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am MR, LERAAT FECA 
0393 Fan 108 
Oat FO cases / oy 


VWMUANAUDINNN 


24503386094 





DR. W. A. BAYLRY 


EW. SAWYER 
425 North June Street 
‘Los Calif. 





Ernest Walker Sawyer 
Trace Element Collection 
In Memory of Ray Lyman Wilbur, M.D. 








DIET IN HEALTH. 
AND DISEASE 


BY 
JULIUS |FRIEDENWALD, M.D. 


“These few rules of diet he that keeps, shall surely 
find great ease and speedy remedy by it.”—BURTON 
Second Edition, Thoroughly Revised and Enlarged 


PHILADELPHIA AND LONDON 


W. B. SAUNDERS COMPANY 





Set up, electrotyped, printed, andcopyrighted November, 1904. Reprinted 
June, 1905. Revised, reprinted, and recopyrighted May, 1906, 


Corvnicir, 1906, ay W. B. SAUNDERS ComPANY 





jOTROTYPEO BY nese oF 
WESTOOTT & THOWSON, PHILADA. \w. & SAUNDERS COMPANY. 


To 
William Osler, M.D. 


AS A SLIGHT TOKEN OF OUR APPRECIATION OF HIS PERSONAL 
FRIENDSHIP, OF MANY FAVORS, AND OF THE EN- 
COURAGEMENT HE HAS ALWAYS GIVEN THE 
MEMBERS OF THE PROFESSION. 


PREFACE TO THE SECOND EDITION. 


THE success of the first edition of this book seemed to 
indicate that it filled a need of the profession. In this second 
edition we have made numerous minor changes and additions’ 
which we trust will make the book more valuable. We have 
re-written and enlarged the section upon salts, noted the work 
of Chittenden, given a more extended account of Prochownick’s 
diet for pregnancy complicated by contracted pelvis, and have 
added an account of the diet at water cures, and of Klemperer’s 
work on oxaluria. We have added a revised list of recipes 
and a new set of diet-lists for ready reference at the end of the 
book. 

We are indebted to numerous friends for criticisms and 
suggestions, which have been most helpful, and trust that in 
the future we may continue to have their aid. We wish to 
express our thanks to the W. B. Saunders Company, for the 
courtesy they have shown in the preparation of the book. 


May, 1906. 


PREFACE. 





Tis book has been prepared to mect the needs of the 
general practitioner, hospital interne, and medical stadent, as 
well as for a reference handbook for training-schools, 

The aim of the book is entirely practical. We have en- 
deavored to give a reasonably concise account of the different 
kinds of foods, their composition and uses, and also to set forth 
the principles of diet both in health and disease, The greater 
part of the book is devoted to the sick, and we have tried to 
tell the doctor how to feed his patient, We have gone over the 
literature of the subject, much of which is inaccessible to the 
general practitioner, and have given what seems to us to be the 
most useful, We trust that the book is simple enough to be 
used for rapid reference by the busy practitioner, and that there 
is sufficient detail to make the way clear for the medical student 
and the uninitiated hospital interne. We have gathered to- 
gother many dict-liste and recipes, which we trust will be of 
service both to the physician and to the nurse. 

Tn the preparation of this work we have consulted many 
books and journal articles, and we are under obligation to the 
many authors whose names are mentioned throughout the book 
in connection with their contributions to the science of dietetics. 

We are especially indebted to Dr. W. O. Atwater and his 
collaborators for much valuable material. We wish to express 
our thanks to the publishers, Messrs. W. B, Saunders & Co, 
for the courtesy they have shown in its preparation. 


CONTENTS. 


‘Tse Cremistry anv Puysiotoay or Digestion. ... 17 


jigestion and Absorption. .......... ~ + 20 
JOD Se Cohan dese ar Wr tg GME iy bse 20 


Absorption. ©. 0. ee ee 27 
Peculiarities of the Digestion in Infants. . . . . . 31 
Metabolism «6... ee 32 
Absorption of Foods. 2... 2... ee ee ee 41 
Quantity of Food Required... oe 46 
American and European Dietaries and Dietary Stand- 
BPOB Ses Sea Ree Bove a a Shaanleas sick 51 


The Influence of Various Factors upon the Digestion . 54 
The Relation of Food to Various Inherent Conditions . 58 





Ciasses or Foops 63 

Animal Foods . 63 

Milk and Milk Products 63 

ue Modification and Preservation of Milk 69 

ih ea Steere yd Be ord ay Gay es 76 

Mest and the Meat Preparations 78 

Fe tipss Sid Ae SNS oS) WE BS cat face 85 

Vega Foods 89 

90 

umes. . 92 

lege and Tubers 95 

Green Vegetables... 1. 1 ee ee 96 
Fruits and 





Salts 
Salt Metabolism and Disease ........2..- 119 
BEVERAGES AND STIMULANTS... 1... 1 wee + 120 





10 CONTENTS, 


Beverages anv SrmmuLanrs (Continued). rave 
Cocoa 





Guan et: eis & Sta Gwe 18T 


Concentration of Food... 2... 2... 


es ete: 
Cooking of Fi Tee 
Effect of Cooking . 
ees Sea 















Diet as a Means of Diagnosis 
Diet for Singers Cian 
Diet During Athletic Training . 








Artificial Feeding 
Feeding During ts Second Year. . . . . eval 
if School Children 2... 0. ee wee 245 
Other Factors in Infant Feeding . . . . . Peer) g 
The Feeding of Sick Infants Rei 5: ek 
Rage ree isc ee ak Gee eatery) 
Diet in Dizeases of Children sees 256 
Drer ror Specran Conprrions. . . . . . pate co RT 
Diet forthe Aged. 2 2... ee viele 6 (277 
Diet During Pregvancy and the Puerperium . . . . 279 
Dict in the Special Diseases of Prognancy . . . . . 282 
Srecia. Meruops or Freping ..... « +» 284 
Rectal Feeding . 2. 2... - 284 
Indications for the Use of Nutrient nem: 287 


Recipes for Nutrient Enemata. . . 2... 6 
Other Methods of Nourishing the Body... . 2... 290- 


CONTENTS. 11 







Pace 
Drerm Dwessz.. 2... 2. ee see. 298 
Feeding in Fever. 2. 2... ee eee ee 297 
Feeding in Infectious Diseases... .......- 301 
Typhoid Fever 
Atypical. . . 
Comp! licated 


Typhue Fever. 
Small-pox . 
Bearlet Fever . 
Measles . . . 
Mampe. ae 
hooping-cough | 
Hse neh as cavecena re 
Meningitis and Cerebrospinal Fever... . .. . . 314 
Diphtheria. 2 2 ee 
ipelas . . 
Rheumatism : 
Asiatic Cholera . 
Yellow Fever 








Diet in Diseases of the Stomach .......... 335 
Special Cures in the Treatment of the Diseases of the 
Stomach. . . 





Chronic Gastri 

Atrophic Catarrh of the Stomach. ........ 357 
Hypersecretion . 2... ee ee ee ee 358 
Dilatation of the Stomach. .. 2... ..... 359 
Atony of theStomach ...........2. 362 
Uleer of the Stomach .. 2... ....20- 365 


Gastroptosis and Enteroptosis ... 1... 1... 372 
eerone Disorders... . . ie RAD Brea le oie 
lyperchlorhydria or Hyperacidity ........ 
Diet in Intestinal Diseases 





12 CONTENTS, 


Drer m Disease ( Continued). TAR 
Malignact Growtte See mnae,felselteSegee s+ 384 
Acute Intestinal Obstruction 2... 1... . 384 
Chronic Intestinal Obstruction. . . 2... 1. . 385 
A Pas ie je see ele wie este me 2 SOD 

fucomembranous Catarrh . ee ee ee + 886 
eryounpAmeonong yy oe ple ns 388 
Hemorrhoids... 1... 28/8 st bas, SOR 
Chronic Diarrhea . 1. ee ee ee 88D 
Habitual Constipation... .. 2... 2... BO 
ToeR Ae Oris airs foes 5 5 ee ae +. 898 
Dict in Liver Disonsos . 2 6 6 1 ee ee ee 893 
Catarrhal Jaundice... .- + e+ ee eee ee 
Acute Yellow So ei ae hater Ua aS bola a 398 
Abscess... .. a ea trcann tates ie \chbotetre Mela 898 
MANCERTEN SS (aise (os S560 ee Be 398 
AERGMOMSNE APRESS eS oe wo Gila) fais Pe Ge 6 898 
WT oka Oyen ee cued ee eee wwe eee 898 
stone Disease. 2. 1 ee te ee 398 
MSS MN e wt ED te a) shore set wenn « 401 
Diet in Diseases of the Pancreas... 2.2... - 402 
Diet in Diseases of the Respiratory Organs. . . . . . 403 
PEM MRC Suresh? «te Larue an tet Ooh ae 403 
peers pyema . Ai eT Oe ae 
08 (Ty oath a gitar te Se 
ASSURE ears, ee ee es pe Mpa, zl 404 
YE Ae ae ee a ee ce 405 
Een eB Oe ee os 406 
pas apne A ahah Laser otha ies 
femorr! PAAR AD Costas eM ote et NY 
1 Es Ain aa ae ce ne oy 407 
Diet in Diseases of the Circulatory System. . 2... 410 
Diseases of the Heart... 2... 22-25: 410 
Heart Lesions in Children... 2. .--.4- 414 
Baa ekrits sa arater cates Whee 414 
ASANTE. es 418 
BROMO ns ke te eh ee 418 
Apvise\Posiriy’s sca es is wes Wawel. 419 
ERO eee OY Dame Dae be pale ae 420 
PRUNES ics ae we love as Ne 421 
Leukemia... 2 Pee she . 425 
Poxpara Hiemorzhagicn Mt. ursthee 
VT a ae oo 426 
Diet Pay tees of the Genitourinary System - 426 
Acute Nephritis. . . ~ . 435 
Chronic Parenchymatous Nephritis wre aha ae ve . BT 


CONTENTS. 18 























rags 
- 489 
a ey eal sae Ho heen Es anes phe sees 442 
i reAg ae britis 2+. 442 
Renal and Caleuli sees 448 
Lithemia—The So-called Uric-acid Diathesis . . . . 443 
Gonorrhea. 2. ww ee ee ee os 447 
Dict in Diseases of’ the Nervous Gystem:.: wees MAT 
+ Neuralgia Pe Bocatte: Bi gck det ot cay 4 day 2 we. 449 
Gastralgia 2 we oe 449 
7 Visceral N Neuralgia 2... 2. see « 450 
Migraine... 2... 2 1 ee wees 450 
* Insomnia and Disturbed Sleep. . . . . eee 461 
Weri@0o rs. ait. 20s. Gis iat we. es eee 451 
flepey ee a 462 
a : + 463 
Apoplexy 453 
Dist Vaious fe rea ce wee 464 
ronic in-poisoning .. 1.2... eee 464 
AloohOliaa ss tse eae wee 454 
Chronic Lead-poisoning. . . . . . . eee 465 
Weir-Mitchell Reet Cure... .... oe. 456 
Diet for the Insane wee. 464 
Diseases in which Diet iss Primary Factor... . . 466 
Diabetes Mellitus. 2... ..... wee. 466 
Dietetic Treatment see TB 
Substitutes for Sugar 489 
Substitutes for Bread wee + 490 
Gout and Goutiness .. 1... 2... wee 499 
Rheumatoid Arthritis (Arthritis Deformans). . . . 509 
Se) A Ra aT ana Se a eee Re ea 
Diet for Leanness . 2... 1 1 we oe 
Scorbutus or Scurvy 
Unclassified Diseases... 2... 1. 
Exophthalmic Goiter 


Addison’s Disease . 
Osteomalacia . . . . . . 


14 CONTENTS. 









roe 

Srectan Curns 540 
Milk Cure 540 
Whey Cure 541 
Kumiss Cure 541 
Yolk Cure 542 
Diet Cures 543 
‘Tue Dusrerte MaxAcement or Surorcan Cases . 545 
127s 3 SS SS Erie trae + + 550 


Army axp Navy Rations . . 
iy Rations 




















The Commissary Store . 
‘The Preparation of Food . 


Dreraniss wx Pusnic Institutions 
Sexi Distacien « 





ne Urea etek Hospitals 
ig Colony of Epileptics 

Diet for Chorister Boys i in St. Pa 
Tuberculosis paneer, Metropolitan Hospital, Black- 
well’s Island , 





Children’s Hospital of Boston . 
Great Ormond Street Hospital for S 


Cereal and Cereal Gruels. . 
Length of Time to Cook Cereal 


Bread 
Vegetables. 
table for Cooking Vegetables i in Water = 
General Rules for Cooking Vegetables...‘ * |. 623 


CONTENTS. 15 


Recipes (Continued). PAGE 
Without Meat... 2... eee ee 624 
Preparations. . 2. 2... ee ee ee 626 
BSc beh Bast, oe Cr bes Hiding wh Sey ea RACE 630 
00d MINE a) ae seo ne Maca ph ance MS 631 
ee ee ee 631 
General Rules forSoups . 2. 1. we eee 633 
Methods of Preparing Raw Beef... .. 2... . 637 
Panopepton 2... we ee ee 638 
Meat Jellies Without Gelatin ........... 640 
Recipes for Foods for Diabetics. 2... 1... 642 
Tae CwemicaL CompostTioN oF AMERICAN Foop- 
MATERIAIS © ww ee 648 
Explanation of Terms . 2... 2. 2 7 ee eee 648 
Cuts of Meat. 2 0. ee ee 652 


Rapip Rererence Dret-uiers 





Fever 
Dyspepsia and Chronic Gastritis 
Dilatation of the Stomach. . 2... 2... 27s 687 
Atony of theStomach ... 2... .- ee we 687 
Tryperehloshyatla a or Hyperacidity......... 688 
a haa, Ene ceairls. eae ar 688 
Chronic Diarrhea. 2 2... 7 1 ee ee 689 
Chronic Constipation. © 2. 2. ee ee ee 690 
Debility and Anemia «2... 1.1.72. eee 690 
Obesit 





Gout and Goutines | |. Boos arya: a4: Be we OO: 
Albuminuria . . 





Tuberculosis: - 
OpBY se ee ee ee ee ee 
Bet x Normal Confinement 
Welcnts anp MeasuRE8 .... 1... ..---- 696 
A Sxorr Lier or Booxs on Foop anp Drer.. .. . 698 


MMDEK 55, 4e da Ga arate kk tea a UP eee a Sa 699 





DieT IN HEALTH AND DISEASE. 


THE CHEMISTRY AND PHYSIOLOGY OF 
DIGESTION. 


Foop is the matter that is taken into the body to supply 
nourishment or to replace tissue-waste. Every  Byeoal act 
consumes a part of the force that has been derived from food. 
The maintenance of the body-heat consumes another and 
in growing individuals a certain amount is utilized ia! bullding 
up the new tissues, 

Food as it is taken into the ag eper el gape ees 
position from the material that can be utilized in cell-growth 
and in replacing the tissue-waste. The function of digestion is 
80 to ‘alter the food that it may be absorbed by the blood, and 

repare it for assimilation and utilization by the various tissues. 
Te food of mankind is most varied in nature, differing with 
the seasons, and with climates, races, and countries. 

‘The study of foods is a most complex one, and until recently 
few scientific investigations along this line had been made. 
Fortunately, however, experiments are now being carried on 
the world over, and it is to be hoped that the subject of diet in 
health and in disease will soon be lifted out of the vale of em~- 
piricism where it has so long rested, 

‘The chemie elements of which the body is composed are sim- 
ilar to those contained in the food. generally employed. 
See em Semi) elemento captained in, the, body: the 
pri ones are Ox) hydrogen, carbon, nitrogen, calcium, 
Pinan and sulphur. nee and others that are present in 

quantities form a large number of compounds, In foods 
these compounds are most conveniently grouped under the head~ 
ings of in, fats, carbohydrates, mineral matter, and water. 
various classifications are in use, this one, owing to its 
simplicity, is that generally adopted, 
‘ater.— Water enters into the composition of every tissue 
2 vw 





18 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


in the body and forms more than 60 per cent. of the eatire body- 
weight of a full-grown man. As it is not burned up in the 
metabolic processes, it does not, however, furnish any energy. 

Salts.—The earthy salts, which form about 6 per cent. of 
the body-weight of an adult man, furnish little if any energy. 
They are most abundant in the bones and teeth, but they also 
enter into the composition of other tissues and fluids of the 
body. The principal salts of the body are calcium phosphate 
and the various compounds of potassium, sodium, maguesium, 
and iron, The mineral salts ure very necessary to life and health, 

Protein.—Under this heading are included most of the 
nitrogenous food-compounds. Various terms have been applied 
to this claas of foods, the terminology here employed being that 
recommended by the American Association of Agricultural Col- 
Jeges and Experiment Stations. 

Protein is found in both animal and vegetable food, familiar 
examples of it being the lean and gristle of meat, the white of 
egg, and the gluten of grain. Proteins are divided into albu- 
minoids, gelatinoids, and extractives, 

Albuminoids include such substances as the white of egg, 
the lan part of meat, the curd of milk, and the gluten of 
wheat, 

Gelatinoids (called albuminoids by some writers) occur 
chiefly in the connective tissues, as the “collagen” of tendons 
and skin and the ossein of the bones, Gelatin is a familiar 
example of this class of proteins. 

The extractives contain nitrogen, but differ widely from 
both albuminoids and gelatinoids. They are the principal con- 
stituents of beef-tea and meat-extracts. Vegetables contain sub= 
stances known as amids—for example, asparagin—which have 
similar propertics. 

The proteins, especially the albuminoids, are of the greatest 
importance to the animal economy. They help to build up new 
tissues and to repair the waste of the old; they are also burnt 
up in the body, and are important as a source of energy and of 
heat, Further, they may be converted into fat and stored in 
the body for future use, this last function, however, being of 
minor importance. 

Proteins form an essential part of the diet, for without them, 
er when they are supplied in too small quantity, the body 
wastes and a condition of malnutrition supervenes. Carbohy- 
drates and fits can not replace proteins. As will be shown fur- 
ther on, they may, by supplying a source of heat and energy, 


a 


CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 19 


protect the protein material, but they can not fulfil the function 
of repairing or up tissues, with the ex: of 

Lape Tas die ln anil tat he itr al 

te largely on non-protein substances and derive 

ge ply sey a 

are of com) composition, and evidently 

es y pale le in the growth and repair of 

Be body. a he he ee 

and fats. The extractives are iy. 

eleia dig ake come! eect o's actos 


tissues. They act as stimulants and as a] , and it has 
been stated that the craving some individuals have for meat is, 
in reality, a desire for the extractives. 

Carbohydrates contain no nitrogen. They are composed 


of carbon, hydrogen, and oxygen, the last two in the 
to form water—as, for example, starch or dextrose, C, a 
hence the name, carbohydrates. ‘They include the oe 
sugars, and le fiber or cellulose. Carbohydrates are 
burnt up in the body, and their energy is changed into heat or 
Be ead be ote op na they may also be converted into 
be stored up in the reek superficial fatty tissue 
of the body serves as a direct protection against cold and as a 
storehouse for heat and en Starch forms only about 1 per 
cent. of the body-weight. weight. The carbohydrates, an account of 
ae hes ama and availability, are the most prolific source 
Baer Ge pdemerton, ts an Sey it element of food, serv- 
ing the same purpose as the hydrates, but more valuable 
weight for weight as a source of energy than the latter, but 
neither so easily digested nor so available. Fat is found in 
animal fuods, such as meat, fish, and butter, in vegetable foods, 
as oils, in the various cereals, and in the kernels of nuts, Taken 
as food in exceas of the needs of the organism, fat is usually 
stored in the fatty tissue. It forms about 15 per cent. of the 
it of an average man, but there are wide variations in 
ith. Apart from the effects of certain diseases, the ten- 
dency toward leanness or toward the accumulation of fat is de- 
indent upon personal habit, heredity, ete., more than upon the 
tity or quality of the food taken. Individuals with a ten- 
to take on fat become stouter on being overfed and on 

taking too little musoular exercise. 

Ebstein maintains that the pigeon of fat is a factor in 
preventing muscular fatigue. It is mid that during the 


20 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


Franco-Prussian War, with this end in view, the German 
ordered that each soldier receive 250 grams of fav 
bacon a day. 


DIGESTION AND ABSORPTION. 


DIGESTION. 


The digestion of food takes place through a number of 
chemie changes brought about in the alimentary tract by the 
action of certain unorganized ferments usually known as en- 

65. i Mes these chemic changes there are, of courses 

iterations in the physical properties of the food, the two com- 
bined allowing the useful part to be assimilated while the re- 
mainder passes off as refuse. 

Enzymes.—Enzymes are the products of protoplasmic 
changes, and are not endowed with life. They are complex 
Heh ow substances, the exact chemic nature of which has 
not been determined. Howell makes the following classi- 
ean: 

Proteolytic enzymes, or those acting upon proteins, con- 

veg then them into a a eoluble substance—peptone or proteose, In 

Is the pepsin of the Cea juice and the trypsin of the 

pancreatic juice are examplos of this class. A similar enzyme 

is found in plants, in the pineapple family (bromelin) and in 
the Fa (papain). 

2. Amylolytic enzymes, or those acting upon starches, con- 
verting them into soluble forms—sugar or sugar and dextrin. 
As examples of this class we have, in the animal body: in the 
saliva, ptyulin; in the pancreatic juice, amylopsin ; and in the 
liver, one capable of converting glycogen into sugar. In plants 
there is a similar enzyme, known as diastase, 

3. Fat-splitting enzymes, or those acting upon the neutral 
ana splitting them up into glycerin and the corresponding 

acid. Steapsin, present in the pancreatic juice, is an 
example of thisclass. Similar enzymes occur in a number of 


4, " Sugar-splitting enzymes, or those having the property 
of converting the double into the single sugars—the disacchar- 
ids, such as sugar-cane and maltose, into the monosaccharids, 
as dextrose and levulose. ‘Two such enzymes are found in the 
small intestine, One of these acts on cane-sugar, and is known 
as invertin or invertase; whereas the other acts on maltose, and 
is known as maltase. Other enzymes split the monosaccharids, 


DIGESTION AND ABSORPTION. 21 


Se aeapanent of the gastric juice, is an example of this 


6. Oxidizing Enzymes or Oxidases.—These set up oxida- 
tion processes. They are found in the various organs and 
tissues, 


A Partiat List of the Concerned in the Processes 
of ee er lion (Howell), oR 
Whorw chiefly found. Action. 
Pytalin (salivary dias Salivary secretion. Converts starch to sugnr 
tase), (munltose), 
lopain (pancreatic Pancreatic secretion. cues starch to sugar 
Liver dinvtase, Liver. Converts. gly to dex 
trose (maltose). 
Tavertase, Small intestine. Converts to dex- 
trose 
Maltase, Small intestine, mli- Converts maltose to dex~ 
vary and neatic trose. 
Lactase. Sunall intestine. Converts Inctos to dextrose 
a ee, 
Glycolytic (1). Muscles (?). Splitaand oxidizes dextrose. 
Lipase tinentain), : secretion, Splits neutral fata to fatty 
fat-tissues, blood, ete. acids and glycerin, 
Popsin. Gastric juice. Converts ine to pep- 
tones and proteoses. 
‘Trypsin. Pancreatic juice, Splits ea An simpler 
orystall note, 
Erepain. Small intestine, Bollea pestiecs into simpler 
uct 
Group of antolytic en- ‘Tixmes generally. Fice proteins into nitro 
sme, “eno Tages and amido 
Goanan Thymus, adrenals, pan- Converts guanin to xanthin. 
creas, 
Ademase, Spleen, pancreas, liver. Converts adenin to hypo 
xanthin, 
‘Oxidases Lungs, liver, Cay idatic organ! 
sg euneci ene ane 
Catalase. Many tissves, eit s hydrogen per- 
ox 


have certain properties in common. They are, for 

example, soluble in water and glycerin. They are destroyed at 

a tem Se eendel bp eter action a 
or entirely su: low temperatures,—e. 7. 

without, however, actually destroying the enzyme. 

They are characterized further by the fuct that after a certain 


22 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


degree of change has been affected the lucts of their activi 
snes sate = that most Ce ae may be said to S 
incom: in this respect. 

‘Asciiec'enctone fect iat an sativty of an enzyme is 
not in proportion to the amount present. A trifling quantity 
cee es ee ie ereasing the amount of 

augments the change produced, but only to a certain 

int, “aS which the pre is the same whether much or little 

be added, An enzyme can not be used over and over again, 

as it is altered in some way and so rendered incapable of 
indefinite action. 

It is commonly believed that enzymes effect their changes by 
hydrolysis ; that is, they cause the substance acted upon to take 
up one or more molecules of water, the result being that the 
complex body separates into two simpler ones. Take, for 
example, the familiar example of the change in cane-sugar: 


GyFlaOy + HO = GH yOy-+ CoE yOe 


How this change is brought about is not known. 

With this preliminary consideration of the enzymes we may 
now proceed to the study of digestion. 

Salivary Digestion.—On being taken into the mouth, 
solid food is masticated and brought into contact with the 
saliva, which is a mixture of the secretions of the salivary 
glands and of the smaller mucous or serous glands that open 
into the mouth. 

The active principle of the saliva is the enzyme 
‘This ferment converts starch into sugar, a change that is not a 
as process, but one accomplished through a series of inter- 

ite changes. These are not at present thoroughly under- 
os but they probably consist in the starch taking up water 
and becoming soluble starch—amylodextrin, which splits up 
into dextrin and maltose. The dextrin again takes up water 
and more maltose is formed. This process continues until all 
the dextrin has been converted into maltose, or until, owing to 
unfavorable or changed conditions, the fermentation is arrested. 
The dextrins formed during this process differ somewhat in 
their relation to iodin, and are called erythrodextrin, which 
gives a red reaction with iodin, and achroddextrin, present- 
ing no color reaction, Of the latter—those presenting no 


| 


I 
| 
i 

i 


of the ic juice acts in a similar way. 
Seca eeastlen roadie atti saliva is slightly Y alkaline, but 
act just as well in a neutml medium, alka 


EY 
& 
: 
i 
& 
i 
E 
= 
yi 


TA 


gFE 
ip 
is 
5 F28 
: 
: 
1G 
i 
z 


may be after even one minute. This is 
fact that the are surrounded by an 
vegetable fiber (cellulose) that protects it from the 
action of the ferment. On boiling, this cellulose ing is 

is not only liberated, but also 
rendering it easy of digestion. (See section on 
Digestion. —On entering the stomach food is 
the gastric juice and is into e, being 
pala yet reapers igre Atten- 
called to the fact that, food absorption does not 
stomach, It is believed by many that even 
the small intestine for absorption. 


af 
te 


TE 
FE 


FE 
F 

A 

rr 


i 
ie 


iments 
< any caine permet agree ery 
a it was situated for physiologi i 
in other respects he was a fairly healihy rane 
Normal gastric juice is a thin almost colorless liquid, with 
a characteristic odor and strong acid reaction, The acidity 
ea ey Brees 20 to 60, t being the number of cubic 
test-solution required to neutralize 100 0.0. of 
gastric filtrate, but under the influence of certain diseases the 
nitecd may be very much increased, greatly diminished, or even 
firely absent. The acidity of the gastric juice is due to the 


eee eis ots clans experince ree tiered to 
wumont's: Physiology of Digestion, pul in subse 
seve) 


} LANE LIBRARY. STANFORD UNIVERSITY 





24 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


in changes proteins into peptones, The process is a 
complicated ie asa is effected gradually. Kiihne’s investi- 
have done much to enlighten us on this point. His 
methods and terminology have been adopted extensively by 
recent writers, The process is described as follows: The pro- 
tein material is changed first into syntonin or acid-albumin. If 
the solution is rendered alkaline, acid-albumin will be precipi- 
tated, The next step is the taking up of water by jidexes 
which splits up into several soluble ing called collectively 
bumose from albumin ; globulose from globulin, ete. 
in turn take up more water, and split up into another 
series of soluble proteins known as the secondary proteoses or 
deuteroproteoses. These again undergo the same process and 
form peptones, Gelatinoids are acted upon by pepsin in mach 
the same way as are proteins. The intermediate products have 
been termed gelatoses or glutoses, The end-product is known a8 
gelatin-peptone. 

Rennin curdles milk very rapidly at the body-temperature, 
The casein is converted from a soluble protein into a more or 
Jess solid clot, which gradually becomes firmer and expresses all 
the whey that was contained in the mass. The casein of cow's 
milk precipitates in large firm clots; that of human milk, into 
very fine flocculent particles, which explains the great difference 
in the digestibility of the two milks. 

