A STUDY OF PROLONGED FASTING

GANO BE NE DI C T

WAS HI NGTON D , . C .

PUB L IS HE D B Y TH E C ARNE G I E I NS T I TU T I ON OF

1915
 PREFACE .

Th e r e s e arch r eport ed in this bo o k o n th e metabolism durin g pro

lo n ge d fasting is a con tinuation an d amplification of th e investiga
“ ”
tio ns reporte d in Th e in flu e n c e of i n ani tio n o n me tabolis m (Carne gi e
I nstitutio n of Was hi n gt o n Publi catio n N o 7 7 .
,

Th e opportuni ty to co n duct t his s e ri e s of sci e ntific obs e rvatio n s on a

m an living for 3 1 days without food and dri nkin g o nl y distill e d wat e r
would have b e en of littl e valu e without th e coop eratio n of a l arge
numb e r of sci en tific associat e s an d comput ers C e rtai n cO work e rs .
-

ki n dly assume d th e r espo nsibil ity n o t o nly for th e accumulatio n of th e

data but also for th e preparation of a report of th eir resp e ctive fin din gs .

I n thi s book sp e cial r eports are mad e by D r H W G oodall o n th e . . .

physical co n ditio n of th e subj e ct during th e fast hi s subj e ctive impre s ,

sio ns and mental attitud e toward th e fast an d th e mi croscopy of th e ,

urin e and th e te sts for albumi n ; by D r J E Ash o n th e blood ; by D r

. . . .

H S L angf e ld o n th e psycho physiology of th e fast ; by D r A I Kendall

. .
-
. . .

o n bact e rial i n t e stin al flora ; an d by Mr H L H iggi n s o n alv e olar air

. . . .

Aside from those who shar e d dire ctly in th e r e spo nsibility of th e

stu die s I am in debt e d to numerous sci entific authoriti e s for cou ns el and
,

advic e both durin g th e e xp e rimen t and durin g th e preparatio n of th e

,

mat e rial for publicatio n Thos e no t sp e cifically men tio ne d in th e te xt

.

are P rofe ssors Luciani of R ome F a n o of Flor en c e Z u ntz of B e rli n

, , ,

Tan gl of B udap e st Tigerste dt Of H elsi n gfors an d Lusk of New York

, , .

I n n o u n d e rtaki ng of th e N utritio n L aboratory have th e co n c e ntratio n

an d th e u nificatio n of r esourc e s an d assista nts b e e n so int en s ely appli e d

and to th e whol e staff of th e L aboratory my warm e st than ks are due .

Their in t erest and consci entious pain stakin g work alo n e made sur e
,

th e co l l e ctio n of th e data r eport e d in th e following pag e s Th e labor .

of th e fin al pr eparatio n of th e mat e rial has fall en in n o small part i nto

th e e xc ell e n t han ds of my e ditorial associat es Mr W H Le sli e and ,
. . .

Miss A N D arling. . .

NUTR I T I O N LAB OR ATOR Y O F THE C AR N E G IE INsTI T UTI O N OF WA S H I N G T O N ,

B oston, Ma8 8 .
, July 29 , 19 1 4 .

3
 C O NTENTS .

Previ o us o bse rv ati o ns o f pro l o nged fasts

O bser v ati o n o n S u cci s

G e n e ral ch aract eristics o f subj ec t

Pro gram fo r resear ch

S ummar ya s to p h y sical co nd itio n .

Anal y i f l
ss o in b d y w igh t
o sse s o - e .

I n n i bl e pe p irati n
se s rs o
D rin king w te a r

O bservati o ns o f th e bo d y te m perature in th e nigh t pe rio d

-

Re co rds o f p ulse -r ate o b tained in th e p im e n t wi th

ex er su b j ec t L .

Co m pari so n o f p ulse c d
re o r s O b tain ed in p im en ts wi th
ex e r th e be d calo ri

I nfl ue n c e Of th e w o r k O f wri tin g

O bservati o ns o n L s bl o o d '

M e th o d c al cu l atin g th e to tal v n til ati n f th l un gs

of e o o e

M e th o d f c al cul atin g th e v lu m pe i n pirati n

o o e r s o

Res ult f b
s o o vatio n n th m ch anic f pi ati o n
se r s o e e s o res r

R pi ati n ate
es r o -r

V ntil ti n f th l un g p m inut
e a o O e s er e
6 A S TUDY OF P R O L O NG E D FA S T I N G .

PA GE .

c h o n m eta bo l i m in pro l o n ged fast in g at th Nut iti n La bo at y— C

R e se ar s e r o r or i
o nt n ue d .

M c h anic o f
e s p i ati n— C o ntinu ed
res r o .

R e u l ts o f o bse v ati n
s n th m ch anic o f espi ati o n C o n tinu d
r o s o e e s r r — e .

I nflu n c e e of ch an gebo d y po i ti o n
s in s .

I nfl u n c e e o f th e w o k o f w i ti ng r r

I nfl u n c e e Of bre ath in g an o xyg en rich -

atm o s ph ere
A l veo lar air
S igni fi can c e o f al v eo l a air r

Me th o ds o f d et rm ini n g th e al veo l ar air

e

Haldan e m e th o d
Pl esc h m e th o d
Me th o d o f cal c ul atin g al veo lar ai fro m resp ir atio n e xperim en ts r

Co ndi ti ns o f taking alv lar air sam pl es

o eo -

D i c u s i o n o f re sults
s s

S iz e o f d ead space in fastin g

D ifl e re n ce in m e c h anics o f resp irati o n in m o rn ing an d e v enin g
'

S ign ifi cance Of c h an ge in th al veo lar air d uri ng th e f ast e

Co n clusi o ns
S u bj e c tiv e im pre i o ns an d m e ntal atti tu d e to w ard th e fast
ss

S u bj ec tiv e im pressi o ns .

Me n tal atti tud e Of th e su bj ec t to w ard th e fast

Ro te m em o r y fo digi tsr

Lat r t
e e sts

G en era l sum m ary and co ncl usi o ns

O bservatio ns u po n th e bac ter ial in testinal flora o f a starving m an

G l ro utine o f co ll e c tio n an d sam plin g

e nera

Co m po i ti o n o f th e urine pri o r to th e fasting exp er im ent

s

T l so lid s
o ta

Day an d nigh t urin es

Co m par i o n Of to tal nitro gen

s c
ex r e ti o n o f L . i
w th th at o f o th er fasting
su bj ec t s

Nit g ro e n ex re t o n c i ki l o gram o f bo d y weigh t

per -
.

Co m p ari so n o f m e th o d s fo r d e termi n i n g to tal ni tro ge n an d am m o n a i

ni tro ge n .
 C O NTE NT S . 7

Researc h o n m etabo l i m s in p o lo nge d fastin g at th e Nut itio n Labo rato ry— C o ntinued
r r . m en .

Ch em ical co nst ituen ts o f fast in g ur ine — Co ntinued .

y buty ic aci d
fi -O x r

Min eral m eta bo lism .

Re d u cin g po w er
C ar bo n in ur ine
C ar bo n ni tro gen rati o -

C alo ie ni tro ge n ratio

r -

C alo rie car bo n rati o

- .

Ab p ti
so r o n of wate r- a v po r and car bo n di xi d e o

Anal y i ss c
o f h am er air b at th e n d o f per i o ds e

G aph ic gi trati n o f d gr f m u c ula po o f su bj ect insi d th e resp i

r re s o e ee o s r re se e

ati n c al
r im eter
o or

M th o d use d i expe im n ts wi th th re pi ati o n appa atus

e s h r e e s r r .

S tu di
es wi th th b d cal im e ter e e or
Atm ph ic c ndi ti n in i d th ch am b
os er o o s s e e er

M a u m nt f th esp i ato y xch an ge in i d th bed calo im eter

e s re e o e r r r e s e e r

Vari ati n in th e m etabo li m as th e fa t p g essed

o s s s ro r

R elati o nsh i p b twee n th e p ul eate an d th e m etabo lism se -r

Di u n al vari atio ns in m tabo lism

r e

E xte rnal in fl u n ces u po n m e ta bo lism

e

E ffe c t o f c h an g es in bo d y po si ti n o .

I nflu n c e o f th e w k o f wr i ting
e or .

Me tabo li sm per kil o gram o f bo dy weigh t in cal orim eter experim en ts

- .

Me tabo lism per kil o gram o f bo d y weigh t in r esp irati o n app ar atus ex
- -

Co n cl usio ns re gardin g th e m e tabo l ism per ki lo gram of bo d y wei gh t

-

Metabo lism per q

s uare m eter o f body surface in th e calo rim eter experi
-

Metabo lism q
per s uare m eter of bo d y surface
- in th e res piratio n appa -

Co n clusio ns re gar ding th e m etabo li sm per sq uare m eter o f bo dy surface -

S umm ary o f re sul ts re gar d ing th e m e ta bo lism per kil o gram o f bo d y weigh t -

an d per sq uare m e ter o f bo d y surf ace -

Dire c t cal rim et y

o r
In direc t cal im t y or e r .

B alan ce o f in c m and utgo

o e o

To tal car bo n d io xi d e prod ucti - o n an d o xy ge n co nsum p ti on per 24 h o urs .

8 A S TUDY OF P R O L O NG E D F A S T ING .

Rese arc h on bo lism in p ro l o nge d fa tin g at t h e N ut i tio n La bo

m e ta s r y— C
r ato r i
o nt nu ed .

B alan c e i co m e an d o utgo — C o ntin u d

of n e .

Appo tionm
r en t o f acep- ro te in ka ta bo li sm be twee n carbo h yd rate and fat .

C arbo n di o xi d e pro du ce d an d o xyge n co nsum e d in th e k atabo lism of

En er gy d erive d fro m ka tabo lism of car bo h y drate and fat

 IL L US TR AT I O NS .

PA GE
P late 1 . A C h aracteri tic po se o f L si ttin g in th e bal co ny d urin g th e day wri ting at
. s .
, , ,

his d esk B Use o f univ e rsal resp irati o n app ar atus fo r stu d yi n g th e esp ira
. . r

to ry e xc h an g e whi l e wri ti n g
P l at e 2 . C R esp irati o n e xp rim n t mad e b y T M C a pe n ter o n th e u nive rsal respi a ti o n
. e e . . r r

app aratu D W eighin g th e su bj ec t o n t h e th irty fir t day O f th e fast

s . .
- s .

P l at e 3 . E Th e su bj ec t L asc e ndi n g t h e stairs O f th e b al co n y o n th e t h ir ty first day o f

. .
-

th e fast F Cli nic al e xam i nati o n b y Dr H W G oo d all

. . . . .

P l at 4
e . Vi ews o f su bj e c t L e van in o n fir st day Of 3 1 day fast z -

P late 5 . Vi ews o f subj e c t L evan in o n last day O f 3 1 d ay f a t z - s

1 . B d y weigh t cu v f fa ti g xpe im ts wi th S ucci

o -
r es or s n e r en .

2 . B o d y w igh t cu v f L v a in
- e r e or e nz
3 . B o d y w igh t cu v f p l ng d fa ti g xp im nt wi th d g
-
e r es or ro o e s n e er e s o s
4 . B d y t m pe atu cu v d u i ng th nigh t a d a ly m ni ng f th c nd a d
o -
e r re r es r e n e r or or e se o n
f urth to eigh th d y f f t
o a s o as

5 B d y tem p atu c u v d u i g th nigh t and l y m ni n g f th ninth to the

o -
er re r es r n e e ar or or e

ixt nth d ay f fa t
s ee s o s

6 B d y te m p tu cu v d u i g th nigh t d ly m nin g fe th v ntee n

o -
e ra re th r es r n e an e ar or r e se e
t tw n ty
o c dd y ff t e - se on a s o as

B d y tem p atu c u v d uring th nigh t a d a ly m ni ng fO tw nty thi d to

“

7 o -
er re r es e n e r or r e -
r

t w nty ni th d ay
e f fa t - n s o s
8 . B d y t m p atu cu v d u i n g th nigh t an d ly m ni n g f th irti th an
o -
e er re d r es r e e ar or or e
th i ty fi t d ay
r f f t a d c d and th i d d y wi th f d
-
rs s O as n se o n r a s oo
9 . B o d y t m p atu cu v f app xim at ly 24 h u n t w ty f u th and
- e er re r es or ro e o rs o en -
o r

10 . B d y t m p atu cu v h win g ch an g f m lyi ng t i tti n g po i ti n

o - e er re r es s o e ro o s s o .

11 . B o d y tem m atu cu v h win g ch g f m l yin g t si tting po i ti n

-
r re r e s o an e ro o s o
12 . Pu l e ate ch art f ubj c t L f d ay p c d in g fa t
s -r o s e or s re e s
13 . Pulse at ch a t f u bj c t L f fi t to fif th d ay f fa t
-
r e r O s e . or rs s o s

Pul ate c h a t f su bj c t L f ixth to el v th d ay f f a t

se -r r O e . or s e en s O s
15 . Pul ate ch a t f u bj c t L f tw l fth t igh t nth d ay f f t
se-r r o s e . or e o e ee s o as
16 . Pul ate ch a t f ubj c t L f ni n te nth t tw nty fi fth d y f fa t
se -r r o s e . or e e o e -
a s o s
17 . Fum e t c h a t f u bj c t L f
- ra e tw ty ix th t
r th i ti th d y
o f fa t
s e . or en -s o r e a s o s .

18 . P ul at c h art f u bj c t L f thi ty fi t day f fa t and th ree ub qu n t

se- r e O s e or r -
rs o s s se e
d y w i th f d
a s oo
C h a t h wi g bl od p u p ul p u and pul
.

19 . r s o n o te f u bj c t L re ss r e , se re ss re , se - ra o s e
20 . C h a t I R l ti
r f h a m gl bi n to
. yth r cyt
e a Ch a t I I C m p i t cu v f
on o e o o er o es . r . o os e r e o
th p ly n u l a
e c m pa d wi th n f m n nu cl a
o c e rs o re o e o o o e rs
21 . C h arts I I I nd IV R l ti n f t tal t difl ntial l u c cy te c u nt
a . e a o o o o
'

e re e o o s
22 . S p cim n
e p i ti n c u v f u bj c t L wh n l yi n g n c u ch in xp im n t
e re s ra o r es or s e . e o o e er e s
w i th th pi ati n app a atue re s r o r s
23 . M m yt t
e or es s
24 . Tappi g t t n es s
25 . S tre n g th tests
26 . g
S tre n t h t ests
27 . g
S tre n t h tests
28 . T ac tual p ace thr h ld an d vi ual acu i ty
-s
es o s
29 . F a ci ati n te ts
ree sso o s
30 . Asso ci ati n te t Re ac ti n t v b an d n un
o s s . o s o er s o s
31 . Asso ciati n test R ac ti n to adj c tive
o s
. e o s e s
32 . A ciati n t ts R ac ti n to ab t ac t n u n
sso o es . e o s s r o s

33 . R pro d u c ti n te t an d m an v a i ati n
e o s s e r o s
34 . C n t ll d a ci ati n t ts
o ro e sso o es .

35 . C an c ll ati n t t
e o es s
36 . S p ci m n e co rd
e e f c h an g in vo l um e o f th
r p i m te n th be d c al im e te
s o e e s ro e r o e or r

duri n g l a t 5 m i nute f pe i o d in xp erim n t wi th L

s s o r s e e .

37 . M th d f O b tai ni n g g aph ic ec d Of ac tivi ty in b d cal i m t

e o or r r or e or e er .

38 . S pe cim n p n um g aph e co d o f m vem nts f bed c al rim t l v m att

e o r re r s o e o o e er e er re ss
su ppo t in ni g h t xpe i m n ts w i th L
r e r e
39 . S c h m atic u tl i n
e f u niv alo p i ati n app aratu
e o ers re s r o s
10 A ST UDY OF P R O LO N GE D FA S T ING .

Spirom ete r fo r stud ying th e m e ch anics Of ven til atio n

. Curves sh o wing o xyge n co nsum p ti o n carbo n di o xi d e pro d u c ti n an d respiratory
,
- o ,

quo ti en t d ur ing nigh t per io d s In th e bed cal o rim e ter fo r th e fo ur d ay s prece ding
t h e fast an d th e first to th e fo urth d ay O f th e fast
s

42 . C ur ves sh o wing o xyg n co nsum ptio n carbo n di o xi d e pro d u c tio n an d resp ir ato ry
e ,
-
.

quo ti ent d ur in g nigh t perio d s in th e bed calo rim e ter fo r th e fif th to th e fif te en th

d ays o f th e fast
43 . Curv es sh o wing o xyge n co nsum p ti o n car bo n d io xi de p o d u c ti o n an d respirato ry
,
- r ,

quo ti en t d urin g nigh t perio d I n th e bed cal orime ter fo r th e sixtee nth to th e
s

twen ty fo ur th days o f th e fast

-

44 . Cu rves sh o wing oxygen co nsum p tio n carbo n diO

.
- xi de p o d u c ti o n an d res pi rato ry
r .

quo ti en t durin g nigh t perio ds n th e bed cal o rim e te r f r th e twen ty fif th to th e

I o -

th i rty fir st days Of th e fast an d th e se co nd an d thir d fo o d da ys

-

Co m ple te m etabo li sm ch art Of fastin g do g (Awro ro w No 2) .

Co m pl ete m etabo li m ch art o f fasting do g (Awro ro w NO 3 )

s .

Me ta bo l i m c h ar t o f th e m o st im m tant fac to m easur ed o n u bj ec t L th ro ug h

s r rs s .

o u t th e fast.
FAS TIN G P
L ATE 1

A . Ch i ic p
arac te r st o se o fL . ii
s tt ng in the Bal c o ny , d i g th
ur n e day w riting
. at hi s de sk .

8 . Use o f Unive rsal Re spiratio n A pparatus fo r study i g th

n e i y c
Re sp rato r Ex han ge wh il e ii
w r t ng .
 INTRO DUCTIO N .

Prolo n ge d fastin g has form e d a part of r eligious c ere mony for c entu
ri e s I n e arly times th e asc e tic in his efforts to subdu e all carn al
.
,

d e sire s b e li e v e d it ne c e ssary to withdraw from th e distractio ns of daily

,

l if e an d to abstain eithe r wholly or in part from food particularly th e ,

fl e sh of animals ; by thus r efraini ng from mate rial thin gs h e hop e d to ,

be fr ee for spiritual thought an d philosop hi cal in trosp e ctio n .

P e riodic fasting still co nstitut e s a part of th e rite s of some r eligious

bodi e s p articularly amo n g th e H e br ews but in mod ern times a pro
, ,

lo n ge d fast is usually u n d ertak en e ither in th e h Ope of curin g or all e

vi ating some a ilmen t or for p e cu ni ar y gain Wh en a fast is re sorte d .

to for its suppos e d therap eutic valu e informatio n as to its history and
,

results usually app e ars in o ne of th e numerous books publishe d by th e

advocat e s of p e culiar di e te tic re gim es Wh en a fast is made by a .

”
so—cal l e d prof essional fas ter for p ecu niary gai n th e subj e ct is e xhi b
“
,

ite d to th e public as an attractio n to th e lov ers of s e nsatio nal amuse

ments Thr ee de cad e s ago such e xh ibitio ns w ere not u n commo n and
.

in ma n y i n stan c e s th e subj e cts cons e n te d (possibly in th e hop e of

in cre asi n g th e i nt er est in the ir p erformanc e ) to more or l e ss strictly
co n troll e d obs ervations of th eir fasts N ot infre qu ently th e obse rva
.

tio ns mad e in the s e prof e ssio nal fasti ng e xhibitio ns have co ntribu te d
mat e rially to th e sum of human kn owl e dge sinc e there is an i nte ns e ,

physiologi cal inte re st in th e vital proc e ss e s during such prolo n ge d

absti nenc e from food .

Wh en o ne co nsiders th e compl e x activiti e s whi ch make up th e lif e of

m an it will be s een that no m e cha nism thus far i nv e n t e d approximat e s
,

th e high organizatio n of th e vital proc e ss e s which are ne c e ssary to th e

lif e of e ven th e simpl e st of th e warm blood e d a nimals ; an d y et sufficien t
-

e xp e rime n tal e vid en c e has b e e n accumulat e d to show that u n d e r n ormal

co nditio ns of life an d with sim ilar routin e th e re are n o marke d vari

, ,

atio n s in th e lif e proc e ss e s of normal individuals U n d er varyin g .

c o n ditio n s of life how e ve r we fi nd that th e vit al activiti e s are carri e d

, ,

o n with a gr e at e r or l e ss i n t en sity this b ein g tru e e v e n of th e n ormal

,

in dividual We thus se e that the re may be de fin it e w e ll e stablishe d

.
,
-

plane s of vital activi ty F or e xampl e whe n th e av erage h e althy indi

.
,

vidual is lyin g in be d asl ee p there is no intell e ctual activity and no e xte r

,

n al muscular activity th e vital acti vity b ei n g o nl y suffici e n t for S impl e

,

mai nten an c e Wh e n h e is lyin g qui e tly in be d awak e th e plane of

.
,

vital activity is highe r and as we study th e me tabolism u n de r th e vary

,

ing co n ditio n s of sittin g stan d i ng walki n g an d doin g muscular work

, , , ,

we fin d an i n cr e asin g in t ensity in th e vital proc e ss e s with an i n cre as e ,

in pro d uctiv e capacity and oft e n an i n cr e as e in e ffici en cy .

12 A S TUDY OF P R O L O NG E D F A S T ING .

Th e av erage normal m an re pres e nts th e mean b e twee n th e two

e xtre me s of th e e maciat e d half starv e d in dividual disi n cli ne d to phys
,
-
,

ic al or me ntal work and th e ov e r fe d obe s e epicure both e xtre mes

,
-
, ,

be in g re lative ly low in vital activity and in productivity F urther .

more if we co nsid e r th e me taboli sm u n d er pathological co nditio ns we

, ,

fin d e ve n gre ate r variatio ns in th e diff e re n t l e ve l s Of vital activity .

Thus a sick p e rso n much e maciate d lyi ng in be d without foo d and

, , ,

with sub normal te mpe ratur e has u nqu estio nably a low c ellular activity
, .

On th e oth e r han d a sick p e rso n with a hi gh f e ve r e ve n wh e n aslee p

, ,

an d without e xt ra neous musc ular activity may hav e a gr e atly i n cre ase d ,

c ellular activity I t will be s een the re fore that from th e sta ndpoi n t
.
, ,

o f both n ormal physiology and pathology a study of huma n i n d ividuals ,

u nde r diffe re nt co nditions and with di ffere nt plane s of activity is of

f undame ntal importa nc e .

For such study it is ess e ntial to d e te rmine th e basal or fu ndamental

me taboli sm whe n th e activitie s are o n a low pla ne to be us e d as a basis
, ,

O f compariso n wi th othe r v alu es We may ask the n What is th e

.
, ,
“

lowe st pl ane of vital activity w hi ch is compatib l e with life ? ”

Unques
tio nably there have be e n se ve re patholo gical cas e s with e maciatio n and ,

muscular atrophy in which lif e has be e n mai ntai ne d at a p l ane far

,

be low tha t which c an be re ache d by th e ave rage normal m an b ut it has ,

bee n th e prime O bj e ct of most i nv estigators in me tabolism to co n ee n

trate the ir eff orts Upo n s e curing with normal i ndividuals physiolo gical
, ,

valu es whi ch may wi ths t critic ism sin c e th e s e co n stitut e th e o nly ,

tru e basis of compari so n .

Ta kin g in to co nside ratio n th e influ e nc e upo n metabolism of muscular

activity of th e in ge stio n of food and th e stat e of b eing awake we may
, , ,

asse rt that th e low est me tabolic plan e would be found for an i n dividual
durin g d ee p sl ee p in be d with compl et e muscular re pose and without
, ,

food in th e alimentary tract As a matte r of fact with most p e opl e

.
,

such a co ndi tio n is usually close ly appro ximate d e ach day about 4 a m . .

Whil e in ge neral no food is tak e n by an in dividual for about 10 or 1 2

hours duri n g th e night y e t for a co nsiderabl e p eriod of time aft e r th e
,

e v e ni ng m e al n utri en ts are be in g absorb e d from th e i ng e st e d food mate

ria l s and carri e d to differen t parts of th e body there to be oxidiz e d or ,

d eposited I t is fur the rmore tru e that c e rtai n mol e c ular fragments
.
,

pro b a b ly aci d in n ature may be absorbe d from th e food materials which

, ,

whe n carri e d to th e various parts of th e body may actu al l y stimulate ,

me taboli sm to a gre ater i n te nsity the se be ing th e so call e d katabolic ,

-

stimuli U su ally th e i nflu e nc e of th e inge stion of food c e ase s from

.

6 to 8 or 1 0 hour s afte r th e me al particularly if th e food in ge st e d is no t

,

prot e in rich Accordin gly for o ne or two hours prior to risin g in th e

-
.
,

morni n g th e n ormal man is probably living at hi s lowe st metabolic

plane .
 P RE V I OU S O B S E R V A TI O N S P R OLO N G E D FA S T S 13
‘

OF .

As is w e ll kn own th e n ormal bo dy is libe rally provide d with re s erve

,

mate rial a f ac t whi ch has b een strikin gly brought out and e mphasiz e d
,
1
by M eltz e r Co n se qu ently th ere is always a pl ethora of availabl e
.

mate rial store d in th e body for dr afts in e merg en ci e s In th e normal .

life of m an th e de mands for nutritio n are usually m e t by p eriodic

,

f ee din g Wh e n th e d e mands are n o t m et body re s e rv e s must be drawn

.
,

upo n Un de r such co ndi tions it is Of p articular in t erest to n ot e what

.

kin d of body mat e rial is first use d th e rapidi ty of its d epl e tio n and th e
-
, ,

proportio ns of th e various body constitu e nts disi nte grate d as th e drafts

co ntinu e I t is to study the s e probl ems that Obse rvatio n s are ma d e
.

upo n fastin g in dividuals Fu rthe rmore sin c e ma ny promi ne n t clin .

,

icians are incline d to co n sid e r dise as e as close ly alli e d to th e various

stage s of i nanitio n data s e cur e d in a study of me tabo lism duri n g fasti ng
,

hav e a gr e at pathological importanc e for int e rpre ti ng th e tra nsforma

tio n s of matte r in dis e as e .

PREVI OUS OBSERVATIONS OF PROLONGED FASTS .

Th e lite rature givi n g th e r esults of obs e rvatio ns duri ng fasts has b ee n

2
re vi e we d at some l e ngth in a pre vio u s publicatio n sp e cial e mphasis ,

be in g laid upo n th e r esults O btaine d in th e e arli e r stage s of a fast I n .

this publicatio n it s e ems d e sirabl e to give a r evi e w of th e lo n ge r fasts

which have b een more or l e ss scie ntifically co ntroll e d and whos e re su lts
c an be co n sid e re d as worthy of car e ful co n sid eratio n .

Th e lo n ge r fasts have almost without e xc eptio n be e n mad e by pro

fessio n al fast ers wh o for purpos e s of exh ibitio n hav e purpos e d goin g
, ,

without food for a d e fini te l e n gth Of time Whil e such a purpose would .

of itse lf s e e m to S how an ab n ormal men tal co nditio n y et th e maj ority ,

of professional fast ers wh o hav e b ee n us e d in thes e e xp e rime nts are for

th e most part physically stro n g an d th e r esults may usually be looke d ,

upo n as of physiological importan c e n o t comp l icat e d by patholo gical ,

l esio ns of any me asurabl e magnitud e This is particularly fortu nat e .

,

as ma ny fasts r e port e d in th e daily pre ss are u n d e rt ak e n as a th e rape utic

me asure to overcome some more or l e ss d e fin it e ly lo c alize d o rganic r

or fu nctio nal troubl e I t is Obvious howe ve r that such e xp e riments

.
, ,

are of physiolo gical import a n c e wh e n th e subj e cts are n ormal i n divid

uals volu n tarily fasti n g u n d e r strict sci en tific co n trol
, .

Many profe ssio nal faste rs hav e mad e e xp e rimen ts Of long er or shorter
duratio n and have b ee n studi e d by various inve stigators but no ne have ,

b een so car e fully stu di e d and had so many exp e rimen ts mad e with
them an d of such lo ng duratio n as th e I talian Succi I nd ee d th e , .
,

classical work of Luciani o n Succi emphasiz e d p erhap s more than any

M lt T h Fac t f S f t y in A nim al S t u c tu a d Ani m al E c n m y H a v y S ci t y
l
e ae r , e o rs o a e r re n o o . r e o e
L c tu N w Y k N Y 1 906 19 07 p 1 39
e res, e or . .
—
, . .

2
B dic t C a n gi I n t W a h Pu b N 7 7 1 90 7
ene , r e e s . s . . o .
, .
14 A S TUDY OF P R O L O N GE D F A S T ING .

othe r pi ec e of re se arch th e importanc e Of studying prolonge d fasti ng .

I n thi s re vi e w of th e lit eratur e o n lo ng fasts th ere fore bri ef d e scriptio ns , ,

of th e fasts made by subj e cts oth er than Succi will first be giv en chro n o
logic ally the s e be in g follow e d by d escriptio n s of e xp erime n ts mad e
,

with th e I talian subj ec t Such discussio n of th e re sul ts as may be .

ne c e ssary will be r e s e rv e d for lat e r chapte rs .

1
Obser vatio ns by Paton and S to ckman An e xp erim en t was made in .
—

th e fall of 1 888 by P ato n an d S tockman o n th e prof e ssio n al faster

Jacqu e s and co ntinu e d for 30 days T h e body w eight was re cord ed .
~

but un fortunate ly th e urin e was analyz ed by th e old hypobromite

me thod Furthe rmore th e valu es for total nitroge n output w e r e un
.
,

doubte dl y disturb e d by th e sin gular fact that th e subj e ct drank from

60 to 3 00 c c of his o wn urine e ach day
. S in c e th e volume of fluid .

tak e n pe r day v aried gre atly th e body w e ight fluctuate d co nsid e rably ,
-
,

ac tual g ai ns in w e ight be in g S how n o n some days N o fe c e s w ere .

passe d durin g th e fast .

Obser vatio ns by L e hma nn , Mueller , Mu nk, S e nator , and Z u ntz ?

Al though this re se arch was hardly lo ng e n ough to be c all e d a study of

prolo nge d fastin g , t h e two e xp erime nts m ad e by Le h mann , Mu e l l e r ,
Munk , Se nator , and Zuntz , o ne o n Ce tti of 1 0 days and o ne o n B re it
haupt of 6 days , pre se nt a study of me tabolism during fasti ng which
has n ev e r b ee n e xc e ll e d in ac curacy for this l e ngth of time Th e .

e xp e rim e n tal plan adopte d in this rese arch has b ee n follow e d with but

min or change s by prac tically all succ ee din g invest ig ators I t was t h e .

in te n tio n to co n tin u e th e e xpe rim en ts with th es e subj e cts for 20

or 3 0 days but the y w e re un avoidably short e ne d owin g to th e co n di
, ,

tio n of th e subj e c ts Th e e xp e rimen t o n C e tti was mad e in March

.

1 88 7 an d th e obse rvatio n s se cure d in this e xp e rim ent we re of such

,

importanc e that th e e xp e rimen te rs took adva ntag e of an opportu nity

occ urrin g in March 1 888 to mak e an e xp e rim ent with th e profe ssion al
faste r B re ithaupt U nfortunate ly this e xp e rime nt co nti nue d o nl y
.

six days O b se rvations w e re mad e in both e xp eriments of th e bo dy

.

functio ns body me asur e ments p ulse rate urine fe c e s an d r e spiratory

, ,
-
, , ,

e xcha n g e an d th e computatio ns and co n clusio n s are of fu n dame n tal

,

M po rtance Th ey will be co ntinually r efe rr e d to in co nne ctio n with

.

this report .

3
Obser vations by van Hoogenhu yze and Verploegh I n a study mad e of .
—

th e urine e xcr e te d by a profe ssio n al fasting woma n van Ho o g enh uy ze ,

an d V e rplo eg h gav e e sp e cial att e ntio n to th e cre ati ni ne co n te n t Th e .

e xp e rim e n t b e ga n o n Jun e 1 1 1 90 5 and en de d Ju ne 25 1 905 ; th e , , ,

— 1 889 1 6 p 1 2 1
lP t n and S to c km an Pr c R o yal S oc
a o f E di b g
n u h 1 888
, o . . o r , , , . .

2L h m ann Mu ll Munk S nat and Z un t A ch iv f path Anat u Ph y i l u f kh n

e , e er , , e o r, z, r . . . . so . . . .

Med 1 89 3 , 13 1 S u , pp p .
,1 . .

f p h y l C h em p
. ,

‘
V an H o o g enh uy z e an d V erploe g h , Z eitsc h r . . si o . .
, 1 905 , 46 , . 4 15 .
 16 A S TUDY OF P R O L O NG E D F A S T ING .

th ex rim t of G rafe with th e Jaquet re spiratio n apparatus at th e

e pe en
1 2

M edi cal C l i ni c in Heidelb e rg is of in te re st in thr owing light u p o n th e

gas e ous e xcha nge and th e characte r of th e katabolism durin g pro l o n ge d
i n anitio n and o n th e ratio of carbon to nitroge n in fastin g uri ne Fur .

th erm o re it substan tiate d th e obs e rvatio n s mad e b y B rugsch an d

,

othe rs o n th e acidosis durin g fastin g as i ndicat e d by th e e xcre tio n of ,

ac e to ne and 6 o xybutyric aci d -

.

Obser vations at Wesleyan Uni ver si ty Mi ddletown Connecticut With , ,

—

a s p e cial vi e w to studying th e drafts upo n body mate rial d uring fasts -

of 24 to 1 68 hours a l e n gthy se ri e s of e xp erime nts was u n d e rtak e n at ,

We sl e ya n Unive rsity Middle town Co nnecticut th e re su l ts of which , , ,

3
have alre ady bee n publishe d These e xp e rimen ts thr e w much l ight .

upo n th e charact er of th e d rafts upon bo dy mate ria l d urin g th e e xperi -

ment al pe riods an d showe d that th e organism and partic u l arly th e

storage of glycoge n in th e body may be gre atly affe cte d by e ve n a
short fas t I t h as furthe rmore bee n shown that glycogen th e body
.
—

mate rial which is first an d most he avily drawn upo n durin g fasti ng may —

be co n sid e re d as o ne of th e most quickly r e alizabl e ass e ts th e r emova l ,

of which affe cts profou n dly o ne Of th e safe ty factors of th e human bo d y .

OBS ERV ATIONS ON S UCCI .

Fast i n Flor ence , 1 8 88 Although a short account of th e e xp eriment .

—

o n Ge tti mad e by Le hma nn , Mu e ll e r , Mun k , S e n ator , an d Z u nt z was

4
publishe d in 1 887 , th e d etails O f th eir investigatio n did n o t app ear
u ntil and th e first exte nsive report of a pro l o n ge d fasti ng i nve sti
g atio n was that mad e by Lucia ni of th e fasti n g e xp e rimen t with S ucci
in F lore nc e durin g th e sprin g Of 1 888 Th e I talian report of this fast .

was publishe d in but th e work is b est kn own to othe r than

’ 7
I talian re ade rs by Fraenk e l s tran slation .

L uciani s study of S ucci include d an e xt e nsive s e ri e s of obs e rvatio ns

’
.

Unfortun ate ly, sin c e th e partitio n of th e nitroge n in th e urine was at

that time imp e rfe ctly u nd erstood an d as th e gas e ous exchange was
studi e d un de r co nditio n s affe ctin g s e riously th e accuracy of th e re sul ts ,

L u ciani s Obse rvatio n s are more e sp e cial l y of valu e as i n d icatio n s of

’

th e g e neral body functio ns of a fastin g man than as measuremen ts of

1G rafe Ze itsch r f ph y si l Ch em 1 9 10 65 p 2 1
, . . o .
, , . .

2
G eh ei mrat W Hi
‘
r n a c nt vi i t to th Nutri ti n Labo ato y info m d u s th at a fastin g
. s, o re e s e o r r , r e

expe im n t wi th a p o f si n al f a te
r e a wo m an co n tinui n g 4 w
r k s h ad bee n c arried o ut no t
es o s r, , ee ,

l ng be fo in his c linic in B lin by Pro f

o re S taeh elin in w hi ch th Jaq u et piratio n appa atu
er esso r , e r es r s

h ad bee n u ed O wi n g to th indi po i ti n Of th
s . u bj c t th e exp er i m e n t w as l su cc
e sf u l s s o e s e , e ss es

th an h ad bee n h pe d an d Pro fesso r S tae h lin em v al to B asel h a i n d fi ni te l y po tpo n d t h e

’
o , e s r o s e s e

publicati n f th esu l ts
o o e r .

g i e I n st W a h Pub N
xB n di t C arn
‘
e e c 7 7 1 90 7 e . s . . O . .
, ,

Lehm ann Mu ll Mun k Se nato r and Z un tz B li n kli n W ch 1 88 7 pp 29 0 and 4 25

4
, e er , , , , er er . o , . .

L eh m ann Mu ll
ls Mun k S nato and Z un t A ch iv f p ath Anat u Ph y i l u f kli n
, e er, , e r, z, r . . . . so . . . .

Med 1 893 131 S upp p 1

.
, , , .
, . .

Lu cian i Fi i l gia del d igi u no ; tud i ull u m Flo nc 1 889

“
, s o o s s
'
o o . re e, .

7 L ci Translati n by M C Fr a nk l Ham burg and L ip i c 1 89 0

u ani D a H un g rn , s e . o . . e e . e s , .
 P RE V I O U S OB S E RV AT I O NS OF P R O L O NGE D FA S T S . 17

S p e ci fi c che mical transformations Su cci s p eculiar psychi c al co n di .

’

tio n a co n ditio n which s eems to be charac te ristic of th e asc e tic who

,

su b j e cts hims elf to a fast of 30 days or more is int ere stingly commen te d ,

upo n in extenso by Luciani Th e re se arch as a whol e was a mod e l in .

plan and as a pain stakin g re cord of Ooop er ative re se arch in fastin g it is

,

eq ual e d o n ly by th e e xp e rime nts of th e B erlin i nv e stigators L u ciani s

’
.

study u n qu e stio n ably stimul ate d th e co nsiderabl e numb e r of experi

me n ts subse qu ently carri e d out with S ucci at l e ast 7 exp e rime nts e ach , ,

co n tin ui ng 20 or mor e days b eing mad e with him by di ff er ent in v e sti,

gato rs and in di ffe rent plac e s

’

Fasts i n Milan and Paris 1 886 —

I n r e porti n g th e r e sults of th e , .

F lorenc e fast Luciani r efers to two fasts said by Succi to hav e b e en

,

made pre viously o ne in Milan in August and Se pte mb er 1 886 an d a

, ,

se co n d in P aris in th e latte r part of N ov emb er and th e e arly part of

D e c e mb er 1 88 6 Th e S hort time b e tw e en th e fasts is of S p e cial in t e rest
. .

Littl e is k nown re gardin g th ese two fasts but Luciani co nsid e re d th e ,

re cords of th e body weights Obtai ne d from Su c ci s n ot ebooks suffici e ntly

-
’

re liab l e to i nclud e in th e publishe d report of hi s re s e arch an d h e plott e d

curve s from the m S howi ng th e loss in body w eight during th e fasts -
.

Fast i n L ondon 1 8 90 I n 1 890 S ucci carri e d out a 4 0 day fast in

, .
— -

1
Lo ndo n whi ch b e gan o n March 1 7
,
Although Obs e rvatio ns we re .

mad e of a numb er of factors durin g this fast th e co ntrols w e re so ,

in comp l e t e that aside from th e body w eight th e obs e rvatio ns hav e but
,
-
,

litt l e valu e at th e pre s ent time T h e body w eights w e re appare ntly .

-

r ecorde d with a gre at de gr ee of accuracy and form th e basis of a curve

whi ch will be discusse d lat er N o stat e ments accompani e d th e re cords .

of th e pu l se an d r espiratio n as to whether th e subj e ct was lyi n g S ittin g , ,

or stan din g so that the y c an hav e but little Sig nifica n c e ; fluctuatio n s
,

in th e puls e r at e give e vid e n c e of mark e d cha n ge s in th e muscular

-

activity at time s S tren gth t e sts we re made with a han d dyn amome t e r
.

e ach d ay showin g practically no al teratio n in th e stre n gth Th e

, .

axi ll ary re cords Of th e body te mp erature i n dicat e a low eri ng of th e

.
-

temp erature toward th e en d of th e fast .

Fast i n New York 1 890 Accor di ng to Su cci s o wn stat e me nts —

’
.
, ,

substantiat e d b y newspap er reports S ucci carri e d out a larg e numb er ,

of fasts which were no t sci entifically co n troll e d One of th e most .

important of the s e was made in New York City about 8 mo n ths afte r
th e L o n do n fast 2
T h e New Y ork fast b e ga n o n N ov e m b e r 6 1 890
.
, ,

an d was said to have co n tin u e d 4 5 days Corr e spo n de nc e with s e veral .

of th e physicians who attend e d this fast shows a diversity Of opinio n as

to its authe nticity On th e othe r ha n d th e body w eights r e corde d if
.
,
-
,

corre ct i n d icat e about th e usual loss in we ight th e re cords b ei n g

, ,

l
B ritish Med Jo urn . pp 7 64 8 1 9 87 6 935 99 6 and 1 05 6 al so p 1 4 4 4
.
, 1 89 0 , .
, , , , , , . .

2
T h e New o r a Y k D ily Tr i bun e No vem be r 6 1 890 and D ec em be 2 1 1 890
, , , r , .
18 A STUDY OF P R O L O NG E D F A S T IN G .

pou nds kilograms) at th e b e ginn in g of th e fast an d pou nds

kilogr ams ) at th e e n d .

Fast i n Naples 1 892 Th e ne xt sci e ntifi cally co n tro ll e d fast with

, .
—

S ucci was in N ap l es be ginnin g August ,

Obs ervatio ns we re -

1
made b y Aj ell o an d S o laro m o st of the se b ei ng o n th e urine Th e , , .

body weight was l ik ewis e caref t

-
re corded as th e fast progr e ss ed as ,

w ell as th e amou nts of water tak en Th e d et e rmi natio ns mad e o n th e .

urin e which are of i n te rest at t hi s time are those of th e chlori ne and

phosphoric and sulphuric acids On th e se co nd day of th e fast 2 .
,

grams of fe c e s we re passe d an d o n th e e l e ve nth day 3 1 7 grams , .

Fast in Rom e 1 89 3 A numbe r of O bs ervatio n s w e re mad e o n S ucci

,
.
—

2
by Dutto and Lo Mo naco d urin g a 20 day fast in R ome b e gi nnin g
- -

D e c e mbe r 1 6 1 893 Th e body weight was r e cor d e d e ach day also

, .
-
,

th e amou n t of wate r tak e n An al yse s we re mad e of th e uri ne e xcre t e d

.
,

thes e b ein g much m Ore compl e te tha n in any of th e e arli e r fasts as th e ,

nitroge n was d e te rmi ne d by th e K j e l d ahl m e thod D e t ermi natio n s .

w e re also mad e of th e aci dity of th e urin e and th e co nt e n t of sulphur ,

e th e re al sulpha te s n eutral sulphur ch l ori n e phosphorus sodium an d

, , , , ,

potassium .

Fast in Vie nna 1 896 Th e uri n e e xcre t e d by S ucci in a 21 day fast

,
.
- -

3
was stu d i e d by E and O F re u nd in Vi e nn a in 1 896 an e xtensiv e
. .
,

p artitio n of th e n itrogen be in g att e mpt e d for th e first time Th e .

obse rvatio ns as to S uc c i s co n d itio n i ncludi n g th e body we ight w ere’

,
-
,

unfortun ate ly lost .

Fast i n Z uric h 1 8 9 6 Duri ng a 21 day fast of S ucci in Z urich

, .
- -
,

be gi nni n g Sept e mbe r 1 3 1 896 Daibe r stu die d th e uri n e and obtai ne d
“
, ,

th e body w eight
-
Th e body t e mp e rature th e amou nt of wat e r tak e n
.
-
, ,

an d th e chl orid e s in th e urine we re a l l d e t e rmi n e d with suffici e n t accu

racy to m ak e the m of value at th e pre s e nt day .

Fast in H amburg 1 9 04 Th e last re cord e d e xp erimen t o n S ucci was

,
.
—

mad e in H amburg in March 1 904 D uri n g th e last 1 0 days of t h is .

5
3 0 day fast th e uri ne was exami ne d by B rugsch who d e t e rmine d th e
-
, ,

partitio n of th e ni troge n S p e cial e mphasis w as laid upo n th e acidosis

. .

Aj ll a d S l
l
e o L R if m a M d ic a 1 893 2 p 54 2
n o aro , a or e , , , . .

D utt and L M c P l lini 1 89 5 2 p 1

2
o o- o na o, o Ic co , , , . .

E3 d O F u d Wi n
. an kl i n R und ch u 1 9 0 1 1 5 pp 6 9 and 9 1
. re n , e er . s a , , ,
. .

Daib
‘
S ch w iz W ch f C h m
e r. Ph a m 1 896 34 p 3 9 5
e . o . . e . 11 . r .
, , , . .

B rug c h Z it h f xp P th Th api 1 90 5 1 p 4 1 9
5
s , e sc r . . e . a . 11 . er e, , , . .
FAS T ING PL ATE 2

C . Respiratio n e xpe rime nt made by T M Carpe nte r o n the Universal Respi ratio n A pparatu s
. . , .

T hese e xpe rime nts we re made each mo rni ng just afte r the S ubje ct le ft the Respiratio n Calo ri
,

me ter and be fo re he sto o d up

, .

D Weighing the S ub ee t o n the T hirty-first day o f the Fast A t the rig ht as sho wn the Be d o n
'

.
.

w hi c h he has just rushe d the Respi rati o n EXpe n me nt ; the Unive rsal Respi ratio n A pparatus
is sho w n at the extre me right
.
RESEARCH ON METABOL ISM IN PROLONGED FASTING AT
THE NUTRITION LABORATORY .

PROBLE MS TO BE STUDIED .

I n th e re s earch o n me tabolism durin g short fastin g p eriods w hi ch ,

was carrie d out at We sl eya n Univ ersity Middl e town Co nne cticut th e , , ,

chan ge s in cidental to th e first days of fastin g w ere it is b e li e ve d ade , ,

q u ately studi e d On th e oth e r han d it was d esirabl e to suppl e men t th e

.
,

e arli e r obs e rvatio n s by a study of th e me tabolism durin g prolo n ge d

fastin g sin c e ma ny poin ts re gardin g th e cours e of th e me tabolism

,

aft e r th e bo d y had adj uste d its e l f to th e fastin g co n ditio n had no t b ee n

e stablish e d . F or in stan c e as th e fast progre ss e s it is importa nt to
,

k now whethe r th e gross me tabolism alt e rs e ither per kilogram of body

w e ight or per square me ter of body surfac e also W hethe r th e acidosis -
,

is extr e me or wh e the r th ere is an acquir e d tol e ra nc e of it an d what ,

e ffe ct th e acidosis if pres en t has upon th e m etaboli sm S in c e th e

, ,
.

carbo n th e ammonia and th e h e at of combustio n of th e uri ne also

, , ,

th e compositio n of th e alve olar air giv e in di catio n s as to acidosis a , ,

study of prolo n ge d fastin g should in clud e d e te rmi n atio ns of all of th es e

factors I n th e e arlie r fastin g study d e t e rminatio n s w ere mad e of a
.

numb e r of th e co n stitu ents of th e uri ne in cluding total so lids nitroge n , , ,

cre ati ne and cre ati nin e phosphorus sulphur and c hl ori ne I n th e
, , ,
.

lo n ger re se arch it would be ne c e ssary to e laborate the se d e te rmin a

tio n s studyin g also th e composition of th e fe c e s should any be p ass e d
, ,

duri n g th e p e riod Fu rthe rmore th e relatio n s hi p b e twee n th e pulse

.
,

rat e and th e me tabolism th e charact er of th e re spiratio n as shown by

,

grap hi c re cords th e variatio ns in th e body t e mp e rature and th e cha ng es

,
-
,

in th e compositio n of th e blood all have sufficie n t significa n c e to ,

warran t i nv estigatio n S i nc e muscular activity has so gre at an influ

.

e n c e upo n me tabolism th e e xp e rim e n ts of Z un t z o n B r e ithaupt should

,

be duplicat e d with more mode rn t e ch niqu e Compariso n should be .

mad e of th e me tabolism in s el e cte d p eriods with co nstant e xte rn al

c o n ditio n s i n st e ad of with chan gin g activity as in th e e arli e r r e s e arch ,

an d e xp e rime n ts in which th e subj e ct bre ath e d a hi gh oxyg en atmos

ph ere would also be d esirabl e .

Th e N utritio n L aboratory was e sp e cially fitt e d to carry out a r e s e arch

of this ki nd b ein g w e ll e quipp e d with apparatus for d etermin in g th e
,

respiratory e xchan ge and th e he at output as well as for me asuring th e ,

pu l se r e spiratio n an d muscular activity

, ,
I t was the refore of fu n da .

me ntal importanc e to hav e re ady a care fully pre pare d plan for studyi ng
th e me tabo l ism duri n g prolo n ge d fasti n g which could be us e d wh e n
e ve r an Opportu nity o ffe r e d for co n ductin g such a r e s e arch On th e .

other han d it was no t d e sirabl e to mak e u n du e haste in b e ginn in g th e

,

19
20 A S TUDY or PR O L O N G E D F A S T ING .

stu d y in asmuch as th e e quipme n t of th e L aboratory was ste adi l y b e i ng

,

in cre ase d Th e che mical te chniqu e was also b e ing rapidly p e rf e cte d
.
,

th e d e ve lopme n t of th e new mi cro methods of Profe ssor F o l i n b e i n g of

e sp e cial val u e in studyin g th e re l ativ e ly small volume s of uri ne e xcr e t e d

durin g prolo nge d fastin g .

SELECTION OF S UBJECT .

While no p articular e ffort was mad e to s e cur e a subj e ct for this

res earch adva ntage was tak e n of a visit to New York by S ucci to co nfe r
,

with him H is age and his some what u nr e aso n abl e d e mands for a
.

large comp e nsatio n made an arran gemen t with him u nde sirabl e F ur .

th erm o re h e would n o t have coop e rate d r eadily in th e gre at numbe r of

,

te sts that we re in clud e d in th e pla n for th e fasti ng re s e arch A numb e r .

of in dividuals stimul ate d by th e report of th e e arli e r study o ffe re d

, ,

the mse lve s to th e N utrition L aboratory as subj e cts for a fastin g e xpe ri
men t A large maj ority of the s e we re e ithe r sufferers or ima gi ne d that
.

”
the y w e re su ffe re rs from nervous dis e ase and w e re there for e patho
“
,

logically o r psychologica l ly u n d e sir abl e Furthe rmore no ne of the m.

,

had a cl e ar co nc eptio n of a scientifically co ntroll e d fast and of th e

importan c e of th e obs e rvatio n s which would be in clud e d in such a
re se arch The y w e re the re fore no t se riously co nsid ere d
. .

I n th e spri n g of 1 9 1 1 a l e tte r was re c eiv e d from A L e van zin of Malta

, .
,

o ffe ring hims elf as a su b j e ct for a lo n g fastin g e xp e rime nt to be carri e d

out at th e N utritio n Laboratory Th e l e tt er was volumi nous but ve ry
.
,

in t elli ge ntly writte n and show e d an appre ciatio n of th e sci e nti fi c valu e
,

of such a re s e arch As Profe ssor Luciani of R ome who had ma de

.
, ,

th e classical study with Succi lat e r e xp re ss e d his co n fi d e n c e in th e

,

ab ility of L e vanzin to c arry out a fast of this l e ngth it s e e me d p robabl e ,

that th e subj e ct d esire d for th e re se arch had b e e n fou nd I t was sub .

se qu e ntly l e arne d that P rofe ssor L u c iani s acquain tanc e with L e vanzin
’

was through corre spo n den c e o nly but his re commendatio n w ent far
,

to co nvi nc e us of th e de sirability of att e mp ti n g an e xp erimen t with

this man A ccor dingly an e xact stat emen t was s e n t A L of th e dutie s
. . .

in vo l ve d in a re se arch of t hi s n atur e an d an arrange men t was e n te re d

i n to for him to come to B osto n for th e purpos e I n accorda nc e with .

his o wn propositio n th e agr ee ment was mad e to cover his e xp ens e s with
, ,

a bo nus if th e e xp e riment was succ e ssfully compl e te d an d e very ,

atte mpt was made to mi nimi z e anxie ty o n th e part of th e subj e ct T h e .

risk of protract e d il l ne ss in cid en tal to th e j ourn ey from Malta to B osto n ,

to th e chang e in climat e an d possibly as a r e sult of th e fasti n g experi

,

men t ha d to be co nsi d e re d and a swor n state me nt e xo n eratin g th e

, ,

N utritio n L aboratory from any re spo n sibi l ity for il lne ss of more than
4 days duratio n was obtaine d from L b e for e h e l e ft Malta
’
. .
22 A ST UDY OF P R O L O NG E D F A S T ING .

AUTOBI OG RAPHI CAL NOTES .

On th e twe n ty ninth thirtie th an d thirty first days of his fast at th e

-
, ,
-

N utritio n L aboratory L wrot e a sk e tch of his life This is reproduc e d ,

. .

ve r b atim sin c e it shows ma ny of th e i nt ere stin g fe ature s of th e lif e

, ,

e ducatio n an d habits of thought of th e subj e ct

, .

o f May
(29th day of my fast)
1 2th ,
1 9 12 .

Mo re th an o ne hundre d ye ars ag o G ab ri el e Avan z ino a Si cili an settl ed in , , ,

Mal ta G rad ually th e sur nam e was c o rru p ted i nto L e vanzin My mo th e r
. .
,

Lo re nz a B org l ivi ng an d ag e d ab o ut 58 d escend s from pure and no bl e Mal tese

, ,

bl ood sinc e 4 00 ye ars Her grandfather s uncl e was th e fam o us Vince nz o

.
’

B arb ara th e d aring se a c ap tain o f o ne o f th e French b attl e shi p s wh o was b y

,
- -

B ot ta and other histo ri ans fal se l y accuse d o f having b etraye d Marat when h e
l an d ed him to tak e po ssessi o n o f N apl es o n b eh al f o f N ap o l eo n B arb ar a was .

th e right arm o f N ap o l eo n to pl o t an d g e t rid Mal ta fro m th e yo k e o f th e

K nights of S t John and h e was al so th e first G ran d Mas ter o f Free Mas o ns
.
- -

in t h e I sl an d Her gran dfath e r was Jose ph B o rg ano ther sea c ap t ain wh o

.
,
-

came to Americ a in th e time of th e R evo l utio n vol unteered with th e insurgents ,

and fo ught fo r th e Am e ric an i nd e p end e nc e many b att l es as in h is p o rtrai t th at

we k ee p h e h as o n his b re ast fro m seve n to eight med al s Th at is why I .

p ro b abl y l o ve so much freed o m ind e pe ndence of thought an d sym p athi z e , ,

k ee nl y with Am e ric a .

My father Pao l o l iving and age d ab o ut 68 is al so th e so n of a sea c ap tain ,

-

Agosti no wlio w as dro wne d when my father was o nly 3 ye ars o f age and so
, , ,

could no t have a l ib eral e duc atio n He l earne d th e art o f sh i p buildin g wh ich .

-

was ve ry fl o uri shi ng in tho se c omm erci al tim es but now b eing di sabl e d from ,

b oth his ha n d s th ro ugh two accid e nts that h appe ne d to h im duri ng his wo rk ,

h e 1 8 c arrying a gro cery sho p in a vi ll age as my mo th e r 1 8 c arryi ng a co nfe c

-

tio ne ry and to y o ne in th e same pl ac e Th ey are b o th very ho nest an d h ard .

wo rkin g p eo pl e and al tho ugh th ey have suffici en t p ro p erty to k ee p them up

c o m fo rt abl y d uri ng their o ld d ays they do no t want to give up th eir business ,
”
as th ey want to l e ave us something after their d e ath
“
I h ave a sister .
,

Tere si na 20 years l iving wi th my mo th er and a marrie d o ne to an engi neer

, , ,

U rsol a 28 ye ars
,
.

I was b orn in th e C itt a C o p cus o

s i f M a l t a o n h
t e 2 3 rd of M a y 1 87 2 —
40 , ,

ye ars ag o At 6 ye ars o f ag e I we nt to Egypt wi th my mo ther where my

.

father was wo rki ng b ut c ame b ack afte r two years as th e h o t c limate did no t
su it us . q u
Fre e te n d th e p ubl ic f ree sch oo l s a n d at te n h ad my fi rst p ri z e—-
a
hi
fi ve s l n l i g p i e c e — f r writi n g th e b est essay ag ai nst
o C rue l ty to Animal s “
.
"

Then p riz es fo r drawi ng as I am very fo nd o f art esp e ci all y o f m usi c an d

p ai nting At 1 2 I entere d th e free D o ckyard S ch o o l s and h ad several p ri z e s
. .

At 1 4 I was admi tte d b y c omp e titive examin ati o n as shi pwright app re ntice as
I wish e d to fo ll o w my father s c areer th en p ro mo te d to d raugh tsm an an d th en
’
,

to cl erk From infan cy I was al ways i n c l in e d to h ard study an d so m e time s

.

d uring th e night I use d to ste al o ut o f bed to re ad so m e interesting b o o k

b ec ause my p are nts di d no t l ik e to se e m e o verstrain my alre ady we ak e yes .

Dur ing th e tim e that I se rve d my app rentic eshi p l n th e D o c kyard I p ubl ishe d
two we ekly p ap e rs successive ly in Mal tese th e
”
,
Habit ta Cu llh add (T h e
,
“

”
Frien d o f All) and I s S engka (Art) to e d uc ate and e nl ighte n th e wo rking
-

c l asses that live m a very mi serabl e co nditio n and are to tally fo rsak en by th e
G o vernm e nt but b o th p ap ers fail e d after a few mo n ths thro ugh l ac k o f sub
,

sc ri b ers At 1 7 I fe l t i nc l ine d to foll ow th e e cc l esi astic al c are er to d evote

.
 AUT O B I O G R APHI C AL N O TE S . 23

m yse l f tirel y to study and o rato ry that I lik e so m uch an d b e came a cl eric
en , , ,

but after fo ur years through matter o f c o nvicti o ns an d b igo te d tyranny o f th e

,

sup e ri o rs I put Off my bl ac k ro b e and e nt e re d th e Lyc eum to p re p are myse l f

,

fo r a p ro fession al c are er .

At 20 ( 1 892) I p asse d my matricu l ati o n exam in atl o n and to o k up th e me dic al

c ourses At th e same time I was co ntrib uting l iterary and p o l itical c ontribu
.

tions to o ur b est p ap ers and publ ishe d se veral p oems in I tali an that were very
favo rabl y app reci ate d b y th e p ress I star t e d al so th e publ ic atio n o f a .

U niversity Magaz ine L 0 S tudente M altese to stimul ate th e o th er stu d ents to

c o ntri bute literary and scientifi c articl es an d I publish e d in Engl ish an d
I tali an a st udy o n S h ak e sp e are an dr ama and some b iographies o f emi ne nt
Mal te se p erso nages T h e p ap er dr agge d a stinty existen ce fo r two ye ars an d
.

p erish e d through l ack o f fun ds At th e same time I was c o n d ucting two o the r
.

p o l itic al p ape rs in vern acul ar (Mal te s e) th e Co ttonera and th e Habit ta l

”
,
“ “ ’

”
an d it was o n e o f th e art ic l es c o ntri b ute d to th e Cottonera that
“
Paplu ,

p ro vo k e d ag ainst m e my fi rst l ib e l and was tri e d by j ury .

My father was still wo rking in D o ckyard and as h is fo reman use d to t ak e

b rib es from his empl o ye es and b o rro w from them m o ney that h e never use d to
re tu rn b ac k an d as my f ath e r di d n e ve r l i k e to sati sfy h im in thi s b e c ause h e
,

fulfill e d al ways all h is d uti es ho n estly and regul arl y h e b ec ame h is sc ap ego at
and was al ways o r d e re d to do th e mo st d angero us and h ar d ki n d o f wo rk .

Twice h e was hurt twice amp utati o ns h ad b e en Op erate d o n finge rs o f b o th

,

hand s with p e ri l to h is l ife till h e b ec ame a di sabl e d m an I p ro teste d to th e

, ,
.

sup e ri o rs an d th ey answere d th at they d i d no t c are a b it ab o u t it an d so at ,

l ast I p ubl ishe d in th e Co tton era in 1 895 a vi o l ent articl e in English in

,
“
, ,

whi ch I e numerate d with d etail s th e many b rib e s and i rregu l ariti es th at were
c o ntinu all y c ommitte d in H M D o cky ard signe d th e articl e an d d e fi e d th e
. .
,

Ad m i ral S up erinte n d e nt that I was re ady to p ro ve in c o urt all my asserti o ns .

T h e artic l e p ro vo k e d a gre at sc an d al and th e Admiral w as o bl ige d to arraign

m e b efo re th e c rim i n al c o urts to p ro ve my asse rti o ns T h e p en al ty d eman d e d .

a ainst m e was six mo nth s o f h ar d l ab o r imp ri so nme n t an d a fin e Of £ 500

Ag
.

I m y asse rti o ns were p ro ve d to th e very h i l t aft er a fi erc e fi ght an d I was

trium p h an tl y ac q uitt e d u n animously b y th e j ury
,
As I w as d efen di ng th e
,
.

c ause o f thousand s o f l e ech bl e d victims against a few vamp ire s I was tri umph
-

e ntl y c arri e d o n th e sho u ld e rs O f th e wo rkme n wi th b e ngal a fi res an d b an d s ,

-

pl ayi ng but th e n ext mo rning m y father was di sch arge d fro m th e D o ckyar d
,

and l o st h is b re ad th at was k ee p ing I fe l t th e sh o c k tremend o usl y but

di d n o t di sco urage myse l f I put myse l f in c o rresp o n d en ce wi th Mr L ab o u
. .

”
ch ere o f th e Tru th o f Lo n d o n wh o no t o nl y p ubli she d my c o ntrib uti o ns in
,

h is very i n fluenti al p ap e r but b rought th e matter b e fo re Parl i ament b eing an ,

M P and fo ught it o ut very b ravel y A C ommi ssio n was se nt to Mal t a

. .
, .

and all my stateme nts h ave b e en fo u n d to be t ru e my father was put to wo rk

“

agai n an d seve ral imp o rt an t refo rms were i ntro d u c e d

, B ut after a few .

m o nths my father was di sch arge d again and un d er th e fre e an d

gl o rio us b anner o f l ib eral
T h e l ib e l to o k place o n th e 7 th o f August 1 89 5 I n S e p t emb er o f th e same , .

ye ar I to o k my d e gree of B ache l o r o f Art s fro m th e Mal ta U niversity afte r

,

Ob taini ng fo r thre e ye ars a 50 pe r c ent in higher mathematic s p h ysic s n atural , ,

h i sto ry p h i l o so phy Lati n Engl i sh an d I t al i an l ite ratur e and histo ry

, , , Bu t .

m y fath er ab o ut that time was o ut o f wo rk an d so I h ad to add to my al re ady

o verstrai ni ng wo rk p riv at e l esso ns afte r my l e c ture s so m etimes ti ll 1 0 p m ,
. .
,

and pl o dd e d o n in thi s ve ry h ar d an d anxi o us l ife fo r ab o u t two ye ars in wh i ch

I have fo ll o we d successfully th e An at o m ic al G e neral an d Path o l o gic al th e , ,

D isse cti o nal th e Physio l o gic al th e Ob ste tric al th e S urgi c al th e G ene ral
, , , ,
24 A ST UDY OF P R O L O NG E D F A S T ING .

Patho l o gy , th e C h emi stry , th e B ac te ri o l o gy , th e Mate ri a Me dic a, th e The ra

pe u tic al and th e Ph armaceutic al C o urses B ut as at that time I was un d er th e .

fal se imp ressio n th at as I was wo rking mentall y very hard I h ad to e at mo re

and mo re , I use d t o stuff myse l f wi th a lo t o f me at and e ggs an d mi lk an d these ,
add e d to th e gre at o verst rai n, sh attere d my n e rvo us system d o wn wi th a severe
sho c k o f n e urast h e nia My p rofesso rs gave m e th e go o d advice to tak e a l o ng
.

rest an d to susp e n d my stu di es fo r a p ro l o nge d pe ri o d o f time B ut my famil y .

c o uld no t aff o rd th at fo r my fath er was no t wo rki ng all th e time and I h ad to

wo rk to l ive S o I to o k t h e warr ant as a Ph arm aceutical C h emist af te r a
.
-

se ve re examin ati o n an d was empl o ye d as d ire c to r o f th e mo st i m p o rt an t

pharmacy in Vall e tta (th e c ap ital Of Mal ta) , c all e d Miz z i s Disp ensary
“ ’ ”
.

I live d there fo r a ye ar and my neur asthe ni a g o t a l ittl e b ette r thr o ugh enfo rce d
rest .

B ut I l iving away fro m my family an d h ad to run i nt o many exp ense s

was
to have my me al s in ho te ls an d I w as al ways sl ee p i ng in th e pharmacy n o t to
c ro ss th e se a l ate in th e night an d g o home S O I empl oye d mysel f in a p h ar .

macy at C ospic ua very near ho m e and l ive d t h e re fo r ab out two years My

, , .

fath e r and mo ther at th e sam e time starte d the ir b usiness and were p ro gressi ng
ve ry p ro spe ro usl y My wife Lucia live d j ust Opp o site and we l o ve d e ach
.
, , ,

o the r I marri e d h er o n th e 24 th o f Ap ri l 1 900 S h e is th e e lde st d aughter

.
, .

of D o cto r G F Ing lo tt Medic al Officer to G ove rnm e nt K night o f th e POpe

. .
, , ,

an d me m b e r o f se ve ral l it e rary and sci e nti fi c ac ad emi e s an d is c o nsi d e re d as

t h e mo st c l e ve r Ob ste tri ci an an d gyne c o l o gi st in Mal ta e nj oyi ng a ve ry wi d e ,

p rac tice S o I was de te rmi ne d by h im to start a pharmacy o f my o wn which

.
,

I did and th e re sult was a very successful o ne but a sh o rt time afte r th e ,

Transvaal W ar b ro ke o ut and as h e is well c o nve rsant wi th th e Engli sh lan

gu age was c all e d by th e mi li tary autho riti es in charge Of th e Military H ospital
and so all his tim e w as ab so rbe d in the se ex acti ng d utie s an d c o uld n o t t ak e
c are any mo re of his p rivate p ractic e This l asted fo r o ver two years and at .

l ast th e p h armacy b ro ke d o wn and I h ad to rem o ve to a we al thy country

d istric t call e d B irchircara .

f May 1 9 1 2 (3 0th day of my fast)

1 3 th o , .

B efo re go ing to l ive in B i c rc a a I ad f ug t

r hi r h o h t w o g re t b tt l e
a a s—
o ne o n
be hal f o f d o wn tro dde n an d negl e cte d D emo c racy an d th e o ther o ne advo c ati ng
-

th e mai nte nance in o ur tri b unal s o f th e I tal i an l anguage that h as be en th e

means o f o ur civi li z ati o n sinc e ab o ut 600 years I have fo und e d th e fi rst .

“
Mal t a Trad e U nio n o f which I was e l e cte d Pre si d ent wi th 700 me m b e rs
”
, , ,

free schoo ls l e ctures h onest amusements b and and c arri e d it o n successfully

, , , ,

fo r so me time but p o l itic al i ntrigu e no t to e nc o urage a lab0 1 p arty and no t to

,

e nl ighte n th e l o wer c l ass mad e it d win dl e i n to n o thi ngness an d all my l o ve s “ ’

”
l abo r was l o st .

Then I went to I t aly at my o wn expe nse fo r ab o ut a mo nth to l e cture , , ,

ag ai nst Mr C h am b e rl ai n s (Engl an d s Prime Mini ste r at th at ti m e ) e di ct that

’ ’
.

t h e I tal i an l angu age h ad t o be c l e are d o ff from o ur c o urts with in a l ap se o f

fifteen years T h e mo vement h ad some go o d effe ct b ec ause all th e I tal i an
.
,

p ress was awakene d and p ro te ste d l o u dly and vigo ro usly and Mr C hamb erl ai n .

h ad to give up his Ord e r in C o unci l .

Af te r c re ating in B irchi rc ara a p ro sp e ro us p ractic e fo r my pharm acy I

wi she d to p ro vi d e fo r th e future and as my ne urasth eni a was p ro gressi ng ,

t h ro ugh th e very c l ose and se d ent ary l ife that I was c o n ducting sh ut up from ,

7 a m to 1 0 p m i nc l u di ng ho l i d ays I d eterm ine d t o se c ure a mo re e asy

. . . .
, ,

c aree r— law I e ntere d th e l egal c ourse and suc ce ed e d to Ob tain a warrant

. .

B ut to co nti nue to c arry o n th e pharm acy to keep up my fami ly and to fo ll ow , ,

 AU T O B I O G R A P HI C AL N O T E S . 25

a d iffi cul t uni versity course was a very s evere t est o n my al re ady sh att ere d
n erve s an d al ways u nd er th e fal s e i d e a th at to wo r k very h ar d I h ad t o o ve re at
,

and to st uff myse l f with as much p ro tein as p o ssibl e I rui n e d my he al th t o su ch ,

an exte nt th at I was comp e ll e d t o give up my p h armacy f o rever an d d e di c ate

myse l f to th e p ractice o f law th at o ff ere d mo re l ei sure and al so b ette r p ro sp e cts
fo r m e as I was an d am sti ll very p op ul ar and b e l o ve d b y th e p eopl e Fo r tu .

mate l y eno ugh to help m e at th e st art of my l egal c are er I w as o ffere d at S l i ema ,

(a b e autiful summ er resort in Mal ta) th e management Of a p harmacy with a

ve ry goo d sal ary with th e p ermi ssion to ab sent myse l f duri ng th e mo rning
ho urs to g o to co urt and pl ead my c ases S o I went to l ive there and Mirand a .

C o rd e li a was b orn whil e Jo l an d a B e atrice was b o rn in B irchir car a My l egal

,
.

p ractice p ro sp ere d so rap idly th at after a ye ar I h ad to give u p my p harmacy

managem ent and d edic ate mysel f entirely to th e l egal c are er that I am sti ll
fo ll o wi ng at p resent .

W h en I tho ugh t to have fixed a soli d b asis fo r my fami l y s sub sisten c e I trie d ’

again to do so m e go o d wo rk fo r th e c ause o f o u r trampl e d d o wn an d utterl y

negl e ct e d l o we r c l asse s I t h as b ee n al ways my i d e al to e n lighten th em to
.
,

he lp them to p ush themsel ves fo rward as th e wo rkmen Of o the r mo re pro gre s

sive c o untri e s do b e c ause al tho ugh I have p arte d from th eir c l ass my d emo
,

cratic so ul was always with the m So I starte d th e p ublic ati o n o f a weekl y .

”
p ap er entitl e d I n Nahla (Th e B ee) th e sc Ope o f wh ich was to instruct
“

in sci enti fi c artistic histo ric al an d l it e rary kn o wl e d ge as pl ai nl y an d as e nte r

, , , ,

tainin gly as p o ssibl e Th e e ffort was a b ri ll i an t succ e ss b e c ause I h ad imm e di

.

ate ly th e gr e atest circ u l ati o n ever attai ne d b y any p ape r p u bl ish e d in any
l angu age in M al ta My wife Co op erat e d he rse l f very effectively b ec ause sh e
.

co ntributed every we ek some interesting artic l e ab out th e re aring up o f

, ,

b ab ie s hygi en e against th e marri age o f co nsump tives o r b etwe en re l ative s e tc

, , , .

”
I h ave publ i she d in th e same p ap er a historical no vel I s S ahhar Falzon “

(Th e Wi z ard Falz o n) in which I have tre at e d f ull y an d f ai thf ully all th e
histo ry Of th e fi rst 60 years o f th e d omini o n o f th e Knigh ts o f Mal ta o ver th e
I sl and from L isleadam to L a C assiere My intent was to teach to th e p e o pl e .

its hi sto ry n o t in th e usu al p e d antic and mo not o nou s way but e nh an ci ng it by

intermingling to it th e attractive e pi so des of chival ry and lo ve I n th e th ird .

p art Of th e nove l I h ave t rie d th e sci entific no ve l tryi ng to p o p ul ari z e sci ence in
a d e l e ctabl e an d e asy way as I h ave d o ne wi th hi st o ry an d as Falz o n was a ,

Roman C atho l ic p ri e st wh o was b urn e d up al ive accuse d o f witchcraft I ,

d eve l o p e d all th e up to d at e p ositive k no wl e dge ab out p sychic al scie nc e of

- -

wh ich I am an ar dent and k een stud ent I n many no te s I have suggeste d th e .

b est b oo k s and autho rs and d escri b e d th e mo st autho rit ative e xp eriment fo r

tho se wh o wishe d to d e l ve d e ep er i nt o th e matter All th e f ac ts ab o ut Falz o n.

were gathere d through a lo t o f p o ki ng in o ur archives amo ngst very rare

m anuscrip ts of tho se p ast d ark and b arb aro us ages Thi s no ve l was a gre at
, , .

succ e ss be c ause I h ad to p ubl i sh se p ar at e l y in thre e vo l um es c omp risi ng o ver

6 50 l arge p age s an d th e e ditio n was so ld o ut very r ap i dl y .

”
I n th e N ahla I have no t o nl y trie d to i nstru ct th e l o we r c l asse s but I h ave
“

fought hard al so to defend th eir rights and to uplift my vo ice fo r th e inj ustices
c omm itte d agai nst them Twice I was trie d b y j ury fo r l ib e l o us artic l es but
.

twice I was triump hantl y ac quitte d T h e fi rst time was o n th e 28th o f.

Octo b er 1 909 when Anto ni a Azz o p ardi a murderer was hange d

, , Th e
, , .

d o ct o rs in charge h ad e xe c ut e d their post mortem ex am inatio n so c are l essly -

that the re was d o ub t that th e m an was b uri e d al ive o nly o ne ho ur afte r th e

exe c uti o n ! I acc u se d them o f that in a ve ry vi o l e nt artic l e and all Mal ta ,

was in a d evi li sh ro w ab o ut it T h e G o vern o r o rd ere d t h e C h i e f Me d ic al

.

Offi c er wh o was re sp o nsibl e to libel m e and afte r a very h ar d st ruggl e b e fo re

, ,
26 A ST UDY OF P R O L O NG E D FA S T IN G .

th e j ury I have succe ed e d to p ro ve that t h ere were no p o sitive and scientifi c

f acts to p ro ve th at th e exe cuted m an was d ead when b uri e d This resu l t .

p ro vo ke d a new law in Mal ta an d n o w i nstead o f b ur yi ng th e exe cute d m en

afte r o nl y o ne ho ur fro m th e exe cuti o n as b e fo re they watch them k ee n ly fo r ,

24 hours an d as I p ro te ste d al so th at it was b arb ar o us to b ury the m in a sac k

,

afte r th at Justic e h ad m ad e its c o ld ve nge anc e o n a c re ature o f G o d ag ainst

who se life sh e h as no right at all n o w they b ury them in a cheap c o ffi n , .

Th e se c o n d trial was p ro vo k e d b y thi s fact T o c o mmunic ate by me ans Of .

te l e pho ne in Mal ta y o u have to pay 60 c ents and th e te l ep h o nes are at th e ,

Po l ic e S tati o n Po o r p e o pl e are suppl i ed gratuito usl y by G o vernm e nt wi th

.

d o cto rs m i dwives and med icines At a vi ll age c all e d Z e itum a very p o o r

, ,
.

wo man was dying through p o st p artum hemo rrh age T h e midwife sent fo r
-
.

th e d o c to r fo r assistan c e as sh e tho ugh t th e c ase a fat al o ne Th e d o c to r .

happ ene d to be in an oth er vi ll ag e and th e p o l ic em an refuse d to c all h im ,

imme di ate ly be fo re l evyi ng th e tax o f th e tel epho ne T h e p o o r woman h ad .

no t th e 60 c e nts to pay fo r it an d mo re th an an ho ur was sp e nt ti ll they got

,

them fro m a distant siste r When th e d o cto r arrive d there was no mo re ho p e s

.

to save h e r and th e p oo r victim O f human b ru tali ty di e d l e avi ng a husb an d and

six o rp h ans I publishe d a vio l e nt attac k agai nst th e p o l ic e acc usi ng th em o f
.

mansl aughte r and was l ib ell e d but h avi ng p ro ve d to th e hi l t all th e fac ts

,

st ate d I was agai n acquitte d tri um phantl y by th e j ury

,
.

” ”
As y o u c an see my B ee was re all y a busy o ne an d pl aye d ve ry we ll and
“

smartl y h e r hum ani tari an and d emo cratic mi ssi o n At th e sam e ti m e we di d .

”
no t mi ss to ad vo c at e an d ve ry ard e ntl y Fl etche ri sm and th e Fasti ng C ure
“
, ,

fo r th e c ure Of dise ase as al so m any o th er imp o rt ant di ete tic refo rm s Many .

artic l es we re al so p ubl ished o n b eh al f o f th e i d e a o f an i nte rn ati o nal L angu age .

A l e cture in I tal i an that I d el ivere d in Mal ta seve ral ye ars ago advo c ati ng
Espe ranto was p ubl ish ed in it Ab o ut 25 ye ars ag o I l e arne d S ch l eyer s
’
.

”
Vo l ap uk th at b ro k e d o wn sub stit ute d b y I dio m N e utral a m o re natio nal
,
“
,

system I fo ll o w my frie nd R o sen be rger o f S t Petersb urg an d l e arne d it al so

. .

but h ad very l ittl e success The n m y d e ar friend s Dr Z am e n h o f o f W arsaw

.
’
.

”
E sp eran to c am e in vo gu e an d I l e arne d it an d too k u p arm s in f avo r Of it
ve ry ard entl y I have give n in Mal ta fre e co urses in th e U niversi ty l e cture s
.
, ,

fo un de d so cie ti es and succ ee d e d al so to start th e fi rst femal e c o urse in th e

U n iversity in any b ranch o f kno wl e dge Mrs L evan z in was a gre at help to . .

m e in this mo vement and no w sh e is th e fi rst wo m an in Mal ta to enter th e

Un iversity to fo ll o w a me dic al c ar e e r S h e is tryi ng with all h er effo rts no t .

o nly to e nligh t e n th e fe m al e c l asse s o f M al t a th at are y e t sh ro u d e d in m e diaeval

d arkn ess b y p ubl ish ing very instru ctive articl es but al so b y setti ng them th e
goo d e xampl e o f Op e nin g fo r th em new and p ro sp erous c areers Esp eranto .

h ad a gre at vo gue in Mal t a ; I wi th Mrs L e van z in too k p art in th e I nte r

, .
,

n ati o n al C o ngre ss o f B arc e l o na and there I w as e l e ct e d Presi d ent o f th e

“

I nt e rn atio nal Asso ci ati o n o f Pharm ac eutic al Esp erantists e dito r o f th e ,

”
sci en ti fi c Esp e ranto mo nth l y L a V oc h o de Farm ac ustoj , an d C o rr esp o nd ing ,

Memb er o f th e C o l e gi o des Farm aceutico s (th e Oldest o ne in th e wo rld and

wh ere th e fi rst ph arm ac o pmia was p ubl ishe d ) afte r my l e cture in E sp eranto o n
Fun gus M e l itensi s
”
th e
“
b y co ll e agues o f o ver 3 0 different n ati o nal iti es .

No w I am advo c ati ng I do o r Si m pl i fi e d Esp e ranto as I fi nd that it is e asi er ,

mo re l o gic al and cro pp e d o f all th e erro rs and i nco ngruities co nt aine d in Dr

,
.

Z am enh o f y m
’
s s ste .

1 4th o f May f my fast)

,
1 912 (3 1 8 t and last day o .

I have al so at th e same time fo ught h ar d against much ri dicule and p rej udice
to fo un d th e fi rst S o ci ety o f Psychi c al S tudi e s an d Re se arch in Mal ta o f
“ ”

wh ich I am Presi d ent H o norary Memb ers are Pro f C roo k es Russell
. .
,
 AU T OB I O GR A P H I C AL N O TE S . 27

W all ace Lo dge Maxwell Richet Lomb ro so Mo rse ll i C arringt o n etc No w

, , , , , , , .

ano th e r b attl e fo r S ci en c e an d H umani ty Fasti ng Ab o u t two and a h al f

—
.

ye ars ag o wh i l e I was over e ating o b e se neurasth eni c p e ssimistic and wi th a

,
-
, , ,
”
shattere d ne rv o us syst em I chan c e d to re ad in th e Con tem porary Revi ew an
,

art ic l e ab o u t fastin g I t was a flash o f ligh t th at stru ck m e vividly

. I t i n di c ate d .

to m e th e right p ath to he al th an d happ iness and I fo ll o we d imme di ate l y its

dict at es with e nthusi asm I f aste d fo r 8 d ays with very great be nefit Then
. .

I p ro c ure d all th e p o ssi bl e l it eratur e in several l angu ages ab o ut fasting and

”
p re p are d m ysel f tho ro ughl y fo r a who l e ye ar fo r a l o ng and c o nq uest fast .

I start e d that o n th e l st o f March 1 9 1 1 an d Mrs L e van z in di d th e same as , ,

.

sh e h ad b e e n suff e ri n g si nc e several ye ars fro m se vere dysp e p si a an d i ns omni a

th rough o ver e ati ng S h e b ro ke h er fast o n th e 3 3rd day an d I o n th e 4 0t h
-
.

with i mmense b enefi t to o ur he al th b e c ause o ur ail ments di sapp e are d We .

c o ntinue d all o ur usual o ccup atio ns during o ur fast and di d n ever fee l any bad
e ff e cts .

I n th e fo ll o wi ng August cho l era b ro k e o ut in Malt a an d as a p reventive

,

p re c autio n I faste d again for 1 2 Mrs L e van z in fo r 1 7 an d my d augh ters fo r

,
.
,

seve ral d ays e ach I have cure d Jo l and a fro m a severe case O f small po x b y
.
-

1 7 d ays o f f asting an d Mir and a fro m a severe case o f fever with 8 d ays .

S everal o ther fri e n d s and p aren ts un d erwent th e cure o f fasting und er my advice
with marvel ous e ffe cts Enthuse d b y these be nefi cial resul ts I determ ine d to
.
,

fi x a scientifi c b asis to it by un dergo ing a tho ro ugh and seri o usl y c o ntro ll e d
e xp e rime n t u nd e r th e di re cti o n o f a p hysi o l o gi st o f high re p ut e and gre at
ex p e rien c e I submitte d th e c ase to my fri en d Pro fesso r Luci ani o f Physi
.
, ,

ol o gy o f Rome wh o studie d S ucci and p ublishe d a go o d b o o k o n th e Physi

, ,
”
o l o gy o f Fasti ng an d h e sugge ste d to m e t o c o me ove r t o B o sto n at th e
,

C arne gi e I nstitu tio n as th e I nstit uti o n was th e b est e qui pp e d in

,

th e wo rld fo r such an imp ort an t exp erime n t I to o k up h is suggestio n and .

cro sse d over mi l es to und ergo my fast refusi n g any p e cuni ary r emun era ,

ti o n o n l y th e exp enses b eing d e fraye d fo r it To day is th e 3 l st day and l ast

,
.
-

day o f it and I c an simpl y t e ll y o u that it is a c o mpl e te succ e ss

, I am fee l ing .

very we ll very uplifte d an d I wi sh e d to p ro l o n g it further at l east to 4 0 d ays

, , , ,

b e c ause I do no t fee l y et any trace Of hunger at all B ut Pro fesso r B ene dict .

thought it al re ady very exp ensive and fatiguing and b i d m e to b re ak it to

m o rro w He o nl y all o we d m e to p ro l o ng it fo r a day mo re simpl y t o beat the
.
,

recor d of the lo ngest con tro lled sci entific fast ever made D uring th e fast I did .

n o t fe e l th e l e ast un c omfort abl e se nsatio n exc e p t th e bad t aste of my c o at e d

to ngue an d th e c atarrh an d c o ngesti o n o f m y e yes th at I h ad at th e st art
,

have ne arl y disapp eare d I ho p e that a gre at b e nefi t to my he al th shall

.

acc rue fro m it .

 GENERAL CHARACTERI STI CS OF SUBJECT .

As will be inf e rr e d from hi s b iographical not e s L : was a propagandist ,

with pro n oun c e d vie ws o n all subj e cts He had had some l e gal traini ng
.

an d was i n c l ine d to be e xc ee din g l y co n t en tious H is chirography was .

e xc e l l e n t He also had a goo d comma n d of th e E n g l ish l an guage as w e l l

.
,

as of I talian Fr e nch Spanish Malte s e and E sp eranto H is fami l iarity

, , , , .

with th e vagarious lit eratur e o n fasti n g was asto nishi n g and le d him ,

to mak e many suggestio ns in dicative of a mi n d worki n g upo n a pro pa

gan da for th e suppos e d b ene fi ts to manki nd to be de rive d from fasti n g ,

i nst e a d of an appre ciatio n of th e tru e sci entific value Of a prolo n ge d

fastin g e xp e riment As an e xampl e Of this whil e h e was u nwi l li n g to
.
,

u n d ergo a s e ri e s Of care fully planne d stren gth t e sts h e ne v e rthel e ss ,

atte mpt e d some s ensatio n a l stre n gth t ests of whi ch h e had r e ad , such
as lifti ng up a m an and holding him susp en d e d for a mome nt or two .

He was a mode rat ely we l l nourish e d m an but his fl e sh was soft and
-
,

flab b y This was n atural as h e was d e ci d e dly s e d en tary in hi s ha b its

.
,

an d much ave rs e to any muscular e ffort I t was hop e d that me asure

.

me nts of th e fastin g me tabolism durin g muscular work could be mad e

with this subj ec t by havin g hi m tak e a moderat e amou n t of e x ercis e
da ily o n th e bicycl e e rgome te r but h e absolute ly refus e d to mou n t th e
,

e rgom e t er He said h e n ev e r rod e th e bicycl e and thought it b e neath

.

his dignity an d that although th e bicycl e was us e d in Malta it had n o t

, ,

b e en e mploye d by hi s p e opl e As L show e d so stro ng an o b j e ctio n to

. .

muscular activity we w e re oblige d to omit thes e valuabl e O bs e rvations

, .

This subj e ct call e d hims elf a v e ge tarian an d fre qu ently mad e a

stat e me n t to that effe ct d urin g th e fast but his practic e d id n o t wholly,

be ar out his claim He admitte d that h e ate me at in th e E urop e an

.

re stauran ts and o n th e boat during his trip to B osto n but said that it ,

made him S ick and u n co mf ortabl e and that h e was oblig e d to e at th e

,

me at si n c e h e coul d n o t ge t th e food h e wishe d Of co n side rabl e sig

,
.

n ifi c an c e in this co n n e ctio n is his s el e ctio n of food o n th e days pre c e di n g

th e fastin g p e riod On his arrival in B osto n h e was take n to a hot e l
.

by o ne of th e l aboratory assista nts an d wh en give n his choic e of food

from th e menu h e ord ere d a larg e st e ak c ove re d with o ni o ns ; o n othe r
,

oc casio n s h e ord er e d salmo n pork an d lamb chops D uri ng his stay

, ,
.

in th e hospital aft e r th e fasti n g e xp e rimen t was ove r h e agai n cal l e d ,

for a b e e fst e ak Whil e pro b a b ly n o t an e xc e ssive e at er of me at h e

.
,

was by n o me ans a v e ge tarian for s e ve ral weeks prior to th e fast .

Th e nitroge n fou n d per day in th e uri ne durin g th e ten days pr e c e di n g

th e fast i n dicat e d that h e was livin g o n a fairly high prot e i n l e ve l .

D uri n g th e food days in B osto n hi s die t Was u nr estrict e d and h e was

r ep e at e dly told that h e could have wha te v e r h e wishe d to e at durin g
t hi s prelimi n ary p e riod e xc ept that it was prefe rre d that th e last me al
,

Of th e day should n o t be e xc e ssive ly hi gh in prot e in to avoid th e lo n g

duratio n Of th e S p e cific katabolic actio n of th e prot ei n .

v
28
 30 A ST UDY OF P R O L O N GE D F A S T I NG .

Th e t hr ee days pre c e din g th e fast th e so call e d pre l imin ary p e riod

— -

w e r e us e d to accustom th e su b j e ct and th e staff of assistants to th e

apparatus an d to th e ge ne ral rout ine in orde r that th e program could ,

be carrie d out as smoothly as possib l e an d withou t too gre at a d e ma n d ,

u p o n th e t ime of th e physicia ns and c o work e rs wh o made obs ervatio ns -

U po n th e subj ect H is d i e t and d aily lif e w er e u n d e r co nstan t o bser

.

vatio n d urin g this p e riod but h e was fr ee to choos e his food and to
,

arrange his time as h e d e sire d whe n n o t e sts w ere b e i ng mad e upo n hi m .

I t was ne c e ssary to be c ertai n that L was physical l y an d psychical l y .

a fi t subj e ct for th e lo n g fastin g e xp e rime n t He was accordi ngl y give n .

se ve ra l rigid physic al e xamin atio n s by D r H W G ooda l l of th e H arvard . . .

,

M e di ca l S chool and also u nd e rw en t a psychical e xami natio n by Prof

, .

E E S outhard dir e ctor of th e Massachus e tts P sychopathic H os p ital

. .
, .

Th e r e sults of the se e xamin atio ns gave us e ve ry assura nc e that L .

was a suita b l e subj e ct for thi s lo n g fastin g e xp e rime n t .

Th e b o d y w eight of thi s subj e ct wh e n h e r e ach e d B osto n was some

-

what sma ll e r than th e initial body w e ight re port e d for his e arli e r fast
-
.

L stat e d that his body w eight at th e b e gi nni ng of th e pre vious fast

.
-

was e xc e ssive an d that h e d e sire d to b e gi n this e xp e rime nt with his

n ormal body we ight -
Whil e this re aso ni n g was sci en tifica l ly correc t
.
,

hi s small w e ight cause d us co n sid erab l e a nx i e ty as it was fe are d that ,

h e wo uld be u n a b l e to e n dur e a 3 1 day fast I n asmuch as a fast Of

-
.

7 to 1 0 days duratio n would be of practical l y no value to us e xc e pt as

’

a duplicatio n of th e e arlie r work e ve ry possibl e a rr a ng e me n t was mad e

,

to a djust th e co n ditio ns so as to prolo ng th e fast ; th e subj e ct quickly

fou n d that if h e made th e stat e ment that any particularly distasteful
routine or te st would t e n d to shorte n th e fast it would be omitt e d
“
, .

On th e othe r ha n d h e took an i nt e ns e i n te re st in th e outcome of th e

e xp e rim e n t an d had an almost r e l igious b e li e f in th e b e ne fi ts to

humanity to be de rive d from it He e nj oye d th e distinctio n of havi ng

.

so many obse rve rs studyi ng him and his p eculiar appre ciatio n of th e
,

scie nti fi c va l u e of th e Obse rvatio ns e nabled us fre qu e nt l y to i nduc e him

to waive his obj e ctio ns to any routi ne by a summary r e fusal to go o n
with that particu l ar t e st u nl e ss th e routi ne were carrie d out To his .

credi t it must be said that whate v e r idiosyn craci es h e e xhibit e d at

time s h e would afte r r e fle ctin g o n th e importan c e of th e e xp e rimen t
, , ,

be g for th e co n t inuatio n O f th e compl e t e routi ne .

To s e cure as much informatio n as possib l e re gardin g th e n ormal

me tabolism of L h e was ask e d to sl ee p i nside th e r espiratio n calo
.
,

rim e te r imme diat e ly o n arrivin g in B osto n He was provid e d with a .

comforta bl e be d air mattre ss an d be d clothi ng th e be d compari ng

, , ,

well in siz e an d co mf ort with a b e rth o n an oc e an ste amer I mportant .

data re gardin g th e n ormal me tabolism Of this subj e ct were thus s e cure d

for s e ve ral nights b efore th e actual fast b e gan F ortu n at ely L sl ept . .

ve ry quie tly an d when no t asl e ep h e remai ne d v ery quie t l y in th e

,

same positio n for lo n g p e riods of time thus gr e at l y facilitati ng th e ,

accurate me asure me nt of th e me tabolism .

FAS TING P L ATE 3

E . L . on the T hi ty
r first day o f the
- F ast, asc e n di ng the S tairs o f the Bal co ny . T he p1c ture q u re
re i d
20 se c onds ; the re i s no Evide nce o f Unste adiness .

F .
Clinic l a Exami natio n by Dr H . W . G o o dall . T hi p h t g
s o o raph w as take n o n the T hi ty fi
r - rst day
o f Fasti n g p , u on the lc y cc pi d by
Ba on O u e i g th d y
dur n e a .
 GE N E R AL H I S T O R Y OF FA S T ING E XP E R I ME N T . 31

PROGRAM FOR RES EARCH .

Th e ma ny Obs ervatio ns an d th e large numb er of c o work e rs and -

as sistants made a care fully prepar e d program absolutely e ss e ntial so ,

as to u se th e actual availa b l e time of th e subj e ct an d th e co work ers to -

th e b e st advantage T h e obs e rvatio n s p lann e d for e ach day w er e th e

.

w eighi n g of th e subj e ct aft er h e had uri nat e d and aris en ; blood te sts ;
me asure ments of blood pr e ssur e and th e alve olar air ; t e st for ac e tone
-

in th e br e ath ; r e cords of r e ctal t emp e ratur e an d of puls e rat e ; th e -

care ful coll e ctio n me asur e men t and subs e qu en t compl e t e a nalysis
, ,

of th e urin e ; and th e apportionment an d me asure ment of th e wat er

tak en T h e subj e ct e n te re d th e be d calorime ter about 8 O clock e ach
.
’

night r e mai n in g the re unt il 8 O clock th e n e xt morn in g durin g w hi ch

’
, ,

time th e re spiratory e xchan ge water vaporiz e d and he at produc e d , ,

w er e co nti nuously me asure d He was then tak en out an d hi s re spira .

tory e xchan ge was obse rve d in three e xp erime n tal p e rio d s by mea ns
of th e u nive rsal re spiratio n apparatus (Se e P lat e 2 fig C pag e .
,
.
,

Re s p iratio n e xp e rimen ts we r e also fre qu en tly mad e with th e subj e ct

at othe r times of th e day an d in varyin g body positio ns Th e r espira .

tory exchan ge whe n th e subj e ct was bre athi ng an oxygen rich atmos -

ph er e was d e te rmi ne d s e ve ral time s and a s e ri e s of r e spiratio n expe ri ,

men ts was made by Mr T M Carp e n t e r when th e subj e ct was writin g

. . . .

(See Plat e 1 figur e B pag e

,
I n additio n to th e r e gu l ar routin e
, ,

the re was a rigi d clini ca l e xamin atio n by D r G oodall e ve ry se co n d .

d ay (se e Plat e 3 fi gure F ) psycho l ogical te sts we re mad e by D r

, , .

H S L an gfe ld an d anthr opome tric measur e men ts we re tak en by

. .
,

Profe ssor W G An d e rso n o nc e a week E v e ry fi ve or six days a

. . .

compl e te seri es of photographs was mad e of th e n ak e d subj e ct (S ee .

P late s 4 and 5 p ,
On c e a wee k his body was wash e d with di sti l l e d
.

water th e wat e r use d b ein g pre se rve d and a n alyz e d Amo ng th e many
, .

i nci d en tal Obs ervatio n s carri e d out dur in g th e e xp erime n t was a s eri e s
of X —ray plat e s o n th e thirtie th day of th e fast by D r F H Wil l iams . . .

an d a stu d y of th e flora in th e colo n o n th e thirty fi rst day by D r A I -

. . .

Ken dall I n cl e ar pl e asan t we athe r th e subj e ct was tak e n to th e

.
,

roof or more fre qu e n tly given a driv e thr ough th e park syste m of B osto n .

Th e program for a typical day that of May 7 8 1 9 12 app e ars b e low : — —

,
—

M ay 7 7 h 4 6m a m
. . B d c al im t
. xp im t nd ed e or e er e er en e .

8 1 5 a m to 9h 1 7m m. R p i ti n xp i m nt (th
. e . p i d )
. es ra o e er e ree er o s .

9 28 a m . W igh d
. e e .

1 0 00 a m . Ph to g ph tak
. o ra s en .

1 0 30 a m . B l d am pl t k n
. oo s e a e .

1 40 p m . B l d p u t t Al v la ai
. oo ress r e es s . eo r r .

3 4 3 p m to 4 h 1 4 m p m
. R pi ati n xp i m nt m d wi th u bj c t
. . . es r o e er e a e s e
w i ti g ( tw p i d ) r n o er o s .

5 00 p m . P ych l gic al t t
. s o o es s .

7 0 1 p m to 7 h 4 4 m p m
. R pi ti n xp im n t ( tw p i d )
. . . es ra o e er e o er o s .

7 50 p m . B ath f d i till d wat ; u d w a ch g d

. o s e er n er e r an e .

8 23 p m . E t ed b d c l i m t
. n er e a or e er.
9 34 p m . C l im t xp im nt b gu n
. a or e er e er e e .

May 8 7 5 0 a m
. . B d c l im t
. xp i m t n d d (5 n e a or e er e er en e e co
u tiv p i d ) se c e er o s.
 32 A ST UDY OF P R O L O NGE D F A S T IN G .

I t will be n ot e d that th e r e gular cli nical e xami n atio n di d n o t tak e

p l ac e o n thi s d ay as the s e e xami n atio n we re made o nl y o n a l t e rnate
,
s

days Furthe rmore no drive was take n As will be s e e n from this

.
,
.

typica l pro g ram th e subj e ct fou n d hi ms elf fully O ccupie d by th e vari

,

ous obse rvatio n s ; in all of thes e h e took a k ee n p e rso n al in terest .

DAILY RECOR S OF D FAST ING EXPERI MENT .

Although a d e finite ly arran ge d program was pr epar e d an d for th e ,

most part rigidly followe d th e daily routine was vari e d by a large ,

numb e r of e xt ra ne ous O b se rvatio ns particularly in re gard to th e f ee l ,

ings and moods of th e subj e ct as wel l as obs ervatio n s mad e b y c o ,

work e rs To prese nt thes e ad e quate ly it s ee ms d esirabl e to give

.
,

the m in th e form Of a daily re cord b e ginnin g with th e arriv al of th e

su b j ect at th e N utritio n Laboratory This r ecord will be in th e n ature .

”
of a log book which will S imply give th e ge n eral history O f th e
“
-
,

e xp e rime n t from day to day with n o atte mpt to d e scrib e th e t e ch n iqu e

,

or di scuss th e re sults .

Th e e xp e rime ntal d ay for most purpose s e n de d with th e comp l e tio n

"
O f th e re spiratio n e xpe rime n t at about 9 3O a m Th e last m e al
’u

f . .

was e ate n at 6 p m o n April 1 3 1 9 1 2 ; thus th e tru e fasti ng p e riod

. .
,
" m
be gan at 9 3 0 a m April 1 4 or about 15 hours aft e r th e last me al
. .
, , .

I n this daily history th e p e rso n al obse rvatio ns of th e subj e ct o n h is

e xp e ri e n c es d uri n g th e night are always give n in th e n ote s for th e n e xt ,

d ay but all e ve nts up to th e mome n t Of e nte rin g th e calorimete r are

,

r e cor d e d o n th e date of occurre nc e Whil e much that is said re gard in g .

th e pre vious fasts of th e subj ec t must from a strictl y sci e n tific sta n d ,

poi nt be co nsid ere d as worthle ss y et th e tre nd of thought is n o t

, ,

without i nte r est in i n te rpre ti n g th e mental mak e up of th e subj e ct -

.

P R ELI MINAR Y P E R I O D .

A pri l 1 0 , 1 9 1 2 rrive d at th e Nutritio n Lab orato ry ab o ut 8 p m

—
L . a . .
,

c oming di re ctl y fro m th e ste amer and l eaving h is b agg age o n th e wh arf but
b ri nging with him th e sam m
,

e s o f urine which h e h ad c o ll e c te d fo r se ve ral d ays

o n h is p assag e ac ro ss th e o c e an He sho we d himse l f to be he artil y in sym p ath y
.

wi th th e pl an o f th e e xp e riment and appe are d to be a subj e ct wh o wo uld

,

c oo p erate fully in th e expe rime ntal routine ; h e pl ace d him se l f entire ly in o ur

hand s As h e h ad h ad no e veni ng me al h e was se nt to a ho tel with o ne o f th e
.
,

l ab o rat o ry assistants This me al whic h was o f his o wn se l e cti o n c o nsiste d

.
, ,

o f a l arge b e e fste ak wi th o ni o ns o ne b o il e d p o tato o n e p o rti o n c h o c o l ate ic e

, ,

cream and a gl ass o f wate r

, .

He returne d to th e l ab o rato ry at 1 0 o c l o c k and th en re p o rt e d t h at h e h ad ’

,

h ad a ve ry ro ugh p assage o n th e ste am e r t h e re b ei ng but a few ho urs o f sm o o th ,

sai l i ng o n th e thi rd day o ut an d a fe w ho u rs o n th e l ast day On th e o ther .

hand h e app eare d to be in very goo d c o ndi tio n and sh o we d no bad eff e c ts fro m
,

th e d isc o mf o rt s o f th e trip H e maintai n e d that d uri ng th e p revi o us ye ar h e

.

h ad live d al m o st e xc l usive l y o n a veget ari an d ie t taki ng o cc asi o n all y m i lk an d ,

ch eese very rare ly e gg s and n o me at On th e ste am er h oweve r th e menu

, , .
, ,

did n o t i n c l ud e th e foo d h e was ac custo m e d to and h e was c o m p e ll e d to e at

 GE NE R AL HI S T O R Y OF FA S TIN G E XP E R I ME N T . 33

me at and highly seaso ne d sauces which h e di d no t p articul arly c are fo r .

D uring th e p revious ye ar h e h ad been livin g up o n o ne me al a day whi ch was ,

e ate n ab out no o n u sing th e j uic e of an o range to sati sfy h is thirst whe n

,

ne cessary . He c l aime d that this lim ited di etary h ad b e en very b e nefi cial to
h is he al th . D uring th e fast h e wishe d to drink disti ll ed water He di d no t .

espe ci all y l i k e it and usuall y drank h o t wat e r b ut si n ce so me pe o pl e b e l i eved

, ,

that there was nutriment in wate r h e wi shed to use di sti ll ed water so that there
,

c o uld be no question as to his o b taining nutrim ent i n thi s way .

I n his p revi o us fasts it h ad b een his c usto m to c arry o n his re gul ar b usi ness
and to g o into court an d pl e ad his c ases as usual thus e ngaging in a no t i n c o n ,

siderable amo unt o f muscul ar activi ty He sho we d a de ci d e dly int e ll igent

.

inte rest in th e expe rim ent as was i n dicate d b y hi s asking if th e eyes should no t
,

be e x am i ne d by an ey e s p e cial i st fo r h e h ad found that as a fast p ro gre sse d

, ,

th e eyesight im p ro ve d consi d erabl y tho ugh normall y h e h ad ve ry p oo r e y e

,

sight . He al so thought it impo rt ant to study th e bl ood an d se eme d much

gratifie d when h e was to ld that b oth ey e and bl ood te sts wo uld be mad e Th e .

im p o rtant rol e which h e would pl ay in th e expe riment was emphasiz ed to him

and h e w as sho wn th at th e eff o rts o f th e l ab o rato ry st aff wo ul d be o f n o avai l
with o ut h is full Ooo pe ratio n His attitude toward th e expe riment an d under
.

standi ng o f th e re quirements showe d him to be b y far th e most inte lligent

m an that h as eve r b een stu die d as a fasti ng subj e ct .

Whe n di scussing th e q ue stion of defe c atio n duri ng a fast h e mad e th e state ,

ment that in so me of h is l ong fasts h e h ad d efe c ated o nly o nce or twi ce Often .

h e d e fe c ate d short l y afte r th e be ginni ng o f th e fast and th e n no t ag ai n unti l

afte r th e fast was o ve r b ut after b egi nnin g e ating h e d efe c ate d q uite regu l ar ly
, .

I n o n e fast h e sai d that h e d i d n o t d efe c ate unti l th e twenty se ve n th day -

.

As the re was n o time th at eve ni ng to di scuss with h im at l e ngth h is p ast

his to ry and th e d et ai l s o f th e fasti ng e xpe rim ent h e was t ak en d o wn to th e ,

c al o rim e ter l ab o rato ry where h e urinated remo ve d al l but his und erc l o thing
, , ,

and p re p are d to g o i nto th e c al o rim e te r T h e stetho sc o pe was adj uste d and

.
,

th e re ctal temp erat ure t ak e n wi th a cl i nic al the rm o me ter which was l eft in th e ,

re ctum thre e mi nute s He dran k a gl ass o f wat er an d was then pl ac ed insid e

.

th e ch amb e r o f th e c al o rime te r Afte r h e had be e n sho wn h o w to u se th e te l e

.

p h o ne and th e signal b e ll a bl ac k cl o th was pl ace d b efo re th e wi ndo w so th at

,

th e e l e ctric l ight wo uld no t disturb him an d th e c al o rim e ter was th e n se al e d .

Eve n o n this fi rst day th e subj e ct was i n c l ine d to t alk ab out th e metho d o f
breaking h is fast saying that h e was acc usto med to d o this by taking th e j uic e
,

o f o ne o r two l emo ns an d afte rwards o range j uic e to which h e some time s

, ,

add e d sugar As was se en l ater such a metho d fo r b re aki ng th e f ast p ro ve d

.
,

to be di sastro us to o u r p re d e termi ne d pl an o f se c u ri ng d ata afte r th e f ast .

A pril 1 1 1 9 1 2
,
Th e c al o ri m e ter exp eriment fo r th e p revi o us nigh t was
—

u v tful and end e d at 8 0 a m T h e me asureme nts we re mad e in th ree

n e e n h
2 m
. .

co nsecutive p erio ds th e i d e a b eing to se cure ob se rv atio ns during th e l atter

,

p art o f th e ni gh t and thus e lim in ate if p o ssibl e th e infl uence o f fo o d tak en, ,

d uring th e evening Th e subj e ct k ep t very quiet mo st o f th e time an d p ro ve d

.
,

exc ee di ngl y t rac tabl e an d i nte lligent Th e im p o rtanc e o f lying quietl y i nsi de
.

th e resp iration cham be r h ad b e e n im p resse d up o n h im and we have rai e ly h ad

a subj e c t wh o lay so q uie t l y fo r so l o ng a tim e Ab o ut 5 3 0 a m be te l e
h m
. . .

p h o ne d to ask if everything we re all righ t rep o rting that h e felt very we ll but ,

h ad b ee n awak e fo r so me ho urs He was i nstruc te d to ring an e l e c tric b ell

.

every fe w m i nutes b y p re ssing a small p ush b utto n i n si d e th e cham b e r so -

,

as to sho w us th at h e was awak e He rang this b e ll regul arl y thro ugho ut

.

th e re st o f th e e xpe riment b e ginning at 5 h 30m a m , . .

When th e c al o rimet er was op ened a stro ng o do r o f o nio ns was app arent , ,

34 A ST UDY OF P R O L O N G E D F A S T IN G .

d o ub tl ess due to th e fact that h e h ad e aten bee fsteak and o ni o ns th e evening

be fo re L re po rte d that fo r th e first two h o urs afte r h e e nte re d th e chamb er
. .

h e w as ve ry warm but l ate r be c am e c oo l and sl ep t c o mfo rtabl y

, S i nce th e .

te mpe rature in si d e th e c al o rime te r se ld o m v arie s by C su ch an o bse rv a .

,

ti o n se r es excell e ntl y to i llustrate th e f util ity o f pl aci ng any weigh t o n pe rso n al

v
imp re ssi o ns T h e in te ri o r o f th e resp irati o n c h amb e r re mind e d h im Of h is
.

c ab in o n th e ste am e r I t was imp ossibl e to o b tain re c o rd s o f th e p ul se rate

.
-

fo r ab o ut o ne ho ur afte r 5 h 3 0 m a m th i s b ei ng due to some c h ange in th e . .

,

p osi tio n o f th e ste thosc o pe Late r th e subj e c t was abl e to re adj ust it and th e
.

re co rd s we re o b tai ned th e re afte r .

Wh en L c ame o ut o f th e cham be r sho rtl y afte r 8 a m h e uri nate d an d

.
, . .
,

imme di ate l y th e e xpe rim e nt with th e universal re sp iration app aratus was
be gun (See Pl ate 2 fi gure C p age
. This expe riment co nsiste d o f thre e
, ,

1 5—minute pe riods .

Almo st th e e ntire day was spe nt by th e subj e ct in fami l i ariz i ng h imse l f wi th

th e e xpe rim e ntal ro utines Afte r th e re spi rati o n e xpe rime nt was over seve ral
.
,

te sts o f th e bl o o d p ressure we re mad e an d sam pl e s Of th e al veo l ar air t ak e n by ,

th e Pl esch and H aldane me tho ds Pro fesso r W G And e rso n mad e a se ri es . . .

o f physic al me asureme nts an d atte mp te d th e ro uti ne st re ngth t ests but ,

was no t abl e to O b tai n these o wi ng to th e di si nc l i nati o n of th e subj e ct

, I t did .

n o t see m advisabl e to c ompl ic ate th e p ro gram b y taki ng p ho to grap hs o n this

day . An ex ami natio n o f th e bl ood was made al so a mo st c are ful c l inic al ,

e xami nati o n L th e n to o k a h o t b ath and went o ut with Mr H L H iggi ns

. . . . .

fo r th e fi rst me al o f th e day This me al se l ecte d ala c arte co nsiste d o f o ne

.
, ,

po rtio n o f sc all o p s and tart are sauce o ne p o rtio n o f ro ast l amb and mi nt sauce , ,

two p o rtio ns o f mashed p o tato th ree ro ll s two po rti o ns o f b utte r and o ne , , ,

po rtio n o f c ust ard pie .

On re turni ng to th e l ab o ratory in th e afte rnoon h e o ccupi ed himse l f in ,

wri ting l e tte rs and in t alking wi th diff e re n t membe rs of th e staff unti l

4 3 0 p m whe n th e first se ri es o f psycho l o gic al tests was mad e
h m
. .
,
T h e vi sual .

ac ui ty te st was no t ve ry su cc essful as L h as a ve ry sho rt visio n and t h e l e tte rs , .

use d we re so small that ne w o nes h ad to be se c ure d T h e c h ie f val ue o f th e .

test o n this day was to fami li ari z e th e subj e c t wi th th e ro uti ne L c o nti nued . .

to have a k ee n i nte rest in th e succ ess o f t h e e xpe ri me nt and c oo pe r ate d in

e ve ry way e x ce p t in th e stre ngth te st .

I n o rd e r to mak e sure that th e l ast me al of th e day sho uld c o nt ai n o nl y a

small amo unt o f p ro te i n I we nt pe rso nall y with h im to th e rest aur ant
,
His .

su ppe r at this time c o nsi ste d o f h al f a gr ape frui t to which h e add e d qui te a ,

l ittl e sugar a pl ate o f spl it pe a so up (this c o ntaini ng p ractically all Of th e

,
-

p ro te in in th e who l e me al ) two o r three slice s Of b re ad and b utter o ne po rtio n

, ,

o f st uffe d to matoe s o ne o f f ri e d swe e t p o tato es an o th e r o f white p o tat oe s

, , ,

o ne di sh o f strawbe rri es and c re am an d so me st rawbe rry ic e c re am He ,

.

re t ur n e d to th e l ab o rato ry ab o u t 9 30
m p m
an d p re p are d fo r th e night in
h
. .

t h e c al o rimeter .

W hil e I was with h im in th e aftern o o n and eveni ng L gave m e co nsi d erabl e , .

info rmatio n regarding his p revio us fasts Al tho ugh th e unscienti fi c nature o f .

th ese pe rso nal im p ressi o ns is re cogni z e d it se em s d esirabl e t h at th ey sho uld ,

be re c o r de d His Ob servatio ns fo r th e mo st p ar t h ad to do with d efe c ati o n

.
,

feel ings of hunge r and changes i n b od y weight D uri ng h is fast o f 4 0 d ays

,
-
.
,

which h e re p o rt s as having be en b ro k e n o n Ap ril 1 0 19 1 1 h e d efe c ate d twice

d uri ng th e fir st two d ays and ag ai n acc o r ding to his re in em brance o n th e
, ,

, , ,

twenty fifth day Th e feces o n th e l atte r day c o nsiste d Of a s m all am ount o f

-
.

bl ac ki sh o r very d ark b rown mate ri al with a yell o wi sh white muc us He ,

.

d efec at ed again th e eve ning o f th e day o n wh ich h e b ro k e th e fast He .

36 A ST UDY OF P R O L O N GE D FA S T IN G .

ho urs e ach day but h e to o k no very l o ng walk s He sai d that at o ne time

, .
,

whe n h e was be ing j eere d at in re gard to h is fasti ng by o ne o f h is clubm ates

wh o said that h e was l o si ng stre ngth h e sugg est e d th at they te st h is stre ngth ,

with a hand dynamomete r and h e was abl e to sh ow mo re p ressure o n th e hand ,

dyn amomete r than th e m an wh o ridicul e d h im He di d no t be l i eve in S ucc i s .

’

theo ry ho wever th at there is an i ncre ase in musc ul ar stre ngth d uri ng a fast
, , .

A pri l 1 2 1 9 1 2 Th e re co rds o f th e night Ob se rve rs sho we d that L sl e p t

,
—
.

r athe r quietl y from 9 40 p m o n Ap ri l 1 1 until 3 33 a m o n Ap ri l 1 2

h m h m
. . . .
,

afte r whic h time h e rang th e be ll at i te rval s fro m 5 to 1 0 minute s

“ m
n At 5 30 .

a 111 h e te l e p h o ned t h at it was ne ce ssary to uri n ate

. . Fo r thi s h e use d a 500 .

c c uri ne j ar which h ad b ee n pl ace d i nsi de th e c al o rim e te r th e night be fo re

. .
,

but n o twi th standing its si z e it was n o t sufficie ntl y l arge to c o nt ai n all o f th e

uri ne h e d esire d to p ass T h e subj e ct re po rte d no p articul ar d isc omfo r t fro m
.

th e fac t that h e c o uld no t c o mpl e te l y emp ty th e bl add e r .

At n oo n o n th is day L we nt to di nner wi th Mr T M C arpe nte r , . His . . . .

di nner se l ecte d by h imsel f co nsi ste d o f o ne po rtio n o f b roil ed salmo n and a

, ,

sm all quanti ty of gree n p e as two po rk cho p s sau te three he api ng tabl e spo o n , ,

f ul s o f mas h e d po tato a dish o f sliced cucum b ers and tomato es thre e small
, ,

ro ll s two sm all p iec es o f butte r o ne po rtio n Of strawb erry ice c re am and two
, , ,

gl asses o f wate r .

At 7 p m h e to o k suppe r li k ewise wi th Mr C arpe nter e ati ng o ne l arge

. .
, , .
,

p o rti o n o f mac aro ni with app are ntly but li ttl e chee se in it o ne l arge p o r tio n o f
, ,

f rie d swee t po tatoes and o ne l arge p o rtio n of frie d eggpl ant In additio n h e
, .
,

ate two sl ices o f Fre nch b re ad two p o rtio ns of b utte r o ne p o rti o n o f cho c o l ate , ,

ice c re am o ne half do z e n macaroo ns an d d rank fi ve gl asse s o f wate r

,
-
He , .

se eme d to e nj oy thi s me al ve ry muc h .

Fo r th e first tim e o n this day h e sho wed app rehe nsio n in regard to t h e
e xpe rime nt mai ntaining th at th e numbe r o f tests made wi th h im wo uld te nd
,

to sho rte n th e fast as it require d c o n c entration o n h is p art to co o pe rate wi th

,

th e d iff e re nt o b se rve rs and this c o nce ntrati o n use d a ce rtai n amount of h is

e ne rgy On th e o th e r h an d h e sugge ste d that a se ri e s o f anth ro p o me tric
.
,

me asurements sho ul d be add e d to th e te sts pl anne d fo r h im in o rd er to sh o w

that h e was a no rmal indivi d ual citing th e fac t that o ne o bj ec tio n that is ,

made to p ro fessio nal f aste rs and m en wh o faste d any great l ength of time is
that they are no t normal peo pl e inte ll e ctuall y and fo r th at re aso n th e resul ts
o b tai ne d wi th them c o uld no t be c o nsi d e re d n o rmal He c o nsid ered these .

me asureme nts O f th e gre atest impo rt ance and tho ught they c o uld be Ob tained
b y t aking a pho tograph showing th e angl e o f th e face wi dth o f th e he ad e tc , , .

S i nce h e d esire d th em a se ri e s O f the se p ho to graphs was sub se que ntly tak e n

,
.

A pril 1 3 1 9 12 — Th e re c o r ds fo r this day sho w that th e subj e ct e nte re d th e

,

c al o ri m ete r ch am be r at 9 4 0 p m Ap ril 1 2 and app arently was q ui e t unti l

h “
. .
, ,

1 2 1 7 a m Ap ri l 13 wh e n h e be gan ri ngi ng th e be ll and c o nti nue d th is mo re

h m
. .
, ,

o r l e ss re gul arl y i e se ve ral tim e s an ho ur througho ut th e remai nd e r Of th e

, . .
, ,

nigh t He te l e p h o ne d at 4 h 1 1 m a m and again at 5 h l 0m a m stati ng

. . .
, . .
,

that h e h ad sl e p t l ittl e but fe l t very c o m fo rt abl e He uri nate d at 4 1 1 a m

h m
. . .
,

p assing 5 95 c c Of urine On c o ming o ut o f th e c al o rim ete r h e h ad c o nsi d er

. . .
,

abl e to say re gar din g th e d re am s th at h e h ad h ad ; be tw ee n 9 4 0 p m and

h m
. .

1 2 1 7 a m h e sl ep t ve ry we ll wi tho u t dr e aming
h m
. .
, Aft e r that p eri o d his .

sl ee p was m u ch b ro k en and h e h ad a n um be r o f dre am s o n e o f wh ich was

, ,

acc o mp anie d b y a se min al e m i ssi o n He expl aine d th is by sayi ng that h is .

suppe r th e nigh t b efo re c o ntaine d too l arge a p ro p o rtio n o f c arb o h yd rate s ,

wh ich he ated h is bl oo d and mad e him very un co m fo rtabl e He almo st im me .

diate ly re m ark e d th at h e h ad b ee n ve ry c omfo rtabl e i nsi d e th e c h am be r and ,

in fac t rather e nj o ye d b ei ng th ere

, .
 GE N E R AL HI S T OR Y OF FA S TIN G EX ER P I ME NT . 37

A co nsid erabl e numbe r of photographs were tak en o f th e nud e subj e ct a ,

p roced ure which e vi dentl y gave h im much pl e asure (se e Pl ate s 4 and
At l l 1 6 a m be uri nate d and de fe c ate d an d l ate r went o ut to hi s mi dd ay
b m
. .
, ,

meal with Mr H igg i ns He se l ec te d pe a so u p with thr e e crac k ers o ne gen

. .
,

ero us po rtio n o f fi sh (fi nnan h addie ) mashe d po t ato e s two l amb cho p s o n e , , ,

p o rtion o f French frie d po tato es four s l ices of b re ad with b utter and o ne , ,

po rtio n of strawbe rry ice cre am and fruit syrup (c o ll ege ice ) .

I n th e fo ren oo n of th e thir d day I to ld th e subj e ct that it was imp o rtant

that we sho uld have some i de a as to h o w l ong h e exp ecte d to fast fo r h e h ad ,

fre quentl y mad e th e statement that so many te sts up o n him wo uld ten d to
sho rten th e fast He was sho wn that a sho rt fast would have no interest fo r
.

us . He re pl ie d that h e expec te d to f ast unti l h is bo dy weight fe ll be l o w 1 00 -

pounds ki l o grams) I nasmu ch as h is i niti al weight was 1 34 p o un ds

.

ki l o gr ams) h e thought h e wo uld l o se ab o ut a p oun d a day which wo uld

, ,

mak e th e fast app ro ximately 30 d ays l o ng .

He b rought m e two se al e d b o ttl e s o f th e l i quo r that S ucci uses in h is fasts to

all ay th e p angs o f hunge r at th e be ginni ng o f a f ast One o f the se b o ttl es h e .

p re se nte d to th e Lab o ratory an d aske d m e to k ee p th e o ther fo r h im until th e

,

fast was c o nc l ud e d as h e did no t wish any o ne to say that h e to o k th e l i quo r

,

and th at it he lp e d h im to c arry o ut th e f ast T h e subj e ct symp athi z e d f ull y .

with th e st ricte st survei ll ance and was much im p resse d with th e fact that so
many co wo rkers were watchi ng and studying him
-
.

I n o rd er to o b t ain an e xpe rt o p i ni o n re gar di ng th e me nt al stat e o f th e subj e ct

at th e b e ginni ng o f th e fast arr angements were mad e b y which Dr E E , . . .

S o uthard o f th e Massachuse tts Psycho p athic H o sp ital could examin e him

, ,
h
at 3 3 0
m
p m o n thi s day
. . .

L was excessiue ly vol ubl e continual ly emphasi z in g th e im po rtan ce o f maki ng

.
,

me asurements of his face and head th e l ength o f th e e ars and simi l ar measur e , ,

me nts as h e de si re d that a c areful study should be mad e in o rder to p ro ve

,

that h e was a n o rmal m an and n o t e rratic an d ab no rmal , He al so ad voc ate d .

wi th gre at pe rsisten cy th e study o f th e i nfluenc e o f fast in g o n th e se xual organs .

At 6 p m h e went wi th Mr C arpenter to a l o c al rest aurant fo r th e l ast me al

. . .

b efo re b e ginning th e fast This me al c o nsiste d o f b ananas and cream straw

.
,
~

b e rry S ho rt cak e ice cre am and three gl asse s o f water

, , .

I n th e eveni ng h e to o k a h o t b ath afte r which h e was sp onge d wi th di sti ll e d ,

water and then put o n a uni o n suit and a p air o f white sto c kin gs b o th o f which
, ,

h ad bee n p reviousl y tho ro ughly washe d and ri nse d in disti ll e d wate r and d ri e d .

Th e uni o n suit ab so rb e d th e p e rsp i ration so that a me asure c o uld be o b t aine d ,

o f th e ni tro ge n e l imi nate d thro ugh th e sk i n in th e fo rm o f ure a o r o rg anic

ni tro ge no u s mate ri al Afte r d rin ki ng a g l ass o f water h e e nte re d th e be d
.
,

c al o rimete r at 9 44 p In
h m
. .

FAS T ING PER I O D .

A pri l 1 4 , 1 9 12 (first day of fast) — Accord ing to t h e exp erimen tal re c o rd s ,

L rang th e b ell to sho w that h e was awake from time to time during th e night,
.

the re b ei ng o ne hour of q ui e t b e tween l oh 1 7 m p m and 1 1 h 29 m p m an d . . . .

an o ther ho ur be twe en 1 1 4 8
h
p m and 12 9 a m , but from 2 0 6 a m ,
h
4 m h m
“
. . . . . .

Ap ri l 14 , h e rang th e b e ll more o r l ess re gul arl y unti l 5 h 25 m a m , when fo r . .

two h o urs h e remai ne d q uiet an d was app arentl y asl e e p h m

At 2 06 a i n h e . . .

te l e pho ne d that h e was c omp e ll e d to uri n ate This disturb e d h im , as h e h ad .

b ee n sl e eping very so u ndly Later h e suggest e d th at if h e c o uld d rin k water

.

d uring th e day and no t have to urinate d uring th e nigh t, h e wo ul d fee l m o re

c o m fo rt abl e His p ro gram was th erefo re arrange d sub se q uentl y, to i ncl ude
.

th e taking o f th e gre ater p art o f th e water d uri ng th e d aytime .

38 A ST UDY OF P R O L O N GE D FA S T IN G .

Whe n h e c ame o ut o f th e c al o rim eter, h e re p o rt e d th at h e fe l t fairl y co m

fo rt able. S ome o f th e air h ad b ee n le t o ut o f h is ai r mattre ss, so th at h e fo un d
it e asi e r th an fo rme rl y . After th e resp i ratio n e xp e riment was o ve r an d h e h ad
wash e d h is hand s an d face , h e we nt up into th e b al c o ny and a tho ro ugh
e x am i n ati o n w as mad e o f all h is c l o th i ng an d b agg ag e .This was d o ne to
mak e sure th at n o thing was hi dd en , such as foo d tabl ets, o r alk al o i d s O f any
ki nd , in a fo rm th at mi gh t be sewed into his c l o thi ng, c o nc e al e d in ho ll ow
b o o ks, in th e tip s o f h is shoe s, o r in some simi l ar pl ace As h e h ad h ad p revio us
.

e xpe ri e n c e as a p h armac i st, it seeme d d esi rabl e that such p re c auti o ns sho uld

be tak en . Even th e l inin gs o f h is c l o thi ng we re exami ne d , but no thi ng was

fo und , o nl y two sm all c ak es o f so ap b ei ng remo ved from th e b al co ny B esi de s .

hi s c l o thi ng an d n um ero us te stimo ni als from many o f h is Mal ta asso ci ate s, a

”
l arge p art o f his l ugg ag e co nsi ste d o f so c all ed fasti ng l iterature ; o f partic u
-
“

lar i nte re st to us we re th e mate ri al s h e h ad co ll e cte d in his vi sit to S u cci o n h is

way to B o sto n .

He h ad never bee n in th e h abit o f using h is eye s fo r re adi ng o r studying in

th e eve ni ng , but fi ni she d h is wo rk by 6 o r 7 o c l o c k and ro se e arly in th e mo rning
’
.

I t h ad b ee n h is custo m to spe nd th e evening with h is fami l y o r g o o ut fo r a

walk, o r to so me pl ac e O f am useme nt .An tici p ating th e te d i o usness o f th e
fast, we so ught to i nte rest him in some S impl e gam e as so l itaire , che c k e rs, o r
whi st , but h e refuse d all o f th ese and p referre d to re tire e arl y, e nteri ng th e
re spi rati o n c al o rime te r eve n e arl i er than w e h ad pl anne d .

Much o f th e first day h e talk ed abo ut h o w we ll h e wo uld fee l as a resul t o f

h is fast , h o w happy h e was to th i nk that h e was b egi nni ng it, h o w h e wo uld be
re l ieve d fro m th e necessi ty O f e ating and d ri nk i ng , so th at th e time h e no w
s pe nt in this way c o uld be d e vo te d to higher mental work As h e usu all y fel t
.

so much b e tte r d uri ng a fas t , h e e xpe cte d t h at these f asti ng d ays wo u ld be

am o ng th e happiest o f h is l ife He c o nsi dered that h e b ore th e te sts o n this
.

day much be tte r than p re vio usly , sho wing a gre at e r po wer of c o n ce ntratio n .

I n th e p sycho l o gic al test h e O b se rve d th at th e ticki ng o f th e me tro nome

seeme d l o ud e r than in p re vi o us te sts and attri b ute d thi s to th e f act th at duri ng
fasting h is he ari ng was al ways mo re ac ute I nasmuch as this Ob servatio n was
.

mad e when e ad o itte d but e me l th e me al in th e mi ddl e o f th e day

h h m o n a —

th e weigh t whi c h sho uld be given to this Ob serv ati o n is e asi ly e stimate d .

Al tho ugh th e we athe r was d ull , whi ch usuall y d e p re sse d h im , h e was p e rfe c tl y
ce rt ai n that thro ughout thi s day h e fel t much b e tter b o th mentally and p h ysi
c ally th an th e day b efo re D uring th e eve ning h e was unusually l ive ly and
.

chee rful , sang and whistl e d q uite a l ittl e , an d sai d h e fe l t l i k e d an cing .

Al th o ugh th e tempe r ature o n th e b al c o ny was 22 C , h e b egan to c ompl ai n o f

°
.

th e c o ld and in th e afte rnoo n wo re a bl ank e t wrapp er and b e d ro om sl i ppe rs in

add iti o n to h is re gul ar c l o th i ng .
(S ee Pl ate 1 , fi gu re A, p age S ub se q ue ntly
h e wo re h is h e avy weigh t sui t o f und erc l o thes o ver th e unio n suit and sto c kings,
-

whi ch h ad b e en washe d in di sti ll e d wate r .

H e sai d that h e neve r use d al c o ho l in any form and in th e afte rn o o n c o m

pl aine d o f h aving to dri nk to o much wate r, remarking that it wo uld sho rten
th e fast if h e d rank so much , as it wo ul d wash o ut th e sal ts W h i l e th e re was
.

a l e giti m ate fo und ati o n fo r th e stateme nt th at th e di sti ll e d wate r might affe ct

th e sal t m etab o l ism, it was evi de nt that L h ad di sco vere d an effi c acio us way o f
.

Ob t ai ni ng anyt h ing th at h e wante d b y b ri ngi ng f o rward th e argume nt th at it

”
wo uld sho rten th e fast
“
. I t was d eci d e d th at if th e am o unt o f wate r give n
h im to d rink c ause d h im disco mf o rt , h e c o uld l e sse n th e am o unt . He pre
fe rre d to d ri nk o nl y when thi rsty , but that m o rning h ad t ake n wate r wi th out
fee l ing th e ne e d fo r it, an d h ad h ad ab so l ute l y no hunger all th e day Th e .

water taste d m uch b ette r th an h e h ad expe cte d it to taste , as h e usually dis

lik e d th e t aste o f disti ll e d water .
 G E N E R AL H I S T O R Y OF F A S TIN G EX P E R I ME N T . 39

In p re p ari ng him fo r th e re sp iration chamb er at night it w as diffi cu l t to ,

adj ust th e stetho sc o p e so as to he ar th e p u l se b e ats thr o ugh it c l e arl y Th e -

.

b est resu l ts were Ob tain e d by pl acing th e ste tho sco p e ab o ut 1 cm ab o ve th e .

l eft ni ppl e and 2% cm t oward th e ce nter l ine Of th e che st He uri n ate d at

. .

6 20 p m and tho ught h e woul d no t uri n ate ag ai n d urin g th e nigh t

11 m 1
. . By .

this tim e h e h ad b e co me thoro ughly accustome d to th e c al o rimeter showi ng ,

n o anxi e ty re garding his st ay in it and h avi ng th e gre at e st c o nfid en c e in tho s e

wh o h ad charge Of th e exp e riment He e ntere d th e resp iration cham b er at .

8 4 8 p In
h m
. .

A pri l 1 5 1 9 1 2 (second day of fast)

,
From th e exp eriment al re c o rd s an d th e —

re p ort o f th e subj e ct L e vi d entl y h ad a ve ry c omf o rt abl e night ri nging th e

, .
,

b e ll o nl y o cc asi o nally and sl eeping much b etter than h e h ad any night since
h e h ad c ome to B o sto n When h e l eft th e app aratus h e rep o rte d h imse l f to
.
,

be in e xc e ll e nt c o nditi o n There was no no tice abl e o do r when th e c al o rime te r

.

was o p ene d He fe l t no p ain o r se nsatio n o f hunger an d ve ry l ittl e thirst

.
, .

D uring th e fo reno o n h e wro te busil y an d seve ral l ong l etters we re mai l e d fo r

h im at no o n L is am b i dextro us using his right hand fo r wri ting and l eft
. .
,

han d fo r wo rk that is in tak ing th e dynam ometer te st h e al ways use d th e l eft

, , ,

hand first I n c o nversatio n h e invariabl y le d up to th e di scussi o n o f th e

.
,
”
i nnum erabl e p o p ul ar boo ks o n fasting wi th which h e was remark ably
“
,

fam il i ar An i ngenio us argume nt ag ainst fasting which h e rep o rte d as having

.
,

b een given h im by a p rominent Americ an veget ari an was that in a fast a m an ,

b e cam e a flesh e ater as h e e xiste d up o n h is o wn fl esh

-
,
.

At 4 p m 250 c c o f wate r were t ak e n from th e 1 l ite r o f di sti ll e d wat er

. .
, . .

c o ntaine d in h is b ottl e red ucing h is app o rtio nment o f water to 7 50 c c , . .

S ub se que ntl y thi s amo unt was give n to h im d ai l y T h e re ct al thermome t er .

was use d fo r th e fi rst time during th e night o f th e se con d day o f fasting L , .

inserting th e thermometer him se l f Previo us to en te rin g th e cal orime te r th e .

,

subj e ct was in unusually goo d sp irits singing and t alki ng a gre at d eal , .

A pri l 1 6 1 9 1 2 (thi rd day of fast) —On c o ming o ut of th e app aratus in th e

,

mo rning L sai d that h e wo re th e rect al th ermo meter all night an d s uffere d no

,
.

distress al tho ugh at times it tro ubl e d h im somewhat Th e Ob se rver re p o rte d

,
.

a go o d se ri e s o f temp erat ure me asuremen ts thro ugho u t th e night L evi d entl y . .

sl e p t mo re so undly than usual ringi ng th e b ell o nly o cc asio nally NO sp e ci al , .

o d o r was no te d whe n th e ch ambe r was o pe ne d .

Afte r th e subj e ct h ad b ee n weighe d se ve ral p h o to graphs were tak e n o f him ,

n ud e in v ari o us p o si tio ns co rre sp o nd in g app ro ximate l y to tho se t ak e n o n

,

Ap ri l 1 3 After h e was d re sse d at h is re quest seve ral pho tographs we re t ak e n

.
,

o f th e h e ad to S ho w th e f aci al c h aracte ri stic s His innum erabl e suggestio ns .

displ aye d a wo rthy inte rest in th e exp eriment tho ugh many o f th em h ad to ,

be di sre garde d .

