THE PERSONAL "CASE" AND
"ENDORSEMENT"
of
DR. ERNEST VAN SOMEREN
AN
ENGLISH PHYSICIAN AND SURGEON, PRACTISING
IN VENICE, ITALY
"My dear Mr. Fletcher:
"It would be almost àpropos to send you, as an endorsement of your principles, the dictum of the ragged and dirty tramp in the advertisement of Pear's soap. I would have to amend it slightly and say: 'I used your {principlessoap} three years ago; since when I have used no other.' I say 'almost àpropos' advisedly, for, while the soap claims to keep the outer man clean, the practice of your principles justly claims to keep the inner man sweet and clean, so lessening the need to cleanse the outer man!
"A well-known English surgeon (I think Sir Wm. Mitchell Banks) recommends physicians and surgeons to take a leaf from the book of patent-medicine vendors, and make their patients testify to their successful treatment. I will take the hint and give you, as my 'doctor,' a testimonial of how personally I am benefited by your advice.
"Three years ago, when I first met you, though under thirty years of age, and myself a practising physician and surgeon, I was suffering from gout, and had been under the régime of a London specialist for the treatment of that malady. Though vigorously adhering to the prescribed diet, I suffered from time to time. My symptoms were typical – paroxysmal pain in my right great toe and in the last joints of both little fingers, the right one being tumefied with the well-known 'node.' From time to time, generally once a month, I suffered from incapacitating headaches. Frequent colds, boils on the neck and face, chronic eczema of the toes, and frequent acid dyspepsia were other and painful signs that the life I was leading was not a healthy one. Yet I was accounted a healthy person by my friends, and was, withal, athletic. I fenced an hour daily, took calisthenic exercises every morning, forcing myself to do them, and I rowed when I obtained leisure to do so. In spite of this exercise and an inherent love of fresh air, which kept all the windows of my house open throughout the year, I suffered as above. Worse still, I was losing interest in life and in my work.
"In one or two conversations you laid down your simple principles of economic nutrition. You told me that my food ought to be masticated thoroughly, until taste was eliminated, and that (my) liquid nourishment, if taken, ought to be similarly treated. You also told me that, taking food in this way, I might, without fear of consequences, give free rein to my appetite. To shorten my story, I'll say that in three months after the practice of these principles my symptoms had disappeared. Not only had my interest in my life and work returned, but my whole point of view had changed, and I found a pleasure in both living and working that was a constant surprise to me. For this, my dear Mr. Fletcher, I can never repay you. My only desire has been and is, to try and do for others in my practice what you did for me.
"Now I have since that time had occasional colds, headaches, and gouty pains; but, whereas formerly I could not explain their causes, I can now invariably trace them to carelessness in the buccal digestion of my food, and can soon shake them off. So much for my testimonial. Now for other matters.
"I do not know what may be the extent of the claims you are advancing in regard to the benefits accruing from the practice of your principles. If you, as you in justice may, claim even the widest benefits as surely following the practice of these principles, many will relegate these claims to the limbo where all such 'panaceas' are soon forgotten. They will err greatly if they do so. The seemingly simple procedure of insalivating one's food most carefully is not calculated to impress people with the fact that great permanent benefit follows. The subtlety of the changes that occur is due to the greatly increased action of a vital process, i. e., of the admixture with the food-stuffs of saliva, in such quantities as to alter the chemical reaction of the initial stage of digestion. This initial change causes a consequent change of all the processes following it, and a change also in the final products of the entire process of digestion; the greatest change being, perhaps, the elimination of last-resort digestion by the intestinal flora (digestion by decomposition caused by bacteria), and consequent elimination from the body, of the toxins they produce. The life of an organism has been defined as 'the sum of all those inter-actions which take place between the various cells constituting the organism and their several environments.' (Harry Campbell.) The final products of digestion are absorbed into the blood stream, and go to form part of the 'several environments' of the cells. The individual cell, the various groups of specialised cells, such as the brain, nerves, muscles, bones, etc., in short, the whole organism is beneficially influenced and made more resistent to disease by the purity of a blood stream that no longer contains the toxins of bacterially digested food.
