we infused a patient afflicted with empyema, whose blood showed a low leukocyte count. The effect was startlingly typical of what the French authors had described: the leukocyte count rose from 15,200 to 32,500; there was severe chill, sweat, and rising fever, and then a sudden fall of the temperature to subnormal. Chart III illustrates this case.

It would seem, therefore, that puerperal cases do not react to saccharine infusions like other infections. Further study is necessary, however, to determine this point and also whether or not frequently repeated doses will bring about a leukocytic response and, perhaps, correspondingly greater therapeutic effect. The encouraging clinical results obtained thus far made it seem desirable to release this preliminary report at this time and to reserve fuller details and data from a larger series of cases, as well as results of collateral studies, for a more comprehensive subsequent announcement.

80 East Concord Street.

THE SUGAR PROBLEM *

JOHN P. SUTHERLAND, M.D., Boston, Mass.

Why do we eat sugar? Ask the ordinary individual, and he will probably answer, because we like it or because it is sweet. Certainly, the average individual does not know why he eats sugar, except that it is sweet, and he likes it.

With the exception of white flour and flour products, there is probably no article of food that is eaten so extensively, and in such large quantities, as sugar; in fact, starch and sugar form the bulk of the average diet. It is right and proper that they should form the major part of one's diet, because the body is composed, to a very large extent, of carbo-hydrates and their products.

It is a curious fact that only a few short months ago the population of this great country of ours was thrown into a feverish panic over the official announcement made through the press concerning the "shortage of sugar." The coal situation has affected the people profoundly; but the fact of being restricted in the supply of sugar, and the possibility of being obliged to go without it, produced an alarm, an unhappiness and a dread, that made the coal shortage sink into insignificance. The excitement was hysterical in its manifestations, and anticipation of acute and dire suffering swayed the popular mind. The people considered themselves deprived, or on the verge of being deprived, of not only a staple article of food, but of one of the essentials of life. The idea of getting along comfortably without sugar did not seem to enter people's minds, and the suggestion that instead of being a calamity, the "shortage of sugar was in reality a blessing, was looked upon as unworthy of a moment's consideration.

During the short time at our disposal, it is not my purpose to attack the sugar problem with the thoroughness of the research investigator. It will be necessary to omit lengthy discussion of the commercial, the agricultural, the chemical, the physiological, and other aspects of the subject, and, instead, to devote ourselves to only a few practical points.

Is sugar really a necessity? If so, what kind, and how much should one eat? Is there any standard that may be used as a guide? What becomes of it in the body? Can sugar hurt anyone? In answer to the first question, we are justified in saying "Yes." Sugar is an absolute necessity to the mammalian body, but this does not by any means mean refined, granulated,

*Read before the "National Society of Physical Therapeutics" at the meeting of the American Institute of Homœopathy, Detroit, Mich., June 19, 1918.

or commercial sugar. In this matter of sugar, mankind has been guided, as in other dietetic matters, by his palate, or by race or national habits, etc. Sweet things are said to taste good, and therefore everything is sweetened, especially among our modern peoples. There are very few articles put upon our table which do not contain sugar. Baked beans, lettuce and bread are not eaten without their share of sugar or sweetening. Porridges frequently are so covered with sugar that the cereal itself can not be seen and the natural taste is obscured. Tea and coffee are taken in a super-saturated solution of sugar. Cookies, cakes, pastries, puddings, jellies, jams, preserves, confectionery, and ice cream enter into the average daily menu, and berries, melons and fruits which are very sweet by nature have a liberal amount of sugar added to them, by perhaps the majority of people. If this were done in an intelligent response to a definite requirement of the body, it would be all right; but into this, as into so many of our habits, intelligence does

not enter.

I have enumerated only the more common uses of sugar; many others will occur to you.

The re

Attention should be called to the fact that the sugar in such common use is the refined sugar of commerce. fining process need not be described; it is enough to say that the process which has been universally employed, and even now is in vogue in most places, is a complicated chemical one, which results, among other things, in a rather thorough demineralization of the sugar. This is the great fault of the diet of civilized peoples. Most of our food in the preparation or cooking becomes more or less demineralized, and to my mind this is the cause of many of the diseases to which humanity is subject.

