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The man or woman who has never undergone a fast, or who has never had opportunity to watch the varied phenomena that are to be seen in cases of fasting, labors under the belief that a fast must be a very harrowing and severe ordeal. Such a person is likely to picture the faster as suffering the most intense agonies from starvation, his agonies increasing in intensity until, finally, the victim expires in the most excruciating pain. If this picture had any truth at all in it, it would certainly be impossible to induce any person to enter voluntarily upon a second, much less a third or fourth fast.
"Fasting is not always a pleasant experience, but, then, neither is it a pleasant experience to be sick." It is certainly not pleasant to go through a period of drug medication. But fasting may be a period of comfort and pleasure. The individual who suffers after each meal may find perfect comfort through a long fast.
In his "Diary of a Faster" (Physical Culture, Feb. 1914), Fred Busch describes his fast of 17 days, day by day. He tells us that he undertook a fast only after his condition had grown so bad that he was unable to eat even the simplest of foods without distress. He adds: "sound sleep is unheard of--work is a punishment--life in general a drudge." He records on the morning of the second day of his fast that he slept a full eight hours the night before and that he was feeling rather good. He slept well every night through his fast. Seventeen days of comfort, during which he carried on his regular work in his office, and did more work than while eating, reveals that fasting may be a very pleasant experience in many conditions of life.
When a man goes on a fast, every abnormal sensation, every "craving," every ache and pain that he may develop immediately thereafter, is credited to lack of food. They are, in reality, due to the absence of his accustomed stimulants--coffee, tobacco, condiments, alcohol, etc. That they all disappear as the fast progresses, proves that they are not due to lack of food.
Dr. Shew says of the first few days of fasting: "A feverish excitement of the system, together with a feeling of debility, faintness and depression is generally experienced. The patient becomes discouraged and melancholic, and is very excitable and sensitive to surrounding influences. He also experiences pains and soreness in the loins, feet, and sometimes in the joints. He becomes very tired of the sitting posture and leans to one side or the other for support. But all of these disagreeable symptoms, which are necessary in the process, grow by degrees less and less, as the morbid matter is eliminated from the vital economy. And when the body has at last grown pure, these unpleasant consequences disappear entirely, and the convalescent gains strength with inconceivable swiftness through the period of the after-care."--The Hydropathic Family Physician, p, 790.
As we almost never meet with fasters who present the picture here drawn by Dr. Shew, I am of the opinion that his description is a good index to the grossness of living habits of the people of his time. When we consider that the symptoms presented by the faster are in keeping with the unphysiological character of his mode of living, this seems to me to be a fair conclusion. Great changes for the better have taken place in our living habits during the hundred years that have elapsed since Shew wrote the foregoing lines. Any of the symptoms he enumerates may be met with, but we almost never see all of them in a single patient. Many patients never develop any of them.
The first two days of the fast are usually the hardest, due (1) to the persistence of the demand for food, and (2) to the sudden withdrawal of the accustomed stimulation. Headache, dizziness upon arising, spots before the eyes, nausea, vomiting and gnawing, or an "all-gone" sensation in the stomach, are the chief elements of discomfort during the first few days of the fast. These symptoms are largely the result of the withdrawal of coffee, tea, tobacco, condiments and stimulating foods. Fat people and "good livers," suffer most in these respects. As a general rule, it may be set down that the more marked these symptoms are during the early days of the fast, the sooner the fast will accomplish the desired results.
I do not think that it can be too strongly emphasized that the bodily sensations of fasting are, in many cases, more pleasant than the bodily sensations of feasting. The patient who has suffered so much previously from being forced to eat when there was no desire for food, the patient who has suffered so much pain after all food, is likely to feel a great sense of relief and satisfaction from the time the fast begins.
The tongue becomes coated, the breath foul and there develops a very bad taste in the mouth. These are all indications of a process of elimination and are favorable signs.
As the fast progresses, the symptoms grow less and less marked until they cease entirely. Many things that the sick customarily do are more disagreeable than the most disagreeable symptoms that ever develop during a fast. These things are disagreeable always; whereas, the fast is so only in a minority of cases and not so throughout its length. The original symptoms, for which the fast was instituted, also gradually cease. Sinclair says in describing his first fast, "Previous to the fast I had a headache every day for two or three weeks. It lasted through the first day and then disappeared--never to return."