"The further investigation of your discovery by those competent will, I am confident, result in such a simplification of the rules for a healthy life that the medical profession, at present forced by a lack of knowledge of the vital processes of nutrition to base their treatment on the veriest empiricism, will then be able to teach all and sundry how to live. At present, all we can do is to treat and perchance cure for a time certain symptoms, allowing the patient to return afterwards to a mode of life that is really responsible for his malady. 'Disease is an abnormal mode of life.' (Harry Campbell.) The three factors in its causation are:
"(a) Cell structure.
"(b) Internal cell environment.
"(c) External body environment.
"Heredity determines, to a very large extent, our cell structure, and consequently our body structure.
"Sanitary science regulates our external body environment as much as the artificial and noxious habits of so-called civilisation will allow. The mental and physical external body environments have also their effect on the organism.
"Your discovery of simple rules for an Economic Nutrition will control the internal cell environment. In doing this, the predisposition to disease is materially affected. The internal cell environment being free from toxic material, and the cell itself better nourished, the cell's resistance to disease is increased, the possible source of disease being limited to the external body environment.
"In concluding this endorsement I can promise, to each and all who may intelligently practise the principles of Thorough Buccal-Digestion, a complete knowledge of their body's food requirements, or, as a patient of mine tersely put it, they will learn the way to 'run their own machines.'
"Yours ever,"Ernest van Someren."
Dr. Van Someren and the author, assisted by Dr. Professor Leonardi, of Venice, as Consulting Physiological-Chemist, and several colleagues, pursued some experiments during the winter of 1900-1901; and Dr. Van Someren read a paper on our work, entitled, "Was Luigi Cornaro Right?", before the meeting of the British Medical Association the following August.
The paper is too long to reprint here but it will be found in full in another volume, entitled, "The A.B. – Z. of Our Own Nutrition."
The following "Note" by Dr. Professor, Sir Michael Foster, K.C.B., M.P., F.R.S. etc., is a further link in the chain of development of appreciation of the need of serious attention to the science of human nutrition excited by this initiative. (Dr. Foster is the Permanent Honorary President of the International Congress of Physiologists.)
EXPERIMENTS UPON HUMAN NUTRITION
NOTE BY SIR MICHAEL FOSTER, K.C.B., M.P., F.R.S
"In 1901 Dr. Ernest Van Someren submitted to the British Medical Association, and afterwards to the Congress of Physiologists at Turin, an account of some experiments initiated by Mr. Horace Fletcher. These experiments went to show that the processes of bodily nutrition are very profoundly affected by the preliminary treatment of the food-stuffs in the mouth and indicated that great advantages follow from the adoption of certain methods in eating. The essentials of these special methods, stated briefly and without regard to certain important theoretical considerations discussed by Dr. Van Someren, consist of a specially prolonged mastication which is necessarily associated with an insalivation of the food-stuffs much more thorough than is obtained with ordinary habits.
"The results brought to light by the preliminary experimental trials went to show that such treatment of the food has a most important effect upon the economy of the body, involving in the first place a very notable reduction in the amount of food – and especially of proteid food – necessary to maintain complete efficiency.
"In the second place this treatment produced, in the experience of its originators, an increase in the subjective and objective well-being of those who practise it, and, as they believe, in their power of resistance to the inroads of disease. These secondary effects may indeed be almost assumed as a corollary of the first mentioned; because there can be little doubt that the ingestion of food – and perhaps especially of proteid food – in excess of what is, under the best conditions, sufficient for maintenance and activity, can only be deleterious to the organism, clogging it with waste products which may at times be of a directly toxic nature.
"In the autumn of 1901 Mr. Fletcher and Dr. Van Someren came to Cambridge with the intention of having the matter more closely inquired into, with the assistance of physiological experts. The matter evoked considerable interest in Cambridge, and observations were made not only upon those more immediately interested, but upon other individuals, some of whom were themselves medical men and trained observers.
