With a group of 25 college students under observation for 3 to 4 months it would be expected that a certain number of minor illnesses, colds, slight infections, etc., would occur. These appeared in both Squads A and B and apparently as often in Squad B prior to dietetic restriction as in Squad A. In the personal histories, however, emphasis has been laid only upon those slight illnesses which were observed with Squad A. The extraordinary severity of the winter and the necessity for many of the men in Squad A to increase their clothing materially perhaps make it all the more surprising that a larger number of colds and minor illnesses did not occur. The question of constipation, which was present more or less as a result of the reduced and somewhat concentrated diet, was readily controlled in most cases by the use of bran and has been discussed in detail in the section on diets. The only serious trouble was with Tom, who stated that he believed the condition which made his operation for hemorrhoids necessary was the result of straining at stools during the reduced diet.

One of our first difficulties experienced with the two squads was the distinct tendency for the men to overeat on the free Sundays permitted once in two weeks. This resulted almost invariably, especially at the beginning, in digestive disturbances which bordered on nausea and occasionally provoked diarrhea. This tendency to overeat, with consequent digestive disturbance, persisted more or less throughout the entire experiment in spite of repeated warnings.

In a number of instances there appeared to be clear evidence of so-called hunger pains. Certain of the men complained of a continuous gnawing sensation in the stomach, headaches, inability to study, etc. These minor disturbances were anticipated; in fact, the men were told at the beginning that discomfort might be experienced as a result of the restriction in diet. Only one subject found it necessary to withdraw on this account. Fre, three weeks after the beginning of the experiment, found himself discommoded by the feeling of hunger and the time demands of the experiment. He became very much disturbed, and, on the advice of the physician, withdrew from the squad. At first his physician suspected the discomfort might be due to a gastric ulcer, and with this possibility it appeared unwise to continue him on the squad. As a matter of fact, when full diet was resumed all his symptoms disappeared.

At least three of our subjects underwent ether narcosis for minor operations during the research. Thus Bro injured his foot in a football game and, as shown in his personal history (see p. 47), underwent ether narcosis for a resetting of the toe. He experienced no difficulty and made a rapid, uneventful recovery. Kon underwent ether narcosis for a throat and nose operation which involved the removal of adenoids and tonsils, trimming of turbinated bones, and straightening of the septum (see p. 48). Tom, in the Christmas vacation, was operated on for hemorrhoids under ether narcosis, but evidently returned to college too soon after the operation. Yet we have no reason to believe that the fact that he was on low diet in any way delayed his ultimate recovery. His post-dietetic history shows that he finished his college work in good condition and, in fact, was one of the best students in the institution.

The post-experimental history of practically all the men in both squads showed pronounced digestive disturbances following the return to normal diet. Special cautions were given to resume normal diet very slowly, but the men not only overate but, in certain instances, passed all reasonable bounds. The reports of the meals eaten by some of the men are so amazing as to seem of doubtful value and hence are not recorded here. Many suffered from abdominal pains and distress, not infrequently nausea, but usually all the men were in good condition within 2 or 3 days.

The most pronounced and puzzling development of abnormal nature throughout the entire test was that occurring with Spe. In the experiments in the group chamber apparatus on the morning of December 9 his rectal temperature at 6 a. m. was 97.6° F., and pulse rate 53. On December 10 and 11 he reported that he felt very well. On December 12 he reported that he felt weak and. that his throat was a little sore. His temperature at 5h 45m a. m. was 99.6° F. He was therefore excused from the respiration test and stayed in bed with a headache and a poor appetite. December 13 he reported himself as feeling better, with a temperature of 100.5° F. in the early morning. The temperature, taken at 2 p. m. by a local physician, was reported as 102° F. and the pulse rate as 120. At 6h 30m p. m. the temperature was 102.5° F. and the pulse-rate was 102. The physician and two others suspected typhoid fever and advised him to return home. On December 15, although he still had a high fever, he went to his home at Andover, Massachusetts, and the case was pronounced typhoid fever by his local physician. The subsequent course of the disease is best recorded by the charts of the temperature, pulse, and respiration (figure 87), and by the reports kindly furnished us by the subject's physician, Dr. W. D. Walker, of Andover. The treatment given Spe, as outlined by Dr. Walker, is as follows:

"Warm bath every day; cold sponge for temperature; mouth irrigated with Dobell's solution every 2 hours; swabs of Tr. Myrrh frequently; gargle and spray before and after feedings; drops in the eyes three times a day".