On thi s day th e d ri nkin g water an d th e urin e b o ttl e were pl ac e d o n a t abl e

at th e foot of th e stai rs l e adi ng to th e b al c o ny th e subj e c t n o tify in g th e ,

assi stan t whe never h e wishe d wate r o r th e urine b o tt l e I n thi s way all .

p o ssibi l ity o f h is d ri nking th e u rine as was d one by th e subj ect o f Pat o n and ,

S to c kman was e l imin ate d ,

Al though L was l ess chee rful than h e was th e . .

day b e fo re h e was by no means d e p re sse d S p e n di ng a c o nsi d erabl e p art o f th e

, ,

fo renoo n in writing in his di ary He was p articul ar ly c autio ne d agai n st writing .

any o f h is exp eri enc e s o r sen din g o ut info rmati o n un autho ri z e d as mi suse ,

wo uld be mad e o f th e m ateri al wh ich h e gave o ut be fo re th e fast was co mpl ete d .

We h ad exp e cte d that h e would lie d o wn o ccasio nall y and h ad p ro vi d e d a .

well upho l ste re d c o uch fo r h is use but h e sat up p ractic all y all day
-
I t seem e d , .

d esirabl e therefo re to study h is met ab o lism in this p o siti o n Acc o rdingly in

, , .

th e afte rno o n h e c ame d o wn fro m th e b al c o ny an d a resp irati o n exp e ri m e nt was

40 A ST UDY OF P R O L O N GE D FA S T IN G .

mad e with him in two e xpe rimental pe ri o ds whi l e h e was sitting in a co m ,

fo rtable chai r .

D urin g th e day th e subj e ct re po rte d th at h e h ad no bad fee l ings o f any kin d .

He fe l t slightly irri tabl e but c o nsid e ring th e c o nfi neme nt h e was remark abl y
, ,

free from th is fee lin g o f i rritatio n muc h more so than in h is l ast fast Th e
, .

d isin cl inati o n to exert himse l f in any way which might c ause th e slightest
strain w as sho wn o n this day when h e c o m pl ai ne d th at th e d yn am o me te r hurt
his right han d an d h e did no t d are to p re ss it as har d as h e would h ave li ke d
to He p assed no uri ne from 8 05 a m whe n h e c am e o ut o f th e bed
.
h m
. .
,

c al o ri m e ter unti l 8 05 p m j ust be fo re ente ri ng th e chamb er altho ugh h e

,
h m
. .
, ,

drank all o f th e 7 5 0 c c o f distille d wate r , taking th e l ast p ortio n at 5 50 p m

. .
h m
. .
,

wh en h e finish e d th e p sycho l o gic al tests .

I n th e e ve ning j ust be fo re e nterin g th e cal orime ter h e sai d th at th e re ctal

, ,

thermo m ete r irritate d him c o nsi d erably an d h ad ke p t h im awak e mo re o r l ess

th e night be fo re He was aware o f its p re se nce e ve ry time h e wo k e up and
.

d uri ng th e day th e anus h ad be e n some wh at irritate d He ask e d if th e temp .

e rature c o ul d n o t be tak e n eve ry o ther night i nste ad o f e very night as h ad bee n ,

pl anne d an d th e the rmome te r was acc o rdi ngl y no t u se d o n th e night of

,

Ap ril 16 17—
.

A pril 1 7 1 9 1 2 (fou rth day of fast) — B oth th e e xp erime ntal re c o rd s and L s

’
.
,

re po rt i ndi c ate that h e sl ep t b etter o n th e night p rece di ng this day th an h e h ad

any night thus far p asse d in th e ch am be r Th e day was u neve ntfu l He sai d . .

th at h e h ad no great thirst and h e dr ank th e disti ll e d wate r more fro m a se nse

of d uty than fro m any d esire fo r it He did no t l e ave th e b al co ny d uri ng th e.

day exc e p t fo r th e p sycho l ogic al test at 4 50 p in

h
At o ne time d uri ng th e 11“
. .

fo re noo n h e was see n to ho ld up a l ight m an weighi ng but 1 25 p o unds ,

ki l o gram s) fo r a few se c o nds He appe ared pl ease d with this supp ose dl y
.

se nsati o nal fe at and was q uite u napp re ci ative O f th e c autio n to c o nse rve
“

his stre ngth fo r tests o f muscul ar stre ngth that coul d be me asur e d te sts that ,

h e h ad re pe ate dl y re fuse d to mak e .

On th is day h e wo re th e ste th o sc o pe most o f th e day an assistant c o unti ng th e ,

pulse rate at a distanc e fro m him and un kno wn to h im fo r th e gre ater p art Of
-

th e ti m e . I t was ho pe d that mo re o r l ess c o ntinuo us re c o rd s o f th e pul se rate -

co uld be o b taine d in this way I n p rep ari ng h im fo r th e c al o ri m eter at night

.
,

I p erso nally inse rte d th e re ctal thermomete r and h e rep orte d th at it did no t
hurt h im in any way He be lieve d that when putti ng it in himse l f th e fi rst
.
,

nigh t h e must have i rritate d th e anus so mewh at t h u s c ausi ng th e sub se q ue nt

, ,

disc o m fo rt T h e subj e ct e nte re d th e c alo rime ter fo r th e night at 8 1 9 p In

.
h m
. .

A pri l 1 8 1 9 1 2 (fifth day of fast)

, Th e subj e ct re p orte d in th e mo rni ng that
—

h e sl e p t q uite we ll d uri ng th e night but no t so we ll as h e did th e night be fo re

, .

He th o ugh t h e went to sl ee p ab o ut an ho u r after e nte ri ng th e c al o rim ete r an d

wo k e up se ve ral tim es d uri ng th e night He sai d h e was e n ti rely c o m fo rt abl e .
,

th e re ctal th ermo m e ter givi ng h im n o t ro ubl e T h e sp rin g suppo rti ng th e .

be d h ad b ee n so m ewh at we ak e ne d in o rd e r to o b t ai n a gre ate r se nsi tivi ty fo r

th e app aratus re c o rd i ng th e mu sc ul ar ac tivity Th e re c o rd s sh o w fo r th e .
,

mo st p art a re m ark ably q ui e t night so that l o ng c al o rimeter exp erim ents o f

, ,

1 0 o r 1 1 ho urs wi ll be p e rfe ctl y c o m p arabl e so far as th e muscul ar acti vi ty is

co n cern e d I n this resp ec t th e subj ect was exc ep ti o nall y well ad ap ted fo r an
.

e xp erim e nt o f th i s ki nd .

N o twi th st andi ng th e d ull we ather L sai d th at h e fe l t very well with no , .

,

l oss o f strengt h he ad ac h e feel ing o f h unger o r o f app re h ensi o n He was no t

, , ,
.

usuall y tro ubl e d with he ad ach e d uri ng a fast When h is me asurements were .

t aken h is height was fo und to be

, m ete rs H e sai d th at his m axim um .

weight was 1 4 sto ne o r 1 96 p o und s ki l o gram s) His i niti al weigh t fo r .

 GE NE RAL HI S T O R Y OF FA S TI NG E XP E R I ME N T . 41

th e Mal ta fast was 1 2 sto ne and 3 p ounds o r 17 1 p ounds (7 7 6 ki l o gram s) , .

D uring this fast h e l o st 3 7 p o unds ki l o gram s) and thus weighe d at th e ,

e nd Of th e fast 1 34 po un ds ki l o grams) These measurements inc l ud e d .

th e we ight of th e c l o thi ng wo rn and we re tak e n with o rdi nary sc al e s b ut ,

p rob abl y re p rese nt average weights .

I n th e eveni ng L talk e d ab out his work in Mal ta and h is int erest in th e

.

nume ro us fasti ng b oo ks whi ch h e h ad re ad He b e c ame q uite e xcite d in .

talki ng of three l egal cases in which h e was i nvol ved in Mal t a sp e aki ng with a ,

goo d d e al Of vigo r and enthusiasm There was not th e sl ighte st evi d ence o f .

his havi ng fasted fo r 4 % d ays Afte r i nse rti ng th e re ctal the rmo me te r th e
.
,

subj ect entere d th e be d c al o rim ete r ab ou t th e usu al time .

A pri l (si xth da y fo f ast) Th e subj e ct was s l ee p ing very so undly

—

whe n th e c al o rimeter exp eriment was ended and o n l e aving th e app aratus
.

re p o rt ed that h e h ad h ad a very comfo rt abl e night He seemed very b right .

an d q uit e l i k e h imse lf Acc o rding to th e re co r ds Of th e Ob se rve rs th e subj e ct

.
,
m
sl ep t very we ll thro ughout th e night until 5 30 a m when h e rang th e be ll
h
. .
,

int ermitte ntl y for a Sho rt time He still continue d to have no d isc omfo rt no
.
,

se nsatio ns o f h unger and no app rehe nsions an d fe l t ve ry much incl ine d to

, ,

ment al wo rk He sai d h e di d no t exp ect to have such an exce ll ent fast and
.

seeme d to be co ntent with th e p rogress o f th e experiment On thi s day th e .

subj e ct sp e nt co nsi d e rabl e t ime in writing To p ro vi de d at a fo r sub se q ue nt .

c omputatio n o f th e to t al energy transfo rmation during th e 24 ho urs it se emed ,

d esirabl e to me asure th e respiratory e xchange whi l e th e subj ect was writing .

This typ e of exp eriment which h ad never be en attemp ted in this l ab orato ry
,

b efo re p rove d to be very successful th e subj ect sitting in a c o m fo rtabl e chair

, ,

and writing as usu al (Se e Pl ate 1 fi gure B p age

.
, ,

A pril 20 1 9 1 2 (seventh day of fast)

,
—
When th e c al orimeter was o p ened no ,

o do r o f ac e to ne was app are nt and n o unpl e asant o d o r o f any k i nd

,
Thus far .

in th e se ri e s of c al orime ter exp eriments th e only unpl e asan t O d o r which h as ,

b een no ted was th e stro ng smell of onions o n th e mo rni ng foll owing h is evening
meal o f b eefsteak and o ni o ns L sai d that h e was in excell ent c o nditio n ;
. .

i ntell e ctually h e was ve ry acute He sl ep t well thr o ugho ut th e night wi th no .

discomfo rt and ran g th e b ell o nl y a few times With th e sunny weather th e .

subj e ct s sp i rits ro se and h e re p o rt e d hi mse l f as fee li ng ve ry happ y and

’

upl ifte d ; h e sang at times duri ng th e mo rni ng A b arb er cut h is hair an d .

b eard o n t h i s day th e trimmi ngs b eing save d fo r anal ysis

, .

Afte r t aki ng a b ath in th e evening h e entere d th e c alorime te r He to ld , .

o ne o f th e assist ants th at h e fe l t very dr owsy and exp e ct e d to g o to sl ee p

almo st imme di atel y .

A pri l 21 1 9 1 2 (ei ghth day of fast) — Ou c omin g o ut o f th e app arat us th e ,

subj e c t re p o rt e d th at h e d i d n o t go to S l e e p as q uic kl y as h e h ad exp e cte d to ;

h e lay awak e fo r 2 ho urs and al so wo k e up in th e night o nc e o r twice He .

S l ep t we ll ho we ve r and h ad se veral d re ams which h e re p o rte d to Dr L angf e ld

, ,
. .

L ask e d if h e di d no t have fever d uring th e first 2 o r 3 d ays o f th e fast st ating

.
,

that h is wife durin g th e first d ays o f h er fast h ad quit e a high fe ve r W h en .

h e was t o ld that h e h ad h ad no fever h e was much surp ri se d His theo ry was .

that in th e first d ays o f th e fast th e bl o o d rid itsel f Of all imp uriti e s th e

“
, ,

b urni ng p ro c ess p ro duci ng a high fever .

I n th e aftern o o n th e subj e c t went up to th e ro of using th e el evato r ; h e

, ,

rem aine d there fo r ab out 1 i hours sitting in th e sun an d ch atting o n ge neral

’

subj e cts He sai d c o nsi derabl e ab o ut h is exp erien c e with Esp eranto an d ab o ut
.

m any o f his Mal te se custo ms His vo ic e was stro ng an d h e seem e d to be.

,

very well and b righ t He c ame d o wn from th e ro o f b y th e el evato r to th e

.

o ffic e an d di c tate d i n to th e di c tap ho ne a st ateme nt re g ardi ng h is fee l i ngs .

Th e d ictate d rep o rt is as fo ll o ws .
42 A ST UDY OF P R O L O N GE D FA S T ING .

I fel t very b righ t thi s mo rni ng b e c ause th e sun was shi ni ng very b rightl y
an d t h e day is so fi n e an d so sunn y th at it l oo k s very mu c h l i k e o ne o f m y
Mal tese d ays fo r which I am ve ry d esiro us This afte rn o o n I h ave b ee n o n
.

th e ro o f o f th e l ab o rato ry so as to e nj o y th e sun , which I l o ve so mu ch b e c au se

I was b o rn and b re d in it, and I do no t fee l very fatigu e d at all o r any appre
h ensio n o r any fe ar I fee l ve ry ho p eful th at m y fast wi ll be no t o nly a
.

very l o ng o ne but a very successf ul o n e , and I fee l no p angs o f hunger whatever

o r any o th e r se ns ati o ns in my sto mach , and I thi nk th at my he al th is p ro gre ss
ing b e c ause th e c atarrh o f th e he ad in m y no se and in my p harynx be fo re th e
starti n g o f t h e f ast h as n e arl y d isappe are d an d I c an aspi rate very e asi l y
thro ugh m y n o stri l s, a thing wh i ch I c o ul d n o t do very e asi l y b e fo re , and also
I fe e l that my eyes are getti ng l ess c o ngeste d and b etter I do no t fe e l any .

di zzine ss at all, and I have never fe l t it, neith er wh en I l e an d o wn to g et u p

s ometh ing th at fall s fro m th e hand ; in fact , I c an come d o wn th e stee p stairs
o f my b al c o ny ap artme n t very e asil y wi th o ut t ak i ng h o ld o f th e rail i ng an d
with o ut any ne cessity o f be ing helpe d by any o ne My l egs fe e l ve ry stro ng
.

”
and I do no t fe e l any numb ne ss in them .

T h e subj e ct we nt fro m th e o ffi c e to th e c al o ri m e te r l ab o rato ry o n th e e l e vato r

an d d ran k a gl ass o f water, b ut did n o t re turn to th e b al c o ny, as it was al mo st
time fo r th e p sycho l ogic al t e sts T h e re c tal th erm ome te r was use d d urin g
.

th e be d c al o rime te r e xpe rime nt, o b se rvati o ns b ei ng mad e eve ry 1 0 m i nu tes

d uring th e night .

A pril 22 , 1 9 12 (ninth day of fast) —

Ou o p e ni ng th e c alo rimeter cham b er n o
O d o r w as n o tic e abl e .T h e subj e c t re p o rt e d a ve ry c omfo rt abl e night an d sai d
th at h e fe l t very we ll , exc ep t th at h e h ad h ad a bad taste in h is mo uth fo r
seve ral d ays .He sl e p t ve ry quietl y, ri nging th e b ell o nl y three time s .

D uri ng th e day h e h ad visits from a num b er o f scie nti fi c m e n , with whom h e

tal k e d c o nsi d e rabl y He was p artic ul arl y i nterest ing and vivaci o us in dis
.

c ussing his expe riments with Pro fe sso rs C ann o n and Fo l i n and with Dr .

C athc art He re p o rte d th at h e di d no t no w fee l so much i ncl i ne d to mental

.

wo rk , e xpl ai ning this fact o n th e gro und that th e b rain was o c cup ie d in
“

”
e l im i nati ng th e impuriti es fro m th e bl oo d .

A pr l 23 , 1 9 1 2 (tenth day of f st)

i a —
Th is mo rni ng L sai d that th e p re ce ding
.

night was th e b est th at h e h ad h ad in th e c al o rimet er He was very q uie t

.

d uring th e night and rang th e b ell but a few times He sti ll compl aine d o f th e
.

bad taste in his mo uth .

I n th e afte rnoo n a re sp iratio n e xp eriment o f two p e ri o ds was mad e wi th th e

subj e ct S ittin g in a chai r I n thi s exp erim ent c ertai n ab no rm al val ues were
.

Ob tai n e d fo r t h e p ul se- rat e an d th e resp irato ry q uo ti ent , and Mr C arpe nte r .

thought th at there was a slight i rre gul ari ty in th e acti o n o f th e he art Since .

th e m an was essenti all y d iff erent as to hi s t o tal met ab o l ism f rom th e day
b efo re , Dr G oo d all was ask e d to exam ine him d uring Dr L angfeld s tests
.
’
. .

Dr G o o d all no te d th e he art rate b efo re , d uring, and after th e dynam o m et er

.

te st , an d p ro no un c e d th e s ubj e ct to be in an exce ll ent c o n di tio n .

L h ad b e en l ess self asse rtive fo r th e week p revi o us, m u ch mo re i nc line d

.
-

to c o o p erate in th e exp erime n tal ro u tine , and a l ittl e m o re re c o nci l e d t o th e

fact that th e o b se rvers were fami li ar wi th their te chni q ue He was mo re .

q ui et and l ess argum ent ative th an fo rme rly and was at tim es c o nsi d erabl y
d e p re ssed , sp e nding mu ch o f th e time in thinki ng o f h o m e In co nversatio n .

h e see m e d v ery i nte llige nt and i nte reste d in e veryt hi ng, an d by no me ans
l eth argic He p ro fesse d to have n o d isc o mfo rt fro m th e re ctal ther
.

m o m eter, al th o ugh h e state d frankl y th at h e fe are d its use very much b efo re
co m ing to Americ a He al so was b ecoming accustome d to th e respi rati o n
.

cham b er and did no t fi nd it at all irk so m e .

44 A ST UDY OF P R O L O NG E D FA S T ING .

was mad e wi th him whi l e h e was si tting in a chair He was very dro wsy and .

tho ught h e c o uld sl eep thro ug ho ut th e wh o l e night, as th e p revi o us night h e

h ad n o t sl e p t as well as fo rmerly As h e d oe s no t re ad in th e eve ni ng , h e fo un d
.

it so mewhat te dio us to S it i dl e unti l 8 o cl o c k , when h e usu all y we nt into th e

’

c al o rimete r, and h e ask ed to go into th e app aratus an ho ur e arlier A resp ira .

tio n expe riment was made e arl y in th e e vening j ust be fo re h e went i nto th e
c al o rimete r, an d this expe riment was mad e a p art o f th e expe rimental ro utine
o n sub se q u e nt d ays He e nte re d th e bed c al o rime te r at 9 p In
. . .

A pril 2 7 , 1 9 1 2 (f rtee
ou n th da y ff
o a st) Th e subj e ct re p o rte d that h e h ad
—
.

h ad a ve ry c o mf o rt abl e night ; h e rang th e be ll b ut twic e duri ng th e who l e time

h e was i t e c o ime
n h a l r te r ch mb
a e r A b ut 0 5 a m , L was t ak e n in th e
o 1 h
4 m . . . .

e l evato r to th e thir d fl oo r o f th e l abo rato ry , where h e was sho wn abo ut and

several p iec es of app aratus were exp l ai ned to him He then walk ed d own .

st airs to th e se co nd fl oo r and when abo ut a third o f th e way d own, h e co m

m en c ed to mo ve rap i dly an d finall y ac tuall y ran d o wn th e stairs I n th e Offi ce .

h e l oo ke d at some pho to graphs and di ctate d th e fo ll o wi ng stateme nt :

To—day is th e fo urtee nth day o f my fast I feel exce e di ngl y we ll ; I fee l .

chee rf ul and ho pe ful o f th e gr an d succ ess I have sle p t several go od ho urs .

d uri ng th e night, and am e nj o ying with gre at enthusias m all th e exp eriences
that are c arried o n m e b y th e p ro fesso r I have to- day with Pro fesso r .

B enedi ct go ne aro und th e uppe r fl oo rs of th e l ab o rato ry and I have admire d

all th e gre at fo rmal ities that I have se e n .

S ub se q ue ntl y h e walke d o ut i nto th e hall an d d o wn st airs to th e c al o rime ter -

roo m whe re h e sat d o wn in an arm chai r and was th e s ubj e ct o f a respiration

,

e xpe rime n t .

I n th e afternoo n I spe nt ab o ut an hour wi th L o n th e b al c o ny He was very . .

chee rful and talk e d a gre at d eal gesti c ul ati ng free ly wi th h is han ds He
, .

se eme d to e nj o y talking abo ut th e b e autiful i sl and o f Mal ta “

He wo re .

very much l ighte r cl o thi ng to day no t using his heavy bl ank et wrappe r at all
-
, .

I n fac t whi l e walki ng ab o ut th e l ab o rato ry h e c arri e d his bl an k e t wrapper

, ,

ove r his arm and al tho ugh th e offi ce was a l i ttl e coo l h e d i d no t put it o n but
, , ,

sat n e ar th e wi nd o w .

One o f th e striki ng fe ature s O f this fast is th e fac t that it h as b ee n so d iff e re nt

fro m what h e expe cte d in many ways a goo d ill ustratio n o f th e unre l i ab il ity
,

of p e rso n al imp ressio ns Fo r i nstan ce h e h ad exp e cted to fee l very chi lly
.
, ,

but wh il e h e sai d h e fel t ch ill y th e fi rst two o r thr ee d ays it is po ssi bl e th at ,

thi s m ay have b e e n due to his imaginati o n as sub se quentl y be was n o t n e arly ,

SO chi ll y an d o n thi s day ask e d t h at th e t emp erature o f t h e ro o m sh o uld be

l o we re d wh ich was d o ne He al so s ai d o ne o f th e fi rst d ays that h e was in
, .

th e l ab o rato ry that h e wo uld have a l ar ge amo unt o f phl egm as th e fast pro
g ressed bu t t his h ad n o t bee n th e case u p to th is d ate
, Wh il e talking with .

Dr Ash o n thi s day L s ai d that h e h ad expe ct e d that h e wo uld b ec o m e very

.
, .

ho arse d uring th e fast but thus far h is vo ice h ad n o t change d excep t to gr o w

, ,

cl e arer I n th e evening h e was given a b ath h is b o dy b eing sp o nge d with

.
,

disti ll e d water after wh ich h e entere d th e c al o rim e te r

, .

A i ri l 28 1 9 1 2 (fifte enth day of fast) — Th e e xp e rim ent al re c o rd s sho w that

,

th e subj e ct sl ep t ve ry we ll thr o ugho ut th e night and h e himse l f re p o rte d a

go o d night I n th e aftern oo n h e was tak en o ut fo r a c arri age d rive with th e
.
,

wi nd o ws o f th e c arri age Op en He was we ll wrapp e d up and sai d th at h e was

.
,

p e rfectly c omfo rt abl e and did no t get to o ti re d He walke d d o wn to th e .

b asem ent and o ut to th e c arri age and o n h is return walk e d fro m th e c arri ag e
up stairs again i nto th e c al o rimeter l ab o rato ry
-
He th e n sat do wn fo r several .

minutes and l ater a p ho to graph was t ak en o f him with th e bl ackb o ard sho wing ,
 G E N E R AL HI S T O R Y OF FA S T I NG EX ER P I ME N T . 45

h is b o dy weight curve as a b ack gro und He see me d unusually stro ng and

-
.

ac tive walk e d with c e rt ain fe e t and di d no t seem to be in any way e xh aust e d

, ,

o r tire d He t alk e d ve ry excite dl y duri ng th e who l e o f th e d rive ; in f act h e

.
,

talk e d co ntinuo usl y He sai d that abo ut 6 O c l oc k th at mo rni ng h e h ad h ad

.
’

a no rmal semi n al emissi o n whi ch d i d no t irri tat e h im as d i d th e o ne j ust p rior

,

to th e fast His Ob se rvation was veri fi e d b y Dr G oo d all s sub se que nt exam i

. .
’

n ati o n o f th e uri ne a l arge num b e r of sp e rmato z o a be ing fo und

, .

A pri l 29 1 9 1 2 (sixteenth day of fast)

,
When th e c al o rimete r was Op ene d in —

th e mo rning th e usu al ab senc e o f o d o r was re c o rd e d an d th e subj e ct rep o rte d

, ,

h imse l f as very c omfo rt abl e and as havi ng sl ep t very we ll I n asmu ch as it .

was no t L s c to m t t thb ru at l e ast no too thb rush w as fo un d in

’
u s o
. u se a o o s h —

h is l ugg age and h e h ad n o t b rushe d h is t ee th si n c e h is arrival in B o sto n it —

se eme d d esi rabl e to o b tai n so me cul tures o f th e mic ro o rg ani sms o f th e mo uth - .

These were se cure d b y Dr Kend all o f th e H arvard Me dic al S choo l b ut th e .

, ,

ex ami n ati o n o f them sh owe d o nl y ad ve ntiti o u s o rgani sms L was much i nter . .

e ste d in thi s t est e spe ci all y as such a t est h ad never be e n mad e in a p revi o us
,

fast E arl y in th e fo re noo n h e was very irri tabl e an d co mpl ained o f th e ex ecs
.
,

sive amo u nt o f dri nki ng wate r ; h e w as e spe ci all y di sturbe d b e c ause h e h ad no t

he ard from home Whil e Mr C arpe nte r was maki ng th e respi ratio n expe ri
. .

ment in th e aftern o o n th e subj e ct di d no t se em quite so we ll as o n o th er d ays

, .

A pri l 3 0 1 9 1 2 (seventeen th day of fast) —Whe n h e c am e o ut o f th e chamb e r

,

in th e mo rni ng L re po rte d th at th e night h ad be en o ne of th e b est h e h ad

, .

h ad si nc e c o mi ng to th e l ab o rato ry T h e Ob se rve r s ai d th at there was n o o d o r .

and th at th e subj e ct was ve ry c o mfo rt abl e Asi d e from th e taki ng o f a se ri e s .

Of new p ho to grap hs th e day was un e ve ntful , .

May 1 1 9 1 2 (eightet , d y of f )
a ast —
Th e o b se rve rs re cord s S how that th e
’

subj e ct sc arc e l y mo ve d d uri ng th e night and th at th e b e ll r ang o nl y o nc e o r ,

twice There was no o d o r when th e app aratus w as O pe ne d I n th e afternoo n

. .

of this day L was t ak e n fo r a d rive

, . .

M ay 2 1 9 1 2 (nineteenth day of fast) — L re po rt e d a very comfo rt abl e night

, .

in th e c al o rimet e r ; n o o d o r was app are nt when th e app aratu s was o pen e d .

At thi s st age o f th e fast it h ad b e c o me ve ry c l e ar to th e o b se rve rs that L h ad

,
.

change d sinc e th e b egi nning Wh i l e h e walk e d sl o wl y and st e adi ly and gave .

no sp e ci al e vi d e nc e o f we ak n ess h e was much l e ss talk ative l e ss i nc l ine d to , ,

o ff e r advic e and mo re qui e t and subd u e d

,
He was b y no me an s so ac tive a .

m an as at th e b e gi nn ing of th e f ast He c ompl aine d th at fo r se veral mo rni ngs .

”
p ast h e h ad fe l t h is b o nes d uri ng th e nigh t and was SO unc omfo rtabl e th at
“

h e wak e d up and turn e d o ve r I t h ad be co me i ncre asi ngl y d iffic ul t to adj u st

.

th e stetho sc o p e so as to o b tain a c l e ar re c o rd o f th e p u l se rat e On thi s day -

.

so m uch d iffi c u l ty was e xpe ri e nc e d th at an assi stant was d e t ai l e d to watch th e

m o ve m e nt o f an art ery in th e nec k His vo ic e was so mewhat weak er though .
,

no t husky but it o cc asion all y ro se to its o rigi nal to ne

,
Furt h erm o re al though .
,

h e h ad mai ntaine d th at ab o u t th i s pe ri o d o f th e fast h e wo u ld be i nt ell e ctuall y

b ette r h e was in re al ity disi nc li ne d to re ad write o r talk as mu ch as at th e
, , ,

be gi nni ng Th i s was well b ro ught o ut by th e fact that when h e was to ld o n

.

this day that h e o ught to sp e n d his time stud yi ng th e p rin ci pl e s o f th e app a

ratus and th e te chni q ue rath er than to tro ubl e h imsel f ab o ut th e re sul ts h e ,

st ate d that h e did no t want to S pe nd so much time in th i s way and th at h e did

no t fi nd himsel f very mu ch i nte re ste d in them bu t th at h e wo u ld be b ette r ,

l ate r o n Th i s app e ars to c o ntradict th e statement that h e wo uld be mo re

.

active int e ll e c tu all y as th e fast p ro gre sse d He was me asure d by Dr An de rso n . .

o n th i s day wh o remark e d th at as h e saw h im o nl y o n c e a wee k it w as ve ry

, , ,

Ob vi o us to h im th at h e h ad ch ang e d very much S i n ce th e b e gi nni ng o f th e fast .

His l o ss in fl e sh was o f c o urse much m o re app arent to D r And erso n th an to .

46 A ST UDY OF P R O L O N GE D F A S T ING .

tho se of us wh o saw h im d ail y I n th e afterno o n h e was tak en to th e roo f

.

ag ai n whe re h e staye d fo r a l ittl e mo re th an an h o u r

, W h e n h e returned to .

th e c alo rime te r l ab o rato ry h e sat d o wn in a ch ai r unti l th e p sycho l o gic al te sts

,

b egan He still h ad a gre at intere st in th e vari ous te sts and made th e sug
.

gestio n th at th e re ctal th ermometer be i nse rte d b e fo re th e evening re spirati o n

e xp e rime n t so as t o g e t t h e tempe ratu re change s d urin g thi s e xpe rime nt
, .

May 3 1 9 1 2 (twentieth day of fast) Al th o ugh th e subj e c t re po rte d th at h e

, .
—

did n o t sl ee p so we ll as h e did th e night b e fo re h e neve rthe l e ss h ad a fairl y ,

c o mfo rt abl e nigh t Th e re was no odo r app are nt o n O pe ni ng th e cham be r

. .

As th e we athe r w as exc e p ti o nall y fi n e L was tak e n fo r a d rive in th e afte rno o n , . .

M ay 4 1 9 1 2 (twenty fi rst day of fast) Th e subj e ct re po rte d this morning

,
- —

”
th at h e h ad h ad se ve ral go o d ho u rs o f sl ee p
“
He was ve ry c omfo rt abl e .
,

e xc e p t th at h e h ad to c h ange h is p o si tio n sev e ral times d uri ng th e night A .

numbe r o f u nsuccessf ul atte mp t s we re mad e to t ak e th e p u l se r ate wi th th e -

stri ng g al van o me ter bu t th e app ar atus was b ro k e n

, I n th e afte rn o o n th e .

subj e c t w as tak e n o ut drivi ng I n th e eve ni ng much t ime was s pe nt in fi n ding

.

a sui tabl e l o c ati o n fo r th e ste tho sco pe an d whe n th e pl ac e was fi n all y fo un d ,

it w as so sharply l o c al i z e d that a moveme nt of th e st e thosco pe be ll 1 cm in .

any d i re cti o n wo ul d p reven t t h e t aki ng o f goo d re cords I t was the n agre ed .

Up o n th at if d u ri ng th e night th e p ulse re c o rd s were no t o b t ai nabl e a signal ,

t o L wo uld be give n wh o wou ld pl ac e t h e h e ll o f th e ste tho sc o p e as ne arl y as

.
,

h e c o uld in th e pl ac e d e ci ded o n Fo rtu n ate l y o n thi s and al so o n th e fo l

.
,

l o wi ng nigh t th e p ul se rate was se c ured with co nsid erabl e regul ari ty

-
.

May 5 1 9 1 2 (twenty seco nd day of fast) — T h e e xpe rime nt al rec o rd s S ho we d

,
-

th at th e subj e c t re maine d ve ry q ui e t thro ughout th e night ri nging th e be ll ,

o nly o n c e o r twic e I n th e afte rnoo n o f this day h e was t ak e n o ut fo r a c arriage

.

d rive o f two ho urs He e nj o yed this drive very mu ch i nd ee d sp e aki ng enth u

.
,

el astic all y ab o ut th e be auty o f B o sto n and its sub urb s an d h o w it e l evate d h im ,

to see it W h e n h e re turned h e c l aime d that h e was ne ith e r ti re d n o r c o ld

.
, ,

al t h o ugh th e air was c o o l e r th an wh e n h e we nt o ut t h e day be fo re .

He h ad changed co nside rabl y d uri ng th e p re ce di ng wee k a fact wh ich was ,

no te d by seve ral pe rso ns wh o h ad n o t se e n him d uri ng th at p e ri o d He .

walked much more de li be rate l y but appe are d to be pe rfe ctl y sure o f h is foo ti ng
,
.

W h e n h e c ame d o wn st airs to t ak e t h e p sycho l o gic al tests h e to o k th e l ast

-
,

three o r fo ur ste ps q uite rap i dl y an d ste ppe d o ff briskly to gree t Dr Langfe ld . .

On th e o the r hand at th e e nd o f th e p syc h o l o gic al test h e sat rather d ej e c te dl y

, ,

in h is chai r Whe n Dr Langfeld to ld h im th at th e te sts were o ve r ho wever

. .
, ,

h e ro se fro m th e c h ai r i mmed i ate l y and returne d to th e b al c o ny but sto pp e d, ,

h alf way up th e stairs to l oo k at th e st ri ng gal vanome ter with which we were

-

wo rking and seeme d as inte ll e ctually k een and b right as any o ne

, .

May 1 9 1 2 (twenty third day of fast) On co mi ng o ut o f th e ch ambe r L

- —
, .

re po rte d that h e h ad a fai rly c o mfo rt abl e night S l e e ping ve ry well He co m ,

.

pl aine d ho wever that as h e h ad l o st SO mu ch adip o se tissue h e fo und it

, , ,

rathe r d i ffi c ul t fo r h im t o sl e e p o n o ne si d e fo r any l e ngth o f time and h e was ,

o bl ige d to turn fro m o ne si d e to th e o ther freq ue ntl y T h e Ob se rv e rs al so .

fo und it e xt reme l y diffi cul t to g e t th e re co rds o f th e p ul se rate L was much -

. .

sti m ul ate d as a resul t o f vi si to rs in th e f o re n o o n He e xhi b ite d a much .

S harp er i nte ll e c t ual ac tivity th an h ad b e e n app are n t fo r se ve ral d ays which ,

m igh t p o ssibly p ro ve his st atemen t that h e wo uld b e c o m e m o re i nte ll e c tually

k e en as th e f ast p ro gresse d Oth er th an that we c o ul d see l ittl e evi d ence Of
.

th e so c all e d i nte ll e ctual acti vi ty th at h e h ad re fe rre d to fre q u e ntl y d uri ng

-

th e f ast .

May 7 1 9 1 2 (twenty fou rth day of fast) T h e subj ect was fai rl y qui e t
,
- —

th rougho ut th e night mo ving only o c c asio nall y When th e c al o rime te r was

, .
 G E N E R AL H I S T O R Y OF FA S T IN G E X ER P I ME N T . 47

o p e ne d no o d o r was o b serve d Thus far in th e fast no ace to ne o d o rs h ad

,
.
,

bee n no te d I n th e fo reno o n a numb e r o f vi sito rs c ame into th e l ab o rato ry

.

an d seve ral small p h o to gr ap hs we re tak e n o f L I n th e afte rn o o n re sp i r ati o n .

e xp e ri m e nt when th e subj e ct sat wri ti ng h e was rep o rte d as b e ing very

, ,

o b sti n ate and i ntrac tabl e He seeme d to have so me diffi c ul ty in fin d ing a

.

p ositio n to suit h im and th e no se pi e c es h ad to be i nserte d a se c o n d time to

,
-

mak e sure that they were we ll fi tte d He al so compl ai ne d that th e writing .

p ape r was to o he avy so that h e wo ul d have to write o n b o th si de s o f th e p ap er

,

to save p o stage He appe are d to be very diffi cu l t to pl e ase At 5 o cl o c k o n

’
. .

this day L re p o rte d that h e was fe e l in g ve ry much d e p resse d o wi n g to th e

, .
,

weather and that h e S pent th e who l e time th inkin g ab o ut home and was
,

much wo rri e d .

May 8 1 9 1 2 (twen ty fifth day of fast) Th e subj e ct re p o rte d a ve ry c omfo rt

,
—-

abl e night mo vin g o nly o n ce o r twic e d uring th e night I n o r d e r to c o ntro l

,
.

th e po ssi bl e i nfluence o f small muscular mo vements o n th e t emp erature of th e

air in th e chambe r at t h e e nd of an e xp erim ent al p e ri o d th e height o f t h e ,

S p i ro me te r at tache d to th e c al orime te r was re c o rd e d o n a smo k e d p ap e r d rum ,

a ro uti ne which p rove d very he lp f ul o n sub se q uent nights On t h is mo rni n g .

L was very sull e n and disag ree abl e when spo k en to e sp eci ally with Mr
.
, .

C arpenter He sai d that h e h ad e xpe cte d there wo uld be a ye ll o w pigmeu

.

t atio n o f th e sk i n as in o ther f asts but thi s d i d n o t app e ar , I n th e afte rn o on .

I aske d him h o w much l o nger h e wi shed to f ast He repl ie d by aski ng h o w .

l o ng I want e d h im to fast As I h ad p re viousl y to ld him o n se veral occ asio ns

.

that I sho uld l i ke h im to fast 3 0 d ays it was o b vio us that h e wi she d to be ,

ask e d to sto p f asti ng r athe r than to b re ak th e fast himse l f I to ld him that .

we sho uld p ro b abl y wish him to fast fo r 30 o r 3 1 d ays T h e d i et o f t h e .

re al ime nt ati o n p e rio d was the n di scu sse d

-
He be lieve d ve ry stro ngl y that .

th e f ast sho uld be b ro k e n with aci d fruit j uices al o ne Th e re ctal the rmo me te r .

r emai ne d in p o si ti o n thro ugho u t th e day and th e tempe rature re c o rd s we re

se cure d fo r th e gre ate r p art o f th e time .

May 9 1 91 2 (twenty sixth day of fast) Th e subj ect spe nt an unusuall y

,
-
.
-

q ui et night ri ngi ng th e be ll o nly three time s thro ugh o ut th e ni ght I n th e

, .

afte rn o o n d uri ng an active c o nve rsati o n which I h ad with h im in which

, ,

ge neral q uestio ns were di scusse d h e see me d to be ve ry sp iri te d l ive ly and , , ,

intere ste d His pul se rate was 86 at this time I n th e eveni ng when h e c am e
.
-
.
,

d o wn stai rs to t ak e th e p sycho l o gic al test h e appe are d to be q uite unste ad y

-
,

o n h is f e e t and sai d th at h e was l ight he ad e d He tho ught that h is unste adi

-
.

ne ss w as due to th e fac t th at h e h ad l o st so much weight th at h e p ut u nusual

stren g th o n hi s fo o t mo re than h e n ee d ed to t ak e his weight an d th at thi s
, ,

te nde d to unb al ance h im Mr C arpe nte r al so no tice d that wh en walking L

. .
, .

was q uite uncert ai n in h is ste ps and there afte r we watche d h im mo re c l o se l y

when h e was o n his feet He sai d co nsi d erabl e o n this day ab o ut t h e me tho d
.

o f b re aki ng th e f ast emphasi z i ng th e f act that h e wi she d to be abl e to say that

,

th e fast was b ro k e n b y request and no t b y h is d e si re I t was arrange d t o .

all o w h im to fast fo r 3 1 d ays an d then to be gi n t aki ng fo od , He al so exp re sse d .

a p re fe re nc e fo r b re ak ing his fast o n a d ie t c o nsisti ng o f b o i l e d ric e an d h o ne y ,

with th e j uice o f o rang e s and l emo ns and grape j uic e Ob vi o usl y such a die t .

sho uld h ave many sci e nti fi c p o ints o f i nte rest but it was questio nabl e ,

whe ther after fasting so l o ng th e stomach sho uld be fill e d wi th th e aci ds o f

, ,

o ranges l emo ns and gr ape s

,
He w as fi rm l y c o nvince d th at thi s was th e d ie t
,
.

that sh o uld be use d and c o uld no t be dissuad e d from it S ub se q ue nt experi .

e nc e p ro ve d th e u nd esi rabi l ity o f t h i s ki n d o f a di et for b re aki ng a l o ng fast .

May 1 0 1 9 1 2 (twen ty—seventh day of fast) — T h e subj e ct rep o rte d th at h e did

,

no t S l ee p S O we ll d uring th e nigh t as h e h ad th e nigh t p re vi o u s H e was no t .

48 A ST UDY OF P R O LO NGE D FA S T IN G .

uncomfo rt abl e in any way but simpl y could no t sl eep Th ere was no no tice
, .

abl e o d o r I n a d iscussio n wit h some physici ans wh o vi si te d h im to day L

.
-
, .

emp h asi z e d th e fac t th at h is to ngu e remaine d c o ate d thro ugho ut th e who l e

fast and that h e h ad mo re o r l ess o f a bad taste in h is mouth His theo ry was .

th at th e waste p ro d uc ts we re no t al l e l im inate d from th e b o dy an d that they “

”
were trying to fin d th ei r way o ut by th e mo uth He th o ugh t th at if h e h ad .

d efe c ate d h e wo uld have h ad l ess discom fo rt Al tho ugh th e subj e ct we nt fo r .

a drive o n th e afte rno o n o f this day h e c ompl ai ne d th at th e we ather h ad ,

c h ange d and that it was no t pl e asant He al so c o m pl ai ne d b itte rly to Dr . .

Langfe ld re gardi ng Mr C ar pe nte r sayi ng that h e wo uld l i k e to b re ak eve ry

.
,

b o ne in his b o d y This wo uld p ro no unce ag ai nst fasting fo r amiabi lity

. .

May 1 1 1 9 12 (twenty eig hth day of fast) L rep o rte d that it was l ate be fore
,
- -
.

h e fe ll asl e e p and th at h e h ad no t be e n abl e to sl ee p mu ch o r so un dly d uri ng

th e night I n th e e arl y p ar t o f th e eve ning afte r h e h ad b ee n se al e d i nto th e
.
,

c al o rime te r h e signal e d that h e was o bliged to uri nate an d h e h ad to be tak en

,

o ut .Wh e n h e was se al e d up agai n s o rtly afte r 1 0 30 p m h e tho ught h e

h h m
. .
,

did no t go to sl ee p u nti l 1 2 o c l o c k He mo ve d several ti m es during th e night

’
. .

D uri ng th e afte rnoo n O f thi s day h e sp e nt some ti m e o n th e roo f re adi ng and , ,

se eme d to e nj o y hi mse l f ve ry mu c h app e aring to be in g oo d sp i ri ts all o f th e

,

afte rn o o n B ut whe n h e c ame d o wn fro m th e roo f h e was ext reme l y stubb o rn

.
,

wh e n taki ng h is tests with Dr Langfeld Fo r exampl e in a list o f te n wo rd s

. .
,
”
which was re ad to h im fo r memo ri zi ng th e eighth wo rd was wart ,
L did “
. .

n o t und e rst and wh at it me ant and ask e d to have it e xpl ai ne d Dr L angfe ld . .

tri e d to k ee p h im q ui e t u nti l th e l i st w as re ad a se c o nd ti m e b ut h e wo u ld no t ,

l iste n and i nsiste d upo n kn o wi ng wh at th e word was W h e n Dr Langfe ld . .

re ad th e l i st to h im a se c o nd time h e sai d that h e h ad no t he ar d th e wo rds as

, ,
”
h e was th i nk i ng o f wh at th e wo rd wart meant .

May 1 2 1 9 1 2 (twenty ninth da y of fast) T h e subj ect sai d that h e sl e p t very

,
- -

well th e p revio us nigh t and in th e mo rning see med very b right He busie d .

himse l f much o f th e fo re noo n in wri ti ng a histo ry o f h is l ife (Se e p . .

A re spi rati o n expe rime nt was mad e wi th h im in th e mo rning in which t h e

subj e c t b re athe d an atmosphe re c o ntai ni ng a l arge pe rc e ntage o f o xyge n .

I n th e af te rn oo n I too k h im fo r a dri ve Of 2 ho urs D uri ng th e d rive h e .

was b righ t and very t al k ative te ll i ng a goo d d e al ab o ut his f amil y h is pe r

, ,

so n al histo ry and his diffi cul ty in ge tti ng an e d uc ati o n

,
He b e c ame m o re .

q uiet b e fo re h e re tu rned to th e l ab o rat o ry and in th e p sycho l o gic al test h e

to ld Dr L angfe ld th at t h e we athe r d e p resse d h im ve ry mu c h
. He al so .

to ld Dr Langfe ld that h e was very so rry t h at I wante d him to b re ak th e f ast

.

and th at h e c o uld e asi l y f ast fo r 1 0 d ays mo re ; h e d i d n o t l i ke to b re ak h is

fast unti l h is to ngue h ad be co me c l e ar On th e o the r han d h e said th at h e .
,

wo uld be o ut o f th e l ab o rato ry o n May 23 and wo uld be a free m an agai n and

”
h ave fre e ice c re am I t was e vi d e nt that h e wo uld be diffi c u l t to c o ntro l
“
. .

There h as bee n no ne o f th e pigmentati o n o f th e ski n which h e h ad e xp e cte d

and ve ry l i ttl e p h l e gm .

M ay 1 3 1 9 1 2 (thirtieth day of fast) L rep o rte d that h e h ad sl ep t we ll He

,
—
. .

was in e x ce ll e nt S p irit s o n this day and very l ive l y and j o ll y His mo vem e nt s .

were vigo ro us and h e was unusuall y b righ t and active All o f h is sp are tim e .

was oc c up ie d in writi ng h is auto bi o graphic al no te s which at th is time c o ve red ,

1 3 cl ose l y written p age s As usu al h e fe l t q uit e abl e to be p ho t o grap hed

. .

At noo n I ask e d him h o w h e was and h e re pli e d that h e fe l t very we ll i nd e e d ,

sayi ng : We have see n th e l igh tho use and are no w entering th e harb o r an d
”
wil l se e l an d sh o rtl y .

I n th e aftern oo n I too k him to th e B osto n C ity H ospit al where D r Francis ,

.

H Willi ams made an exte nsive serie s o f X ray p h o to gr ap h s L was inte nse l y
.
-
. .
 G E NE R AL HI S T O R Y OF FA S T I N G E XP E R I ME N T . 49

inte reste d in this, and also tho ro ughl y e nj o y ed th e ri d e to and fro m th e ho spit al .

He was ve ry much pl e ase d wi th th e whol e d ay s p rogram He sai d that h e

’
.

was no w dro pp ing an chor and therefo re at th e e nd o f th e vo yage His

“
.

me ntal c o n diti o n seeme d to mak e a gre at d iffe re nc e in hi s who l e mak e- up .

On some d ays his f acultie s we re ve ry much k eene r than o n others Fo r in .

stan c e , d uri ng th e te st for vi sual acuity, h e answere d th e posi tion of th e

”
l ette r E with gre at strength of vo ice and wi th no he sitatio n whatever
“
.

May 1 4 , 1 9 1 2 (thirty first day of fast) — Ou this day , which was th e l ast day
-

of th e fast, th e p rogram was very full , includi ng an exte nsive se ri es Of p ho to

graphs (see Pl ate 5 ) and th e b o d y measurements Th e fi rst wo rd that L . .

spo k e whe n th e c al orime te r was o p e ne d was in re g ar d to havi ng his pho to grap h

t ak en I n resp o nse to an invi tation issued b y th e Nutritio n Lab o rato ry, a
.

n umb er o f me dic al m e n fro m th e vici ni ty o f B o sto n c ame to se e th e subj e c t

b etwee n 2 and 3 o c l o c k in th e aftern oo n L t alk e d very rap i dl y and in a
’
. .

l ive ly manner fo r ne arl y 4 0 minute s, se tting fo rth h is vi ews in a mo re o r l ess

l uci d m ann er to h is au dience I n th e middl e o f his t alk , I too k h is p u l se rat e and
.
-

fo und it to be 82 T h e subj e ct was p articularly d esir o us o fhavi ng h isp hoto grap h

.

t aken during th e afte rnoo n and wi she d to be pho to graphe d with e ach i ndivi dual
who h ad wo rk e d with hi m In this afte rnoo n talk wi th th e physicians, L
. .

made many co n flicting statemen ts Fo r i nstanc e , h e sai d that h e neve r use d

.

wine o r al co ho l in any fo rm, whi l e h e h ad re pe ate dl y to ld m e that h e freq uently

d ran k Mal ta wine and w as no t a te etot al e r He al so rep o rt e d that h e was .

invariably a vegetarian, frui tari an, and nutari an, e ating no me at ; thi s was
stri ki ngl y in c o ntrast with th e fact that h e ate me at se ve ral times in th e d ays
j ust p re ce ding th e fast D uri ng th e vi sit O f th e p h ysicians, h e b e c ame very
.

much excite d and e nth usiastic , e vi d entl y e nj o ying th e Opp o rtuni ty o f sp eaking
to h is audien ce D uring th e respiratio n e xp erime nt in th e evening, h e talke d
.

c o nsi d erabl y ab o ut th e end o f th e fast , saying th at wh i l e h e was n o t exactl y

ti re d , y e t th e re was mu ch emotio n c o nne c te d wi th h is fast and h e was thi nk i ng
Of th e e ff e c t p ro d uc e d at ho me whe n th e ne ws re ache d the m that h e h ad
c ompl e te d th e fast o f 3 1 d ays succ e ssfully Malta was awaiting th e news and .

all o f th e pe o pl e wo u ld be disc ussi ng h is won d e rf ul fe at .

Figures D , E , and F in Pl ates 2 an d 3 (p ages 1 9 an d 3 1 ) are fro m p ho to

grap hs se cured o n this l ast day o f fasting Figure E is of sp ecial i nte rest , as .

it sho ws L p o sing fo r 20 se cond s whi l e th e expo sure was be ing mad e There
. .

is vi dence of unste adiness

no e .

RE ALI ME NTAT I O N P E R I O D — .

May 1 5 1 9 1 2 (first day with food) Th e bed c al o rime ter expe riment was
, .
—

a m When th e app ar atus was O pe ne d th ere was no o d o r

m
end e d at 7 5 6
h
. .

app arent T h e o b se rve r re po rte d that th e subj e ct was c o mp arativel y qui et

.

thro ugho ut th e night wit b ut o ne moveme nt be tween l l 4 4 p m and

h ,
b m
. .

5 28 a m
1 1 m
. L compl aine d howeve r that h e was k ep t awak e b y aci d fum es
. .
, ,

and n o ise in th e c al o rime te r ro o m Ph o to grap hs we re t ak e n o f th e subj e ct

.

whi l e h e was up o n th e respiratio n app aratus and al so l at er in vari o us p o sitio ns , .

When h e was weigh ed aft er th e re sp iratio n expe riment was o ver it was fo un d ,

that h e h ad l o st kil o grams of h is initi al weight H e se eme d much .

pl e ase d th at th e fast was e nd e d and sp oke o f th e excitement there wo uld be at

his ho m e when th e c abl egr am was re ceive d anno un cing th e successful c o m
pletio n o f his fast .

Th e metho d o f b re aking th e fast h ad b een tho ro ughl y discusse d wi th th e

subj e c t p re vi o usl y b ut h e i nsi ste d up o n usi n g l emo ns o ranges grap e j uice
, , , ,

and ho ney I t was fi nall y arrange d th at h e sh o uld fo ll o w h is o wn cho ic e i n

.

th e matter and acc o r di ngl y l emo ns o range s b oi l e d rice and ho ney we re

, , , , ,
50 A ST UDY OF P R O L O N GE D F A S T ING .

su ppl ie d h im at h is re q uest At 9 3 8 a m be pe e l e d and ate two l emons .

h m
. .
,

u si ng n eith er wate r no r sug ar I n additi o n th ree o ranges ab o ut 300 gr am s

.
, ,

o f h o ney and app ro xi m ate l y 1 l i ter o f grap e j uic e w e re t ak e n in p o rti o ns

,

d uri ng th e day To stu dy th e fl o ra o f th e c o l o n a re ctal i nj e ctio n o f steril e

.
,

sal t wate w as given him at 1

r
1
l o p
m
In Ab o ut 4 30 p i n h e c o m pl ai n ed o f
h m 1
. . . .

se ve re c o li c bu t was so m ewh at re l i eve d ab o ut 5 3 0 p m b y a c o p i o us m o v e

h m
. .
,

me nt Of th e b owel s S ub seq u entl y h e ag ain h ad c o l ic with a seco nd mo ve

.
,

ment o f th e b o we l s and vo m iting He app e are d to be utterly wre tch e d and .

we ak and to have e ntire l y l o st h is c o urage Th e c o ntrast be tween h is high

, .

S p i ri ts o f th e day be fo re and h is c o ndi ti o n o n t h i s day w as ve ry stri ki ng .

NO re spirati o n expe riments were attem p te d o n th i s day afte r th e i ngesti o n

o f fo o d but a sampl e o f th e bl o o d w as tak e n an d re c o rd s we re mad e o f th e
, ,

bl o o d p re ssur e and th e al ve o l ar air U nd e r th e circum st anc es it did n o t se e m .

,

wise to have th e subj e ct S l eep in th e c al o rim ete r Arrangem ents we re there .

fo re mad e fo r hi m to sl e e p o n a c o uch in th e cal o rim eter l ab o rato ry with a ,

physici an in c o nstant atte nd anc e Whi l e n o re co rd s o f th e met ab o l i sm we re .

Ob tai ne d d uri ng th e night th e pul se rate was re c o rd e d b y me an s o f th e

,
-

ste tho sc o p e t h e assi stan t si tti n g b e h i n d a sc ree n o u t o f sight o f th e p ati e nt

, .

May 1 9 12 (seco nd day wi th food) T h e subj e ct p asse d a re stl e ss night .

-
,

having ano th er attac k o f c o l ic ab o ut 2 a m and d efe c ating Th e p ul se rate . . .

-

t h ro ugh th e nigh t was somewhat higher than o n p revi o us nigh ts As h e .

see med we ak and si c k in th e mo rnin g Dr G o o d all w h o c ame to se e h im e ar l y , .

,

in th e day urge d him to take so m e we ak b e ef te a o r c l am b ro th al so to ast

, , ,

but h e u tterl y re f use d to t ak e anythi ng o f this n ature sayi ng th at such f o o d ,

wo uld p o iso n him He furtherm o re sai d th at as we we re no w thro ugh wi th

.

h im we wi sh e d to p o iso n h im
,
He was as fi rm l y c o nvinc e d as e ver t h at his
.

me th o d o f b re aki ng th e fast w as th e c o rrec t o ne but tho ught that h e to o k fo o d ,

to o so o n an d th at h e sho u ld have wai te d until h is to ngu e h ad c l e are d as h e ,

c o nsid e re d it d angero us to b re ak th e fast so o ne r He to ld th e p h ysici an in .

atte nd anc e d uri ng t h e nigh t th at a m an m igh t h ave to f ast 1 00 d ays b e fore

th e n atural hunge r w o u ld re turn L lay o n th e c o u ch unti l ab o ut 1 0 a m . . . .
,

wh e n h e went to th e b al c o ny and d resse d He c o ntinue d h is diet o f frui t j uices .

and h o ney th ro ugho ut th e day but at o u r u rge nt re q uest d i l ute d th e l e m o n , , ,

j uic e with d istill e d water tak ing fi rst 77 c c o f l em on j uice an e qu al amo unt
,
. .
,

o f di sti ll e d wate r and 1 1 gram s o f ho ney ,

B etwee n 9 3 0 a m and 7 30
h m h m
. . .

p m h e d rank at inte rvals a mixture c o ntaining th e j uice o f 6 o ranges 3 67 c c

. .
, , . .

o f wate r and 1 28 gram s O f ho ne y making a to t al vo l ume of ab out

, cc , . .

Ab o ut 7 3 o p m h e too k th e j uic e o f ano ther o range sayi ng th at h e was

h m
. .
, ,

hun gry but fe l t ve ry well D uring th e day Dr G oo d all made th e usu al . .

physical examinatio n ; th e bl oo d p ressure and th e al ve o l ar air were also

o b se rve d T h e subj e c t e ntere d th e be d c al o rim e te r at 8 l 4 p m fo r th e
.
b ‘n
. .

usual night experi m ent .

M ay 1 7 1 9 1 2 (third day with food) At 1 0 p m th e subj e ct te l epho ne d and

,
—
. .

uri nate d but afte r th at tim e th e e xpe rimental re co rds S ho w th at h e was very
,

q ui et Wh e n h e l eft th e app aratus in th e mo rning h e sai d that h e h ad h ad a

.
,

very c o m fo rt abl e night S l ee pi ng b etter than h e h ad fo r ye ars He th o ught

,
.

h e must have h ad at l e ast 10 h o urs o f dr e am l ess sl e e p He app e are d to be in .

go o d S pirits Th e usual re spirati o n expe rime nt was mad e with him this
.

mo rning Th ro ugh o ut th e day h e co ntinue d taking at inte rvals a m ixture

.
,

o f o range j uic e an d h o ney di lute d wi th wate r ; h e was al so suppl i e d with

,

rai sins and d ates T h e usual physi c al e xam in ati o n was made by Dr G o o d all ;
. .

al so te sts o f th e bl o o d p ressure th e al ve o l ar air an d fo r ac e to ne in th e b re ath

, ,
.

A sampl e o f th e bl oo d was t ak e n b y Dr Ash I n th e afte rn oo n h e we nt u p o n . .

th e ro o f fo r a time but was ill h um o re d very diffi c ul t to pl e ase an d full o f

,
-
, ,
52 A ST UDY OF P R O L O N G E D FA S T ING .

May 20 . Patient was v ery an gry o n c o m i ng i nto th e ho spit al , fir st,

—

b e c ause h e was in a p ublic institutio n , whe re as h e h ad expe cte d to g o into a

‘
c o nval escent h o m e fo r we al th y p eo pl e ’
S e c o n d , b e c ause th e fact o f h is
.

g i g o a ho sp ital after his fast wo u ld d etract from th e renown and i nte rest
0pnl l is e at
.

Y e sterd ay h e app e are d very happ y He see me d to re al i z e and acce p t th at

.

the re were c e rt ai n disad vantage s h e re He was aske d what di et h e wanted

.

an d r eq ue ste d straigh t ho use di et , an d this was given h im in acc o rd an c e wi th

th e i d e as o f Dr B ene dict
. He ate this wi th relish He appe ar e d a l ittl e weak ,
. .

but abl e to be ab o ut He sp ent th e day in writing an d in so rting out vari o us

.

artic l es and p ic tu res, o f which h e h ad a h al f o f a v al ise full .

“
Last nigh t h e was nause ate d and vomite d several times, but was no t ill
e no ugh to be re p o rte d This mo rni ng h e was agai n very angry He co m
. .

pl ained that o atmeal was ve ry bad fo r a m an re c o veri ng from starvatio n .

He re pe ate d h is co mpl ai nts o f S atur d ay (May 1 8) an d sai d that h e was be ing

h e ld b y c o nsp iracy and wante d to summo n o r g o to th e B riti sh c o nsul He .

was th e re fo re discharge d at h is o wn req uest .

“
Whi l e at th e fro nt d oo r waiting to have his b ill arrange d an d his v aluabl e s
p ro cure d , h e co mpl aine d l oudly that his po sse ssio ns were b ein g withh eld from
h im . W hi l e wai tin g fo r a c arriage to be s ummo ne d , h e c all e d o ut l o udly many
tim es that h e wo uld get o ut of he re if h e h ad to crawl o n h is h ands and knee s .

“
Whi l e in th e war d s h e was sh own eve ry atte nti o n by th e nurse s, and
e s pe ci ally all foo d an d dri nk b ro ught to h im as d esi re d .

“
D ischarge d to o wn M D (No t . .

S ub se que nt to h is l e aving th e Massachusetts G e ne ral H o spit al , L was se en .

by Drs Langfe ld and G oo d all and a se c o n d se t o f X —ray pho to graphs was

.

tak e n by Dr Will i ams S uch d ata as were se cure d are inc lude d in th e
. .

indivi dual re po rts .

 PHY SI CAL CONDITION OF THE SUBJECT DURING THE FAST .

BY HARRY W G OO D AL L .
,

A compl e t e physical e xami n atio n of th e subj e ct was made 60 hours

b efore th e b e ginni n g of th e fast o n th e fir st day of th e fast an d e v e ry
, ,

alt ern ate day there aft er So far as possibl e th e same conditio ns as to
.
,

time of day p osture m ethods etc w er e Obs erv e d at e ach e xaminatio n

, , ,
.
, .

Th e p e rcussio n outli ne of th e various organs was mark e d with p e n cil an d

thes e li ne s we re n o t disturb e d u ntil variation s in th e siz e of th e organ s
mad e it ne c e ssary Owi n g to th e thin n ess of th e subcutane ous tissu e
.

th e p ercussio n n ot e could be sharply d e fi ne d and th e favorabl e me ntal

attitude of th e subj e ct p e rmitte d compl e te muscular relaxatio n .

Family h istory — Fathe r 6 8 ye ars o f age , mo ther 64 ye ars, b o th l ivi ng and

we ll Two siste rs, o ne 27 ye ars o f ag e , th e o ther 1 9 ye ars, b o th l iving and
.

well One sister die d in i nfan cy o f mal ari a One b ro ther di e d in chi ld h o o d
. .

o f c ro up Twi n b ro ther die d in infan cy , c ause unkno wn

. .

Past history — W as a d e l ic ate chi ld , th e mo st p ro n o un c e d char acte ristic

b eing a se nsitive nervo us o rgani z atio n D oe s no t rememb er ab out disease s .

o f chi ldh o o d I n h is twenti eth ye ar (20 ye ars ag o ) whi l e in th e uni versity

.
, ,

h e h ad a severe n ervo us b re akd o wn an d h ad to give u p h is studi es Has .

suff e re d fro m n eu rasth eni a S in c e H as b e en und er th e c are o f several p h ysi

.

e i au s at diffe re n t p eri o d s witho ut re c eivin g any be n e fi t B eing disco urage d .

wi th the se exp e ri en ce s h e b e came i nte reste d in c ert ain p o pul ar artic l es advo
,

c ating fasting as a cure fo r dise ases inc l uding neurasth e ni a and in Ap ri l 1 9 1 0

, ,

h e u n d erwe nt h is fi rst fast S O gre at was th e im p ro vement in h is nervous

.

c o nditio n foll owing this fast that h e h as since d evo te d much o f h is attentio n
to th e stu dy o f fasting Previ o us to th e p resent exp eriment h e h as und ergone
.

th e fo ll owing fasts :

Apr il 1 91 0 . Faste d 8 d ays t aking

,
no thing b ut wat er ; no t u nd e r o bse r
vati o n .

March 1 91 1 Faste d 4 0 d ays taking no thing but water ; und er p arti al

,

ob servatio n .

A ugust 1 91 1 Faste d 1 2 d ays t aking no thi ng b ut wate r ; un der p arti al

,

o b serv ati o n .

Novem ber 1 9 1 1 Fasted 5 d ays compl ete fast ; no t und er ob se rvation

.
, .

Thes e e xp e ri en c e s hav e convin c e d hi m that in he alth food no t o nl y , ,

mak e s th e i n di vidual susc e ptibl e to di s e as e s and cause s dis e as e but ,

also i n t erfe re s with th e prop er e xercis e of th e mental faculti e s He .

state s that durin g th e fasti n g p e riod th e min d is cl e ar and al e rt an d

that the re is a stro n g de sir e for study I t is n o w th e practic e of his .

wif e his two chil dr en and hi ms elf to abstai n e n tirely from food duri n g
, ,

any ill n e ss an d h e is co nvi n c e d that th e s e v e rity of any dis e as e is

,

r educ e d th e subj e ctive symptoms made l ess disagr ee abl e and th e cours e
, ,

of th e dis e ase short e ne d if such a cours e is pursu e d .

54 A ST UDY OF PR O L O N GE D F A S T IN G .

His p e rso nal e xp e ri en c e s and

have b ee n so co nvi ncin g thathi s study
h e was d e sirous of u n d ergo ing a scie n ti fi c e xp e rim en t u n d e r th e most ,

p e rf ect co n ditio ns for th e b e ne fi t of humanity H avin g l e arne d that

,
.

th e most p e rf e ct e quipme n t in th e world was at th e N utritio n Labor

ato ry h e appli e d for th e privil e ge of u n de rgoin g th is e xp erime n t the re
,
.

He e xpre sse d hi s pl e asure at th e cordial manne r in which h e had b e e n

r e c e ive d at th e l aboratory an d stat e d that h e was v e ry happy in th e
,

thought that h e was about to u nde rtak e th e fast n o t alo ne o n ac c o rin t ,

of th e scie n tific valu e of th e e xpe rimen t but also b e caus e O f th e im ,

provemen t whi ch h e an ticipate d in his o wn w ell b e in g He e xpr e ss e d -

.

his pl e asure in goin g into mi nut e d e tails as to his subj e ctiv e f ee l in gs .

RES ULTS OF PHYSI CAL EXAMINATION .

A pril 1 1 , 1 9 1 2 (6 0 h ou rs before begi nning the fast) :

A we ll d eve l o p e d , we ll p ro p o rti o ne d , an d f airly
- -
uri sh e d m an we ll -
no .

H eight ,
cm weight ki l o grams ; ag e 4 0 ye ars S tan d s
.
, , .

e re c t W alk s with b o dy e re ct wi th no ab no rm al ities in th e g ait

.
, .

H air o f h e ad and b e ard d ark S k in h as a muddy yell o wi sh tinge but .

,

is so ft and m o ist S l ight c o nj unctivitis o f b o th eyes Very mo d e rate

. .

am o un t o f sub c u tane o us fat Muscl es o f mo d erate si z e but rathe r

.

soft H as a small i nfe cte d p apule o n l eft al ae naszs No pul sati o ns

. .

n o te d in th e n e c k chest o r abd ome n , N o visibl e ab normalities

, . .

Mo uth : Mucous memb rane o f th e lip s and che ek s o f go o d c o l o r an d mo ist .

To ngu e mo ist wi th a sl ight co ating e sp e ci all y o n th e c entral and p o ste ,

ri o r p o rtio ns Tee th in fai r c o nd itio n There is a sligh t d ep osi t o f

. .

disco l o re d tart ar at th e b ase o f th e tee th and two te eth have temp o rary
so ft fill i ngs No p artic ul ar o d o r to th e b re ath
. N o enlargement o f .

th e to nsil s Pharynx is re dd e ne d t h e bl o o d vesse l s di l ate d an d the re

.
, ,

are a fe w bl e b s o n th e p o ste ri o r p h ary nge al w all with a l it tl e muc u s

adhe ri ng .

G l an ds : C e rvic al axill ary an d ep itro c hle a glan ds n o t p alp abl e

, , A fe w .

sm all gl an ds in bo th gro i ns .

Re fl exe s : Pu pi l s eq u al and re ac t n o rmally to l igh t an d dist an c e Abd o m .

inal c remaste ric p ate ll a Achill es an d pl antar re fl exes no rm al

, , , , .

C h est : S ymme tric al we ll fo rmed so me sink ing in o f th e sup ra an d i nf ra

, ,

c l avic ul ar sp aces G oo d exp ansio n with i nsp irati o n NO bul gi ng

. .

o f th e p ra ec o rdi a an d ap ex b e at o f h e art is n o t vi si bl e o r p alp abl e

, .

Lungs : Percussio n o f th e righ t lung sho ws no rm al reso nance to th e upp er

b o rde r o f th e fi fth rib in th e ni ppl e l i ne to th e l o we r b o rd e r o f th e ,

fifth rib in th e axi ll ary l i ne and to th e e l eve nth rib in th e b ack On

,
.

th e l e ft no rmal reso n anc e to th e eighth rib in th e mi d axi ll ary l ine -

and to th e e l eve nth i nt e rsp ac e in th e b ack Vo c al fre m itus is .

sl ightl y i n cre ase d an d e xp i rati o n sl ightl y p ro l o nge d at th e right ap e x ,

e xt e n di n g to th e se c o n d rib in fro nt an d th e sp in e o f th e sc ap u l a
b ehin d Th ere were n o rAles and th e l ungs we re o th e rwise negative
. .

H eart : T h e are a o f supe rfi ci al c ardi ac dull n ess (ligh t p ercussio n ) was

m e asure d from a pe rpe ndi c ular l ine thro ugh th e m id sternum an d a -

h o ri z o ntal l in e drawn at th e l e ve l o f th e nippl es Th e upp er b o rd er .

o f c ar di ac d ull ness was at th e thir d i n tersp ac e T h e l eft b o rd er o f .

c ardiac d ull ness was cm from th e mi d—ste rnum cm insi de

.
, .

th e ni ppl e T h e righ t b o rd er o f c ar diac d ull n ess was

. c m fro m .
 S UEJE CT
‘

P H Y S I C AL C O NDI T I O N OF DU R ING F A S T . 55

April 1 ,
1 1 9 1 2 —
C o nti nue d .

th e mi d ste rnum
-
Th e to tal wi dth o f c ardi ac dull ness was
. cm .

Th e c ardi ac so un d s were so m ewh at di stant but o f go o d q u al ity an d ,

re gu l ar rhyt hm There were no murm urs to be he ard Th e ao rtic

. .

and p u l mo ni c se c o n d so un ds we re o f e qu al i nte n sity .

Pul se : T h e p ulse s were e qual re gu l ar at th e r ate o f 82 per minut e , .

Rhyt h m re gu l ar vo l ume f air No sc l e ro sis o f th e vesse l s no t e d

,
. .

Abd o m en : T h e abd omen was symme tric al rather p romi n ent wh en ,

stan din g but flat when re c l ini ng

,
I t was soft tym p anitic but with .
, ,

n o di stensi o n There was no te nderness o n p alp atio n N o thing

. .

ab n orm al was fe l t .

Liver : T h e upp er b o rder o f l iver d ull n ess was at th e l o wer b o rd er of th e

fi fth rib in th e ni ppl e li ne Th e l ower b o r der of l iver d ull ness was .

1 cm b e l o w th e c o stal margin
. To tal wi d th o f dull ness cm . .

T h e e d ge o f th e l iver was i n di sti n ctl y p alp abl e so ft and wi thout , ,

irregul arities .

S to mac h : Th e me asurements of th e stomach were d ete rmi ne d as accu

rately as p o ssi bl e b y me ans o f au scul tato ry p ercussi o n Th e l i ne s .

of me asurem ent were th e me di an line o f th e b o dy an d a ho ri z o ntal

li ne thro ugh a p oint hal f way b e twe en th e tip of th e ensifo rm and th e
-

umb i licus Tymp any in th e me dian l ine exte nd e d from th e ti p o f th e

.

ensifo rm to a p o in t cm ab ove th e um b ili cus a to tal dist an ce o f .

,

1 1 cm . T h e l eft b o rd er of tym p any exte nd e d to a p o i nt 16 cm fro m .

th e me di an li ne Fai nt rhythmic sound s were to be he ard wi th th e

.

st e tho sc o p e There was n o spl ashing wi th p alp atio n

. .

S pl ee n : Th e upp e r b o rd er o f spl enic dulln e ss was at th e eighth ri b Th e .

are a o f spl enic du ll n e ss was v ague l y d e t erm in e d as 7 X 5 cm Th e .

S pl ee n was no t fe l t .

Ki dneys : Neither ki dney was p alp abl e .

G enital o rgans : Asi d e fro m a l o ng p rep uc e and a sl ight l eft vario co cele ,

th e p eni s and t e stic l es were no rmal .

A pri l 1 4 , 19 12 (first day of fest) :

Abd omen : No t as p ro mi ne nt Fl at to . p ercussi o n verywhere excep t
e
o ve r th e are a Of stomach tym p any .

S to mach : No rhythmic so un ds he ar d .

N o chan ge no te d in ge neral app e aranc e , mouth gl ands refl exes ch est , , , ,

l ungs he art p ul se liver S pl een

, , , , ,
ki dneys o r genit al o rgans
, .

Apri l 1 9 1 2 (third day of fest)

Mo uth : O ch ange n o te d with th e excep tio n o f a p ro no un ce d o d o r to th e
N
b reat I
,

Re fl exes : N O change note d exc e p t p ate ll a re fl e x n o t as active .

Liver : Lo wer b o r der of liver dulln ess at c o Stal margi n To t al wi dth o f .

dull ne ss cm E dge no t fe l t (First change no te d )

. . .

S tomach : Tymp an y in th e me di an line exte nd s fro m a p o int 3 cm ab ove .

th e tip o f th e e nsifo rm to 7 cm ab ove th e umb i l ic us To tal wi dth . .

cm Le ft b o rd er o f tym p any 1 8 cm from th e me dian line

. . .

Ac tive p e ri stal si s with p ro no un ce d rhythmic so un d s .

NO change no te d in general appe aran c e gl an d s chest l ungs he art pul se , , , , , ,

abd omen S pl e e n ki dneys o r ge nit al o rgans

, , , .

April 1 8 1 9 1 2 (fifth day of fe st) :

,

Mo uth : No change no te d Od or to b re ath sti ll p ro no unce d and to ngue

.

more heavi l y co ate d .

Re fl exes : Pate ll a re fl exes o nl y o b t ai n e d with re enfo rc eme nt .

56 A ST UDY OF P R O L O N GE D FA S T ING .

A pril 1 8 , 1 9 1 2— C o nti nu e d .

Abd ome n : No t as p ro mi n e nt whil e st anding retrac te d wh i l e re c li ni ng , .

D ull to p ercussio n e xc ep t o ve r th e are a o f stomach tym p any

, .

Mark ed vi sibl e p u l satio n o f th e ao rta .

Liver : NO ch ange fro m no te o f thi rd fasting day .

S to mach : Tym p any in th e me di an l i ne fro m a p o i nt cm ab o ve th e .

tip o f e nsifo rm to c m ab o ve um bilic us To tal wi dth . cm .

, .

Le ft b o rd er o f tym p any 1 6 cm from me di an l ine Rh yt hm ic so un ds . .

were au dibl e but no t mark e d .

No c h ange n o te d in ge n e ral appe ar an c e gl and s c h est l ungs h e art p ul se , , , , , ,

S pl ee n ki d neys o r ge ni tal o rgans

, , .

A pril 20 , 19 12 (seventh da y of fast)

G e ne ral appe ar ance : No chan ge no te d , e xce p t that th e fe ature s are sl igh t l y
drawn and subj e ct mo ve s abo ut a l ittl e more sl o wl y .

Mo uth : No change fro m no te o f fif th fasting day .

Re fl exes : NO c h an ge in p upi ll ary an d pl antar re fl ex es Pate ll a re fl exes .

o b taine d wi th di ffi c ul ty Achi ll es re fl e x ve ry slight . .

H e art : Le ft bo rd e r o f c ardi ac d ull ness cm and right b o rd er 1 cm . .

fro m mi ds te rn um To tal wid th, c m (fi rst ch ange n o te d )

. NO . .

c h ange in characte r o f so un ds .

Abd ome n : NO change fro m no te o f fi fth fastin g day .

Liver : N 0 ch ange fro m no te o f third fasting day .

S to mac h : M
pany fro m a p o i nt 3 cm ab o ve th e tip o f th e e nsifo rm to .

8 c m ab o ve th e um b i li c us
. To tal wi dth cm Le ft b o rder 1 4 . .

c m fro m me di an lin e
. Rh ythm ic sound s he ard . .

No c h an ge no te d in gl an ds, che st, l ungs, p ul se , spl ee n, ki d neys, o r genit al

g
o r ans .

A pril 22 , 1 9 1 2 (ni nth day of fast) :

G e ne ral appe aran ce : C o nj un ctivitis n o t q uit e so mark e d I nfe cte d .

a w
lg a i se
l g O t h e rwise no p art icul ar 0 ange
Mo ut Muco us m e mfi rane o f to ngue and mo uth dry To ngue sl ight ly
.

l ess co ate d Od o r to b re ath no t so p ro nounce d

. .

Re fl exes : Pate ll a an d abdo mi nal re fl exes ab se n t Achi ll es re fl ex O b t ain e d .

o nl y wi th diffi cul ty C remaste ric an d pl an tar re flexes no rm al

. .

H e art : Le ft b o rd er o f c ar di ac dulln ess 8 cm , right b o rd er 1 cm fro m . .

mid ste rnum -

To tal width 9 cm (se c o n d change in si z e o f heart
. .

no te d ) No chang e in characte r of S o unds

. .

Abdome n : No change fro m no te o f fi fth day .

Liver : NO ch ange from no te Of third day .

S to mac h : Tymp any fro m a po i nt 4 cm ab o ve ti p o f e nsifo rm to 8 cm . .

abo ve th e umb i lic us To tal wi d th, cm Le ft b order tymp any

. .

1 4 c m fro m me di an l i ne
. .

No ch ang e no te d in gl an d s, c h est, l ung s, p ulse , spl e en, ki dneys, o r genital

g
o r ans .

A pri l 24 , 1 9 1 2 (eleventh day of fast)

Ge ne ral appe ar anc e : Fe atures so mewhat dr awn Musc l es no t q uite so .

fi rm S kin mo re e l asti c
. S eb o rrhe a sicc a o f entire sc alp . W alks .

with o ut evi dence o f we akness No unste ad iness when stan ding with .

e yes c l o se d .

Mouth : Muc o us mem b rane o f mo uth an d tongue dry Lip s dry and .

d e sq uam ating Odo r to b re ath l e ss marke d

. .

Re fl e xe s : N o change fro m no te o f ninth day o f f ast exce p t Achi ll es re fl ex ,

Chest : S o me sinking in o f su p ra i
an d nfr a-c a l vicul ar sp aces .
 P H Y S I C AL C O N D I T I O N OF S UBJ E C T DU R ING F A S T . 57

Apri l 24 , 1 9 1 2— C ontinu e d .

H e art : NO change no te d in me asurements o f heart fro m ninth day o f fast .

Faint systo l ic so uffl e he ar d all o ve r th e p raeco rdi a l o ud e st at th e ap ex , .

No t transm itte d and no t re l ate d t o th e resp irato ry murm ur I nten

, .

sity n o t i nfl u en ce d b y p o sture H e art so un ds no t so distin ct . .

Pul se : Vo l um e o f p ul se no t so goo d .

Abd omen : N o change fro m no te o f fi fth day o f fast .

Liver : NO change from no t e o f thir d day o f fast .

Sto m ch z N o change from n o t e o f ni nth day o f f ast Rh ythm ic so unds

a
.

l e ard
N o change no et d in gl and s l ungs spl een k i dneys
, , , , or geni tal organs .

Apri l (thirteenth day of fast)

G ene r al app e ar ance Fe atures no t so dr awn
. C o nj un ctivitis somewhat .

im mo ve d Otherwise no change from no te o f e l e venth fastin g day

. .

Mouth : NO change from no te o f e l eventh fasting day .

Re fl exes No change fro m no te o f e l eve nth f asti ng day

. .

Chest : No ch ange fro m n o t e o f e l eventh fasting day .

H e art : No chan ge fro m no te o f e l eventh fastin g day .

Pulse : No change fro m no t e o f e l e ve nth fasting day .

Abdo me n : Mark e dl y retract e d whe n re c l inin g .

Liver : No change from note o f third fasting day .

S tomach : Tymp any from a p o i nt 3 cm ab o ve ti p of ensiform to 8 cm . .

ab o ve th e um b il ic us To tal wi dth . cm Le ft bo rder of tym p any .

cm from me di an li ne Rhythmic so un ds he ar d
. . .

Ki d neys : Po l e o f right ki d ney j ust p alp abl e (First change not e d ) . .

No change n o te d in gl ands , l un gs , spl e e n, or genit al o rg ans .

Apri l 28 , 1 9 1 2 (fifteenth day of fast)

G ene ral app e aranc e : Od or to b re ath l ess p ro no un ce d S tan ds ere ct . .

H as n o rmal gait but moves abo ut mo re d el ib erate l y Se b orrhea

m
.

w rgl’fi d .

Mo uth : Muco us memb rane o f mouth and lip s moist N o d esq uamation .

o f lip s .To ngue slightly l ess c o ate d .

R e fl exe s : No change from n o te o f e l eventh fasting day .

Chest : No change from n o te o f el eve nth fasting day .

H e art N o chang e i n me asurements o f heart fro m no te o f ninth fasting

.

day . Th e systo l ic so uffi e which app e are d o n th e e l eve nth fasting

day i s no l o nge r he ar d I ntens ity o f he art soun d s no t incre as e d
. .

Pulse No change n o t ed from n o te o f e l eventh fasti ng day

. .

Abdo men : R e tracte d D ull to pe rcussio n e verywhere exc e p t over th e

.

are a Of stomach tymp any N O te n derness o n p alp atio n excep t slight

.

ten dern ess o ver th e p ul sating aort a Th e l arge inte stines appe ar to .

be ab o ut th e S i z e o f a thumb an d c an be roll ed und er th e fi nge r

e xte n ding fro m th e c a ec um up to th e right hyp o cho ndrium and from
th e l e ft h yp o cho n drium d o wn to th e b rim o f th e p el vis There is no .

gurgl ing Wi th pressure .

Liver : T h e upp er b ord er of l iver dull ne ss is 1 cm l o wer th an at th e .

b eginning o f th e fast To t al wi dth 9 5 cm (seco nd ch ange i n si z e)

. . . .

S to mach : Tymp any fro m a po int 8 cm ab o ve th e umb il icus Tot al . .

width cm Le ft b o rd er o f tym p an y 1 3 cm from th e med i an l ine

. . .

Rhythmic so und s he ar d .

Ki dneys : No change from no te o f thirteenth fasting day .

No change no te d in gl ands l ungs spl e en o r genital o rgans

, , , .
58 A ST UDY or P R O L O NG E D FA S T ING .

A pril 3 0 , 1 91 2 (seventeenth day of fast)

G e ne ral appe aran ce : Fe ature s n o t so drawn ,
o th e rwise no change from
no te o f fiftee nth fasti ng day .

rwise no changes
Re fl exes : No c h ange from no te o f e l even th fasting day .

Chest : No chang e from no te o f e l eventh fasting day .

H eart : Le ft bo rd e r o f c ardi ac d ull ness cm right c m fro m medi an .

, .

l in e To tal wi dth 8 cm (third c h ange in th e si z e o f he art note d )

. . .

No f urthe r change in q ual i ty o f he art so und s .

Pulse : No ch ange fro m th e n o te o f th e e l eve nth fasti ng day .

Abd o m e n : No c h ange fro m th e n o te o f th e fi ftee nth fasti ng day .

Liver : No change from th e no te o f th e fi fte enth fasti ng day .

S to mac h : No change fro m th e no te o f th e fi ftee nth fasti ng day .

Ki dn eys : N o ch ange fro m th e no te o f th e thirt e enth fasting day .

No change n o ted in gl and s l ungs spl ee n o r ge nital o rgans

, , , .

May 2 1 9 1 2 (ni netet

,
day of fast)
G e ne ral appe ar an ce : No change from n o te o f se ve nte e nth f asti ng d ay .

Mo uth : No change fro m no te of se vente enth fasting day .

R e fl ex es : No change fro m n o te o f e l eventh fasting day .

Chest : No ch an ge from no te o f e l eventh fasting day .

H e art : Le ft b o rd e r o f c ardi ac d ul lness 7 cm from th e me di an l ine right .

,

b o rd e r at me dian li ne Total wi dth 7 cm (fourth change in meas

.
, .

ur em e n ts o f he art n o te d ) No ch ange in q ual i ty o f so un ds fro m th e

.

no te o f th e fif tee nth fasti ng day .

Pul se : No chang e fro m no te o f e l eve nth fasting day .

Abd o men : No change fro m no te o f fifte e nth f asti ng day .

Live r : N0 change fro m no te o f th e fif te enth fasting day .

S to mach : Tymp any fro m a p o in t cm ab o ve tip o f th e ensifo rm to .

cm ab o ve th e um b il icus Total W i d th
. . cm Left b o rde r of tym , .

p any 1 1 cm fro m median li ne No rhythm ic so und s he ard

. . .

Ki d neys : No ch ange fro m no te o f th e thi rte enth fasting day .

N o change no te d in gl ands l ungs spl een o r ge ni tal o rgans

, , , .

May 4 1 9 1 2 (twenty fi rst fasting day)

,
-

G en e ral appe aranc e : T h e so ft p arts of th e e xtr emiti e s no t so fi rm and

n o t so l arge Otherwise n o ch ange fro m th e no te o f th e se vente e nth
.

fasting day .

Mo uth : No change fro m th e no te o f th e seven te enth fasti ng day .

Re fl exes : No change fro m th e no te o f th e e l e ve nth fasting day .

Chest : N0 change from th e no te o f th e el eventh fasting day .

H e art : N o change from th e n o te o f th e nin et eenth fasting d ay .

Pulse : No change fro m n o te o f th e e l e venth fasti ng day .

Abd ome n : No chang e fro m th e no te o f th e fif te enth fasti ng day .

Liver : U pp er b o rd er o f liver d ul ln ess at sixth rib l o wer b o rder at costal ,

margin To tal wi dth

. c m (thir d ch ang e n o te d In si z e o f l iver)
. .

S to mach : Are a o f tymp any th e sam e as n o te d o n th e nineteenth fasting

day . Rhythmi c so un ds h e ard .

Ki dneys : Righ t kidney p alp abl e po l e o f l eft ki dney (fo r fi rst time) j ust
,

fe l t with d e e p inspiratio n .

N o ch ange no te d in gl and s l un gs S pl een o r genital o rgans

, , ,
.

May 1 91 2 (twenty third day of fast) :

-

G e neral appe ar an ce : No change fro m n o te o f th e twe nty fi rst f asting day -

.

Mo uth : Muco us mem b rane mo ist Very sl ight co ating o n to ngue . .

Very l ittl e o d o r to b re ath .

60 A ST UDY OF P R O L O NGE D F A S T I NG .

May 1 2 1 91 2 C o nti nue d

,
—
.

H e art : No chang e fro m no te of twenty—fifth fasting day .

Pul se : No chang e fro m no te o f el eve nth fasting day .

Abd ome n : Asi d e fro m a slight gurgli ng o f g as and li qui d in th e right

hypo cho n dri um wi th p alp atio n no chan ge n o te d fro m twe nty fifth -

fast ing day .

Liver :f l o tal wi dth o f liver d ullness

l
cm (fi fth chang e note d in si z e
i
.

0 1 ve r )
S to mach : No change fro m no te o f twenty first fasti ng day Rhyt hmic -
.

so un ds he ar d .

Ki dneys : No chang e fro m no te of twenty fi rst fasting day -

.

No c h ange no te d in gl an ds spl ee n o r ge nital o rg ans , , .

May 1 4 , (thirty fi rst day of fast) -

G e ne ral appe ar an c e : T h e fe ature s h ave a dr awn appe aranc e S ubj ect .

stan ds e re c t W alks wi th b o dy e re ct an d sh o ws no ab no rmalities in

.

gait but mo ves ab o ut sl o wl y as if fatigu e d Th e skin h as a mu dd y .

ye ll o wish app e aran ce but is so ft and mo ist Th e ski n is rel axed an d .

is e asi l y p ic ke d up as if there we re but l ittl e sub cutan eo us fat

, Th e .

muscl es are rather small and no t fi rm There is a sl igh t co nj un c .

tivitis o f b o th eye s No ab no rmal p ul sati o n no te d in th e ne c k o r

.

ch est but th e p ul satio n o f th e abd o mi nal ao rta is mark ed espe ciall y

, ,

whe n rec lining .

Mouth : Muco us memb rane o f th e l i ps and chee k s o f goo d co l o r and moist .

To ngue mo ist wi th a ve ry slight co ating o n th e p o ste rior p art Tee th

, .

sho w a sl ight d e po sit o f d isc o l o re d tart ar at th e b ase T h e b reath .

h as a very sl ight o d o r No e nl argement of th e to nsi ls T h e pharynx

. .

sho ws so m e i nj e ct i o n o f th e bl oo d v esse l s and a few bl eb s o n th e

p oste rior pharyn ge al wall There is a l ittl e mucus o n th e p o ste rior .

naso —p h arynx .

G l an ds : C ervic al axi ll ary and ep i tro chl ea gl an ds no t p alp abl e

, A few .

small gl an ds in b o th gro ins .

Re fl exes : Pupi ll ary cremaste ric and plantar re flexes no rmal Abd o mi nal
, ,
.
,

p ate ll a and Achi ll es re fl ex n o t o btaine d No ankl e c l o nus No . .

Rho mbe rg .

C hest : S ymm etric al Rib s p ro minent Mark e d si nki ng in o f th e sup ra

. .
~

and infr a c l avic ul ar space s

- G o od e xp ansi o n with i nsp iratio n . .

Lun gs : Pe rcussi o n o f th e right lung sh o ws no rmal reso nance to th e l ower

bo rd er o f th e sixt h rib in th e axill ary line to th e e l eventh rib in th e ,

mi d axill ary l ine an d th e e l eve nth rib in th e b ac k On th e l eft no rmal

-
.

reso n an ce t o th e eighth rib in th e m id axill ary l i ne and to th e e l eventh -

i nte rsp ace in th e b ac k T h e pe rc ussion no te is high p itche d at .

b o th ap ices V o c al fremitus is sl ightl y incre ase d at b o th apices

.
,

mo re espe ciall y o n th e right Th e resp irato ry murmur is normal .

thro ugh o u t .

H e art : Th e u ppe r b o rde1 of c ardi ac d ulln ess is at th e fo urth rib ; th e l eft

b o rder o f cardi ac d ull ne ss cm fro m th e mid sternum ; th e right .
-

b o rd er c m to th e l eft o f th e m id s te rn al l i ne
. To tal wi d th -
.
,

cm T h e c ardi ac sounds are di stant ; th e fi rst so un d o f th e heart

.

is no t c l e ar T h e ao rtic se c o n d so un d is somewhat sh arp e r than th e

.

p ulmo nic se co n d .

Pulse : T h e p ul ses are eq u al an d regu l ar but small vo l um e No scl e ro sis ,

.

o f vesse l s n o te d .
 PH Y S I C AL C O NDI T I O N OF S U B JE CT DUR I NG FA S T . 61

May 1 4 1 9 12 C o nti nue d

,
—
.

Abd ome n : S ymme tric al Fl at whe n stan di ng . Much retracte d when .

re cl ining Marke d vi sibl e pul sation of th e abdo minal ao rta Th e

. .

abd o men is everywh ere flat to pe rc ussio n e xc e p t o ve r th e ar e a o f

st o mach tymp any There is no te n de rne ss excep t o ver th e abd o minal
.

ao rt a I ntestines ab out th e si z e o f a thumb ; c an be ro ll e d un de r th e

.

finger extending fro m th e c aecum to th e right hypoch on drium and

fro m th e l eft hypo cho ndrium d o wn to th e b rim o f th e p e lvi s There .

is sl igh t gurgl in g wi th p re ssure in th e right hyp o ch o n dri um .

Liver : Th e uppe r b o rder of l iver d ullness is fro m th e l o we r b o rder o f th e

sixth rib to th e c o stal margi n To t al wi dth o f l iver d ull ness 6 cm
. .

E d ge n o t fe l t .

S to mach : Tym p any fro m a p o int 2 cm ab o ve ti p o f th e e nsifo rm to a .

p o int 8 cm ab o ve th e um bilicus To t al wi d th
. cm Le ft b o rder . .

o f tymp any 1 3 cm fro m me di an l ine Rhyt h mic so un ds he ar d

. . .

S pl een : Th e upp er b o rder o f spl e ni c d u ll ness is at th e e ig hth rib Ar e a .

o f spl e nic d ull ness vague l y d e termin e d as 6 X 5 cm T h e S pl e en .

was no t fe l t .

Kidneys : Right ki dney readi ly p alp ated Th e p o l e o f l eft ki d ney is fel t . .

G eni tal organs : Asi d e fro m a l ong p re p uc e and a slight vario co cele o n th e
l eft th e pe ni s an d testicl es are no rmal
, .

May 1 5 1 9 1 2 (two h ours after breaki ng fast) :

,

G en eral appe ar anc e : Fe at ures slight l y drawn W alk s ere ct but delib .

e rate ly as if f atigue d
, No unste ad iness in gait . Th e t o ngu e is c l e an .

and the re is no o d o r to th e b re ath Otherwise n o ch ange in th e .

p h ysical exam i natio n fro m no tes o f th e thirty fir st and l ast day o f fast -
.

May 1 6 , (24 h ou rs after breaking fast) :

G eneral app e aran c e : Fe ature s quite drawn W alk s hesit atingly an d a .

l ittl e unste adi ly Mark e d l assitud e Vo ice we ak an d fal te ri ng

. . .

Mo uth : Mu cous memb rane o f l ip s and to ngue dry To n gue sl ightl y .

co ate d p o ste rio rly .

Abd omen : W h e n subj e ct is stan ding abd o m e n is symmetric al an d sl ightl y ,

more p ro minent than o n l ast day o f fast W h e n re c l ini ng th e .

,

abd o me n is no t so re tracte d Th e right half o f th e abd o me n is

.

so mewhat more p ro mi ne nt th an th e l eft T h e right hal f o f th e .

abd o me n is tym p ani tic ; th e l e ft h al f fl at to p e rcu ssio n Palp atio n .

o f th e righ t h al f e l ici ts so me rumbl i ng of g as and l i q ui d and c auses

slight p ai n Rh ythmic sound s are he ar d o n th e right hal f
. .

Liver : U pp er b o rder o f d ull ness at uppe r b o rd er o f sixth rib l o wer b o rder ,

at th e c o stal margi n To tal wi dth cm . c m wi d e r than o n , . .

l ast day o f fast) Ed ge no t p alp abl e . .

S to mach : Tymp any fro m a p o i nt cm ab o ve e nsifo rm to a p o int 8 cm . .

ab ove t h e umb il ic u s To tal wi d th 1 0 cm Left b o rde r o f tym p any

.
, .

1 7 c m from me d i an l i ne
. Rhyt h m ic so un ds he ar d . Oth erwise th e .

p hysic al exam inati o n is th e sam e as o n th e l ast fasting day .

May 1 8 1 9 1 2 (3 days after breaking fast)

,

G en eral app e aran c e : Fe ature s app e ar thin b ut no t dr awn Walk s sl owl y .

but with n o unste adiness Vo ice mo re n atural . .

Mo uth : To n gue is cl e an .

H e art : Th e l eft b o rder o f c ar di ac d u ll ness is 7 cm fro m th e mi d sternal .

-

li ne th e righ t b o rde r at th e mi d stern al line To tal wi dth 7 cm

,
-
. .

cm l arger than o n l ast fasting

. B o th so un ds o f h e art
distant but c l ear an d distin ct .
62 A ST UDY OF P R O L O NGE D F A S T ING .

May 1 8 1 9 1 2 C o nti nue d

,
—
.

Pulse : G o o d vo l ume to p ul se .

Abd omen : S l igh tl y mo re p ro mi n e nt whe n st andi ng Abd ome n full when .

re c l ini ng S y mme tri c al . Ty mp anitic all ove r wi th no di ffere nc e .

,

b etwee n th e two si d es .

Live r : U ppe r b o rd er o f l ive r d ull ness at fifth rib l ower b o rd er at cost al ,

margi n To tal wi dth . c m (th e same as at th e b egi nni ng o f th e

,
.

fast) Edge n o t fe l t
. .

S to mac h : Tym p any fro m a p o i nt cm ab o ve th e ti p o f th e e nsifo rm .

to a p o in t c m ab o ve th e um b il icus To tal wid th

. cm Th e .
, .

l eft bo rder o f tymp any extends to a p o int 1 6 cm from th e me dian .

line Rhyth mi c so unds he ard Oth erwise no change from th e l ast

. .

fasti ng day no te d in th e p h ysic al ex aminatio n .

May 19 1 9 1 2 (4 days after breaki ng fas t)

,

G ene ral appe arance : Fe atures dr awn Co nj un ctivae i nj ecte d (from wee p .

ing ) . Fo rehe ad b athe d in c o ld p ersp ir ati o n Mark ed tremo r to .

ban ds G ai t unste ad y
. W alks as if q uite we ak physic all y (Ge n
. .

e ral c o nd i ti o n t h at o f hyste ri a ) .

To ngue : Th e to ngue is c l e an .

H e art : Le ft b o rd e r o f c ardi ac d ul lness 7 cm from me di an l i ne Right . .

b o rd er cm to right o f m id ste rn um
. To tal wi d th cm -
.
, .

So u nd s c l e ar and mo re distin c t Ao rtic and p ulmo ni c se c o nd .

so und s o f e q ual i nte nsi ty .

S to mac h : Tymp any f rom a po i nt cm ab ove th e tip o f th e e nsifo rm to .

cm ab o ve th e umb ilic us To tal wi d th

. cm Le ft b o rd er .
, .

o f tymp any 1 6 cm f ro m th e me d i an li ne Rhythmic s o und s he ar d

. . .

Othe rwise no c h ange fro m th e l ast fasti ng day no ted in th e physic al

e x ami nati o n .

Octo ber 1 9 , 1 9 1 2 (5 months after breaking fast) :

G e ne ral appe aran c e : G e neral aspe ct n o t th at of a we ll no uri she d m an -
.

W eight 1 26 lbs , 15 o un ces kil o grams) (nud e) S tand s e re ct

. . .

G ai t no rmal S kin h as a muddy ye ll o wi sh ti nge , but is so ft an d

.

mo ist S l ight c o nj unctivi tis o f b o th eyes Small amo unt o f sub

. .

c utan e o us fat Muscl es mo d e rate in si z e and rathe r so ft No pul

. .

sati o n n o te d in n e c k , c h est , o r abd ome n .

Mo uth : Muco us memb rane o f l ip s and chee ks mo ist and o f go o d co l o r .

T h e to ngu e h as a sl ight c o at, espe ci ally o n th e p o ste rio r p o rti o n .

D e po si t o f disc o l o red tartar o n th e t ee th S l ight o d o r to b re ath . .

Pharynx is re dd e ned, t h e bl o od vesse l s inj e cte d , and some muc us

ad h e re nt .

G l an ds : C e rvic al , axill ary an d e p itro chl e a gl and s are n o t p alp abl e A .

fe w small gl an ds in both gr o ins .

Re fl exes : Pupi l s e q ual an d re act n o rmall y to l ight and distance Abd om .

i nal , cremaste ric , p ate ll a, Ach i ll es, an d pl ant ar re fl exes normal .

Chest : S ymm e tric al , we ll fo rme d S o m e sinki ng in o f th e sup ra and .

i nfr a cl avicul ar sp ace s G o od exp ansio n with i nsp irati o n No bul g

-
. .

ing o f th e p raeco rdi a an d apex b e at o f th e he art is no t visi bl e or

p alp abl e .

Lungs : Percussio n o f th e right l un g sho ws no rmal reso nance to th e u pp er

b o rd er o f th e fi fth ri b in th e nippl e line to th e l ower b o rd er o f th e ,

fi fth rib in th e axi llary l i ne an d to th e e l eve nth rib in th e b ack On ,

.

th e l e ft no rm al reso n an ce to th e e igh th ri b in th e m id axill ary l i ne -

and to th e e l eve nth i nte rsp ac e in th e b ac k Vo c al frem itus is sl igh tly .

i ncre ase d and expirati o n slightly p ro l o nge d at th e right ap ex ex ,

 P H Y S I C AL C O ND I T I O N OF S U B JE CT DU R IN G FA S T . 63

October 1 9 , 1 9 1 2— C o nti nue d .

tending to th e se c o n d rib in fro nt and th e sp ine o f th e sc ap ul a b eh ind .

The re we re no ral es and th e l un gs were o therwi se negative .

H e art : Left b o rder o f c ardi ac d ull ness 9 cm from mi d sternum Right .

-
.

b o rd er 2 cm to right o f mi d stern um To t al wi d th, 1 1 cm S o un ds

.
-
. .

cl e ar No m urmurs Ao rtic and p ulmo nic se co n d soun ds of e qual

. .

intensity .

Pul se : T h e p ul ses we re e qual , re gul ar at r ate o f 82 per minute Rh ythm .

re gu l ar , v o l ume f air No scl ero sis o f t h e vesse l s note d

. Systo lic .

bl oo d p ressure , 120 mm Hg , di asto l ic , 85 mm (Riva- Ro cci instru

. . .

ment , sitting p o sitio n ) .

Abd ome n : T h e abdo me n is symm e tric al , r ather p romi nen t when standi ng
but flat whe n re c l i ni ng I t is so ft , tym p ani tic , but n o d i stensi o n
. .

The re is no ten dern ess o n p alp atio n N o thi ng ab no rmal fe l t . .

Liver : T h e uppe r b o rder o f l iver d ullness at th e u pp e r b o rd er o f th e S ixth

rib . D ul lness e xt en ds to 2 cm b e l ow c o stal margi n To t al wi d th
. .

f d ull ne ss 1 1 cm E d ge indi stin ctl y p al p abl e , an d wi th n o irre g u

f
.

arities .

S to mach : Tymp any in th e me di an l i ne ext en d e d fro m th e ti p o f th e ensi

fo rm to a p o int c m ab o ve th e umb i l ic us, a to t al di stan c e o f 1 1 cm
. .

Th e l eft b o rd er o f tymp an y e xte n d e d t o a p o i nt 1 6 cm from th e .

me di an line Faint rhythmic sound s are to be he ar d wi th th e ste tho

.

scop e Th ere is no spl ashing with p alp atio n

. .

S pl een : T h e upp er b o rder o f spl e nic d ull ness is th e eighth ri b Ar e a o f .

spl eni c d ull n ess vagu e l y d ete rmi ne d as 7 X 5 cm S pl ee n n o t fe l t . .

Ki dn eys : Neither kid ney p alp abl e .

G e nit al o rg ans : Asi d e fro m a l o ng p repuc e an d a sl ight l eft vario co ce le ,

th e p enis an d t e stic l es are n o rmal .

SUMMARY AS TO PHYSICAL CONDITION .

G eneral pp e aranc e : Th e general app e aranc e of th e subj e ct remaine d

a
go o d th rougho ut th e p erio d o f o b serv atio n A grad ual l o ss o f b o dy .

ti ssue was evi d ent but th e chan ges were no t mark e d fro m day to day
, .

T h e mo st p ro no un ce d change w as in th e abd omen wh ich b e c ame flat ,

as so o n as h e c e ase d to tak e f o o d an d w as di sti nct l y re tracte d after

th e fi fth f asti ng day This fo r th e mo st p art app e are d to be due to
.

th e p ro mp t di sappe ar an c e o f g as in th e i nte sti ne s T h e ac tu al l o ss .

in b o dy tissue app e are d to be q uite e ve nl y d i stri b ute d o ver th e b o dy ,

but was mo st n o tice abl e in th e tissue o f th e b ac k of th e n e c k in th e ,

si nk i ng in o f th e sup ra and i nfra c l avic ul ar sp ac es and in th e p ro mi-

,

nemc e o f th e ri b s .

T h e musc l es o f th e e xt remitie s which were but moderate l y fi rm at t h e

,

be ginning o f th e fast appe are d to have so ftene d to a slight d egree

, .

T h e m u scul ar mo veme nts b e c ame l e ss active afte r th e seventh fasting

day but th e imp ression was th at o f muscu l ar fatigu e r ather than
,

we ak n ess Th e gait was always ste ady an d there was no swaying

.

o f th e b o dy whi l e stan di n g wi th th e fee t toge ther an d t h e eyes c l o se d .

T h e fe atures fre q uently app e are d d rawn after th e fi rst wee k but thi s ,

was p rese nt as a rul e o nl y d uring p e rio d s of me ntal d e p ressi o n

, , .

Th e tremo r o f th e h and s th e we ak ness o f th e musc ul ar mo vem ents

, ,

and th e c h anges in th e vo ic e n o te d at th e e n d o f th e f ast an d after

b re aking th e fast were app arentl y a p art of h is h yst eric al co n diti o n .

Th e muddy ye ll o wi sh ti nge to th e sk in di d n o t c h ange th ro ugh o ut

 A ST UDY OF P R O L O N GE D FA S T IN G .

T h e c o nj un c tivi ti s p rese nt at th e b e gi nni ng imp ro ve d sl igh tl y afte r

th e ni n th day o f th e fast , but was e ve n mo re mark e d after t h e fas t
was b ro k e n , p ro b abl y b e c ause o f wee p in g .

Mouth : T h e co l o r o f th e muc o us memb rane remaine d go o d thro ughout .

No change was no te d in th e tee th (th e te ethwere no t b rushe d thro ugh

o ut t h e p eri o d o f o b serv atio n) T h e sl ight c o ating o n th e to ngue
.

b e c am e mo re p ro no un ce d unti l th e ninth f asti ng day , when it b egan

to disapp e ar sl o wl y T h e to ngue did no t b e c o m e e ntire l y c l e an
.

u nti l th e thir d day after fo o d was t ak e n On th e third day th e o d o r

.

o f th e b re ath w as o ff e nsive , b e com i ng fe ti d Afte r th e ni nth day this .

w as l e ss p ro no un c e d and grad u all y d e cre ase d unti l th e twenty- thi rd

day , afte r which time ve ry l i ttl e od o r w as no tic e d .

On th e ninth fasti ng day th e muc o us memb ran e o f th e mo uth an d l i p s was

dry . On th e e l eve nth day th e l i p s were d esq u am ating (at th e same
time th e se b o rrhe a o f th e sc alp app e are d ) and thi s c o nti nue d unti l
th e fi fte enth day o f th e f ast an d di d no t o cc ur ag ain Th e d e cre ase .

o f these signs p romp tl y fo ll o we d th e p re scri b e d i nt ak e o f l arge r

q uan tities o f water No change was no te d in th e chronic naso
.

pharyngitis .

G l an d s : No chan ge wh ate ver was n o te d in th e c ervic al axi ll ary epi , ,

tro chl e a gl an ds o r th e gl an ds in th e gro ins

, .

N ervo us system : D uri ng th e fi rst wee k o f th e fast th e mental attitud e

was a c h e e rf ul o ne He was enthusi astic ab o u t th e exp erim ent but
.

very O pi ni o nate d Fro m th is time o n to th e e nd o f th e f ast h e was

.

fre q ue ntl y d ep resse d and so metim e s i rri tabl e On these d ays h e was .

d isin c l ine d to talk h is physic al mo veme nts were mo re d e li be rate

, ,

an d h e w as mo re se nsi tive to any physic al di sc omfo rt such as ,

p ressure o f th e h ands He attri b ute d this to th e d ep ressive e ffects

.

o f th e rai n and c l o udy we ather but th e i m p ressi o n was that h e fe l t

,

ac tu al p h ysi c al f atigue On th e l ast day o f th e f ast an d fo r th e

.

remaining p erio d o f o b se rvati o n be e xh ibi te d varying m e ntal states

o f d ep ressi o n i rri tab i lity and sull e nn e ss we e p i n g at tim es
, , Tak ing , .

th e pe rio d as a wh o l e th e re was a grad ual i nc re asi ng d ep re ssio n and

irritab ili ty which wi th th e o nse t o f abd o m inal p ai n manifeste d
, , ,

itsel f in h yste ric al c o n di tio ns There was no o utward d emo nstratio n

.

o f any me ntal imp ro veme nt as a resu l t o f th e f ast .

Re fl exes : Th e p upi ll ary plantar and cremaste ric re fl exes were no rm al

, ,

thr o ugh th e fast Th e p ate ll a re fl e x grad uall y dimi nishe d an d o n

.

th e fi fth day c o u ld o nly be o b tai ne d b y re e nfo rc ement an d o n th e -

ni nth day and d uring th e remaind e r o f th e fast c o ul d no t be o b t ai ne d .

Th e abd o min al re fl exes we re ab se nt o n an d afte r th e ni nth day and ,

t h e Achi ll es o n and afte r th e e l e ven th day Five mo nth s after th e .

,

re fl e xes were no rmal .

Che st : No change was no te d in th e ch est wi th th e excep tio n o f th e gradual,

si nki ng in o f th e sup ra an d infra c l avic u l ar sp ac e s an d th e p ro mi

-

n enc e o f t h e ri b s as t h e sub c utan eo u s tissu es d isapp e are d .

Lungs : As th e l o ss o f tissue in th e su p ra c l avicul ar sp ace p ro gre sse d th e

-
,

p erc ussio n no te o f th e apice s be cam e sligh tl y high er pitch e d Th e .

l o wer b o rde r o f reso n ance o f th e right l ung fo ll o we d th e d e cre ase in

t h e si z e o f th e l iver N0 ch ange was no te d in th e respirato ry murm ur
. .

H eart : Th ere w as a gr adual d e cre ase in th e p ercussio n b o rde r o f th e he art

n o te d as fo ll o ws th e to tal d im i nutio n in si z e o f he art during fast
,

b eing cm
 P H Y S I C AL C O NDI T I O N OF S UB JE CT DUR IN G FA S T . 65

H eart so un s : N o change was note d in th e character of th e he art soun ds

d
unti l th e e l eventh fasting day when th e soun ds were l ess distinct and
,

a systo l ic so uffl e was h e ar d all o ver th e prz e c o rdi a Thi s souffl e was .

n o t he ar d afte r th e fi fte e nth day b ut th e so un d s remain e d mo re dis ,

t ant thro ughout th e fast an d afte r th e twenty fifth day th e fi rst -

so u n d o f th e he art was n o t disti n ct After th e twenty thi rd day th e .

-

ao rtic seco nd soun d was mo re d istin ct than th e p u lmo ni c se co n d .

Th e systo l ic so uffl e app e are d at th e sam e p e ri o d as th e se b o rrh e a ,

th e dry mo uth and d esq uam ati ng l i p s and d isapp e are d when th e
,

water intak e was incre ase d .

Abdo me n : On th e fi rst fasti ng day mo st o f th e g as di sappe are d fro m th e

intest ine s Th e abdomen bec ame retracte d and by th e fifth day h ad
.

re ach e d its maximum th e p ul sation o f th e abdominal aort a b eing

,

p ro no un ce d After thi s time it was everywhere flat to p ercussion

.

e xc e p t o ve r th e are a o f g astric tymp any After th e fi ftee nth day o f .

th e f ast th e c o ntracte d l arge i nte stin es could be p al p ate d al o ng th e

co urse of th e asce nding and d e scen ding col on On th e twe nty third .
-
,

twenty—ninth an d thirty first d ays there was a sl ight gu rgling of g as

,
-

and l i qui d in th e right hypocho n drium wi th p re ssure .

Twenty fo ur ho urs after b re aking th e fast th e ascending co l o n was dis

-

tende d with gas but th e desce n di ng col on was still co ntracte d On

, .

th e third d ay afte r b re aking th e fast th e who l e abd omen was tym

panitic an d symmetric al .

Liver : A grad ual de cre ase in wi d th o f l iver d ull ness as me asure d in th e

ni ppl e l in e was n o te d as shown in th e t abl e , T h e to t al diminuti o n .

o f th e wi d th o f l iver d ul lness in th e ni ppl e l ine was cm o r .

per ce nt o f th e total wi dth at th e b eginni ng o f th e fast On th e t h ir d .

day after t ak ing fo od th e l iver was fo un d to be o f th e same wi d th

,

as at th e be gi nning o f th e fast .

11 5 . cm e d ge palpa bl e .

10 5 cm .
, e d g e no t p alp abl e .

F iftee n th day o f fa t s cm .

Twe nty fir st day o f fast

-

Tw e nty fifth day o f fast

-

Tw e nty nin th day o f fast

-

f
O ne day a te r re a n ast ki g f
b
T d y
h ree a s a ter rea n f b ki g f
ast
Fv
i e m o nth s a te r rea i nf b k gf
as t .

S pleen . No chang e was no e t d in th e pl een

s during th e fast .
66 A ST UDY OF P R O L O NG E D FA S T IN G .

Ki dn e ys : On th e thirtee nth day o f th e fast th e right ki dney was p al p abl e

an d o n th e twe nty fi rst th e l e ft was p alp abl e and b o th remaine d so
-

d uri ng th e rest o f th e fasting pe ri o d Five mo nths l ate r nei th e r .

ki dn ey was p alp abl e .

G e ni tal o rgans : No chan ge no te d in th e ge ni tal o rgans d uri ng th e fast .

Obse rvati o ns o f th e physic al c o ndi ti o n o f B rei thaup t , wh o f ast ed fo r 6 d ays,

o f Ge tti , wh o f aste d fo r 1 0 d ays, an d o f B e auté , wh o f asted fo r 1 4 d ays,

f ai l ed to Sho w an y change in th e si z e o r p o siti o n o f th e o rg ans .

PHOTOGRAPHI C STUDY OF SUBJECT .

Th e most strikin g e xte rn al e videnc e of prolo nge d in an itio n with a

fastin g subj e ct is th e de gree of e maciatio n I n ord er to visualiz e this .

as much as possibl e as th e fast progr esse d an e xtensive s e ri e s of photo ,

gr aphs was tak e n practically o nc e a w ee k A t the s e time s th e calo .

rim e ter laboratory was sp e ci al ly warm e d with gas stov e s particularly ,

in th e p art of th e room whe re L was to pose and scre e ns w e re put in .

,

plac e for th e backgrou nd T h e subj e ct undr e ss e d and put o n a small

.

loin c l oth ; h e was the n pos e d o n a low p e de stal whi ch was covere d ,

with black cloth I n th e s el e ctio n of pos e s we had th e valuabl e advic e

.

of Profe sor W G And e rso n of Ya l e Unive rsity

s . .
, .

Proba b ly n o routine throughout th e whol e fast pl e as e d th e subj e ct

more tha n this se ri es of photographs as h e s e e me d obs e ss e d wi th th e ,

de sir e to have hims elf photograph e d We we re accordingly abl e to .

obtain a large n um b e r of photographs of th e subj e ct in a vari ety of

pose s Se ve ral of thos e o b tain e d o n th e first and last days of th e fast
.

are give n in P lat e s 4 an d 5 I n th e latt e r part of th e fast th e subj e ct

.

be came some what l ess sur e of his footin g and re ste d lightly agai nst a
wood e n frame A rough approximatio n of th e me asure ments of this
.

m an may be ma d e b y usin g 64 0 m as th e inside distan c e be twee n .

th e wood e n uprights L ack of time pre ve nt e d our adj usti n g th e

.

1
accurate mirror arra nge me n t of F ri e d en thal for s e curin g photo g raphs
that coul d subse qu e ntly be me asure d I t should be co nside re d .
,

howe ver that th e c hi e f re aso n for taking this s e rie s of photographs

,

was to visua l i z e th e ge ne ral app e aran c e of e maciatio n an d no t to furnish ,

mate rial for e xact me asur e me nts of th e loss of tissu e This was sup .

pli e d by th e accur at e me asure me n ts made according to th e re gul ar

sche du l e by Profe ssor W G Ande rso n (S ee p . . . .

I n additio n to th e a natomical photo grap hs a gr e at ma ny photo ,

grap h s we re take n of L at his o wn d e sir e si nc e t hi s s eeme d to be

.
,

th e o ne thi n g which would amus e him at any time A ccor di n gly th e .

came ra was poin t e d at him s e veral hun dr e d time s t h roughout th e

cours e of th e fast although admitt e dl y many of the s e w e re fa l se e xpos
,

ure s A co nsi d erab l e numb e r of photogra p hs were thus o b tai ne d w hi ch

.

S how him in hi s e n viro n me n t som e of which are d e e me d worthy of ,

reproductio n (see P l at es 1 2 an d 3 pag e s 1 1 1 9 and , , , , ,

l
Friede n th al , Me d . K lm ik , 1 909 , No . 19 , p . l .
 ANTHROPOMETRI C MEASUREMENTS .

Th e importa nc e of c are ful anthr opome tric me asur e men ts for notin g
th e d imin utio n in si z e of th e body as th e fast progr e ss e d has b een r e cog
n iz e d by all writ e rs o n fasti n g F ortun at e ly Professor William G
. .

An de rso n of Yal e University was in B osto n durin g th e p erio d whe n

, ,

thi s fasti n g e xp e rime nt was b ei n g mad e an d h e ki n d ly o ffe re d to mak e

a s eri e s of anthropome tric meas ure m ents of th e su b j e ct I n thi s h e .

was assiste d by D r W L An de rso n Th e s e me asure ments w ere made

. . . .

approximat ely o n c e a w ee k D r W L An de rso n maki ng a sp e cial

, . . .

trip from Ne w H aven to compl e te th e s e rie s at th e e nd of th e fast .

“
Profe ssor Ande rso n r eports that th e measure ments of th e fore arm
are tak e n with th e ha n d tightly clos e d an d th e wrist s l ightly fle x e d .

Th e me asure me n ts of th e upp e r arm are take n at th e large st part aft e r

th e e lbow is compl e t e ly fl e x e d an d a l l flexo rs an d e xt e n sors co ntract e d
to th eir utmost I n takin g th e me asure me nts of th e calf an d thi gh we
.
,

s e l e ct th e largest part afte r th e m an has co n tracte d th e muscl e s as

”
w e ll as h e c an whil e in th e sta ndi n g positio n .

Th e me asur e men ts for e ach w e e k are giv en in tabl e 1 th e total ,

d e cre as e s in th e various girths for th e whol e fast b ei ng give n in th e last

column A would be e xp e cte d th e large st chan ge in girth was at th e
.
s
,

waist there b e in g a de cre as e of 1 53 mm Th e g irth of th e a b d ome n

,
.

d e cre as e d 1 1 9 mm wh il e a large d e cre as e is S hown for both thighs

.
,

an d for th e ch e st C e rtai n of th e me asure ments we re n o t mad e u n til

.

th e s e co n d or third e xami n atio n ; th e loss e s are th er e for e i n close d in

par enthe s e s to in dicat e that th e s e ri e s of me asure me nts was n o t
compl e te Th e disti nct loss in practica l ly all measure me nts is obvious
. .

I n th e hop e of s e curi n g some e vid en c e in r e gard to th e muscular

stre n gth of th e subj e ct Profe ssor A nd e rso n brought with him hi s
,

dyn amome ters to t e st th e strength To our gre at surpris e th e subj e ct .

,

e ve n b e for e th e fast b e gan re fus e d to carry out any of th e s e t e sts ,

stoutly mai n tai nin g that h e was no t an athl e t e but a profe ssio nal
gen tl e man an d that h e was n o t accustome d to doi n g muscular work of
any ki n d This was wholly in li ne with hi s attitude toward other
.

muscular work t e sts which w e re co nt e mp l at e d but which it was n eces

-
,

sary to omit gre at l y to our re gre t Th e o nl y e vide nc e that we have

, .

re gardi ng th e muscular strengt h of th e subj e ct is th e mat e rial o b tai ne d

in th e dyn amome t e r t e sts which we re s e cur e d e v ery aft e r n oo n by Pro fe s
sor L an gfeld E ven re gardi n g the s e we are somewhat u nc e rtai n as to
.

whe ther th e subj e ct e xe rt e d his gre ate st stre n gth in all th e t e sts Th e .

pre ssure which h e plac e d Upo n th e dyn amome t e r was cl e ar l y i n flu en c e d

by his fe ar that such pre ssur e might giv e hi m a littl e pai n to which h e ,

was stro ngly ave rs e .

68 A ST UD Y OF P R O L O N GE D F A S T IN G .

T AB L E 1 .
— Measu remen ts of bj ect
su L .
 BODY WEIGHT - .

To th e ordi n ary i n dividual th e most striking i n d ex of th e s e ve rity of

a prolo nge d fast is th e loss in body weight th e absti ne n c e from food -
,

re sultin g in gr e at e maciatio n Th e fact that e ven in th e S hort spac e .

of 24 hour s th e body weight chan ge s co nsid e rably is n o t so pat ent and

-
,

a consideration of the s e change s is of int ere st I f th e body weight is .

-

de te rmin e d e ach hour thr oughout th e day it will be s e en that whil e ,

sudd en fluctuatio ns accompany th e in ge stio n of food th e voidi ng of ,

urine or th e p assin g of f e c e s there is a ge ne ral t en den cy for a re gular

, ,

fall in th e body weight from hour to hour amoun tin g with adults to
-
, ,
1
n o t far from 4 0 grams pe r hour D uri n g th e night th e de cre as e in .
,

th e body we ight is r e gular although n o t quit e so rapid

-
S in c e such a
,
.

t en de n cy is shown in th e cours e of 24 hours it would n ormally be ,

e xp e ct e d that it would be mor e e sp e cially e vid e n t in th e 20 or 30 days

of a fast and that th e body w eight would d e cre as e st e adily as th e fast -

progre ss e d .

ROUTINE OF OBSERVATIONS .

Th e loss e s in body w eight hav e usually b een r e corde d in e very

-

r eport e d fast whe the r sci entifically con troll e d or n o t Unfortu nat ely
,
.
,

how e ve r th e obs e rvatio n s vary in valu e as th e weighi n gs have no t

, ,

always be en mad e u n de r co n stant co n ditio n s A t time s the y e ven .

show a gai n rather than a loss Comparabl e r esul ts in such obs erva .

tio ns may be s e cure d by th e foll owing routine :

Th e weights should be t ak en at app ro ximate l y th e s ame time e ach day .

I f th e subj e ct is no t weighe d nude , th e c l o thi ng wo rn sho uld be appro xi

matel y o f th e s ame weight, and its weight sho uld be d e d uct ed from
th e to tal weight re c o r d e d , thus giving th e t rue v al ue fo r th e b o dy
weight o f th e subj e ct .

T h e bl add er shou ld al ways be emp tie d imm e di at el y o r a sho rt time b efo re

th e weighing .

T h e amo unt o f d ri nki ng water t ak en pri o r to th e weighing should be

c o nstant .

N o water sho uld be t ak en fo r some ho urs b efo re th e o b servati o n is mad e .

Th e weighi ngs should al ways be mad e o n th e same c aref ull y c al ib rate d

sc al es and should be chec k ed by a se con d o b server .

Th e enviro nm ent al temp e ratur e an d th e muscu l ar ac tivity should be

app roxim ate l y c o nst ant th ro ugho ut th e who l e p eri o d o f th e f ast .

As usually fastin g subj e cts are ve ry captio ns inve stigators are ordi ,

n arily co n t e n t to co ntrol th e m o nly in so far as th e coll e ctio n of th e

e xcr e ta an d th e abstin e n c e from food are co n c e rn e d without rigor ,

o usly i ns istin g upo n th e ir r e main in g in a qui e t clos e d room duri n g ,

l
B n di t an d C arp nt
e e c C a n gi I n t W a h Pu b N 1 26 1 9 1 0 p 1 1 3 B en d ic t and
e er , r e e s . s . . o .
, , . . e

Jo sli n C a n gi e I n t Wa h Pu b N 1 7 6 1 9 1 2 p 9 0
, r e s . s . . o .
, , . .
70 A ST UDY OF P R O L O NGE D F A S T IN G .

th ewhol e p e riod of th e fast , with a co n sta nc y in th e muscular activity .

In th e lo n g fastin g e xp e rime nt with L , howe ve r , th e routin e for weigh .

in g pr e viously out l ine d was followe d v e ry c l ose l y .

T h e subj e ct e mpti e d th e bladd er imm e diately aft e r l e aving th e be d

calorime te r e ach day about 8 a m A re spiratio n e xp e rime nt of three . .

or four 1 5 minut e p eriods was next mad e with him T hi s was usually
-
.

"
fin ishe d about 9 30 a m He was then carefully w eighe d o n a
m
. .

cali b rat e d platform b a l anc e , th e w eighin gs and re cords b ei ng mad e by

Mr Carp e nt e r and che cke d by a s e co n d obse rv er (Se e plate 2,
. .

T h e scal e s u se d we re th e so - ca ll e d sil k sc al e s ,
“
figure D , pag e
capabl e of w eighi n g 1 5 0 k ilograms with a s ensitivity of 1 0 grams with
a full load Th e t e mp e rature of th e calorime t e r room was rarely
.

°
be low 20 C , but as th e subj e ct was use d to a warme r climat e h e was
.

e sp e cially s e nsitive to cold He was the refore no t weighe d nude but .

,

in a cotto n u nio n suit an d socks which had be en wash e d in di still e d

wate r He also wore ove r this u nio n suit his he avy wool e n u nd erw e ar
. .

Th e e x act we ight of thi s clothin g was known and d e duct e d from th e

w e ight shown o n th e scal e s I t was n o t practicabl e to mak e th e w e igh .

in g dire ctly afte r h e ha d e mptie d th e bladd e r as it s eeme d und e sirabl e ,

to have hi m stand so lo ng b e fore th e r espiratio n e xp e rime nt be gan .

N o wat e r was tak e n duri n g th e night so that wh en th e subj e ct was ,

weighe d h e had b ee n without wat e r for some 12 hours Furthe rmore .

,

th e amoun t of wate r tak e n d uri n g th e day was approximate ly co nstant

in quantity i e for th e first 1 0 days of th e fast 7 5 0 c c and for th e
,
. .
,
. .

r e maini n g days 900 c c During th e night th e subj ect had re mai ne d . .

in th e c alorime t e r chambe r u nde r co nstant t e mp e rature co n ditions ,

an d as h e usu ally lay v e ry qui e tly th e activity was at a mi nimum ,

.

Wh il e th e te mp erature co n ditio ns an d muscular activity ne c essarily

vari e d some what durin g th e day the y we re fairly co nstant e spe cially , ,

as th e subj e ct was by natur e ave rs e to musc ular activity .

As L was extre mely i nt e re st e d in th e re cords of th e body weight

.
-

from day to day th e chan ge in we ight was compute d an d roughly

,

plotte d dail y in th e form of a curv e o n th e blac kboard in th e c alo rim me r

laboratory Any irr e gularitie s in th e curv e would be i nstantly d e te c te d
.

and ve ri fi catio n s made if ne c e ssary AS a matte r of fact such verifi .

,

catio n n ev e r i ndi cate d a discre pan cy and we have th e full est co nfiden c e
in this s eri e s of weights .

Whil e th e time r e latio ns we r e no t the ore tically ide al they w ere as ,

ne arly so as was practicable with th e large numb e r of obs ervations

’
n e c e ssary to be mad e simulta n e ously upo n this m an A sampl e day s .

comp utatio n of th e loss of w e ight is as fo l lows :

B d y w igh t in c tto und w a c k and h avy w l un d w a kil
o -
e o n er e r , so s, e o o en er e r, o s.

9 3 5m m A p i l 20 1 9 1 2
ll
a . .
, r ,

W igh t f c tto n und w a and h avy w l u nd w a

e o o 1 48 er e r e oo en er e r .

Nak d b d y w igh t 9h 35 m a m A p il 20 1 9 12
e o - e , . .
, r , .

Naked b d y w igh t 9h 4 0 m a m Ap il 1 9 1 9 1 2
o - e ,
‘
. .
, r , .

Lo in b d y w igh t Ap i l 1 9 20 1 9 1 2
ss o - e , r —
,
 72 A ST UDY OF P R O L O NG E D FA S T ING .

change s in th e e n vir o n mental t emp eratur e or mus cular activity will

of course incre as e or d e cre as e th e re gular loss of mate ri al .

Tab l e 2 also give s th e re cords of th e body we ights obtai ne d in th e -

fastin g e xp eriment with our own subj e ct L Th e gr e at e st loss shown .

duIi ng th e 3 1 days of th e fast was kilograms o n th e first day and

th e small e st loss in weight was kilogram o n th e thirt ee nth day .

T AB LE 2 .
— L osses o
f body wei ght
-
by fasti n g subj ec ts, with i nitial we ig h t and weight
o n eac h da y of fast .

( We ig h t g iv
en il
in k o g ram s

Day of

I ni tial wt .

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0 0 0

0 0 0 0 0 0 0

1
L
o ss fo r 3 d ay s
.
3
L o ss fo r 2 d ays
.
 BO DY W E I GHT
-
. 73

T AB LE f bo dy weight by fasting subj ects

”

2 — L o sses
. o -
with i ni tial weigh t and weig h t
,

o n each day of fast— C o n tinu ed .

( We ig h t g iv en in k il o g r am s .
)

E ve ry e ff
ort was mad e to s e cure un iformity of co nditio ns throughout
this fast and probably in n o lon g fast with man have the se ide al co n
,

di tio ns b ee n so ne arly approache d Yet e v en with this care it will be

.
, ,

s een that th e loss e s were by n o me an s re gular from day to day although ,

th e variatio n s are n o t so gr e at as in th e oth e r fasts r e f e rr e d to in tabl e 2 .

Un qu e stio n ably t h e loss in w eight in a strictly co n troll e d fast may

be co nsidere d a good gene ral me asure of th e i n t e n sity of m e tabolic
proc ess e s ; y e t with such wide fluctuations as are S hown for L it hardly .

s ee ms probabl e that th e body weight c an be look e d upo n as an accurat e

-

in de x of th e total tissu e change B ut atte mpts hav e fre qu ent l y b een

.

mad e by i nv e stigators to e stablish a mathe matic al r elatio nshi p b e twee n

th e daily loss in w e ight an d th e l e n gth of th e fast Luciani basing his .
,

co n clusio n s upo n th e re sults of hi s study with S ucci in F lor en c e and

particularly upo n two lo n g e xp e riments with dogs was co n fi den t that ,

such a mathe matical relatio nship e xist e d To stu d y th e possibiliti e s .

74 A S T UDY O F P R O L O N GE D F A S T ING .

FI G 1
. .
— B o d y weigh t cu ves f fa ting
- r or s p im ents
ex e r
 BO DY W E I GHT
-
. 75

FI G 2
. .
— Bo d y weigh t cu v
- r e fo r L e van z in .
76 A ST UDY OF P R O L O NG E D F A S T I NG .

of thi s relationship curve s have bee n plotte d S howin g graphically th e

,

chan ge s in w eight duIi n g e ach of Su cci s fasts (See fi gur e A ’

.

simil ar curv e has b ee n p l otte d showi ng th e r e cords of body we ights -

durin g th e fastin g e xp e rime nt with L (Se e figure .

I f we a nalyz e th e compo ne n ts which mak e up th e loss in w e ight

of th e body we fi n d it is due no t o nly to th e loss of body tissu e whi ch is
,

oxidiz e d to supply mate rial for th e mainte n anc e of th e body activity ,

but to th e loss of preforme d wa te r i e th e wat er e xisti n g in th e tissue s ,

. .
,

oxi diz e d A ccording to o b se rvatio n s in some of th e e arli e r fastin g

.

e xp e rime n ts in Mid dl e town Co nn e cticut this pr eforme d wat e r w hi ch

, , ,

vari e s widely in amou nt app e ars to be rapidly discharge d in th e first

,

days of fastin g We woul d co ns equ e n tly e xp ec t to fin d that th e curv es

.

for a fasting e xp e rime nt would i ndi cate a rapid fall in w eight at th e

be ginnin g of th e fa t th e p e rc entage loss b e comin g graduall y smalle r
s
, ,

until th e body we ight curve t e nds to be come a straight li ne I f th e

-
.

curv e s for Succi and L e van z in are e xami ne d this t e nd ency will be s ee n , .

On th e othe r hand whil e all th e curv e s hav e th e same g e ne ral trend a

, ,

car eful mathe matical an alys is shows no re gularity that woul d justify
th e use of a math e matical e xpr e ssio n by me an s of w hi ch loss e s of we ight
may be pre dicte d duri n g prolo nge d fasts Wh e n o ne conside rs that .

o nl y th e Flore nc e fast was co ntroll e d by Luciani an d that th e oth ers ,

w ere mad e in di ffe re nt y e ars at d i ffe ren t s e aso ns an d in di ffe rent , ,

cou ntri e s it will be s ee n that but littl e c an be exp e cte d from a com
,

pariso n of the s e curv e s .

N e ve rthel e ss th e s e mblan c e of mathe ma tical re gularity shown in

,

th e re cords of body we ight obtai ne d in Su cc i s Flore n c e fast an d in th e

’
-

e xp e rime n ts with dogs le d Lucia ni to s e e k th e aid of his associat e ,

B ufalin i who compu te d that th e body w eight curve s e sp e cially those

,
-
,

o b taine d in e xp e rime n ts o n dogs (see P and P o n figur e 3 ) had a te n ,

’

d ene y to r epre s en t an e quilat eral hyp e rbola R e aso n in g from th e .

e quilat e ral hyp e rbola e q uatio n obtain e d with dogs Lucian i comput e d ,

th e pro b abl e curv e for S u c c i s w e ights durin g th e Flor en c e fast and

’

found that th e loss in w e ight was v e ry much l ess than h e woul d hav e
e xp e cte d He int e rpre te d this as b e i n g due to th e fact that S ucci
.

drank much larger amou nts of wat e r tha n did th e dogs an d that wate r
apparen t l y act e d as a nutri en t thus sparin g th e tissu e s ,
.

S in c e a re aso n ab l e re gularity was also shown in th e cours e of th e

curve obtai ne d for L a probabl e curv e for this subj e ct was de velop e d
.
,

by Mr E H L an ge physicist of th e N utritio n L aboratory (Se e

. . .
,
.

curve in light li ne in figur e U sing W to re pres ent th e w e ight in

kilo grams an d T th e time in days th e weight for any given day is ,

foun d by th e formula
W ( 1 0)
"
0 14 3 T
'
 BO DY W E I GHT
-
. 77

Asimilar e quatio n has bee n worke d out for Su c ci s Lo n do n

’
fast as
,

W= 4 . 98 ( 1 0)
(See curve in light li ne in fig Obvious l y such a complicat e d curv e
.

c an n ot in any wis e be co nsid e re d a s impl e math e matical re la tio n ship .

IO IS 20 25 30 35 4 0 4 5 50 55 60 65 70 75 80 85 90 95 100 I0 5 H O ”5 12 0

FI G 3.
—
. B o dy w igh t cu v
-
e r es fo r p o lo n ged fa tin g exper im e n ts wi th do g s
r s .

I de al con ditio ns for studyi ng th e loss in w eight duri ng fasts wo uld

be those in whi ch th e subj e ct had a co n stant amou nt of dri nkin g wate r ,

e mpti e d th e bladd e r compl e t e ly at a de fini t e p e riod e ach day r e mai ne d ,

‘
in an absolute ly co n stan t e nviro nme nt with a co nsta n t t empe rature ,
78 A ST UDY OF P R O L O NGE D FA S T ING .

and th e me tabolism pursu e d a cours e e nt ire ly un affe ct e d by e xtra ne ous

co n ditio n s S uch co nsta n t co n ditio n s are impracticab l e with human
.

b e in gs but are more e asil y obtain e d with ani mals S e ve ral r e markab l y
,
.

lo ng fastin g e xpe rime nts have bee n m ade with dogs but th e r ecords are
‘

for th e most p art no t e asily acc essibl e Curv e s showi n g th e re cords of .

body w eight in thes e a nimal e xp e rime nts are give n in fig 3 Th e body

-
. .

w eights obtaine d by Luci an i o n two dogs o ne in S ie n a an d a nother ,

’
in Flore n c e are r e p re se n t e d by th e curv e s d e sign at e d as P and P
,
.