Action of the Gastric Juice on other Food Elements.— 
Beyond the mechanical alterations that take place from the 
presence of fluid and from the churning movements of the 
stomach, the starches are not acted upon by the gastric juice. 
Lusk believes that sugar is inverted in the stomach, whereas in 
reality it undergoes inversion much more completely in the small 
intestine. In the stomach fats are, for the most part, dissolved 
by the body-heat and become thoroughly mixed with the other 
food elementa by the movements of the stomach. Beyond this 


they remain unchanged. 
Intestinal Digestion.—When the food has been passed 
into the small intestin is acted on simultaneously by three 





secretions—the pancreatic juice, the intestinal juice, and the bile. 
Although these secretions, as stated, act together, for the sake 
of simplicity each will be considered separately. 

Pancreatic Juice—Our knowledge of the functions of the 
pancreatic juice is obtained largely from experiments made on 
the lower animals. In man it enters the intestine together with 
or closely following or preceding the bile, boing mixed with the 


DIGESTION AND ABSORPTION. 26 


latter secretion and the food-material at the same time, It is 
alkaline in reaction, and contains at least three, and probably 


more, bx poameay pyre, amylopsin, steapsin, and, it is 
ferment similar to rennin, 


said, a 

Trypain.— is a more active ferment than is 
and acts nea |, or even in slightly acid fe 95 
is most active, however, in alkaline solutions. The process by 


which are formed from proteins is similar to that of 
peptic di but differs somewhat in detail. Trypsin, how- 
tr bale warping oh diein f further 


The of the consist in separating 
Teepe merges 
it, which is split up into 
anak ban substances, such as amido-acids and nitrogenous 
bases. Beet Macau sion os eared ee 
Just what réle these end-products play in the animal economy 
has not been definitely determined. They do not replace tissue- 
waste, and are leas useful sources of energy than is 
itself, which is absorbed as such and utilized by the body. 
Howell the following scheme, modified from Neumeis- 
ter, to graphically tryptic digestion : 


Proteid 
Dees hacen 
Peploe 
ca =) 
Antipeptone on kee 





tebsin Tyrbin i pads eal ena bases. 

‘The digestion of gelatinoids is similar to that of the proteins, 
Trypsin luces gelatin-peptone, whereas pepsin, as previously 
Say ohio oe wih the formation of gelatose. 4 

A iced gyal ates 
ptyalin nasmuch as gestion ceases Wil 
entrance of the food into the stomach, it is important that the 
starches cases rg Oy ted ii e the small a 
ened io toc e heat and energy consut 

Pint some form of starchy food, 
sail also as Hae splits up the neutral fats into 

gh and free fatty uci ‘This emulsification is of para- 
mount importance in fat-digestion and absorption, The process 


26 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


now becomes again one of hydrolysis. The fat takes up water 
and splits cae into other atlinia The following bona 
explains the process : 


GHL(C.Hpp + 000), + 3H,0 = GHAOH)s + 8(G,Hyp « COOH) 


There are two views concerning the ion of fat, The 
older view is that the fat splits or is saponified only to a small 
extent, the larger part of it being emulsified by the fatty acids 
formed during the pice ay eto ‘This emulsified fat is 
See ee fat. The view more recently 
is that is split up into glycerin and 
pi ap eh ae or not eatobadation fas areal pen! 
‘Tho fatty acids are saponified by the action of the ine ealts 
in the intestine, the products being then absorbed, and bronght 
into combination again to form a neutral fat. This reoombina- 
tion may occur in the epithelial cells of the intestine. As the 
action of lipase is reversible, that is, may split up the fats or it 
may cause synthesis of the split products. Lipase is found in 
many tissues of the body, as liver, muscle, and mammary glands, 
It is possible that fat is split and re-formed many times in the 
of nutrition. 

Emulsification takes place more rapidly in the presence of 
bile and pancreatic fluid than in the presence of pancreatic fluid 
alone. Although bile itself causes no emulsification, it aids 
very materially in the process. 

Intestinal Secretion.—This is the secretion of the intestinal 
glands, the crypts of Lieberkiihn, It is strongly alkaline from 
the presence of sodium carbonate, and this may aid in the emul- 
sification of fat, Otherwise the intestinal secretion probably 
has no action on the proteins or fats, The secretion and the 
walls of the small intestines contain three ferments which act 
upon carbohydrates. These are invertase, which acts upon cane- 
sugar; maltase, which acta upon maltose and dextrin, and lac 
tase, which acts upon lactose. The walls of the intestines con- 
tain also erepsin and enterokinase. Hvepsin probably continues 
or supplements the ch: begun by trypsiu. It is supposed 
to act upon the deutero-albumoses and peptones, Erepsin has 
been found by Vernon in all the tissues of the body, It is 
present in the kidneys in greater quantities than in the intesti- 
nal mucosa. Dniterokinase acts upon the pancreatic juice. Apart 
from the small intestine the pancreatic juice has no digestive 
action on proteins. The explanation of this ix that the juice 


DIGESTION AND ABSORPTION. 27 


contains a substance, trypsinogen, capable of being converted 
into trypsin by the action of enterokinase. As soon as the pan- 
ereatic juice comes in contact with the intestinal wall the 


viously inert trypsinogen is changed into the very active ferment, 


in.—This is not an enzyme, but a definite chemical com- 

pound. It is secreted by the wall of the small intestine when 

een oes it in contact with it. Secretin is su to be 

esa and being thus carried to pancreas, 

excites pcrog cnet ct the pancreatic juice, As we descend 

the intestinal tract the quantity of enzymes contained in the in- 

testinal secretion becomes ler. The lange intestine secretes 
mucus but no enzymes. 

Bacterial Changes.—The changes produced by bacteria are 
an extremely important factor in digestion, especially from the 
pathologic standpoint. The subject can not, however, be entered 

upon fully rae and for a complete knowledge the student 
should consult the special text- on bacteriology. For our 
EEeroe ite sufficient to say that, in the small intestine, 
changes are pr robably limited to the carbohydrates, 

Under abnormal conditions, or when excessive quantities of 
grea food are taken, utrefiaction of the proteins may occur, 
the lange intestine, ver, the extreme alkalinity over- 
comes this acidity, and allows putrefaction of the feces to take 
place. The products of bacterial action are many, and consist 
of Ieucin, tyrosin, phenol, skatol, and varions acids and gases. 
Some of these, after having undergone certain changes, are ab- 
sorbed and excreted again in the urine. It is not definitely 
known just what part they play in the nutrition of the body. 
aan from the experiments of Nuttall, it is reasonably cer- 
that bacterial action is not essential to nutrition. 


ABSORPTION. 


In order properly to understand digestion and assimilation it 
is necessary to know something of absorption. This occurs in 
two ways: cither by the material absorbed entering directly 
into the blood and passing thence to the liver, or by its entering 
the lacteals and passing thence through the thoracic duct to 
enter the blood-current of the left ng lar and subclavian veins, 

was formerly believed to take place to a very 
marked extent in the stomach. This view is now held to be 
erroneous, probably little or no absorption taking place in this 





28 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


organ. Water, as well as most other ata may, basal be ab- 
sorbed slightly from the stomach. Alcoho! 
in it, and solutions of various salts may be acted eae 
Condiments, by stimulating the mucous membrane of the 
, and increasing the secretion of gastric juice, aid in 
stomach absorption. Fats are not absorbed by the stomach. 
Proteins and if taken in sufficiently concentrated solu- 
tions, may be rbed, the con; gn brought about by the 
use of alcohol or condiments ai the absorption, On the 
whole, however, absorption from the stomach is of trifling im- 
nee, 
Pabeocpélon in the Intestine—Absorption takes place 
principally in the small intestine. Food passes from the small 
intestine in from five to twenty hours. On entering the large 
intestine the food is still in a very fluid condition, notwith- 
ing the large amount of absorption of water and salts that 
takes place during its passage through the small intestine. 

The absorption of water is a special function of the intes- 
tinal epithelium, and not a simple question of osmosis. Solu- 
tions that closely resemble the blood as regards alkalinity may 
rapidly be absorbed. The water absorbed is taken up directly 
Be the capillaries, without first passing through the lacteals, 

though i very large quantities are taken, this last may occur. 
Onur knowledge of intestinal absorption is due largely to the 

experiments of Heidenhain. 

This absorption of water is largely replaced by the abundant 
secretion of the small intestine. 

‘The protein food-material is absorbed chiefly as peptone or 
pacesces but it is very probable that syntonin, and even pro- 
teins, like lbumin, may be absorbed directly. Peptones 
and the like are dialyzable, and may pass through dead animal 
membranes, but tho rate of absorption is greater than can be 
explained in this way. Dislyzable proteins, like egg-albumin, 
may be absorbed directly, so that absorption as it takes place 
in the intestine is a specialized function of the intestinal epi- 
thelium, and not a simple problem in physics. 

The proteins absorbed as peptones or proteoses pass directly 
into the capillaries, or, at least, they do so under certain experi- 
mental conditions. Their ce can not, however, be demon= 
strated in the blood, and if solutions of them are in: jected 
experimentally, they produce poisonous effects. From this it 
may be seen that a change must be effected in these substances 
during their passage through the intestinal epithelium. It is 


eal 


DIGESTION AND ABSORPTION. 


= oath aeartegg thong angraiegy definite eds 
th drag of water and ply 


Tees tsa be dancaurtel in tha blood and If ulnans of 
this substance are injected directly into the circulation, it ney 
Sy utilized by the tissues, The absorption of dextrose from 
the intestine more than a simple process of diffusion 
through an Sayeenl esp pe wee parang 
activity of the intestine is here brought into pla 
‘The fate are absorbed either directly as pa paehe ky 
of fatty acids and soaps. The absorption of the small droplets 
es pane tap apes tbactrnatepr sre: 
ids are into neu’ a process that 
fais lanets dhe eth cells of the intestine. Tie its 
for the most part directly into the lacteals and into the 
by way of the thoracic duct. 
rion takes place in the large intestine, but it is chiefly 
of water, The feces enter in a very liquid con- 
dition, and, after making slow progress for almost twelve hours, 
they reach the rectum in an almost solid condition. The lange 
intestine possesses remarkable powers of absorption, since egg- 
albumin, milk, and the like, given in the form of nutrient ene- 
mata or experimentally, may be absorbed into the 
Liver.—tThe liver plays an im nt part in the nutrition 
of the body. This importance is due largely to the bile which 
it secretes, and which is an adjuvant to intestinal digestion, and 
to the action of the liver-cells on the absorbed food-material as 
it is found in the portal circulation. 
‘The bile contains bile-pi; ita, bile acids (glycocholic and 
taurocholic), Korein lecithin, fats, and nucleo-albumin. 
The function of the bile-pigments is Cates eey 
“rise are waste-products of metabolism. The bile oe 
wk an important physiologic rdle. They de 
mle th the cholesterin aa facilitate the absorption fats. 
is regarded as a waste-product formed in various 
ty and is excreted by the liver-cells, as well as by the 
skin glands, and the mammary gland. Lecithin is also a waste- 
product. Antiseptic properties have beon ascribed to the bile, 
a property that has never been demonstrated. When a biliary 
fistula occurs and the bile is diverted from the intestine, the 
feces are very light in color and give off « fetid odor, especially 


aad 





Mal 


30 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


if large quantities of meat and fat are taken, The anti 
factive action of the bile is bly an indirect one. In those 
patients in whom ithe supply of bile is cut off from the intes- 
tine a considerable amount of undi; and unabsorbed food 
passes through the intestine. It been “proved, however, 
that in healthy animals the entire sw tei he 
diverted and the animals still continue thy, which 

that the functions of the bile can, to a certain extent, te 
replaced. The bile also helps to arrest peptic digestion in the 
intestine, 

Glycogen.—One of the most important functions of the 
liver is the so-called glyeogenic function. In 1857 Claude 
Gren demonstrated the presence of glycogen in the liver. 

Glycogen is is soluble in water, and has the same general chemic 

starch. Toward digestive juices it also behaves 
ine starch, and the end-products are same as in the case 
of starch, namely, maltose and dextrin, Glycogen is commonly 
koown as animal starch. With iodin it gives a reddish instead 
of the blue color of ordinary starch. Glycogen is elaborated 
by the liver and can be demonstrated in the liver-cells. It 
occurs in greatest quantity after meals, and decreases with 
fasting. After prolonged fasts it may disappear een 
The carbohydrates aid directly in the formation of glycogen. 
‘These reach the liver in the form of dextrose and levulose, and 
are converted into glycogen by the abstraction of « molecule 
of water. Lactose is not so easily changed, and if given in 
excessive quantities, can be demonstrated in the urine, which 
shows that it has not been utilized. During infancy, however, 
Jactose, or milk-sugar, forms an amps rtant addition to the diet, 
and is used up in the | body in consi arable quantities, 

Glycogen may be formed directly from proteins, a process 
that occurs pathologically in diabetes. According to some 
authors, fat can not be converted into glycogen ; others, how- 
oo believe that, under certain pathologic conditions, this may 


ec 5 
The function of glycogen has been a matter of much dis- 
pute. Bernard’s view was that it furnishes a means of storing 
up the sugars until they are needed, the glycogen being con- 
verted into sugar (dextrose) and taken up by the blood. The 
same amount of sugar is found in the blood whether the indi- 
vidual is fasting or is living on protein food. If the amount 
ets in the blood exceeds a certain percentage, it is ex- 
by the kidneys, According to some authors, glycogen 

is changed into dextrose by the action of an enzyme. 


™ 


DIGESTION AND ABSORPTION. 


31 

(bre ens ep ede redler in all proba- 

for immediate use. The difference that aus between 

the muscle and liver supple of glyengen may be compared to 
it here 


PECULIARITIES OF THE DIGESTION IN INFANTS. 


Daring the first year of life the infant takes his food by 
ekg. If het et defect of the lips or of the palate, or 
if obstruction occurs from any cause, nursing may be 
difficult or Spell. It is important, therefore, to examine 
the infant ily to ascertain if it is capable of taking suffi- 
cient nourishment by natural methods, 

The Saliva.—At birth the amount of saliva secreted is so 

+ pl aca  i Manhatten 


able to a small quantity of starch. 
fig al gives the following table regarding 
the capacity of the infant stomach : 


Number of eases. Average capnelty. 
1.20 ounces. 
1 r 


seSiowalaan 
ra 
& 


s 
2 
r 





32 CHEMISTRY AND PHYSIOLOGY OF DIGESTION, 


In infants digestion is probably of no very great 
importance, ts Yer young stoma acts chiefly as a 
from whi is passed into the intestine, 
The length of time the food remains in the infant stomach 
increases with the age of the child. Holt states that in healthy 
breast-fed infants one month old the stomach is found empty 
at the end of an hour or an hour and a half after nursing. 
When fed cows’ milk, the food remains, on an average, 
halfan hour longer. In infants from two to eight months old 
the food remains somewhat longer—two hours for breast-fed 
and an and eget to ery er for Lain babies. 
Gastric digestion is lor in cases where there is am 
derangement of digestion. The milk, however, begins o 
leave the stomach very soon after feeding, and continues to do 
50 gradually until it it Bas all passed into the intestine. 

Pepsin is present in the infant stomach at birth. The reac- 
tion of the stomach-contents is acid, depending on the presence 
of hydrochloric acid, and in early infancy of lactic acid as 

Rennin plays an important part in infant digestion. It 
cougulates mother’s mill in loose flakes, whereas cows’ milk is 

ted in large masses. This fact must be borne in mind 
in feeding cows’ milk to young infants, and the milk should be 
s0 modified as to prevent curdling in large masoes 

Intestinal Digestion.—The starch-digesting ferment of 
the pancreas is not very active during early life. In amount 
and it seems to correspond largely to pytalin. 

ikbeorpHion differs somewhat in infants, depending on 
whether they are breast- or bottle-fed. In breast-fed infants 
from 2 to 5 per cent, of the proteins and fats pass directly 
thro the intestine. In bottle-fed babies, Uffelmann states 
that the residue is from 1 to 3 per cent. more for the fats, 
whereas for the proteins there is a still greater increase. 

Numerous bacteria are present in the intestines of infants, 
and while they may play some part in the digestive process, it 
is one on which neither life nor health depends. 


METABOLISM. 
Food is required for two purposes; to build up the body and 
repair tissue-waste, and to supply energy and heat. 
For Lured of study food may be classified into proteins, 
fat, carbohydrates, mineral salts, and water. These are more 


METABOLISM, 33 


u 
into others. These changes are termed metabolism. While not 
chet the oxygen of the air plays an important part in nutri- 

Th youth, until the body attains its full size, material is 

needed from which to build the tissues. This material is de~ 
rived from the food. From birth until death the life-processes 
een optaas , Sante ot ithe tse, Ae this ute must be 

or ly wil unable properly to carry on 
its functions. Only protein substances, that is to say, food 
containing nitrogen, can be used for this purpose. Fat may he 
used to store material in the connective tissue for future use 
as fuel, and also to protect the body from cold, 

Every act consumes energy. If a man lifts a pound a foot 
he must operas in his body that amount of energy. 
oye obtained from the food. The force that hol 

the food ents together in combination is called potential 

energy. In breaking up the food into simpler compounds the 

body thi onerey free or changes it into kinetic energy. 
by whi 


sets 
The chan this is brought about are not very well 
iideestiol at present, but they may be likened to combustion ; 


com) 
all be it up to furnish heat and energy ; the last two—fats 
and carbohydrates—are used exclusively for one or the other 
(oh te! ele alate fat stored in the body merely as fuel 

future use. 

The salts aid in the digestive and other processes, and are 
utilized in the composition of the bones and teeth. Water 
is probably not used to furnish energy, but it serves as a 
menstruum, if the term be allowable, for the processes. 

Atwater gives the following table to illustrate the uses of the 
different food elements : 

a 


| 
ae 


| 


34 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


Mutritive Ingredients of Food. 
Water. 


Edible portion—«. 9, flesh 
Food ax ‘of meat, yolk white Protein, 
purchased of Cg, wheat Sour, eto, Nutrlenta (& 
ad Stitend ster 
Refuse—e g., bones, entrails, shells, bmn, etc. t 


Uses of Nutrients in the Body. 
Protein—forms tissues—e. y., white (albumin) of 
curd (casein) of milk, lean meat, gluten of wheat, etc, 
stored ns fit—e. g., fat of meat, batter, olive | All 
oil, oils of corn, wheat, etc. to 
eee transformed into fut—e. g., sugars, in the forma 
15, 
Mineral matters (ash)—share in forming bone, assist in cular power, 
digestion—e. 9. phosphates of lime, etc., potash, soda, 


After the body has reached its full deve ent, the body- 
weight remains more or less constant, and the food that has 
been used is excreted by means of the respiration and the 
urine, and, to a large extent, by the feces. 

The well-known law concerning the conservation of energy 
apparently applies to metabolism in animal bodies, and this has 
been practically proved, although the experiments have never 

ite reached the ideal owing to the almost insurmountable 
difsculties that attend such experiments. In other words, food 
that is used in the body furnishes the same amount of energy 
that it would furnish if burnt in a furnace or a calorimeter, 
payee the end-products in each case are the same. 
t-values of foods may therefore be taken as a standard of 
their food-value, but it must always be remembered that in the 
practical application of this fact in working ont dietaries the 
Nigestibility and adaptability of « food are of great importance, 
as well as the amount of energy it contains. 

‘The heat-value of various foods may be determined experi- 
mentally by the use of an instrument known as a bomb calor- 
imeter, the result being expressed in calories, A calorie is the 
amount of heat that is necessary to raise the temperature of 1 
kilogram of water 1 degree C. (It is nearly the same as the 
amount required to raise 1 pound of water 4 degrees F.) This, 
expressed in mechanical force, means that a calorie would raise 
a ton abont 1.54 feet, or that it is equal to 1.54 foot-tons. 

According to Atwater, the fuel-value of the various classes 
of food as ordinarily supplied is as follows : 


METABOLISM, 85 
0mm poten fri nein; 1 prund frmie 1690 ao, 
1 “carbohydrate furnishes 4 calories; 1 pound furnishes 1820 calories, 


‘These figures are somewhat lower than the figures given by 
older estimations, and are based upon the most recent experi- 
ments, The fuel-values formerly given were: protein and care 
bohydrates, 4.1 calories per gram ; fat, 9.3 calrien per gram. 
Tt will be observed that fat has a very high food-value, which 
doubtless explains why it is stored as a reserve fuel, , 

Experiments in metabolism have been made to determine 
many things, but the relation of energy and food to mental 
labor is a problem that has never been worked out. The 
scope and importance of such experiments have been stated by 
‘Atwater, the leading American authority on this science, as 
follows : 

“The science of nutrition must be studied from the stand- 
points of the metabolism of matter and energy if its funda- 
mental laws are to be thoroughly learned. The ideal experiment 
for va determination Leno Lee would include a 
respiration experiment, a dietary study, and a digestion experi- 
ment in which the thermal aible of food and aaa 
determined, It would also include a measurement, with a 
calorimeter, or by other suitable means, of the heat produced 
in the organism. If work is also performed, it’must also be 
measured. No experiment has yet been made which reaches 
this ideal, More often special problems connected with metab- 
olism have been the subject of investigation, such as the fol- 
lowing: The functions of the nutrients of food ; the formation 
of fat from protein and from carbohydrates ; the digestibility 
of foods of various kinds ; the isodynamic values of nutrients ; 
the value (potential energy) of food; the influence of 
metabolism of various diseases, of alcohol, drags, condiments, 
and the like, and of various forms of treatment, medical or 


animals fed for different economic purposes.” 

In metabolism-experiments the results are usually expressed 
in terms of the in-come and the out-go. The terms used 
designate the amounts of nitrogen and of nitrogen and carbon. 
‘These are the most readily ascertained and are of the greatest 
importance. The thermal value of the food and excreta must 


36 CHEMISTRY AND PHYSIOLOGY OF DIGESTION, 
Be macertslbet well as the amount of energy used during 
it. 


The theories concerning metabolism held by the ancients and 
by the older writers are both curious and interesting. John 
Mayow, who in 1668 advanced the belief that food is to the 

ly what fuel is to fire, came near the view as held to-day. 
‘This was fora time fo . but has since been revived by 
later Sees Haller, in 1762, formulated a mechanical 
theory, which was that both liquid and solid particles were 
rubbed together until they became exhausted, and that the 
débris from this process was then excreted. Lavoisier, in 1789, 
stated that combustion occurs in the body in a way analogous 
to combustion as we ordinarily know it. Liebig contributed 
much to this subject, and many opinions which he advanced 
have since been proved to be correct. In 1840 he published 
a dietary study that was an attempt at a carbon balance. 
Pettenkofer invented the respiration-apparatus, and during 
1865-66 both he and Voit published the results of their classic 
experiments. 
principal work along these lines is now being done in 
the United States. Especial mention must be made of At- 
water, who, with Langworthy, collected data and published a 
xésum6 of almost all the known metaboliam-experiments of 
value in which the balance of in-come and out-go has been de- 
termined. This was later published by the United States De- 
Vins of Agriculture, as have been many of his experiments. 
ith his coworkers he has conducted numerous investigations— 
too numerous to receive even mere mention here. Of especial 
interest are his experiments on alcohol, concerning which more 
will be said in another place. The building of a respiratory 
calorimeter and the experiments made with it, the effect of 
muscular labor on metabolism and on the digestibility of food, 
the related work on the chemic composition of American foods, 
ete., are among the interesting experiments conducted by this 
ardent worker. H.W. Wiley, of the Division of Chemistry 
of the Department of Agriculture, and his associates have con- 
tributed numerous valuable papers on the chemic composition 
of food and on the use of preservatives and adulterants. The 
results of motabolism-studies furnished by Americans probably 
far exceed those of any other country. Much credit is due the 
Government for its efforts along these lines as well as to private 
individuals who have labored in this ficld. Of these, mention 
must be made especially of Prof. Chittenden, of Yale Uni- 


| 


METABOLISM. 37 


ae LAE epee olbermann are a 
of most students” Amoo tse workers Tebudnoveli, Pasha 


amount of work having a direct bearing on the management of 
disease. In J: Kellner, Mori, and Oi; in Italy, Malfetti, 
Albertoni and Novi; in England, North and Paton, and in 
may be mentioned. 

of Experimenting in Determining the 

Feared Ragretener ts tin voptrciry chen vil 
tus of i nce is the i levi 

Pettenkofer and Voit of Munich. Many differont forms of 
this apparatus have been made and used by various observers. 
Among the most im) it of these are the so-called respira- 
tory calorimeters. bner and Rosenthal and Atwater and 
Rosa have devised useful forms of these. The earlier ones 
were metal chambers large enough to permit a man or an ani- 
mal to live comfortably in them. Air was pumped through the 
apparatus, and measured and analyzed ; food and exereta under- 


calorimeters or experiment chambers the one at the Wesleyan 
University, made by Atwater and Rosa may briefly be de- 
scribed. It takes into consideration not only the air and the 


temperature. In this a man lives, eats, drinks, works, and 
al The air that ventilates the chamber is warmed or 

ag necessary to have it always of a certain temperature, 
and the amount of moistnre within, it is regulated. The eur- 
rents of air passing into and out of the chamber are measured, 
and the amount of carbon dioxid and water is ascertained by 
analyzing samples of it. The food and drink, the urine and 
the feces, are weighed and analyzed, their potential energy is 
determined, and the kinetic energy as given off from the body 
in the form of heat and external muscular work is also ascer- 
tained. The arrangements for measuring the heat are very 
complete, and consist of devices for preventing gain or loss of 
heat through the walls or by ventilation. The heat given off 


— A 





38 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


the man in the chamber is carried off a series of 
by means of a current of water, The quantity of the water 
and the rise in temperature indicate the amount of heat that 
has been given off. The measurements of the temperature of 
the interior, of the inner walls, af the incoming and ontgoing 
air, and of water are made for the most part by electric means 
which are so delicate that differences of a hundredth of a degree 
are easily determined. The apparatus is provided with appli- 
ances for passing food and drink into the chamber and for re- 
moving the excreta, It is also supplied with a telephone. 

The accuracy of this apparatus was determined by passing 
an clectric current through a resistance coil and by burnin, 
alcohol in the chamber. In the electric tests the amount of 
heat detected was found to be almost identical with the amount 
generated. In the alcohol tests the average amounts found by 
actual experiment were: for carbon, 99.9 per cent. of the 
amount generated ; for hydrogen, 100.6 per cent.; and for 
heat, 99.9 per cent, The measurements of heat given off from 
the body of a man inside the chamber are so delicate that very 
slight bodily movements, such as rising from a chair or turning 
over in bed, are noted by the observer who is watching the gal- 
vanometer and thermometers. 

‘The experiments are usually conducted for a period of about 
eight days, the last four days and five nights being spent in the 
chamber, During the entire time the diet is uniform, The 

reliminary period of four days is occupied in bringing the 
ly, at least approximately, into nitrogen and carbon equi- 
libriam with the food, and to make the determination of the 
nutrients absorbed as nearly accurate as practicable. The 
actual und the theoretic results obtained were very close, 99 
cent. of the theoretic 100 per cent. being accounted for. 
is, with a physiologic experiment, is practically a demon- 
stration of the law of conservation of energy. 

It is impossible, in the present volume, to give anything 
like an adequate idea of the Retails of metabolism-experiments, 
and for figures and results the student is referred to 
of the investigators and to the excellent summary of Atwater 
and Langworthy already referred to. A few of the results 
may be of interest. 

