Laymen are too much accustomed to give vent to all sorts of prophetic utterances as a result of their single experiment on their own bodies, forgetting that not even a skilled observer can be trusted to determine the true significance of his own symptoms. Quite recently the author of a sensational book on the stockyards of Chicago fasted for twelve days, and on the strength of the loss of a headache on the third day of the fast and his perfectly ravenous desire for physical and mental work when he resumed a milk diet, set the fashion for a renewed outburst of fasting for the cure of ill-health. How many people died as a result of this craze it is impossible to say, but the daily papers certainly recorded more than one death distinctly attributable to the effort to emulate his ill-timed experiment. Dr. Saundby, in the British Medical Journal, states: -

"That this is no imaginary danger is proved by three fatal cases which have come under my notice. The first, a motherless girl, the daughter of a busy doctor, was treated in Dr. Playfair's home, returned home, was not supervised, and died. The second was a woman under the care of an old practitioner who refused to believe in the risk; she also died. The third was a young man whose nurse neglected her duty, and after his death food supposed to have been eaten was found concealed everywhere in his bedroom."

The inmate of a prison or a lunatic asylum who refuses to take his meals is fed by compulsion; the trained scientist who subjects animals to a period of enforced fasting without a Government license (and in Great Britain this is practically always withheld) is subject to the severest of penalties; but the irresponsible member of the public who, for the sake of notoriety or in obedience to impulse, impels misguided human beings by his example to play with their lives, is immortalised by the public Press and placed on a pedestal scarcely less prominent than that of the greatest benefactors of humanity. The entirely unwarranted statements of such individuals are quoted with such a show of authority that people whose mental balance is impaired by ill-health are instigated "to expel the food poisons which have accumulated in their body, as well as throw off the poisons of any disease" which may attack the system, by a method whose right to a place in therapeutics has not yet been vindicated.

It is cruel to suggest to the victims of inanition due to the ravages of consumption and other diseases of malnutrition that further depletion of their vital resources will be attended by remedial results. Surely the days of famine in India, Ireland, and elsewhere have provided a sufficient number of involuntary examples of fasting and the diseases directly dependent thereupon, to demonstrate the perils of the practice, especially when carried to excess by one already exhausted by the inroads of serious disease. Whether in health or disease it is an indubitable fact that during a fast the body lives at the expense of its own substance. The organs by which the greatest amount of work is done are the least encroached upon and maintain their integrity for the longest period - which means that they work not at the expense of their own substance but of that of the less vital organs. E. Voit fed pigeons on an acalcic diet, and after death the bones which had least demand made upon them, such as the skull and the sternum, were found to be brittle and perforated, whereas the bones of the active parts of the body, such as the legs, were strong and well-developed. It has also been pointed out that the Rhine salmon lives in fresh water for from six to nine months without indulging in food, and that the muscles are used up in order to feed the reproductive organs. But in the end even the vital organs must contribute their quota to the general demand for nutrition, and when they are exhausted death supervenes. Therefore, although the brain and nervous system resist the demands for a lengthened period, it is a mistake to say that they can exist without nutriment. Fasting, indeed, in nowise implies abstinence in the true sense of the term. It is simply a change of diet, the body living on its own tissues instead of on vegetable or animal tissue.

The assertion also that only the excess of nutriment or accumulation of morbid waste matters is destroyed during a long fast is essentially erroneous, although it is true that during the first few hours after the last meal a sufficient amount of ingested food substance will be available without any drain upon the tissues themselves. The simile which best fits the fasting man is not that of a furnace whose bars are choked with ashes and whose flues are clogged up with soot, so that a general conflagration is welcome to clear away the obstruction in order to produce more effective combustion. It is rather that of a furnace which has disposed of its extraneous combustible material and proceeds to attack the furnace bars and flues, and even the very boiler plates themselves, so that an explosion is imminent. Nor is it possible that the waste matter can be lessened in any appreciable degree, because waste is formed whatever fuel is used, and the so-called clogging of the tissues is all the more certain because the organs of excretion are themselves weakened on account of their necessary contribution to the nutritive demands.

It is hardly fair to conclude this chapter without referring to the modified form of fasting coupled with purgation championed by Dr. Guelpa, of Paris, as a therapeutical procedure of great value. He is evidently obsessed by the doctrine of auto-intoxication, for he protests against the recognition of emaciation as an unfavourable sign or of weakness as a sign of deficient nutrition, encouraging the presence of the former as a means of ridding the system of toxins and maintaining that the latter is an indication of their imperfect removal. Hunger he considers an expression of intestinal auto-intoxication, as it can be appeased by repeated purgation, and boldly declares that death from starvation is never due to insufficient tissue repair, but to an accumulation of toxins. Manifestly this is a frank confusion of appetite and hunger, and there is nothing very new in his practice, except its details. It is simply a revival of the method of depletion familiar in the days of bleeding and antimony presented in a new guise, for although it may be frequently repeated in the course of many months, the purgation is not a daily procedure and the fasting never continues at the outside for more than a few days at a time. The cases of diabetes and gout which are cited as having been cured by the treatment are evidently typically sthenic, and doubtless because of careful selection he is able to announce that this method of treatment is never harmful, nearly always useful, and sometimes gives truly marvellous results.

Whatever be the value of a few days' fast, subsequent to a food debauch interposed occasionally in the regimen of diabetes, or preliminary to an effort of hyperalimentation, I am quite certain that the risks of a prolonged fast are out of all proportion to the anticipated advantages. Nay, I would go further and say that there are absolutely no benefits which can be obtained from even a very short fast that cannot as certainly accrue from a moderate restriction of the diet within reasonable limits, and that the dangers associated with a prolonged fast can only be combated by a powerful and vigorous constitution.