The se dogs we re cathe te riz e d e ach d ay were giv en exactly 1 50 c c , . .

of wate r daily an d w e re k ept in a room fr e e from disturba nc e of any

,
° °
kin d an d in a te mp e ratur e of approximate ly 12 to 1 3 C I t will .

be s ee n that th e loss in weight follows a fairly re gul ar cours e save o n ,

th e last fe w days of e ach fast no ne of th e irre gularitie s sho wn in th e ,

body we ights of Succi an d our subj e ct L b e in g appare n t

-
. .

L u ciani s two e xp e rimen ts with dogs co ntin u e d 34 and 4 3 days

’

r esp e ctive ly but st ill lo ng e r e xp e rime nts have bee n mad e by P B

, . .

H awk in which a d og fas te d in two e xp e rim e n ts of 1 1 7 and 1 04 days

,

resp e ctively Th e compl e te resul ts of thes e e xp eriments have no t y e t

.

‘
bee n pub lishe d b ut th e inv estigator has ki ndl y give n m e th e privil e ge
,

of usi n g c e rtain of th e data in this co nne ctio n T h e body w e ights .

-

obtai ne d during thes e fasts are also shown in fi gure 3 Th e amou nt .

of dr inking wate r give n to th e dog was constant but th e a nimal was ,

n o t k e pt in a chambe r with e v e n t e mp eratur e and th e oth e r co nditio n s

we re no t so we ll co ntroll e d as in L u ciani s e xp erime n ts as th e purpose s ’
,

of th e fasts w ere e ntirely diffe re nt As id e from slight fluctuatio n s .

,

howe ve r th e curv e s follow a re aso nably co nsta n t course The se

, .

c u rv es ar e of particular valu e owin g to th e extr aordin ary l en gth of th e

fastin g p e riods .

A s eri e s of obs erva tio ns mad e by Awr o ro w o n dogs with compl e te

fastin g is of e ve n more inte rest in studyin g this sp e cific probl e m .

Th e dogs we re co n fi ne d in th e Pash u tin r espiratio n chamb e r in th e

I mp erial M e dical A cad emy in S t Pe t e rsb urg re c eivi ng neith e r food .
,

n o r wate r The y w e re cathe te riz e d da ily weighe d at a re gul ar hour

.
, ,

an d s p e n t 22 or more hours out of th e 24 ho u rs in th e qui e t an d iso l atio n

of th e re s p iratio n chambe r during wh ich th e carbo n dioxide productio n ,

-

was car e fu ll y me asure d Th e p e riod of fastin g with th e four dogs .

co ntin u e d for 1 6 44 60 an d 6 6 days r e sp e ctive ly Unde r the s e c o n

, , ,
.

ditio ns o ne would e xp e ct a most reg ular progre ss in th e me ta b oli sm ,

with co nstant loss of wat e r and organic mat e rial and change s in th e ,

body we ight That this is tru e to a marke d e xt e nt is shown from an

-
.

e xamin atio n of th e thr ee curve s for th e dogs whi ch fast e d th e lo n ge st ,

i e 4 4 60 an d 66 d ays
. .
, ,
T h e striki n g r e gul arity of th e s e curve s b e ars
,
.

out compl e te ly Profe ssor L u ciani s vi ew that if such e xp erime ntal c o n ’

H w
1
o e and H awk , Am . Jo urn Ph y i l
. s o .
, 1 9 1 2 , 30 , p . 1 74 ; H o we , M attill , and H awk J , o ur n .

B io l Ch. em .
, 1 9 12 , 1 1 , p . 1 03 .
 A ST UDY OF P R O L O N G E D FA S T I NG .

TOTAL LOSS IN BODY-WEIGHT .

An examin atio n of th e data in tabl e 2 for th e subj e cts othe r than L .

show apparen t discrepanci es in th e initial we ights and in th e loss of

w eight o n th e first day Th e e xact l ength of th e f asti n g p e riod and
.

th e weight o n th e last day are also fre qu en tly doubtful T h e F lor e n c e .

w e ights w ere all tak en from th e plate s at th e e n d of L u ciani s re port ’

“ ”
F isiologia del di giu no I t is obviously importa n t to n ot e whe the r
.

th e i nitial we ight was tak e n imm e di ate ly af te r th e me al or be fore

th e me al or what was th e co n ditio n of th e alimen tary tract
, With .

our subj e ct L we b e lie ve d it to be ne c e ssary to obtain an accurate

.

w eight at th e b e ginnin g of th e fast ; co ns e qu ently th e initial w eight was

t ak e n approximate ly 1 2 hour s afte r th e l ast me al s e ve ral hours afte r ,

drinkin g wate r an d a de fi nit e tim e afte r uri n atin g Such pre cautio n s
,
.

w e re no t tak e n we be li e ve with any of th e other subj e cts given in

, ,
’
tabl e 2 with th e possibl e e xc e ptio n of C ath c art s subj e ct B eauté
, , .

Th e total losse s in th e various fasts pa rticular l y whe n compute d as ,

p erc entage s of th e i nitial w eights have c e rtain feature s that are no t

,

without in te rest F or compariso n we give in tabl e 3 th e total loss an d

.

th e p e rc entage loss for e ach subj e ct at th e e n d of 1 4 1 6 30 3 1 , , , ,

an d 4 0 days re spe ctiv e ly (us in g th e data re cord e d In tabl e Obvi

o usly a compariso n c an be mad e for all of th e subj ec ts for o nly 1 4 days ,

wi th all th e subj e cts but o ne for 16 days with al l th e subj e cts but two ,

for 20 days an d fi n ally with but o ne su bj ec t for 4 0 days A t th e e nd

,
.

of 1 4 days th e av e rage pe rc e ntage loss was per c en t Th e lowe st .

loss was with S ucci in th e R ome fast of , pe r c e nt ; and th e highest

,

loss was pe r c e nt with th e sam e su bj e ct in th e P aris fast F or , .

T AB L E 13 — S um mary
,
f losses of
o body weig ht by fasting subjects
- .
 BO DY W E I G HT
-
.
81

16 days th e av erage p erc entage loss was 1 3 4 per c ent th e lowe st again .
,

app e arin g with Succi In th e R ome fast of 1 1 2 per c e nt and th e highe st .

1 6 3 per c en t in th e P aris fast

. F or 20 days th e ave rage p erc en tage .

loss was per c ent th e lowest b e in g with Jacqu e s of 1 3 per c en t , ,

an d th e hi gh e st per c en t with S ucci in th e P aris fast F or 29 .

days th e av e rage loss was per c en t th e low e st again b ei n g with ,

Jacqu e s of per c ent and th e highest per c en t in th e P aris fast

of Succi F or 3 0 days th e average valu e was
.
per c en t th e lowe st ,

b e in g with Jacque s of per c ent and th e high est , per c en t in th e ,

Paris fast of Succi F or 3 1 days o nly two e xp e riments w er e com .

par abl e th e p erc entage loss in both of th ese b ein g about 21 per c ent
, ,

whil e in th e 4 0 day exp eriment th e p erc entag e loss was

-
per c en t .

Of sp e cial inte re st is th e fact that aside from th e fast with Jacqu es in , ,

whi ch th e w eights of th e drinkin g wat er and urin e w ere p erhaps l e ss

trustworthy than in th e othe r fasts it can be said that at th e end of 30 ,

days of fastin g per c en t of th e i niti al body weight was lost This -

.
,

is strikingly r e gular in th e fasts of both S ucci and L e vanzin Th e .

maximum loss of w eight re corde d in any co ntroll e d fasting e xp e rimen t

with m an was in th e Lo ndo n fast with Succi wh e n at th e e n d of 4 0 ,

days a loss of pe r c e n t of th e i n itial body we ight was show n -

.

I n co ntrast wi th the s e valu e s foun d with m an are th e losse s foun d

with animals whe n th e de gr ee of e mac iation h as b ee n carri e d to an
,

e xtre me an d in d ee d in some in sta n c e s to th e point of d e ath

, , In .

H awk s first fasti n g e xp e riment in w hi ch th e dog fast e d 1 1 7 days

’
, ,

per c en t of th e in itial body we ight was lost Th e dog r e cove re d -

.
,

was fe d and lat e r unde rw en t a s e co n d fast of 1 04 days in which h e

, ,

lost p e r c e n t of t h e initial body w e ight an d th e n suddenl y die d -

.

H awk s dog live d in th e laboratory and was give n a de fin it e amou nt of

’

’
wate r but Awro ro w s dogs re c eive d neithe r food no r wat er and th e
, ,

fasti n g was carrie d to th e point of de ath With dog N o 2 th e fast . .

laste d 4 4 days with a loss of 55 per c en t of th e in itial body w eight

,
-
.

With dog N o 3 th e fast co ntinu e d 60 days with a loss of

.
pe r c en t , ,

whil e with dog N o 4 th e fast was 6 6 days in l en gth with a loss of

.
,

pe r c e n t of th e i niti al body w eight S till othe r v al u e s we re obtaine d -

.

by Luciani with th e two dogs whi ch faste d unde r sp e cial e xp e rime ntal
1
co n ditio n s As shown in his curve th e dog P lost
.
per c e n t of his ,
’
in itial body w e ight in a 4 3 day fast whil e th e dog P lost
-
per c e n t
-
,

in a 34 day fast -
.

I ncid entally it should be me ntio ne d that G ayer in his 30 day fast In ,

—

Ne w Y ork In 1 9 12 was said to have lost 1 7 4 per c en t of his i nitial

,
.

we ight of 2 1 0 pounds kilograms ) whil e Pe nny in his s e lf co n , ,

-

troll e d fast of 3 0 days lost 1 9 per c ent of his in itial body we ight of ,
-

poun ds kilograms ) Whil e both the s e value s are some what .

L u iani Da Hun g n H m bu g and Le i p ic 1 890 plate 11

l c , s er S ee al
, th i p u blic ati n fig
a r s , , . so s o , .

3, p . 77 .
82 A ST UDY OF P R O L O N GE D FA S T IN G .

l e ss than th e ave r age loss found with L and Succi the y are sufli ciently .
,

close to imply that in all probability no me asurabl e amoun ts of food

we re tak e n durin g the se two unco ntroll e d fasts .

ANALYSIS OF LOSSES IN BODY-WEIGHT .

An a nalysis of th e factors influ encin g th e body weight sho ws that -

there may be a re te ntio n of wa te r in th e body due to th e drinkin g of

more wate r than is e xcre te d in th e urine ; a loss due to fe c e s ; a re gular
lo ss due to th e oxidatio n of organiz e d mat e rial th e carbo n burn in g ,

to carbo n dioxide and th e hydroge n to wat e r ; and a furt her lo ss of solids

in th e uri ne .Th e amount of orga niz e d mate ri al oxi diz e d in th e bo dy
will be influenc e d in large part by th e muscular activity of th e subj e ct ,

and if th e activity is consta nt th e loss due to oxidatio n will pro gre ss in

,

a re aso n ably re gular man ne r .

Conside rin g th e body as a li vi ng orga nism the re fore we see that in , ,

a fasting e xp e rime n t th e in tak e co nsists of dri nki ng wate r and oxyge n

from th e air Th e output co nsists of wate r vapor and carbo n dioxide
.
-

give n o ff from th e lungs an d ski n and th e uri ne and fe c e s e xcre ted .

I n this particul ar fast howe ve r th e subj e ct did no t d e fe cate duri n g th e

, ,

e xp e rim e nt.

Th e wate r vaporiz e d f rom th e lu n gs and th e ski n and give n o ff in th e

urin e u ndoubte dly co ntain s a large amount of pre forme d wate r whi ch
was tak e n with th e wate r dru nk e ach day I t also contain s wate r .

which has b ee n store d in th e body and is give n o ff as a re sult of th e

bre aking down of th e p rote i n i e muscul ar tissu e The re is like wise
,
. .
, .

a small amoun t of wat e r due to th e combustio n of th e organic hydro ge n

of th e body with th e oxyge n take n from th e air Without e stimatio ns .

of th e carbo n dio xi d e e xcre tio n th ere are at pre se nt no kn own me an s of

-
,

satisfactorily computin g these s eparate factors in th e me asure me nt of

th e wate r output When it is possibl e to have th e subj e ct liv e th e
.

e n t ire tim e insid e th e re spiratio n chamb e r as was do ne in th e experi ,

l
me n ts at We sl eya n Unive rsity th e compl e te in come and outgo may ,

be de t e rmine d in cludin g th e in come of o xyge n and wat e r an d th e out

,

put of carbo n dioxide wat er vapor wat e r in urine solids in urine and
,
-
, , ,

an a n alysis of th e solids An approximat e apportionm ent may the n

.

be mad e of th e wate r l e avin g th e body as oxidi z e d orga nic hydroge n

and as pre forme d wate r in th e body This has alre ady b ee n do ne .

2
for th e 7 day e xp e riment re port e d in th e e arlie r pub l icatio n
- From .

th e comput e d amounts of carbo n dioxid e e xcre t e d and th e probabl e

organic hydrog en oxidi z e d a similar apportio n men t of th e wate r loss
,

has b een made for this e xp e rimen t (see page 4 0 7 of thi s report ) .

I n asmuch as th e body consists in large pa t of wat er some 60 pe r

r —

c e n t or more it will be se en that th e re may be an additio n to or loss

—

B l
di t C a n gi I t Wa h Pu b N
ene c , r7 7 1 907
e e ns . s . . o .
, .

”B n ed ic t C n gi I n t W h Pub N
e 7 7 1 90 7 p 4 6 9
ar e e s . as o
, . . .
, , . .
 BO DY -
W E I G HT . 83

from th e storage of water in th e body as for in stanc e 200 grams , , , ,

without mate rially affe cti ng th e total p e rc en tage of wat er I t is e asy .

to see therefore that th e change s in weight not e d from day to day with
, ,

a fasti n g subj ect have o nly an i ndi re ct an d p assin g in flu enc e .

INSENSIBLE PERSPIRATION .

I n th e lo n g fasti n g e xp e riment with L , th e subj e ct was n o t k ept .

inside th e re spiratio n chamb e r for th e entir e time of th e fast , so that th e

c ompl e te output of wat er vapor was no t d e t e rmin e d On th e othe r
-
.

han d, a study of th e so call e d ins e nsibl e p e rspiratio n , which has b een

-

of gre at in tere st e v e r sin c e th e days of S an ctorius , shows some facts of

valu e .

Th e body los e s in w eight re gularly as a r esult of th e elimi natio n of

c arbo n dioxide and wate r vapor I t lose s weight spasmodically by
-
.

th e passi n g of uri ne and it gains in w eight spasmodically by th e dri nk

ing of wat e r B y corr e ctin g for th e amou nt of wat er tak en and th e
.

weight of uri ne pass e d th e de gree of i nse nsibl e loss or th e i nse nsibl e

, ,
“

”
p e rspiratio n may be accurate ly calculate d This has be en do ne in
,
.

tabl e 4 which give s for e ach day of th e fast th e loss of body w eight
,
-

in grams th e we ight of th e urin e p ass e d th e we ight of th e dr inki n g

, ,

wate r tak e n an d th e i n s en sibl e pe rspiratio n Th e e xcre tio n of urine

,
.

was always l e ss than th e amou nt of th e dri nking wat er with o ne excep

tio n that of A pril 29 30 Th e i ns ensibl e p e rspiratio n is the re fore
,
-
.

r ea dily obtai ne d by fi ndin g th e differen c e b e twe en th e amount of wat e r

tak en and th e w eight of uri ne e xcre t e d an d addi n g it to th e obs e rv e d
loss in body w eight -
.

A fact of spe cial i nte rest in this co nne ctio n is that whil e th e loss e s
in body we ight fluctuate co n sid e rably th e loss e s as shown by th e i n s en
-
,

sib l e p e rspiratio n are re aso n ab l y r e g ular th e low e st b ein g 3 7 1 grams ,

o n May 3 4 ; aft e r th e first 1 0 days th e hi gh e st valu e was 6 9 1 grams on

—
,

April 25 26 The ore tically thi s i ns ensibl e p erspiratio n should giv e us

—
.

a re aso nabl e clu e to th e progre ss of th e fast and should be an i n de x of

th e loss of wat e r an d carbo n dioxid e On th e oth e r ha nd whil e th e loss .
,

of preforme d wat er is a re al quan titativ e loss th e carbo n di oxide and ,

wat er of oxidatio n are n o t as the y are in large part made up of oxygen

,

which is tak en from th e air .

In th e lat e r part of th e fast it will be s een from tabl e 4 that this m an , ,

had o n th e ave rage an i ns en sibl e p erspiratio n of not far from 20 grams

per hour Th e i n s e nsibl e p e rspiratio n of th e subj e cts in th e fasts
.

de scrib e d in th e e arli er publicatio n particularly S A B was i n ad , . . .

,
l
ver te ntly not r eport e d S ubs e qu en tly B e n e dict and Carp en te r in
.
, ,

discussin g th e me tabolism of he althy m en comput e d th e i ns en sibl e ,

p e rspiratio n of all of th e fasti ng subj e cts From their figure s it will .

be s e en th at th e fastin g subj e ct S A B who sp e nt 24 hour s of e ach day . . .

,

B nedic t a d C a pe nter C n gi I t W h Pub N 1 26 1 9 1 0 p 1 1 4

1
e n r , ar e e ns . as . . o .
, , . .
84 A ST UD Y OF P R O L O NGE D FA S T IN G .

insid e th e respiratio n chamb er h ad an in s ensibl e p e rspiratio n of no t

,

far from 25 to 27 gram s per hour Wh en it is co nsid e re d that thi s .

re pre sen ts th e first 5 to 7 days of fasting it will be s ee n that th e results ,

obt aine d for L are quite in accordanc e with those s ecure d with th e
.

e arli e r subj e ct in that th ey indicate a distinct te nd e n cy for th e in s e n

,

sibl e p e rspiratio n to decre ase as th e fast progre sse d I t should be .

T AB L E 4 .
- I nsensi b le perspi ratio n duri ng fasting p
ex eri ment with su bject L .

D ay
Ur in e
.

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

0 0 0 0 0 0

born e in m in d howe v er in makin g any compariso ns b e tween th e res ults

, ,

obtain e d in the s e two fastin g e xp e rime n ts that whil e th e subj e ct ,

S A B re main e d in a re spiration chamb e r th e whol e p e riod of th e fast

. . .

and co ns eq uen tly h ad an approximately co n stan t t emp erature e nvir

o nm ent an d min imum muscular ac t ivity th e subj ec t L was n o t in a , .

respiratio n chamb e r but was for c e rtain days partially n ak e d for some
,

time whil e be i ng photographed me asur e d or clinically examin e d , , ,

occasio n ally had a bath and s e veral time s we nt out for a carriage
,
 BO DY W E I GHT
-
. 85

drive H is temp erature en vironment and muscul ar activity we re

.

therefore more variab l e than thos e of th e subj e ct of th e e arli e r fastin g

e xpe rimen t .

An e xact e xpla n atio n of th e variatio ns in th e i n s ensibl e p e rspiration

from day to day is diffic ult p articularly for those of May 3 4 an d 4 5
,
— —
,

when th e lowe st valu e of th e fast was found o n th e day b efore a v e ry

much hi gh er valu e was fo und I t is always possibl e that there may
.

hav e b ee n an e rror in th e weighing but o n th e othe r han d th es e weigh ,

in gs were very carefull y made an d r e corde d Furthe rmore an att e mpt .

,

to e xplain th e vari atio n s on accou n t of a differen c e in th e activity is

some what difficult si n c e th e subj e ct had a driv e o n May 3 4 and a bath
,
—

an d driv e o n May 4 5 an d o n oth e r days whe n h e was give n a carriag e

—
,

rid e th e ins ensibl e p erspiratio n was much gre at er than o n May 3— 4 .

I t is obvious the re fore that thes e fi g ur e s should n o t be co nside re d

, ,

in dividually but o nly as a ge n eral pictur e this showin g that th e in s e n

’

, ,

sibl e p erspiratio n had a te n d en cy to d e cre as e as th e fas t progre ss e d .

Th e i n cr e ase d valu e for May 14 1 5 may without doubt be e xplain e d—

by th e fact that this b e ing th e last day of th e fast th ere was much ,

gre ate r e xcit e me nt and musc ular activity on th e part of th e subj e ct .

On t hi s day h e talk e d vigorously to a group of m edical m en for some

4 0 or 5 0 minu te s ; o n this day also h e was nude for a tim e whil e photo
, ,

graphs w ere b e ing tak en and durin g a s e ri e s of physical me asur e me nts .

Co nsid eri ng th e valu e s generally howe ve r it will be s een that th e i nse n

, ,

sibl e p erspiration is a far more sci e ntific basis for estimatin g th e loss of
body substan c e during a fast than is th e me re r e cord of body weight
- -
,

w h ich co nsiders neithe r fluctuatio n s in drinkin g wate r n or th e volum e

of uri ne p ass e d .

DRINKING WATER .

Th e i ntak e of a fasti ng m an is co nfine d to water and oxyge n of th e

air Of the s e th e wate r may be re adily me asure d Such me as ure
. .

me nts are of gre at importanc e in in te lligently i nte rpre tin g th e loss es

in w eight from day to day A ccordin gly sp e cial c are was tak en to
.

i nsur e accurat e r e cords of th e wate r co n sume d .

Th e s el e ctio n of th e ki n d and amount of drinki n g wat e r for u se in a

lo n g fast is by no me ans simpl e On th e o ne hand the re is th e b elie f
.
,

that di still e d wat er is dang erous in that it washe s out th e salts from th e
body whil e o n th e othe r there is th e fac t that in man y fasts th e subj e cts
,

took e ither or din ary tap wat e r or as in Su cci s fasts various alkaline ,
’
,

or sprin g wat ers co ntai ni n g large amou n ts of salts some time s of a ,

distin ctly purgativ e charact e r I t has b ee n b eli e v e d by some that

.

the s e mi ne ral wat ers have an actual nutritiv e va l u e du e to th e salts

co ntain e d in th em if no t to th e organic matt e rs Furthe rmore th e sup
, .
,

positio n is r e ason ab l e that th e s al ts int e rf e re se riously with th e mi n eral

metabolism and it is obviously impossi b l e in a metabolism exp eriment
,

to mak e an int e lligen t study of th e output of sulphur phosphorus or , ,

86 A ST UD Y OF P R O L O NGE D FA S T IN G .

chlorine in th e urine if at th e sam e time th e subj e ct is taki ng a large

amoun t of wate r co ntainin g su l phates phosphate s or chlori d es , ,
.

I n th e fastin g e xp e rim ents at We sl e yan Unive rsity o n e of th e ,

1 2
subj e cts S A B pre fe rre d distill e d wat e r
,
. . .
, S imilarly Pe nny re cords .

that h e us e d o nl y d istill ed wat e r durin g his fast Our su b j e ct L .

,
.
,

hi mse lf sugge ste d that h e be given distil l e d wat e r durin g th e fast as ,

oth erwis e it might be said that tap wate r was e ithe r no t pure or c o n
taine d min e ra l or organic matte rs whi ch would co n tribut e to hi s sus
te nan c e Although an exp e rim en t in whi ch th e m an use d distil le d
.

wate r o nl y was some what unusual th e de sirability of be i n g abl e to ,

study th e m ineral me tabolism without th e co nflictin g factor of th e

in gestio n of salts was of cours e apparen t and arran geme nts were , ,

the refore made for sup p lyin g L with distill e d wa ter throughout th e fast . .

D r E P Cathcart was at this tim e a R ese arch Associat e of th e

. . .

N utritio n L aboratory and advis ed that L be given a co nstan t amoun t .

of drinking wate r e ach day sin c e in his obse rvations o n B eauté h e had ,

expe ri e n c e d co n sid e rabl e di fficulty with th e volum es of th e urin e .

Our subj e ct was fir st give n c c of distill ed wate r but was abl e . .

,

to take but 7 20 c c o n th e first day L then sugge st e d that h e be

. . . .

give n only 7 5 0 c c This amount was co ntinu e d for a n umbe r of days

. .
,

when it was in cre ase d to 900 c c at which volum e it co ntinu e d through . .

,

out th e remainin g days of th e fast .

Th e amoun t of wate r tak en each day by th e subj e ct is give n in

tabl e 4 S in c e th e bo dy e xcre te s so large an amou nt of water it is
.
,

per haps some what un fortunate that th e volum e tak en by th e subj e ct

was not consta n t for th e whol e pe riod of th e fast although it is much ,

more ne arly uniform than in any lo n g fast h e re tofore report e d In any .

discussio n of th e body we ight or th e volum e of urine it is obviously -

,

ne c e ssary to conside r the se fluctuatio ns in th e i ntak e of wate r .

Th e subj e ct was v e ry in co nsist en t in his comme nts r e gardin g th e

wate r On some days h e said it was ve ry good but o n othe r days
.
,

consid ere d it to be v e ry bad although e xact l y th e same amoun t was ,

given him and from th e same glass c arboy On some days also h e .
, ,

fou nd th e amoun t giv en him was no t enough and again no t i nfrequ e ntly
complaine d that h e was given too much wat e r He re cogni z e d th e .

im portanc e how ev er of maintaini n g th e volume of uri ne so that a large

, ,

numb e r of an alys e s could be mad e .

Th e daily allotmen t of di still e d wat e r was suppli e d to th e subj e ct in

a bottl e an d from this h e pour e d out th e amou n t de sir ed E arly in th e .

fast h e found that it was d e sirabl e to drink as large a portio n of wate r

as possibl e durin g th e first part of th e day so that it would no t be ne c e s ,

sary fo r him to urin at e during th e night Th e re cords show that h e rarely .

ur in at e d durin g th e night F urthe rmore as in th e l ater p art of th e .

,

B n dict Ca n gi I n t Wa h Pub N 77 1 90 7 pp 13 6 a d 14 0
1
e e . r e e s . s . . o .
, , . n .

2
P nny B i ti h M d J u l 1 909 p 1 4 1 4
e , r s e . o r na , , . .
 BODY-TEMPERATURE .

Th e profoun d alte ratio n s in me tabolism in th e body of a fasti n g man

would le ad o ne to e xp e ct some disturbanc e b e twee n thermogenesis and
the rmolysis B ody te mp erature whi ch is th e in de x of th e res ul tant
.
-
,

of thes e two factors may obviously be affe cte d by th e disturbanc e of

,

e ith e r . I f th ere is a d e cre as e in the rmoge nesis with no change in th e

the rmolysis there will be a fall in body t emp erat ur e Co nve rs ely if
,
-
.
,

there is an in cre ase in the rmolysis with co nstancy of the rmogene sis ,

the re wi ll again be a fall in t emp erature .

I n thi s laboratory body t emp e ratur e me asur e men ts have a dual-

significanc e : first th e v al ue per so of th e actual fluctuatio n which indi

, ,

c ate s a disturbanc e in th e re lationshi p b etwee n the rmolysis an d the rmo

genesis an d s e co nd th e importanc e of kn owing body te mp e rature
, ,
-

chan ges for th e accurate computatio n of th e he at production in th e

body To de te rmin e th e he at production it is n o t sufficie nt simply
.

to me asure th e he at radiate d from th e body and to add to this value

th e h e at of vaporizatio n of wate r for if in a giv en e xp e rimental pe riod ,

th e body t e mp e ratur e has d e cre as e d the re has b ee n a loss of he at from

-
,

th e body u naccompa ni e d by a productio n ; he nc e th e h e at productio n

is me asure d o nly af ter corre ctin g for th e bo dy te mp erature changes -
.

I n th e se ri es of bo dy te mpe rature me asure me nts in th e short fasts at

-

Wesl e ya n U nive rsity th e ave rage body te mp erature did not alte r
,
-

n otic e ably although the re was distin ct e vid e n c e of a flat ten i n g out of
,

th e curv e showing th e daily rhythm I n th e prolonge d fastin g expe ri .

men t with our subj e ct L we atte mp te d to me asure with th e gre atest

.
,

de gree of re fin ement all th e factors I t s ee me d important there fore .

, ,

that fre qu en t an d care ful re cords of th e body t emp erature should be -

made in co nne ctio n with th is fastin g ob se rvatio n .

Th e subj e ct of body te mpe rature has b een giv en sp e cial at ten tion
-

in this laboratory for a consid e rable p e riod and a y ear pre vious to thi s ,

fastin g e xp e riment an e xte nsive study of th e fluctuatio ns of th e tem

1
peratu re in th e various p arts of th e huma n body was r eport e d As a .

re sul t of thi s r e s earch it b e came e vid en t that th e only sui tabl e plac e
,

for measuring body t emp eratur e is deep in th e body tru nk pre f e rably
-
,

in th e r e ctum Th e id en tical apparatus us e d in th e study r eferr e d to

.

was availabl e for this fastin g exp e riment and conse qu ently body te m -

perat ure m e asure men ts w ere s e cure d as fre qu e n tly as possibl e A .

detail e d d escriptio n of this apparatus and th e t ests mad e with it we re

publishe d in th e report cite d B ri e fly th e apparatus co nsists of a .
,

the rmal el e ment which is in se rte d about 7 cm in th e re ctum this .

,

thermal e l ement b ein g co nne cte d with another thermal j u n ctio n in a

constan t te mp eratur e bath B y me ans of this apparatus it is possibl e
-
.
,

B e nedic t and S lac k C a n g i I n t W a h Pub N

l
,1 55 1 9 1 1
r e e s . s . . o .
, .
 BO DY TE MPE R AT U R E
-
.

to d e t er mi ne th e re ctal te mp erature of a subj e ct within and

re cords c an be made as fre quently as d esire d .

Re cords of th e re ctal te mp eratur e w ere obtaine d n e arly e very night

whil e th e subj e c t was in th e c alorime te r chamb er th e j unctio n b e in g ,

inserte d in th e re ctum of th e subj e ct conn e ctio ns made with th e bin ding

,

posts i nsid e th e chamb e r an d obs ervation s taken o n an average of

,

e v e ry 1 5 mi n ut e s thr oughout th e ni ght On some nights r e cords we re .

tak en e v ery 5 or 6 min ut es Obs e rvatio ns w e re also made at various

.

tim e s du rin g th e day and o n at l e ast two days co ntinuous r e cords w ere
s e cur e d for ne arly th e whol e day p e riod Th e apparatus was fre qu ently
-
.

co ntroll e d by compariso n with a standard the rmome te r so we b e li e ve ,

that the s e observatio n s repre se n t th e absolute t emp erature chan ges

of thi s i ndividual .

AS in most of th e me asure ments tak en durin g th e fast th e subj e ct ,

coop erat e d he artily in the s e body te mp e rature obse rvations Af te r -

.

th e first ni ght an d in fact aft e r th e th e rmome te r had b ee n ins ert e d

, , ,

a few momen ts h e e xp eri enc e d no p articul ar difficulty an d expre ss ed

,

hims elf as b ei ng v ery much pl e ase d that this routin e gave him no dis
comf ort It is cl e ar that th e use of th e th ermome te r did no t in t e rfere
.

in the slighte st with his sl eepin g Th e obs e rvatio ns we re there fore made
.

under normal co n ditions so far as it was possibl e to co n trol the m

, .

Th e body t emp eratur e me asur e men ts mad e in this fastin g e xperi

-

ment may be co nsid e re d in two ways : first as to th e alt eratio n in th e ,

r e gular rhythm of th e t emp e ratur e as th e fast progre ss e d and s e co n d , ,

as to th e effe ct of th e fast upo n th e average of th e te mp eratur e me as

urem e nts .

CHANGES IN TEMPERATURE RHYTHM .

I n ord er to study th e first of the s e probl ems namely th e chan ge s in , ,

th e t emp eratur e rhythm curve s hav e b een plott e d givin g th e t e mp era

,

tur e valu e s for th e p eriod b e ginning about 8 p m and e ndin g about 1 0 . .

a m th e following day D uring this time th e subj e ct was in th e

. . .

calorime t e r chamb er from 8 p 111 u ntil about 8 a m an d the n , Without

. . . .
,

l e aving th e be d, h e was withdrawn from th e apparatus and was for th e

n e xt two hours th e subj e ct of th e mornin g r espiratio n e xp e riments .

A ccordingly h e was lying on th e same be d in th e same position for

,

th e e ntir e time th e o nl y chan ge b eing that in th e last two hours h e

,

was in th e calorime te r room inste ad of i nside th e calorime t er chamb er .

S inc e th e t e mp e ratur e of th e calorime t e r laboratory was e ss entially that

of th e r espiratio n chamb er there was practically n o alt eratio n in th e
,

temp erature e nviro nme nt throughout th e whol e p eriod cov ere d by th e

obs ervatio n s shown by th e curv e .

I t is furthermore , of val u e to n ot e that this p eriod in cludes what is

,

normally found to be th e maximum di urnal chan ge for with normal ,

i n dividu al s it has b e en S hown that th e lowest t em p e rature s are found

about 3 a m and th e highe st about 5 p m From 5 p m u ntil
. . . . . .
90 A ST UDY OF P R O L O NGE D FA S T ING .

about 1 1 p m or u ntil b edtime th e te mp erature usually r e main s

. .
, ,

approximat ely co n stant Th e te mp erature as a rul e falls rathe r

.
, ,

rapi dl y afte r o ne go e s to be d re achi ng th e mi nimum about 2 or 3 ,

a m With th e fastin g subj e ct th e maximum te mp eratur e u ndoubt

. .
,

e dly was re ach e d prior to hi s e n t e rin g th e chambe r at 8 p m as h e

‘

. .
,

usually lay o n th e couch for an hour or more pre vious to that time .

Th e bo dy te mp e ratur e was un qu e stionably fa l lin g co n tinuously durin g

-

this pre li mi n ary p e riod so that th e ran ge for th e night wo ul d be some

,
a

what l e ss than th e actual daily range .

PM . AM .

FI G 4. .
— B dy t m p
o -
e e rature cu v d u i n g th e nigh t an d a ly m o rni n g
r es r e r

fo r th e se co n d and fo urth to igh th d ay f fast

e s o .
92 A ST UDY or PR O L O N GE D FA S T IN G .

OBSERV ATIONS OF THE BODY-TEMPERATURE IN THE NIGHT PERIOD .

AVE RAG E B O DY T E MPE RAT U RE

- .

Th e gr e at est in t er est , at l e ast to th e clinician , li e s n o t in th e cours e

of th e te mp eratur e curv e throughout th e night , but in th e average tem
p eratu r e valu e s as th e fast progr ess e s Th e s e are re cord e d in tabl e
.

5 (p ag e 95 ) for ne arly e ve ry night of th e fastin g e xp erim en t , onl y th e

time that th e subj e ct was in side th e be d calorimete r b eing includ ed in th e
valu es These av erages we re tak en dire ctly from plotte d curv e s and
.
,

e xc ept in th e valu e s for th e t en th to th e fourt ee n th nights of th e fast .

6 m moo 3 :00 A M cm

FI G 6
. .
— B o d y tem pe ature cu v d u in g th nigh t and a l y m
- r r es r e e r o rnin g
for th se v n tee nth to tw nty
e e co n d day f fast
e -se s o .
 BO DY TE MP E R A T UR E
-
. 93

S how a general tenden cy for th e te mp eratur e to r emain r e aso nably

constant Up to th e s e venteenth ni ght of fastin g Th e te mp e rature the n .

fluctuate d falling as low as

,
C o n th e twenty fourth ni ght of
.
-

fastin g and risin g as hi gh as C o n th e twenty e igh th ni gh t of th e

.
-

fast Th e maximum ave rage valu e for th e body t emp e ratur e obs e rve d
.
-

in any night during th e fast was C on th e twelfth night and th e

.

min imum valu e was C o n th e twe nty fourth night On th e

.
-
.

l ast night of th e fast th e av erage body temp eratur e was

,
-
C .

FI G 7.
—
. B o d y tem pe
-
rature curv esd urin g th e nigh t an d early m o rn ing fo r twenty th ird
- to
twen t y nin th d ay s o f f ast
-
.
94 A ST UDY OF PR O L O N GE D FA S T IN G .

With th e re sum ptio n of food th e average tempe rature in cr e as ed on

May 1 64 7 to C and o n May 1 7 1 8 to C .

—
.

R ANG E IN B O DY T E MPE RAT URE

- .

Th e maximum an d minimum t emp eratur e s and th e range in th e

temp erature for e ach night are likewis e re corde d in tabl e 5 Th e maxi .

mum te mp erature obs erv e d o n any fastin g night was C on th e .

fif th night ; th e m in imum t em p eratur e was C on th e twe nty .

s eco n d and twe n ty third nights Th e diffe re nc e be twee n th e minimum

-
.

an d maximum valu e s or th e ra n ge in te mp e rature is also re cord e d in

, ,
°
tabl e 5 Th e ave rage rang e was no t far from 0 9 0 C Th e maximum
. .

ran ge 1 2 7 C was obs erv e d o n th e fifth night of fastin g ; th e mi nimum

,
°
.
,

PM . m ay .

FI G 8
. . B dy t
- o - e m pe rature c ur ves d uri n g th e nigh t an d ear l y m o rni n g fo r thi rti e th and th i rt y fi rst
-

days o f f ast and se co n d and thir d d ays wi th f oo d .

 A ST UDY OF P R O L O NGE D FA S T I NG .

day for b efore th e night obse rvation b e gan th e subj e ct had bee n in a
,

co nditio n of rest for o ne or more hours On the s e two days th e maxi .

mum te mp erature obse rvations occurr e d durin g th e dayt ime as for , ,

instanc e on May 7 8 when th e maximum te mp e ratur e obse rv e d was

,
—
,

37 1 0 C at about 5 p m th e n ormal hour of th e day

.
°
. . .T h e minimum
,
.

re cord was C at 4 a m th e e ntir e ran ge b e ing

. C a valu e
. .
,
.
,

e xc ee ding any rang e giv e n in tabl e 5 i

S mil ar l y o n May 9 th e hi gh
8 —
.
,
h m
e st te mp e ratur e re cor d e d was in th e daytime at a b out 1 2 1 5 p m . .
,

when a temp e ratur e of C was re corde d Th e min imum value . .

1 m
was C at 2 4 0 a m .
,
Thus th e range was
1
C e xc ee di n g
. . .
,

e ve n that of th e pre c e din g day Th ese curv e s give a general pictur e .

of what was probably th e ave rage daily cours e of th e body—te mp eratur e

B OO P M

FI G 9
.
—
. B o d y tem p
- er atur e cu rv es f or a ppro xim atel y 24 h o urs on y fo urt h
tw e n t -
an d twe n t y fif th d ay
- s of fast .

of thi s subj e ct throughout th e 3 1 days of fastin g H ere again there is a .

, ,

distin ct te nde ncy for th e maximum temp erature to app e ar in th e lat e

afte rn oo n and th e mi nimum tem p e rature in th e e arly morni n g thi s no t ,

be in g affe cte d by many days of fasting .

On t hr e e othe r days bo d y te mp erature re cords we re obtai ne d for a

,
-

part of th e mornin g On May 1 an d 4 observatio n s we re made duri n g

.
,

r espiratio n e xp erime n ts in whi ch L was sittin g up and writing (S ee . .

plat e 1 fig B ) The s e valu e s are give n in figure 1 0 This e xp e rimen t

,
. . .

follow e d th e re gular morni n g res p iratio n e xp e rim e nt in whi ch th e ,

subj e ct lay upo n a couch ; th e obs ervatio ns re cord e d for th e lying

positio n are also given in fi gure 1 0 for compariso n Of particular .

in te re st is th e fact that th e cha nge in positio n from lyi ng to sittin g

did no t gr e at l y alt er th e rat e of th e mornin g ris e in te mp erat u re .

On May 15 whe n th e subj e ct fir st b e gan to e at th e obs e rvatio ns

, ,

commen c e d shortly afte r th e en d of th e re gular respiratio n e xp e rimen t

 B O D Y TE MPE RAT U R E
-
. 97

and co n tinu e d until noon D uring this time th e subj e ct was sittin g up
.

and e ating . Th e curve give n in figur e 1 1 for both th e re spir atio n

expe rim en t and th e e atin g p e riod shows that wh e n th e subj e ct was

sitting and e ating th e asc ent is somewhat more notic e abl e than in th e
lying p e riod but it is evide nt tha t e ve n e ating after a 3 1 day fast did
,
-

not mate ri ally disturb th e cours e of th e re ctal te mp e ratur e curv e .

CONSTANCY IN BODY TEMPERATURE AT A GIVEN HOUR - .

S inc e at 7 a m th e subj ect had b een living unde r constant co ndi tions
. .

of qui e t and re st inside th e cham b e r for 8 or 1 0 hours , a compariso n

may be made of th e value s for th e body t emp eratur e obtain e d at thi s -

time from day to day This comparison is th e more importan t sinc e

.

FI G 1 0 —
. . B o dy—tem p er ature cur ves sh o win g ch an ge fro m l yin g to
si tti ng po si tio n
.

FI G . 11 —
. B o d y tem peratu cu v
-
re r e sh o wi n g ch an ge fro m l ying to
98 A ST UD Y or P R OL O N GE D FA S T I NG .

in many fasts th e body te mp e rature me asure ments are made but o n c e

-

e ach day and usually at a give n hour A ccordingly in tabl e 5 th e

.
,

tempe rature re cords obtaine d at or ne ar 7 a m have bee n given for . .

e ach day . I n ge ne ral th e variatio n s in th e t empe rature at 7 a m are

, . .

n o t mar ke dly diffe re nt from th e variatio n s in th e ave rage t e mp e rature

throughout th e night sin c e th e maxim um and minimum r e cords for
,

this time w e re foun d o n th e same days as th e maximum and mi nimum

ave rage t empe rature s Th e maximum value foun d at 7 a m was
. . .

C at th e e nd of th e tw elfth night of fastin g and th e minimum

.
, ,

value C at th e e n d of th e twe n ty fourth night of fasting

.
,
-
No .

uniformity in th e valu es is appar ent .

With th e fluctuatio ns in th e body t emp eratur e varyin g as the y do

-

it will be s ee n that th e diffic ultie s in s e curin g an ave rage t e mp erature

throughout th e fastin g pe riod by means of o ne or two obse rvations
duri n g th e day have be en ove rlook e d O nl y by s e curi ng average value s
.

throughout th e e ntire night or throughout s e ve ral hours at appro xi

mate ly th e same time e ach day c an a tru e picture of th e ave rage te mp er
ature chan ge of th e body as affe cte d by i nanition be s e cure d .

Th e w e ll k n own i n flu e n c e of muscular activity o n body t e mp e rature

- -

makes it th e more re gr e ttabl e that c e rt ai n e xp e rime nts with muscular

activity could no t have bee n carri e d out with this subj e ct as th e e ffe ct ,

of a mode rate amou nt of muscul ar e xercis e upo n th e temp erature re gu

latio n as th e fast progre ss e d would have gr e at the ore tical i nt ere st .

This is o ne of th e probl ems that should c e rtainly be studi e d in any

subs e qu ent fasti n g e xpe rimen t .

Th e obs e rvatio ns of body te mp e rature o n othe r fastin g i n dividuals

-

have fre qu ently bee n made without re fe renc e to th e pre c e di ng muscular

activity or th e g ene ral co ndi tio n of th e subj e ct Obviously those made in
.

th e mornin g j ust be fore th e subj e ct rise s have by far th e gr e ate st value

, , .

I t is a charact e ristic of practically a l l th e fasts here tofore report e d in —

which th e te mp e rature obs e rvatio ns have b een made for th e most part
in th e axilla or in th e mouth (both localiti e s unsuit e d for physiological
e xp e riments ) that there has no t be en s ufficie nt distur b anc e in th e
—

te mp eratur e re gulatio n to be re cord e d by t hi s me thod of the rmome try .

1 00 A S T UD Y O F P RO L O NGE D FA S T I N G .

di sturbing to th e subj e ct than fee lin g of th e radial p ul s e but a fe w ,

addi tio n al re cords w e re obtained by th e latt e r me thod In th e late r .

days of th e fast when th e ap e x b eat of th e he art be came fain te r it was

, ,

occasio nally ne c essary for th e obs e rve r in th e re spiratio n e xp e riments

to n ote th e pulsations of th e carotid art e ry .

Th e puls e rat e r ecords may be classe d in two groups

- Th e first in .

e lud e s a large n umb e r of p e rfe ctly C omparable obs e rvatio n s : thos e made
throughout th e night whil e th e subj e ct was inside th e be d calorime t er
, ,

an d thos e durin g th e 1 % o r 2 hours of th e mornin g r e spiratio n e xp e rime n t .

U sually th e pe riod of co n tinuous obse rvatio n e xt ende d from 8 p m to . .

h m
9 30 or 1 0 a m . durin g thi s time th e subj e ct was lyin g qui e tly upo n
.

a couch The s e re cords w ere mad e re gularly e ve ry day of th e fast

. .

Whil e th e subj e ct was in th e be d calorime te r th e re cords w ere mad e ,

by th e re gular ch emical assistant as ofte n as possibl e th e fre qu ency of ,

th e obs e rvatio ns ob vi ously d e p en ding somewhat upo n his oth e r duti e s .

Oc casio nally when th e su bj e ct moved in side th e calorime te r so as to ,

slightly displac e th e be ll of th e st e thoscop e th e pulse b e ats could not ,

be h e ard an d th e re would co nse qu ently be a bre ak in th e r e cords u ntil

th e subj e ct again chan ge d hi s positio n so as to bri n g th e b e ll to its
forme r locatio n D uring th e mo rning respiration e xp e riment a sp e cial
.

obs e rve r was d e taile d to count th e p ulse rate co n ti nuously throughout -

th e whol e p e riod (Se e plate 2 figur e C pag e

.
, ,

Th e se co nd group of obse rvations co nsists of those tak e n at various

times throughout th e day a part of which we re co ntinuous while othe rs
, ,

w e re in dividual re cords This group in clud es th e obs e rvatio ns in th e

.

misc e llaneous re spiratio n e xpe rime nts such as those mad e in th e e ve n ,

in g b e fore th e subj e ct en te re d th e be d calorime t e r whil e th e subj e ct was ,

writin g or wh en h e was bre athin g an oxygen rich atmosph e re D uring

,
-
.

th e latt e r part of th e fast th e p u lse ra te was also re cord e d twic e wh en

,
-

th e daily r e cord of th e blood pre ssu re was taken and occasio n a l ly whe n ,

othe r sp e cial t e sts w e re mad e A t time s th e subj e ct wore th e ste tho

.

scop e throughout th e whole day so that th e obse rvatio ns we re more or

,

l e ss co ntinuous for th e 24 hours On th e days when th e co n tinuous .

obse rvatio ns we re mad e th e subj e ct was followe d by an assistan t who

,

kept out of sight but ma de th e re cords re gularly an d also note d th e

change s in bo d y positio n Th e se re cords we re fre qu ently v e rifie d by
-
.

a se co n d obs erv e r .

RECORDS OF PUIS E RATE OBT AINED IN E R A LIER FAST ING EXPERI MENTS .

B e fore givin g th e re cords of th e pulse rat e obtain e d in th e fastin g -

e xp e rim en t with L it will be of in te re st to cit e thos e se cur e d in fastin g

.
,

e xp e rim e nts mad e by othe r in v e stigators I n dis cussin g such o bser .

vatio ns two e ss e ntial ly di ff e re n t compariso n s c an be mad e first th e

, , ,

i n flu en c e of a prolo nge d fast upo n th e pulse rat e de te rmine d u nd e r any -

given co nditio ns an d s e co nd th e vari atio n s in pulse rat e in cid ental to

, ,
-

th e cha n ge s in positio n or m ental activity U sually in fastin g e xpe ri .

 PUL S E -
R A TE . 101

ments observ ers have co nte nt e d the mse lves with taki n g th e morn in g
pulse rat e and occasio nally th e e vening p ul s e rat e N o particular em
- -
.

phasis has b een plac ed upon the s e indi vidual obse rvation s asid e from ,

th e g eneral fact that th e pulse may have alte r e d as th e fast progr e ss e d .

N ot re cognizin g th e gr e at sign ifican c e of th e puls e rate in re latio n to th e -

me tabolism exp eriment e rs have no t ordinarily tak en e sp e cial prec au

,

tions (as did Luciani) to k eep th e subj e ct lyin g qui e tly while th e puls e
rate was be ing obs erve d and indee d for some time pre vious to th e , ,

obse rvatio n Thi s probably e xplains difficul ti es found in comparin g

.

th e r e cords in that some obs e rvers n ot e a c o ntinually d e cre asin g puls e

,

rat e du ring th e fast whil e others fi nd marke d irregul arities As would

,
.

be e xp e ct e d th e more r e c en t obse rvatio n s tak e in to accou nt th e factors

,

influencin g th e p ulse rate and th e re cords are thus more trustworthy

-
.

’
Of th e puls e r e cords obtaine d in Tann er s fast we have b een able to ,
l
fi nd o nl y those given in th e B ritish M e dical J o urnal On th e t hi rty .

s e venth day of thi s fast th e pul se r espiratio n and t emp eratur e are, , ,

reporte d as having b een norma On th e twenty fifth day th e p ulse -

rat e is give n as 75 th e respiration as 1 5 and th e t emp erature of th e

, ,
°
mouth as 98 4 F . On th e thirti e th day th e puls e rat e was -

°
report e d as 84 and sligh tly more re gul ar th e t emp erature as 98 8 F , .

and th e re sp iration as 14 with th e general stat ement that ,

h e was we ak e r tha n o n any pre vious day On th e twen ty n inth day .

-
,

two of th e e xp erts at te n ding him reporte d that there was no mat e rial
alte ration in th e vascular pre ssure indicate d by th e h e art s impul se ’
,
”
while its volume was scarc e ly l ess than in h ealth .

2
P ato n and S tockman report that th e pulse—rat e of th eir subj e ct
averag e d b e tw ee n 5 0 and 60 and th e r espiration usually be tween 23 and
30 but no continuous r e cords of th e p ulse rat e are given
,
-
.

Th e most e xt en sive se ri e s of co n tinuous obs e rvatio n s of th e p ul se

3
rate of a fasting subj e ct is that reporte d by H oover and S o llm ann .

I n t hi s 5 day fast th e pul se was coun te d and re cord e d o n c e e ve ry hour

-
,

by r e lays of watchers Th e initial re cord of th e pulse rate was 75 th e

.
-
,

lowe st value of 3 7 be ing re corde d on th e last day thus showing a dis ,

tinct t e nde ncy for th e pulse rat e to d e cre ase as th e fast progr e ss e d -
.

U nfortunate ly th e fast co ntinu e d for only 5 days and in th e opinion ,

of th e authors th e pulse r e cords are vitiate d by th e fact that they w ere

,

obtain e d with a hyp notic subj e ct and that th e puls e rat e was purpose ly -

lowe re d by sugge stio n .

I n re portin g a fast carri e d out by Succi in New York in D e c emb er

1 890 and said to have continu e d for 4 5 days a n e wspap e r stat es that
,
“
,

o n th e last day of th e fast S ucc i s puls e rat e was 62

’
Unfortu n at ely no -
.

scien tific re cord of this fast was e ve r publish e d .

l B itish Med J o u n 1 880 2 p 1 7 1

r . r .
, , , . .

z
Pato n and S toc km a P o c R y S o c Ed in bu gh 1 888 1 889 16 p 1 2 1
n, r . o . .
, r ,
-
. , . .

‘
H v and S llm a n J u n E xp M d 1 897 2 p 4 03
oo er o n , o r . . e .
, , . .

‘
N Y D ail y Tri bun D c m b 2 1 1 890
. . e, e e er , .
1 02 A S T UD Y O F P R O L O NGE D FA S T IN G .

In a fast carri e d out by Succi in L o ndo n in 1 890 which co ntinue d ,

1
4 0 days th e puls e rat e s t ak en e ve ry d ay at n oo n vari e d from 82 o n
,
-
, ,

th e se co n d day of th e fast to 5 2 o n th e thirty fifth day Th e d e gree of -

.

irre gularity note d in all co ndi tions of th e fast how e ve r shows that , ,

prop e r att e ntio n had not be en pai d to se cur e u niform quie t b efore th e
obs e rvatio ns w e re made Th e re spiratio n s vari e d from 1 6 o n th e .

thi rty first day of th e fast to 28 o n th e sixth day of th e fast H e re

-
.

again th e irre gularity not e d o n all days impli e s variatio ns in muscular

activity prior to th e obse rvatio ns no general trend of th e re spiratio n ,

rate be in g apparen t .

2
I n th e 1 0 day fastin g e xp e rim en t with C e tti th e puls e rate ra ng e d
-
,
-

from 6 8 o n th e mornin g of th e fourth day to 92 in th e afternoo n of th e

s e venth day Th e high p ulse rate was accompa nie d by abdomi n al
.
-

pai ns I n c e rtai n of th e respiratio n e xp e rime nts carri e d out with C e tti

.
,

th e pulse rate was like wis e re corde d

-
I n o ne in sta nc e it was not e d that .

th e pul s e rate cha ng e d from 88 whil e th e subj e ct was lyin g dow n to 1 20

-

whil e h e was walkin g about th e room I n another e xp e riment th e .

pulse rat e cha nge d from 86 whil e h e was lyi ng down to 98 whe n h e was
-

sittin g smokin g and talkin g Th e gre at in creas e in th e he art actio n

, ,
.

of this subj ec t was commente d o n at some l e ngth by th e se authors .

I n an e xp e rim e n t with B re ithaupt co nti nui ng for 6 days th e same , ,

authors re cord a mini mum puls e rat e of 4 7 o n th e last day of th e fast -

an d a maximum rat e of 66 o n th e mornin g of th e s e c o nd day Takin g .

adva ntage of th e fact that the ir subj e ct p erforme d musc ular work o n
th e e rgostat th e authors mad e some int e re stin g not e s upo n th e in cre ase
,

in th e he art b e at with a d efinit e amount of work and th e re turn of th e

-

puls e rate to normal aft e r th e work c e as ed In the ir ge neral co nclusio ns

-
.

the y mai ntained that with Cetti who was of an e xcitabl e temp e rament , ,

th e puls e rat e in th e re stin g co n dition was no t notic e ably cha nge d by

-

fasting but that it slowly de cre ase d with B re ithaupt who was qui e t
, ,

an d phl e gmatic They also e mphasiz e th e fact that duri g th e fast

.

n
there was a distinct t en d ency to a co nsiderabl e inc re as e in th e irri
tability of th e h e art slight muscular activity producin g a gr e at In cre ase
,

in th e puls e rat e -
.

Luciani co n te n ds that duri n g his e xp e rime nt with S ucci th e pulse , ,

rate re maine d strictly i n side th e physiological limits risi n g to 7 0 but ,

twic e and o nl y occasio nally falling b e low 50 He also poi nts out that .

th e pulse rat e as we ll as th e t emp eratur e and th e r e spiratio n w ere

-
, ,

always me asur e d d urin g compl ete muscular re st as th e subj e ct was ,

lyin g in be d An i nt ere sti ng obs e rvatio n o n th e irritability of th e he art

.
,

as i ndicate d by th e ris e in th e puls e rate afte r e x ercis e was likewise -

,

made by Luciani who was fortu n ate in havin g a fasting subj e ct who
,

fr ee ly i ndulge d in muscular activity .

1
B i ti h M d ical J u nal 1 890 pp 7 64 8 19 8 7 6 9 35 99 6 1 056 and 14 4 4
r s e o r , , .
, , , , , , .

’
L h m n Mu ll Munk Se nat and Z un t A c hiv f p ath An at u Ph y i l f kli Med
e an , e e r, , o r, z, r . . . . s o . 11 . . n .

1 89 3 , 131 , S u pp p.
, . 1 .
104 A S T UDY O F PR O L O N GE D FA S T I NG .

more or l ess re gular Th e pulse re cords which w ere obtained in th e

.

e v eni n g re spiratio n e xp e rim ents may logically be attach e d to th e

re cords for th e bed c alorime te r e xp e riments as pre liminary p e riods but
-
,

th e fact that th e e ve nin g e xp e riments w e re mad e o nly 111 th e latte r

p art of th e fast complicate d th eir prese ntatio n in thi s mann er As a .

matte r of fact th e re cord of th e p ul se rate from th e b e ginning of th e

,
-

e ve nin g respiration e xp e rim e n t i e

,
about 7 p m until th e close of
. .
,
. .
,

RM . 20 0 A . M .

100
 PUL S E -
R ATE . 1 05

th e er spiratio n e xp e rim e nt t h e n e xt morning at 9 3 0 or 1 0 a m11 w as

m
. .
,

continuous as th e subj e ct di d no t rise from his couch duri n g that p e rio d

,
.

He uri n at e d lying o n th e sid e S i n c

. e th e co n ditio n s of activity w e r e

s
es e ntially uniform from th e tim e th e subj e ct e nt e r e d t h e be d calorim et e r

at about 8 p m until th e
. . e n d of t h e i
morn g r spiratio
n e n e xp rim t
e e n

at 9 30
h m or
10 a m t.h e r.e cords
,
of th e puls e rat e tak e n duri
- n g t hi s

p e riod on e ve ry day of th e fast ar e more comparabl e I t is th ere fore .

FI G 1 3. .
— PuISG-rate ch art o f ub j c t L
s e . fo r first to fif th d ay s o f f ast .
1 06 A ST UDY OF P R O L O N GE D FA S T ING .

p e rmissibl e to discuss these obse rvatio ns first and late r co n sider th e ,

more or l e ss he terogene ous obse rvatio ns tak e n d uri n g th e day when th e

activity might vary .

PULS E RATE IN - NIG HT PE R I O D S T HE .

Th e re latively large fluctuatio n s in th e pul se rat e that are -

in th e first two or thr ee nights are n aturally to be e xplaine d b

that th e subj e ct was a stran ge r in Ame rica and was e xp e riencing for ,

FI G 1 4
. .
— Pu l se -r a te ch art f su bj e ct
o L . fo r i
s xth to
e l eventh d ays o f fast
.
1 08 A ST UD Y OF P R O L O NGE D FA S T I NG .

th e curve to b ec ome l e ss and le ss that is th e fluctuatio ns from maxi

—
,

mum to minimum thr oughout th e night w ere l e ss an d th e p eriods of

re aso nably co nstant pulse valu e s gre w lo n ge r and lo nger .

On th e night of May 1 4 —1
5 th e last night of th e fast (figure
,

spe cial attentio n was given to th e pulse rate th e re cords b e in g made -

,

frequently throughout th e whole night Although th e curve is in con .

FI G . 1 6 .— PuI
SG-ra te ch a t o f sub j ect L
r . fo r nine teen th y fifth days of fast
to twent - .
 PUL S E -
R A TE . 1 09

se quen c e irr e gular in shap e th e general tre n d is not m arke dl y diffe rent
,

from those for th e pre c e di n g and following nights E ven on May 1 5 1 6 —

.
,

th e first night follo wi ng th e i n gestio n of food although th e subj e ct was ,

in such distre ss that h e did not go inside th e chambe r but lay on a couch ,

outside th e fre qu ent re cords of th e pulse rate did not S how extrao rdi
,
-

narily large fluctuatio n s On th e ni ght of May 1 6 1 7 relatively few

.
—

re cords of th e pulse rate we re tak en ; and also on May

- 1 7—
1 8 but o n ,

this night we fi nd a greatly in cre as e d amplitude Th e g ene ral deduc .

tio n is there fore th at th e amplitude of th e fluctuatio ns of th e pulse

, ,

rate dur ing th e night d e c re as e d re g ularly as th e fast progre sse d showing ,

a te nden cy upon th e resumptio n of feeding to re turn to th e variations

commo nly e xp e ri enc e d .

FI G 1 7 .
—
. Pu l se rate ch art o f su bj e c t L
- . fo r twe nt y sixth
- to th irtie th d ay s of fast .
1 10 A ST UDY OF PR O L O N GE D FA S T IN G .

PULS E RATE
- I N T HE DAY PE RI O D S .

From 1 0 a m u ntil 7 p m th e re cords are n aturally much l e ss com

. . . .
,

ple te than th e s e ri e s obtain e d duri n g th e n ight ; n e ve rth e l e ss o n c e rtain

days re aso nably comple te re cords of th e pul se rate we re obtained -

thr oughout th e day .

18 Pulse rate chart o f su bj e c t L fo th irty fi rst

.
— - . r - day of fast b
and th ree su seq uen td y
a s
wi th foo d Th e po in t wh en th e ubj e c t to o k foo d
. s on M ay 1 4 — 1 5 is n i dic d by
a te vy
a h ea
vertical l ine .
 1 12 A ST UD Y OF PR OL O NGE D FA S T I NG .

tio n s o n this day we re obtaine d at a time when there was a re aso nably
small amount of muscular activity I n a s e ri e s of obs ervations from .

2 4 5 p m until 4 p m whi ch w e re made whil e th e subj e ct was sittin g

b m
. . . .
,

quie tly e atin g an orange or drinking grap e j uic e a valu e of 1 1 2 was ,

foun d E ven an hour aft e r e atin g when th e subj e ct h ad colic and was
.
,

in much distre ss th e pulse rate was co nsid e rably lowe r than durin g
,
-

th e p e riod of e atin g whi l e th e ave rage valu e obtaine d wh e n th e subj e ct

,

was l ying o n th e couch durin g a re spiratio n e xp e rim en t in th e e arly

morni ng was about 5 9 E vid ently th e proc e ss of e ating or drin king
.
,

imme diately followi n g a prolo nge d p e riod of inanition in cre ase d th e ,

puls e rate v e ry gr eatly On May 1 5— 1 6 th e se co n d day of thi s p e riod

-
.
, ,

th e S harp rise in th e puls e rate in cid e ntal to taki n g food was lik e wis e
-

n ote d at 9 40
“ m
.
”
a m and again at 1 1 4 6 a In On May 1 7— 1 8 th e
m
. . .

valu e s obtain e d from 6 a m to 9 a m we re unusually high this b ein g

. . . .
,

due in p art to th e fact that th e subj e ct was e xtre mely e xcite d and aft e r
th e e xp erim ental p e riod was ove r broke out into abusive la nguage .

Th ere was undoubte dly a gre at in cre as e in th e psychi c disturbanc e .

C O MPAR I SO N OF P ULS E RE C OR D S O B TAINE D I N EXPE R I MENTS W I TH T HE

BE D CALO RI METE R A ND T HE R E S PI RAT I O N APPARAT US .

Whi l e an e xaminatio n of th e general trend of th e pulse c u rve s shows

admirably th e te nde ncy for th e amplitude during th e night to fall to
a lowe r l e vel a compariso n of th e average valu es obtaine d unde r varyin g
,

co n ditio ns can be st be made in tab ular form A ccordin gly in table 6 .

,

th e ave rage value s are give n for obse rvations mad e wh en th e subj e ct
was lying in th e be d calorime te r and also th e average of th e re cords
obtain e d whe n th e pul se rate had re ache d its low e st l e ve l duri n g th e
-

calorime te r p e riod Th e valu es for th e e xpe rim ents with th e re spira

.

tion apparatus are like wise given in cluding those mad e in th e morn ,

ing in th e e ve ning wh en th e subj e ct was sittin g qui e tly and also

, ,

wh en wri tin g Furthe rmore for p urpo ses of compariso n th e pulse rate
.
,
-

re cords take n during th e blood pre ssu re t ests are i nclude d for both -

positio ns of sittin g and lying A num b e r of important compariso ns can .

thus be mad e .

D urin g his stay in th e bed calorime t er th e subj e ct was probably aslee p

for th e gre at er part of th e time at l e ast o n ma ny nights On e ve ry —
.

night h e had p eriods of wak e fuln ess w hi ch at times may have b een of ,

co nsid erabl e l e ngth Conse qu en tly no t all of th e valu es obtaine d in

.

th e be d calorime te r exp e riments c an be tak en as actually obtain e d

-

during sl eep but by exami nin g th e curves for the se e xp e riments it is

,

re l ative ly e asy to se l e ct a value whi ch probably repre se nts th e ave rage

minimum pu l se rate for this subj ect during sleep Thes e valu es are
-
.

g iv e n in colum n B in tabl e 6 B oth th e av e rag e night pulse rate an d

.
-

th e average mi nimum p ul se rate have a di stin ct te nd ency to d e cre ase as

-
,

th e fast progr e ss e s u n til about th e tw e nty se co n d fast ing day

,
From -
.
 1 13

that time u n til th e end of th e fast th e puls e records usually ris e so that ,

at th e e nd of th e ob se rvatio ns th e average valu e s are 3 or 4 b e ats higher

than th ey were at th e mi nimum poin t .

TAB L E 6 Average puke rate of subject L at dif erent times of the day and with varying activity
.
— - . .

1
The piratio n expe rim cnts in th e m o rning
r es w ere usu a ll y d b
m a e e twee n 8h 3 0m an d 9 b
2Duri n g th e respirati o n expe rim ents in th e m o rni ng o n bj ec t
A pril 1 1 , 1 2 1 3 , and 1 4 t h e su
,

was wi th o u t b ea k f ast
r .

‘
T h e u b j e c t h ad b ro k e n h is fast b y m eans o f frui t j uic es d ur ing th e m o rni n g
s .

‘D uri n g th e nigh t o f May 1 5 —1 6 th e su b j e ct lay o n th e co u ch in th e cal o rim e ter l abo rato y r .

“D
uri n g th e m o rn in g r esp ir ati o n e xpe rim e n ts o n May 1 7 an d 1 8 th e su bj ec t was wi th o ut
break fast .
 A ST UD Y O F P R O L O NG E D FA S T I NG .

T AB L E 6 .
— Average pulsem te of subj ect L . at di fi erent ti me s of the day and with varying
ii
act vt y— Co nti nued .

l
i dic d b y
Pe rio d s n ate ik w ere o b tai n d wi th th
an aste r s u b j e c t si tti n g wri ti n g
e e s , .

’
v g p l p d 3 h 1 6m p m to 3h 5 1m p m o n th is day wi th th e su bj e c t
T h e a e r a e u se- r ate fo r a er io . . . .

l yi n g c c i
o n t h e o u h w as 6 1 per m nu te .

An y importan t d e ductio n s from average value s for th e night are out

of th e qu estion o n accou nt of th e irr e gularity in th e numb e r of th e pulse
r e cords durin g th e ni ght and th e impossibility of re cordin g accurately
th e t ime wh en th e subj e ct sl e pt an d wh e n h e wok e I f how e ver we .
, ,

compar e th e va l u es for th e av e rag e puls e rate with thos e for th e av er-

ag e mi nimum pu ls e—rat e we fi n d that about th e middl e of th e fast

,

th e diffe r e n c e 1 s o n ly 1 or 2 b e at s Th e g re ate st variation b e tw ee n

.

the se two s e rie s of ave rage s is o n th e fourth day of fastin g when th e ,

ave rage durin g th e night was 6 5 and th e ave rage min imum valu e was
58 . For further purpose s of compariso n it is obvious l y more logical ,

to u se th e average mini mum valu es .

1 16 A ST UD Y OF P R O L O NGE D FA S T IN G .

pulse rate was as hi gh as 82 ; th e lowest obse rvation was

th e -
60 , which
1
was re cord ed on th e tw e lfth day of th e fast .

IN FLUE N CE O F T HE WOR K O F W R ITING .

As th e subj e ct sp en t a co nsid erabl e portio n of th e day sitti ng up

writing an effort was made to study th e pulse rate during ap e riod of
,
-

writin g H e nc e o n a numb e r of days th e subj ect was connec te d with

.

th e r espiration apparatus th e metabolism was stu di ed and records of , ,

th e pulse rate w e re tak en -

On two of th e days the se te sts w e re carri ed
.

out in th e morning immediate ly afte r th e re gular se ri es of respiration

,

e xp e rime n ts On the se two days th e s e v en tee nth and twen tie th days
.
—

of th e fast th e combine d influ enc e of thi s positio n and occupatio n was

—

to in cre ase th e pulse rate ove r th e re cords obtaine d in th e lying p osition

-
,

thi s in cre ase being 12 be ats o n th e se ve n tee nth day and 7 b eats o n th e
twentie th day F our expe rim ents of this characte r w ere also mad e in
.

th e afte rn oo n but th e pulse—rate show ed littl e in cre ase over rec ords
,

obtaine d in similar aft e rnoo n exp e riments wh en th e subj ec t sat qui e tly
without writin g .

INFLUE NCE O F B R EATH ING AN O XYG E N R I C H AT MO S PH E R E -

.

I n an e arli e r s e ri e s of obse rvatio ns of th e pulse rat e in which n ormal -

subj e cts bre athe d an oxygen rich atmosphe re there was a disti nct -
,

tend e n cy for th e pul se rate to d e cre ase Si n c e it was of i n te re st to note

-
.

if this tend ency to a d e cre ase in th e pul se rate would be gre ate r in -

prolonge d fastin g than under normal co nditions re spiration exp erime nts ,

w ere mad e o n th e twe nty e ighth twe nty ni nth and thi rti eth days of -
,
-
,

th e fast in which th e subj e ct bre athe d an oxygen rich atmosph er e and

,
-

pulse re cords w e re simul taneously obtaine d Thes e e xp e riments imme .

diate ly fo l lowe d th e mo rning re spiration e xp e riments for those days in

which th e subj e ct bre athe d air wi th a normal con te nt th e ave rage ,

pulse re cords for th e latte r e xpe riments b e ing 6 1 6 3 and 59 r e sp e ctive ly , ,

.

Th e puls e re cords in th e exp eriments with th e oxyge n rich atmosph e re -

w ere as shown here with .

F rom th es e res ul ts it app e ars that th e pulse rat e in th e high oxyge n - -

exp e rime n t o n th e first day in cre ase d by 1 b e at o n th e s e co n d day ,

d e cre ase d by 2 b e ats and on th e thi rd day de cre ase d by 1 b e at In

,
.

2
former e xp eriments with normal i ndi viduals th e average d e cre ase in ,

‘
Th d igna ti o n f th d ay f
e es pa t f th e d ata in ta bl 6 is n t in stric t acco d an c wi th o u
o e s or r o e o r e r

m th d f n din g th e e xpe rim n tal day wi th th

e o o e nd f th m rni n g e pi ati n xpe im e n t
e e e o e o r s r o e r ,

bu t th e am nu m be in g i u d th o u gh u t f
s e r c m pari n pu po ses
s se r o or o so r .

2B n dict and Higgi n Am Jo urn Ph y i l 1 9 1 1 28 p 1

e e s, . . s o .
, , , . .
 PUL S E -
R A TE . 1 17

th e puls e rate with th e oxygen rich atmosphere was not far from 5 to
- -

6 be ats but with thi s fasti n g subj e ct th e inhalatio n of an oxyg en rich

,
-

atmosphere appare ntly produc e d no change in th e puls e rat e -

.

DI UR NAL R HYTH M .

B eginni ng with th e tw elfth day of th e fast r espiratio n e xp erime nts ,

w er e made e ach e venin g j ust b e fore th e subj e ct e nt e re d th e be d calori

,

me t er Comparing th e re cords of th e puls e rate for th e s e exp e rime nts

.
-

with thos e obtaine d in th e mornin g exp erime nts it will be s een that , ‘

th e pul se rat e in th e e venin g was almost in variably high e r tha n in th e

-

morn in g Whil e th e di fferen c e in th e middl e of th e fast is v e ry slight it

.
,

te n ds to incre ase as th e fast progre sse s until o n th e thirti e th day the re is

,

a diffe ren c e of 1 2 b eats On th e tw enty fir st day th e e venin g rat e was

.
-

2 b e ats low e r tha n that obs erv e d in th e morning th e low e st puls e ,

re cords for th e e v ening e xp e riments b e in g fou n d o n this day .

I RRITABILITY OF THE HEART .

I n all of th e compariso n s of th e p u ls e r e cords it is di fficult to find

any v e ry d e fin ite i n dicatio n s of th e so ca ll e d
“
irritabl e h e art e sp e
-
,

c ially e mphasiz e d by th e B e rli n i n v e stigators in th e ir study of C e tti .

I t is t rue that th e change from lyi ng asl e e p to lyin g awak e r e sult e d in an

i n cre ase in th e pulse—rat e th e diff e ren c e in th e fastin g p e riod b e in g not
,

far from 7 to 8 b e ats with a maximum of 1 0 and a mi nimum of 4 b e ats

,
.

I t is fu rther tru e that th e chan ge from a sitti n g to a lyin g positio n as ,

n ot e d at th e time of th e blood pr e ssure t e sts in th e latt e r part of th e

-

fast t e nd e d to de cre as e th e puls e rat e from 4 to 1 5 b e ats per mi nut e

,
-
,

ave raging no t far from 7 to 8 b e ats Lik e wis e th e p ul s e rat e in th e .

,
-

e ve ni n g r e spiratio n e xp e rime n ts ave rag e d a few b e ats more tha n in th e

morn i ng r espiratio n e xp erim e nts B ut no gre at in dicatio n of an irrita

.

bility of th e he art was not e d wi th any of the s e mi n or cha nge s in positio n

an d activity .

On th e food days how eve r th e re was a gre at i n cre as e in th e puls e

, ,

rate at th e time th e food was tak en E u th erm o re th e r e cords obtain e d

.
,

at th e time of th e blood pressure obse rvatio n s show that th e puls e rate

- -

did n o t quickly re turn to th e mi n imum aft er chan gi ng from a sittin g

to a lyin g position for th e pulse rat e in th e lying positio n is usually a
-

few b e ats high e r than th e value obtaine d in th e morni n g r e spiratio n

e xp e rim e n ts S in c e th e valu e for th e lyi ng positio n was foun d almost
.

imme diately aft er th e t e st it is hardly po ssi b le that th e body had time

,

to adjust its elf to th e positio n but th e t en d en cy to re ach th e mi nimum

,

fou n d in th e morni n g is worthy of not e E ve n wi th th e slight activity .

due to th e bloo d pr essure t ests an d chan gi n g th e positio n th e pulse

-
,

rat e is no t so hi gh as th e pulse rat e obtai ne d in th e e ve ni n g re spir atio n

-

e xp e rime n ts sho wi n g that th e pr e vai l i n g di ur n al variatio n was gre at e r

,

than that obtain e d with slight activity e arlier in th e day .

1 18 A ST UD Y OF P R O L O NG E D FA S T I NG .

A poin t of considerabl e importanc e is th e fact that ther e was a

distin ct te n dency for th e pulse ra te to re ach a minimum b e tw ee n th e
-

fourte enth an d tw en ty se co n d days of th e fast that is during th e third

-
, ,

w ee k Conse qu e ntly all of th e p ulse r e cords in cludin g th e average

.
, ,

min imum re cords i nside th e bed calorime t er th e ave rage for th e calori,

me te r e xp erime nts and th e ave rage for th e mornin g re spiratio n expe r

,

im ents S how a t e n de n cy to in cre as e in th e fourth w eek

,
Th e same .

tend e ncy may be note d in th e puls e re cords obtaine d at various time s

th roughout th e day I t is cl e ar the re fore that during th e latte r part
.
, ,

of th e fast th e h e art of th e subj e ct was in a some what more irritabl e

conditio n tha n during th e third w eek .

Th e obse rvations o n th e pulse rat e in thi s fasti n g e xp erimen t hav e

-

gre at signi ficanc e wh en compare d with th e simultaneous me asurements

of th e metabolism as is do ne in subse qu e nt s e ctio n s of thi s publicatio n
, .

Th e re cords have the re fore bee n pre se nte d in extenso as th e y show ,

strikingly that th e puls e-rat e may le gitimate ly be use d as an i ndex of

th e me tabolism . Th e total metabolism was me asure d o nl y during th e
time s when th e subj e ct was o n th e re spiratio n apparatus or i nside th e
be d calorime te r . F or th e re maind e r of th e day e sp e cially durin g those,

tim e s when th e subj e ct was most active th e me tabo lism was no t me as

,

ure d so tha t th e probabl e m e tabolism at th e s e tim e s must be e stim ate d

,

in so far as possibl e from th e re cords of th e pulse rate We there fore -

.

hav e littl e e viden c e of th e effe ct of muscul ar activity upo n th e he art ,

e xc e pt as shown by th e fe w pulse r e cords tak e n following s light activity .

Th e se do no t in dicate a distinctly irritabl e he a rt .

Th e muscular activity of th e subj e ct was probably gre ater at th e tim e

of th e dyn amome te r te sts tha n durin g any othe r obs ervatio ns Th e .

re lative ly few re cords mad e b efore and aft e r these t e sts S how a distin ct
ris e in th e p ulse rate incid ental to th e dyn amome ter t est but also a very
-
,

rapid re turn Unfortunate ly the y were not tak en with suffici en t

.

r e gularity for us to note positively any in dicatio n of th e i ncre ase d or

d e cre ase d irritability of th e he art as th e fast co ntinu ed I t was th e .

in te n tio n to study in this exp e riment th e influen c e of light muscular

activity upo n th e h eart b eat and th e me tabolism but here again th e ,

unwilling ne ss of th e subj e ct to engage in muscular activity of any kind

prev ent e d valuable obse rvatio ns origin ally planne d for .
1 20 A ST UD Y OF PR O L O N GE D FA S T IN G .

ste adily during th e fast from 1 1 0 to 90 mm Th e daily obse rvatio ns are .

n o t r e cord e d .

N o dire c t blood pressure me asurements w ere mad e by th e B e rlin

-

in vestigators o n the ir fastin g subj e cts although from an examin ation ,

of th e p ulse curve s made with a Mare y sphygmograph at th e radi al

1
art e ry Se nator and Mue lle r co nclude d that the re was a n otic eabl e
,

d ecre ase in th e arte rial t ensio n which produc e d no t o nly a dicrotism

but lik e wis e a de cre as e in th e elasticity This was more notic eabl e .

with a subj e ct who fast e d 1 0 days than with anothe r who o nly faste d
6 days n otwithsta n di n g th e fact that o n th e last fastin g day th e p ulse
,

rat e was so w e ak that th e y could not se cure a suitabl e curve .

Th e obse rvatio n s mad e of th e blood pre ssure in th e fastin g experi

men t with our su bj e ct L are given graphi cally in figure 1 9 th e curv es .
,

repre se nting th e systolic diastolic and pul se pressure s for both posi , ,

tio ns of lyin g and sitting With th ese are compare d curv e s S howi ng .

th e ave rag e pulse—ra te se c ure d in th e be d calorim e t er e xp erim en ts -

thr oughout th e night and also in th e mornin g re spiratio n e xp e riments .

Durin g th e latte r part of th e fast th e pulse rate was lik ewi se s e cure d ,
-

at th e time th e blo o d pre ssure was tak en in both positio ns of lyi ng and ,

sittin g Thes e value s are give n in tabl e 6 (pages 1 1 3 and

.

As is usually th e case th e systolic bloo d pre ssure wh e n th e subj e ct,

was lying down was i nvariably somewhat hi gher tha n whe n th e subj e ct
was in a sitt ing positio n with a gen e ral t end ency for th e differenc e ,

b e tween th e two to b e come gre ate r as th e fast progress e d On th e last .

'

day of th e fast howe ve r th e diflere nce was no t much gre at e r than at

, ,

th e first of th e fast Th e curves for th e diastolic pr e ssur e also S how

.

hi gher valu es for th e lying positio n although th e diffe ren c e is no t so ,

gre at as with th e systoli c pre ssure for up to about th e fift e enth day ,

th e two curve s are appro ximat e ly th e same .

Th e systolic pr essur e for th e lying positio n falls qui te rapid l y through

th e fir st half of th e fast fluctuatin g co nsid e rably in th e last half above
,

or b elow th e ave rage valu e of 1 00 mm of mercury T h e re cords ran ge d . .

from 1 34 mm o n April 1 6 to 94 mm o n April 30 An e ve n low e r valu e

. . .

was obtai ne d o n May 1 6 26 hours aft e r takin g food namely 92 mm , , , .

Two days late r how e ve r it had i ncre ase d to 1 24 mm

, ,
.

Th e curv e for th e systolic pre ss ure for th e sitti n g positio n is n e arly

p arall e l to that of th e systolic pre ssure for th e lyi n g positio n although ,

in th e latt e r part of th e fast th e valu e s w e r e co n sid erably low e r and th e

fluctuatio n s w ere n o t so gr e at Th e range in valu e s was from 123 mm . .

o n A pril 1 6 to 83 mm o n May 8 D uring th e latte r part of th e fast

. .

it av erage d no t far from 90 mm .

Th e diastolic pr essure for th e l y i n g position shows a mark e d fall from

th e third to th e fourth day S ubs e qu en tly th e re is a gradual fall to th e .

m iddle of th e e xp e rim e n t with a distin ct te n de n cy in th e latt e r p art of

,

l
L h m nn Mu ll
e M unk S nato and Z u ta A c h iv f p ath An t u Ph y i l u f kl in
a , e er, , e r, n , r . . a . . s o . . . .

M ed .
, 1 89 3 , 1 3 1 , S u pp p . . 101 .
 B L O O D P R E S SUR E . 12 1

A PRIL MAY
l l 12 6 14 15 1 6 | 7 I8 19 20 2 I 2 2 23 24 2 5 26 27 28 29 30 l 2 3 4 5 6 7 8 9 IO ” 12 I3 I4 l S 16 17 18

DAY S OI
FO OD
D
DAY S OF FA S T ING DA
gg
s or
é o
1 2 3 4 5 6 7 8 9 l0 1 l 12 l3 t4 l 5 16 | 7 l 8 | 9 20 2 l 22 23 24 25 26 27 28 29 30 3 l

FI G . 19 —
. C h art sh o wi n g bloo d p ressure pulse p
, r essure , an d pul se rate
- o f su bj ec t L .
122 A S T UDY O F PR O LO NGE D FA S T I NG .

th e fast for th e general course of th e curve to rise Th e highest re cord .

was 1 00 mm o n April 1 6 an d th e low est was 7 3 mm o n May 6

. Twen ty . .

six hours afte r food was first tak en th e diastolic pressure in this position
fe ll to 74 but it rose o n th e thi rd day to 1 02 mm
, .

A simi lar cour se is followe d by th e curve for th e diastolic p ressure in

th e sittin g positio n although th e fall from th e t hi rd to th e fourth day is
,

not so pro nounc e d Th e sli ght te ndency to rise in th e last part of th e

.

fast is also shown in this curv e Th e highe st re cord was 90 mm on . .

April 1 6 and th e lowe st was 7 0 mm re cord e d on April 30 May 1 an d .

, , ,

May 2 .

Th e general tre nd of all four curve s for th e systolic and diastolic

pressur e s in th e two positions is a di stin ct de cre ase in blood pressure
d uring th e first 15 days of th e fast followe d e ithe r by an ave rage co n ,

stant value or a slight t enden cy for th e pressure to rise in th e last part

of th e fast .

With th es e obse rvations of th e systolic and di astolic pre ssure it was ,

possibl e to obtain th e p ul se pressure this b e ing th e di ffe ren c e b e twe e n ,

th e maximum and mi nimum blood pre ssure s A ccordi n g to some .

write rs th e p ulse pre ssur e is of more signi ficanc e than th e blood pres
,
-

sure obse rvations the mse lve s An examinatio n of th e curv e s S hows

.

that th e pulse pre ssure in th e lying positio n was e xc e pt o n o ne day , ,

highe r tha n th e puls e pre ssure for th e sitting positio n Th e curve s are .

by n o me ans p arall el how e ve r as th e re are gre at diffe renc e s in th e

, ,

l e vels Th e puls e pre ssure for th e lying position d e cre as es u ntil th e

.

fif t een th or sixtee nth day of th e fast and th e n fluctuat e s conside rably , ,

but average s approximate ly 23 mm Th e pulse pre ssure for th e sitting .

positio n shows a much more mark e d similarity to th e trend of th e bloo d

pre ssure curve s i e a falli ng pre ssure u ntil about th e fifteenth day of
,
. .
,

th e fast follow e d by a p eriod of approximate ly co nsta n t value s and

, ,

fin ally a distin ct ten d en cy to i n cre ase d pressure towards th e e nd of

th e fast .

I n co nsid e rin g th e blood pre ssur e re cords it is of i n t ere st to compare

-
,

th e m with th e av erage pulse rate curve s obtaine d in th e bed calorime te r

-

e xp e rim en t during th e night an d o n th e r e spiratio n apparatus in th e

morning The s e curv e s are give n in th e low er part of figure 19 and

.
,

S how a g e ne ral parall e lism with e ach oth e r Curve s are also given .

showi ng th e pulse rat e re cords for both positio n s obtaine d in th e latter

-

part of th e fast at th e time th e blood pressure was tak en A fact of .

S p e cial in te re st in co nn e ction with th e s e c urv e s is that th e ave rage

p uls e rate in th e latte r part of th e fast has a t enden cy to rise during th e
-

calorime t er exp erim ent an d also in th e morning re spiration exp eriment .

D uring th e same p eriod th e blood pressure cu rve s remain e ssen tial l y -

co n stant showing only a S light t enden cy to ris e th e pulse pressure for

, ,

th e sitti n g position alo ne having a t e nd en cy to fo llow more close ly th e

ave rage pul s e re cord From thi s it may be co nclude d that th e pulse
.
 THE BLOOD .

BY J . E AS H
. , M D .

CORRELATION OF LITERATURE .

Th e blood has fre quently b ee n studi ed d uring i nanitio n but an ,

exhaustiv e se arch through th e lite rature brought to light o nly a fe w

re cords of syste matic e xam inations cove ring so lo n g a p e riod of fasting

in man as th e cas e that forms th e basis of this re port F asts of man .

co nducte d unde r sci entific sup e rvisio n and including blood examina
tio n s are limite d in numb er though th e work on a nimals has b een ,

rather prolific B efore prese nti ng th e fin dings in L e van zin s blood

.
’
,

there is give n a corre latio n of abstracts from this lit erature of i ntere st ,

not o nly from an his torical stan dpoin t but in de monstratin g th e diver ,

sity of re s ults obtain e d by th e various ob se rv e rs .

Amo n g th e e arlie st re fe re nc e s are those to th e work of Val e ntin l in

1 83 8 wh o co n clud ed that th e re was no alt eratio n in th e r elation of
,

blood w e ight to body w eight as a result of e xhaustive starvatio n and

- -
,
”
that of B idd e r and S c h midt in 1 85 2 though thes e latt e r do not report , ,

a nythi ng more sp e cifi c than an incre as e in th e solid constitu ents in

th e blood of a starvi ng cat With refe re nc e still to th e blood as a .

3
whol e Lo ndo n much later studying a s eri e s of 8 rabbits from which
, ,

both food and drink w ere withh e ld fou nd a loss in total quantity , ,
4
proportio n al though to loss of body w eight Pash utin co n clud es
, ,
-
.
,

as th e r e sult of th e work of H eid enha in P a num and Voit that th e , , ,

blood is no t impove rishe d by fasti ng o n th e co ntrary in c ertai n p eriods , ,

th e orga nism is pl e thoric He holds it as re markabl e that th e numb e r .

of e rythrocyte s i n cre as e— probably howe ve r o nly b e caus e of th e rapid , ,

d e cre as e in plasma This latt e r fact is d emo n strate d mark e dly in th e .

dogs obse rv e d by W Miiller and Buntz en though in no ne of th e ir

5
.
,

animals di d a loss of more than 1 5 per c ent in body w eight occur -

.

6
Luciani ho l ds that asid e from wat e r co n t ent th e blood exhi bits a ,
-
,

r e sistan c e similar to th e ne rvous syste m and that th e appar en t fluc tua

tio ns in corpuscul ar co n te nt at l e ast d ep e nd chi efly on th e am ount of
, ,
4
wat er co nsume d C h o ssat how eve r quot e d by Pash utin consid ere d .
, , ,

1
Val ntin R p l f Anat u Ph y si l 1 83 8 3 p 1 56
e , e e . . . . o .
, , , . .

2
B idd u S ch mi d t Di V dauung f ah t in d S to fi w h l Mitau u L i pz ig 1 85 2 p 328
er .
, e er s r e er
'

ec se , . e , , . .

a
L o d n N te u l qu ti du ch an g m nt d la qu a ti té gé né l t d l al ali ité du ang
’
n o , o s r a es on e e e n ra e e e c n s

d n l j fi n ab l u A ch d S ci n c B i l 1 895
a s s e e so p 5 1 6 (Ab trac t by Muhlm an n S e
. r . es e es o .
, . . s . e

f t t 4 p
oo n o e , .

‘
Pa h u ti
s P th l gic al Ph ysi l gy I nani ti
n, a 1 90 2 2 p t I p 8 1 ( R u i
o o ) o o , on . , , .
, . ss an .

5
M ull a d B un t n T a fu i n a d pl th
er n Ch i tiani 1 87 5
ze , r ns s o n e o ra. r s a, .

6 Lu ci ani Fi i l gi a d l d igiun Fi nz 1 88 9 Au th i z d t an l ati b y M O Fra nk l

, s o o e o. re e, . or e r s on . . e e .

Da Hung n S tu di n u E xp im nt am M n c h n H am bu g u L i pz ig 1 890
s er , e . er e e e s e , r . e , .

1 24
 T HE B L O OD . 1 25

that ne xt to th e fat th e blood suffere d th e gre ate st loss amo unting e ven
, , ,

to 75 per c en t of its former w e ight This vi e w is not ten abl e in th e light .

of practically all othe r work and was e vi d ently th e result of faulty

1
te chniqu e or obs e rvations Pash utin quote s V ale ntin as noti ng .

striking general cha nges during hib e rn ation in p art that th e blood
—
,

putrefi es from 2 to 4 time s more slowly that th e art erial blood is not so ,

bright a re d and that th e v enous blood is not so dark as n ormally due

, ,

to disturbanc e of oxygen in te rchange .

ER YTH R O CYT ES .

Conside rin g more sp e c ifically th e blood e l ements and b e ginnin g with

2
th e e rythrocyt e s we fi nd that as e arly as 1 84 3 S chul tz studi e d star vi n g ,

animals and found the se c e lls atrOphic attributin g th e d e ath of th e ,

anim als to th e in ability of th e shr unk en c ells to bind oxygen Jone s .

,

but a few ye ars late r obse rv e d that th e corpuscles in dogs ’

“ ’
blood app e are d to have undergon e partial d e compositio n Others .

sin c e then have no te d the se strikin g al te ratio ns in shap e and siz e of th e

corpuscle s amo n g the m Manassein Andral Gavarre t Laptschi nski
,
4 4 4
,
-
, ,

an d e sp e cially K agen
5
who studi e d do gs and rabbits He found littl e ,
.

change in th e first days but as th e fast progre sse d th e red c e lls b e came ,

small e r and cre na te d o ne s app eare d more fre quen tly u n til at th e end ,
“”
many star forms w ere se en an d microcyt e s pre dominate d Liu .

6
bo um dr o w also found variations in th e charact e r of th e re d c e lls
macrocyt e s microcyt e s and nucl e ate d c e lls b e in g co mm o n e sp e cially
, , ,

th e larg e form which r e ache d 20 to 3 0 per c ent of th e total re d coun t , .

7
I n th e roundabout way we g et from Pash utin an abstract from ,

Wratsch 1 88 1 p 78 quotin g from foreign j ourn als (n o t sp ecifie d ) a

, ,
.
,

referenc e to D r Tann er s blood after his 4 0 day fast in 1 880 This was .
’
-
.

a public e xhi bitio n but w ell co ntrolled and was absolute for th e first 1 5 ,

days T h e plasma and white c ells pre se nte d nothin g unusua l Th e red
. .

c ells however w ere somewhat smaller than normal b ein g

, , i nch in ,

diam eter i nstead of fi l m; to ” i n i nch .

8
C urtis mad e syste matic obs e rvations of Grisc o m s blood during ’

his 4 5 day fast in 1 880 Thi s constitute s th e lo ngest p eriod with blood
-
.

e xaminatio n s of whi ch any r e cord could be found .

Pa h u tin P ath l gic al P h y i l gy I nani ti n 1 90 2 2 p t

l
s , p 8 1 (R u ian)
o o s o o , o , , , . I, . ss .

S ch ul tz B it z ph y u p ath C h m v n S im
2
, e 1 884 ( qu ted b y Mahlm ann
r . . Se f t te
s. . . e . o on , o . e oo n o
4 th i p g )
, s a e .

a
J n o S m i th n i an C nt to Kn wl d g 1 85 6
es , so o . o e e, .

M uhlm ann R ussi c h Li te atu fi ber di P ath l gi e d H un g n

‘
, C ntralblatt f allg m
s r r e o o es er s . e . e .

Path 1 89 9 10 p 1 60
.
, , , . .

Kag n B l o d an d bloo d pressur in starvin g gani m D i ert S t P t bu g 1 884 R u sian

‘ e , o e or s s
. ss . e e rs r , . s .

F m th Lab ato y f G
ro e l and E xp im ntal Path Pr f V Pa h utin S t P tersbu g
or r or e n e ra er e .
, o . . s , . e r .

‘
L iubo um d w C h a g in th bl oo d andro gan in ta vati n 7 1 D i sert 1 893 R u i an
, n es e or s s r o . s .
, , ss .

Fr m th Path An at Labo ato y P f W W in g ad w S t P tersbu g

o e . . r r , ro . . o r o , . e r .

Pa h tin P at h l gic al P h y i l gy I na n i ti n 1 90 2 2 f tn te p 6 05 (R u i n)
7
s u , o o s o o , o , , , oo o . ss a .

C u ti A tud y o f bl d du ing a p l ng d fa t P c Am A A dv S ci c 1 88 1 30
8
r s, s oo r ro o e s . ro . . ss. . en e , , ,

pp . 9 5 — 1 05 .
1 26 A S T UDY O F P R O L O N GE D FA S T I NG .

Curtis d escrib es th e morphology of th e erythrocyt es as follows :

Th e fi rst examin ati o n mad e j ust afte r G risco m s l ast me al showe d th e c e ll s
’
, ,

in abun d ance o f b righ t c o l o r re gul ar smoo th o f outlin e so li d in appe ar anc e

, , , , ,

an d o f usu al si z e fi m; in ch
l .

On th e third da y they were p al e r and app ar e nt l y no t so fi rm .

Fou rth day : T h e change h ad p ro gresse d There were two so rts of ce l ls to be .

se e n o ne p al e an d l arge th e o ther d ee pe r in c o l o r an d c o ntr ac te d

, , S ome o f .

th e fo rm e r we re al most i nvisibl e appe are d so ft and stic ky e nve l o p ing obj ects , ,

e nc o untere d in flo w Their shap e was al te re d to a round rim wi th ab rup t

.

d esc ent to a flat fl oo r They averag e d “ In inch Th e other so rt were. .

d ee pe r in co l o r l ess transp arent than no rmal and covere d with nod ul es l ik e

, ,

bl unt co nes (evidently crenated) Th e c e lls h ad l ost their usual co n c avity an d .

,

se eme d as t h o ugh acte d u po n b y an ast ri nge nt be ing much small er than ,

n o rm al “
i
n in ch .

Fifth da y : Th e so ft p al e cel ls h ad disappe ared th e small er vari ety seemed ,

l arge r and no d ul ar I rre gul arities in S hape were fi rst n o ticed so me c e ll s be ing
.
,

e l o n g ate d o the rs l emo n or c l ub shape d and sti ll othe rs h ad p oi nte d e nds

, , .

S ixth to ni nth days: Th e l arge so ft fo rm appe ar e d and pe rsiste d in gre ate r

o r l ess numbe rs Late r small col o re d b o di es l i k e red c o rpusc l es app eared
.
,

me asuri ng “ A“ inch All th e e rythr o cyt e s at thi s ti m e were small Th e

. .

e xt reme l y small o nes c o ntinue d to i nc re ase in numb e r an d d imi nish in si z e .

S ixte enth day : C o rp usc l e l i k e b odies o b se rved as smal l as “ 1” i nch

-
Tho se .

o f ” In to “ 1” i n ch di ame te r were li k e normal re d c e lls Othe rs we re nod u .

l ate d o r of a chest nut b urr appe arance -

.

Thirty sixth day :

-
S aw an e rythro cyte unde rgo di re ct divi sion
“
From thi s .

”
day o n th e re d c e l ls changed fo r th e wors e
, They b e c ame p al e ragge d and .
,

shrive ll e d At this tim e t h e subj e ct showe d signs of we ak ened ci rcul ati o n

.

ve rtigo numb ness of han ds and feet

, .

Thirty eighth day : He f ain te d o n risi ng from be d

-
.

Thirty n inth day : The re was sc ar c e l y a no rmal c o rp usc l e to be seen

-
.

Fortieth day : Afte r an excursion o f 2} ho urs o n th e l ak e the re was a remark ,

abl e ch ange in th e bl oo d pict ure T h e ragged p al e an d b rok e n corp usc l es all.

, ,

disapp e are d and all th e e rythro cyte s b e c ame smo o th in o ut line and b right in
c o l o r They seemed q uite normal excep t that they were small er averaging
.
, ,

“
1” i nch After this they ag ai n re tro grade d be c ame so ft pale and stic ky
.
, , , , ,

but ne ver so b ad as j ust be fo re th e l ak e exc ursi o n C ert ain mi nute gr anul es .

were se en in this bl oo d gr anul es which in th e author s exp erience e xist in all

, ,
’
,

other p erso ns exc ep t o ne who se bl o o d was exam ine d They we re small re d

, ,
.

po in ts fi l my inch in di am ete r and highl y refractil e They are fo un d al so in .

l ymp h an d co w s mi lk They e xiste d in th e bl o o d in gre at numb ers at fi rst

’
.
,

d e creasing till afte r th e eighth day ; then dis app e ari ng unti l th e twenty fo urth -

day whe n a fe w p al e o nes app e are d

, They then i ncreas e d in num be r but .
,

o nly re turn e d to t h e ir no rmal ab un dan ce afte r th e f ast was b ro k en (These .

were apparently th e platelets that he was observi ng ) .

This report is given in d e tail to illustrat e no t o nly th e pain staking

care with whi ch th e obse rvatio n s w ere mad e but somewhat th e com ,

p a rativ e crudity of th e m e thods e mploy e d at that tim e A s will b e .

s ee n it is o nly in th e e arli er reports that th e app e aran c e of macrocyt e s

, ,

mi crocyte s cren ate d and distorte d c e lls are r e corde d and it has
, ,

occurre d to th e writ er th at with th e improve ment of blood te chniqu e

th e occasio n for th e ir pre se n c e was e limin ate d .
 A ST UDY OF PR O L O NGE D FA S T IN G .

o nly re lative d ep endin g on th e conc entration or dilutio n of blood from

,

alte ratio n in wate r co nte nt While on th e tw en ty se venth day th e

-
.
-

greate st loss was note d th ere foll owed on th e twe n ty ninth day a ris e ,
-

1
t h at brought th e numbe r to th e le vel of th e first day Andreese n .
,
1 l
Ma l asse z and Lepine foun d that whil e in th e be ginnin gs of th e fastin g
,

p eriods there wo ul d be an incre ase in numbe r in th e late r days a ,

d e c re ase occurred .

Bef o re fast

14
80 1 000
6 83 0 000

2d et di
2 w ee s k l ater

1
Be fo re and af te r first meal o n th e sixth day .

Clinical re cords furn i sh us with th e two follo wi ng reports of rel e van t

’
inte re st Th e fir st is of o ne of Lan douzy s patie nts studi e d by
.

2
M alasse z .

A boy o f 1 8 live d 3 mo nths and 20 days wi th a stricture o f th e eso phagus

“
,

th e res ul t o f swall o wing H, S O, He o b t ain e d p ractic ally no no urishme nt as .

,

h e v omi ted foo d administe re d by tu be Te n d ays b e fore d e ath h e be gan to .

,

t ake a small quantity o f milk and meat Th e red ce ll s numbe re d .

20 d ays b efore d e ath and a wee k be fore th e e nd , a d e ci d e d l o ss

fro m no rmal Two d ays b efo re th e bo y die d th e c o unt h ad rise n to
.
,

A transfusi o n was pe rformed imm e di ate l y afte r this e xami nation fo ll owe d in ,

20 m inut es b y ano th e r c o un t which showe d a ri se to Th e next day

they h ad returne d to
This is a striking loss and whil e it is no t possibl e to rule out a toxic ,

i nfluenc e in this case th e almost complete i nani tio n was no doubt th e,

T h e se con d c ase (re po rte d b y Bro uardel) was a m an o f 4 8 ye ars , wh o l ive d 3

4 mo nth s 1 2 d ays after an e x pe ri ence S imi l ar to that j ust quote d B ut o ne .

bl o o d e xam inatio n was made , and that 2 d ays b e fo re d eath, when th e erythro
cyt es we re and the l euc o cytes

Whil e to th e prese nt write r these would be considered as practically

n ormal counts th e author of th e report co ncludes that th ey demo nstrat e
,

a con c entration of th e blood .

l
Mti hlm R i h Li t atu
ann , fi be di P ath l gi d
u ss c e Hun g n C nt al blatt f allg m
er re r e o o e es er s . e r . e .

Path 1 89 9 10 p 1 6 0
.
, , , . .

2Mala e z B u ll t m em d la
ss , m ed d h opi taux d P ar is 1 8 7 4 1 1 p 1 24
. e . e so c . . es e , , , . .

aB ua d l U ni n Mé d
ro r e1 87 6 , 3 22 p 4 08
o .
, , se r . , , . .
 THE B L O OD . 1 29

1
has foun d th e corpuscular cont ent n ormal in fi ve cas e s
V o n N oorden
of gastric ulc er with e maciatio n He remarks that in S pite of th e anaemic .

appe aranc e pres ented by patients sufferin g from various co nditions caus
ing maln utritio n th eir blood is usually n ormal
,
This of cours e do es no t .

hold in those cas es where th e caus e of th e malnutrition has a direct

T A BLE 8a — . E sti mati ons of
’
red cells during Griscom s fast (Curtis)
’
.

0 0 0 0 0 0

0 0 0 0 0 0

Flatul en ce Pati en t fe l t q ui te ill ;

.

to o k e n em a c ausi n g stoo l
, .

Th ese fi gures a no t enti l y d

re re es

titu te o f sym m tr y e .

C o unts o n 6 inte rval s o f 6 d ay s .

0 0 0 0 0 0 0

10
3
4
0 0 0 0 0 0 P o intin g t th e O pi ni o n h ld f a
o e o

cert ai n lim i te d d urati n o f l ife o

o f re d bl oo d c o rp u c l s s e .

in fluenc e o n th e blood as in i nfec tions He di scuss es this practic al phas e

,
.

of th e subj e ct and give s many refere nc es to o b servatio ns of th e effects

o n th e various prop ertie s and co nstitu ents of th e blood of cli ni ca “

l
Von N oor de n , M e tabo li sm an d prac tic al m ed ici ne Angl o Am ric an i
,
- e ssu e , C h ic ago , 1 907 , 2,
p . 28 .
 1 30 A ST UD Y OF P R O L O N GE D FA S T IN G .

I
R e turning to Curtis s articl e , we fi nd th e followi n g protocol (tabl e 8 a)
’

of th e 38 num e rica l e stimatio ns made of th e re d c e lls durin g th e 4 5—d ay

’
fast of G riscom, with th e former s comme nts .

Th e subj e ct was at h is wo rst p hysic all y an d men tall y be twe e n th e twenty

“

se ve nt h and fo rti eth d ays, an d d uri ng thi s p eri o d th e c o unts we re c o nsi st e ntl y
lo w On th e fo rtieth day h e to o k th e e xc ursio n o n th e l ak e , which was app ar
.

e ntl y th e c ause o f th e d ro p o f from th e c o unt o f th e p rece ding day .

I t wi ll also be n o te d th at fo r th e fe w d ays b efo re a d eci de d fall in n umbe r the re

was usuall y a ri se T h e c o rp usc l es o n th e d ays o f these lo w c o unts al ways
.

app e are d h e al thie r t h an at o ther time s On th e l ast day Mr G d rank n o . . .

”
wate r and th e high c o unt of that day m ay have b ee n due to conce ntrati o n .

2
K age n in 1 884 claim e d that th e ordi nary me thods of de t erminin g
, ,

th e c e ll co nt e n t of blood we re op e n to so ma ny sourc e s of e rror that th e

re s ults w e re no t d ep e ndabl e He limi t e d his O b s e rvatio ns the re fore .
, ,

to th e dir e ct e stimatio n of th e solid co nstitu ents th e sp e cific gravity ,

by pyk om t r ) d haemoglobin co nte nt (Malasse z s h aem o chr o m o m

’
( n e e an ,

e t e r) He examin e d 6 dogs and fou n d in th e e arly days an i n cre as e in all

.

thr ee factors attributin g th e cha nge s to co n c en tration t h rough wate r

,

loss Th e amou n t of solid constitu e nts h e claims c an e qual e ven at th e

.
, ,
"
e n d of th e fast that pres e n t u n d e r normal co n di tions Liubo u m dro w .

n ot e d as an ave rage of obs e rvatio ns o n 1 7 dogs a slight i n cr e as e in

, ,

e rythrocyt e s till th e loss of body w e ight amou n te d to 1 0 to 1 5 per c e n t -

,

then a ste ady d e cre as e till d e ath th e dimi nutio n amou nting to as high ,
“
as 32 pe r c e n t o n th e tw e nty e ighth day N ass e also fou n d an i ncreas e -
.

in numb e r in a dog aft e r 1 1 days of compl e t e fasting AS proof that .

thi s was due to variatio n in wate r co n te nt h e state s that h e obtaine d a -

,

re actio n in th e Opposite dir e ctio n whe n th e a nimal was agai n allow e d

water .

5
Po lé taew studi e d 8 dogs that r e c e ive d ne ith e r food n o r wat e r dying ,

aft e r loss of 5 0 per c en t in body w eight The s e all showe d an i ncre as e -

.

in re d c ells u n til la te in th e fasts aft e r a loss of 30 p er c ent body w eight ,

-
,

wh e n there was a gradual de cre as e till d e ath Po lé taé w is no t satisfie d .

with th e e xp l anatio n of t hi s fin din g simply o n th e grounds of co n een

tratio n for h e fou nd an i n cr e as e also in th e dogs that w e r e allow e d
,

wat e r He hol ds that whil e the re may be i n te rf erenc e with blood

.

6
formatio n the re is also l e ss d e structio n for bile formatio n Tauszk
,
.
,

C u rt i P h y i l gy f au t nu t it i n ; A tud y o f bl d d u i n g a p l ng d f a t
l
s, s o o o Am A o r o s oo r ro o e s . . ss .

Adv S ci n c. 1 880 30 pp 9 5 1 05
e e, , , .
—
.

Kag n B l d an d bl d p u in ta vin g gani m

2
e , oo D i t S t P ete bu g 1 884
oo re ss re s r or s s . sse r . . rs r , ,

R u i anss F m th Labo ato y f G n al an d E xp im n tal Path P f V Pa h utin S t

. ro e r r or e er er e .
, ro . . s , .

P t bu g
e e rs r .

Liu bo um d w C h an ge in t h bl d an d
3 ro g an in ta vati n 7 1 D i rt 1 893 R u i an
, s e oo or s s r o . sse . ss .

F m t h e Path Anat Labo at y P f W W in g ad w S t P te bu g

ro . . r or , ro . . o r o , . e rs r .

de Ma ti g n y u Na
‘
r U be d n Einflu de Nah run g auf das B lut Ma bu g u L i p ic
. sse , e r e ss r . r r . e s ,

1 85 0 .

5P lé ta e w Th e m o r h o o
o ,
o m o s t o n o f th e p l gic c
oo p ii
in o m e te and n o m e te st ar at o n bl d c pl i c pl v i
d g
in o s .
Di
sse r t 9 7 , 1 894 , S t e te rs ur
.
( R u ss an ) ro m th e a o r ato r
. P
of b g
a th n at , i . F L b y P . A .

P f
ro Usko w , Riv in te rn az
.
’
, R o m a,
.
’
95 , 6 , 1 29 , an d . r h d igse o St
. e ter s u r , p . Ac . d . . Bi l . . P b g
1 89 3 2 , . 7 94 p . .

“
T au sz k , ah r sJ
b u e r F o r t sc h r d e r
. h e r-
b d
h e m e , 1 894 , 24 ,
. 1 4 7 ; a str a te ro m O rv o rs
. T i C i p . b c df
h e tilap , B d p
u a e st , 1 89 4 , 5 12 p
so H ae m ato lo g isc h e Al
n te rsu h u n e n am h un e rn e n m en s
. . U c g g d
ch en . en W i kl i
n R un s h au , 1 89 6 , 1 0 ,
. . 3 06 dc p . .
1 32 A ST UD Y OF P R O L O NGE D F A S T I NG .

hand in th e cas e of his al re ady mentio ned could find no suggestive

, ,

variatio n though there was some daily fluctuation

, .

1
G ordo n studyi ng th e blood of Martin a m e dical student who und e r ,

w en t a 9 day fast with th e uniform daily wa ter co nsumptio n of 24

—

ounc e s, could fi nd practically no variatio n in re d c ell cou nt e xc ept that -

,

o n th e sixth day o f re f ee di ng it was about be low th e n ormal .

’
A t th e en d of th e first wee k of Succ i s fourth fast o ne of 4 0 days co n ,
2
ducte d in Lo n do n th e re d c e lls numb e re d an i n cr e as e of
,
’
ove r th e ave rage normal in dividual s count I t may be more .

or l e ss in this particul ar case as th e normal cou nt is no t given A R , . . .

D ie fendorf howe ver foun d a slight diminutio n duri n g and a re lat ively
, ,

rapid rise immediat e ly followin g e ach of th e two fasts of a m an of 7 and

4 days int e rrupt ed by a fe e din g p eriod of 1 9 days which form e d th e ,
3 ’
basis of B e ne d ict s report .

4
Thr ee coun ts w e re made o n th e blood of D r P enny who fast e d for .
,

30 days in 1 909 dri nking o nl y distill e d wat e r

,
They de mo nstrate d a
,
.

mod e rate in cre ase till th e tw entie th day and a loss of durin g
th e re maini n g 1 0 days H ere again no normal coun t was obtaine d . .

Th e r e sults for th e thre e coun ts w e re for th e tw elfth day ,

tw enti e th day thi rti e th day , R o nsse an d van ,

5
Wild e r hold there will always be a slow in cre as e in e rythrocyt e s if
wa te r as w ell as food is withhe ld .

Though th e co nditio ns are no t altoge ther analogous it is i ntere sti n g ,

to note that in hib e rn atin g a nimals ther e is a de cide d d ecre as e in e rythr o

°
cyte s as is report e d by Rank e
,
.

H fE MOG LO BI N .

S enator , usin g th e v Fleischl me thod , not e d a mod erat e i n cre ase in .

7 8
his woma n subj e ct and in B re ithaupt ; a loss , how e ve r, of about 20
pe r c e n t in C e tti 8
in 9 day s ( Tabl e .

Liubo um dro w (with Malasse z s m e thod ) fou n d a slight in cre ase in

9 ’

th e blood of dogs until a loss of 10 to 15 per c en t of body w eight had -

occurr e d , whe n a d e cre ase was re cord e d that pro gre ss e d u ntil th e
ani ma l s di ed .

3
B e ne dict reports a slight loss d uring , with a ris e aft e r , th e fasts ,
corre spo n ding to th e fluctuatio n s of th e erythrocyt e s Th e v Fleischl . .

an d T allq vist m e tho d s w e re use d .

l p ro lo n ged fast Mo ntr e al Med Jo urn 1 90 7 36 p 4 8 2

G o rdo n , A . .
, , . .

2
T h e f asti n g m an B it M e d Jo u n 1 890 1 p 1 4 4 4
. r . . r , , . .

‘ B e ne d ic t C arn e gi e I n st W ash Pu b 7 7 1 90 7 p 3 22 . . . .
, , , .

enn y No tes o n a th irt y d ay fast B i t Med Jo urn 1 909 1 p 1 4 1 4

‘P -
. r . . .
,
.
, , , .

“ R o n sse e t v an W i ld er V ar i ati o n s du n o m bre de s gl o b ul e s ro u g es e t du taux de l h em o lo bin e ’

, g
e u co urs de l inani tio n c h e z le l api n
’
Arch intern de Ph arm et Th en 1 903 1 1 p 30 1 . . . .
, , , . .

6
Rank e G run dz ug s der Ph y sio lo g 3d cd p 380
.
.
, .
, . .

7
Se n ato Ue be e i n e n Fall vo n so g S c hl af u c h t m it I n an i ti o n C h a i t é Annal e n 1 88 7 1 2 p 3 1 6
r, r . s . r -
, , , . .

a
L e h m ann Mu e ll e Mu n k Se nato and Z u n t Un te u c h ung en an z we i h u n ge rn d en Me n
,
r, , r, z, rs

sch e n Ar ch iv f p ath Anat u Ph y io l Vi c h o w 1 89 3 1 3 1 su pph ft p 1

. . . . . s r
’
s, , , .
, . .

L u bo u m d o w C h an g e in t h e bl oo d and o gan s in starv atio n

“ i r , s 7 1 D i sse rt 1 89 3 R us i an r .
, s .

h o rn t h e P ath Anat Labo ato y P ro f W W i Ogrado w S t P e te sbu g

. . r r , . . B , . r r .
 T HE B L O OD . 1 33

Martin s haemoglobin was 90 per c ent th e first day 95 per c ent th e

’ 1
,

fourth and 90 per c ent agai n o n th e last day th e nin th droppin g to 8 0

, , ,

p e r c e n t 6 days afte r r e sumin g food .

2
P enny showe d an incre as e of 8 per c ent during hi s 30 day fast goi ng -
,

from 1 04 to 1 1 2 per c e nt .

TAB LE 9 .
—
Haemoglob in estimatio ns on Getti and B reithau pt .

P er c e
nt .

B f e o re fa t s

Fo urth day
S i xth day ( b e fo r e fir st m ea ) l
( 2 h o urs af te r first m eal)
Se c nd day
o of d iet

3
In L u ciani s r eport is to be se en a variation syn chro nous with that
’

of th e e ryt hrocyt e s , e xc ept o n th e e l eve nth and thi rte enth days , whe n
th e p e rc e ntage faile d to rise with th em The re was a small in cre ase o n .

th e thir d and twe n ty fi rst days and it was low e st o n th e thirteenth and -

twe nty sixth days Th e highe st e stimatio n was 90 per c ent , th e low e st
-
.

7 2 per c e nt (v Fleischl apparatus ) He co n clude s that th ere is an

. .

actual loss of haemoglobin Q uotin g his studie s with B ufali ni , carrie d .

out in S ie nna in 1 882, o n a dog that live d 5 3 days without food , h e state s
the re was a rapid ris e duri n g th e first 6 days (Modifi e d B izzoz ero s ’
.

me thod us ed ) This h e e xplain s as b ein g due no t o nly to co n c entration

.

from loss of wat er , but to th e more rapid co nsumptio n of plasma than

corpuscle s Th e initial ris e was follow e d by a gradual d e cre as e co n
.

tinuo u s u ntil th e last 12 days of th e fast , durin g which th e p e rc en tag e

was co nst ant .

“ ’
G ay er s p erc en tage ros e from 80 o n th e e ight eenth day to 1 00 o n th e
thir ti e th when his fast was brok en
,
.

5
Chart eris reportin g th e 1 4 day fast note s a drop from 1 1 0 per c ent
,
-
,

to 96 per c e nt after re maining u naffe cte d for th e first few days Th e

, .

loss was no t re cov e re d u n til s e ve ral days afte r bre akin g fast .

6
S ubboti n usi n g Pr e ye r s me thod (sp e ctroscop e) fou n d a d e cr e as e
’
, ,

of h aemoglobi n in a cas e fe d on nitrogen fre e di e t B y th e twen ty sixth -

.
-

day it had falle n from per c e nt to per c ent an d o n th e thirty

G d n A p l n g d f t M t al M d J u 1 9 07 3 6 p 4 82
1
or o , ro o e as . o n re e . o rn .
, , , . .

2
P n y N t n a t h i ty day f a t B i t M d J u
e n , o es o 1 909 l p 14 1 4 r - s . r . e . o rn .
, , , . .

L cia i Fi i l gi d l d igi un Fi z 1 889 A th i z d t l ti b y M O F a k l

8
u n , s o o a e o, re n e. . u or e r an s a on . . r en e .

D as H g n S tud i u E xp im t am M n c h H m b g u L ipz ig 1 890

un er , en . er en s e s en , a ur . e , .

‘
G y a f t A p ivat c mm u ic ti f m D Wil f N w Y k Ci ty
er s
'
as : r e o n a on ro r. e, o e or .

“
C h a t i R c d f c h g b v d in th bl d c n t an d in th p nic p w f a m an
r e r s, e or o an es o se r e e oo ou e O so o er o
u d
n er og in g a p l g d fa t L c t 1 90 7 2 p 6 85
ro o n e s an e , , , . .

6
S u bb ti n Z it h f B i l 1 8 7 1 7 p 1 8 7
o , e sc r. . o , . . .
13 4 A ST UDY OF P RO L O NGE D FA S T I NG .

e ighth it was per c e nt I n starvin g rabbits how eve r th e re was.

, ,

an in cre ase due (h e co n clud e s ) to d e cre ase in wat e r co n t en t of th e blood -

.

I n a dog tha t starv e d for 38 days the re was v e ry littl e variatio n from ,

at th e b e ginning to per c e n t at th e e n d .

Though th e ina nitio n was o nl y partial th e e xp e rimen t of v H e ss , .

1
lin is sugg e stive and his co n clusio n s are in t e re stin g He obs e rve d .

two gro n dogs o ne of which (a) w eighing , kilograms was give n , , ,

o nly o ne thi rd th e nourishme n t that (b) w eighing

-
kilograms , ,

re c eive d Table 1 0 prese n ts th e res ults :

.

TAB LE 10 .
—
Results of v
. Hessli n s ’
b
o servations .

Th e diffe renc e in haemoglobin co nte nt of th e two dogs in spite of ,

extre me e m aciatio n in dog (a) is still withi n physio l ogical limi ts , ,

pro vin g how i ndepe nd e nt of th e am ount of nourishme nt th e haemoglobin

really is He claims a gre ate r influenc e o n th e blood constitu ents
.

through th e nature than th e amoun t of nourishment lo ng co ntinu e d ,

-

im pov e rishmen t in albume n e g causi n g a d e cre ase in both b asmo ,

. .
,

globin and re d c e lls We do wro ng h e claims to co nside r as a re sult

.
, ,

of th e mal nutritio n th e apparent or r e al a naemia s een in poorly nouri she d

in dividuals Eithe r it is o nly ( 1 ) apparent th e haemoglobin and re d
.
,

c e ll co ntent r emainin g high whil e th e patien t app e ars anaemic from

co ntractio n of p e riphe ral v e sse ls in an e ffort to comp ensate for th e
l e ss e ne d thermoge ne sis or it may be (2) actual anaemia th e re sult
, , ,

howe ver of th e co nditio n that is re spo nsibl e for th e mal nutritio n e g

, , . .
,

lo n g co ntin ue d fe ver can c erous ulc ers rep e at e d h ae morrhage s inte s

-
, , ,

tinal parasite s e tc T h e amou nt of nutritio n how e ver has a gr e at

,
.
, ,

i nflu e nc e o n blood formatio n so that a naemia from what e ve r cause , , ,

will cl e ar up much more re adily u n der good tha n poor n ourishm ent .

Th e eff e ct of u n complicat e d in a nitio n th e refor e is to re duc e th e total , ,

quan tity of blood as it do e s th e muscl e an d organ volume gen erally ,

rath e r than di s t th e i n dividual co n stitu e nts On r efe e din g this .

,

total qua ntity is r e store d quickl y so that th e re app e ars an a naemi a in , ,

S pit e of th e b e tte r n ourishm e n t a r e l ative co n ditio n howe ve r due to —

, ,

1
v H a lin U b
. ss d n E influ
, e u ng
er ii g de E nah ru ng u f di B c h aff nh i t d
ss en B l ut en er r a e es e e es es .

G ll ch aft f M ph l gi u Ph y i l Munich 1 890 p 1 1 9

e se s . or o o e . s o .
, , , . .
 13 6 A ST UD Y OF P R OL O NGE D FA S T IN G .

LE U C OCYTES .

More atte ntio n has b ee n paid to th e whit e c ells than to any of th e

other blood co n stitu e nts an d reports are more at varianc e as to j ust what
do e s happ en to th em durin g stat es of i na nitio n Almost e very possibl e .

cha ng e e sp e cia ll y n ume rica l has b een obse rv e d at o ne time or anothe r

, , .

1
Morphologi e alte ratio ns are rec ord e d by Luciani who note d an e arly ,

d e cre as e in S iz e so that by th e fifth day all th e l e ucocyt e s we re small er

,

than th e re d c ells The y r e cove re d th e ir normal S iz e by th e ni nth .

day howeve r ,
.

2
Chart eris o n th e other hand men tio ns sp e cifically th at h e obs erve d
, ,

n o alt e ratio n in siz e .

Manasse in re ports th e pres en c e in th e l eucocyt e s of fastin g rabbits

3

of re fractil e bodi e s that are n o t affe ct e d by ac e tic acid .

“
K allm ark obse rve d, in hi s rabbits rar e factio n in th e basophil e s , ,

with agg luti natio n an d p eripheral arra nge ment of th e gra nul es .

5
Curtis in 1 880 obse rve d p e culiar bodi es re s e mbli ng l e ucocyt e s but
, , ,

large r co nsistin g of sphe rul es too small to measure The se c e l l s meas

,
.

1
u re d 5 0 6 6 i n ch in diame t e r and e xhibit e d amoeboid mov e men t
7
When .

th e s e ve ry i nde finit e bo di es we re most abu ndan t th e granul e s w ere ,

abs e n t from th e l eucocyt e s Cu rtis doe s no t sp e c ulate as t o wh e the r .

th e se we re alt ere d whi t e corpuscl e s or a foreign c ell ent eri n g th e blood

from th e tissu e s .

6
H aye m co n clude s that the re is n o e sse ntial cha nge in th e l eucocyte s
during starvatio n at l east in dogs ,
.

Co nsid ere d numerically bo th as to total and di ffe rential e stimatio ns ,

th e followi n g r esults are re port e d from studi e s of fasts in m an :

T AB LE ll .
—G etti ’ s and Breith aupt s whi te—cell
’
count .

C e t ti fa te d s 11 d ays B ei th au pt 6
, r .

Ni th day n . 4 200
B k f t ro e as
S c nd d y
e o a of di e t .

T wo wee ks la te r

l
Fi io l o gia del d igi uno Fi re nz e 1 88 9 Au th o i z e d t anslatio n by M O Frae nkel
L u c iani , s , . . r r . . .

Da H un ge n S tu d ie n u E xpe im e n te am M e nsc h e n H am bu g u Le i pz ig 1 890

s r , . r , r .
, .

2
C h a te i R eco d o f c h an ge s o bse rv ed in t h e bloo d co unt an d in th e O pso nic po wer o f a m an
r r s, r

u n d e go in g a p
r l o nge d fa t Lan ce t 1 90 7 2 p 6 85
ro s .
, , . .

aM
tI hl m ann R u ssic h e Li te r ature fi be r d e P ath o l o gi e des H u n g erns C e ntral blat t f all g em
‘

, 1 . . .

P ath 1 899 1 0 p 1 60
.
, , , . .

4
K allm ark Z ur K e nn tni ss des Ve h al te ns de r w ei sse n Blu tkbrpe ch e n be i I n ani ti o n
, Fo lia r r .

H aam at 1 9 1 1 1 1 pt 1 p 4 1 1
.
, , , .
, . .

5
Curti Ph y i o lo gy o f au to nutri tio n : A study o f bl oo d d u in g a p ro l o n ge d f ast Am A s Adv
s, s r . . s . .

S cie n c e 1 880 30 pp 9 5 1 0 5
, , , .
—
.

“
H ayem L e co n s ur les m o di fic atio n s du an g Pa i s 1 88 2 p 3 82
, s s . r , , . .
 THE B LO OD . 1 37

l
With both Ce tti and Breith aupt a mod erat e de cre as e was obs erve d
duri ng with a considerabl e ris e for th e first few days follo wi ng th e
, ,

fastin g p e riod (S ee tabl e .

2
Sen ato r co n clude s that there is a lively new formation of l eucocyt es
o n re fee di n g .

3
Luciani re cords a mark e d diminution in th e e arly p e riod of Su cci s ’

30 day fast droppin g from

-
,
th e cou n t o n th e fi rst day to 86 1 on ,

th e se venth Th e cou n t th en rose to

. wh e re it r e mai n e d u ntil th e
t wenty ninth day with slight fluctuations due to co n c entration and
-

di lution of blood He attribute s th e mark ed diminutio n to th e di ge s

.

tive actio n of try p si n which e vidently e nt e rs th e blood as such durin g ,

th e c e ssation of in t e sti nal di ge stio n He base s thi s th e ory o n th e work .

of Al berto ni wh o by in travenous in j e ction of trypsin got alm ost a

,

comple t e disapp ear an c e of l eucocyt e s Th e trypsin apparen tly has .

no effe ct on th e e rythrocyt e s I t is quit e possibl e also that the re may .

, ,

e xist in th e e arly days of th e hu n g e r p e riod som e sp e c ial d e structive

condition e viden c e d also by th e loss of h azm o glo bin Two other factors
,
.

at work h e ar gu e s are first th e di sapp e ara n c e of th e lymphocyt e s th e y

, , , , ,

no lo nger b e ing re quire d to alt e r th e assimilat e d products of dige stio n

in th e blood plasma (afte r th e work of S cha effe r H ofme ist e r and ,

Z awary kins) s e co ndly th e l eucocyt e s may hav e lost th e ir Wand er

“
,
”
lust There would then not o nly be a failur e of o u twandering
.
, ,
“

”
from th e blood but of inwa n d erin g from th e tissu e s as w ell and th e
“
, ,

latte r woul d e xert th e gre at e r influ enc e o n th e numb er Th e whit e .

’
c e lls practically disapp e are d from Su cci s blood during his fourth fast ,

till lat e wh en small an d ill forme d corpuscl es we re found

,
-
.

4 ’
Tauszk not e s a d e cre as e in total count durin g o ne of Su c ci s 30 day -

fasts As will be s ee n in tabl e 1 2 a th is was due to loss of mo no nu

.

T ABL E 12 a — S ucci s to tal and differential white cell counts .

’
-
.

ll
L e hm ann Mue e r , Mun , S e nato r an d Z un tz ,
l
, k
n te rsu h un e n an z we h un e rn e n M en , U c g i g d
c
s h en .r h A c iv f p
ath n at u
. h so . A
r h o w s, 1 89 3 1 3 1 , supphf t ,
’
. 1 . P y i l Vi c , . p . .

2
S e nato r , B ic
er h t fi ber die E r e n sse de s auf Ge tti au sg efuh rte n Hun g e rsve rsu ch s gb ier n . B li
kl in W o c h en sc h r
. 1 88 7 , 24 , 4 27 p . .

8
L ci i Fi i l gi
u an s o o
, a d el uno re n e 1 8 89 u th o r e d igi
tr an s at o n M O rae n e, Fi z , . A iz d l i by F . . kl .

H g di p i H b g L i pz ig
!

Das un ern S tu e n u E x e r m e n te am Me n sc h e n
, .am u r u e 1 8 90 , .
, .

‘
T au sz k Jah rsb tI be r
, Fo r tsc h r de r
.
’

d
h e r— h e m e 1 8 9 4 24
. 14 7 , a stra te ro m O rv o si . T i C i , . , p . b c df
h e tilap B d p
u a e st 1 8 9 4
, 5 12 , p
Al so H aem ato lo g isc h e
, n te rsu h u n e n am h un e r n e n M e n
. . U c g g d
c
s h e n W en . i kl i
n R un s h au 1 896 , 1 0
. . 3 06 dc , , p . .
1 38 A ST UD Y OF P R O L O NGE D FA S T I NG .

cle ar c e lls in cludin g lymphocyt e s Th e e o sinophiles and polymorphs

,
.

1
were i n cre ase d N eub e rt foun d th e opposit e chan ge s that is an
.
, ,

in cre as e in mo no nuc l e ar c e l ls and decre as e of th e e osin ophil es an d

po ly m o rph o nu clears H is studies w e re made o n cas e s of carcinoma
-
.

an d pul mo n ary tub erculosis so that th e i n a nitio n was n o t S impl e , .

The re Was litt l e chan ge in th e white c ell co n te n t of Martin s blood

2 -
’

during his 9 day fast e xc ept that o n th e s e co n d and ninth days the y
-
,

rose to As will be s ee n in tabl e 1 2 b there was a ve ry S light ,

progre ssiv e loss in th e polymorphs whil e th e lymphocyte s w ere ,

incre ase d some what o n th e sixth and nin th days There was no .

diffe re ntial cou nt m ad e to S p e cify th e total ris e note d o n th e s e co nd

T AB LE 12 b.— Marti n s differential white cell counts

’
- .

’ 3
Th e re sul ts of th e two e xami nations of G ayer s blood are give n in
table 1 3 Th e striking po ints in this case are th e ve ry low total cou n t
.

o n both occasio n s , th e i n cre ase in th e small an d th e drop in th e large

lymphocyte s at th e e nd of th e fast N o e xpla natio n of the s e chan ges is .

off e re d by Wil e , who mad e th e obse rvatio n s .

T AB LE 13 .
— G ayer ’
s total and differential white- cell counts .

s subj e ct whos e blood was studi e d by D r

I n P rof e ssor B e ne dict
’
,
.

4
D ie f e n dorf there was e vid ently normally a hi gh whit e c e ll c ou nt
,
-
.

Th e r e sults are given in ta b l e 1 4 .

D uri ng th e fir st fast of 7 days th ere was a progr e ssive diminutio n till

th e last d ay whe n th e r e was a slight ris e
, Aft er an in te rval of 1 9 days .

the re was a s e co n d fast of 4 d ays Duri n g this p e riod a gradual rise .

N ub t E i B i t g u B l t t
l
e er , n ch u g p i ll Ph th i i p l m und
e ra z r i m D p t
u u n e r su n , s ec e s s u . c arc n o , or a .

1 88 9 .

2 G dor on, p o lo nge d fa t Mo n t e al Me d Jo u n 1 9 0 7 36 p 4 82

A r s . r . r .
, , . . .

G ay e s fast : A priv ate c o m m u nic at i n f m D W il o f Ne w Yo r k C i ty

’
3 r o ro r . e, .

‘ B en e dic t C a n e gie I n t Wa h Pu b 7 7 1 90 7 p 3 22
,
r s . s . .
, , . .
14 0 A S T UDY o r P R O L O NG E D FA S T IN G .

results shown in tabl e 1 5 Th e note worthy fe atur es of th e diff e re ntial .

counts are th e hi gh polymorph p e rc entage th e ve ry mark e d falling o ff ,

-

of th e l ymphocyt es and th e incre as e in th e large mo no nucle ars , .

l
R e yne coul d d e monstrate no i n flu en c e o n th e l e ucocyt es in his dog
that faste d for 25 days .

2
H owe and H awk e studi e d two m en duri ng 7 day fasti ng p e riods -

with u niform wate r allowan c e Th ere was an increase in th e poly .

morphs at th e b e ginn in g follow e d by a de cre as e to b elow normal by ,

th e e n d of th e fast Th e small lymphocyte s pre sent e d th e r e ve rs e .

picture while th e large lymphocyt e s in cre as ed d uring th e e arly days

, .

One subj e ct showe d a mod erat e in cr e as e in e osin ophil e s Th e blood .

of both m en r eturn e d to normal afte r s e veral days of di e t .

T AB L E l5 .
— Penny s to tal and diflerential white cell cou nts
’
-
.

E ve n in a ni m als whe re co nditio ns c an be comparative ly re adily con

troll e d the re has b ee n a stri kin g lack of harmo ny in th e fin di n gs
, .

R abbits and dogs have bee n th e a nimals of most fr e qu e nt choic e and

3 ’
Okintschitz s re port of his work o n th e l eucocyt e s of th e form er in
1 892 is o ne of th e e arlie st He was co nc e rne d o nly with th e diff ere n tial .

variatio ns No rm ally in rabbits th e e osi nophil e s co nstitut e about 50

.

per c e nt lymphocyt e s 25 p er c en t large rou n d c e lls and polymorphs e ach

, ,

per c ent of th e total whit e c e ll co nt e nt F ollowi n g Profe ssor Luk -

.

’
j an o w s classificatio n of th e i n a n itio n p e rio d h e divid e s it i n to four parts ,

( 1 ) th e stage of i n diffe re nc e ; (2) that of excitatio n ; (3 ) of d epre ssio n ;

(4 ) paralysis of fun ctio n s Th e a nimals w ere allowe d no wat e r He . .

fou n d a dimi nutio n of th e lymphocyt es and po l ymorphs and an i n cre as e

in e osin ophil e s an d l arge roun d c e l ls D uri ng th e middl e p erio ds th e .
,

re lative dimin utio n was no t so rapid as in th e first and last p eriods .

Th e lym phocyte s and mo no nucl e ars showe d th eir re sp e ctive alt e ratio ns
in th e first p e rio d whil e th e po l ymorphs and e osi nophil e s w ere no t ,

affe ct e d till lat e r T h e polymorphs show e d th e most mark e d dim i nu

.

tio n and o n re fee di ng the y were i n cre as e d s ee mi ng there for e to be th e , , ,

l
R yn equ te d by E B di in h i a t ic l n I a i ti n in D ic t i n ai d P h y i l gic
e, o . ar er s r e o n n o , o n re e s o o ,

C h l R ic h t 9 p 99
ar e s e , , . .

H w a d H wk Fa tin g tudi
fir
o e n N IX a O n th d i ff
s, n tia l l u c cy t c un t d u ing p
s s es, o . . e ere e o e o r ro
l ng d fa tin g Am J u n Ph y i l 1 9 1 2 30 p 1 74
o e s . . o r . s o .
, , , . .

a
O kin t hi t U b di Z hl nv h al t i v c h i ed n A t n w i
sc z, e er e B lutkc p a h n be i e er n sse ers e er r e e sse r r er c e
v ll t an dig
o s I nani ti n und b i n h t ag li h Au fl ute un g (V u ch an Kanin ch ) A chi v f
er o e ac r c er r . ers e en . r .

e xp P ath
. Ph a m 1 89 2 9 3 31 p 3 83
. 11 . r .
,
—
, , . .
 T HE B LOO D . 14 1

form most a ffe cte d by food Th e di sturbanc e in blood pictur e was .

still e vid ent e ve n whe n th e animals had almost compl e te ly re gai ne d

,
1
the ir body we ight H aye m much e arlie r in 1 882 could see no di ffer
-
.
, , ,

en c e in th e variatio n s of th e l e ucocyte s in th e dog studi e d by hi m durin g

its 25 day fast and thos e whi ch occur u n d er normal circumstanc e s
-
, .