In addition to the demineralization, the sugar represents a tremendously concentrated product. The sugar cane contains from 14 per cent. to 18 per cent. of sugar. The expressed juice contains from 15 per cent. to 20 per cent. The sugar beet contains from 12 per cent. to 16 per cent., and the juice from 13 per cent. to 17 per cent. By the simple process of evaporation, these percentages are raised to practically 100 per cent. This tremendous concentration, plus the demineralization, renders the sugar a very different thing from Nature's simple product, and it is to this point I am most anxious to call your attention. In the days of the Civil War and for some time thereafter, there were found at our ordinary grocer's two or three or four kinds of sugar, ranging from the dark brown, slightly refined product to the "coffee crushed." It is only about 50 years ago that the refined granulated product became popular and

the brown varieties disappeared from the market, so that now they are difficult to obtain.

Co-incident with this change, there has been a marked increase in the number of cases of certain diseases. I will mention but one at this time: cancer. In my medical student days, cancer was supposed to be a disease of senility, not to occur until its victim was 65 or 70 years of age. Later it was found to occur in the 50's; still later in the 40's, and it is not uncommon today to come across cases of cancer in the 30's. Vital statistics show that in the registration portion only of the United States there are upwards of 52,000 deaths from cancer annually, and the number has been steadily increasing of late. I do not claim that the over-free use of granulated sugar is the cause of cancer or the direct cause of other serious diseases, but there is a suggestive co-incidence found in the facts referred

to.

In this connection I frequently ask myself, why should there be so much tuberculosis; why so much insanity; why such a woeful prevalence of nervous prostration in its myriad forms? Why should the most intelligent and most highly civilized creatures upon the earth be subject to so many diseases? Why is the modern mother in such a majority of cases unable to nurse her offspring? Why should there be such an appalling number of children with defective teeth and the ill results of this condition?

Many diseases are said to be caused by germs, but the fact of immunity is well recognized, and why should not the human family be immune, as it doubtless was intended to be, to germ activities? It is well known everywhere today, that beri-beri, a very fatal disease, affecting chiefly the nervous system, is a result of eating an excess of demineralized rice, the popular food in countries where beri-beri prevails so alarmingly. It is well recognized today, as so beautifully proved by our National Public Health Service, that pellagra is produced by a one-sided carbo-hydrate (demineralized) diet. For many years scurvy among mariners has been duly recognized as a dietetic disorder. It can easily be proved that infantile scorbutus is due to an unbalanced ration. Now then: If these and many other conditions are known to be due to improper food, why is it not reasonable to assume that many or most other diseased conditions may be due directly or indirectly to improper food?

If granulated, commercial sugar can be shown to be an unbalanced and unnatural food, why is it not proper under the circumstances to eliminate it from our diet? To suggest, if not to prove, that granulated sugar is unnatural, it is simply necessary to refer to its production. Nature certainly does not give

it to us in its commercial form. It comes in a weak, or moderately weak solution, and is obtained by evaporation, crystallization, and refining. Nature gives us sugar in a wonderful variety of substances. Our fruits and berries, many of our vegetables, and milk contain sugar in varying proportions. For instance, lemons, rhubarb and apricots contain from less than 1 per cent. to 2 per cent. of sugar. Blackberries, huckleberries, and blueberries contain 4 per cent. to 5 per cent., currants between 6 per cent. and 7 per cent. Strawberries, gooseberries, raspberries, and apples average 7 per cent. Sweet potatoes contain 4 per cent. to 6 per cent., corn and carrots 6 per cent., beets 8 per cent., oranges 5 per cent. to 10 per cent., bananas and peaches about 11 per cent., pineapples 12 per cent., plums 14 per cent., grapes and sweet cherries 15 per cent., fresh figs 15 per cent., and dried figs 51 per cent. Figs, dates and raisins go as high as 50 per cent. in the dried form. Peas, parsnips, turnips, and other vegetables contain easily demonstrable amounts of sugar.*

The sugar content of milk is an important as well as an interesting and suggestive matter.

COMPARISON OF BREAST AND COWS' MILK WITH RELATION TO LACTOSE CONTENT

The variation in the above figures depends in part upon the accuracy of the methods used and in part unquestionably upon the period of lactation which predominated in compiling the averages. Meigs' figures are most recent and probably the most reliable.

In milk from the pig, goat, buffalo, cat and ewe, is to be found 4 per cent. or 4 per cent. plus of lactose; in the rabbit only 2 per cent.; in the dog 3 per cent plus; in the llama, camel, and mare, over 5 per cent.; in the ass 6 per cent.; and in the elephant 8.8 per cent.

My point in citing these various statistics is to draw attention to the fact that Nature has a serious plan in view in the food she furnishes her creatures. If we do not comprehend the full importance of that wise plan, would it not be well for us to use it as our guide and standard, and not try to modify or improve a plan of which we do not at present grasp the significance? Certainly Nature intended us to eat sugar.

*(These percentages are from "Farmers' Bulletin 535," year 1913.)