Eighteen years ago a patient came to me from New York. All save one physician who had cared for him had insisted upon an operation for tumor of the brain. For months he had suffered day and night with a severe headache that the drugs of physicians had failed to relieve, even temporarily. Twenty-four hours without food brought complete relief from the pain. The patient described the results as a miracle and wanted to start immediately for home.
Another remarkable example of the gradual disappearance of symptoms during a fast is presented by the usually rapid clearing up of skin eruptions. One example will suffice. A young man who had suffered with acne for ten years and had tried medical and drugless methods to no avail, was placed upon a fast. In nine days his skin was as clear of eruptions as that of a baby. The remarkable changes that occur in the skin and the increased brightness of the eyes add greatly to the youthful appearance of those who fast.
I have emphasized the gradual disappearance of symptoms. I must also emphasize the fact that there is sometimes a temporary increase in symptoms during the early days of a fast. Headache may sometimes increase at first and then diminish. The gastric pains in hyperacidity and gastric ulcer are almost sure to increase during the first three days of the fast. Nervous symptoms are sometimes aggravated at first. It also occasionally happens that skin eruptions grow worse. Catarrh is most likely to increase at the outset. Streams of mucus may pour from the nose, sinuses, throat, vagina and colon. An amazing quantity of mucus is often excreted through the uterine and vaginal walls. This is especially true in those women patients who had leucorrhea before the fast was instituted. In all cases, however, these increased symptoms are only temporary and the reverse process soon sets in, resulting in ultimate recovery.
In some forms of gastric derangement, especially hyperacidity and certain nervous states, ulcer, etc., pain accompanies an empty stomach and is relieved by food. It is known to everyone of experience that the relief from pain afforded by eating is only temporary and is soon followed by the same pain and gnawing. Eating does not remedy the condition, which may persist for years of eating.
When such a patient is placed upon a fast, there are two to three days of suffering, often increased suffering, followed by relief. If the fast is persisted in, permanent relief, or actual recovery, follows. With the coming of relief the patient experiences greater happiness and peace of mind.
A very unusual case was cared for at the Health School while this revision was underway. A man with a large gastric ulcer, very nervous and irritable, depressed, emaciated and weak, whose ulcer was of several years' standing and who had marked hyperacidity of the stomach, experienced no relief from stomach distress for more than ten days and then only intermittently. For some reason which I do not know, gastric secretion continued in this man long after it customarily ceases and, after it had practically ceased, it would start up at times and cause considerable discomfort with eructation of gastric juice. It need hardly be added that this man's fast was far from comfortable.
Increase of symptoms in the early days of a fast or the development of new ones should not cause the fast to be broken. The really healthy person experiences no reactions from the fast. Major Austin says: "A very good test indeed of a so-called perfectly healthy person's real state of health is the effect produced on him or her by missing one or two meals. If the tongue begins to get coated and the breath foul and the individual feels seedy and out of sorts, it is proof positive that the state of health is not as good as it was supposed to be." The more severe the reactions produced the greater is the real need for the fast. "In exact proportion to the severity of her fasting symptoms," says Dr. Dewey (A New Era for Women), "so is her need to persevere and for the reason that they all mean disease in course of development."
Crises developing during the fast are not different from those developing at other times and are not to be cared for any differently. They are all orthopathic in character and, although often disagreeable, should be welcomed.
The increase in symptoms previously noted should be considered as critical action. Fever, dizziness, headache, vomiting, nausea, backache, skin eruptions of various kinds, but particularly urticaria (nettle rash), jaundice, diarrhea, etc., may develop.
Many of the symptoms experienced by the faster are due to nervous re-adjustment. Take the case of a woman patient who "suffered" from sensory paralysis in an area of skin about the size of the hand at the base of the spine, and who, after a few days of fasting, experienced severe pain in this part for about two hours, this followed immediately by restoration of normal sensibility in the part--the pain in this case was patently a part of the process of nervous readjustment.
The headache that follows the giving up of coffee and the headache that often follows immediately upon the cessation of eating are both processes of nervous readjustment. Depression and irritability that sometimes accompany the early part of the fast are processes of readjustment similar to the irritability and depression that follow the discontinuance of tobacco.