2
Arg aud and B illard fou n d about th e same alte ratio n s in th e blood
of th e two rabbits they studi ed as did Okintschitz The y r eport a , .

marke d hyp oleucocytosis with an i nversio n of th e formula there b e in g ,

pres en t 3 mo n onucl ears to e very polymorph Th e re cove ry in thes e .

a nimals howe ver was more rapi d for in a few days th e blood picture
, , ,

h ad resum e d th e n ormal .

K allm ark also studi e d rabbits durin g p e riods of comple t e starvation

3

varying from 7 to 1 4 days He not e d a primary fall in lymphocyte s .

an d po ly neutro philes follow e d by a ris e u n til th e s e ve n th day slow in , ,

th e latt e r form more rapid in th e lymphocyt es , I n th e lo n ge r fasts .

this ris e was followe d by fluctuatio ns n o ne of whi ch howe ve r w e nt as , , ,

high as th e n ormal cou nts Th e basophil e s show e d a marke d ris e o n .

th e thi rd day of th e lo n ger fasts On re fee ding th e poly morphs showe d .

,

a more rapid ris e than th e lymphocyte s duplicatin g th e exp e rienc e of ,

Okintsch itz K allm ark co n clud e s that th e lymphocyt e s ar e supplie d

.

in gr e ate r abu ndan c e duri n g ina nitio n most probab ly by th e thymus , ,

which in so doing atrop hi e s Th e primary fa l l and th e post i na nitio n .

-

rise in th e leucocyt e s occur h e b elie ve s b e fore comp ensatio n for th e , ,

di sturba n c e of e qu ilibrium has b een e stablish e d or th e organism has

adapt e d its e lf to th e alt e re d conditio n s Wh en this has b ee n ac c o m .

plish e d th e cha n ge s in th e bloo d are no t so much d iff ere nt from thos e

,

n ot e d u n d e r n ormal circumstan c e s .

“
R ie de r re ports fi ndi ng a mark e d hypol e ucocytosis in th e dogs h e
studie d in 1 892 .

5
L iubo um dr o w fou nd that th e l eucocyt e s of his 1 5 dogs d e cre as e d
gradually at th e b e gi nnin g of their fasts or u n til a loss of 20 per c ent
body weight was re ache d A gradual rise was then n otic e d e xc ept in
-
.
,

6 of the m fre qu e ntly re achin g n ormal , T h e lymphocyt e s showe d a .

dimi nutio n p ers istin g to th e end most mark e d e arly dr oppin g from , ,

1 5 per c e n t to 3 per c en t or l e ss Th e mo nocyt e s re app e ar e d to a .

c e rtai n e xt e nt aft er th e primary fall Th e polymorphs were propor

,
.

tio nal throughout to th e total cou n t E osin ophi l e s app e ar e d e arly in .

thos e anim als that did no t show the m b efore fastin g and in most cas e s ,

there was an i ncre ase of 7 to 8 times which laste d u n til a loss of from ,

H ay m L c m u l m d i fi c ati
l
e , du
e o g Pa i 1 882 p 3 82
as r es o o ns san . r s, , . .

A g u d t B ill a d I nv
2
i n d la f m ula l u c cytai e u l influ n de l i n ani ti n C m p t ’
r a e r , ers o e or e o r so s e ce o . o .

rend S . B i l 1 9 1 1 70 p 7 4 6
oc . o .
, , , . .

I'
K §illm k Z K t i
ar d V h al t n d w i n Bl tk6 p h n b i I nani ti n F l ia
, ur e nn n ss es er e s er e sse u r erc e e o . o

m 1 9 1 1 , 1 1 , pt 1 ,
at .
, 4 11 . p . .

‘
id
R e er , Bi g
e tr a e z ur K e nn tniss de r L e u ko cy to se u s w , ei s 1 89 2 . . . L p ic .

l‘
L iu bo um dro w h an e s in t h e oo C g
an d o r an s in star at o n
, 71 bl d g v i Di . sse rt 1 89 3 , R uss i an .

Fro m t h e ath n atP a o r ato r ,.ro A L b

W in o g rado w , S t e te rs u r
. y P f W . . .P b g .
 14 2 A ST UD Y OF P R O L O N GE D FA S T ING .

10 to 30 c en t in body w eight had occurre d when they b egan to

per
-
,

di min ish B y th e e n d of th e fast th e y had dis app e ared altoge the r

. .

l 2
Po lé tae w and R e yne both o b s e rv e d gr e at variatio ns in th e numb e r
of whi t e c e lls in th e d ogs th ey studi e d th e former co ncludin g that there ,

was e vid e ntly a di minution in all th e forms until a loss of from 30 to

4 0 pe r c e n t in we ight and then an i ncre as e toward th e e nd of th e ,

youn ge r e l e me nts in cludin g lymphocyt e s , .

Usko w i nt e rpre ts these re sults as follows : I n th e b e ginni n g th e

l

e ntra n c e of you n g l e ucocyt e s in to th e blood is re tard e d as is also th e ,

tra nsitio n of th e young in to rip e forms I n th e later p eriod howe ver .

, ,

th e lymph tissue probably stimulate d into in cre as e d activity by th e ,

products of d e ge neratio n s en ds more c ells into th e blood and further , , ,

there is probably a more rapi d d e velopme nt of th e you ng forms alre ady

pre s ent in to rip e c e lls .

3
K eu th e n ot e d a d e cre as e in polymorphs and an i ncre ase in ly m ph o
cyt e s during th e fir st days and a re ve rsal of this r elatio n in th e late r
days of fastin g .

4
Pash u tin o n th e othe r ha nd conclud e s that th e fast has practically
, ,

n o e ff e ct o n th e l e ucocyte s that th e y show v e ry littl e alt e ratio n , .

5
H owe and H awk e ob se rve d th e followin g changes in four dogs
re c e ivi n g o nl y a co nsta nt qua ntity of water : Three of the m fasti ng 1 1 7 , ,

1 5 and 3 0 days re sp e ctive ly showe d a d e cre ase in polymorphs with

, , ,

an incre as e in th e small lymphocyte s Th e basophile s e osin ophil es .

, ,

an d tra nsitio n al forms show e d n o n ote worthy cha n ge s Th e fourth .

dog fastin g for 4 8 days was alre ady anaemic H is blood pre s ente d th e
, ,
.

re ve rs e picture th e polymorphs in cre as e d th e lympho cyt e s d ecre ase d

, , .

An e arly d e ve loping e osinophili a disapp e are d

-
Two of the s e four .

a nimals showe d an in cre ase in large lymphocyt e s whil e th e oth er two ,

show e d a fairly co nstan t d e cre ase in th e same vari e ty of c ell D u ri ng .

late r fastin g p eri o ds of 1 5 and 30 days in thes e dogs th e results w ere ,

quite di ff ere nt all th e forms re main ing practically co nsta nt save th e

, ,

large lymphocyte s .

6
T h e work of Mann and G age is of i nt erest though it is co nc ern ed with ,

th e effects of food rathe r than of starvatio n o n th e morpho l ogy and stai n

ing prop e rtie s of th e l eucocyt es They co nclude that duri ng di gestion .

there is a marked i ncre ase in th e i ntensity of staining in th e nuc l ei ; th e

P lé taé w T h m ph l gic c m p i ti n f th bl
l
o d in c m pl te and i n c m pl t ta v ati n
e or o o o os o o e oo o e o e e s r o

in d g o D i t 9 7 1 894 S t P t b g (R u i ) F m th Labo at y f Path A at

s . sse r .
, , . e e rs ur ss an . ro e r or o . n
P f U k w R iv in te a d ig R o m 1 895 6 p 1 29 an d A ch d
ro . s o . B i l S t P t bu g
rn z .
’
.
, a, , , . . r . . 30 . o . , . e e rs r ,

1 8 93 , 2 , p . 7 94 .

2 yn e qu o te d b y E B a d ie in hi articl n I nani ti n in D ic ti nnaire d Ph y i l o gie

Re , . r r s e o o , o e s o ,

C h a R ic h t 9 p 99
l
r es e , , . .

3
K u th U be di fun kt io n lle B ed eu tu n g d L e uk yt e n im Z i kul i n d en B lu te be i
e e, e r e e er oc r ere

v ch i ed n E n ah ung D utsch m ed W o h en h 1 90 7 33 p 5 88
ers e er r r . e . . c sc r .
, , , . .

‘
Pa h u tin P ath l gic al P h y io l o gy I n ani ti n 1 90 2 2 pt I p 8 1 (R u i an )
s , o o s , o , , , .
, . ss .

H w an d H aw k Fast in g t u di e N I X
l‘
o e O n th diff e,n ti al l uc o cy t co u n t d u in g p o s s o . . e e re e e r r

l o n ged f a tin g Am J u n Ph y i l 1 9 12 30 p 1 74
s . . o r . s o , , . .

M ann and G ag O n th c h an g i n du c ed in blo d b y fee din g tc Lan ce t Lo n d 1 9 1 2 2

“ e, e es o , e .
, .
, , ,

p 1 06 9
. .
 14 4 A STUDY or P R O L O N G E D FA S T ING .

orga n but in th e numb e r of mitotic figure s an e vid e nc e of its i n activity

, , .

He quot e s v Frie dl ebe n as havin g ma d e th e sam e o b s e rvatio n s as e arly

.

as 1 85 9 H ammar in 1 905 and v Jo nso n in 1 909 Thes e are th e

, ,
. .

o nl y re feren c e s that could be foun d mentio ni ng th e hi stological app e ar

an oe s of th e h mm ato po ie tic organ s d urin g starvatio n This is a neg .

lec te d fe ature of th e su b j e ct that would se em to o ff e r a rich fi el d for

1 2
i nvestigatio n Curran and Jolly and Le vin write of th e general patho
.

logical changes T h e latte r carri ed out the ir stu di es o n rats and de sc ribe
.

particular l y th e change s in th e lymphatic tissu e e ss entially atrophy , , ,

particul arly of th e Ma l pighian b odi es .

PHYS I C O C H E MI CAL C HANG ES -

.

S pecific gr avi ty qu e stio n of influ enc e of food and dri nk and th e —

Th e
abstin enc e from the m o n th e d ensity of th e bloo d has b een rather
fre qu e ntly th e subj e ct of in ve stigatio n We fi nd that as e arly as 1 83 4 .
, ,
3
Th ac rah n ot e d an i n cre ase in th e sp e cific gr avity during hu n ge r p e ri
4
o ds J D avy obtained th e same r esult by d eprivin g his subj e ct o nly
. .

5
of wat e r an d N ass e starving dogs but allowin g wat e r fou nd that a
, , ,

d e cre as e occurr ed in sp e cific gravity af t e r 3 to 4 days but that by th e ,

e l e v e n th day th e blood had r e turn e d to or e ve n e xc ee d e d its n ormal

d e nsity .

6
Liubo um dro w usin g th e pyknome te r d e t e ct e d fluctuatio ns in den , ,

sity as mark e d comparativ e ly as thos e n ot e d in th e numb e r of red , ,

c e lls but a compl e te agree ment b e tween sp e cific gravity and erythr o
,

cyt e count was not found .

7
Caste l lin o studying starving rabbits fo und an i ncre as e in d e nsity
, ,

an d at th e same ti m e a d e cre ase in th e s e rum co n t e n t of th e ir bloods .

8
P0 pe l also r eports an i n cr e ase though a slight o ne He stu di e d , .

’
both rabbits and dogs usin g H ammersc hl ag s me thod I n th e forme r ,
.

th e i ncr e ase did not e xc ee d pe r c en t an d it was still l e ss in th e dogs .

Aft e r li gatio n of th e ur e t e rs th e re was th e slight fall of per c e nt ,

from normal in rabbits whil e th e dogs show ed a ris e of per c e n t , ,

a rather u ne xp e cte d result if taking o nly th e wat er co ntent of th e blood ,

into co n side ratio n .

l
C urr an Th e , p ath o l o gy o f star v ati o n , M ed . P ress an d Ci c Lo n d o n
r .
, , 1 8 80 , n. s .
, 29 , pp .

2 1 0 an d 229 .

J ll y e t Le vi n S ur l m di fi catio n hi to l g q u de la ate ala ui te du j une C o m p t nd

2
o , es o s s o
’

es r s e . . re .

So B i l P a i 1 9 1 2 7 2 p 8 29
c. o . r s, , , . .

T h a ah An i n qui y i n to th e nature and p pe rti

3 cr , o f th e bl oo d a
r xi te n t in h al th an d ro es s e s e

di a
se Lo nd n 1 8 1 9— 1 834
se . o , .

‘
D avy Ph y i l g and An at R esea ch e Lo nd o n 1 83 9
, s o o . . r s . , .

d M a t ig n y u Na
‘
e U b d n Einfl u d Nah ru n g auf da B lu t Ma bu g u Le ip ic 1 850
r . sse , e er e ss er s . r r . s .

L iu bo u m d w C h an g
°
in t h bl d and gan in ta v ati n 7 1 D i t 1 89 3 R u i an
ro , es e oo or s s r o . sse r .
, , ss .

F o m th Path Anat Labo ato y P f W W in g ad w S t P t bu g

r e . . r r , ro . . o r o , . e e rs r .

C a t ll in L a S u c tti b il i ta inf ttiv a n ll a i nani z i n e l n ta Riv d I gien e e S anita Pu b

7 s e o, s e e e o e . .
’
.
,

Ro m a 1 8 9 3 4 N
,
3 p 4 61 , , o .
, . .

P0 p l S ur l
3
e va i atio n de la d n i té du an g d an ls i fin ab l u i m pl o u co m pl iq ué de
, es r s e s s s c e so , s e,

la lig atur d u eter F o m th Labo ato y f G n al Path o lo gy Pr f S L ukj ano w A ch d s

e es r es . r e r r o e er , o . .
, r . e

s ci B i l
. 1 89 5 96 4 p 3 54
o .
,
—
, , . .
 T HE B L OO D . 14 5

’
Lo ndo n s findings do not agree with thos e above 1
. He also us ed
H amme rsc hl ag s me thod , but reports a slight dim i nutio n in th e rabbits ’

that starv e d for from 5 to 14 days th e average dr opping from ,

to Th e animals in bot h t h e above s erie s were d eprive d of water .

2 ’
There was e vidently a co n sid erabl e fall in Martin s blood for whil e ,

no preliminary e stimati on was mad e o n th e sixth day of his fast th e ,

spe cific gravity was o n th e e ighth it ros e to and on th e

ninth an d last day it had dr op pe d to One w ee k aft e r breaking
fast it was sti ll ve ry low if we conside r th e n ormal to be to
3
Lloyd Jo ne s is quote d by L y o nn et as finding , on th e tenth day of
’
o ne of Su c ci s fasts a sp e cific gravity of that rose to o n th e
,

thi rty ninth day In sp e aki ng of th e in flu en c e of food and drink on

-
.

th e sp e cific g ravity L y o nnet holds that the re is usuall y though no t , ,

invariably a diminutio n after th e i ntak e of wate r th e change b ein g

, ,

but ve ry t emporary Abstinen c e from all liquid cause s an i ncre ase .

,

but no t of so marke d a d e gr ee as o ne would suppose (I n this h e is .

quoting Lichtheim ) F oo d apparently has some effe ct in that afte r .

,

me als the re is a de cre ase to be fou n d that lasts for an hour or so .

Coagulabili ty Ve ry littl e mentio n is made in th e lit eratur e of th e

.
—

4
i nflu en c e of i nanition on th e coagul ation tim e V ierordt was amo ng .

th e first to r efe r to t hi s fe atur e of th e subj e ct havi ng mad e th e o bser ,

vatio n in 1 878 th at an acc e leratio n of th e proc e ss occurr e d as a result

, ,

of starvi n g .

5 5 6
A rnold and Coll ard de Martigny both n otic e d that th e clot was '

larger than usual in r elatio n to th e amoun t of s e rum and th e latte r in ,

1 850 found a d e cr e ase in fibri n cont e nt .

5
Jo ne s also note d that th e wat er and fibri n d e cre a se d more rapidly
than th e solid co nstitu ents .

7
K allm ark notic e d that in rabbits aft er th e fifth or sixth day of ,

starvatio n th e blood coagulat e d more rapidly but no e stimatio ns of

, ,

th e time are given .

8
Tria reports quite re c ently that h e could d e te ct v ery littl e variatio n
during short fasts in rabbits and dogs .

l
L nd n N t la q e ti n d c h ang m nt d la q u a ti t é g ne al e t d l al alinité du an g
’
o o , o e su r u s o u e e e n e r e e c s

d an l j un ab l u A ch d S ci n c B i l 1 895 96 4 p 5 1 6 (A b t act by Muhlm ann

s s e e so . r . es e es o —
, , . . s r .

See f tn t 5 thi p ag )
oo o e , s e .

2
G d A p l g d f a t M n t l M d J u n 1 9 0 7 3 6 p 4 82
or on, ro o n e s . o rea e . o r .
, , , . .

“
Ly t D la d n i té du an g
o nn e , a det rm inati n c li ni qu
e vari ati n ph y i l gi qu et
e s s , s e o e , ses o s s o o es
path l gi qu
o o P a i 1 89 2 p 7 3 es. r s, , . .

‘
Vi dt A ch d H ilk 1 8 7 8 14 p 1 93
e ro r , r . . e .
, , , . .

‘
Mfi hl m ann R u i h Li t atu fi b di Path l gi d Hun g n
, ss sc C nt alblat t f allg m er r er e o o e es er s. e r . e .

P th 1 89 9 1 0 p 1 60
a .
, , , . .

°
d M tigny u N
e ar U b d n E infl u d Nah ung auf da B l ut M bu g u Le ip ic 1 850
. asse , e er e ss er r s . ar r . s .
, .

7
K allm k Z K nn tn i
ar d V h al t n d w i n Blutko p h n bei I nani ti
, ur e F lia ss es er e s er e sse r er c e on . o
H aam at 1 9 1 1 1 1 pt 1 p 4 1 1
.
, , , .
, . .

aT ia P
r p i é té c h imi c ph y i qu du an g d u a t l naniti n A ch iv i tal d bi l Pi
, ro r s o- s es s r n r o . r . . o o .
, se ,
1 9 1 1 55 p 4 9
, (A ch di fa m a l p
, . R m a 1 909 8 p
. r . r co . s er . . o , , , .
14 6 A S T UDY o r P R O L O NGE D FA S T I NG .

l
Val entin notic ed a mark ed re tardation of coagul atio n in hibe rnatin g

N o re port of th e Sp ec ific es tim atio n of coagul ation t ime duri n g fast

2
ing in man could be found D r Wil e reports that o n both e xamina . .

’
tions of Gay er s blood mad e o n th e e ightee nth and thi rti eth days , ,

ther e was apparent d ecre as e in th e platel ets but that coagulatio n was ,

acc el erate d He says of th e last e xamin ation that th e blood was

.
, ,
“

”
thick dark red and did no t flow easily
, A sid e from such ge neral
, .

co nclusions without data to d emonstrate the m th e o nly clue as to what ,

might be e xp e ct ed in man are a few obs e rvations that have b ee n mad e

re lative to meal times .

8
Cole ma n fou nd th e lo n ge st coagulation time an hour afte r th e
prin cipal meal an d th e shortest b e fore breakfast .

4
Cohen using th e method d e vis e d by hi m s elf d ete rmin ed that th e
, ,

ave rage time be fore me als was 71; minut es and afte r me als 9 mi nute s
1
,

whil e M e rcie r quote d by Cohen in th e above articl e co nstantly fou nd, ,

5
th e coagulatio n more rapid afte r me als tha n b e fore and Addis clai m s ,

that foo d has no i nfluen c e o n th e proc e ss .

“
Cohe n quote s A E Wright as cre diting fluids wi th a gr e ate r influ . .

e n c e o n co agulability of th e blood than food but that hunge r doe s ,

re tard th e p roc e ss a Vi e w no t uphe ld by th e obs ervatio ns of Col e man ,

and Cohe n I ncre ase d consumption of liquids l engthe ns th e time and

.

withh oldin g the m has th e opposite effe ct .

I mmu m ty Th ere have b een a few studie s made of th e e ffect of

'

—
.

starvation on immunity in g eneral and th e immu ne body co ntent of -

th e blood sp e cifically but th e data are scarc e ly s uffici en t to warra n t ,

d e fini te conclusio ns .

I n 1 890 Ca nali s and Mo rpu rgo studi e d th e effe ct on th e n atural

6

immunity pigeo ns e xhibit toward a nthrax They w ere fou nd con .

stantly to lose this re sistan c e if th e fast w e re be gun imm e diate ly aft e r

th e in j e ctio n of th e orga nisms or a day or so b efore They re gai ne d ,

.

it howe ve r o n refee din g if th e in anitio n p eriod had no t b een too lo ng

, , ,
.

7
This sam e nat ural immunity poss ess e d by chi ck ens was no t lost
unl ess they w ere starv e d for more than 8 days I f starved b efore .

i noculatio n they prove d more susc eptibl e Thes e worke rs we re u nabl e .

to mak e rats susc eptible to anthr ax by starving .

V al nt in R e pel f Anat u Ph y i l 1 838 3 p 1 5 6

l
e , . . . . s o .
, , , . .

2
G ay f t A p ivat c m m unicati f m D W il f N w Y k C i ty
er s
’
as : r e o on ro r. e, o e or .

Co l m n Th c gula ti n f th bl o d and th
a
e a , ff c t f c rt ai n drug u p n it
e oa B i ch m o o e o e e e s o e s o . o e .

J u n 1 9 06 7 2 p 1 84
o r .
,
—
, , . .

C h C agulati n tim f th bl oo d a afi ted b y v a i u c ndi ti n Ar ch I nt M d

4
o en , o o e o e s
'

ec r o s o o s
. . . e
1 9 1 1 , 8, pp . 684 an d 820 .

5 Addi im e o f th bl o d in m an Qua t Jo u n E xp Ph ysi l

s, Th e c agul ati
o p 305
on t e o . r . r . . o .
, . .

C an ali an d M pu g U ber de n E infl uss des Hung s auf die E m pfangli hkeit ffir I nf c ti ns
°
s or r o, e er c e o

kran kh i te n F t h r d Medi ci n 1 890 8 p 6 9 3

e . o r sc . er , , , . .

C analis and M rpu g o ibid 8 p 7 29

7
o r , .
, , . .
1 48 A S T UD Y O F P R OL O NGE D FA S T I NG .

1
A d e cre ase in alkal e sc enc e was notic e d by T auszk in Su cc i s blood ’
,
2
by Caste llino in rabbits and B ene dict re ports th e same cha nge in his ,
3 4
subj e ct A ve ry mod erat e d ec re a se was also obse rv e d by Lo n do n in
.

2
his eight rabbits Caste lli no fou n d also a d e cre as e in N aCl cont en t .

and in th e bulk of s e rum .

For a d ditional data as to th e effects of in anition o n th e physico—chem

5
ical p rope rties reference can be made to th e work of Githens Schoe , ,
6 7 8 9 10 11
neich Fri a L att es R obertso n B ierry an d Fandard D addi , Moro z
, , , , ,
12 13
O ff an d We be r
, (who includes an exhaustive correlation of referenc es
14
to th e lite rature of th e entire su b j ect of in anition) Manca and Mac .

15
alum confined their investigations to th e cold blooded animals -
.

OBSERVATIONS ON L S BLOOD
'
.

’
The re is littl e da nge r of o ne s Opinio ns b ei n g bias e d by th e diverse
results abov e corre late d We c an therefore tak e up th e co nsid e ratio n .

’
of our subj e ct s blood eithe r with an op e n min d fre e from pre co nc e ive d
ide as or with co nfuse d e xp e ctatio ns ra ngin g from absolute ly negative
, ,

fin di n gs to ve ry grave disturbanc e s with th e confiden c e that we have ,

pre c e d e nt for almost any picture that may pres e nt itself Th e co agu .

latio n time an d sp e cific gravity we re i nve stigat ed but th e exami na ,

tio ns we re co n c e rne d prin cipally with th e re d and whit e c e l l and h ae m o

g l o b i n co nte nt th e t e chn iqu e for which follows That employe d in th e , .

T au k J ah h fi b
l
1 F t h d
sz T h i —C h m i 1 894 24 p 1 4 7 ab t ac t d f m O v i
, re . er ( . o r sc r . er er e e, , , . s r e ro r os
h tila p B ud pe t 1 894 p 5 1 2 al
e , H am ato l gi h U nt u c h ung n am h un ge n d n M
a s h n
, , . : so o sc e e rs e r e e n sc e .

W i n kl in R un d c h u 1 896 1 0 p 3 06
e . . s a , , , . .

C a t llin L a u c t ti bil ita i nf ttiva n ella in ani i n l n ta Ri v d I gi n S ni ta Pub

3
s e o , s s e e z o e e . .
'
e e e a .
,

R o m a 1 8 9 3 , 4 , NO 3 , 46 1 .
, p . .

aB e n edict
, ar ne e nst ash Pu b 7 7 , 1 90 7 3 22 C gi I . W . .
, p . .

‘
on onL d o te sur la , N
u es t o n du h an em e n t de la u an t t q i g c q i é gé né al t d l al alanité du r e e e
’
c san g
d j
an s lo eun e a so u b l Ar h des S e n es o 1 8 9 5—96 4 , 5 16 . c
S ee . ci c B i l , p .
(A bstrac t by Muh lm ann
. .

foo tno te 5 p , .

G ith n s I n fl u e n c o f h u ng er and h aem o rrh ag e o n th e c o m p o si ti o n o f t h e bl o o d pl asm a

l‘
Pro c ‘

e , e . .

Ph ila Co un t Med S o c Ph ila d elph ia 1 9 04 5 25 p 27 9

. . . .
, ,
—
, , . .

S c h oe n ei h B esc h afi nh eit des B l u te s unte r v e rsc h i ed ene n B e di ng un g e n Z t sc h r f e xp P ath

'
‘
c , e . . . . .

11 T h e ap
. 1 905 2 p 4 1 9
r .
, , , . .

7
F ia Al cu ne ric er ch e co m par ative sul san gue di anim ali nu tri ti naturalm e nte ed innaturalmente
r , .

Fo lia cli n c h im et m ic o s S also maggi o re 1 9 1 0 1 1 3 p 4 4

.
, . r . , ,
—
, , . .

Latt U e b r de n F ttg h al t des B lute s des Hun d es u n ter n o rm al e n u u nter v ersch i e d e n e n

8
e s, e e e .

e xper i m e n te ll e n V er h alt niss n ( Ve rd auu n g H un g ern Arc h f e xp Path u Ph arm ac o l e , , . . . . . .

,

Lei pzig 1 9 1 1 66 p 1 3 2 , , , . .

R o bertso n S tu di es in th e bl oo d rela ti o nsh i p o f ani m als e t c

9
, 1 A c o m p ari so n o f th e ser a o f , . .

th e h o se r abb i t rat an d o x wi th
r , pe c t to th ei r c o n te n t o f v ari o u s p ro tei n s in t h e n o rm al
, , r es

an d in t h e fasti n g c o n di ti o n Jo u n Bi o l C h e m B al tim o re 1 9 1 2 13 p 3 25 . r . . .
, , , , . .

B i y e t Fandar d Va i ati o ns d la gl ycé m i e pe n d an t l in ani tio n Co m p t re nd Acad d se

10
e rr , r e
’
. . . . . .
,

Paris 1 9 1 3 156 p 20 1 0
, , , . .

11
D addi S ur les m o di fic ati o ns du po i d s de l extrai t é th é é du san g d uran t ls j eune de lo n gu e
,
’
r

d urée Ar ch i tal de B io l Turi n 1 898 30 p 4 39 ; al o S ull e m odi fi c a io ni del p so d e ll estratto

. . . .
, , , , . s z e

est er e d l san gue d uran te il digiun o di l ung a d ur ata ( S pe rim e n taL) Ar c h di bi o l Fi en z e

1 89 8 g
e . . .
, r ,

z p 43
, . .

12M o o o ff O n th e e ff e c t o f f asti n g fo r
r z a sh o rt tim e o n th e m o rp h o l o gic c o m p o si ti o n o f th e bl o o d
, .

(R ussi an ) Vra c h S t Pe ter sbur g 1 89 7 1 8 p 1 08 1 . .

, , , . .

3 W be r U e be r H un g er to ff w e c h se l
1
e , E g e bnisse de r Phy iolo gic ( B i o ch e m i e ) 190 2 1 A bt s . r s , ,

p .

M an c a L e co ur de l in anitio n ch ez les ani m aux a san g fro i d Ar c h itaL de bi o l Turi n

’
“ s . .
, ,

1 895 23 p 2 4 3 an d 1 8 96 25 p 29 9 ; al so C h e mi c al rese a c h es o n anim al ( c o ld bloo d e d ) d ur in g

, , .
, , , . r s -

i n ani tio n (I tali an) Arch i tal de bi o l Turi n 1 9 03 39 p 1 9 3 . . . .

, , , , . .

1 M ac alu m T h e i n o g anic c o m p o i ti n o f bl o o d pl asm a in th e f o g af t

6 a l n g peri o d o f i nani
r s o r er o
,

ti o n R e p B ri t Asso c A d v S e Lo n d o n 1 9 1 1 80 p 7 66
. . . . . .
, , , , . .
 T HE B L OO D . 14 9

coagulation and specifi c gravity estimatio ns is given und er the s e he ad

-

ings Th e attempt was made to d e t ermi ne th e opsonic i nd ex but t h e

.
,

subj ect was so far from an incubator and c entrifuge that it was fou n d
impossible to obtain accurate resul ts Th ere was a possi b ility also of
.
, ,

this additio n a l manipulation havi n g a disturbi n g influ enc e o n th e physi

ological investigatio ns so this fe atur e was abandone d though still re cog
, ,

nize d as o ne of th e most important l e sso n s to be l e arne d from th e blood .

Tech nique F or th e three days just pre c e di ng th e fast L e vanzin s

—
,
’

blood was exami ne d to d e t ermine a normal picture with which to

compar e th e results late r obtaine d D urin g th e fast with th e excep
.
,

tio n of th e first day and three days scatte re d thr ough th e p eriod ,

daily e xaminatio ns were made and also o n th e first and third days of
r efee din g T h e time o f th e day did not vary more than half an hour
.

m
throughout all th e sp e cimens b ein g obtain ed b e twee n 1 0 and 1 0 30
,
h

a m so that there was a co nstant re latio n to th e general routi ne of

. .
,
’
th e subj e ct s daily activiti e s that is imm e di at ely aft e r h e had finishe d
—
,

with th e r espiration exp eriment had b ee n weighed had washe d hi s

, ,

fac e and hands and climb ed th e short fli ght of stairs to his balcony
, .

I t was hi s habit to tak e about half a glass Of wat e r be fore submittin g

to th e lan c e t prick (I t may be we ll to mentio n h ere that for th e fir st
.
,

1 0 days of th e e xp e rime nt th e subj e ct re c eive d th e co nstant quan

,

tity of 7 50 c c of distill e d wate r per day and th ereafte r 900

. .
, ,

per day ) Th e sp e cimen s of blood we re obtain e d from alt ern at e

.

fin ge rs of th e l eft han d and occasio nally from th e ear D eep pricks .

w ere mad e so as to obtai n su fficient bloo d without squ e e zi ng F or

, .

cou nti ng th e re d and whit e c ells th e Thoma Z eiss apparatus was -

us e d diluti ng with fresh salt solution for th e former and 1 per c e nt

,

ac etic acid so l ution tinge d with gentian viole t for th e l eucocyt e s Th e

- -
.

usual pre cautio ns were taken to insure u ni form susp ensio n of corpuscl es
and th e e v e n fil ling of th e cou ntin g chambe r I n th e case of th e ery .

thro cyt e s 80 small squar e s we re co unt e d and 4 ciph ers add e d to th e

,

total T h e ave rage of two or more such figure s was tak en as th e fin al

.

r e sult I n e stimati n g th e l eucocyte s th e whole cross rul e d fi e ld was

.
,
-

count e d and th e re sult multip lie d by 200 Th e ave rage of thr ee or .

more such figur es was tak e n as th e fin al e stimatio n Th e u se of genti an .

vio l e t in th e ac e tic acid solutio n mak e s th e cou nti ng of th e l eucocyt e s

-

much e asier and th e like lihood of mistaking forei gn p ar ticle s for c ells
practically impossibl e Th e sme ars for th e di fferential coun ts we re
.

staine d by th e Wright me thod ; 200 or more c ells were exami ne d

by th e u se of th e far obj e ctive and N o 1 e y e pi e c e and classifie d as fol
.
-
,

lows : P o l ymorpho nucle ar neutrophile e osinop h il e and basophil e ; small

, ,

an d larg e lymphocyt e ; mo nocyt e ; tra n sitional c e ll A s th e c l assificatio n .

of th e last thre e forms is so moot e d a qu e stio n it will be n e c e ssary to ,

go i n to some d e tail as to j ust what c e ll s w e re p l ac e d u nd er th es e h e ads .

Und e r large lym p hocyt e was classifie d th e mo no nucl e ar c el l co n ,

siderably large r than th e re d corpuscl e with a rou nd or typically,

1 50 A S T UDY O F P R O L O N GE D FA S T IN G .

inden te d nucl eus (lik e that of th e small lymphocyt e though no t stain in g

as dee ply) sm all am ount of cyto plasm in proportio n to nucleus th e
, ,

former not be in g mark e dly baS Ophili c and usually co ntai nin g a few
fain tly staini ng gra nule s Th e mo nonucle ar was consid ere d th e c ell
-
.

whos e nucl eus was more in d ent e d th e proportio n of cytoplasm was ,

greate r and gran ul es more e vide n t th e latte r basophilic and th e whol e ,

c e ll staini ng more d ee ply than th e large lymphocyte Th e occasio nal .

large mo nonucl ear c e ll of th e endothelial type was also cou n te d in with

these c e lls though no t consid ere d as be in g associate d with the m ge ne ri
,

call y Th e tran sitional c e ll show e d a pal e staini ng usually kidney or

.
-
,

horse sho e shap e d nucl eus surround ed by cyt oplasm pal e and free from
-
, ,
1
granul es This classificatio n follows gene rally that of P app enh e im
. .

2
I n estimatin g th e haemoglobin p erc entage th e Tallq vist scal e was
use d throughout th e s eri es This me thod it is tru e is Op en to some .
, ,

criticism in that it is scarc ely possible to d e t e ct diffe renc e s of le ss tha n

3 pe r c en t My e xp e ri en c e s howe ve r have d e ve lop ed a co nfiden c e in
.
, ,

it that has b ee n j ustifi e d by compar ative re adings with other me tho d s .

In th e pr e se n t cas e from th e ni ne t ee n th to th e tw en ty fourth day ,

-
,

e stimatio n s w e re mad e with th e S ahli apparatus an d th e re s ults w e re

practically th e sam e as those obtaine d for th e same days wi th th e

Tallqvist scal e Care must be tak en to follow e xactly th e same te ch
.

niqu e for e ach re ading particularly in th e matte r of light ; th e re sults ,

will then be re latively corre ct e ve n if th e me thod is comparatively ,

we ak er than some of th e othe rs .

Th e results of th ese examin ations are co n tai ne d in tabl e 1 6 Th ey are .

correlat e d and pre se nted more graphi cally by curv es given in figures
20 an d 2 1 N o I shows th e relatio n of haemoglobin to re d c ells and N o
. .
, .

III th e re latio n of th e total white c ell count to th e differential To avoid -

.

co n fusio n of curv es th e tra nsitio nal e osinophil e and basot e are , ,

plotte d s eparate ly in N o I V and th e scale enl arged In N o II th e . . .

composit e curv e of th e po lyn u cle ars that is neutrophiles basophile s , , , ,

and e osinophile s and o ne of th e mon o nucl e ar c e lls large and small ,

lymphocyt es tran sitio nal s and mo nocyte s are giv en for compariso n
, , , .

Th e subj e ct s normal coun t appar en tly was high ; th e

’
E ry throcytes .
—

three preliminary e stimate s range w e ll abov e I t mai n taine d

this high figure thr oughout th e t e st goi ng b elow it o n o nly two occasio n s , ,

th e t e n th day of th e fast and th e third day followi ng I n th e e arly part .

of th e fast th ere is dail y variatio n ranging u nd er This ,

b e come s l ess e vid en t towar d th e end Th e gen eral impre ssio n given .

by th e curv e is that of a ve ry mo d e rat e d e cre ase Th ere w ere no alte r .

atio ns in th e charact e ristics of th e in dividual c e lls as to si z e shap e an d , ,

staini ng prop ertie s and no nucle at e d re d c ells w ere foun d at any time .

1 Papp nh im u F ta U ber di v ch i d n n ly m ph id n Z llfo m n d n m al n und

e e . e rra , e e e rs e e e o e e r e es or e
p ath l gi c h B lu tes F lia Ha m at 1 9 1 0 10 p 7 8
o o s en . o e , , . .

2
T llq vi t U b
a di Anw d un g d
s ,
Fil t i papi
e in D i n t d
er p ak ti ch n Haam t l gi
e en es r r e rs e s er r s e a o o e,

B erl klin W h n hr 1 904 4 1 p 9 26

. . oc e sc , , . .
1 52 A S T UD Y O F P RO L O N GE D FA S T I NG .

A P R IL MA Y
la wn ms e n ws maa a u fi ma ma m l 2 34 5 6 7 ss wu mwmws n
DAY 3

ERYTHROCYTES

M MOGLOBIN

DAY 3

Y NUCLEAR
POL

F m 20 —
. . C h art I R elatio n o f h e m o gl o bin to erythr o cytes
. .

Ch art I I C o m po si te curve o f th e po ly nu clears

.

co m pared wi th o ne o f m o no nuc lears .

 TH E B L OOD . 1 53

A PRI L MAY
7 18 19 20 21 2223 24 25 26 2728 29 30 I 2 3 4
II 12 8 14 15 16 1 5 6 7 8 9 10 1 1 12 l3 l4 15 16 l7

l 2 .0 0

l 0 .0 0 0

TOTAL
LEUKOCY

00

S MALL

I .0 0 0

FI G 2 1
.
—
. C h arts I I I and IV . Re latio n o f to tal to d iff e i l l euc o cy te c
r e nt a o u n ts .
1 54 A S T UD Y O F P R O L O NGE D FA S T IN G .

Polymorpho nuc lear neu tr ophiles The se ran throughout rather con .
—

siste n tly with th e total cou n t an d th e mark e d variatio n s in this latte r

we re quit e apparently due to th e change in polynucl e ar co ntent .

S mall lympho cytes —

The re are fluctuatio ns in th e count of this c ell , .

e xc ept during th e p e riod b e tw ee n th e fourt e en th and twe n ty-s e ve n th

days , when the y w e re comparative ly co nstant , as w e re also th e total and

o
p y l m o rph o -
neutrophil e coun ts I t will be note d that th e maj ority of .

th e rise s and falls are th e opposite of those seen in total and po lym o r
pho- neutrophil e curv e s This is particularly th e cas e o n th e se co nd , .

fourth thirte enth fourtee nth S ix teenth s e ventee nth twentie th and
, , , , , ,

twen ty fi rst days of fast and th e first day of refee din g I t se e ms saf e
-
.

to co nclude therefore that the se fluctuations are only relative due

, , ,

re ally to th e fluctuatio ns in polymorphs and that their numb er was ,

practic ally constan t throughout th e fast .

Th e oth e r forms of l eucocyt es pre se nt no distin ctive fe atur es exc ept th e

transitio n al which was su b j e ct to s e ve ral ris e s name ly o n th e se venth
, , , ,

sixt ee nth nin e tee nth an d twen ty first days when they were above 5
, ,
-
,

per c ent O nl y an occasio n al e osi nophile was fou nd during th e last

.

1 0 days of th e fast and the y had n o t r e turn e d to th eir usual numb e r

when e xami nations w e re di sco ntinu e d B y exami nation of chart N o . .

II (figure there app e ars to be a ve ry slight increase in th e combine d

mo no nucl e ar c e lls throughout th e fasting p eriod th e average be ing ,

raise d by th e fluctuatio ns in th e transitio nal form for th e othe r typ e s , ,

13 e. mo nocyt e large and s m all lymphocyte ar e practically constant

.
, ,

thr oughout exc e pt th e variatio ns alre ady not e d in th e latte r

,
.

Coagu lation time Toward th e e nd of th e s e co n d w ee k of i nanitio n —

it was notic e d that th e blood coagulate d more rapidly tha n it had durin g
th e e arli e r days This b e came more notic e abl e e ach day so that if th e
.
,

mixing pip e tte s w e re no t fille d v e ry rapidly th e drop would coagulate

or th e b l ood would clot in th e tub e s I t is c e rtai n that this was no t due .

’
to any physica l alte ratio n of th e pati en t s e nviro nment Th e t emp era .

ture of th e balco ny whe re th e subj e ct staye d and whe re th e e stimatio n s

w ere made was practically co nstan t Thi s is a ve ry importa n t factor .
,

for most exp e ri me n ta l e viden c e go e s to S how that vari atio ns in t e mp er

atur e hav e d e cid e d influ e nc e s o n th e coagulatio n time A ddis F ox .
, ,
1
an d Wright quot e d by Coh e n an d th e latt e r hims e lf all show e d that
, , ,
2
rise in t e mp e ratur e acc e l e rat e s an d cold re tards th e proc ess H artma nn .

also n ot e s that th e high er th e t e mp e ratur e th e short e r th e coagul ation

3
tim e and Rudolf d et ermi ning th e effe ct more sp e cifically sta te s that
, , ,
° °
in g ene ral e ach d e gr ee of ris e and fall b e tween 1 5 and 20 C d e cre ase d .

and in cre as e d r e sp e ctive ly th e tim e o n e min ut e , ,

.

On th e s even tee nth d ay th e e stimatio n s of th e coagulation tim e w ere

b e gu n Until th e twen ty fi fth day th e Mc G o wan me thod was us e d
.
4 -
.

C h n Co agul ati n tim

l
o e f th bl d a
,
ff c t d by v a i u c nd iti n A ch I nt M d
o e o e oo s a e e r o s o o s . r . . e

1 9 1 1 , 8, pp
6 84 an d 8 20 . .

“ H
ar t m ann , Z ur r a e de r F g
u t e r nn u n s e t Bl g i gzi
Mun h m ed W o ch ensc h r . c . . 1 9 09 , 56 , p . 7 96 .

aR u do lf T r
, sso Am . A c P y P il d lp
h s , h a e hi a, 1 9 1 0 , 25 ,.504 . . p . .

‘ cl i ic l d i i g
M c G o wan , A n a m eth o fo r e st m at n th e o a u at o n t m e o f th e c g l i i bl o o d . B it
r . Med .

J o u rn 1 90 7 , 2 ,
.
, 1 580 p . .
1 56 A ST UDY OF PR O L O NGE D FA S T IN G .

°
most 2 C cool e r than that of th e subj e ct s e nviro nme nt but a deduc
.
’
,

tio n of 2 mi nutes as corre ctio n for this st il l l e ave s th e time disti nctly
, ,

lo n ge r tha n that obtain ed o n th e same d ay in Le van z in s blood A ’

.

compariso n of th e two s eri e s of r e sults will de mo n strat e a distinct

i ncre as e in th e coagula b ility of th e starvin g ma n s blood more notic e ’
,

abl e toward th e e nd o f his fast .

S pecific gravity Th e sp e cific gravity was d e te rmi ne d o nly twic e

—
,

whil e th e subj ect was eati ng hi s first meal aft er fasti ng and o n th e
third d ay of refe e di n g T h e first tim e it was th e s eco n d it was
.

Th e e stimatio n s w e re mad e by th e Hamm e rsch lag me thod

l
,

th e sp e cific gravity of th e mixture of chloroform and b en zol b ei ng

de te rmi ne d by th e pyknome t er AS no figures w ere obtai ned eithe r .
,

b e fore or d uring th e fast the s e two e xamin atio ns are of little valu e
, ,

e xc e pt that from th e m it may be assume d th e re is a ve ry slight in

crease in d e nsity taking to as th e average normal spe cific

,

gravity .

DISCUSSION AND CONCLUSIONS .

Th e re sults of th e above studi e s are conspicuous rather from th e

absenc e tha n th e pres en c e of strikin g alte ratio ns in th e blood picture .

R e ally th e o nly promin en t fe atur e s are th e e arly ris e in po lym o rph o

nucl e ar neutrop h il e s and th e d e cre as e in coagulatio n time Th e l euco .

cyt es i e th e neutrophile s at l e ast are th e most s ensitive of th e blood

,
. .
, , ,

c e lls to cha nges in body co n ditio ns and we k now that apparently S light ,

disturban c e s will call forth a re co g nizabl e incre ase in thes e c ells —a cold
bath for e xample Th e y see m always to be o n th e al e rt ready at th e
,
.
,

l e ast e vid e n c e of disturbanc e to rush forth in d efense of th e orga nism .

I t is scarc ely to be wo nde re d at the re fore that in re spo ns e to such an , ,

unusual co nditio n as starvatio n the re should be an outpourin g of th e

re se rv e supply at l e ast for a day or so or u ntil th e organism has had an
, ,

Opportu ni ty to adapt its e lf to th e alt e re d co ndi tio ns T h e variatio n s .

in wate r co nt e nt O f th e blood c an no t be co nsi d ere d a factor in this ris e

-
,

i nvolving as th is do e s o nly th e o ne form of c ell Th e o nly expla natio n .

that suggests itse lf the refore and fra nkly no t a particu l arly sci en tific
, ,

o ne is this al ert n e ss of th e po ly m orph o n eutrophil e and its e ve r r e adi ne ss

,
- -

to be o n th e d efe ns e for th e organism Th e products of th e somewhat .

p erv e rt e d me tabolism may e xcite them i nto thi s e arly activity and
lat er fail to do so but there is no e vid enc e to prove this suppositio n
, .

I t is n o t e asy to u nd e rsta n d why the y S hould respo nd to toxic pro duc tsin
th e e arly days and no t durin g th e lat e r as w ell u n l e ss we assum e th ey ,

acquire a tol e ra n c e for th e m which s eems improbabl e wh e n we compare ,

th e reactio n to i nf e ctions in which th eir fight rs e vid e nt throughout th e

,

dise ase if th e o rg anism is to co nqu er I t 1 s furth e r possib l e that an insig .

nifi c an t obscur e sourc e of b acte rial i nfe ctio n happ e ne d to d e v elop at

,

this particular time ; if so th ere was no other e vid en c e ,

.

H m m ch l ag Wi n klin W h n h 18 90 3 p 1 0 1 8
1
a ers , e . . oc e sc r , , . .
 T HE B LO OD . 1 57

A s to th e effe ct of th e starvi n g o n th e total qua ntity of blood it do e s ,

s ee m e vide nt that there ar e fluctuatio n s at l e ast in th e first two w e eks ,

.

B y comparin g th e curv e s of th e whit e and re d c ell cou nts it w ill be n ot e d -

that th e variation s are syn chro nous ; that o n th e third fifth ni n th and , , ,

e l e ve n th days particularly th e notic e abl e i n cre as e s in th e o n e are acco m

p a n ie d by e qual l y fra nk ris e s in th e oth e r I t would s e e m that this .

coul d o nly be due to variatio ns in wat er co nt ent Th e sp e cific gravity -

.

would have go ne far toward proving thi s poi nt but unfortu n at e ly this ,

was not d ete rmi ne d duri ng this p eriod Taki ng thes e fluctuatio n s as .

in d icatio n of variatio ns in wat er c o nt ent it app e ars that durin g th e mid

-
,

dle p e riod of th e fast at l e ast th e e quili brium of i n take (includi n g that

, ,

dr awn from tissu es ) an d output was pre tty w e ll e stablish e d Th e last .

cou nts ma d e n amely o n th e third day aft er th e fast was brok e n are
, , ,

co nsid e rably low e r than thos e of th e last day of fast Thi s n o doubt is .

a r elative d e cre ase due to in cre as e in wat er content Whil e th e d i e t

,
-
.

was of cours e li m it e d th e re was an i n cre as e in th e intak e of fluids

,
.

Th e h aemoglobi n app e ars to be particularly r esistan t th e p e rc en tag e ,

o n th e last day b e i n g withi n 2 per c en t of th e hi gh e st e stimatio n ,

fou n d o n th e day b efore fast b e ga n, though the re was a mod erat e

d e cre ase duri ng th e s e co n d 10 days .

I t 1 s di fficult to accoun t for th e o nly oth er mark e d chan ge l n th e

blood th e acc e l eratio n of coagulatio n Loss of wate r could be re spo n
—
.

sib l e but th e re is no e vid enc e that this occurr e d Th e v e ry slight

,
.

in cre as e in d ensity at th e l ast d e t e rmi ne d by th e sp e cific gravity would

, ,

c ertai nly n o t d e mo n strat e a suffici e nt co n c entratio n Th e r e w e re no .

e stimatio ns of th e plat e l e t co n t e n t mad e but it is possibl e that th e ,

e xpla natio n li e s with the s e An i n cre as e in th e m co ul d be r e spo n sibl e

. .

T h e fin al co n clusio ns as to th e eff e cts Of uncomplicat e d starvatio n o n

th e blood to be draw n from th e r e sults of e xamin atio n s o n L e van z in are :
.1 Th e re is a slight actual loss in h aemoglobin mor e mark e d duri n g ,

th e s e co n d 1 0 da y s .

.2 The r e are mod erat e fluctuatio n s in wate r cont ent particularly -

,

duri n g th e first half of th e p e riod an d an increas e aft e r bre akin g fast

, ,

e vi d e n t till aft e r th e third day at l e ast , .

.3 Th er e is a d e cid e d rise in po lym o rph O neutrop h il e s in th e e arly -

days .

.4 The re is an in cre as e in coagulability e sp e cially aft e r th e first two ,

w e eks .

.5 I n an oth e rwis e n ormal i n dividual whose m en tal an d physical ,

activitie s are re strict ed th e blood as a whol e is abl e to withstan d th e

,

e ffe cts of c o m ple te abstine n ce from food for a p e riod of at l e ast 3 1 days
~

without d isplayin g any e sse ntially p athological chan ge .

 MECHANICS OF RES PIRATION .

A physiologic al study of th e human body during a prolo nged fast

woul d be in comple t e without a care ful i nv e stigation of th e influ enc e of
i n anitio n upo n th e me chanics of respiratio n F ortu nat ely it was pos .
,

sibl e to obtai n such data in all of th e e xp e rim ents with th e re spiratio n

1
apparatus as th e spiromet er gave a graphic re cord of th e re spiratio n
, ,

from which accurate data re gar ding th e respiratio n rat e th e ven tilation -
,

O f th e lun gs pe r mi nut e and th e volum e of air per in spiratio n could be

,

obtain e d S uch data are availabl e for th e morni ng re spiratio n experi

.

men t for e ve ry day of th e fast for th e e xp e riments mad e in th e e veni ng

,

b e fore th e subj e ct e n te re d th e be d c alorime te r for e xp eriments made ,

o n s e ve ral occasio ns wh e n th e subj e ct was sitti ng q ui e tly or sittin g

writin g and also for e xp e rim e nts in whi ch h e breath ed an oxygen rich
,
-

atmosph ere .

TYPICAL GRAPHIC RECORDS OF RES PIRATION .

Th e graphic re cords obtain e d by th e sp iromet er method have a

sp ecial in te rest in co n nectio n with th e fastin g e xp e rim en t in that they
i ndicat e th e charact er and rat e of th e respiratio n as th e fas t progre sse d .

Ou t of 200 or more re cor ds obtain e d with this subj e ct fo ur typical ,

curv e s hav e b ee n s el e cte d for reproduction in figure 22 i e o ne e ach , . .

,

for April 1 7 and A pril 30 and two for May 1 4 1 9 12 From th e se

, , .

curv es it will be seen that at e ach inspiratio n th e point e r o n th e S piro

mete r ris e s and at each e xpiratio n falls Th e e xp e rime nts w ere so .

co nduct e d that th e communicatio n b e tw een th e subj e ct and th e spiro

me te r was made at e xactly th e e nd of a normal e xpiratio n ; co ns e qu e n tly
th e first d e viatio n from th e straight line is that due to an in spiratio n .

S imilarly at th e e n d of th e e xp e rim ent th e communicatio n with th e

,

spirome ter was cut o ff at th e e xact end of th e normal e xpiratio n .

Fr om this re cord th e re spiratio n rat e c an e asily be cou n t e d -

.

I m me d iat e ly b elow th e re cord of th e re spiration is th e li ne showi ng

th e time in mi nut es ; th e low est li ne in dicat e s th e numb e r of re volutio n s
of th e r e cordin g d e vic e th e S O call e d work adder whe el from whi ch
— - - —

th e total volume of ventilatio n is calculat e d S i n c e a r e cord of th e .

musc ular activity is e ss ential for all in te lligent compariso n of th e re sults

of r e spiratio n e xp e riments a method was follow e d simi lar to that us e d
,

for th e bed calorimet er th e be d upo n whi ch th e subj e ct lay b eing

,

provide d with a p neumograph tambour and point e r by which a re cord , , ,

of th e d e gree of muscular repos e was obtain e d This re cord is S hown .

in th e lin e dire ctly above th e re spiratio n curv e Fre qu en t t e stin g has .

2
shown that this form of be d is e xtre mely s ensitiv e .

1
S e d c i p ti n and ch m tic u tlin
e es r o f p i m ter n p 3 1 7 a d fi gu
s e a o 40 e o S ro e o . n re .

S e a ang m ent f b d insi d

2
e rr e pi ati n c al im t figu e 37 p ag e 3 1 2
o e e res r o or e e r, r , .

1 58
1 60 A ST UD Y OF P R O L O NGE D FA S T I NG .

th e p e riod so far as e xt e rnal muscular activity is co n c e rne d although ,

it is obvious that no ide a of th e muscular to nus c an be obtai ne d by

this me thod .

Th e s e co n d curv e tha t for April 3 0 1 9 12 was o b tain ed about th e

, , ,

middl e of th e fasti ng p e rio d an d is typical of many Obtaine d about this

time I n this re spiratory re cord but two ab normally d eep bre aths
.

are n o te d .

T h e third curve was O btai ne d o n May 1 4 1 9 1 2 at th e en d of th e , ,

thi rti e th day of th e fast In this re cord a gr e at e r frequ e ncy of re spi

.

ratio n may be not e d with l e ss amplitud e this b ei ng cl e arly S hown e ve n

, ,

without me asure me nt Th e gre at s en sitivity of th e d e vic e for re cord

.

ing th e d e gree of muscular r epos e is S how n in th e origi nal kymograph

curv e b y a wave lik e lin e above th e re spiratio n r ecord i ndicating th e
-

slight disturbanc e in th e c e nte r O f gravity of th e body du e to th e res

pirato ry mov e me n ts Whil e thi s may be v e ry plainly s e en in th e origin al
.

curv e it is lost in th e repro d uctio n

,
.

I mm e diat ely aft e r th e third curv e was Obtain ed th e apparatus was ,

fill e d with p ure oxyge n so that th e subj e ct breath e d an atmosphe re

,

co ntainin g 95 per c ent oxygen One d ee p re spiratio n is shown in th e .

curve obtai ned (curve I V ) Th e rate is apparently a littl e slowe r tha n

.

in th e pre c e ding curv e and th e volum e somewhat large r Th e li n e .

above th e re spiration re cord again shows that th e subj e ct was abso

lutely qui e t throughout th e whol e p e riod as was usual with this man , .

METHOD OF CALCULATING THE TOTAL VENTI LATION OF THE LUNGS .

Th e co nstructio n of th e S pirome ter b e ll is such that e ach mi llimet er

l ength corr e spo n d s to a volume in th e b e ll of 23 c c ; henc e by me asuri n g . .

th e v e rtical distanc e b e tw ee n th e bottom and top l e v e ls of th e r e cord

mad e o n th e kymograph drum by th e poi nt e r at th e b e gi nnin g and e nd
of e ve ry i nspiratio n or e xpiratio n th e appare n t volume of air in hal e d ,

or e xhal e d may be comput e d B y me asuri ng all th e risin g portio ns

.

of th e re spiratio n curve and subs e qu ently multiplyin g th e re sult by th e

kn own factor th e total ventilatio n of th e lu ngs during th e exp erimental
,

p eri o d c an be obt ain ed To S imp l ify this calculatio n a re cordin g

.
,

d e vic e has b een add e d to th e spiromet e r which is somewhat in th e

1
n atur e of a work add e r wh e e l an d p e rmits th e accumulativ e m e asure
-

ment of th e movements of th e spiromet er b el l in o ne d ir e ctio n E ach .

r evolutio n of this whee l corre spo n ds to a ris e in th e S pirome ter b e ll of a

c ertai n numb e r of mi llime te rs and from th e re cord of th e numb er of
,

r evolutio n s of this whe el th e appar en t volume of air passi n g th rough

th e lun gs c an be ca l culat e d .

I n th e s e exp e riments th e appar ent volume Obtai ne d by th is calc ula

,

tio n was co n ve rt e d to standard co n ditio ns of t emp eratur e and pre ssur e

by multiplying it by th e fractio n in whi ch p repre se n ts th e baro
lB
e nedi c t, D e u ts ch Ar ch iv f kli n
. . . Med .
, 1 9 12 , 1 02 , p . 1 76 .
 ME CH A N I C S OF R ES PI R A T I O N . 161

me tric re adin g corre ct e d for scal e corre ctio n and diminishe d by 5 mm .

Thi s corre ctio n of 5 mm was fou n d d e sirabl e as a re sult of exp e riments

.

in whi ch th e humidity of th e air in sid e th e S pirome t e r b ell was foun d to

be usually about 30 pe r c e nt A s a matte r of fact calculatio n s showe d
.
,

that th e di ffere nc e due to usin g an assume d valu e for comple te satu

ratio n or partial saturatio n is no t more than 1 or 2 per c ent I n addi .

tio n to th e corr e ctio n for th e pre ssure th e usual corre ctio n for t emp era ,

ture was made Th e total volume as report e d is the refore th e total

.

°
ven tilatio n pe r mi nute corr e ct e d for 0 C and 7 60 mm and lik e wis e
,
. .

for an ave rage valu e of 5 mm corre spo n di n g to th e probabl e humidity

.
,

of th e air insid e th e spirome t er b ell .

METHOD OF CALCULATING THE VOLUME PER INSPI RATION .

Th e me thod of calculatin g th e volume per i nspiratio n is not so simpl e

as it at first appe ars I n stead of simply dividi ng th e total ve ntilatio n
.

per mi nut e by th e numb e r of re spiratio ns most writ ers hav e b ee n ,

accustome d to calculating th e volume per i nspiratio n from th e volume

of th e air co nve rt e d to th e co nditio ns which e xist in th e lu ngs that is , ,

th e pr e vaili n g atmosph e ric pre ssure l e ss th e t en sio n of wat er vapor at -

°
3 7 C and corr e c te d for th e t e mp erature of th e lu n gs at 3 7 C
°
. The re .

has be en co nsid e rabl e discussio n particularly in co nne ctio n with th e ,

1 2
e xp e rime n ts of G al e otti and Lo e wy and G e rh artz
,
as to whe the r th e ,
°
te mp erature co n ditio n s should be taken as 3 7 C and whe the r th e air .
,

is saturat e d at this te mp e ratur e or no t This value is howe ve r mos t .

, ,

commo nly us e d and i ndee d we are no t far in e rror in doin g this

, , , ,
3
although as was shown i n an e arlie r publicatio n th e corre ct determi
, ,

n atio n of th e t e mp e ratur e of th e air i n th e lu n gs an d th e d e gre e of

saturatio n will obviously affe ct the se computatio ns some what .

Th e me thod use d for calculatin g our r e sults is as follows : Th e total

v e n tilatio n of th e lu ngs whi ch has b ee n re duc e d to standard conditio ns
,
°
of 0 C and 760 mm pre ssur e is divide d by th e numbe r of re spiratio ns
. .
, .

This valu e is the n co nve rt e d to th e pre ssure e xisti ng in th e lu ngs whi ch ,

is th e atmosphe ric pre ssure l e ss th e t ensio n of aqu e ous vapor at 3 7 C .

,

or mm I t is subse qu e ntly conve rt e d to th e t e mp e ratur e of th e

.

l u ngs by th e usual calc ulatio n A sampl e calculatio n will s e rve to .

show th e me thod use d : In th e morning re spiration e xp erime nt o n April

1 1 th e ve n tilatio n of th e lu ngs was liters per mi nute at 0 C and °
, .

7 60 mm Th e obse rve d barome t e r was

. mm and th e num b e r O f .

re spiratio n s per mi nute was Th e volume per inspiratio n would

therefore be

l
G aleo tti , Bi c
o h em Z ei tsc h r , 1 9 1 2 , 4 6 , pi 1 73
. . .

2
L
oew y
and G erh ar t z , Bi c
o h e m Z e itsch r , 1 9 1 2 , 4 7 , 34 3
. . p . .

B
” ene
t,dic C gi I
arn e e n st W ash Pu b 7 7 , 1 90 7 ,. 4 36 . . p . .
1 62 A ST UDY OF P RO L O NGE D FA S T IN G .

RES ULTS OF OBSERVATIONS ON THE MECHANICS OF RES P R I ATION .

Th edata s e cure d by thes e methods reg arding th e re spiratio n rat e -

,

th e ven t ilatio n of th e lun gs per m i nut e an d th e volume per i n spiration ,

give mate ria l for an in t e re stin g study of th e effe ct of prolo nge d fasti n g
upo n th e m e chani cs of re spiratio n The s e data are give n in tabl e 1 8
.
,

which shows two e xten sive s eri e s of valu e s o ne for th e morni ng re spi ,

ratio n e xp e rimen ts mad e dire ctly aft e r th e subj e ct came out of th e

T AB L E 18 .
— V entilatio n f lungs i n experi ments with L at difi erent ti mes of the day
o .
, and with
varyi ng acti vity (Respi ration apparatus )
. .

1
The lung v e ntil atio n o bserve d d u c ed to 0 C and 7 60 mm p essur e
is h e r e r e °
. . r .

2
C al cu l ate d to th e pre ssure existin g in th e lun gs and to 3 7 C .

3
D uring th e pe i d 3 h 1 6 m p m to 3 h 5 1 m p m wi th subj e c t in l yi n g po si ti o n th e o bserv a
r o . . . .
, .

ti o ns were : respir ati o n r ate -

,lun g v entil ati o n li ters; v o lum e pe r i nspirati o n 4 66 c c
, . . .
1 64 A ST UDY OF P RO L O NGE D FA S T I NG .

rigidly adhe re d to e ach day th e subj e ct lyi ng v e ry quie tly for some time
,

whil e th e re spiratio n rate s w e re be i ng re cord e d

-
.

Th e e xp erime nts of th e B erlin in v e stigators with Ge tti an d B re it

haupt w ere no t su fficie ntly lo ng to mak e th e m c o mparabl e with thi s
3 1 day e xpe riment and the y w e re lik e wis e complicat e d co nside rab l y
-

by th e fact that th e subj ects suffe re d from cold and colic .

F rom an e xamin atio n of all of th e kymograph re cords obtai ne d

with L it is cl e ar that while prolo nge d fastin g t end ed to i ncre as e
.
,

th e ave rage re spiratio n ra te the r e was gr e at reg ularity of r e spiratio n

'
-
,

throughout e ach LE S minute p e riod-

Occasio nally a d ee p bre ath was
.

tak e n but the re was nothi ng lik e th e gre at irre gularity note d by Zuntz
,

and hi s cO work e rs o n th e two B e rlin taste rs an irre gularity which may

-
,

agai n be explai ne d by th e complicatio ns of cold and colic .

VENTILAT I ON O F T HE LUNG S PER MINUT E .

Th e actual amou nt of air passing through th e lu ngs was measure d o n

th e spirom ete r an d it s rec ordi n g attachm ent Th e ve ntilatio n of th e .

lu n gs per minute which is given for e ach e xp e riment in table 1 8

, ,

followe d a somewhat sin gular cours e I n th e morn in g ob se rvatio ns .

th e v e ntilatio n pe r minut e show e d a pe rsist e nt though slight te nd e ncy , ,

to d e crease durin g th e first 4 days with food ; it th e n rose p erc e ptibl y

in th e fir st 3 days of th e fast and subse qu e ntly d e cre ase d u ntil th e low
value of lite rs was re ached o n th e el e venth day This was clos ely .

approximate d o n th e twe nty first day wh en a valu e of -

lite rs was
,

o b tai ne d Th e low e st value in th e expe rimental pe riod was fou nd o n

.

th e s e co nd day with food afte r th e fast wh en th e v e ntilatio n was ,

lite rs Few d e ductio ns can be drawn from the se figur e s for th e lu n g

.

ve ntilatio n pe r minute save that o n c e rtai n fasting days th e va l u e s

,

w e re v e ry low as compare d with th e four days pre c e di ng th e fast ,

although as has alre ady be en poin te d out th e minimum valu e was

, ,

obtained o n th e se co nd day with food after th e fast H ere agai n th e .

valu e s for th e e ve n in g obs e rvatio ns S how an in cre ase th e ve ntilatio n ,

b e in g i nvariably gre ate r tha n duri ng th e mornin g e xp e riments risi n g ,

at tim e s as hi gh as 6 lit ers Th e average valu e was 1 lite r higher than

.

thos e obtai ne d duri ng th e morn ing Obse rvatio ns .

VOLUME PE R INS PI RAT ION .

I n discussi n g th e valu e s for th e volum e per i n spiratio n given in tabl e

1 8 , it must again be stated that th e s e w ere n o t obtai ne d by divi d i n g
th e total v e nti l atio n of th e lu ngs by th e num b e r of r e spiratio ns , b ut
by usi n g th e volume s chan ge d to th e co n ditio n s in th e lu ngs , as is com
m o nly d o ne by oth er writ e rs of th e pre s en t day The se figure s S how .

that the re is a distin ct te nd e n cy for th e vo l um e per i nspiratio n to de

cre as e as th e fast progre sse d, although c e rtain high valu e s are fou nd on
th e e ighth , e l e v en th , and tw e n ty fi rst days of fasti n g On th e oth e r
-
.
 ME C H A N I C S O F RES PI R A T I O N . 1 65

i
band, th e lowe st value re corde d n th e mor i g xpe rim ts 3 9 1 c c
n n e e n —
. .

was o n th e thirtie th day of fasting I n th e e v enin g se rie s we n ot e that

.

while th e value s in gen eral are somewhat high e r tha n in th e morn i n g ,

thi s i n cre as e s e em s to b e come gre at er toward th e e nd of th e fast Thus , .

o n th e thirti e th day Of th e fast it was 39 1 c c in th e morni n g and 5 1 4 c c

. . . .

in th e e ve n in g Whi l e , the re fore , the re is a positive ave rage d iffe ren c e ,

.

in asmuch as in th e e ve nin g th e volume per i nsp iratio n is gre at er than

in th e morn i ng , th e diffe ren c e has a t e nd e n cy to b e come v ery much
gre a te r in th e last w e ek of th e fast .

INFL UE NCE OF C HANG E S IN B O DY PO S IT I ON .

On a numb e r of days th e subj e ct was studie d wh en sitti ng in hi s

chair e ithe r resti n g or wri ti n g Th e valu e s obtain e d ar e give n in tabl e
,
.

1 8 for compariso n with those fo un d while th e subj e ct was lyi ng o n a

couch D uri ng th e sitting e xp e riments whe n th e subj e ct was no t
.
,

writi ng th e respiration rat e was in practically all case s slightly h igher

,
-

than th e valu es obtaine d in th e morning re spiratio n e xp e rimen ts whil e

th e subj e ct was lyi n g qui e tly On th e n i nth day of th e fast it i n cre as e d
.

from to re spiratio n s per mi nut e Th e ventilatio n of th e .

lu ngs per minute also in cre as e d p erc eptibly in e ve ry i nsta n c e th e in ,

cre as e b e in g no t far from lit er On th e othe r hand th e volume per

.
,

ins p iratio n varie d co nsid erably In two in sta nc e s the re was a per
.

c eptible i n cr e as e o n two oth e r days it d e cr e ase d whil e o n an oth e r day it

, ,

re maine d e ss entially co nsta nt This di ff e re n c e is n o t so appar e nt when

.

th e r e sults are compar e d with th e re cords for th e e ve ni ng r e spiratio n

exp e rim e n ts .Unfortun at ely th e sittin g e xp erime nts w e re no t su ffi
c ien tly e xt e n d e d to draw any d e fi nit e co n clusio ns r e garding th e e ffe ct

of th e c h ange in body positio n ; furthe rmore th e whol e study lacks ,

suitable normal valu e s for compariso n .

INFLUE NCE OF T H E W OR K OF W R IT ING .

On 6 of th e fastin g days th e me tabol ism of th e subj e ct was studi e d

whil e h e sat in a chair and wrote active ly On 2 of th e s e days h e was .

stu die d in th e forenoo n and o n 4 days in th e aft e rnoo n S in c e there .

is a te nd en cy towards a diurnal variatio n in th e me cha nics of re spiratio n

b e tw e en morn in g and e v enin g , as S hown by th e in cre as e in th e r e spira
tio n rat e and th e v e n ti l atio n of th e lu ngs per minut e , and th e t en d en cy
-

for th e volume pe r inspiratio n to incre as e , it is ne c e ssary to tak e this

fact i nto co n sid e ratio n in di scussin g th e r e sults I n th e two forenoo n .

e xp erime n ts th e r e was in bo th i n sta n c e s an i n cr e as e in th e r e spiratio n

rat e , a marke d i n cre ase in th e v en ti l atio n of th e lu ngs per mi nut e , and

a gre at i n cre as e in th e volume per i nspiratio n I nasmuch as th e writi n g .

was accomp anie d by disti nct , though p erhaps slight , muscu l ar e ffort ,
the s e fi n d i ngs are o nly what woul d be expe ct e d In th e aft ernoo n .

e xp e rime n ts th e r e was an i n cr e as e in th e r e spiratio n rat e much more -

16 6 A ST UDY OF P RO L O NGE D F A S T IN G .

n otic e a b l e tha n in th e exp e rim en ts in th e fore n oo n Th e v en tilatio n .

of th e lu n gs per minut e show e d a large increas e th e va l u es ave ragi ng ,

about lit e rs per min ute Th e re was a l so usually a me asurab l e

.

in cre as e in th e volume per inspir atio n .

F rom th e s e re sults it c an be in fe rre d that th e slight muscular work of

writing l e tt ers p e rc epti bl y a ff e ct e d th e me cha nics of v entilatio n in that
th e r e spiratio n rat e was some what in cr e as e d and th e v e n tilatio n of th e
-

lu n gs pe r mi nut e n otic e ab l y so SO far as we kn ow no study has b een

.
,

ma d e with n ormal in dividua l s in which th e v e ntilatio n of th e l u ngs per

minut e and th e volum e per in spir atio n w e re so care fu ll y obs erve d as
w e re thos e of our fastin g subj e ct an d he n c e we have n o comparabl e ,

valu es wh ich will S how to what e xt en t th e factors a ff e ctin g th e me chanics

of re spiratio n w e re influ enc e d b y prolo ng e d fastin g I t is reaso nabl e .

to suppo se how ev er that muscular ex e rcis e of any kin d would re quir e

, ,

a gr e ate r e ffort in th e late r stag e s of in a nitio n I t is of particular .

in tere st that th e lu ng v e ntilatio n per m in ut e in th e aft ernoo n e xperi

me nts was p e rc eptibly gre at er than when e ssentially th e same amoun t
of work was carri e d out in th e forenoo n .

INFL UE NC E OF B REATH ING AN O XYG E N R I C H AT MOS PH ERE

-
.

On three days d urin g th e fast an e xp eriment was mad e d ire ctly aft er
th e morn ing r e spiratio n e xp erim e nt in whi ch th e subj e ct br e athe d an ,

atmosphe re co ntain in g from 95 to 7 5 per c ent of oxygen Th e i nfluen c e .

O f this incre ase d amoun t of oxyg e n was di stin ctly n otic e abl e with th e

v en tilatio n of th e lu ngs per minute and th e volume per i nspiratio n ,

although th e r e spiratio n rate chang ed but littl e On th e first day o n

-
.

which the se exp e riments w ere mad e (May 12 1 9 1 2) th e volume per ,

i nspiratio n with normal air was 4 1 0 c c and with th e oxyge n rich . .

-

mi xtur e it was 4 87 c c an in cre ase of 16 per c en t

. .
,
T h e valu e s obtai ne d .

in th e s e e xp e rimen ts w e re as follows : Tw en ty e ighth day of fast r e spi -

,

ratio n rate
-
,
lu n g ven tilatio n volume per i nspiratio n 4 87 ;, ,

tw en ty ninth day re spiratio n rat e

-
,
lu n g ven tilatio n
-
an d , ,

volume per in spiratio n 4 7 1 ; o n th e thirtie th day re spiratio n rat e

, ,
-
,

lun g ven tilatio n ,

volume per in spiratio n 4 54 I t is cl ear there ,
.
,

fore that with this subj e ct th e breathi ng of oxy gen rich mi xture s
,
-

r e sul te d in a co nsid erabl e in cre ase in th e ventilatio n of th e lun gs per

minute and whil e th e re spiratio n ratef was not mate rially affe cte d
,
-
,

there was a co nsid e rabl e in cre as e in th e volume per in spiratio n .

MAXI MUM E XPI RATI ON O F THE LUNG S .

As i d ex of a possibl e chan ge in th e volume of th e lu n gs an d par

an n
ticularly in th e stren gth of th e ch e st muscl e s ob se rvatio n s in re gard to ,

th e maximum e xpiratio n of th e lu n gs w ere mad e by Mr Carp en te r o n .

5 days durin g th e fastin g p e rio d F or the se o b se rvatio n s a lo n g rubb er

.

tub e was attache d to a 1 0 lite r B ohr me t er Th e subj e ct stood up and

-
.
,
 BY HARO L D L . HI GG INS .

Obs e rvatio ns w ere mad e of th e carbo n dioxid e p e rc entage of th e -

alv eolar air ne arly e ve ry day throughout thi s fastin g e xp e rime nt This .

offe re d an ind e x as to th e acidity of th e blood and also an opportu nity

to study th e co ntrol and me cha nics of respiration throughout th e fast .

Alve olar air is th e air which is in or comes from th e alve oli of th e

lun gs As th e active e xcha nge of carbon dioxid e and oxyge n be twee n
.

th e bloo d and th e lun gs tak e s plac e in th e alve oli it is re adily seen that ,

th e t e nsio n or partial pre ssures of th e diffe re nt gas e s in th e alve oli

(carbo n dioxide oxyge n and also nitrogen argo n etc ) will be very
, , , ,
.

n e arly th e same in th e alve oli as in th e blood l e aving th e lu n gs I nas .

much as th e quantity of a gas dissolved in a liquid is proportio nal to

th e p artial pre ssure and no t to th e p e rc entage of th e gas th e compo
, ,

sitio n of alve olar air is th e re fo re probably b e tt e r e xpre ss e d in t e nsio ns

or partial pre ssure s than in p erc entage s .

SIGNIFI CANCE OF ALVEOLAR AIR .

‘
H aldan e and Pri estley have shown that carbon dioxid e is th e pre
va ilin g stimulus to respiratio n under normal co nditio ns Thus if th e .
,

car bo n di o xid e te nsio n in th e re spiratory c ente r falls b elow a c e rtain

-

le ve l apncn a is th e re sult ; and if on th e othe r hand it rise s abo ve this

, , ,

l ev el th e re spiratio n volume is gre atly i ncre ase d and hyp e rp noea s et s

,

in I n othe r words th e respiratory ce nte r by respiratory impulse s

.
,

automatically k ee ps its carbo n di oxid e te nsio n co nstant B ut th e -

.

car b o n di oxide tensio n of th e respiratory c en te r is largely co ntrolle d by

-

that of th e art e rial blood and th e latte r is as me ntio ned pre viously , ,

e ss e n tial l y that Of th e alve olar air H aldan e has th ere fore introduc e d .

th e u se of alveolar carbo n dioxid e t ensio n an d show n that in any o ne

-

indivi d ual it is practically co nstan t un d e r normal co nditio ns although ,

th e n ormal valu es of in di vi d uals may di ff e r mark e dl y from e ach

othe r . I t has be en discovere d that when there is an i ncre ase d
acidity of th e b l ood as in d iab e tic acidosis or with reduc e d barome tric
, ,

pre ssur e as in high altitud e s th e alve olar carbo n dioxi d e t en sio n is

, ,
-

low e r tha n norma l and a small e r te nsio n of carbo n di oxi d e stimulates

,
2
re s p iratio n Thi s has le d to th e pre se ntatio n of th e the ory n o w
.
,

quit e satisfactorily e stab l ishe d that th e H io n co n c e ntratio n of th e ,

-

b l oo d rathe r tha n th e carbo n d ioxid e t ensio n is th e pre dominati n g -

factor in th e co ntro l of re spiratio n Thus wh en th e H io n co n c e ntra .

,
-
“

tio n (or d e gree of aci dity) of th e bl ood co m in g to th e re spiratory c e nter

re ach e s a c ertai n le ve l impu l s e s are s e n t out from th e c e nte r to i ncre as e
,

H ld l
d P i tl y J u n P h y i l 1 90 5 3 2 p 225
a an e an r es e , o r . s o , , . .

Wi t t i n A chi v f di g Phy i l 1 9 1 1 1 38 p 1 6 7
2
n e rs e , r . e es. s o , , . .
 AL VE O LA R A IR . 1 69

th e re spiratio n so that th e net re sult is always th e same H io n c o ncen -

tratio n in th e c en te r .

Th e acidity of th e bloo d may be divid e d into two parts t h at due to ,

carbo n dioxid e and that due to other acids A s th e total acidity .

ne c e ssary to cause re spiratio n must always be th e same it is r e adily ,

se e n that if th e other acids in th e blood in c re as e in amount l e ss carbon ,

dioxid e is ne c essary to raise th e acidity to th e poin t of stimulatio n of th e

re spiratory c ente r Thus o ne may say that th e quantity of carbo n
.
,

dioxide wil l vary conve rs e ly from that of th e other ac ids of th e arterial

blood S in c e alve olar carbon dioxide t ension repres ents so clos ely th e
.
-

carbo n—dioxid e tension Of th e arte rial blood it affords a v ery good ,

i n de x of th e acidity of th e blood I t was mainl y for this re aso n that .

th e alve olar carbo n dioxid e in th e e xp e riment with L was so clos e ly .

followed In fact it see ms that this i nde x of th e d egree of acidosis is

.
,

much more satisfactory and important than th e urinary tests for acidity
E N
l;
i
(as B oxybutyric acid
-
, . total titratabl e acidity , b e caus e
th e forme r represen ts th e acid actually in th e blood whi l e th e latt er ,

o n ly r e pre s e n ts that e xcr e t e d from th e body Th e oth e r factors which .

affe ct th e alveolar carbo n di oxide t ensio n such as th e absorption of

-
,

foo d and varyi ng posture s w e re avoide d with L and thus o ne is abl e to

,
.
,

study th e re sults almost purely from th e point of vi ew of blood acidity .

METHODS OF DETERMINING THE ALVEOLAR AIR .

HALDANE METHOD .

Haldane 1
me thod for d ete rmin ing th e alveolar car bon dioxide ten
’
s -

sio n is th e olde st and probably the ore tically th e most sou nd of any o f
th e m e thods no w in use B y it o ne coll e cts two sampl es of alve olar air
.

from diffe rent phase s of th e respiratory cycl e and ave rag e s their carbo n
dioxid e co nt ent Th e two phas es chose n are imme diate ly at th e e n d
.

of an i nspiratio n whi ch is approximat ely when th e alveo lar carbo n

,

dioxid e t en sio n is low est and at th e e nd of an expiratio n whe n th e

, ,

alve olar carbo n dioxid e t ensio n is nearly at its highe st point Th e

-
.

subj e ct bre ath e s normally for some time ; then at th e e nd of a n ormal

i nspiratio n h e mak e s a rapid d ee p e xpiratio n t h rough a tub e about ,

2 cm in diame t e r an d about 1 5 0 cm lo n g se al in g with his to n gu e th e

. .
,

e n d h e has j ust bre ath e d i nto A sampl e of th e air in th e tu b e n e ar

.

th e mouth is th e n take n This sampl e is co n sid e re d to be alve olar air

.
,

as th e air in th e de ad spac e of th e respiratory passage s an d in that part

of th e tub e from which th e sampl e is tak e n has pre viously b een pushe d
out b y th e air from th e alve oli S imilar l y a sampl e is taken of air .

forc e d t h rough th e tub e from th e lungs at th e e n d of a n ormal e xpira

tio n I nst e a d of se alin g O ff th e en d of th e tu b e with th e to ngu e use
.
,

I
H aldane and Pri e tl y Js e , o u rn . Ph y i l
s o .
, 1 905 , 3 2 , p . 22 5 .
1 70 A ST UDY OF PR OL O NG E D F A S T ING .

1
has b ee n ma d e in our la b oratory of a simpl e Si eb e ck valve whi ch puts ,

th e subj e ct u n d er much l e ss strain as h e do e s n o t hav e to hol d his to n gu e ,

to th e tub e whi l e th e sampl e is b ein g tak e n i nto a gas sampl er Th e -

.

av e rage of th e two a nalys e s give s v e ry clos e ly th e compositio n of th e

alve olar air .

Th e H alda ne me thod re quir e s co n sid erab le att e n tio n o n th e part of

th e subj e ct an d as it was f e are d that possi bl y in th e cours e Of th e lo ng
,

fast th e subj e ct would n o t be physically ab l e to c o op erat e v e ry satis -

fac to rily th e me tho d us e d in th e s e t e sts was modifi e d som ewhat

, In .

vi e w of what w e n o w kn ow O f th e co n ditio n of th e subj e ct throughout

th e fast we may feel assure d that this me tho d would hav e b een v ery
,

succ e ssful ; but as s e v eral samp l e s are often re quir e d to be sure O f good
agre ement and as it was pro b abl e that th e subj e ct s time would be
,
’

much occupi e d it was d e cid e d to modify th e method somewhat to be

,

sure of b e tte r agr eeme nt o n f e w e r sampl e s .

I t has b ee n o b s e rve d that in th e H al da ne me thod hol d i ng th e bre ath , ,

for se ve ral s e co nds b efore th e expiratio n do e s no t caus e th e percentag ;

of carbo n dioxid e in th e alveolar air to incr eas e with v ery gr e at rapidity e
this is n aturally to be e xp e cte d for as th e carbo n dioxid e t ensio n s of ,
-

th e alv e o l ar air an d th e blood comi n g to th e lu ngs approach th e same

figure th e incre as e in th e forme r is slow er Furthe rmore it app ears
,
.
,

that if a subj ect has pre viously b ee n breathing somewhat ab normally

for n o t ove r thr ee or four respiratio n s th e p erc entage of carbo n dioxide ,

in th e alve olar air aft er holdi n g th e bre ath for a few se co nds will be
, ,

ne are r that of th e alv e olar air wh e n th e bre ath is h eld similarly aft e r
normal re spiratio n than is th e p erc entage of carbo n dioxid e in th e
alve olar air of th e same two cas e s when th e bre ath is no t held Thus .
,

it woul d s ee m that small d e viatio ns from th e n ormal such as app e ar in ,

co nscious re spiratio n would n o t be disturbin g to agr e ein g re sults an d

,

that in a v e ry small numb e r of d ete rmin atio ns (s eldom more tha n two )
figure s c an be obtain e d which are v e ry good duplicat e s and which will
b e ar a co nsta nt relatio n to th e tru e alve olar carbo n dioxi d e t e nsio n -

whe n th e subj e ct is in th e same positio n (S itti ng quie tly) .

Th e modifi e d m e thod use d in th e s e t e sts which lat e r is call e d th e H al ,

da ne me thod is as fo ll ows : Th e subj e ct b e gan by bre athi n g n ormally

,

in to th e room thr ough a short (5 cm ) tub e co nne ct e d with th e S ieb e ck .

valve Then at th e end of an i nspiratio n s e l e ct e d by th e obse rv e r who

.
,

was watchin g th e r e spiratio n th e subj e ct was tol d to hold his breath ,

.

A t th e e nd of 5 s e co n ds time d by th e obse rv er duri ng whi ch th e valve, ,

had b e en op ene d th e subj e ct bre ath e d out rapi d ly an d d ee p ly through

,

th e lo n g tub e as in th e H aldan e me thod Af t e r th e e xpiratio n th e valve .

was again clos e d U sually two samp l e s w e re tak e n e ach day in whi ch
.

th e subj e ct h eld his br e ath 5 s e co n ds and two in which h e h e ld hi s bre ath

8 s e co n ds Th e re sults obtai ned wh en th e subj e ct h eld his bre ath 8
.
.

1
D R S i b c k f H i d lber g h a d vi d an in g ni u
r. . e e , o li d val ve f th i pu po wh ic h
e e , s e se e o s s e- or s r se ,

m ay b c u ed f Univ itat M h ani k R un g in H i d lbe g

e se r o er s s ec er e e e r .
1 72 A ST UDY OF P R O L O NGE D F A S T I NG .

Thi s me thod is probably th e most adaptabl e for use with th e average

patie nt when th e condition of aci d osis is be ing compare d from day to
,

d ay or whe n a gross picture of th e d egree of acidosis is d esire d

, Th e .

me thod doe s no t give th e car bo n dioxide t ension of th e arte rial blood -

,

but s eem s rathe r to appro ach th e carbon dioxid e te nsion of th e venous -

blood be cause as th e same air is rebre ath e d it is obvious that th e

, , ,

a lve ol ar air th e arte rial blood an d ve nous blood will all have e ventu
, ,

ally th e sam e carbo n dioxid e te nsio n n ame ly that of th e ve nous blood

-
, , ,

be cause it is th e highest F or this re aso n e spe cially as it is th e normal

.
,

c arbon dioxide te nsio n of th e art e rial blood which is th e important

-
,

factor in th e re gulatio n of th e respiratio n this me thod theore tically is ,

1
n o t so importan t as th e H aldan e me thod B ut with th e subj ec t in .

th e sam e po sitio n and with th e same am o unt of pre vious acti vity we ,

have found that th e carbo n dioxide tensio n d e te rmi ned by this me a ns -

be ars a ve ry co nstan t relation to th at of th e H aldane me thod ; this was

a ssured from n um e rous compariso ns of th e differen t me thods on ma ny
normal in dividuals th e re sults be ing a bout 20 pe r c en t higher tha n the
,

valu e s obtain ed with th e H aldan e me thod Th e same re latio n may .

also be obse rv e d with L as th e re sul ts in tabl e 20 S how that e xc e pting

.
, ,

o n th e first fe w days th e diffe re nc e be tw ee n th e 5 and 8 se co n d H alda n e

,
-

me thod and th e mod ifie d P l e sch method is about 1 0 pe r c e nt .

METHO D OF C ALCULAT ING ALVEO LA R AI R FRO M RES PI RAT I ON

E XPE R I ME NT S .

Th e morni ng and e ve ning respiration e xpe riments which w ere made ,

with th e unive rsal respiration apparatus includ ed th e de terminatio ns ,

of th e carbo n—di oxid e productio n oxyge n c o nsum mio n respirato ry , ,

q uoti ent pul se an d re spiration rate s and in spiratory ventilation of

-
, ,

th e lu n gs Thes e e xpe riments also give some data re garding th e alve

.

o lar carbo n dioxid e te nsio n and th e d e ad spac e of br e athing which are

-
,

o f i n t e rest in co nsid e ring th e oth e r alveolar air d e t e rmi n atio ns Th e -

.

de ad spac e in re spiration is th e air that is insp and again e xpired

without e nte ring th e alve oli in which active gas eous excha nge takes ,

plac e and thus is unchange d Th e follo wi ng formula for calculat ing

,
.

t h e p e rc e ntage of carbon dioxid e in th e alv e olar air is th er efore r e adily

u n d erstood :
C0 2 V = To tal volume of air ex
Alv per c en t 0 0 2
pi red in c c
.

V (DS X R )
— . .

C0 2 C0 2 productio n in DS = D ead spac e in c c . .

R N umb e r of r e spiration s .

N aturally the s e factors must be me asure d for th e same u nit of time

an d u n d e r th e same co ndi tio ns of pre ssur e t e mp eratur e and aque ous , ,

t e n sio n Th e u n it of time chosen in th e e xp e rim ents with L has b ee n

. .

1
Th ame s c i tic i m appl i to th 8 c nd and 5 se c nd Hald ane m th d a u ed in th
e r s es e -se o - o e o s s ese

exp i m
er t al th u gh p
e n s, babl y to a l d g ee
o ro e ss e r .
 AL V E O LA R AIR . 173

1 mi nut e whil e th e gas volume s co n sid ere d in th e applicatio n of th e

,

above formula have for th e sake of S implicity in calculatio n b ee n taken

, ,

at 20 C 7 60 mm an d dry
°
.
,
.
,
.

Elaborati n g this gene ral form ula for u se in con ne ctio n with and cal
culatio n from th e r espiration e xp erimen t we get th e followi ng : ,
.

Alv p c t COg
. . .

°
C0 2 0 0 2 production in c c per mi nute at 0 C and 7 60 mm ;
. . . .

°
and C 0 2 X 0 0 2 production at 20 C , 7 60 m . .

°
co nsumptio n in c c per minute , 0 C , 7 60 mm . . . .

V = inspirato ry ve n tilatio n of lu ngs per min ut e at barom

e t e r , t e mp e rature , an d humidity pr e vaili n g in spiro m
°
e t e r of respiratio n apparatus (i e , about 20 C and . . .

33 pe r c e n t or 66 pe r c en t humidi ty ) .

95 1 0
( 2
expirator y ven

°
tilatio n
of lu ngs per minut e at 760 mm 20 C dry .
,
.
, .

DS = de ad spac e in c c (20 C dry 7 60 m ) . .

°
.
, , .

R = respiratio n rate per mi nut e ~

.

P barometric pressure .

1 075 = factor to co nve rt gas volume s from 0 C to 20 C

° °
. . .

I n a r e spiratio n e xp e rim en t th e i nspiratory ventilatio n is o btaine d at

th e p re ssure t emp eratur e and humi d ity of th e air in th e spirome t e r o n
, ,

th e apparatus Th e t emp e ratur e is n o t tak e n in e ach e xp erimen t but

.
,
°
as it is probably ve ry clos e to 20 C this t emp erature is assume d in .
,

P
ea ch calculatio n Th e te rm O bviously reduc e s th e ven tilation to
760
.

7 60 mm . Th e t erm —
0 0 15
. V
(77 30) corre cts for moisture in th e
S pirome te r ; this moisture come s from two sourc e s namely from th e , ,

l un gs of th e subj e ct and from th e moist e n er us e d to pre v en t th e air in

th e respiratio n apparatus from b e comi n g too dry for comfortabl e r e spi
ratio n Two kin ds of moiste ne rs we re use d durin g th e fastin g e xperi
.

ment In th e first part of th e se rie s (u n til A pril 22) a moist ene r co n

.

structe d Of th e lowe r part of a Kipp gas ge ne rator was e mploye d In -

.

this th e air be fore comi n g to th e nos epie c e s bubbl e s through wat er ;

th e humidity with this form of moist e n e r h a s b ee n fou n d to be 66 per
c e n t saturate d ; per c ent of th e re cord e d ve n tilatio n was th e refore
wat e r vapor an d accordin gly subtracte d Th e othe r moist e ne r was a
-
.

pi e c e of moist che es e cloth in th e tub e l e adi n g to th e nos epi e c e Wh en

-
.

this was use d th e humidity in th e spirome te r was fou n d to be o nly 33

,

per c e nt so that in th e s e exp e rime n ts

, p e r c e n t of th e r e cord e d
volume was su b tracte d and no t pe r c e nt Th e e xpiratory volume .
1 74 A ST UDY OF P R O L O NGE D FA S T I NG .

is small er than th e inspiratory volume b e caus e th e amount of oxyge n ,

co nsume d is gre at e r tha n th e amou nt of carbo n d ioxid e pro d uc e d .

Accordingly we subtract (0 2 0 0 2) from th e i nspiratory ve nti

-

latio n B ut durin g i nspiratio n s in a r espiratio n e xp eriment o ne half

.
-

of th e carbo n di oxi d e pro d uc e d is absorb e d in th e soda lime bottl e s -

,

so that th e r e cord e d in spiratory vo l um e is correspo n di n g l y in cre as e d ;

o n th e oth e r ha n d a volum e of oxyg en e qual in vol um e to o n e half th e -

vo l um e co ns ume d is add e d to th e re spiratio n apparatus duri ng an

in spiratio n and thus make s th e re corde d inspiratory volume corre
spo ndin gly too small Thus in st e ad of
.
(Oz
, th e factor
for chan gin g th e inspiratory vol ume to th e e xpiratory volume b e come s
02 002

Th eo nly other factors in th e e quatio n are Alv p ct 0 0 2 and DS . . . .

With eithe r o ne kn own th e oth er may e asily be d e te rmin e d Th e

, .

formul a for calculating th e d ead spac e is as fo l lows :

O, X 1 075 .

DS
Wh en th e e xp e riments on L w e re mad e we had no t co nsid e re d th e
.
,

possibl e use of this e quation and so have no t th e compl e t e data for

cal culatin g e ithe r of the s e factors but we still have sufli cie nt mat e rial
,

to draw some inte re stin g co nclusions .

Assumin g th e p e rso nal d e ad S pac e of bre athi ng for th e subj e ct L .

,

tog e the r wi th that of th e nos epi e c e s e tc to be 120 c c th e p e rc e n tage

, .
, . .
,

O f carbo n di oxid e in th e alv e ol ar air has b ee n calculat e d for a l l of th e

mornin g and e venin g respiratio n e xp e riments an d th e re sults for e ach ,

se ri e s have b ee n average d as shown in tab l e 20 Also maki ng u se of .

,

th e alve olar air figure s fou nd o n th e same d ay th e r e spiratory d e ad

-
,

spac e in e ach e xp e riment has similarly b een calculate d an d ave rage d .

As th e alveolar air was no t tak en at th e tim e of th e re spiratio n experi

ments and as th e d e ad spac e might possibly hav e change d in S iz e
d uri ng th e fast fixe d di fferentiatio n of th e re sults is di ffi cult The se
, .

r esults will be discuss e d lat er .

C ONDITI ONS OF TAKING ALVEOLAR AIR S AMPLES -

Th e sampl e s w ere tak en by th e H alda ne and P l e sch me thods with

th e subj e ct sittin g in an armchair Aft er th e fast had b e gun they w ere
.
,

tak en at about l 35 p m to 2 p m B etween th e taking of th e sampl e s

1 l m
. . . .
,

e ach of w hi ch was a n alyz e d b e fore a n oth e r was tak en th e subj e ct was ,

sittin g qui etly an d usually re adi ng On s eve ral days h e had visitors .

whil e th e exp erim en t was in progr ess On o ne of th es e days April 22 .

, ,

whil e talkin g with a visitor h e b e came quit e excit e d On th e other

,
.

days the re was n o mark e d e xcit emen t whil e th e sampl e s w e re b ei n g

tak en On April 22 it is in t e restin g to not e that th e alve olar carbo n
.
,

dioxid e t ensio n by th e H aldane method was v ery low in fact much

—
,
 A ST UDY OF P RO L O N GE D FA S T IN G .

thi s valu e for e ach day it was ne c essary to assume that th e alv eo lar
,

p erc entage of car b o n dioxid e had not change d be twee n 8 a m or . .

8 p m when th e re spiratio n e xp e rime nts w e re mad e and 2 p m of

. .
, , . .

th e sam e day wh en th e alveo lar p e rc en tage of carbo n dioxid e was

,

tak e n I t would s ee m how e ve r that if the re w ere a chan ge in th e

.
, ,

l
O btaine d by taki ng 9 7 per c e n t o f th e pe rc e ntages al veo l ar C 0 fro m wh ich th e fi gu es in co l um n G
2 r

wer e cal cu l ate d .

2C al c ul ate d pe c e n tag es fo r th e f o ur t h per i o d o n Ap ri l 1 9

r M ay 1 7 May 1 8
, , ,

‘Th e su bj e c t e n d e d h is f a t wi th t h e t ak i n g o f frui t j uices an d h o ne y o n th e m o rni n g o f M ay 1 5 af te

2 s ,

th e co n c l u i o n o f th e re p ir ati o n e xp e im e nts
s s r .
 AL VE OLA R AI R . 1 77

alveol ar air duri ng that time it would be proportio nal o n e ach day ;
,

o n c e rtain days subs e qu en tly sp e cifi e d th e re is good r e aso n to b eli e ve

that th e chan ge was no t proportio nal Th e re sults of the s e calcula

.

tio n s are given in column H for th e morni n g e xp erim ents and J for th e
e venin g e xp e rim e n ts with th e ave rage s in columns I an d K re sp e ctiv ely
, , .

T AB L E 20 .
— A lveo lar-ai r and dead-space determinatio ns i n experi ment with L .
— Co n tinued .

‘
C al cul ated v o lum e o f d ead sp ace fo r th e fo urth perio d o n April 1 9 1 21 c c ; May 1 8 1 33 c c
, . .
, . .

2T h e su bj c t e n d e d his f ast with th e takin g o f fru i t j uic e s and h o n e y

e o n th e m o n in g o f May
r f
15 , a te
th e c o n c l u si o n o f th e resp ir ati o n ex pe i m ents
r .
1 78 A ST UDY OF P R O L O NGE D FA S T I NG .

Co nsid e ring e ach s eri e s b y its e lf th e co nclusio n may be draw n from

,

both th e morni n g and th e e ve nin g e xp e rime nts that the re is no consta nt

chan ge in th e siz e of th e d ead spac e of bre athin g as a re sult of th e fast .

Although the re is more or l e ss fluctuatio n from day to day y et th e ,

gene ral ave rage of d e ad—spac e volume s found at th e b e ginning of th e

fast is much th e sam e as that towar d th e e nd Of th e fast A numb e r .

of v e ry low valu e s may doubtl e ss be e xplai ne d quite w e ll as fo llows :

On April 1 5 an d 1 6 th ere is a mark e dl y lowe r valu e for th e d e ad spac e ;
thi s is probably due to an e sp e cia l ly larg e drop in th e alveolar air
during th e day as o ne mi ght p e rhaps exp e ct thes e two days b eing th e
, ,

first two of th e fast As pre viously m entio ne d th e subj e ct was much

.
,

e xcit e d o n A pril 22 wh e n th e H alda ne sampl e s w e re take n an d as a

, ,

re sult th e valu e obtained for th e alve olar air was probably low ; thus
th e calc ulatio n mak e s th e d e a d spac e figur e s also too low
-
On A pril 2 7 .

and 28 th e re is a lso an in dicatio n of a low e r d e ad S pac e ; t hi s is lik e

wi se probably due to a change in th e alve olar air as it will be note d that
,

tabl e 20 shows a mark e d fall in th e alveolar carbo n dioxid e t ensio n -

about this date .

DI FFERE NCE I N MEC HANI C S OF RES PI RAT I ON I N MORNING AND E VENING .

On comparin g th e valu es for th e d e ad spac e calculat e d from th e

e ve n in g e xp e rim ents with those for th e morni n g e xp e rim e nts o ne fi n ds ,

a co nstantly hi gh e r d e ad spac e which is o n th e ave rage 55

, , This , ,

of cours e is bas e d on th e ass umptio n that th e alveolar p erc en tage of

,

carbon di oxid e is th e same in th e morning as it is at n ight S inc e some .

physiologists b e l i e ve that th e d e ad spac e is always e ss en tially th e same ,

it s ee ms d e sirabl e to consid er how larg e a differenc e in th e alve olar

p erc entage of carbo n dioxid e must hav e e xist e d b etwe en th e mornin g
an d e v e nin g e xp e rimen ts to in dicat e so mark e d a cha n ge in th e ven ti
latio n A ssumi n g for th e siz e of th e d e ad spac e th e fi gur e 120 c c
. . .
,

which r epres ents approxim ately th e me a n valu e pre viously calculate d

for th e d ead spac e in th e mornin g e xp e riments th e alve olar air has ,

b een compute d for e ach respiratio n e xp e rimen t as shown in column s ,

B an d D an d th e av e rag e s in colu m ns C and E Th e alveolar p e rc e ntage

.

of carbo n dioxide (carbo n di oxid e t ensio n) in th e morning e xp e riments

-

shows in general th e same change s that th e alve olar carbo n dioxid e

, ,
-

t e nsio ns by th e other methods have in dicat e d I n fact th e alve olar .

,

carbo n dioxid e t ensions obtai ne d in this ma nn er ve ry satisfactorily

-

supply th e value s for April 2 5 and 26 when th e alve olar air was n o t
,

tak en by th e other methods Th e clos e agree ment of th e valu e s for

.

th e alve olar p e rc entage of carbo n dioxid e in th e s e ve ral duplicate experi

ments gives e vid enc e of th e e ven and normal respiratio n of th e subj ect
an d th e gr e at care in making th e re spiration e xp e rim e n ts .

I f th e alveolar carbo n dioxide t e nsio ns of th e morni n g and e venin g

-

e xp e rim en ts of th e sam e day are compar ed an av erage di ffe ren c e is

,
1 80 A ST UDY OF P R O L O NG E D FA S T I NG .

of gas take s plac e A s L was bre athin g through th e thr e e way valve
. .
-

an d nos e pi e c e co nne ct e d to th e apparatus th e figur es giv en are 30 ,

hi ghe r than hi s actual p erso n al d e ad spac e S i nc e th e subj e ct with ,

e ach r espiratio n dr e w from th e air syst e m of th e apparatus 3 0

whi ch did not reach e ithe r th e re spiratory p assag es or th e lu ngs .

S IGNI FI CANCE OF C HANG E I N T HE ALVEO LAR AI R DURI NG T HE FAS T .

Fi nally it is advisabl e to compare th e data of th e alveolar carbo n

,

dioxid e t ensio ns as th e fast progre sse d Col umns 0 F an d G in tabl e .

, , ,

20 se rve this purpos e th e b e st As o ne would n aturally exp e ct th ere is a

,
.
,

drop in th e alve olar carbo n dioxid e te n sio n with th e i n creas e d acidosis

-

of th e fast Th e subj e ct ate th e last meal b e fore fasti ng o n th e e veni n g

.

of April 1 3 ; o n th e aft e rnoo n of A pril 1 5 th e fall in th e alve o l ar carbo n

dioxid e te nsio n is first note d This fall is about 4 to 5 mm (2 mm . . .

P l e sch me thod ) ; aft e r this th e alveolar air co ntinu es at about th e sam e

l e ve l u ntil April 27 or 28 when a s eco nd qui t e sh ar p dr op also of about
, ,

4 to 5 mm is appar e nt .
,
Th e new l e ve l is mai ntai ne d with o nly sligh t
.

fluctuatio n s u ntil th e end of th e fast With th e taki ng Of food again .

,

th ere is a rise in th e alveolar carbo n dioxide t ensio n as would be -

,

e xp e ct e d with th e re sultin g diminutio n of acidosis On th e morning .

of May 1 8 a s light fall in th e alve olar carbo n dioxid e t ensio n is again -

not e d in co nne ctio n with th e re spiratio n exp erimen ts b efor e bre akfast .

P ossibly a part of th e ris e o n May 1 5 and subs e qu en t days with th e

P l esch and H aldane m ethods may have b ee n du e n o t o nly to th e dimi
nu tio n of acidosis but to an e ff e ct simil ar to that si n c e n otic e d in this
,
1
laboratory with th e in ge stio n of food .

I n co nn e ctio n with th e s e co n d S harp fall in th e alve olar carbo n

dioxide t ensio n it is of i nt ere st to not e s e ve ral parall e l e xp erime ntal
,

fin di ngs Th e chlori ne e xcre tio n in th e uri ne o n April 27 and 28

.

dropp e d from a pre viously high l e ve l to a low er figure at which it ,

co ntinu e d for th e re maind e r of th e fast A ris e in th e total volume Of .

th e urin e occurr e d also at about thi s time Th e daily nitroge n e x ore .

tio n in th e uri ne for th e first 1 0 or 12 days of th e fast was slightly

ov er 1 0 grams ; th ere was th en a fall to about 8 grams which was ,

mai ntain e d throughout th e re st of th e fast I t may be note d that thi s .

drop in th e nitroge n e xcre tio n is S imultane ous with th e drop in th e

alveolar carbo n dioxide t en sio n -
.

S i n c e alve olar air is i n timat e ly associat e d with th e aci d osis of th e

subj e ct o ne n aturally looks for simultane ous chang e s in th e facto rs of
,

th e uri ne whi ch are tak en as in dicators of acidosis Thus th e fi Oxy .

-

butyric aci d s eems to S how a ris e to a high l e vel about th e tw elfth day
of th e fast ; such a change is difficult to judge how e ver as th e fl oxy , ,
-

butyric acid variatio n s from day to day are quit e large Th e othe r
-
.

i n d e x th e ratio of ammo nia n itrog en to total nitroge n also shows a

,
,
,

Hi ggins Am J u n Ph y io l 1 9 1 4 34 p 1 1 7
1
, . o r .
, s .
, , , . .
 AL V E O LAR AI R . 181

simultaneous rise by r eason of th e in cre as e of th e ammo nia and th e

d e creas e of th e total nitrogen .

F rom the se data o ne may safely co nclude that there is a marke d

incre as e in th e acidity of th e blood in th e fast b e ginn i ng o n th e se co nd
,

day ; th e acidity then di d not change mark e dly u ntil about th e four
tee nth day of th e fast wh e n a noth e r de cid e d i n cr e as e in blood acidity
,

occurr e d Th e re covery to n ormal acidity in th e blood b e gins to be

.

e vid en t in th e first few days aft e r th e fast .

CONCLUSIONS .

Th e re sults for th e alve olar air and d ead spac e may be summ ariz e d
as follows :
( 1 ) On th e s e cond day of th e fast th e carbo n dioxid e t ensio n in th e
,
-

alv eolar air show e d a drop from th e n ormal valu e I t remain e d at this .

new l e ve l unt il about th e fourte en th day O f th e fast wh en th e re was a ,

s e co nd rathe r sharp fall aft er whi ch no further mark e d cha nge occurre d
, .

E ach of th e se falls is about 4 mm Thus th e blood aci d ity may be said

.

to have mark e dl y i ncre as e d o n th e s e co n d day of th e fast an d to

hav e remain e d at thi s highe r l e ve l u ntil th e fourt een th day wh en a ,

s e co nd i n cre as e occurre d ; the re was no furthe r change u n til th e end

of th e fast .

(2) There is no sign of an accumulative cha nge in th e siz e of th e d e ad

spac e from day to day as th e fast progress e d .

(3 ) A chan ge in th e me chanics of respiratio n o n th e r espiration

apparatus b etw een mornin g and e venin g e xp erimen ts d uri ng th e fast
S hows that th er e was e ith e r a mark e d cha n ge in th e alv e olar air or

e ls e a chang e in th e siz e of th e d e ad spac e duri n g th e cours e of e ach

day . I f th e forme r th e alve olar air fe ll about 6 m m b e tween morn

,
.

in g and e ve ning r e turn i n g d uri n g th e co urs e of th e n ight to e ss en

,

tially th e morni n g figure I f th e d e ad spac e cha nge d it i n cre as e d in

.
,

siz e about 5 5 c c and again b e came n ormal by th e next morn in g

. . .
 SUBJECTIVE IMPRES SI ONS AND MENTAL ATTITUDE TOWARD
THE FAST .

BY HARRY W GOO D AL L M D
.
, . .

Th e freedom of sp ee ch charact erizin g this subj e ct hi s pre co nc eive d ,

id e as o n fasting and o n th e humanitaria n s e rvic e of his fast led to exc ep

tio n ally ful l comm e nts o n th e whol e proj e ct an d sp e cifically his subj ec
tive impre ssio ns His habit Of thought and i ntrosp e ctio n probably
.

mak e them of av erage valu e though admitt edly the y are re corde d no t,

as sci entific obs e rvatio ns but as general in dic e s to his men tal mak eup
, ,

his p ersonal e xp e ri e nc e s and his b eli efs as outlined freely to th e writ er ,

o n e ach visit .

SUBJECT IVE I MPRES SIONS .

Apr il 1 4 1 91 2 ( 1 8 hours after be gi nni ng th e fast)

,

T h e subj e ct state s that h e is ve ry happ y in th e though t that th e fast has

act u all y be gun Th e val ue of th e expe rimen t to th e wo rld c an no t
.

be e stimate d and afte r a few d ays th e mi nd wi ll be c l e ar an d active

, .

I n e xpl ai ni ng th e i nfl uence of fasti ng upo n th e min d h e st ate d that ,

o n hi s l o ng j o urne y fro m Mal ta h e h ad be en o bl ige d to e at f o o d th at

was po i so no us mo re espe ci all y animal fo od s an d that hi s bo dy was
, ,

saturate d with th i s po i so nouswaste maki ng th e mind d ull an d c ausing ,

a kin d o f p hysic al f atigu e Wh en the se waste matte rs are c l imi

“
.

”
nate d th e mi n d wi ll be c l e ar an d I wi ll fe e l buoyant and ho pe ful
, .

I n refe rri ng to th e no c turnal e missi o n which oc curre d duri ng th e

nigh t of Ap ri l 1 2 1 3 h e st ate d th at o ne of th e most impo rt ant thi ngs
—
,

n ote d in co nne c tio n wi th his f asts was th e be havior o f th e se xual

organs D uri ng fasting the re is a reversion to th e animal type a
.
,

peri o dici ty o f se xual d e si re at monthly i nte rval s I n spe aki ng of his .

subj e c tive se nsati o ns si nce be gi nni ng th e f as t h e st ate s th at h e fee l s ,

perfectly well h as h ad no se nsatio ns of hunger an d no tho ugh t Of

, ,

fo o d He h as b ee n a mo uth b re ather fo r ye ars I s tro ubl e d with

. .

n as o ph aryngi ti s an d tinitus aurium

-
B o th these condi tions al ways .

imp ro ve wi th fasting .

A pril 1 6 1 91 2 (th ir d day o f fast) :

,

Feel s p erfe ctl y we ll H as h ad no se nsati o n of hun ger and no abd omi nal
.
,

se nsati o ns asi d e from sligh t rum bli n g o f g as in th e i nte sti ne s H as

,
.

p asse d very l ittl e o d o rl ess g as by rectum ; the re h as b e en no be l chi ng

o f g as n o sense o f f atigue
,
Min d is no t y et c l ear enough for active
.

mental work .

Apri l 1 8 1 9 1 2 (fifth day o f fast) :

,

Feel s p e rfe ctl y we ll No sens ati o n o f hu nger NO l o nging for foo d but
. .
,

o cc asi o n all y thi nk s o f th e agree abl e t aste o f ic e c re am NO se ns e o f .

muscul ar we akness o r fatigue Has p asse d a l ittl e o d o rl ess gas b y .

re ctum N aso p h aryngitis and tinitus b etter

.
-
.

A pril 20 1 91 2 (seve nth day Of fast ) :

,

Mentall y d ep re sse d ye sterd ay and to day He attri b ute s this to th e rain -

.

an d c l o u dy we ath er as h e always fee l s d e p re sse d when th e sun d o e s

,

n o t shine Fee l s as well p h ysic all y as usu al

. Exp re sse d h is s atis .

faction at th e manner in which th e fast was b ei ng c o nd ucte d .

 A ST UDY OF P R O L O N GE D FA S T IN G .

May 1 4 ,
1912 —
C o ntinue d .

th e fast
This however is no more mark e d than it is many d ays
.
, ,

when h e is t aki ng re gul ar me al s T h e mo st p ro no unce d p h ysic al .

change is a sensatio n th at his b o dy is very light This h as gradually .

d eve l o pe d as his weight h as d e cre ase d and n e cessitate s his me asuri ng ,

hi s ste p s wh en h e walk s S ays that at n o time has h e fe l t l i ke .

rec lini ng o n acc o unt o f b o dy f atigue His neurasthenia is gre atl y .

impro ve d and during th e e ntire fast h as onl y shown itse lf as sl ight

,

d e spo ndency and some irritabi lity o n th e rai ny d ays His mi nd h as .

b ee n much c l e arer thro ugho ut th e fast than it is when fo o d is t ake n .

To day h is m in d is cl ear He h as be tte r imagination He is full o f

-
. .

ho pe and c o urage I s ambitio us to do mental wo rk H as h ad no

. .

sensatio n o f h unger no sensations of f ai ntness He had no de sire , .

fo r fo o d asi de fro m th e pl e asant tho ugh t o f ic e cre am o n th e third

,

an d fo urth d ays o f th e fas t an d h as be e n gl ad that h e di d n o t have ,

to e at Has h ad no abd o m inal p ain o r disc omfo rt His nas o

. .

pharyn gitis is much imp rove d and h is tinitus has p ractic all y dis ,

appe are d .

Mayl1 5 1 9 1 2 (two hours afte r b reaki ng fast)

,

E xtreme l y d e p resse d and d e sp ond ent b e c ause h e h ad b een o bl ige d to b reak

his fast be fo re his b o dy was p re p ar e d fo r it Fe l t ve ry we ak p hysi .

c all y Th e fo od s that h e sel e cte d in b re aki ng h is fast were c oncen

.

trate d o range an d l emon j uic e grape j uic e and ho ney Expe ri ence , , .

h ad t aught him that the se we re th e o nl y n atur al ratio nal fo od s to be ,

tak en at t h is time Me at b ro ths and o ther animal fo o d s were p oi

.

so no us I n h is Op inion these natural food s should be fo ll o we d fi rst

.

b y coo k e d fruits then veget abl es and l ater a return to th e ordinary

, ,

die t S tate d that h e h ad no appe tite and that no thi ng tas te d goo d
.
, ,

al tho ugh th e l emo n j uice was n o t un pl e asan t .

10 a m . Foo d was first i ngeste d

. This i mme di ate l y c ause d a sensatio n .

O f warmth in th e stomach an d h e was c o nsci o us of a p ul sation in th e ,

e p ig astri um There was no d e sire to b e l ch g as no nause a o r other

.
,

sym p to m s unti l
1 l 45 a m when h e b e g an to h ave di stre ss in th e abd ome n st arti ng in
b “
. .
,

th e e pigastri um an d r adi ating to wards th e right hyp o cho n d rium .

Th e p ai n was d ull i nte rmi tte n t in charac ter but n o t c o l i c ky

,
He ,
.

d e scri be s it as a sensatio n o f d iste nsio n o f th e stomach acco m p ani e d

b y rumbl ing and b el ching o f g as Furtherm o re h e b el ieve d h e c oul d .
,

fe e l th e p ro gress o f th e diste nsi o n o f th e al im e nt ary tract as th e

i nge ste d fo o d move d al ong th e intestines and h e fe l t by ,

1 2 1 0 m p m th at th e fo o d h ad p ro c ee d e d as far as th e righ t i l i ac fo ssa

“
. . .

Then at
1 p m th e rumbl ing an d b e l ching o f g as was much mo re mark e d an d th e
. .

p ain was somewh at mo re se vere Marke d l assitude an d d e pressio n . .

S o o n after p ain b e c am e e asi er unti l ,

4 1 5 p m whe n th e c h ar acte r o f th e p ai ns change d fro m th e p ains o f

“ m “
.
.
,

diste nsi o n to inte rm itte nt attac ks o f cram p lik e o r c o l i c ky p ai n -

,

which b e c am e very seve re Th ese were e xpe ri e nce d ab o ut th e um .

bilic us and in th e l o wer abd o m e n B etwe en th e attac k s h e was very .

dr o wsy Th e c o lic grad ually i ncre ase d in se verity unti l

.

5 p m wh en h e d e fe c ate d fo r th e first ti m e
. .
,
Th is was acc o m pl ishe d .

wi tho ut difli c ulty o r p ain Th ere was so m e g as and th e mo vement .

,

h ad a very bad o d o r After th is h e was fre e fro m p ain unti l

.

5 4 5 p m whe n th e cramp s b egan ag ain i n c re asi ng in se verity th e

h m
. .
, , ,

l o c ati o n b eing th e sam e Th is tim e th e p ain m ade h im e xtreme ly .

 U B J E CT I VE I MPR E S S I O N S A ND ME N T AL A TT I T UD E
'

S .

May 1 5 , 191Q —
C o ntinue d .

we ak Th e re was p ro fuse pe rspirati o n an d i ntense thirst This

. .

c o ntinue d unti l
7 1 5 p m whe n h e h ad a se cond mo vemen t o f th e b o we l s l i qui d i n
h m
. .
, ,

character After thi s h e was nauseate d and th e p ai n continue d

.
,

se vere unti l
9 45 p m when h e vomite d and then b egan to fee l b e tter an d at
h “
. .
, ,

1 1 p m th e p ain sto ppe d

. . .

M ay (se c o nd day afte r bre aki ng fast)

Ab o ut 2 a m b eg an to h ave se vere abd o mi nal c ram p s ag ai n c o n ti nui ng
. .
,

unti l
2 3o a m when h e h ad a thir d mo veme nt o f th e b o we ls l i q ui d in
“ m
. .
, ,

char acte r After thi s h e was c o mfort abl e but p asse d g as at fre quent
.
,

i nte rvals T h e o d o r of th e g as was very dis agree abl e but th e p assage

.
,

was n o t acc o mp ani e d b y p ain W as co mfo rt abl e unti l .

8 p m when h e stat e d that h e was in n o p hysic al di stress b ut that h e

. .
, ,

was very d esp ond e nt He app e are d hysteric al crying a go o d d e al .

, .

He was o ffe nd e d b e c ause h e had be en o blige d to b re ak th e fast and .

,

co mpl aine d that this to ge ther with a f ew disagree abl e expe ri ences ,

with s ome o f th e m e n in charge o f th e expe riment and th e l ac k o f ,

fr esh air and exercise through o ut th e fast was resp o nsibl e fo r h is ,

p h ysical an d ment al we akne ss He attri bute d th e abdominal p ain .

to th e p re senc e o f g as I nasmuch as h e h ad no t d efe cate d duri ng th e .

fast a hard plug o f intestin al se cretion h ad accumu l ate d in th e

,
“

re c tum and when h e t o o k fo o d th e advan ci ng b o l us comp re sse d th e

,
”
g as p re se nt in th e i n testi nes c ausing p ain , .

May 1 7 1 9 1 2 (third day after b re aking fast) :

,

Fee l s ve ry we ak but n o abd o min al p ain for p ast 24 ho urs , Passe d a .

fairl y c o m fo rtabl e night but di d n o t s l eep as we ll as usual Is still , .

d ep resse d and emo ti o n al but to a much l e ss d egre e since th e p ain ,

sto pp e d I s t aki ng th e same ki nd s o f fo o d but we ll d i l ute d with

.
,

water as was suggeste d to h im Fe el s much b etter physic ally

, .
,

but h as no amb iti o n fo r mental wo rk Late yest erd ay afte rno on .

h e w as ve ry thi rsty fo r ab o ut an ho ur d rinki ng 5 gl asse s of water ,

.

U p to th e p re se nt time h e h as e ate n th e j uic e o f two l emo ns di l u te d

with e q u al p art s o f wate r an d swe ete ne d with a te asp o o nf ul o f ho ney ,

al so c c o f o range j uic e di l ute d o ne third wi th water to which

. .
-
,

e no ugh ho ney was add e d to m ak e it swe e t S ays h is gene ral c o n d i .

tio n is no t ne arl y so go o d as it was o n th e l ast day o f th e fast H is .

app e tite is j u st b e gi nnin g to retu rn b ut h e is n o t h un gry y e t ,

.

May 1 8 1 91 2 (fo urth day after b re aki ng fast)

,

Extreme me nt al d e p re ssio n Marke d e xcitab i lity hyste ric al in character .

,
.

W ee p s when sp o ke n to and h is vo ic e is sc arc e ly audi bl e C ompl ains , .

of gen eral we akness almost p ro stration S ensatio n of trembli ng all , .

o ve r th e b o dy D i d n o t sl ee p o ne moment d uri ng th e entire night

. .

B egi nnin g at 5 a m h e h ad thre e l o o se mo veme nt s o f th e b o wel s . .

p re ce d e d by seve re c o l ic ky p ains He attrib utes th is di arrh ea to .

wo rry C an n o t b e ar th e thought o f fo o d to day Expl ai ns h is

.
-
.

m e ntal state as b e i ng due to hi s gene ral dissati sfacti o n at h is t re at

m e nt at th e l ab o rato ry Later in th e day at h is o wn re q uest h e .
, ,

was se n t to a p rivate roo m in th e Massac h use tts G e ne ral H o sp i tal .

U p o n ad m issi o n h is c o n diti o n was full y d e sc rib e d by th e writer to

th e re si d e nt p hysi ci an an d th e vi siting p hysici an .
 A ST UDY OF P R O L O N G E D FA S T ING .

May 1 9 1 91 2 (fifth day after b re akin g fast)

,

Was se en at th e Massachuse tts G ene ral H o sp ital at 9 a m At th e time . .

h e w as sitti ng o n o n e o f th e ve ran d as re ad i ng W h il e h e still appe ared .

so mewh at emo ti o n al h e sai d h e was n o l o nge r d e p resse d but was

, ,

in a mo st chee rful state o f min d He exp resse d h is regre t fo r th e

.

tro ubl e h e h ad c au se d at th e l ab orato ry and said h e w as so n e rvo us ,

an d i rri tabl e that h e d i d n o t re al i z e j ust what h e w as d o i ng He sent .

hi s ap o l o gi es to Pro fe sso r B ene dict an d wi sh e d m e to say that h e

,

would be gl ad to g o b ac k to th e l ab orato ry and go into th e c al orimeter

agai n if it wo u ld add anythi ng to th e val u e o f th e e xp erime nt
, .

When aske d ab o ut h is c omfo rt at th e ho spital h e sai d h e was very ,

much pl e ase d wi th th e c are an d attenti o n h e was ge tting H is .

appe tite h ad re tur n e d an d h e h ad re l ishe d h is b re ak fast of B oston “

,
”
b ak e d b e ans which h e ate fo r th e first time
, .

May 20 1 9 1 2 (sixth day afte r b re aki ng fast) :

,

Th e ho spi tal re po rted that h e h ad vo l untari l y l eft th e i nstit uti o n H is .

re aso n fo r l e aving co uld no t be l earne d b ut in so far as could be ,

d ete rmine d h e h ad no gri evanc e .

October 1 9 1 91 2 (fi ve mo nths afte r b re ak i ng fast)

,

On ac c o unt of th e se nsati o nal sto ries which we re circul ate d an e ffort was ,

mad e to o b tain as much i nfo rmatio n as po ssi bl e re gar ding th e p erso nal
e xpe ri e n c es o f th e subj e ct af te r l e avi ng th e ho sp i tal He was fi rst .

q uestio ne d as to th e re aso n fo r l eavi ng th e hosp ital so ab rup tl y .

First o f all h e state d that h e was no t S i nc e re in his remark regard i ng

t h e ho sp i tal as note d un d e r t h e d ate o f May 1 9
,
His re aso ns fo r .

misre p resenti ng th e tru e conditi o n was a fe ar that h e wo uld no t get

go od tre atme nt if h e mad e an y compl ai nts He was q uite dissatisfi e d .

at th e ho sp i tal I n t h e fi rst pl ac e his p ri d e was i nj ure d in that h e

.
,

was no t given th e atte ntio n which was due an indi vi dual o f h is stand
ing . One gri evan c e was t h e fact that h e was re c o rd e d o n th e chart
”
A l ab o re r fro m th e i sl an d o f Java Ano the r was th e fact t h at
“
as .
,

al tho ugh h e was in a roo m b y hi m se lf the re we re a go o d many ro oms

,

in th e war d and h e was o bl ige d to use th e c ommo n to i l e t an d b ath

roo m S till ano the r was th e fact that th e p h ysici ans at th e ho sp ital
.

h ad n o e xpe ri e n c e in fasting an d d i d no t o rd er t h e p ro p er fo o d fo r
him Th e day fo ll owi ng hi s admi ssi o n h e w as give n milk and e ggs
.
,

and h e b e l i eve d that the se animal foo ds wo uld p o i so n h is bl o o d and

sp o i l all t h e b e ne fi ts o f t h e f ast T h e i ngesti o n of th e foo d was
.

fo ll owe d by c ramp s and di arrhea and h e th o ught h e was d el irio us

, .

T h e fo ll o wi n g mo rning (May 20 ) h e l ook e d at his chart and fi nd ing ,

h is temp e rature re cord e d at 99 d e gr ees an d h is p ul se rate 90 h e -

,

kn ew h e was be ing po iso ne d and h asti ly l eft th e i nstitutio n .

Wh en h e reache d th e stree t h e di d no t kno w where to g o i nasmu ch as h e ,

was e ntire l y unf amil i ar with B o sto n B eing a newsp ape r e di to r

.

himsel f h e tho ught h e wo uld fi nd tru stwo rt h y advice as to where to

,

g o b y c o nsu l tin g an e dito r o f o n e o f th e B o sto n p ap ers He th e n .

t o o k a c ab to th e Ofli ce o f o n e o f th e n ewsp ape rs t h e e dito r o f wh ich ,

e ng age d a ro o m fo r hi m at o ne o f th e l arge ho te l s I n his ro o m at .

th e ho te l h e was vi site d b y some o f th e staff o f th e p ap er an d talk e d

th e situati o n o ver wi th them He was surp ri se d to fi nd an acc o unt
.

o f h is f ast wi th p hoto gr ap hs of hi m se l f in th e p ap er th e f o ll o wi ng
, ,

morni ng as h e th o ught h e was sp eaking in co nfid ence and h e was

,

n o t aw ar e that p ho tograp h s were b eing t ak en .

188 A S T UDY O F P RO L O N GE D FA S T I NG .

d ear doctor you know nothi ng about fasti ng whi l e I have mad e it a
, ,
”
s ci e n tific study He co n side re d himse lf an authority qualifyi n g th e
.
,

asse rtio n by sayi n g that h e is n o w an d always has b een a stud en t that ,

h e has r e p e at e dly fast e d car e fully watc hi n g th e e ffe cts of fast ing and
, ,

that h e has stu di e d all th e availabl e writings upon th e subj e c t He .

s tat e d that hi s obj e ct in und e rtakin g th e pre s e n t e xp e rime n t was to

a ccomplish th e most compl e t e fast y e t u nd e rtak en u n d e r th e b est ,

s ci e n tific co n ditio n s possi b l e to obtain n o t for his o wn e nlight e nme n t

, ,

but to d emo nstrate to th e world b eyo n d doubt th e truth of his theori es .

He said : Th e e xp eriment I am about to u n de rtak e wi l l be of th e gre at

“

”
e st b e ne fit to ma nkind .

Upo n car eful que stio ning it wasle arned that h e had n ever u nd ertak e n
a fast und e r strict sci e n tific obs e rvation and that his r e ading had be e n in

th e main co nfin e d to n o n scie ntifi c works larg e ly magazi ne articl e s

-
, .

On th e occasio n of th e first visit it was e vid ent that h e was not o nly
willi ng but anxious to assist in e ve ry way possibl e th e work that was
b ei n g do n e He was ve ry chee rful and was plai nly pl eas e d with att en
.

tio n shown him T hi s chee rful attitud e co ntinu e d for th e first w ee k

. .

He was i nte re st e d in what was b ein g do ne and appar en tly trie d to

d escrib e his subj ec tive fee lin gs with e xact ne ss I f any att empt was .

mad e to oppos e his ide as as to fastin g his usual smil e disapp eare d ,

q uickly and h e assume d a sob e r slightly injure d air , .

On th e s e ven th day h e app e are d down cast his movements w ere ,

l ess active and h e was d e cid edly d epresse d mentally He attributed

,
.

this to th e cloudy we ath er and rain and in so far as could be d e termi ned
no oth e r r e aso n for th e cha n ge e xis te d He e xpress e d no disple asure
.

at th e ma nn e r in which th e e xp e riment was b ei ng co nduct e d On th e .

ni n th an d e l e v e n th days h e was again ch e e rful but n o t so e nthusiastic ,

as h e had b e en durin g th e first w eek and h e move d about as though,

h e felt some physical fati gu e He admi tt ed th at h e e xp eri en c ed

.

muscular w eakn e ss Any co nversatio n how e ve r whi ch was pl easing

.
, ,

to him woul d arous e hi s e nthusiasm for a short time From this time .

Up to th e tw en ty ninth day of th e fast h e was fre qu ently d epr e sse d

-
,

but always court eous and r e ady to sub mi t to th e e xami natio n On th e .

d ays wi th sunshin e h e was always more ch ee rful but at no time was h e ,

as e nthusi astic as duri n g th e first w eek He app e are d to be slightly .

fatigu e d most of th e time afte r th e first w eek His move men ts in .

pr epari ng for th e examinatio ns w e re more d elib erat e and any attempt ,

to hurry hi m was polit ely r es en te d After th e first w eek h e gradually

.

b e came more s ensitive to disco mf ort an d pain complai nin g of any ,

u nusual pre ssur e of th e st ethoscop e or press ure of th e han d s in palpat

ing th e orga ns He fre qu en tly spoke of th e annoyan c e of th e re ctal
.

th e rmomet e r and of th e adh e sive tap e us e d in r etainin g th e st e thoscop e

o n th e ch est wa l l Thi s a nnoyanc e was p l ainly shown in th e expre ssion
.

of hi s fac e and in th e careful manne r in which h e mo ve d about wh en th e

 S UB J E CT I V E I MPR E S S I O N S AND ME NT AL A TT I T UD E .

th ermome t er was in th e re ctum D uri n g th e p eriods of d e pre ssio n h e .

was fre quen tly disi n cli ne d to talk and was some time s irritabl e A t no ,
.

time how ev e r did h e obj e ct to th e e xami n ation and h e always s e e me d

, , ,

willin g to do what e ver was n e c e ssary for th e succ e ss of th e exp e rime nt .

On th e fif te en th day h e said that hi s mi n d was b e gin ni n g for th e firs t

time to b e come cl e ar ; o n th e ni ne tee nth day h e b e gan to fe e l th e de sire
to do mental work ; and from this time o n h e d e clare d that his mi nd was
co ntinually gron cl e ar er C e rtainly there was no outward e vid en c e .

of th e truth of this state men t He app e are d fatigu e d mentally and .

,

h e ne ithe r u n de rstood nor a nsw e re d th e qu e stio n s put to him so

promptly as h e did e arly in th e fast A s far as could be d e termi ne d .

the re was no such stimulatio n for study as h e had predi cte d On th e .

co ntrary h e s ee me d to be le ss occupie d with his books and pap ers .

On th e last day of th e fast h e app e are d to be ve ry sob e r and assumed

rathe r an i nj ure d air His ge neral attitude was a complai ni n g o ne . .

Th e fast was b e i ng broke n co n trary to his j udgme n t as it was harmf u l ,

to tak e food b e fore th e d esire for food had re turned Then for th e firs t .

time h e complai ne d of hi s me dical care sayi ng that whil e th e e xamin a ,

tio n s w e re made in th e most careful and pai nstaki ng ma nner n o atten

tio n had b een paid to his physical ex e rcis e an d h e had no t b een a ll ow e d
to go out in th e fre sh air as much as h e should hav e .

N othi ng was obs e rv e d at any time whi ch would l e ad o ne to suppose

that th e su b j e ct e xp e rien c e d any s ensatio n of hu nge r or any fe eli ng o f
1
distre ss in th e abdomen throughout th e entire fast .

Two hours aft e r br e akin g th e fast h e was s e en s eat e d at a tabl e

whe re h e was S lowly e atin g his fruit j uic e an d ho ne y H is e xpr e ssio n .

was down cast and his fe atur e s drawn H is voic e was w eak and h e .

S pok e with d e lib e ratio n N otwithsta ndin g his r e s e n tmen t at th e bre ak

.

in g of his fast h e willi n gly submitt e d to e xamin atio n He comp lai ne d o f .

pain in th e abdomen an d sudd en spasmodic cha n ge s in hi s e xpre ssio n

occurr e d at th e time h e said h e was havi ng pai n P a l patio n of his .

abdomen how e ve r o nly S lightly i nt en sifi e d th e discomfort

, ,
.

Tw en ty four hour s after breaki n g th e fast th e g e ne ral e xpressio n of

-

d epre ssio n was mor e mark e d Th e voic e was we ak and h e move d .

about ve ry S lowly A t this time there was no evid en c e of any physical

.

discomfort othe r than lassitud e .

On th e third day aft e r partaki ng of food h e app e are d in d e cid e dly

b e tte r spirits The re was n o expre ssio n of discomfort and h e s mi l ed
.

fre qu e ntly duri ng th e e xamin atio n His mov ements w ere n o t so .

de lib erat e He attribut e d his bad fe elings of th e pre vious days to th e

.

pain an d discomfort h e had su ffe re d an d did no t app e ar to en t e rtain

C t ti n th fif th day f th fa t c m pl ai n d f p i in t h
l
e o e piga t i um f m tim t tim n
o e s o e o a n e e s r ro e o e, o
th ixth d y f b l ch i g g a an d f di t in th abd m n th igh th d y f v abd mi nal
e s a o e n s o s ress e o e , on e e a o se er e o

p i n w hi ch di app a ed n th ni nth day af te th bo wel m v d ; n th t th day h c m pl ai ned

a , s e r o e r e s o e o e en e o
o f f l in g v y w ak ph y ic ll y a d f b i g au at d
ee er e N n te i m ad
s a f th g a t n te io
n o e n n se e . 0 o s e o e s ro -e r
c nd i ti n in th c ase f B i th aup t and B auté
o o e o re e .
1 90 A ST UDY OF P RO L O N GE D FA S T I NG .

such a stro ng f eeli ng of re s e ntment b e cause h e had b een oblige d to

bre ak hi s fast .