"Certain facts were established by these observations, which, however, are to be looked upon as still of a preliminary nature. The adoption of the habit of thorough insalivation of the food was found in a consensus of opinion to have an immediate and very striking effect upon appetite, making this more discriminating, and leading to the choice of a simple dietary and in particular reducing the craving for flesh food. The appetite, too, is beyond all question fully satisfied with a dietary considerably less in amount than with ordinary habits is demanded.
"Numerical data were obtained in several cases, but it is not proposed to deal with these in detail here, as they need the supplementary study which will be shortly referred to.
"In two individuals who pushed the method to its limits it was found that complete bodily efficiency was maintained for some weeks upon a dietary which had a total energy value of less than one-half of that usually taken, and comprised little more than one-third of the proteid consumed by the average man.
"It may be doubted if continued efficiency could be maintained with such low values as these, and very prolonged observations would be necessary to establish the facts. But all subjects of the experiments who applied the principles intelligently agreed in finding a very marked reduction in their needs, and experienced an increase in their sense of well-being and an increase in their working powers.
"One fact fully confirmed by the Cambridge observations consists in the effect of the special habits described upon the waste products of the bowel. These are greatly reduced in amount, as might be expected; but they are also markedly changed in character, becoming odourless and inoffensive, and assuming a condition which suggests that the intestine is in a healthier and more aseptic condition than is the case under ordinary circumstances.
"Although the experiments hitherto made are, as already stated, only preliminary in nature and limited in scope, they establish beyond all question that a full and careful study of the matter is urgently called for.
"For this fuller study the Cambridge laboratories do not possess at present either the necessary equipment or the funds to provide it. For the detailed study of the physical efficiency of a man under varying conditions, elaborate and expensive apparatus is required; and the advantages claimed for the special treatment of the food just discussed can only be fully tested by prolonged and laborious experiments calling for a considerable staff of workers.
"It is of great importance that the mind of the lay public should be disabused of the idea that medical science is possessed of final information concerning questions of nutrition. This is very far indeed from being the case. Human nutrition involves highly complex factors, and the scientific basis for our knowledge of the subject is but small; where questions of diet are concerned, medical teaching, no less than popular practice, is to a great extent based upon empiricism.
"But the scientific and social importance of the question is clearly immense, and it is greatly to be desired that its study should be encouraged.
"M. Foster.
"April 26th, 1902."
The interest excited in Professor Foster was coincident with that espoused by Dr. Professor Henry Pickering Bowditch, Professor of Physiology of Harvard Medical School, and Dean of American Physiologists. Under the ægis of such encouragement the later developments are not at all surprising. In order to extend and verify the findings of Dr. F. Gowland Hopkins, of Cambridge University, England, as stated in the preceding note by Professor Foster, Professor Russell H. Chittenden, President of the American Physiological Society, Director of the Sheffield Scientific School of Yale University, and one of the leading chemico-physiological authorities of the world, as measured by accepted research work, volunteered to submit the author to further test. The report of this test is too long for reproduction here. It was first published in the Popular Science Monthly of June 1903, but will be found in full in the "A. B. – Z." just referred to. The special reference to the author's case and the quoted report of Dr. William G. Anderson, Director of the Yale Gymnasium which tells the story of efficiency, was as follows:
Extract from an article by Professor Russell H. Chittenden in Popular Science Monthly, June, 1903
"The writer has had in his laboratory for several months past a gentleman (Horace Fletcher) who has for some five years, in pursuit of a study of the subject of human nutrition, practised a certain degree of abstinence in the taking of food and attained important economy with, as he believes, great gain in bodily and mental vigour and with marked improvement in his general health. Under his new method of living he finds himself possessed of a peculiar fitness for work of all kinds and with freedom from the ordinary fatigue incidental to extra physical exertion. In using the word abstinence possibly a wrong impression is given, for the habits of life now followed have resulted in the disappearance of the ordinary craving for food. In other words, the gentleman in question fully satisfies his appetite, but no longer desires the amount of food consumed by most individuals.