Vegetarian Dict.—Conclusions are not quite in accord. 
Voit concluded that while it is perfectly possible to subeist on 
a egetatle diet, 2 mixed diet is to be preferred. Cramer 
found that a vegetable diet with milk and eggs furnished suffi- 


' 


METABOLISM, 


39 
for the body, but if the milk and eggs were 
the body had to do work to get the 


| 


Pe 
add 
Hh 
ca 
at 
epee 
Pe 
= At 
Tie 


7 a 1 paatinige onal pect dene eh ae cg 
fe found that ng children digest milk more completely 

ees may be due to the amount of ash in 

milk, much of which is not needed by the adult but which 
we in the bone-formation of the growing body, 
Marko found that the nitrogen metabolism in healthy persons 
amount taken : it was lowered when much 


ang 
iH 
pily 


muscular work per 
formed. A man may do considerable work on plenty of car- 
bohydrates and fat and a small amount of protein, but he will 
be in munch better condition if the food elements are correctly 
pera Eijkmana pian stated ales A pmecabniies ae, 
in the tropics is not diminished, a tt Europeans w! 
liye in the tropics consume as much food as those doing the 
same work in temperate climates, The difficulty of gettin 
CS sl eel eer tile Bary (Ge 
‘oodruff, in the section, Diet and Tropics and Army Rations.) 
~—During the continuance of fasting the daily 
Joss of weight in the individual diminishes. The law worked 
out for that the intensity of metaboliam is inversely 
proportional to the size of the organism, seems to hold good for 
man. According to von Noorden, the exeretion of nitrogen 
during Hah aioe experiment was as follows: For five days 


before ing the daily average amount of nitrogen excreted 
in the urine was 16.2 grams, On the first five days of the fast 
the ay daily output was 12.9 grams. The amount dimin- 
ished, from the twenty-first to the twenty-fifth day the 


was 4.7 grams and from the twenty-sixth to the 
thirtieth day it waz 5.3 grams. The prpenaacs lasted thirty 
professional. faster 


pe 





Mi 





40 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


The Influence of Drugs on Metabolism. (See also 
Food Adulteration.)—Forster found that boric acid did not 
influence the metabolism of protein. It diminished the 
absorption of nutrients in the intestine, however, and is not 
recommended as a food-preservative to be given any extended 


use, 

Bromid of Potassium—Chittenden and Cuthbert state 
that this drug increased the metabolism of nitrogen and 
slightly diminished the excretion of phosphoric acid. Ammo- 
nium bromid increased the nit metabolism, while the 
amount of phosphoric acid ex remained about the same. 

Cinchonidin Sulphate.—Chittenden and Whitehouse deter- 
mined that this drug caused a diminution of the excretion of 
urea, and that the effect lasted for some days after the last dose 
had been given. The excretion of uric acid was not corre- 
spondingly increased. The exeretion of phosphoric acid was 

iminished. 

Antipyrin.— Walter says that the influence of antipyrin was 
to decrease the metabolism of protein in all subjects, and that 
the assimilation of protein was improved in fever subjects and 
was unchanged in healthy individuals. 

Lithium Carbonate.—QGorsky states that the metabolism of 
nitrogen and the quantity of urea and uric acid were consider- 
ably increased under the influence of lithium carbonate. The 
increase of urea was still greater after the period when lithium 
was taken, whereas the quantity of urie acid was less, 

Cigarette-smoking.—Gramatchikoy and Ossendovski draw 
the following conclusions: Smoking cigarettes lowers the ratio 
of the nitrogen of the urine to that assimilated,—i. e., lowers 
the metabolism,—this decrease being especially marked in the 
ease of non-smokers on their first attempts at smoking. Cigar- 
ette-amoking also lowers the assimilation of the nitrogenous 
constituents of the food. (There were no conclusions drawn 
as to the influence on body-weight.) 

Muscular Work.—It has been shown that the energy for 
muscular work may be derived from fats and carbohydrates, 
and for the most part the energy for work is supplied by such 
food. Work may be done on 4 non-nitrogenous diet, but it 
must not be inferred that nitrogen is unnecessary, In experi- 
ments with non-nitrogenons diets it was found that the men 
tired very quickly and soon became exhausted. It may be 
that with such a dict the nitrogen of the body is utilized. 
Practically, nitrogen must be supplied in the food in proportion 
to the amount of work done, 


7 


ABSORPYION OF FOODS. Al 


Mental Work.—There have been but few experiments al 
this line. EES can tet es eee eee 
olism of matter with severe mental labor than with the most 
complete rest possible. 


i increases the appetite and the nitrogen 
mm 

Baths.—Frantzius has drawn the following conclusions from 
his experiments: Under the influence of warm mineral baths 
the metabolism and assimilation of nitrogen were increased. 
Under the influence of fresh-water baths there was no appreci- 
able effect on the nitrogen metabolism, Les assimilation of 
nitrogen was improved in most cases. increase of weight 
in children was greater with the use of mineral baths than with 
fresh-water baths at the same temperature. 

Metabolism in Disease.—For various reasons this can not be 
discussed here. Where experiments having a practical i 
on the subject of diet in disease have been made the results wil 
be stated with the consideration of that disease. 

From their experiments Huppert and Ricsell have drawn the 
conclusion that more body protein is consumed in fever than 
during fasting. 

ABSORPTION OF FOODS. 

Food absorption takes ¢ chiefly in the small intestine ; in 
the stomach and in the large intestine it takes place only to a 
limited degree. In determining the Co ae) of absorbability of 
food, the amount of the elementary food principles ingested 
must first be ascertained, and the proportion that has not been 
absorbed determined from the feces, The degree of absorbabil- 
ity of a food indicates, in a measure, its nutritive value, Ac- 
cording to Atwater,’ from an ordinary mixed meal an average 
of 92 per cent. of protein, 95 per cent. of fats, and 97 per cent, 
of ydrates is absorbed in the body. “The proportion of 
the several nutrients which the body retains for its use are com- 
monly called percentages or coefficients of digestibility.” The 
ering table, taken from Atwater, gives these coefficients of 


4 Principles of Nutrition and Nutritive Value of Food, Farmers Bulletin No, 
149, Canal ates Departinent of yell! 





| 


42 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


nae Age 


and Fuel-value per Pound of Nutrients in 























pea ee 
‘Pat. Carbobydrates. 

Puel- 
“aig jralue pe iy vali er 
Per cent, | Calories. | Per cent, | Calories, 
95 4040 98 1730 
95 4090 OB 1730 
93 | s000 | 98 | 1730 
95 4050 98. 1730 
90 | 3800 | 98 | 1860 
9% 3300 7 1840 
we sae 98 1750 
Se [S55] as | 1880 
90 3800 95 1800 
9 3890 90 1630 
90 3300 97 1820 
95 4050 a7 1820 





Riibner' gives the following table, showing the absorbability 











of various foods ; 
oe Atworbed In percentage of 

Food-stutt. = 
Frosh. | Dried. | syigiance, {Albumin Fat, |,care., | Ash. 
Mat... .. asa | 376 95 o7 | 9 | .. | a2 
Eps nee 934 | 247 95 97 | 95 | .. | 82 
a U70 | 316 92 | 9-99 |95-97] 100 | 51 
Milk and cheese 420 4 96 | 97 | 100 | 74 
«| 860 | 753 95, Bi] .. | 99 | 98 
+ =| 1360 | 705 86 os |. . | 39 | of 
«| 895 | 626 26 a3 | of 99 | 76 
a 750 | 646 93 85 | 83 97 | 70 
Comand cheese | .. | 780 96 93 | 91 96 | Sr 
Rice . . - 38 | 552 96 80 | 93 99 | 85 
Peas... i+ 600 | 52 91 83 | 93 96 | 68 
Potatocs 9078 | 819 OL 63 | 96 oz | 34 
Cabbage 3830 | 408 85 s | 4 | 85 | BL 
rots 2566 | 352 79 61 | 94 82 | 76 








The accompanying chart, taken from Atwater, indicates the 
nutritive ingredients, refuse, and fuel-value of principal foods 
Absorption of Proteins,—Kighty per cent. of proteins 


i eeaatlf 
+ Farment 


Biol, vol. x¥., 
‘Balletin No. 1 


ie 


115, 


United States Department of Agriculture, 1902, 


ABSORPTION OF FOODS. 


COMPOSITION OF MILK AND OTHER FOODMA’ 
Nutritive ingredients, refuse, and fuelralue, 


Bee-watrionts 
Bea ass ‘Postralve, 
SS ass =] 
rotata. Tol Corbe, Miserat ‘Waur. eto, — 
hydredme mations 


guna Son SRE tig 
Puts, 6. 9. tat Make maselo, bone, ete. milk, and 
6 9y Gt of meat, butter, and 
Carbohydrates, 


and oil, | serve as fuel to yield heat and muscular 
%g. starch and sugar,} power, 





44 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


are absorbed in the small intestine; and 14 per cent. in the 
large intestine. ae pees ot ane Se ee 
completely absorbed are those of vegetable origin. The 
following table, taken from Hutchison (p. 164), gives the rela- 
tive absorption of protein in various food : 





Absorption of Carbohydrates.—Carbohydrates are ab- 
sorbed more completely than either the fats or the proteins ; eon- 
sequently these foods leave but a small residue in the intestine. 

As Ribner, Atwater, and others bave pointed out, foods 
taken in combination are absorbed more completely than when 
taken alone. Atwater has shown that the following proportions 
of the alimentary principles are absorbed when the individual 
takes a mixed diet : 


Protein, Fat, Carbohydrates, 
Animal foods... - . 98 per cent, 97 per cent, 100 per cent. 
Geenlsand omar =: 8 8 8 
Vegetables and fruits. . 80 9 « Ce 


Food that leaves a small quantity of unabsorbed residue in 
the intestine is not undesirable, in that this residue stimulates 
peristalsis and thus regulates the condition of the bowels. 

Absorption of Meat.—Meat leaves a very small residue 
in the intestine—abont 3 per cent. of that ingested is not ab- 
ie On this account meat is a most valuable article of 

Absorption of Fish.—Fish is very completely absorbed 
in the intestine. According to Langworthy, 95 per cent. of total 
solids, 97 percent. of protein, and 90 per cent, of fat are absorbed. 

Absorption of Mile. “When milk is taken alone, only 
90 cent. of the constituents are absorbed ; if two liters of 
maers are taken daily, the loss of dry substance, according to 


ABSORPTION OF FOODS. * 45 


Riibner, is 5.7 to 7.8 per cent. ; if three liters, the loss is 10.2 
to 11.6 per cent. When taken with other food, howevér, milk 
is much more completely absorbed. Wait found that on a 
milk diet alone 92.1 per cent. of protein and 86.3 per cent. of 
ar wore abd ah oe ee ue 
iet 97.1 per cent. of protein 98.7 per cent. of y> 
drates were absorbed. 


othe elsewhere, infants and children absorb milk much 
rapa do adults. In childhood, milk leaves 

Sy only 4 per cent., whereas in adults 10 per cent. is 
not absorbed. According to Hutchison, boiling does not inter- 
fere with the absorption of milk. Kumiss and kefir are as 


spon absorbed as is milk. 
of are very thoroughly ab- 


ag in the intestine. Riibner states that hard-boiled eggs 
are ae almost as completely as meat, only 5 per cent. 


Bi ereace of Vegetable Foods.—Vegetables are 
more or less com ly absorbed in the intestine. If the bulk 
of the vegetables is not too great and the amount of cellulose is 
not too lange, they will be almost entirely absorbed. On ac- 
count of their bulk and the large proportions of cellulose which 
bed contain pee ibles are, however, incompletely absorbed. 

protein is here the element that is not absorbed com- 
eel, Eibe carbohydrates and fats undergoing complete ab- 


of Cereals.—Such cereals as rice are very 
completely absorbed ; the starch is entirely absorbed, and 19 
BS cent. of the proteid i is lost. 
of Legumes.—The legumes, such as peas 
nee beans, if given in a finely divided state, are very com- 
absorbed. Riibner finds that even when given in 
amounts of 600 grams daily the loss is but slight. He cal- 
culated this at: 





Tf, however, these substances are not given in a finely divided 


1 Nutrition Investigation at en eee ae 
meat of Agrioutors, Ballon No. 63, 1008, 2 a oe 


Absorption of Green Vegetables.—Most green veg- 
etables are very incompletely absorbed in the intestine. They 
leave a Jarge residue, which acts as a stimulant to intestinal 


peristalsis, 

0 of Fruits.—Fruits, like green vegetables, are 
usually incompletely absorbed; according to Hutchison, 80 
per cent. of the protein, 90 per cent. of the fat, and 95 por 
cent. of the carbohydrates are ordinarily absorbed. 


QUANTITY OF FOOD REQUIRED, 


‘This varies necessarily under special conditions. 'The adult 
requires more food than does the child ; a man at work, more 
than one at rest; an emaciated individual leas than when he 
was in robust condition. The selection of a proper diet is de- 
pendent upon a knowledge of the amount of the three alimentary 
substances, proteins, carbohydrates, and fats, necessary to main- 
tain the nutritive equilibrium and consequently the body-weight. 

Dietaries are formulated by computing the quantities of the 
alimentary principles required under special conditions. 

—The quantity of protein disintegrated daily by a 
fasting healthy individual weighing 70 kilograms is 60 grams ; 
it is obvious, therefore, that at least this amount should always 
be present in every computed dietary. Ordinarily from 100 to 
125 grams of protein are consumed daily, As has been stated 
sieahet 1 gram of fat can replace 2.4 grams of protein or 
carbohydrates, and the protein can replace and be partly replaced 
by the carbohydrates and fats. Fats and carbohydrates are, 
therefore, protein economizers. That Ee of the protein, how- 
ever, required for organization of the body can not be replaced 
by the carbohydrates or fats. 

Chittenden’s Experiments.—Of particular interest in this 
connection are the recent experiments of Chittenden.! These 
were made on three groups of individuals: College professors 
and instructors, representing mental workers; United States 


* Physiological Economy in Nutrition, 


the tea food supplied = mre conticd 


fradually, 

rein and Bt on ly was not, but was left to the appetite 
of the individual, the restricted diet there was at first a 
slight loss of weight, but this soon stopped and the mental and 
physical vigor was maintained at a high standard and was even 
[ere the feeling of well being said to be more marked 

on the full diet. Voit has clear that the ideal diet + 
consists of the smallest amount of protein food, together with 
non-nitrogenous food, that will keep the body in a state of vigor. 
‘The explanation given of the advantages of this diet is that the 
protein food when metabolised ste s onmnleeics ees 
nil ucts which are excreted through the kidneys. 
If in excess the kidneys are overworked and the products 
may before complete metaboliam or afterward either surch: 


was citablished on a daily intake of 8.5 to 9.5 grame of nitrogen, 
or about 55 of nitrogenous food together with the fat 
and carbohydrates, to bring the fuel value up to 2500 to 2600 
calories, and this was neat to meet the requirements of men 
under conditions of bodily and mental activity. Chittenden 
‘urges the physiologic economy in nutrition, which he says means 
* and simplicity in diet, coupled with intelligent 
ition, which, however, soon becomes a habit, and event- 
Jeads to a moderation in diet which fully satisfies all the 
of the epee as completely as it suffices to maintain 
sea x in equilibrium and in a general condition of health 
vigor. 
Of great interest in this connection are the experiments of 
Folin," to which the reader is referred for a fuller discussion of 
the underlying principles of the subject. 


‘American Journal of Physiology, vol. xili.. Nos 1 and 2 


an Pe 





= 


48 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


Carbohydrates and Fats.—Carbohydrates diminish 
nitrogenous waste and are also sparers of the fats, 240 
of carbohydrates being equal to 100 grams of fat. 100 
grams of protein are taken and absorbed with 600 grams of 
carbohydrates, the amount of fat can be completely protected. 
Fat alone can not check the waste of the nitrogenous tissues - 
and can not replace carbohydrates in their protein-eparing power. 
‘The ingestion of quantities of fat increases the aecumu- 
lation of fat in the body, and this continues until the quanti 
administered reaches 300 grams, when no more can be 
Gelatin is a valuable protector of protein, 100 grams of gelatin 
being equivalent to about 35 grams of protein or 200 grams of 
carbohydrates ; it does not, however, protect against fat loss so 
well as the carbohydrates or fat, 100 grams of gelatin being 
equivalent to about 26 grams of fat. Ordinarily about 500 
grims of carbohydrates and 50 grama of fat are consumed 
daily. 

Proteins, Carbohydrates, and Fats in Combina- 
tion.—If fe is combined Lf the protein, less than half the 
quantity of protein is required to maintain the nitrogenous 
equilibrium. If more protein, fat, or carbohydrate be supplied 
under these conditions, fat will be deposited in the tissues. 
Tnasmuch as food’contains a variable proportion of proteins, 
carbohydrates, and fats combined, the food-value must be deter= 
mined from the standpoint of the combined effect of the three 
alimentary principles contained therein. 

To repeat, the proper form of diet is a mixed one, the excess 
of any food principle in one being counteracted by a deficiency 
in another. Hutchison cites the case of Dr. Stark, who lived 
for forty-four days on bread and water, for a month on bread, 
water, and sugar, and for three weeks on bread, water, and 
olive oil, and who thereafter became feeble in health and ulti- 
mately died with symptoms resembling scurvy. Hammond 
attempted to live on water and 1} pounds of starch daily; on 
the tenth day, on account of extreme debility, the experiments 
had to be discontinued. 

Tn order to supply the requirements of the organism a certain 
amount of potential energy is needed to overbalance the amount 
dissipated in waste and in the production of body-heat. More 
potential energy is consumed during work than when the indi- 
vidual is at rest. The following table, computed by Ribner, 


* Jour, Amer. Med. Asoc. 1857, p. 611. 


QUANTITY OF FOOD REQUIRED, 49 


shows the daily heat-consumption, in units of heat (caloris 
iy atiadeal wesking ae eeu pa ee 





Tt has also been determined that 1 gram of alcohol equals 7 
calories* In other words, the number of grams of proteins, fata, 
and carbohydrates required daily can be converted into their 
calorimetric equivalents, and inasmuch as we have seen that 
the various alimentary principles can in a degree be substi- 
tuted for one another (law of isodynamics), the daily food re- 
quirements can be easily estimated in calories of heat. Thus 
in order to calculate the ailoric value of any food in preparing 
a dietary the number of grams of proteins contained are multi- 

lied by 4.1; the number of grams of fat, by 9.3; and the 
Se ms of carbohydrates, by 4.1; the total is then 
ascertained Fy adding. Bearing the weight of the individual 
in mind, a dietary can easily be constructed according to the 


ing method : 
Fee a oe eaten a Bane 41 = OD 
~ «3 «8 Xam ae 
2025 


The average number of calories required daily by an individual, 
according to this calculation, is therefore 3000. The following 
table, from Hutchison (p. 30), illustrates the method of 


constructing standard dietaries : 
1 Soe Atwater'’s determinations, p. 34. 


7 


50 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


STANDARD DIETARIES. 


a 











| 
i 
i 
# 






seal 





g 
3! 





stant? 








Be |§ 





B) oo Stem 











SebeaSa-S 








slesvenees |Eetsenue [Bs 











Sisseseggse 

















QUANTITY OF FOOD REQUIRED. 61 




















AMERICAN AND EUROPEAN DIETARIES AND DIETARY 
STANDARDS, 


“Many interesting things come to light on comparing the 
dietaries of persons with different occupations and incomes and 
performing different amounts of muscular work. A compari- 
son of the dietaries of the inhabitants of different countries is 
also interesting. Such comparisons are made in the following 
table, which includes as well the commonly accepted dietary 
standards. The figures show the quantities of both total and 
available nutrients. The fuel-value represents the actual 
amount of available energy, and may be computed from either 
the total or the digestible nutrients by use of appropriate 
factors.”’! 

The following table, taken from Atwater,? gives : 

1 Atwater. 
+ Farmer’ Bulletin No. 142, United States Department of Agriculture, 1902 


52 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


and 
Feodconmunption of Persona, in Diferont Circumstancen, onil Prapeted 











Tanorers 
cities of 
states 





{Quantities per Man per Day.) 
Actually eaton, Digestibte, 
i ili 
JABIIEI EAL 
ary fF ay Calor: 
Gm, Gn. om, ies, | 12 
i Es 13) S| tam & 
om om a6 6090) 66 
iso cH in| a | fio | La 
467 14 nb 
aa 14 ‘6 
Gentine fn” large um 110 0 
Aavorers fasatlies in Cried 
peers ee | is] g] lee 
pas tea 2 imo 
tain “ ws a 
College ch diet alc Wiis “9 
Seta pean 4 ite s 


302 WITH LITTLE O& NO Hx: 


. 
man oe 
cee 


PRRsONS ry DEsTITOTHCINCUM: 


mir ah fualties tn 1 in New York 
Labor farasiten in “Pitts. 


Gafni nay 


SeRCRLLANROTE, 
Negro familie in Alabama 


aece. 
hemian families in ai 
Toile “Java ‘vitis 
Colum ee ch lon, 
‘taxol 
hei 


Russlan Jows 














#88 8 


35e 8 

















2 Se 5 See 


#3 


Bee 8 28s 











cy 
% 


188 
105, 
160 


8 8s 8 








#58 8 
Ue 2 


"Ss & 888 








5 88 = 38 


5 5 2 G8 


QUANTITY OF FOOD REQUIRED. 53 






































gf | actually eaten. Digestible. 
FEA epee tesa Mien 
BE i g 
# = B\g|5 
©: 2 
23) 3 4\4 a\#| 
eee ia/4 H wlt}/3|8 
*E\E|E| 3 e/a /éle 
Ean 7 a 
MISCELLAXEODS (Qnntinued), Gm. | @m. | om.| Gm. | Gm,| Gm, [den 42 
Chinese dentist in California! 1 | 115| 13) 999| 106 | 107| 990 | 260° 4.9 
Chinese Iaundryman in Cal es] 
fornia... +} 1 | 185] 76) 566) a4] 72] sap | st80 5.7 
Chins rm laborer in Cali- | 
Dene has Pours 1 Ma %) HO 182 90 | 621 | 3980) 62 
ni rmiy’ ration, 
peace. |. | 10 | 161] 454] 10] 158] 440 ra | 71 
German army ration, peace || > | 114) 39 | 490) 105 | 87) 466 | 275 | BO 
DIETARY STANDARDS, | | ! 
Man at bard work (Voit) ~+ | M45) 100) 450 | 183) 95 | 497 | 8270 4.9 
‘Man at moderate work (Voit) us 56 | 500 109 68) 480 | 200 85 
Man with very bard muscular 
work (Atwater). es]. | 176) (| () | ao] (| () |e 72 
Man with hard ‘muscular ' 
work (Atwater)... .. | wo 0) |) | a8) (| | 480 | 62 
Man with moderately active | 
‘musealar work (Atwater) 5) (|) | us| @ | @ | sin 62 
Man with light to moderate | | 
muscular work (Atwater) |. | m2 | (#) | (1) | 1a) () | () | 050 | 6 
‘Mun at “sedentary” or | 
woman with moderately 
active work (Atwater)... | . . 100 (#) .O] v2) (") () | 2700) 61 
Woman at light to moderate 
muscular work, or man | 
without muscular exerci 
(Atwater)... . - Brey om “ 8) 0) () | 2650 | 61 











Material Amount | proteia, | Fat 
Oz. | Gm. | Os. | Gm. | Os. 
| ae Hr] oe 
8 | ibea ba |"bot| Or 
1 6.60 0.23 | 7.50) 0.26 
4 3.63 0.18 | 442) 0.16 
ES 18.14) 0,64 | 18.14) 0.64 

4} onal ¢) |13% 
106.80 








It should be understood that standard dietaries, such as have 
just been given, must be modified to meet individual condi- 
tions. Without modification they are useful in preparing 
dietaries for persons living together in large numbers, as for 
armies or on board ship. 


1 Fate and carbohydrates in sufficient amounts to furnish, together with the 
protein, the indicated amount of energy. 


54 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 
An Ideal Ration of Liquid Food—(Mrs. B. H. Richards.) 














While diet-lists are easily prepared according to the method 
Ah outlined, it must always be remembered that the digesti- 
ility and absorbability of food play a most important role, and 
are not to be neglected in formulating the dietary ; for while a 
certain food may contain a great many more calories than an 
equal weight of another food, yet its relative indigestibility 
and non-absorbability may render it far less available as an 
article of diet. For example, while 4 ounces of sausage pro- 
duce 510 calories, 4 ounces of cheese 520, and 4 ounces of 
beef only 280, yet the beef is far more digestible than either 
the sausage or cheese, and thus more valuable as an article of 
food. As hus been aptly said, “We live not-upon what we 
eat, but upon what we digest.” Therefore, a diet-list giving 
quantities of food principles or calories is useful only as it 
suggesta general principles that may be modified to meet indi- 
vidual conditions im health and in disease. 


THE INFLUENCE OF VARIOUS FACTORS UPON 
THE DIGESTION. 


Apart from the selection of a proper diet, important factors 
that especially affect the digestion are the following: 1. The 
hours, order, and frequency of meals. 2. Variety in diet. 
3, The appetite. 4. the temperature of food. 5, Rest and 
exercise before and after meals. 6. Emotion. 

1. Order and Frequency of Meals.—It is usually 
customary to fix certain hours for the taking of meals; these 


1 According to how the rice is given. 


OF VARIOUS FACTORS UPON DIGESTION. 565 


of the individual. In large 
am hour is taken up largely with active 
is selected as the most convenient 
Sir Henry Thom 


i 
ii 
ge 


i 
j 


states that three gen~ 
1G whic, two, thneslce Bee 
inst system, which consists of two 
France and other countries on the 
eae eal, ing of fish or 


HE 
By 
pres 
iBes 


meal, 
id foods, is eaten noon ; 
no food is taken before the noon meal, exi on arisin; 

a of coffee or chocolate and a si uantity 
bread and butter are taken, Mihe scaad seal, which isa 
is eaten between 6 and 7 o'clock in the evening. This meal 
is the largest meal of the day, and consists of , fish, meat, 
vegetables, salads, dessert, and black coffee. second 
commonly in yogue in England, consists of four meals 

. The first meal, or breakfast, is taken at about 8 A. M., 
and consists of cocoa, tea, or coffee, bread, butter, bacon, fish, 
or eggs; dinner is eaten between 1 and 2, and consists of 
soup, meat, fish, vegetables, and pudding; tea is taken at 
6 ¥. M., and supper is served at 8, and consists of meat, fish, 
‘vegetables, and stewed fruits. Dinner is taken in the evening 
by the well-to-do , and a substantial lunch is usually taken 
at noon. The third system, ee in the United States, 
consists in taking three meals daily, In many towns it is ous- 
i ; in others, in the evening. The usual 
taken between 7 and 8 A. M., consists of fruita, 
cereals, eggs, bacon, or salt fish, tea, cocoa or 
= “ae bread and butter. Luncheon, eaten between 12.30 

2 o'clock, consists of cold meat or a chop, vegetables, 
salads, and desert. Dinner, eaten between b.30 and SP. My 
is the heaviest meal of the day, and consists of soup, fish, 
meats, vegetables, salads, and fruit. 

‘The conventional order of taking food at dinner appears to 
be most rational, namely, soup, fish, entrée, meat, vegetables, 
salads, fruits. Small quantities of soup stimulate the gastric 
secretion, do not interfere with digestion, and pass rapidly 
from the stomach; the fish and entrée are then partaken of, 
before the acidity of the gastric secretion has reached its 
height; next follows the meat, the stomach now secreting 
liberal quantities of gastric juice wherewith to carry on the 
digestive processes ; finally come the carbohydrates, which do 
not undergo digestion in the stomach, and which enter this 


ll 


: 
a 


656 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


organ when the food already taken is about to pass from the 
stomach into the intestine. The eating of bountiful dinners, 
made up of many courses, when frequently indulged in, is 
likely to lead to digestive disturbances. Children and invalids 

always eat dinner at midday, between 12 and 2 o'clock, 
and should never be allowed to take this meal at ni 

The frequency of meals must be regulated according to indi- 
vidual conditions. Patients suffering from digestive disturb- 
ances and those who take very small quantities of food at a 
time require nourishment at frequent and regular intervals ; 
whereas those whose digestion is feeble, should allow six or 
seven hours to elapse between meals; ordinarily the interval 
between meals should be about four or five hours, this bei 
about the time necessary for complete digestion of a mi 
meal in the stomach. The habit of habitually omitting the 
noon luncheon, so commonly practised by busy Americans, 
should be discou: 

2. Variety in Diet.—In order thoroughly to satisfy the 
needs of the body the diet must be varied. Although a diet 
restricted to but a few articles of food may contain a sufficient 
quantity of the alimentary principles to sustain the body nutri- 
tion, yet the monotony of such a diet becomes so objection- 
able that it can not be digested thoroughly, According to 
Woods and Merrill,! “it is a matter of common observation 
that digestion experiments made with one kind of food-mate- 
rial do not give on the whole as reliable results as those in 
which two or more food-materials are used. In other 
it appears that with a mixed diet the same person will digest a 
larger proportion of nutrients than with a diet composed of a 
sh food-material.” Certain races restrict the variety of 
food from religious motives, such as the Jewish restriction of 
ham, pork, and oysters. (See Leviteus, chapter xi.) 