On th e fourth day afte r taki n g food hi s mental attitud e had e ntirely

chan ge d He was ve ry e motio nal his voic e scar c ely audibl e He
.
, .

w ept as h e talke d His han ds trembl e d and his fac e was bath e d in
.

p erspiratio n He app e are d w eak physically an d whil e h e made no

.
,

obj e ctio n to th e e xamin atio n any undue haste or u nusual pressure

,

o n th e body made hi m compla in He e vid ently f elt that h e had no t

.

b ee n given th e prop er medi cal atte ntion duri n g th e e ntire p e riod ,

although h e had refuse d at all time s to acc ept sugge stio n e xc ept that
, , ,

h e dilut e his fruit j uic e This was b e caus e th e physicia ns had n o

.

”
e xp e ri e n c e in fastin g He d e ma nd e d that h e be s en t to a hospital
.
,

where h e could get th e attentio n h e nee de d in his pre s ent sick w e ak ene d ,

co nditio n .

Th e followi n g morni n g wh e n visit e d at th e hospital his e ntir e

, ,

attitud e h ad again chan ge d He was sitti ng on a v e ra nda re adin g and

.
,

app e are d d e lighte d at s ee ing m e He was in a v e ry chee rful state of

.

min d but was still e motio nal He move d about quickly showing no ne
,
.
,

of th e prostratio n of th e pre vious day He app e are d to be v ery sorry .

that h e had b ee n so unre aso nabl e at th e laboratory was apologe tic , ,

and e xpress e d his wi lli ngne ss to re turn .

Wh en see n fi ve mo nths afte r th e fast was brok en h e app e ar e d rathe r ,

unhappy In t e lling his story it was e vid en t that h e h ad had diffe r

.

e nces with n e ar ly e ve ry pe rso n h e had come in co n tact with He was .

plainly disappoi nt e d b e cause th e world had no t given him th e reco gni

tio n due him for th e sacrific e h e had mad e for th e b enefit of ma nkin d .
 1 92 A ST UDY OF P R O L O NGE D FA S T IN G .

ditio n of hi s to ngu e and th e unpl easant taste in his mouth I t was .

his ide a that th e fast should co ntinu e u ntil this di sapp e are d an d it was
for this re aso n that h e was loath to break his fast o n th e thirty first -

l
day Al though h e se emed more fee bl e toward th e e nd of th e fast and
.

gave o ne th e impre ssio n of a man con val esci n g from a we ak enin g

illn ess y et h e was always abl e to walk without assistan c e and at no
,

time was it n e c e ssary to o m it or alt er a t est through lack of strength o n

his part On May 1 5 th e day h e brok e his fast h e suffe re d s e vere
.
, ,

colic in duc e d by th e food h e ate and although te sts w e re made th e c o n

, ,

ditio ns w er e most unfavorabl e I t had b een plan ne d to co ntinu e th e .

e xamination for se ve ral w e e ks long er i n asmuch as such t e sts would ,

obviously be of i ne stimabl e valu e for compariso n with th e fastin g te sts .

U nfortunat ely that was quit e impossibl e u n d e r th e circumsta nc e s and

an e n tire y e ar e lapse d b e for e furth e r r e cords could be obtai n e d .

Se ve ral factors i nfluen c e d th e s e l e ction of th e t e sts I n th e first .

plac e th e time was lim ite d There was o nly 1 hour daily availabl e and .

it s eeme d advisable to arra nge for as ma ny t e sts as possibl e duri ng this

hour in orde r to obtain a good mental pictur e I t was th er e fore nece s .

sary to choose S hort te sts and also thos e re quirin g th e mi nimum of

e ff ort as o ne t e st had to follow th e oth e r without paus e for re cup era
,

tio n F or exampl e prolo ng ed t ests for fatigu e wo uld have b een of

.
,

gre at valu e but the y could no t be co nsid ere d I n th e s e co nd plac e th e

,
.
,
’
fasting b e ga n a few days afte r L s arrival and littl e time could be .

d e vote d to preli m in ary trials in orde r to obtain th e b est combin atio n ,

?
an d th e program o n c e arra n g e d could no t be fundame ntally cha nge d
Aft e r co nsultatio n wi th Profe ssor R aymo nd D odge a s eri es of t ests we re ,
’
s el e cte d A fe w days e xp eri e nc e how e ver S how e d th e ne c e ssity of
.
, ,

se veral alteratio ns and th e r e vise d program was as fo llows : ( 1 ) R ote

,

memory for words ; (2) tappi ng t e st ; (3 ) stren gth t e st ; (4 ) tactual spac e -

thre shold ; (5 ) touch thre shold ; (6) free associatio n and reproductio n
re actio ns ; (7 ) associatio n reactio ns g e nus sp e cie s ; (8 ) associatio n re ac ,
-

3
tio n s noun v e rb ; (9) canc e llatio n t e st ; ( 1 0) han d writi ng ; (1 1 ) visual
,
- -

acuity ; ( 1 2) memory for words aft er 5 5 mi nute s L at er th e touch .

thre shold which was tak e n o n th e u nder part of th e low er fore arm
,

with a vo n F re y hair was disco ntinu e d o n accou n t of th e im po s ,

sibility of obtaini n g re liabl e re sults in a short p e riod of tim e Th e .

associatio n re actio n genus S p e ci es was also omitte d through difficulty -

in fi n din g su ffici en t r e actio n words of e qual simplicity I n additio n to .

th e t e sts L was r e qu e st e d to d e scrib e a l l th e dr e ams h e had o n th e pre

.

4
vio u s night This was giv e n b efor e th e visual acuity t e st All th e
. .

Th i ty d y w
l r c n i d ed u fli i nt f th ph y i l gic al te t and h wa all wed n day
a s ere o s er s c e or e so o s s e s o o e

to xc l S u i c d '
mo re e e cc s re o r .

2
A f w m in e ch an g w i tro d u c d
or es e re n e .

A u p fi cial xam inati

3 s er f th d il y c d v al d no ch ng A y te m atic exami nati n
e on o e a re or s re e e a e . s s o

of th e d ata h as no t y e t be en m ad e .

‘
S ee Appe nd ix I p 222 , . .
 T HE P S Y CH O P H Y S I O L OGY
-
OF A FA S T .

t e sts with th e exc eptio n of that Of visual acuity w e re ma d e in a smal l

1
room free from disturbi n g influ en ces .

Th e g e n e ral co n ditio n s of th e e xp erime n ts an d th e n atur e of th e

t e sts havin g b ee n de scrib e d e ach t e st will no w be tre at e d s eparate l y
, ,

fi rst as to th e particular co n ditio n s an d s e co n d as to th e re sults .

MEMORY FOR WORDS .

T en syllabl e words w ere chos en an d th es e w ere r ead twic e to

o n e-

th e subj e ct wh o r e call e d as ma n y as possibl e imme diat e ly aft e r th e

,

th e s e co n d r e adi n g Aft e r 5 5 mi nut e s th e subj e ct agai n att e mpt e d to

.

r e ca l l the se words .

FI G 23
. .
-
Mem ory te sts .

From th e curv es (figure 23) it will be s een that ther e are marke d
fluctuatio n s a circums tan c e which is always m et with in mental t e sts
,

an d which will be fou n d in all th e curv e s I t will th ere fore be o nly.

possibl e to S p e ak of gene ral t en d en cie s throughout In th e cur ve for .

i m me diat e rot e me mory (A) it will be s een that th e poor re cord ma d e

o n th e e l e v e n th day (th e thi rd day of th e t e st ) o n ly occurs o n c e agai n ,

an d that o n th e tw en ty fourth day whil e a p e rf e ct score of th e 1 0 words

-
,

was mad e 3 time s an d a l l of the m during th e last two —thirds of th e fast .

I t c an be said that although th e e arly re cords re occur fre quently

toward th e end y et th e curv e as a whole shows a sli ght genera l improve
,

men t but so s l ight that no t much significanc e c an be attache d to it

,
.

n c h to b g tt d th at tim and c n d iti n s pr v nte d tests fo th e thr h o ld o f au d i ti o n

gm a
ti sr e re r e e e o o e e r es

an s e
1 94 A S T UD Y O F PR O L O NGE D FA S T I NG .

Th e curve B , in dicati n g th e amou n t of re t entio n aft e r 55 mi nut e s , o n

th e oth e r han d , shows a mor e or l e ss st e ady improve me nt u n til ne ar
th e e nd of th e s e ri e s , and e v e n wh en th es e last trials are i nclud e d th e
general tende ncy of th e curv e is d e cide dly upwar d I n 4 instan c es , .

and the s e all in th e last two- thir ds of th e s eri es , th e rete ntio n curv e
crosse s th e rote memory curve , which mean s that o n the se day s th e
re te ntio n afte r th e lapse of almost an hour was b e tte r than th e im
me diat e me mory L , upo n b e in g qu e stio n e d , was e mphatic in hi s
. .

assura nc e that h e n e ve r thought of th e words in th e i nte rim , so that

this re lative improve me nt in re t entio n was not du e to any conscious
r ep e titio n during th e pause .

Th e instrument us e d was similar to th e tapping board d escribe d by -

1
Whi ppl e . I t consiste d of a board 1 2 cm squar e and covere d with .

aluminu m Thi s me tal is no t v e ry w ell adapt e d for th e tappi ng board ,

.
-

but it was se l e ct e d for its light ness , it be i ng thought quite probab l e that
th e t ests would have to be mad e toward th e e nd of th e e xp e rime n ts
with th e subj e ct lying do wn and th e board re sti ng o n his chest Th e .

styl us also had an alumi num poin t T h e records w ere taken o n a .

kymograph Th e tappin g las te d for 3 0 s e co nds and p eriods of 1 0

.

se co nds w ere marke d o ff o n th e re cords Th e subj e ct b ein g l eft hand ed

.
-

us e d that han d As h e was ove r se nsitive to cold during th e fast h e

.
-

wore , b esid es a h eavy wool en undershirt , a heavy dre ssin g gown, which -

adde d to th e w eight h e had to lift N eithe r th e han d no r arm was .

allow ed to re st o n th e table during th e tappin g .

Curve III (figure 24 ) shows a gradual improvemen t for th e first

h
6 days , wh en t e maximum of t h e s ri e s
e —
2 1 5 taps or about 7 taps
per se co n d was reach e d
—
Th e curv e th en d esc en ds for th e next
.

9 days , wh e n th e mi ni mum of 1 70 taps was re ache d From this .

poin t to th e end of th e s e ri e s the re is a ris e to a poin t just b e l ow th e

maximum Thi s rise is no t, how ev e r , gradual , but co n sists rather of 2
.

plat e aus , o ne of 9 th e other of 7 days , s eparat e d by d ecide d j umps and

foll ow e d by a gradual but ve ry mark e d e n d s p urt Of 4 days .

Th e i nitial improve men t c an w ell be du e to practic e in usi n g thos e

particular s ets of muscl e s , combin e d with i ncreasi n g fami liarity with th e
work Th is same ris e also occurre d in th e dyn amomet e r t ests Th e
. .

drop , how e ve r , b e gin s much soo ne r than in th e dynamomet er t e sts .

I n fact , it en d s in th e forme r wh ere it b e gi n s in th e latt e r One c an .

th erefore har dl y say that it is a matte r of muscular fatigu e Th e first .

e xpla n atio n to sugge st its e lf is a l e ss e ni n g in i n t e re st , and thi s is

stren gthene d by th e fact that th e drop occur s at that time whe n h e was
most affe ct e d by th e mo noto n y of th e routi ne work I n thi s t est l ess .

d ep en ds for improvemen t upo n th e i ncre ase in muscu l ar powe r than

l
Wh ipple s Manu al
’
of Me ntal an d Phy ical T
s ests, B al tim o re , 19 10, p . 101 .
 A ST UDY OF P R O L O NG E D FA S T IN G .

1
In g en eral , it may be said that a l though i nitial l ack of i nt er e st
and lat e r muscular fatigu e p l ay e d a ro l e , b oth factors b ei n g dire ct e d
toward a de cre ase in th e amou n t of work , y et th e wil l impu l s e towar d
th e e n d was su ffi ci e n tly gr e at to bri n g th e curv e back to its i n itia l l e ve l
an d almost to its maximum .

STRENGT H TES TS .

Th e s e t e sts imm e diat ely fo l low e d th e tappi ng te sts Th e subj e ct .

stood and re c e ive d th e dyn amome t e r o ne of th e Colli n typ e fro m th e , ,

e x p e rime n t e r and pre ssin g it re tur ne d it to th e e xp e rim en t e r

, ,
Th e .

re cor d was not e d and th e i nstrumen t re turne d Th e i nt e rval b e tw ee n .

tria l s was a b out a s e co n d Te n tria l s w er e mad e with th e l eft ha nd

.
,

FI G 25 .
—
. g
S tre n th te sts .

fol l ow e d by te n tria l s with th e right B oth in th e right han d (VII .

-
,

fig 26) and l e ft han d (V fig 25) curve s there is an i nitial fallin g o ff

.
-
, .
,

which is more marke d with th e ri ght han d T h e l eft han d curv e .

-
,

howe ve r co ntinu e s to fall to th e t enth d ay when it take s a de

, ,

ci d e d drop whil e th e right han d curv e d e cline s more gradual l y to th e

,
-

nin th d ay wh e n it re ach e s its mi nimum

,
B oth curv e s th en ris e to a .

maximum which is r eache d by th e l eft ha n d o n th e sixt eenth day an d

,

by th e right han d o n th e tw e l fth d ay (th e r e cor d of th e first day no t

b ein g co n sid e re d in sp e akin g of thi s maximum) Th e curv e s the n .

fal l th e l eft much more tha n th e right e sp e cial l y in th e middl e of th e

, ,

s e ri e s th e forme r re ac hi n g its mini mum o n th e thirty fi rst day B oth

,
-
.

1 Ag in t th i u gg ti n i th fac t th at o th tests di d n t h w th i lac k f inter t but it i

a s s s es o s e er o S o s o es , s

qui te po i bl th at th i nte t v ari ed wi th th e different tests

ss e e res .
 THE P S Y CH O P H Y S I O L O G Y
-
OF A FA S T .

curve s S how a S light en d spurt This is as a glan c e at th e curv e wi l l

.
,

S how ,
mere ly a rough picture the re b ei n g d e cid e d ris es an d fal l s
,

throughout .

’
I n i n t e rpre tin g th e c u rv e it must be re memb er e d that L s l e ft ha n d .

is th e practic e d han d an d it c an th ere fore be assume d that th e muscl e s

of that han d are th e stro n ger In fact th e re sults mak e this more than
.
,

an assumptio n for th e r e cord of this ha n d is at a ll tim e s d e cid e d ly

,

b e tt er than that of th e right han d Th e i ni tial falli n g o ff is what o ne

.

must e xp e ct wh en th e subj e ct is n o t accustome d to th e particul ar

muscul ar e x e rcis e Th ere is a gr eat ex e rtio n at first and th e muscl e s
.
, ,

skin an d subcutan e ous tissu e fe e l th e u nusual strai n for s e v e ral days

,
.

Th e muscl e s l e ast accustome d to e x e rcis e are th e most aff e ct e d an d ,

FI G 26 . .
— g
S tren t h tests .

for this re ason th e right ha n d r ec ord dr ops more than that of th e l e ft

-

han d The n th e musc l e s gradually re cove r and th e eff e ct of practic e

.

b e gi n s to app e ar A cti n g agai nst th e practic e is th e i ncre asi n g fatigu e

. .

Th e right han d b ei n g th e u nus e d ha n d give s practic e mor e cha n c e for

its i nflu e n c e an d although fatigu e ne v e r a ll ows th e curv e to re ach its
’
first d ay s re cor d y e t th e drop which soo n b e gi n s is much mor e gradual
, ,

as has b een poi nte d out than it is with th e l eft han d which shows
, ,

more cle arly th e e ff e ct O f fatigu e .

Th e diffe ren c e c u rve s (V I an d V III ) which w e re obtain e d by su b ,

tracti n g th e ave rag e of th e last thr ee re cords of e ach d ay from th e

av e rage of th e first thr ee h elp to stre n gth en th e co n clusio n s j ust
,

d rawn Th e ris e of th e d iffer en c e curve at th e same time as th e fa l l

.

of th e main curve me an s of cours e i n cre asi n g fati gu e wh ich S hows

, , ,

its elf in a gr e ater and gre ate r d rop towar d th e e n d of th e d ai l y s eri e s .

 A ST UDY OF P R O L O NG E D FA S T I N G .

This ris e in th e two di ff e re n c e curv e s is relative ly about th e same ,

whi ch me an s that th e d aily i ncre as e in fatigu e is re latively th e same

for th e two han ds Furthe r if we glan c e at cur ve s I X and X fig
.
, ,
.

2 7 we fin d additio n al i n d icatio n s in th e same dire ctio n

,
This curve .

is plotte d from th e first of th e daily s eri e s of 1 0 tria l s This trial is .

l e ast a ffe cte d by fatigu e an d the refore shows th e gr e at e st influ e n c e of

practic e H e re the re is a gradual ris e for th e right ha nd u n til ne xt to
.

th e last day whil e th e c u rv e for th e l e ft ha n d b e gi n s to drop whe re

,

it should according to our a nalysis .

I n g e n e ral we may th e re for e say that fatigu e app e ars in both ha nds
,

e arly in th e s e ri e s T h e curv e for th e l eft ha n d d rops far b e low th e

.

re cord of th e first few d ays Th e curv e for th e right hand shows l ess.

drop due to th e gr eate r i nflu enc e of practic e so that th e two curve s

, ,

t en d to approach o n e a nother .

FI G 27 — S tren th tests
. . g .

A pair of divid ers with wooden tips w e re use d as an aesth esio m eter .

Th e thr e shold was found o n th e volar sid e of th e fore arm about 4 ,

i n che s from th e e lbow Th e poi n ts w e re appli e d o n either side of a

.

re d ink dot which was mad e o n th e arm o n th e first day an d re ne w e d

-

when ne c essary Th e me thod of mini mal change with asc en din g and
.
,
”
d e sc en din g serie s was employe d ; 5 trials e xcludi n g o ne point ve xie r
,
“
,
-

trials w e re made at e ach distanc e ; 4 corr e ct out of 5 was co nsidere d

,
?
th e thr e shold
F or th e first few days th e curv e (X I fig 28) keeps th e hi gh l e ve l of 7 , .

cm On th e s e v en th day there is a drop to

. cm then a slight ris e to a .
,

l e vel of 6 cm and a hi gh thr e shold of

. cm o n th e fo urt een th day , .

fol l ow e d by a fall to th e minimum of 5 cm o n th e tw enty s eco nd day .

-
,

which minimum is agai n reache d o n th e tw en ty sixth and thirti e th -

I t h ad b e n i nte n d ed to c all 3 o u t o f 5 th e co ec t th re h o ld bu t t h i wa n t f und feasi bl e

1
e rr s , s s o o .

Th e th resh ld i p babl y too h igh bu t f

o s ro th p nt p ur po
, wh ere th ch an g an d no t th e
or e r ese se , e e

abso lu te th r esh ld is b i n g i nv
o tig ate d th is d oe n o t m atter
e es , T h e cur v sh o w no re co d f
s th e . e s r or

f urth and fif th d ay T h e expe rim ente w as abse nt o n th ese d ays and th e ph ysician wh o kin dly
o s . r

vo lunteered his rvices di d n t dee m him lf su ffi ci ntly ski ll ed in this particular test to undertake it
se o se e .
200 A ST UD Y OF P R O L O NG E D FA S T IN G .

Th ere is howe ve r a ve ry low minimum in th e s e co nd half of th e curve

, ,

an d a d e cid e d drop from th e maximum of th e thirty fi rst day One c an -

.
,

the re fore h ardly sp e ak of an improve me n t T h e most that c an be

,
.

sai d is that towar d th e en d of th e fast th e subj e ct was agai n a b l e to

r e ach th e maximum r e cord of 1 0 digits o b tai ne d ne ar th e middl e of
th e s e ri e s From curve B we se e that o n th e third day a mistake was
.

ma d e at 4 digits y et th e re t entio n is 9 digits ; o n th e e le ve nth day a

,

mista k e at 4 di gits an d a re t e ntio n of 8 e tc I t s eem s fair to assume , .

from the s e re sults that curv e B r epre s e nts in a rough ma nner th e d e gre e
of atte ntio n I t is o nly i n atte n tio n that c an pro d uc e re sults lik e th e
.

a b ove Curv e B shows a de ci d ed rise to th e eightee nth day when it

.
,

re ache s a maximum and although it follows a low e r l e vel from thi s day
,

it ne ve r re ache s th e min imum of th e fir st thir d O f th e s e ri e s One may .

th e re fore say that th e re is an improve me nt in th e stat e of atte n tio n at ,

l e ast for this e xp e riment as th e fast progre ss e d , .

ASSOCIATION TES TS .

Th e free associatio n e xp e riments co nsiste d of th e daily pres entation

-

of a list of 20 words which w ere s e le cte d pri n cipa l ly from th e lists pre
,
1
pare d by Woodworth an d We l ls and with th e e xc e ptio n of th e list ,

of May 9 which was a re p e titio n of that of April 1 1 th ey w er e all

, ,
?
di ff e r e n t S e ve ral days aft er th e te sts w ere b e gu n it was thought
a d visable in orde r to make th e li sts as u niform as possibl e to have
, ,

th e m compos e d of an e qual numb er O f v erbs co ncre t e nou ns a d j e ctive s , , ,

an d abstract n oun s in th e ord e r give n Thi s arra nge me nt was

,
.

a dh e re d to from A pril 1 8 to th e e nd of th e t ests with th e e xc eptio n of ,

May 9 Th e words w ere r e ad aloud by th e exp erimen t e r and th e time

.

tak e n with an ordi nary stop watch Th e r eproductio n e xp e rime nts -

.

fo ll ow e d the s e with o nl y a pau se of a minut e Although th e subj e ct .

was tol d that h e nee d no t rep e at th e same wor d if it did no t come at ,

o n c e y e t th er e is little dou b t that his e fforts w ere always dire ct e d

,

towar d that e nd L ha d a goo d comma nd of th e E nglish l a n guage

. .
,

a l though it is no t his n at iv e to ngue but at time s h e had difficulty in ,

fi n d i n g th e wor d h e want e d In such cas e s h e mad e a ge sture as soo n .

as th e i d ea came to him an d th e watch was s napp e d at that time rathe r

tha n whe n th e E nglish wor d was fou nd This me tho d of proc e d ur e .

was no t oft en ne c e ssary and it s ee me d a l e gitimat e me a ns of ba l an cin g

th e s l ight dis adva n tag e h e ha d as a for ei gner A re s e rv e list was pre .

pare d u p o n which to d raw wh en h e did no t u n d erstan d th e word of th e

mai n l ist .

T h e curv e (X III fig 29) is plott e d from th e dai l y ave rag e

,
. Th e .

av erage was us e d in or d e r th e b e tt er to i n clud e th e i nflu en c e of th e

l
W dw th a d W ll A o ci ati n T t P yc h M
oo or n e g
s, 191 1 3
ss o es s, s . o no .
, , .

2
T h li ts wi ll be f und i App nd ix I pp 222 229
e s o I a f w in t nc
n eth am w d appear s
I, .
-
. n e s a es e s e or

i n tw l i t
o s s .
 TH E P S Y CH O P H Y S I O LO G Y
-
OF A FAS T . 20 1

lo ng time s which might ve ry w e ll be o f 1 m po rtan ce in th e s e t e sts ? Th e

,

few e xc e p tio n a ll y l o n g time s such as 20 s e co n ds w hi ch may hav e b ee n

, ,

cau se d by e motio nal comple x e s w e re no t i n clu de d , .

Th e curve b e gi n s with ve ry l o n g re actio n time s L h ad ne ve r . .

p erforme d such t e sts b e fore so that th e sudd en drop o n th e thir d d ay

,

FI G 2 9
. .
— F re e asso ciati on te sts.

FI G 30. . A ci ti n t t
— sso a o es s . R ea tci no s to v b
er s an d n o u n s .

1
The m e d i an , w h ich w a alsc lc l so a u ate d gav
, e th e sam e g e n er a l curv e .
 A S T UDY O F PR O L O NGE D FA S T I N G .

must be attribut ed to th e practic e improv ement whi ch at this e arly ,

stage coul d ve ry w e ll be sudden and of co nside rabl e amou nt , rather

than to th e fact that it is th e fir st day of th e fast From thi s poin t th e .

curve d e sc e n ds with a few bre aks to th e fiftee nth day when it re ache s ,

s e co n ds ; it th en ris e s to th e tw enty s e co nd d ay when it re ache s th e

-
,

maximum (if we do n o t co nsider th e fir st few days ) and then falls to th e

e n d of th e s e ri e s
. On th e s e co n d from th e last day it r e ach e s th e m in
imum of s e co n ds Also th e re cord of
. s e co n ds is Obtain e d 3 tim e s

FI G 3 1 . .
— Asso ciati on te sts. Reac t i o ns to adj ec tive s.

FI G 3 2
. .
— As o ciatio n tests
s . R e ac t i o ns to abst act no un
r s.

in th e se co n d half of th e se ri es I f we i n clud e th e first few days it c an

.

be said in gen eral that the re is a ve ry de cid e d b e tte rm en t in th e associa

tio n time s ; and e ven if o ne calculat e s from th e thi rd day the re is an
appre ciabl e drop E sp e cially in te restin g is th e almost st e ady improve
.

men t shown in th e last thir d of th e curv e .

I n ord er to an alyz e th e curve furthe r , separate curve s (X I V , XV ,

XV I , an d XV II , figs 30 to 32) have b ee n plotte d for e ach of th e four
.
2 04 A ST UDY OF P R O L O NG E D F A S T IN G .

tio ns w ere o n th e whol e rapid ave raging about 1 s e co n d and dr oppi ng

, , ,

as low as s e co nd As th e numb e r of fals e repro d uctions was very

.

small (see I tabl e amountin g to o nly 23 in 680 re actio ns or 3 per

, ,

c en t an d ne ver more than 3 in o ne list an improveme nt or th e revers e

, ,

in this r e sp e ct would me an littl e A t l e ast o ne c an say that th e quality

.

O f r e productio n suffe re d n o d e t e rioratio n with th e progr e ss of th e fast ,

but that r e te ntio n was e qually as good at th e end as at th e b e gi nning .

q nh n e nt

No . of test .

duc fi o ns
 T HE P S Y CH O P H Y S I O L OGY-
OF A FAS T . 205

Th e quality of th e associatio n r e actio ns was of high gra d e throughout

th e mai n t e st (1 1 tabl e ,
Ther e w er e no s e ns el e ss or pur e sou nd
re actio n s and v e ry few re p etitio ns Syno nym s word co m po un dings .
,
-
,

an d mi su n d erstood stimulus wor d s occurr e d s e l dom and w e r e scatt er e d

” “
throughout th e days Th e word woma n app ears a n umb e r of tim es
.

“ ”
an d m an sli ght l y l e ss O ft en Th er e was a l so e vi d e n c e of a r e l igious
.

compl ex An exami natio n of th e differ e nt cat egori es did n o t S how suffi

.
~

ci ent cha ng e to warran t an a nalysis or tabulatio n as to quali ty I t was .

thought that th e i n troductio n of wor d s d e sign ati n g food might pro

duc e d e laye d r e actio n s both with th e word its e lf and th e words imm e di
at ely fol l owi n g This was no t th e cas e For exampl e o n April 1 6 we
. .
,

fi n d e gg whit e -
s eco n ds ; o n April 1 9 ome l et eat s eco n d s ; o n -
,

April 2 1 fi sh se a -
s e co n ds ; o n May 7 ca ndy sw e et
,
s e co n d ; o n -
,

I 7 /8 20 l l 8 2 23 2 4 85

FI G 34
. .
— C o nt o ll e d
r asso ci ati o n te st s .

May 9 appl e fruit -

s e con d ; o n May 1 0 roast me at 1 s e co n d ; o n
,
-
,

May 1 3 chocolat e sw ee t 1 s e co nd N o n e of the s e re actio n s w er e

-
, .

follow e d by u nusually lo ng re action time s I t might be of in t er est to .

me ntio n at this poin t th e u nusually lo n g re actio ns which poin t to com

pl ex e s On April 1 3 we fin d puls e han d 9 s e co nds ; o n April 2 1 d e ath
.
-
,

e t e rn al , s e co nds ; and o n April 26 u n c ertain ty p en dulum -

,

s e co n ds The s e are th e o nly e xtre mely lo ng re actio n time s Th e

. .

n ext lo n g e st is 6 s e co n ds All of th es e de laye d re actio ns may be

.

e xplai n e d from th e sam e caus e L had asse rt e d that th e chie f factor

. .

for a succ e ssful fast was faith and co n fi d enc e and absolut e lack of fe ar .

He thi nks it is th e f e ar combine d with exposure which caus e s d e ath

in shipwr e cks and oth er calamiti e s wh e re food is no t obtai nabl e an d no t ,

th e actual lack of food I t is also claime d that thos e wh o fast fre qu en tly
.

cove r th eir mirrors in orde r that the y may no t be disturb e d by th e

e vi d e n c e s of e maciatio n On e of th e suppose d dan ge rs in fastin g is
.

’
he art failure I f L S he art had show n a l armin g symptoms th e fast
. .

would hav e b e en t e rmi nat e d at o n c e I t do e s n o t the refore re quire .

, ,
206 A S T UDY O F P R O L O NGE D FAS T I N G .

a stre tch of imagi nation to suppose that L woul d k ee p his min d from .

such subj ects as de ath an d u nc ertain ty an d that h e would e ve n avoid

thought of th e co n ditio n of his h e art and that th e mentio n of the s e
words woul d caus e he sitation .

Th e d e te rmi ne d associatio n re actio n n oun verb was be gun o n th e -

e ighth day .Curve XX (figur e 34 ) re se mbl e s that of th e ve rb curve ,

e xc e pt that th e ris e co ntin u e s lo n g e r I t starts ve ry low ( 1 s e co n d )

.
,

in cre ase s with rathe r large daily fluctuatio ns and on th e last day of th e ,

fast re turns to se co nds A partic u larly disturbi n g factor in thi s

.

se ri e s was th e fact that the re was an e ver in cre asi ng difficulty to obtain
-

appropriate words A t first th e words had obvious associatio ns

. .

The y w e re n ame s of commo n obj e cts su ch as dog gun eye etc but , , , , .
,

more u nusual words had to be e mployed in i ncre asing numb e rs and ,

the re see ms no doubt th at this circumsta nc e was at l east partly th e

caus e of th e i n cre asi ng len gth of th e re action time I t is e v en more .

importa nt in th e d e te rmi ne d than in th e free associatio n e xp e rime nts -

,

to have th e qu ality of th e words th e same and not more di fficult .

F or lo ng se ri e s of t ests th e free associatio n exp eriments are much to

-

be pre fe rre d .

CANCELL ATION TEST .

S p e cial forms w e re mad e for thi s te st , co nsisti ng of typ e- writt e n pi e d

te xt of 1 00 a s an d 5 0 of e ach of th e oth er l e tt ers of th e alphab e t A
’
.

diff e re nt combin atio n was made e ach day, so that th e subj e ct should
n o t b e com e accustome d to th e ord e r L was re qu este d to ca nc e l all
. .

th e a s
’
He use d hi s l eft ha nd and th e tim e was tak e n with a stop
.

watch S p e ci al car e was obs e rv e d to have th e illumi natio n co nsta n t

.

and th esame p e n cil was e mploye d .

Th e curve (XX I fig 3 5 ) re pre s e nts th e time for th e compl e tio n of th e

,
.

task As in some of th e other curve s SO here we have th e i nitial rise

.
, ,

whi ch co nti nu es to th e sixth day whe n there is a sudd en drop to a

,

l ev el which slop e s slightly to a nother sudde n drop o n th e twen ty ni n th -

day an d a ve ry low l e ve l for th e final days Th e differenc e b e tw e en th e .

maximum of 3 mi nute s 4 8 s e co n ds o n th e sixth day and th e mi nimum

of 1 mi nu te 5 3 s e co n ds o n th e last fast day 1 s v e ry co n siderabl e Th e .

maximum is over dou b l e th e mi nimum and e ven if we compare th e ,

minimum with th e i ni tial time of 3 minute s 7 s e co nds or with 2 min

ute s 4 3 s e co n ds O f th e s eventh day which is th e fir st an d largest
,

practic e dr op we still fi n d a ve ry co nsid era b l e di ff e ren c e Th ere d o e s

,
.

not s eem any doubt th erefore that there is v e ry much of a b ett erment
, ,

in th e time as th e fast progr e sses and that this d e cr e as e in th e time

co ntinu e s to th e en d of th e s e ri e s N or is thi s improvement in time
.

gai ne d at th e sacrific e of accuracy A t n o time w er e there ma ny .

mistak e s made (se e III tabl e I n fact th e d e gree of acc u racy was
, ,

always so high that we c an no t plac e any importan c e o n th e S l ight

2 08 A ST UDY OF P R O L O N G E D F A S T IN G .

out of th e ten trials ? Th e alt eratio n in th e positio n of th e E fo l low e d

n o d e fi nit e ord e r but e v e ry m e a n s was us e d in this r e spe ct to co n fus e
,

th e subj e ct in or d er to r e move all possibi l ity of hi s gu e ssi n g th e positio n .

Most of th e j udgmen ts w ere ma d e without he sitatio n both at th e ve ry ,

l ow an d ve ry hi gh thresholds .

Th e cur v e (X II fig 28 ) r epres ents th e daily thr e shold in f ee t

,
. .

Th e re is a ve ry rapid ris e from th e fif th to th e fourt ee n th day whe n ,

th e maximum of 3 7 fe e t is re ach e d Then the re fo l lows a drop to 24 .

fee t and a ris e to 36 fe e t o n th e n e xt to th e last d ay of th e fast Th e .

thirty fourth d ay shows a drop to 1 9 f e et Th e re cor d of th e fi fth

-
.

day is 1 6 fee t which is th e mini mum ; that of th e thirty s e co n d day is

,
-

3 6 fee t which is 1 foot l e ss tha n th e maximum

,
This d i ffere nc e of 20 .

fee t is ve ry gre at for visual acuity He saw twic e as far at th e end .

of th e fast as h e did at th e b egi nni n g .

Owi n g to an attack of coli c re sultin g from th e natur e of th e first foo d

tak e n aft e r th e fast and th e su b s equ e nt withdrawal from th e labora
tory it was impossibl e to co nti nu e th e t e sts d uri n g th e re cup e rative
,

p e riod as had b e e n pla nne d Only by la te r t e sts for compariso n could

,
.

a d e cisio n be re ach e d as to th e e fficacy of fasti n g One ye ar afte r th e .

te sts j ust de scri b e d L vo l u nte e re d as subj e ct for a short s erie s of te sts

. .

Th e se wer e co nduct e d at th e H arvard P sychological L aboratory an d

e xt e n d e d ov e r a p e riod of 6 co n s e cutiv e days I t was no t possi b l e to .

’
arra n ge for the m to tak e plac e at 5 o clock as pre vi ously and 1 0 O clock ’

in th e morning ha d to be chos e n Al l th e other co n d itio n s w er e .

obs e rv ed as clos e ly as poss ibl e Th e same t ests with th e e xc e ptio n of .

,

th e visual acuity t e st and th e ha n d writin g t est w e re p e rforme d

- -
,
.

L s ee me d in good h e alth He w eigh e d about 1 26 pou nds which is

. .
,

somewhat l e ss tha n h e w eighe d whe n h e b e ga n his fast H is physical .

app e ara nc e was how e ve r v e ry much th e same as o n th e day h e arrive d

, ,

at th e N utritio n L aboratory He had remai ned in Am e rica duri n g .

th e pre vious y e ar e n gag e d in me dical studi e s l e cturi n g e tc

,
ha d , , .
,

n o t fast e d agai n and had had n o i l l ne ss du ri n g that tim e

, I n com .

ing to th e laboratory h e mad e a j ourn ey of 4 mil e s and had alr e ady

’
had s e veral ho urs work havin g risen e ach day at 5 o clock e x ercis e d
’
, ,

for half an hour an d mad e s ev eral visits Th e co n ditio ns pre vious to

,
.

th e t e sts are th er e for e hardly comparabl e to thos e of th e forme r s e ri e s

, ,
.

I t is e vide n t how e ve r that h e was as strenuous if no t more so than h e

, , , ,
’
ha d b ee n up to th e lat er hour of 5 o clock of th e pre vious te sts .

T h e rot e memory for digits (II A) was some what poor e r tha n it was
duri n g th e l att e r part of th e lo n g s e ri e s I t d i d n o t re ach th e maximum .

1 L c k f ti m p v nt d th th h ld be in g tak n in th v
a o e re e e edi cti n T h t t to o k
r es o e e re erse re o . e es s

5 t 1 0 m i ut
o n e s.
 TH E P S Y CH O PHYS I O L O G Y
-
OF A FAS T . 209

by two numb ers y e t it did no t S how any poor score s Th e curve (II B )
,
.

which repre se n ts th e first mistak e or as it was suppose d a b ov e th e

, , ,

state of att en tio n S hows an improv e ment ov er th e latter part of th e

,

first s eri e s in that it do e s no t drop so far On th e othe r ha nd th e rote .

,

me mory for words (I A ) s ee me d as good if no t b e tt e r tha n duri n g th e

fast I t r eache d th e forme r maximum o n th e fourth day and n e ver
.

dropp e d b e low eight words Th e me mory aft er 55 mi nut e s (I B ) was

.

as good as th e imme diate me mory F rom the se re sults it may be .

’
co n clud e d that th e me mory was still aft e r th e y e ar s int erval at about
, ,

th e l e ve l that it was at th e e nd of th e fast .

Th e curve (III ) for th e tappi n g b e gin s co n sid erably high e r tha n th e

maximum of th e fastin g t e sts and although it drops somewhat still it
, ,

re mai ns above th e former maximum Th e dr op in th e diffe ren c e .

curv e (I V) is cause d prin cipally by a falli n g o ff in th e i nitial spurt .

This is co nclud e d from th e fact that th e re sults of th e last 1 0 s e co nds

vary much l e ss tha n those of th e first 1 0 .

Th e r e sults of th e fi rst day of th e tactual spac e thr e shold can no t be

utiliz e d as a compariso n (X I ) Th e un usually hi gh thre shold was
.

u n doubt e dly cau se d by i n att e n tio n o n th e part of L wh o admitte d .

,

that h e had b e e n v e ry much worri e d ove r an appoi ntme n t h e had b e en

forc e d to miss an d upo n whi ch hi s mi n d had b e en durin g the s e t e sts .

Apart from this d ay th e curve has th e sam e form it ha d duri n g th e l att er

part of th e pre vious trials Th e s e co nd an d third days S how th e mini
.

mum which was last re ach e d o n th e thi rti e th day of th e form er trials
,
.

T h e dyn amome te r us e d in th e pr e vious t e sts could n o t be O b tai ne d

u n ti l th e s e co n d day Th e re are there fore o nly 5 re cords Th e
.
, , .

curve s for both th e right han d (V II ) an d th e l e ft ha nd (V ) b e gi n with

very high re cor d s and drop co n siderably o n th e s e co n d day j ust as they ,

did in th e forme r s e ri e s The s e fi rst re cords are v e ry much b e tte r than

.

any mad e in th e pre vious trials E ven aft e r th e drop th e right ha nd

.

twic e surpasse s th e pre vious maximum and re main s close to it o n th e

othe r days Th e differen c e curv e s (V I an d V III ) S how that o n th e first
.

day th e high r e cord for th e l eft ha nd was mad e by a sustai n e d e ff ort .

Th e right han d spurt cause d fati g ue toward th e e n d

-
Th e larg e dif .

fe ren c es d u ri ng th e ne xt 3 days for th e l e ft ha n d we r e cause d by spurts

followe d by fatigu e that of th e right ha nd by fatigu e I t is s ee n that
,
.

th e str en gth of th e muscl e s of th e ha n d had v e ry much incr e as e d si n c e

th e e n d of th e fast and j udgi n g from th e first day s re sul ts was much ’
,

gr e ate r tha n at th e b e gi nn in g of th e fast One acqui re s a k n ack in .

gri p p i ng th e i nstrumen t an d it may be tha t this was carri e d ove r from

th e forme r te sts an d mad e th e s e i nitial r e cords hi gh e r tha n thos e of th e
y e ar b e fore I n othe r words some of th e e ffe ct of practic e was still
.
,

pre s e nt and i n flu en c e d th e re su l ts much more tha n it did whe n it had

th e op p osi ng e ffe ct of fatigu e .
21 0 A ST UD Y OF P R O L O NG E D FA S T ING .

Th e free associatio n re actio n time (X III ) b egins at th e low poin t

-

O f th e last day of th e pre vious se ri es ; o n th e third day it re ache s th e

short est time of that se ri e s and agai n o n th e fifth day and o n th e last ,

day it falls almost o ne fifth of a s eco nd b elow t h is poin t That is th e -

.
,

curve co n ti nu e s th e desc ent it b e gan in th e middl e of th e forme r s eri es

in as r eg ular a ma nne r as if a y e ar had n o t i nt erv e ne d I nasmuch as .

some practic e was ne c e ssary afte r so lo ng an i nte rmissio n it may be ,

said that th e re actio n times we re b e tt e r tha n the y w ere at th e e nd of

th e fast Th e m V (XV III ) was
. s e co nd o n th e first day and
. .

se co nd o n th e sixth with an almost st eady de cli ne ,

.

T h e ave rage r eproductio n time (X I X ) is s e co nd for all th e days ;

this is ve ry low and although s e co n d was re ache d 3 time s in th e
,

former te sts it is safe to co nclud e that th e reproductio n times are at

,

l east as good as the y w ere at th e end of th e fast I n fact th e ave rage .

,

for the se days is b et te r than for any 6 co ns e cutiv e days of th e pre vious
”
te sts There was o nly o ne fals e reproductio n and that was wro ng
.
“

“ ”
for bad I n vi e w of th e fe wne ss of th e trials littl e would be gai ne d
.

by an a nalysis of th e re sults accordi ng to cat e gori e s X I V XV XV I , , ,

XV II Th e noun an d adj e ctive curve s are low er tha n th e verb and

.

abstract curv es Th e quali ty of th e re actio n s is about th e same

. .

E vid en c e of a re ligious or mystic compl e x is as plai n he re as in th e pre

” ” ” “ “
vi o u s re sul ts God was th e re actio n for adore worshi p
“
.
, ,
“ ” ” ”“ ” “ ” “ “
u ns ee n me rcy , D ivi ne and I nfin i te, supreme gave , ,
” “ ” ” ” ” “ “
B eing sacred gave church
,
adorabl e gave sai nt lif e
“
, ,
“

” ”
gave e te rn a l and orn ame nt gave church
“
,
“
There w e re no v e ry “
.

lo n g re actio n time s In co nne ctio n with th e pre vious comple x it may

.

” “ ”1
be m e ntio ne d that d e ath was th e re actio n word for fe ar .

Th e re actio n n ou n v e r b (XX ) b e gi n s at th e av erage of th e thirty

-

se co n d day of th e forme r s eri e s and o n th e third and fourt h day re ache s

th e mi nimum of th e n e xt to th e last day of th e lo n g se ri e s T h e ave rag e .

O f th e se days is ve ry much b e tt e r tha n that of th e last d ays of th e fast

se ri e s or e ven of th e first days so that the re is n o doubt of an improve ,

ment in the s e re actio ns .

Th e ca n c e l latio n t e st (XX I ) b e gi ns at about th e poi n t of th e twe nty

s e v enth day and th e time gra d ual l y d e cre as es but at th e six th day ,

has no t re ache d th e rapid time of th e last fast day ; but j u d gi ng from

th e slop e of th e curv e o ne would e xp e ct it to do so shortly so that o n e , ,

c an co n clud e that th e m e n tal fu n ctio ns n e c e ssary for this t e st are in

about th e same stat e they w ere at th e e nd of th e fast There were o nly .

6 mistak e s 4 of th e m b ei n g o n th e fi rst d ay
, .

I t w a th u gh t th at a y a i nt m i i n w uld m ak th ld li t equival t t n w and

’
1 o e r s er ss o o e e O s s en o e o n es
s

as o n w u ld th
e b ou f h vi n g th li t f th i
en i f th am quali ty wi th th
e s re o a f th e s s o s se r es o e s e o se o e
f m th ld li t w u d n th fi t day bu t 7 f th 20 eacti n w th am a th o se
or er , e o s s er e se o e rs , o e r o s e re e s e s

m ad a y a ag
e th at n w li ts w
e r m ad
o , so e s ere e.
21 2 A ST UDY OF P RO L O N G E D FA S T I N G .

coul d say with e qual w eight that th e fatigu e followi ng th e u nusual

e x e rtio n was th e caus e Only th e most r e l iabl e i n trosp e ctio n o n th e .

part of th e subj e ct b efore an d aft er e ach te st could have give n stre n gth
to such e xpla n atio ns and both th e lack of time an d trai ni n g o n th e part ,

of th e subj e ct mad e such a proc e dure impossibl e .

I t did se e m po ssi b l e how e ve r to mak e an e xc eptio n of th e days on , ,

whi ch L took a dr ive or was allow e d o n th e roof and that if th e curve s

.

show e d an agree me nt in th e ir fluctuatio ns o n th e s e days an u ne quivocal

e xpla natio n could be fou n d Th e drive s w e re tak e n o n th e fourt ee nth .
,

se ve n te e n th tw en tie th tw e nty se co n d twe nty fourth tw e nty ni nth

, ,
-
,
-
,
-
,

thirty fi rst and thirty s e co n d days ; th e visits to th e roof o n th e te nth

-
,
-
,

fif te e nth twe nty first an d thirti eth days As was state d above th e re
,
-
,
.
,

was no ge ne ral agree ment e v en o n th ese days In regard to th e i n divid .

ual curv e s how eve r th e visual acuity c urv e s ee me d to S how th e i nflu enc e
, ,

of th e drive s Th e b e st resu l t in th e visual acuity te st was mad e o n th e

.

first dri ve day and th e curv e always asc e nds o n th e driv e days although ,

not always to a p e ak I t falls how e ve r o n all but o ne day whe n a visit .

, ,

was mad e to th e roof ; that it ris e s o n th e drive d ays is co ntrary to what

o ne would e xp e ct and is difficult of e xpla n atio n S i n c e th e subj e ct s e y e s
’
,

shoul d if a n ythi ng have be en fatigu e d b y th e i n cre as e d light I f th e re

, , .

had b e en a stimulatio n of th e c entra l proc e ss e s causi ng a h eighte ne d

po we r of discrimi natio n thi s ought to have i nflu e n c e d th e othe r curve s ,

as w e ll .

GENERAL SUMMARY AND CONCLUSIONS .

Th e fact that a huma n b ei ng could live for a mo n th or lo nger without

food had alre ady b ee n satisfactorily prov e d ? Merlatti is report e d
to hav e faste d for 50 days and D r Ta nner for 4 0 d ays Th e fast of . .

2
S ucci is most similar to that of L in that it was u n d e rgo ne for about .

th e same l e n gth of ti me and u n d e r similarly strict s ci e n tific co n trol ,

although ne ve r b e fore had quit e so ma ny pre cautio n s b ee n tak e n as

in th e cas e of L S ucci fast e d for 3 0 d ays but took p epto n o n th e
.
,

twen ty se ven th day L co nti nu e d for o ne day lo ng er absolut e ly

-
. .
,

n othi n g but disti l l e d wat e r passi n g his lips durin g that time B oth .

m e n r e mai ne d in good physical co n ditio n thr oughout and s ee me d at

n o tim e to su ff e r an y u nusual discomfort I t was with difficu l ty that .

L was p e rsua d e d to disco n ti nu e his fast o n th e thi rty fir st day

.
-
.

Although Lucia ni doubt e d that Succi was mentally normal ge ne ral ,

O bs e rvatio n s an d th e te sts poi n t e d to a sou n d mi n d in th e cas e of L .

B oth m en w ere n atura l ly m e n of gr e at d et e rmi n atio n and above a l l of

, ,

E B a di in h i a tic l L a Fai m ( C h Ri ch t D i c ti nnai e d Ph y i l gic 1 9 04 6 p

’
1
. r er , s r e . e s o r c s o o , , , .

re ma k i r g a d t v lun ta y and i v l unta y fa t

s n re r o On p u a o u m tt v l ntai m n t
r n o r s s: o rr sc so e re o o re e

a u n j fi n p l gé c m m l xpé i f i é té te t ée t du a facil m nt
’
e e ro o n a plu i , o e c r c n ce e n s er s o s n . c en rer sses e e

l
es so ufl a d c la fai m L be i d c m ang
'

r nc e s a d au ta t m i d ul u ux d autant plu
. e so n er sc r
’
n o ns o o re ,
’
s
f i l a upp te q u i l u ffi d un sign p et mi n fac d un u ccul nt pa A u c nt ai e
ac e S or r
’
s ra
’
e o ur re se e
’
s e rc s . o r r ,

la f aim a b au c u p pl u pé ni bl m anif t ti beau p pl u d ul u u il n c it ’

sc r e o s c , sc s es a o ns co u s o o re se s, S o sc ro

d an u n nauf g d a u n xpé di ti
s ra v u é a u in ani ti
e, nsm plé tc an p i d al u t
c c o n— o nc o n co s s es o r c s .
”

O n p ag 6 in f c t f ced fa ti g b furth L a lu tt q u l n t bligé d c

“
u tc nir
’
e , r e e re n e y o or s n . e er sa s: c c o es o so
c nt l cau m em d c c tte i na ni ti n augm nt l n ati o n d c fai m
o re es ses es e o e e a se s .
"

D a Hu g n by Luigi Lu ci ani
2
s n er Tr an late d i nto G m an b y D M O F a nk l 1 89 0
, . s er r . . . r e e . .
 P S YC H O P HY S I O L O GY 213
’

T HE -
OF A FAS T .

implicit faith and co n fid enc e in the ir ide a L b e lie ve d fasti n g to be a . .

panac e a for a l l i ll s and th e v e ry fact that h e is of that typ e of m an who

c an n arrow his horizo n about an ide a an d stubbornly r e sist all i n va
sio n s gave hi m th e b e st e quipmen t for th e fight agai n st th e natural '

d e man ds of th e fle sh S uch a type o f mi n d c an no t be ca ll e d ab n ormal .

,

although it is u nusual Th e f ee lin g of hu n g e r was at all time s e v en .

,

duri n g th e fir st stage s of th e fast den i e d by L This stat emen t should ,

.

not be disb e li e v e d e v en though fr e qu en tly th ere is e xtre me discom fort , ,

which those who fast t ell us o n l y disapp e ars aft e r th e s e co n d or third

day as in th e cas e of Succi With L an d p erhaps with othe r faste rs
,
. .

this f ee lin g of hu ng e r may have b e en suppre ss e d from th e b e gi nni n g

by auto sugg e stio n Th e fact of th e d e ep i n grai ne d faith in th e fast
-
.
-

mak e s thi s plausibl e ?

’
Th e co n d itio n of Su cci s high e r me ntal proc e ss e s was o n l y asc e rtai ne d
by gene ral Obs ervatio n The s e Obs e rvatio ns agree with thos e made .

upo n L The re was at no time any symptom of halluci natio n or

.

lack of cl e arne ss in th e thought proc e ss e s Lucia ni writ e s : .

Am 1 3 Hunge rtag e wo ll te ich sei n e Au sd au er be z gei stige r Anstrengungen

“
.

auf die Pr o b e ste ll e n i n d em ich ih m schwi erige O d er u nlOslic h e me t ap hysi sche

,

un d the o so p hi sche Fr age n vo rl e gt e un d be stan dig Einwii rfe ge ge n sei n e Ant

wo rte n erh o b in der Ab sicht seinen Ve rstand z u e rm irden I c h muss geste
’

.
, ,

h e n ni ch t b emerk t z u hab e n d ass se in G ei st d ab e i me h r e rm irde te als de r

’

, ,

j e d es an dern S te rbl ichen vo n gl eichem B i ldungsgrad e und gl ei ch e r B egab ung ,

”2
we nn m an ih n so l chergestal t martert .

L is a m an of a much highe r l e ve l of i nt e l l igen c e and i nt elle ctual

.

trai ni n g than S ucci At al l tim es duri ng th e fast h e was v ery e age r to .

e n t e r i n to discussio n s upo n abstract su b j e cts such as th e va l u e of th e

E sp e ra n to la n guag e th e political co n d itio ns in Malta th e possibi l ity , ,

of mental t e l epathy and the ori e s of spiritism as w e ll as th e valu e of , ,

fasti n g I t cou l d no t be O b s e rve d that th e re was any dimi nutio n of

.

his argumentative powe rs or lack of lucidity of e xpressio n Wh en .

arous e d to cou n te r argumentatio n h e show e d th e same e nergy in reply

at th e en d as at th e b egi nni n g of th e fast .

Su cc i s muscular stre n gth as w e l l as his s e nsory acuity was ascer

’

taine d in a ma nne r some what similar to th e m ethod e mploy e d for L .

,

an d th e r e sults wi l l be compare d in th e fo ll owi n g summary an d i n t e r

pre tatio n of re sults :

( 1 ) I n th e d ynamome t e r t e sts ma d e upo n S ucci it is impossibl e to
t e ll from th e t e xt how ma ny tria l s w e re mad e dai l y A s th e curv e s for .

E B di
1
i n c i tici z i g B h im w i t t d B nh i m l j u u
’
. ar er , Au h l r n q ui ern e . r es : se n s O c n en er e , es e n e rs sc

u m tt n t a l i é i t t f ci l m n t t t i m pl m t p a l f ai t d un u gg ti n
’
iti ’
so e e n an o n r s s cn ut a e e , ou S e en r e e a o- s es o .

D i cut t p a t ic li l j u d c C tti il d m t q u cc d i t t n n é t t p u n h y t iq
s an en r u er e e ne e , a e e er n e r -
ou e
'
an as s er ue
’
s es t gg ti é I l d msu c vai cu qu i l c
es o nn vait t t a f c ph y i q ccl uffi t p u
. e eu re on n
’
o n ser ou e s or e s u e,
‘
a s o r

é l i l ph é m é ; l i d ec f it l t ; il x lt il
r a s er c no t f ilne u it d’
i d é il a
'
ac c s c
’
a e,
’
s e n ra n e , sc no rr e so n e, se

m t v c c m pl i c a
on re a vi i t u il j i t d n t i m ph ; l p it d m i l c p ;
e o a san e . se c s e r s, ou e so r o e
’
es r o ne e or s
t
c c .
’
L j fi u p v l té a iv a é i t a l h bitud d m g ; il b éi t a
e e ne r, ar sa o on , rr e r s s er
” ’
a e e an er o se
c ci c q i l
o ns m t al b ti
en e m i c t i m
u t av l
e so u t é d i t et
e i c p bl d c p v’
a s ne n c e , a s e r a ne en s o on o re n a a e ro o

q u l pp i d ti L F im i C h R ic h t Dic ti i d c Ph y i l gic 1 9 04
' " ’
er a su re ss o n u n e se n sa on . a a n . e s o n n a re s o o , ,

6 p 10
, S l f t t 3 p 1 9 1 f th i p blic ti
. . e e a so o o no e , . o s u a on .

L ci i D H g
2
u G m t l ti n by D M O F k l 1 89 0 pp 6 8 6 9
an , as un e rn . er an r an s a o r . . . r ae n e , , .
— .
2 14 A ST UDY OF P R O L O N GE D FA S T IN G .

th e 1 0 trials an d for th e in itial trial for L are similar th e 1 0 trial c urve .

,
-

will be co nsid ere d I t is saf e to assume from lack of mentio n of th e .

fact and from th e nature of th e curv e s that S ucci was right hand e d -
.

I t will the re fore be ne c e ssary to compar e th e curv e of th e right hand of

S ucci with that of th e l eft ha n d O f L .

I t wi l l be rememb ere d that th e strength of both ha nds was fou nd to

i n cre ase afte r th e d rop o n th e s e co nd day un til th e right ha nd (V II fig 26) , .

re ach e d its maximum o n th e twe lfth day and th e l e ft hand (V fig 25 ) o n , .

th e sixt ee n th day both curv e s th e n droppi n g st e adily from this poi n t

, ,

th e right howe v e r less tha n th e l e ft for th e l eft r e ach e d a mi nimum

, , ,

o n th e thirt y fi rst day while th e right durin g th e fast ne ve r dropp e d as

-
,

low as th e re cord of th e ni ne te enth day Th ere is a v e ry stri ki ng .

?
similarity b e tw ee n thes e and S ucc i s t e sts B oth of Su c ci s curves ’ ’

also drop aft er th e first trials and the n ris e agai n his l eft re achin g a ,

maximum o n th e fourt e e nth his right ha nd o n th e tw enti e th day as , ,

compar ed to th e tw e lfth and sixte enth days of L Suc c i s curv e s th en .

’

drop also but th e l eft drops more than th e right which is th e re ve rs e of

, ,

L s c u rve s
.
’
With S ucci both maximums are gre at er tha n th e first
.

day s re cords whil e with L this is th e case with o nly th e l eft hand
’
,
. .

Thi s agr e e s how e ve r with L s re cords for th e i nitial daily trials (I X

, ,
.
’

and X fig ,
Furth er L was abl e to mak e a sp urt at th e en d of th e
.
, .

fast with both hands this sp urt e xtendin g through s e veral days Succi , .

was o nly abl e to spurt with o ne hand and that o n th e last day th e curve ,

for th e other hand remaining statio nary .

Lucia ni attribute d th e rise of th e curv e alone to auto suggestio n I t -

.

s ee ms quite probabl e in asmuch as Succi and possibly L also b eli eve d ,

.

that th e ir stren gth wou ld be i n cre ase d by th e fast that this id e a strength ,

e ne d th eir d e te rmin atio n an d that th e y b e tte re d th eir re sults by sh ee r

”2
“
will pow er There is how eve r another possibility whi ch may be
.
, ,

assum e d without d en yi ng th e influen c e of auto sugge stio n namely -

, ,

that at l e ast in th e case of L who was unus e d to such t e sts th e coor

,
.
, ,

di natio n of th e muscl e s b e cam e graduall y more p erfe ct and furthe r that , ,

the s e muscl e s which w ere b e in g e xercise d daily i n cre ase d for a time in
, ,

stre n gth as the y would have do ne un der normal co n ditio ns but in this ,

case possibly to th e d e trimen t of othe r muscl e groups In both case s .

,

with both han ds fatigu e gai n e d th e asc e nden cy over practic e effe ct
,

and possibly ov e r auto suggestio n about th e middl e of th e fast causin g -

th e curv e s to drop
,
’
I n th e cas e of L s unpractic e d han d how e v er th e
. .
, ,

eff e ct of practic e had more room to work an d h e ld th e curve up lo nge r

than in th e cas e of th e practic e d han d .

( )
2 T h e tappi n g t e st (III fig 24 ) is also i n flu e n c e d by t h e co n dition , .

of th e muscular tissu e but the re is a nothe r factor more e sse ntial he re ,

l
L u i ni D a Hun g n 1 890 p 5 5
c a . s er , , . .

2E K S t ng J in hi p ap ti tl d Th fl t f v a i u typ f su gg ti n u p n m u scu lar

'

. . ro , r .
, s er en e e e ec o r o s es o es o o

a c tivi ty ( P y ch R v 1 9 1 0 p ay T h au t sugg t i n tend m t tr ngl y o f all th e

” “
s . e .
, , . s s: e o- es o s os s o

t y pe s o f su gg ti n to h ig h t n th m axi m a
es o e e e .
21 6 A ST UD Y OF P R O L O N GE D FA S T ING .

( )
3 T h e t h re shold for tactual spacc p e rc e ptio n (X I , fig 28 ) d ecre ase d
-
.

some what as th e fast progre sse d I t was o n th e average much b e tte r .

duri n g th e last half tha n th e first half of th e s e ri e s S im ilar te sts w ere .

mad e upo n S ucci upo n a numb e r of diffe re n t parts of th e body , but o nly
o n 3 days , b e fore th e fast , o n th e fift e e n th day , an d o n th e tw e nty ni nth -

day On some parts of th e body the re was an in cre as e , o n othe r parts

.

a de cr e as e Lucia ni b elie ve d th e di ffe renc e in th e 3 days due to differ

.

e n c e s in d e gre e of att e n tio n On that part of th e body corre spo ndi n g .

most close ly to th e spot use d in these te sts , i e , th e lowe r thi rd of th e . .

volar sid e of th e fore arm , th ere happ ened to be a rather large d e cre ase
in th e thr eshold , th e three thre sholds b e in g r e sp e ctive ly 1 6 , 1 1 , and
?
10 mm Authoritie s d iff e r as to whe the r practic e low e rs th e thre shold
in t ests p e rforme d u n de r normal co n ditions Dre sslar , for example ,
2
.

3
fou nd that practic e had a co nside rabl e effe ct S olomo ns found that .

if th e subj e ct is n o t i nformed of his e rrors th ere is no eff e ct of practic e .

I n th e above te sts th e subj e ct was ne ve r told of his mistak es and

”
“
v e xi er trials w ere i ntroduc e d at frequ en t inte rv al s and in no sp e cial
ord e r , y e t the re was a lowerin g of th e thr eshold This may b e and prob .

ably is du e to se veral cause s A physiological caus e woul d be a d e cre ase .

in th e fat , thus e xposin g th e n erv e e ndi ngs and maki ng th e m mor e

se nsitive On th e psycholo gical sid e incre as e d att e ntio n , which we
.

fi n d in dicate d in oth er of th e te sts , would lowe r th e thr e shold for dis

crimin atio n Also , as th e te sts progre ss th e image of th e crite rio n used
.

b e come s cl e ar e d F rom what is k nown of th e proc e ss of p erc eptio n ,

.

this is a most important factor in e xplainin g th e abov e e ffe ct of practic e .

T h e physiological cha nge is th e only o ne which could be attribut e d

u ne quivoca l ly to th e fast Th e c entral cha nge occurs in series u nd er .

n ormal co ndi tio ns .

I f , as has ofte n b e en ass u me d , th e tactual spac e thr e shold t e st is a

me asure of men tal fatigu e , the n it must be co n clud e d that there is n o
i n d icatio n O f such fatigu e duri ng th e fast .

(4 ) T h e visual acuity (X II , fi g 2 8 ) show e d a n asto n ishi ng b e tt er .

ment F rom 1 7 fee t as th e dista n c e of cle ar visio n for th e particular

.

t e st car d employe d , th e curv e asc e n de d rapid l y to 3 7 fee t o n th e four

te e n th d ay an d, although ther e is a fallin g o ff, 3 6 f ee t is th e r e cord for
th e l ast d ay of th e fast .

I f it w e re no t for th e maximum of 3 7 fee t midway in th e series,

th e im p rove me nt wo irld be comparative ly a st e ady o ne One e xp la n a .

tio n that sugge sts its elf is that th e possibl e cha nge in i ntra oc ular -

te nsio n cau se d th e e y e ball to cha ng e its shap e Unle ss his glass e s

-
.

w ere n o t th e prop er o ne s for hi m , howe ve r , a chan ge in th e e y e should

caus e more rathe r tha n less di fficulty as lo ng as h e wore hi s glass e s .

F urth e r , th e su dd enness of th e ris e s e e ms to vitiat e such a the ory .

‘
Lu ci ani , D as H un g e rn , 1 890 , p . 64 .

2
F . B D . resslar . di es in th e p ych o l o g y o f to u ch Am J u n Psych pp 3 1 3 368
S tu s . . o r . .
, .
—
. 1 89 4.

3
L . M . So lo m o n s. D isc rim i nati o n in cu taneo us sen ati o ns P ych R ev pp 24 6 25 0
s . s . .
, .
—
. 1 89 7 .
 TH E P S Y CH O P H Y S I O L O GY -
OF A FAST . 217

A satisfactory e xplan atio n s ee ms diffi cult to fi nd I t mi ght be said .

that th e 3 7 foot re cord was made by chanc e This also s ee ms pre

-
.

clud e d by th e fact of th e numb er of pre vious st eps in which 1 0 corre ct

a nsw ers w ere given and from th e e vid en c e of co nfid en c e displaye d
by th e subj e ct ?
S u cci s e ye s wer e e xami n e d with th e ophthalmoscop e and his acuity
’

me asure d b efore th e fast and o n th e fif t ee nth and tw enty e ighth days of -

?
th e fast but no chang e was d e t e ct e d
,
I f L had happ e ne d to be .

me asure d o n th e thi rd sixte e n th and o ne of th e days toward th e e n d of , ,

th e s e ri e s o nl y th e chan ge wo ul d hav e b e en thought as ne gligibl e as in

,

th e cas e of S ucci I n all such t e sts wh e r e th e daily fluctuatio n is c o nsid.

c ra b l e three t e sts in a mo n th are n o t suffici e n t upo n w hi ch to bas e a j u d g

men t as to th e chan ge in s ensory acuity or hi gher mental proc e ss e s .

(5 ) Th e rot e memory for di gits (II fig 23) showe d ve ry littl e change ,

. .

The re is a sli ght sugg e stio n of immo vem ent d urin g th e first half of
th e s e ri e s Judgin g from th e c urv e whi ch i n dicat e s th e poin t at which
.

th e fi rst mistak e was mad e (II B ) o n e c an say that th e r e was a gradual ,

improv ement in t hi s re sp e ct e sp e cially in th e first half of th e s e ri e s , ,

which is probab ly in p art du e to a b ett e rme nt in th e pc rceptio n of th e

spok e n word but e s p e cially to an in cr e ase in atte ntio n it b e comi n g
, ,

mor e sustai ne d as th e fast progr e sse d T h e rot e memory for s en s e .

wor d s (I A ) showe d a gre at er improve ment than did that for digits .

H e re probab l y th e practic e eff e ct co nsist e d in th e formi n g of associa

tio ns b e tw ee n th e words Th e most mark e d improve men t of all is .

in th e re t entio n aft e r a lo n ge r p e riod of tim e i e afte r 5 5 mi nut e s (I B ) ,

. .
, .

This is probab l y also due in part at l east to th e more fre qu e n t formi n g , ,

of associatio ns B e side s th e re p e titio n of th e sam e task thr ough so

.
,

many days u n doubt e dly stren gth ene d th e d e te rmini ng ten den cy i e , . .
,

th e d e t e rmin ation tak en at th e time of me morizi ng for th e words to ap

p e ar in co nsciousne ss again it re maini n g either in co n scious ness or ,
’
subco n sciousne ss durin g th e i n te rval A ccording to L S stat emen t . .
,

h is m i n d did no t re ve rt to th e task within th e hour I n d ee d th e oth e r .

,

te sts follow e d e ach othe r so rapidly that this wo uld have b e en a dith
cu l t thi n g to do .

E xp e rimen ts upo n me mory u nd e r n ormal co ndi tio n s also S how th e

effe ct of practic e as e vid e n c e d by an appre ciabl e i n cr e as e in th e m em
,
3
ory s p an which may co ntinu e for a p eriod of 2 mo n ths .

u bj ec t di d n t kn o w wh th h w as igh t o wro n g o h o w m any co ct an we c n ti

1
Th e s o e er e r r r rre s rs o s

tu ted a th sh o ld so th at th e esu l ts c o uld n t h a ve bee n p a an g ed b y him ; and if t h y c uld

re , r o re rr e o
h av b n h wo uld n t h av e all wed u ch a g o d e co d o n th fo urt nth day T h h ig h t h
e ee e o h o s o r r e ee . e re s

o ld n th o la t day i b vi u sly du e to hi u nu uall y po o p h y ic al co nd i ti n (wh en if at any tim e

e s so o s s r s o , ,

o n m igh t b j u sti fied in pe ak in g

e e f a l ac k f e ff t) s o o or .

2
L u an i D a H u n g n 1 890 pp 66 —6 7
cn , s er , , . .

3
T L B l t n T h g wt h f m m y in c h oo l c h i ld e n Am J u n P yc h 1 89 2 pp 36 2 3 80
. . o o . e ro o e or s r . . o r . s , .
—
.

G M ull . an d F S c h um ann er E xp rim ntc B ei t ag zur Unte u ch u ng d c a h tni s

. . e e r e rs cs c s ,

Z it h f P yc h 6 1 89 4 pp 8 1 1 90 2 5 7 33 9
e sc r . . s , , .
-
,
-
.

W H Wi n ch T h t an sf f i m p o v m ent in m m o ry in sch o l c h i ld en B i ti h J u n
. . e r er o r e e o - r . r s o r .

P ych 1 90 8 pp 28 4 29 3
s , .
—
.
218 A ST UDY OF P R O L O NGE D FA S T I NG .

(6) Th e ca nc e llatio n te st (XX I ) whi ch employs to a gre at er d e gree ,

th e high e r fu n ctions of p e rc eption and att e n tio n shows th e gre ate st

improveme nt of any of th e t e sts us e d Thi s improve ment co ntinu e s .

from th e S ixth to th e last day of th e fast Th e accuracy is so hi gh .

thr oughout th e series that th e slight improve ment in th e latt er part

of th e te sts is of no signi fica n c e E xp erimen ts hav e S hown that fatigu e .

affe cts th e accuracy so that again we have e viden c e agai nst an in cre as e
,

in men t al fatigu e ?
B e side s an im prove ment in th e above n am e d fun ctio ns th e i ncre ase -
,

in visual acuity may have b een a factor in th e re sults On th e oth e r .

han d fro m th e r e su l ts Of th e tappin g t e st and stre ngth t e sts o ne must

,

co n clude that th e b e tte rme n t is in n o d e gree due either to a b e tte rment

in re actio n time or mo tor ability .

( )
7 Th e f ree associatio n tim e (X III fig 29 ) is o n th e whole shorte r , .

during th e l atte r part of th e s eri e s I f it w ere no t for a rapid drop in th e .

middl e of th e curv e aft e r a rise sim ilar to that in th e tappin g t e st th e

improv e ment would be comparatively st e ady Th e mi nimum of .

se co nds is r e ache d o n th e day b efore th e last day of th e fast and should

be compare d rath e r with th e s e co nds of th e thi rd day than wi th th e
se co nds of th e first day wh en L was u nacc ustome d to th e mann er of
, .

re actio n E ve n whe n this compariso n is mad e it is se en that th e

.

improv emen t is consid e rabl e A se paratio n of th e curve in to four

.

curve s corre spo nding to th e four cat e gorie s use d m ade a more minute
analysis possibl e Th e curv es X I V XV XV I and XVII figs 30 to 32
.
, , , , .
,

S how fe w e r high av e rag es in th e se co n d half of th e se ri e s but it is only ,

in th e abstract curv e and in l ess d e gre e in th e adj e ctiv e s e ri es that the re

are more low ave rage s in th e sec o n d half of th e curv e I n fact in ne ithe r .
,

O f th e othe r two cu r ve s is th e low e st av e rage of th e first half of th e s e ri e s

again e quale d Thi s s ee ms to in dicate that th e be tt e rment in th e
.

g ene ral ave rage of th e 20 words is pri n cipally du e to a be tt e rmen t in

th e r e actio n to abstract words I t is to be e xp e ct ed that th e most.

difficult associatio n s woul d S how th e gr e ate st prac tic e effe ct I n th e .

n oun and v e rb curv e th e r e is an almost st e ady rise in th e middl e of th e

curv e corre spo nding to th e ris e in th e m idd l e of th e mai n curve I .

se e ms plausibl e to suppose that the re is he re as in th e tappi n g te st a , ,

fallin g off of int erest and tha t this wo ul d ma nife st itse lf mor e re adily in
,

th e e asi e r tasks in whi ch th e r e actio n is lik ely to b e come mor e ne arly

,

me chanical .

Th e g ene ral improveme n t is also s een in th e d e cr e ase in th e variations

of th e re actio n time s I n all four curv e s th e daily variatio n is much
.

less in th e s e co n d half of th e s eri e s Par allel with this is th e d e cre as e in .

B B urd n O b ervatio n co m p a ativ es sur la re co nn ai an ce la d i c i m inati n e t l as o ia

’
1 s r ss s
. o o s , s r o c

t io n R e v P h il 1 895 pp 1 53— 1 85
. . A B in t
. Att n ti n c t ad ap tati n Anné c P ych 1 900
. . . e . e o o , s ,

6 pp 24 8—4 04
, . C Ri ttc r E m fi dung m ssu ng n Z itsch f P ych 1 9 00 pp 4 0 1 4 44
. . . r s e c , e r. . s .
, , .
-
.
 2 20 A S T UDY O F P R O L O N G E D FA S T I NG .

I t will be r eme mb e re d that th e t e sts range from those i nvolvin g

p ri n cipa lly th e muscl e gr oups to thos e d ep en din g in a hi gh e r d e gree

upo n c entral factors T h e te st d ep ending most on th e muscular .

r e actio n s i e th e strength t e st S howe d a falling Off Th e tapping

, . .
, , .

t e st which also in volve d th e muscl e s but in which th e rapidity of re ao

,

t io n was a more important factor showe d no improve men t AS soo n , .

as o ne t urn s how e ve r to th e s e nsory discrimin atio n s o ne notic e s an

, ,

in cre ase d efficien cy which is probably due eithe r to a chan ge in th e

,

p e riphe ral orga ns or c e ntral proc e ss e s or both F inal ly all th e tests , .

in volving th e higher proc e ss e s of att entio n p erc eptio n and associatio n , ,

S how improve m en t I n a word the re was a lo ss in muscular stren gth

.
,

due probably to loss of ti ssu e a possib l e gain in s ensory acuity and a ,

d e cid e d in cre as e in th e e ffici en cy of all th e c e ntral proc e ss e s I t would .

be pre mature to say t h at th e improve men t is th e dir e ct r e sult of th e

prolo nge d abstin e nc e from food as similar improv ement has bee n ,

O bs e rv e d in such t e sts und e r normal co n ditio ns due e n tire ly to th e e ff e ct ,

o f practic e I t c an be stat e d howe ve r with some d egree of c e rtai nty

.
, , ,

that th e compl e te a b stine nc e from food for 3 1 days ha d littl e e ffe ct

upo n th e high er mental fun ctio ns which w e re abl e to d eve lop through ,

practic e v e ry much as the y wo uld have do ne u nd e r normal co nditions .

This agree s with th e Obse rvatio ns upo n th e physiological co nditio ns .

I t has b ee n fou nd that d uri ng a fast th e muscl e tissu e s are th e first to

suffer and th e ne rvous tissu e s th e last From the se re sults it se e ms .

t hat up to th e thir ty fi rst day th e ne rvous tissu e s have no t suffe re d

-
.

The se re sul ts also co nfi rm in part th e gene ral obs ervations mad e by

tho se fastin g I t is fre qu e ntly state d by the m tha t they can do b e tter
.

me n tal work T h e results show that at l e ast the y c an do appro xi

.

mat ely as we ll and it is no t at all u nlik ely that some c an do b e tter , for it
,

must be re me mb ere d that there is no ne of that sluggish ne ss of th e

m en tal proc e sse s di re ctly afte r e atin g wh en th e dige stive proc e sse s are ,

at th e ir h eight an d there is also absen c e of indi ge stio n and th e afte r

,

e ffe cts of al coho l an d t o bacco That o n th e other hand as has b ee n .

, ,

O ft e n c l aim e d th e y are abl e to do more muscular work and that th e ir

,

pow e r of e ndur an c e is gr e ate r is in thi s case at le ast no t t rue Probably .

t h e co n trast of th e ir actu al r e sul ts compare d with what th ey e xp e cte d

w ou l d happ e n to a m an without food mak e s th e r e sult s eem gr e at e r
tha n it is Th e claim that th e s ens e s are more acut e has b ee n v erifie d
.

as to th e Visual acui ty I t is hardly lik ely that th e s light differenc e in

.

the tactual —spac

e t hr e shold would hav e b ee n n otic e d by th e fast e r ?

Th e qu estio n r emain s as to wh e th e r prolo ng e d fasti n g is b en eficial

or da nge rous to th e organism This c an o nl y be satisfactorily answere d .

L tat d th at th e h eigh te ned

l
. s e n i tivi ty fo o d mad e w alkin g n th t
se s ts o f Mal ta d u in g
r o rs o e s ree r

hi fir t f a t po i ti v l y unpl easan t
s s s s e Th e th nse s w e x am in ed in th e case o f S u cci an d n o
. o er se er e

app ci abl ch an ge di c v ed Lu ciani Da Hun g n 1 89 0

re e s o er .
, s er , .

Whi ppl ( Manu al f M n tal an d Ph y ic al T t B altim o e 1 9 1 0 p

e o e s in sp eak ing o f th ees s, r , , .

ff c t f p ac tic in th e ae th esi m te t est em a ks th a t D T h i s p ac tice fl t is “

lar tat
'

e e o r e s o c r , r r ress s es : r e cc

ap i dl y l t b i n g r d u c e d v ry d fi ni t l y wi thi n 8 d ay and c o m pl e te l y l t wi th i n a m n th
”
r os , e e e e e s os o .
 P S Y CH O—P H Y S I O L O GY
'

TH E OF A FA S T . 221

aft e r an e xhaustiv e physiological examinatio n ext en di ng over a lo ng

p e riod Of time subs equ en t to th e fast T h e te sts made afte r th e l aps e .

of a ye ar p ermit how e ve r of some co nj e cture in this r e gard co n c ern in g

, ,

thos e fun ctio ns at l e ast whi ch hav e b e en discuss e d in this pap er .

Th e str e n gth te st shows a gr e at improve me n t ove r th e forme r r e cord .

L e x e rt e d a pre ssur e co nsiderably gre at er than at any tim e duri n g

.

th e lo n g s e ri e s Th e re cord for th e tappin g t e st is also abov e th e maxi

.

mum o f th e pre vious re cord Th e a ssociatio n t e st S hows a marke d.

improve me nt an d th e r eproductio n is also b e tte r e sp e cially in that it ,

vari e s l e ss an d th e re t entio n of s ens e words has p erhaps also slightly

,

improve d Th e tactual spac e thr e shold and th e rot e me mory for s ense
.
-

words are about th e same as at th e en d of th e fast O nly in th e cas e of .

th e me mory for digits and in th e ca n c ell atio n t e st has th e pre vious

maximum no t b ee n r e ache d but both of the se re sults S how co nsiste ntly
,
’
good r e sults I t may be stat e d in short that aft er an entir e ye ar s
.
, ,

inte rmissio n th e curv e s co n tinu e d practically from th e poi nt th ey had

pre viously r e ache d if not co n sid erably abov e that poi n t without show
, ,

ing that loss of practic e whi ch mi ght well have b e en e xp e ct e d These .

improv e d co ndi tio nsare how e ver n o t ne c e ssarily trac e abl e dir e ctly to
, ,

th e b e ne ficial e ffe cts of th e fast I n r e gard to th e associatio n t e sts L

. .

has u ndoubt e dly b e come still b e tt e r acquain t e d with th e E n gl ish lan

guage an d in re sp e ct to th e stre n gth t e sts it must be not e d that L has
,
.

e x e rcis e d hi s muscl e s daily accordin g to his r eport ,

I n g e neral h e h as .

led a care ful life p ayi n g e sp e cial att entio n to his di e t

, Th e possibl e .

e ffe ct of climat e an d hi s n ew s u rrou n d i n gs is also to be co n sid e re d .

F i n ally and most import ant is th e possibili ty that the re was actually
, ,

a g re at e r effe ct of practic e in th e first s e ri e s than app e are d in th e

re cords but that it was co n c e ale d by c e rtai n opposi n g effe cts of th e
,

fast so that th e re sults of th e lat e r te sts may n o t be quit e what might

,

be suppose d from a compariso n of th e r e cords .

I t r emains how e v er an indisputabl e fact that according to th e t e sts

, , ,

mad e there was no lasting e vil effe ct of th e fast eith e r upo n muscular
, ,

stren gth or mental activity .

22 2 A S T UDY O F P R O L O NGE D FA S T I N G .

APPENDIX I DREAMS —
. .

As h as b ee n alre ady state d L was aske d to re c o unt th e dre ams h e h ad h ad

, .

d uring th e p revi o us night From these re co r ds tho se dream s are he re given

.

whi ch pe rtain to fo o d I t wi ll be se en that at o ne tim e h e ate at ano ther

.
,

re fuse d fo o d bu t in n eith e r c ase was the re e vi d en c e of anyt hi ng but a n o rm al

,

emo tio n al re acti o n Accor di n g to th e Fr e udi an theo ry this ab se n c e Of an

.

in tense emo tio n al state (there were no night m ar es n o r anyt hin g e l se in th e

re c o r ds in dic ative e ith e r o f me ntal o r b o di l y di stre ss) me ans that t h e wi ll
to fast w as to o stro ng t o all o w o f any se rio us c o nfl ict o f i d e as A .

gre at p art o f th e dre ams are of a sexual n atur e and are no t here give n .

Ap ri l 1 3 .I saw a b asket c o vere d with a whi te p i e c e o f c l o th whi ch I ,

imagin e d full o f fo o d Whe n I t rie d to unco ver it seve ral bl ac k rats j um p ed

.

o ut o f it an d frighten e d m e .

I dre ame d I was p assing d own o ne o f o ur stre ets in Mal t a with a p ap e r bag
un d e r my arm c o ntai ni ng chee se c ak es fo r my d aughter I fo un d myse l f in
-
.

a state o f me ntal exciteme nt and afte r goi ng a c ert ain di st anc e I fo un d that th e
l o we r e nd o f th e bag was o pe ne d an d th e chee se c ak es we re go ne In their .

ste ad was a white han d .

Ap ri l 1 9 .I dre am e d I was in a sh Op an d o n th e co unte r the re was a ve ry

b ig h am ab o ut 1 0 fee t in di amete r Th e p ro p rie tor was ri ding o n th e top of it
,
.

”
wi th a kni fe in o ne han d I t is a ve ry go o d o n e h e sai d
.
“
I an swere d I , .
,
“

”
do no t l ik e it Do y o u no t kn ow I am fasting? Then a friar c am e in and sai d
.
,

I wi ll tak e it in h is ste ad b e c ause I l i ke it,

He to o k it and swall o we d it
. .

Ap ril 2 1 .I dreame d I h ad b e e n fo r a walk in th e coun t ry I went to a .

co untry tavern and ask e d fo r so methin g to e at Th e p ro p rieto r gave m e a .

bee fste ak an d so me fri e d red fish I ate them wi th rel ish and ask e d what I
.

h ad to pay He t o ld m e
. an d ask e d if t h at was to o much I sai d I did .

no t thi nk so In c omi ng o ut of t h e t ave rn I saw a rive r full of the se re d fi sh

.

an d p eo pl e we re tryi ng t o c atch the m I sai d Yo u are fish ing o ut all th e “

.
,

fi sh an d if y o u co nti nue y o u wi ll no t have any more to e at

’
.

APPENDIX II— COMPLETE SERI ES OF ASSOCIATION TES TS .

A pril 1 1 , 1 9 1 9 A pri l 1 2
c
R ea tio n S tim u lus R eactio n R ea ctio n

wh t ei

Av er a e g
Av e ra e g
224 A S T UDY O F P R OLO N G E D FA S T ING .

A pril 2 2
R eac tion

Av g
era e Av er ag e

All ow

m o ne y

Av g
era e
Av erag e
furni tur e

l etter

Mu sic

e te rn al

Av g
er a e

Av g
er a e
 TH E P S Y C H PH Y S I O L Q G Y O F A
O -
FA S T . 225

Ad van c e

Ho use

Wh i te
Unc l ean
Vacant
R o tte n

go v e rnm ent Pro po si ti o n

I m p o v em ent
r

I n fam y
( C o m p ti ti o n)
e co mm rce e

c
S c rat h co m pe ten ce
Att ac ti n
r o ac tress
Av g
er a e

Ave ag r e

n ew s

blac k

I m p i ti
os on
Av g
er a e

Av er a e g

so un d

E l e v ati o n
Av g
e ra e Lvl e e

Averag e
226 A ST UDY OF P R OLO N G E D FA S T IN G .

Mau l
R ead io n Reac tio n

so un d
calum m/

I ntim acy

Ave age r Ave age

r

favo r I nvi te

B y
e tr a

m o ne y
Tro u bl e
Re pro ac h
Crac k
Av era eg

H eal th

Titanic
Av g
er a e
Av era eg
228 A STUD Y or P R O L O N G E D FA S T I NG .

May 18 J u ne 2 , 1 9 1 3
R eac tion Reacti on
wor d .

sw ee t

i
w h te

Average Av g
era e

l eath e r
v eg ble
e ta

ch urch

Av g
er a e Av g
era e

Sm a ll
Th irsty
I m pu l iv s e

Pr v c ati o n
o o

Co nte n tm e nt
Pro fani ty
Av g
er a e Ave ager
 THE P S YCH O—P H Y S I O L O GY or A FA S T . 229

Ju n e 6 — C o n ti n u e d .

c tion R eac ti on

h o use

wa ve

l e aves

Av g
er a e

S c ld
o

stree t

E lbo w

Mo o n
Av g
er a e
 FECES .

I n th e days pre c e din g th e fastin g p erio d there was more or l ess re gu ,

lar d efe catio n but th e sp e cial in t e re st in th e fe c e s in conn e ctio n with

,

this fasting e xp erimen t has to d o with th e d efe catio n immediat e ly pre

c e din g th e fast and that o n th e days following th e fast Af ter th e .

e v e nin g me al o n April 1 3 L had a larg e d e fe catio n as was n ot e d l n

,
.
,

th e hi story for that day The re was no defecation h owever through

.
, ,

ou t th e en tir e fasti ng peri o d as n o fe c e s w ere pass e d from th e tim e of

,
h m
th e d e fe catio n o n April 1 3 u ntil 5 3 0 p m o n May 1 5 i e about . .
, . .
,

8 hours afte r th e fir st food ha d b een tak e n I t was sugg e st e d to th e .

su b j e ct tha t it wo uld be d e sirabl e e sp e cially on th e fir st d ay or two to

, ,

e mpty th e low e r bow e l with a warm wat e r e nema but h e pref e rr e d no t-

,

to do this .

Th e d e fe catio n o n May 1 5 was coin cid e n tal with a s e ver e attack of

colic occasio ne d by th e takin g of an e xc e ssiv e amou nt of acid fruits ,

w hi ch floode d th e stomach and th e int e sti nal tract Th e d efecatio n .

,

whi ch was copious co ntaine d a few hard w ell forme d lumps of fe c es

, ,
-

about 1 cm in di ame te r and with a total l en gth of

. cm Th e re st .

of th e mat erial was spo n gy and soft run nin g lik e liqui d when turne d ,

from th e v e ss el Th e fe c e s had a naus e atin g odor ne c essitating

.
,

fre qu e n t acc e ss to th e outdoor air in transfe rring and handli ng th e

mat e ri al Anothe r d e fe catio n took plac e about 8 p m a third shortly
. . .
,

afte rward an d still a noth e r during th e night Th e fec es w ere all of a

, .

v e ry soft and li qui d co nsiste ncy and of a light y ellowish brown color
,
-
.

As th e hard mat e rial was obviously entir e ly diffe rent in n ature from th e
soft mate rial it was re move d and probably this alo ne can he re be c o n
,

side re d as in any way approximatin g fasting fe c e s Th e s e co n d and .

third de fe catio ns we re te ste d with litmus pap e r and fou nd to be stro ngly
aci d probably du e in part to th e organi c acid pre se n t in th e fruit juic es
,
.

Th e fact that th e re w e re no fe c e s thr oughout th e 3 1 days of thi s pro

lo n ge d fast is of sp e cial significan c e as it is commo nly stat ed that fast,

ing m en e xcre t e from 2 to 5 grams of dry fe cal mat e rial e ach day .

I n th e e arli e r e xp erimen ts at We sl e ya n Uni ve rsity no e vid en c e was ,

foun d of what mi ght be call e d strict l y fasting f e c e s I n th e prolo nge d .

fasti n g exp erime n t with L sinc e th e last d efe catio n prior to th e fast
.
,

took plac e o n l y a half hour aft er th e last me al o n April 1 3 at l e ast a ,

portio n of th e f e c e s of May 15 might be exp e ct e d to r e sul t from th e food

o n April that we fi nd it d ifficult to d e t e rmine what proportio n ,

if any of th e mat erial d efe cat e d should be ascrib e d to th e fastin g p e riod

,
.

U nfortu nate ly th e e xigen ci e s of th e situatio n e sp e cially in V i ew of th e ,

i ll ne ss of th e subj e ct mad e it impracticabl e to pre s erv e an d prepare

,

th e se fec e s for a mi croscopic al e xaminatio n Thi s is much to be .

r e gre tt e d as some light might have b een thrown upo n their sourc e
,
.

Th e amoun t was how e ve r extr eme ly small as th e total air dri e d

, , ,
-
 OBSERVATI ONS UPON THE BACTERIAL I NTESTINAL FLORA OF A
STARVING MAN .

Br ART HU R I K E N D AL L
. .

Th e qu estio n of th e compositio n of th e n ormal bact erial flora of

adult man h as ne ve r b een satisfactorily s e ttle d , although th e c o nsen
sus of opini o n app e ars to be that B co li is th e form most commo nly .

foun d Th e obs e rvatio ns r ecord e d b elow , whil e no t co n clusive ,

.

fur nish i nformation which t e nds to show that at le ast thr ee organisms
may p ersist in th e i nt e sti nal tract for a mo nth aft er all food is withh eld ,

an d in this s e ns e th e s e bact e ria are n ote worthy Th e history of th e .

cas e nee ds no comm ent here othe r tha n to stat e that th e subj ect had
,

no food for 30 days prior to th e taking of th e sampl e h erein report ed .

Th e mat e rial for study was obtaine d from an e ne ma of st e ril e physi

ological salt solutio n 300 c c in all which was in j e ct e d i n to th e re ctum
, . .
, ,

re tai ne d for approximate ly 5 min ute s and re cove re d in almost full ,

volume Th e re turn fluid (coll e cte d in a ste rile co n taine r with appro
.
,

priate pre cautio ns) was turbid with but littl e odor practically color , ,

l e ss and e xc e pt for a v e ry small amou nt of c ell d e tritus free from

, , ,

particulat e matt er N o fe cal mat eri al was re cove re d

. .

Th e fluid was plat e d in plain agar in a dilutio n of T u rin tr whil e a ,

-

portio n (u ndilute d and dilut e d fi r m) was exami ne d for a na erob e s

,

an d c e rtain oth e r bac te ria Th e latt e r t e sts we r e ne gative

. .

Th e total cou nt on agar plat e s (in duplicat e) was 1 3 1 and 13 3 col

o nie s r e sp e ctiv e ly gi vin g a total of
, , and bact eria
pe r cubic c e ntim e t e r of washi ngs Of th e 1 3 1 colo ni e s 4 w ere id e ntical
.
,

cu l t urally with B m esen tericus 1 7 w ere fou nd to be Micro coccu s ovalis

.
,

of E scherich and th e r e mai ni ng 1 1 0 w e re fou nd to be B co li B co li

,
. . .

was also re cove re d from fe rmentatio n tub e s i noculate d with 1 c c of a . .

T am i m
-
d i lutio n of th e washin gs thus co n firm in g th e cou n t by th e ,

plat e me thod for this organism .

The s e re sul ts whil e no t striki ng are i nt ere sti ng for two re aso ns :
, ,

( 1 ) C e rta in bacteria app e ar to be a b le to live upo n th e i nt e sti nal

s ecr e tio ns e ve n whe n all food is withh eld for at l e ast a mo nth
,
.

(2 ) I t app e ars to be impossibl e to st eri liz e th e i nt estinal tract by

simp l e starvatio n T h is l att e r co nsid e ratio n shoul d be of cli ni cal
.

” “
i nt e re st sin c e it is customary in c ertain di s e as e s to try to starv e out
,

bact e ria from th e in testi nal tract .

23 2
 EXCRETION THROUGH THE SKIN .

S o gre at is th e total excre tio n from th e body , in th e re spiratio n, uri ne ,

and f e c e s , that asid e from th e s e n sibl e p e rspiratio n , th e ski n as a path of
e xcr e tio n is rar e ly co n sid e r e d in any di scussio n of th e loss of body

mate rial B ut l e avi ng th e s ensibl e p erspiration entir e ly out of c o n

.

sid e ratio n , th e skin plays an importa n t part , for th e r e is cuta ne ous

r e sp iratio n , in cluding both th e absorptio n of oxygen and th e e xcretio n

of carbo n dioxide ; the re is a very co n sid erabl e i n sensibl e p erspiratio n ,

which in its strict e st me ani n g re fers to th e vaporizatio n of wat er from

th e ski n surfac e ; and the re are th e e xcre tio n s of both ni trog e nous
m at e rial and chlorid e s through th e skin .

Although th e excr e tio n of gas eous and solid mat erial through th e
ski n of th e fasti n g m an would n ormally be e xp e ct e d to be at a mi n i

m u m it s ee me d d e sirabl e in ord e r to e stablish sharp bala n c e s of th e

, ,

n itrog e n an d particularly of th e salts to d e t e rm ine care fully th e cuta

,

n eo u s e xcre tio n of solubl e nitrog en ous mat e rials as w e l l as th e sodium

chlorid e e xcre tio n I t was n o t possi b l e to me asure th e cuta ne ous
.

r e spiratio n of our subj e ct in an y of th e forms of r e spiratio n apparatus

us e d in th e fasti ng e xp e rime nt for in th e calorime ter th e cuta neous

,

r e s p iratio n is me asur e d with th e pulmo n ary r e spiratio n an d with th e ,

r e spir atio n apparatus n o provisio n is mad e for th e m e asur e m e n t of

t h e cuta ne ous r e spiratio n .

T h e e xcr e tio n of th e nitrogenous mat erial and c hl orid e s through th e

ski n as th e fast progr e ss e d was how e ve r of particular signi fi ca nc e an d
, , ,

arrange men ts w ere mad e for d etermi nin g the s e B y nitrogenous .

mat e rial is me a nt n o t th e de ad cuticl e but th e excre tio n of wat e r ,

s olubl e mat e rial c hi e fly in th e form of ur e a

,
In ord e r to d e t e rmi ne
.

this accurat e ly th e body of th e subj e ct was giv en a thorough washi ng

,

before th e fast .He was then S po n ge d with di stille d wat e r an d a

fre shly e xtract e d and dri e d cotto n uni o n suit was plac e d upo n him .

A t th e e nd of th e w ee k th e u nio n suit was r e mov e d th e subj e ct was ,

a gai n spo n g e d with distill e d wat e r an d a noth e r fr e shly e xtract e d and

,

d ri e d cotto n u nio n suit was given him T h e u nio n suit whi ch ha d b e en

.

r e move d was then carefu l ly extracte d with disti l l e d wat er an d th e

e xtract wat e r e vaporat e d aft e r th e a dd itio n of acid Th e wat e r in .

w hi ch th e subj e ct had b ee n bathe d was also save d and evaporate d

aft er th e a d d itio n of acid Th e e ntir e op e ratio n was in th e skil l e d
.
.

han d s of Mr T M Carp e nt e r B y thi s proc edur e it was e xp e cte d

. . . .

that th e p ers p iratio n accumulating duri n g th e w ee k would be a b sorb e d

by th e cotto n u nio n suit an d th e solubl e so li d s i n cludi ng salts ur e a , , ,

o r oth e r mat erial wou ld be e xtract e d by th e distill e d wat e r

,
.

T h e nitrog e n was d e te rmi n e d by th e K j e l d ahl m e tho d T h e ch l orine .

w as d e t e rmi ne d b y titratio n with si l ver nitrat e an d su l phocya n at e .

23 3
2 34 A ST UDY or P R O L O NG E D FA S T ING .

Th e tota l amou n t of ni trog en an d chlorin e fou n d e ach w eek is given

in tabl e 22, in w hi ch it is s ee n that th e ni trog e n ra n ge d from gram
in th e first w ee k to gram in th e l ast w eek , and th e c hl orine from
gram an d gram for th e first two w eeks to gram in th e last
w ee k .

I t will be not e d that as much as gram per day of nitrogen

in wat e r so l u b l e mat e ria l may be e xcre t e d through th e skin during th e
-

first w eek of fastin g an d that in all probability thi s me thod d e te rmi ne s

th e minimum rath e r tha n th e maximum amou n t si n c e u n qu e stio nably ,

the re is a co nti nu al tra ns formatio n of ure a to ammo nium carbo n ate

with a loss of ammo ni a On th e oth e r han d it is proba b ly tru e that .
,

th e s e cr e tory activity of th e ski n d e cre as e d somewhat as th e fast pro

gre sse d as is e vid e n c e d by th e va l u e s for both nitrog e n and c h lorin e
,
.

This loss of n itroge n through th e skin has sp e cial sig ni ficanc e in c o n

” “
n e c tio n with so ca l l e d n itroge n bala n c e e xp e rim e n ts
- -
.

TA B LE 22 .
-
C uta neous excretion f
o nitrogen and chlorine i n experi ment with L .

D at e . C h l ri ne o .

0 0 0 0 0

1
Th e su e t w as bj c bath ed o n th e e ve ni ng of Ap i l r

1 3 an d at th e e nd o f eac h w e k t h er eaf te r
e .

1
I t has pr e vious l y b ee n shown that d uri ng s e vere muscular work as
much as 200 mi lligra m s of ni troge n may be e xcre te d thr ough th e
skin per h ou r I f the refore th e e xcretio n of n itroge n in a fastin g exper
.
, ,

imc nt with min imum activity amou nts to gram or more per day ,
it is obvious that ni troge n bala n c e e xp erimen ts whi ch do no t take i nto -

accoun t this loss through th e ski n will n o t give accurat e r e sults I .

am u n aware of any d et e rmin atio ns of this ki n d ma d e o n a fasti ng m an ,

although Zu ntz an d his c c —work e rs o n Mo n t e R osa re cord e d th e loss of

nitrogen and chlorin e thr ough th e ski n in the ir e xp e rimen ts o n th e high
2
Alps .

Th e amou nt of chl orine e xcre t e d thr ough th e skin of L was r elatively .

sma l l b e in g approximat e ly from 5 0 to 60 mi ll igrams per day in th e

,

first 2 w ee ks of th e fast D urin g th e fourth w eek of th e fast o nly .

1 B enedict J urn B i l Ch m 1 906 l p 263

, o . o . e , , . .

1’
S ch w nk nbec h
e an d S p i tt a (Ar c h f
e erxp P ath 11 P h a m 1 90 7 56 p 2 84 ) fo u n d abo u t . . e . . . r .
, , , .

g am ach f ni tro g n an d o di um ch l i d p 24 h urs wi th a h al th y p n in bed T aylo

r e o e s or e er o e e rso . r

( J o u n B i l C h m 1 9 1 1 9 p 2 1 ) f u n d wi th tw o m n at w k bu t n vi i bl p p i ati n p
r . o . e .
, , , . o e or o s e e rs r o er

day gr am ulph u g am ph ph u and

s r, g am ni t g n in o n c a e an d th e
r os or s, r ro e e s

co p n di ng fi gu fo th th w
rr e s o r es an d
r e o er er e
 URINE .

Urine a nalysis has in th e past d e cade u nd ergo ne a strikin g re volution

as a r e sul t of th e d e velopme nt of u niqu e an d e xc ee dingly acc urate
methods by F olin F ormerly clinical e xaminatio ns of uri ne i nclude d .

ur e a d et erminations usually by th e hyp obromit e method and quali , ,

t ative or roughly qua ntitative e stimatio ns of phosphat e s c hl orid e s , ,

e tc but to day th e inte llige nt clinicia n d e als o nly with th e 24 —hour

.
,
-

e xcr e tio n of th e various urinary constitu en ts Th e i ntroductio n of .

th e K j eldahl me thod did much to adva n c e our knowl e dg e of th e con

s titu e n ts of th e urin e by givin g us informatio n as to th e total orga nic

n itrog e n but it r e m ain e d for F olin to show us th e me thods for th e

,

p artitio n of th e nitroge n in th e urin e and its sig nifica nc e Th e ammo .

nia ur e a uric acid cre at inin e and cre atine 1n th e urine th e n b e ga n to

, , , ,

be of much gre ate r signifi ca n c e than was th e total nitrog e n ; but m all
t he se advan c e s in th e d e velopme nt of uri ne a nalysis and particularly ,

in th e int e rpretatio n of th e r e sults we find stre ss invariably laid upon ,

th e nitroge nous constitu ents To such a d e gree is this tru e that we .

are in cli ne d for th e most part to thi nk of th e urin e sol e ly as a path for
nitrog e n e xcre tio n .

Our pre vious e xp erie nc e with fastin g subj e cts howe ve r has shown us , ,

that in th e urin e we have no t only i ndic es of th e protein katabolism ,

but that with ac e to ne diac e tic acid and B—oxybutyric acid present , , ,

we have indic e s r e gar di ng th e d e fe ctive fat kataboli sm ; furthermor e ,

th e inorga nic constitu e nts such as chlorine phosphorus sulphur and , , , ,

t h e alkalin e bas e s gi v e us e vid enc e as to th e mine ral me tabolism th e

, ,

sulphur e xcr e tio n al so having an importanc e in int e rpre tin g th e prot e in

katabolism I t was th e re fore ess e ntial to study th e urine of our fasting

.

subj e ct n o t o nly from th e sta ndpoin t of prot ei n katabolism but lik e ,

wis e from e ve ry other possible standpoint so that comple te a nalys es ,

w e re n e c e ssary I n carryin g out such a study of th e fastin g urine we

.
,

have de p e nd e d more largely upon th e re sults of o ur forme r study of

1 2
fastin g subj e cts than in any oth er part of th e r es e arch .

GENERAL ROUTINE OF COLLEC TION AND SAMPLING .

ord er to give us as much i nf ormatio n as possibl e about th e pre

In
vio u s d i e t e tic habits of thi s m an particularly for th e fe w w ee ks prior t o ,

B l
di t C n gi I n t W a h Pu b 7 7 1 90 7 pp 34 5 —4 1 9
ene c , ar e e s . s . .
, . .

Af t th p g f th i b k w i p ag p f m y att ti w c ll d to th rt icl f m
2
er e a es o s oo e re n e roo , en on as a e e a e ro

A y am
o cli nic in T ki by W ta b a d S
a s
’
ti tl d D i H a
o o, al y w h d d zw i
a na e n assa, e n e
“
e r n an se a ren es e

W o hig n Hu g n in M ( Z it h f B i l 1 9 14 64 p i u d f m Munich n ”
c e n er s e es ann es e sc r . . o .
, , , . ss e ro o

A gu t 27 1 9 1 4 bu t n t c iv d h un til l t in N v m b
u s , o I t i th u im p
re e i bl t m k any
e ere a e o e er . s s o ss e o a e

co mm t up thi in t
en s tin g p p
on Th u th s tu d i d b d y w igh t m a
e res m nt f th a er . e a o rs s e o -
e , e su re e s o e

b d y b d y t m p at
o , o -
pu l p i ati n d th bl d but lai d p ci al m p h i u po xt n
e er u re , se , re s r o , an e oo , s e e as s n e e

siv i ly
e u r n e an a T h i fi d in g a f th m t pa t i full c nf m ity wi th th
ses . e r n c dd s re , or e os r , n o or o se re o r e

h ere .
 U R INE . 23 7

th e fasting exp e rimen t L was re qu e ste d to me asure and sample th e

,
.

urine e ach day from th e first of Ap ril u n til h e re ache d th e N utritio n

L aboratory o n Ap ril 1 0 pre s ervi ng th e sample s with chloroform Thi s
,
.

h e did most car e fully his trainin g as a pharmacist assistin g h im mat e ri

,

a lly in carryin g out th e routine accurate ly Wh en it is co nside re d that .

h e was trave lin g rapidly and whil e o n th e st e amer was oblige d to make
all hi s obse rvations and me asure ments in th e narrow co nfin e s of a stat e
room havi ng three oth er occupan ts it will be s een that it is much to,

his cre dit that th e re cords w e re so carefully k ept Al though it was im .

possibl e to k ee p an accurate r e cord of th e amou n t of food e aten and

‘

particu l arly th e ki nd and amou n t of th e various prot ein s a study o f ,

the s e urine sample s should give some in formatio n as to th e normal c o n

sumptio n of protein by thi s i n dividual .

F rom th e time of his arrival at th e N utrition L aboratory th e col ,

l e ctio n me asuremen t and samp ling of th e urine w ere mad e by memb ers
, ,

of th e laboratory staff P articular att entio n was give n to th e uri ne

.

e xcr e t e d duri n g th e fasti n g p e riod as it was e sp e cially importa n t to

,

study th e e ntire output of th e body at thi s time .

Wh e n th e preliminary arran ge ments w ere mad e for th e analyse s and

the ir assignme nt to th e various me mb ers of th e laboratory staff and its
co work e rs it soo n b e came appar e n t that th e numb e r of d e t e rmi n atio ns
-
,

n e c e ssary would r e quir e a gr e at er volume of uri ne than wo uld ordinarily

be p ass e d by a fastin g m an I t was there fore arra n ge d in accor d an c e
.
,

with a sugge stio n made by D r Cathcart to provide th e subj e ct with a

.
,

lib e ral an d co n sta nt supply of drin ki n g wat e r Furthe rmore th e -

.
,

smalle st volume of sample which would give accurat e d e te rmi n atio n s

was carefully co nsid ere d in orde r to obtai n th e gre at est numb er o f
re sults with th e availabl e mat erial H ad it no t b e en for th e r ec e n t
.

d e v e lopmen t of th e ne w F olin me thods it is probabl e that muc h ,

valuabl e data would hav e b e en lost F or e xampl e whil e forme rly .

,

300 c c or e ven more w er e r e quir e d for th e d e te rmi n atio n of th e uri c

. .

acid with th e new F oli n method 5 c c would suffic e Many of th e

, . . .

d e t ermin atio n s of th e ammo ni a as carri e d out by th e new method were

also made with a re lative ly small amou nt of urine .

B e fore th e subj e ct came u nde r obs e rvatio n th e time of urin ati ng was
more or l e ss irre gular D urin g th e three food days pre c e di ng th e fast
.
,

th e subj e ct uri n at e d at irr e g ular time s although e n di ng e ach day at ,

approximat e ly 8 a 111 D uri ng th e fasti n g p e riod h e was re quire d

. .
,

to empty th e bladd e r immediat e l y afte r coming out of th e be d calori

mete r in th e mornin g thi s b ei n g usual l y no t far from 8 o clock He
,
’
.

again e mptie d th e bladde r short l y b e fore e n te ring th e be d ca l orime te r

at night We w e re thus abl e to divid e th e urin e i nto two p e riods e ac h
.
,

approximate ly 1 2 hours in l en gth Use was ma d e of this routi ne in th e

latt e r part of th e fast to study th e apportio nm
.

e n t of th e n itrog en and

ammo nia e xcre tio n b e tw ee n th e d ay and night p e riods .

 A ST UDY OF P R O L O NG E D F A S T I NG .

Th e urin e was collect e d at th e laboratory by havi ng th e subj e ct

urinat e in to a pre viously dri e d and w e ighe d bottl e ; th e bottl e and c o n
te nts w e re th en care fully w e igh e d and th e urin e me asur e d in a gradu
ate an d th e vol u me r e cord e d S hortly aft e r th e e xp erime nt b e gan
.
,

it was co nsid ere d advisa b l e in accordan c e with a suggestio n made by

,

D r F olin to add sufficient distill e d wat e r to bring th e urine to a de finite

.
,

volume e ach day U nd er thes e circumsta nc es a normal e xcr etion of

.

urin e of 600 to 7 00 c c would be w eighe d and its sp e c ific gravity d e ter

. .

min ed ; it would then be imme diat ely dilute d to c c and di visio n . .

made for th e various a n alys e s This proc e dure was ve ry satisfactory .

and minimi z ed th e calc ulations .

COMPOSITION OF THE URINE PRIOR TO THE FASTING EXPERI MENT .

As a ge neral indicatio n of th e charact er of th e subj e ct s uri ne prior ’

to th e fastin g e xp eriment we have fragm e ntary data re garding th e

,

urin e passe d o n th e 1 0 days b e fore h e arrive d at th e laboratory and for

th e 3 food days in B osto n b e for e th e fast
Th e volume and nitro
T AB L E 23 Nitrogen excreted i n uri ne -

ing p e riod be ga n
.

.
previous to the fast .

g e n co n t e nt o f this u ri n e are giv e n in tabl e

23 th e nitrog e n b e i n g d e t e rmi ne d by th e
,

K j e ld ahl m e thod I n addi tio n to th e

.

tabulate d data th e a mm o nia nitroge n

,
-

was d e t e rmi ne d for th e last 3 days by

th e old F olin me thod th e amou nts found ,

b e in g and gram re sp e ct
ively On th e last 2 days th e h e at of
.

combustio n was 1 29 and 1 04 calori e s

re sp e ctive ly ; th e total carbo n in th e urin e
for th e same d ays was and

g rams r e sp e ctiv e ly Th e acidity

. was
d e te rmi ne d o n but o ne day (April 1 1
thi s expre ss e d as cubic c e ntime t e rs of
,

N/10 NaOH solutio n b ein g 4 0 9 c c ,

. .

Th es e data will be use d in subse qu en t di scussio ns an d are h ere re corde d

to avoi d co nf usio n with th e r e gular e xami n ations of uri ne in co nne ctio n
with th e fastin g e xp e rimen t .

HYSICAL CHARACTERISTICS
P OF THE FASTING URINE .

In co n sid e rin g a subj e ct as compl e x as is th e uri n ary e xcr e tio n it is ,

advantage o us to n ot e first th e physical characte ristics an d the n th e

ch emica l compositio n Th e i nflu enc e of various physica l agen ci e s
. ,

particularly th e re l atio n b etwee n th e amou nt of wat e r dru nk and th e

volume of uri ne may no t be without in flu e nc e upo n th e ch emical
,

compositio n for u n d er c e rtain co n d itio n s the re may we ll be a washi ng

,
24 0 A ST UDY or P R O L O NG E D FA S T I NG .

VOLU ME OF UR INE .

I n th e publicatio n giving th e re sul ts of th e e arlie r fasti n g research ,

it was cl e arly brought out that no o ne factor aff e cts th e volume of

urin e as do e s th e volume of th e wat er in geste d particularly when th e ,

volume of drinki n g wate r is ove r c c In th e exp eriment with

-
. .

L th e wate r co n sume d was always u nd e r 1 lit e r and h enc e th e i nflu e n c e

.
,

of th e amou nt of th e drinkin g—wate r o n th e volume of th e urin e was no t

so obvious .

Th e volum e of urin e vari e d from 4 68 c c o n April 1 5— 1 6 to 88 9 c c . . . .

o n A pril 29 30 —
Th e ave rage volume was 6 5 9 c c
. On April 24 25 . .
—
,

th e volume of th e wat e r tak e n was cha nge d from 7 5 0 c c to 900 c c . . . .

,

and it was e xp e ct e d that this cha n g e woul d mat e rially aff e ct th e volum e
of th e urine An insp e ctio n of th e data shows how e ve r that it pro
.
, ,

du c ed n o mark e d e ffe ct upo n th e wat e r e xcr e t e d in th e urine at l e ast ,

during th e first 3 days Thus on th e 9 days from th e s e co n d to th e

.
,

t e nth days of th e fast i n clusive wh en th e subj e ct drank 7 5 0 c c of

, , . .

wate r daily th e ave rag e volume of uri ne was 5 90 c c per day and o n th e
, . .

3 days from th e el e ve nth to th e thirt eenth days of th e fast i nclusive , ,

whe n th e daily amou nt had b ee n i n creas e d to 900 c c th e ave rag e . .

,

volume of urin e per day was 54 7 c c S ubs equ ently th e re was a dis . .

tin ct t e nd e ncy for th e urine volume to i n cre as e and o n th e next 1 0 days

th e av e rage volume was 728 c c an in cre as e of 1 38 c c ov er th e p e riod . .
, . .

wh e n 7 50 c c of wate r was tak en close ly approximating th e in cre ase in

. .
,

th e amou n t of drinking wate r I t is to be not e d how eve r that at this

-
.
, ,

stage of th e fast 900 c c of drinking wate r was proportio nate ly large

, . .
-

’
for th is man s nee ds sinc e h e had d e cre as e d mate rially in w e ight I n
, .

th e e arli e r fasti n g e xp erime nts wh en s e ve ral lit e rs of wat e r w er e tak e n ,

daily th e amo un t of wate r dr unk u nqu e stio nably influ e nc e d th e

,

amou n t of wate r in th e urine e xcre te d b ut with th e comparative l y ,

small amou nt tak en by th e subj e ct L th e effe ct was e vid e ntly at a .

,

mi nim um and th e abse n c e of any flushi n g—out of th e end products of

,
-

prot e i n katabolism simplifi e s th e subse qu ent discussio n .

I n compari n g th e wat e r dru nk with th e volume of uri ne th e discus ,

sio n may be bas e d more adva ntage ously upo n th e wat er in th e urine .

A d e t e rmin atio n of th e solids in th e uri ne was mad e o nly o n th e last

1 6 days of th e fast but amou n ts for th e e arli e r days of th e fast have
,

b ee n comput e d and the s e are suffici ently accurat e to u se in this c o n

n e c tio n for obtai ni n g th e amou n t of wat e r in th e uri ne .

F rom th e valu e s given in column E of tabl e 24 showi ng th e r elatio n ,

ship b e tween th e wate r in th e urine and th e wat e r co nsumed it is s ee n ,

that in th e first days of fastin g wh en th e amou n t of wate r tak en by ,

th e subj e ct w as o nly 7 50 c c about 74 pe r c e n t of th e wat e r co n sume d

. .
,

app e are d in th e uri ne Wh en th e amou n t of dri nki n g wate r was

.
-

i n cre ase d to 900 c c th ere w er e mark e d disturbanc e s in th e ratio for

. .
,

th e n e xt 7 days Th e wi d est variatio n s in th e e ntire s e ri e s app e are d in

.
 U R I NE . 24 1

th e se 7 days , n ame ly , from 54 per c ent April to as hi gh as 9 6 on 25— 26

pe r c e n t o n A pril 29—
3 0 On th e oth e r han d from May 1 2 to th e end
.
—
,

of th e fast th e ratio r emain e d v ery co nstant with but minor variations

, ,

above or b elow th e av erage figure for th e whole se ri e s of 0 2744 e ssen ,

tially that obtain i n g o n th e fir st 1 0 days of th e fast Th e disturban c e .

in th e ratio was fou n d the re for e o nl y during th e 7 days imm e diat e ly

, ,

following th e chan ge in th e amou nt of wat er consume d from 750 c c . .

to 900 c c . .

This surprisin g co nstan cy in th e ratio b etween th e wat e r of urine an d

th e wat e r co n sum e d asid e from th e 7 days m en tio ne d is difficul t to
, ,

e xplain partic u larly sin c e at l e ast two factors might hav e b e en ex

,

pe cte d to disturb t hi s re latio n shi p D uring th e fir st 1 0 days of th e

.

1
fast the re was a co n siderabl e loss of preforme d wat er from th e body
, ,

ran gi ng from 7 69 grams to 1 83 grams This loss of wat er might be .

e xp e ct e d to in cr e as e th e volume of urin e durin g th e s e days I n d ee d if .

,

th e volume of urin e w er e no t in cr e as e d in th e abs en c e of othe r e vide n c e , ,

thi s mi ght be tak en as an argume nt against such an e xcre tio n of pre

forme d water .

An oth er poin t whi ch should be tak en in to co nsideratio n in this

co nn e ctio n is that o ne would e xp e ct that with th e gre atly dimini she d
body substanc e th e amoun t of drinking wat er co nsume d might exc eed
,
-

th e physiologica l ne e d an d hen c e would disturb th e re latio n ship

b e tween th e volume of urine an d th e vo l ume of wat e r co nsume d On .

th e oth e r han d it is w e ll kn own that duri n g fastin g th e re is a t en d e n cy

,

for all th e tissue s to b e come wat er rich this r et entio n of wate r possibly -
,

comp ensatin g for th e d e cre as e in th e physiological nee d followi ng th e

d e cre as e in th e siz e of th e organism .

That th e re latio n ship b e tw e en th e wat er of uri ne and th e wate r

co nsume d is re aso nably co nsta nt e v e n when th e quan tity of wat er is ,

but 1 lit e r or l e ss is lik ewis e substantiat e d by calcu l atio n s from data

,
’
pub lishe d re gar din g C ath c art s exp e rime nt with B e auté , in whi ch th e
volume of drinking wat er was also co nstant i e -
c c per day B y , . .
,
. . .

usin g th e data for th e volum e of urin e th e sp e cific gravity and th e , ,

factor (see page we have comput ed th e total solids an d also

th e wat e r in th e uri n e for th e sixt h , s eventh eighth t enth e l e venth , , , ,

tw e lfth and fourt eenth days of B e auté s fast Th e ratio of wat er in

,
’
.

th e ur ine to th e wat e r co nsume d was for th e s e ve ral days as follows :

Th e av erag e value
was which is no t mat e rial l y di fferen t from th e averag e
obtai ne d for th e valu e s for L wh e n th e 7 days r e fe rr e d to hav e b e en
.

omitte d Th e hi gh valu e of
. fou nd o n th e t e nth day with Cath
’
cart s su b j e ct e xc ee ds any fo und with our subj e ct L .

I n ge neral th en , th e volume of wat e r in th e uri n e is approximat ely

,

7 5 per c e n t of th e amou n t of dri nkin g wat er tak en e ven wh e n but -

,

S discussi o n f p f rm ed wat l o n p age 4 08

1
ee o re o er o ss .
24 2 A ST UDY or P R O L O N GE D FA S T I NG .

1 li te r or l e ss is tak en provid e d th e in tak e of wat e r is constan t I t

, .

is obvious howe ver that t hi s wo ul d hold tru e o nly wh en th e factors

, ,

influ en cin g th e loss of wate r such as e n vironmental t e mp erature and

,

ex ercise also re main cons tan t

, .

Th e e vid e n c e is cl e ar the re fore that e ven with th e small amou n ts of

, ,

wat er tak e n in this fast the re was a re aso nably co nstant relatio nshi p
,

be tw e en th e wate r consum e d and th e wat er in th e urine th e absolute ,

fluctuations in th e volume of urine note d b e ing so small that there

could have b een no disproportio nate washi ng out from th e tissue s of
th e c rystal line e nd products of pro te in katabolism
-
The re is to be .
,

s ure a disti nct i ncre ase in th e ave rage volume of th e uri ne aft er th e
,

twe lfth day but in this e xp e riment we d e al with an ave rage in cre as e
,

of approxim ately 1 00 c c and h en c e the se absolu te variatio ns in volum e

. .
,

are no t to be compare d with th e v e ry larg e variations n ot e d in th e

e arli e r fasts at We sl e yan Unive rsity wh e n th e amou n t of drin king ,

wa te r vari e d withi n wid e limits .

S PE CI FI C G RAVI TY .

Th e sp e cific gravity of th e uri ne was car efully d e te rmine d by Miss

°
Alic e John so n at a co nsta nt t e mp e ratur e of 20 C o n a We stphal bal
, .
,

anc e Th e positio n of th e scale wh en th e w e ight was susp end e d in

.

distill e d wate r was accurate ly che ck e d th e t emp eratur e of th e sur ,

°
rou ndi ng liquid b e in g in variably arti fi cially main tai ne d at 20 C .

Thus th e sp e cific gravity of th e urine for e ach day of th e fast was

re adily obtaine d to th e fifth significa nt figure .

Thes e value s which are give n in ta b l e 24 ra nge d from

,
on ,

April 5 1 6 to
1 —
o n May 1 3 14 an d are th e re fore w e ll within —
,

normal limits As th e fast progre ss e d there was a di stinct t en de n cy

.
,

for th e sp e cific gravity to d e cre ase although for th e first 1 0 or 12 days ,

it was approximately co nsta nt at about falling the re aft e r some

what sharply and r emaini n g at about for th e re main d e r of th e fast .

This approximatio n to consta ncy may be 1n p art accou nt ed for by th e

approximate ly co nsta n t volum e s of uri ne passe d I n th e short fasting .

e xp e rim e nts at We sl e ya n U n ive rsity th e sp e cific gravity ra n g e d be ,

tween an d but th e low e st sp e cific gravity was a e com

panie d by a ve ry large volume of urin e and th e hi gh sp e cific gravity
by a ve ry small volum e of mi ne .

I t is obvious that th e n ature of th e solids dissolve d in th e uri ne has

a n otic e abl e i n flu en c e u p o n th e sp e cific gravity F or i nstan c e a solu .
,

tio n co n tain in g 1 00 grams of sodium chl orid e in 1 lit e r has a d en sity at

1 5 C of
°
. while a solutio n of ur e a 1 to 1 0 has a density of but
co ns e qu e ntly a large amount of sodium c hl orid e in th e uri ne
would hav e co nsiderabl e effe ct upo n th e sp e cific gravity F rom other .

fasting studi es it is known that a large amount of sodium chloride is

e xcre t e d in th e first days of fasti n g which would thus in cre ase th e ,
244 A ST UDY or P R O L O N G E D F A S T IN G .

Wh e n th e total amount of dry matt e r was d e t ermine d th e co nte nts ,

w e re afte rwards car e fully transfe rre d from th e metal bottl e cap to th e -

ni ck el cap sul e by me an s of a swab of ignit e d asb e stos th e last trac es ,

of so li d mat e rial adh e ring to th e bottl e—cap b ein g re mov e d by a bit of

asbestos wool moiste ne d with wat er Finally th e mat e rial was dri e d .
,

in an air curr e n t to a pasty co nsiste n cy an d the n plac e d in a high

-

vacuum until d ry e nough to burn .

1
This me thod has b ee n pre viously d e scrib e d and nee d o nly be refe rr e d
to h ere Th e 3 sample s always gave p erfe ctly agree in g re sults in dica
.
,

tin g that th e dryi ng was e ss e ntially compl e te an d t e stifyin g to th e ,

skilful te chniqu e of Mr Arthur W Corne ll who carrie d out th e d e te r

. .
,

m inatio ns of th e total solids carbo n and he at of combustio n Th e

, , .

re sults of th e d e te rminatio ns of th e total solids for th e last 1 6 days of th e

fast are give n in tabl e 24 and ra nge from g rams o n A pril 29 30
,
—

to grams o n th e las t day of th e fast From the se absolute .

d e te rminatio ns of th e total soli ds toge th er with th e volume s of uri ne ,

an d th e sp e cific gravi ty it was possibl e to comput e a factor i n di cati n g

,

th e ratio b e tw ee n th e total solids and th e sp e cific gravity This factor .

,

although high e r than th e valu e for normal in dividuals

v e ry co nstan t in the s e late r days of th e fast ran ging from to ,

with an ave rag e of Th e valu e which re prese nts th e ave rage

ratio b e tw ee n th e total solids and th e sp e cific gravity in th e last part
of th e fast agr ee s v e ry close ly with those foun d in thr ee of th e fasti ng
,
2
exp e rim e n ts with th e subj e ct S A B in th e Midd l e town r e s e arch . . .
,

nam ely e xp e rim e n ts N os 7 1 7 3 and 75 th e ratios b e in g

,
. and
, , ,

re sp e ctively I n e xp e rime nt N o 7 7 with th e same subj e ct much

. .
,

large r amoun ts of sodium c hl orid e w e re excre te d and this doubtl ess ,

was th e cause at l e ast in par t for th e low e r ratio of 2 5 for this 4 d ay

, ,
.

fastin g e xp e rim en t In th e late r days of th e fasti ng e xp erime n t with

.

our subj e ct L the re was u doubte d l y a min imum sodium —chloride

.

n
e xcr e tio n an d th e co nsta n cy in th e ratio b e tw ee n th e total soli d s an d
,

th e spe ci fi c gravity poi nts towards an approximat ely consta nt re latio n

ship b e tw ee n th e organic and inorganic solids of th e urin e Unf o r .

tun ately we are una b l e to apportio n th e total solids b e twe en th e m in

,

e ral an d organi c co nstitu e n ts sin c e it was impossibl e to d e t e rmi ne ,

th e ash co n t e n t of th e fastin g urine owin g to th e d e fi ci en cy in mat e rial , .

I t c an o nly be poin te d out he re the re fore that whil e th e factor , ,

is co nsid e rably larger than that acc epte d for normal p e opl e n ame ly , ,

it is probably e xplaine d in part b y th e fact that there w e re pro

ducts of d e f e ctiv e fat katabolism in th e urin e .

Thi s ave rage ratio i e was use d for computi n g th e total soli ds
,
. .
,

for th e first 1 5 days of th e fast Th e re sults of the s e computatio ns are .

also give n in tabl e 24 In comparin g th e valu e s we fi nd that th e large st

.

Higgin an d B dict Am J u n Ph y i l 1 9 1 1 28 p 29 1
1
s en e , . o r . s o , , . .

B ned ic t C a n gi I n t Wa h P b 7 7 1 90 7 p 3 5 5
2
e , r e e s . s . u .
, , . .
 U R IN E . 45

amoun t was grams o n Ap ri l I t is probabl e that owin g 1 7— 1 8 .

,

to th e in cre as e d sodium chlorid e excretion in th e first days of fasting

-
,

th e valu e s are some what too high an d that th e factor use d shoul d have
b ee n l ess than
DAY AND NIGHT URINES .

Whil e with a fast as prolonge d as this th e main int ere st li e s in a

compariso n of th e urinary e xcre tion from day to day and there is but
littl e i nt ere st in a sub divisio n of th e day in to 12 hour p e riods y et we -
,

hav e c e rtain fragmentary data re gardi ng th e diurnal excre tio n of urine

whi ch are of suffici ent import an c e to r e cord he re U sually th e bladd er .

w a s e mpti e d at 8 a m an d at 8 p m t
.h e 24 —ho u r day b e in g thus divid e d
. . .
,

i n to two p eriods i e from 8 a m to 8 p m and from 8 p m to 8 a m

,
. .
,
. . . . . . . .

Whi l e thi s subdivisio n was no t ma d e exactly e ach day n e v erthel e ss ,

th e variatio ns w e re g ene rally w e ll within o ne half hour On o ne day -

.

TA B LE 25 .
— Periodic distrib utio n f
o vo lu me and nitrogen of uri ne in p
ex eri ment with L .

Day pe io d r . Nigh t p eri d o .

D at e .

D u ati r on . D u ti ra on .

a m .
p m
. . .
pm . . c . m .

m m m
b
8 05 to 7 h
2 7 7 h
27 to 7 h
57m

2 1 — 22 .

1
G r am s .
24 6 A ST UD Y or P R O L O N GE D FA S T I N G .

( May 1 0—
1 1 ) th e day p e riod was 14 hour s and 5 mi nut e s and th e night
p e riod o nly 9 hours and 55 mi nut es a di screpa ncy whi ch re sult e d in th e ,

omissio n of th e day from th e re cord of th e p eri odic distributio n of th e

urine B e ginning with April 1 8 19 th e volume s of th e day an d night
.
—
,

urine s w ere se parate ly re cord ed Furthermore toward th e end of th e .

,

fast p e riodic d ete rmi natio ns of th e nitrogen for th e day an d night

,

w e re mad e Th e d ata thus obtai ne d are give n in tabl e 25 Without

. .

layin g e mphasis at this time o n th e absolut e valu es of total nitrogen

e xcre te d a di scussio n whi ch b e lo n gs lat e r in thi s repo rt
—
we may —

prop e rly co n sid e r th e data in this tab l e as i ndicatin g th e divisio n of

th e urin ary e xcre tio n b e tw ee n night and day wh en no food was tak en .

Th e volume of uri ne duri ng th e day ra n ge d from a minimum of

24 2 c c o n May 1 1 1 2 to a maximum of 4 0 7 c c o n April 29 30
. .
—
Th e . .
—
.

ave rage volume for th e day urin e was 293 c c Th e average volume for . .

th e night uri ne was 3 7 6 c c an i ncre ase of 83 c c On s e ve ral occasio n s

. .
,
. .

th ere w e re large diflerences b e tw een th e day and night urine s whi ch ,

are n o t e asily e xplaine d Thus o n April 28 29 the re w ere but 263 .

,
—

c c in th e daytime and 4 95 c c during th e night Although th e day

. . . . .

p e riod was but 1 1 hours and th e ni ght p eriod 1 3 hours this differen c e ,

in vo l ume is v e ry larg e Whil e in general th e volume s for th e day and

.

th e night w e re no t far apart th e ave rag e differ en c e as we have se en , , ,

b e in g but 83 c c it is i nd ee d surprising that a larger volume was no t

. .
,

e xcre te d d urin g th e day for th e subj e ct dr a nk his e ntire allotme nt ,

of 900 c c of wat e r b e fore 8 p m takin g it in fairly re gular portio ns

. . . .
,

throughout th e day U su ally but a small amou nt was l e ft aft er 6 p m

. . .

T h e drinkin g of wat e r was thus distribut e d to obviat e th e ne c e ssity for

uri natin g i nside th e calorim et er chamb e r durin g th e ni ght ; and i ndee d ,
throughout th e fast th e subj e ct retaine d th e uri ne in th e bladde r
,

th e e n tir e night p e riod .

On th e days for whi ch we hav e th e data for both th e volume and

th e n itrog e n of th e urine we fi n d that o n an ave rag e 4 2 pe r c en t of th e ,

total volume of uri ne and per c en t of th e total nitroge n w e re

1
e xcre t e d d uri n g th e daytim e I f th e volume of uri ne had had a .

mat erial eff e ct upo n th e total nitrogen o ne woul d e xp e ct that a some ,

what gre at e r proportio n o f nitrogen would have b ee n excret e d d uring

th e night tha n was actually fou nd and it is r e aso n abl e to suppose that , ,

with th e re lative l y small total volume of ur i ne here i nvolve d there could

have b een but littl e washin g out of th e nitroge nous products as a re sult
of th e diffe re n c es in volume B ut in Vi ew of th e w ell k nown fact that .
-

large quan titi e s of wat e r assist in washin g out nitrogen ous mat e rial n o ,

other exp l anatio n than th e i n cre as e in th e volume of uri ne s e ems possi

ble for thi s small but positive in cre as e in th e nitroge n output duri n g
th e ni ght .

O bvi u ly l igh t c
l
o c ti n f v a i ti in th l tiv l gth f th day and ni gh t p i d
s s o rr e o s or r a o ns e re a e en o e er o s

sh uld be m d bu t an i n p cti n f th tabl

o a e, h w th at th p c ntag fi gu
s e w u ld n t be
o o e e s o s e er e e r es o o

m ate i all y al te d
r re .
24 8 A ST UDY OF P R O L O NG E D FA S T I NG .

re sults in ma ny exp e rime nts having b e en r e cord e d in t e rms of ur e a .

N e ve rthe l e ss th e nitrogen valu e s foun d in s eve ral fasts Of 7 or more

,

days are co n sid ere d O f suffici e n t importan c e in co nn e ctio n with th e

study of th e f as tin g urine of our subj e ct to be reproduc e d h ere and
are accordingly r e cord e d in tabl e 26 .

I n this tabl e th e body w eight at th e b e gin nin g of th e fast is give n -

for ne arly eve ry subj e ct and fre qu ently for comparison th e nitroge n ,

e xcr e tio n is in c l ud e d for th e day prior to th e fastin g Th e value s for .

L are first shown the s e b e in g follow e d by th e nitrogen found in Su cc i s

.
,
’

fasts Un fort unate ly th e se latt er val ue s are not strictly comparable

.

with th e othe rs owing to th e diff eren c e s in me thods of d e t e rminatio n

, .

Thos e foun d for Getti c an be re li e d upo n as c an thos e for B e auté , ,

S che nk Tosca and S A B ,

Th e valu e s report e d for S ucci for th e
,
. . .

Lo n d o n an d N aple s fasts are undoub te dly somewhat low but thos e ,

for th e F lore n c e fast have b een corre cte d by Mun k E ve n whe n the se .

po ints are tak e n in to co nsideratio n th e most strikin g fe ature in this ,

whol e group of re sul ts is th e fact that th e nitrog en excre tio n of our

subj e ct L co n tin u e s to be extraordinarily high to th e fifte en th day of
.

th e fast and in d ee d throughout th e r e mai nd e r of th e fast th e valu es

, , ,

are notic e ably hi gh e r tha n those found in any oth e r study O f prolo ng e d
1
fasti ng Valu e s as high and e ve n highe r are shown for C e tti for
.
, ,

th e 1 0 days of his fast and also for th e 7 day e xp e rime n t Of S A B ,

-
. . .
,

but in no ne of th e lo ng er fasts are such hi gh valu es so co ntinuously

shown I n S ucci s 30 day fast in H amburg th e valu e fou nd for th e
.
’
-

last day grams) was highe r than that for th e thirti e th day of
th e fastin g e xp e rim e nt with L but th e e arli e r valu e s w ere me asurably .
,

low e r An othe r poin t of in te rest is that th e gene ral t en d en cy is toward

.

a low ni troge n output o n th e firs t day of th e fast with a hi ghe r nitrogen ,

e xcre tio n o n th e subs e qu e nt o n e or two days This characte ristic is .

show n in th e fasts with L S A B Tosca and B e auté and may .

,
. . .
, , ,

e asi l y be attribut e d to th e prot e ctin g actio n of th e body storag e of -

g l ycog en d urin g th e first few days .

On e striki n g fact in co nne ctio n with th e high nitroge n output in

L s fast is that o n th e fif te e nth day th ere was a Sudd en fall of n e arly
’
.

