FASTING AS MEDICINE
FOREMOST in all therapy is rest. The injured, or poisoned, or over-exerted, or otherwise ailing organ, tissue or function must rest : and then, very pro- bably, it will heal itself. The drug which really helps the heart does so not by flogging it into greater efforts, but by prolonging that interval between the beats, in which the heart -rests and in which, if at all, it must recover.
No organ nor system in the body of modern man is in more frequent need of rest than the food canal. It is per- petually being overloaded, poisoned, irritated. The con- sequences are lodal and general. The canal itself suffers grievously ; and the remotest tissues are fortunate if they escape -the consequences of being burdened with superfluous fat, or poisoned with products of the insani- tary processes set up in the food canal by, for instance, the action of microbes which feed upon the vast excess of proteins consumed in the form of meat by nine people out of ten.
Faced with these morbid phenomena, the orthodox physician, during many past ages, has prescribed a large i-aiiety of medicines for the relief of the patient. With scarcely an exception, if any, these medicines are sub- stances entirely foreign to the body ; poisons, in short, the excretion of which is a burden added to the already excessive labours of the excretory organs. The patient, being poisoned by his illness and his drugs, is, of course, weary and incapable of much exertion.. An abundance of good food has therefore been called in to " keep up his strength "—though lack of food has not been the cause of his weakness.
Now comes a school which takes different views. It really dates from the late Dr. George Keith, " the starving doctor,"• whose Plea for a Simpler Life, Fads of an Old Physician, and many other works were widely read in their day. Modern dietetics is in accord with his -views, notably in respect of the quantity of protein which we need, and the danger of exceeding that quantity. First, the excess may yield poisons, absorbed with evil results, after the " proteolytic " bacteria in the bowel have attacked them. Second, proteins are combinations of acids, and when they are digested in excess, the propel alkalinity of the blood and the tissues is endangered.
Hence we may apply logical principles of rest for the suffering organ, and of " removing the cause," to many forms of illness, and drastically reduce the diet, perhaps even to •the extent of fasting. The overstrained organs immediately receive rest, of all things most needed by them. An extensive process of intoxication is imme- diately arrested. The body still• needs food, even if the patient be lying motionless in bed ; for the respiratory muscles and the heart must continue their fundamental work, and must- be supplied with fuel. But this fuel is obtainable from within the body itself. Certain food- stuffs cannot be-'stored—notably proteins. But fats, typical fuels, can be stored, and now they arc called upon. It is very interesting to observe the fashion in which, during starvation, the body yields its store for these con- tinuous vital necessities. The obviously superfluous fat, deposited under the skin and elsewhere, is always used first. Next the least essential organs and tissues are depleted. Only if the process be continued to dangerous lengths do we find the substance of the heart muscle or the cerebral tissues called upon. Such being the selective judgment of the body, there is no fear that a moderate period of fasting will injure any vital organ. On the con- trary, the vital organs may gain far more vigour from lack of food-poisoning than we might expect them to lose through the deprivation of food.
When food is resumed, we must remember, the digestive organs may have grown unaccustomed to exertion. The unused muscular fibres may well be flabby : the secretory glands have not been called upon for many days or even weeks, and any large calls upon them are un- likely to be met. Hence the utmost skill and caution will be found necessary in resuming the intake of food. Not only the quantity but the nature of this food must be well considered. We do not expect a patient to walk with ease after he has lain upon his bed for weeks, resting and mending an injured limb. Evidently the same principle should be remembered after long resting a strained digestion.
There are diseases which are due to lack of enough good food. All the evidence teaches that under-nutrition is a leading cause that predisposes to tuberculosis. If we had ever doubted this, the fate of Vienna, for instance, towards the end of the War and thereafter would have con- vinced us. " The key to the treatment of- tuberculosis is the state of the digestive tract." Always the physician watches his patient's weight : and many physicians do all they can to achieve " suralimentation," as the French call it, in these cases. In a sense, therefore, we must include tuberculosis with many • other diseases as partly caused by deficiency in the diet. This must be remem- bered when we praise fasting as a cure.
And here we come to the reason which has led me to accede to the suggestion that I should write an article on this subject. It is that fasting, whether complete fasting, or a drastic reduction in the food-intake, is not a panacea, and may prove calamitous, even to fatality, as in cases of unsuspected tuberculosis. The treatment has in it a grave element of danger, especially in respect of its application to unsuitable cases. Hence, only the skilled and fully-qualified physician can hope to achieve the differential diagnosis which is absolutely essential if we are to hope for success in the use of this or any other form of treatment. Therefore, I strongly deprecate the existence of any institutions for the practice of fasting, or any other method of treatment, unless they be under the control and direction of responsible physicians, from first to last. Serious consequences are certain to follow if the casual reader of the -newspapers considers, in view of cases about which he has read, that what he needs is a good long dose of fasting, All this is nonsense. Only the skilled physician who sees the case can judge whether fasting, or some treatment in that direction, be best or it ; and only he is capable of watching the progress of the case, under any such treatment, so as to determine how long it should be con- tinued. Probably the cases which really need anything like absolute, fasting are very rare, if there be any such ; and a skilled doctor could exclude the food or foods which are doing harm, whilst admitting those which may do good.
This is an entirely disinterested opinion. Nothing can alter the view of any man who has had a medical educa- tion that diagnosis is the foundation of all good medicine. Doctors in these times are allowing themselves to be com- peted with, often successfully, by exponents of many un- orthodox methods, especially those which abandon drugs. It is for them to meet such competition by learning and adopting all that is good in such methods, and getting vastly more good out of them than any clinician can pos- sibly achieve who is not well grounded in the primary concern of learning exactly what is the matter with his patient..
CRUSADER.
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