The various pathologic degenerations unquestionably depend to some degree upon disturbances of nutrition, though not very directly upon diet. Neither are they amenable to dietetic treatment to any great degree, although in most of them, a fairly liberal diet is indicated.

Necrosis, certain fatty degenerations, fibroid change and calcification, the last being almost invariably if not always secondary to fatty degeneration, through the intemediation of a saponification, are, however, pretty directly dependent upon local lack of nutriment, in which vascular degeneration plays an important part. It has been established by animal experiment that indican and other products of intestinal putrefaction,'not only cause fibroid changes in the liver but in the vessels as well as in the kidneys. Thus, a chronic dyspepsia, originally trivial and functional, ultimately leads to the most serious results. Undoubtedly too, badly balanced, insufficient and excessive dietaries, long continued, lead to the same results.

Fibroid change is, to some degree, inevitable with advancing years. It may be delayed by careful diet, making sure that the average ration conforms approximately to the standard, and avoiding gross excesses of diet. The repeated stimulation of heart and arteries by tea and coffee or the alternate constriction by their active principles and relaxation by alcohol or tobacco or both, also, unquestionably tends to such changes. Since such changes are relatively frequent in women, who do not so generally have the latter vices, it seems probable that tea and coffee are in the long run more dangerous, providing the alcohol and tobacco habits are moderately indulged. Purin derivatives include xanthin, which is closely related chemically and in its toxic action to theine or caffeine and to theobromine which last is rarely indulged in to any great extent. Hence continued indulgence in purin and nuclein-containing foods is a further factor in producing fibroid degeneration.

The tendency to fibroid change once established, vicious cycles are established and there is a further tendency to fatty, saponaceous and ultimately calcareous change. After forty, lime should be taken in as small quantities as possible. Hard water, including various mineral waters supposed to have a miraculous action on the liver and bowels, is a factor of some importance. It is practically impossible to avoid lime in any diet, especially in the vegetable foods which should be so important a part of the diet of later adult life.

The author has found of apparent value in the declining years of life, a mixture of salts, approximating those of the blood, omitting lime and distributing the acid radicles between sodium and potassium. With this modification, there are in each liter of blood plasma:

Sodium chlorid..................... 5.54 grams

Sodium phosphate...................50

Potassium chlorid...................36

Potassium sulphate..................28

The sulphates and phosphates tend to precipitate the lime present in the food. Water with this strength of mineral ingredients has an unpleasantly salty taste but it may be further diluted, or the mixed salt may be used instead of ordinary table salt. Probably, if a liberal diet is taken, it is better to omit the potassium salts altogether, to prevent an excess of this element. Thus, the mixture may still further be modified as follows:

Sodium chlorid.......................6.00 grams

Sodium phosphate.....................50

Sodium sulphate......................25 given daily in place of table salt.

Inflammations. In general, the diet appropriate to acute and subacute inflammations is described under the heading of fever. Chronic inflammation as related to diet is discussed under the heading of degenerations, and the special consideration of such viscera as the liver, kidney etc. Inflammation includes cloudy swelling and, etiologically, many of the degenerations.

Tumors

There are no general dietetic indications in tumors.

General lipomatosis is, possibly, due to the same causes as obesity and may possibly be improved by the same line of diet. Discrete lipomata are not thus influenced.

Cancer has been variously ascribed to an excessive meat diet, to excessive use of salt, to conveyance of a supposititious parasite by raw vegetables and to the ingestion of embryonic cells as in raw eggs. None of these contradictory hypotheses is substantiated.

The diet is an important factor in many cases of tumor located in the alimentary canal and such tumors are usually cancerous. However the dietetic problems depend upon mechanic factors, the presence of ulceration etc. and not upon the neoplasm itself. They will, therefore, be discussed under local headings.