2 grams An insp e ctio n of th e valu e s for th e oth e r subj e cts shows

.

that in all of th e fasts thi s sud d en fall in th e nitrog en e xcre tio n occurred
’
at some poi n t Thus in Su c ci s fast at Floren c e th ere was a fall of
.
, ,

1 gram o n th e e ighth day ; in th e L o n do n fast th er e was a fa l l of

N 1
f th u bj
o ne o t h w a ab l u t a mini m u m v al u f
ese s ni t g n xc ti n a wa f nd
ec s s o s s so e e or ro e e re o s s ou

n n d y wi th G af i u bj c t ( G f Z it h r f ph y i l Ch m i 1 9 1 0 65 p
’
o o e a r e s nsa n e s wh n e ra e , e sc . . s o . e e, , , . e

th v y l w xc ti n f
e er o g am f ni t g n w a f u nd S i c th b d y w igh t f thi
e re o o r s o ro e s o . n e e o - e o s

s u bj c t w at t h
e tim as ki l g m th i xc ti n w ld c e po n d t app xim ate ly
e e o ra s, s e re o ou o rr s o ro

g m f ni t g n pe kil g am f b d y w igh t T h i u p i i n gl y l w val u i diffi cul t to xplai n

ra o ro e r o r o o - e . ss r r s o e s e ,

f
or wh i l G f t tes th at d u i n g t h l att
e ra e s a pa t f th xp im t th uri wa f qu ntl y p n r e er r o e e er en e ne s re e s o

tan u ly p aeo d an d h n c th 24 h u p i d c uld n t b ccu at l y d te m in d y t his dis

s sse e e e - o r er o s o o e a r e e r e , e

u i n f th i l w v al u f g am i ndic tes th at h b li v d it p nte d a 24 h u x e re re se o r e cr

-
c ss o o s o e o r s a e e e e

ti n f ni t g n
o o Th i m ain th l w t val u th at w h v a y t n po rted in any fa ti ng
ro e . s re s e o es e e a e s e se e re s

ob vati n n m n w m n
ser o o e or o e .
 U R INE

grams o n th e s eventh day ; in th e N apl e s fast th e nitroge n output ,

fell grams o n th e eighth day ; in th e R ome fast it f ell grams on ,

th e ni nth day ; whi l e in th e Vie nn a fast it f e ll grams o n th e t enth ,

day With C e tti there was a fall in th e ni trogen e xcr e tio n of 2 grams
.

o n th e e ighth day ; with B e auté th e d e cr e as e was grams o n th e

s e v enth day ; with S ch enk it was 1 gram o n th e t enth day ; with Tosca ,

TAB L E 26 .
—
Nitrogen elimi nated i n uri ne daily by fasti ng su bjects .

Su cci .

Day of fa st .

1
Th efigu in th i c l um n a giv n f th e fi r t 1 0 d ays o f th e f a t a c o c ted by Munk
res s o re e or s s s rr e . Th e r e su l ts fo r
th erem ai ni n g d ay h av b n i n c a d in l i k e p p ti n
s e ee re se ro or o .

2
G iv n by Aj ll and S l a
e e o a u a an d ho c n v t d to n i t g n f p u p
ro s re f c m pa i
e re o er e ro e or r o se s o o r so n . S i n ce th e
auth rs d n t giv t h
o o o m th d m pl y d n o att m p t i h
e e e o e m ad to c
o ec t th fi gu
, e s ere e o rr e e re s
.

u l t in t h i c l u m n w p t d by th i nv tigat a g ai n f u a bu t a e h c o nverted
3
Th e r es s s o e re r e or e e es o rs s r s o re , r ere to
gram s o f ni t g n in u a f
ro e pu p
re f c m pa i n
or r o se s o o r so .
25 0 A ST UDY OF P R O L O N G E D FA S T IN G .

grams fourte e nth day ; and wi th S A B

on th e grams o n th e . . .
,

fourth day Th es e sudd en dr ops w e re almost invariably p ermanent

.

and w ere sometim es followe d by a day o n whi ch e ven lowe r valu e s w e re

found I t is difficult to pre di ct at what poi n t this bre ak in th e nitroge n
.

curve is likely to app e ar and th e irr e gularity of c e rt ain curv es do es no t

,

j ustify givi n g s e rious att en tion at pr ese nt to this fe atur e of th e general

cours e ; n e ve rthel e ss th e fact that it is charact e ristic of all lo ng fastin g
e xp e rim e n ts is worthy of n ot e .

Th e most acc urat e nitrogen d e t e rmin atio ns for th e prolonge d fas ts

’
shown in tabl e 26 are unqu e stio nably thos e mad e by B rugsch for Succi s
fast at H amburg Th e se valu e s are somewhat lower than thos e found
.

’
for L although Succ i s bo d y we ight was 1 8 kilograms gre at e r than
.
,
-

that of our su b j e ct In no ne of th e fasti ng e xp e riments do we fi nd

.
,

sav e p erhaps in th e H amburg fast any i ndicatio n Of an i ncre ase in th e ,

nitroge n e xcre tio n ne ar th e e n d of th e fast which may be consid e re d

” “
as correspo ndi ng to th e so call e d pre mortal ris e which has bee n
- -

obse rve d with ma ny fasti ng a nimals part icularly with rabbits I t may , .

be said th e re fore that th e value s fou n d for L foll ow much th e same

, ,
.

g e n e ral cours e as th e valu e s foun d with th e subj e cts O f e arli e r fasti n g

e xp e rim e n ts e xc e pt that th e l e v el of th e nitroge n e xcre tio n aft e r th e
,

first 7 days was distin ctly high er than with th e oth er subj e cts .

DAI L Y Ex cnar ro x o r NrrROO EN .

S inc e L had car efully pre se rv e d sp e cime n s of th e u ri ne from April 1

.

unt il th e time of his arrival at th e N utritio n L aboratory we w e re abl e ,

to O btain i nformatio n as to th e nitrogen excre tio n O f this subj e ct for

13 days pre c e din g th e fastin g e xp e rimen t B y refere n c e to th e re sults .

of the s e de te rminatio ns (see tabl e 23 page it will be s een that in ,

ge neral th e ni troge n excre tio n was o n a mod e rat e ly hi gh l e ve l ave r ,

agi n g no t far from 1 3 grams pe r day and e ve n e xc e e di ng th is wh en th e ,

low valu e O f grams is exclud e d .

On his first day in B osto n (Ap ril 1 0 th e nitroge n e xcr e tio n was
grams This was th e high e st valu e fou n d an d doubtl e ss re sult e d
.

in p art from th e large b ee fst e ak e at e n by th e subj e ct o n th e night of

hi s arrival Th e nitrog en e xcr e tio n subse qu en tly d e cr e as e d u ntil o n
.

th e last d ay b e for e th e fast it was but grams F rom April 1 0 .

until th e b e gi nn i ng Of th e fast th ere fore th e total nitroge n in th e urine

, ,

average d ov e r 1 4 grams per day This is signi ficant as i ndicati ng that .

L was subsisti n g o n a nitrogenous di e t w hi ch was quit e i nco nsist ent

.
,
“ ”
with his claim that h e was a low prot eid v ege tarian -
.

Th e valu e s for th e nitrog e n e xcre tio n for th e whol e exp e rime n t ,

i ncludi n g no t o nly thos e for th e fasting p eriod but for th e food days ,

prior to and following th e fast are give n in ta b l e 27 ,

A s not e d in th e compariso n with oth er fasti ng subj e cts two striki n g ,

fe ature s of the se value s for th e total nitroge n excretio n are th e imm e di

2 52 A ST UDY OF P R O L O NGE D F A S T I NG .

Although thi s is primarily a stu d y of th e excretio n of nitroge n during

fasting th e valu e s foun d for th e 3 d ays subs equen t to th e fast have a
,

c e rtain in tere st D uring the s e days th e subj e ct took an almost

.

1
prot ein free die t co n sistin g of fruit j uic e s and ho ney Th e large
-
, .

am ou nt of carbohydrate co ntaine d in this di e t imme di ate ly prote cte d

th e prot ei n in th e body and in co ns e qu en c e th e re was a co ntinu al ly
d e cre as in g nitrogen e xcre tio n un til o n th e last day we have th e lowe st
,

amo unt fou nd with this subj e ct n am ely grams This 22 hour , , .
-

val u e is actually somewhat low e r than that foun d with B e auté by

Cathcart in a 3 day e xp e rim ent with a starch cre am di e t of F oli n
- -

B e auté with a body w eight Of no t far from 5 8 kilograms showing a

,
-
,

minimum ni troge n output of grams S i n c e L had a body w e ight . .

-

a t this tim e of o nly kilo g rams it wo uld p e rhaps be exp e cte d that ,

his nitrogen e xcre tio n would be much low er tha n that of C ath c art s ’

subj e ct ; it should be note d howe ve r that hi s total ni trogen l e ve l was

, ,

c o nsid e rably high e r tha n that show n by B e auté .

T h e valu e s fou nd for our subj e ct L o n the s e days of food following .

t h e fast have a sp e cial in t e re st in that th e y show that th e e xc e ss Of

,

carbohydrate in th e di e t acte d as a gre at prot e ctio n of th e body prot e in ,

an d h e n c e we hav e h e re probably th e n e ar e st to th e mi nimum prot ein
”
r e quire me nt Of this m an corre spo ndin g to th e Ab nutzu ngsquote
“
,

o f R ub ne r .

N rrna N B O DY WE G HT
Ex CBBTrO N p an K ILO G RAM or - I .

We have no i nformatio n as to th e fluctuations in th e body w eight -

prior to th e arrival of th e subj e ct at th e laboratory but accurate Obse r ,

vatio ns w e re mad e from April 1 1 to th e end of th e e xp e rim en t and th e ,

n itrog en pe r kilogram of body w e ight may thus be compute d for that -

p eri o d Th es e valu e s are also given in tabl e 27 On th e first day Of th e

.

fast th e nitroge n output per kilogram of body w e ight was ve ry low b eing -
,

o nly gram I t th en ros e r e gularly unt il it re ach e d a maximum on

.

th e fourth d ay of gram There aft e r there was in gene ral a st e ady

.
, ,

fal l with two mi nima of

, o n th e twe n ty third and th e thirty fir st - -

1
T o aid in n i dic i g
at n t h e ki d
n s an d am o un ts o f oo f d
e ate n o n th e fir st two a s o f oo fo l d y f d
l o wi n g f i d
t h e ast , th e est m ate am o u n ts and o m o s t o n o f o o c p ii
e ate n are ta ulate h erew th : f d b d i
C arbo

19 12.

M ay 1 5—1 6 L e m o ns

T o ta l .
 U R I NE . 25 3

days r e sp e ctiv ely Aft er food was agai n taken .

,
th e itroge n excre tio n
n

d e cre as e d to th e surprisin gly low valu e Of g ram per kilogram of

body w e ight
-
.

C O MPAR I S O N or ME TH O D S FO R D E TE RMI NI N G T OTAL NITR O GE N AN D AMM O NI A NI TR O G E N

-
.

Th e mi croch emi cal m e thods had b een de ve lop e d j ust pr e vious to

thi s fastin g e xp eriment and w e r e the refore us ed by Mr H L Higgin s . . .

for de te rmi ning th e total nitrogen and th e ammo ni a nitrog en Th e -

.

total nitrogen was also d e t e rmin e d by th e K j e ldahl me thod an d th e

ammo nia nitroge n by th e o l d F olin me thod , both d e t ermi natio ns b ein g
-

made by Miss E B B abcock Th e s e an alys e s Of th e fastin g uri n e s

. . .

we re the r efore th e first co ntrol a n a l ys e s which had b e e n mad e outsid e of

th e F olin laboratory B oth th e K j e ldahl m ethod an d th e F olin micro
.

che mical method were fre qu ently t e st e d by d et ermi ni ng th e nitrogen of

TABLE 28 —
. Comparison of the de termi nations of nitrogen and ammo n iam itrogen by for mer
meth ods and the new micro chemical methods of Fo li n .

Am m ni a N o - .

D at e .

1912 .

2 7— 28

0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

1
Fo r to ta l am o un ts o f ni tro g en an d amm o ni on th i s day , see ta bl e 29 .
2 54 A ST UDY OF P R O L O N GE D FA S T I NG .

kn o wn su bstanc e s such as a m mo nium sulphate ammo nium ferrous

,
-
,

sulphat e ur e a an d uric acid We w ere thus assur e d of th e accuracy

, ,
.

of th e me tho ds S inc e th e F olin microch emi cal me thods p l aye d such

.

an importan t rol e in th e s e a nalys e s particularly in an e co nomical ,

distributio n of th e availa b l e urin e it s e ems d esirabl e to publish th e ,

re sults of th e co n trol t e sts A ccordingly in tabl e 28 th e valu e s .

, ,

o btain e d for th e total nitroge n by th e K j e ldahl m e thod are compare d

with those s e cure d by th e microch emical metho d s ; th e valu e s for th e

ammo nia nitrogen Obtaine d with th e new and old F olin methods are
-

also compare d As will be s een th e results of such compariso n are

.
,

most satisfactory We wish again to e mphasiz e th e gre at valu e of

.

the s e me thods particularly whe n the re is urge nt ne c e ssity for th e use of

,

small sampl e s .

T HE PAR T IT I ON OF T HE NIT R OG E N EXC RET I ON .

Whil e th e total nitrogen e xcre tio n in th e uri ne of a fasti ng m an has

a g e neral i nt e re st more particularly in th e apportio nme nt of th e total
,

e n e rgy re quire me nt an d th e e ne rgy output amo n g th e various factors ,

prot ein carbohydrate and fat a cl e ar u nd erstan di ng of th e n ature of

, , ,

th e disin te gratio n of th e nitrog eno us mat erial is O btai ne d o nly wh en a

partitio n of th e ni trog en excre tio n is mad e accord ing to th e a n alytical
sch eme of F o lin F ortun ate ly with all of th e sampl es Of urine col
.
,

lec te d for th e 3 1 days of th e fast we w e re abl e to s ecur e a compl e t e

partitio n O f th e nitroge n with th e sin gle exc eptio n of th e d e te rminatio n
,

of th e total purine s ; we w ere howe ve r abl e to d e t e rmi ne th e uric , ,

acid nitroge n Thi s partitio n i n clud e d th e d ete rmin atio n of th e total

-
.

nitroge n and th e nitroge n from ure a ammo ni a uric aci d cre ati ni ne
, , , ,

pre form e d an d total cre atini ne Th e nitrogen u nd et ermi ne d is given

,
.

”
as re st nitroge n
“
Furthe rmore si n c e F oli n has shown th e gr eat
.
,

significan c e of th e proportio n ate distributio n Of th e nitrogen de rive d

from the se various sourc e s we have comput e d th e p erc e ntage O f th e ,

total ni troge n in th e se nitrogenous co nstitu e nts of th e uri ne T h e .

value s for e ach day e xpre ss e d in grams an d in p erc entage s of total

,

n itroge n are give n in ta b l e 29

,
.

U REA .

With th e microchemi cal me thod of F olin th e ure a nitroge n in th e ,

-

fastin g urine s could be dete rmi ne d with gre at accuracy T h e d ete r .

m in atio n s w e re accordi n gly mad e by Mr H iggi ns for th e 3 1 d ays of th e .

fastin g p eriod and for th e 3 days followin g th e fast Th e re sults are .

give n in tab l e 29 toge th er with th e p e rc e ntag e O f ure a nitrog en in

,
-

t e rms of total n itrogen .

I n ge ne ral th e cours e of th e e xcretio n Of th e ur e a nitrog en fo ll ows -

qui t e clos ely that of th e total nitroge n Th e r e gular i ncre ase shown .

in th e first 3 days for th e total nitrogen is also apparent h ere ; th e

25 6 A ST UDY OF P R OL O N GE D FA S T I NG .

TA B L E 29 .
— Partition of nitrogen excreted in uri ne per iment with L
i n ex .
— Co nti nued
.

Pro po rti o n o f to tal ni tro ge n in

Day of
D ate .

19 1 2 .

7 0 63
.

1 5—1 6

1
Th e am o un ts fo r th i s day w ere d e term i n ed in th e urin e fo r abo ut 22 h o urs .

during th e last 26 days was per c en t o n th e nine t een th day and

th e hi ghe st o n th e e l e ven th day of per c ent Th e ave rag e valu e .

for the s e days was pe r c e n t with a distin ct tend en cy towards

,

co nsta n cy Upo n th e r e sumptio n of food the re was at first no marke d

.
,

disturba nc e in this ratio but o n th e third day th e p erc entag e of ure a

,

nitroge n d e cre as e d to th e low valu e O f 5 6 per c en t this va l u e b e in g ,

foun d at th e time that o nly grams of nitroge n w e re excre te d in

th e u ri n e The s e low va l u e s in th e p e rc en tage Of ure a nitroge n are
.
-

p e rfe ctly comparabl e with thos e fou n d by F o l in o n su b j e cts subsisti ng

 UR I N E : 25 7

on a starch cre am die t with an e xcre tio n of nitrogen corre spo ndin g
-
,

to n o t far from 4 to 5 grams per day .

Thes e figur e s are also substantiat e d by th e Obse rvations Of Cathcart .

’
Whil e h e foun d in th e first 3 days Of B e auté s fast that th e ure a n itro -

g e n av e rag e d n o t far from 8 7 pe r c e n t i n st e ad O f th e 80 p e r c e n t fou n d

with our subj e ct L an d that th e valu e s also av erage d somewhat highe r
.
,

for th e remai n de r of th e fast ne v e rth el e ss th e p erc entage fell as lo w as

,

7 1 per c e n t on th e e ighth day of th e fast On th e food days followi ng

.

th e fast th e ure a ni troge n f ell to per c en t o n th e day wh e n th e

-
,

mi nimum nitrogen e xcre tio n was Obs erv e d .

E and O F r eund fou n d in the ir obs e rvatio ns o n S ucci that th e ur e a

. .

n itrog e n was 8 2 per c e n t or more of th e total ni trog en e xcre tio n for

th e first two w eeks of th e fast Th ere was then a rapid fall in th e
.

p erc entage u ntil but 56 an d 58 per c en t of ure a nitrogen w e re found -

’
o n th e last 2 days B rugsch s Obs e rvatio n s o n S ucci in H amburg S how
.

that for th e last 8 days of th e 3 0 day fast th e ure am itro g en was no t

-
,

far from 60 per c en t of th e total nitrogen .

V an Ho o genh u y z e an d V erplo e gh in th eir O bse rvatio ns o n Tosca

, ,

n ot e most irr e gular proportio n s O f ur e a nitrog e n Th e p erc e ntage s

-
.

of ure a nitroge n comput e d by us from the ir data are as follows th e

-
,

day of th e fast b e in g give n in pare nth ese s : (1 ) (2) (3 )

(4 ) (5 ) (6) (7 ) (8) (9) ( 1 0)
(1 1 ) ( 1 2) (13 ) (1 4 ) On th e sixth day th e
low valu e of 59 per c en t is from data qu estio ne d by th e authors I n .

th e light of oth e r fasting studi e s th e re is n o obvious expla n atio n

,

for th e u nusual l y high averag e valu e e sp e cially for th e last 8 days of ,

th e fast .

F rom all th e e viden c e it c an be s een that in general during fasting

th e ure a output approximat e ly parall e ls that of th e total ni trog en ,

there b ei ng a d e cide d i ncre as e o n th e first few days of fasti ng follow e d ,

by a d e cr e as e I n practically e ve ry i nsta n c e wh en there is a fluctua

.

tio n In th e total nitrogen output thi s 1 s parall el e d by th e ur e a nitrogen

,
-
.

I t wou l d thus app e ar that th e d e t e rmi nin g factor l n th e fluctuatio ns

of th e total nitrog en I S probably th e proportio n of ure a nitrogen and -
,

not th e gross alt eratio n s in th e othe r factors T h e variatio n in th e .

p erc en tage distributio n c an howe ver be i nt elligently tre at e d o nly aft e r

, ,

a co nsid e ratio n of th e change s in th e output Of ammo nia nitrogen -

.

AMMO NIA .

Th e ammo nia ni troge n o n account of its gr e at s ignifica n c e in co n

-
,

side rin g th e products of d e fe ctiv e fat kataboli sm was d e t e rmin e d by ,

both th e old and th e n ew F o l i n methods Th e re sults of thes e two .

s eri e s of de t ermi nations are given in tabl e 28 page 25 3 An ave rage of , .

the s e two s e ri e s of value s is also given in tabl e 29 .

N ormal uri n e always co ntain s a relative ly small amoun t O f am mo nia ,

and th e amounts foun d for L o n th e 3 days prior to th e fast were

.
25 8 A ST UDY OF P R O L O NGE D FA S T IN G .

approximat e ly thos e whi ch would be n ot e d for normal i ndi viduals

su b sistin g o n a d i e t co ntai ni n g about 1 5 gram s of nitrog e n Th e .

ammo nia nitroge n form e d no t far from per c ent of th e total n itrogen
-

e xcre tio n per d ay At th e b e gi nn i ng O f th e fasti ng p erio d th e amoun t

.

of ammo nia nitroge n e xcre t e d fell somewhat an d no t u n til th e third

-
,

day do we fin d va l u e s e xc ee di ng thos e O btai ne d b efore th e fast On .

th e fourt h day it ros e quit e sharp l y to grams an d the n co nti nu ed

to rise st e adily with S l ight fluctuatio ns u ntil th e maximum valu e of
, ,

grams was r e ach ed o n th e S ixt e enth d ay There aft e r it slowly .

and quit e r e gularly d e cre as e d u ntil th e e n d of th e e xp erimen t th e ,

e xcre tio n of ammo nia n itroge n o n th e last day b e i n g

-
grams This .

gradual i n creas e and d e cr e ase was e xactly that Obs erv e d b y Cathcart ,

although th e maximum valu e with his subj e ct was obs erv e d o n th e

e ighth day whi l e with L it did n o t app e ar u n til th e sixt e en th day
, . .

B rugsch fou n d th e excre tio n Of a m mo nia nitrog en quit e re gular ra ng -

,

ing be twee n grams and grams in th e last 8 days of Su c ci s ’

fast in H amburg .

S in c e th e amou n t O f ammo nia ni trog en would n ormally be expe ct ed -

to fluctuate somewhat with th e fluctuatio ns in th e total nitrog en

e xcre tio n th e p erc e n tag e of ammo nia nitrog e n in th e total nitrog en
,
-

must be consi d er e d On this basis th e mi nimum p erc entage

.
per
c ent) is fou nd o n th e first day Of th e fast with th e maximum ,

per c ent ) o n th e s e v e nt e enth day E v e n o n th e p erc e ntag e basis th e .

ammo nia ni troge n t en ds to in cre as e u ntil th e middl e of th e fast and

-

then slowly to d e cre as e although towards th e end it was still 1 0 per

,

c en t or more large r tha n it was prior to th e fasti ng p eriod .

I t is cl e ar th ere fore that the re was some factor which stimulat e d

, ,

th e e xcr e tio n Of ammo nia nitrog en From previous e xp eri enc e with
-
.

fasting subj e cts it is Obvious that thi s i ncre as e in th e excre tio n was
,

due to th e orga nic acids chi efly th e B—O xybutyric acid r e sulti n g from
,

d efe ctiv e fat kata b olism Th e large e xcre tio n of ammo nia th e refore
.

u n doubt e dly corr e spo n ds to an i ncre asi ng acidosis th e productio n of ,

th e ammo nia b ein g a prot e ctive actio n o n th e part Of th e bo d y to ove r

come th e effect of th e acids Th e amou nts Of ammo ni a nitroge n fou n d .
-

for L du ri ng fasti ng w e re me asurably gr e at e r than thos e O bs e rve d by

.

Cathcart for his su b j e ct and th e p erc e n tage of th e total nitrog en was

also co n sid erably gre ater Thes e valu es would th erefore imply that L
. .

’
had a some what gre at e r acidosis tha n had B e auté in C ath c art s re s e arch .

Th e r e sults of th e O bs ervatio ns of E and O Fr eun d o n S ucci are . .

diame trica lly Oppos e d to th e valu e s fou n d by Cathcart o n B e auté ,

B rugsch o n S ucci and by us with L for both th e absolut e amou nt an d

,
.
,

th e p erc entag e Of th e total nitroge n fou nd an d o n e is i n cli n e d to qu e s ,

tio n some what th e t e chni qu e of th e Fre u nds Whi l e th e obs ervatio ns of .

1
B o nnige r an d Mo hr o n th e fasti n g woman S che n k are com pl icat e d by th e
l
B nni g
o and M h r Z it h r f e xp P ath u T h
er o ap i
, 1906 3 p 6 75
e sc . . . . . er e, , , . .
26 0 A ST UDY OF P R O L O NGE D FA S T I NG .

tio n Of nucl e in katabolism is undoubte dly tru e B eyo n d this u nive r .

sally acc epte d fact th e e vid en c e as to th e influ en c e Of i nt esti n al

, ,

glandular ki dne y and muscu l ar activity is much d ebat ed

, , .

I n pre vious fastin g e xp e rime n ts it has b ee n shown that th e gla n dular

ac tivity at l e ast so far as th e digestive orga n s are co n c erne d is at a
, ,
1
min imum and h en c e w e should e xp e ct to fi n d that if any co nsidera b l e
,

proportio n of th e uric acid w e re Obtaine d as th e re sult O f gla ndular

activity there woul d be a minimum uric acid nitroge n e xcre tio n d uri n g
,
-

th e fast As i d e from th e admi tt e dly low valu e s o n th e s e co n d to th e

.

fifth d ays of th e fastin g e xp e r iment with L this was no t th e case for .

, ,

the re are ma ny days during th e fast o n which the re was ful l y as much
uric acid nitrog e n if no t i nd e e d more than o ne woul d exp e ct to fi nd
-
, ,
2
with a normal indi vidual subsistin g o n a puri ne fre e di e t -
.

Af te r L had tak e n food the re was a s l ight in cre as e in th e total

.
,

uric acid ni troge n e xcre tio n from

-
gram whi ch was O btai ne d o n ,

th e last day O f th e fast to gram o n th e first day with food Ordi , .

n aril y thi s would n o t be co nsi d e re d as a substa n tial in cre as e in th e

tot al uric aci d n itroge n e xcre tio n and y e t in re c e n t co ntrov e rsial
-
,

pap e rs Mare shas poi nte d out that a 1 0 pe r c e n t i n cre as e is no t to be

,

ign ore d and that it d o e s re pre s e n t an actual I ncre as e Whil e accord .

in g to Mar e s th e i ng e stio n of food which stimulat e s th e dig e stive

,

glan ds to the ir gr e at e st activity is most productive O f an i ncre as e in

th e e xcre tio n of uric acid ne v e rth e l e ss S me t ank a has fou nd that such , ,

an e xcre tio n took plac e e ve n with ho ne y I nasmuch as th e food take n .

by L was in large part carbohydr ate a portio n of th e di e t b e in g

.
,

ho ne y it is no t impossibl e to b e l ie ve that the re may hav e b ee n

,

a positive i n cre as e in th e uric acid nitrog e n as a r esul t O f th e i nge stio n -

O f this food This is th e more cre d ibl e if we giv e h ee d to S m e tanka s

.
’

criticism that 24 —hour p eriods are not b e st suite d to th e study of thi s

probl e m as th e i nflu enc e of th e activity of th e d ig e stive glands d is
,

app e ars rapidly afte r th e in ge stio n of food .

D urin g th e fasti n g p eriod th e p e rc en tage of th e total nitrogen in ,

th e form of uric acid nitroge n like wis e u nd e rw ent co nsid e rabl e flu c tua
-

tio n approximat e l y para ll elin g th e abso l ut e amou nt of this co nstitu en t

,
.

Th e p e rc e ntag e valu e sh ows a di stin ctly i n cr e ase d uri c—acid nitroge n

e xcr e tio n in th e post fasti n g p e riod risi n g to per c e nt and whil e
-
, ,

th e e vid en c e is by no m e a n s compl e t e t h is may w e ll be in t e rpre te d ,

as an in dex O f an i n cre as e d gla ndular (dige stiv e) activity .

Cathcart also d e te rmi ne d th e uric acid nitroge n e xcre tio n for his -

subj e ct usin g th e me tho d of H opkins F o l i n D uring th e first half

,
-
.

Of th e fast h e fou n d a distin ctly low e r valu e for th e uric acid n itroge n -

than in th e pre c e din g food p eriod but there was a co n tinual t en den cy ,

for this form of nitrogen to i ncreas e as th e fast progre ss ed With th e .

takin g of food there was an in cre as e in th e uri c acid nitroge n at - —

L u ciani Da H un g n H am bu g an d L i p ic 1 89 0 p 44
l
, s er , r e s , , . .

F lin Am J urn Plur i l 1 905 13 p 6 2

2
o , . o . s o q , , . .
 U R I NE . 26 1

l e ast onfirst day foll owe d by 4 days with th e same e xcr e tio n as
th e —

’
in th e last p e riod of th e fast Thus in B e auté s fast th er e was a .
,
1
d efi nit e t en d en cy towards r e gularity in th e e xcre tio n Of th e uric acid -

n itroge n in asmuch as th e r e was from th e b e ginni n g to th e e n d a

,

r e gu l ar though slight i n cre as e a re gularity that was by no me ans

, ,
—

parallel e d by th e Obs e rvatio n s o n L .

Whil e th e valu e s fou n d for L w e re d e cid e dly variabl e y et in s e veral .

,

poin ts th ey strikin gly co nfirm th e e arlier o bservatio ns Thus th e x .

mark e d fa l l o n th e s e co n d fasti n g day follow e d by a low e xcr etio n for ,

s e v e ral days and a subse qu ent ris e with a high e r valu e on th e first ,

food day than that shown o n th e last fasti ng day are all in agree me n t ,

with th e Obs e rvatio ns o f Cathcart with B e auté and of V an H ooge n ,

h u y z e an d V e rplo egh in th e ir 1 4 day e xp e rim e nt with Tosca -

.

Th e rapid fa l l in th e uric acid nitroge n e xcre tio n o n th e s e co n d day -

2
has also b een obs erve d in short er fasts by S chreib e r and Waldvoge l ,
3 4 5
by H irschst ein and by F e ldmann ,
S c affi di in e xp e rimen ti n g o n .
,

th e p urine me tabolism in fasti n g co n clud e d that with thos e a nimals ,

with whi ch the re was a formatio n Of oxidative uric acid th e uric acid ,
-

n itroge n d e cr e as e d du rin g starvatio n an d th e r e was n o r e gularity in

th e r elatio n Of total uric aci d n itrog e n to th e total nitrog en -
.

This d e cre as e in th e uric acid e xcre tio n O f L was coi n cid ent with -
.

that p eriod Of th e fast wh e n th e supply Of glycog e n was rapidly b ei n g

d epl e t e d and th e subs e qu e n t i ncr e as e fo ll ow e d sharply th e in cid en c e
of th e prot ein fat katabo l ism charact e ristic Of th e re mai n d e r of th e
-

fast Th e c e ssatio n Of th e g l an dular activity of dige stio n o n th e first

.

few days may e xplain th e fall in th e uric acid n itrog en but th e sub -
,

s e qu e nt i ncre ase c an o nly be e xp l ai ne d b y an i ncre as e in th e katabolism

of th e active protoplasm ic tissu e Th e fact that this e xcre tio n do e s no t .

r emai n co n stan t or at l east do e s no t r e gularly i n cre as e or d e cre as e

, ,

is in dee d difficult to explain si n c e th ere are n o O bvious r e asons for ,

assumi ng that th e cha ng e s in th e amou n t Of th e e xcre tio n of uric acid -

n itrog e n are du e to corr e spo ndi n g cha n ge s in th e rat e of d e struction

O f th e active protoplasmic tissu e I n d ee d if we ob se rv e th e total .
,

cre ati ni ne e xcre tio n th e re gul ar d e cre as e Of that uri n ary co nstitu ent
,

woul d imply a proportio nal re gularity in th e rat e Of d e structio n of th e

active protoplasmi c tissu e I t is e vid en t that th e value s O btai ne d for .

th e e xcr e tio n of th e uric acid nitrog e n in thi s fasti n g e xp e rime n t Offe r -

n o proof of th e validi ty of any Of th e pre s e n t d ay co n c eptio n s as to -

th e origi n Of e n dog en ous uric acid e xcr e tio n -

.

l
R g ula ity i th u ic aci d xc ti
e r n a th
e fa t p g
r -
d w a al n ted f th g at p a t
e re on s e s ro r esse s so o or e re er r
o f th xp im t with T ca b y V an H g nh uy and V pl gh (l it ) and wi th S u cci in
e e er en os oo e ze er oe oc . c .

Vi na by E and O F un d ( Wi
en . klin R u d h 1 90 1 1 5 p
. re B u g c h ( Z it h r f en e r . n sc .
, , , . r s e sc . .

exp Path u T h
.
. .pi 1 905 l p 4 1 9 ) f un d v y c n tan t v alu f th puri n ni t g n d uri ng
. era e, , , . o er o s es or e e- ro e
th e l a t igh t d ay f S n l H am bu g fa t
s e s o oo
’
s r s .

S ch i b a d W ld v g l A c h f xp P ath Ph a m 1 89 9 42 p 6 9
2
re er n a o e , r . . e . . 11 . r .
, , , . .

”Hi c h
t irs A ch fs e n,p P ath r Ph a m 1 9 07 5 7 p 229
. . ex . . 11 . r .
, , , . .

‘
F ld m e ci t d by S ivé A ch iv f d g Ph y i l 1 9 1 2 1 4 6 p 4 99
ann , e n, r . . . es . s o .
, , , . .

S affi di B i ch m Z it h
“
c , 1 9 1 1 33 p 1 53
o e . e sc r .
, , , . .
26 2 A ST UDY OF P R O L O N G E D FA S T I N G .

C REA TI NI NE .

’
As a r esult of F oli n s fu ndame ntal obs ervatio ns o n th e partitio n of
th e nitrog en of normal uri ne s sp e cial stre ss was lai d upo n th e d e t e r ,

minatio n of th e cr eat ini ne e xistin g in th e uri ne of this fasti n g m an ,

F olin having emphasiz e d th e fact that th e total cre ati ni ne may be

1
look e d upo n as an i nd e x of th e total tissu e me ta b o l ism I mme d iat ely .

af te r F O li n s pap e rs had app e are d a large num b e r O f re s e arch es o n th e

’
,

cre ati nine in uri n e w ere re p ort e d and Obs e rvatio ns w ere simultane ,

o u sly mad e in s e v e ral laboratori e s which impli e d th e pr e s e n c e of

creatin e in uri ne u nd e r c ertai n co nditio ns particularly in pathological ,

cas e s and during fastin g .

F olin s a nal ytical sch e me e nabl e d th e d ire ct d et ermi natio n O f crea

’

ti ne th e creatini ne b e in g fi rst d ete rmi ned and subs equ e ntly any cr e ati ne
, ,

in th e urine was co nv ert e d to cr eati ni ne by h e ati n g with acid for 3

hours The s e r esults w er e r eport e d by hi m as cr e ati ni ne pr eform ed
.

an d total cr e ati ni ne th e diff e re n c e in th e two va l u e s b ei n g e stim at e d

,

to be a me asur e O f th e cre ati ne express e d in t e rms Of cre ati ni ne .

Th er e is littl e of positiv e valu e to be said regardi ng th e de t e rmin atio ns

of cr e ati ne or cre atin in e in fasti n g exp eriments prior to th e i ntroductio n
2 ’
of th e F oli n m ethod h e nc e Baldi s Obs ervatio ns as w ell as thos e of th e
,
3
Fr eu nds o n Succi c an hav e but littl e qua ntitative i n t ere st On e Of th e .

first studi es mad e aft er th e F O li n m e thod was put forth is that of V an

Ho o ge nh uy z e and V e rplo egh o n Tosca 4
T h e co nsid erabl e d e cr e as e in .

th e cre atini ne O btain e d by th e m at th e b e ginnin g of th e fast fol l ow e d ,

by an i ncre as e aft er food shows (in part at l east) that o nly preforme d
,

cre ati nine was d e t e rmi ned and h enc e the ir valu es correspo nd more ,

n e arly to th e valu e s r eport e d for our su b j e ct as preform e d cr e ati ni ne .

I n th e e xp e rim ents at We sl eya n U nive rsity th e total cr e ati ni ne ,

was i nva ri ab l y fou nd to be somewhat high er in th e fasti ng p e rio d s

than th e preforme d cre ati ni ne th e diff er enc e disapp earin g wh en food ,

was tak e n an d thus th e co nc l usio n was draw n that creati ne was to be

,

fou n d re gu l arly in th e uri ne of fasti ng subj e cts This Obs ervatio n was .

5
simulta ne ously mad e and pu bl ish ed by Cathcart L ayi n g sp e cial .

e mphasis u p o n th e d i ff e re n c e b e tw ee n pre form e d an d total cre ati ni n e ,

Cathcart d iscuss e d at co n side rabl e l ength th e app e aranc e of cre ati ne

in th e uri ne Although our i nt e rpretatio n of th e pres enc e of cre ati ne
.

in th e uri n e di ffers co nsid erab l y from that O f Cathcart th e fact r emai n s ,

that si n c e that tim e co nsid erabl e re s earch has b e en carri e d out o n both
cre ati ni ne and cre ati ne excre tio n and h en c e an O bs ervatio n O f th e ,

amou n t excrete d by our fasti n g subj e ct was particularly d e sirabl e .

I
Fo lin , Am o u rnJ . . P yi l
h s o , 1 9 0 5 , 13 , 6 6 an d 1 1 7
. pp . .

2 B ld p i l c
a i , S er m e n ta e , M ar h 1 8 8 9 ; C e n trlb n M ed 1 889 , 10 , 65 1 f kl i
. . p . .

3
E an d O
. F
re un , . ener d Wi kli
n R u n dsc h 190 1 , 1 5 , 6 9 an d 9 1
. pp . .

‘
V an H o o g e nh uy z e and V erplo e g h , Z e itsc h r h so h e m e , 1 90 5 , 4 6 , . f p yi l C
. . i p . 4 15 .

ls
C ath c art , Bi c
o h e m Z e itsc h r , 1 9 0 7 , 6 ,
. 1 09 . p . .
264 A ST UD Y OF P R O L O NGE D F AS TI NG .

and are giv en in tabl e 29 A s with th e e arli er fastin g exp eriments

.
,

th er e was a diff erenc e b etw ee n th e cre atinin e preform ed and th e tot al

creatini ne as thus me asur ed .

A t th e t ime th es e analys es w er e mad e we w ere firmly of th e Opinio n ,

that th e r esults Obtai ned by such analysis woul d r epres ent quanti
tatively th e amoun t of cre atin e in ur ine e xpr ess ed as cr eati n i ne , .

S in c e th es e i nvestigatio ns w er e carri e d out two pap ers hav e app eare d ,

whi ch l ead us to qu estio n th e quantitative r elatio ns e xhibite d in th e

l
valu es here given G ree nwald in his work o n diab etic urines co n
.
, ,

sid e rs th e eff ect of th e ac eto ne bodi es upo n th e Jaffe re action and con
c ludes that urin e co n tain in g ac eto—ac e tic acid an d ac e to n e will giv e

correct results for creatinin e by th e F olin m ethod o nly aft er th e

2
removal of th ese substan c es More rec ently G raham and P oulto n .

have stu die d th e in flu en c e of ac eto ac etic acid o n th e estimatio n of -

creatin i ne and have call ed i nto qu estion th e i nt erpre tation of th e dif

f er enc e b etw ee n preform ed and to tal cre atinine as r eport e d in fasti n g
e xp e rim e nts an d in e xp e rim e n ts with carbohydrat e starvatio n Th ey .

co nclud e that ac e to ne and Boxybutyric acid if pres ent in amounts -

,

comparabl e to thos e which usually occur in urin e produc e practically no ,

”
error in th e estimation of cr e ati nin e Th ey furth ermor e stat e that .

ac eto ac etic acid caus es an e rror in th e preform ed creatinine d et ermin a

-

tio n but do es no t aff ect th e d et e rmin atio n of total cre ati nin e On
, .

th e basis of th eir exp erim e nts th ey co nclud e that th e diffe re nc e ,

b etw ee n creatinin e pre formed an d total cr e ati nine do es not r epres ent
c re atine si nc e in th eir exp eriments with carbohydrat e fr ee di e ts th ey
,
-
,

fou nd no excre tio n of creatin e .

I t is obvious th e refore that th es e two r es earch es throw co nsid erabl e

, ,

dou b t upo n th e valu e of th e figur es report ed u n d e r th e h e ad of th e

preform ed cre ati nine but aff ec t in n o wis e th e valu es for th e total
,

cre at inin e We m ay th erefore without furth er r es ervatio n proc eed to

.

a co nsid e ratio n of th e total creatin ine ni troge n as r eport ed in tabl e 29 -

.

On e of th e most strikin g f e atur es of th es e r es ults is th e ir gr eat r e gu

larity . Af t er th e first 2 days th ere was an almost co nti nuous fall in
th e total cre atini n e nitrog e n from th e maximum o n th e third day of
-

to a minimum o n th e last day Of th e fast of Th e mi n or

fluctuatio n s from this re gular fall ar e so few as to be n egligibl e .

I n th e fasti n g e xp erim ents with S A B at We sl eya n U niv ersity . . .

,

th e a l most absolut e co n sta n cy in th e total cr e atini n e nitrog e n was a -

matt er of sp ecial comm ent and in th e r eport of th e re sults it was

poi nt e d out that it was probably mor e than a m ere coi ncid en c e that
th e sum of th e cr e ati n e nitrog en and th e pr e form e d cr e ati ni ne nitrog en
- -

r emai ne d co nstan t e ach day as th e fast progre ss ed I t will be s ee n .

that for th e first 7 days O f th e fast with L whil e th e results w ere no t .

,

G nwald J u n B i l Ch m 1 9 13 1 4 p 8 7
1
ree . o r . o . e .
, , , .

G ah am and P ul to n Pro c R o yal S c

2
r o B 1 9 1 4 87 p 205
, . o .
, ser .
, , . .
 U R IN E . 26 5

co nstant ne verth el ess th e amoun t e xcret e d did no t vary gre at l y

, ,

although th e variatio n was wholly in th e li ne of a d e cr e as e toward th e

en d . I t was o nly aft er th e thi rt ee n th day that any co nsiderab l e de
cre as e in th e total cre ati nine ni trog en app eared ; from that tim e it
-

r e maine d at a low er l e v el gradually d ecr e asi ng u n til th e end of th e

,

fast th e l ow e st valu e b e in g foun d o n th e last day Of th e fast

,
.

Of particular i nt erest is th e strikin g r e gularity in th e p erc entage of th e

total nitrogen e xcret e d in th e form of total cr e atini n e Omittin g th e .
-

fir st 2 days th e p e rc en tage ra ng e d from

, per c en t o n th e sixth day
to per c en t o n th e tw e n ty fourth day
-
.

On th e first 2 days of th e fast th e valu e s for pre forme d cr e ati n i ne

,

n itrog e n an d for total cre ati n i n e ni trog e n are e ss en tiall y th e sam e

-
,

an d it is o n ly with th e third day that we b e gi n to fi n d th e m e asurabl e

diffe ren c e s which hav e b een ascrib e d to cre ati ne I n an att empt to .

e xplai n th e pr e s e n c e O f cre ati n e in th e fastin g uri n e two hypoth e s e s ,

have b e en pres en t e d : o n e that as a r esult of i na nitio n th e bo d y los e s

,

its pow er Of co nv e rting creati ne to cre ati nine b efore e xcre tin g it an d ,

th e oth e r that cre ati ne was r e pr e s en tativ e of th e fl e sh katabo liz e d as ,

in th e d isapp e ara n c e of th e body mat erial a c ertai n amoun t Of cr e ati n e

n ormally e xisti n g in th e fl e sh w as lib erat e d an d e xcr e t ed in th e uri n e .

A gai n st th e va l i d ity of thi s latt er assumptio n was th e obviously sig

nifi c an t fact that th e sum of th e cre ati ni n e nitrog en an d th e cr e ati n e -

nitroge n r emai n e d co nsta n t While without doubt th e obs ervatio n s

.

O f G r ee nwald an d of G raham an d P oulto n a ff e ct th e qua n titativ e valu e

of th e diff eren c e b etw een preforme d creati ni ne an d total cr eati ni n e th e ,

accumulativ e e vid enc e of th e past eight ye ars is such as to mak e it

r easo nably c ertain that cr eatin e is excre t e d u n chan ge d in fasti ng and
pathological uri ne s an d our u n c ertainty lies the refore o nly in our , ,

knowl edg e as to th e quan titi e s thus e xcre t ed .

1
I n a r ec ent pap er F oli n has r eit erat e d his b eli e f r e gardi n g th e
i nt erpretatio n of th e cr e ati ni n e output in th e followin g t e rms : Th e
creati ni ne elimi n atio n b e comes more cl e arly tha n e v er th e most cl ear
”
cut i n d e x or me asure of th e total normal tissu e metabolism I n this .

pa p er F oli n explai ns th e app earanc e of cre atine as an ab normal S plit

ti ng Off of a cl e avage product which is normally e xcr e t ed as cre ati ni ne
and di sclaims th e pr e s en c e of isolat e d u n combi n e d cr e ati n e in fl esh , ,

admitti ng that in fasti n g and in various pathological co n ditio ns th e

n orma l br e aki n g dow n i n to cr e ati n i n e is accompa ni e d mor e or l e ss by

an ab n ormal bre aki n g dow n i n to cr e atin e I t is cl ear th erefore that .

, ,
’
accor d i ng to all of F o l i n s r e c en t i n te rpre tatio n s th e exact quantitative
k nowl e d g e re gar di n g th e cre ati ne in uri ne has n o lo n g er th e signi fi can c e
form er l y attribut e d to it an d h en c e th e criticisms O f G r eenwal d and of
,

G raham and P o ul to n whil e a dm i tt e dly j ustifiabl e so far as t e ch niqu e

,

is co n c e rne d apply to a d et e rmi n atio n which bi d s fair to hav e b ut

,

F l i a d D ni J u n B i l C h m 1 9 1 4 1 7 p 5 0 1
1
o n n e s, o r . o . e .
, , , . .
26 6 A ST UDY OF P R O L O N GE D F A S T IN G .

littl e physio l ogical sig nifican c e T h e pathological significa nc e must .

,

how ev e r be me asurab l y in creas ed in valu e as a re sult Of th eir r e s earch es

, .

’
Of fun dam e nt al importa nc e is th e possibility Of usi n g F oli n s in t er
p r e tatio n of t h e tota l cr e atin i n e e xcr e tio n as a n i n d ex Of th e m etabolism
of normal tissu e Throughout th is e ntir e mo nograph stress has b ee n
.

laid upo n th e import an c e of kn owi n g if possibl e th e activ e mass of , ,

1 “
protoplasmic tissu e in th e body an d th e qu estio n aris es H ave we in , ,

th e total cr e atin in e excre tio n an int e rpre tabl e in d ex of th e chan g es

”
in th e activ e mass O f protoplasmic tissu e ? I f as is poi nt e d out in ,

th e s e ctio n o n e ne rgy t ransformatio n th e activ e mass of protoplasmic ,

tissu e is th e fun dame ntal factor in th e d et ermi natio n of th e total

e n e rgy r e quir e me n t w e S hould n ormally e xp e ct to fi nd that th e total
,

e ne rgy output d ec re as e d with th e loss of cre ati nin e indicati n g a c o n ,

tinu al d ecre as e in th e tis su e m etabolism As a matt er O f fact as th e .

,

fast progr ess es such a d ecreas e in th e total h e at productio n is cl early

,
-

shown by vari o u s methods and y e t as a refe re nc e to th e s e ctio n o n th e ,

pul s e rat e will show our whol e co n c eptio n of th e relatio nship b e tw een
-
,

cre atinine and e ne rgy transformatio n is s eri ous l y a ff e ct ed by th e

in cre ase in th e puls e rat e fo un d with this subj e ct duri n g th e last w ee k
-

of th e fast Th e total e nergy tra nsformatio n is cl e arly due to th e

.

active mass of protoplasmic tissu e and th e stim u l us to c ellular activity ,

but at no part O f th e fast w e re c on ditio ns so sharply diff erentiat ed that

we may say with accurac y that th e loss in th e h e at productio n was -

dir e ctly compar abl e to th e lo ss in th e n ormal katabo liz ed tissu e as ,

indi cat ed by th e d ecr ease in th e total cre ati nine excre tio n S imilarly .
,

we fin d no d efi nit e re latio nship b e tw ee n th e cr e atinine excr etio n and

th e tota l basal he at productio n uti l i z ing th e cre ati ni ne e l imi n atio n as ,

an i n d e x O f th e total mass of active proto p lasmic tissu e r emaini n g in

th e body I t is how e v e r of great sig nifica nc e that th e total cre ati ni ne

.
, ,

e xcr e tio n d e cr e as e d r e gul arly as th e fast progr ess ed thus i n dicati n g ,

not an approxim atio n to d ep l e tio n but a d isti n ct t end ency o n th e

part O f th e body to a co ns ervatio n of its active protoplasmic tissu e .

Th e d e cr e asi ng diff e r en c es b e tw ee n th e pr eforme d cr e ati ni n e and

th e tot al cr e ati ni n e obs e rvabl e towar d th e e n d of th e fast are n o t
e asily explai n e d upo n th e groun d O f th e i nflu en c e of ac e to n e bodi es

in th e uri n e sin c e from th e d et e rmin atio n s of th e ammo nia an d th e

,

B oxybutyric acid we have no r e aso n to b el i e ve that th e aci d osis was

-

mat erially l ess in th e last w ee k than at any oth er time Thes e valu es .

would th er efore i ndicat e that a suffici en t amou nt of ac e to ne bodi es

was no t pre s ent in these urin e s to affe ct mat e rially th e qua ntitative
d e te rmi n atio n s O f preforme d cre atin ine .

D ing t h ad i g f th i p f w c iv d
1
ur e re n o s roo , e re e e d i rabl e a tic l B a al Me tabo lism and
th e a m r e, s

C ti in E l im in ti n b y W W Palm J H
re a n e a o ,
"
. . er , . . M ean s an d J L G am bl e (Jo urn B i o l C h em
, . . . . .
,

1 9 14 , 1 9 , p .
2 68 A ST UD Y OF P R O L O NGE D FA S T I NG .

20 to 30 milli grams We have compute d th e creatinine c o efli cient for

.

our subj e ct L for e ach day of th e 3 1 day fast and give th e valu es in
.
-

tabl e 30 Af t er th e first 2 days of fastin g th e co e ffici ent r emai ns

.
,

practically constant until th e fourt ee nth day ; it then shows a t end ency
to fall for a w eek and th e last 10 days it re mains ne arly constant at
,

1 9 milligrams .

RES T NrTR OG E N .

Wh en th e ur ea nitrog en th e ammo ni a nitrog en th e uric acid nitro

-
,
-
,
-

g e n,
a n d th e total cr e ati nin e n it rog e n are combi n e-
d w e fi n d that th e ,

total amou n t is somewhat l ess than th e total nitrog en found by th

“ ”
K j eldahl method This r emai nd er or th e so call e d r est nitrogen
.
,
- -
,

amou nts usually to no t far from gram of nitrogen in th e Obs erva

tio ns with our subj e ct L Th e valu es for t hi s und et ermi ned nitrog en
.

are r e cord ed in tabl e 29 in which it is s ee n that th e larg est amou n t

,

gram) was fou nd o n th e fourth day and th e small e st gram )

o n th e tw en ty s eco n d day
-
Si nc e th es e valu e s i nclude all th e e rrors in
.

th e a nalys e s th e amoun ts thus r ecord e d are n o t u ne xp e ct ed

,
U sually .

th ey form about 5 per c en t of th e total nitrog en and in th es e r ecords

vary from per c e nt o n th e fourth day O f th e fast to per c ent
o n th e tw e n ty—s eco n d day I n th e food p e riod follo win g th e fast we
.
,

fi n d a larg e i n cre as e o n th e p erc e ntag e b as is in this r est nitrog en ,

which re aches per c ent of th e total nitrog e n excre tio n I t thus .

app ears that th e chi e f factor a ff ecti ng th e nitrog en excr etio n o n th e last
day was th e ur e a for th e absolut e amounts of ammo nia nitrogen uric
,
-
,

acid nitrog en cre atinine-nitrogen and res t nitrogen remained ess en

, ,
-

tially co nsta n t o n all thr ee days of food .

AC ID R ADI C LE S .

F astin g uri ne co ntain s a large numb er of acid radicl es which

may be either organic or inorga nic Thus there are always pres ent .

c o n sid erabl e amo u n ts Of chlorine phosphorus p entoxid e sulphur , ,

trioxid e and (particularly in fasti n g exp e riments ) B—o xybutyric and

,
’
oth er fatty acids B y usi n g F oli n s titratio n method it has b een possi
.
,
“ ”
ble to d e t e rmi n e th e total acidi ty F or a cl ear und erstanding of .

t h e qua ntitative r elatio nships Of th es e various acid radicl es dir ect ,

d e t erminations were mad e of th e tot al chlori ne phospho rus p entoxide , ,

tota l sulphur and Boxybutyric acid

,
-
.

C HLO RI NE .

Owi ng to th e gene ral satisfactio n with th e stan dard Vo lhard method ,

chlorin e has p e rhaps rec eive d more attention than any oth er of th e
inorganic co nstitu ents of th e urin e Recognizin g th e importanc e of .

th e det e rmin atio n of this co nstitu ent esp ecially in vi ew O f th e emphasis ,

l aid upo n th e suppos ed e xc ess storag e of chlorin e in th e body un d er

 U R IN E . 26 9

n ormal co n ditio ns we mad e duplicat e d et ermin ations Of th e chlori ne in

,

th e u ri ne for e ach day of th e fast Th e chlori n e e xcr etio n in fasti ng

.

e xp e rim en ts has always had a partic ul ar i n t e r e st as th e chlori n e curve ,

ah n o st i n variably follows a fairly r e gular cours e I t is furth e rmore .

im portant as pre sumably d emo n stratin g whe th er or not th e fast is

a tru e o ne for it is comm o nly suppos e d that u nl ess th e food sur
,

r eptitio u sly tak e n is pur e fat or pur e carbohydrat e it is practically ,

impossibl e for a subj e ct to bre ak hi s fast without almost imme diat ely
affe cti ng th e chlorin e excretio n On th e other han d it was foun d
.
, ,

TAB L E 31 .
— Ch lori ne (Cl) ex retedc in uri ne daily by fasti ng su bj ects
.

‘
po rted b y th e i nv estigato r as NaCl but co nverted to ch lo ri ne fo r purpo ses o f co m p ariso n
Re s ,
2
Average o f 6 d ays be fo re fast be gan .

3
D eterm i ne d in th e u i ne fo r abo u t 22 h o urs
r .
2 70 A ST UDY OF P R O L O N G E D FA S T I NG .

in th e xp e rimen t with L that when th e subj e ct took co nsid erabl e

e .
,

amoun ts O f food o n th e 3 days followin g th e fast th e excretio n Of chlor ,

ine was but slightly aff ect ed c e rtainly n o t en ough to be co n sid e re d as ,

proof that foo d had b ee n tak en T h e charact er of th e di et o n th es e .

food days e asily explains this abs en c e of i nflu enc e upo n th e e xcre tion
of chlori ne .

Th e d et ermi nations of th e c hl ori ne excre tio n w ere mad e u n d e r D r .

Pe ters s su p e rvisio n by Mr W F O Hara according to th e Volhard

’ ’
. . .

metho d th e exc ess of silver nitrat e add ed b ei n g d ete rmi ned in a filt ere d
,

po rtio n of th e uri ne These valu es are compare d in tabl e 3 1 with th e

.

valu es Obtain e d for s e veral oth er su b j ects in lo ng fastin g exp eriments .

With L there was a larg e excretio n of c h lori ne o n th e first day of th e

.

fast doubtl ess from th e food pre viously tak en This was follow ed by
,
.

a mark ed fall e ve n o n th e s eco nd day this d ecreas e co nti nui ng almost

, ,

re gularly until th e fift ee nth day wh en th e excre tio n re ach e d a new ,

min imum l ev el I t subs equ ently fluctuat ed slightly u ntil th e end Of

.

th e fast On th e 3 food days th ere was a S light i ncr e as e ove r th e latt e r

.

p art Of th e fasti ng p e riod .

An in t elli g ent compari so n of th e valu es fou nd for L with thos e fou nd .

for oth er fasti ng subj ects is somewhat diffi cult o wi ng to th e facts that ,

frequ ently th e basis upon which th e chl orin e is report ed is somewhat

O bscure and that som e O f th e subj ects S ucci in particular w ere accus , ,

to m ed to dri nk wat e r contai nin g more or l ess c h lori ne Appare ntly .

th e chlorine e xcr etion in compl e t e in a nitio n vari es wid ely with di fferent
individuals for it will be s ee n at o nc e by in sp ectio n of th e valu es in
, ,

tabl e 3 1 that th e excre tio n fou nd for L particularly in th e first part

,
.
,

of th e fast was lower tha n that fou nd for any oth er subj ect e xc ept for
,
1
a few days with S ucci in th e N apl es fast for 3 days with Tosca and for , ,

4 days with S A B I n th e latt er part of th e lo n g fasts how e v er

. . .
, ,

th er e is more Of a t en d ency toward u niformity although th e valu e s ,

for S ucci at N apl es and at Vi e nna and thos e for th e latt er portion ,

of Tosca s fast are much hi gher tha n thos e fou nd with L The re is
’
,
.

a general t en de ncy S hown with all O f th e subj ects for th e excre tio n to
d ecre as e gradually until th e fif t eenth day but no t so rapidly as was ,

fou n d for our subj ect Th e obs ervatio ns Of B rugsch o n Succi at H am

.

burg give valu e s that agree w ell with thos e fou n d for L .

Relatio nship between ch lor ine excreti on and preformed water lost A —

critical e xaminatio n Of th e tabl e s in th e report of th e e arli er fasti ng

2
e xp e rim e nts shows a rath er i nt ere sti ng r e latio n ship b e tw ee n th e e x ore
tio n of chl ori ne and th e loss of pr eform ed wat er from th e body F or .

a lo ng time we have b ee n at a loss to e xp l ai n th e mark e d variatio ns in

th e a b solut e amou nts of chlorin e e xcr et ed o n differ en t days of a fast
1 v b bl b i
I h a e ee n u na e to o ta n th e o r na h o r ne ata in th e stu igi l c l i
m a e o f S u cc i s d dy d '
i
ur n e by
K o ré y .
n i p bli
u sh e in O rvo si h e tilap d
1 894 , N os 3 9 —4 0 S ee au to re e rat, M a
, Jah rb
. . f ly , . d Ti e r
.

Ch e mi e 1 89 4 24 ,
,
2 68 ,
K o rz p . . l
i ny i a so stu d e th e e re ss o n o f th e r ee n i do nt d p i f zi g p i -
.

z
B ene dic t , arne e C gi I
nst W ash Pub 7 7 , 1 907 , ta . e 2 1 6,
. a e 4 1 5 an d ta e 229 ,
. bl p g , bl p ag e 4 6 9 .
272 A S T UDY or P R OLO N G E D FA S T I NG .

a n umb e r of short fastin g e xp e rim ents ma d e with eight subj ects at

Wesl eyan Un ive rsity .

I t is co nc eiva b l e that variations in th e chlori n e e xcre tio n might be

due in part at l east to a flushin g out of th e body and h en c e we should
, , ,

e xp ect to fi n d th e chlorin e excr etio n varyin g to a c ertain d e gr ee with th e

variations in th e volume of urine or of th e wat er tak en An exami na .

tio n of th e figur es in th e last column of tabl e 3 2 (column F) shows ,

how e ver that th e wat er in th e urin e per gram of chlori ne excreted

,

und e rgo es wid e variatio ns ra ngin g from 1 02 grams to

, gram s with ,

no obvious av erag e valu e .

I f we co nsid er th e body as losin g regularly no t only carbohydrat e fat , ,

an d prot e in from its original stor e of substa n c e at th e b e gi nni n g of

th e fast but also losin g r e gular amou nts of pre form ed wat er i e wat er
, , . .
,

of fl esh and fatty tissu e (see not e to tabl e and wat e r e xisti n g in

th e flui ds of th e body we c an see that th e importa nc e of th e d e t ermin a

,

tio n of th e preform ed wat er lost is much gre at er than would at first

app e ar Th e valu es for th e preforme d wat er lost by thes e fasti ng sub
.

j ec ts are giv e n in column 0 of tabl e 3 2 a n d for th e pre form ed wat er ,

lost per gram of chlorin e in column D An examin ation of th e valu es .

for th e preformed wat er lost per gram of chlorine shows that th er e is

at l e ast a s e mblanc e to re gularity Thi s is more cl e arly s ee n if th e first
.

day of th e exp erim ent is omitt ed as may prop erly be do ne si nc e it is , ,

natural to suppos e that th e chlorin e excre tio n o n th e first day may

hav e b ee n i nflu enc e d by th e pr evious di et E xcludi ng th e valu e s for .

th e first day th e n we find that th e r e mai nin g valu es ra ng e from 726 on

, ,

th e s eco nd day of e xp erim ent 7 3 with S A B to as low as 1 4 8 on th e . . .

se co n d day of e xp e riment 82 with H C K Asid e from th e v e ry high . . .

valu e foun d in e xp e rim e nt 73 it will be s een that th er e is a fairly clos e

,

agr ee ment b etw ee n th e c h lorin e excrete d and th e pr eform e d wat er lost

from th e body I t would thus app e ar th at in th e di scharge of this
.
,

wat er th ere is e xcre t ed simul ta ne ously an amount of chlorin e approx

,

imat ely proportio nal to th e total pr eform ed wat e r lost I t is obvious .

that all of th e factors involve d in th e d et e rminatio n of th e pr eform ed

wat er lost from th e body are such as to mak e th e absolute valu es of
som e of th e d et e rmin atio ns prob l ematical and y et we b eli e ve that as ,

a whol e th e re is suffici ent agre eme nt h er e to i ndicat e some approximat e

r elatio nship b etw ee n th e chlorin e and th e preforme d wat er l ost from
th e body .

S ource of chlorine excreted Th e exact so urc e of th e chlori n e e xcre ted

—

in th e first days of fasti n g is by n o m e a n s c ertain but it is cl e ar that ,

th e sma l l amou n ts e xcr e t e d in th e uri ne aft e r th e first few days of

,

fastin g corr e spo nd to th e usual p erc entag e of chlori ne commo nly c o n

,
1
sidere d as b elo n gi n g to huma n fl e sh Thus K atz whos e a na l ys es .
,

have b e en co nsid er e d as remarkab l y accurat e main tains that human ,

K atz A ch iv f d g Ph y i l 1 89 6 63 p 1
1
, r . . es
. s o .
, , , . .
 UR INE . 273

muscl e contain s p e r c e n t c hl ori n e Furth ermore Magnus Le vy s .

,
-

a nalysis of th e flesh o f a suicid e agr ee s r emarkably w ell with th e valu e s of

K atz I f we u se thi s factor
. for computin g th e chlorine in th e fl esh
katabo liz e d by th e subj e ct L as r ecord ed in colu m n Q tabl e 6 1 (pag e .
,

th e valu e s foun d wo u ld be approximat ely th e amounts of chl ori ne

actually excr et ed F or i n stan c e o n th e tw enty fifth day th er e w er e
.
,
-
,

23 5 grams of fl e sh katabo liz e d th e e xcr e tio n of c hl orin e b ein g som ewhat ,

large r than th e av erag e for thi s part of th e fast Applyi n g th e factor .

of K atz we fin d that, p e r c e n t of 23 5 grams wo ul d give g ram

of chlori ne whi l e th e amou nt actually excr e t ed o n that day as shown
,

by an alysis was gram I t is cl ear th ere for e that at l east in th e .

, , ,

lat er stage s of i nanitio n chlori ne is d eriv ed for th e most part from dis ,

int egrat e d muscl e substan c e Th e larg e storag e o f salt in th e skin .

,
2
which was n ot ed by Wahlgr en and subs equ ently further studi ed by
3 4
Padtberg and Scholz and H ink el must th er efor e hav e b ee n rapidly
, ,

d epl et ed duri ng th e first days of th e fast I n any e vent th e total .

,

amount of c hl orin e i n volved throughout th e whol e 3 1 days of our

fastin g exp eriment was but grams an amou nt so small as to cast ,
5
a doubt upon th e th eory that th ere is an exc ess of chlori n e store d in
th e body .

Pn o sr n o nus .

S inc e phosphorus has so intimat e a r elatio nship with both th e mi n eral

and th e organic co n stitu en ts of th e body , obs ervatio n s hav e b ee n mad e
of th e amou nts pres ent in th e fasti n g uri ne of a large numb er of subj e cts .

Th e phosphorus in th e uri ne of L was d e t ermi ne d by Mr W F . . . .

O Hara un d er th e sup ervision of D r P et ers , for e ach day of th e fast

’
.

an d for th e followi n g food days by titratio n with ura ni um ac e tat e , .

Usage is follow e d h ere in e xpressi ng th e valu e s as phosphorus p entoxid e

in st e ad of as phosphorus , although th e i nco nsist ency of expre ssi ng
th e el em en ts in t e rms of th eir compou n ds is obvious Th e absolut e .

amou nts of phosphorus p entoxid e d et ermi n ed in the s e uri nes , toge th er

with thos e foun d in oth er lo ng fasti ng exp e rim ents , are given in tabl e 3 3 .

Th e valu e s obtain ed for L show an i n cr e asi ng amou n t for th e first .

4 days and th er e aft er a v e ry r e gular d e cre as e for th e r emai nd er of th e

fast Th e maximum amount ,
. grams of phosphorus p entoxid e ,
was obs erv e d o n th e fourth day an d th e mi nimum amou nt , grams ,
o n th e last day Whil e in th e fir st part of th e fast th e valu es for L
. .

are e xc ee d e d by thos e for Ge tti an d B e auté an d approximat e ly e qual e d

by those for S A B , in th e latt er part of th e fast th ey are me asurably
. . .

l
M ag nus-Le vy B i ch m Z it h 1 9 1 0 24 p 3 63
. o e . e sc r , , . .

re n A c h iv f
7W h lg
a xp P ath
, Ph a m 1 9 09 6 1 p 9 7
r . e . . 11 . r .
, , , . .

‘
Pad tb g A c h iv f xp P th u P h m 1 9 1 0 63 p 60
er , r . e . a . . ar .
, , , . .

‘
S ch lz n d Hi n k l D u t c h A ch iv f kl in M d 1 9 1 3 1 1 2 p 3 34
o a e , e s . r . . e .
, . , . .

“
F a d i cu s i n f th i p i n t M agnu L vy Ph y i l gi d S t fl w h l v N d n ’
'

or s s o o s o , see s- e , so o c es o ec se s, on oo r e s

H an dbuch d P ath d S t fl w h el B li n 1 906 l p 4 5 1 ; Munk A ch iv f P th An t u

er . es o
'

ec s s, er , , , .
, r . a . a . .

Ph y i l 1 89 3 S upp 1 3 1 p 14 6 ; and M awi t O pp nh im er s Handbuch de Bi o ch mi J na

s o .
, , .
, . or z, e e
’
r e e, e ,

19 1 0, 4 p . 2 82 .
2 74 A S T UD Y o r P R O L O NGE D FA S TI NG .

high er than thos e r ecord ed for any oth er subj ect Th e o nly oth er fast .

in which th e phosphorus was d et ermi ne d an d which ext en d ed ove r ,

’
so lo n g a p erio d as that for our su b j e ct was Su c c i s fast in F lore nc e
, ,

but th e amou nt excret e d by thi s subj e ct was co nsid erably l ess than
that fou n d for L Th e valu es obtain e d by B rugsch o n Succi in th e
.

TAB LE 33 .
— Phosphorus ( P30 5) eli mi nated in ur ine daily by fasting bjects
su .

! D m in e d in
e te r i
ur n e fo r b
a o ut 22 h o ur s .

H ambur g fast are also me asurably l ess than thos e r eport ed for our
fasti n g subj ect .

Relationship between phosph or us and to tal nitr ogen Owing to th e —

i ntim at e relatio nship b etw een phosphorus and th e organic tissu e s of th e

body , particul arly muscl e , th e ratio b etw een phosphorus and total
27 6 A ST UDY or P R O L O NGE D FA S T I NG .

on th e
s eco nd day of th e fast Furth ermore th e fi g ure s show no .
,

d efinit e i ncrement in th e ratio as th e fast progr ess ed Whil e it is tru e .

that valu es l ess than 5 are no t found o n th e last 8 days of th e fast ,

n e v e rth el e ss th er e is a p eriod that b etw een th e s eventh and th e fi f —

tee nth days wh en th e valu e s agai n all lie abov e 5 whil e b etw ee n th e
—
,

fift ee nth and th e tw en ty fourth days valu es as low as 4 4 are fou nd

-
. .

I n examinin g th e valu e s for th e oth er f asts we fin d s eve ral whi ch ,

show distin ctly ab normal valu es for th e first day i e 7 87 for th e , . .

, .

’
first day of Su cc i s Flore n c e fast and for th e first day of th e fast ,

of S A B but this would n aturally be e xp e cted On th e oth er hand

. . .
, .
,

aft er th e first day th e value s should lie w ell b elow an d any abov e
th is are Op en to suspicio n Th e ratios establishe d by th e Fr eu n ds for
.

th e Vi enn a fast of S ucci are rem arkably co nsta nt as are thos e of ,

B rugsch for a lat er fast of S ucci in H amburg P erhaps th e gr eat est .

uniformity in ratios is shown by C ath c art s subj ect B e auté thes e ’

,

ratios gradually an d st eadily i ncre asin g as th e fast progress ed Th e .

valu es for Succi in th e F lorenc e fast are som ewhat vitiat ed by th e

unc ertainty in th e nitrogen d ete rminations al though th e values w ere ,

comput ed o n th e basis of nitrog en as corr e ct ed by Mu nk .

S ou r ce o f phosphorus exc r eted Comparin g thes e ratios particularly —

,

thos e for L wi th th e theoretical relatio nship with fl esh we fi nd in

.
, ,

all of th e exp erim ents a t end ency towar d a much larg er excretion of
phosphorus p entoxid e in its r elatio n to nitrog en tha n occurs in th e
ordinary compositio n of fl esh Th e possibl e sourc es of phosphorus in .

th e body oth er th an th e fl esh are of cours e th e nucl eins and abov e all , ,

th e mine ral matt e r of th e bo ny structur e I t is no w th e cons ensus .

of opi nio n that th e di sturb anc e in th e r elatio nship b etw ee n th e phos

ph o ru s p e ntoxid e an d nitrog e n in fasti ng e xp erim e nts is due exclusiv ely
1
to th e mate rial draft upo n th e bo ny stru ctur e as th e fast progre ss es .

This was cl early set forth by Mu nk in his discussio n of th e experi

m ents with Ge tti an d B r eithaupt but as th e s e w ere short e xp erim en ts ,

Mu nk fra nkly stat ed that h e exp e ct ed to fi nd that th e ratio would

b ecome small er and small er as th e fast progr ess ed Th e ratios in th e .

3 1 day fast with L do n o t how e ver b e com e small er as th e fast co n

-
.
, ,

tinu e d but o n th e oth er ha n d t en d to b e come high er in th e last w ee k

,

than at any oth er tim e B rugsch has already comm ent ed upo n th e
.

v ery hi gh valu e s fou nd in th e last w eek of his study with Succi .

2
D urin g th e fast with L 27 7 3 2 grams of nitrog en w ere excret ed
.
, .
,

corr espo n di n g to grams of fl e sh katabo liz ed I f we assume .

that thi s fl esh had n orma l ly combine d with it per c ent of phos
p h o r u s p e n toxi d e th e total amou n t combi n e d with th e katabo li z ed
,

fl e sh wou l d be e qual to grams S in c e grams of phosphorus .

l
W ellm an (Ar ch ivf d g Ph y i l 1 9 07 1 9 08 121 p 5 08) be l i ves th at th c al cium and
. . es
. s o .
,
—
, , . e e

ph p h u l
os or fo un d by hi m c nfo m wi th Munk s co nc lusi o n th at th e e is co nsi de abl
s o sses o r
’
r r e

l f c al ci u m an d p h o sph o rus f m th e bo n
o ss o d uri n g tarvati o n
ro es s .

This am o unt d oe s no t in clud e th e ni tro g n exc te d thr o ugh th e skin (se e table
2
e re
 UR I NE . 277

p en toxid e w er e excr et e d duri n g th e fast it will be s ee n that th er e was ,

distin ctly an e xc ess excretion amou nti ng to 15 grams of phosphorus

,

p en toxid e for th e whol e fast Thi s was u n doubt edly d erive d in larg e
.
—

part at l e ast from th e bo n e s I t was hop e d that th e pr e s ent day

,
—
.
-

t echni qu e of R o entg en photography would show any mat erial attacks

upo n th e bo ny structur e and possibl e d epl e tio n of calcium but th e ,

e xc e ll en t s e ri e s of X ray photographs tak en by D r F ra n cis H Wil l iams

-
. .
,

of th e B osto n City H ospital did no t i n dicat e thi s On th e othe r han d

,
.
,

wh en o ne co nsid e rs th e larg e storag e of calcium in th e body an d th e

r elativ e ly small draft an ocular indicatio n of such a draft which could
,

be m e asur e d co ul d hardly be exp ec t e d .

Th e e xact apportio nm ent of th e phosphoru s p entoxid e b etw e en

muscle an d bo ne is no t p e rmi ssibl e with th e e xp erim en tal data at
pres ent in our hands In all probability th e amoun t of phosphorus
.

p en toxid e actually drawn from th e sk el eto n was con sid erably more
than 1 5 grams .

S inc e aft e r th e first few days th e re was n o mat erial in cr e as e in th e

uric acid e xcre tio n as th e fast progr ess ed th ere was doubtl e ss no dir e ct
-
,

attack upo n th e nucl ei ns an d thus th e i n crease in th e phosphorus

,

pe ntoxide co ul d no t have b ee n de rive d from that sourc e .

S UL PHU R .

Sul phur as an in t e gral compo nen t of protoplasm is o xidiz e d and ex

c rete d in th e uri n e in s e v eral forms : fir st , as sulphat e s ; s e co n d , in th e

form of co njugat ed sulphat es , or sulphuric acid combi n ed with organic

radicl es ; an d fi n ally , as so call ed n eutral or u n oxi diz ed sulphur Th e
-
.

apportio nment of th e total sulphur output amo ng th es e various com

po nen t e h as b een studi ed duri ng fasti ng in co nsid erabl e d eta il , both
in th e laboratory of We sl eya n Unive rsity and by Cathcart I n th e .

s eri es of exp erim en ts carri e d out o n L , it was impossibl e to s eparat e .

th e sulphu r o wi ng to th e lack of exp erim e n tal mat erial , and o nly th e

,

total sulphur was d et ermi ne d The s e d e t ermi n atio n s w ere p erso n ally
.

mad e by D r A W P e t ers , th e co n stan cy in th e r esul ts t estifyi ng to

. . .

his t e chnical skill .

I t has b ee n th e custom of many writ ers to r eport th e sulphur excre

tio n as sulphuric acid or s ulphur trioxid e but th e valu es given for L ,
.

in tabl e 3 5 r epr e s e n t th e daily excr e tio n of total sulphur F or com .

pariso n th e sulphur excr e tio n has b een comput e d from th e r esults

,

given by oth er obs erv ers for fastin g subj e cts an d th es e valu e s are ,

includ e d in th e tabl e Two difficulti es aris e in comparin g our r e sults

.

with thos e obt ai ne d with oth er subj e cts In th e first plac e fr equ en tly .
,

o nly th e total sulphuric acid was d e t ermi ne d an d th e orga nic sul

phur was no t i n clud ed S eco ndly (in th e cas e of Succi at l e ast ) th e
.
, ,

subj e ct oft en drank mineral wat er co ntainin g measurabl e amounts of

sulphates .
278 A ST UD Y or PR O L O NGE D FA S T I NG .

With our subj ec t L th e sulphur e xcre tio n follow ed a cours e no t u nlike

.
,

that of th e ni trogen excretio n th er e b ei n g a slightly in creasin g amou nt

,

e xcr e t e d for th e first 3 days and th er e aft e r an ah no st co n ti nuous

d e cr eas e un til th e en d of th e f as t Th e maximum amoun t . gram)

TAB LE 3 5 Total sulphur (S ) excreted i n urine daily by fasting subjects
.
—
.

‘
Pro babl y i n ganic and e th eal G iven by th e i nvestigato r as H SO
or er .
z 4, bu t co nve rte d to S
fo r p u po es f co m pa i n
r s o r so .

2
Pro bably i n ganic and e th e eal
or r .

a
‘
D termined in mi ne fo r abo ut 22 h o urs
e .

was excr e t ed o n th e thir d day of th e fast and th e mi nimum amount ,

gram) was foun d o n th e tw enty fourth tw enty fifth and thirty -

,
-
,

first days .

Th e most car e fully d e t ermi n e d r esul ts for th e oth e r subj e cts are
u n doubt e dly thos e for C ath cart s subj e ct B e auté H ere agai n we fi nd
’
.

a d ecre as e in th e sulphu r excr etio n as th e fast progress es th e valu es for ,

280 A S T UD Y o r PRO L ONGE D FA S T I NG .

sulphur excr etion in th e oth er fasts in tabl e 3 5 it was no t p ermissibl e ,

to compute th e ratio b etw ee n th e nitroge n and th e s ulphur sinc e th ere ,

w ere undoubt edl y errors in th e nitrog en d et ermi n atio ns and probably

lik e wis e in thos e for th e sulphur excre tio n .

T h e ratios fou n d for L show at first a slight i n cre ase risin g on th e

.
,

fourth day to a maximum of The y the n d ecre as e with co nsid er

abl e re gularity th e low est valu e
,
b e i ng o n th e last day of th e fast
,
.

I n ge neral th e ratios re main withi n v e ry n arrow limits

, The s e valu es .

are again no t u nlik e thos e foun d by Cathcart with B e auté which ,

show ed a te n d e ncy to d ecre as e as th e fast progress ed Th e sam e ten .

d eney is shown by th e valu es for S A B although at no time duri ng . . .

,

th e 7—day fastin g exp erim e nt did th e ratio fall b elow

A ll of th e valu es fou nd for L show a som ewhat hi gher excr etion of
.

nitrog en than woul d normally accompa ny th e amou nt of sulphur ex

c re ted ; it would app e ar th er efor e that th er e was a disi n t e gratio n of
, ,

s ul phur poor and nitrog en rich substanc e oth er than muscl e Through
- -
.

out all o f th e obs ervations it has b ee n not ed that o n c ertai n days th ere
,

was always a mark ed low e ring in th e excre tion of th e u ri nary compo

n en t e
. Thi s low erin g may be du e either to an actual d e creas e in th e
katabolism o n that day or to a possibl e loss of urin e Th e han dli ng .
,

samplin g an d pres ervatio n of th e uri ne w er e so strictly co ntroll e d that

,

it would s ee m impossibl e for such a loss to occur I t is co nc eivabl e .

,

of co urs e that th e subj e ct may not have empti ed th e bladd er com

,

p le te ly in th e mor n in g but a
,
comp e n sati n g in cr e as e in th e uri n e of
th e ne xt day would th en be e xp ect e d which was no t obs erv ed , I f we .

e xamin e th e valu e s for sulphur total cre atini n e nitrog en chlori ne

, , , ,

an d phosphorus we fi n d that th ere was a disti n ct low e ri ng in th e

,

amount excret e d o n th e fiftee nth day of th e fast with occasio nally a ,

slight indi catio n of a comp ensatin g incre as e o n th e sixteenth day .

Thi s poin ts towar d a loss of urine which we are as y et u n abl e to

account for As a matt er of fact no disturba nc e in th e nitrogen
.
,

sulphur ratio was fo und on th e fif t ee nth day and ind eed such dis , ,

turbance was not exp e ct ed .

On th e oth er han d we n ot e a v e ry d efin it e in cre as e in th e s ulphur

,

nitrog e n ratio from o n th e tw en ty t hi rd day to o n th e tw enty

-

fo urth day An exami natio n of th e valu es for th e total nitrog en

.

e xcr e tio n shows that h e r e also th ere was a mark e d incr e as e thus i n di ,

cati ng th e disin t egratio n of a nitrogen rich and a sul phur poor sub - -

sta n c e oth er than muscl e Th e g eneral cours e of th e valu es for s ulphur

.

an d total cr e atin i n e show a striki n g simil arity i n dicati n g that th e ,

katabolism re sultin g in th e excr etio n of total cre ati ni ne is accompanie d

by an excretio n of sulphur I f we are to acc ept F oli n s vi ew that th e ’ ‘

total cre atini ne is an admirabl e i n d ex of th e total katabolism of tissu e ,

we may th en conv ers ely stat e that th e sulphur is lik ewis e an ind ex .
 UR I NE . 28 1

TOTA L Ac m rr r .

Wh en th e co ndi tio ns are such that acidosis may be exp e ct e d to

d ev elop as in fasti ng a d et e rmi n atio n of th e total acidity of th e uri ne
, ,

is of sp e cial valu e A ccor di n g l y th e total acidity of th e urine in this

.

e xp e rim en t was d e t e rmi ne d for e ach day of th e fasti n g p eriod an d also

for th e 3 days followi n g wh en food was tak en Un d er th e dir e ctio n .

of D r A W P e t ers th e d et e rmi n atio n s w er e mad e by W F O Hara

. . .
,
. .
’
,
1
accordi n g to th e method of F oli n in which potassium oxalat e was us e d ,

an d th e titratio n was carri e d out with 25 c c of urin e Th e valu e s are . . .

given in tabl e 3 7 express e d in t erms of cubic c entimet ers of d eci n ormal

,
-

sodium hydroxid e solutio n .

n
T AB L E 37 — To tal acidi ty
( NaO H ) o f uri ne o f fasting su bjects .

1
Aci di ty f u i n n th i d f d day b f th fa t
o r e o r oo e o re e s .

’
Th fi gu
e i th i c l u m n w
r es n po t ed by th inv tigat
s o ere re r e es o r as no rm a l sulph uric aci d , bu t
are here p p ti at l y in c a d f pu p
ro or on e f c m pa i n
re se or r o se s o o r so .

3
D te mi n d n uri n f 22 h u
e r e o e or o rs.

A t th e b e gi nning of th e fast , th e acidity i n cre as ed rapidly u n til th e

maximum of 6 55 c c was r e ach ed o n th e fourth day I t th en show e d a
. . .

g eneral t end en cy to d e cr eas e as th e fast progr ess ed although occa ,

sio n ally u nusually high valu e s w er e fou n d as o n th e sixt ee n th an d ,

s ev ent eenth days of th e fast I n th e 3 foo d days followi ng th e fast th e .

,

acidity dropp ed alm ost imm ediat ely to about 60 c c . .

Th e fasti n g valu es b est suit e d for compariso n with th e valu e s for

acidity fou n d for L are thos e d et ermi ne d by Cathcart o n B e auté and
.

by B rugsch o n Succi in H amburg Cath c ar t s figur e s for th e total .

’

acidity in th e 1 4 —day fast of B e auté show valu e s rangi n g from a maxi

Fo lin Am Jo u n P h y io l 1 9 0 3 9 p 2 6 5
l
. . r . s .
, , , . .
282 A S T UDY o r P R O L O NGE D FA S T I NG .

mum of 687 o n th e third day of th e fast to a minimum of 212 o n th e

tw elfth day of th e fast F ollowin g th e fasti ng p eriod th e subj ect was .

giv en a starch cream di e t and th e acidi ty imm ediat ely dr opp ed to

-
,

approximat ely 1 00 c c . .

F rom th e tw enty third to th e th irti eth days of th e fast in H amburg

-
,

B rugsch foun d with S ucci valu es ran gi ng from 3 84 c c o n th e tw enty . .

third day to 1 03 c c o n th e thi rti eth day valu es whi ch are no t inco m
. .
—

parabl e with thos e foun d by u s with L .

I t was impossibl e owing to th e insufficient supply of urin e to d et er

, ,

mine th e min eral acidity in th e urin e of our subj ect .

B—o xYB UT YnIc Ao m .

I n th e
arli er fasti ng e xp eriments at Wesl eyan University th ere was
e ,

stro ng e vid enc e that a nitrogen poor carbo n rich substanc e was pre s ent -
,
-

in th e urin e in larg e amounts This was show n by d ete rminations of .

th e carbo n in th e urin e and th e r elatio nship b e tw ee n th e carbo n and

nitroge n and calori es A t that tim e th e opinion was express ed that in .

'

all probability th e mate rial was Bo xybutyn c acid but we w ere then -
,

unabl e to make th e d e te rmi natio ns in additio n to th e other a nalys es .

S p ec ial effort was th er efore mad e in this fasti ng exp erimen t to d e t e r

min e th e Boxybutyric acid in th e urin e as accurat ely as possibl e
-
,

although th e interestin g pap er of B rugsch reporti ng th e H amburg ,

1
fast with Succi an d more rec ently th e pap e r by G rafe have l eft no
, ,

doubt as to th e n atur e of thi s exc ess no n nitrogenous mat erial in th e -

urine of a fasting man .

Resu lts of determinations Of th e m ethods for th e d e t ermi nation of .

—

fl oxy butyric acid which w ere availabl e at th e tim e of this exp eriment
-
,
”
that of B lack was b est fitt ed for our purp os e B y thi s method plast er .
,

of paris is first mix ed with th e acidulated dri e d uri n e and th e mi xtur e ,

is th en extract ed with e th er th e B—oxybutyric acid r emov ed b ei ng ,

8
d ete rmin e d with th e polariscop e Th e d e t ermin atio ns w er e carri e d .

out by Miss A lic e John so n u nd er th e sup ervisio n of D r A W P e t ers . . . .

S inc e th e s e d et e rmin atio n s w ere mad e a larg e amou n t of res earch ,

o n Boxy butyric acid has b ee n carri e d out in th e light of th e t e ch niqu e

-

e xisti n g at th e tim e of th e e xp e rim e nt how ev er th e d e t e rmi nations , , ,

whi l e admitte dly havi ng a relative ly larg e error are neverthel ess suffi ,

c ie ntly accurat e to i ndi cat e that th er e was a mat e rial e xcr e tio n of

B oxybutyric acid throughout th e fast Th e results are record ed in

- .

tabl e 38 (column F) .

On th e s e co n d day of th e fast o nly gram of B oxybutyric acid was -

found ; this was wholly in lin e with what would be e xp e ct e d Subse .

qu ently n o valu es l ess than grams w ere fou n d until th e fast ha d b een
G af Z i ts h r f ph y i l Ch m i 1 9 1 0 65 p 2 1
1
r e, e c . . s o . e e, , , . .

’ B lac k J u n B i l Ch m
o r 1 9 08 5 p 2 07
o e
, . . .
, , , . .

‘
F a m or exp lici t tate m n t f th is p
o re ce d u B n dic t an d J li n C a n gi I n t W a h
s e o ro re , see e e os , r e e s . s .

Pub 13 6 . 1 9 1 0 ,
. p . 25 .
284 A S T UD Y o r P RO LO NGE D FA S T I NG .

of fi oxybutyric acid e xcre te d w ere also comput ed by an in dire ct

-

m ethod usin g th e r elatio ns hi p b e tw ee n th e nitrog en and th e carbo n

, .

Th e carbo n and th e nitrog en in th e urin e w er e d e te rmin e d for e ve ry

day of th e fast and for th e 3 food days followi ng th e fasting p e riod .

N ormally th er e exists a r elatively d efinit e relatio nship b etw ee n th e

carbo n and th e nitrogen of urine a relatio nship which was d et ermin e d ,

by Munk o n B reithaupt and Getti as b ein g no t far from 1 part of

nitroge n to of carbo n This relatio nship was d e t ermi ned for L
. .

for 2 days b e fore th e fast and a ratio found which may be t ermed , ,
“
n ormal
”
of 1 to , We th ere for e comput e d th e amou nt of carbo n
that would no rmally be e xcret ed from th e amount of nitrogen actually
e xcr e t ed and d educt ed th e r esult foun d from th e total amount of
,

carbo n found in th e urine Th e exc ess carbo n would be du e in all .

,

probability to B—oxybutyric acid or to ac eto ne bodi es Th e results

, .

of this computatio n are co nsid ered of suffi ci ent importanc e to be

in clud ed in tabl e 38 whi ch gives th e total nitroge n for e ach day th e
, ,

v al u es for th e normal e xcretion of carbon as computed with th e ratio

C th e total carbo n as actual ly d e t ermi ned th e differ e n c e ,

whi ch would be ascrib ed to B o xybutyric acid and fin ally th e valu es for -

,

6 oxybutyric acid obtain ed by usin g

-
as th e p erc entage of carbo n
in B—oxy butyric acid As th e valu es for B o xybutyric acid actually
.
-

d ete rmin ed are also give n in this tabl e a compariso n may re adil y be ,

mad e .

I n general th e d e te rmined valu es are somewhat low er than thos e

obtain ed by computatio n Occasio nally esp ecially toward th e en d of
.
,

th e fast th e d e t ermin ed valu es are high er than th e calculat e d valu e s

,
.

On th e whol e how e ve r the re is sufficien t agree ment to giv e an appro xi

, ,

mat e estimate as to th e amou nt of B oxybutyric acid pre s ent I nd eed -

.
,

taking everythin g i nto consi d eratio n and th e r egul arity of th e figur es ,

it would app ear that th e comput e d valu e s are probably more n e arly
accurat e than thos e which w ere actually d et ermi ned In any e vent .
,

th e amounts h ere fou n d are no tice ably less tha n thos e comput e d from th e
lse vo rotatio n of th e urin e obs e rv ed by B rugsch with S ucci and by G raf e
-

with his fastin g woman When th e computed valu es are compar ed it

.
,

is found that th e gr eat est excretio n of fi oxybutyric acid was from th e -

sixt ee nth to th e nin etee nth days wh en for 4 days an av erage amou nt ,

of over 7 grams was excret ed .

Th e amounts of B—o xy bu tyn c acid pr es ent in th es e urines are not

unlik e thos e foun d in short fasting exp erim ents or in exp eriments with
a carbohydrat e free di et and th e stimulatin g effe ct of the s e acids upo n
-
,

me tabolism is c ertainly no t to be ign or ed On th e oth er hand with th e .

,

acid pres ent in th e body for so lo ng a tim e th e subj e ct might easily ,

have b e com e accustom e d to its pres en c e and the refore th e reactio n be

l ess as has b ee n found in cas es of s ev ere diab et es
,
.

I t is p erf ectly cl ear how ever that th e amounts of B oxybutyric acid

, ,
-

involved in thes e d et ermi nations are no t suffici ent to aff ect th e r espira
 UR I NE . 285

l
tory quoti ents to an appre ciabl e d e gr ee S i n c e as Magnus L evy has , ,
-

point e d out th e excr etio n of 20 grams of 6 oxy butyr ic acid per day
,
-

re sults in a low ering of th e re spiratory quoti ent o nly Th e pr e s

en c e of this acid is how e v e r suffici en t to accou n t for th e in cr e as e in
, ,

th e ammo nia e xcr etio n as th e fast co n ti nu e d Th e effort of th e body .

to corr e ct thi s u n du e acidity by combinin g am mo nia with th e acid is

thus cl e arly S hown .

2
Bo nnig er and Mohr foun d with S ch enk much gr e at er amou nts of
acid than w er e fou nd or i n d eed calculat e d for th e uri n e of L B rugsch 3
.

likewis e foun d larg e amou nts with Succi an d th e excretio n for G rafe s 4
,
’

i nsane pati ent was also larg e Th e u n c ertainty in th e m ethod for th e .

quantitativ e d e t ermin atio n of 6—oxybutyric acid do es n o t p e rmit u se

of th es e valu e s for compariso n an d it is suffici ent to stat e that lsevo ,

rotatory B oxybutyric acid in appr e ciabl e amounts is excre t ed in th e

-

uri ne durin g fasti ng .

B egi nni n g o n th e aft ernoo n of April 21 1 9 1 2 and co nti nui ng at , ,

l e ast ev ery oth e r afte rn oo n duri n g th e fast a qualitativ e t est for ac e to ne ,

6
in th e br e ath was mad e usin g th e r e agen t of S cott Wilso n S e v eral
,
-
.

t ests w er e also mad e e ach day aft er th e fast th e lat est b ei ng o n May ,

1 7 at 7 p m .I n e v ery cas e th e t e st show e d ac e to n e pr e s en t but it is

.
,

im possibl e to draw qua ntitative d e ductio ns from th e results .

MINE RAL ME TAB OLI S M .

With n ormal m an th e mi neral m etabolism has two main paths for

e xcr e tio n thr ough th e solid salts of th e urine and thr ough th e fec es
—
.

With L th e e ntir e mi ne ral excr etio n took plac e through th e uri ne if

.
,

o ne e xc epts th e small amou n t of sodi um chlorid e e xcr e t e d through th e

ski n Usually much stre ss is laid upo n th e d e t ermi n atio n of th e acid

.
-

radicl es in th e uri ne n am e ly chlori ne sulphur trioxid e an d phosphorus

, , , ,

p ent oxid e and but littl e atte ntio n is given to th e calcium magne sium
, , ,

potassium an d sodium metabolism Th e importan t relatio nship

,
.

b etw een phosphoru s and calcium and th e possibl e draft upo n th e

S k el e tal tissu e of th e body mad e th e d e t e rmi n atio n of th e mi n e ral

co n stitu ents of th e uri n e d esirab l e an d although a v e ry larg e numb er of ,

d et e rmi natio ns w ere mad e of th e various compo nen ts of th e uri n e of

our subj e ct it was possibl e by combini ng an d apportio ni ng th e mat e
, ,

rial to s e cur e a su ffici ent sampl e of urine for th e d et e rmi n atio n of th e

,

mi neral co nstitu e nts .

Th e a n alys es w er e mad e by Mr J C B ock who was at that tim e a . . .

,

m emb er of th e L aboratory staff an d who had had pr evious exp eri en c e

in mi neral a n alysis S in c e sp e cial trai ni n g was ne c essary for this in ves
.

M agn L vy Z it h f kl in M d 1 9 0 5 5 6 p 83
1
u s- e , e sc r . . . e .
, .
, . .

B nnigz
nd M h o Z it h f xp P th Th api 1 906 3 p 6 75
er a o r, e sc r . . e . a . 11 . er e, , , . .

B u g ch Z it h f exp P th l u Th api 1 9 05 l p 4 19
3
r s . e sc r. . . a o . . er e, , , . .

G raf Z it h f p h y i l C h m i 1 9 1 0 65 p 2 7
‘
e, e sc r. . s o . e e, , , . .

Seo tt Wil n J u n P h y i l 1 9 1 1 42 p 4 4 4
l‘ - so , o r . s o .
, , , . .
 A ST UD Y OF P R O L O N GE D FA S T IN G .

tig atio n of th e mi neral m etabolism duri n g fasti ng Mr B ock was allow ed , .

th e privil e g e through th e kin d ne ss of D r R ufus S Col e of th e R ock e

, . .

fell e r H ospital of worki ng with D r F ran cis H Mc Cru dden at that

, . .
,

tim e of th e R ock ef el l e r H ospital and whos e r es earch es in mi n eral ,

metabolism are too w e ll known to n eed S p ecial mentio n here H aving .

acquire d c e rtain of D r Mc Crudden s m ethods and t echni qu e Mr

.
’
, .

B ock mad e a most car eful a nalysis of th e uri ne of L d et ermini ng th e .

,

calcium magn esium sodium and potassium so that we have a fairly

, , , ,

T AB LE 39 .
—
Mine ral metabo lism (uri ne excretio n ) in experiment with L .

Day of

0 0 0 0 0

0 0 0 0 0

0 0 0 0 0

Apr 3 0—May 1
.

May 1— 2

l
De te rm i natio ns i n i
u r ne fo r b
a o ut 22 h o urs .
“

1
‘
o t
288 A S T UDY O F PR O L O NG E D FA S T I NG .

l
sium in th e a nimal body hav e b een r ec ently carefully studi ed and we ,

may more advantageously study th e e xcre tio n of thes e four el ements by

n otin g th e ratios of th e ir oxi d e s to e ach oth er tha n in any oth e r way .

Co ns equ ently th e p erc e n tag es of calcium oxid e and magnesium oxi d e

e xcre t e d hav e b ee n comput e d usi n g th e total of th e calcium oxid e and,

magnesium oxid e as 1 00 S imi larly th e potassium and sodium oxi de s .

hav e b ee n add e d togeth er and th e p erc en tag es of potassium oxid e and

sodium oxid e comput e d Thes e p e rc e ntage s which are giv en in tabl e
.
,

4 0 w e re comput ed for e ach sampl e of urin e a nalyz e d

,
.

P rior to th e fast th ere was about eight tim e s as much calcium oxid e
excre t e d in th e uri n e as ma g ne sium oxid e but this r elatio nshi p b e cam e ,

4 to 1 o n th e first fastin g day and subs equ ently th e p erc entag e s w er e

fairly co nsta n t at approximat ely 75 per c ent for th e calcium oxid e an d
25 per c en t for th e magne sium oxid e I t was no t until th e third day .

with food followin g th e fast that this r elatio nship was di sturb ed wh en ,

th e original p e rc entag e s prior to th e fast w ere agai n approximat ed .

A ccording to thes e ratios th en ther e w er e r elativ ely much larg er , ,

amoun ts of magne sium excret ed duri ng fasting than o n th e food days .

I n co nsid e ring th e ratios for th e potassium oxid e an d sodi um oxid e ,

we fin d that th e probl e m is co nsid erably complicat ed by th e fact that

a c ertain amoun t of so dium chlorid e exists in th e body whi ch is ve ry
loos ely if at all combi ne d in th e tissu es Co ns equ ently o n th e first
, , .
,

day of th e fast o nly , per c en t of th e total alka li was fou nd in th e

form of potassium oxid e and per c ent in th e form of sodium oxid e .

On th e ne xt day th e proportio n was re vers ed and from that tim e u n til ,

th e eight ee nth day th e r e was a t en d ency toward a gradually i n creasin g

p erc e ntag e of potassium oxid e F or th e r emai ni ng days of th e fast .
,

about 90 per c ent of th e alkali was in th e form of potassium oxid e and

1 0 per c e n t or l ess in th e form of sodium oxid e On e sp e cim en of urine .

that for th e tw e nty e ighth and tw enty ninth days S hows th e hi gh

- - —

p erc en tage of for potassium oxid e as compare d with per c en t

for sodium oxid e .

I t is Obvious from th e valu es for th e potassium and sodium that

S hortly aft e r th e e xcr e tio n of th e u n combi ne d sodium c hl orid e o n th e

first few days th e body e xcret e d th e potassium and sodium from muscl e
,

substan c e and we the n have th e large diffe re nc e s b e tw ee n thes e two

e l e m en ts ; in th e last part Of th e fast approximat ely ni n e or ten tim es ,

more potassium was e xcre t ed than so di um This far e xc ee d e d th e .

ordi nary proportio n b etw een potassium and sodium in muscl e given
2
as a re sul t of th e analys e s of B u ng e .

T h e r elatio n shi p b etwe en ca l cium and magnesium in a nimal tissu e s

has b een ext ensively studi e d particularly with dogs and hors es , .

1 G e a d An n d l I n t P t u 1 9 12 26 p 1 2
r r , . e
’
s . as e r, . , . .

2
S eeA O pp nh i m
ro n , e Ha dbu ch d B i ch mi d M n ch n u d Ti re 1 909 l p 84
e er s
’
n er o e e es e s e . er e , , , .
,

Where th l ati n h i p i giv n a 5 to 6 tim es as m u ch po ta i um a dium

e re o s s e
‘

s ss s so .
 U R IN E

T AB L E 40 .
—
Distri b ution of mi neral metab olism (uri n e excretion ) i n experi ment wi th L .

Po tassium an d so d ium .

C C C C C

0 7 65 0 74 4

1 06 2 O 6 24

0 6 16 0 26 8

0 604

0 659 0 29 3

0 59 7

0 701

0 664 0 176

0 5 00 0 224

0 4 68 91 6 0 1 74

0 4 28 0 14 6
0 0 0 0 0

0 36 6 0 09 6

0 385 0 14 2

1
D i
e te rm n at o ns i in i
ur ne for b
a o ut 22 h o urs .

1
To y o n aga in Tokio fou nd that in th e muscl e s ther e is always l ess
2
calcium than magn e sium thus co nfi rming th e analys es Of K atz but , ,

in th e glan ds th e r e is always mor e calcium than mag nesium .

3
Al oy studyi n g th e calcium and magne sium co nt e nt of muscl e foun d
, ,

about twi c e as much magn esium as calcium P erhaps of mor e i nt ere st .

1
T y g a B ul C ll
o f Ag
o na T ki 1 9 02 1 9 03 5 p 1 4 3 a d p 4 5 5 ; al o 19 04 1 9 05 6 pp
, . o . o r .
, o o, —
, , .
, n . s —
, , .

89 an d 35 7 .

2
Kat z Ar ch iv f d g e s Ph ysi o l
, . . . 1 89 6 , 63 , p 1 . .

a
Al o y C o m p t re n d So c B i o l
, . . . .
, 1 9 02 , 54 , p 6 04
. .
29 0 A S T UDY O F PR O L O NGE D FA S T I NG .

1
in this particular study ar e th e obs ervations of Magnus L evy , wh o an a —

ly z ed th e body of a m an wh o had co mmi tt ed suicid e H is r esults .

S how ed about thr e e tim es as much magne sium as calcium in th e muscl es .

2
On th e basis of all th e analys es prior to thos e of Magnus Le vy , Aro n -

gives th e average figur e for th e r elatio nshi p of magne sium to calcium

in th e muscl e Of dogs as 1 to 0 54 0 60 an d in th e muscl e of hors es as
—

1 to I n g eneral , th en , we may assum e that th er e is appro xi

mat e ly thr ee times as much magnesium as calcium in th e muscl e of m an .

W e may co nsid e r th e magn esium excr etio n as more n early an in d ex

of th e muscl e disin t egratio n than calcium , for whil e th ere is , to be sure ,
a sma l l p erc en tag e of magnesium oxid e in bo ne , th er e is a much larg er
availabl e supply of calcium oxid e in th e form of bo ne which is unqu es
tionably drawn upo n Th e calcium oxid e excre tio n is therefore th e
.
-

r esultan t of two factors , i e , muscl e disin t egratio n an d bo n e disin

. .

tegr atio n , whil e magnesium oxid e is d eriv ed almost exclusiv ely from
th e no n oss e ous tissu e
-
.

I t is a matt er of r e gr e t that th e small amount of magnesium pres ent

in th e urin e and th e n ec e ssity for combin in g th e sampl e s for s ev eral
days rende rs it ve ry difficul t to mak e an e xact compariso n b etw ee n
th e magnesium e xcr e tio n and th e oth e r uri n ary co nstitu ents In .

g eneral , how ever , th e magn esium excr etio n follows approximately

th e ni trog en e xcr e tio n Of strikin g i nt er e st is th e fact that , o n th e
.

first day of th e fast , an extraordinarily low amou nt of both magn esium

an d calcium w er e e xcr e t e d Th e in cr emen t in th e magn esium excre
.

tio n o n th e s eco nd day (i e , 1 00 pe r c e nt) was no t approximat e d by

. .

th e e xcr etio n of any oth e r e l emen t in th e body .

Th e r esults of th e a n alys e s r eport ed by Cathcart for B eauté , while

relativ ely few in numb er , ar e in full co nf o rmity with our findi n gs ,
sav e that th e magn esium excr etio n o n th e days prior to th e fast is
much larg er than that found with L F urth ermor e L e xcret e d c o n .
, .

siderably mor e c al cium per day tha n did B eauté d urin g th e fasti n g

p eriod .

I n th e food p eriod following th e fast it is i nt er esti n g to n ot e th e ,

strikin g fall in th e excre tio n of all of th e mi nerals sav e sodium F or .

th e fi rst 2 food days th er e was but half as much calcium e xcr e t ed as

o n th e last day Of th e fast about o ne third as much ma gn e sium s e v e n
,
-
,

t enths as much potassium and about th e same amou nt of sodium ,

.

On th e last day of th e food p eriod aft e r th e fast th e calcium was s ev en ,

ten ths that of th e last fastin g day th e magn e sium o ne s eve nth th e ,
-
,

potassium o ne fifth and th e so di um about th e same as o n th e last fast

-
,

ing day .

Th e amounts of calcium magne sium potassium and so di um i ntak e

, , ,

ar e unk n ow n for th e s e days y e t th e s e e l em e n ts must hav e b een pr es en t

,

in th e food tak en I t is Obvious that th e effe ct of th e i n ge stio n of a large

.

1
Magnu L vy B i c h m Z its h 1 9 1 0 24 p 3 63
s
~
e , o e . e c r .
, , , . .

2A o n Oppe nh im H an dbu ch der B i ch m i d M n ch n u d Ti

r .
e er s
'
1909 l p 88 o e e es e s e . er ere , , , . .
292 A ST UDY OF P R OL O N GE D FA S T I NG .

reducing pow er as th e fast progr ess ed r egardl ess of any inh erent diff er ,

e n ces whi ch mi ght e xist in th e two m e thods .

Th e r educin g powe r of th e fastin g uri ne s in th e e xp erim en t with L .

was at all tim e s w ell within n ormal limits av eraging no t far from th e ,

valu es Obs er v ed o n co n trol normals in thi s laboratory Th e larg est .

am ount o n th e fastin g days was 4 98 milligrams for th e fo urth and six

tee nth days an d th e small est amou n t was 29 6 milligrams for th e thi rd
,

and S ixth days .

A large amou nt of r educing pow er was fou n d o n th e first day of food

followin g th e fast On this day th e subj ect ate in a r elatively S hort
.

tim e about 5 00 grams of carbohydrat e chi e fly in th e form of solubl e ,

TAB LE 4 1 To tal reduc ing power of u rine i n experi ment with L

.
—
.

‘
D e ter m ne i d in urine f b
o r a o ut 2 2 h o urs .

d extros e th e di e t consistin g of ho ney and th e j uic e of grap es orang es

, , ,

an d l e mons Unqu estio nably t hi s amount exc ee de d his carbohydrat e

.

tol eran c e o n that day and grams of d extros e w ere th erefore

e xcr e t e d in th e urin e I t is possibl e that we fi nd h ere with man th e
.

1 ” “
co ndi tio n with dogs d escrib e d by H ofmeiste r as hunge r dia b e tes ,

an d it may be an i n t er estin g co n firmatio n of h is th e ory .

R e c ent l y al so R ietsch el has n ot e d that th e fasti ng of infa n ts has

2
, ,

r esul te d in a mark e d low e rin g of th eir tol era n c e for carbohydrate sub
stan c e s Thi s loweri ng has b een so n otic e abl e as to l ead R ietsch el to
.

warn clinicians in th e following words ag ai nst th e u n du e u se of starvin g

in treatin g pathological cas es :
“
D ass de r H un ger spe z die ab so l ute Nah rungsentz ie h ung fur den ge sund en
.
,

wie b eso n ders fii r den e rnah rungsge stbrten S ii ugling auch schwere G efahren
”
nach S ich z ie h en k ann ist he ute allgemein ane rk ann t
,
.

H fm i t A ch iv f xp P th
1
o e s e r, Ph a m 1 889 1 89 0 26 p 35 5
r . e . a . 11 . r .
,
-
, ,
. .

Ri ts h l H u bn
2
e c e F tsch ift B li n 1 9 1 3 p 5 1 6
, e
’
er s es r , er , , . .
 U R IN E . 2 93

To att empt an an alysis of th e re duci n g substanc es in th e uri n e dur i ng

th e fastin g p eriod would be somewhat difficult A c ertain portio n .

has alr e ady b een ascrib e d to cr eati nin e an d to uric acid but th er e is no ,

d efin it e r elatio n shi p b etw een th e amounts of uric acid cr e atini n e an d , ,

th e re duci n g pow er to be n ot e d in th e r e sul ts obtai n ed in this fastin g

exp e rim en t .

CAR B ON IN U R INE .

Wh ile th e excre tio n of carbo n in th e form of carbo n dioxid e is of gre at

S ign ifican c e as i ndicati n g th e total amou nt of en ergy tran sform ed i n to
h eat in th e body n ev e rth el e ss wh e n a study of th e total loss of body
,

mat e rial is of importan c e as it is duri n g comp l et e fasti n g th e carbo n

, ,

in th e urin e must be tak e n i nto co n si d e ratio n S i n c e we w e re also .

maki ng a study of th e en ergy output of th e uri ne by burni n g sampl e s

in a calorim e tric bomb it was r elativ ely S imp l e to combi ne th e d e t er
,

mi n atio ns of th e e n ergy output and th e carbo n co n t en t C o nse .

qu en tly aft er th e dri e d uri ne had b een bur ne d i nsid e th e bomb th e

, ,

carbo n dioxide produc e d in th e combustio n was allow e d to e scap e from

th e v e ss el t hr ough w e igh e d soda—lim e tub es in accorda n c e with th e ,
1
me thod of F ri es The s e d et ermi natio ns w er e ski l fully carri e d out by
.

Mr A W Corne ll of th e L aboratory staff

. . .
, .

T h e d escriptio n of th e m e thod of pr eparatio n and dryi ng Of th e uri ne

sampl es for th e bomb calorimet er has a l re ady b e en giv en in th e dis
2
cu ssio n of th e total solids in th e uri n e From th e w e ight of th e carbon .

dioxid e in th e soda lim e tub e s an d th e w eight of th e uri n e th e amount

—
,

of carbo n per day e xcr e t e d in th e uri ne is r e adily comput e d Th e s e .

valu es are giv en in tabl e 4 2 .

T h e d e t e rmi n atio n of carbo n in uri ne has b e e n for ma ny y e ars a

subj e ct of r es earch in this laboratory an d in th e ch e mical laboratory
of Wesl e yan Un iv ersity Various m e thods hav e b een tri e d in cludi n g
.
,

th e moist combustio n proc ess dryi ng with and without th e additio n ,

of salicyli c acid an d with an d without th e u se of th e c ellulos e filt e r

,
3
blocks re comm en d e d by K ell ner Th e method which giv e s th e large st .

p e rc e ntag e of carbo n is presumably th e b est o n e an d this has b een our ,

crit erio n N o m ethod that we hav e thus far us e d approach e s th e larg e

.

p erc e ntag e of carbo n which is o b taine d by th e me thod pre vious l y de

4
scrib e d n amely dryi n g fi rst with 50 mi ll igrams of salicylic acid th en
, , ,

transferri n g to a n ick el capsul e dryi n g in a d e siccator un til r e ady to burn , ,

and fi n a l ly burn i n g in compr e ss e d oxyg e n in a bomb calorim e t e r an d ,

a ll o wi ng th e carbo n dioxi d e to e scap e i nto soda lime Wh en th e h eat -

.

of combustio n is d e sir e d th e d e t e rmi n atio n of carbo n occupi e s but

,

a few mome nts ad d itio nal thus provi di n g th e S impl est and b est me thod
,

for O b tai ni ng th e require d valu e s Th e pr el imi nary op eratio n s of dryi n g .

re quir e b ut l itt l e att entio n from th e assistan t .

F i J u n Am Ch m S
1
r es, 1 9 09 31 p 2 7 2
o r . . e . oc .
, , , . .

2
S ee p 24 3
. .

“
Ke ll ner , L an dw Jah r b , 1 8 96 , 4 7 ,
. . p 2 97
. .

4
Higgi n s an d e ne t , AmB o urn dic . J . Ph y i o l
s , 1 9 1 1 , 28 , p . 29 1 .
294 A ST UDY OF P R O L O N G E D F A S T ING .

T h e total amount of carbo n e xcre t ed in th e uri ne rang e d , accordin g

to th e va l u es in tabl e 4 2, from grams o n th e first d ay of th e fast
to grams o n th e fou rth day of th e fast I n th e first half of th e .

f as tin g p eriod th e carbo n excretio n averaged som ewhat abov e 1 0 grams

p er day ,
but in th e latte r part th e e xcre tio n was not far from 8 grams .

TA B L E 42 .
—
Nitrogen , b
car o n , and energy o f urine i n experi ment with L .

In th e fasting e xp eriments at Wesl eyan Un iv ersity th e carbo n

co nt ent of th e uri ne i ncre as e d notic e ably o n a num b er of d ays as th e
fast co n tinu e d This i n cre as e in carbo n was accompani e d by an
.

in cr e as e in th e e nergy co n t ent which was attribut e d at th e tim e to th e

,

pre s en c e of a larg e amou n t of fl oxybutyric acid A simi l ar in cremen t

-
.

in th e carbo n co nt en t of fastin g uri ne was n ot e d wi th an insane pati en t

1
by B enedi ct an d D i efen dorf This e xc ess of carb o nac e ous mate rial
.

1 B n dict a d Di f d f Am J u n Ph y i l 1 907 1 8 p 3 6 2
e e n e en or , . o r . s o .
, , , . .
296 A ST UDY OF P RO L O N G E D FA S T I NG .

With normal urin es therefore o ne may co n clud e that th e carbon

, ,

nitrogen ratio may vary from to Many interestin g cas es

are re c ord ed in which th e disturba n c e of th e carbo n nitrog e n ratio has -

b ee n fo und In th e fastin g exp erim ents at Wesl eya n Un ive rsity

.

carbo n nitrogen ratios during fastin g ra nged from a minimum of

-

to a maximum of On 7 days out O f 4 3 th e ratio was ov er 1 ,

thes e 7 days b eing th e last 4 days of a 7 day fast and th e l ast 3 of a -

1
4 day fast
— . I n c ertain typ e s of f e ver also Magnus Al sl eb e n found , ,
-

an i ncre as e of th e carbo n nitrog en ratio whil e in oth e rs th er e was a

-
,

mark ed d ecre as e He also r eports thr ee cas es in which extremely

.

hi gh ratios w ere obtain ed aft er s evere muscular work th es e ratios ,

b e in g an d resp ectiv el y I t is thus cl ear that u nd er .

co n ditio ns which result in an a b normal katabolism disturbanc es in ,

th e car bo n nitroge n ratio are fou nd and co nv erse ly a disturba nc e of

-
,

this ratio may be tak en as prima facie e vid en c e of a disti nctly disturb ed
katabo lism .

Th e carbon nitrogen ratio has b ee n comput ed for each day of th e

-

fasti n g e xp e rim en t with L and lik ewis e for th e food days prior and sub
.

s equ ent to th e fast Th es e valu es are includ ed in tabl e 4 2 togeth er

.
,

with th e valu es for th e total nitrog en On th e 2 days b e fore th e fast .

th e ratio was v e ry consta n t av eragi ng I t th en ros e rapidly u ntil

,

th e fo u rth day wh en it was S li ghtly ov e r

, an d r e mai ne d at appro xi

mat e ly 1 u ntil th e maximum l ev el was reach ed b etw een th e sixt eenth

an d n in e t ee nth days of fastin g Th e ve ry high valu e of o n th e
.

first day with food aft e r th e fast is in part explai ned by th e e xcretio n
of grams of d e xtros e in th e urin e I t is s ee n from th es e ratios .
,

th e re fore that th e u rin e excretion after th e first day or two re gularly

,

co ntain ed some nitrog en poor and carbo n rich substanc e which from
- -
,

a l l e vi d e n c e app e ars to be B—oxybutyric acid Si n c e th e 2 days with

,
.

foo d b efore th e fast agr ee so p e rfectly we hav e fe lt justifi ed in usi ng th e ,

av erag e valu e of for computin g th e n ormal amou nt of carbo n

accom p an ying nitrog en in th e i n direc t computatio n of th e amou n t of
B oxy b utyric acid pre s en t in th e urine (S ee column B tabl e 3 8 pag e
-
.
, ,

T h e valu e s foun d with L duri ng fasti n g are mat eriall y high e r .

throughout th e e ntir e fast than thos e r eport e d by Mu nk for B reithaupt ,

for o n 6 days of th e fast Munk fou nd n o diff e re nc e in th e carbo n

ni trog e n ratio b e tw e en th e fastin g days an d th e 2 days with food
2
followi n g th e fast On th e last 6 days of a 3 w e eks fast G rafe fou nd
.
-

e xtraor di n arily hi gh carbo n nitrog en ratios as fo llows : -

On th e first food day th e ratio f e ll to

3
Th e thr ee Obs ervatio n s of Pette nko fer and Voit may also be cit e d ,

th es e i nv estigators fi ndi n g o n th e first fasti n g day an averag e of

as th e car b o n ni trog e n ratio
-
.

Magnu Al l b
l
Z it hs- f kli M d 1 909 68 p 35 8
s e e n, e sc r . . n . e .
, , , . .

G f Z it h f Ph y i l Ch m 1 9 1 0 65 p 2 1
2
ra e , e sc r . . s o . e .
, , , . .

a
P t te nk f an d V i t Z it
e o erh r f B i l 1 86 6 2 p 4 59
o , e sc . . o .
, , , . .
 U R I NE . 29 7

E NER GY OF U R INE .

I n stu dyin g th e m etabolism of a fastin g m an , although we are par

ticularly i n t er e st e d in th e e ne rgy tra nsform ed in th e body an d l e avi n g
th e bod y as h e at , a compl e t e pictur e of th e total br e akin g down of -

tissu e an d loss of body mat e rial c an no t be had without a knowl e dg e of

th e pot e ntial energy of u n oxi diz ed mat e rial in th e uri n e throughout
th e fasti n g p eriod D et e rminatio n s of th e h e at of combustio n w er e
.

mad e by Mr A W Corn e ll , th e r esults giv en in tabl e 4 2 b ein g always

. . .

th e av erag e of two or thr ee w e ll agr eei n g a n alys e s -

.

D uri ng th e fasti n g p e riod th e total amou n t of en ergy lost in th e

uri ne ran ge d from 6 5 calori e s o n th e fir st day to 1 34 calori es o n th e
fourth day There was a g en eral t e nd en cy aft er th e fourth day for
.

th e valu e s to fall o ff gradually as th e fast co n tinu ed ; e xcluding th e fir st

day , th e small est amou n t (80 calori es ) was foun d o n th e last d ay of th e
fast Th e energy was also d et e rmi n ed for th e 2 days imm e diat ely
.

prec e di ng th e fast , th e valu e s b ei ng 1 29 and 1 04 calori e s r esp e ctiv e ly .

O n th e days with food fo llowi n g th e fast , v e ry small amou nts of en ergy

w er e foun d , the s e b ei ng 74 calori e s o n th e first and 4 5 calori es o n th e
s e co n d food day .

CA L O RI E NI TR O GE N
- RA TI O .

S i n c e th etotal amou nt of energy lost per day may vary with th e

amou n t of nitrog en e xcr et e d an d si n c e th e r e will always be a c ertai n
,

amou n t of pot e ntial energy n ormally accompanyi ng e ach gram of

n itrog e n in th e uri n e it is importa n t to comput e th e numb e r of calori e s
,

per gram of nitrog e n Th e r e sults of such computatio n are also giv e n

.

in tabl e 4 2 .

On th e 2 days b efor e th e fast th er e w e re about 9 calori e s daily per ,

g ram of n itrog en Th e ratio r emai n e d practically u n cha n g e d o n th e

.

first day of th e fast but for th e next 4 days it S how e d a disti n ct ten
,

dency to i ncr e as e Th e high e st ratio fou n d duri ng th e fasti n g p eriod

.

was calorie s per gram of nitroge n o n th e s ev ent ee nth day an d th e ,

low e st was calori e s o n th e first day of th e fast I t is thus s een that .

,

e xc ept o n th e first day th e ratios throughout th e fast w er e compara

,

tively high exc e edi n g thos e foun d for th e pr e c e di n g food days

, Th e .

ratios for th e 2 days with food fo l lowing th e fast are i nflu en c ed by th e

fact that o n th e first day wh en th e di e t co ntai ned an e xc essive amou nt
,

O f carbohydrat e ther e was a me asurabl e amou n t of sugar e xcr et ed

,

grams ) which would obviously i ncre as e th e e ne rgy but hav e n o

,

e ffe ct upo n th e n itrog e n ; furth e rmor e o n th e s e co n d day a v e ry small ,

amou n t of nitrogen was excr et ed N eith er of the s e valu es c an of cours e .

be look e d upo n as obtai ne d u n d e r normal co n ditio n s .

With n ormal subj e cts an d an ordi nary d ie t th e ratio of ca l ori e s ,

1
to nitrogen is e ss e ntia l ly co n stan t Thus B enedict an d Mi l n er fou n d .

l
B n di t
e e d Mi l
c U 8 D pt Ag O ffi c E p S t B ll 1 75 1 9 0 7 p 1 4 5
an n er , . . e . r .
, e x . a . u .
, , . .
2 98 A S T UDY O F P R O L O NG E D FA S T I N G .

an av erag e calori e nitrogen ratio of for 58 r est and work experi

-

ments with normal individuals in th e r espiratio n calorim et er at Wes

l eyan Univ e rsity th e variatio n s b ein g extremely small rangi n g from
, ,

to Wh en u nbalan c ed di ets are tak en this ratio may be some ,

1
what alt e re d T an gl r eports th e ratio co nsid erably high er o n th e
.

days wh en th e di e t was rich in carbohydrat es and poor in fat th e ratio ,

b ecoming as hi gh as o n th e carbohydrat e rich days and fall i n g -

to o n th e carbohydrat e poor days On th e oth er han d B ene dict -

.
,

an d Miln e r n ot e d n o appreciab l e cha n g e due to di e t .

I n th e e arli er fasti ng e xp erim ents th e energy in th e uri n e has b ee n

rar ely d et ermi ned th e most e xt ensiv e in v estigatio n b ein g that in Wes
,

l eya n U niv ersity ? in o ne e xp erim ent a calori e—ni trog en ratio was found
ran ging from to
T h e larg e ratios fou nd duri n g fastin g e xp e rim ents are unqu estio n ably
to be e xplained by an e xcr etio n of nitrog en poor carbo n rich mat erial -
,
-
,

whi ch is c hi e fly B oxybutyric acid Unfortu nat e ly in th e e arli er

-
.
,

O bs e rvatio n O f B e ne dict an d D i e fe ndorf in which th e v e ry high ratio ,

of was fo und dir ect e vid en c e of th e excre tion of B oxybutyric ,

—

acid was no t obtai ned as th e d e t ermin atio n s w ere no t then f e asibl e , .

A ssumi n g that th e high c alo rie nitro g en ratio is due to th e pres enc e of
ac eto ne bodi es it c an be s e e n that durin g th e fastin g exp erim en t of
,

th e subj ect L th e high est acidosis as m e asur e d by thi s m e a ns occur r e d

.

b etw ee n th e fif t e en th and tw en ty fifth days high ratios prevaili ng for -

,

thi s entire p e riod .

CAL O Bm - CA RB O N RATI O .

While it is p e rfe c tly po ssibl e to have a carbo n rich nitrogen fre e -

,
-

substan c e in th e uri ne which would profou n dl y affe c t th e calorie

nitrogen ratio th e pres enc e of carbo nac eous mat erial in all energy
,

producing mate rial foun d in uri ne woul d l ea d o ne to suppos e that th e

relationship b etw een calori es an d carbon woul d be much more r egular
than that b e tw ee n th e calori e s and th e nitrog en T h e calori e carbo n .
-

ratios hav e b ee n comput ed for thi s exp e rim ent and are i n clud e d in
tabl e 4 2 Th e striking irr e gulariti es in th e oth er ratios given in thi s
.

tabl e are entir ely abs en t in th e calori e carbo n ratio for th e y remai n -
,

remarkably co nstan t un d er all co n d itio ns Th e valu es for th e entire .

s eri es includi n g both th e first and s ec o nd food p eriods range o nl y

, ,

b etw een o n th e tw en ty thi rd day of th e fast an d o n th e first -

day with food aft e r th e fast I n th e fasti ng p eriod its elf th e minimum .

valu e was o n th e tw e n ty sixth day I t is thus s een that duri ng -

.

th e total 3 1 days of th e fast th er e w e re o n th e average calori e s , ,

for e ach gram of carbo n .

Th e av e rag e ca l ori e carbo n ratio in the s e fasting uri ne s n ame ly -

, ,

calori e s is almost exactly th e sam e as that foun d by H iggins and

,

T ng l A ch iv f Anat u Ph y i l 1 8 9 9 P h y i l Abth S pp p 25 1
l
a , r . . . s o .
, , s o . . u .
, . .

B dict C n gi I t !V h Pub 7 7 1 9 07 p 4 93 and B dic t a d Di f d f Am

2
e ne , ar e e ns . as . .
, , .
, e ne n e en or ,

J u n Ph y i l 1907 18 p 362
o r . s o .
, , , . .
 MI CROSCOPY OF URINE AND TES TS FOR ALBUMIN .

BY HARR Y W . G OO D AL L , M D . .

Th e h eat t est was us e d in making th e albumi n d et ermin atio ns F or .

t h e sak e of uni formity th e mi c roscopic examinatio n was m ad e as fol

lo ws z Two 1 5 mm x 1 5 mm cover gl as s fi elds w ere exami n ed with each
. .
-

sp ecime n 20 minut es b ei n g given to s earc hi ng for and countin g casts

,
.

Th e urin e was c entrifuge d at a uniform rat e for 5 mi nut es Th e resul ts .

o f th e te sts are giv e n h e re with .

D ETAILE D RES ULT S .

A pril 1 4 1 5 (first d ay of fast)

—
Albumin ab sent S ediment no c asts
.
—
, .
, ,

bl oo d o r pus ; rare ro und c ell occasion al s q uamous c e ll ; l i ttl e mucus

, ,
.

A pril 1 5 1 6 (se c o n d day of fast )

—
A lbu min ab se nt S edi ment no c ast s .
—
, .
,

o r pus ; rare n o rmal re d bl oo d c o rp usc l e rare s m all ro un d c e ll , ,

o cc asi o nal sq u amous c e ll ; li ttl e muc us .

A pril 1 6 1 7 (third day Of fast)

—
A lbu min ab se nt S ediment o ne hyali ne
.
—
, .
,

c ast sm all di am e te r no bl oo d o r pus ; few small ro un d c ell s rare l arge

, , ,

c aud ate ce ll nume ro us squam o us c ell s ; rare sp e rmato z o a normal

, ,

in appe aran c e ; l ittl e mucus .

A pril 1 7 1 8 (fo urth day of fas t)

—
Albumi n ab se nt S edi ment no casts
.
—
, .
, ,

bl o o d o r pus ; fe w small ro un d an d squamous c ell s l ittl e mucus

, , .

A pril 1 8 1 9 (fif th day o f fast)

—
Albumi n sl ighte st p o ssibl e trace
.
—
S edi , .

me nt 1 3 hyal ine c ast s 3 c o arse granul ar casts all o f l arge d iame ter ;
, , ,

a fe w o f t h e c asts wi th c e ll s ad he re nt ; small rou nd c e ll s mo re numer

o us ; fe w sq u am o us c e ll s .

A pri l 1 9 20 (sixth day o f fast)

—
A lbumin l e ast p ossi bl e trac e
.
—
S edi ment , .
,

1 5 hy ali ne casts 2 c o arse gr anul ar c asts ne arl y all Of l arge di am ete r

, , ,

so me wi th c e lls adh ere nt ; fe w small ro u n d and squ amous ce lls .

A pri l 20 2 1 (se venth day of fast )

—
A lbu min sl ighte st p ossi bl e trace S edi
—
, .

ment 5 hyaline c asts 9 c o arse granul ar c e ll s all of l arge di amete r

, , , ,

so me with ce lls a dh erent ; rare n ormal re d bl oo d gl o b ul e numerous ,

small ro un d c ell s few s qu amo us c ells ; rare sp erm ato z oa normal in

, ,

appe ar an c e .

A pri l 2 1 22 (e ighth day of f ast)

—
A lbumin slighte st p ossi bl e trac e -
, .

ment 4 hyal i n e c asts 5 co arse granul ar c asts n e arl y all Of l arge

, , ,

d i ame te r so me with c ell s adherent ; num erous medi um and small

,

ro un d c e ll s ; rar e small caud ate c e ll ; l ittl e mu cus .

A pri l 22 23 (ni nth day o f fast)

—
A lbumin sl ight est p o ssi bl e trac e S edi -
, .

ment 5 hyal ine c asts thr ee of which h ad a few c ell s and fat dr op s
, ,

ad here nt ; 5 c o arse gr anul ar cast s with c e ll s a dherent all cast s of ,

l arge di ame ter ; n o bl o o d o r pus ; few small and me dium round and
squ amo us c e ll s ; rare S p erm ato z o a n o rm al in app e aran c e , .

A pri l 23 24 (te nth day o f f ast)

—
A lbumin sl ightest p ossibl e trace (alb umin
—
,

c l oud mo re mark e d than at p revi o us examinatio ns) S ediment .

,

8 hyal in e c asts some wi th c e ll s and fat d ro p s adhe rent ; 4 coarse

,

granul ar c asts ; all c asts o f l arge di ameter ; n o bl o o d o r p us ; few small

and me d ium ro un d an d squamo us c e ll s ; l itt l e m ucus .

A pri l 24 25 (e l eve nth day of fast)

—
Albumin sl ighte st p ossibl e trac e (same —
,

as l ast e xam ination) S ediment 4 hyal ine c asts ; 3 c o arse granul ar

.
,

c asts; general te ndency to diminutio n in di ameter o f casts; adherent

c ell s an d fat drop s l ess numerous; few small and m e dium ro un d and
squ amo us c e ll s .
 MI CR O S C O P Y OF UR I NE AND TE S T S FOR AL B U MI N .

A pri l 25 26 —
( tw e l fth d a y o f f ast ) A lb u mi n l e as t p o ssi bl e t rac e (same as
.
w

l ast examinati o n) S ediment 7 hyaline c asts 6 c o arse granul ar c asts

.
, , ,

chie fly small di ameter ; few fat dr op s and cells adherent ; few l eucocyt es
an d small roun d ce ll s ; fe w aci d s o di um ur ate c ryst al s ; l ittl e mu cus -
.

A pril 26 2 7 (thirteenth day of f ast)

—
A lbumi n sl ight e st p o ssi bl e trace .
—
,

( re a cti o n l e ss m ar k e d ) S edim en t 1 5 hy
. al i n e c ast s ; 2 c o ar se gran ,

ul ar c asts o f me di um si z e and with a few c e ll s adherent ; fe w l euco

cyt es and small ro un d c ell s .

Apri l 2 7 28 (fo urt eenth day o f fast)

—
A lbu min sl ight est p o ssibl e t rac e .
—
,

(sam e as l ast examin ation) S edimen t 6 hyaline casts 2 coarse .

, ,

granul ar c asts all c asts o f me di um S i z e an d with a few c e ll s adherent ;

,

few l eu c o cyt es an d small ro und c e ll s ; numero us S p ermato z o a .

Apri l 28 29 (fiftee nth day o f f ast)

—
Albumi n slight e st p o ssi bl e trac e (ve ry
—
,

faint re acti o n) S ediment 1 5 hyal ine c asts ; 1 0 co arse granu l ar c asts

.
, ,

few c e ll s an d fat d ro p s adhere n t ; g en e ral t en d en cy to d e cre ase in

di ame t er o f c asts ; few small an d me dium roun d ce ll s ; rare small
c aud ate and n e c k o i bl adder c e ll s - -
.

April 29 3 0 (sixt eenth day o f f ast)

—
A lbu min sl ightest p o ssi bl e trac e .
—
,

(same as l ast examination) S edimen t 1 4 hyal in e c asts ; 1 2 c o arse .

,

granu l ar c asts chi e fly o f small di amet er ; few small an d me dium

,

ro un d ce ll s; rare n e c k o f bl add er c e ll s - -
.

Apri l 30— May 1 (seve nteen th day o f f ast) A lbu mi n sl ight est p o ssi bl e .
—
,

trace (ve ry f aint re acti o n) S edi ment 7 hyaline c asts 2 fi ne granul ar —

, ,

c asts some with few fat d ro p s and c e ll s adherent ; c asts o f small

,

di amet er ; few small and me dium ro un d c ell s ; r are n e c k Of bl adder - -

ce ll s ; few s qu amo us c e ll s .

May 1 2 (e ighteenth day o f fast) A lbu min sl ightest p o ssibl e trace (ve ry
— —
,

faint reactio n) S ediment 8 hyal ine c asts ; 4 c o arse granul ar casts

.
, ,

small d i ame t e r fe w fat d ro p s an d c e ll s ad h ere nt ; few small an d

,

me dium ro un d c ell s; few squ am ous ce ll s .

May 2 3 (ni nete enth day o f fast) A lbumin sl ighte st p o ssibl e trace (very
— —
,

faint reacti o n) S ediment 8 hyal ine c asts ; 4 co arse granul ar c asts

.
, ,

small di amet er few fat dr o p s an d c e ll s adheren t ; few small and

,

med ium roun d an d s qu amous ce ll s ; l ittl e mucus .

May 3 4 (twentieth day o f fast) A lbu min sl igh te st p o ssi bl e trace (ve ry
— —
,

faint re action) S edim en t 6 hyal in e c asts ; 2 fi ne granul ar c asts al l

.
, ,

c asts o f small di amete r a few co nt aini ng fat dro p s; few S quamous

,

c ell s ; l ittl e mucus .

May 4 5 (twen ty fi rst day of fast) A lbumin l e ast p o ssibl e trace (very faint
— - —
,

re action) . S edi men t 4 hyal ine casts ; 2 fi ne granul ar c ast s o f small

, ,

di am e ter ; few smal l an d medium ro und ce ll s; few squamo us ce ll s .

May 5 6 (twenty se con d day o f fast) A lbumin sligh test p o ssibl e trace
-
'
- —
,

(very fain t re acti o n) S ediment 7 hyaline c asts ; 4 c o arse granul ar

.
,

c asts all c asts o f small di ame ter ; few small ro und and sq uamo us c e ll s
, .

May 6 7 (twenty third day o f fast) A lbumin sl ighte st p o ssibl e trace

— - —
,

(ve ry f aint re acti o n) S edimen t 7 hyaline c asts ; 3 c o arse granu l ar

.
,

c asts all casts o f small di am eter ; few smal l ro un d and squ amous c ell s
,
.

May 7 8 (twenty fo urth day o f fast) A lbu min l e ast p o ssibl e trac e (very
— - —
,

faint re action ) S ediment 6 h yal ine c asts ; 4 c o arse granul ar c asts all
.
, ,

o f small d i ame ter ; few small an d me d i um roun d an d sq u amo us c e ll s .

May 8 9 (twenty fi fth d ay o f fast) A lbumin slight est p ossibl e trace

— - —
,

(very faint re actio n) S ediment 6 hyaline c asts ; 2 c o arse granul ar

.
,

c asts ; all casts o f small di ameter o cc asi o n al fat dro p s and cell s ,

adherent ; few small an d me di um ro u n d an d sq uamo us c e ll s ; s o me

ce ll s sl ightly fatty ; rare S p ermato z o a n o rmal in app e aran ce ,
.
3 02 A ST UDY OF P RO L O NGE D FA S T I NG .

May 9— 1 0 (tw y ixth

e nt -S
of fast) A lbumin sl ightest p o ssibl e trac e
day —
,

(very fain t reacti o n) S ediment 8 hyal ine c asts ; 1 co arse granul ar

.
,

c ast ; all c asts o f small di ame ter ; occ asional fat drop s an d ce ll s
adherent ; fe w small and me di um ro un d an d squam ous c e ll s some ,

c e ll s sl ight ly fatty ; rare sp ermato z o a normal in app e arance , .