"For a period of thirteen days, in January, he was under observation in the writer's laboratory, his excretions being analysed daily with a view to ascertaining the exact amount of proteid consumed. The results showed that the average daily amount of proteid metabolised was 41.25 grams, the body-weight (165 pounds) remaining practically constant. Especially noteworthy also was the very complete utilisation of the proteid food during this period of observation. It will be observed here that the daily amount of proteid food taken was less than one half that of the minimum Voit standard, and it should also be mentioned that this apparent deficiency in proteid food was not made good by any large consumption of fats or carbohydrates. Further, there was no restriction in diet. On the contrary, there was perfect freedom of choice, and the instructions given were to follow his usual dietetic habits. Analysis of the excretions showed an output of nitrogen equal to the breaking down of 41.25 grams of proteid per day, as an average, the extremes being 33.06 grams and 47.05 grams of proteid.
"In February, a more thorough series of observations was made, involving a careful analysis of the daily diet, together with analysis of the excreta, so that not alone the proteid consumption might be ascertained, but likewise the total intake of fats and carbohydrates. The diet consumed was quite simple, and consisted merely of a prepared cereal food, milk and maple sugar. This diet was taken twice a day for seven days, and was selected by the subject as giving sufficient variety for his needs and quite in accord with his taste. No attempt was made to conform to any given standard of quantity, but the subject took each day such amounts of the above foods as his appetite craved. Each portion taken, however, was carefully weighed in the laboratory, the chemical composition of the food determined, and the fuel value calculated by the usual methods.
"The following table gives the daily intake of proteids, fats and carbohydrates for six days, together with the calculated fuel value, and also the nitrogen intake, together with the nitrogen output through the excreta. Many other data were obtained showing diminished excretion of uric acid, ethereal sulphates, phosphoric acid, etc., but they need not be discussed here.
* Average of the four days.
"The main things to be noted in these results are, first, that the total daily consumption of proteid amounted on an average to only 45 grams, and that the fat and carbohydrate were taken in quantities only sufficient to bring the total fuel value of the daily food up to a little more than 1,600 large calories. If, however, we eliminate the first day, when for some reason the subject took an unusually small amount of food, these figures are increased somewhat, but they are ridiculously low compared with the ordinarily accepted dietary standards. When we recall that the Voit standard demands at least 118 grams of proteid and a total fuel value of 3,000 large calories daily, we appreciate at once the full significance of the above figures. But it may be asked, was this diet at all adequate for the needs of the body – sufficient for a man weighing 165 pounds? In reply, it may be said that the appetite was satisfied and that the subject had full freedom to take more food if he so desired. To give a physiological answer, it may be said that the body-weight remained practically constant throughout the seven days' period, and further, it will be observed by comparing the figures of the table that the nitrogen of the intake and the total nitrogen of the output were not far apart. In other words, there was a close approach to what the physiologist calls nitrogenous equilibrium. In fact, it will be noted that on several days the nitrogen output was slightly less than the nitrogen taken in. We are, therefore, apparently justified in saying that the above diet, simple though it was in variety, and in quantity far below the usually accepted requirement, was quite adequate for the needs of the body. In this connection it may be asked, what were the needs of the body during this seven days' period? This is obviously a very important point. Can a man on such a diet, even though it suffices to keep up body-weight and apparently also physiological equilibrium, do work to any extent? Will there be under such condition a proper degree of fitness for physical work of any kind? In order to ascertain this point, the subject was invited to do physical work at the Yale University Gymnasium and placed under the guidance of the director of the gymnasium, Dr. William G. Anderson. The results of the observations there made, are here given, taken verbatim from Dr. Anderson's report to the writer.