Since they are always followed by improved health, it seems certain that these symptoms are necessary parts of an essentially beneficial process that the fast has enabled the body to institute and consummate.
Not all fasting cases develop any appreciable crises and in the great majority of cases where these do develop, they are mild and of short duration and result in improvement in the patient's condition. For the guidance of the reader I will describe some of the more severe crises and crises that are of relatively rare development.
Doubtless imperceptible crises occur in every fast in chronic "disease." Crises that make themselves felt by marked outward symptoms do not always occur. Whether evident or not, these crises always lead to better and ever better health.
Most of the symptoms here considered are of no special significance. Others are of such rare development that the person contemplating a fast need not expect them to develop. In no case do all of these symptoms develop. Indeed, many fasters go through a long fast without the development of any symptoms at all. The purpose of discussing these developments is not to lead the reader to believe that they indicate that fasting is dangerous, for they do not, but to acquaint him with possibilities (they are hardly probabilities in most cases) and to tell him how to deal with such crises if they do develop. They are not serious and they do not develop in more than a small percentage of cases. They need not be feared.
The varied symptoms that are seen in fasting do not represent any "turn for the worse," in the patient. On the contrary, they are symptomatic of certain internal vital or functional and organic changes, which are always for the better. Unfortunately, most people, including most doctors of all schools, are still laboring under the old delusion that symptoms are, or represent destructive processes, hence there is no understanding of the actual beneficial character of these crises.
Spitting: What may be denominated a "spitting crisis" develops in a few cases. An almost incessant stream, of mucus is poured into the mouth and throat necessitating constant spitting. Often this lasts for several days and it may be so persistent during this time as to prevent sleep. It is so obviously an eliminating process that we need not dwell on this part of the phenomenon. Like most crises it is uncomfortable and annoying while it lasts, and, like all crises, it is succeeded by marked improvement in the general condition.
Although there are occasional cases in which the saliva flows as freely during the fast as when eating, it is the rule that it is greatly reduced in amount and the other secretions of the mouth are so reduced that there is dryness of the mouth, lips and throat. In occasional cases the secretion in the mouth, chiefly mucous, may be so unpleasant as to induce vomiting. This unpleasant taste will gradually lessen and will disappear altogether before the fast is to be broken. For immediate relief, the tongue may be thoroughly scrubbed with a brush and the mouth cleansed with water.
Nervous Crises: One case in my practice presented a nervous crisis which I believe to be unique. Fasting literature does not contain a description of another such case. Slight pain and severe burning would begin at the base of the skull and travel down the spine, the part above ceasing to suffer as the pain passed below it. When the pain and burning reached the base of the spine, it "jumped" to the knees, the back side of these, and from here it would "jump" to the base of the skull. This would last an hour or more, and then there would be a period of intermission during which the patient would secure rest and sleep before it would set in again. The patient was very weak during the three or four days the crisis persisted. As soon as it was over she was as strong as ever.
Catarrh: A cold may sometimes develop near the beginning of the fast. Soreness in the throat may also occur, though rarely. The elimination of mucus is almost always increased in the early part of the fast in chronic "disease."
Skin Crises: Skin eruptions may cover the whole body. (I have had but one such case in my own practice), or they may be only local. The eruption usually itches. One case in my practice was that of a woman who developed a solid mass of urticarial eruptions on both forearms, from hand to elbow. One arm itched intensely, the other itched not at all. Such eruptions may last but a few hours but usually they persist for from three to four days. They are processes of elimination.
Headache: Severe headache and backache are usually accompanied with considerable prostration. Sometimes the patient and family become frightened. The pains are severe but there is no danger. No attempt should be made to break the fast during this stage. The headache and backache may last for from one to three or four days. They represent nervous readjustment and are met with largely in nervous patients. Headaches are usually due to the withdrawal of tobacco, tea, coffee, drugs and stimulating foods. Headache commonly develops from the first to the third day. By no means all patients present this symptom.
Aching Limbs: Besides pains in the back, usually in the lower spine, there frequently develop in the early days of the fast, pains in the hips, pains at the base of the skull and aching in the limbs, particularly in the joints. These pains and aches are often very annoying, but seldom last more than one or two days. They develop chiefly at night and cease during the day.
