Reading Salisbury, Part 5: Feed and Starve

Twenty and twelve

Salisbury opens the chapter on healthy feeding by counting teeth. “As a general rule, we have twenty meat teeth, and only twelve vegetable teeth; while four of these latter, the ‘wisdom teeth,’ are poor apologies as grinders.”

The count is a choice dressed as a fact. He is calling every incisor, canine, and premolar a meat tooth and only the molars grinders, and a dentist would say human teeth are those of a generalist that can manage both. Of all the legs his argument stands on, dentition is the shortest, but it is the one he leads with.

The rest of the paragraph is better anatomy than it looks. “The stomach, in man, is a purely carnivorous organ, and is designed, both in structure and function, for the digestion of lean meats.” The small bowels and their glands, the liver and pancreas, “are herbivorous mainly, and are designed to digest vegetables, fats and fruits.” Strip the labels and that is roughly how a modern textbook divides the work: acid and pepsin in the stomach for protein, bile and pancreatic enzymes downstream for fat and starch. He puts fat on the plant side of the ledger, which seems odd until it is clear he is sorting by where a thing is digested, not where it comes from.

Then the ratio, stated for everyone this time. “Healthy Alimentation would consist in a diet of about one part of vegetables, fats and fruits, to about two parts of lean meat.” Sweets and fruits “in moderate quantity, and as relishes only.” Fruit after breakfast or dinner, “on a full stomach,” and “never at or after supper.” Supper itself should be the meatiest meal of the day, and “the best meat for supper is broiled lean beef. This digests easily and quickly, and is less liable to produce flatulence than any other food.”

Broiled lean beef at the end of the day. The Salisbury steak, before anyone put gravy on it.

Chemistry is not enough

Then a sentence that is more modern than most of what is printed on a nutrition label.

“It is not enough to take solely into account the chemistry of foods. Many foods which are chemically rich are so composed that it is beyond the power of human stomachs and bowels to digest them.”

A food is not what it contains. It is what a human body can get out of it. The spinach that is rich in iron on paper gives up almost none of it in the gut; the bean that outranks beef in a nineteenth-century physiology table is, in Salisbury’s experience, mostly gas by the time it reaches the colon. The whole twentieth-century habit of judging food by the numbers on its label, grams of this and milligrams of that, is the error he is warning against, and he is warning against it a hundred years before the label existed.

His two examples of chemically rich, practically useless food are “the connective tissue of meat, on the one hand, and beans on the other,” which “are products that no human being should undertake to subsist upon.” He is not sentimental about meat. Gristle is gristle.

The bean, again

He returns to the bean that opened his eyes in 1854, this time with the mechanism. The bean “is chiefly made up of double walled sacs of legumen, which are filled with starch grains. These sacs are as insoluble in the digestive fluids as woody fibre.” Nothing can reach the starch until the starch ferments, the gas “explodes the sacs,” and by then the contents are “carbonic acid gas, alcohol, vinegar and yeast vegetation, products that are quite unfitted to afford healthy nourishment, but are rather agents to feed pathological states.” Under the microscope, the day after a meal of beans, the stool is “exploded and non-exploded sacs of legumen, and the products of their fermenting contents.”

The mechanism is wrong in its particulars. The gas from beans comes mostly from sugars the human gut cannot break down and the bacteria in it can, not from exploding sacs. But every person who has eaten a plate of beans has run Salisbury’s experiment and gotten his result, and he was the one who went and looked at the result under a lens.

What follows is a ranking most modern readers will not expect. Vegetables and fruits have their starch in single-walled sacs, “somewhat insoluble” but “far more easily and expeditiously digested than beans.” Grains have no sacs at all, so “the digestive fluids coming in contact with them as soon as eaten, renders them much more easily digested than vegetables.” Salisbury, the beef doctor, rates grain as the most digestible plant food there is. His quarrel with the plant third was never that it was poison. It was that it ferments, and that civilized people were eating it by the bushel, all day, in a chair.

The man with the notebook

The chapter ends with numbers. When a person eats only what digests well, “there is no fermentation or flatulence in the digestive organs, and the urine flows at the rate of from 3½ to 4½ pints daily, stands at a density of 1.015, and is free from sediment on standing in the cold.” Eat what cannot be digested and the chain starts: gas, reversed peristalsis, bile forced upward, the patient “bilious,” the urine “high colored and scanty,” its density “1.030 and upwards,” with sediment in the glass by morning.

A nineteenth-century doctor could buy a cheap glass float called a urinometer and read that density off a scale, and Salisbury expected his patients to use one. He is handing them an instrument and a number. Not a feeling, not a theory, a measurement they could take every morning in their own house and watch move as they changed what they ate. The body keeps score, and he wanted people to read the scoreboard.

