kidneys, heart, etc. This work, of course, has been done on control animals, but doubtless applies to the human body. If fat is not disposed of in this way its other means of disposition is harmless. The following is taken from the excellent work of Haig on uric acid as the cause of diseases:

In a paper in the British Medical Journal, 1894, volume II, on the direct introduction of uric acid into the body, its bearing on the prevention and treatment of diseases, I have pointed out that, judging from the quantities of various substances taken and the quantities of uric acid or xanthins they contain, a man may easily introduce nearly two grains of uric acid with an ordinary dinner, and as we shall see further, in chapter XVII, the percentage of uric acid from which this is calculated is probably decidedly under the truth, so that the introduction of four or five grains with a carnivorous dinner is by no means extraordinary.

It appears then from this figure that uric acid passed almost directly into the blood and urine, and that there was no first stage of stimulation due to the blood being cleared of uric acid, and this illustrates a very important point, namely, that uric acid will produce one or the other of two opposite effects according as it is introduced, with conditions which are favorable to its solubility in the blood or the reverse.

Now, in Fig. 25 the conditions were distinctly favorable to its solubility in the blood, because, as I generally take neither meat nor wine, the alkalinity of my blood rules high, and uric acid was already in some excess in that fluid on the day before the first dinner. The first dinner, therefore, failed to stimulate; it failed to overcome the depressing effect of the uric acid already in the blood; it failed, therefore, to raise either urea or acidity, and the uric acid it introduced passed almost at once into the blood, and added its depressing effects on circulation, nutrition, and metabolism to those of the uric acid previously there.

On the 13th almost the same thing occurred; there was again a failure of stimulation and a further fall of urea, and again the uric acid introduced passed almost at once into the blood, and added to the general depression. The rise of acidity in this figure is very slight, and was very probably due to the rise of urinary acidity which excess of uric acid produces (see page 39, and also chapter VII) rather than to any real fall in the alkalinity of the blood, but those who eat meat two or three times a day must not expect that they will be able to intro

duce uric acid into their blood in the direct manner shown in this figure; with higher acidity, which they are certain to have so long as they keep well, the uric acid introduced will pass much more slowly into solution, and be much more gradually excreted. A dinner of this kind will act as a stimulant, they will feel better, and stronger, and happier for it, and nothing will persuade them that they are doing themselves any harm by taking it. And so long as they keep well they have decidedly the best of it, and can point triumphantly to very good results; it is true they are continually introducing considerable quantities of uric acid, which remain in the body and may produce now and again more or less decided reminders of their presence in the shape of gout or rheumatism; but so long as the blood is kept clear of uric acid by continued stimulation there is no great harm done, and they may suffer neither from gout on the one hand nor high blood-pressure on the other.

Unfortunately, however, in the natural course of events, as old age comes on, nutrition begins to fail and further stimulation becomes more and more difficult; then alcohol, morphine, and cocaine are, perhaps, called in one after the other to help keep the fires going brightly; at first they succeed; later, like everything else, and even in large doses, they fail, and then comes the final disaster.

Urea and acidity fall down and down for the last time, and with this the long pent up store of urates breaks its dams and rushes into the circulation with an overwhelming flood which completes the ruin.

Circulation, nutrition, and function are soon rendered nearly impossible, and the physiological wreck has a chance of destruction by some of the most terrible effects of the most severe colloemia, as we shall see in the following chapters.

If it escapes the ever-threatening rock of cerebral hemorrhage it may drift onward through some years of the discomfort and misery of high blood-pressure and chronic Bright's disease, to end in uremia on the one hand or heart failure on the other.

Long before this stage has been reached, however, it will be quite obvious to onlookers that the meat-eater has got far the worst of the argument, and presently will have to pay a terrible price for his stimulants. Figs. 25 and 26 shows what his meat does for him, and how it does it.

In the chapters that follow we shall see how uric acid in the blood blocks the capillaries, overworks the heart, prevents circulation, nutri

tion, and combustion, and produces anemia, and how the effects of such meals as those recorded in Fig. 25 can be observed by any one who has the means of estimating either the quality of the blood or its rate of circulation through the capillaries, or the effect of the capillary circulation on the blood pressure.

Fig. 26 shows in the same way as the previous figures the effects of taking meat extracts. On the 4th uric acid is below urea, urinary water is consequently high, and acidity stands about fifty-five grains; on the 5th three drachms of Liebig's extract are taken in the course of the day, and the effect is that urea remains steady, uric acid rises quickly and decidedly, and water comes down equally decidedly, while acidity rises a little above sixty grains.

Here, again, just as in Fig. 25, the rise of acidity was probably due to the increased quantity of uric acid in the urine, and does not show any diminished alkalinity of the blood, or the uric acid would not have been so freely excreted.

