Then again the total bulk of the diet may be greatly diminished by substituting gluten or protene for some of the bread; or by adding gluten to some of the bread or cereal foods, or by taking a bread such as Hovis, which contains a larger percentage of albumens than ordinary bread, thus:-

Table II

5 ozs. Hovis bread1

16 per cent. of albumens

= 340 grs.

2 ozs. oatmeal

12 ,, ,,

= 104 „

1 oz. gluten

80 ,, ,,

= 344 „

1 pint milk

3 ,, ,,

= 262 „

2 1/2 ozs. cheese

33 ,, ,,

= 350 ,,

1,400

A further modification of such a diet, and one that is sometimes convenient, if only because it entails almost no labour for preparation and cooking is one consisting of milk and cheese, fruit and vegetables, thus:-

1 While most of the above percentages of albumens are from Parkes' "Practical Hygiene," 5th ed., with which my researches agree, the value of Hovis and of nuts is that calculated from my researches alone.

Table III

2 1/2 ozs. cheese

33 per cent. of albumens

= 350 grs.

3 pints milk

3 ,, ,,

= 787 „

15 ozs. potatoes

2 ,, ,,

= 126 „

16 ozs. fruit

2 ,, ,,

= 137 „

1,400

I may say that I took the above diet of cheese, milk, potatoes, and fruit for four or five months with very good results, and should recommend it for those who suffer from dysyepsia, when on cereal foods and bread, or as a change from these. It is convenient for those who desire for a time, either at home or while travelling, to be almost independent of cooking, as except for the potatoes and occasionally a little stewed fruit, almost no cooking is required, and raw fresh fruit can be substituted for potatoes and cooked fruit if necessary.

It is also a diet that does pretty well for children, who are often fond of fruit and vegetables, and as these would only rarely require more than some 1,200 grains of albumen, the cheese could be reduced to 1 oz. or less in their case.

Some may be able to take more than the above quantities of potatoes and fruit, and then the milk may be somewhat reduced, as 3 pints is rather a large quantity of fluid, especially in cold weather and for those who are sedentary.

My own experience is that I can take 2 1/2 or even 3 pints of milk quite well in summer, especially if not sedentary; but 2 pints are quite enough in winter and when sedentary.

Others, again, may be able to take more than 2 1/2 ozs. of cheese and can reduce the milk while increasing the cheese; and those who get on well with nuts or dried fruits can considerably reduce either cheese or milk, replacing them by one or both of these as mentioned with regard to Table I.

Such are some of the chief modifications of the diet, but it is obvious that it can be altered in an almost endless variety of ways, and those to whom few foods come amiss, and who have good digestion, can have a different diet, or at least a considerable change of food, every week throughout the year.

There are some people, however, who do not take kindly to any of these foods and who are in a very poor way, feeble and dyspeptic; with these any of the above modifications of diet may be difficult, and for a time even impossible.

They cannot drink milk, or they greatly dislike it; they cannot digest cheese, and they can eat but little bread, and so on through the whole list; there is practically nothing but meat, fish and eggs which they can eat, and they have but a poor appetite even for these.

With these people it is best, I think, to improve the general health, and get up an appetite by tonics and change of air before altering the food at all; and the meals, if too frequent, may be spaced and reduced to three, two, or even one in the day.

Or in some cases food may be altogether withheld for some days till there is a decided appetite, as recommended by Dr. Dewey (previous reference), and then when there is a good appetite for ordinary food, some of the flesh food of the old diet may be gradually replaced by equivalent value in milk, cheese, or bread; and one meal at a time may be changed, with more or less interval between the changes as may be required.

But to put a debilitated and dyspeptic patient suddenly on to a diet which is not relished, and may not be digested, is, I think, at best rash, and may even be somewhat dangerous.

I believe that, with care, patience, and determination, these initial difficulties can generally be overcome, especially when the fear of serious or painful disease furnishes some vim a tergo.

But even in those who get over these initial difficulties, dyspepsia may now and then cause some more or less decided trouble, and I shall, therefore, mention shortly what have appeared to me to be the chief causes of this.

Too much albumen, especially in the form of milk and cheese, to which the patient is not accustomed. Bread is a better and more reliable food, and its 5 bulk generally prevents its being taken in too large a quantity.

Too great bulk of food (fruit and vegetables), especially in those accustomed to such foods of small bulk as meat, fish and eggs.

For this trouble food may be reduced, at least for a time, to little besides milk, cheese and bread stuffs, the more nourishing and important foods; and vegetables and fruit should be taken only after these have been provided for, and in quite small quantities.

Too much fluid. It should, I think, be a rule with all who go on to these diets never to drink when not thirsty, for those who do so tend to get a dilute and watery condition of the blood, and this entails a more or less dilute and watery condition of the digestive secretions poured out from the blood.

Such dilute digestive secretions will act slowly and inefficiently, and more or less fermentation and putrefaction will, meanwhile, be going on in the food masses, resulting in the formation of gases, acids, and decomposition products.

Too much sloppy and pultaceous food, especially starchy food. This, I have already referred to, and pointed out the importance of taking starchy foods as dry as possible, for if such foods are sodden with fluid, the salivary digestive secretion obviously cannot very easily get into contact with its starchy particles, or can only do so slowly and after more or less dilution.