Nearly every person who has turned their health around in the last decade has done it the same way, with a glucose meter or a scale or a blood pressure cuff on the kitchen counter, and a notebook. The instruments are better. The idea is his.

The list

Chapter V begins with the thesis stated as flatly as it can be. “Healthy alimentation, or feeding upon such foods as the system can well digest and assimilate, is always promotive of health. Unhealthy alimentation always acts as a cause of disease.” And then the turn that gives the chapter its title: feeding is not only the cause, it is the cure. “Special feeding, indicated by the condition of the system, acts as a means of cure in all diseases arising from unhealthy feeding.” Special feeding means “living on precisely such food as can be most thoroughly digested and assimilated, or upon such food as the diseased tissues require, and upon no other.”

Then he lists the diseases he believed he could cure this way, and the list is where most modern readers close the book.

Consumption in all its phases. Dyspepsia in all its forms. Rheumatism in all its varieties. Gout, Bright’s disease, diabetes, locomotor ataxy, ovarian tumors, goitre and cretinism. “All fibrous tumors, including uterine fibroids and cancerous growths.” All paralytic diseases not caused by injury. Softening of the brain “and most cases of insanity.” All forms of deafness. Diseases of the eye and ear. Catarrhs, gravel, asthma, fatty heart, anaemia, prolapse, “many demented conditions,” hypochondria, loss of voice, erysipelas, eczema, scald-head, “etc., etc.”

That is a man claiming to cure deafness with beef. Goitre and cretinism are iodine deficiency and were understood as such within a generation of his death. Much of what he lists has nothing to do with food at all, and he had no way to know which was which, because he had one tool and it seemed to work on everything he pointed it at.

And yet. Pull out of that list the ones a physician today would agree begin at the table, and the pile is not small. Diabetes. Gout. Fatty heart and fatty liver. Dyspepsia. The anaemias of malnourishment. The thickened, failing kidney. Most of the cancers he could see were not dietary, but several that he could not see are now linked to it. He threw the net far too wide, and the net still came up full.

Any one kind of food

Then he defines his terms.

“By unhealthy alimentation, then, is meant the too exclusive, too long-continued feeding upon any one kind of food.” Not starch specifically. Not sugar specifically. Monotony, and excess, and duration. Any one kind of food, eaten too exclusively for too long, “overtaxes those portions of the alimentary canal designed for digesting this particular character of aliment,” until digestion fails and fermentation sets in.

He is explicit that the knife cuts both ways. “The abnormal states produced by a too exclusive amylaceous and saccharine diet, differ from those produced by one that is too exclusively carnivorous.” He does not spell out the carnivorous failure here; there is a chapter on it near the end of the book, under the name meat dyspepsia. But he names it, on the same page where he lays out the starch disaster, and he does not pretend it is not there. Salisbury was arguing for a ratio and against excess. He would have had sharp words for a man eating nothing but ribeye, and sharper ones for the man eating nothing but bread.

The slide

What follows is four pages of the most elaborate wrongness in the book.

The person on a starchy, sugary, abundant diet, “leading an inactive or sedentary life,” develops first “a yeasty, gaseous, highly deranged, half paralyzed state of the alimentary canal and nervous system.” Fibrinous deposits form in the heart and great vessels. They break loose, travel the bloodstream, lodge in the lungs or limbs. That is the fast road. The slow road is worse. The gut lining, half paralyzed by fermentation, begins to secrete “a thick, ropy, tenacious, gelatinous mucus.” The mucus clogs the follicles. The clogging produces stasis, stasis produces “hypernutrition of the tissues named, and of the fibrous tissues around and beneath, under a state of partial death.” The walls of the stomach and colon thicken. In some cases they close. In some cases the new tissue hardens into cancer. The same glue tissue, as he calls it, forms in the ovaries as a tumor, in the womb as a fibroid, in the sheaths of nerves as sclerosis, in the spinal cord as the creeping paralysis of locomotor ataxy, in the brain as dementia.

“No matter where these excessive developments of glue tissue may occur, they all emanate from such fermentative changes in the alimentary canal as serve to generate poisonous, highly paralyzing gases and yeast products.”

Almost none of that is how any of those diseases work. There is no glue tissue growing from gut gas. The mechanism is a nineteenth-century man’s best guess, built from a microscope and a theory of fermentation, and it did not survive.