3. Appetite.—Appetite is the desire for food, and is 
dependent upon various conditions. It is controlled by the 
sensation of hunger, and is often induced by the sight, smell, 
and taste of food. As Pawlow has shown, the smell or sight 
of food will excite the flow of the gastric secretion, and this in 
turn will produce an appetite. Simple bitters or some form 
of alcoholic drink will at times induce ie are Ths 

pearance of badly prepared or improperly serv: wi 

en dispel the appetite Tn children the appetite is usually 


* United States iment of Agriculture Bulletin No. 85. 
The Work ofthe Digetve Gland 


INFLUENCE OF VARIOUS FACTORS UPON DIGESTION. 57 


good, whereas in the aged it is lessened. Some persons have 
voracious appetites, and abnormal craving for food. This is 
often the case in diabetic and other conditions, when, at times, 
the a can not be satistied, 

4. iperature of Food.—The temperature of food 
when taken is of considerable importance. The ideal tem~ 
perature is that of the body, from 98° to 100° F. (Uffel- 
mann), the limits of safety being between 45° and 130° F, 


to Hutchison, extremes of ture of food are 
ee. ic disturbances, as gastric catarrh, 
felmann states that a drink at a temperature of 122° F. 


increases the body-temperature 0.1 to 0.3 degree C. It is 
believed by many that ulcer of the stomach, e common in 
cooks, is often due to the taking of too hot foods, Hutchison 
considers that the proper temperature of water intended to 
quench the thirst should be between 50° and 70° F. 

5, Rest and Exercise before and after Meals,— 

It is often advisable to rest, but not to sleep, after meals. The 

part of the work of the stomach should be completed 

retiring at night, otherwise the sleep is apt to be dis- 
turbed. About one or two hours should be allowed to elapse 
between a light evening meal and bedtime, and three or four 
hours between a heavy meal and sleep. From personal obser 
vations (see the section on Rest and Sleep in Gastrie Disturb- 
ances) the authors have concluded that digestion is improved 
by rest after meals, but impaired by sleep. In many instances 
4 period of rest before eating meals is a valuable aid to diges- 
tion. Violent exercise immediately after meals inhibits diges- 
tion, whereas moderate exercise one or two hours after meals 
materially aids this process. 

6. Food and Emotion.—Severe mental strain and stron; 
emotion disturb the digestion, and for this reason food shoul 
not be taken until a period of rest and composure has inter- 
yened. On the other hand, pleasurable sensations aid the 
digestion, and pleasant conversation at the table is therefore 
to be recommended. 


58 CHEMISTRY AND PHYSIOLOGY OF DIGESTION, 
‘THE RELATION OF FOOD TO VARIOUS INHERENT 
CONDITIONS. 


Inquiries are often made concerning the relation of food to 
various conditions, such as the influence of sex, race, and the 
like. These conditions will now be briefly discussed. 

Heredity.—Certain systemic conditions and diseases, or the 
tendencies to them, are inherited. Those of especial interest, 
from the standpoint of diet, are leanness, obesity, diabetes, 
gout, and alcoholism, Food idiosyncrasies are also often 
inherited. Among these are the liability to the development 
of urticaria or poisoning from the eating of strawberries, crabs, 
ete. In the ease of obesity, gout, and the like, the dict should 
be regulated with a view to preventing these diseases. 

Sex.—As a rule, women eat and require less food than 
men. This is probably due in large measure to the indoor and 
sedentary life led by so many women. Under equal conditions 
sex has little influence on food requirements. Atwater states 
that under similar conditions women require four-fifths as much 
food as men, 

Age in some measure influences the quantity of food taken ; 
a child requires proportionately a larger amount of food than 
an adult, Atwater! thus compares the amount of food required 
in childhood with the quantity needed by a man at moderately 
active muscular work : 


Boy 15-16 yr, requires 0.9 the food of « man at moderate work. 


Girl 15-16 08 
i os 8 u « 
Girl 1314 “ 7 « ¥ as 
2 « eae! “ ic 
Gin 1012 og “ « 
10-1l * oe 4 LA ” 
of oe « “ 
Child 25 « 04 " « 
Child under 2 og “ “ 


A growing active boy usually requires more animal food pro- 
portionately than an adult, whereas a man of middle age 
requires more than an old man. 

Race.—The food of different races varies widely, but this 
is due, for the most part, to the varying conditions under which 
they live, and especially to the food-supply that is most avail- 
able by reason of cost and the ease with which it can be pro- 


* Principles rition and Nutritive Value of Foods, Farmers’ Bulletin No. 
142, United Bites D Department of gic 


RELATION OF FOOD TO VARIOUS CONDITIONS 59 


aye quantities as would at home, and even after years 
of life in the poalieei dh not make any great change in their 


civilization causes over-population) are in a condition of 
nitrogen Seryation and need much more ni than they 
can ibly get. The old standards of ing that we 
Bian ‘eat sa the natives is most vicious. They do not eat. 
meat because they can not get it. They crave it, need it, and 
eat it when they can. On account of the destructive effects of 
the concentrated tropical actinic rays on protoplasm we need 
more nitrogen than at home. Please don’t copy the old false- 
hood that we need less. It is also true that we need fut, as it 
furnishes energy better than carbohydrates, It is eaten in 
preference to starches and sugars for this purpose by workers 
when they can aiford it, but they take to starch (rice) because 
it is cheaper. It is incorrect to say that it overheats, It does 
not overheat us, and it is fulse to say thut fut is not needed in 
the tropics.” 

Climate.—In close relation to the question of race is the 
question of temperature and climate. There are many differ- 
ences of opinion, as one can gather from Major Woodruff's 

In regard to the subject he says: “Climate affects diet 
mainly by the supply it affords.” The main difference lies in 
the amount of heat and energy that must be supplied. In cold 
climates more food, especially fat, is needed, because the amount 
of heat required to maintain the warmth of the body is greater, 
If the individual is doing a large amount of work, a proper 
Loge of food must be supplied whether the climate is hot or 
cold. the individual is in a hot climate and is doing 
little or no work less food is required. 


Pa 


60 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


Season.—What has just been said rding climate applies 
also to season. Somewhat more food iarequired in winter than 
in summer, in order to supply the extra heat. People who are 
well clad and well sh need less food in cold weather and 
in cold climates than those who are poorly clad and exposed to 
the elements, (See the abstract from Woodruff in the section 
on Army Rations.) 

Size and Weight.—Other things being equal, the larger 
the body the more food is needed. This is an important point 
in feeding infants, and is discussed in the section on Infant 
Feeding. If the food-supply in childhood is insufficient, the 
child will be undersized. As applied to races, however, this 
rule is theoretic, and, since evidence to the contrary exists, the 
subject requires further study, 

The weight of the individual is very important in the manage- 
ment of diseases that are influenced by diet. The weighing of 
patients is a practice that is much neglected. Weighed with 
the same scales at different times during the day the weight of 
an adult.will vary, on the average, two pounds, and in many 
instances as much as three. With changes in clothing the vari- 
ation may be much more. The differences in weight are 
governed by the amount of food and drink ingested, and by 
the condition of the bowels and bladder, whether they have 
been emptied or are full. It is easy to see how errors may 
arise unless all these things be considered. Patients are easily 
buoyed up or depressed as a result of weighing, and care should 
be exercised to avoid the latter, If the patient is weighed in 
his clothes, the same garments should be worn at each weigh- 
ing. The relation to mealtime and to the voiding of urine and 
feces should also, so far as possible, be the same at each weigh- 
ing. The patient should be instructed not to drink water for 
the sake of increasing his weight. 

Rest and Exercise.—Much less food is required during 
rest than during exercise, In exercise the muscular activity 
increases oxidation and tissue-waste, and this waste must be 
counterbalanced by an increased consumption of food. Accord- 
ing to Atwater: A man at hard work requires 1.2 of the food 
of a man at moderate work ; a man at light muscular work re- 
quires 0.9 of the food of a man at moderate work ; a man of 
sedentary habits requires 0.8 of the food of a man at moderate 
work. Riibner states that: (1) At rest a man requires 2500 
calories ; (2) at professional work a man requires 2631 calories ; 
(3) at moderate muscular work a man requires 3121 calories; 


RELATION OF FOOD TO VARIOUS CONDITIONS. 61 


(A) at severe muscular work a man requires 3659 calories ; (5) 
at hard labor a man requires 5213 calories, 
Apahpesl aia eee have some effect on the amount 
i are many persons who eat very 
paragiy ans who nevertheless become obese ; others partake 
of an unusually large quantity of food and never fatten, This 
is due probably, as Hutchison points out, to the fact that the 
‘activity of the cells in certain individuals is greater than in, 
others, and leads to a more rupid breaking-down of food and a 
greater waste of heat,” 

The great tendency with most persons is to overeat, in con- 
sequence of which fats are stored up; as a result, obesity or 
gustro-intestinal or other disturbances occur, and thus the excess 
of food is eliminated, At times the reverse condition—that of 
consuming too little nourishment—occurs, The period during 
which an individual can subsist without food varies, and de- 
pends largely upon the amount of exercise taken and upon 
atmospheric conditions, such as moisture and temperature. a 
condition more frequently met with than actual starvation is a 
one-sided or improperly balanced diet—that is, one in which 
one or the other of the food elements is taken in excess, while 
the other elements are diminished or lacking. Thus if an indi- 
vidual eats excessive quantities of meat and no vegetables, the 
diet is too rich in proteins and too poor in carbohydrates; again, 
if large quantities of butter and rich cakes be eaten and no 
meat or vegetables, the diet will be too rich in fats and carbo- 
hydrates and too poor in proteins, and may, therefore, prove 
harmful. Asa rule, in a badly balanced diet the number of 
calories is too small to meet the requirements. The following 
dict-list, given by Mra. E. H. Richards, shows a common 
invalid diet too low in proteins : 


A Common Invalid Ration Too Low in Protein.—| Mrs, E. H. Richards.) 





Proveins| Fat. hastens Caloriea. 





om | am | Gm. 
205 | 05 88.7 


25 | 79 | 5217 


:| 680 | 04 | 64 | 2940 
-f2730 | 224 | 193 | 11004 











62 CHEMISTRY AND PHYSIOLOGY OF DIGESTION. 


Tobacco and Digestion.—Tobacco frequently plays an 
important réle in influencing the digestion of food. It is a well- 
known fact that the chewing of tobacco increases the salivary 
secretion, frequently reduces the appetite, and increases the 
movements of the bowels. As a rule, it is better to smoke 
after meals than before, the irritating effect of tobacco being 
thus lessened. In acute gastric disturbances tobacco should be 
interdicted entirely, and in chronic forms the smoking should 
be limited to a very few cigars a day. 

Tobacco acts as an excitant to the nervous system, and should 
be prohibited in all nervous diseases, 


CLASSES OF FOODS. 


ANIMAL FOODS. 


AsIMAL foods contain much digestible matter, chiefly y Bro 
teins, a considerable: quantity of fat, in some foods carbo- 
hydrates, and, in addition, water and mineral salts. Being 
Tercaty digwine, they leave but little residue in the intestine. 

The various forms of animal foods—millk, eggs, meat, fish, and 
gelatin—will now be described under these headings. 


MILK AND MILK PRODUCTS. 

Milk, the most important of animal foods, contains all the 
elements necessary for the maintenance of life, and constitutes 
a complete food, 

Composition.—Milk contains varying proportions of each 
of the four classes of food principles—proteins, fats, carbo- 
hydrates, and mineral salts. Unadulterated, it contains from 
90 to 84 per cent, of water, varying with the quality of the 
milk. It forms the exclusive diet for young, growing mam- 
pale bo owing to the fact that the proportions of proteins 

and fat are in excess of the carbohydrates, it is unsuitable as 
an exclusive diet for adults, 

The principal nitrogenous compound of milk is casein, It 
cites from the other protein compounds in that it contains 

iat, fa th and sulphur. Casein is not coagulated by 

this change may be effected by adding acid or by 

The casein clot formed by adding acids may be dis- 

Cre by neutralizing the acid, while that formed by rennet is 
not affected by the addition of alkalis, Milk contains, besides 
casein, lactalbumin, which is similar to the serum-albumin of 
the blood. The total proteins averages about 3.3 per cent, of 
the bulk of the milk, or about 25 per cent, of the total solids, 

The fats of milk consist of the glycerids of palmitic, 
stearic, and oleic acids. In addition to these, milk contains 
several other fats in smaller proportions, to which the flavor of 
butter is due. The fat is suspended in the milk in the form 
of minute globules, which give the milk its white color and 
Kye ‘at averages about 4 per cent. of the milk or about 

cent. of the total solids, 


64 CLASSES OF FOODS. 


‘The chief carbohydrate of mill is lnctose, or milk-sugar, 
Milk-sugar is not nearly so sweet as ordinary sugar, and is 
Tess soluble in water. It reucts to Fehling’s "solution like 
glucose. In the presence of the lactic acid bacillus it is con- 
yerted into lactic acid, which causes the milk to turn sour, 
Lactose forma about 38 per cent. of the total solids. 

Milk contains about 0.7 per cent, of salts. These salts exist 
chiefly in the form of phosphates, chlorids, and sulphates, 
Potassium salts occur in larger quantities than do sodium salts, 
Calcium salts are very essential to young, growing animals, 
inasmuch as they play a very important part in the formation 
of bone. The relative percentages of salts in the ash of human 
milk are shown by the piowite table: 





Variations in Milk.—There are wide variations in the com- 
position of the milk of different animals. While human milk 
contains more sugar and less protein than cows’ milk, the fuel- 
value is about the same. Dog’s milk seems to be the richest, 
whereas thab which comes from the horse is exceedingly poor, 
as may be seen from the following table : 


Comparative Composition of Various Kinds of Milk. 








Total solid, 
Protein, 
Kind of | ator, | Total = Mineral vale 
mi *| sottds, Toul | Fat, eee en gee 
Casein.) Albu ‘an any | 





Per ct.| Per ct.| Per ct.| Per ct.| Per ct. |Perct.| Perot. | Por et. | Calortes. 





ga | 6 | 10 | 13 | 23 | 38] 62 og 29 
gia | ws | 30 | 06 | 35 | 37 | 49 07 B18 
ma | wo | O12 | 51 | 12 | oo] ar O7 on 
ws | 92 | 50 | 15 | 6b | 69) 49 09 508 
aia | wo | 58 | os | or | 25} 4 09 cd 
gi] 79 | 31 | 60 | 91 | aa) 49 06 400 
Sa | ws} ga | ar | 4a | ae] an 0.8 2065 
#5 | m5 | 30 | o9 | a9 | Bz] 56 08 az 
#6 | wa | o7 | 16 | aa | ae] Go 06 bt 
ms | 85 | u2 | o1 | 13 | 1z] 37 08 0 





nig, Onis der menuchn Narwnge nd Gensemittel, 8d ed, vol in 
pp. 207 


ANIMAL FOODS, 65 


Not only is there a wide variation in the milk of different 
animals, but cows’ milk itself is subject to great changes in 
the eae composition of its ingredients. These may be 

po seey nee, tha teed end condition of animala, 

tod the io the care they receive being responsible in a 

ee a for these changes. As a rule, a young cow gives 

milk than an old one, and a well-fed animal yields richer 

milk than one that is poorly fed. The milk flow is greatest 

shortly after calving, but the milk increases in richness as the 
quantity becomes smaller, 

Adulteration—Milk is often adulterated by unscrupulous 
dairymen by the addition of water, This is the most common 
method of adulteration, and, if the water used for this purpose 
ix pure, produces no ill effict. other than to dilute the milk and 
peer lees the percentage of its ingredients. Unfortunately, 

water used for this purpose is not always pure and is 
Sopeuctly & source of contamination. Other methods of alter- 
ing re Banity of milk consist in the removal of the fats—the 
increase in the cara gravity which is produced thereby is 
countenicted by the further addition of water ; and in the addi- 
tion of preservatives, The latter method, while it does not 
detract from the nutritive value of the milk, may, if the milk 
be used regularly, produce deleterious results. 

Digestion of Milk—When milk enters the stomach, it is 
coagulated by the hydrochloric acid and the rennin of the gastric 
juice. These curds, or coagula, consist of precipitated casein 
and a portion of the fat that hae become entangled in the curd. 
They in size and consistence according to the amount and 
the dilution of the milk taken, The casein soon undergoes 

change, being converted into some form of peptone, and the fat 
is a Liberated, ‘The albuminous envelope of the fat-glebules 
oy and the fat coalesces, forming larger drops, in 
which condition it passes into the duodenum. A portion of 
the water and some of the salts are absorbed in the stomach. 
The curd that has not been acted upon by the gastric juice, 
together with the water, salts, and carbohydrates that still 
ema a also into the intestine, where their digestion is 
Boing increases the digestibility of milk, the 
eit being ited in a more floceulent form. If the 
is previously mete ted with lime-water, barley-water, or 
one ag the aérated waters, such as Vichy, the curds formed are 
smaller and softer, and the milk often rendered more palatable. 
Bread or crackers added to milk make a good mechanical 
5 


_wté{ 


66 CLASSES OF FOODS 


diluent by mingling with it and maintai a soft condition 
of the curds. ‘The addition of alkalis may be resorted to with 
a view to neutralizing the acids, oe 
lating the casein eaeileelyani forming flocenli rather 
Sree 


eam.—When milk is allowed to stand for some hours, 
Groin ean intone ead tegen wie eee 
able milk, are removed as cream. This product contains about 
18 per cent. of fat, and some protein und carbohydrates from 
the milk mixed with it. Sewing io Letietiy Seen 
from Yeo, the following table shows the average composition of 
cream ¢ 





Skimmed Milk.—The residue remaining after the removal 
of cream from ordinary milk is called skimmed milk. The 
amount of fat has been greatly reduced by creaming, but the 
percentage of protein remains almost the same, It is more 
easily digested than whole milk, inasmuch as the fat has been 
removed. The composition of skimmed milk, according to 
Letheby, as stated by Yeo, is as follows : 





Devonshire cream is « solid cream obtained by skimmi. 
milk after it has been heated slowly to not over 150° F. 
is more nutritious, but not so easily digestible as ordinary 
cream, 

Butter.—Butter is made from the cream of milk by the 
process of churning, which causes the fat-globules suspended 
in the milk to coalesce, thus forming a solid mass. Butter 
is occasionally made from milk other than that from the 
cow. A varying proportion of common salt is always added 
to it to enhance its palatableness and its keeping quali- 
ties. The flavor of butter is due to the growth of micro- 
organisms, Pure cultures of certain organisms are now 


ANIMAL FOODS. 67 


utilized to butter and so impart a constant flavor, 
~ cena apelin prot pry a 





» 90.0 
Water. 2 ‘+ 100 
ele ee et ee ee a eae 


On account of the ease with which it is digested butter, when 
fresh, is one of the most valuable fatty foods. The rancidity 
which occurs when butter is kept too long seems to be due to 
the casein, which, on undergoing fermentation, liberates fatty 
acids. On this account that butter keeps best which contains 
the least casein, Butter is best preserved by keeping it at low 
temperature, and good results are also obtained by salting. 

Buttermilk.—Buttermilk, which is formed during the 
manufacture of butter, is another milk derivative of no little 
importance, It is used extensively as a beverage, and is highly 
nutritious and easily digested. It contains the casein of the 
milk ina finely coagulated form. According to Pavy, as quoted 
from Yeo, the composition of buttermill: is as follows : 





juice, white vinegar, etc. Whey is the fluid ‘ion af the 
milk remaining upon the coagulation and removal of the casein. 
Whey is an excellent drink and food in those cases in which 
milk is not well borne. 

Cheese.—Cheese is made up of curd and a certain propor= 
tion of the fut of milk. Cheeses vary in composition and con- 
sistence according to their preparation. Some cheeses are soft, 
while others ure hardened into cakes by pressure. The flavor 
of cheese is due to the growth of certain micro-organisms during 
the ripening process. The harder cheeses keep much longer 
than the soft ones. The average composition of cheese, as 
shown by Parkes,’ is as follows : 





4 Hygiene, third edition. 





68 CLASSES OF FOODS. 


Cheese is a nutritious and agreeable food, but it is often dif- 
ficult of digestion, The harder cheeses are much more indi- 
gestible than those of soft consistence. Like milk, cheese may 
contain certain poisonous substances, due to organisms that 
enter the milk; of these, one of the most common is tyrotoxi- 
con. Poisoning may follow the eating of such cheese. 

Kefir, and Matzoon.—Kumiss is a fer- 
mented drink prepared by both lactic acid and alcoholic fer- 
mentation. For many centuries it has been made from mares” 
milk by the nutives living near the shores of the Caspian Sea, 
‘The milk is obtained from a special breed of mares, the animals 
boing fed very carofully. The milk is mixed with a kumiss 
ferment, the lactic acid ferment converting some of the sugar 
into lactic acid, while another part of the sugar is converted 
into alcohol and carbonic acid; a small quantity of casein is 
digested. ‘The milk is constantly agitated, and the fermenta- 
tion allowed to proceed for a period of twenty-four hours or 
more, 

Kumiss is an acid, effervescing drink, and contains a very 
small proportion of alcohol, It is very easily digested, being 
much more digestible than milk. The casein is #0 finely 
divided that lumps can not be formed in the stomach, and it is 
easily acted upon by the gastric secretion, In the United 
States it has been prepared from cows’ milk to which an arti- 
ficial ferment is added. ; 

Kumiss Cure—In certain parts of Russia this form of cure 
is not uncommon. It consists in drinking small quantities of 
kumiss and gradually increasing them until large quantities 
are taken, Kumiss cures have been prescribed in chronic 
gastro-intestinal catarths and chronic catarrhs of the respiratory 
tract. 

Kefir resembles kumiss, and is often used as a substitute 
for it. It was originally made in the Caucasus from cows’ 
milk fermented with Saccharomyces mycoderma, lactic acid 
fermentation going on at the same time, Alcohol, lactic acid, 
and albumins are formed as a result of the fermentative proc- 
esses. The casein is partly digested. Tablets of the kefir 
ferment have been prepared by Jurock. These are sold under 
the name of kefilac tablets. They render the home manufac~ 
ture of kefir an casy matter, (See Recipes.) 

Matzoon.—In this form of milk lactic acid is produced by 
fermentation with a ferment obtained from Syria. It is thicker 
than knmiss and does not contain alcohol. 

Kumiss, kefir, and matzoon are agreeable forms of milk 


— 


ANIMAL FOODS. 


foods, are easily digestible, and are 

cases in which milk can not be taken or 

‘The following table is taken from Hutchison (p. 137) and gives 
Tactic 
‘eld. 


ze 
é 


the composition of kumiss, kefir, ete, : 














Bottermik -.-::| 38 | a3 | 12 





THE MODIFICATION AND PRESERVATION OF MILK, 

The chemic composition, variation in, and adulteration of 
milk, as well as of some of the milk-products, have already 
been considered. It now remains to discuss the methods of 
modifying and preserving milk and milk-foods. Inasmuch 
as milk is ly taken in the raw state, it is highly important 


that it be free from all sorts of contamination. 


Contamination of Milk.—An im; it source of con= 
tamination of milk is through disease of the udder of the cow 
or carelessness in handling this organ. Cows are too often 
kept in filthy stables, from which dust and excrementitious 
matter find their way into the milk-pail. The germs of disease 
thut do not get into the milk in the stable, frequently do so through 
the agency of the bottles or cans in which the milk is shipped, 
and which are often unclean or cleansed with polluted water. 

Cows should not be allowed to eat the dry leaves on which 
they are mostly bedded, lest their color, odor, or even poisonous 

be imparted to the milk. Sour milk and milk from 
poor cows is unfit for food and should not be used, 

At times tuberculosis or inflammatory conditions due to 
micro-organisms may exist either in the ndder of the cow or in 
some distant organ, and may be so slight as not to attract the 
attention of the milker. Tastes, in a report to the British 
Medical Association in 1899,' described his analyses of 186 
samples of milk obtained from various sources; of these, 
tubercle bacilli were present in 11; pus in 47; streptococci in 
106 ; the percentages were as follows: 5.3 per cent. contained 
tubercle bacilli ; 78.7 per cent. contained pus. At times micro- 
organieme are introduced into mille from an udder that has not 
been properly cleansed before milking or from the unclean 

4 Brit, Med. Jour, 1809, 


70 CLASSES OF FOODS. 


hands of the milker. Among the pathogenic 8 that may 
thus gain access to ie tlk are the bacilli of typhoid fever 
tuberculosis, diphtheria, and cholera, On entering the milk 
these organisms continue to grow and in a short time multiply 
enormously. In addition to pathogenic organisms, other micro- 
organisms which produce souring but are otherwise harmless 
may gain access to the milk. 

De Schweinitz, in the Sixteenth Annual Report of the Bureau 
of Animal Industry, 1899, calls attention to the fact that in 
our cities milk contains from 3000 to 8500 bacteria in a cubie 
centimeter; in some instances there are as many as 1,000,000 
to 4,000,000 in a cubic centimeter. The maximum limit of 
the number of organisms in milk that is fit to be used is 50,000 
in a cubic centimeter. Applying this rule to the samples 
obtained by de Schweinitz from 32 dealers, but 13 were fit 
for use. In 130 samples examined by de Schweinitz in which 
the greatest care was taken to prevent contamination, from 200 
to 50,000 bacteria face Nae * a gals iaoerdd = om 
largest proportion, however, but from to 5000 were found. 
From this 4t will be seen that the greatest care is required in 
handling milk from the time it comes from the cow until it is 
served as food. 

At Barnside Farm, Green Spring Valley, Md., the farm of 
Mr. Samuel Schoemaker, from which the Walker-Gordon milk 
sold in Baltimore is obtained, the following precautions to pre~ 
vent contamination are taken : The dairy is managed by trained 
persons, and is being constantly inspected by experts in their 
respective departments. The number of bacteria in the milk 
is recorded daily at the laboratory. ‘The cows are tested for 
tuberculosis at frequent intervals. The stables are kept in 
a thoroughly hygienic condition, the floor and walls being 
cemented and well scrubbed each day. The milker is required 
to scrub his hands thoroughly before milking, and to clothe 
himself in a white sterilized suit. The cows are thoronghly 
groomed one hour before milking, and the udders of the 
cow are cleansed just before milking. The cows are milked 
into special milk-pails so arranged as to prevent dust from 
entering. The first milk drawn, which usually contains any 
germs that may have entered the milk-ducts, is discarded. 
The pails, bottles, and other apparatus are sterilized at a tem- 
perature of 212° F, The mille is passed from the pail inte 
cans, and is then taken to the milk-house, where it is strained 
throngh sterile cotton into a sterilized cooling tank, after which 


ANIMAL FOODS. 71 


it is bottled, corked, and sealed. A guarantee as to the purity 
of the milk with each bottle. 

Milk.—Modified milk is prepared from the care- 

fully selected cows set aside for producing milk that is to be 

and recombined according to the prescription of the 


The separated 
milk cream, as well as the whole milk, which has been 
cooled se Aienperaiare of 40° F. or below, are then sent to 
the city tory, where the definite percent of cream and 
modified milk are recombined. basis 

It is the general belief that invalids and infants thrive better 
upon mixed milk obtained from a number of cows, than upon 
the milk of a single cow, which is to vary with the condi- 
tion of the animal. According to Rotch, “certain breeds of 
cows are better than others for copying human milks.” The 
following list of breeds best adapted for modified milk, with 
analyses, is taken from Rotch : 


Milk- | Albu. | Mineral] Total 
ugar. [ae Tnatter. | solids, 











430 4.09 0.73 12.86 | 87.14 


Sterilization and Pasteurization of Milk.—Milk is 
sterilized by boiling, and is thus rendered less digestible for 
dyspeptic pationts ; its taste is also altered; on the other hand, 
sterilization destroys all micro-organisms. For persons with 
normal digestion milk is usually more easily digestible when 
boiled. The disadvantages of sterilization are in a measure 
overcome by Pasteurization. By this process the milk is 
kept at a temperature of 70° ©. (158° F.) for from twenty 
to thirty minute: ; thus most micro-organisms are killed, the 
spores, however, not being destroyed, although their growth 
is inhibited. The taste of the milk is not so markedly altered 
as in sterilized milk, and it is said to be more easily digestible 
for patients suffering from gastro-intestinal disturbances. It 
does not, however, keep so long, and sours in one or two days. 