Nausea: This seems to be an expression of a sudden decrease of the normal tension of the stomach. It may be induced by a foul odor, a bad taste, a disgusting sight, or an emotional shock. Severe pain, illness, fatigue, rapid descent in an elevator, etc., may produce nausea by lowering the tension of the stomach. These things bring about a loss of tension through a complicated "reflex" mechanism.
Continual emotional disturbances, such as prolonged worries, anguish, grief and repeated shocks, may result in a persistent loss of tone in the stomach and produce the "all gone" sensation or vague nausea often complained of.
In many cases there is no doubt that the sudden withdrawing of all food, as in fasting, results in a temporary lowering of tone or tension in the stomach and this produces nausea. On the other hand, tall, thin, undernourished people are likely to suffer with a chronic lack of tension in the stomach and this becomes more noticeable when they fast. The presence of bile in the stomach also causes nausea. Its presence is very likely to lead to vomiting.
Vomiting: I had one case to vomit almost continuously for six days and nights, although such vomiting usually lasts not more than a day or two. Much mucus and bile are thrown out. It is a cleaning-out process. The aforementioned case developed persistent hiccoughs when the six days of vomiting ceased, and this persisted for seven days before it ceased. The cessation of these two crises was the end of her suffering which had persisted for seven years. Another case, an old lady, vomited four days and nights, but made an excellent recovery. I do not regard vomiting as a danger signal, but as a cleansing process.
Mr. B, who underwent a 31 days fast in my institution in 1932-33, began vomiting on the 23rd day of his fast and vomited day and night for 7 days, or through the 29th day of fasting. Large quantities of mucus and bile were brought up. He was very weak while vomiting, but became strong again as soon as the vomiting ceased. This, however, is the usual experience.
Efforts to break a fast while the patient is vomiting are futile, even harmful. "Only God could break a fast," wrote Dr. Dewey, in a personal letter to Hereward Carrington, dated March 26, 1903, "where there is a sick stomach and there is no time to let nature perform the task. Taking food in such a stomach would be death-dealing. There is nothing to do but make the body and mind as comfortable as possible, and Nature will cure, if the seal of death is not set."
Speaking of the occurrence of vomiting during a fast, Mr. Macfadden says: "It is certainly inadvisable to break a fast at such a time. If food be administered at such a time, it most certainly will be ejected, and it may aggravate the vomiting all the more." Dr. Dewey records a case in which vomiting began after fasting fifty days. Food was tried, but promptly ejected. There was nothing to do but wait, with the result that one day after the last vomiting spell, there was a natural call for food--and this on the sixtieth day of the fast.
Much mucus is often (usually) expelled in the vomiting process. I have seen no pus so ejected but Carrington tells of such. I have seen vomiting last for as long as two weeks after forty or more days of fasting and, while it leaves the patient very weak, there has in no case been any danger of death.
Sometimes vomiting, headache and eruption will all come together. With a little experience in handling cases, one can judge fairly accurately in advance who is and who is not going to develop a severe crisis. Long standing cases of digestive troubles, particularly those accompanied with nervous disorders, are most prone to develop these.
As vomiting is merely part of the elimination that fasting encourages, most often due to overactivity of the liver with regurgitation of bile into the stomach, it needs only to be let alone. It may develop early or late in the fast, but it constitutes no danger, so far as my own experience and observations go. Carrington says that such vomiting spells occurring at the end of a prolonged fast have been known to terminate fatally. I have seen no such fatalities and naturally wonder if death in such cases may not have resulted from the heroic treatment designed to stop the vomiting.
Cramps: These may occur in the bowels of both sexes, or in the womb of females. In the bowels they may be due to gas, to bowel action, or to "psychic" interference with sympathetic control of peristalsis. Uterine cramps are rare, occurring chiefly in those patients who bleed from the uterus. More rarely the cramps result from efforts to disgorge the womb of an accumulation of mucus.
Gas: Many patients have considerable intestinal gas while fasting. Those who suffer with digestive troubles, visceroptosis, colitis, enteritis, etc., and "nervous" patients are most likely to be troubled with gas. In not a few cases there is sufficient gas to cause distress, even sleeplessness. Most of these cases experience difficulty in expelling the gas.