But stand back from the mechanism and look at the shape of the thing he drew. A daily excess of fermentable food. A sedentary life. A slow, step-by-step derangement that begins in the gut and spreads, over years, to the heart and vessels, the liver, the kidneys, the nerves, the brain. A disease that does not announce itself but accumulates, attacking, in his phrase, “the weakest, most exposed, most abused and most used part or organ” first, and proceeding “along the line of least resistance.” A single upstream cause with a dozen downstream names.

That is the architecture a modern physician draws on a whiteboard when explaining metabolic disease. The intermediate is not yeast and gas; it is insulin, and inflammation, and fat where fat does not belong. But the beginning is the same, and the end is the same, and the slow invisible middle is the same. Salisbury had the first page and the last page of the story and made up the chapters in between. Medicine spent the next century filling in the chapters and, for most of that century, forgetting the first page.

The strait and narrow path

He closes the chapter the way a man closes an argument he has been making for thirty years.

“If we feed as nature designed us to do, all these tissues may be maintained in perfect health. They become diseased by our departures from the ‘strait and narrow path,’ in which we should travel gastronomically. We may look to the foods and fluids of civilized life for a large causal share in those ‘ills that flesh is heir to.’”

Two borrowed phrases in two sentences. The first is from the Sermon on the Mount: “strait is the gate, and narrow is the way, which leadeth unto life, and few there be that find it.” Salisbury has taken a verse about salvation and applied it to supper, and he was not joking. He had watched the broad way fill up with his patients.

The second is Hamlet, alone, weighing whether to go on living. The thousand natural shocks that flesh is heir to: the sufferings a body is simply born into and cannot escape, the inheritance nobody asked for. That is how the line has always been read, and that is how most people still experience their own bodies at fifty, as an inheritance arriving on schedule: the father’s heart, the mother’s sugar, the family’s knees. The decline feels like fate because it came to everyone before.

Salisbury takes the phrase and quietly reverses it. A large share of what flesh is heir to, he says, is not inherited. It is eaten. It arrives on schedule because the broad way is the same in every generation and everyone walks it. The thing that felt like fate was a habit with a family history.

Seneca, writing to a friend eighteen centuries earlier, had already noticed where the diseases came from. Do you wonder that illnesses are beyond counting? Count the cooks.

Then the symptoms themselves get recast. “The abnormal conditions herein set forth become simple systemic expressions, warning us against the further transgression of dietetic laws.” Not failures. Expressions. The high number on the lab report, the joint that aches in the morning, the weight that will not move, the fog: a body saying, as plainly as a body can, that it is being fed something it was not built for. It is not breaking down. It is talking. Most people spend thirty years taking something to make it stop talking.

Feed and starve

Then the last paragraph, which contains the whole book.

“Thus the philosophy of this physiological work is to dispense with all foods, drinks and medicines which tend in any way whatsoever to getting and keeping the histological elements, organs and tissues out of order, and to persistently and continuously feed and starve tissue so long as any remnant of disease remains. Healthfully feeding those tissues which require nourishing, and starving such as have been over and unhealthily fed, will in time restore the equipoise of an unbalanced organism.”

Feed and starve. Two verbs, and a man’s whole therapeutic system is inside them. Feed what is starving. Starve what has been glutted. Remove everything, foods, drinks, and medicines alike, that keeps the machine out of order. Then do it again tomorrow, and the day after, “persistently and continuously,” for as long as “any remnant of disease remains.”

Equipoise. Balance, restored. Not by a drug, not by a procedure, not by anything done to the body from outside, but by the body itself, once the daily insult stops and the daily nourishment starts, doing what it has been trying to do the entire time.

The quietest words in the paragraph are in time. He does not say quickly. He does not say in thirty days. He had sat on this book for twenty years waiting for his cures to be beyond dispute, and he knew that a body that took thirty years to derange does not come back in a season. The feeding and the starving are not an event. They are a way of living, kept up through the long stretch where nothing seems to be happening, where the scale does not move and the number does not fall and the only thing holding a person to the strait and narrow path is the conviction that the body is not broken, only unbalanced, and that balance returns to those who wait for it.

It does. Anyone who has stood on the far side of that stretch knows it does. The morning comes when the urine is clear and the joint does not ache and the fog has been gone so long it is hard to remember what it felt like, and a man realizes that the thing he was told was his inheritance has quietly been declined. The flesh was never heir to it. It was only fed it, every day, for a very long time, until someone stopped.

Read along

The book is in the public domain, and the Internet Archive has the complete scan free of charge, in PDF, EPUB, and plain text:

The Relation of Alimentation and Disease (Internet Archive)

With Chapter V the foundation is laid, and the book turns to its great subject. Part 6 begins the long section on consumption, the disease that accounted for one death in seven in Salisbury’s century, which he insisted was not what every other doctor said it was.