He alleges that there are many reasons why such a blood condition should not supervene. In the first place an excess of carbonaceous material is apt to originate "glycogenic distention" of the liver, and by overfilling the portal system this causes congestion of the mucous membrane of the stomach and bowels, so that digestion ceases, or is restricted, and the supplies diminish. An excessive expenditure of carbon may also exist and act as a restricting factor, and this may occur during formation of fat, lactation, menstruation, or pregnancy. If these two means are insufficient for the disposal of the excess of carbon, disease arises, producing restriction by similar methods, e.g., migraine, by causing indigestion and stopping the supplies, or asthma, by excessive exertion of the respiratory muscles increasing combustion. Acute gout, catarrh, and febrile attacks likewise increase combustion, and in this way disperse hyperpyraemia. The conditions which favour hyperpyraemia, therefore, are (1) a small carbonaceous expenditure, by reason of diminished combustion, and (2) a large carbonaceous income, due to eating a heavy mixed diet.

These two factors, he considers, explain why migraine and asthma are so apt to arise during the sleep which follows a heavy meal, while exercise and restricted diet tend to prevent both conditions. Typical attacks of asthma occur between 2 and 3 a.m., because at that time vitality, i.e., combustion, is at a low ebb, and it is worthy of note that in those who turn night into day the conditions are reversed and the time of election for an attack is subsequent to sleep in the afternoon. Morning headaches disappear shortly after rising because of the increased combustion produced by the muscular activity required for dressing;

Conditions which are inimical to the production of hyper-pyryemia are muscular exertion, exposure to cold, the presence of pregnancy, menstruation, lactation, glycosuria, pyrexia, and the formation of fat; and when hyperpyraemic disorders exist, they are rapidly cured by the supervention of one of these conditions. By increasing combustion Hare makes the trenchant observation that in a case of suspected tubercle with fever, where migraine, asthma, or even acne is present, one may safely predict that tubercle does not exist, but if these ailments should disappear, then the case is likely to be tubercle.

Both volumes of Hare's book will well repay the most careful study, replete as they are with the most interesting clinical material. The sketchy reference which I have made to the theory by no means does it justice, but it is probably sufficient for the purpose I have in view, and in any case, in fairness to its author, I must be content. One cannot help being struck with a certain family resemblance between this book and that in which Dr. Haig propounds his uric acid theory, a resemblance which I do not suppose for one moment is intentional. It is, however, a clear illustration of how an author, having formulated a theory, spares no effort to make every possible clinical fact fit into it as accurately as may be. Of course this procedure is not necessarily due to the theorist having forgotten that there is another side to the shield, for he is conscious that the greater the array of evidence he is able to produce, the more credible his theory becomes. His position, however, becomes all the more impregnable when he stops to consider the possible objections to his theory, and in justice to Dr. Hare, as we shall see, this is precisely what he does in many instances.

Theory Consistent With Moderation

It is important to note at this juncture that although he is up in arms chiefly against carbohydrates and fat, he fully recognises that proteins contain a large amount of carbonaceous material, and while insisting on a liberal amount of proteins, he does not advocate excessive quantities, nor, indeed, much more than that represented by the Voit standard diet. It is well known that in diabetes sugar is formed from an exclusive diet of protein, and it is calculated that for each gram of nitrogen eliminated 2.4 grams of additional sugar appear in the urine. Lusk, as the result of experiment, satisfied himself that the sugar production from meat was equal to 58 per cent. by weight of the meat proteins metabolised, and contained 52.5 per cent. of its total available energy. To estimate approximately the amount of sugar excreted in the urine which is formed from proteins in the food, it is only necessary to double the quantity of urea; therefore, the combustible material contained in an excess of protein would equally tend to accumulate in the blood, establish hyperpyrsemia, and be liable to induce the disorders incident to this condition. From this point of view, therefore, I consider Hare's theory as the most profound declaration in favour of simple moderation that has been advanced, and it is a fact of pregnant import that he does not proscribe any particular article of diet. In this regard he is in the same position as Chittenden. The one theory may be looked upon as the antithesis of the other - this emphasising the danger of excess of carbohydrate material, that of protein.