The physician adds that his patient had 24 days of temperature, a very sore mouth for two weeks and a cough. Through Dr. Walker's kindness we are permitted to quote from his letters further as follows:

"Wesley G. Spencer came home from Springfield with a diagnosis of typhoid fever. At the end of nine days he had a crop of what I supposed were rose spots, but their subsequent behaviour leads me to conclude that I was wrong. They were at first rosy red, much larger than the ordinary rose spot and s'peedily became vesicles. They were all over the body, but more especially on the penis and scrotum, where they caused considerable irritation. All this time the patient's mouth was in a most deplorable state in spite of constant care. A bronchitis was present. The temperature chart you have. There were no abdominal symptoms. A slight trace of albumin was present in the early part of the fever. Widal reactions taken at weekly intervals negative. Urine and stools negative for typhoid bacilli. I conclude that he did not have typhoid, but I cannot make a diagnosis".

Subsequent correspondence with Dr. Walker, with special reference to the character of the vesicles, is as follows:

"The eruption in his case came on the ninth or tenth day, first on the abdomen and arms. It was at first very much like large rose spots, but these in a day or two became vesicular. There was no bleeding. I should say there was no ulceration, except on the scrotum and glans penis, where the eruption was abundant and marked. There was some pigmentation after the vesicles dried up and the spots were still visible after several weeks. The mouth first became involved about the sixth or seventh day of the disease. I am not quite clear as to the progress of this condition, but the whole inner surface of the cheeks and tongue was involved and covered with a dirty greyish membranous coating which finally peeled off after at least a week and possibly longer. There was considerable bleeding from the areas about the inside of the lips, which were much swollen. I have told you of the bronchitis which accompanied the disease. I had the sputum examined for tuberculosis on two occasions, with negative result. I had no report as to any other organism.

"The eruption was pretty generally distributed over the whole body, arms, legs, back, and, I think, on the forehead. The spots were fairly far apart; for example, perhaps a dozen spots on the abdomen and chest, half a dozen on the arm, etc. These are, of course, only guesses, but the glans penis and scrotum were peculiarly involved and were quite sore".

Simultaneously with the illness of Spe the younger brother and the attending nurse became ill. The following sentence in Dr. Walker's letter relates to this phase of the illness:

"The brother's illness came after Wesley's. It began about ten days after Wesley came home and was like a grippe bronchitis with persistent and moderately high fever which lasted ten days to two weeks. No eruption or sore mouth. The nurse who cared for these boys was also ill for a few days with a bronchial attack with fever for a few days. Much milder than the brother's".

Of special note in connection with this case is the fact in the first place that the subject obtained this infection which, it is reasonable to argue, he might not have had if he had been on normal diet. On the other hand, he made complete recovery and returned to college on April 2, 1918. He has completed his college year and is in excellent health. It is extremely unfortunate that a clear, unquestioned diagnosis could not have been made of this case. Conference with several of the best clinicians in Boston leaves the whole situation very uncertain. It would be useless here to record the various conjectures made from the clinical picture outlined, but there seems to be a reasonable uniformity of opinion that Spe did not have typhoid fever.

The whole history of this case is of special interest, in connection with the statement made by Loewy and Zuntz in the article reporting their experience on war diet, in which they especially emphasize the fact that the possibility of a lowered resistance to infectious diseases can only be studied when there is extensive clinical material at hand.

The number of men under observation was approximately 25. One (Fre) withdrew primarily on account of his inability to withstand the discomfort of hunger pains. Spe is the only case of a serious illness occurring during the research. Since all the men were given substantially the same treatment, ate at the same table, and had the same food, it is highly probable that we deal in this case with a sporadic infection that is without direct connection with the dietetic conditions. It still remains a fact, however, that one man out of the 25 men studied - i. e. 4 per cent of our men - contracted a severe illness. This, in connection with the suggestion made by Dr. Minot in his report on the blood examination, would certainly be taken into account as an argument against the general use of restricted diets.

Fig. 87. - Temperature, pulse, and respiration charts of Wesley G. Spencer (Spe) during suspected infection of typhoid fever, December 12, 1917 - January 21, 1918.