In most cases, distress is probably not due to the presence of a large amount of gas, for this is seldom present in large amounts. It seems rather to be due to increased internal tension. A constant internal tension or pressure is maintained in the digestive tube. This is regulated by the sympathetic nervous system. Increased tension is felt, reflexly, as pain or discomfort in the muscles of the abdomen.
"Nervousness," shock, strong emotions, etc., may cause increased tension in the tube and the faster will experience some kind of discomfort. Subconscious fears also may cause the so-called gas pains. Those who have long suffered with digestive derangements are especially prone to changes in the internal tension of the tube.
Functional irregularities in the stomach and intestine may cause pain because of increased peristaltic contractions that often exist in these. Marked visceroptosis, with sharp angulations, may increase the internal tension and cause discomfort or pain.
Increased peristaltic activity of the stomach walls, due to "nervousness," may also result in discomfort that is mistaken for "gas pains." Increased tension may occur in any section of the tube and thus pain or discomfort may be either general over the abdomen or may be more or less localized.
Fasters who so suffer generally complain that the "gas" makes them nervous and keeps them awake at night. It seems that the opposite of this is the truth--the nervousness causes the increased tension and resulting discomfort. Where these patients are able to completely relax, their "gas pains" cease. Although I no longer employ any of these: suggestion, abdominal massage, hot water applications to the abdomen, a drink of warm water and other measures, will usually relieve this distress, at least temporarily without actually lessening the amount of gas.
Gas rumblings in the intestine mean unstable nerve control of this organ. Cathartic drugs will almost always produce these rumblings. This is due to excitement produced by the irritating drugs.
The gurgling and rumbling often heard in the abdomen is due to the movement of gas from one section of the intestine to another. It may often be due to emotional interference with the normal sympathetic control of the gut. A nervous patient may exhibit such rumbling on the slightest provocation. Enemas, due to the excitement they occasion, often produce these symptoms.
Diarrhea: This is a rare development, although it is more common in fasting than some advocates of fasting know about. This is due to the fact that their use of the enema hides the actual development. It comes, when it does, only as a house-cleaning process, and only because there is an imperative need for it.
Dizziness: This is a very frequent symptom and manifests chiefly in the early part of the fast, or when one arises suddenly. It lasts but a few seconds and may be prevented by rising slowly. It is a common development during the fast and arises out of the sudden withdrawal of blood from the brain. If the faster will "take it easy," he will rarely experience any dizziness.
Fainting: This may occur in the early days of a fast. It should occasion no alarm or apprehension, and the patient should be cared for merely by stretching him, or her out and loosening all tight clothing and admitting plenty of fresh air to the patient.
Although relatively few fasters faint, many of them do at some time or other during a fast. Often this may occur on the first or second day and not again thereafter. Carrington mentions a case in which "a practical suspension of all consciousness resulted from the ingestion of the first meal, after the breaking of the fast, and lasted some hours." He emphasizes the fact that such occurrences are merely rare curiosities rather than "pathological phenomena likely to occur." He says that "it is doubtful if precisely the same effects will ever again be observed in fasting patients--being due, in every case, to a peculiar combination of causes, all but impossible to duplicate again."
When a fasting patient faints he should be cared for precisely as if he fainted while eating three square meals a day. All he needs is fresh air and time. He should not be set up, but should be left in a prone position. No stimulants or smelling salts need be given. Let him alone and he will soon open his eyes and look around, then get up and go about his business. Dashing cold water in his face is equally unnecessary. Rest, not shock, is the need of the person who has fainted.
Sore Throat: Although sore throat is most often seen following immediately upon breaking the fast, it occasionally develops during the fast. The soreness is never great, lasts but a day or two, at most, and need occasion no concern.
Palpitation: "Pain in the heart" and palpitation of this organ are due to gases in the digestive organs. These symptoms are of rare development and are not dangerous, although they are usually the source of much needless apprehension on the part of the patient. Palpitation may be the result of "nervousness," fear or exertion.
Pain felt in the heart is rarely actual pain in the heart. It is usually pain in the chest. It may be due to gas, it may be of "psychic" origin, it may be of toxic origin. Unless it is accompanied with other symptoms that indicate heart trouble, it should be ignored. It is not serious and soon passes.
Insomnia: This is most often due to a lack of need of sleep. Little sleep is required by the average fasting individual. In a few instances sleeplessness is due to nervous tension or to discomfort. Sleeplessness should cause no worry.