While bacteria are destroyed by sterilization, their oes 
which are also present, are not killed, and if kept at ordinary 





72 CLASSES OF FOODS, 


temperature, they continue to increase largely in number and 
thus render the milk unfit for use. These organisms frequently 
destroy the protein of the milk rather than the lactose, and as 
there may be an absence of the customary souring, the fact that 
the milk is contaminated may thus be overlooked, The dis- 
advantages that accrue from sterilizing milk are manifested in 
the constipating effect and in its altered taste. As the result of 
sterilization various chemic changes take place : the lactalbumin 
is somewhat coagulated, the casein is so changed that it is less 
easily acted upon by the rennin, and part of the lactose is 
changed into caramel ; some of the soluble salts are converted 
into insoluble ones. A la mn of these are 
ee oe ee 
eae to sterilizing milk lies in the fact that many infants 

upon it for long periods of time are apt to suffer from 
scurvy ; he reports that at least a dozen such cases have come 
under his notice. By Pasteurization all these difficulties are 
overcome, and from 98 to 99 per cent. of all micro-organisms, 
including the bacillus of typhoid and of tuberculosis, are de- 
stroyed, although their spores are not killed. Special care must 
be exercised in Pasteurizing milk, and as soon as it is Pasteur- 
ized it should be placed on ice. 

Process of Sterilization —By means of the Arnold sterilizer 
milk can easily be sterilized in small bottles in quantities just 
sufficient for each feeding. Sterilization may also be effected 
simply Ye exposing the bottles in a vessel that is tightly cov- 
ered and open at the bottom, and allowing the steam from 
boiling water to enter from below. The milk is then kept at 
a temperature of 212° F. for one hour. 

An excellent apparatus for Pasteurizing milk is that devised 
by Freeman. “This apparatus consists of two parts, a pail for 
the water and receptacle for the bottles of milk. The pail is a 
simple pail with a cover; there is a groove extending around 
the pail to indicate the level to which it is to be filled with 
water, and supports inside for the receptacle for the bottles of 
milk to rest on. The receptacle for the bottles of milk con- 
sists of a series of hollow zine cylinders fastened together ; 
this fits into the pail, so that the lower inch of the cylinders 
is immersed in the water, This receptacle has two sets of 
horizontal supports, the upper set continuous around the recep= 
al for use while the milk is being Lert ve lower sh 
rm set is used for raising the receptacle during cooling. 
Such receptacles are made for ten 6-ounce bottles, seven 8-ounce 


ANIMAL FOODS. 73 


bottles, 1-pint, and one }-pint bottles, and two 1-quart 
bottles. Theres sae ajpartos for dee of a 
or public institutions which bas a receptacle for forty-three 


G-ounce or 8-ounce bottles, 
“The tus is used in the following way: The pail is 
filled to the level of the groove with water, covered and put on 


the stove, the receptacle for the bottles being left out. The 
milk are then filled, stop) with cotton, and 

dropped into their places in the cylinders. Sufficient water is 
poured into each cylinder to surround the body of the bottle. 
As as the water in the pail boils thoroughly it is taken 
stove and set on a mat or table or other non-conductor 
where there is not a draft of wind blowing on it, The 
il is removed and the receptacle rests on the upper 
ms supports. The lid is then rapidly put on the pail, 
is thus allowed to stand for three-quarters of an 
uring the first fifteen minutes the temperature of the 
to about its maximum, or above 65° C., the point 
for Pasteurizing, and remains there the remaining thirty 
mites. During the last fifteen minutes the cover of the pail 


cPELTRGET? 
reate 


perature of the cold water used. The bottles may then be put 
into a refrigerator until required for feeding. This rapid cool- 
ing is a most important part of a low temperature sterilization, 
the importance of which is apt to be overlooked.” 

Since heating does not destroy the spores of bacteria nor the 
toxins in milk, it is essential that the milk be as fresh and as 
free from disease germs as possible before sterilization is under- 
taken. As Holt points out, it is also important to bear in mind 
that “sterilized milk requires the same modification for infant 
feeding as plain milk. There is no evidence to show that. its 

ligestibility is in any way enhanced by the process of heating, 
but rather to the contmiry.” A question frequently asked of 
the physician is whether all milk should be sterilized before 
using. The milk usually sold in large cities is, as a rule, trans~ 
from considerable distances, and is often not consumed 

from twenty-four to forty-eight hours; it is thus apt, espe- 


a. 


4 CLASSES OF FOODS, 


growing seh 
cially in large cities, toward the establishment of dairies, such as 
the Walker-Gordon Laboratories, from which perfectly pure milk 
may be obtained, thus obviating the Scone eel 


immersion in hot water. During this fermentation the casein 
is partly or completely converted into albumoses. If the 
process is allowed to continue too long, the milk becomes 
bitter. For this reason it is ordinarily removed from the hot 
water after a few minutes, and is placed upon ice, which pre- 
vents further fermentation. In order to predigest milk in 
alkaline solution pancreatin is substituted for pepsin ; pancrea= 
tization of milk ca now largely replaced peptonization. 

order to effect pancreatization of milk Fuirchild’s peptonizing 
tubes are ordinarily employed. These tubes contain five grains 
of pancreatic extract and fifteen grains of sodium bicarbonate. 
Each tube contains sufficient powder to digest one pint of milk. 

Where the taste of pancreatized milk proves objectionable, 
the addition of carbonated waters or of small quantities of 
coffee may render it more palatable. 

‘The digestibility of milk may be increased by the addition 
of hot or cold water, carbonated waters, such as Vichy or 
Apollinaris, lime-water, oatmeal-or barley-water, or farinuceous 
foods, such as arrow-root or flour; occasionally small quantities 
of salt or sodium bicarbonate are ‘helpful. 

Humanized Milk.—Ry the term “humanized milk” is 
meant cows’ milk that has been so modified as to approach 
human milk as nearly as possible. This is accomplished by 
decreasing the casein and increasing the fats and sugars. The 
milk is areal 7 redigested and Pasteurized. The following 
directions of Teds for the preparation of humanized milk are 
given by Fairchild : 


“Quehalf pint of pare cold water. 
measure powder. 
‘One-half pint ore sold aie 

Four tablespoonfuls of sweet fresh cream, 


ANIMAL FOODS. 75 


“First dissolve the powder in the water by rubbing and 
stirring with a spoon, then add the milk and cream ; mix well ; 
heat in a in with constant stirring until, blood-warm— 
not too hot to be agreeably borne by the mouth; at about 
this temperature for ten minutes; then bring quickly to boil- 
Serct pour at once into a clean bottle, shake thoroughly, 

tightly, and place directly on ice or in a very cold 

“When a feeding is required, apd the portion and warm 
it to the temperature, lukewarm; always shake the 
bottle ly before and after pouring out a feeding.” 

Condensed Milk.—Condensed mille is manufactured by 
Spica ts. Ws ted begay song. the poor dass By 

j t is i ly among the poorer al for 
infant fading. Although they aj to fatten and thrive on 
it, infants fed on this form of mill are often poorly developed 
ae rachitic. The two are ni heaps” anil 

ror comparatively little sugar to whi 
cane-sugar has added, The first contains from 15 
to 18 per cent. of sail angers the latter, from 15 to 18 per 
cent, of milk-sugur and from 36 to 40 per cent. of cane- 

Condensed milk is most easily digested, but is apt to contain 
foo little fat; the unsweetened condensed milks are the most 
satisfactory forms for infant feeding. Condensed milk is to 
be used only when fresh milk is not obtainable, or temporarily 
when modified or humanized milk is not well borne. The 
ee ition of unsweetened and sweetened condensed 
milk is as follows: 

Set. re ME Oe 
Percent, Percent. Per cent. Per cent. Per cent. 


Unsweetened condensed milk. . 40 12 12 16 0 
Sweetened condensed milk. . . 80 12 12 16 40 


For use in infant feeding condensed milk should be diluted 
with water at least equal in amount to that which has been 
evaporated ; this is usually twice its volume. Fora child ten 
months old Starr advises that condensed milk be diluted ten 
times, ft Infant Feeding.) ‘There ure many objectionable 
forms of condensed milk on the market some of which are 
manufactured from skimmed milk. Among the best brands 
of condensed milk may be mentioned Borden’s Eagle Brand 
Condensed Milk, Anglo-Swiss Brand, and the Ideal, 


76 CLASSES OF FOODS. 


EGGS. 
Eggs, like milk, form a complete food—that is, they contain 
a proportion of exch of the fundamental food elements neces- 
sary for the preservation of life. Eggs and milk are the only 
con Bodpreducte furnished by the animal kingdom. 
eggs of the hen are consumed in largest numbers, but 
those of the duck, turkey, guinea-hen, and of some wild fowl 
are also eaten. The eggs of domestic fowls vary in size and 
appearance, but their composition is about the same. 
The shell of a hen’s egg constitutes 11 parts, the white 57 
, and the yolk 32 parts of the entire weight of the egg. 
following table, taken from Langworthy,' shows the com- 
position of bens’ eggs, cooked and raw ; of white-shelled and 
of brown-shelled eggs; and of the yolk and white of the egg 
of the duck, goose, turkey, and guinea-fowl ; 


Average Composition of Eggs. 



































rel fee ah 2 
g)a]2 c 38 
2 4 & 
fol A Wa fo 1 se ih 
Hen: Per ct, | Peret.| Per ct. | Peret, | Per ct.| Por et, |Calories, 
Whole aa poranee ue Lei 19 9.30 on 0.9 685 
Whole egg.edlvleporion| - + | 737 | ae | rot | 22 | 10 | ao 
errs ae 26.2 128 0.20 o- 08 0 
* * 49.6 M7 | 98.90 ae Mw 1705 
- Ba Ww. 12.00 Oe 705 
7 Oe 8 10,80, oe O68 om 
HOD ce ee 109 Os ng 11.00 o7 605 
Whole ege aa purchased.| 1.7 | 608 | 191 | 19.80 os | 760 
Whole egg, edibie portion |. | 7.5 | 133 | 1430 10 | 80 
White gts zo | wi | oe oa | 30 
You lL SLL] fs | aos | 368 | 9620 x2 | 1840 
Peasecmmvers| “| er] at ]ue)-: | | 
1 Se Serpent 863 | 115 |, O02 Os | 25 
Che 441 | 37a [3020 1a | 1880 
5 122 970 on 08 685, 
a | wa | us| i: | o9 | m0 
gor | 315 | 00s | 22 | oa | 6 
f Si] 488 | 474 | azo | 23) 12 | amo 
Guinea-fow! 
Wholeese mapurchued.| 169 | gs | 19 | 90 | .. | oa) go 
Wholecgrediuieporion| “| ws | ies | yam] >: | a9 | gs 
Whlte roses ess | os | eae | 16 | Ons os | 25 
Yolk ee 407 167 | S180 2 1655 








As may be seen from the foregoing table, the egg contains 
mainly protein and fats, in addition to water and mineral 
matter. The white and the yolk differ in composition, the 

1 Farmer’ Bulletin No. 128, United States Department of Agriculture. 





ANIMAL FOODS, 7 


white containing less protein and water than the yolk, and 
any fat and ash, whereas the yolk contains considerable 
fat and ash, The white is said to be pure protein ; it is com- 
mainly of four albumins and a slight amount of carbo- 
The albumins are ovalbumin, conalbumin, ovomucin, 
and ovomucoid, the ovalbumin being the main constituent. 
‘The yolk of the egg is very complex in composition, and con- 
tains 15 per cent. of protein (vitellin), 20 per cent. of palmi- 
tin, olein, and stearin (the fatty elements), and 0.5 per cent. 
of tter, besides lecithin, nuclein, salts of iron, cal- 
cium, potassium, aud magnesium ; the total phosphorus equiva- 
lent in the yolk is slightly over 1 per cent, while that of the 
white is but 0.03 per cent. The shell of the hen’s ogg has no 
food-value ; it consista mainly of mineral matter containing 94 
per cent. of calcium carbonate. 

The flavor of the egg is dependent in large measure upon the 
food eaten by the laying hen. Fresh eggs have the finest flavor. 
Langworthy ' gives the following methods for testing the fresh- 
ness of eggs: “*Candling,’ as it is called, is one of the methods 
most commonly followed. The eggs are held up in # suitable 
device against a light. The fresh egg appears unclouded and 
almost translucent; if incubation has begun, a dark spot is visi- 
ble, which increases in size according to the length of time ineu- 
bation has continued. A rotten egg appears dark colored. The 
age of eggs may be approximately judged by taking advantage 
of the fact that as they grow old their density decreases through 
evaporation of moisture.” According to Siebel, a new-laid 
egg placed in a vessel of brine made in the proportion of two 
ounces of salt to one pint of water will at once sink to the 
bottom. An egg one day old will sink below the surface, but 
not to the bottom, while one three days old will swim about just 
immersed in the liquid, If more than three days old, the egg 
will float on the surface, the amount of shell exposed increas~ 
ing with age. If the is two weeks old, only a little of the 
shell will dip in the li id, Penzoldt * gives the following table 
showing the digestibility of eggs : 

‘2eoft-boiled eggs leave the stomach in 1 hours. 
inw Teave the stomach in 2} hours. 


2 and 5 grams of butter leave the stomach in 2} hours 
2 fard-boiled cers eave the somach in $ hours 
egg omelet leaves the vtomach in 3 hours 





} Farmery Bulletin No, 128. 
? Hutchison, Food and Dietetics, p. 152. 


Ms 2 


78 CLASSES OF FOODS. 


‘The fact that raw eggs remain in the stomach longer than 
apft-boiled eggs is due to the fact that they are so bland that 
they excite neither the motor nor the secretory function ; if 
thoroughly masticated, hard-boiled eggs are as digestible as 
soft-boiled ones, With some persons eggs in any form are 
fralguiitle, and produce unpleasant eructations, nausea, and 

e, 


Raw eggs are best taken directly from the shell, or they 
may be combined with milk broths or with coffee. In various 
diseuses accompanied by loss of flesh and strength raw eggs in 
large numbers are prescribed, as many as 24 eggs being given 
in twenty-four hours. 

Egg-albumin is best absorbed when eaten raw and prop- 
erly diluted. Tts palatability may be increased by flavoring it 
with sherry wine, orange, lemon, or grape juice, or by serving 
it in cream, cocoa, or coffee. 

Egg-nog is prepared from milk and eggs, flavored with 
some alcoholic drink, and sweetened with sugar. 

When allowed to remain in the air, = decompose from 
the entrance of germs through their 1. Decomposition 
may be prevented in various ways, such as by coating them 
with oil or varnish, packing them in sawdust, or placing them 
in cold storage or in certain solutions, such as salicylic acid 
and glycerin. 


MEATS AND THE MEAT PREPARATIONS, 


Meat forms the fleshy or muscular ie of the body. It is 
one of the most important articles of food, and is the chief 
source of man’s protein supply, Meat may be eaten raw 
or cooked. Raw meat, when well ground, is very easily 
digested. 

Meat is composed of musele-fibers held together by conuec- 
tive-tissue bands; between the musele-fibers are bits of fut. 
As ordinarily seen, meat contains muscle tissue, connective 
tissues, blood-vessels, nerves, and lymphatics, together with a 
varying amount of fat. The more fut there is in meat, the less 
water and nitrogenous matter does it contain, and vice vered, 
Cooking has the effect of rendering the connective tissues solu- 
ble, thereby causing a separation of the muscular fibers, allow- 
ing the digestive secretion to mingle more thoroughly with 
them. Cooking also enhances the flavor and appearance of the 


1 Ely, “Fable of Egg,” New York Med. Jour., November 14, 18. 


ANIMAL FOODS. 79 


but, on the other hand, canses a loss in fat and extrao- 
likewise de 8 the micro-organisms that 
in the meat, thus renders it more whole- 


may be cooked in various ways—it may be boiled, 
roasted, or fried. Meat is boiled by placing it in cold 
and subjecting it toa moderate heat for some time. In 
@ connective tissue becomes gelatinized, and a por- 
pepaats salts, albumin, and extractives is dissolved. 
nger the process is allowed to continue, the more taste- 
the meat become and the richer is the broth. This 
mass of meat has a high nutritive value, and, com- 
with the broth, constitutes a nutritious food. The 
saline stewing meat is Masia mas by placing the meat 
a wae, yen of wi the albumin on the surface 
uickly coagulated, thus preventing the juice from escaping 
2 50 aati the flavoring matter; the broth that is pro- 
cured in this way is very poor in quality. Meat is roasted by 
placing it in a very hot oven, the superficial layers thus be- 
coming immediately coagulated, and so preventing escape of 
the juice. To broil meat, emall bits are cooked over an open 
fire, the albumin of the surface being thus not only coagulated, 
but the inner fibers being cooked at the same time. Frying 
is accomplished by placing the meat in boiling oil ; the surface 
albumin is at once coagulated, the juice is prevented from 
escaping, and the meat is rapidly cooked, 

Digestibility of Meats—-The digestibility of meats is 
governed by many conditions: The age at which the animals 
eaten were killed, the length of time the meat is kept before 
eee the care bestowed upon the animals during life, and the 

methods of preparing the meats for the table. Meats are most 

digested when stewed ; frying renders them most indi- 

wo The flavor of meat varies with the condition of the 
animal from which it was obtained, The meat of matare ani- 
mals is more pronounced and agreeable in flavor than that of 


tint ie | 
et 


int 


cattle. 
The following table, taken from Penzoldt, gives the relative 
of meat foods : 
One to two hours : Two to three hours: 
200 beef juice, 250 gm. calf’s brain boiled. 
a 250 peg Sweethrend boiled. 


‘Three to four houre = Four to five hours: 
230 gn, stewed young chicken, 210 gm. roust 
230 gm. broiled partridge. fm. roast Allee” 
240 gm. stewed pigeon. 350 gm. beefsteak grilled. 
195 em. roast pigeon. 250 gm. smoked tongue. 
250 gm. beef (raw or boiled). 250 gm. hare, 
250 gm. calf’s foot, boiled. 240 gm. roast partridge, 
160 gm. ham boiled. 250 gm. rost gone. 
100 gm. roast veal, 280 gm. ronst duck. 
100 gm. beefoteak. 
100 gm. becfsteak pulp. 
100 gm. roust 


Beef,—The composition of beef varies greatly, especially in 
regard to the amount of fat and water it contains. An ox from 
three to five years old supplies the best beef. The meat of a 
very lean animal will contain about 75 per cent. of water and 
about 2 per cent, of fat. The water in fat meat is reduced to 
between 50 and 55 per cent., while the fat reaches 2.5 per cent. 
or over, The amount of nitrogenous substances is also con- 
siderably reduced in fat meat. Beef-fat is composed of the 
glycerids of the fatty acids, the ratio being three parts of stearic 
and palmitic acids to one part of oleic acid. 

Meat Preparations.—Numerous meat preparations, both 
solid and liquid, are now on the market, the aim being to pro- 
duce a concentrated food that will be readily clgedets The 
different beef-juices have but slight nutritive value, most of 
them containing only 4 or 5 per cent. of protein; their chief 
value lies in the fact that they stimulate the appetite. 

Bouillons.—Bouillons are iy by cutting meat into 
small bits, heating slowly in water for a time, and then boiling 
it quickly. The fluid thus produced has a very agrecablo flavor, 
but its nutrient value is exceedingly small, as it contains only 
extractives, salts, and a very minute quantity of gelatin. Bouil- 
lons increase the flow of the digestive secretions, and can be 
rendered more nutritious by the addition of an egg, certain 
cereals, or vegetables. 

Beef-extracts.—Beet-extracts are concentrated bouillons 
that are to be diluted at the time they are taken. Their nutri- 
tive value is about the same as that of bouillon. 

Beef-juice.—To produce a nutritious liquid beef prepara- 
tion the meat should be boiled slightly and then cnt into small 

jieces and pressed throngh a Jemon-squeezer or a meat-press. 
as this way considerable quantities of protein, in addition to 
the salts and extractives, are obtained. The beef-juices sold on 
the market, such as Valentine’s, are prepared by subjecting the 


ANIMAL FOODS. 81 


mi ‘These preparations contain from 5 
to 10 per cent. of protein. 

Meat Powders.—The nutritive value of these preparations 
varies greatly. Those most frequently used are a number of 
Bogie, Somatose, and the Mosquera “ Beef Meal.” 

it-jellies.—Meat-jellies are frequently given to invalids, 
and are an agreeable means of administering protein 
Although they do not entirely replace the protein in the tissues, 
they produce a considerable oun of energy. According to 
Bauer, “By the addition of gelatin very large quantities of 
albumin can be spared in the body or devoted to increase of 
bulk, just as by the supply of fats ia carbohydrates.” Meat~ 
jelly is, therefore, a protein-sparer. Among those most com- 
eer employed are calf’s-foot and calf’s-head jelly. 
follows ing table, taken from Chittenden,’ gives the per- 














. iaetes oa of beef-products : 
Percentage Composition of Beef-products (Analyzed, 1891). 
———— ~ : 
rity Gee 
sy | 3, 3.13 E 
Beal ta Dl 
Ee |ala |e f 
105 | ost | 67.88 | 61.0 | 85.80 0am “968 
| Bias Ral | That |B | Bed 
4B) uB ie tl ig Re) 48 te 
eal aa| aa] ia] ag] eae 
REE be 
5) 268) 3 br Fe] oe oD oa 
0.68) 0.55) O47 | 13.98) 14.29 
Sa Sp SAE ta 1 
So eee 0.68) 0.00| O47 | 15.98 | 14.29) 912) 27.01) 77.8 
‘ite vale soup 
(EE peels | eso| 6] 200] 240 | ran | n00| 47.20 | 148.0) 400.00 























An examination into the chemic composition of beef prey 
(Sang Ameria Ay Scere , Brahaeest 
‘hysiologie Chemistry in the Baltimore Medical College, 
and his assistant, Dr. C. A. Clapp. A report of these valuable 
analyses in advance of their publication has been furnished the 
authors by Professor Whitney : 


iecieememenee = mock County Medical Society, 1891, p. 150. 


bw 











CLASSES OF FOODS. 











sonny, | + sasoumaye Kampuooos yo uaSarytyy 
souny, | * *vosoumngye Kewunad yo uaoaytyy 
698'T | + * aaroad ayquynstuos yo uadosy yy 














MOPED ic = Aten ares o ke ToHoOLy 
PRES 0 SS See a aia wy 
1a) Riis ama i Raa spros POL, 
yan aay 
ouynpaog, “PHL LeveL, 














= 


ANIMAL FOODS, 83 
Veal.—Veal is tough and i ible, especially when ob- 
tained from animals that are too young. It tehed 


Epes i Saver fom boc and sortcan nat 
the latter. ‘As in many persons veal hus a tendency to rea 
gy a ee areidet dal ee eee bility. 
Mutton ms es mie can te 
English writers, use in a average 
re ss wee tae tt hasicel ts he Ve aes 
the beef, however, is inferior to that raised in this country. Its 
ue finer, but it contains more fat than does beef. Mutton 
contains a larger proportion of glycerids of stearic 
which mas move SO aed To get han thet 


Lamb.—Lamb, when of the right age and tenderness, is as 
seeitle as beef or mutton, but it contains entirely too much 


. wenn iy heeeety wal Sechelt voce a 
is vi an jort-f venison is to 
be imate 3 jon. On account of its stimulati ae 
it should be avoided by dyspeptics and others with weak 


Pork.—Pork is the most indigestible of all meats on ac- 
count of the large tage of fat that it contains. This fat 
consists chiefly of a de gives of mitic and oleic acids, and 
may be present in the proportion of 37 per cent. or more, 

Ham and aad Bacon.—Haun stl bacon ary both more 
pe tea park. Tn some parts of Germany ham pis ron 

t part in invalid dietaries, but in Englan 
ft seldom prescribed, Bacon is used largely as an army 
ration. When cooked crisp, thin slices of bacon are easily 


Horse Meat.—Horse meat is not used for food in the 
United States or in England, but is consumed in large quanti- 
ties in France and Germany, and to a less extent in some other 


countries. 
abate Whe ‘oung, rabbit meat is quite digestible, bat 
it is ee necally omitted lists. 

Fowl.—Chicken is one of the most digestible and agree- 
able varieties of meats. The meat of young pigeons also is 
cpa digestible; that of ducks and geese contains too 


aris uk of quate & caily digeta, the meat of the breast 
being best adapted for invalid use. 


A 








84 CLASSES OF FOODS, 


The following table, taken from Atwater,' gives the general 
composition of the various meats > 


































‘Food-materials (as pur Pro- Cpe: vole 

\ chased). \Refuse.| Water. tein. | Pat aks. Ash. ate, 

Dee, Oalor- 

is a 

ta Hid 

i @ 

0] ite 

OT wo 80) 

0 10 

# alg 

a 0. 105 

4 | Be 

See 

i] @ |) 

| 74h 

3) Belem 

. Or id 

ri 08 I 

it | 8 |B 

r2 | or | 

. or 1210 

. os 0% 

“ oo Lo 

oe 08 130 

ne. Re 1M 

co] th | Me 

ae) ag] Bt] cs | | 

1 2 . a9 & 
vA 62.2 . an 

55.2 19.7 a8 us 
8 “2 22 
m2 18.6 a 

ee) | atl | | 

wo 43 iu 3 
WO Li 1 

aT 14 Or = 
cies 123 : 07 

88.5 ws OF um 

aA A an OB 108) 

















' Principles of Nutrition, United States Department of Agriculture, p. 16, 


ing table, compiled fe Hutchison,’ gives the 


composition of animal viscera : 











The different kinds of fish vary widely in their nutritive and 
digestive qualities. For example, the flounder and the oyster 
are much casier of digestion than those that contain a la: 
amount of fit, like the salmon and the herring. Eels contain 
the greatest rtion of fat, which may reach 28 cent, 
Whitefleshed feh, as a rule, contains little fat. RS 

All fish are best in season ; ont of season they lose flavor 
and have a diminished nutritive value, and in some cases de- 
velop an offensive odor. These changes are due chiefly to the 
in food. Fish are in best condition just before spawn- 
ings after this process they become thin and unfit for food. 

flavor of some varieties, such as the ray and the turbot, is 
improved by keeping. 

On account of the rapid changes they pcan way of 
decomposition, fish should always be eaten in as a condi- 

1 Food and Principles of Dietetics, p79. 


i 


86 CLASSES OF FOODS. 


that may be present in fish are destroyed during the cooking. 
Ptomain-poisoning is of rather rare occurrence. 

‘The following table, taken from Langwortby,' gives the com- 
position of the fish most commonly eaten: 















la 

i 

gf 32 

‘Preah [Per ct Per ot| 
Alowifs, whole. on | 190 
ber ~~ arararae oe | 144 
eo os Lay 
by on | 185 





Seebesreaeeesereaueas 3 3 2 aff |"Vsryatte 



































‘Bagg, genall-coo 
aes rT 
‘nea, dremed 
Se ee ors 06 
ari a 
1 dreraod os 
eae Hf 
h, 06 
09 
08 
10 
os 
og 
6 
05 
08 
08 
or) 
08 
/ dreased 1 
Mackorel, Spanish, di 
‘Mackerel; Spanish) whole , 10 315 
‘Mullet, divased 06 4 
whole 2 
Porch. white, dressed ‘25 
Perch; white, whol 1 
Boren, yellow. d 365 
ickerel, dressed 20 
1, whole 100 
Pike, : 30 
Pike, whole . | 210 
Pollock, dressed a6 
1 Fish as Food, partment of 


Agriculture, 1898, p. 12. 






ANIMAL FOODS. 87 






Biall ila 
el 
Mert Por Per 
+ | m5) 102) 45. 
ti | see] se] ae 
ti) me) aa] a 
wo) ea! 02 
43) 96) 06 
wa | 365 | 33 
12) 145 
Wa 

92 

ma 

100 

64 

a 

a 


ebek 





SEsee 
2 sk © BEcbRReEEeeececess: 


ee & Esecteeeseece: Senceeeee J | 


ge § wuuRegeusnaruaneaieaues!y 


E62 & BREESRESSRESEESE: 


“1 


bt 
































and the lobster are especially apt to bring on nausea, vomiting, 
and other and more distressing conditions. 