"'On the 4th, 5th, 6th and 7th of February, 1903, I gave to Mr. Horace Fletcher the same kind of exercises we give to the Varsity Crew. They are drastic and fatiguing and cannot be done by beginners without soreness and pain resulting. The exercises he was asked to take were of a character to tax the heart and lungs as well as to try the muscles of the limbs and trunk. I should not give these exercises to Freshmen on account of their severity.
"'Mr. Fletcher has taken these movements with an ease that is unlooked for. He gives evidence of no soreness or lameness and the large groups of muscles respond the second day without evidence of being poisoned by carbon dioxide. There is no evidence of distress after or during the endurance test, i. e., the long run. The heart is fast but regular. It comes back to its normal beat quicker than does the heart of other men of his weight and age.
"'The case is unusual and I am surprised that Mr. Fletcher can do the work of trained athletes and not give marked evidences of over exertion. As I am in almost constant training I have gone over the same exercises and in about the same way and have given the results for a standard of comparison. (The figures are not given here.)
"'My conclusion given in condensed form is this. Mr. Fletcher performs this work with greater ease and with fewer noticeable bad results than any man of his age and condition I have ever worked with.'
"To appreciate the full significance of this report, it must be remembered that Mr. Fletcher had for several months past taken practically no exercise other than that involved in daily walks about town.
"In view of the strenuous work imposed during the above four days, it is quite evident that the body had need of a certain amount of nutritive material. Yet the work was done without apparently drawing upon any reserve the body may have possessed. The diet, small though it was, and with only half the accepted requirement in fuel value, still sufficed to furnish the requisite energy. The work was accomplished with perfect ease, without strain, without the usual resultant lameness, without taxing the heart or lungs, and without loss of body-weight. In other words, in Mr. Fletcher's case at least, the body machinery was kept in perfect fitness without the consumption of any such quantities of fuel as has generally been considered necessary.
"Just here it may be instructive to observe that the food consumed by Mr. Fletcher during this seven days' period – and which has been shown to be entirely adequate for his bodily needs during strenuous activity – cost eleven cents daily, thus making the total cost for the seven days seventy-seven cents! If we contrast this figure with the amounts generally paid for average nourishment for a like period of time, there is certainly food for serious thought. Mr. Fletcher avers that he has followed his present plan of living for nearly five years; he usually takes two meals a day; has been led to a strong liking for sugar and carbohydrates in general and away from a meat diet; is always in perfect health, and is constantly in a condition of fitness for work. He practises thorough mastication, with more complete insalivation of the food (liquid as well as solid) than is usual, thereby insuring more complete and ready digestion and a more thorough utilisation of the nutritive portions of the food.
"In view of these results, are we not justified in asking ourselves whether we have yet attained a clear comprehension of the real requirements of the body in the matter of daily nutriment? Whether we fully comprehend the best and most economical method of maintaining the body in a state of physiological fitness? The case of Mr. Fletcher just described; the results noted in connection with certain Asiatic peoples; the fruitarians and nutarians in our own country recently studied by Professor Jaffa, of the University of California; all suggest the possibility of much greater physiological economy than we as a race are wont to practise. If these are merely exceptional cases, we need to know it, but if, on the other hand, it is possible for mankind in general to maintain proper nutritive conditions on dietary standards far below those now accepted as necessary, it is time for us to ascertain that fact. For, if our standards are now unnecessarily high, then surely we are not only practising an uneconomical method of sustaining life, but we are subjecting ourselves to conditions the reverse of physiological, and which must of necessity be inimical to our well being. The possibility of more scientific knowledge of the natural requirements of a healthy nutrition is made brighter by the fact that the economic results noted in connection with our metabolism examination of Mr. Fletcher is confirmatory of similar results obtained under the direction and scrutiny of Sir Michael Foster at the University of Cambridge, England, during the autumn and winter of last year; and by Dr. Ernest Van Someren, Mr. Fletcher's collaborateur, in Venice, on subjects of various ages and of both sexes, some account of which has already been presented to the British Medical Association and to the International Congress of Physiologists at its last meeting at Turin, Italy. At the same time emphasis must be laid upon the fact that no definite and positive conclusions can be arrived at except as the result of careful experiments and observations on many individuals covering long periods of time. This, however, the writer hopes to do in the very near future, with the coöperation of a corps of interested observers.