The rest of the figure merely shows that uric acid comes gradually down, there being no further introduction, that acidity falls more or less in parallel with it, and that urea falls also, part of its fall being no doubt due to the diminished metabolism which excess of uric acid in the blood produces (see chapter VIII), and last, but not least, the water falls and remains low the whole time the uric acid is high, thus again proving in the most absolute manner the obstruction of the capillaries of the kidney by the excess of uric acid in the blood. Will any one, after looking at these figures, dare to tell me that I can not control, from hour to hour or day to day, the excretion of water from the kidney, or, for that matter, the circulation, function, and nutrition of every organ and tissue of the body? We shall see further on that what controls the flow of water from the kidney controls also its exhalation from the lungs, and controls, also, digestion and all its secretions.

days 2 and 3

Fig. 27 shows the effect of eight grains of hypoxanthin taken on day 2, and it appears to increase very markedly the excretion of uric acid which rises on days 2 and 3 in spite of a slight rise of acidity, and falls again on day 4 in spite of the fall of acidity. Note, also, the inverse relation of the urinary water which falls on with high uric acid, and rises again on day 4 as uric acid comes down. What I have just said about the previous figures will apply almost word for word here; the hypoxanthin does not appear to increase the urea, and so far as acidity rises this is probably due merely to the excess

of uric acid in the urine, and not to any change in the reaction of the blood.

It thus appears probable that the metabolism of the human body makes short work of the slight chemical differences between members of the xanthin group and passes the greater part of them through the blood and into the urine as uric acid, and one very important consideration forces itself in here, though I shall have to return to it again later on, namely, that if members of the xanthin group are thus converted into and must practically be reckoned as uric acid, present in any food substance, it gives only an imperfect record of the amount of uric acid it may introduce into the body, for the xanthins and hypoxanthins remain unestimated to a considerable extent. The table, therefore, which I give of the amount of uric acid found in various food substances must be taken only as showing a part of the uric acid which these substances may introduce into the body, and important substances should be put to the more valuable physiological test of taking known quantities by the mouth, and estimating the increased excretion of uric acid produced, as in the figures I am now describing. (See chapters I and xvII.)

With regard to xanthin, I note that Bunge says (in Physiological and Pathological Chemistry, Wooldridge's translation, 1890, page 348) xanthin occurs in too large quantity in the tissues and in too small quantity in the urine to be eliminated unchanged, and Fig. 28 shows that it is changed into uric acid.

In conclusion, let me state, first, that the flesh of warm-blooded animals is not essential as a diet for the purpose of maintaining the human body in perfect health and working condition.

Second. That we have many substitutes for meat which are free from the deleterious effects of that food upon the animal economy; namely, in the production of rheumatism, gout, and all other kindred diseases, to say nothing about cerebral congestion, which frequently terminates in apoplexy, and renal diseases of one kind or another— migraine and many other severe forms of headache resulting from the excessive use of meat, and are even produced when meat is not used to an excess. So, with the facts before us as they exist to day, I think that it may be justly said that we are well prepared to fight the present beef trust, not only in the interest of our pockets, but what is far better, the interest of our physical bodies and our general good health.

LOUISVILLE.

CONVERGENT CONCOMITANT STRABISMUS.*

BY BENJAMIN L. W. FLOYD, M. D.

[CONCLUDED.]

During the first few years of life these newly acquired faculties are very easily disturbed and much more easily upset than later in life, and hence the reason of the greater likelihood of squint in children. Now, if the child fails to fuse the retinal impressions into one mental picture and produce binocular vision, the eye which receives the less distinct impression turns inward, not only from the association of accommodation and convergence, but also from the greater strength of internal rectus over external rectus, if it exists. Parents will frequently give you a history of squint beginning in infancy or childhood, following a blow on the head, a severe spell of sickness, or the most common of all exciting causes-whooping-cough. Just how these troubles can upset the convergent mechanism and produce squint is not easily explained, but if the fusion faculty is normal I believe them to be powerless. There being a failure to blend the two retinal impressions into one mental image there is no desire for binocular vision, and the eyes turn inward for the same reason that a congenital amblyopic eye squints.

This blending of the two impressions into one mental image is the fusion faculty, and where this faculty is absent or undeveloped you will have squint regardless of the refractive error, and if it is well developed you will have no squint, although the person may be suffering from hyperopia and hyperopic astigmatism. This is no doubt the condition in those cases of alternating squint in which the error of refraction is very small and about the same in each eye. They squint from the undeveloped state of the fusion faculty and from it not being susceptible of much development on account of its rudimentary condition. They do not respond to treatment as well as the monolateral form, and therefore the prognosis as to cure is not so good. Mr. Worth holds to the same views as to the etiology of squint, and believes the fusion faculty is the key to the solution of this problem and the proper development of which is the only rational treatment.

From his experiments he is led to believe that the first distinct evidence of binocular vision appears about the sixth month of age, and that the fusion faculty is normally developed by the sixth year of age,

* Read before the Ohio Valley Medical Association, Owensboro, Ky., May 1 and 2, 1902.