ES) sters, clams, and mussels are the forms of 
shellfish chiefly eaten. Oysters, when eaten fresh and mw, 
constitute the most digestible animal food, but when cooked, 
their digestive value is much lowered. The soft part is propor~ 
tionately larger and more nutritious than the corresponding 
portion of the clam. The hard or muscular portion is tough 


CLASSES OF FOODS, 


rather in le, aud is best omitted from invalid dicta- 
never be fried for the sick. atening” 
call attention to the practice of 
3 this is done by placing them in 
a definite length of time, which 
p appearance. If the water a 
contamination is sure to follow. 


feet 
fel 
i tH me 
fais 

ik 

ae 


ee has in ecg following Ry of the average com- 
position of mollusks, crustaceans, ete. : 


Comporition of Molluske, Crustaceans, eto, 

















i il 

Kind of food-material, J : By t = i 
s 2|§ g z EG 3h 

a\e és" |a é 
omtonadtine......Juc|--|aa] Sle |e | ae 
wns, in ahvell a28 154] 11] G2 | 06 | o4 | 29] 40 
eanned 73 a58| 74| 21 | 39 | 28 | 247 | 800 

5 808 | 147] 02 | 34 | 14 | 197 | Be 
asa | aa] co | xi | 35 | ‘so | aa 

BS) 90) 18 | 29 | 28 | 165 | 276 

808 | 106) 11 | 61 | 28 | wa! 360 

ga) a1| 01 | 13 | 09 | 4a] “6s 

‘BAO | 104) 08 | 80 | 28 | 17.0] oa 

7) 44) 05 | 2a | 10 50 | 100 

MO) 32) o4 | 13 | OF 38 | 100 

Bt) 55) OT). | 06 6.8 | 130 

728 | 181) 11 | 08 | 24 | aha | 806 

100) 20/ 01 | Ot | O1 28) 4 

B41) 7.8) OO | OF | 24 | aha | 285 

840) 158) 15 | 08 | 19 | 200) 870 

8 | 4) 10 | O92 | 26 om 

m9) 48) 04 |) 02 | 05 | BA) 100 

6) 46 7 oz Ba) us 

Wr) 46) O8 Os | 49) 0 

Wa) 42) 07 o2 5.1 | 105 

‘570 | 102 a 07 | 11.0) 210 

425 | 100) 25 | G1 | ao | a8 | 208 





























1 Fish Farmers’ Bulletin No. 86, United Stat ent of 
noe ak io. ites Departm Agri- 





VEGETABLE FOODS, 89 


VEGETABLE FOODS. 
Vegetable foods differ from animal foods especially in that 
Sipeetaisin a Jargn gropoction of stanly eri ieogareedienes 








Fat beef 
Lean beef . 
Pea-flour 
Wheat . 
Rice. . 


i 


do, however, contain a certain amount of proteins 
oe aoe Bea in fats, 
hydrates of Vegetab! -These are starches and 


means of dry heat or by cooking. The starch- 
vegetables are 


g 
er 


i 


a 
can not be digested, and hinders 
enveloped by it. Besides the starch and cellulose, 


it 
i 
& 
i 
4 
£ 
= 


i 


description of sugars.) 

Protein in Vegetables.—These proteins belong mainly 
to the globulins, but in addition vegetables contain a large 
number of nitrogenous substances that are not proteins. Among 
the various proteins in vegetables are gluten, as found especially 
in flour, legumen found in the legumes, and vegetable protein 
eG ange juices. 

ves in Vegetables.—There is a considerable 
amount of extractive matter in certain vegetables, such as 
asparagus, which is not utilized in the body. 
1 Foad in Health and Disease, p. €8. 





90 CLASSES OF FOODS, 


Fats in Vegetables.—The fats in vegetables are chiefly 
in the form of oils. In addition, vegetables contain a consider- 
able amount of water and salt. The amount of water varies 
between 70 and 90 cent. The main mineral constituents 
are the salts of and sodium united with organic acids. 

Digestibility of Vegetables.—The digestion of vege- 
tables takes place mainly in the intestine, Owing to the 
greater bulk of ible food and to the cellulose that sur- 
rounds vegetable and thus prevents the ready access of the 
digestive juices, vegetable food is not so easily digested as animal 
food. (For an account of the absorbability of vegetable foods the 
reader is referred to p. 45.) For convenience of description 
the following classification of vegetable foods has been adopted : 


1. Cereals. 5. Fruits. 
2. Legumes. 6. Nuts. 
8. Roots and tubers, 7. Fungi. 
4. Green vegetables, 8. Lichens. 
CEREALS, 


Cereals are the most jeapgciaat food-products derived from 
the vegetable kingdom. Of this class of foods those in com- 
monest use are wheat, corn, rye, oats, barley, rice, and buck- 
wheat, The cereals are eaten chiefly after having been ground 
into flour or meal. Flour is most commonly made from wheat 
and rye, whereas corn and oats are the chief sources of meal. 
Corn is also eaten in large quantities whole, and barley and rice 
are also eaten in this way. The following table! gives the 
chemic composition of the most common cereals : 





Carbohydrates. 
Water. | Protein.| Fat. | “Steen, | crude | 2a 
etc. "| aber. 











Per cont.| Per cent,| Per cent.| Per cent.| Per cent. | Per cont, 











124 | 18 | 698 7 | Be 

100 | 22 | 645 7 | 20 

99 28 749 A 16 

66 | 38 | 695 1 | 23 

us 5.0 50.7 5 30 

74 | 04 | 792 2 | O04 

3 10.6 | 17 | 720 7 | 1 
it: 

varieties . .| 104 | 125 22 72 LS 19 

inter varioties. .| 10.5 | 118 | 21 | 720 8 | 18 

1 United States Department of Agriculture, Office of iment Station, 


Bulletin No. 11, pp. 16 and 17, and Bulletin No. 28 (Revised Edition), p. 56, 


all 


VEGETABLE FOODS. 91 


Wheat is the most important source of flour, to the 
fact that it can be mised in any temperate climate i 
the best flour at the least expense. It is rich in solids and con- 
tains little water. The wheat-grain is covered by six layers, 
which form the bran. Of these six, tho three outermost coats 
form the skin, and the remaining three layers the envelop of 
the grain. The outermost layer is called the testa; the inner- 
most, or cereal layer, takes its name from the cerealin which it 

‘ contains. Within the corealin layer, and adjacent to the embryo, 
lies the endosperm, which contains the starch, The embryo 
lies at the lower end of the grain, The five outer layers are 
ped chiefly of cellulose, The cereal layer is the richest 
in nitrogenous substances. The endosperm contains a large 
amount of starch, a Sep pate substance called gluten, some 
sugar, and the cellulose of its cell-wall. 

Flour is made by grinding the grain of the various cereals. 
Although flour is shige chiefly from wheat and rye; barley, oats, 
maize, etc., are also manufactured into flour. 

Bread is made by adding to flour a definite proportion of 
water, a little salt, and the leavening agent. The mixture or 
dongh is then kneaded, either with the hands or, better, with a 
spoon. In the large modern bakeries the kneading is done en- 
tirely by machinery. After this the dough is set aside fora 
number of hours, during which time fermentation takes 
Tt is then molded into loaves and baked. The leavening is 
dependent upon the action of the yeast on the starch, some of 
which it converts into sugar, and then into alcohol and carbon 
dioxid gas. The gas causes bubbles to throughout the 
dough, and renders it light and spongy. ring the baking 
process the yeast germs are killed and the aloohol and carbonic 
acid gas are driven off. Hot or fresh bread, when masticated, 

. forms a tenacious, doughy mass, and hence is not so digestible 
as stale bread, or bread that has been allowed to dry slightly, 
for the latter will crumble into fine particles and so is more 
thoroughly mixed with the gastric juice. Tonsting bread makes 
it more digestible. A slice of bread remains in the stomach 
about two and one-half hours. 

Next to wheat bread, which thus far has alone been men- 
tioned, rye bread is the most important of the breadstuffs. 
While it is not so digestible for invalids as wheat bread, it is 
more laxative and keeps fresh longer than wheat bread. Wheat 

* and rye flour are often mixed in bread-making. 
Pumpernickel is a whole-rye bread made by the Germans 


92 CLASSES OF FOODS, 


Tt is slightly laxative, Gluten bread is made from gluten flour, 
an pgp ly ran aties: i sg Desi hae bomicleny sia from 
40 to 50 per cent. of gluten, Biscuits, pastries, uddings 
are made by adding to the flour varying quantities of eggs, 
= milk, butter, fruit, flavoring extracts, etc. They vary 

idely in richness and digestibility, and are to be avoided by 
persons with weak digestion, 

Buckwheat flour is often made into batter-cakes in the 
United States, but in some parts of Russia buckwheat porridge 
forms the principal cereal food. Bread made from buckwheat 
crumbles and does not keep well, 

Millet is largely used in India, China, and Russia. 

Sorghum is occasionally made into bread, but in America 
it is grown usually for the molasses and syrup that may be 
obtained from it. 

Rice constitutes the staple food of many of the peoples of 
the Orient. It is grown chiefly in Asia, but is also raised in 
some parts of Europe. In the United States rice culture is 
confined chiefly to South Carolina. Rice contains a large pro- 
portion of starch in very digestible form, but it is comparatively 

in other constituents. 

Barley bread was used for food by the early Greeks and 
Romans, who also used barley meal to a large extent in the 
training of their athletes. Since the introduction of potatoes as 
food, and with the ee wheat flour, barley bread has 
gana fallen into disuse, Barley-water is used as a beverage 

invalids and infants. 

Oats contain liberal proportions of fat, pron, and salts, a 
large amount of starch, and considerable indigestible cellulose. 

Oatmeal is used to the best advantage in making porridge ; 
owing to its lack of gluten it makes only the poorest kind of 
bread. What is known as Scotch groats is prepared by freeing 
the grin from its outer husk. Oatmeal porridge is said to act 
as a mild laxative in some persons, and to excite dyspeptic 
symptoms in others, 


Of the legumes, the pea and the bean are the most important 
food-products. In the middle and northern parts of Europe 
the pea is the most popular legume, while in the Mediterranean 
countries the bean predominates. In America peas and beans 
are extensively mised. The peanut is an American favorite, 
but the lentil is eaten only to a very small extent. 


VEGETABLE FOODS, 93 


The | contain a liberal of protein (legu- 
Rasy ectotgdeene, and utinae pt ming igcolll 
water. Although legumes contain a proportion of protein in 
excess of that of meat, a large amount of fat, and considerable 
starch, they are less easily digested than animal foods, As 
pointed out by Abel,! this is due to three reasons : 

a generally prepared and used, the nutrients of vege- 

are inclosed in cells composed of cellulose or wood! 
fiber, which is more or leas hard and greatly interferes with 
their absorption, 

IAs Space food is prone to fermentation in the intes- 
tine, thus increasing the peristaltic movements, and, if large 
amounts are eaten, hastening the food onward before there has 
been sufficient time for the absorption of its contained nutrients, 

*(3) The cellulose present acts as a local irritant and pro 
duces the same effect.” adaoil ee 

Legumes are apt to luce fermentation, and in this wa: 
occasion flatulence and gastro-intestinal distress. The dij i 
bility of the legames depends largely upon the manner in which 
they are A se i and the amount that is eaten, A large ee 
tion of the legumes ordinarily eaten is imperfectly absorbed by 
the intestine. Striimpell? hus shown that about 40 per cent. 
of the contained protein in cooked beans is left unabsorbed, the 
beans being eaten with the skins; and that with a flour made 
from lentils only 8.2 per cent. of the original amount of protein 
is left unabsorbed; so that when eaten simply cooked, a much 
larger proportion remains unabsorbed than when finely divided 
into a powder. 

Beans form one of the oldest forms of vegetable foods, hav- 
ing been cultivated by the ancient Greeks, Romans, and Egyp- 
tians, The numerous varieties used for food have all been im- 

by cultural methods, The Windsor bean, the one which 
was first cultivated, is still grown in Europe, but does not thrive 
well in America. The kidney bean, the most important species, 
is easily cultivated, growing rapidly and seeding early. The 
Lima bean is a great favorite, especially in America. It is a 
short flat bean, somewhat like the kidney in shape, This variety 
is a climber, although bush Limas have been developed by cul- 
tural methods, 

‘There are several varieties of peas, the most important being 
the field and the garden pea. The former is generally used for 

+ Farmery’ Balletin No. 121, United States Department of Agriculture, 1900, 


18, 
Ps Suriimpell, Deatech. Arch. f. Kin. Med., vol. xvii, ps 108. 





04 CLASSES OF FOODS. 


fodder ; but one variety, the Canadian field pea, is grown for 

table use. There are many varieties of the gurden pea, The 

shelling peas, the kind in most common use in America, and the 
pea are the most important varieties. 

‘he lentil, as has been stated, is but little used in the 
United States. The chief supply of lentils comes from Egypt, 
very few being grown in Europe. They form a highly nutritious 
food, but the flavor is disagreeable to many persons, and they 
are suid to produce indigestion in some instances, | 

The peanut, although peculiar in its growth, is a legume 
as well as the pea and bean. It differs chemically from the 
other legumes in that it contains a large amount of fat, 


Comporition of Fresh and Dried Legumer compared with that of other 
































Foods,—( Abel?) 
i | 33 if 
; = £ 
2) 4] 4/8 
Pov ct, | Peret. Per ot.| Per et, | Calories, 
28 08 ™ 08 18 
4h 06 Bo 12 265 
a4 Ot 17 or 3) 
a4 0.6 Da 20 40 
mW Or mo wy 70 
70 06 169 10 405 
a 0.6 27 4 0 
ll ol 38 13 & 
B) 8) 8] B 
m0 02 aS 16 2 
3B) ge) ae) ae 
69 15 6 a1 0 
23 | 405 | ar. | bo | ome 
18a 16) OD a 1625 
25 18 | 6 BS 1605, 
So] ge) ae) ee 
7 0 | #2 67 160 
oy] up| me) oe] ie 
4 | 8 uM 1500, 
Mo 168 33.7 a7 1970 
wa | 67 | ess | 28 | 1690 
me me Me 20 660 
50 13 | HB 25 1565, 
| | Bt) | as 
16 Os 66 10 a 
00 oO 10 06 106, 
‘7 mw 2 a 1850, 
w1 ped D2 18 1700, 
nz uo) MS Oo 1680, 
107 10 Ds 06 1650 
218 ced ae Ll 7 
9.0 65 04 $3 0 
33 44 40 7 Sah 
oa 7 uu a 9150 
on 148 105 ~y" w 77 
@ European analysia, 


1 Farmer Bulletin No. 121, United States Department of Agriculture 1900, 


Pp 


= 


VEGETABLE FOODS. 95 


ROOTS AND TUBERS. 

Roots and tubers constitute another class of le foods: 
that are of great importance. They contain starch and 
sugar, and to these constituents is due their chief value as a 
food. On account of the small proportion of protein and the 
large amount of water they contain, they are inferior in nutri- 
tive value to both legumes and cereals, 

The potato is, for several reasons, the most important 
member of the group. It is a tuber or thickened under- 
ground stem of Solanum tuberosum, It grows equally well in 
a variety of soils, and when properly cooked is easily digested. 
‘When cooked in water, the salts pass into the water, but 
when cooked in their skins this loss is largely prevented. By 
baking or roasting the salts are best retained and the potato 
rendered most easily digestible. 

‘The sweet potato contains more water and but less 
starch than the white potato. When boiled, it ly becomes 
mealy, but is often converted into a stringy, sodden mass that is 
difficult of digestion, 

The yam is a tuber somewhat resembling the potato. It is 
pee om ee ety in the tropics, but also in some parts 

rope. 
The Jerusalem artichoke is commonly used in 
It is sweet and watery, contains little starch, is only slightly 
nutritive, but quite easily digestible. 

The beet contains a very large percentage of starch and sugar, 
Tt is raised extensively for the sugar industry, and is also largely 
employed for making salads to lend variety to the diet. 

» when young and tender, form a very nutritious 
food, and are greatly relished by many persons. They contain 
from 85 to 90 per cent. of water. 

Parsnips when boiled long enough form a good food; like 
carrots, they contain a large proportion of water and a con- 
siderable amount of sugar. 

Turnips have very slight nutritive value, but are, never- 
theless, very popular as a vegetable. They have a tendency to 
canse flatulence. 

Radishes are used chiefly to give a relish to the food. 
ar conta little starch and 2 large percentage of water. 

following table, taken from Atwater,’ gives the average 
composition of the common roots and tubers : 


* Priney Nutrition and Nutritive Value of Foods, Farmer’ Bulletin, 
No, 142, 1 be a 














- | 8 
iit 


664! 13'| 04 | 108) 11 
6271) 09! 01! 571 06 


. GREEN VEGETABLES. 

The green vegetables are valuable not only on account of the 
amount of nutriment present in them, but for the variety and 

lish they give to the diet. They contain a large amount of 
salts and have valuable antiscorbutic ies, 

Bryant and Milner, in a very careful series of experiments,' 
have arrived at the following conclusions concerning the digesti- 
bility of certain vegetables : 

‘So far as sources of protein or fat are concerned, the vi 
tables (potatoes, cabbage, and beets) included in these studi 
may be considered as of little value. They do, however, con- 
tain carbohydrates which are well digested and absorbed ; and 
they may therefore be considered as of value as sources of 
energy, a large proportion of which appears to be available to 
the body. The chief value of many vegetables, however, is, 
perhaps, aside from the nutriment or energy they furnish ; they 
add a pleasing variety and palatability to the diet, supply 
organic acids and mineral salts, and give the food a bulkiness 
that seems to be of importance in its mechanical action in 
maintaining a healthy activity of the alimentary tract. Pos- 
sibly the result of these conditions is a favorable influence upon 
the digestion of other food eaten with the vegetable.” 

Cabbages contain « considerable quantity of sulphur, and 
on this account are apt to cause flatulence ; where digestion is 
good, however, they are considered a wholesome form of food. 
Sauerkraut is cabbage prepared by placing salt between layers 
of shredded cabbage leaves and then subjecting the mass to 
pressure, This presses out the juice, after which acid fermen- 
tation sets in. Owing to the fermentation it produces sauer- 
kraut is considered indigestible. 

Cauliflower is the most digestible member of the cabbage 
family. It may be eaten either as a salad or boiled and served 
with a milk-sance. 


* American Journal of Physiology, 1903, vol. x., No. 2 p. 81. 








VEGETABLE FOODS. 7 


Spinach is a popular form of vegetable and is used toa 
great extent, ce valuable chiefly for its laxative effect. 

Lettuce is most important representative of a 
of vegetables usually eaten mw. Ith made into ated = 
dressed with vinegar. The various cresses also belong to this 

Sorrel is eaten chiefly in Europe. It has a peculiar acid 
taste, due to acid oxalates, on account of the presence of which 
it is to be avoided by those subject to gout or rheumatism. 

Celery, which is usually eaten raw, is stringy and has 
scarcely any nutritive value. Cooked in milk it forms a whole- 
some and digestible article of food. 

Tomatoes are caten both py and tiga = are tyr 
ing, generally liked, and easily digested. are to 
flavor broths and are valuable for canning purposes, inasmuch 
as they retain their flavor better than most vegetables. 

The eggplant, a close relative of the tomato, is less diges~ 

ible, especially when fried, than the latter. 

Cucumbers are eaten mw, and when young are often 
pickled in vinegar. They are very indi tibie, 

Asparagus is highly esteemed for its delicate flavor. It 
is easily digested, even by invalids. It has a slightly diuretic 
action, and imparts a most offensive odor to the urine, which 

ists for from twelve to twenty-four hours. 

Rhubarb, when thoroughly cooked, is quite digestible and 
Sahel 7 op sed largely in the making of bui 

'p! are u: in the ing of pies, ete., but 
they have no speci foods vali. ered 

Squash, when young, is quite digestible. 

Onions, garlic, etc., are used both as vegetables and as 
condiments. While onions are used largely for flavoring meat- 
stews, salads, and the like, they are also eaten for their mildly 
laxative ties. 

The following table, taken from Hutchison (p. 239), gives 
the composition of the various vegetables : 

7 


98 CLASSES OF FOODS. 





























iH z iq i if i 
Per ct, | Per ct, | Der ct. | Per et,| Per ct. |Caloriea 
1. 58 | 130) 110) 165 
0.60 | 0.10} O4 | O13) 1.30] 1 
2. 40 | 47 | 080 | 1,20) 175 

040 | 38 | 060 | 0.90 | 175 
0. 0.07 | 03 | 0.20) 110) 175 
2.50 | 0.50 1,70 | 0.90 

0.20 | 26 |) 0.50 | 130] 120 
0.09 | 0. 0.2 | 0,05 | 0.37 | 120 
1.50 | 0.10 | 34 | 130 | 0.37 
1.30 | 0.20 | 5.0 | O70 | 1.10) 105 
1.00 | 0.20 | 01 | 0, 1,60 | 105 
8.80 | 0.90 | 8&9 | 350) 1.50 | 275 
1.40 | 040 | 26 | 1,00 | 0.50 | 105 
0.50 | 0.16 | 0.5 | 040 | 0,90 | 105 
1.20 | 0.50 | 58 | 070 | 0.90) 150 
140 | 0.10 | 33 | 090] 0.90] 85 
0.30 | 0.06 | 0.8 | 0.50 | 1.00 85 
2.60 | 0.20 | 7.1 | 160 | 130) 145 
0.70 | 0.70 | 23 | 0.60) 1.10] 105 
1.40 | 0.70) 4.5 | 1,00) 110) 110 
0.70 | 0.50 | 37 | 130) 010) 110 
0.80 | 0.10 | 21 | 040 | 0.50] 70 
0.50 | 0.02 | 0.7 | 0.20 | 0.90] 70 
2.20 | 0.20) 29 | 0.90] 210 | 110 
1.20 | 0.08 | 90 | 030) 220) 110 
1,00 | 0.08 | 3.0 | 080 | 0.60 | 110 
3.30 | 0.70 | 60 | 160 | 1.20} 110 
1.80 | 0.18) 6&8) 070) 1.20] 110 
140 | 0.70 | 29! 1.70 | 0.90 | 110 








Vegetarianism.—It will not be out of place here to point 
out the disadvantages of an exclusive vegetable diet. 
tarians are those who subsist almost entirely upon vegetables, 
cereals, fruits, and nuts ; exceptionally milk and eggs are added 
ee diet-list. rs 
t is quite i y the eating of vegetables alone, to 
Rea constituents—carbohydrates, fats, and pro- 
teids—that are required by the body. Proteins are obtained 
partly from vegetables, milk, and eggs; those derived from 
vegetables, however, are digested with much more difficulty 
and absorbed to a much slighter degroe than those derived 
from animal food. Persons subsisting on a purely vegetable 
diet for any great length of time are apt to lose strength, as 
well as physical and mental yigor and endurance. Laborers 
are unable to perform the same amount of work they could 





FRUITS AND NUTS, 99 


nal disorders, A purely vegetable diet, 


disturbances, particularly in those suffering from gastro-intesti- 
Heer seolsc oneal 
said! to lessen the power of resisting disease.* 


FRUITS. 


Fruits are of little value as nutriments, and are useful 
mainly to give variety to the diet. They are used extensively 
as flavoring agents. The chief nutritive constituent of fruits is 
sugar, and they also contain a small amount of nitrogenous 
matters, cellulose, starches, nic acids, and a vegetable jelly 
ealled pectin, which causes fruit to gelatinize when boiled. 
The sugar present in fruit is mainly fruit-sugar, or levulose, 
but some fruits contain, in addition, considerable 4 
In fruits contain a amount of water, but 

iy salts than other foods, The mineral elements of fruit 

consist of potash, united with tartaric, citric, and malic acid. 

To these salis is due the antiscorbutic property of fruit, In 

addition to this property fruits also act as diuretics, laxatives, 

and cathartics, The flavor and odor of fruits are due to the 
co of essential oils and compound ethers. 

The digestibility of fruits varies with the kind of fruit eaten 
and its mode of preparation; stewed fruits are more easily 
digestible than raw fruits. Among the more easily digestible 
fruits are oranges, lemons, grapes, and peaches; raw apples, 
pears, and bananas are somewhat leas digestible. 

limes, and shaddocks, possessing similar 

ies, are, for descriptive purposes, classed together. 

are valuable antiscorbutics, and have an acid, pungent 
flavor that may be imparted to otherwise tasteless foods. A 
cooling and refreshing drink may be made from lemon-juice 
diluted with water and sweetened with a small quantity of sugar. 

Oranges are used in invalid dietaries, their juice allaying 
thirst very effectively ; it can be borne often by even the most 
irritable stomach. 

1 Hutchison, Dideties, p. 109, 

* Fora discusaic ‘vegetarianism the reader is referred to F, 
W. Newsnts Mops on Dies. ya wir 








ad 


100 CLASSES OF FOODS. 


Apples are wholesome, digestible, and slightly laxative. 
Fresh apples contain approximately 8 per cent. of sugar and 
85 per cent, of water, but in drying two-thirds of the water is 
lost and the sugar is inereased to about 45 per cent. 

Pears are, as a rule, more easily digestible than apples, 
owing to the fact that their flesh is soft and their skin not 80 tough. 

Peaches are wholesome and digestible. They contain less 
sugar than most fruits. 

Bananas are the most nutritious of the raw fruits. The 
many varieties differ in digestibility and in flavor. The ordi- 
nary banana, as obtained in the United States, is considered 
indigestible. The flour which is produced from dried bananas 
is very easily digestible. 

Grapes contain a amount of water and considerable 
iy Wises tneactiy ce Gey are rey teeta 
iron. en ripe they are v le, 
form a useful addition to the: invalid iet. The habit of swal- 


being those most used. They are indigestible unless well 
cooked ; they are usually to pud , sweet breads, eto. 

Plums and green gages are quite apenas when fully 
ripe. They soon overripen, however, and then are as harmfal 
as when unripe. 

Prunes are dried plums. They contain much sugar and 
are markedly laxative in their effect. 

Olives havea bitter taste, and are eaten chiefly as a relish with 
salads. Their nutritive value is due to the oil they contain. 

Strawberries are very wholesome unless taken in excess, 
They are quite rich in salta of sodium, potassium, and calcium, 
and have mild diuretic and laxative properties. 

Currants, gooseberries, raspberries, huckleber- 
ties, mulberries, and a few other berries contain considera- 
ble amounts of free acids. They have slightly laxative prop- 
erties. 


Melons contain over 95 per cent. of water and about 5 per 
cent. of other constituents ; they are considered indigestible. 

Figs and dates contain large quantities of sugar. In the 
eastern part of the United States they are seen only in the dried 
form, although in California, where they are raised, they may 
be obtained fresh. The value of the date as a food to the 
Arab is well known. 





FRUITS AND NUTS 101 


The i taken 
a epee 










HE 


zt 























pie 








ey have but little food-value, and are 
eaten mainly as a dessert, The average composition of the 
nats 





Owing to the large amount of cellulose, as well ae 


pees. ot Bt y contain, nuts are not easily . 
denze cellulose framework which makes nuts so in i- 


E. 





102 CLASSES OF FOODS 


ble can be destroyed by grinding, and thus the nut made more 
easily digestible ; such LE iaary ac Nutrose, Bromose, and Nut- 
meal, of the Sanitos Nut Food Company, are prepared in this way. 
Almonds contain much fat, but no starch and very little sugur, 
and they are, therefore, often utilized as a bread for diabetics, 


hydrate, but is exocedingly indigestible. : 
"The following table, “ag oem Bulletin No. 122, United 





S5aursesresunce> 
2 gene: 


UESSeSsess scenes 


67.40 





























* These ralues were calculated ; unless otherwise indicated the fuel-values 
were determined. 





SUGARS, 108 


FUNGI, ALGAE, AND LICHENS. 


Fungi.—The three varieties of fungi usually eaten are the 
Smamatone te trical ees thei bl 
iS are i for their agreeable taste. 
possess some nutritive value, being rich in nit 
matter, this material, however, occurring in such form that it is 
but slightly absorbed. They are apt to produce gastro-intestinal 
irritation, and disagree with many peers: Bi 
The truffle grows un and is es; sought for 
Bees talon host ts ta ilar coated 
the finest, 
Focedepeed is ay eee. Some Tae Tt is sold in 
state, and is utili: iefly for seasoning purposes. 
The following table, by Kénig, gives the composition of the 
mushroom, truffle, and morel : 





Many are poisonous, and these are usually distinguished 
bya tigre or st td other pecnlaries in 
structure, etc. ‘or an excellent description of the various 
fungi the reader is referred to Farmers’ Bulletin No, 15, United 
States Department of Agriculture.) 
‘The only one of this group that is utilized as food 
is Irish moss. Its most important constituent is lichenin, a 
sapatiage. Ie is made into a soothing drink for patients suffering 


irritation. 
Tichens.—The only important lichen used as a food is 
Iceland moss. It contains two carbohydrates: (1) lichenin,- 


8 gelatinous substance ; (2) isolichenin, ine resembles starch, 
Iceland moss is utilized as a food in the Arctic regions, It has 
been made into a bread that has been recommended by Senator 
for diahetios. 