While few fasters sleep as much as when eating, all of them sleep much more than they realize. This is also true of all patients who suffer with insomnia. Ten hours of sleep seem like fifteen minutes because we are not conscious of the passage of time while we are unconscious; an hour of wakefulness seems like a whole night, because time drags so slowly when we are waiting to go to sleep.
Visual defects: While it is no uncommon thing to see great and lasting improvement in vision develop during a fast, particularly during a long fast, there are somewhat rare instances in which there develops temporary weakness of vision. Carrington mentions what he regards as a "curious development" which he says may never be seen again. A patient saw double for a time just prior to breaking the fast. Two visual images were perceived instead of one. I have seen one or two such developments myself at the end of a very long fast. What is seen more often, but still only rarely, is weakness of vision, so that the faster can see but little. He is forced to discontinue reading, or his vision may become weaker, even, then this would indicate. Much of this seems to be due to a temporary loss of coordination between the two eyes, as they do not focus upon the object viewed. That no real injury to the nerves or mechanism of vision occurs is shown by the fact that the weakness and defect soon disappear after the fast is broken and vision is soon better than it was before the fast. I had one case in which this development occurred, in a man who had worn heavy lenses for years prior to the fast. After the fast was broken he was able to discard his glasses and got along without them. Another case is that of a woman who wore glasses but who saw double (without her glasses) before the fast, and regained normal vision while fasting. She was able to discard her glasses on the sixteenth day of her fast and could see to read, sew, thread needles, etc., without her glasses. She did not return to the use of glasses until about seven years later.
Under the head of danger signals or complications, works on fasting usually list uncontrollable vomiting, persistent hiccoughs, a persistent, very erratic pulse, extreme weakness, fear of starvation, or an unreasonable and persistent determination to break the fast. The last three of these, I think, may be properly considered as signs of possible danger.
Great Weakness: This is not always a danger signal; but may be in some cases. Although it usually causes the practitioner to terminate the fast, this is due more to fear on his part than to any actual danger to the patient. Persistent extreme weakness is more likely to prove a danger signal, although this is so rare that I have seen but one such case.
Erratic Pulse: This may sometimes be a danger signal, but is not so in most cases. The heart will bear careful watching in such cases, and the fast may be terminated if the practitioner deems this advisable. An erratic pulse is usually of short duration, and should be taken seriously only when it is lasting.
A very rapid pulse or a very low, feeble pulse is usually considered a danger sign. This is certainly not always so. I have frequently continued fasts with a very rapid pulse, and I have continued others when the pulse was so low that one could hardly count it. All such symptoms must be considered in relation to the general condition of the patient and not in isolation.
Difficult Breathing: Dr. Kritzer lists the following symptoms that should be carefully watched because "they are nature's warnings to discontinue the fasting:" "palpitation of the heart; dysnea (difficult breathing); vomiting, hiccoughs, night sweats, a rapid, thin, wiry pulse, extreme nausea," The experienced practitioner knows that these are not indications for breaking the fast, and that they are not danger signals. I have witnessed the development of difficult breathing during a fast in but few cases and I have not seen it mentioned in any of the literature on fasting. It must be an exceedingly rare occurrence and, if and when it does occur, must be considered in relation to the general condition of the patient.
Retention of Urine: This is a very rare occurrence. I have never seen it develop. Authors attribute it to insufficient water drinking; but this cannot be the cause. Hot sitz baths and hot enemas are advised to secure relaxation. I do not favor their use. A catheter may be employed if necessary. Dr. Christopher Gian-Cursio reports a few cases of suppression of urine. In one case he secured a flow of urine by resort to a vaginal douche. No catheter was used. He says he much prefers fasters to have other reactions as this creates a great amount of fear in the patient and their panic-stricken "friends." Carrington mentions one case in which there was "prolonged retention of urine toward the end of a prolonged fast."
Delirium: This condition is of very rare occurrence; but may develop in those who have taken large quantities of nerve paralyzing drugs, or who are very toxic. The delirium is of short duration, and by itself should cause no apprehension. Should it develop in connection with suppressed urine, extreme weakness, rapid, feeble pulse and other signs of prostration, it should be considered a sign of danger. Such dangers do not arise from the fast, but from other causes.
