blood-pressure fell quite 25 per cent. The amount of haemoglobin diminished from day to day, but with this exception the composition of the blood was hardly altered, although there was a tendency to leucocytosis. Neither the opsonic index nor the composition of the serum was altered in any degree.

The actual cause of death from starvation has given rise to a good deal of discussion. It cannot be due to any radical alteration of the cell structure, because chemical analysis has failed to detect any. Nor is it to be attributed to a general failure of all the cells, because then death would occur whenever a certain percentage of their protoplasm has been decomposed. This, however, is not the case, and more protein indeed may be lost from the muscles of a spawning salmon than is usually found in animals which have died from starvation. The hypothesis which best meets the case is that of E. Voit, who considers that it is due to a loss of substance in the organs important to life, although it may also arise owing to deficient nutrition of these organs.

It is important to note that once it has been lost protein is none too readily replaced. After a prolonged fast recovery is a slow affair, and very special dieting is necessary if the best results are to be obtained in the shortest space of time. Subsistence on a diet of insufficient caloric value is "economically" unsound, and if we are to maintain our supremacy as the leading industrial nation of the world we must take steps to ensure the adequate nutrition of our working class population. Rowntree, in his investigation of poverty, points out that amongst the lower classes in Philadelphia, U.S.A., each individual consumes on an average 110 grams protein daily, as compared with a daily consumption of only 90 grams protein per head in York. Although doubtless other factors must be taken into consideration, he considers this defective feeding as the most important item in the production of a lower standard of health in York. He subdivided the population of York into three classes, according to their financial position, and ascertained that amongst the lowest class the average height of boys of thirteen - the age when they left school - was less by three and a half inches than the height of the children of the upper classes, whilst the average weight of the same boys was 11 pounds less than that of boys of a similar age in the upper classes. Of the children of the lowest class, 2.8 per cent. were mentally deficient, as compared with only 1.3 per cent, of the children of the better classes. Whilst it is impossible to eliminate altogether other deleterious influences in accounting for this lowered standard of health and growth, these statistics are quite on a par with those obtained by Major C. D. McCay in Calcutta, in which case there was no question of the introduction of any disturbing factors, save that of an insufficient diet.