SUGARS. 
Sugars are carbohydrates that contain hydrogen and oxygen 
ina mm to form water. Sugar is one of the most valu- 
able popular forms of food, Thi ity is due not 


only to its nutritive value, but also to its t taste. Ac 





104 CLASSES OF FOODS. 


fing to Abel,’ 86 pounds of s capita were consumed 
pete in 1895 and 64 pounaada the nited States in the 
same year. From 7,000,000 to 8,000,000 tons are consumed 
annually in the different countries of the world. The principal 
variety of sugar in use is cane-sugar ; besides this, grape-sugar, 
fruit and milk-sugar also enter into the composition of 
our ls. Sugar is obtained in a fluid state, as in honey, as 
Lah as in Biase eee a oe 
is tteni at the same time is a great 
Hears of a eer ‘The negroes working in the me 
‘ons in the West Indies show the effect of eating sugar 
luring the harvest season; they chew the sugar-cape con- 
stantly, in consequence of which their weight and muscular 
it increase most remarkably. Sugars and starch are 
said to be identical in nutritive value, owing to the fact that 
both must be converted into dextrose before they can be ab- 
sorbed. Most of the ill effects attributed to the use of sugar 
are due to the fact that more than one-quarter of a id is 
consumed daily (Hutchison); this amount may be taken with 
ene] by the healthy adult, but if more be taken, it will be 
ex rapidly by the kidneys, giving rise to a condition 
known as temporary or alimentary glycosuria. Hutchison (p. 
270) gives the following figures us the maximum amounts of 
the various sugars necessary to produce alimentary glycosuria : 
Porlnctowe. sss sb rete ee 
« fevalooe |: 3 : 
“dextrose 





Sugar can be absorbed only as dextrose and as Jevulose, all 
varieties of sugur being converted into these forms before they 
are absorbed. In strong solution sugar irritates the mucous 
membrane of the stomach, and is apt to undergo fermentation 
and thus produce gastro-intestinal distress, Robertson? gives 
the following table, arranged according to the rapidity with 
which sugars are apt to ferment : 

Tactic. 


Butyric, Alcoholle. 
Levulose i for Levulose (most fer Maltose (most fer- 
‘mentable). mentable), mentable). 
ltose. Tnvert-sugar, 
Dextrose. Dextrose Cane-sugar, 
ag ee Levul 
z jesugar. lore. 
Malton. Lactose Tacioee 





* Farmer? Balletin No. 9%, United States Department of Agriculture, 1809. 
4 Edinburgh Med. Jour., March, 1804, : 





SUGARS, 105 


Cane-sugar is the most common and most extensit used. 
Bese ee see Tt is made chiefly from sugar-cane and from 
sugar-beet. When pure, it consists of a mass of white 
ae It is soluble in one-half its weight of cold water and 
in even less of hot water. In order to obtain the from 
the cane the canes are crushed and the fluid obtained treated 
with sulphurous acid, neutralized with lime, and boiled; it is 
then filtered and evaporated, when the sugar crystallizes ont. 
The ee eel further refined by remelting and filtering 


through 

Caramel is made by heating refined cane-sugar to 400° F., 
when it is melted and browned. The resulting brown sub- 
stance is called caramel, It has a bitter taste, and is often 


pepsia, and because of their relatively active muscular energy 
and relatively large body surface for losing heat, in proportion 
to their size. TTI hy es a rule, care for fat meat, and 
Sweets as a natural substitute.” Contrary to popular 
, there is no evidence to show that candy produces any 
injurious effect on the PET 
Molasses, Treacle, and Syrup.—Molasees and treacle 
are by-products formed in. the manufacture of cane-sugar. 
Molasses forms a highly nutritious food. On account of the 
impurities it contains molasses has a more pronounced aperient 
effect than refined syrup. Besides cane-sugar and certain acids, 
ete., molasses contains about 30 per cent. of invert-sugar and 
the same amount of water, 
Hutchison (p. 264) gives the following table showing the 
composition of molasses, treacle, and syrup: 





Glucose, or grape-sugar, is chiefly made from starch by 
iexeraton or hydrolysis. It is not nearly so sweet as cane 
sugar, and crystallizes with difficulty. It is present in small 


ve 


106 CLASSES OF POODS. 


quantities, in combination with other varieties of sugar, in 
most fruits. When taken in excess, glucose appears in the 
urine unchanged. 

Lactose, or sugar of milk, is the natural carbohydrate 
for the young, growing infant. It is less abundant in cows’ 
milk than in human milk, and for this reason it should be 
added to the milk of bottle-fed infants. 

Honey is sugar in a concentrated solution. It is made by 
bees from the nectar gathered from various flowers, It contains 
a crytallizable sugar, resembling glucose, and a non-crystal- 
lizable form, Honey was formerly used as a sweetening agent, 
but cane-sugar, on account of its cheapness and abundance, has 
largely superseded it. Besides sugar, honey contains wax, gum, 
and coloring substances, 

Saccharin is used largely as a substitute for sugar in eases 
of rheumatism and diabetes. After long-continued use of large 

antities of saccharin digestive disturbances are apt to be pro- 
luced, 

Levulose, or fruit-sugar, is also utilized as a form of 
sugar in certain cases of diabetes. 


SPICES AND CONDIMENTS. 


Spices and condiments play an important role in increaai 
the appetite and siding the digestive fanctions ; they have Bare 
tically no nutritive value. By the action of these substances 
on the organ of taste as well as on the mucons membrane of 
the stomach the appetite is stimulated and the secretion of 
gastric juice increased. In certain gastric disturbances, as well 
as in diseases of the kidneys, they act as irritants and should 
be avoided. 

The peppers are among the favorite spices; there are two 
varieties, the white and the black, 

Mustard.—Mustard is used chiefly in salads or with other 
foods, and has a marked tendency to increase the appetite. 
There are two forms of mustard: that which is obtained from 
the black mustard plant and that derived from the white 
mustard plant, In large quantities and diluted with water 
mustard acts as an irritant to the stomach, producing nausea 
and vomiting. 

Vinegar is produced from various alcoholic drinks and from 
fruits. It contains 5 per cent, of acetic acid. By its action 
on the cellulose of vegetables vinegar softens the fiber, so that 


FATS AND OILS. 107 


“oh alae condiment, but also assists in the digestion 
of the cellulose; for this purpose it is added to such vegetables 
as cabbage, lettuce, and cucumbers. 

Hi is a condiment that is much used with various 
foods ; it stimulates the flow of saliva as well as of the gastric 
secretion, 

Satces, such as tomato, catsup, Worcestershire, and the 
like, increase the appetite and give a relish to certain foods. 
leering Sho apptio oe food tnt would otherros be ing 
it i appetite for t ise be insipis 
‘Those most in era ginger, cinnamon, nutmeg, and aoe 


FATS AND OILS. 


One-fifth of the body-weight consists of fat. This is ob- 
tained in part from fatty food and in part Gueeeee 
hydrates and the proteins. Most of the heat furnished 
the body is supplied by fat; it oxidizes very rapidly, and in 
this way spares the protein elements that would otherwise be 
required to furnish energy. Fats are digested in the intestine, 
where they are emulsified previous to being absorbed. The 
most useful forms of fat are cream and butter; other forms are 
bacon and cod-liver oil. When eaten too liberally, fats are apt 
to cause indigestion, and when this exists, they should be taken 
only in very restricted quantities. 

Foods fried in fat are indigestible, and hot fats are more 
indigestible than cold. Fats and oils have « tendency to reliove 

ition, but are counterindicated in diarrhea, 

The most important animal fats are butter, cream, lard, suet, 

\, cottolene, butterine, cod-liver oil, and bone-mar- 
row. the vegetable fats, those most commonly employed 
are olive oil, cotton-seed oil, linseed oil, cacao-butter, and the 
oils obtained from nuts, such as cocoanut oil, peanut oil, and 
almond oil. 

Indications for the Use of Fatty Foods.—Fatty 
foods are indicated especially in wasting disorders and in con- 
valescence from certain acute diseases. They are needed par- 
ticularly in tuberculosis, ruchitis, chronic bronchitis, and chronic 
diseases accompanied by the formation of abscesses. 

‘There are many proprietary fatty foods on the market, some 
of which are worthy of mention. In most of these the fats, 
usually cod-liver oil, have been emulsified ; this emulsification 
aims to make the oil less objectionable to the taste and also to 
render it more easily digestible. 





a 


108 CLASSES OF FOODS 


The Use of Olive Oil in the Treatment of Certain 
Diseases.—The external and subcutaneous use of olive oil 
will be discussed further on (p. 290), Chaufford and Dupre 
were the first to advocate the use of olive oil in the treatment 
of cholelithiasie. They recommended that two doses of 400 

each be given at half-hour intervals, the patient being 
directed to lie for three hours on his right side. The use of 
olive oil in the treatment of this condition has subsequently 
been advocated by Walker, Vettsteiner, and others. 

Rosenheim has advised the use of olive oil in the treatment 
of stricture of the esophagus due to carcinoma. After allowing 
a small quantity of oil to flow into the esophagus, patients who 
were unable to swallow before have frequently been enabled to 
swallow fluids and semisolids. 

Recently Cobnheim' has advocated the use of large quanti- 
tics of olive oil in the treatment of certain forms of gastric 
disorder. Tn cases of gastric dilatation he usually administers 
the oil once daily, in the morning before breakfast, in doses of 
from 100 to 150 c.c.; in those instances in which lavage is 
practised the oil is es immediately after this procedure. 
After taking the oil the patient is required to lie on his right 
side for from fifteen to twenty-five minutes, and is not per- 
mitted to partake of any food for an hour. The oil is admin~ 
istered warm, at about the body-temperature. If, notwith~ 
standing this procedure, the patient still continues to suffer 
pain, 50 c.¢. are again given at night, before retiring. Later 
Cohnheim orders that a wineglassful be taken one hour before 
breakfast and two dessertspoonfuls from one to two hours 
before dinner and before supper. In simple forms of ulcer 
he recommends that the olive oil be used only in the morning, 
and the emulsion of sweet almonds (see below) at noon and 
night; most patients do not object to the taste of the oil. 
According to Cohnheim, in those instances in which the taste 
of the oil is objected to, this may be overcome by taking a 
pinch of salt, a swallow of brandy, or by allowing « pepper~ 
mint drop to dissolve in the mouth, The oil treatment must 
be continued over a period of weeks or months. Cohnheim’s 
conclusions are as follows : 

“1, Cases of dilatation of the stomach due to spasm caused 
by an ulcer or fissure at the pylorus are cured or at least markedly 
relieved by the use of large quantities of oil (100 to 150 grams). 

“2. Cases of stenosis of the pylorus due to organic disease 

+ Zeitechr. J, blin, Meck, vol. W., pts 1 and 2 p. 110, 


FATS AND OILS. 109 


these cases the oil acts mechanically by relieving friction. 

«3, Cases of relative stenosis of the pylorus and duodenam 
which are clinically marked by a continnous hb: 
and pylorospasm several hours after the principal meals, are 
much improved or cured by the oil treatment. 

“4, The py! found in cases of carcinoma of the 
pylorus is much diminished or relieved by the oil treatment. 

5, Cases of ulcer of the pylorus associated with or without 
hyperchlorhydria are quickly cured by means of the oil treat- 
ment or by an emulsion of sweet almonds. 

«6. The oil is best taken three times daily, half to one hour 
before meals; asa rule, it is best to administer a winoglassfial 
early in the morning and two dessertspoonfuls before dinner and 
supper. In mild cases an emulsion of sweet almonds may be 
substituted for it. 

“7, The oil fulfils three indications; it overcomes pyloro- 
spasm ; it relieves friction, and tends to improve the general 
nutrition, 

“8, The oil acts as a narcotic in cases of pylorospasm, pro- 
ducing, however, no unfavorable effect—neither eructations nor 


“9. No favorable effect of the oil treatment has been found 
in purely hysteric gastric colics. 

“10. In that form of gastric neurosis manifested by pain 
when the stomach is empty very favorable symptomatic relief 
has been obtained from the use of olive oil. 

“11. A certain number of cases of stenosis of the pylorus 
accompanied by a consequent gastrectasia can often be so much 
relieved by the oil treatment that no oj ive procedure need 
be undertaken. A trial should be made of the oil treatment 
in all cases of stenosis of the pylorus before advising operative 


jure. 

“12. The treatment prevents prophylactically the jue~ 
tion of gastrectasia and prevents relapses when utilized in 
favorable cases.” 

Olive Oil in the Treatment of Chronic Dysentery—Ruth- 
erford ‘ gives his results with olive oil in the treatment of chronic 
dysentery. According to him, “ Upon the internal administra~ 
tion of olive oil ote cases of chronic dysentery practically 
without exception show changes in their condition as follows : 

¥ American Medicine, March 1904. 


110 CLASSES OF FOODS. 


' “1, Positive evidence of increased quantities of bile in the 
feces, 

“2, Decrease in the number of daily bowel movements and 
marked improvement in the character of the same. 

“3. Gradual cessation of signs of fermentation and putre- 
faction along the intestinal tract and consequent subsidence of 
pain and tenderness, 

“4, General systemic improvement ; gain in appetite ; repair 
of digestive faculties ; symptoms of improved nervous system ; 
and rapid guin in weight and strength. 

“5, Apparent positive cure after an average time of two 
months and upward, with few recurrences.” 

The method of carrying out the treatment is as follows : 

“ First Period.—The patient is given one ounce (30 c.c.) of 
olive oil three times a day for the first three days, when the 
quantity is increased to two ounces (60 ¢.c.) three times daily, 
and on the sixth day the same quantity is given four times a 
day. During the first three days the patient is to be kept on 
a milk diet. During the latter half one to three ounces (30- 
90 c.c.) of scraped beef or its equivalent of egg-albumin will 
be added daily. During this treatment a slight loss in weight 
may Rete be temporarily noticed. 

.—Dnuring this period the amount of oil is 

given in pei quantities (not less than three ounces—90 c.c. 

—three times a day without discomfort to the patient), and 

pos Ve bers ae for a length of time in severe and chronic 

cases ; perhaps for two months or longer, during which period con- 
valescence will have been established and the weight regained, 

“ Third Period.—During this period the patient is gradually 
restored to a full diet, and the oil decreased in amount until the 
ulcers have permanently healed and recurrence not probable.” 

Blum first advocated the use of olive oil by rectal injection 
for the treatment of gall-stone colic, and claims good results from 
its use. Feiner first recommended the use of copious oil in- 
jections—400 to 500 c.c.—in the treatment of certain forms 
of chronic constipation. Remarkable results are produced in 
the spastic forms of chronic constipation when this quantity of 
oil is injected two or three times weekly, The oil should be 
heated to the body-temperature, and injected high at bedtime 
and retained during the night ; the same precautions should be 
observed as in giving nutrient enemata, (See p. 285.) 

The Use of Emulsion of Sweet-almond Oil in the 
Treatment of Certain Gastric Disorders.—Cohnheim' 

1 Zeiteche, f, bin, Med., vol. lii., Nos. 1 and 2. 


olive oil is not well borne. In effect it is identical to olive oil, 
ly described, relieving spasm and irritation; on the 
other band, it Incks the nutritive value of olive oil. On ac- 
count of its more pleasant flavor it is preferred by some. 
Cobnheim gives the fillowing directions for preparing an emul- 
sion of almond oil: A dessertspoonful of sweet almonds are 
blanched by scalding with hot water and removing the skin: 
after being allowed to dry they are ground into a powder an 
of boiling water; this mixture is next rabbed 
a spoon, and strained through a piece of gauze; a 
ae equal to from 200 to 250 grams should be obtained 
a dessertspoonful of almonds. The emulsion should be 


it 
: 
2 


Butterine is a fat prepared from beef and hog’s fat, and is 
frequently used in this country instead of butter; oleomar- 
garin is a similar preparation made from beef fat. Both but- 
terine and oleomargarin are wholesome futty foods, the only 
objection a them being that they are often sold fraud- 
ulently for butter. 

Bone-marrow is a fat obtained from the large bones of the 
ox. It is used in the treatment of tuberculosis and in the 
‘various seus of anemia, nel in Laser ream The 
marrow of young animals is usually preferred. preparation 
known as the glycerin extract of bone-marrow is often utilized. 


SALTS. 


‘The principal mineral constituents of the body are the chlorids, 
phosphates, sulphates, carbonates, fluorids, and silicates of 
‘jum, sodium, magnesium, calcium, andiron, Todin is pres- 
ent especially in the thyroid gland, and the other halogens are 
also found in the body. The amount of heat and energy sup- 
plied by alt metabolism is go small as to be practically disre- 
garded, but the salts play a most important part in the metabolic 
processes and also maintain osmotic pressure. They are also 
essential to nervous and muscular reaction. 
The following table shows the salt content of some of the 
tissues of the body: 





CLASSES OF FOODS, 


112 








280-20 ores 880-160 ODOT: | Mie ete s aah oAen Ss s TS AKS, 


Lr0-Le0 oF sro-w'o | wow | ste ‘ora 
4000-700 + 920-2900 Wo! Wie anese iy Poa ae omK 
800-980 | O0s-0Le £00 OM cl ah i Be aE on 
SUT-FT 00 STSLD I) PRS |i kee hee ots 
L869 00 ER ALGil| Bose! Ps 8 “Ros eae ou 
8100-2200 | 0s a) CRN ea Wed IEE ae ‘ols. 
6070-600 00 wo eee ee eas we ‘os 
2ey-BOS | Lee-OBT | TORO Bid) eo eee es ab a0 oe ‘oa 
wre-ss0 | 20-90 ¥o La las ake ee ae aor 
TL%6 | 069-079 Pad Sty Ber eis aommsqns qsauy 
“w04p, “nwnay “muna, rani — | J ser QQOT Jad serwUE PUBUEAY 

















sagt ouos, mousy | jorge 


“poory 0 maw oo, UT 








Camng )—eubig yor ay fo 391 000 4of—sunbsg pociourscy oy) vs pourwpuay annoy poaruipe 


114 CLASSES OF FOODS. 


ities of the alkaline bases and also phosphoric acid. 
Tie akan bases are, however, always in excess. 

i eera ene of the alg tere boty plage. ae 

percent pert in the Biyeialoay ot of ster an turbances of 

salt metabolism may be the cause of aes ‘This subject 
is as yet but little understood, but the therapy of the future will 
undoubtedly depend upon the ical = ition of the po 
ciples of nutrition. If the salts are withdrawn cantiealy da 
results, and Forster and others have shown that dogs fed pn 
foods from which the salts had been extracted by water die in 
from 26 to 36 days. If salts are given in excess they aro ex- 
ereted, but if greatly in excess, may be retained in the body 
and cause untoward symptoms. Under certain conditions even 
small amounts may be retained or, on the other hand, salts may 
be exoreted in such quantity in the urine that they cannot be 
held in suspension, and are consequently deposited in the urinary 
tract and cause stone, 

Animal food contains sulphur and phosphorus compounds, 
which by oxidation in the body are changed into sulphuric and 
phosphoric acids, which tends to render the blood and tissues 
acid. The destructive metabolism of the tissues of the body 
tends toward the same end. The vegetable foods, the cereals 
excepted, contain lange amounts of alkaline bases, which tend 
to neutralize the acids and to render the tissues alkaline, A 
small amount of the acids formed in the metabolic processes is 
neutralized by the ammonia from the protein, and this is ex- 
creted as ammonium salts, and takes the place of the alkaline 
salts from vegetable foods. The daily needs of the body are 
summarized by Gautier as follows for the average adult : 


Acids. 





Nao 03 
25 

MgO 50 

Fe,0; 0,05 


‘z) The food does not in reality contain 3.9 grams of PO; 
and the 2.03 grams of sulphur trioxid indicated, but contains 
phosphorous and sulphur, which if reduced to the given com- 
pounds would yield these figures. 

(b) This comprises the amount of sodium chlorid taken in 
twenty-four hours, 

Alimentary Alkalis.—The average ration of 110 grams 


116 OLASSES OF FOODS. 


chief of ieee lassitude,an pa BNIB in er 

5 symptoms are promptly relieved by restoring 
areal allowance of salt, On the other hand, a salt-free 
diet or a lowered salt allowance seems to have a beneficial effect 
in some nervous diseases, as in epilepsy, in which disease it in- 
creases the action of the bromids. It has been suggested that 
a salt-free diet be tried in hysteria and some of the other func- 
tional nervous troubles, as an addition of 12 to 15 grams of 
salt to the diet in hysteria aggravates the condition very much, 
and in latent hysteria may make it manifest. The effect of a 
salt-free diet in edema is noted in the section on Nephritis. 
Animals which feed exclusively upon meat do not need salt, a 
fact pointed out by Bunge. The acids formed in metabolism in 
these animals is neutralized by bases formed by the breaking 
down of protein. Potassium salts being present in vegetables 
causes an excess of potassium in the blood. In order to elimi- 
nate this, as explained above, a large amount of sodium chlorid 
is necessary. All gramniyorous animals need salt, and the same 
is true of man, who is omnivorous, The average individual 
takes more than there is any necessity for, however, the taste 
for this Havor leading to excesses, An average amount for an 
adult is from 20 to 30 grams a day. 

The Halogens.—The elements chlorin, iodin, bromin, 
and fluorin are taken into the body in food or drink. The 
most important, chlorin, is taken princi as sodium chlorid. 

Todin is found in Rrlageatstaa Se aly in the thy- 
roid gland, which contains 0.075 to 0.13 per cent. It is al 
found in the other organs. Gautier gives the following tables 
(after P. Bourcet), showing the iodin content of various food : 


odin per Kilogram of Fresh Material. 


0.32 
31 





proteins and is excreted 
ee eee Jotin sles tere bromin in 
not in saine quantities. luorin is present 

in fraud da taken do With te Gckiog-waien 
‘ar.—Sulphur is contained in both animal and vege- 
table proteins. Four-fifths of the sulphur taken is oxidized 
exereted in the urine either as sulphates or phenol sulphates, 
'po= 


. ingault estimates the daily loss of 

grams, and most of this is excreted through 
the intestinal wall and ont of the body in the feces, a 
small amount is ex in the bile and a trace in the urine, 
Animals fed upon foods poor in iron become anemic. Young 
animals thrive upon milk which is poor in iron, but this is ex- 
plained by Bunge, who has shown that the bodies of animals 
which live milk contain at birth a large amount of iron, 
Thich ie suflclent to tide them over until they take food richer 
in iron. Tron is eliminated from the body dose 
and, according to Salkowski, the amount is 





1s CLASSES OF FOODS. 


during fever. The amount of iron contained in food material 
is shown in the following tables : 
sph ake ay la daar aon» 
= 6 





Miigrams of Irom én 200 Grams of Dried Subtance (Bunge). 
0 Black chercew without etanes a3 
“Trace | White beans 
+ 1.0-2,0) Carrots. 
+ +s 24-15) Wheat bran 
o* “1 Gee 
> Boa] Gee i rao 
32 Biemoge withoutstones 10 
a pecen eck hazel nuts. ag 












Manganese.—This metal is found in the body in minute 
Tea and small amounts are found in some food materials. 
of legumes, asparagus, cauliflower, lettuce, grapes, am 
of various grains contains Varying amounts of manganese, 
Silica.—This element is eliminated in the hair and desqua- 
mated epithelium. It is present in many vegetables, but the 
part played in the animal economy is unknown, 
Arsenic.—Gautier has demonstrated the presence of a trace 
of arsenic in the ectodermic tissues, the skin, hair, brain, mam- 
mary gland, and thyroid. Smaller traces have been demonstra- 
ted in other organs. The role of arsenic in metabolism is un- 
known. ‘Traces of arsenic have been found in certain vi 
tables, as cabbage and turnips, as well as in some ae: 
Common salt may contain some arsenic, and it is sometimes 
in foods either as an adulterant or asa food poison. 
‘See same), 


SALTS 119 


SALT METABOLISM AND DISEASE. 

The tissues differ in their salt composition, and changes in 
sult metabolism are probably due either to atrophy or growth of 
certain organs or tissues, or to their taking on new functions, or 
to the processes of disease. Studies of the balances of the var- 
ious salts, have been made but sparingly in disease, and doubt- 
loss this mes will be taken up more energetically in the future. 
Tn hunger, Wellman found that there was a greater loss of salt 
than could be accounted for by the metabolism of the fl 
parts, ‘The principal excess was phosphoric pentoxid and 
cium and magnesium oxid in about the same proportion as are 
found in bone, and the skeletons of the animals were found to 
have actually lost 6 or 7 per cent. of their weight. There is 
a lowered calcium excretion in many diseased conditions, among 
which may be mentioned, pleural effusion, pneumonia, “ddiriun 
tremens, and various fevers. In pulmonary tuberculosis Senator 
found that there was an excess of calcium excreted. Tn osteo~ 
malacia the calcium balance is disturbed, and more is excreted 
than is taken into the body, Phosphoric acid lessens the cal- 
cium exereted, and this might be used in experimental thera- 
peutics, Custration, which bas been done in a few cases, res~ 
tores the CaO, equilibrium, and there is also a tendency to 
restoration of the sulphur equilibrium. On the other hand, in 
myositis ossificans the amount of calcium excreted in the urine 
is lower than normal. There is also a retention of lime alts in 
arthritis deformans. In endarteritis the caleium exeretion is 
interfered with, and Rumpf claims to have obtained good re- 
sults by giving salts which aid the excretion of caleium as lac- 
tic acid, sodium lactate, sodium citrate, sodium carbonate, and 
sodium chlorid. 





BEVERAGES AND STIMULANTS. 


WATER. 


Warer is the chief constituent of all beverages, and also 
enters largely into the composition of solid food. The human 
body itself is composed of about 60 per cent. of water. While 
man can live for weeks without food, he can abstain from water 
for but a few days, Water is absolutely necessary as a solvent, 
and as it is constantly being eliminated by the skin, lungs, and 
kidneys, this loss must be replaced by some means in order to 
maintain the functions of the body. This is most conveniently 
done through the agency of the various beverages. The best 
method, however, of replenishing the water-supply is that of 
drinking the water in its pure state, when it retains all its sol- 
vent properties. Some waters are taken for their laxative or 
purgative action, and others for the salts which they contain. 

e amount of water consumed daily by the average person 
is from six to eight glasses. This varies, however, with the 
amount and variety of food and exercise taken, The age, sex, 
and size of the individual and the season of the year also in- 
fluence the total daily consumption of water. In very warm 
weather, for example, und under severe physical strain, much 
water that would not be lost in the cold season of the year is 
eliminated in the form of perspiration and must be compen- 
sated for. 

Water is absorbed chiefly in the intestine ; a small amount is 
absorbed in the stomach, and but a very trifling amount, if 
any, in the mouth. The water absorbed in the intestine is 
passed into lymphatics, and carried on into the circulation, 
whence it is eliminated. Thus by removing the water from 
the blood and sending it through the kidneys into the bladder, 
space is made in the circulation for the entrance of more fluid 
from the alimentary tract. 

‘As previously stated, water is climinated through the skin, 
kidneys, lungs, and feces. The amount of water excreted daily 
varies greatly under special conditions. In cold weather the 
skin is inactive and the kidneys excrete a greater amount 
of water than in hot weather, when the sweat- glands func- 

120 


WATER. 121, 


tionate more actively, When there is a tendency toward 
liquid movements from the bowel, the elimination by the kid- 
neys is lessened. In warm weather climination by the lungs 
is stimulated. 

‘The temperature of drinking-water is a matter of some im- 
portance. Iced water will stimulate a more rapid and a greater 
secretion of gastric juice, but lessens the motility of the stomach, 
Teed water in excess is injurious, and should not be taken when 
one is overheated. Hot water has a very beneficial effect on an 
irritated stomach, 

Water is a most valuable diuretic and diaphoretic. When 
the stomach can not retain it, it is often given by the rec- 
tum. A pint of salt solution, if injected by the use of a rectal 
tube, will, if the colon has previously been emptied, be retained 
Tong enough to be absorbed. If a half-pint or even a pint of 
salt solution be introduced under the skin, it will be hed 
rapidly and as rapidly be eliminated. ‘This is one of the most 
useful measures producing rapid elimination through the 


According to the amount of mineral water they contain 
waters are classed as hard and soft. Rain-water is soft, and is 
the purest form of natural water. The hardness of water is 
due to earthy carbonates ; by boiling, the carbonic acid gas is 
driven off and the carbonates are precipitated, and the water 
thus rendered more suitable as a beverage. Boiling has the 
additional advantage that it destroys most of the micro-organ- 
isms that may be present in the water. 