Petechiæ: These are small purplish hemorrhagic spots in the skin which are chiefly associated with severe fevers, such as typhus, and are supposed to be indicative of great prostration. I have seen them develop in about a dozen fasters during more than thirty years of conducting fasts. Only two of these fasting patients have been young; the remainder have been well past middle life. They appear in patients who are in very low states of nutrition. This development has not been observed in any of the longest fasts I have conducted, while three or four of them have been in comparatively short fasts. The patients have at no time been prostrated. They probably mean great weakness of the capillary walls so that these break easily, permitting the blood to flow into the skin. It has been my practice to break the fast immediately upon their appearance. Only in one instance was the fast carried several days beyond their appearance. In this patient no harm resulted from extending the fast.
There are really few danger signals that develop during a fast and these are extremely rare. Perhaps in all cases these are due to something other than the fast. Due to popular prejudices against fasting and to the violent opposition of the medical profession to the procedure, practitioners who employed fasting hesitated to continue a fast in the face of developments they considered danger signals. Should the patient die they are likely to be accused of starving him to death and sentenced for manslaughter.
Ten thousand patients may die after swallowing poisonous drugs or after having one or more of their organs removed and no one is held responsible; but let one patient die while fasting and an autopsy is at once ordered to fix responsibility for death. This hindered, for a long time, progress in knowledge of fasting and prevented the discovery that what were thought to be danger signals often were not.
Benedict devotes consideration to strength tests during the fast. He says "The tests made by Luciani on Succi in which a dynamometer was used to measure the strength of the right and left hands, showed results seemingly at variance with popular impressions. Thus, on the 21st day of the fast Succi was able to register on the dynamometer a stronger grip than when the fast began. From the 20th to the 30th days of the fast, however, his strength decreased, being less at the end than at the beginning of the fast. In discussing these results, Luciani points out the fact that Succi believed that he gained in strength as the fast progressed, and hence probably did not exert the greatest power at the beginning of the experiment. Considering the question of the influence of inanition on the onset of fatigue, Luciani states that the fatigue curve obtained by Succi on the 29th fast day was similar to those obtained with an individual under normal conditions. . . ."
Levinson says: "Many people think that during a long fast you have to sit down on a Morris chair reading newspapers or dozing because you have not sufficient strength for doing any work at all. If you weigh two hundred pounds and your normal weight should be one hundred and thirty-two you can fast for sixty days and for each day you increase your strength, because you are coming back to your normal point. I started this fast from my normal weight; I have gone through thirty-two days of continuous scientific hardships and tortures, but I never felt that I was losing any strength and there are the dynamometer tests to show it.
"On the last day I could press up to one hundred and twenty pounds without any difficulty with my left hand and I never do any regular exercise except walking. I could go up and down a steep flight of steps to my balcony without support or shaking in the knees. I never lay down except during experiments.
"I used to pass the few spare hours that were at my disposal writing long letters and busying myself actively; on the evening of the last day I was dancing in the laboratory and laughing. In the afternoon the elite of the medical and scientific men of Harvard University and the medical colleges came to see me. I stood up for nearly two hours and for the whole time."
Telling of his discussion with the reporters at the end of his experimental fast he says: "I explained to them the impressions of my fast, compared them with those of my precedent fasts and answered many questions with my spirits up and without feeling the least exhaustion. Those that feel any lack of strength during a fast are to be classed in the same category with those who feel hungry. They are nervous, and very impressionable people, and their sufferings are only the baneful effect of their too vivid imagination.
"If you suggest to yourself that you are strong and that you can walk two miles on the thirtieth day of your fast, believe me, you can do it without great difficulty, but if you fix in your weak mind that you are going to faint and worry and persist to worry about it, be sure that not a very long time will elapse before you faint really, a victim of your wrong auto-suggestion."
What may, at first, seem paradoxical is the fact that when a patient becomes very weak in fasting, if he persists in the fast, the weakness ceases and he grows stronger. Indeed I have seen patients who were one day so weak they could hardly raise their heads from the pillow and, next day, still fasting, were so strong they wanted to get out and do things. Great weakness, bordering on prostration may be seen in certain crises, especially in vomiting, so long as the crisis lasts. As soon as the crisis has ended, strength returns with a rush.