"The problem is far-reaching. It involves not alone the individual, but society as a whole, for beyond the individual lies the broader field of the community, and what proves helpful for the one will eventually react for the betterment of society and for the improvement of mankind in general."
This test of work was accomplished on food of the nitrogen value of less than 7 grams daily, whereas the text-books declare that from 16 to 25 grams of nitrogen are necessary to human existence. The heat value of the food consumed during the test, and which was like in amount to what had been habitually taken by the author for about five years previously (less than 1600 large Calories), was only half the amount set down by the majority of the presently-accepted authorities as necessary to run the body of a man of the author's weight and activity. The heat-economy-showing was verified a week or two later in a 32-hour calorimeter measurement in the apparatus of Professors Atwater and Benedict at Middletown, Conn.
Evidence of even more significant value has accumulated outside the field of the author's own experiments and tests. After more than a year of careful trial among some thousands of patients and among some hundreds of earnest employees, Dr. James H. Kellogg, of the great Battle Creek Sanitarium, has adopted the suggestions contained in this book as the first requirement of the treatment at the Sanitarium. In like manner, Dr. Edward Hooker Dewey, the sturdy advocate of dietary-economy for the past thirty years, author of the "No-Breakfast" regimen, and various books upon the subject of auto-nutrition and dietary-rest, bent his attention upon the effect of thorough buccal digestion prescribed after a period of rest from outside feeding, and here follows his appreciation as extracted from personal letters.
Before quoting from the high appreciation of Dr. Dewey and Dr. Kellogg it may be well to state that the author stands simply for a test-subject-factor in a commonweal natural inquiry and no praise of the subject attaches to the person of the author. Whatever the author is, in the enjoyment of health and strength, is the result of natural causes which have developed during his study of the natural requirements in our nutrition. Please forget the personal element and consider that what is the author's gain in efficiency as related, is the possible possession of the reader as well, and whatever work or test the author performs is done as much for the reader as for the author himself.
The several extracts from the letters of Drs. Kellogg and Dewey; the statement relative to an endurance-test made on the author's fiftieth birthday, on a bicycle in France, volunteered by Edward W. Redfield, last year's Medal-of-Honorist at the Pennsylvania Academy of Fine Arts, Philadelphia, as well as medalist of last Exposition Universale, Paris; are appreciated and accepted for the subject they endorse; and, as before stated, are entirely impersonal. Instead of using dumb animals for test subjects and getting their unwilling, and sometimes abnormally deranged, participation, the author takes pleasure in submitting to the tests himself, and is thus able to state "symptoms" and "feelings" more accurately, perhaps, than any dog could do. Were vivisection necessary the author would willingly submit to that inconvenience also; but thanks to the skill of a Pawlow, and the ingenuity of a Bowditch coupled with the patience and persistence of a Cannon, as fully related in the "A.B. – Z.," we not only get the economic results but we are able to know and even see some of the "reasons for things" as well.
Interesting testimony and comment relative to the present study will be found at the end of the volume in communications from Commandante Cesare Agnelli, Clarence F. Low, Esquire, Baron Randolph Natili, and one of unusual suggestiveness, as evidence of the need of further study of nutrition, from Dr. Hubert Higgins of Cambridge, England.
MILITARY-SCIENTIFIC COÖPERATION
With the evidence and interest just outlined, it was not difficult for the author to enlist the coöperation of Surgeon-General O'Reilly of the United States Army and the endorsement of General Leonard Wood for larger investigation of the subject. These officers, both of them surgeons and medical doctors, had supported the militant-martyr-scientist, Dr. Major Walter Reed, in his great sanitary accomplishment; had fought yellow fever to a finish together in Cuba; had traced its spread to a specific cause; and were thereby encouraged to tackle even so common and powerful enemies as Indigestion and Mal-Assimilation.