May 1 0 1 1 (twenty seventh day of fast) A lbumi n slighte st p o ssi bl e trace

— - -
,

(very fai nt re ac tio n) S ediment 8 h yaline c asts ; 1 c o arse granul ar

.
,

c ast ; all casts of small di ame te r with a few fat dro p s and c ell s adh er,

e nt ; r ar e spe rm ato z o a no rmal in app e ar anc e ; few me dium ro un d

,

ce ll s slight l y f atty ; fe w sq u amous c e ll s

, .

May 1 1 1 2 (twenty e ighth day of f ast) A lbu min sl igh test p ossibl e trace
— - —
,

(ve ry fain t reaction) S ediment 6 h yal ine c asts ; 2 co arse granular

.
,

c asts ; all casts of small di am eter a few fat dro p s an d c ell s adherent ; ,

numero us sp e rm ato z o a no rm al in appe ar anc e

, .

May 1 2 1 3 (twenty ninth day o f fast) A lbu min slightest p o ssi bl e trac e
— - -
,

(ve ry f ain t re acti o n) S edi men t 1 0 hyal ine c asts 3 co arse granular
.
, ,

c as ts ; all casts o f small di ameter few fat dro p s and numero us c ell s ,

adhere nt ; few sm all and me dium roun d c e ll s ; few squam o us c e ll s ;

few S p ermato z o a norm al in appe ar anc e
, .

May 1 3 1 4 (thirtieth day o f fast) A lbumin s lightest p ossibl e trace (very

- —
,

fai nt re actio n) S ediment 1 2 hyal ine c asts ; 1 c o arse granul ar cast ;

.
,

all c ast s o f small di ame te r fe w fat d ro p s and r ather num e ro u s c e ll s

,

adh e re nt ; fe w small and me d i um r o un d c e ll s ; few sq u amous c e ll s ;

fe w sp e rm ato z o a no rm al in app e aranc e
, .

May 1 4 1 5 (thi rty fir st day o f f ast) A lbu min sl ighte st p o ssibl e trace
— -
.
—
,

(di sti nct l y mo re th an l ast exami nation) S edi men t 3 6 hyal ine c asts ; .
,

2 c o arse gr anul ar c asts ; c asts o f sm all and l arge di ame ter ab o ut e qu al

in numb er ; fe w fat dr o p s and e p i thel i al c e ll s adherent ; fe w small
an d me di um ro un d c e ll s ; nume ro u s sq u am o u s c e ll s .

May 1 5 1 6 (fi rst day afte r b re akin g fast) A lbumin slighte st p o ssi bl e

—
‘
.
—
,

trace . S edi ment 1 8 hyal in e c asts ; chi e fly o f sm all di ameter with a

, ,

fe w fat dro p s an d rare e p ithe l i al c e ll s ad h erent ; fe w sm all an d me dium

ro un d c ell s ; fe w squ amo us c ell s ; very many sp ermat o z o a no rm al in ,

app e aran c e ; many aci d so di um urate c rystal s -

.

May 1 6 1 7 (se c o n d day afte r b re aking fast ) A lbumin sl ighte st p o ssi bl e

—
.
—
,

trace S edi men t 2 hyal in e c asts o f sm all di ameter ; few small and
.
,

me dium ro un d ce ll s ; few squam o us ce ll s ; l ittl e m uc us .

May 1 7 1 8 (th i rd day afte r b re ak ing fast) A lbu min sl ightest p o ssibl e
—
.
—
,

trace . S ediment 2 h yal ine c asts ; 1 epi the l ial c ast of small di am ete r ;
,

fe w small an d me dium ro und c e ll s ; few squamo us c ell s; many spe rm

ato z o a no rmal in app e ar an c e ; m any c al cium o xal ate c ryst al s
,
-
.

October 1 9 (fi ve mo nths afte r b re akin g fast) A lbumin l e ast p o ssi bl e trace -

, .

S edim ent 2 h yal i ne c asts o f sm all di ame ter ; few small and me di um
,

ro un d c e l ls ; o ccasi o n al ne c k o f bl adde r c e ll s ; few s quamo us c ell s

- -
.

S U MMAR Y .

Th e most r e markabl e chan g e in charact er of th e urin e n ot ed durin g

th e fast was th e app e ara nc e O f albumi n an d casts o n th e fif th day whi ch ,

p ersist e d t h roughout A summary of th e r esults is giv en in tabl e 4 3

. .

1
D uri n g th e fi rst 24 hours that food was tak en th e urin e co n tai ne d sugar ,

an d th e s e dim e n t S how e d n um e rous ca l cium oxalat e crysta l s

-
.

Th e s e xua l syst em of th e subj e ct r emaine d activ e throughout th e

e n tir e p e rio d of obs e rvatio n Accordin g to his o wn stat emen ts a
.
,

se minal e missio n occurr e d two n ights b efor e th e fast b e ga n h e had ,

1
See p . 292 .
 THE RES PI RATORY EXCHANGE .

An y study of th e re spiratory exchange in a livi ng animal is of dual

va l u e for if prop erly co nduct ed it throws li ght upo n th e charact e r of
,

th e kataboli sm and also suppli e s data for computin g by th e i ndirec t

m ethod th e h eat production of th e body thus s ervi ng as a co ntrol
-
,

upo n th e di rect calorim etric measur emen ts of th e h e at productio n - .

I n th e fastin g e xp erim e nts at Wesl eyan Unive rsity th e m e as urem ents of ,

th e r espiratory exchan g e and of th e h e at production w e re coin cid ental -

throughout th e e ntir e p e riod of th e fast This S imultane ous d e ter .

min atio n had c ertain gr e at advantage s particularly in estab lishin g ,

th e fun dam e ntal laws O f me tabolism obtai ni n g in th e e arly stag es of

ina nition On th e oth er han d it gav e v ery littl e opportuni ty for
.
,

s ecuring e vid enc e regarding th e mi nimum or basal metabolism of th e

fasti ng subj ec t S in c e a prereq uisite of a study of th e basal metabolism
,

is a p e riod of absolute muscular repose .

I n these e arli e r fastin g e xp e rim ents such a p eriod Of absolut e mus ,

cul ar repos e was b e st s ecur ed d urin g th e night wh e n th e subj ect was ,

in bed and suppos edly sound aslee p i e qui etly at rest Th e subj ec t
, . .
, .

’
w ent to bed at 1 1 O clock and as th e exp e rim ental p e riods w ere all of
2 hours duratio n th e p e riod from 1 a m to 7 a m could r easonably
’
. . . .
,

be tak e n as th e tim e wh e n th e subj ec t had a minimum activity Unfo r .

tun at ely no di r ec t evide nc e re gardin g th e d e gr ee o f muscular activity

co uld be Obtained Furth e rmore th e re was no e vid enc e as to wh eth er
.
,

th e subj ec t was asl ee p th e e ntir e tim e or more or l ess awak e and som e
what restl ess .

I t s eem e d advi sabl e ther efor e in planni n g th e study of th e lo n g fast

, ,

at th e N utriti o n Laboratory so to arra nge th e exp erim ental t echniqu e

,

and routine as to in clud e a s eri e s of r e spiratio n exp erim ents which

would thr ow d e fini t e li ght upo n th e character of th e katabolism ,

measur ed in both lo n g and short p eriods and to be abl e to isolat e ,

c e rt ain p e riods in whi ch th e subj e ct was p e rfectly qui e t and und er th e

sam e co nditio ns of musc ul ar activity thr oughout th e entir e s eri e s of
fasti n g days Th e respiratory exchang e of th e fasting subj ect was
.

th erefore studie d in two ways i e by usin g th e bed ca l orim et er ,

. .
,
“ ”
an d th e so c all e d -
univ ersal re spiratio n apparatus With th e bed .

calorime t er both th e h e at productio n an d th e gas eous exchange could

-

be studi e d throughout th e p e riod that th e subj e ct r emai ne d in th e

chamb er In th e exp e rim ents at We sl eya n University th e subj e ct
.

r emai ne d in th e chamb er throughout th e whole fasti ng p eriod and th e

r e spiratory e xchang e could be stu di e d in 24 hour p eriods I n th e pro -
.

lo n ge d fastin g e xp e riment at th e N utritio n L aboratory howe ve r th e , ,

calorimet e r p eriods usually b e gan at 9 or 1 0 p m and co ntinu e d u ntil . .

8 a m th e followi n g day
. . Thus for 10 or 1 1 and but rare ly for 9 c o n
.

3 04
 TH E RE S P R I A T OR Y E XCH ANGE . 3 05

secutive hours th e gas e ous m etabolism of th e subj e ct i nsid e th e

,

chamb e r could be studi e d G raphic r e cords of th e d e gree of muscular

.

activity w ere also s e cur e d by a sp e cial form of be d .

Th e possibl e diff er en c e s in th e d e gr e e of sl eep an d th e d e gr e e of

r estl ess ness an d th e impossibility of d et ermi ni n g th e actual p eriods
of wak e fuln ess and S l eep mad e it s ee m u n desirabl e to r ely wholly upo n
th e d et ermi n atio n s of th e r e spiratory exchan g e mad e by t hi s m e thod
for a compariso n of th e m etabolism as th e fast progr e ss e d C o nse .

qu ently e ach morn i n g at th e co n clusio n of th e night e xp erim ent th e

, ,

r espiratory e xchan ge alo n e was studi ed for two or thr ee exp erim en tal
p eriods by mean s of th e u ni v ersal r espiration apparatus With this .

apparatus it was possibl e to obtain th e gas eous m etabolism for s e v eral

l 5—mi nut e p e riods in which th e subj e ct l ay p erf e ctly qui e t an d awak e ,

thus givi ng mat erial for compari so n for e ach day of th e fasti n g p eriod .

Th e el emen t of u n c ertai nty as to th e d e gr ee of muscular activity an d th e

d e gr ee of wak eful ness or sl ee p was by this method e ntirely elimi nat e d .

With both forms of apparatus th e r espirato ry quoti en t could be accu

rately d e t e rmi n ed S O that a mu tual co n trol was obtai n e d o n th e accuracy
,

of th e two me thods of d et ermi ni ng th e re spiratory exchan g e .

APPARATUS AND METHODS USED IN THE CALORIMETER EXPERIMENTS .

I t is u nnec essary to ent er i nto th e d etails of th e co nstructio n an d th e

t e chniqu e O f usi n g th e re spiratio n calorim et e r or of th e m e thods of c al
culating th e r e sults Obtai n e d with it as th e s e hav e b ee n fully e xp lai n e d
,
1
e ls e wh er e. S i n c e th e publicatio n of this d e scriptio n how e ver a n umb er , ,

of mi n or though import an t chan g e s hav e b ee n mad e in th e apparatus ,

and h e n c e it s ee ms d e sirabl e to discuss th em h er e som e what at l e n gth so ,

that th e compl et e t echn iqu e us e d in th es e exp erim e nts may be availabl e .

Al though th e fu ndamental pri ncipl e involve d in th e d e t ermi natio n of th e

respiratory excha nge has no t b ee n alt e red in th e slight est d e gr e e our ,

accumul at e d exp eri e nc e e n abl ed us to d ev elop a t echniqu e to meet th e

sp e cial co nditio ns of th e fasti ng exp erim en t which no t o nly facilitat ed
th e manipulatio n of th e apparatus but also gav e gr e at er accuracy .

AB SO R PT I ON OF WAT E R - VAPOR A ND CAR B ON DI OXID E .

A ccordi ng to th e usual arran gem ent of th e absorbi ng syst em of

this apparatus large porc e l ain v ess els of sp e cial form mad e by th e
, ,

R oyal B erli n P orc elai n Works of B erli n G e rmany are us e d to hold th e

, ,

su lphuric acid for absorbi n g th e wat e r from th e air curr en t an d silv er -

,

plat e d brass cans for holdi n g th e soda lim e for absorbin g th e carbo n
-

dioxid e B oth of th es e co n tain ers w eigh co nsid e rabl e and when th e

.

amou nt of wat er or carbo n dio xid e absorb e d is 20 to 3 0 grams th e ,

bala nc e o n which they are w eigh ed (which is accurat e to about

gram) is suffici ently e xact On th e othe r han d wh en small amou n ts of
.
,

B ne dict and C ar pe nt C arn gi I nst Wa h Pub 1 23 1 9 1 0

1
e er , e e . s . .
, .
306 A S T UDY O F P R O L O N GE D FA S T I NG .

wat er or carbo n di oxid e are to be d e t ermi n ed as for e xampl e 1 0 grams ,

or l ess th es e v ess els are too large

,
.

I n th e e arli er part of th e fasti n g e xp e rim e nt th e calorim et er experi ,

m ents w ere usually sub di vid ed i nto thr ee p e riods S O that th e amou nt of ,

carbo n di oxid e to be w eigh ed represent ed that produc ed in about 3

hours or appro xim at e ly 4 5 to 60 gr ams Toward th e end of th e fastin g
,
.

p erio d it s ee med d esirabl e to obtai n mor e d efini te i nf ormatio n regarding

th e progr ess of th e m e tabolism throughout th e night and h en c e an
att empt was mad e to s ecure short e r p erio d s On o ne ni ght (May 4 — 5 ) .

th e p e riods w er e but 1 hour lo n g ; und er th es e circumsta nc es o nly about

1 1 grams of carbo n dioxid e w e re absorb ed in e ach p e riod I t was .

n ec essary th ere for e to hav e som e form of absorbi n g v ess el which would
, ,

w e igh co nsid erably l ess tha n th e usu al co ntai ners as th e e rror in w eigh ,

in g might mak e a m e asurabl e d iff e re n c e in th e r esults We accordin gly .

r eplac ed th e large v ess els with soda lim e bottl es and glass s ulphuric -

”
acid co n tai ners i e Willi ams bottl es similar to thos e us ed in th e
,
. .
,
“
,

absorbin g circuit of th e r espiratio n appar atus and from that tim e ,

divi d ed th e calorime te r exp erim en ts i nto relatively S hort p eriods

throughout th e night w eighi n g th e wat er and carbo n dioxid e in th es e
,

small e r and more accurat e ly w eigh ed co ntainers A compl e te descrip .

tio n of th e glass so dw lim e bottl e and th e Williams bottl e is given els e

1
wh ere S oda l im e was us e d as th e absorb e nt for carbo n dioxid e
.
-

throughout th e whol e fasti ng e xp e rim ent for although at th e time th e ,

d escriptio n of th e re spiratio n ca l orime t er was publish e d exp erim ents w ere

b ei n g ma d e with potash lim e subs equ e nt e xp e ri enc e has convi n c ed us
-
,

that as y e t th e original form of soda lim e has no t b een improved upo n

, ,
-
.

ANALYS I S OF C HAMB E R AI R AT T HE E ND O F PE R I O D S .

While it was d esirabl e to Obtain as S hort and as many p eriods as

possibl e in th e night calorimet e r e xp eriments it naturally b ec ame diffi ,

cu l t to arra nge th e routi ne so as to s ecur e th e large st numb e r of p eriods

without d ecre asi ng th e accuracy and ov e rt axi n g th e str en gth of th e
assistan ts e sp e cia l ly as a co nti nuous m etabolism exp eriment of 35 to
,

4 0 d ays was quit e outsid e Of our e xp eri en c e With thr ee p eriods in .

e ach exp e rim e n t as was at first pla nn ed it was possibl e to arra ng e th e

, ,

program so that a trai ned obs e rver with two re spo nsib l e assistants
could re adily carry out th e routin e of a ca l orimet er exp e rim en t One .

of th e di fficult parts of th e program was to mak e provisio n for th e

a nalysis of th e air resi d ual in th e chamb er at th e end of e ach p e riod .

I t had b ee n our custom to do thi s by d efl ectin g a c ertai n volum e of th e

air from th e outgoi n g air curr en t through a s eri es of U tub es co ntaini ng
- -

so da lim e an d pumic e sto n e and sulphu ric acid r e sp ectiv ely whi ch
, ,

absorb e d th e carbo n dioxid e an d wat er vapor from th e air Th e air -

.

l B e ne di t D u t c h A c h iv f klin Med
c , e s . 1 9 1 2 1 07 p 1 6 6
r S e also fi gu
. .39 p 3 1 6
. f, , , . . e , , re , . , o
th i p u bli c ati n f
s a d iagramm atic
o . or p ntati n f th bo ttle re rese o o ese s.
308 A S T UD Y O F PR O L O NGE D FA S TI NG .

co ncordant r esults could be obtained H e nc e to s ecure records of .

,

th e wat e r vapor in th e residual air it was o nly nec essary to plac e this
-
,

psychr omet er in th e air curr en t i nsid e th e respir atio n chamb er I t

-
.

was so arra nged that th e air l e aving th e chamb er cam e through a pip e
Op eni n g at th e re ar an d e xt e ndi n g alo n g th e bottom to th e fro n t of

th e chamb e r n e ar th e glass win dow Th e air pass ed over th e dry .

bulb of th e psychr omet e r an d from th ere ov er th e wet bulb an d then ,

dir ectly to th e blow e r outsid e I t was th erefore possibl e for th e o bser

.

ver o n th e outsid e to r ead both m ercury th e rmom e t e rs thr ough th e

glass fro nt of th e calorim e te r chamb er ; readings to 0 0 1 C could °
.

ordi narily be reli ed upo n B y m e ans of p sychr ometric tabl es th e

.
,

amou n t of wat er vapor residual in th e chamb er coul d be v ery r eadily

-

comput ed I t is thus appar ent that by re adin g th e psychromet e r and

.

taking a sin gl e sam pl e of th e air in th e chamb er and subs equ en tly ana
ly z in g it it was possibl e to obtain informatio n r e gardin g th e co nt ent
,

of wat e r vapor and carbo n dioxid e in th e chamb er air at th e end of e ach

-

p e riod with a mi nimum utili zatio n of th e assistant s time duri ng th e ’

night .

Th e psychrome t er is at pre se n t us ed in this laboratory for short

e xp e rime nts with babi es and small a nimals in which r e spiration

chamb e rs are employ ed H avin g t est ed this m ethod of d et erminin g

.

th e wat e r vapor by two oth e r m e thods we f elt j ustifi ed in employi ng

-
,

i t in th e lo ng calorim e ter exp eriments esp ecially as it requires o nly ,

th e r e adin g of th e two th e rmome t e rs by th e assista nt at th e end of

e ach p e riod To use th e psychrom et e r succ essfully it is n ec essary
.
,

that th e air S houl d p as s rapidly ov er th e bulbs of th e th ermomet ers .

Car e should als o be tak en that th e fabric about th e wet b ul b th er -

m o m eter is k ept moist as in lo ng e xp erim e nts of 1 0 or 1 2 hours it

,

occasio nally b ecomes dry so that fals e r eadi ngs are obtained
, .

I t is obvious that no o ne of th es e m ethods i e th e sulphuric acid ,

. .
,

pumic e sto ne th e S o ndé n hygromet er or th e psychromet er give s th e

, , ,

tru e valu e for th e wat er vapor in sid e th e chamb er as th ey me asur e

-
,

o nly th e wat er vapor in th e outgoin g air an d th ere is c e rtainly an area

-
,

about th e i ngoi ng air pip e (wh ere th e air is ent eri n g absolut ely fre e
from wat er vapor) which is of a much low er wat er co nt ent n o twith
- -
,

sta ndi n g th e fact that th e air is fairly w e ll circulat e d i nsid e th e chamb er

by me a ns of an el e ctric fan I t shou ld be co nsid ere d how ev e r that
.
, ,

th e va l u e s obtain e d at th e b e gi nni n g an d e n d of e ach p eriod are for

comp ariso n o nly an d we d e al h ere with di ffe ren c es rather than wi th
absolut e amounts .

This chan ge in methods was p articularly advantage ous for th e de t er

mi natio n of th e re sidual carbo n dioxid e Wh en U tub e s are us ed it .
-
,

is n ec essary to pass 1 0 lit ers of air thr ough them in order to s e cure a
w e ighabl e amou n t of carbon dioxid e F or doi ng t hi s in a relativ ely .

short time such as 3 mi nut es a ve n tilatio n thr ough th e U tub es of

, ,
-
 T HE RE S PI R A T OR Y E XC HA N GE . 3 09

about 3 % lit ers per mi nut e is r equir e d and th e u se of fairly large U tub e s -
,

e ach w eighi n g about 80 to 90 grams A combin atio n of o ne soda lim e .

-

U tub e follow e d by a pumic e stone sulphuric acid U tub e w eighs n o t

- - -

far from 1 60 to 1 80 or ev en 1 90 grams whil e th e amou n t of carbo n ,

dioxide to be weigh ed is some tim es no more than 60 milligrams Wh en .

exp e rim en tin g with a m an awak e or doin g s e v e r e musc ular work th e ,

m ethod is p erf e ctly satisfactory but when exp erim enti n g with a m an as ,

emaciat e d as o ur fastin g subj e ct with a minimum m e tabolism an d , ,

produci ng o nly a small amou nt Of carbo n dioxid e per hour it is obvious ,

that th e residual carbo n dioxid e in th e chamb er would be lo w and it

would be diffic ul t to obtain v e ry accu rat e d et erminatio ns u nd er th es e
co n ditio ns With th e S o n dé n gas analysis apparatus o n th e co n trary
.
-
, ,

it was possibl e to d et ermi ne per c ent of carbo n dioxid e to th e third

significa nt figur e with gre at accuracy Th e advantag e of thus obtain .

ing a mor e d elicat e d e t e rmi natio n of th e carbo n dioxid e and at th e same

tim e d ecre asi ng th e work r equired of an ass istant duri ng th e lo ng night
p eriod mad e it d esirabl e to i ntroduc e th e m ethod by which th e sam
pling pip ett e with subs equ en t analys es could be us e d to d et ermi ne th e
carbo n dioxid e and th e wet and dry bulb psychrom et er for d etermini n g -

th e wat er vapor -
Th e sampli n g tub es w er e coll ect ed each morn in g aft er
.

th e night exp erim en t was over and th e a n alys es mad e o n th e S o n dé n ,

apparatus by Miss Alic e Johnso n who se t echnical skill in th e use of ,

this apparatus was w e ll att este d in th e r es earch o n th e composition of

outdoor air previously re fe rre d to .

TE NS ION E QUALI ZE R .

rubb er bathing cap us ed as a t ension equaliz er in th e e arli er

Th e
form of r e spiratio n calorim et er has b ee n replac e d by a sp iromet er whi ch
was first d e sign e d for th e u niversal r espiratio n apparatus A bri ef .

d escriptio n of thi s S piromet er with diagram (figur e 4 0) is given o n

page 3 1 8 but a mor e d etail e d d esc ri ption may be fou n d in an e arli er
,
1
publi catio n .

Th e S pirome t er is attach e d dir e ctly to th e sid e of th e r espiratio n

chamb e r and th ereby b ecome s a part of th e chamb er volum e thus ,

providi ng for fluctuatio ns in th e volum e of th e air i nsid e th e app aratus .

As th e carbo n dioxid e is absorb e d by th e soda lim e and th e oxyg en is -

us e d by th e man i nsid e th e calorim e t er th e total volum e of th e air ,

i nside th e chamb er gradually d ec r e as es A ccordingly th e S pirome t er .

b ell slowly falls u ntil a c ertain poi nt is re ach e d wh er e an el e ctric co ntact

(no t shown in figur e 4 0) is mad e an d oxygen th ereby automatica ll y
admi tt e d by me ans of an e l ectric valve attach e d to th e oxyg en cyli n d er .

Wh en suffici ent oxyg en is admitt e d to rais e th e b ell and bre ak th e

“

co ntact th e flow of oxyge n is automatica l ly stopp e d ; in this way th e

,

supply of oxyg en is u n d er co ntinuous co n trol .

B n dict D utsch Ar ch iv f kl in Med 1 9 12 107 p 1 7 2 See also Benedict and Tal bo t

1
e e , e . . . .
, , , . . .

C arn gi In t Wa h Pub 20 1 1 9 14 p 43
e e s . s . .
. , . .
3 10 A ST UDY I N P R OL O N GE D FA S T I NG .

In th e fasti ng exp erimen t use was mad e of this spirome t er to i n di ,

cat e th e con stan cy of co n di tio ns F or exampl e if th e oxyg en supply .

,

was compl et e l y S hut o ff for 5 or 6 mi nut es b efore th e proba b l e end of

an exp e rim e n tal p e rio d and th e poin t e r o n th e spirom et er b ell was

allow e d to rest again st th e smok e d pap er drum a reg ular risi ng curv e -
,

would be drawn o n th e rotati n g drum thus i nd icatin g th e slow st eady , ,

fall of th e spiromet e r b ell I f th e subj ect mad e a muscular mov ement.

,

as in turni ng ov er or for any re aso n th ere was an irr e gularity in th e

,

curv e it was O bvious that th ere was a sudd en exp ansio n or co ntractio n
,

of th e air in th e cham b er which could no t be corr ec t ed for by th e meas

urem e nt of th e t e mp eratur e and barom e t e r Co ns equ ently if such an .
,

irr e gulari ty in th e line occurr ed du ri ng th e last 5 mi nut e s of th e experi

mental p e riod th e l en gth Of th e p e riod was ext end ed u ntil a r e gular
,

curv e could be s ecur ed This was most h elpful in ma ny i nstanc es

. .

S p ecim en curv es are g iven in figur e 3 6 S howing this m ethod of utilizi ng

th e S pirome t e r I t is of cours e n ec e ssary to n ot e th e exact h eight of th e
.

spiromet e r at th e moment th e p eriod is e nd ed This is do ne by r ead .

in g th e positio n of th e poi nt er attach ed to th e count e rpois e of th e Spi

ro m e te r as it trav els ov e r a millim e t e r scal e .

7 m!
in m us .

MAY I L IQIZ

FI G 3 6
. S e im e n
.
— pc c d re o r s o f ch an ge in vo l um e o f th pi m ter o n th e bed e s ro e

l i
ca o r m eter ur d in g l ast 5 mi nu te s f peri o d s in exp i m ent wi th L
o er .

AR G O N IN O XYG E N FR OM LIQU ID AI R .

In rec ent y ears we hav e us e d th e n early pur e oxyg en obtain ed from

liquid air by th e Lin d e Air P roducts Company A t first we w ere .

unawar e of th e fact that th e r esidual gas was no t as commo nly co n ,

S idere d all nitrogen with an atomic w eight of 1 4 bu t co nsist e d in larg e

, ,

part of argo n with an atomic w eight of 4 0 H e n c e it has b ee n n ec essary .

to emphasi z e th e fact that in computi n g eith er th e volum e of oxygen

admitt e d from a cylin d er or in calibratin g a gas met er by th e m ethod of -

1
w eighi n g th e oxygen th e compositio n of this r esidual gas should be
,

tak e n into co n sid eratio n as oth e rwis e an appreciabl e error in th e per

,

c entage of oxyge n may e asily occur Thus in a s eri es of obs ervations .

,
2 3
carri e d out o n diab etics an d lik ewis e another s eri es o n muscular work ,

B dic t Ph y ic al R vi w 1 906 22 p 294

1
e ne , s e e , , , . .

B edict an d J li D u t c h A ch iv f klin M d 1 9 1 3 1 1 1 p 3 50
2
en os n, e s . r . . e .
, , , .

B n dic t and C ath c art C a n gi I n t Wa h Pub 1 87 19 1 3 p 7 4

‘
e e , r e e s . s . .
, , . .
3 12 A ST UDY OF P R O L O N GE D FA S T I NG .

tio n apparatus in which th e subj e ct li es upo n a couch This bed was .

so susp en de d that th e slightest chan ge in th e c e nt er of gravity of th e

body such as moving th e han d or th e foot woul d alt er th e t ensio n o n
, ,

th e sprin g in sid e a p neumograph an d thus tran smit th e mov emen t to

a tambour an d kym ograph B y this m eans th e l e ast musc ular activity.

would be re cord e d With th e susp en d ed crib us ed in e xp eriments with

.

infants expe ri enc e has shown that th e b est poin t of support was at th e
,

FI G 3 7
. .
— Me th o d btai ni n g graphi c re co rd o f ac tivi ty in bed c al o rim eter
for o .

Th e su bj e c t li es o n th e be d o n th e f am e w o k i nsi d e th e c al o i m e te
r r O ne si d e o f th e f am e
r r. r

ts o n a knif e e d ge K ; th e o th si d e i s u ppo rt e d b y t wo sto u t p ir al sp i n g s S an d S

'
r es -
, er s s An y r , .

ch ange in th e te nsi o n o n th e sp i ngs l i k e wi e affe cts t h e te n io n o n th e pn um o gr aph P th us

r s s e , ,

al t i n g th e te n i o n o f t h e air in t h e p n um o gr ap h
er s B y m ans o f a u bber tu be and a m etal pi pe
e . e r

p a i n g th o u gh th e c o ppe wall C z inc wall Z and a be to s w all A o f th c alo ri m e ter th e l o wer

ss r r , , . , s s , , e ,

e n d o f t h e p n e u m o g ap h c o m m u nic at e s wi th a t am bo ur w h ic h wri tes o n th e k ym o g ap h pl ac e d

r r

abo v e t h e c alo ri m e te An y l ate al c h an g e in th e c enter o f gr avi ty o f th e bo d y i nstantl y pro d u ces

r . r

a m o v em e n t o f th e po in te r o n th e k ym o gr ap h .
 T HE RE S P R I A T OR Y E XC HA NGE . 3 13

foot of th e crib th e S pring b ein g plac ed at th e h ead With adults how

,
.
,

e v e r we soo n fou n d that th e maj or mov em en ts w e re lat e ral rath e r than

,

l en gthwis e Of th e body and th e supports and S pri ngs w e re accordin gly

plac e d at th e sid es of th e bed inst e ad of at th e h ead and foot .

This bed wh en us e d in th e calorim et er chamb er was support e d at

, ,

o n e sid e o n two frictio nl ess st ee l poin ts an d at th e oth er by two stout

S piral S pri n gs whi ch co ul d be adj ust e d by turnbuckl e s to bri n g th e bed

to a l e vel positio n Obviously any cha n ge in th e c ent er of gravity of .

th e body alt er e d th e t en sio n upo n th e two support in g spri n gs which ,

w er e th ere fore elo ngat e d or short ene d Wh en th e p neumograph was .

attach ed to th e bed th e sam e forc e producin g th e elo n gatio n or ,

co n tractio n of th e S pri ngs aff e ct ed th e p neum ograph Th e change .

in th e t ensio n of th e air i n sid e th e p n eumograph was transmitt e d by th e

usual method i e by me an s of a metal tub e passin g thr ough th e walls
,
. .
,

of th e chamb er an d subs equ ently by a rubb er tub e co nn e ctin g with th e

tambour writi ng poi nt and kymograph Th e method of obtain in g
,
-
,
.

this graphic r e gistratio n of th e muscular activity is S hown in fi gur e 3 7 .

In t hi s figur e th e op en end of th e bed calorim et er is shown in per

spec tive an d in a som e what sch e matic way C Z and A repres ent .
, ,

resp e ctiv ely th e i nn er copp er wall of th e chamb er th e zin c mi ddl e wall , ,

an d th e out e r asb estos wall T h e frame work of th e be d is s een at th e .

bottom of th e calorim eter chamb e r with th e l eft han d e dg e r estin g -

’
o n th e st ee l support K Th e two Spiral spri n gs S an d S e ach pro ,
.
, ,

vided with a tur nbuckl e are attach e d at th e upp er end to th e wall of th e ,

calorim et er chamb er and at th e low er end to th e right hand edge of th e -

bed Midway b e tw ee n th e S pri ngs is attached a p neumograph P th e

.
, ,

upp er end of which is attach ed to th e wall of th e calorim et er chamb er .

Th e subj e ct lyi n g upo n an air mattr ess whi ch is in turn r e stin g upon
,

a lo ng plat e of gal vaniz e d iro n is slid o n to th e bed framework feet first , .

AS th e w eight of th e body falls upo n th e fram ework th e S pri n gs S and , ,

S b ecom e ext end ed th e adjustm ent ne c e ssary to s e cur e p erf e ct l e ve l

’
, ,

in g of th e bed b ei n g mad e by m e an s of th e tur nbuckl es I f th e subj ect .

turns duri n g th e night a gre at er t ensio n is put upo n th e S pri ngs S , ,

’ 1
an d S an d th e p n eumograph P is e lo n gat e d
, Th e air in th e tub e , , .

conne ctin g th e p n eumograph with th e outside of th e chamb er is thus

somewhat rarefi e d and th e tambour poi nt er si nks thus produci ng a ,

depressio n in th e li ne o n th e kymograph drum .

F 1
th b n fi t f th
or w k
e in th i fi eld it i
e e o f into t to c d h th c nt xp ri
er or e rs s , s o e res re o r ere e re e e e
e nc f D P ul R th
e O f B attl C
r . k Mic h igan I c di g th bo d y m v m nt f m n
a o , o e ree , . n re o r n e -
o e e s o e or
w m o ly i g n b d h
en pl ac d th p n um g ap h wi th a m all P litz b lb
n o e s, e re adj u t d
e e e o r s o er u , so s e

a t s be o m w h at c m pso d by th b d f m T h bu lb wa c n c t d t t h t m b u an d
e o resse e e — ra e. e s o ne e o e a o r

ky m g aph P l imi na y t t m ad in th Nut i ti n Lab t y wi th th P li tz bulb a

o r . re r es s g e e r o o ra o r e o er rr an e
m t h v h wn th t th
en a e s ul t f t h v i ati n i n p
o a u n th b lb by v i t i i m u c ul
e r es so e ar o r ess re o e u ar a on n s ar
ac tivi ty a m t a ti f ac to y
re t nl y wi t h ad ul ts bu t al
os s swith m all ani m al
r ,a f c t f p ci al
no o so s s— a O s e

i t t in c
n er e s c ti n wi th th a ch
o n ne n i nf ant Tw
o i u bj c ti n t th p um g ph
e re se r o s . o se r o s o e o s o e ne o ra ,

i. eth d a g
.
, f l k th u gh th
e n er o u bbe an d th difficul ty f
ea s wi ng th
ro u bb a th u e r r e O re n e e r e r, re s
o b vi at d by th u f thi bulb A fl xi bl u bb bul b f m all i z i b t u d
e e se o s . e e r er o s s e s es se .
3 14 A S T UD Y O F P R OL O NGE D FA S T I NG .

I A P R IL IO- l I l9 | 2
. .

1 A PRIL I4 - IS
. . l9 12

—
rag
“

7 mm IIL A PRIL 29 30
-
. l9 l2

11 MAY l3 - l4 . I9 I2

FI G 3 8 — S
.
pe ci m en p neum o graph re co r ds o f m o v em en ts o f bed c al o im e ter le ver m attress
r

supp o rt in nigh t e xp eri m e n ts wi th L

.

.
3 16 A S T UDY O F P R O L O NGE D FA S T I NG .

hav e b ee n mad e wi th it in this laboratory and its accuracy has b een ,

thoroughly te st ed N ot o nly m en and women hav e b ee n us e d as sub

.

j ec ts but by addi ng a small chamb er exp erim ents hav e also b een
, , ,

mad e with infa nts and small ani mals Th e appar atus has b een .

1
d escrib e d in d etail els ewh ere .

With thi s apparatus th e subj ect lay qui e tly on th e sam e bed upo n
which h e S l ept during th e night th e bed b eing withdrawn from th e ,

r espiratio n chamb er and plac ed upo n a smal l framework in th e calo

rim e ter laboratory H e was cov ere d with be d clothin g and two soft
.

rubb e r nos e pi ec es w ere inse rt e d in th e nostrils th e subj ec t b ein g cau

-
,

tio ned to k ee p his mouth clos e d Aft er h e had bre ath ed a few mi nut es .

thr ough a two way valv e op enin g in to th e room th e valv e was turned
-
,

an d h e b egan to bre ath e in to a clos ed volum e of air some 8 or 1 0 —

liters which was kept in motion by a v entilator or blow er As th e

—
.

air l e ft th e n ostrils of th e m an it was carri e d by th e blow e r to suitabl e ,

FI G 3 9
. .
- c
S h em at ic o ut li ne
pirati on apparatus i
o f un ve rsa l res .

Th e su b j ec t l ying u po n a c o u ch o bed breath es ei th er th ro u gh th e two no se pi e c es o r a m o u th

, r ,
-

pie ce i nto a venti lating curre nt o f air ke pt in m o ti o n by a ro tary pum p Th e m o isture in th e

, .

air is abso b e d in t wo gl ass v esse l s c o n t ai ni ng sulp h u i c aci d an e m p ty gl a s vesse l se r vi n g as a

r r , s

t ra p to pre v e nt acci de ntal ba c k su c ti o n o f a ci d T h e dri e d air t h en p asses t h r o u gh so d a l im e and

.
-

agai n t h o u gh sulp h uric aci d i n a spe ci al fo rm o f bo ttl e an d finall y t h ro u gh a c an c o n tai nin g

r

so di um b ic ar bo na te to free th e air o f any trac es o f aci d v apo r O xyge n is i ntro d u c ed a d e i re d . s s .

T h e ai is th e n re ad y to be i nh al e d b y th e l u n gs
r As th e air l e av e th e l u n gs th e c h an g s in t h e
. s , e

vo lum e o f th e co n fin ed air are reco rded o n th e sp iro m eter wh ich m o ves free l y up an d do wn wi th ,

e a c h i ns pir ati o n an d xpi ati o n

e T h e c h a n ge i n weigh t o f th so d a li m e vesse l and its acc o m pany
r . e -

ing su lp h uric aci d bo ttl e gives th e w igh t o f t h e c a bo n di o xi d p o d u ce d

- e T h e w igh t O f th e
r e r . e

o xyg n i O b tai n e d e i th er by no ti n g th e l o ss in we igh t o f t h e cylin d er Of th e g as o

e s m e a uri ng th e r s

g as c ar e fu ll y adm i tte d thr o u gh a m e ter .

1B
e ne d ict De u tsch Arc h iv f klin Med
, . 1 9 1 2 107 p 1 5 6 . .
, . . .
 T HE RE S P R I A T OR Y E XC HA NGE . 3 17

co n tai ners in which th e wat er and carbon dioxid e w ere absorb e d ;

oxygen was next add ed from a cyli nd er of w eigh e d gas or thr ough a
calibrat e d m et er to r eplac e that us e d by th e m an ; th e air was th en
r eturne d to th e subj e ct Th e amou n t of carbo n dio xide excre t e d was
.

obtaine d from th e chan ges in w eight of th e absorb ersand th e amou nt

of oxygen co nsumed from th e r e cord of th e oxygen admitt e d to th e air
curr ent Exp erime n ts could be mad e with thi s apparatus with p eriods
.

as short as 1 5 mi nut e s Th e general sch e me of th e r espir atio n appa

.

ratus is show n in figur e 39 .

I n this apparatus provision has b ee n mad e for fluctuatio n s in th e

volum e by attaching a t ensio n e qualiz er I n th e e arli er forms of th e .

r e spiratio n apparatus a rubb er bathin g cap was us e d as a t ension

,

equaliz e r but mor e r e c en tly thi s has b ee n r eplac e d by a S pirom e t er

, .

This S piromet er no t o nly provid e s for th e fluctuatio ns in th e volum e of

air but has b een utiliz e d for re cordi ng th e charact er of th e re spiratio n
, ,

as has already b een not e d in a pr evious s e ctio n of this publicatio n .

(See page I t has also b een us ed with th e bed cal orim et er for i ndi
cati ng th e co nstancy of co n ditio ns (See page Th e d e tails of
.

th e S pirome t er are S hown in fi g ur e 40 .

With e ach i nsp iratio n and expiratio n th e thin copp er b ell c of th e , , ,

spirome t er falls an d ris e s in th e annular spac e b etw een th e copp er walls ,

a an d b thi s spac e b ei n g fill e d with wat e r

,
To th e cou nt e rw eight rod .
,

g g g
,
is
,
attach
,
e d a poi n t e r h which writ e s o n
, th e smok e d pap er
,
-

surfac e of th e kym ograph drum A wh eel r with a mill e d e dg e is .

, , ,

rotat e d by e ach upward mov ement of th e cord t which r ests in a groov e , ,

in th e e dge of th e wh eel th e pawl u pr e v entin g any backward move

, , ,

m en t Of th e wh eel B y me ans of a platinum co ntact o n th e p eriph ery

.

of r e ach compl et e r evolutio n of th e wh ee l may be r ecord ed An expla

,
.

n atio n of th e u se mad e of th e r ecords obtai ne d with t hi s spirom e t e r

and a s e ri es of typical kym ograph curv e s are fou n d o n pag es 1 5 8 to 1 60 .

Th e r espiratio n apparatus was us e d r eg ularly each mor ni n g of th e

’
fast for an exp erim en t imme diat ely followi ng th e night s soj ourn in th e
be d calorim e t er Th e subj e ct lyin g upo n hi s bed was tra nsf e rr e d
.
, ,

dire ctly from th e calorim et e r chamb er to th e r espiratio n apparatus .

He th en tur ne d upo n hi s S ide and urin at e d without risi n g an d th e

r e spiratio n exp erim en t was b e gu n short ly aft erwards I n th e latt er .

part of th e fast th e apparatus was us e d for a r espiratio n exp eriment

,

e ach e v e ni n g about an hour b efor e th e subj e ct e nt er e d th e calorim e t e r .

A t irre gular i nt ervals throughout th e fast th e r espiratory excha ng e was

a l so studie d with th e re spiratio n apparatus whil e th e subj e ct was ,

S itti n g qui e tly in a chair or writi n g st e adily as h e did much of th e tim e , .

Th e apparatus was lik e wis e us ed for exp e riments in which th e subj e ct

bre ath e d an oxyg en rich atmosph er e whil e lyi ng upo n th e couch
-
.

All of thes e exp erim ents i nclud e d two or thr e e p eriods of appro xi
mat ely 1 5 mi nut es e ach in which re cords of th e d e gree of muscular
,
318 A S T UDY O F P R O L O N GE D FA S T I NG .

l v g l g
Air ea in th e un s e nters t h e pi p e , m n,
an d p i pi
asses n to th e s ro m e ter b ll c T i
e , h s .

b ll v
e d
m o es u p an d o wn in t h e an nu ar s a e l p c
fil d i b
l e w th wate r e twee n th e n n er o i c pp er

sh ell ,0 , and th e o uter c ppo er sh e ll b Th e

, .

b ll c
e p i d by
is o un te r o se a ro d. 0 g a an d a ,

l ppl
sm al su e m e n tary w e ig c d
h t , 1, atta h e to a
c d
or , c
t, th e p i b i g pp d by
o u n te r o se e n su o r te
l i i
an a um n u m wh ee l v
e o er wh
. ic
, h th e th rea d
(1p asses . ig pi
Th e h e h t o f th e s ro m e ter c an
be re a d by p i
th e o n te r, h , o n a m i ll im e ter
c l
s a e, p o r th e
. p i o n ter It c an be m a e to d
i di c l y p
wr te re t u on a ky g p d
m o ra h ru m A .

k dd l c d
wo r a er wh ee r, is so atta h e th at th e
,

c d p
or t asse s th ro u h ag g vro o e in its p i
er

ph ery an d th e w h e e
. l c o n se
q ly
ue nt i
ro tate s w th e a hc d o wn

d i
war m o t o n o f th e e b ll c The .

p l p v
aw u,, re e nt sb ck a mot o ni .

p j ci p ip y
A ro e t o n, w, in th e er h e r
l k
o f th e w h e e m a e s an e e tr l c ic
c c p i g p ic
o nt a t and erm ts ra h te

c d or c c pl
Of e a h om e te re v o lu
i k dd
t o n o f th e wo r a er wh e e l .

c i g pi i
Fo r o u nt n th e res r at o ns
c
a ne w at ta h m e nt , 3 , h as b ee n
pl y d
em o e l i l
A st ee w re is o o se
. ly
f aste ned aro und th e h u b O f t h e
l
wh ee , r By m e ans o f a
. lig ht
pi g l
s r n l
ate ra , i
te ns o n is
b gro u h t gi
a a nst
v bl
th e m o a e ro d, 0 .

c d
As th e ro d as e n s,
l
th e ste e wi re t o
t ates o ut o f th e
m er ur c y c p
u
re a n b ki g
th e e e l c
tr ic c c
o nt a t : as t h e

ro d m o es v d
o wn ,

th e o nta t is c c
ma e d
A sm a . ll
sto a o e p b vth e
m er ur c y
c u p p re

v
e n ts th e w re r o m i f
r s n ii g
to o far .

FI G 4 0
. .
— Sp iro m eter for studying th efm ec h ani cs of ventil ati o n .
3 20 A S T UD Y O F P R O L O N GE D FA S T I NG .

quoti ent of but wou l d u n d er lik e co n ditio ns be Obtained with th e

, ,

r espiratio n apparatus On th e oth er han d th e e xp e rim ents made

.
,

with th e u nive rsal re spiratio n apparatus are extrem ely h elpful as a

ge neral i nd ex of th e r es p iratory excha ng e from which th e calorimetry
c an be comput e d by th e i n dir e ct m ethod We co nsid er ed it of im .

portan c e to mak e a sp eci al eff ort to s e cur e exp erim ents of short
duratio n as th e t e chni qu e of th e exp erim e n ts mad e by Luciani o n Succi
,

hav e b ee n adve rs el y criticiz e d by Z u ntz an d th e experim ents mad e by

Zu ntz an d his c o work ers o n th e fast ers B r eithaupt an d Ge tti in B erli n
-

w ere c ertai nly complicat e d by colic an d a h e ad cold More over it is .

,

n o t u nr e aso nabl e to sup p os e that th e t e ch niqu e in thirty y e ars has

b ee n mat erial l y improv ed .

STUDI ES WITH THE BED CALORI METER .

AT MOS PHE R I C C ONDI T I ONS INS IDE T HE C HAMB E R .

Prior to a co n sid eratio n of th e r esults of th e study of th e gas eous

e xcha nge i nsid e th e bed calorim et er it is advisabl e to not e th e exact,

co nditio ns of ve ntilatio n t emp erature and particularly r elativ e

, ,

humidity u nd e r whi ch thi s subj e ct was livi ng in th e chamb er Th e .

re spiratio n c alorim ete r was vent ilat ed at a rat e of appro ximat ely 4 0
lit ers per mi nut e or roughly sp e aki n g
, lit ers per hour S in c e
,
.

th e volume of th e chamb er was n o t far from 800 lit ers th eore tically ,

th e air would be r e plac e d i nsid e th e chamb er thr ee times e ach hour .

Th e coolin g arra nge me nt pr e v ent e d an ab normal ris e in th e t e mp era

tur e an d a study of th e re lativ e hu m idity u nd er th ese co nditio ns pre
,

s ents c ertai n fe ature s O f i nt ere st S i nc e th e air is dri e d ov er sulphuric

.

acid b efore it is returned to th e ca l orim et er it ent ers th e re spiratio n ,

chamb er absolut ely wat er free and co n s e qu en tly th e o nly sourc es

-

of wat er vapor i nsid e th e chamb er are th e lu n gs an d th e S ki n of th e

-

m an .Th e v entilatio n of th e chamb er per hour th e amou nt of wat e r ,

vaporiz ed per hour th e average t emp eratur e of th e calorimet er cham

,

ber an d th e r elative humi di ty of th e air are give n in tabl e 44

,
.

D aily t ests in whi ch th e numb er of revolutio ns of th e blow er are

,

record ed by an automatic cou nt er hav e show n that in g en eral 2 1 0 r e vo

,

lutio n s of th e blow er corr espo nd to a ventilatio n of 1 cubic foot or

lit ers of air Th e total v entilatio n may th erefore be obtai ned by divid
.

ing th e numb er of re volutio n s by thi s factor an d multiplyi n g by

A s a matt er of fact th e numb er of r evolutio ns per cubic foot of air
,

was d et ermi n ed e ach day and thi s variabl e us ed in th e calculatio n .

From th e l ength of p eriod as giv en in tabl e 4 4 th e v entilatio n per ,

hour was r e adily fou nd .

All of th e wat er vapor r emov e d from th e chamb er was absorb ed by

-

sulphuric acid as th e v entilati ng cur r en t p ass e d through th e absorbi ng

syst em Th e total amou nt was corr ect ed for th e small amou nt of
.
 T HE RE S P R I AT O R Y E XC HA NGE . 321

wat er vaporiz ed from th e wet bulb of th e psychrom et er and th e amou nt ,

pe r hour fou n d in th e usual way .

T h e av erag e calorim et er t emp eratur e w as s ecur e d by m ea n s of a

s eri es of r esistanc e th ermome t ers Th e r elativ e humidity was c alcu
.

lat e d from th e amou n t of wat er vaporiz ed per lit er of ven tilatio n and
th e num b er O f mil ligrams of wat er vapor in o n e lit er of air saturat e d
-

at th e calorim et er t emp eratur e .

Th e rat e of v en tilatio n an d th e rat e of carbo n dioxid e pro ductio n -

w ere such that th e usual proportio n of carbo n dioxid e residual in th e

TAB L E 44 .
—
Venti lation of chamb er and relative h umidity duri ng p
ex eri ments wi th L i n bed
.
3 22 A ST UDY OF PR O L O NGE D FA S T IN G .

chamb e r at th e e nd of e ach exp erim ental p eriod throughout th e night

was not far from per c e n t by v olum e or approximat e l y 1 3 time s that
of normal air This p erc entage of carbo n di oxide in th e air and i nd ee d
.
,

a v ery much hi ghe r p erc e ntage has b ee n shown to be e ntir e l y without ,

l
e ff e ct upo n p e rso n s br e athin g such an atmosph ere S O that it may be ,

state d with p e rfe ct co n fi denc e that th e exc ess amo unt of carbo n dioxid e
presen t in th e chamb e r co ul d in no way have i n flu enc e d e ithe r th e
r e spiratory e xcha ng e or th e h eat productio n of th e subj e ct -
.

AS will be s ee n from tabl e 4 4 th e ve n ti l atio n of th e chamb e r aver ,

ag ed n o t far from to lit ers per hour throughout th e 3 1 days

of th e e xp e rim e nt th e range b ei ng from , lit ers to lit ers per
hour Th e hourly vaporizatio n O f wat er had a t end ency to d ecreas e as
.

th e fas t pro g r e ss ed th e larg e st amou n t b ei ng o n th e night of th e thir d

,

day of fastin g and th e s m all est o n th e night of th e fift ee nth day of

fasti n g Th e average t emp erature of th e calorim e t er remai ne d for th e
.

most part within a few t enths of a d e gr ee of th e av erage figur e C , .

T h e r elativ e humidity shows an in t er e sti ng cours e B e ginn i n g with .

approximat ely 60 per c ent o n th e nights fo ll o wi ng food it d ecr e as e d ,

to a m inimum l e ve l of approximat ely 3 9 per c ent from th e fif t e enth to

th e tw e n ty first day and th e re aft er ros e gradually to th e en d of th e
-

fast T h e variatio ns in th e excr etio n of wat er vapor and th e caus e Of

.
-

th e fluctuatio ns in th e r elative humidity will be discuss e d in a subse

2
qu ent se ctio n of this publicatio n T h e r esults s ecur ed in th e m e asur e .

m ents of th e r espiratory excha ng e i nsid e th e bed calorimeter may ,

th ere fore no w be co nsid ered

, .

MEAS UR E ME NT O F T HE R E S PI RAT OR Y E XC HANG E INS ID E T HE

BE D C ALO RI ME TE R .

With th e bed calorim et er it is possibl e to de term me S i multa neously

th e wat er vaporiz ed i nsid e th e chamb e r th e carbo n dioxid e produc e d , ,

an d th e oxyg n co nsum ed Th e s e d e t e rmi n atio n s w e r e mad e dir e ct l y

e .

o n four nights prior to th e fast o n th e 3 1 n ights of th e fast and for two , ,

ni ghts aft e r th e fast Whil e th e gr eat est emphasis must be laid upo n
.

th e total amoun ts m e asur e d th e absorbi ng v e ss els w er e chan g e d s everal

,

t im es dmi ng th e n ight so that th e e xp erim en t was usua l ly sub d ivide d

,

i nto three p e rio d s In th e latt e r part of th e fast th e me asure ments

.
,

w ere mad e in fi ve or six p eriods and o n two nights s e ven and ni ne , ,

p e riods r e sp e ctiv e ly I t was accordi ngly possibl e to comput e th e car

.

bo n di oxid e output th e oxyg e n i n tak e and th e r e spiratory quoti en t for

-
, ,

t h e whol e e xp e rim en t an d a l so for th e i ndi vidual p eriods thus givi n g a ,

co ntrol o n th e m easure ment of th e r e spiratory excha n ge .

B n di c t a d Miln U S D pt A g O ffi c E xp S t B ul N 1 7 5 1 907 p 23 7
‘
e e n er , . . e . r .
, e . as. . O. , , . .

S2
p ag 3 7 3
ee e .
 A S T UDY OF P R O L O NG E D F A S T ING .

265 . c c per mi nut e an d for th e third p eriod 270 c c per mi nut e T h e

.
,
. . .

car bo n dioxi d e pro d uctio n for th e corr e spo nding p eriods was respec
-

tive ly 227 22 1 and 2 1 8 c c per mi nut e an d th e r e spiratory quoti e n ts

, ,
. .

an d r e sp ec tiv e l y .

T h e subdivisio n into exp e rim e ntal p eriods was mad e in an att e mpt
to s e cure i n formatio n r e gar d i ng th e p e riodic chan ge s throughout th e
n ight . B ut from fu ndame ntal factors in th e t e chni q u e of th e calori
me te r ex p erime nts th e lo ng e r th e exp e rim en tal p erio d s th e mor e accu
, ,

rat e are th e me asure ments of th e carbo n dioxid e productio n and es -

p e c ia lly of t h e oxyg e n co n sumptio n ; h e n c e b y su b d ividi ng th es e total

va l u e s a c e rtai n d e gr e e Of accuracy is sacrific e d in th e me asur eme nts
, ,

a l though th e av erag e valu e s for th e night are u naffe cte d Thi s may .

e xp l ai n c e rtai n discre pa n ci e s in th e r e sp iratory quoti e nt an d in th e

g e ne ra l co nfo rmity of th e curv e s for th e oxyg e n and th e carbo n dioxide .

I t will be s ee n that as a rul e th e curv e s for th e carbo n dioxi d e and

oxyge n are e ss entia l ly paral l e l although th ey are b y no me a n s straight
,

O OOPM
‘

Q OO ’ M Z OO A M

-
A PR . 20 2 !

O 7 l

FI G . 42 — . C urves sh o win g o xyge n co nsum p ti o n car bo n di o xi d e p d u ctio n and re p i ato y quo tient
,
- ro , s r r durifl
nigh t pe i o ds in t h e be d c alo i m e ter fo r th e fif th to t h e fi f tee n th d ays o f t h e fa t
r r s .
 TH E RE S PI R AT O R Y E XC HANG E .

lines for th e whol e exp erim ent Occasio n ally discrepan ci es are foun d
.
, ,

as o n April 1 0 1 1 (th e first n ight of th e e xp erim ent ) wh en th e carbo n

—

di oxid e productio n is hi gh er in th e s eco n d p eriod tha n in th e last p eriod ,

whil e as a matt er of fact th e oxyg en co nsumptio n is apparently some

what low e r T hi s is e sp e cially n otic e abl e o n April 22 23 wh en th e
.
—
,

car bo n dioxide productio n in th e last p eriod i n cr e as e d an d th e oxyg en

-

co nsumptio n d ecre as e d As would be e xpe ct ed th e possibiliti e s for a

.
,

discrepan cy b etw e en th e curv es i ncre as e as th e p eriod is short ene d and

co ns equ en tly we fi n d o n th e night of May 4 5 wh en th e exp erim ent was —
,

divid e d in to nin e p eriods that whil e th e valu e s as a whol e are appro xi

,

mat e ly parall el in th e sixth and s ev e nth p eriods the re is a gr eat in

,

cre ase in th e oxyg en co nsume d which is u naccompani e d by a corre

spo n ding i n cr e as e in th e carbo n dioxi d e pro d uctio n S i m ilar irre gu
-
.

larities are to be n ot e d o n th e night of May 1 3 1 4 I n g en e ral how e v e r —

.
, ,

there is a striki n g t end en cy toward para ll elism in th e two curv es .

A ft er th e first three nights of fasting th e mi nimum valu e s for carbo n,

di oxid e an d oxyg en are usually fou n d in th e middl e p eriod of th e night ,

i e from 2 to 4 a m or th er e abouts th e mor ni n g p e riod almost i nva

. .
, . .
, ,

MAY 4 -
5

FI G 4 3 —
. . C v i g yg c
ur e s sh o w n o x e n o n sum t o n , pi
ar o n c b
d id p d c i pi
io x e ro u t o n , and res rato r yq
u o t e nt ur n i d i g
ig p i d c l i
n h t e r o s in th e be d a o r m e ter fo r th e s xtee n t h i
to th e t we yf
nt -
d y
o urt h a s o f th e ast f .
 A ST UDY OF PR O L O NG E D FA S T I NG .

riably showing a t en d ency to ris e This may be s een with gr eat r e gu .

larity throughout most Of th e curv es a l though th ere are en ough ,

exc eptio n s (for in stan c e o n May 4 — 5 an d May 6 — 7 ) to make it in appli

,

cabl e in all cases .

Af t e r th e first few days of th e fast o n e would not exp e ct a gr e at ,

change in th e r e spiratory quoti e nt Si nc e th er e woul d be no mat erial ,

alt e ratio n in th e charact er of th e mat e rial oxi d i z e d in th e body An .

examin atio n O f th e r e spiratory quoti e n ts giv e n with th e curv es shows

that the y ru n no t far from a co n sta n t va l u e throughout th e night with

th e diffe re n t co n ditio n s of food and fasti n g Thus o n th e first few .
,

nights wi th food th e valu e s are c o nsid e ra bl y abov e

,
but with th e
b e ginn i ng of th e fast th e y drop rapidly to about r emai nin g not
far from thr oughout th e remain d er of th e fast Occasio nally cer .

tain fluctuatio n s above or b elow th e av e rage fi gur e may be obs e rv ed ,

MA Y 13 - 14

M AY
“

l6 '
l7

h e . 44 .
— C u ve
r i g
s Sh o w n yg n c n
ox e o su m p ti o n c ar bo n di xi d e pro d u c ti o n an d re p ir ato ry qu o ti e n t d urin g
,
- o , s

pe io d
r in th bed c al rim
s e o e te r fo r t h e tw e n ty fi fth to th e th i r ty fi r st d ay s o f th e f ast an d th e se
- -

and th ir d f d d ay
oo s .
 3 28 A STUDY OF P R O L O NG E D FA S T IN G .

10 or 1 2 hours Co ns equ ently a compariso n may be mad e of th e

.

r esu l ts obtain e d for th e i n dividual nights as th e fast progr e ss ed We .

may in d eed go furth er and compar e no t o nly th e averag e valu es fou nd

, ,

throughout th e ni ght b ut like wis e th e av erage valu e s for th e mini mum

,

p eriods in th e exp erimen ts Whil e obviously th ere is an opportu nity

.

for possib l e error in thus s e l ecti ng mi nimum p eriods parti cu l arly in ,

th e me asur em ents of th e oxyg en co nsumptio n n ev erth el ess it is be ,

li eve d that such e rrors will be e quali z e d thr oughout a 3 1 d ay fast -

.

A ccordin g l y in tabl e 4 5 we give both th e av e rage and th e mi nimum

,

T AB L E !
ti — G as eo us exc ha ng e o f bj ect L
su . during experi ments i n the bed calori meter at night .

1F r
o th e d uratio n o f th e pe i d d uri ng w h ic h th e m e tab l ism was m e a ur d see tabl 44
r o o s e e .

3T
he d ur atio n o f th e pe io d in wh ich th ese m i ni m u m values we e o bserve d v ari e s in ge neral
r s r

fro m 3 h o urs to 1 h o ur .
 THE RE S P I R ATO R Y E X C H A N G E . 3 29

p erio d ic valu es for th e total gas eous exchang e and th e r espirato ry

quoti e n t for e ach night of th e exp erimen t .

Th e av e rag e for th e carbo n di oxi d e productio n vari e d from 228 c c -

. .

e r mi n ut e o n A pri l 1 1 1 2 (t h e s e co n d n ig ht of th e pre limi n ary food

—
p
p e rio d ) to 1 09 c c o n May 7 8 (th e tw e nty fourth ni ght of th e
. .
— -
,

T h e carbo n dioxid e e xcr e tio n duri n g th e fastin g p eriod was much l ess
-

tha n duri n g th e days when food was tak en ra n gi n g from 1 6 5 c c o n , . .

th e first night to 1 0 9 c c o n th e tw e nty fourth night . Thi s i ncre as e

.
-
.

with the taki n g of food is also shown in th e two nights followi ng th e

fasti n g p eriod wh e n th e car b o n dioxid e productio n i n cre as e d from 1 1 5
,
-

c c t o 124 c c o n th e s eco n d night aft er t h e food was tak e n and to

. . . .
,

1 88 c c o n th e third night
. . .

Th e mi nimum p e riods hav e a sp e cial i n t er e st as th ey i n dicat e th e ,

low e st pla ne of m etabolism duri ng th e exp erime n t The s e va l u e s ra n ge .

from 2 1 8 c c o n th e first ni ght with food to 1 03 c c o n both th e tw e n ty

. . . .

fi rst and thi rti e th nights of th e fast A s with th e av erag e valu es an .

,

in cre as e aft er taki ng food is not e d in th e minim um p e riods for th e two

nights followi n g th e fast .

Whil e th e carbo n dioxid e of its elf is a w ell known i nd ex of th e me tab -

o lism particularly in fasting wh en th e charact er of th e mat erial

, ,

burn e d r e mai ns relativ ely co n stant ne v erth el ess th e valu es for oxyg en ,

lik e wis e hav e sig nifican c e Th e av erag e valu e s for th e oxyg en co n sum p
.

tio n ran ge from 27 6 c c on th e first night with food to 1 5 1 c c o n th e

. . . .

thirti e th night of th e fast Co nsid eri n g o nly th e fasti n g valu e s th e.

,

oxyge n co n sum ed rang es from 2 1 2 c c o n th e first night of th e fast to . .

th e min imum n ot e d a b ov e Whil e n o i n cre as e in th e oxyg en con .

sumptio n is apparen t in th e fir st valu e obtai ne d aft er th e taki ng of

foo d a co nsi d erabl e i ncr eas e is show n o n May 1 7 1 8 th e oxygen c o n
,
—
,

sume d b ei n g 1 94 c c . .

Th e mi n imum p eriodic valu e s for th e oxyg en co nsumptio n c an n o t be

co n sidered to hav e th e same d e gr e e of accuracy as th e minimum
p e riodic valu e s for th e carbo n dioxid e productio n but a compariso n is -
,

of i nt ere st The s e valu es rang e from 2 65 c c o n th e fi rst night with

. . .

fo o d to 1 3 7 c c o n th e tw e nty fi rst n ight of th e fast D uri ng th e fast

. .
-
.

ing p e riod th e ra n g e is from 208 c c o n th e s e co n d night of th e fast to . .

1 37 c c o n th e tw enty fi r st night
. . A s with th e averag e valu e s th e
-
.
,

mi nimum p erio dic va l u e s for th e oxygen co nsumptio n do no t S how an

i ncr e as e aft e r taki n g foo d u n til th e third night .

From an e xami n atio n of all of th e d ata giv e n in tabl e 4 5 for th e car

bo n di oxid e pro d uctio n and th e oxyg en co nsumptio n it will be s ee n
-
,

that th ere was a striki n g t end en cy for th e total metabolism to d e creas e

as th e fast progr e ss e d B oth th e av erage an d th e mi nim um p e riodic
.

valu e s show that th e me tabo lism re ach ed a low poi n t about th e

tw enti eth day of th e fast an d from that time to th e end of th e fast there
,

was but littl e alt eratio n .

330 A S TUDY OF P R O L O NG E D F A S T IN G .

Th e oxyg en co n sumptio n show e d th e same g e neral cours e as th e

carbo n dioxi d e productio n th ere b ei n g a st e ady d e cre as e u nt il about
-
,

th e tw e n ti e th day Wh il e th e valu e s for th e oxygen b etw ee n t h e

.

twe nty first and th e thirty fi rst d ays do n o t S how th e r e gularity that
- -

was obs erv e d wi th th e carbo n dioxi d e durin g th e same p eriod th e y still ,

do n o t fluctuat e wid e l y from th e low va l u e th e av erage valu es r emaini n g ,

b e tw ee n 1 5 1 c c and 1 6 2 c c an d th e va l u e s for th e mi nimum p erio d s

. . . .

b etw ee n 13 7 c c an d 1 5 3 c c I t will be s ee n th erefore that th e m etab

. . . .
, ,

o lism as i n dicat e d b y th e carbo ndioxid e productio n and th e oxyg e n

-

co nsumptio n d ecre as ed re gularly u n til th e tw enti e th d ay and from that

tim e un til th e e n d of th e fast r e mai ne d e ss entially co nsta nt .

This o b s e rvatio n is stri kin g l y significant i nasmuch as o ne would nat ,

u rally e xp e ct that as th e orga nism wast ed away as a r e su l t of fasti n g

, ,

th e total m e ta b o l ism would d e cr e as e and lik e wis e th e i nt ensity of th e

m eta b olism T h e fact that th e d ecre as e in th e m e tabo l ism di d n o t co n
.

tinu e b eyo n d th e tw e n ti e th d ay is th e mor e surprisi ng si n c e th e loss ,

in w eight co n tin u e d r e gu lar ly throughout th e fast Th e abs e n c e of a .

co ntinu ed d e cre ase in th e me tabolism will subs equ e ntly be giv en sp ecial
discussio n .

R E S PIR ATO R Y Q UO TI E NT .

A t pre s e nt th e b e st i n d ex we hav e of th e charac ter of th e mat erial

burne d in th e body is th e r elatio nship b e tw een th e volume of th e carbo n
dioxid e e xcre t e d and th e oxyg e n co n sumed i e th e so call e d r e spira ,
. .
,
-

tory quoti e nt Wh en carbohy drat es are bur ned th e volume of carbon

.
,

di oxi d e produc ed is equal to that of th e oxyg e n co n sum ed th e r espira ,

tory quoti e nt b e i n g On th e co ntrary wh e n fat is bur ned th ere is , ,

a much l e ss volum e of carbo n dioxid e produc ed per lit er of oxygen and

th e r espiratory quoti e n t is n o t far from
I n th e study of short fasts pre viously mad e at We sl eya n Unive rsity ,

it was show n that th e carbohydr ate s store d in th e body (chi efly in th e

form of glycog e n) we re h e avily drawn upo n in th e first fe w days of th e
fast and th ere aft er th e body su b sist e d substa ntia ll y upo n fat and pro
t ein but chi e fly fat
,
I n this fasti n g e x p e rim en t th e r efor e a rapid
.
, ,

fall in th e re spiratory quoti e nt would be e xp e ct e d duri ng th e first days

of th e fast an d a possi b l e co nstan cy duri ng th e r emai ni n g d ays show
, ,

ing a combustio n of fat .

B y ref eren c e to th e valu e s for th e re spiratory quotien t giv e n in ta b l e

4 5 it will be s een that o n th e 4 n ights prior to th e fast th e va l u e s
,

ra ng e d from to av eragi n g n o t far from T hi s quoti ent

is approximat ely that whi ch woul d be e xp e ct e d with i n d ividuals su b
sisti n g upo n a mix e d di e t On th e first day of fasti n g th e respiratory
.
,

quoti e nt f e ll to an d r e mai n e d for th e n e xt few days n o t far from

to On th e sixth day a low valu e was fou n d of but for

th e r emai nd e r of th e fast th e r e spiratory quoti ent ra n g e d above or
3 32 A STUDY OF P R OLO N G E D F A S T ING .

poin t ed out that th ere is an i ntimat e r elatio nship b e tw een th e body

t em p er atur e and th e m eta b o l ism I t is importa nt th er efor e to co n .
, ,

si d e r th e r e latio ns hi p b e tw ee n th e m e ta b olism as show n by th e gas eous

e xcha n ge and th e s e two i n dic e s of th e i n t er n al co n di tio n .

I t h as s ee me d impracticabl e to comp licat e th e curve s in fi gur e s 4 1 to

4 4 by sup e rimposin g oth ers but a compariso n c an be mad e by r eferri n g
,
1
to th e c u rv e s for th e puls e rat e and th e body t emp eratur e give n in
- -

pre vious s ectio n s of thi s publicatio n Such a compariso n shows that .

th e c u rv e s for th e c arbo n dioxid e e xcr etio n th e oxyg en co nsumptio n

-
, ,

th e pulse rate and th e b o d y t e mp eratur e hav e in g e neral th e sam e

,
-

course for e ach e xp erim ent with a disti nct t e nd ency to fall o ff duri ng
,

th e e v enin g u ntil a minim um is re ach e d about th e middl e of th e night ,

an d th en to rise in th e morning Thi s parall elism with th e m etabo l ism

.

is show n mor e cl e arly in th e c u rv es for th e body t emp erature as th ere -

,

are mor e variatio n s in th e curv e s for th e puls e rat e but th e g e ne ral -

,

rhythm of th e l att e r is much lik e that exhi bit e d by th e curv e s for th e

me tabolism Furthe rmore th ere do e s n o t app e ar to be a mat e rial
.
,

differ e nc e in the se two relatio nships at th e be ginn in g and end of th e

fast so that it wou l d s ee m that fasti ng per se do e s no t aff e ct the m
, .

T h e body acts as a uni t th e r efore irre sp ective of th e stat e of nutritio n

, , .

T h e in timat e re latio nship b e twee n th e puls e rat e and th e m etabolism -

(whi ch h as b ee n emphasiz ed in this laboratory for a numb er of y ears )

an d th e r elatio nshi p b e tw ee n th e body t emp eratur e and th e m e tabolism -

are thus no t o nly d e mo ns trate d in a r e markab l e ma nn e r but are also ,

shown to be u naffec te d by a prolo n ged fasti ng p eriod .

T h e r e latio nship b etw ee n th e puls e rat e and th e total me tabo lism -

an d th e b ody t emp e ratur e an d th e m e tabolism as th e fast pro g r esse d

-

m ay be discuss e d mor e in d e tail in co nne ctio n with th e valu es give n

in ta b l e 4 5 usi ng th e averag e valu es rathe r tha n thos e for th e mi nimum
,

p eriods In comparing th es e factors with th e tota l me tabolism o n

.

succ e ssive nights it should be born e in mi n d that th e r e latio nships

,

would no t l ogically be e xp ect e d to remai n co nsta nt for we have o n th e ,

o n e ha n d th e pu ls e rat e an d th e b ody t emp eratur e gov er ne d by c ertai n

- -

laws and o n th e oth er an organism producin g h eat th e h e at produci ng ,

-

m e chani sm of whi ch is co n stantly diminishing in si z e .

Th e puls e r ecords for th e n ights pr ec e di n g th e fast are some what

-

irr e gular but th e t echni qu e for making th e Obs ervatio n s was no t then
,

so p e rf ect l y d e v e l op ed as it was lat er in th e e xp eriment and th e assis

ta nt had no t th e time to mak e such frequ ent r ecords I t will be s een .
,

how eve r that th e high puls e rat e s w er e obtain ed with th e hi gh valu es

,
-

for th e carbo n d ioxid e and th e oxyge n durin g th e 4 ni ghts prior to th e

f ast and throughout th e first 2 w eeks of th e fasting p eriod In th e .

l att er portio n of th e fast th e r e was a distin ct t e n d e ncy for th e ave rage

p uls e rate to incre as e without a corre spo n din g in cre ase in th e total
-

S e fi gu
l
e 4 t 8 p ag 90 to 9 4 a d fi gu
res o , 1 2 to 1 8 p ages 1 04 to 1 1 0
es , n r es , .
 THE RES PI R ATO R Y E X CH A N G E . 3 33

carbo n di oxid e output and oxyg i tak e

-
May how e v er
en n . On 1 7— 1 8, ,

th e gr e at l y i n cr e as e d puls e rat e was accomp ani e d by a corr esp o n di ng

-

in cre as e in b oth th e carbo n di oxid e output an d th e oxygen i nt ak e -

.

I n g e n era l th e n o n e may i n fe r that e v en with an orga nism whos e he at

, ,

pro d uci n g mecha ni sm is co nstan tly d e cre asi n g in siz e th er e is sti l l ,

an i n timat e r elatio n ship b e tween th e puls e rat e per mi nut e an d th e -

total he at productio n I t should also be r ecogniz e d that t hi s r elatio n

.

ship was somewhat disturb e d duri n g th e latt e r portio n o f th e fast ,

but no t suffici ently disturb e d as n o t to be agai n appare n t o n th e third

day with food .

Th e bo d y t e mp e ratur e was no t r ecord ed o n th e nights pr e c e di ng

-

th e fast but obs ervatio n s w e re mad e ne ar l y e v e ry night of th e fast an d

,

for two nights fol l owi n g Th e valu e s giv en in tabl e 4 5 for th e fasti n g
.

p eriod hav e a d isti n ct t en d en cy to re mai n no t far from an ave rag e

valu e of C an d ran g e from .
,
C o n th e tw elf th night of .

th e fast to C o n th e tw e nty fourth night F rom th e tw en ty fir st

.
-
.
-

n ight of th e fast th e valu e s for th e most part lie d isti n ctly b e low th e
,

av erage of th e first 3 w e eks of th e fasti ng p eriod ; but littl e if any rela

tio nsh ip is S hown b e tw een th e av erage body t e mp eratur e an d th e total -

metabo l ism On th e oth e r han d o n th e last night of obs ervatio n

.
,

aft e r th e fast (May 1 7 th e i n cr e as e d m e tabolism and i n cr e as e d

puls e rat e w er e accompan ie d by th e hi gh e st av e rag e t emp erature
-

fou n d o n any night with thi s subj e ct .

I t is evid en t th erefor e that whil e th er e is a t end e n cy towards a

, ,

para l l e lism of th e body t emp erature an d th e metabolism thr oughout

-

any giv en night there is no disti n ct t e n d en cy towards para l l el is m

,

b e tw een th e av erage t emp erature s of succ essive nights an d th e total

me tabolism as m easure d E vid e ntly th e h e at re gulati ng me chanism
.
-

of th e body is in larg e part i n d ep en d en t of th e total he at pro d uctio n -

or of th e co n di tio n of nutritio n of th e subj e ct .

STUDIES WITH THE UNIVERSAL PIRATION APPARATUS

RES .

Th e facility with whi ch exp erim ents could be carri e d out with th e
u ni v ersa l r e spiratio n apparatus mad e it sp e cially adapt e d for m easuring
th e m e tabo l ism of th e fasti n g su b j e ct u n d er various co nditio ns , such as
lyi n g awak e sitti n g up eith er qui et l y or writi n g or lyi ng awak e bre ath
, ,

ing an oxyg en rich atmos ph er e

-
I t was also possib l e to obtain accu .

rat e d et ermi natio n s o f th e re spir atory quotien t with thi s apparatus .

Thi s was of sp ecial importan c e S i n c e it was d esire d to estab l ish as ,

sharp l y as possibl e th e re spiratory quoti en t obtaini n g duri n g pro l o nge d

fasting particularly as th e l ow quoti e n ts fou n d by Lucian i and by
,

Zu n tz an d his co work ers ha v e b ee n th e subj e ct of much d iscussio n

-
.

Co n se qu ent l y it was d e ci de d that throughout th e en tir e fast re spira , ,

tio n e xp erime nts would be mad e as fre qu ently as pr acticabl e in whi ch

th e re spirato ry e xcha n ge would be d e t e rmi ne d u nd e r various co ndi
3 34 A STUDY OF P R OLO N G E D FA S T I NG .

tio ns A summ ary of th e data obtaine d in the s e e xp eriments is given

.

in tabl e 4 6 .

F or purpos es of compariso n th e oxyg en absorb ed an d th e carbo n

di oxid e produc e d w e re c alc ulat e d o n th e basis of cubic c e ntim e t ers
p e r minut e T h e r e spiratory.quoti e n t for e ach e xp erime nt and th e
av erage pulse rat e are also giv e n in thi s tabl e Th e morn ing res p ira
-
.

tio n exp e rim ents we re ma d e imm e diate ly fo ll owing th e calorime te r

T AB L E 46 .
— G aseo us exchang e o f su bject L . at different ti mes o f the day and with varyi ng
activity .
(Respi ratio n a pparatus ) .

1 During peri o d f o m 3
a r
ll 1 6m p m o n thi day wi th th e su bj e c t in th e lyi n g
p m t
. o 3 11
.5 1 m . . s ,

po si tio n th e o bservatio ns were : C arbo n di o xi de 1 4 0 c c ; o xyge n 1 89 c c ; respi ato ry qu o tie nt

. ,
. .
, . . r .

pul se rate 6 1 per m i nute

-
,
.
 33 6 A S TUDY OF P R OLO N G E D FA S T IN G .

valu e of 237 c c was obtained o n th e first day of th e fast whil e th e

. .
,

mi nimum valu e of 1 65 c c was foun d o n th e tw enty third d ay of th e

. .
-

f ast Th e striki n g co nstan cy shown in th e valu e s for th e oxygen co n

.

sumptio n o n th e first four mornings prior to th e fast an d o n th e fi rst

day of th e fastin g p eriod is worthy of sp ec ial n otic e as it giv e s e vi d enc e ,

in th e first plac e of th e r emarkab l e co nsta n cy in th e katabolism of this

m an an d lik ewise of th e r e gularity of hi s muscular r epos e B oth th e .

car b o n dioxid e productio n and th e oxyg e n co n sumptio n f e ll o ff as th e

-

fast progress e d and although th e min imum valu e for th e oxygen co n

,

sumptio n was r each ed o n th e tw enty third day y et th e r emai ni ng days -

,

of th e fast ing p erio d i ndi cat e a kata b olism no t far from th e mi nimum
valu e of 1 65 c c I t is of particular i nt erest to not e that o n th e 1 7 th
. .

of May i e th e s eco nd day of takin g food th e metabolism had no t

, . .
, ,

mat erially in cre ase d as shown by th e oxygen co nsumptio n but o n th e

, ,

las t morn in g (May 1 8) th ere was a mark ed i ncre as e from 1 7 0 c c to . .

1 83 c c . .

Th e tr e n d of th e r e spir atory quoti ent is l ik e wis e sig nifica nt On th e .

fi rst 4 days with food th e re sp iratory quoti ent vari e d from

, to
thi s b ei n g n o t far from th e av erag e respiratory quoti e nt fou nd with
n ormal in di vi d uals su b sisti ng o n a mix e d di e t At th e b egi nni ng of th e .

fast th e r e spiratory quoti e nt was a littl e low e r o n th e fi rst few days

,

an d th e n st e a d i l y d e cr e as e d u ntil a mi nimum valu e of was fou n d

o n th e s e ve nt ee n th and e ight ee nth days D uri ng th e r emai nd er of .

th e fast th e va l u e for th e r e sp iratory quoti en t r emai ne d at about

, 3 .

On th e s eco n d day with food it ros e to an d on th e thi rd day with

foo d it re ach e d th e extraordinarily high valu e of i ndi cati n g that
th e subj e ct was surcharg e d with carbohydrat e mat erial Th e abs en c e .

of v e ry low quoti ents d uri n g th e fast was notic e abl e I t shou l d be .

b orn e in mi nd that th e valu es for th e oxygen co nsumptio n r epr e s ent

more ne arly th e tru e i nd ex of th e total meta b olism tha n do th e va l u e s
for th e car b o n dioxid e productio n particu l arly in th e 4 days with food
-
,

pr e c e di n g th e fast an d th e first few days of fasting Aft er th e thir d or .

fourth day of fasti n g how e v e r th e valu e s for th e car b o n dioxid e pro

, ,
- ~

d uctio n and th e oxyg en co nsumptio n we re e ss entia ll y para ll el so that ,

e ith e r may be look e d u p o n as a tru e m e asure of th e total m e tabolism .

RE LATI ONS H I P B E T WE E N T HE P ULS E RATE -

A ND T HE ME TAB OLI S M .

Th e pu l s e rat e r emai ne d remarkably co nsta nt for th e first 4 d ays

-

with food b efore th e fast and l ik e wis e o n th e first few days of fasti ng ,

ra ngi ng from 72 to 74 which is in g eneral co nformity with th e me asure

,

m ents of th e oxyg e n co n sumptio n I t th e n fe l l with a co nsid erab l e .

de gr e e of r e gularity u n til a mi n imum va l u e of 5 6 was r e ach e d o n th e

e ight ee n th day of th e fast Subs e qu en t l y th e va l u e s S how a s l ight
.
,

though d e fi nit e t en d ency to ris e gra d ua ll y to th e en d of th e fasti ng

,

p eriod Th e i n cr eas e o n th e s e co nd day aft er foo d was tak en was

.
 T HE RE S PI R AT O R Y E X CH A N G E . 33 7

co nsid erabl e with a still furth er i ncr eas e o n th e last day o n whi ch th e
,

obs e rvations w er e mad e .

A car eful e xa mi natio n of th e fluctuatio n s in th e valu e s for th e oxyg en

consumptio n and th e puls e—rat e shows a r e markabl e r e gularity in th e
r elatio nship b etw een th em although th e absolut e mi nimum valu es w er e
,

no t fou n d o n h
t e days that th e mi n imum puls e—rat e was fou n d On .

th e se co n d day with food afte r th e fast th e pulse rat e rose to 72 and ,

-

th e oxyg e n co n sumptio n lik ewis e ros e r e achi n g 1 7 0 c c Th e valu e s

,
. .

taken as a whol e how e v er show that in th e e arli er days of t hi s lo ng

, ,

fast th e r elatio n s hi p b etw een th e oxygen co nsumptio n an d th e puls e

rat e was re aso n ably clos e but in th e latt er part of th e fastin g p eriod
,

th ere was a S light diverg enc e as a some what in cr eas e d puls e rat e was
,
-

occasio n a l ly accompa ni e d by an actual d ecre as e in th e oxygen co n

sumptio n I t S hould be co n sidere d how e v er that th e organism was
.
, ,

changi n g from day to day and whil e th e total tissu e availabl e for
,

me tabolism was slowly d e cre asin g th e p ul s e—rat e may still hav e a

d efini t e r elatio nship to th e total activ e tissu e remaini ng Thus a .

d e cr eas e in th e amount of tissu e may in part be comp e nsat e d for by an

incre as e in th e p uls e rat e although thi s l att er factor may still hav e too
-
,

small an effe ct to pr ev ent a low erin g of th e total m etabolism Further .

discussio n alo ng this line must be d ef err e d u ntil th e metabolism per

unit of body w eight and per unit of body surfac e are co nsid er ed
- -
.

DI UR NAL VAR IAT I ONS IN ME TAB OLI S M .

Th e d et ermi nation of th e r espiratory exchang e at various time s

duri ng th e day giv e s an exc ell ent opport unity for studyi n g th e diurn al
variatio ns in th e me tabolism of th e sam e i n dividua l duri n g fasti n g .

Th e data giv en in tabl e 4 6 show that th e me tabolism duri n g th e e v eni n g

e xp erim en ts was invariably hi gh e r than in th e morni n g e xp e rim ents ,

r egardl ess of wh ether th e carbo n di oxid e productio n or th e oxyg e n

-

co nsumptio n is us e d as an i nd ex .

Th e puls e rat e was also a few b eats high er in th e e veni n g hours thus
-
,

i n dicati n g a clos e r elatio nship b etw e en th e puls e rat e and th e metab -

o lism. Th e S li ght t e n d en cy for th e puls e rat e to ris e in th e morn i n g -

exp e rim en ts b egi nni n g with th e eight e e n th day of th e fast and co n

ti nni ng to th e end was ev en mor e mark e d in th e r e cords of th e pu l s e

rat e for th e s eri e s of e veni n g exp erim en ts in whi ch th e mi nimum valu e ,

of 5 7 was fou n d o n th e tw enty fi rst d ay of th e fast and th e maximum

-

of 7 1 o n th e thi rti eth day A ge neral relatio n ship b etw een th e oxyg en
.

co nsumptio n and th e p ul s e-rat e is show n throughout all of th e s eri e s

of exp erim ents although as th e fast progr ess ed th is r elatio nship was
,

n o t so pro n ou n c e d as at th e b e gi nn i ng I t should be co nsid er e d h er e

.

again how e v er that th e active mass of protoplasmic tissu e was gradu

, ,

all y d e cre asin g so that th e relatio nshi p c an no t be exp e cte d to hold

,

constant .
3 38 A S TUDY OF P R O L O NGE D FA S T I NG .

Th e respiratory quoti ents obtain ed in th e ev ening w ere not unlik e

thos e obtai ne d in th e morni n g e xp e rime nts with a slight t end en cy for ,

th e e arly e v eni ng quoti ents to be somewhat low e r tha n thos e obtain ed

in th e mornin g e xp eriments Thi s low eri ng of th e quoti ent in th e
.

e v e n in g exp e rim en ts mi ght be tak e n as an in dicatio n that th er e may

hav e b een a formatio n of carbohydrat e from fat by a storage of oxygen ,

or a gr e at e r formatio n of B oxybutyric acid and that th e next morni ng

-
,

e ith e r th e formatio n of th e B oxybutyric acid was l e ss or that th e slight

-

supply of glycoge n fo rmed durin g th e early evenin g was b ei ng bur ned .

U nfortu nat ely although th es e respiratory quoti ents w er e d e t ermin ed

,

with th e b e st t e chni qu e that we kn ow of at pres ent we do no t fee l ,

j ustifi e d in laying much stre ss upon a cha ng e of o ne or two units in th e

quoti ents .

E XTER NAL INFLUE NC ES UPO N ME TAB OLI S M .

Whil e th e valu es for th e carbo n dioxid e output th e oxygen i ntak e

-
, ,

th e re spiratory quoti ent and th e puls e rat e are giv en in tabl e 4 6 for th e
,
-

e xp e rim e n ts in which th e subj e ct was lyi n g upo n a couch an d sitti ng

up in a ch air eith er writi ng or qui e tly at re st a b etter u nd e rstan di ng

, ,

of th e influ e nc e of a chang e in co ndi tio n s may p erhaps be s ecure d by

studyi ng e ach cha ng e by its e lf To thi s en d s ev eral small tabl es have
.

b ee n pr epared which show th e i nflu e nc e of th e chang e in co nditio n

upo n th e total metabo lism and also upo n th e mechanics of respiration .

EF FE CT or C HANG E S IN B O DY Po sm oN .

On th e s e co n d , t e nth , tw e lfth , and thirt ee nth days of th e fast , th e

me tabolism was studi e d whil e th e subj e ct was sitti ng in a chair I t was .

thus possibl e to compar e th e m etabolism and th e me chanics of respi

ratio n for th e two positio ns This compariso n is ma d e in tabl e 4 7 , in
.

which is giv en th e i ncre as e or d e cre as e in th e valu es due to th e chang e

to th e sitti ng positio n Th e figur e s show that in general th ere was
.

practical l y no in cre as e in th e carbo n di oxid e productio n and, i n d eed ,

— -

in two in sta nc e s a co n sid erabl e d e cr e as e Th e oxyg en co n sumptio n .

was in cre as e d in 3 out of th e 5 e xp erim ents with a slight d ecr e as e in ,

th e oth e r 2 , an d th e r e was a p erc eptibl e though probably no t S ig nifica nt

cha n ge in th e r espir atory quoti ent , which may hav e b e en caus ed by
th e abs en c e of cha n g e in th e carbon dioxid e pro ductio n There was
-
.

an av erage i n cre as e in th e puls e rat e an d re spiratio n rat e and an

- -

i n cre as e in th e lu n g v en tilatio n , but varyi n g re sults in th e volume per

re spiration .

S inc e th e lying e xp e rim en ts w er e mad e in th e e arly morning and th e

sitti n g exp erime nts lat e in th e aft ernoo n th e y are no t strictly sp e aki ng, , ,

comparabl e On th e other han d o ne would exp e ct that th ere would be

.
,

a high e r me tabolism n ormally in th e lat e aft ernoo n than in th e morning

aft er th e subj ect came out of th e calorim et er and it is accordi ngly v ery ,
 A S T UD Y O F P R OL O NG E D FA S TI NG .

of th e oxygen c o nsum Nio n I n th e light of th es e varying results it is

.
,

to be re gret te d that furthe r obse rvations w ere not mad e with th e sub
j ec t sitti n g quie tly H owe ver a numb er of obs ervatio ns mad e wh en
.
,

th e m an was sittin g up and writing activ ely may also be compar ed .

I NFL UE N CE O F T HE WORK OF WRITI N G .

On th efif th fif t ee nth s ev ent ee nth tw enti eth tw enty thi rd and

, , , ,
-
,

thirti eth days of th e fast th e metabolism was studied whil e th e subj ec t

,

was sitti n g up writi ng an employm ent that occupie d much of his spare
,

tim e duri n g th e entir e fast Th es e six exp e rim ents are compar ed in
.

tabl e 4 8 with data obta ined on th e sam e day wh en th e subj ect was
lying upo n th e couch in th e morni ng exp erim ent Two of thes e experi .

ments thos e on th e s event eenth and tw enti eth days imm ediately
— —

TAB LE 48 .
— C mnparison of the gaseo us exchang e and lung ventilatio n of bject L
su .
,
lying
on cou ch and sitti ng writi ng (Resp iration apparatus ).

D ate . Po si ti o n .

8h 21 tn a m to
. . 9h 3 2m a m . .

4 h 1 0m p m to
. . 4 ll 4 3m p m . .

I ncrease .

Apr 29
. 8ll 1 9m a m to
. . 9h 1 9m e m . .

3 5 23 m p m to
. . 3h bfim p m . .

I n crease .

May 1 8h 22‘n a m to 9h 1 9m
. . a . m .

9h 3 1m a m to 1 0 04 m
h
. . a . m .

I c
n rease .

8h 22m a m to 9h 15 m
. . am . .

9h 3 5m e m to 1 0h 1 0m
. . am . .

Inc re ase

8h 1 5 m a m to
. . 9h 1 7m am . .

3 4 3m p m to
h
. . 4h 14 m p m . .

I nc re ase .

M ay 14 8h 0 3m e m to. . 811 5 6m a m . .

S h 3 2m p m to
. . 7 0 2m p m
h
. .

I nc re ase .

1
Th el un g ve ntil ati o n o bserve d is h ere re du ced to 0 C an d 7 6 0 m m pressure °
. . .

2
C al culate d to th e pressure existing in th e lungs and to 3 7 C °
.
 THE R E S PI R AT O R Y E X CHA N G E . 34 1

follow ed th e morni ng exp erim ents and it is again to be r e gr ett ed that ,

this routin e was no t carri e d out in all cas es .

Th er e was a n otic e abl e i n cr e as e in th e m e tabolism in all of th e writi n g

exp erim en ts w hi ch is shown by both th e carbo n dioxid e e xcr e tio n an d
,
-

th e oxyg en co n sumptio n but th e r e spiratory quoti ent t en d e d to b e com e

,

a few points low er dur i n g th e writi n g p eriod Th e p uls e an d r e spira .

tio n rat e s w ere both i n variably i ncre as e d th e i n creas e in th e puls e rat e

-
,
-

ran gi ng from 7 to 1 6 b eats per mi nut e Th e v entilatio n of th e lungs .

p er mi nut e lik e wi s e i n cr e as e d v e ry co n sid e rably duri n g th e writi n g

e xp e rim en t thi s i n cre as e at tim e s amou n ti n g to 3 % lit ers
,
Th e volum e .

p e r i n spiratio n did n o t i n cr e as e mat e rially e xc ept on th e tw e n ty t hi rd ,

-

an d thirti eth days of th e fast .

Un d er ordin ary co n ditio ns o ne would normally exp e ct an i n cr eas ed

metaboli sm in th e aft ern oo n ov er th e mornin g but th e compariso n ,

pre viously mad e b etw een th e m etabolism for th e lyi n g an d sitti ng posi
tio ns show e d no i n cr e as e for th e sittin g positio n in some i nstanc es and
in oth ers th er e was an actual d e cr e as e Co n s e qu ently a S harp compar .

iso n is difficult to mak e for th e writin g exp erim ents .

We may assume from th es e e xp eriments how e ver that wh en th e , ,

subj e ct was writi n g th er e was i n variably an incr e as e d m etabolism but ,

that o n th e 2 days wh en th e writin g exp erim en t imm e diat ely follow e d

th e lyi n g exp erim ent th e i n cr e as e was o n ly 5 0 to 75 per c ent of that
obtai ne d o n th e days wh en th e writing exp erim ent was in th e aft ernoo n .

On th e s e v ent een th an d tw en ti e th days of fastin g wh en th e writi n g ,

exp erim e nts w er e in th e morni n g th e incr e as e in th e m e tabolism du e to

,

writi n g was r epr es ent e d by an i n cre as e d consumptio n of about 3 5 c c . .

of oxyg en or no t far from 20 per c ent Th e absolut e maximum i n cr e as e

, .

of 64 c c abov e th e lyi ng positio n o n th e fifth day of th e fast amou n t ed

. .

to approximat ely 30 per c ent but whi l e th e absolut e i ncre as e o n th e

,

tw enty third an d thirti e th days was a few cubic c entim e t ers l ess th e
-
,

Oe nta e i n cr eas e was gre at e st i e 3 4 an d 33 per c en t r esp e ctive ly

p e r g , . .
, .

Th e work of writin g th er efor e produc e d a disti n ct in cre as e in th e

, ,

metabolism which is S hown no t o nly by th e i ncreas e in th e carbo n

,

dioxid e productio n an d th e oxyg en co nsumption but also by an ,

in cr e as e in th e r espiratio n rat e th e v en tilatio n of th e lu ngs and th e

-
, ,

volume per i nspiratio n F inal ly th er e was a r egular anddi stin c t increase

.
,

in th e puls e rat e Thes e valu e s are us e d su b s equ ently in computi ng

-
.

th e probabl e m etaboli sm of t hi s subj e ct during s e veral hours in th e

day wh en h e sat in th e balco ny and wrot e .

I NF L UE NC E OF B REATH I NG AN OX Y GE N RI CH ATMO S PH E R E
-
.

On th e tw enty eighth tw enty nin th and thirti e th days of th e fast

-
,
-
,

a s eri e s of e xp erim ents was mad e in whi ch th e subj e ct bre athe d an

oxyg en rich atmosph ere varyin g from 95 to 7 5 per c en t of oxyg en
-
.

At th e b e gi nnin g of e ach exp erimen t th e p erc entage of oxyg en in th e

34 2 A STUDY OF P R O L O NGE D FA S T I NG .

atmospher e was probably no t far from 95 per c ent This fe ll o ff quit e .

rapidly through th e e xp e rimental p eriod so that at th e end of th e ,

e xp e rim en t th e proportio n of oxyg e n in th e atmosph er e was b e tw ee n

7 5 an d 80 per c e n t Th e r esults of th e s e e xp erim ents are n o t includ ed

.

in tabl e 4 6 but are compar e d in tabl e 4 9 with th e morni n g exp erim ents
,

in which th e subj ec t br eath e d a n ormal atmosph ere In e ach cas e .

th e oxyg en exp e rimen t imm ediat ely follow e d th e r egular morni ng

e xp erim en t .

TAB L E 4 9 — C om ari so n of the

. p aseo us exc hange and la ventilatio n o f j
sub ect L .
, breath
i ng difi erent ai r mixtures pparatus j ect lyi ng i n th e m orni ng )
‘

. ratio n a , ,
.

‘ l u ng v il i
Th e ent bserved
at o n o d c d to 0 C and 7 6 0
is h ere re u e
°
. mm . pressure .

C l cu late d to th e pressure existing in th e l un gs an d to 3 7 C

2 a °
.

Thi s s eri es of exp e rim en ts may be compare d with an ext ensive res earch
mad e in this laboratory by Mr H L Higgi ns o n th e i nflu en c e upo n . . .

th e m e tabolism of n ormal in dividuals of br e athi ng oxyg en rich atmos -

p h eres I n.th e pr e vious e xp e rim e n ti n g it was found that th e r e was no

e vid e n c e of th e in cr e as e d p erc en tag e of oxyg e n a ff e cti ng th e r e spiratory

e xchan g e , but th e r e was a slight t en d en cy for th e puls e rat e to d ecr e as e -

with an i n cr eas e in th e p erc entag e of oxyg en In th e exp eriments with .

L , obs ervatio ns w er e mad e of th e effe ct o n th e carbo n dioxid e excre

.
-

tio n oxyg en consumptio n r espiratory quoti ent th e r espiratio n rat e

, , ,
-
,

lu ng v entilatio n volum e per in spiratio n alv eolar carbo n di oxid e and

, , ,

th e puls e rat e - .

Th e data giv en in tabl e 4 9 show a slight i n cr e as e in th e m e taboli sm

i ndicat ed by both th e carbo n di oxid e productio n and th e oxyg en c o n
-

sumption Th e respiration rat e had a t enden cy to fall o ff somewhat ;

.
-
34 4 A ST UDY OF P R OLO N G E D FA S T I NG .

that th e measure men ts w ere mad e wi th a noth er apparatus and th e

subj e c t was awak e thr oughout th e whol e exp erim ent We hav e .
,

ther e for e as a r esult of th e exp eriments with th e respiratio n apparatus

, ,

th e basal mi ni mum m etabolism of th e subj e ct wh en h e was awak e .

I t is accordin gly of gr e at in t ere st to compar e th e m e tabolism as

me asur ed in th e be d calorim et er d urin g th e night with th e metabolism
as me asur ed with th e respiratio n apparatus in th e morning immediately
aft er th e subj e ct has b ee n tak en out of th e calorim et er chamb er .

Such a compariso n has b ee n mad e in tabl e 50 in which th e av erage ,

carbo n dioxid e productio n and oxyg en co nsumptio n are given for th e

-

bed calorim e t er e xp erim ents wh en th e subj ect was a p art of th e tim e

-

asl eep and a p art of th e tim e awak e and also for th e mi nimum p eriods ,

wh en th e subj ect was presumably in d ee p sl ee p Th e av erage valu es .

for th e carbo n dioxid e productio n and th e oxygen co nsumptio n are

-

lik e wis e giv en for th e exp e rim e nts with th e re sp iratio n apparatus in ,

whi ch th e subj ect was awak e throughout th e whol e p eriod Th e com .

pariso n of th es e valu es is also ma d e by noti ng th e i ncre as e wh en th e

subj ect was awak e In th e same tab l e th e minimum lev el of th e pulse
.

‘
rat e o b s e rv ed in th e bed calorime t e r e xp eriments is compar ed with
-

th e av erag e puls e rat e for th e e xp e rime n ts with th e r e spiratio n appa

-

ratus Th e incre as e in th e puls e rat e wh e n th e subj ect was awak e in

.
-

th e exp e rim en ts with th e r espiratio n apparatus is also shown F i nally .

,

th e r espiratory quoti en ts obtai ned in th e be d calorime t er e xp erimen ts -

and in th e exp eriments with th e r espiratio n apparatus are compare d .

I n comparin g th e r esults obtai n e d duri ng th e first 4 days of th e

e xp e rim e n t wh e n th e subj e c t was taki n g food we fi n d that th e carbo n
, ,

dioxid e productio n was 3 2 c c l ess per mi nut e o n th e first day than dur
. .

in g th e minimum p e riod in th e bed calorime t e r wh e n th e subj ec t was

asl eep On th e night of April 1 2 1 3 th e carbo n di oxid e productio n
.
—
,
-

was low er by 4 c c and o n th e followi ng night by 9 c c per mi nut e wh en

. . . .

th e subj e ct was asl e ep tha n wh en awak e Th e s e valu es how e v er pre .

, ,

s e n t no ab normaliti es si nc e th e y are e as ily explai n e d by th e pr e vious

,

ing estio n of carbohy d rat e rich foo d in th e ev eni ng me al This r esult e d

-
.

in a gr e at er productio n of carbo n di oxid e in th e bed calorim et er exper -

im en t tha n was obtai n e d in th e e xp erim e n t with th e r e spir atio n appa

ratus wh en th e subj e ct was without bre akfast and th er efor e in th e
,

post absorptiv e co n di tio n T h e values for th e oxygen co nsumptio n

-
.

follow e d approximate l y th e same cours e Th e puls e rat e also in two .

-
, ,

in st anc e s was l ess in th e morni n g exp eriment than it was th e night

pre vious an d in two oth ers it was 3 and 9 b e ats hi gh er .

H owe ver th e r e sults obtai ne d o n days wh e n food was tak en are no t

,

of such gre at i nt erest as thos e obtain e d d uri ng th e fasting p eriod .

B e gi nni ng with th e first n ight of th e fast it wi l l be s ee n that in th e ,

1
S curv h win g th pulse at in th b d c al im t xpe im nt in figu 1 2 to 1 8 n
ee es s o e -
r e e e -
or e er e r e s r es , o

p ag 104 t 1 1 0
es o .
 TH E RE SPI R AT O R Y E X CH A N GE . 34 5

T AB L E 50 .
— Com pari son of th e gaseous exchange of subject L , i n the bed . calori meter at night and
awake on th e respi ratio n apparatus i n the m orni ng .

26 — 27 .

0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

1T h e du ratio n o f th e p e i o d s in wh ich r th e se m i nim um v al u es w ere o b se rv d vari

e es in g lf
e n er a ro m 3
h o ur s to 1 h o ur .

2 p
R e re se n ts pe rio d o f l o west pul se rate o b erve d S ee p age 1 1 2
- s . .

8
O n th e a s d y p e c e d in g an d f o ll o wi n g th e fast th ni gh t exp erim ents w ere m ad e after th e i ng estio n
r e

f d
of oo .T h e su bj e c t w as wi th o ut break fast d urin g th e m o rnin g resp ir ati o n exp erim ents .
34 6 A STUD Y OF P R OLO N G E D FA S T I NG .

morn in g exp erime nt 3 3 c c more of carbo n di oxid e w e re produc e d than

. .

dur in g th e p eriod of d e ep sl eep in th e night Th ere was lik ewis e an .

e xc e ss of 4 1 c c of oxyg e n co n sum e d an d an i n cr e as e in puls e rat e of

. .
-

10 b eats This i n cre as e in th e gas eous metabolism and th e pu l s e rat e

.
-

p ersists thr oughout th e whol e 3 1 d ays of th e fast for o n no day was th e ,

me tabolism durin g th e mornin g exp eriment wh en th e subj ect was ,

awak e l ess tha n durin g th e mi nimum p eriod of th e night exp eriment

, ,

whe n th e subj e ct was in d eep sl ee p F urthermore in no i nstan c e was .

,

an av erag e valu e s e cur e d in th e mornin g e xp e rim en t with th e r espira

tio n apparatus whi ch was l e ss than th e av erag e valu e for th e whol e

e xp erim en t with th e be d cal orim e t e r wh en th e subj ec t was asl e ep a ,

part of th e tim e an d awak e a part of th e tim c .

I t will be obs e rv e d that thi s in cr ease in th e m etabolism and in th e

puls e rat e u nd e rw e nt extre me variatio ns th e ra ng e for th e carbo n
-
,

dioxid e pro d uctio n b e ing from 3 3 c c o n th e fir st night to 1 1 c c o n . . . .

th e e ightee nth an d thirty first nights and for th e oxyg e n co n sumptio n

-
,

from 4 1 c c o n th e fir st n ight to 8 c c o n th e t enth night N ev er

. . . . .

th ele ss th e r e was a fairly av e rag e valu e of 1 7 c c for th e i n cr e as e in . .

th e carbo n dioxid e productio n th e variatio n as th e fast progr ess ed

-
,

b ein g n o t far from this valu e exc ept o n th e tw enty fi rst tw en ty ,

-
,

s e venth and twenty ni nth nights

,
-
With th e oxyg en co nsumptio n .
,

th e variatio n s are much mor e irr e gu lar ; th es e may partly be explain e d

by th e difficulti es of d et ermi nin g th e oxyg en co nsumptio n exactly ,

esp ec ially wh e n th e valu es for th e mi nimum p eriods are s el ect e d It .

is lik e wis e importa nt to n ot e that th e oxyg en co nsumption for th e

mornin g is in variably high e r tha n not o nly th e mi nimum during th e
night but a lso th e av erag e for th e whol e n ight .

Th e incr eas e in th e puls e rat e u n d ergo e s a much mor e r eg ular chang e

- .

On th e first 4 morn ings of th e fast th e puls e—rat e is 1 0 b e ats high er wh en

,

th e subj e ct is awak e tha n wh en h e is asl e ep duri n g th e night This .

in cr e as e thr oughout th e fast r emai ns r e aso n ably co nstan t at 8 b e ats .

On but two occasio ns i e o n th e tw enty e ighth an d th e thirti eth

, . .
,
-

nights was th e i n cr e as e o nly 4 b e ats

,
.

I t is thus cl e ar that so far as th e absolut e m etabolism is co n c ern ed

, ,

th er e is an in cr e as e in th e p eriod wh en th e subj ect lay awak e o n th e

re spiratio n apparatus ov er that of th e av erag e for th e night when th e ,

subj e ct s l ept for a part or th e whol e of th e tim e and particularly ove r ,

th e mi ni mum for th e night .

I n th e post fasti n g p eriod th e m etabolism o n May 1 6 1 7 co ntin u ed

-
,
—

to be gr eat er in th e mornin g exp eriment than in th e mi nimum p eriod

for th e night e xp eri me nt On May 1 7 1 8 how e ve r when th e subj e ct
.
—
, ,

was in much distr ess and had co n sume d a l arg e amou n t of carbohydr at e
mat erial a co n siderabl e proportio n of which had b een r etai ne d th e
, ,

carbo n di oxid e pro d uctio n was l e ss in th e mornin g than at night and

-

th e oxyg en consumptio n practically th e sam e Th ere was lik ewis e n o .

34 8 A ST UDY OF P R OLO N G E D FA S T I NG .

1
b ee n publish ed but a still lar g er numb er are b ei n g prepare d by Mr
, .

Carp ent er for e arly publicatio n H is r esults give a compl et e answ e r .

to th e first criticism as th ey show that th e me asur e men t of th e m etabo

,

lism by th e bed calorim et er is ess entially th e sam e as that with th e

r es p iratio n apparatus .

Furth ermor e sin c e it has alr eady b een shown that th e charact er of
,

th e katabolism as indi cat ed by th e r espiratory quoti en t was accurat ely

d e t ermin e d by both of thes e app aratus it is u nr easo nabl e to suppos e ,

that th ere would be any mat erial d ifferenc e in th e m e asur ements of

th e total m e tabo lism esp ecially as th e two apparatus ar e co n struct e d
,

o n th e sam e prin cipl e i e th e R e gn a ul t R e is e t clos e d c ircuit pri n cipl e

,
. .
,
- -
.

I f o ne apparatus had b een built o n th e clos ed circuit pri n cipl e and th e -

oth e r upo n th e op en circuit prin cipl e an e rror in th e meas urement of

-
,

th e total v en tilatio n or of th e total volum e of air passi n g through th e

chamb e r would aff e ct th e m e asure ment of th e total m e tabolism without
affectin g th e r espiratory quoti ent Si nc e th e two apparatus w er e .

b uilt upo n th e sam e prin cipl e how e ver th e possibility of such an e rror , ,

wo uld be v ery sma l l and any qu estio n of a fundamental di ff er en c e

b etw ee n th e results obtaine d with thes e two forms of apparatus may
th erefore be e xclud ed from thi s discu ssio n .

I n co nsid erin g th e s ec o n d criticism n amely that th er e might be a , ,

d iff erenc e in activity wh e n th e subj ect was awak e an d asl eep it S hould ,

be poin t ed out that e ach exp e rimen t in both s eri es was accompa ni e d
by a g raphi c r e cord of th e d e gree of muscular repos e of th e subj ect
2
by m e ans of th e movabl e bed pre viously d escrib ed I f th e r ecords .

are compare d it will be s ee n that during th e n ight th er e w e r e s l ight

,

movements as would be n atural si nc e no indi vidual could lie in

, ,

absolut ely th e same positio n for a p eriod of 1 0 or 1 2 hours On .

th e oth e r ha n d th e r ecord for th e e xp e rimen t wi th th e r e spiratio n

,

apparatus in th e morni n g was almost invariab l y a straight li ne showin g ,

that th e subj ec t had no t move d Mr Carp en te r wh o was in charge . .

,

of th e r espiratio n e xp erime nts was of th e opi nio n that th e subj e ct was ,

e n tir ely in diff e r en t to th e m e chanical part of th e r espiratio n apparatus

and show e d n o t th e slight e st e vid e n c e of muscl e t en sio n or appre

h ensio n which might i n cr e as e th e puls e rat e or g e n eral muscl e to nus

,
-
.

I n oth er words this subj e ct u n qu e stio n ab l y approximat e d as ne arly as

, ,

any subj e ct that we hav e e v e r exp erim ent e d with th e co n ditio ns

d escrib e d by Jo h ansso n as V o rsatzlich e Muskelruh e
3 “
I t is furth e r .
,

mor e cl ear that th e av erage r esults obtai ne d in th e two s eri e s of experi

,

m ents S how that as th e fast progr e ss e d there was a t e nd ency for th e

valu es to d e cr e as e an d ess entiall y at th e sam e rat e This wou l d hard l y .

be exp e ct e d if th e subj ec t w er e u n d er any gr e at m ental strain or a nxi ety

l
B edi t and J lin C a n gi I n t Wa h Pu b 1 3 6 1 9 1 0 p 1 7 3
en c os , r e e s . s . .
, , . .

”S ee p ag 3 1 1 e .

J h an n S kand A chi v f Ph y i ol 1 898 8 p 85

8 o sso , . r . s .
, , , . .
 T HE RE S PI R AT O R Y E X CH AN G E . 34 9

an d it would probably no t co ntinu e for 3 1 days L fr equ ently said . .

that th e exp erimen ts w ere very simpl e and occasio nally r emark e d that
th ey w er e qui e ti n g and r estful I t would app e ar ther efor e that h e
.
, ,

was as ne arly u n affe ct e d by th e experimental routine as any p erso n

could be was without anxi ety or appreh ensio n and that th ere was no
, ,

e vid en c e of t en s en e ss of muscl es .

I t thus app e ars that th e o nly evid en c e we hav e of muscular activi ty

durin g th e two s eri e s of exp erim ents is th e slight activity S hown by th e
kym ograph r e cords for th e exp erimen ts with th e be d calorim e t er B ut .

such activity would t e nd to i ncre as e th e metabolism duri ng th e night ,

wh en th e subj e ct was a part of th e time asl eep an d a part of th e tim e

awak e ov er that wh en th e subj ect was fu ll y awak e o n th e r espiratio n
,

apparatus Th e differen c e b etw een th e r e sults would thus be e v en

.

gr e at er if th e subj e ct were absolut ely qui et throughout th e night in

th e bed calorim e t e r .

S i n c e th ere was n o di ff ere nc e in th e m ethods of m e asur em en t and

such activity as exist e d would t en d to l ess en rath er than i n cre as e th e
differenc e b e tw e en th e results it s eems e vid ent that th e diff erenc e in th e
,

metabolism during th e S l eep in g and waki n g co n ditio ns must be du e to

th e i n flu en c e of sl eep an i n flu e n c e which has hith ert o b een disr e gard e d
,

by exp erim en t ers N o s eri es of exp erimen ts with which we are familiar
.

shows so compl et ely an d in such a co n tro l l e d ma nner this striki n g

diff er enc e in th e m etabolism b etw een a subj e ct asl eep and a subj e ct
awak e T h e puls e rat e is lik ewis e i n cr eas e d duri ng th e waki ng p eriod
.
-
,

b ei n g fairly u n iform with th e i ncreas es in th e carbo n dioxid e productio n -

an d o xyg en co n sumptio n This compl e t ely substa ntiat e s our vi ew that

.

th e puls e rat e giv e s an admirabl e i n d ex of th e i n t ern al activity of th e

-

body which largely d e t ermin e s th e basal metabolism

,
.

To S how mor e cl early th e in cr eas e in th e m etabolism wh en th e sub

is awak ov r h m tabolism wh e n h e is asl eep th e p erc e n tag e
j e c t e e t e e ,

i ncre as es in th e carbo n dioxid e productio n oxyg en co nsumptio n and

-
, ,

puls e—rat e are giv en in tabl e 5 1 for e ach day of th e exp eriment D is .

re gardi n g th e results for th e first 4 nights which are complicat e d by th e,

i nflu enc e of food upo n th e me tabolism durin g th e S l eepi n g p erio d we ,

fi nd o n e xamini n g th e valu e s for th e fasti n g p eriod that th er e is invari

ably a co nsid erabl e p erc entage i n cr e as e for th e carbo n dioxid e oxyg en , ,

an d puls e rat e -
F or i nstan c e th e p erc en tage i n cr eas e in th e carbo n
.
,

dioxid e productio n ris e s as hi gh as per c en t o n th e morni ng fo ll owi n g

th e first night an d fa ll s as low as per c en t o n th e morn in g aft er th e
n i n th n ight I n g eneral in th e latt er part of th e fast th er e was n o t far
.
,

from 1 5 per c en t i ncreas e in th e carbo n dioxid e productio n wh en th e -

subj e ct was awak e ov er that wh en h e was asl e ep in th e mi nimum p eriod

of th e ca l orime t er exp erim ent S im i l ar fluctuatio ns w ere obs erv e d in
.

th e oxyg en co nsumptio n but with hardly th e r e gularity n ot e d in th e

,

valu e s for th e carbo n dioxid e productio n D uring th e latt er part of

-
.
350 A S T UDY OF P R OLO N G E D FA S T I NG .

th e fast th e average oxyg en co nsumptio n of th e subj ec t awak e was

,

n o t far from 1 3 to 1 4 per c e n t gr e at e r tha n duri ng S l eep .

Wh il e th ere is no p artic ular re aso n to give th e i ncreas e in th e pul s e

rat e o n a p erc entage basis an d e xp ect that it would hav e a valu e cor
r espo n di ng to thos e for th e carbo n dioxid e productio n and oxyg en co n
-

sumptio n for want of a b ett er compariso n at th e moment it

,

TAB LE 51 .
— I ncrease i n metabo lism of subj ect awake p
as com ared
metabo lism of subject asleep.

ad visabl e to pres ent it in this way Thus we n ote h ere an in cre as e in

.

th e puls e rat e ran ging from

-
per c e n t o n t h e mor n i n g followi n g th e

fourth night of fasti ng to as low as 7 per c ent afte r th e tw enty eighth -

n ight . I n th e latt e r part of th e fast t h e puls e —rat e is n o t far from 1 2

p e r c en t abov e that fou n d duri n g t h e s l e e pi n g p e riod Th e r e was
.

practically no in cre as e in th e c arbo n dio xide productio n th e oxygen

~

,
3 52 A ST UDY OF P R OLO N GE D FA S T I NG .

lying p e rfectly quie t th ere was still an abs en c e of co nstancy for it

, ,

was fou n d that th e me tabolism was much low er duri ng th e hours of

d ee p s l e ep at night tha n in th e morni ng wh en th e subj e ct was lying ,

upo n a couch and co nnect ed with th e r espiratio n apparatus ; also that

th e me tabo l ism d u rin g th e e v e ning just prior to th e night calorime te r
e xpe rime n t was high e r tha n in th e morning We thus fi n d a d efi nitely .

e stablis h e d dail y rhyt hm with th e min imum m e tabolis m in th e e arly

,

mornin g n o t far from 2 to 4 a m a some what in cre as ed me tabolism . .

,

b etw ee 8 a m a d 9 30 a m and a still hi gh e r metabolism

n n.
h
.
m
. .
,

b e tw ee n 7 p m and 8 p m As th e m e asur e ments in all cas e s w ere

. . . .

mad e u nd er co nditio ns wh e n ther e was muscular repose an d no food

in th e alim entary tract it is cl ear that a c ertai n factor not ordin arily
,

co nsid ered in flu en c e s th e daily rhythm Thi s is un qu estio nably th e .

“
factor which we may for wa nt of a b e tt e r t erm d esignate as i nternal
, ,
”
muscular work or c e llular activity Wh en th e stimulus to thi s c el .

lular activity is in cre as ed th e subj e ct shows a corr espo n di ngly high er

,

me tabolism .

As we have alre ady fou nd th e puls e rat e is an admirabl e i nd ex to

,
-

this to nicity or c ellular activity si nc e th e clos est corr e latio n has b een ,

shown to e xist b etw ee n th e puls e rate and th e me tabolism This is -

.

p erhaps no mor e strikingly brought out than in comparin g th e m etabo

lism wh en th e subj ect was asl ee p with th e m etabolism wh en th e subj ect
was awak e . Whil e th erefore th e three s eri es of exp eriments in which
, ,

th e m e tabolism was d et ermin e d w er e no t primarily d e sig ned to throw

light upo n th e da ily rhythm i n asmuch as th e mai n purpos e was th e ,

study of th e alt eratio n s in th e me tabolism as th e fast progr ess ed y et ,

si nc e th e data w ere obtai ned withi n th e 24 hours th ey o ff er a good ,

d emonstratio n of this diurn al variatio n in th e me tabolism and a hint

as to its n ature Furth e rmor e th ey show th e i ntimat e relatio nshi p
.
,

b e tw e en th e puls e rat e and th e diurn al variatio ns

-
.

Duri n g th e 24 hours th ere was of cours e no mat erial alt eratio n in

body w eight or in body surfac e and h enc e th e d ata n ee d no t be com
- -
,

par ed upo n any sp e cial basis oth er than that o f th e body as a whol e .

On th e oth er ha n d as th e fast progr ess e d th er e w er e c ertai n fu n dam ental

,

chan ges takin g p l ac e w hi ch should be co nsid ere d in any att empt to

i n t erpr et th e variations in th e m etabo l ism not e d duri ng th e fast In .

th e first plac e th e m an was ob viously losing w eight e ve ry day

,
As was .

point ed out in th e discussion of th e loss es in body w eight of L duri ng -

.

th e fast it would hav e b een possibl e with a fasti n g a nimal to arra n g e

,

th e co n ditio n s of th e fast so that th e loss in w eight wou l d hav e b ee n

r e gular ; with a fasti ng m an how ev er it was impossibl e so to co ntrol
, ,

th e daily activity th e i ng estio n of wat er th e coll e ctio n of th e uri ne

, , ,

an d th e e n viro n m e ntal t emp eratur e that th e loss in w e ight would

follow a mathematical curv e ; and y et as has alr eady b een shown it , ,

proc eed e d with a co nsid erabl e d egr ee of r egularity .

 THE RES PI R A TO R Y E X CH A N G E . 3 53

As th e w e ight d ecr e as e s duri ng a fast th er e will u n qu estio nably be ,

a chang e in th e body surfac e With c ertai n i n dividuals such loss of

-
.

w eight eith e r through old ag e or ill ness is n o t accompani ed by a cor

, ,

respo ndi n g S hri nkag e of th e S ki n an d th e surfac e of th e skin is co nse

,

qu en tly wri nkl ed an d han gs in larg e folds I n g eneral how ever this .
, ,

is no t th e cas e ; that such a co nditio n c ertainly did n o t e xist with our

fasti ng subj e ct is cl e arly show n by th e photographs giv en in plat es
4 an d 5 . Co ns e qu en tly with L th er e was u ndoubt e dly a d ecre as e
.

in th e radiati n g body surfac e Th e s e factors of d e cr e asi n g body w eight

-
.
-

an d b o d y surfac e may r e aso n ably be e xp e ct e d to play a rol e in th e

-

metabolism duri n g a lo ng fast whil e in a fast of but 24 hours th ey would

,

be n e g l igi b l e .

Usi n g as i ndic e s th e chan ge s in th e puls e rat e th e blood pressur e -

,
-
,

an d th e pu l s e pr e ssur e w e fi n d that th ere was also a co n sid erabl e

-
,

variatio n in th e i nt er nal muscu l ar activity N ot o n l y do we fi nd .

variatio n s in th e pu ls e rat e b etw ee n th e co n ditio n s of lyi ng asl eep and

-

lyi ng awak e but as th e fast progr ess ed we fi nd that th ere w ere lik ewis e
,

chan g e s from day to day in th e s e valu es This is cl e arly brought .

out in tabl e 5 0 On th e othe r ha nd th e puls e rat e did n o t co nti nually

.
,
-

de cr e as e for as was poi nt ed out in a pr evious discussio n of th e cha n g e s

, ,

in th e puls e rat e th er e was a p erio d in which th e puls e rat e f e ll rath e r

-
,
-

rapi d ly fo ll ow e d by a p eriod wh en it r emai ne d approximat ely co nsta n t

, ,

whi l e toward th e end of th e fast th er e was a t end en cy for th e pu l s e

rat e to i n cr e as e Th e s e chang e s in th e puls e rat e i n dicat e a co n sid e r
.
-

a b l e a l t eratio n in th e i nt ern al muscular activity of th e body as th e fast

co nti nu e d thus cl e arly e sta b l ishin g a factor in me tabolism which h as
,

h ere tofore b een ah no st negl e ct e d I t is th e purpos e of this s ectio n to

.

e xami n e mor e clos e ly som e of th e various factors which a ff e ct e d th e

m eta b o l ism duri n g this prolo n g e d fast .

ME TAB OLI S M PE R KILOG RAM OF B O DY WE IG HT -

.

I n th e att empt to fi n d som e u nit of compariso n it has lo n g b een th e ,

custom of ma ny writ ers to u se th e kilogram of body w eight pre suma b ly -

,

o n th e grou n d that with a n imals diff eri n g in S iz e th e larg e r a n imal ,

woul d n orma ll y hav e th e gr e at er m etabolism I n oth er words it has .

,

b een th e custom to assume that th e me tabo l ism per kilogram of body

w eight is e ss entia l ly th e same for most animals of th e same sp e ci es .

As a re su l t of usi ng thi s u nit c ertai n discr epan cie s hav e app e ar ed which
hav e b een r ecogn i z ed by many writ ers but n e v erth el e ss this method ,

of compariso n is sti l l adh er e d to and i n d e e d i ndividua l s of wid ely , ,

varyi ng bo d y w eight hav e b ee n compar e d in this way

-
.

I f we cou l d d e t ermi ne th e compositio n of th e huma n b ody we should ,

c ertai n l y fi nd gr eat di ff er en c e s in i n d ividuals with d iff er en t bo d y

w eights With this fasti n g m an we hav e an id e a l co n ditio n for study
.

ing th e m etabo lism per ki l ogram of body w eight in that we hav e an -

354 A STUDY OF P R O L O N GE D FA S T I NG .

organ ism co n tinua lly losin g w eight from th e b e ginnin g to th e end of

th e p e riod of fastin g Furth e rmor e we c an t ell with a r e aso n abl e
.
,

d e gr ee of accuracy th e charact e r of these loss es and thus s ecur e some

in dicatio n as to th e probabl e composition of th e huma n body at th e
b e ginni n g and th e end of th e fast .

As th e fast co ntin u es th e cha ng es in th e body w e ight show a loss

,
-

of b ody mat erial I t has b ee n d emo nstrat e d in previous fasti n g

.
,
1
studi e s that at th e b e ginnin g of a fast this loss co nsists in larg e part
,

of wate r much of which is preforme d wat er D uri ng th e first two

, .

days of th e fast th ere is unqu e stio nably a furth e r loss of s e veral hu ndre d
grams of c arbohydrat es in th e form of glycogen Subs e qu e ntly th e .
,

loss is of fat ; th e re is also a fairly re gular loss of protei n from day to

day but afte r th e first few days of th e fast th e loss is chie fly fat and
,

wate r Thus th e first 5 kilograms lost from th e body in a 3 1 day fast

.
-

would c ertain ly be of gre at l y d iffe r ent compositio n from th e last 5

kilograms lost Th e compositio n of th e orga nism is th ere fore no t th e
.

same o n th e t e nth day of fastin g for i nstanc e as o n th e first day an d , , ,

vari e s co nsid e rably as to th e a b solut e amou nts of fat carbohydrat e , ,

an d prot ei n Co ns equ ently to compare th e metabolism o n th e basis

.
,

of b ody w eight is who l ly i llogical and although this m etho d of compari

-
,

so n is habitually us e d by ma n y writ e rs it is c e rtai nly inco nsist en t with ,

th e i r knowl edge of th e charact er of th e body loss es .

Th e charact e r of th e body mat erial lost may be d e t e rmi ne d with

co nsid erabl e accuracy Th e loss of prot e in may be comput ed from th e
.

nitrog e n fou n d in th e urine ; th e loss of car b ohydrat e an d fat may be

compute d from th e respiratory quoti e nt and th e carbo n dioxid e pro
du c ed or th e oxyg en co n sum e d makin g due corr e ctio n for th e carbo n ,

dioxid e produc e d and oxyg e n co nsume d in th e combustio n of th e pro

t e in ; th e amou nt of wat er lost may also be fou n d by mod ern t e ch n iqu e .

B ut in co nsid e rin g chan ges in th e m e tabolism we are d eali n g no t with ,

th e mat e rial lo st from th e body but with th e b ody mat e rial r emai nin g ,

in th e orga n ism and to d e t ermi ne th e compositio n of th e body at any

,

given p eriod has b een fou nd v ery difficult Wh il e it may be r e aso nabl e .

to attribut e any d ifferen c e in th e total m e tabolism for th e first an d

thi rty fi rst days of th e fast to th e metabolism that wou l d normally
-

b e l o ng to th e mat erial lost this will be tru e o nly wh en we are ,

assure d that th e livin g tissu e in e ach cas e had pre cis ely th e sam e effi
c iency as to th e productio n of h e at an d th e main t e n a n c e of th e vital

proc ess es .

C e rtain e vid en c e that has b een brought forwar d in d iscussi n g th e

puls e rat e and particularly th e compariso n of th e metabolism for a
-
,

subj e ct lying awak e and lyin g asl eep l e ads us to b e li e ve that th e re are ,

in flu en c es affe ctin g th e total he at productio n e ntir ely asid e from th e -

,

organiz e d mass of h e at producing mat erial -

Thus we may no t say .

B nedi t C a n gi I n t Wa h Pu b 7 7 1 90 7 p 4 68
l
e c , r e e s . s . .
, , . .
35 6 A STUDY OF P R O L O N GE D FA S T IN G .

Th e curv es for th e body w eight will be r ecogni z e d as com p arabl e to

-

thos e giv en in figur e 3 (page although it will be not ed that in thes e

two charts th e p erc e ntage of loss in b ody w eight is p l ott e d whil e in fi g
-
,

ure 3 th e actual b o d y w e ights are plott e d

-
T h e total h e at productio n
.
-

and th e tota l carbo n d ioxi d e pro d uctio n for 24 hours fell r apidly for
'
-

th e first 3 d ays with dog N o 2 an d for 7 d ays with dog N o 3

. Th ere . .

AWROROWS EXPERIMENT No 2
'

. .

Y
DA S OF FAS T o 10 IS 20 25 30

O%

4 0 0 CAL

FI G 4 5
. Co m pl e te m etabo li sm ch art o f fastin g do g (Aw o ro w No
.
- r .

Th e c al o i es fro m fat m ay be fo u n d by d ed u c ti n g th e c alo ri es fro m pro te i n fro m

r l
th e to ta
c alo ri es as in d ic ated by th e sc al e.
 T HE RE S P I R A TO R Y E X CH A N G E . 3 57

AWROROWS ExpERlMENT NO3

’

D AY S o r FA S T s is 20 25 so 35 40

FI G 4 6 —
. C o m ple te m etabo lism ch art o f fasting do g (Awro ro w No
.
.

Th e c al o ri es f o m fat m ay be f o u n d b y d e d uc ti ng th e c al o ie s fro m pro tei n fro m

r r l
th e to t a
c alo ri es as i nd ic ated b y th e sc al e
.
3 58 A STUDY OF P R OLO N G E D FA S T ING .

aft er th er e was a p erio d of 4 or 5 days of equal productio n and sub

s equ e nt l y a mor e or l ess r e gular fall u ntil th e end of th e fastin g p eriod .

I t is thus s ee n that th e organisms of th es e dogs act ed no t u nlik e that of

our fastin g m an that is th e total h eat productio n and th e total carbo n
, ,
-

dioxi d e output d ecreas ed with g en eral re gularity as th e fast progress ed .

On th e oth e r ha nd in both e xp e rimen ts th e curv e s for th e carbo n

, ,

dioxi de and h e at productio n per kilogram of body w eight ris e with

- -

gre at r e gularity throughout th e e ntir e fast fallin g o nly o n th e last 2 ,

or 3 days Unfortu nat ely Awro ro w do e s no t giv e th e puls e rate but

.
,
-
,

from th e curv es for th e t emp erature given in th e upp e r part of th e

ch arts it will be s ee n that th e sharp fall in th e last few days of th e fast ,

in both th e total h e at productio n and th e h e at productio n per ki l ogram

- -

of body w eight was coi ncid ental with a rapidly fall i ng t e mp eratur e
-
,
.

S in c e both d ogs di e d it is probabl e that th ey w er e in a moribu n d c o n

,

ditio n in th e last day or two of th e e xp e riments On th e oth e r ha n d .

,

it is of in t erest to n ot e that th ere was n o app e ara n c e of a pre mortal

ris e in th e nitroge n e xcretio n .

S in c e th e s e d ogs had a un iform e xt e rn al muscular activity duri n g

th eir stay in th e r espiratio n chamb e r and probably a u n iform i nt ern al
muscular activity we d eal h er e o nly with th e relatio nship b e tw een
,

c e llular activity and th e total body w eight Th e i n cr e as e in th e car -

.

bo n—dioxid e an d th e h e at productio n per kilogram of body w eight - -

foun d in th es e exp erime nts indicat e s most stro ngl y a resistan c e to

d estructio n of th e h e at producin g m ec ha n ism in th e body which was
-

wholly disprOpo rt io nate to th e loss e s in body w eight I t is thus s een -

.

that in th e e xp eriments with th es e dogs in which th e m e tabolism was ,

u naffect e d by muscular work or by th e ing estio n of food this distin ct ,

co ns ervatio n of orga ni z e d mate rial had a mark e d i nflu en c e ; accordi ngly ,

th e h e at productio n per ki l ogram of bo d y w eight was not co nsta nt

- -
,

but as a matt e r of fact i n creas e d as th e in ert wat e r and fat w ere lost
, ,
.

S uch i d e a l co n d itio n s for e xp erim e nti ng are obviously impossibl e with

m e n an d e v e n with Awro ro w s dogs th er e was th e disturbi n g e l em en t of
’
,

fa ll i ng body t e mp eratur e o n th e last few days which affect e d pro

-
,

fo u n dly both th e tota l h e at output an d th e h e at output per kilogram - -

of body w eight S i nc e how e ve r it is th e custom of writ ers to give

-
.
, ,

th e h e at pro d uctio n pe r ki l ogram of body w eight it has b ee n ne c essary

- -
,

to u se thi s basis in computi ng th e m etabo l ism for th e exp eriment with

L in ord er that th e valu e s may be compara b l e with thos e of oth er
.

i nve stigators Th e resu l ts of th es e computatio n s are give n in ta b l es

.

5 2 5 3 and 5 4 which S how th e m e tabolism per kilogram of bo d y w eight

, , ,
-

p e r mi nut e for th e e x p e rim e n ts with th e b e d ca l orim e t e r a n d with t h e

r espiratio n apparatus In th e b eli e f that a qu e stio n of such fu n d a

.

menta l importan c e shoul d be co nsi dere d from e v ery standpoi n t no t ,

o nly th e av erage r esu l ts are give n for th e bed ca l orime t e r e xp eriments -

(see tab l e but also t h e r e sults for t h e mi n imum p e rio ds o b tai n ed

with that ap p aratus (see tabl e Th e valu e s for th e morni n g experi

m en ts with th e r es p iratio n apparatus are given in tabl e 5 4 .
360 A STUDY OF P R O L O NG E D F A S T ING .

productio n per kilogram of bo d y w eight ra ng e d from c c per min -

. .

u te (th e e xtraor d i n ar i l y hi gh valu e fou n d o n May 1 7 1 8 ) to cc —

. .

pe r minut e o n th e tw e nty fourth day of fasti n g E xcluding th e days -

.

with food th e hi gh est va l u e fou nd was o n th e first night of th e fast

, ,

n am ely ,
c c per mi nut e T h e valu e s show a disti n ct t end en cy to
. . .

fa ll u nti l th e fourt eenth day of th e fast with a subs equ ent e ss ential l y ,

co nsta nt pro d uctio n of car b o n dioxid e u ntil th e tw enty S ixth day -

.

From that t ime u nti l th e e nd of th e fast th e carbo n dioxid e pro d uc -

tio n t e nd s to be somewhat hi gh er per kilogram of body w eight -

.

Th e high e st valu e for th e oxyg e n co nsumptio n was fou nd o n April

1 0 1 1 th e fi rst n ight which th e subj e ct S p ent i nsid e th e r es p iratio n
—
,

cham b e r i e ,
c c pe r minut e and th e low e st valu e was
. .
,
. .cc , . .

o n th e tw e n ty fir st n ight of th e fast -
E xclu d i ng th e p e riods wh en food .

was tak e n th e high est valu e

,
c c was obtai ned o n th e s eco n d ,
. .
,

ni ght of th e fast T h e oxyg e n co n sumptio n per kilogram of b ody

.

w eight fo ll ow e d a cours e which was n o t u nlik e that of th e carbo n

dioxid e productio n that is a p ers ist ent fall u ntil th e fourt ee nth day
, ,

of th e fast and th e re aft er an approximat e co nsta n cy with a t end ency

, ,

towar d a ris e from th e twe nty sixth day to th e e nd of th e fast -

.

I n th e pr e vious com p a riso n of th e pu l s e rat e and th e total m e tabo -

lism it was fou nd in th e latt e r part of th e fast that th e re was a te n

, , ,

de nc y fo r th e puls e rat e to ris e which was u naccompa ni e d by an i n cre ase

-

in th e total car b o n dioxid e output and oxyg e n i ntak e -

Wh en th e .

valu e s are comput ed o n th e basis of pe r kilogram of body w eight th e -

,

cours e of th e car b o n dioxid e and th e oxyg e n is fou nd to be striki ngly

-

similar to that of th e puls e rat e A t this poi nt o ne n otic e ab l e a nomaly -

.
,

in th e oth e rwis e nearly co nsta nt r elatio nship b e tw e e n th e puls e rat e -

an d th e m e tabolism should be e mphasi z e d On th e last n ight of th e .

fast th e oxyg e n c o nsum p tio n was

,
c c per ki l ogram per mi nut e . .
,

wh il e th e p u l s e rat e was 5 7 On th e s eco nd night th e re aft er (namely

-
.
,

o n May 1 6 1 7 ) th e oxyg e n co nsumptio n was somewhat l e ss b e i n g o n l y

—
,

c c pe r mi nut e w h il e th e re was an i ncre as e of 7 b e ats pe r mi nut e

. .
,

in th e pu l s e rat e This di screpa ncy is in part e xplai ne d by taki ng

-
.

i nto co nsi d eratio n th e d iff er e nc e s in th e calorific va l u e of oxyg en with

th e diff e re n t r e spiratory quoti e nts ; b ut w e stil l hav e a discrepa n cy
which is striki n g th e o nl y o ne of any magnitu d e n ot e d in th e lo ng s eri es
,

of obs e rvatio n s I ts e x p l a natio n is n o t S im p l e

. .

Th e av erag e valu e s fou n d throughout th e night are complicat e d by

varyi n g co n d itio n s of s l eepi n g waki ng and som e muscu l ar activity ; , ,

h e n c e for th e most accurat e compariso n u se shou l d be mad e of th e

, ,

valu es give n in tab l e 5 3 which r epre s en t th e m etabo l ism per ki l ogram ,

of b ody w eight in th e mi nim um p eriods of th e night With this b asis

-
.

of com p ariso n we fi nd that in c e rtai n i n sta nc e s th e carbo n dioxi d e -

productio n do es n o t fo l low clos ely th e oxyge n co nsumptio n but th e ,

g ene ral picture of th e progre ss of th e meta b o l ism duri n g th e fast is no t

 THE RE S PI R ATO R Y E XCH ANG E . 36 1

alt er e d by th e s e few discr epa n ci e s Th e puls e rat e s giv en in tabl e 53 .

-

should be us ed with co nsi derabl e r e s erv e si n c e it is di fficult to s el e ct ,

th em i n t ellig ently o n this basis as th e minimum p eriod for th e puls e ,

rat e may n o t hav e b e en coi ncid en t with th e minimum p eriod for eith er
th e carbo n dioxid e productio n or th e oxyg en co n sumptio n
-
I t is .

safe to co n clud e how ev e r that th e gen eral tren d of th e puls e rat e is

, ,
-

such that its u se in this genera l compariso n is n o t illogical .

T ABL E 53 Mi nimum metab olism per kilogram of body weig ht and per square meter of body
.
— -

surfac e (Meeh ) i n experi me nts wi th L (B ed calo imeter at n igh t ) . r .

Mi n i

D a te .

of fa st .

( su bj e c t

19 12
Apr . 1 0— 1 1 2

2 1 — 22
2 2— 23

25 — 26

2 7— 2 8

A pr 3 0 — M ay 1
. .

1
S ee p ag 1 1 2 e .

u bj e c t h ad at n as u sual d u in g t h e day
2
The s e e r .

8
Th e fa t wa e nd e d wi th th e takin g o f fo o d o n th e m o nin g o f May
s s r 15 . T he su bj c t at
e e at
i n terv al t h o u gh ut th e ub e q u e n t d ay
s r o s s s.
36 2 A STUDY OF P R OLO N G E D FA S T I NG .

Th e high est valu e for th e carbon dioxid e production duri ng th e -

minimum p e riods 18 fou n d as with th e av erage valu es o n th e last day , ,

of th e e xp e rim ent May 1 7 1 8 b ein g 3 64 c o per minute Th e low est

,
—
,
. . . .

valu e is c c o n th e tw enty first day of fastin g D isre garding th e

. .
-
.

days with food we th en fin d th e high est valu e to be

,
c c o n th e . .

s e co nd day of th e fast Th er e is a g e neral t e n d ency for th e carbo n

.

dioxid e productio n per kilogram of body w eight to d ecreas e u ntil th e -

fo urt ee nth day wh en th e re is a mark ed fall ; from that time till th e end
,

of th e fast th e carbo n dioxi d e production r emai ns ess e ntially co nsta nt

-
,

with th e exc eptio n of th e low valu e foun d o n th e tw e nty fir st day of -

fasti ng and th e high valu es o n th e tw enty e ighth and thirty fi rst days - -
.

Owi ng to th e ma ny difficulti es in d e t e rmini ng th e oxyg en c o nsum p

tio n in short p e riods diffi culties which hav e alr eady b ee n em ph a
—

l
siz ed th e s el ec tio n of th e mi ni mum p e rio d s for th e oxyg en c o nsum p
—

tio n is no t e asy and h enc e we must not e xp ec t to fi nd th e r e gularity

in th es e valu es that we should fi nd in th e valu e s for th e carbo n dioxid e -

output Th e figures giv e n in tabl e 5 3 hav e how eve r b een s el e cted

.
, ,

with due care for accuracy Th e valu es ra ng ed from . c c for th e . .

first night th e su b j ec t sp ent in th e chamb er to c c for th e tw enty . .

first night Th e high e st v alu e fou nd for th e fasti ng p eriod was

.

c c o n th e s eco nd night of th e fast Whil e th ere is a g eneral t end ency

. .
,
.

for th e oxyge n valu es to d ecre as e for th e first 1 5 days of th e fast and

th ere aft e r to re main ess entially co nstant o ne may hardly g e n eraliz e ,

from such irre gular fi gur es .

Th e puls e rat es whi ch are tak e n from tabl e 6 show a r e gular fall
-
, ,

un til th e fourt ee nth day wh e n th ere is a drop of 3 poi nts Th e puls e

, .

the n stays at th e low valu e of 5 0 or 5 1 u ntil th e tw enty third day an d -

subs equ ently shows a d efi nit e t e nd e ncy to i ncre as e slowly Th e puls e .

curv e is th ere fore no t strictly parall e l to that for th e carbo n dioxi d e -

productio n per kilogram per mi nut e Th e discrepa n cy pre viously .

foun d in th e relatio ns hi p b e tw ee n th e puls e rat e and th e av erag e oxy -

g e n co n sumptio n also app e ars in t h e va l u e s giv e n h e re for th e mi n imum

p e riods Thus o n th e last night th e oxyge n co nsumptio n was

.
,
cc, . .

p e r mi n ut e a n d th e pu l s e rat e 5 4 ; o n t h e s e co n d night with food th e

-
,

oxygen valu e was o nl y c c l e ss or c c wh ereas th e pu ls e rat e

. . . .
,
-

i ncre as e d 6 b e ats per mi nut e S i nc e it was n ot ed that th e mi nimum .

va l u es for th e body t emp eratur e w e re n o t strictly comparabl e with th e

-

m e tabolism o n this basis we hav e no t i nclud e d th es e valu e s in this tab l e

, .

ME TAB O LI S M PE R ODY W EIG HT I N R ES PI RA TI O N APPA RAT US Ex RI ME NT s

KI LO G RA M OP B - - PE .

Th e difli cul ties in compari n g th e valu es obtai n e d in th e bed ca l ori

m et er exp erime nts due to th e varyi ng co n d itio ns of waki ng sl e epi ng
, , ,

an d som e muscu l ar activity disap p e ar wh en we co n sid e r th e valu e s ,

obtai ne d in th e e xp eriments with th e re spiratio n apparatus In th es e .

1
S ee p ag e 3 24 .
 3 64 A S TUDY OF P R O L O NG E D F A S T ING .

As in th e calorim e t e r expe rim en ts , we agai n fi nd th e highe st record

fo r th e car bo n dioxid e productio n in th e
-
l ast obs ervation of th e s eri es ,

n am e ly , c c per mi nut e o n May 1 8 Th e low e st r e cord was

. . .

c c per minut e o n May 2 D isr egardin g th e food days we fi nd th e

. . .
,

high est valu e of c c pe r minut e o n April 1 5 at th e e nd of th e first

.
,

day of fastin g Th e cours e of th e car b o n dioxid e excretio n per minut e

.
-

was re marka b ly re gul ar in th e first part of th e fast th ere b ei ng an ,

almost st e ady fall u ntil th e minimum valu e was r each e d o n May 2 ; .

su b s eq u e n tly th ere was som e fluctuatio n with a g e neral t en d en cy ,

toward a sli ght ris e .

Th e hi gh e st valu e for th e oxyge n co nsumptio n d uri ng th e fasti ng

p e riod c c ) was also fou nd at th e e nd of th e first fasti ng day and
. .
,

th e low est c c ) was re ach ed o n th e tw e nty third day Th e cours e

. .
-
.

of th e oxyge n co nsum p tio n was in a larg e m easur e parall el with that

of th e car b o n dioxid e productio n th e valu e s showi ng a slight t e n d en cy
-
,

toward a ris e duri n g th e last w e ek .

I t is of sp e cial in te re st to not e that th e curv e for th e puls e rat e pre -

par e d o n t h is basis fo llows with remarkabl e fid elity th e curv es for th e

carbo n dioxi d e output and oxyge n co nsumptio n a l though th e positive
-
,

differe n c es in th e p uls e rat e aft e r th e t enth day of fasti ng are v e ry small

-
,

th e min imum va l u e b ei ng 5 6 and th e high est 63 Our r e c en t experi .

e nc e in thi s laboratory with th e photographic r e gistratio n of th e pu l s e

rate and partic ularly with th e d uratio n of th e puls e cycl e l e ads us to

,
-
,

b eli ev e that our i na b ility to s ec ur e re gistratio n of th e puls e rat e o n -

accoun t of th e bre akin g of th e stri n g galva nomet er was a loss much

gr e at e r tha n was re ali z e d at th e time of e xp erimentatio n Th e puls e .

rate rec ords w ere mad e with as gre at accuracy as wou l d or d i narily
be e xp e ct e d with th e st e thoscop e b ut th e diffe re nc e s are so sma l l that ,

photographic r e gistratio n woul d hav e b ee n most d esirabl e .

C O N C L US I O NS RE GA R DI NG THE ME TAB OL I S M PE B KI L OG RA M o r B O DY W E IG HT - .

I n th es e thr ee s eri e s of compariso n s it will be s ee n that th e m e tabo

lism pe r kilogram of b o d y w e ight f el l rapidly duri ng th e fi rst half of th e
-

fast , th e n r e mai ne d co nsta nt for a time , an d duri n g th e last w ee k

usually i n cr eas ed slightly D uri n g th e entire fasti ng p e rio d th e b ody
.

lost kilograms of b ody mat e ria l of which (accor d i n g to our b est ,

e stimat e s ) th e re w er e ki l ograms of wat er 20 1 grams of carbo ,

1
hy d rat e ,
grams of fat and grams of prot ei n I t is cl e ar
, .
,

th e refor e that a co nsid erab l e proportio n of th e loss or

, per c e nt , ,

was mad e up of mat erial oth er than prot ei n I t has commo n l y b een .

b e li e v e d that th e h e at produci ng orga nism of th e body co nsists in larg e

-

p art of prot e i n Un d e r th es e circumsta nc es we shou l d exp e ct th e

.
,

h e at pro d uctio n per kilogram of body w eight to i ncr e as e as th e fast

- -

progr ess ed for th e total l oss of mat erial was much great er in proportio n
,

tha n th e loss of activ e protoplasmic tissu e could hav e b e en .

s t bl 2 6 1 6 2 and 6 3 l
ee a es , , , .
 TH E RE S P R I AT O R Y E XCH ANG E . 365

An xami natio n of th e re cords of th e puls e rat e shows how ev er that

e -
, ,

a n oth er f actor i n flu en c e d th e metabolism name ly th e stimulus to th e , ,

i n t ern al muscular activity or th e muscl e to nus T h e e xact natur e o f .

this stimulus is difficult at thi s tim e to stat e S hort p eriods of fasti ng .

hav e shown th e pr es en c e of acidosis an d an acidosis exp erim entally ,

i n duc e d by givi n g a carbohydrat e free di e t has b ee n fou nd to in cre as e-

l
th e m e tabolism On th e oth er ha n d it is k nown that diab e tics tol erate
.
,

a co n sid erabl e acidosis without gr eat i n cr eas e in th e m e tabolism an d ,

th e th e ory has b een adva n c e d that th e diab e tic orga nism b e com e s
imm u ne to or re acts l ess vigorously to th e stimulus of th e acidosis 2
.

Wh il e there was u n qu e stio n ab l y an acidosis in th e 3 1 —day fast it ,

is highly probabl e that its i n flu en c e upo n th e metabolism must hav e

b e en practically co nstan t or co ntinual l y d ecre asi n g N e v erth el e ss .
,

duri n g th e last w e ek th er e was a distinct in cr e as e in th e puls e rat e -

,

accompa ni e d by a co nsta ncy in th e m etabolism thus givi n g strikin g ,

e vid e n c e that th e orga ni sm w as b e i n g i n flu e n c e d by som e factor of an

i nt e rn al n atur e This co nsta ncy in th e total m e tabolism may possibly

.

accou nt for th e i n cre as e in th e metabolism per ki l ogram of bo d y w eight -

duri n g th e last w e ek of th e fast which is similar to th e striki n g i n cre as e

,

obs e rve d throughout th e e ntir e fasti n g e xp erime nts with th e dogs

stu d i e d by Profe ssor Awr o ro w .

D uri n g th e first 14 days of th e fast th er e was c ertai nly n o co nstan cy

b etw een th e carbo n d ioxid e output an d th e body w eight for th e
- —
,

carbo n dioxid e output per kilogram of body w eight was co nti nually
- -

d e cre asi ng Th e fact that for two w eeks or mor e th e carbo n dioxid e
.
-

output and th e oxyg e n i ntak e per kilogram of body w eight r emai ne d -

co nstant shoul d no t be tak en as a d emo n stratio n of an i n timat e r ela

tio n sh ip b e tw e e n body w eight an d m eta b o lism si n c e th e m etabolism
-
,

had a t en d ency to i n cre as e duri n g th e last w eek A more i nt e ll ig en t .

i nt erpr etatio n of th e ph en omena would be that th e total m etabo l ism

d ecr eas e d by virtu e of th e fact that th ere was a d e creas e no t o n l y in th e
siz e of th e h e at produci ng orga nism but in th e i n t ensity of th e c ellular
-
,

activity as was i ndicat ed by th e puls e rat e Wh en this activity was

,
—
.

i nc re as e d then th e r el atio nship b etw een body w eight an d m e tabolism

,
-

was e ntir el y obscur e d I f it w er e possibl e to hav e an e xp erime n t in

.

which th e puls e rat e r emai ne d co n stan t an d th e chan g e in bo d y w eight

- -

was whol l y du e to i nert mat erial th en th e valu es for th e h e at productio n

,
-

per kilogram of body w eight coul d logica l ly be compar e d

-
.

Th e d e cr e as e in th e tota l h e at productio n as th e fast progr e ss e d was

-

th er efor e o nly in part due to th e fact that th er e was a d e cr e as e in th e

S iz e of th e h e at produci n g orga nism
-
With a co n stan t siz e of orga nism .
,

as would obtai n o n any given exp erim en tal jday duri n g th e fast th er e ,

stil l w er e mat erial diff er enc e s in th e h e at productio n an d th e i nt ensity

of c el l ular activity which w e re e vi d enc e d by th e chan g e in th e puls e
rat e an d by th e accompanyi n g n otic e abl e i n cre as e in th e m etabo l ism .

l
B n di t and J l in C a n gi I t W a h Pub 1 7 6 1 9 1 2 p 1 25
e e c os , r e e ns . I bid p 1 3 4
s . .
, , . .
2
.
, . .
366 A S T UDY OF P R O L O N GE D FA S T I NG .

Whil e th er efore th e computatio n of th e me tabolism o n th e basis

, ,

of per kilogram of body w e ight is justifiabl e as a gross i nd e x of th e -

probabl e metabo lism of th e orga nism for th e prop er i n t e rpr etatio n of ,

th e valu es fou n d in this r ese arch this m e thod of computatio n is wholly

without avail I t is furth e rmore of gr eat importanc e to not e that
.

th e l e v el of in t ensity of m e tabolism in any giv e n orga nism may hav e

e qual if n o t in d e e d gr e at er in flu e n c e upo n th e total m e tabolism tha n
, ,

may th e bo d y w eight I t is illogical th er efore to compar e subj e ct A with

-
.
, ,

a p uls e rat e of 7 0 with subj e ct B with a puls e rate of 70 an d assum e

- -

that th e m etabolism per kilo gram of body w e ight should be th e same -

.

On th e othe r ha n d subj e ct A with a puls e rat e of 7 0 will almost , ,

-
,

i nvariably have a hi gh er m e tabolism than with a puls e rat e of 60 -

.

E vid e n c e with r e gard to th e i n flu enc e of lo n g co nti nu e d chan g e s in -

th e body w eight e ith er as a re sult of fastin g as a r e sult of dimi n ish e d

-
, ,

di e t in ob e sity cur e s or as a result of th e i n cre as e d di ffe re nc e of body

,

mate rial follo wi n g p e riods of fast ing are thus far too few to e nabl e us ,

to mak e g eneral d eductio ns Th e e normous addition of nitrog en .

1
to th e body in th e exp eriments of Mu ell er without a corre spo ndi ng
i ncre ase in th e me tabolism per kilogram of body w eight suggests a -

lin e of re s e arch that sho ul d prove most profitabl e This fundamen tally .

importa nt obs e rvatio n should c e rtai nly be r ep e at ed an d with e ve ry

co n trol I t is su ffici e nt h er e o nly to poi nt out that whil e custom has
.

sa nctio ne d th e ge neral usage of th e method of computi n g th e m e tabo

lism o n th e basis of per kilogram of b ody w eight such computatio n -
,

c an hav e but li ttl e sig nifi ca n c e wh e n a care ful sci e ntific a n alysis of th e

re su lts of me tabo lism e xp e riments is d esir ed .

ME TAB OLI S M
QUARE MET ER O F B O DY S UR FAC E PE R S - .

S inc e th e h e at productio n of an a nimal body vari e s as to its siz e

-
,

physiologists hav e lo n g sought to e stablish some r elatio n ship b e tw een

’
th em One of th e e arli e st vi ews was that primari l y bas ed upo n N ewton s
.

2
law of cooli n g ; this is se t forth in th e simpl est form by B ergma nn
to th e e ff ect that th e su rfac e of th e body is a much more logical factor
for co nsid eri ng th e n ee d s for h eat productio n than any oth er -
.

B ergmann s origi n al discussion is of i nt erest h ere :

’

“
Die Obe rflach e ist e in e inf acher u nd gen au z u e rmitte l nd er Facto r fu r die
Warm everluste d essen W ert h z usammengenommen mit der B eschaffe nheit
, ,

dieser Obe rflach e (B e d e c kung mit H aaren u s der D ifferenz z wi sch e n . .

Tempe ratur des T h ieres und des umgeb en den Me di ums und B eschaffe nh eit
dieses Me dium s (o b e s Luft O der W asser ist) die Warm everluste b estimmt .

“
D as Vo l umen des Th ieres d agegen wird als e in Maass fur die m Oi ch e
Warm ebildung b etrachtet werd en k ennen G ewi ss ist in gl ei ch em Vo l um en .

so wo h l ve rschie d en e r Thie re als auch d e sse lb en T hi e re s z u ve rschie d e ne r Z e i t

die Warm ebildung sehr ve rschi e d en Ab er m an wi rd e s nicht gewagt fi n de n .
,

l
Mu ll Z t lb f d g
e er, Ph y i l Path d S t fi 1 9 1 1 6 p 6 1 7
en r . . . es . s o . 11 . . es o , , . .

2
B gm ann U b
er die V h altni , d W a m k n mi d Thi
e er u ih erG ea G ift
sse er r eo o o e er ere z re r r se

ti n g n 1 84 8 p 9
e . . . .
 368 A ST UDY OF P R O L O NG E D F A S T ING .

to th e
fact that th e h e at pro d uci n g orga nism of th e b o d y of which -
,

th e bloo d volume is probably a fair i n d e x b e ars a similar r e latio n to ,

th e law of growth as do e s th e body surfac e -

.

I t was b e l i ev e d that furth er i nformatio n mi ght be s ecure d o n this

importa n t poi nt in th e e xp e rime n t with th e fasti ng m an an d si n c e th e
‘

h eat pro d uctio n an d lik ewis e th e oxyge n co nsumptio n an d carbo n

-

dioxi d e productio n are d iscuss e d by ma ny physio l ogists o n th e basis

of per square me t e r of b ody surfac e such a form of computatio n has -
,

b ee n us e d h er e th e valu e s b ei ng giv e n in tabl es 5 2 5 3 and 54

, , ,
.

With th e fasti ng m an w e hav e a h e at producin g organism which is -

co nti nually d e cr e asin g in w e ight and co ns equ e ntly should decre as e in

surfac e I n ou r ca l c ulatio n s it h as b ee n assume d that th e u sual
.

formula for computi ng th e body—sur fac e nam ely that of M e ch in , , ,

x/ W hol d s for e ach w eight as

a ?
which th e surfac e is equal to ’

th e fast progr ess e s I n form er publicatio n s from this laboratory in d is

.
,

cussin g th e me ta b olism o i gr e atly emaciat e d pati ents particularly ,

diab e tics th e co nt e ntio n has b ee n ma d e that ther e may be a lack of

,

proportio n b e tw ee n body w e ight and body surfac e which is no t cor - -

r ec tly co n sid e r e d by this formula B ut with this fasti ng m an as has .

,

b ee n po i nt e d out previously and i nd e e d with diab e tics stu d i e d in this ,

l aboratory th e re h as b een no evi d e nc e that th e ski n did no t shri nk

,

in proportio n to th e loss in w eight i n asmuch as th ere was n o fo l di n g of ,

th e ski n whi ch i ndicat e d such a disturba n c e in th e r elatio nship .

l
R ubner in his e xp e rime nts o n a fat boy an d a thi n boy fou nd that
, ,

by computi ng th e surfac e of th e thi n boy by B ouchar d s formula h e ’

o b tai ne d sq cm i nst e a d of sq cm as comput e d by th e

. . . .

M e ch formula With th e fat b oy th e discr epa n cy was much gre at er th e

.
,

B ouchard formu l a givi ng sq cm and th e Me eh formula . .

sq cm I n any e ve nt th e maximum error was o nly about 7 per c e nt

. . .

F or th e sak e of argum ent it may be co nsid er ed that o n th e fi rst day ,

of th e fast th e bo d y surfac e of th e subj e ct L was pro p er l y i n d icat ed

-
.

b y th e Meeh formu l a but judgi n g from R u b ner s e xp e ri en c e with his ,

’

fat boy th e M ec h fo rmula would give too high a valu e As th e fast

,
.

progr e ss e d th e error with th e M ee b formu l a woul d b ecome l e ss and

,

l e ss u n ti l towar d th e e n d of th e fast it would giv e th e tru e body

,

surfac e I t mi ght th e n be co nsid er e d that at th e b e gi nni ng of th e

.

e xp erim en t th e com p ut e d valu e for th e body surfac e was actually -

somewhat larg e an d that th e comput e d valu e for th e m etabo l ism per

square m et e r of body surfac e woul d co ns equ en tly be s lightly too sma ll-
.

N e v erth e l e ss th e fact that th e e rror c an n o t be more than 7 to 1 0 pe r

,

c e nt shou l d be bor ne in mi n d Furth e rmore any corr ectio n of this .

,

n atur e wi ll t e n d to rais e th e va l u e s for th e m e tabo l ism per squar e m e t e r

of body surfac e in th e ear l y part of th e fast but wil l n o t affe ct thos e
-
,

fou n d for th e l att er part of th e fast .

l
R ub B i t g u E nah u g im K b n l t m it b d
n e r, e ra e z r B m k i h tig u g d
r r F tt
n na e a er e so n e re r e c s c n er e

su ch t B li n 1 9 0 2 p 4 0
. er , , . .
 T HE RE S P I R A T OR Y E XCH AN GE . 3 69

With this corr ectio n in mi n d a compariso n may be mad e of th e ,

m eta b olism fou n d with th e bed calorime t er an d th e r e spiratio n appa

ratus o n th e basis of per square me t er of body surfac e -
.

ME T AB O L I S M PE R S Q UA R E ME TE R OF B O DY S U - RFA CE IN C A L O R I ME T E R E X PE R I ME NTS .

Tabl e 5 2 giv es th e av erag e metabolism per squar e m e t er of body

surfac e as comput e d from th e valu e s foun d with th e be d calorime te r .

On this basis of computatio n th e carbo n dioxid e productio n ra n g e d

,
-

from grams o n th e fir st night i n si de th e r espiratio n chamb e r to

grams o n th e tw en ty fourth ni ght D isr e gardin g th e food days
-
.
,

th e high e st valu e was grams o n th e first night of th e fast On th e .

last food n ight Of th e o b s e rvatio n th e carbo n d ioxid e productio n was ,

-

e ss en tia l ly as high as it was o n th e first 3 n ights prior to th e fast ,

n am e ly ,
grams per square m e t er per hour .

Co n sid eri n g th e valu e s for th e oxyg en co n sumption per square me t er

of body surfac e we fi n d that it vari e d from
-
,
grams o n th e fir st
n ight i n sid e th e r e spiratio n chamb e r to a min imum of grams o n
th e tw en ty fir st n ight
-
Agai n disr e gardi n g th e food days th e high e st
.
,

valu e obs erv e d is grams o n th e s e co n d n ight of th e fast .

I f th e law ho l d s tru e that th e m etabolism per square m e t er of bo d y

surfac e r emai ns co nstant it is surprisi ng that th e variatio n in th e car
,

bo n dioxid e productio n duri n g th e fast is S O gr e at i e

-
grams to , . .
,

7 69 grams a d e cr e as e of 26 per c ent

.
—
An approximat e l y S imi l ar .

de cr e as e is not e d in th e oxyg en co n sumptio n per squar e m et er of body

surfac e . Co n sid eri n g th e va l u e s for both th e oxyg en co nsumptio n an d
th e carbo n d ioxid e productio n we fi n d that th e gas e ous e xcha n g e per
-
,

square m et e r of body surfac e re main e d ess en tia l ly co n stant from th e

-

fif t e en th day to th e tw e n ty s e v en th d ay of th e fast but in th e last 4

-
,

days the re was a d isti n ct t en d en cy for th e gas eous e xchan g e to i n cr e as e

S lightly e v en o n th e basis of per squar e m e t er of body surfac e
,
Whil e -
.

th e va l u e s w er e no t in comp l e t e u niformity with th e curv e for th e puls e

rat e th ey S how e d a distin ct t en d en cy to follow th e same cours e NO
, .

cl e arly e stabli sh e d r e l atio nship how e v e r c an be fou nd b etw een th e

, ,

body t emp eratur e an d th e metabo l ism per squar e m et er of body surfac e

- -
.

S inc e th e obj e ctio n s pre viously cit e d in r e feren c e to compariso ns of

th e av erag e valu e s for th e gas eous e xchan g e may apply with e qual forc e
in this co nne ctio n th e gas eous e xchan g e per squar e m e t er of body surfac e
,
-

in th e s el e ct e d mi n imum p erio d s may a l so be compar e d o n this

basis Th es e valu e s are given in ta b l e 5 3 Th e carbo n dioxid e pro
. .
-

ductio n ran g e d from g rams o n th e fir st night i n sid e th e chamb er

to grams o n th e tw enty fir st night ; but if th e food days are dis
-

r egard e d th e maximum va l u e was

,
grams o n th e s e co n d night of
th e fast We fin d h er e how ever that th er e is stil l a ran ge of 26 per
.
, ,

c ent in th e me tabolism per squar e m et er of body surfac e e ss ential l y -

,

th e sam e as that S hown with th e av erag e valu e s Th e di fficu l ti e s in .

3 70 A ST UDY OF P R O L O N GE D FA S T IN G .

maki ng prop er s el ectio ns for th e p erio d s for th e oxyg en consumptio n

hav e alr eady b ee n outl ined but we fi nd from such s el ectio ns as we hav e
, ,

b ee n abl e to mak e that th e valu e s per square m et er of body surfac e

,
-

ra nged from grams o n th e s eco nd night of th e fast to grams

o n th e tw e nty first night -
.

A compariso n of th e valu e s for th e gas e ous excha ng e with th e r e cord s

for th e puls e rat e also given in ta bl e 5 3 must n ec essarily be mad e with
-
, ,

re s e rv e owi ng to th e charact e r of th e s el ectio n as point ed out in th e

,

c o m pai i so n of th e valu es per kilogram of bo d y w eight but it will be -

,

not e d that at l e ast durin g th e fi rst part of th e fast th er e was a disti n ct

, ,

te nd e ncy for th e me tabolism per squar e m et er of body surfac e to fo l low -

approximate ly th e curv e of th e puls e rat e I nd ee d e ve n in th es e -

.
,

mi nimum s el ec ted p e riods the re was a t end ency for th e metabolism to

,

ris e in th e last w ee k of th e fast although this t end ency was by no ,

means as pro nou nc ed h ere as in th e valu es giv en in tabl e 5 2 .

MET A BO L IS M PE R S Q UA RE METE R or B O DY S URFA CE

- I N T HE RE S PI RA TI O N -
AP PARA TU S
E X PE RI ME NTS .

Perhaps most satisfactory compar ison is that of th e value s

th e
obtained with th e respiratio n apparatus in th e mor ni ng just afte r ,

th e subj ect came from th e calorimet er chamb er si n c e th e co nditio ns ,

w e re co nstant in all of th e e xp erime nts i e simulta neous m easure ,

. .
,

ments of th e carbo n dioxid e productio n oxyg en co nsumptio n and

-
, ,

pulse—ra te wh e n th e subj ect was without food in th e alimentary tract

,

an d th e re was compl e t e abs en c e of muscu lar acti vity Und er th es e .

co nditio ns th e valu e s given in tabl e 54 show a ra ng e in th e carbo n

dioxid e productio n per square met er of body surfac e from grams -

o n May 1 8 (th e last day of obs e rvatio n ) to grams o n th e eightee nth

day of th e fast D isregardi ng th e valu es for th e food days b efore and
.

aft er th e fast th e maximum valu e of

,
grams is fou nd at th e e nd of
th e first fasti n g day With th e oxyg en co nsumptio n per square me t e r
.

of body surfac e e ss entia l ly th e same r esults are fou n d i e a maximum

-
,
. .
,

of 1 0 80 grams at th e end of th e first fasting day and a mi nimum of

.

8 4 7 grams at th e e nd of th e tw enty third d ay

.
-
.

Th e s e figures i ndicat e that th e meta b o l ism per squar e m et er of body

surfac e t ends d istin ctly to d ecr e as e in u niso n with th e puls e rat e durin g -

t h e first ha l f of th e fast I n th e last 15 days th e fluctuatio n was no t so

.

sharply mark ed though th e re was a t end en cy toward high va l u es in th e

,

last w eek coi ncid enta l with th e s l ight t end en cy to a ris e in puls e rat e : -

C ONCL U S IO NS RE GA R D I NG TH E METAB O LI S M PE R S Q UA R E ME TE R OF B DY S URF

O - A CE .

F rom a co nsid eratio n of th e fundamental the ory regarding th e m etab

o lism per squar e m e t er of body su rfac e it will be s ee n that th e valu e s -
,

shoul d be co nstant assumi ng that th er e is no error in th e formula for

,

computi ng th e bo d y surfac e from th e body w eight B ut eve n if a cor

- -
.
372 A ST UDY OF P R O L O NG E D F A S T ING .

m e tabolism stopp e d fa ll in g an d th e sup erimpos ed factor of an alt ere d

c ellular activity comp ensat e d in part for th e n atural fa l l in th e m etabo
lism which would oth e rwis e hav e b ee n expe ct e d .

S U M MAR Y ULT S RE GAR DING T HE ME TAB OLI S M PE R KI LO G RA M

O F RES OF
B O DY W IG HT A ND PE R S Q UAR E ME TE R O F B O DY S UR FACE
- E - .

I f we att empt to a na l y z e th e pr evailin g vi ews in r e gard to th e m e tab

o li sm with th e progr e ss of a fast we fi n d that in th e first plac e it is ,

b el i e v e d that th e me ta b o lism per kilogram O f body w eight should ris e -

wh en th e gre at e r part of th e loss in w eight is ma d e up of i nert fat and

wat e r S eco n d accordi ng to th e th eory of th e r elatio nshi p b etw een
.
,

th e m e tabolism an d th e body surfac e th e m e tabo l ism per squar e m e t e r

-
,

of b ody su rfac e S hou l d r emai n co nstant

-
.

S O far as th e m e tabo l ism per kilogram of body w eight is co n c erne d -

,

it is ill ogical to attri b ut e th e sam e h e at pro d uci n g valu e to th e body -

su b stan c e whi ch re mai ns as th e body los e s w eight d uri ng th e progr ess

of th e fast and this metho d of comp utatio n may n o t be us ed advan
,

tag eo u sly in co nsid eri ng th e m etaboli sm of a fastin g m an Further .

mor e th e valu es for th e m etabolism per squar e met er of body surfac e

,
-

S how difl ere nc es of approxim at ely 25 per c e n t a r e sult which c an n o t

'

be accoun t e d for in any way by a possibl e discr epa n cy in th e formula

us e d for computi n g th e body surfac e each day F i na l ly th e e vi d enc e
-
.
,

is strikingly in favor of th e b el i ef that th e pu l s e rat e is an admirabl e -

in d ex of th e in t ensity of c ellular activity an activity that plays a v e ry ,

importa n t rol e in i nt erpr e ti n g th e total m etabolism entirely irr espe c ,

tive of body siz e or b o d y w eight

- -
.

An e xaminatio n of th e va l u e s app earing in tabl es 5 2, 53 and 54 ,

S hows that th e r e is a t e n d e n cy for th e m e tabolism to di vi d e i n to thre e

p eriods duri n g th e fast Th e fir st pe riod which e xte nds ne arly to th e

.
,

middl e of th e fast is charact eriz e d by a rapid l y fallin g me ta b o l ism and

,

a rapidly fa ll i n g puls e rat e th e fa l l in th e me tabolism b ei ng shown n o t

-
,

o nly in th e tota l valu e s but in th e va l u es calcu l ate d o n th e b asis of

,

p er ki l ogr am of body w e ight an d of

-
p e r square m et er of bo d y surfac e -
.

Th e s e co n d p e riod of a p proximat ely 1 0 days shows a comparativ ely

l e vel metabo lism per kilogram an d per square m e t er with an appro xi
mat ely l e v e l puls e rat e Th e third and last p eriod or th e last w eek of
-
.
,

th e fast shows a g eneral t e n d en cy toward an i n cr e as e in th e m etabolism

, ,

although this was n o t so appar ent in th e valu e s for th e me tab o l ism

p e r kilogram of bo d y w e ight in th e-
mi n i m um p e riods of th e ca l orim e t e r
e xp erim en ts Th ere was also a disti nct t end en cy toward an i n cre as e
.

in th e puls e rat e in th e last w e ek

-
I t thus app e ars that th e strikin g
.

factor of puls e rat e must co nti nually be recko ne d with e v en with th es e

-
,

co n ditio ns of rapi dl y chan gi n g b ody w eight an d b ody compositio n -

.

A mor e exact stat em ent woul d p erhaps be that th e i n t ensity of c ellular

activity p l ays an important part which is no t s e riously aff e ct e d e ith er
by chan g e s in th e body w eigh t or th e body surfac e - -
.
 TH E RE S P R I A T OR Y E XCH ANGE . 3 73

ELI MINATION OF WATER THROUGH LUNGS AND SKIN .

S in c e th e vaporizatio n of wat er from th e lu ngs and ski n is o ne of th e

importan t m ethods of he at r e gulatio n its d e t ermin atio n was form er l y ,

giv en gr eat att entio n particularly in th e s eri e s of 24 hour r espiration

,
-

e xp e rim en ts carri e d out by A twat er an d his associat e s in Middl etow n ,

Co nn ecticut In th e cours e of th e s e i nv e stigatio ns it b e came appar en t

.
,

that th e wat er thus vaporiz ed was subj ect to co nsid erabl e variatio n
which was for th e most part irr egular in charact er Co ns equ ently a
, , .
,

knowl edge of th e wat er vapori z e d from th e lun gs and ski n per se h as , ,

r elativ ely li ttl e valu e in ordi n ary m etabo l ism studi e s esp e cia l ly with ,

n ormal subj e cts an d as such d e t ermin atio n s are d iffi cult an d e xp en siv e
, ,

they do n o t s eem j ust ifiabl e e xc ept so far as it is n e c e ssary to n ot e th e

,

amou n t of wat er vaporiz e d in th e calorim e t e r chamb e r in or de r to

corr e ct for th e h e at absorb e d in th e vapori z atio n B ut with th e u nu .

su al co n ditio ns obtain in g in th e exp erime nts with L wh en the r e was .

,

a co n stantly S hrinkin g S kin and at time s d isti n ct e vid en c e of a physio

logical nee d o f wat er it s eeme d d esirabl e to d e vot e th e additio nal tim e
,

an d e xp en s e to s e curin g accurat e m e asur e m e n ts of th e wat e r vapori z e d

from th e lu n gs and ski n of this m an duri n g th e tim e h e was in clos e d in

th e calorim e t er cham b e r .

I n th e discussio n of th e atmosph eric co n ditio n s i n sid e th e chamb er of

1
th e be d ca l orim et er th e valu e s w er e giv en in tabl e 44 for th e amou n t of
,

wat er vaporiz ed per hour with du e corre ctio n for th e wat er vaporiz e d
,

from th e wet bulb th e rmomet er This hour l y vaporizatio n of wat er

-
.

vari e d from grams o n th e thi rd night of th e fast to grams o n

th e fif t een th n ight of th e fast An i nsp e ctio n of all th e data in tabl e 4 4
.

shows that th ere was apparently n o co nstan t r elatio nship b e tw een

th e amou n t of wat er vaporiz e d and th e v e ntilatio n of th e chamb e r ; n o r
was th e re a co nstan t r e l atio nship b e tw een th e wat e r vapori z ed an d th e
chamb er t emp e rature for although th e highe st av erage t emp eratur e was
,

obs erv e d o n th e n ight of th e high e st vaporizatio n of wat e r per hour ,

y e t th e first n ight th e subj e ct was i n si d e th e chamb er th e t emp e ratur e

was withi n de gr ee of th e maximum whil e th e vaporizatio n of wat er ,

was o nly grams In maki n g a furth e r compariso n with th e relativ e

.

humidity it S hou l d be n ot e d that th e va l u e s for th e r elative humi dity

,

w ere ca l culat e d from th e total amou nt of wat er vapori z e d Thes e .

comput e d valu es how e ve r agree r e markably w e ll with a numb er of

, ,

valu e s obtai ne d by me a n s of a psychrome t er in th e outgo in g air cur -

re nt although usually the y are a litt l e low e r They may thus be r e l i e d

,
.

upo n as indi cati n g th e g ene ra l cours e of th e re lativ e humi dity duri n g

th e fast . An i nspe ctio n of th e valu e s giv en in tabl e 4 4 shows that th e
relatio nship b e tw een th e re l ative humidity and th e total vapori z atio n
of wat er was approximat ely co nsta nt Th e o nly scien tific u se of th e s e .

fi gures is in maki n g corr e ctio n s for th e he at re quire d for th e vaporizatio n .

See p age 3 2 1 1
.
3 74 A ST UDY OF P R O L O NG E D FA S T IN G .

I t is possi bl e how ev e r to apportio n th e vaporizatio n of wat er b e tw ee n

, ,

th e lu n gs an d th e ski n by usi n g a m ethod bas e d o n th e work of Z u ntz b y ,

mea ns of whi ch th e water vapori z ed from th e lu n gs may be e stimate d .

Duri n g th e o b s e rvatio n s of Z unt z an d his c o work e rs it was e stab -

,

li sh ed that u n d er th e e xp erim e ntal co n ditio n s obtai ni ng e ach cu b ic

, ,

c e ntim et er of oxy g en absorb ed from th e air was accompa ni e d by a l u ng

v e n ti l atio n of 2 1 c c I n th e e arlie r pub l icatio n l givi n g th e results of
. .

th e fast in g e xp e rime nts carri e d out in Mi d dl e tow n Co nnecticut this , ,

fi gure was us ed for computi ng i ndir ec tly th e amou nt of wat er vapor -

giv e n Off from th e lu ngs I n th e s e ri e s of e xp e rime nts with L in which

. .

th e re spiratio n apparatus was us ed accurat e me asur ements of th e lu n g ,

v e ntilatio n accompa ni e d th e d e t e rmi natio ns of th e oxygen c o nsu m p

tio n and co ns e qu e ntly th e relatio nshi p b e tw e e n th e lu n g ventilatio n and
,

th e oxy g e n co nsumptio n may be comput e d for th e s e exp e rime n ts .

From th e re su l ts of th es e computatio ns which are give n in tabl e 55 , ,

it will be s ee n that in th e ext e nd ed s e ri e s of morni ng exp erimen ts th e

lu ng v e ntilatio n per cubic c e ntime t er of oxyge n co nsume d vari e d from
c c to
. . c c th es e valu e s b ei n g mat erially gr eate r tha n thos e
. .
,

obtai ne d in th e O b s e rvatio ns of Zuntz As th e fast progress ed th e r e .

,

was a d isti nct t e nd e ncy for th e lu ng v e ntilatio n per cu b ic c entime t e r of

oxy ge n to i n crease Ob s e rv atio ns w ere also mad e of th e i nflu e nc e of
.

co ndi tio ns othe r tha n that of lyi ng qui e tly in th e morni ng such as ,

chan g e of positio n time of day th e muscular activity of writi ng an d th e

, , ,

inhalatio n of oxyg e n rich atmosph er es all of which i n cr e as ed th e lu n g

-
,

ve ntilatio n per cubic c e nt ime t e r of oxyge n co nsumed This i ncre ase .

was usually no t far from 4 to 5 c c exc e p t that in th e last 3 of th e 6 . .

,

e xp e rime nts with writi n g th e i n cr e as e was approximat ely 9 c c ov e r th e

, . .

lu ng v enti l atio n wh e n th e subj e ct was lyi ng qui et l y in th e mor ni n g .

S in c e th e r el atio nship b etwee n th e lu ng v e nti l atio n an d th e oxyg e n

co nsum p tio n in th e mor ni ng re spiratio n e xp e rimen ts with th e su b j e ct
lyin g qui e t l y is thus w e l l e stablish ed it is no t u nre aso nabl e to assume ,

that th e lu n g v e nti l atio n may in turn be Obtai n e d for th e calorimet e r

e xp e rim e n ts from th e oxyg e n co n sum e d wh e n th e su b j e ct was i n sid e th e

r e spiratio n chamb e r Accordi ng l y usi ng th e oxyg e n co nsumptio n for

.
,

th e night p e rio d s and th e lu n g v enti l atio n pe r cubic c e ntim et e r of

oxyge n co nsume d for th e exp e rim ent with th e r e s p iratio n apparatus
o n th e fol l owi n g mor n i n g th e valu e s for th e v en ti l atio n of th e l u n gs
,

hav e b ee n comput e d for e ach of th e be d calorime t er exp erim e nts -

,

th e r e sults b ei n g re cor d e d in tabl e 5 6 .

Th e air which th e su b j e ct i nhal e d whil e i nsi de th e ca l orim et e r

chamb er o b viously co n tai n e d wat er vapor Th e amo unt i nh al e d may -
.

re adi l y be com p ut e d from th e v enti l atio n of th e l u ngs an d th e p e rc en t

ag e o f wat e r vapor in th e air i n sid e th e cham b e r
-
F or i nsta n c e it wi l l .
,

be s e e n b y r e fer en c e to th e va l u e s giv e n in tabl e 4 4 for th e v e n ti l atio n

B n d ic t C a n gi I n t W a h Pub 7 7 1 90 7 p 4 35
1
e e , r e e s . s . .
, , . .
3 76 A ST UDY OF P R O L O NG E D F A S T ING .

T AB L E 55 — Ventilation of lungs per vo lu me o

f oxy en i n arperi ments with su bject L
(Respi ratio n apparatus) é o ntinued
. .

-
.

Ox yg en
D a‘e '

P i d
er o .

mi n u te .

T o tal p er

3 0 th

l
Periods i ndi cate d by an ast risk were o b tained wi th e th e su b j ec t si tting , wr tin i g .

°
a t em p eratur e of 3 7 C and k nowin g th e v e nti l atio n of th e lungs it
.
, ,

is easy to comput e by m ea ns of w ell kn own tabl e s th e amou nt of wat er

,
-
,

in th e air e xp ir e d from th e lu n gs F or April 1 0 1 1 this was foun d to .

—

be grams Th e amoun t of wat er vapor e liminat e d from th e lungs

.
-

is th er efore th e di ffer enc e b etw ee n th e wat er in th e air i nspire d and

that in th e air expir ed thi s b ei n g grams per hour for April 1 0 1 1
,
—
.

Th e amou n t of wat e r vapor e lim i n at e d per hour from th e lu ngs an d

-

skin i e vaporiz e d in sid e th e calorimet er o n this dat e was

,
. .
,
grams ,

(see column D ) so that th e amou nt of wat e r vapor giv e n o ff from th e

,
-

ski n would be r epre s e nt e d b y th e d i ff e renc e b e tw e en co l umn s D an d E

or grams (column F ) for April 10 1 1 Th e p erc e ntag e distributio n —
.

of th e wat er vapor from th e l u n gs and S ki n has a l so b e en calculat e d

-

an d r e cor d e d in this tabl e in co l um n s G an d H an d fi n a l ly (for r e f er e n c e ) , ,

th e r e l ative humidity is giv e n in th e l ast column of th e tabl e .

°
T h e assum p tio n that th e e x p ir e d air is saturat e d at 3 7 C wi l l n u .

l
u n d ou b t e dl y be q u estio ne d in th e light of th e r e c en t work of L o ewy
2
an d G al e otti N e ith er of th e s e r e s earch e s has how eve r s t oo d th e
.
, ,

t e st of s ev er e criticism an d whi l e u n doubt e d ly th e wat er vapor is ,

-

probably n o t quit e so gr eat as that r epres ent e d by assumi n g th e air

to be saturat e d at 3 7 C n e v erth e l e ss for wan t of fi rml y e sta b lish e d .
, ,

va l u e s for thi s factor we a dh ere to th e o l d er assumptio n I t is furth er

,
.
,

mor e important to n ot e that any e rror in this assumptio n affe cts o n l y

,

th e apportio nme n t of th e wat er vaporizatio n b e tw e en th e lu n gs an d

Lo e wy and G h a t B i ch m Z it h 1 9 1 2 4 7 p 3 4 3
1 er r z, o e . e sc r .
, , , . .

G al tti B i ch m Z it h r 1 9 1 2 4 6 p 1 73
2
eo , o e . e sc .
, , , . .
 T HE RE S P R I A T OR Y E XC HA NGE . 37 7

th e ski n for e ach in dividual night Th e most important compariso n s .

are thos e mad e b e tw e en d iff e r en t days of th e fast an d with th e s e a

co n sid erabl e error in th e assumptio n might be mad e without affe cti n g
th e g en eral d e ductio n .

p
the lungs and skin during ex er iments with L i n the bed
ni gh t
.
(A mo unts per

P o p o rti o n
r .

Fro m Fro m
Daise .
l un gs ski n
. . Fr o m Fro m
( c — B ) ( D — E
) l u ng s . S ki n .

( 2 ) ( I)
110 1 00 EX OO
I

E F

0 0 0 0 0 0 0 0 0 0

2 1 — 22 .

27— 2 8

Apr 3 0— May 1
.

1
Fo r t h e d u atio n o f p e io d s see tabl e 4 4
r r .

2
Cal cul ate d f o m th e o xygen c o n um ptio n d urin g th e nigh t and th e v e ntil atio n per vo l um e o f
r s

o xyg n (tabl e 5 5 ) o b se rve d o n t h e fo ll o win g m o n i n g

e r .

a
c o m pu te d b y m e an s o f th e v entil atio n o f t h e l u n g s (c o l um n A ) an d t h w ate ab so b d pe r e r r e

l i te r o f th e ven til atin g ai c urre nt as c o m pu ted fro m c o l um n s A and B ta bl e 4 4

r- ,
'

, .

‘
I t i s a um e d t h at t h e air e xpi red w as satu ate d an d at a te m pe atu e o f 3 7 C
°
ss r r r .

Se e W ate v apo ri z e d pe h o ur tabl e 4 4

“ " ”
r r , .
3 78 A ST UDY OF P R O L O NGE D F A S T IN G .

Th e apportio nm e nt of th e wat er vapor b e tw ee n th e two paths of -

e xcr e tio n pre s en ts c e rtai n particularly i n t e r e sti n g f e atur es On th e .

4 nights prior to th e fast th e r e was a co nti nual l y d e cr e asi ng p e rc ent ag e

of wat e r e xcre t ed from th e lu n gs u ntil th e low valu e of per c e n t was
n ot ed o n th e l ast night D uring th e fasti ng p e riod th ere was a distin ct
.

t e nd en cy for th e proportio n give n o ff from th e lu ngs to i n creas e grad

u ally and a l though th er e w er e mark e d irr e gulariti e s in this i n cr e as e
, ,

particu l arly o n th e t e nth and fiftee nth nights of fasti ng y e t it may be ,

said that in g eneral th e proportio n Of wat er vaporiz e d from th e lun gs

b ecame gre at e r an d that from th e ski n l ess as th e fast progre ss e d Th e .

apportio nm e nt b e tw ee n th e lun gs and th e ski n do es no t how ev er , ,

l
follow any d e fi nit e law .

An oth er i nt er e stin g compariso n may be mad e b etw ee n th e r elativ e

humidity and th e e xcr e tio n of wate r vapor from th e ski n We hav e -
.

e xisti ng in sid e th e chamb e r an ess e ntially co n sta n t v en ti l atio n an d an

e ss e n tially co n sta n t t emp erature With a low relativ e humidity a .

,

high vaporizatio n of wat e r from th e ski n would be look e d for si nc e o ne ,

wou l d natural l y exp ect wat er to vapori z e more rapidly from th e moist
skin of th e subj ect as th e air surroun di ng th e body b e came dri er 2
We .

fin d how e ve r that th e opposit e is t ru e si nc e th e g ene ral cours e of both

, , ,

th e total amoun ts and th e p erc entag e valu e s follows with approximat e

co nsta ncy th e valu e s for th e r el ativ e humidity th e low e st p erc e ntag e ,

of wate r e xcre t e d from th e ski n i e 26 5 per c e n t o n th e fi ft e enth night ,

. .
,
.
,

b ei ng coin ci d e ntal with th e low e st re lativ e humidity As h as b ee n .

point e d out in a pre vious s ectio n th er e was a slight t e nd e ncy for th e ,

re lative humidity to in crease d uri n g th e latt e r part of th e fast ; thi s was

accompa ni e d in ge ne ral by an i n cr eas e in th e wat e r vaporiz e d from th e
ski n I t may be i nfe rr ed howev er that in g e neral th e bo d y surfac e
.
, , , ,
-

of th e m an b e came small er and th e ski n l e ss and l e ss moist as th e fast

progr ess e d and p erhaps in co ns e qu e nc e l e ss ca p abl e of l osi n g wate r
, ,
.

N v th l th wid va iati
1
e er e ess t d by L
e gl i a d B u g u t ( C m p t nd S B i l
e r o ns n o e an o s n o ssa e o . re . oc . o

1 9 12 7 2 p 9 6 7 ) d
, ,t pp .in t h i f ti g xp i m
o no at ; th m th d h
e ar m pl y d i h w v
s as n e er en e e o e re e o e s, o e er ,

fund m n tall y diff

a e t f m th t m pl y d i th F
eren ch ro ch a e o e n e re n re se ar .

3
W lp t A ch iv f Hygi n 1 90 2 4 1 p 30 1
o er . r . e e. , , . .
3 80 A ST UDY OF P R O L O N GE D FA S T IN G .

us to mak e fairly satisfactory compariso ns I t is cl ear how eve r that .

, ,

th e dir e ct m e asur e m en ts of th e h e at output in this particular s eri e s of

calorime t er e xp erim ents w e r e o nl y i n cid e ntal and no t of prim e impor
ta nc e in this study This is particularly fortunat e S inc e as will be
.
, ,

pointed out lat e r c ertain u n avoida b l e co n ditio ns particularly with

, ,

r e feren c e to th e t emp erature e nviro nm en t in th e calorimet er room ,

vitiated to a co nsid erabl e e xt e n t th e dir ect me asur eme nts of th e heat

output .

P rior to th e arrival of th e subj e ct in B osto n th e accuracy of th e ,

1
a p paratus as to h e at m e as ur e men t had b een r ep eat edly t est e d by
e l ectrical ch e ck t ests in whi ch a d e fin it e amoun t of h e at was d e v e l op ed
,

with an el ectric curre n t of kn own amp erag e and voltag e an d also as ,

to th e accuracy of th e m e asur eme nt of th e carbo n dioxid e wat er vapor ,

-
,

an d h e at produc e d as w ell as oxyg e n co nsum e d by bur ni n g k n ow n

, ,

amounts of alcohol i nsid e th e chamb e r I t was possibl e th ere fore .

, ,

to put th e subj ec t in sid e th e calorime t er imm ediat ely o n his arrival

at th e laboratory and d et e rmin e th e h ea t output o n th e s ev eral nights
pr ec e ding th e fast .

Th e ca l orim et er laboratory is so co n struct ed that th e t e mp eratur e of

th e room c an be k e pt co nsta nt and duri ng calorim e t er e xp eriments it
,

is or din arily k ept at th e t emp e ratur e of th e calorim e t er Furth ermore .

,

th e ca l orim e t e r is so mad e that it n ormally m e asur e s th e h e at produc -

tio n with gr eat accuracy irr esp ectiv e of wh e th er th e e n viro nmental

,
°
t emp eratur e is 1 abov e or b elow th e t emp erature of th e calorimet er .

I n thi s fastin g e xp e rim e nt how e v e r a gr eat difficulty was e n co un

, ,

tered at th e outs e t in that th e subj ect (who sp ent th e day o n a bal

,

c o n y in th e calorime t e r room) complain e d so much of cold that it

b ec ame ne c essary to in cre as e th e t emp eratur e of th e room throughout

th e day and to cool it some what duri n g th e night A ccordi n gly th e .

calorim et ers in th e ca l orime te r laboratory b e came v ery much ov e r

h e at e d an d th e me asur e ments of th e h eat output w er e i ne vitably
somewhat too large Aft er th e co n clusio n of th e obs ervatio ns o n L
. .
,

a s eri es of ch eck t ests was carri ed out with co nditio ns as n early ,

comparab l e as possib l e with thos e e xisti n g whil e th e m an was in th e

la b oratory and corr ectio n s for th e h eat output w er e comput e d from
,

th e r e sul ts of th e t e sts I t is u nn e c essary h er e to discuss th e the o

.

re tic al difficulti e s of m e asuri n g h e at with th e i n cr e as e d t emp e ratur e

n e c e ssary to mak e th e subj e ct comfortabl e but w e b e l i e v e th e h e at ,

m e asur ements as fin a l ly re cord ed h er e are within 2 or 3 per c en t of th e

actual valu e s I t may be safe ly said that th e m e asurement is always
.

too gr e at and th e corr e ctio n would th erefor e be a mi nus corr e ctio n th e

, ,

pro b a b l e e rror b ei ng about per c en t .

I t shoul d be borne in mi n d that th e he at productio n as m e asure d by

a respiratio n calorim et er is mad e up of s everal factors F irst a c e rtai n .
,

B n edi t R ich
l
e c ,an d E mm Am J u n P h y i l 1 9 1 0 26 p 1
e, es, . o r . s o .
, , , . .
 C AL OR I ME T R Y . 38 1

amou n t of h e at is giv en o ff by radiatio n and co n ductio n and is absorb e d

by h e at absorbin g pip e s thr ough which cold wat er is pass ed i nsid e th e
-

calorim e t e r Whil e thi s i nclud e s th e gr e at er portio n of th e h eat meas

.

ure d th e r e is lik e wis e a co nsid erabl e elimi n ation of h e at du e to th e

,

vaporizatio n of wat er from th e lun gs and ski n of th e subj e ct This is .

me asur e d by w eighi n g th e wat e r vapor in th e air curr ent an d maki ng - -

du e a l lowa n c e for th e h e at of vaporizatio n per gram of wat e r n amely , ,

calori e Furth ermor e th er e S hould be corr e ctio ns for any loss

.
,

of h eat thr ough th e excretio n of urin e or f e c es and for chan g es in ,

body w eight This latt er corr e ctio n is of som ewhat mor e importan c e
-
.

in fastin g e xperiments tha n in ordi n ary r espiratio n calorim et er experi -

m en ts sin c e th e loss e s in w eight ar e natura ll y gr eat e r Th e corr ect e d

,
.

valu e thus obtain e d may prop erly be call e d th e h eat elimi n at e d by

th e body d uri n g th e e xp erim en tal p eriod .

B y far th e most important corr ectio n how ev er is that for th e , ,

chan ges in th e body t emp eratur e for as was point e d out in th e s e ctio n
-
, ,

in which t hi s factor was co n sid ere d a compl et e compariso n of dir e ct ,

and i n dir e ct calorime try which is always att empt e d in r espiratio n

,

calorim et e r e xperim ents n ec essitat es a kn owl e dge of th e fluctuatio n s

,
1
in th e body t emp eratur e Wh il e it has b e en shown that th e tem pera
'

-
.

tur e fluctuatio ns in th e various parts of th e body follow v e ry clos ely

2
th e t emp eratur e fluctuatio n s in th e r e ctum it is st ill tru e that o n e of ,

th e most im portan t an d difficult probl ems in computin g th e h e at pro

ductio n from th e h e at me asur e d dire ctly by th e calorime t er is th e possi
bility of th e storag e of a co nsid erabl e amou n t of h e at in sid e th e huma n
body F or exampl e th e body t emp eratur e of a m an w eighi n g 60
.
,
-

kilograms fal l s C This wou l d corr e spo n d to a loss of nearly 25

.

ca l ori e s or th e total h e at productio n in 20 to 3 0 mi nut es of a m an

,

asl e ep ; thus by t akin g in to co n sid eratio n th e t emp erature chan ge s of

,

th e body an d th e body w eight multipli e d by th e S p e cific h e at (assume d

-

to be th e amou n t of h e at lost from or stor e d in th e bo d y may be

comput e d and in turn may be subtract e d from or add e d to th e h eat
e limi n at e d Th e h e at me asur emen t thus corr e ct e d is t erm e d th e h e at
.

produc e d In th e tabular pr es en tatio n of our r esults we d e al usually

.
,

with th e h e at productio n an d n o t with th e h e at e limi n atio n

-
.

Th e i nt ellige n t use of corr e ctio n s in th e di r e ct me asur e men t of th e

h e at output of m an is so difficult that th e computation of th e he at
produc e d in S hort p eriods is highly qu e stio nabl e An i n sp e ctio n of th e .

h e at me asure m en ts obtaine d with our subj e ct duri n g th e night S hows a

lack of u niform ity which make s it impracticab l e to pre s ent th e h e at pro
ductio n in th e form of curv e s as was do n e for th e car b o n di oxid e pro
,

du c e d an d oxygen co nsum e d in figur e s 4 1 to 44 but th ere is distin ct ,

e vid en c e of th e low e st h e at productio n occurri n g duri n g th e mid night

B dic t a d J lin C a gi I n t W a h Pu b 1 36 1 9 1 0 p 19
1
en e n os , rn e e s . s . .
, , . .

B n edic t an d S lac k Ca gi I n t W h P b 1 55 1 9 1 1 p 72
1’
e , rn e e s . as . u .
, , . .
38 2 A ST UDY OF P R O L O N GE D FA S T ING .

hours this b eing co in cid ent with th e mi n imum r espiratory e xcha nge
, .

Of far gr eat er sig ni fica n c e is th e cha n ge in th e av erag e h eat productio n

t h roughout th e night as th e fast progr ess e d .

T h e subj e ct spe n t varying l e n gths of tim e i n sid e th e ca l orim e t e r

e ach night av e raging n o t far from 1 0 hours b ut to mak e th e valu e s
, ,

comparabl e th e computatio ns are all bas e d eithe r upo n th e amou nt of

h e at pro d uc e d per hour or pe r 24 hours Th e r esults of th es e computa .

tio ns are record e d in ta b l e 5 7 in which th e h eat produc e d by th e ,

subj e ct in th e be d calorime t er at night is given o n th e basis of th e tota l

T AB L E 57 .
— Heat produced by su bj ect L . during p
ex er i ments i n the bed calo rimeter at nigh t .

I) at e .

7 th
2 1 — 22

l t

1 6— 1 7

1
T h e h eat m e asu re d d i g th e nigh t exp e i m e nts o n th e d ays no ted h as b ee n c o
ur n r rre c te d o nly
fo r th e ch an e g
in o b d y g and n o t fo r ch ange in bo d y te m pe rature
- w ei ht -
.
 3 84 A ST UDY OF P R O L O N G E D F A S T ING .

but durin g th e strict l y fasting p eriod we have a variatio n ra ngin g

from 83 6 calori e s per 24 hours o n th e third ni ght of th e fast to a mini
mum of 625 calorie s per 24 hours o n th e tw enty fir st night a variatio n -
,

of somewhat more tha n 25 per c en t E v en on this basis whe n pre .

,

sumably th e valu e s shoul d all be co nsta nt the r e is a distin ct falli n g ,

o ff in valu e d uring th e first 2 w e eks of fasti n g follow ed by a p e rio d of ,

approxim at ely co nstan t he at productio n per square m et er with a ,

distinct ris e in th e valu e s in th e last w ee k of fasti ng .

I t is thus cl e ar that th e d e ductio ns drawn from an i nsp ection of th e

data for th e respiratory e xchange in th e foregoi n g chapt ers apply
e qually w e ll to th e total h e at productio n as m e asur e d in th e re spiratio n

calorime t er e v en admitti ng th e discrepa nci es outlin e d pre vious l y

, .

Th e g e neral pictur e is by no m e an s obscur e d by th e assumptio n s mad e ,

this sho wi ng that th e influ e nc e of fasting per se upo n n o t o nly th e total

h ea t productio n but th e h eat productio n per kilogram of bo d y w eight -

an d per squar e m et e r of body surfac e was fully in accord with th e in flu

-

e n c e of fastin g upo n th e r espiratory e xcha ng e I t s eems u nwise .

,

how e v er to dwell further upo n th es e r e sults of th e he at measure men ts

,

an d th er eby possibly ascrib e to th e m too much importa nc e Th e .

e rrors cit ed brin g th e m cl e arly out of th e sph er e of accurat e physio

logical e xp erim entatio n and mak e th em of valu e o nly for subsidiary

evid e n c e F or a more car eful and c e rtai nly more n early exact co n
.

sid e ration of th e h e at productio n u n d er di ff er ent co ndi tio ns duri ng th e

fast we must resort to th e me thod of i n dir e ct calorim etry
,
.

INDI RECT CALORIMETRY .

S e co nd o nl y in valu e to accur at e dir e ct measur ements of th e h e at

” “
output from th e body is th e me thod of so call e d in dir ect calorim etry -
,

thi s b ein g an e xc e ll ent substitut e for th e difficult and costly dir e ct

calorimetry B y co nsid erin g th e nitroge nous mat erial e xcr e t e d in th e
.

urin e and t h e amoun t of car b o n dioxid e produc e d and oxyg en absorb e d ,

it is possibl e to apportio n th e katabolism amo ng th e various body c o n

stitu en ts th e s e b e in g chi e fly prot e in
,
fat and car b ohy drat e and to , , ,

comput e (from th e w ell known h eats of combustio n of th es e c o nstitu

-

en ts ) th e amoun t of h e at lib erat e d in th e proc e ss of th eir disi nt e gratio n .

S e ve ral m e thods of computin g th e h e at productio n thus i ndi rectly

hav e b ee n emp l oy ed by various writ ers P erhaps th e most e l aborat e .

an d fu ndam en tal l y e xact is that bas e d upo n 24 hour studi e s of th e -

gas eous e xcha ng e such as w er e mad e wi th th e r e spiratio n ca l orim e te r

,

form er l y us e d at We sl eyan Un iv ersity Th e e l ementary a n a l ys e s of .

food f e c e s an d uri ne an d th e d irect d et ermi n atio n of th e oxyg en

, , ,

a b sorb e d an d th e carbo n dio xid e produc e d gav e data for computin g ,

1
by simultaneous e quatio n s th e amou nts of prot ei n carbohy drat e (g l y
, ,

cog en ) fat and wat er partici p ati n g in th e m e tabo l ism F rom th ese
, ,
.

data and th e h e ats of combustio n of th e various body co nstitu en ts and

of th e uri ne an d fe c e s th e total energy pro d uctio n could be accurat ely
,

B n d ic t C a n gi I n t W a h Pub 7 7 1 9 07 pp 3 6 a d 4 5 2
1
e e , r e e s . s . .
, , . n .
 C AL OR I ME T R Y . 3 85

co m pu tedf Such comput e d e nergy tran sformatio n s agr ee d r emarkab l y

w ell with th e dire ct m e asur emen ts of th e h eat produc ed per 24 hours .

Wh en as is fre qu en tly th e cas e an exact k n owl e dg e of th e various

, ,

amou nts of carbohydrat e fat an d prot ei n disi n t e grat e d is no t of par

, ,

ticular sig ni fi ca n c e it is possibl e to s e cur e th e h e at productio n i n d i

,
-

re c tly from th e m e asur em en ts of th e carbo n dioxid e produc e d an d th e .

oxygen co nsume d without computin g th e di ff er ent co n stitu en ts o xi

diz e d . Zu n tz has comput e d most car e fu l ly th e calorific e quival en ts of
both oxy g en and carbo n di oxid e an d assum es that for e very lit e r of
oxygen absorb e d in n ormal m etabolism a d e finit e numb er of calori e s
must hav e b ee n d ev e l op e d Th e calorific valu e of carbo n dioxid e .

vari es gr e atly th e variatio n s dep en di ng upo n wh eth e r th e carbo n dio x

,

ide is produc e d by th e combustio n of carbohydrat e or of fat Thus with .

,

e v e ry gram of carbo n dioxid e r e sulti n g from th e oxidatio n of c arbo h y

drat e
‘

calori es of h eat are produc e d an d from th e oxidatio n of fat ,

calori es On th e oth er han d th e calorific e quiva l ent of oxy g e n

.
,

do e s n o t fluctuat e S O wid ely for wh en carbohydrat e is burn ed , ,

calori e s of h eat are d e v elop e d for e v e ry gram of oxyg en co n sum e d and ,

wh en pur e fat is burn e d calori e s are produc e d I t is th er efor e

, .

o nly ne c e ssary to d et ermi n e th e carbo n dioxid e productio n an d oxyg e n -

co nsumptio n v e ry e xactly an d from th e r espiratory quoti en t an d ,

th e absolut e amou n t of eith e r oxyg en or carbo n dioxi d e it is possibl e

to comput e th e h eat productio n by usi n g th e calorific valu e for th e
oxyg en or th e carbo n dioxid e .

With th e Z u ntz G epp ert apparatus oxyg en is d et erm ine d as accu

-
,

r ately as is carbo n dioxid e an d S i n c e th e ca l orific va l u e of oxyg e n

,

r emai n s ess en tially co nstan t Z untz has re gularly us e d th e oxyg en ,

measur ements and multipli e d by th e calorific equival ent of oxyg en .

I n co nn e ctio n with hi s r e s e arch e s o n th e physiology of marchi n g pub ,

1
lish ed with S chumburg Z u ntz work e d out a tab l e which gav e th e
,

r espiratory quoti en ts and calorific e quival ents of oxyge n with varyin g

proportio ns of fat and carbohydr at e in th e mat erial oxi di z ed .

A more difficult matt er is th e d e t ermi natio n of th e ca l ori fi c equ iva

2
l en t o f oxyg en wh en prot ei n is burn e d L o ewy has corr e ctly poi nt e d .

out that in exp erimen ts of short duratio n it is justi fi abl e to comput e

th e h e at pro d uctio n i n dir e ct l y by usi n g th e carbo n dioxid e output an d -

oxygen in tak e without taki ng i nto accoun t th e prot ei n disi nt e gratio n ,

S in c e th e prot e i n d isi n t e gratio n may or may n o t be S imu l ta n e ous with

th e nitrog en e xcr e tio n As a matt e r of fact th e calori fi c e quiva l en ts of

.
,

oxyg en and carbo n dioxid e when prot e in is burne d are n o t gr eatly

different from thos e for e ith er fat or carbohydrat e ; an d furth e rmor e ,

S in c e th e prot e i n usually fur ni sh e s only about 1 5 per c en t of th e total

e n ergy th e e rror in thus n e gl e cti n g th e prot e i n is e xtr e m e l y small

, ,

e sp e cially for S hort e xp e rim e nts .

Z un t an d S c h um b u g Ph y i l g i d
I
z Ma ch e B lin 1 90 1 p 3 6 1
r , s o o c es rs s, er , , . .

”L ewy O pp nh i m
o H n dbu ch d B io ch mi J n 1 9 1 1 4
e e er s
’
a p 28 1 er e e, e a, . .
, ,
386 A ST UDY OF PR O L O NG E D F A S T ING .

On th e
oth er hand in co n sid erin g th e re sults of lo ng exp eriments it , ,

is no t justifiabl e to ne gl e ct th e prot ei n entir ely A s th e r esult of a larg e .

numb e r of e xp e rim e n ts mad e by R ub n e r an d by Z u ntz an d his associ

at e s a c ertain numb e r of standard fi gur es r e gardi ng th e combustio n

,

of prot ei n may be us e d with co nsi d era bl e co nfid e nc e Thus the y hav e .

,

d e fi n it e l y e stablish e d that 1 gram Of nitrog e n in th e uri ne corr espo n d s

to a h eat pro d uctio n of calori e s as a r esult of th e oxidatio n of
prot e in Furthe rmore Zun tz has comput e d that for e ach gram of
.
,

n itroge n in th e urin e lit e rs of oxyg en are absorb e d and liters

of carbo n dioxide are produc ed Th es e valu es w er e Obtai ned from e x .

perim ents o n a nimals which w e re fe d a di e t of m e at o nly Th e m e thod .

of computing th e energy from prot ei n by maki ng a sp e cial computatio n

for th e energy accompanyi ng th e nitrogen in th e uri ne was employe d
1
by Zu ntz in computin g th e e nerg y output from th e valu e s fou n d with
th e fasti n g su b j e cts C e tti an d B r e ithau p t .

2
Willi am s R ich e and Lusk hav e a l so mad e u se of th es e valu e s for
, ,

comput ing th e h e at productio n e ven in S hort p eriods and in accor d anc e ,

with th e computatio ns of Lo ewy hav e calculate d th e no n prot ein -

re spiratory quoti ent by d e ducti ng th e carbo n dioxid e and oxyge n

apportio ned to th e protei n oxidatio n from th e total m easur e d amou nts
of th es e gas e s U s in g this no n prot ein respiratory quoti ent and
.
-

Z un tz an d S c h um burg s tabl e th e y hav e comput e d th e e nergy of fat

’
,

an d carbohydrat e Th e total uri n ary n itrog en multipli e d by .

gave th e e ne rgy valu e for prot ein .

3 4
Mag nus Le vy an d Lo ewy in discussi ng th e i ndir ect me thod of
-
,

calcu l ati ng th e h e at output e mphasi z e th e fact that th e computatio n ,

give s accurat e r esults o nly wh en th e oxidatio n in th e body proc ee ds

a l o n g normal l ines Recogn i z i ng th e fact that th er e is a no t inco nsider .

ab l e distur b a nc e of th e i nt e rme diary m eta b o lism duri n g pro l o n g e d

fasti n g du e in part to th e e xcr etio n of larg e amou n ts of am mo nia
,
5
an d th e formatio n O f B oxy b utyric acid G raf e has att empt e d to com -
,

put e th e h e at productio n by maki ng numerous corr e ctio ns som e of ,

which are c e rtai nly bas e d upo n premis e s n o t b eyo n d qu e stio n .

Af t e r a care ful co n si d e ratio n of th e various m e thods for computi n g

i n di r e ctly th e e nergy pro d uctio n from th e gas eous excha ng e and th e
urin ary excr e tio n of ni trog en an d taki n g i nto accou n t al l th e possi b l e ,

e rrors an d th e w e ight of th e e rrors in th e d iffe r e n t d e t e rmi n atio n s ,

it s eem e d most a d vantag e ous to u se in our calculatio n s th e me tho d

re comme n d e d by Magn us Le vy in which th e h e at output c an be —
,

dir e ct l y comput ed by usin g th e calorific e quiva l e nt of oxyge n for

L h m an M ll Mu k S t a d Z u nt A ch iv f p th A at u Ph y i l u f kli n
1
e n, ue er , n , en a o r , n z, r . a . n . . s o . . . .

Me d 1 8 9 3 , 1 31 , S u pp p .
, . 20 8 .

2
Willi ic an d Lu k Jo urn B i o l C h m 1 9 1 2 1 2 p 35 7
am s, R h e, s , . . e .
, , , . .

M agn u L vy vo n No o rde n s H an dbu ch d P ath o l gi e des S to flwec h sel B e li n

'
’
8
s- e , er o s, r , 1 896 ,
l , p 2 17
. .

‘
L o wy O ppe nh e im e s H an dbu ch de B i ch e m i e J n a 1 9 1 1 4 p 28 1
’
e ,
r r o , e , , . .

C rafe Z eitsc h r f p h ysi o l C h e m 1 9 1 0 65 p 2 1

I‘
v , . . .
, , . .
388 A ST UDY OF P R O L O NGE D F A S T ING .

T AB LE 58 .
—
H eat productio n (indi rect) computed from the gaseous exc hange i n experiment wi th
subj ec t L i n the lying po si tio n
. .

B ed c alo rim e ter ( nigh t) .

D ate .

R es pi C al o rifi c
r ato ry eq uival n t e

o f car bo n

ti ent .

2 8—29

A pr 3 0— M ay 1
. .

0 0 0 0 0

l
Fo r du i p i d
r at o n o f t abl 4 4
er o s, se e e .

2
O u th e d y p c di n g and f ll wi n g
a s re e o o th e fa t
s th e n igh t ex p im
er e n ts d e afte
were m a r th e
 C AL OR I ME TR Y . 3 89

TAB L E 58 .
—
Heat p roductio n (i ndi rect) co m puted from the gaseous exchange in p
ex eri m ent
with su bj ect L . i n the lyi n g po sitio n— C o ntrnued .

Res pir ati o n app ar atus (m o rni n g) 1

.

H eat .

(asl ee p )

2 1 — 22

Apr 3 0— M ay 1
.

1
D i
ur at o n o f p i d
er o ll y 8 3 0m a
w as u su a h
. m to 9h 3 011“
. a
. m .

2
T h e su bj e c t w as wi th o u t b eakf ast
r .
3 90 A ST UDY OF P R O L O NGE D F A S T I NG .

Th e r esults of th e computation of th e h eat output o n th es e thr ee

b as e s are giv en in tabl e 5 8 in whi ch are r ecord e d fi rst th e h eat output
,

per 24 hours comput e d on th e av erag e valu es obtaine d with th e bed

,

calorim et er thr oughout th e night ; s eco nd th e h eat per 24 hours com ,

pu te d from r e su l ts o b t ai n e d in th e s el e ct e d mi nimum p eriods duri n g

th e n ight ; an d third th e h e at pe r 24 hours comput e d from th e r e sults
,

o b tain e d wi th th e re spiratio n apparatus ; an d fi na l ly th e he at per ki l o ,

gram o i body w eight per hour and pe r squar e me t er of surfac e per 24

-

hours comput e d from th e obs ervatio ns with th e respiratio n apparatus .

Th e s e va l u es w ere computed from th e tot al carbo n dioxid e output and -

th e ca l orific e quival e nt of carbo n dioxid e corr e ct e d for th e di ff e r e nc e ,

du e to th e e ne rgy from prot ei n as stat ed pr e viously by d e ducti n g

, ,

calori e per lite r .

Th e av erag e h eat output o n th e 24 hour basis ra n g e d from -

calori es o n th e first nigh t in sid e th e chamb er to a mi nimum of

calori es o n th e thirti e th night S in c e th e re sults o b taine d duri ng th e
.

first 4 nights in th e ch amb e r w er e complicat e d by th e pr e vious i n g e stio n

of food particularly th e night of April 1 0 1 1 wh en a large amount of
,
—
,

prot ein was tak en in th e e ve nin g me al th e r esults obtain ed for th e ,

fasti ng p e riod are more prop e rly compare d Th e highe st valu e for th e .

fastin g p e riod is calori es o n th e first night an d th e low est valu e is

calori e s o n th e thirti e th night I t is thus s een that th er e was a
.

st eady d ecr e as e in th e total h eat output as th e fast progr ess e d although ,

from th e twenty fi rst to th e thi rty first day th e heat productio n

- -

show e d a t e n d ency towar ds co nstancy .

U sin g only th e minimum p eriods durin g th e night we fi nd a maxi ,

mum v al u e o f 1 calori es o n th e first night I n th e chamb er an d a

minimum of 94 9 calori e s o n th e twe nty fi rst night F or th e fasti n g -
.

p eriod th e valu es ra ng ed from

, calori es o n th e s eco nd night of
th e fast to 94 9 calori es o n th e tw enty fi rst night H er e again it wi l l
-
.
, ,

be obs e rv ed th er e was a st eady fall in th e h e at productio n to about th e

tw enty first day of th e fast an d from that tim e th e h e at output show ed
-
,

a t end en cy to r e mai n approximat ely co nsta nt for th e last 1 0 nights . .

Any possibl e criticisms of th e compariso ns of th e mi nimum be d

calorimet er p e riods disapp e ar in comparin g th e valu es found with th e
r espiratio n apparatus H ere we fin d that th e h e at productio n ra ng e d
.

from c alori es o n th e morni ng fo l lowi ng th e first night of th e fast

to calori es o n th e mornin g fol l owi n g th e thi rti eth ni ght of th e
fast Th er e is a distin ct t end ency for th e h eat productio n to fall pro
.

gressiv ely u n til th e tw enty third day and from that time o n it r emains
-
,

more or l ess a co nstant .

Of sp ecial importanc e in co nnectio n with thi s compariso n is th e fact

that o n th e first 3 nights th e h e at productio n in th e be d calorime t er -

e xp e rim en ts was gr e at e r tha n in th e e xp erim en ts with th e r e spiratio n

apparatus th e following morni ng This was u ndoubt e d l y due to th e

.
 BALANCE OF INCOME AND OUTGO .

Whil e it was impracticabl e to hav e this fasti ng subj ect r emain in th e

r espiratio n calorim et er for th e e ntir e time as in th e fasti ng e xp erim ents ,

at We sl eya n Uni ve rsity an d thus s e cur e i d eal co n ditio n s for studyi n g

,

th e total m etabolism an d e ne rgy tra nsformatio n duri n g th e fast y et , ,

r ecog nizin g th e great valu e of a k nowl edge of th e en tir e 24 hour ene rgy -

transformatio n we att empt e d to s e cur e as fr e qu ent re spiratio n experi

,

m en ts as possi bl e to suppl eme nt th e data Obtaine d i nsid e th e r espiratio n

calorimete r during th e night T h is suppli e d a logical basis for a subse
.

qu ent computatio n of th e total energy transformatio n .

Th e in tak e of this subj e ct co n sist e d of pur e disti l l e d wat e r and oxy

g en from th e air Th e output co nsist e d of th e wat er of r espiratio n an d
.

p e rspiratio n th e carbo n di oxid e e xcre tio n from th e lu ngs and th e wat er

,
-
,

an d solids of th e urin e Th e or etically o ne shoul d n o t ove rlook th e

.
,

smal l quan titi es of solid matt er in th e p e rspiratio n th es e b ei n g re mov e d ,

by th e baths in di still e d wat er .

Th e oxyg en in th e intak e app e ar e d in th e output combi n e d with

e ith e r carbo n or hydrog en sin c e th e oxy g e n e n t e r e d i nto th e com b ustio n
,

of body mat erial I n this combustio n h e at was l i b erat e d whi ch l e ft

.
,

th e b ody through various paths by simpl e ra d iatio n and co nductio n ;

—

as th e s e nsibl e h eat of excreta i e th e h e at of th e uri ne ; and as h eat

, . .
,

re quir e d to vaporiz e wat er and to warm th e i nspir ed air to th e body

t emp eratur e .

F or a compl et e und ersta ndin g of th e various compo nents of th e out

put particularly wh en co nsid ere d upo n th e basis o f th e total energy
,

tra ns formatio n in 24 ho urs it is n ec essar y to kn ow th e e l em entary

,

compositio n of th e excre ta Thi s requir e s a k nowl edg e of th e total

.

amount of wat e r giv en o ff eith e r as liquid wat e r or as wat er vapor th e

,
-
,

carbo n hy drog en an d oxygen in th e solid matt er of uri ne and th e ni

, , ,

trog en in th e urin e and th e p erspiratio n C ertain of th es e factors w er e .

d irect l y d et e rmine d Thus we hav e dir e ct d e t e rmi natio ns of th e

.

n itrog e n an d carbo n in th e uri n e an d of th e n itrog e n of p erspiratio n .

T h e oth ers c an o nly be comput e d i n d ir e ctly for whi l e we have accurat e ,

e vid e n c e r e gardi n g th e carbo n di oxid e e xcr etio n thr oughout th e ni ght

-

p eriod wh en th e subj e ct was i nside th e be d calorim et e r we have n o

, ,

compl ete e vid enc e of th e carbo n dioxid e excre tio n for th e daytime -
,

wh en h e was outsid e of th e calorime t er Our first probl em th en is .

, ,

to e stimate th e probable katabolism of th e subj e ct t h roughout each 24

hours .

TOTAL KATABOLISM PER 24 HOURS .

Kn owin g as we do th e i nflu enc e upo n th e katabolism of th e s l ight est

, ,

muscular activity it is obvious that th e car b o n dioxid e output d uri n g

,
-

th e night r epr e s ents a minimum amou nt for t hi s subj e ct and that durin g
3 92
 B ALA NCE OF IN C O ME AND O UTG O . 393

th e d ay thi s will be mat erially i ncr eas e d F ortu n at ely th e exp erim ents
.

ma d e with th e r espiratio n apparatus supply evid en c e which e n ab l e s

us to comput e this e xcretio n of carbo n dioxid e with r easo nabl e accuracy .

Thus we hav e r espiratio n exp eriments in th e morn i ng with th e subj e ct ,

lying upo n a couch which giv e valu es high er tha n thos e obtaine d duri n g
,

th e night in th e r e spiratio n chamb er We hav e also in th e latt er part

.
,

of th e fast at l east a s eri es of obs e rvatio n s with th e subj e ct lyin g o n

,

a couch j ust prior to his en t eri n g th e calorim et er which giv e va l u es ,

still high er tha n thos e obt ai n e d with th e sam e apparatus in th e morn

ing . On c ertain days we hav e valu e s obtai ne d whil e th e subj e ct was
sitti n g quie tly in a chair or S itti n g writi ng Th e i n cr eas e in katabolism
.

du e to th e s e cha n g e s in body positio n an d activity has alr e a d y b een

n ot e d in co n sid eri n g th e r e spiratory e xcha n g e .

R oughly S p e aki n g th e subj e ct was i nsid e th e r e spiratio n calorime t e r

,

for approximat ely 1 1 or 1 2 hours each night ; duri ng 1 0 hours of this

tim e th e katabolism was di r e ctly d e t e rmine d ; from th e m easur e d valu e
we may e stimat e th e probabl e katabolism duri n g th e e n tir e soj ourn of
1 1 or 12 hours in th e r e spiratio n calorim e t er Th e katabolism was .

de t e rmi n e d o n th e r espiratio n apparatus for a p eriod of ap p roximat ely

2 hours in th e mor ni n g and an hour at night maki n g a sum tota l of ,

time duri n g which th e r e spiratory exchang e was actual l y m e asur e d ,

at l east in th e last part of th e fast of from 14 to 1 5 hours T h e r emai n

,
.

der of th e tim e i e som e 9 or 1 0 hours th e subj e ct was variously

,
. .
, ,

occupi e d in th e laboratory for th e most part sitti n g eith er writi n g

, , ,

or talki n g with th e various m en exami ni n g him A numb e r of r espira .

tio n e xp erim e n ts w er e mad e which w er e sp ecial l y d esig ne d to s e cur e

i nformatio n r e gardin g th e probab l e kata b olism duri ng such p eriods of
minor physical activity .

DAILY ACT I VI TY .

F rom th e not es mad e by th e obs erv e rs o n th e varI Ou s e xp erim ental

re cord shee ts an d by th e watch ers at oth e r tim es it was possibl e to ,

comput e v e ry car efully th e numb e r of mi nut e s sp ent by th e subj e ct

o n e ach day of th e fast in di ff e r e n t occupatio n s H is dai l y ro uti n e .

co nsist e d of practically fi ve d egr ees of activity lyi n g S itti n g r e stin g —

, ,

sitti n g activ e stan di n g an d walki n g S i n c e th e re was a disti n ct

, ,
.

diur nal variatio n in th e katabolism l yi n g in th e e v e nin g which was

, ,

bas e d upo n th e e v e ni n g re spiratio n e xp erimen ts was accord e d a dif ,

ferent valu e from that given to lyi n g in th e morni n g .

To S how th e subdivisio n of th e day i nto the s e various activiti e s th e ,

numb e r of ho urs an d mi nut e s occupi e d in th e v ario u spo sitio n s is r e cord e d

in tabl e 59 . Th e first column S hows th e p erio d wh en th e subj e ct was
lyi ng in th e morni n g this i n cludi n g th e time from th e e n d of th e calori
,

me t e r e xp erimen t to th e time that h e was w eigh e d T h e lyi ng in th e .

e v e ni n g i n clud e s th e e n tir e tim e from th e mom e n t h e lay d ow n o n th e

3 94 A ST UD Y OF P R O L O N GE D F A S T I NG .

c ouch up to th e b e gin ni n g of th e first p eriod of th e calorim e t er expe ri

m e nt a l though a part of th e time was sp ent lyi n g i nsid e th e ca l orime t e r
,

ch amb er i e th e pr e limi nary p e riod of th e calorime t er exp erime n t

,
. .
, .

Th e t hir d column give s th e tim e S p en t by th e subj e ct lyi n g in th e

apparatus duri ng th e calorimet er exp erim ental p e riod whi ch usually ,

e n d e d about 8 a m . .

T AB L E 59 .
— S um mary of da ily activi ties in p
ex eri ment with L .
(8 a . m to 8
. a .

h r mi n
. . h r min
. . h r min
. . h r mi n . .

5 th . .

2 7 — 28

1 c tivi ty h giv n h uld b add d th

T o th e a ere e s o e e e wo r k of dr e ssin g i g b ath in g
an d u n r e ss n d ,

an d ai in g an d l w
r s i n g th b d y n th tai
o F
er e o o e s rs . o r ex pl anati o n o f e s ti m ate s in c tai n p ti n er or o s

of th i umm a y
s s te xt r , see .

F or a larg e part of th e day th e subj ect was busy writi ng ha ndl i n g his ,

pap ers g esticul atin g and argui ng and hen c e was o n a d isti n ctly
, , ,

hi gh e r m etabolic l e ve l tha n wh en h e sat qui e tly with comp l e t e mus

c ular r epos e Th e S itti n g p e riods hav e th er e fore b een classi fi e d u n d e r
.

” “
two he ads d e sign at e d re sp e ctiv ely as sitti ng re stin g and S itti n g
,
”
activ e Al l of th e tim e n o t oth e rwis e accoun t e d for in th e tabl e
.

”
is classifi e d as sitting active i ncludin g th e p eriods of th e writin g ,
 A ST UDY OF P R O L O N GE D FA S T ING .

T AB LE 60 .
—
Carbon —dio xide production and o xygen co nsumptio n in liters per 24 ho u rs in
experi ment wi th L .
(8 a . m to 8
. a. m) .

C ar b o n di o xi d e .

D ate .

T o tal .

O O O O O

0 0 0 0 0

0 0 0 0 0

23 7 9
0 0 0 0 0

212 1

29— 30 20 1 5 .

A pr . 30 M ay 1
-
.

! Th e ca b r o n- d i o xi d e p o d u c ti o n
r assum e d fo r th e w o r k of b ath in g wa s on Ap i l
r 20— 2 1 ,
li te rs ; April 27 —
28 , li te : M ay 4
rs —
5, li te rs ; M ay 1 1— 12 , li te s r .

L aboratory with a professio n a l ath l et e in whi ch th e subj e ct wa l k e d o n ,

a tre admi l l of S p e cia l co n structio n B asal fi g ure s for the s e stu d i e s w e re .

suppli e d b y th e r esu l ts of a l arg e num b er of d et e rmi n atio n s (mad e by

1
D r Cathcart ) of th e m e tabo l ism of this m an whil e in a lyi n g positio n
. .

A co n trol exp erim en t whi ch was mad e within a few mo n ths by M r L . .

E E mm e s of th e L aboratory sta ff S hows a clos e agr ee men t with th e

.
, ,

e ar l i er Obs ervatio n s of Cathcart D r Murschh auser s o b s ervatio n s . .

’

oth e r than walkin g hav e d e alt e n tir ely with d e t e rmi n atio n s of th e
me tabo l ism whil e th e subj e ct was stan din g in various positio n s such as ,

B n edict an d C ath c art C a n gi e I n t W a h Pu b 1 87 1 9 1 3 p 7 7

l
e , r e s . s . . , , . .
 B ALA N CE OF I N C O ME AND O UTG O .

- !
Th e o x yg en c no sum p ti o n assu m e d fo r th e wo k r of b ath i n g w as o n Ap i l 20 r —21
, li t e rs ;

Ap i l
r 27 2 8 ,
-
li ters ; M ay 4- 5 , li ters ; May 1 1 —
12, l i te s r .

’ “
att entio n r e l ax e d an d similar positio ns U si ng as a basis Cath
, , .

cart s an d E mm e s figur e s for lyi n g an d D r Mursch h au ser s valu e s for

’ ’
.
’

stan di n g we fi n d an i ncr e as e ov e r lyin g of a b out 1 0 per c ent C o nse

, .

qu en tly this 1 0 per c en t i ncr e me n t has b e en us e d to comput e th e va l u e

for stan din g for our fasti ng subj e ct .

F or th e valu e s for walkin g we hav e r eli e d imp l icit l y upo n th e e xt e n

siv e s eri e s of obs ervation s mad e by D r Mursch h au ser with th e .

p rof e ssio n al athle t e T hi s subj ect show e d an i n cr e ment of 1 9 0 per

.

c e n t in th e me tabolism whi l e wa l kin g at a slow pac e me t e rs “

per mi nut e ov e r that whil e lyi n g R e cog nizi ng th e fact that D r

—
. .
3 98 A S T U DY o r P R O L O N GE D FA S T ING .

Mursch h au ser s subj ect was a trai ne d athl e t e

’
r epre s e nt e d th e an d

high e st d e gr ee of muscular vigor and that our subj ect was a no n

athl e t e flabby and as th e fast progr e ss e d still more emaciat e d and
, , , ,

l e ss in cli ne d to physical e xercis e we hav e e mploye d but 1 00 per c ent

,

for th e computatio n of th e valu e for L si nc e ther e was h ere th e possi .

,

bili ty of a v e ry co nsid e rabl e e rror F ortu nat ely as will be s een by

.
,

r eferenc e to tabl e 60 th e total carbo n dioxid e productio n an d oxyg en

,
-

co nsumptio n whil e th e subj ec t was wal ki ng was hardly 2 per c e n t of

th e total valu e for th e day ; we may th er efor e co nsid er any e rror pr es ent
as entirely ne gligibl e .

F or th e num e rous physical t ests and th e photograp hi ng th e subj ec t ,

had to dress and un dr ess at l e ast o nc e or twic e each day and o n some
days s ev eral t im es T h e me tabolism i n volv ed in dr essi ng and undress
.

ing was studi ed in a larg e numb er of e xp e rim ents in th e r espiratio n

1
calorimet e r at Wesl eyan U niv e rsity and it was found that th e r esti n g ,

metabolism was in cre as ed 30 per c ent duri ng o ne hour A ccordin gly .

th e valu es obtai ned whil e th e subj ect was sitti n g r esti ng w er e i ncr e as ed
by 30 per c ent of th e r estin g me tabolism for o ne hour to allow for this
muscul ar work of dr essing and u ndressi ng H ere agai n th e absolut e .
, ,

valu es involv ed are e xtremely small whe n compar ed with th e total for
th e day . On 4 days an additio nal allowanc e was mad e for th e work of
bathin g this b ein g co nsid ered as e quival ent to th e metabolism for 1 0
,

min ut es of standi ng T h e valu e for t hi s o n th e s ev enth day of th e fast

.

was lite rs of carbo n dioxid e and lit ers of oxyg en ; o n th e four

tee nth day it was lit e rs of carbo n dioxid e and lit ers of oxygen ;
o n th e tw e n ty fir st day it was
-
lit ers of carbo n di oxide and
lite rs of oxyg en ; an d o n th e tw enty e ighth day it was lit ers of
-

car bo n di oxid e and lit ers of oxygen .

A furth er computatio n was mad e of th e m etabo lism i nvolve d in th e

work of goi n g up and down stairs F or lack of b e tt er e vid en c e it was
.
,

estimat e d that th e amou n t of work p e rform e d in goi n g dow n stairs

was equal to half of that goi n g up T h e numb er of kilo gramm eters .

w e re compute d by mu l tiplyi n g th e w eight of th e m an by th e height

thr ough whi ch h e lifte d hi s body i n cre asi ng thi s by o ne—half wh en ,

th e work of goi n g d own stairs was i n clud e d Th e numb er of calori e s .

w er e then obtaine d by d ividi ng th e numb er of kilo gramm eters by th e

factor Fin ally by usi ng th e calorific e quival en t for th e av er
,

ag e r espiratory quoti en t for th e day comput e d from th e r e sults of ,

th e e xp e rim en ts with th e calorim e t er an d th e r e spiratio n apparatus ,

we w ere abl e to calculat e th e amou n t of carbo n dioxi d e e xcr e t e d an d

oxyg en co nsum ed in th e muscular work of l ifti n g th e body Th e total .

p ro b a b l e carbo n di oxid e productio n and oxygen co nsumptio n for th e

-

24 hours is th er efor e th e sum of th e valu e s comput e d for th e varyi ng

d e gr e e s of activity ; th ese totals are giv en in th e last column of tab l e 60 .

B nedi t and C arp nter C a n gi I nst W a h Pub 1 26 1 9 1 0 p 24 7

l
e c e . r e e . s . .
, . . .
4 00 A S T UDY o r P R O L O N GE D FA S T I N G .

of th e me tabolism mad e durin g th e lo ng soj ourn of th e subj ec t in th e

r espiratio n cal orime te r at ni ght th e dai ly rec ords of th e occupatio n s of ,

th e su b j ect du rin g th e fast and standard fi g ur es r e garding th e eff e ct

,

upo n th e katabolism of variatio ns in activity we are abl e to mak e for ,

prac tically e v e ry hour of th e day a r e aso n ably satisfactory e stimat e of

th e probabl e activity an d thus obtain th e total katabolism .

Wh en compl e te 24 hour d e t e rminatio ns of th e various factors en te r

-

ing into th e computatio n of th e charact e r of th e katabolism c an be

obtaine d n amely th e dir ect m e asurement of th e total carbo n dioxid e
, ,
-

output oxyg en i ntak e an d el eme n tary compositio n of th e solid matt er

, ,

of urine th e most exact m e thod for computi ng th e charact er of th e

,

katabo lism and th e kin ds and th e amou nts of mat e rial burn ed is that
outli ne d in th e pr e vious publicatio n o n in a nitio n in which u se was ,
1
mad e of simultaneous equatio ns Wh en as is th e cas e with this .
,

fasti n g subj e c t an el e me n t of u nc e rtai nty e nters into th e fu n dame ntal

,

figures which woul d be us e d in such computatio ns and it is n ec essary

to mak e our e stimat e s of th e total carbo n dioxid e output and oxyge n -

i ntake from th e results of fragm e n tary p eriodic d e t ermin atio ns it , ,

do e s no t s ee m j ustifiabl e or i nd ee d logica l to employ th e extrem ely

, ,

e xact math e matical computatio n us e d in th e e arli e r publication .

I t is tru e that th e prot ei n katabolism may be as re adily obtai ne d for

this e xp e rim e nt as for th e exp e riments pre viously reported si nc e we ,

hav e data as to th e total nitroge n e xcre tio n but for th e apportio nment ,

of th e katabolism b e tw ee n fat and carbohydrat e a simpl e r method is

probably more j ustifiabl e We hav e thus first comput e d th e prot ein .

katabol ism and th en apportio ne d th e katabolism of carbohydrat e

,

an d fat by a m e thod to be subs equ e ntly d escrib e d .

P ROTE IN KATAB OLI S M .

In accordanc e with th e curr ent co n c eptio n of th e r elatio nship

b e tw ee n th e nitrogen in th e uri ne an d prot e i n katabolism th e total ,

amou nt of prot ei n katabo liz e d may be comput e d from th e total amou nt

of ni trogen in th e uri n e by usin g th e p erc en tage of nitrogen in th e tissu e
brok e n down I n ordin ary m etabolism e xp erime nts wh en th e food
.
,

i ng est e d is of varyi ng compositio n and co ntai ns prot ei n s of various

ki n ds it is comm o nly assume d that th e nitrog e n in th e tissu e brok e n
,

dow n is r ep re s e n t e d by th e factor so that th e amou n t of nitrog en

in th e uri n e may be multipli e d by thi s factor to obtai n th e amou n t of
prot ei n in th e tissu e brok en down I n a fasti n g exp erim en t how e ver .
, ,

o nl y body mat erial is katabo liz ed an d th e p e rc en tag e of nitrog en in

-

dry fat free an d ash fre e fl esh has b een sh own to be

,
-
,
-
h enc e th e
factor should be us e d in st ea d of for computin g th e prot ei n in
th e fl e sh katabo li z e d from th e amou nt of nitrog en in th e uri n e A ccord .

in gly thi s factor was us e d for our computatio n s of th e prot ei n kata

h o l ism in this e xp erime n t .

B n di t C a n gi I n t W a h Pub 7 7 1 90 7 pp 3 6 and 4 52
l
e e c , r e e s . s . .
. , . .
 B ALA NC E or I N C O ME A N D O UTG O . 4 01

In a pr e vious s e ctio n of this publicatio n (see table 27 p it has , .

b ee n show n that th e nitrog en in th e uri ne gradually d ecre as e d as th e

fast progr ess ed but th e nitroge n excre tio n per kilogram of body w eight
,
-

is also of i nt ere st in thi s co nne ctio n as showin g whe th er or no t th e

d e cre as e was proportio nal to th e loss in w eight Fr om th e valu es given .

in tabl e 27 it will be s ee n that aft er th e first 4 days of th e fast duri n g ,

whi ch there was a mark e d ris e in th e nitrog en excr etio n th e valu e s ,

p e r kilogram of body w e ight had -

a t e n d e n cy to fall as th e fast pro
g r ess e d ,
th e high e st valu e gram ) b e i n g fou n d o n t h e fourt h day

of fastin g and th e low est gram) o n th e tw en ty thi rd and -

thirty fir st days of th e fast I t is thus u n qu estio n abl e that the re

-
.

was a disti n ct t en d en cy in th e latt er part of th e fast for th e ni trog en

e xcr e tio n pe r kilogram of body w eight to be low e r than in th e first
-

part of th e fast Th e valu e s for th e total ni trog en excre t e d and

.

th e comput e d amou nts of prot ein katabo liz e d are giv en in column s
A an d P tabl e 6 1 Th e prot ein katabo liz e d ran ge d from a maxi
,
.

mum of grams o n th e fourt h day of th e fast to a mi nimum of

grams o n th e last day th e cours e of th e prot ein curv e naturally
,

fol l owing that of th e nitrog en e xcr etio n F in ally o n th e assum p .

,

tio n that fl esh co n tain s 20 per c e n t prot ein and 80 per c ent wat e r ,

th e fl e sh e quival en t of th e prot e i n katabo liz e d has b een comput e d by

multiplyi n g th e prot ei n by 5 th e re sults b ei n g give n in c o lunm Q of
,

tabl e 6 1 Th e s e valu e s obviously fol l ow thos e for th e nitrogen and

.

th e prot e i n th e maximum valu e b ei n g 35 6 grams o n th e fourth day of

,

fasti n g an d th e mi nimum 208 grams o n th e last day of th e fast .

APPOR TI ON ME NT OF NO N- R O E P T IN KATAB OLI S M B E T WE E N CAR B OH YD R AT E

A ND FAT .

Th e m e thod us e d in this publicatio n for computin g th e katabolism of

fat and carbohydrat e for our fasti ng subj ec t was in bri ef as follows , ,

Th e amounts of carbo n dioxid e produc e d an d oxyg en co n sum ed in

th e combustio n of carbohydrat e and fat w ere first obtai ne d by d e ducti n g
th e comput e d amou n ts for th e combustio n of prot ein from th e total
amou n ts of carbo n di oxid e produc e d and oxyg en co n sume d F rom .

th es e valu e s th e no n prot ei n r espiratory quoti en t for e ach day of th e

-

fast was r e a d ily calculat e d U sin g th e s e no n prot ein r e spiratory

.
-

quoti e nts we next foun d th e total h e at giv en o ff in th e combustion of

,

th e carbohydrat e an d fat th e apportio nm en t of th e h e at output

,

b e tw een th em b ei n g mad e subs e qu ent l y by th e u se of c ertai n factors .

From th e h e at output du e to th e combustio n of th e car bohydrat e

an d th e fat th e amou n ts of th e s e two body mat erials katabo liz e d w er e
,

finally calculat e d by me ans of th eir h e ats of combustio n .

4 02 A S T U DY OF P R O L O NG E D F A S T I N G .

C A RB O N D I O X I D E PRO D U CE D A N D O X Y G E N C O NS UME D I N THE KA T A B O L I S M or

CAR B O HYDRA T E A N D FAT .

S in c e we kn ow th e amoun t of nitrog en e xcr et e d in th e ur i ne th e car ,

bo n dioxid e produc ed an d th e oxyg e n co nsum e d in th e katabolism of

prot e in may be comput ed by usin g factors e stabl ished by Zu ntz and
hi s c o work e rs
-
Thus for ev e ry gram of nitroge n in th e uri ne Z u ntz
.
, ,

has fou nd that lit ers of carbo n dio xid e are produc e d and lit ers
of oxyg en are co nsum ed Th e total n itroge n e xcr e tio n for each day
.

of th e fast is giv en in column A of ta bl e 6 1 and th e carbo n dioxi d e ,

produc ed and th e oxyge n co nsumed in th e com b ustio n of prot ei n are

give n in co l umn s C and F r esp ec tiv ely D e ducti ng th es e valu es from .

T AB LE 6 1 — Body mate ria ls katabolized and to tal heat roductio n (computed) per 24 hours
f
.

i n experime nt with

Ox yg en.

D a te .
Fro m fat
p ro te in

25 —2 6 .

1
S ee ta bl e 6 0 .
4 04 A ST UD Y OF P R O L O NGE D FA S T IN G .

We fou nd inthi s e xp erimen t n o n e of th e e xtraordi narily low valu e s

r eport e d by oth e r obs erv ers with fastin g m an th e low est quoti ent ,

Obtain e d with our subj ec t b e in g which was fou n d for but o ne day .

Wh en th e difli culties in s ecuri ng accurat e d et ermi natio ns of th e

r espir atory quoti ents ar e co nsid er e d all of th e errors in th e d et ermi na —

tio n of both th e oxyg en co nsumptio n and th e carbo n di oxid e productio n -

a ff ec ting th e valu e of th e r espiratory quoti ent it is p erhaps surprisi n g —

that valu es mor e a b normal tha n thos e show n in colum n H are n o t

foun d I t is of cours e n o t impossibl e that ab normal katabolism r esult
.

in g from th e acidosis of thi s m an may in part accou n t for this slightly

low er e d r espiratory quoti ent .

I n fastin g th e r e is u n qu e stio n ably a larg e r excr e tio n of ammo nia in

th e urin e and lik e wise an e xcr e tio n of fi oxy butyric acid I n d e ed -
.
,
1
an att e mpt has b ee n mad e by G raf e to corr ec t for th e alt e ratio n in th e
valu es for th e r espira tory quoti en t wh e n ammo nia is e xcre t e d in th e
urin e in st ead of th e ordin ary ur ea I t may be qu e stio n e d how e v er .
, ,

wh e th e r data obtain ab l e in fasti ng exp erim ents are suffici ently accurate
an d th e oxyg e n m easur em e n ts are suffici en tly e xact to warra n t such
an att empt . Furth e rmor e sin c e th e alt eratio n from ur e a to ammo nia
,

is m er ely a matt er of hydrolysis th e computatio n may prov e to be ,

some what pro b l e matical I n all probability th e prot ei n katabolism

.

is no t gr eatly afl ec ted for whil e th er e is a disti nct d isturba nc e in th e

,

r elatio nship b e tw ee n th e ammo nia an d th e total nitrog en th er e is no t ,

an e xc e ssiv e amou nt of amin o acids form ed as th e r est nitrogen is no t

-
,
2
unduly larg e On th e oth e r hand Mag nus Le vy has cl ear l y shown
.
—
,

that th e formatio n of ac e to ne bodi e s du e to th e partial oxidatio n of

fat r es ults in th e abso rptio n of oxyg en an d productio n of carbo n dio x
ide thus in flu en cin g slightly th e r espiratory quoti en t but co n clud e s
, ,

that a productio n of 4 0 grams of fi o xybutyric acid alt ers th e respira -

tory quoti e n t no t mor e than

A n o t in co n sid erabl e proportio n of th e total energy tra nsformatio n ,

as h er e comput ed is base d upo n e xp e rime n ts mad e with th e r espiratio n

,

apparatus in whi ch th e cuta n eous r espiratio n was n o t co nsid ere d

,
.

Th e r espiratory quoti en t might thus hav e b ee n slightly high er had th e

cutaneous r e spiratio n also b ee n d e t ermi ne d Magnus- Le vy mentio ni ng ,

as th e probab l e corr e ctio n to be a p pli e d to th e r espiratory quo

ti en t d e t ermin e d by n os e or mouth appli an c es .

Whil e th e d e t erminatio ns of th e r espiratory quoti ent by m eans of

th e bed ca l orim et er an d th e r espiratio n apparatus ch e ck e ach oth e r
an d show that th e r esults are wit hi n a few u nits of b ei n g accurat e ,

n ev e rth el ess when th e prot ei n katabolism corr ec tio n amou n ts to but

a few thousan dths an d th e corr e ctio n for th e formatio n of ac e to ne
bo di es also amoun ts to o nly a few thousan dths it c an be s een that th e ,

G af Z it c h f ph y i l C h m i 1 9 1 0 65 p 2 1
1
r e, e s r . . s o . e e, , , . .

M agnu L vy Z itsc h f klin M d 1 905 56 p 83

2
s- e , e r . . . e , , . .
 B ALA NCE OF IN C O ME AND O UTG O . 4 05

d e gr ee of accuracy in th e d e t e rmi natio n of th e r e spiratory quoti ent

must be e xtraordinarily hi gh to a dmit of an i nt e l lig en t discussio n
of th es e poi n ts Fu rt hermor e it is r easo n abl e to qu e stio n wh e th er
.
,

or no t o n e c an lo gica ll y u se th e d et e rmi n atio n of th e r e spiratory

quoti en t for an alyzi n g in any way th e organic proc ess es whi ch are
a ff e ct e d duri ng fasti n g I t is c ertai n of cours e that th e combustion
.
, ,

of fat forms th e gr e at e st part of th e total com b ustio n On th e oth er .

han d there may be a slight formatio n of carbohydrat e o n some days

,

which would a l t e r th e quoti e nt ; th er e may also be an a b n ormal exc re

tio n of mat e ria l s in th e uri ne which wou l d l ik e wis e alt er th e r espiratory
quoti en t ; an d th er e is a l ways a possibi l ity of th e productio n of B Oxy -

butyric acid All of the s e factors how e v e r a ffect th e quoti en t but

.
, ,

slightly an d th er efor e n o gr e at stre ss nee d be laid upo n th e m I n fact

,
.
,

it is doubtful as was poin t e d out in th e e ar li e r fastin g pub l icatio n

, ,

wh e th e r th e computatio n of th e total glycog en output was su ffici en tly

accurat e to j ustify th e assumptio n that glycog en was actually produc e d
o n 2 days of fasti n g I b eli e v e that th e computatio n s of th e 24 hour
.
-

gas e ous e xchan g e in th e e xp erimen t with L are n o t suffici ently accu .

rat e to throw d e finit e light upo n th e qu estio n as to whe th e r or n o t

glycog en was produc e d aft e r th e first few days of th e fast .

T h e g en e ral cours e of th e r e spiratory quoti en ts fou n d with L is .

wholly in accord with those obs erve d with th e Middl etow n subj ec t
S A B wh o r emai n e d in th e r e spiratio n ca l orim e t er th e e ntir e p eriod
. . .
,

of th e exp e rim ent exc e pt that th e quoti e n ts o b tai ne d for th e latt er

,

subj e ct w e re almost i nvariably somewhat high er Thus th e av e rag e .

,

r e spiratory quo ti en ts for th e 7 days of th e fastin g exp erim en t with

S A B w e re
. . . an d the s e valu e s
b ei n g substan tially hi gh er than thos e obs erv e d for our subj e ct L o n .

th e fourth to s e v enth days of his fast T h e r e spiratory quoti en ts for .

L giv e n in co l umn H of tabl e 6 1 are how e ve r no n prot ein r espiratory

.
, ,
-

quoti ents whil e thos e h er e giv en for S A B are th e total r espiratory

,
. . .

quoti ents i e th ey i n clud e th e prot ei n katabolism H en c e th e dis

. . .
,
.

parity is n o t so gr eat as th e respiratory quotien t for prot ein is no t far

,

from I n any e v en t it is cl e ar that we do n o t hav e h er e suffici en t

,

e vid e n c e of so gr e at a d isturba n c e in e ith e r fat carbohydrat e or prot e i n , ,

katabolism as to l e a d us to b eli e ve that th er e was a fu ndamental alt era

tio n in th e charact er of th e katabolism othe r tha n that accompany ,

ing th e acidosis durin g th e 3 1 d ay fast -

.

E NE R G Y D E RIV E D FR O M KA TAB O L I S M OF CAR B OHYD RATE AN D FA T .

U sin g th e s e valu e s for th e no n prote in re spiratory quoti en t , th e oxy -

g en co n sumptio n r e quir e d for th e combustio n of th e fat an d carbohydrat e

(column G of tab l e an d th e calorific ei1u ivale nts of oxyg e n giv e n in
1
Z untz and S ch um burg s tabl e we are abl e to comput e th e e ne rgy
’
,

Z un t an d S c h u m b u g P h y i l gie d
1
z M a c h e B l in 1 9 0 1 p 36 1
r , s o o es rs s, er , , . .
4 06 A ST UDY OF P R O L O NG E D F A S T I N G .

d eriv e d from th e carbohydrat e and fat katabo liz e d F or i n sta n c e .

,

o n April 1 4 1 5 th e fi rst d ay of th e fast th e n o n prot e i n r e spiratory

—
, ,
-

quoti en t was Th e ca l orific e quival en t of oxyg e n with this r e

spirato ry q uoti e n t is 4 7 5 2 ca l ori e s pe r lit e r ; h e n c e th e total h e at giv e n
.

o fl from th e combustio n of th e fat an d carbohydrat e would be e q ual

to th e oxyg en co nsum e d In th e combustio n lit e rs ) multip l i e d

by th e calorific e quiva l en t for this n o n prot ei n r e spiratory quoti e n t -
,

i e
. .
,
th e ca l cu l atio n b e in g ca l ori e s T h e .

valu e s for th e tota l h e at r e sultin g from th e com b ustio n of th e fat an d

car b ohydrat e for e ach day of th e fast are giv en in column I of tabl e 6 1 .

Th e tabl e of Z u nt z an d S chum b urg has b e en elaborat e d in a most

1
h e lpful and i nge nious way by Wi l liams R ich e an d Lusk wh o hav e , , ,

apportio ned (in t erms of p e rc entage of total e nergy ) th e fat carbo -

hydrat e katabolism usin g th e no n prot e i n r e spiratory quoti en t With

,
-
.

a n o n prot e i n r espiratory quoti e n t of

-
th e s e authors comput e that
p e r c e n t of t h e e n e rgy is d e riv e d from carbohydrat e a n d pe r

c en t from fat ; co ns e qu e nt l y o n April 1 4 1 5 about per c e n t of th e

,
—

calori es as calculat e d pr eviously or 29 1 calori es are d eriv e d from , ,

th e kata b olism of carbohydrat e an d th e r e mai n i n g calori e s from ,

fat Obviously as th e no n prot ei n r e spiratory quoti e nt fa l ls th e pe r

.
,
-
,

c entag e of e nergy d e riv ed from carbohydrat e b e come s l e ss an d l e ss ,

u ntil at ,
or l ess it is assum e d that n o carbohydrat e is burned I n
,
.

fact o n s e v eral days wh en th e no n prot e i n r espiratory quotient was

,
-

’
an d o n o n e day w e hav e fo l l ow e d Lusk s usage in employi n g
th e valu e for th e quoti e nt of

AM
O

OU NT S or CA RB O HYD RA T E A ND OF FA T K A T AB O L I Z E D .

Wil l iams R ich e and Lusk w er e particularly i n t er e st e d in th e

S inc e , ,

e n e rgy tra n sformatio n th e ir apportio n m e n t of th e n o n prot e i n kata b -

,

o lism b e tw een fat an d carbohy d rat e was e xpr e ss e d in p erc e n tag e of

e n ergy from car b ohydr at e an d p e rc en tag e of e n e rgy from fat F or our .

purpos e sin c e w e d e sire th e w e ight of th e car b ohy d rat e and fat burn e d
, ,

it is v e ry sim p l e to comput e th e h e at pro d uctio n an d th en by divi di n g

by th e appropriat e ca l ori fi c valu e s for car b ohydrat e an d fat obtai n ,

dir e ctly th e n um b e r of grams of carbohy d rat e an d fat e n t eri n g i n to th e

katabo lism .

T h e h e at of combustio n of th e carbohydrat e burne d in th e body is

2
tak en as that of glycog en calori e s per gram whil e th e h e at of
, ,

combustio n for th e fat is tak en as that of body fat ca l orie s per ,

gram 3
B y dividi ng th e r e sp e ctiv e amou n ts of e nergy by th e s e h e ats
.

of combustio n th e n umb e r of grams of glycog en an d b o d y fat partici

,

pati n g in th e katabolism ar e comput e d The se are re cord e d in co l umn s .

N an d o in ta b l e 6 1 Whi l e this me tho d of comp uti ng th e proba b l e

.

W illi m R ic h a d Lu k J u
l
a B i l Ch m 1 9 1 2 12 p 35 7
s, e, n s , o rn . o . e , , . .

Em y dB dic t Am J u n Ph y i l 1 9 1 1 28 p 3 0 1
2
er an ene , . o r . s o .
, , , . .

B d ic t d O t b g Am J u Ph y i l 1 9 00 4 p 69
3
ene an s er er , . o rn . s o .
, , , . .
4 08 A ST UDY OF P R O L O N G E D F A S T IN G .

Although L w e nt without food for 3 1 days an d he nc e th e comp li

.
,

c ate d factor of d e te rmi nin g th e in tak e of wat er in th e food was elim i

nate d ne v e rth el ess h e dr a nk a d e fin it e amou n t of wat er e ach day , an d

,

water was lost from th e body through various paths We k now that .

in th e urin e a c e rtain amount of wat e r was mix e d with th e solids T his .

was d e t ermine d v ery car e fully in th e latt er part of th e fast so that we ,

had accurat e informatio n as to th e re latio nship b e tw ee n th e total

am ou nt of wat e r an d total solids and w e r e accordingly abl e to compu te ,

th e wat e r e xcr e t e d in th e urine durin g th e e arli er days of th e fast .

Wat er was also lost by vaporizatio n from th e lun gs and skin In th e .

m ethod formerly us e d for obtainin g th e loss of wat er from th e body

it was lik e wis e ne c essary to d e t e rmin e car e fully th e amou nt of wat er
thus vaporiz e d in th e 24 hours I n this fastin g exp erim ent whil e such .
,

d e t e rmin atio ns w e re mad e for th e p eriod wh en th e subj ec t was i nsid e

th e r espiratio n calorim e t er we hav e no dir e ct e vid e nc e r e garding th e
,

probabl e wat er vaporiz e d from th e l un gs an d skin duri ng th e tim e that

L was outside of th e chamb er E v e n th e r espiratio n e xp erim en ts
. .
,

whil e supplying information r egardin g th e carbo n dioxid e output and -

oxygen i n tak e give no e vid enc e as to th e excre tio n of wat e r Accord

, .

in gly th e total outgo of wate r must be d e t e rmi ne d by i n dir e ct compu

,

tatio n . F ortu nate l y th e data r e gardi ng th e katabolism of L are so .

full and e xact that we are j ust ifi e d in e mploying such a m ethod .

LOSS OF P RE FOR ME D WATE R .

To d et e rmine th e actual drafts upon body mate rial in th e form of

pre form ed wa te r th e computatio n proc ee ds in th e following manner
, ,

th e r e sults b e in g giv e n in tabl e 62 We have first th e in s en sibl e .

“

”
p e rsp iratio n (colum n A) whi ch is lik ewi se r e cord e d in tabl e 4 (pag e
,

From th e discussio n in th e pr ec eding s ectio n we hav e i nforma

tio n as to th e amou nts of carbohydrat e fat an d prote i n which w ere , ,

katabo lized in th e body Th e carbohydrat e was comp l e t ely oxidiz e d

.
,

l e avi ng th e body in th e form of carbo n di oxid e an d wat er and h enc e ,

was a compl e t e loss Th e fat was similarly burn e d to carbo n dioxide

.

an d wat e r On th e oth e r ha n d o nly a portio n of th e prot ein was

.
,

actually oxidiz e d an d so to s p e ak volatili z ed and lost from th e body

, , .

1
U sin g standard figure s Lo ewy h as comput e d that for e ach 1 00 ,

grams of combustibl e a nhy drous fl esh whi ch is katabo liz ed th ere are
availabl e for oxi d atio n an d co nv ersio n to carbo n dioxid e and water
grams of carbo n grams of hydr og en an d
, grams of ,

oxyg en Thus of th e total prot ei n mol e cul e

.
, per c ent may be ,

burn e d and pe r c e n t may b e e xcr e t e d in uri n e or f e c e s I n com .

puti ng th e total w eights of carbohydrat e fat and prot e in oxidiz ed and , ,

volatil iz ed in th e body we must therefor e allow for per c en t of th e

prot e in excre te d in th e uri ne Th e valu es given in column B of tab l e 6 2
.

L o wy O pp h i m
l
e ,
Ha dbu ch d B i ch m i J
en e er s
’
19 1 1 4 n p 15 6 er o e e, e na, , . .
 B ALAN CE OF IN C OME A ND O UTG O .

for th e a n hydrous mat erial burn e d th er e fore r epr e s en t th e total w eight

of carbohydrat e burn e d (column N of tabl e th e total w e ight of fat
burn e d (column an d p e r c e n t of th e total w e ight giv e n in tabl e

6 1 (column P ) for th e amou n t of prot e i n bur n e d .

S in c e th e i ns en sibl e p erspiratio n r epr e s en ts th e actual i n s en sibl e

loss from th e body th e amou n t of pr e form e d wat e r vaporiz e d may be
,

T AB L E 62 — Preformed water vapori zed or excreted from the body

. and drafts u pon the
ori gi nal supply i n exp eri ment with L .

Pr ef o rm e d w ater .

D ate .

A pr 30 — M ay 1
.

1 79
-

— 1 22

1
All c h a b n m ad e fo th e p p o rt i o n
o w an e s ee r p ro er c en t ) of th e pro te in katabo liz ed assum e d to h a v e
b e n x c t e d i th e u i n
e e re n r e .

I t is a su m d th at th am o u nt f w at r f o m f atty ti
2 s e e o e r ssu e is e qu al to 1 0 pe r c ent o f th e fat katabo li ze d .
4 10 A ST UDY OF P R O L O N GE D F A S T IN G .

obtained by d eductin g th e total w e ight of a nhydrous mat erial burn e d

from th e tot al amou n t of ins e n sibl e p e rspiratio n Th e r e sults are .

r e cord ed in column 0 of tabl e 6 2 th ese valu es re pre s e ntin g th e total ,

amount of wat er actually vaporiz e d from th e lu ngs an d skin of th e

su bj ect We kn ow from form e r e xp e ri e n c e that th e preform e d wat e r
.
‘

lost in this way is aff ect ed larg e ly b y muscular activity and that it is
ma d e up in part of wat er w h ich has b een combi ne d with fl e sh an d with
fatty t issu e .

I n additio n to th e loss of wat er through th e lu n gs an d S kin th er e wa s ,

a l so a lo ss of preforme d wat e r through th e uri n e th e am ou nts b ei n g ,

giv e n in column D whil e th e total amou nt of pr eform e d wat e r e ith e r , ,

vaporiz e d or e xcre t ed is show n in column E Th ere was howe v e r , .

, ,

no t o nl y an outgo b ut an i n com e of wat e r as th e su b j e ct dra n k a ,

m e asur ed am ou n t of wat e r e ach day To fin d th e actual loss of pre .

form ed wat e r from th e store in th e b ody this i n com e of wate r (see ,

column F) should be d e duct e d th e valu e s in colum n G showi ng th e ,

actual loss of pre form e d wat e r from th e stor e in th e body .

Th e total loss of pr e form e d wat e r vari e d from 7 69 grams o n th e first

day to 8 gram s o n th e tw e nty th ird day ; as a matt e r of fact th e body -

actuall y stored 80 grams of wat e r o n th e th irt ee nth day T h e h eavi est .

lo sse s occurr e d o n th e first fe w days of th e fast In this discussio n it .

is nec e ssary to co nsider that th e body los es fairly re gularly a quantity

of prote in an d fat e ach day This loss is accompa nied by a loss of th e .

wate r normally combi ne d in th e fl esh and fatty tissue th e amoun t ,

being relativel y co nstant and ave raging no t far from 200 grams of wat er
per d ay Th e portio n of th e body remai n in g (which may for c o nven
.
,
” “
ie nc e be ca l l e d th e re si due ) lik e wis e has a wa ter co nt e n t which un d er
,
-

goe s fluctuatio n Th e total loss of preforme d wate r in co l umn G may.

th e refore be classifi e d u n de r three he ads : ( 1 ) wat er of fl esh brok en d ow n ;

(2) wate r of fatty tissu e brok e n dow n ; (3 ) wat e r from oth e r sourc e s ,

i e from th e r esidu e
. .
, .

T h e amou n ts of wat e r from th e fl e sh d isi n t e grat e d an d fatty tissu e

brok e n dow n may be comput e d b y th e u se of c e rtai n factors Thus it .

is assume d that th er e are 4 grams of wat er com b i ne d with e v e ry gram

of prot e in to form fl esh ; furth e rmore that body fat is combi ne d with ,
2
1 0 per c en t of its w eight in wat e r to form fatty tissu e Th e draft .

upo n th e stor e of p reform ed wat e r du e to th e katabolism of prot ei n

may th er efor e be fou n d by multiplyi ng th e amou nt of prot ei n kata
bo liz ed by 4 an d th e draft upo n th e pr eform ed wat er du e to th e
,

katabolism of fatty tissu e by fi n d in g 1 0 per c ent of th e amou n t of fat

B n di t C a
l
e egi I t W a h Pu b 7 7 p 4 29
c . rn e e ns . s . .
, . .

M k ( L h m n n M ll
z
un Mun k S na te an d Z u t
a , A ch iv f p th An t u Ph y i l
ue er, , e o r, n z, r . a . a . . s o

1 8 93 1 3 1 S u pp p 2 1 6 ) i c m p u ti g th b d y l
. , .
, . 10 p c nt ; Al bu and N b g
n o n e o - o sses u ses er e eu er

( P h y i l u P th d Mi l t fl w h l B li 1 90 6 p 9 ) al um 10 p c t O th '

s o . . a . es n er a s o ec se s, er n, , . so ass e er en . n e

o th ha d B
er n ad ( D u t c h A c h iv f kli n M d
n , oze ra19 1 1 103 p 1 20 ) tat
e th t t h w t
s . r . . e .
, , , . s es a e a er

c nt t f h um fat m y va y f m 7 to 4 6 p c nt T h av ag wat c t t f th f t i
o en o an a r ro er e . e er e e r- o n en O e a n
fa t p o pl w a
e p c t w h il i m ci at d p n it w
e s er pen c nt , e n e a e e rso s as er e .
 A ST UDY OF P R O L O NG E D FA S T IN G .

TOTAL LOSS OF ORIGINAL BODY SUBSTANCE .

Fr om an a nalysis of th e fore goin g data we are in a positio n to state ,

with a co nsid e rabl e d e gr e e of accuracy th e loss of carbohydrat e fat , , ,

pro te in and pr eform e d wat er an d solids e xcre t e d in urin e and from th e

, ,

skin an d thus pr e s ent a general pictur e of th e total loss of origin al body

,

substanc e durin g fastin g This is shown in tabl e 63 Th e combustio n . .

of carbohydrat e c e as ed aft e r th e first 1 3 days of th e fast Th e combu e .

T AB LE 63 .
— Distributio n of loss i n grams of o rigina l
. body substa nce per 24 hours
-
, in experi ment with L .

0 0 0 0 0

0 0 0 0 0

2 7 — 28

A pr 3 0 — May 1
.

1
p g
S ee a e 4 08 .

’
bl
S e e ta e 6 2 .

‘A c l c late d fo first 1 5 day f fa t (S e e tabl e 24

m o unts a u r s o s . .

‘U
rea plus d ium c h l i d c alculate d f m valu giv n in t abl e 22 ( p
so or e ro es e . c f
E x re t a r o m t h e s ki n were
d etermined each w k g f m th e t im f b athi n g o n v ni n g f April
ee , 3 . .
, ro e o e e o i
1 3 to th e t m e o f ath b i ng o n th e
evening o f April 20 F th e to tal ni t o g n xc te d n th e uri n e ach day
. or r e e re I e , see ta bl
e 29 .
 B ALA NCE OF IN C O ME AND O U TG O . 4 13

tion of fat and prot e in co ntin u e d without mat erial alt eratio n in r elativ e
proportio n s u n t il th e en d of th e fast Th e pr eforme d wat er lost from .

th e body came from thr ee sourc e s first that combi n e d with th e prot ei n , ,

to form fl e sh ; s e co n d that combine d with fat to form fatty tissu e ;

,

thir d wat er from oth er sourc e s in th e body F i n ally we hav e th e

,
.
,
1
solid e xcre ta from th e body mad e up of th e solids of th e urin e and th e
solids from th e skin Th er e was no f e cal loss . .

TOTAL ENERGY LOSS .

Th e loss in energy as th e fast progr e ss e d was in two forms i e th e ,

. .
,

kin etic energy in th e form of h e at whi ch i n clud e s th e s ensibl e h e at of ,

e xcr e ta th e h e at lost by radiatio n an d co n ductio n and th e h e at of

, ,

vaporizatio n of wat er ; an d th e pot ential energy of th e solid e xcre ta ,

chi e fly that of th e organ ic mat erial in th e uri n e .

Co nsid erin g first th e kin e tic ene rgy or th e h e at lib erat e d it is cl e ar ,

that th e h e at r e sults from th e actual combustio n of organ ic mat erial ,

such as prot ei n carbohydrat e and fat F rom our form er computatio n s

, ,
.

( s ee tabl e w e c an apportio n t h e h e at productio n amo n g th es e thr ee -

compou n ds This apportio nment is S hown in tabl e 64 whi ch for sub

.
, ,

s e qu e n t discussio n also giv es th e total amou nt of energy lost from th e

,

body .

Th e gr e at e st loss of h e at falls upo n th e fat with th e prot ei n supply ,

ing th e gr e at er part of th e r emai n de r A s a matt er of fact although .

,

th e carbohydrat e (glycog en ) is rapidly draw n upo n an d appar en tly th e

availabl e supply is quickly d epl e t ed suffici e n t glycoge n is burn e d th e ,

first day of th e fast to furnish somewhat mor e h e at than was suppli e d by

t h e prot e i n o n that day A ft er th e first 3 days th e h e at was d eriv e d
.
,

almo st wholly from a fat prot ei n katabolism with a mi nimum supply of

-
,

glycog e n Th e combustio n of glycogen c eas e s aft er th e thirt ee n th day

. .

Th e actual quota e ach compou n d suppli e s to th e daily e nergy r e quir e

men t is b e st s een by placin g th e h e at output subdivisio n upo n th e per
c entage basis This is do n e in tabl e 65 which S hows that o n th e fir st
.
,

3 days from 1 0 to 1 6 per c en t of th e h e at was d eriv e d from glycog e n .

Subs e qu ently th e glycog en c ombustio n furn ish e d hardly mor e than

,

1 to 3 per c en t of th e h e at Aft e r th e thirt eenth day approximat ely

.
,

per c en t of th e h e at was d e riv e d from th e oxidatio n of th e prot ein

an d th e r e main d e r from th e combustion of fat .

In th e fasti n g e xp erim en t with L th e body lost n o t o nly th e kine tic .

,

ene rgy of mat erial burn e d b ut a l so th e pot en tial e n e rgy of solid u n o xi

,

diz e d mat erial co n tai ne d in th e uri ne S in c e ther e w er e n o f e c e s duri n g .

th e fast n o pot en tial e n ergy was lost in this way

,
Whil e both gly co .

g en an d fat bur n compl e t e ly to form carbo n dioxid e an d wat e r in

1
It i b vi
s o th at th un xi di d m at i l f p t i n i a c n ti tu n t in tw c lum n
ou s e o ze er a o f th e
ro e s o s e o o s o

t abl e. I n c lum n oth to tal p te i n i n c lu d

A, e th u n xi di ed m at i al wh ich appea s ag ai n in
ro es e o z er r
the so l i d i n th u i
s e r ne .
4 14 A ST UDY OF P R O L O N GE D F A S T ING .

n ormal katabolism u n d er c e rtain pathological co n ditio n s and in

,

in a nitio n th e fat combustio n is d e f ectiv e an d c ertai n partially o xi d iz e d

,
”
bodi es th e so call ed ac e to ne bo di e s
— -
“
are produc e d an d e xcr e t e d —

chi e fly in th e urine .

I n th e e arli e r r eport of fasti n g e xp erim ents dir ect e vid e n c e of th e

1

pr es e nc e of th es e bodi es was no t availa b l e an d in computing th e h eat ,

TAB LE 64 Distri butio n of heat produc b

g
—
24 hou rs to ody-materials katabolized, and to tal
f tiw g
.
pe r
energy lo ss o dy i n experi ment with L .

T l
o ta
Day Of
D a te .

2 1— 22

2 l st

24 th

29 th

14 —1 5 3 l st

from prote in we assume d e rro neously that a l l of th e u noxidiz e d m at e rial

in th e uri ne was d erive d from th e cl e avag e products of prot e i n Th e .

me thod of simultan eous e quatio ns th e re e mp l oy ed is fu n dam en tall y

base d upo n th e assumptio n that th e cl e avage s all proc ee d in a n ormal
mann er B y thi s m ethod th e total carbo n e xcret e d i nc l udi n g that
.
, ,

of uri ne and carbo n dioxid e was apportio n e d amo n g th e prot ei n car

, ,

B n dic t C gi I n t Pu b 7 7 1 907 p 4 9 5
1
e e , arn e e s . .
, . .
4 16 A ST UD Y OF P R O L O N GE D FA S T I NG .

T AB LE 66 — . C omplete meta bolism results with su bject L during 4 days . presfasti ng

-

period, 3 1 days fasti ng, and 3 days post fasti ng period

-
.

In nose ries of de rive d tabl es IS it p ossibl e to d raw co mpl e te c omp arisons of

th e vari o us factors o f me t ab o li sm an d th i s c an be d on e satisf acto ril y o nl y
,

whe n all o f th e d ata are groupe d to gether I have b een re q ueste d b y a numb e r
.

o f physio l ogists to summ ari z e all of th e d ata o b t ai ne d with thi s subj e c t in

o ne l arge tabl e at th e e nd o f th e b o o k S i n c e so much stre ss h as bee n l ai d
.

upon th e d esir ab il ity o f such a p rese ntation th e d ata are given here in full
, .

I n o rd e r to b rin g t o ge the r comp arative d at a fo r e ach day o f th e fast it ,

h as bee n ne ce ssary to pl ace in each co l um n resul ts whic h re p re se nt in th e agg re

gate a to tal of 36 ho urs e ach singl e re sult howeve r b eing either t ak en at th e
, , ,

e nd o f 24 ho urs o r re p rese nti ng a to t al fo r 24 hours T h e re sul t s re c o rd e d o n

.

th e thirty fi rst day to which an aste ri sk h as b ee n affi xe d we re as a matter of

-
,

fac t o b tai ne d a short time afte r th e first fo o d h ad b een tak en

, .

FI G 4 7
. .
— Metabolism ch art of the mo st i m
th roug ho ut t m f
nt
t
facto rs measu red on su bject L .

Altho ugh tabl e 6 6 gives th e exac t mathematic al exp re ssion o f th e q uan tities
of mate ri als i nvo l ve d in th e di ffe re nt me asurements of th e metab o l ism o f th is
subj e c t a visu ali z ati o n o f th e re l ati o nshi p s b e twe en th e v ari o us f ac to rs o f
,

me tabo l ism is be st se c ure d by a se ri e s of curves A chart c o ntaini ng c urve s.

fo r all o f th e facto rs me as ur e d o n thi s subj e ct wo u ld be o f such gre at si z e as

to p re c lud e conve ni e nt i ns pe cti o n H e nce we have coll e cte d h ere o nl y th e
.

most im po rt ant o r mo re gene rall y o b se rve d f actors Al though no sp e cifi c .

re fe re n ce is mad e to these curve s fo r any c o mp ari so ns in th e text it is o b vio us ,

that a co nstant refere nce to this chart is p resupp ose d in a c are ful re adi ng of
th e re po rt .