‘Water often contains impurities, such as lime, magnesia, iron, 
and other salts, or micro-organisms, and it often becomes neces- 
sary to purify it for drinking purposes. ‘Typhoid fever and 
cholera are communicated chiefly through the agency of polluted 
drinking-water. Tho best method of purification is by distilln- 
tion, by which means both inorganic and organic impurities 
can be removed or rendered innocuous. This method is now 
used largely on ships. When distilled and aérated, sea-water 
makes a most pleasant beverage. Water may also be purified 
by means of filtration, charcoal and sand being used extensively 
for this Porcelain cylinders are also in common use. 
Whatever be filtering agent employed, unless it be kept clean 
it is liable to become a source of contamination rather than of 
parification. Owing to the fact that soluble impurities often 

throngh the filter, filtered water is not nearly so reliable as 
Siatitled water, A very economic and convenient method of 


BEVERAGES AND STIMULANTS, 


122 
purifying water is to dissolve one of alum in a little water 
and pour this solution into one gallon of the water to be puri- 
fied. After standing for twenty-four hours the impurities will 
be precipitated. 

MINERAL WATERS. 


Mineral waters are frequently taken as substitutes for ordi- 
nary water; at times they produce a most marked stimulating 
effect on various organs. ir efficiency is greatly enhanced 
when a “drinking cure” is combined with proper dietetic 
lations. i waters differ from ordinary waters in the 
greater amount of gaseous and solid matters they contain. The 

constituents of mineral waters are mainly carbon dioxid 
and sulphuretted hydrogen. ‘The solid constituents are salts of 
sodium, potassium, magnesium, aluminum and calcium, iron, 
jodin, bromin, chlorin, and sulphur. Taken before meals, 
waters containing carbonic acid have a soothing effect on an 
irritated stomach. Taken in excess, all carbonated waters are 
apt to produce indigestion. 

Some waters have a purgative effect, others a laxative, and 
still others diuretic. "Thermal waters issue hot from springs, 
their virtue being due to their heat. Some mineral waters have 
no medicinal virtue whatever, and are utilized merely as drink- 
ing-water. 

Classification of Mineral Waters.—The following 
classification and description of mineral waters are taken from 
Cohen’s Physiologic Therapeutics, vol. ix., p. 416 (Kisch, Hins- 
dale, and Peale) : 

i Simple acidulons, 
1. Alkaline mineral water: | ieriing nme acidulous 


| Alkaline saline acidulons, 

imple sodiam chlorid. 

TT, Sodium oblorid waters: 4 Sodium cblorid with iodin and bromin. 
Saline water or brine (Soolea). 





TLL Bitter waters 
TV. Sulphurous waters. 
Carbonated iron waters, 
V. Iron waters: 4 Sulphurated fron waters, 
Tron nnd arsenic watere 
VI. Earthy mineral waters, 
VEL. Acratothermal waters, 


IT. Alkaline Mineral Waters.—These waters are divided 
into: (1) Simple acidulous waters; (2) alkaline acidulous 
waters ; (3) alkaline muriated acidulous waters ; and (4) alkaline 


that contain large amounts of carbon dioxid; this ingredient 
increases the peristaltic action of the stomach and intestine. 
‘These waters are utilized largely in the treatment of minor gas- 
trie disturbances and ta catarhal conditions of the respirat 
tract, Among the most important of these waters are: A) 
linaris water ; the Dorotheenquelle, at Carlsbad; the Geyser 
Shee California; and the Manitou Soda Spring in 
Alkaline Acidulous Waters.—These waters contain, in addi- 


tion to wantities of carbon dioxid, v: roportions 
ey <a , varying prop 





Grams, 

Bilin, of sodium bicarbonate . . . . see BBL 
i i 5 3.57 

09 

30 

28 

4.83 

1.80 

0.90 

1.20 

Saratoga (Vichy), of sodium bicarbonate... . . . . » 142 
Saratoga (Vichy), of calcium and magnesium bicarbonates , 2.35 


Alkaline Muriated Acidulous Waters.—These waters contain, 
in addition to sodium carbonate and carbon dioxid, large quan- 
tities of sodium chlorid. They exert a markedly solvent effect 
on uric acid, and liquefy the secretions from the respiratory 
tract. They are especially useful in catarrhal conditions of the 
respiratory tract, such as chronic bronchitis, and in chronic 
catarrh of the stomach, of the biliary passages, and of the 
urinary organs. They are used for gargling and inhalation 
pl , and algo for baths. To this class belong the waters 
of it, Ems, Selters, and Saratoga Vichy. 

‘The chemic composition (in 1 liter) of the most important alka- 
line muriated acidulous waters is shown by the following table :* 


* Taken from Cohen's Physiologic Therapeutics, vol. ix., p. 420, 
1 Thid., vol. ix, p. 422. Ls 


uf 


124 BEVERAGES AND STIMULANTS. 


Sodium Sogtum Seaton 
res maranly 


Grams, 
1.25 
» 1.25 0.13 15) 
+ 10 O18 lu 
» 10 2.03 1.00 
10 2.64 1.85 
10 0.56 
10 6.76 4A5 
- 10 8.01 0.60 
- 10 1.24 1.64 
10 1.35 1.78 
1.0 0,08 1.40 
10 1.48 2.20 
- 10 1.23 2.83 
- 10 844 4.61 
1,35 1,25 





Alkaline Saline Acidulous Waters.—These waters contain sul- 
phate in addition to bicarbonate and chlorid of sodium. They 
occur as both warm and cold waters. The cold waters possess 
a markedly diuretic effect, and when taken in large quantities 
act as purgatives. The warm waters diminish the urinary 
secretion, The cold alkaline saline waters are useful in strong 
individuals for reducing flesh and for the relief’ of constipation. 
‘The warm waters are useful in gastro-intestinal catarrh, ulcer 
of the stomach, gout, catarrhal jaundice, congestion of the 
liver, cholelithiasis, and in conditions associated with urinary 
concretions. Among this class of waters are to be mentioned 
tsiniate agaist Elster, sere rs a Califi reves Le; 

, Hot i in Arizona, 10 Hot Springs, an 
Manitou Springs, 

The following table* gives the chemic composition of im- 

portant alkaline saline water; 1 liter of water contains ; 


Sodium Sodium Sodium = Sodium 
sulphate, carbonate, bicarbonate. chlorid. 


Grams, Grams, Grams. 
0.05 ra 0.05 





608 
002 
Ses abies oe 
jorge (Iron 
bok hes oa Gag 
ages See ae 7 i 
¥ Cohen's Physiologic Therapeutics, vol. ix., p. 424. 


ist 





WATER. 125 


The chemic composition of the salts of Carlsbad 
peemencssied Goctog ow cumpleto\evamrstan ata G 
vi 


to 5 45 to 80 grains) are ed ina of water 
@ = grains) glass 
Carlsbad Bpradel Marlenked Spring 
54.88 per cont. 
23,81 
240 





Il. Sodium Chlorid Waters.—To this class belong the 
simple sodium chlorid waters, sodium chlorid waters containing 
odin and bromin, and brine or saline waters. 

Simple Sodium Chlorid Waters—These waters contain, in 
addition to sodium chlorid and other chlorids, carbon dioxid in 
large quantities. Sodium chlorid increases the secretion of the 
mucous membranes, especially of the stomach. These waters 
have a markedly diuretic and laxative effect, and are useful in 
chronic catarrh of the respiratory tract, and of the stomach, 
intestine, and biliary passages. 

‘The following table,' gives the chemic composition of simple 
sodium chlorid waters ; 1 liter of water contains: 

‘Sodium chlorid. 
Grama, 








Seco Bete sedate 
yron Spring 





Todin and Bromin Waters,—These waters contain iodin and 
bromin in addition to sodium chlorid. The iodin occurs in the 


1 Cohen's Physiologic Therapeutics, vol. ix., p. 425. 
'Dbid., vol tay p42, she 


126 BEVERAGES AND STIMULANTS. 

form of ium iodid, calcium iodid, and sodium iodid ; the 
bromin, in the form of sodium and magnesium bromid. These 
waters increase the activity of the lymphatic vessels and hasten 
absorption ; they are indicated in cases of scrofiula, syphilis, and 


in diseases. of the glands, as in goiter. The principal iodin 
waters are Heilbronn, reasons pa fae pe 


¢ chemic composition of the important iodin and bromin 
waters is as follows ;' 1 liter of water contains : 


Sodium jum Sodius Bodii 
sauna: aia eal ronald 
Grams. 


Grams. Grama, 
0.0039 0.0610 
0.0708 —-0,0610 
0.0040 0.0610 





pil importance has been attached to lithium, which is often 
promt in ehlorid waters, and which is believed to have 
effect in dissolving uric acid. Tt is very donbtful if 
an action occurs, yet these waters possess a markedly 
diuretic action. They are useful in the treatment of gout, and 
of renal and urinary concretions. Among the most important 
simple sodium chlorid waters may be mentioned those of Ham- 
burg, Baden-Baden, Kissingen, Wiesbaden, Pyrmont, Byron 
Springs in California, Congress, Excelsior, Hathorn, High 
Rock, and Selzer at Saratoga. Among the lithia waters are 
Elizabethbrunnen at Homburg, Elster, Kiesingen, Londonderry 
Lithia Springs, Geneva Lit! ia Springs, and Boffalo Lithia 
— 
ith Bitter Waters.—These waters are characterized by the 
large proportion of sodium sulphate and magnesium sulphate 
which they contain ; they also contain varied proportions of mag- 
nesium chlorid, carbonate, and carck ea carbonate, and 


2 Cohen's Phylonie Perapeu 439. 
*Todin. si et Te abe ‘bromid. 


WATER. 127 


sodium chloride. The magnesium sulphate acts as a 
‘These waters are indicated in small as stimulants to the 
LaSahes peristalsis ; they are useful in habitual constipation, 
pe is belonging to this class are the Apenta, 
iedvichsbatl, Kissingen, Crab Orchard Springs, 


Springs. 
one following tuble? gives the chemic composition of the 
most important bitter waters; 1 liter of water contains : 





ria ; 
Castalian Mi Hat) oP 
Gab Oued whecdaest or Foley's ‘ 





IV. Sulphurous Waters.—These waters contain hydrogen 
sulphid or some other sulphur compound, such as sodium, cal- 
cium, magnesium, or potassium sulphid. The sulphurous waters 
are obtained both hot and cold; they are especially useful in 
the treatment of syphilis and of chronic lead-poisoning, and in 
hemorrhoidal conditions and congestions of the liver. es 

‘incipal ae waters are the Anderson Sulphur 
California, ch Lick Springs, Richfield Springs, ani Cod 


gr 

V. Iron Waters.—These waters contain large proportions of 
iron; they are divided into the carbonated iron waters, sulphated 
iron waters, and iron and arsenic waters. The carbonated iron 
waters contain large quantities of carbon dioxid; these waters 
increase the number of the red blood-cells and the amount of 
hemoglobin. They stimulate the appetite, but are apt to pro~ 
duce constipation. They are indicated in chlorosis and in 
anemia, Among the principal carbonated iron waters are those 


* Cohen's Physiologic Therapeutics, vol. ix,, p, 435. 


- 


128 BEVERAGES AND STIMULANTS. 


of Franzensbad, Pyrmont, Schwalbach, Richfield, Cresson 
Keyed Rawley (Va.). : : 

chemic composition of carbonated iron water is as fol- 
lows ;' 1 liter of water contains : 





Sulphated Iron Waters—These waters contain principally fer- 
rous sulphate, in addition to sodium, magnesium, and ea 
sulphate. Many of these waters also contain arsenic, alum, and 
sulpburic acid in small amounts, They are especially indicated 
in cages of chronic diarrhea, in anemic children, in chronic gas- 
tric catarrh, in ulcer of the stomach, and in chronic malarial 
cachexia. These waters should be given cautiously, as at times 
they produce indigestion and nansea. They are best taken in 
small individual doses. Among the principal aioe iron 
waters are those of Sharon Chalybeate Spring, ford Alum 
Alam Sprig White Sulphur Springs, and Rockbridge 
lum 
The ab table* gives the chemic composition of the 
most important sulphated iron waters ; 1 liter of water contains : 
1 é eas : ‘ 
1 Cohen's Physislgic Therapeuicy, vol ix, p44, 
2 Cohen's Physiologie Therapeutics, vol. ix., p. 445, 


WATER. 129 





Schuyler County Spring 2... 1.) Seue ioe ata 


Tron and Arsenic Waters.—These waters contain considera- 
ble quantities of arsenic in addition to the iron; they are 
indicated especially in chlorotic and anemic conditions, in 
chronic paar uel 3 in neuralgias. Among these waters may 
be mentioned Harbin Hot Sulphur Springs, Crockett Arsenic 
Lithia igs, and Swineford Arsenic Lithia 

The ing table* gives the chemic composition of the 
most important iron and arsenic waters; 1 liter of water contains: 


Tien ripen Asem n, Anicnous salte. 





Crockett Arsenio Lithia Soro ‘oon 5a 0.0008 

ieitectirim tae Si 
ar Springs 

Lausigk . 0.0001 0.0050 

Lerico . 0.0060 

Recoaro . . 0.0039 0.0050 

Koncegno . 0.1600 0.0050 


VI. Earthy Mineral Waters.—These waters are character- 
ized by the presence of large amounts of calcium and magne- 
sinm salts. ‘They diminish the production of acid in the stom- 
ach, and also the secretions from the respiratory, digestive, and 
urinary tracts. They are indicated especially in chronic catarrh 
of the urinary ns, in uric acid diathesis, gout, scrofula, 
and rachitis, mis rinking these waters small Bae should 
be taken at first, and gradually increased until the flow of urine 
is markedly increased. Among these waters are those of Con- 
trexeville, Marienbad, Wildungen, Manitou Springs, Mount 
eee ‘Mineral Springs, Bedford Springs, Alleghany Springs, 

rings, act Greenbrier White Sul phur Springs. 
oe composition of the most important earthy min- 
eral waters is as follows ; 3? 1 liter of water contains : 
3 Cohen's Physiologic ica, vol. ix, p. 447, 


s Thi wok tea 451. 





130 BEVERAGES AND STIMULANTS. 


Calclum Calcium Catcium 
bicarbonate, 






sulphate, carbonate, 
Grams. Grams. Grams, 
1,80 oe 0,06. 
1,80 0.42 0.47" 
1,80 0,42 O12 
1.50 0.42 O12 
St 0.42 O12 
18 0.42 0.16 
(10 0.45 0.16 
04 144 0.16 
770,94 14 0.34-0.78 
1.83 144 0.12 
0.20 0.12 
0.09 012 
041 O12 
OAL 0.40-1.11 
0,60 0.40-1.11 
0.60 0.61 
0,10 0.61 
0.10 0,08 
1.27 0.08 
197 0,08 


Vil. Acratothermal Waters.—These waters, also known 
as simple or “indifferent” waters, are characterized by the 
fact that they are obtained at a temperature of 85° F. or over. 
They do not, however, contain any active mineral ingredients. 

are rarely used for drinking purposes, but are used 
mainly for thermal baths. (Fora mare complete description 
of mineral waters and their uses the reader is referred to the 
recent and most excellent volume on “ Balneology and Cruno- 
therapy” by Kisch, Hinsdale, and Peale, in Cohen’s System 
of Physiologic Therapeutics, vol. ix.) 


Diet at Water Cures.—Water cures should always be 
carried out at the watering-places. Under exceptional cireum- 
stances a water cure may be ordered at the patient’s home, but 
the results are never as satisfactory as when the patient has a 
change of air, of scene, plenty of out-door exercise, and freedom 
from care and worry. The methods and the diet vary greatly 
at different springs, and for the most part unnecessarily so. 
Many of the diets and methods are empiric and are not founded 
on any sound basis, Certain articles are forbidden at certain 

‘ings, often for most fanciflul reasons, The routine and the 
te tof many springs is the eame for all patients, quite regardlees 
of the nature of the disease. An important factor in the failure 


* Magnesium bicarbonate, 


WATER. 131 


of water cures chaser ern | Patients with 
weak hearts, chronic nephritis, or dilated and atonic 
muy easily take more water than can be disposed of, and positive 
injury may result. 

As a rule, the water should be taken in the ing after 


F 
E 
z 
3 
5 
: 
8 
z 
z 
i 
i 
7 


water and food. Breakfast should be followed by walking or 


should be in bed by nine o’clock. Care should be taken not to 
disturb too radically the habits of the old and infirm, as by so 
doing often more harm than good may result. 

The diet ordered will, of course, depend upon the nature of 
the disease. In general, it may be stated that the dict should 
be that which the patient’s condition calls for, and not the more 
or less arbitrary diet of the particular spring which the patient 
visits. Healthy individuals may take the strict cures if they 
so desire, and often find the change interesting and feel better 
for the mental effect so produced. In a general way the dict 
cures at watering-places forbid meats difficult of digestion, as 
fat or salt pork, smoked meats, fat susage, pité de foie gras, 
sardines, lobsters, eels, and the like, and certain vegetables are 
usually on the forbidden list, as cabbage, young potatoes, old 
ead truffles, mushrooms, unripe and overripe or stale fruit, 

‘ies in some places, nuts as well as all very highly seasoned 
and complicated dishes, cheese, etc. 

Tn general, all strong alcoholic beverages are forbidden, but, 
asa rule, light wine or beer is allowable in smal! quantities if 
the patient can be trusted not to take to much. Coffee and tea 
are usually allowed in moderate quantities, but chocolate or cocoa 
may be substituted in most instances when they sre contraindi- 
cated, or some hot gruel or substitute for coffee may be taken. 
Smoking is usually forbidden, but this rule is very frequently 


— iil 


132 BEVERAGES AND STIMULANTS. 
broken. The advice of an enlightened physician at the cure is 


very 
Besides water, there are a number of beverages that serve 
not only to meet the physical needs of the body, but are also 
taken to produce a stimulant effect. They also serve the pur- 
pose of a stimulant where such is necessary from time to time, 
as in the case of disease. The habit of using beverages, either 
for the purpose of relieving fatigue or for conviviality, is most 
ious, as it is apt to induce a habit for taking such drinks, 
which in time leads to excesses, We shall now take up in 
order the other beverages—tea, coffee, cocoa, and the various 
aleoholic stimulants. 


TEA. 


Tea is a preparation made from the leaves of an evergreen 
plant known as Thea, It is grown in China, Japan, India, 
Ceylon, and in North Carolina. There are many varieties of 
the plant, and the flavor of tea varies with its source and the 
variety of the plant, There are two great classes of teas, the 

and the black, the distinction between the two being due 
tothe method of preparation. Several times during the year 
the plant sends out young shoots, which are picked as often as 
they appear, Black tea is prepared by exposing the fresh 
leaves to the rays of the sun; after they have become withered 
the constituents are liberated by rolling and breaking up the 
fibers and cells of the leaf. The broken-up leaves are then 
collected and allowed to ferment while still moist; during this 
process the tannic acid is rendered less soluble while the essen- 
tial oils are increased. After again exposing them to the sun 
the leaves are dried in an oven. In the process of preparing 
green tea the Chinese “wither” the leaves in pans at a temper- 
ature of 160° F’.; the Japanese steam them, The fluid principles 
are then liberated by breaking up the leaves; finally they are 
again withered, sweated in bags, and slowly roasted. The 
chief difference between black and green tea lies in the fact 
that black tea is fermented while green is not. As in the 
process of fermentation the tannic acid becomes less soluble, 
black tea contains much less tannic acid than green tea. The 
following table, from Bannister,' gives the composition of black 
and of green tea: 


+ Cantor Lectures, 1890. 


COFFEE. 133 





‘Tea has practically no nutrient-ingredients, Its principal con- 
stituents are caffein and tannic acid, and its jal aroma is 
due to a volatile oil. It owes its stimulating to the pres- 
Sete Agata, to lt be aero gee 

process of digestion, tea shot 50 as to contain 
ae proportion of caffein as possible and the smallest 
possible amount of tannic acid. 

When the leaves are in boiling water, caffein is ex 
tracted very rapidly. Tuannic acid, however, is much less 
soluble; it follows, therefore, that in order to have as little 
tannic acid in the tea as possible, the leaves should be boiled in 
water for as short a time as practicable, To prepare the infusion 
pour boiling water on the tea-leaves andallow the mixture to stand 
where it will keep hot, though not boil, for from three to five min- 
utes, Water used in ring tea should not be hard or stale, 

When the tannic acid which tea contains occurs in large 
quantities, the pepsin of the gastric juice is precipitated ; in 
weaker solutions tea retards digestion. For these reasons tea is 
not a suitable beverage for persons suffering from gastric dis- 
turbanees. Among the more prominent symptoms of excessive 
tea-drinking are gastric disorders, cardiac distress, and a variety 
of neryous symptoms, such as excitability, sleeplessness, and 
muscular incodrdination, 


COFFEE. 


Brazil. The fruit of the plant, which has the appearance of a 
cherry, when opened aianoaae the coffee-bean. In order to 

the beans for use they are dried at a high temperature 
ete roasted and ground. In roasting, one-fifth of the 





ll 


134 BEVERAGES AND STIMULANTS. 


caffein and one-tenth of the fat present are lost. The aroma 
of coffee is due to the presence of caffeol, an oil liberated in 
roasting. According to Hutchison (p. 310), a cup of black 
coffee contains about as large a quantity of tannic acid and 
caffein as a cup of tea. Coffee is often adulterated, chicory, 
acorns, and other substances being added for this purpose. The 
adulteration may not be injurious in its effect, but alters, some- 
times even agreeably, the flavor of the coffee. 

Preparation of Coffee.—In order to obtain coffee of the 
finest flavor, the beans should be roasted and ground shortly 


the boiling-point before it is poured over the coffee. The pot 
should then be placed for a few moments in a hot place, but 
boiling must not be allowed to continue, or the aroma will be 
Jost and the coffee contain too large a percentage of tannic acid. 

The effect of coffee on the system is that of a stimulant, due 
to the caffein present ; it acts directly on the cerebral centers, 
stimulates the heart, und deepens the respirations. It is an 
excitant of the nervous system, and in some persons produces 
nervousness, excitability, and insomnia; in others it acts as an 
agrecable stimulant. In persons suffering from dyspepsia it 
has a tendency to disturb digestion, It lessens the strain of 
fatigue, and soldiers frequently depend upon its stimulating 
effect during large marches. 

The following table, taken from Bannister’s Cantor Lectures, 
gives the composition of raw and of roasted coffee : 


—_= 
| 1.05 





: 
i 
F 

















Raw. | Boasted.| Raw, | Roarted. 

1.08 082 111 

9.55 | 043 | 890 | O41 

843 | 474 | 9.58 2 

6.00 | 1414 | 4.91 | 1267 
a ae ie |e ee 
Doxtrin . - 087 | 124 | 0.84 
Cellulose and insoluble col 37.95 | 3862 | 38.60 | 47.42 
Ashe. ee eee ee 3.74 3.08 
Mostar aie, fasts 2 808 | 063 | 964 | 113 

COCOA. 


Cocoa was introduced into Europe long before either coffee 
or tea. It is prepared from the seeds of the cacao tree, Theo- 


— 


broma cacao, The seeds are contained in a pul some- 
i ey on ae 


COCOA. 136 


what resembling a cucumber, from which 

‘The fruit is gat into heaps and allowed to ferment, when 
the pulp becomes loosened. During this process the seeds 
become dark and lose some of their bitterness. They are then 
roasted, by which process they are broken into bits, constituting 
the so-called “cocoa nibs.” A decoction of cocoa nibs is made 
by boiling the seeds in water for several hours and removing 
the residue by straining. Cocoa, as ordinarily prepared, is 
made by grinding the seeds into a paste, to which sugar or 
aeereh ts icttad; if starch is used, the cocos is boiled for a few 
minutes, but if sugar is added, the cocon only requires the addi- 
tion of boiling water or mill. 

Theobromin, the chief alkaloid present in cocoa, occurs in 
amounts of from 1 to 2 per cent. Cocoa also contains nitro- 
genous substances, 15 per cent.; tannic acid, 5 per cent. ; 
starch, 5 to 15 per cent. ; fat, known as cocoa-butter, 45 to 50 
per cent. ; mineral constituents, 2 to 3 per cent. 

Theobromin, while a stimulant, is leas apt to induce nervous 
symptoms, such as sleeplessness and palpitation, than either tea 
or coffee. By reason of the large proportion of sugar and fat 
contained in it, however, when used in excess, cocoa is likely 
to produce indigestion. When not too rich, it forms a nutri- 
tious drink especially useful for children and for convalescents. 

The following table, taken from Ewell,' gives the chemic 
analysis of various cocoa preparations : 











Pat, | Fiber. | Sane | Ash. Added starch, 
>| 30.95 | 880 |. . |424| None 
- -| 8118] 370] . . |633} « 
+ + | 20.81] 4.38 . 
=| 3148] 376 |. “ 
97.56| 442) .. |848) 
25.84 | 1.30 1.66 | Very lite arrow-root, 
{) ag.04 | 151 £15 | Much arrow-root. 


51 
26 
Much wheatetarch and 
18.60) 0.81 | 55 |1.16| some arrow-root, 
32 
58 


uaa | 213 282 | Much arrow-root 
21.13 | 1.10 1.40 | None. 
Chocolate is prepared by adding starch, sugar, and such 
flavoring substances as vanilla to arn It contains 1.5 per 
4 Allen's Commercial Organie Analysis, vol. ili, p. 2 








136 BEVERAGES AND STIMULANTS, 


cent. of theobromin, 15 per cent. of fat, 5 per cent. of nitro- 
genous substances, and about 60 per cent. of sugar. 

In addition to their stimulant effect, cocoa and chocolate 
BS SN possessed by either tea or 


The kola nut properties similar to those of cocoa, 
Tt contains an alkaloid, caffein, thein, or theobromin. 


ALCOHOL. 


Alcohol is produced by the fermentation of sugars with 
yeast. The principal constituent in all alcoholic beverages is 
ethyl alcohol, The glucose contained in fruits is fermented 
directly into alcohol, whereas the starches in such substances as 
potatoes, grains, ete, are converted into dextrin and maltose, 
and then, by the aid of diastatio ferments, before the alcoholic 
fermentation can take , they are converted into glucose. 

‘The food-value of aloohol has heen a subject for discussion 
for many years. Although all admit that alcohol taken in 
excess is a poison and is detrimental to health, yet opinions 
differ widely as to the food-value of alcohol taken in moderate 
quantities. There are those who maintain that alcohol, even 
in small quantities, is detrimental to health and acts as a 
poison, whereas others believe that, on the contrary, when taken 
in smal] quantities, it possesses a considerable nutrient value and 
is to be recommended as a valuable food. The most recent, as 
well as the most exhaustive, work bearing on this subject has 
been done by Atwater in hia experiments on “The Nutritive 
Value of Aleohol” in The Physiologie Aspects of the Liquor 
Question, 1903. This writer sums up his results under the 
following headings : 

1. Effect of Alcohol upon the Digestion of Food. 
Siete to Atwater, the effect of alcohol in small quan- 
tities is slightly to increase the digestibility of protein, but not 

to alter the digestibility of other nutrients—that is, carbo- 
igdeees and futs. 

2. Proportions of Alcohol Oxidized and Unoxi- 
dized.—Atwater finds that at least 98 per cent, of the alcohol 
ingested is oxidized in the body, whereas ordinarily 98 per 
cent. of the carbohydrates, 95 per cent. of the fats, and 93 per 
cent. of the protein are oxidized ; the alechol is therefore oxidized 
more completely than are the nutrients of ordinary foods. 

3. Metabolism of the Energy of Alochol.—Atwater’s 
conclusions regarding the metabolism and energy of alcohol 


hed! 


- 


are: “The which was latent or potential in the aleohol 
Suen wholly traneiemed in the body, was actually given off 
from the body, and was actually recovered as heat or heat and 
tmusenlar work.” “1, The law of the conservation of energy 
obtained with the alcohol diet as with the ordinary diet. 2. 
The tial energy of the alcohol oxidized in the body was 

completely into kinetic on and appeared either 
as heat or a8 muscular work, or both. min this extent, at any 
rate, it was possi te energy of the protein, fats, and carbo- 


Protection of Body-material by Alcohol.—{a) 
Protection of Body-fat—The conclusion reached by Atwater, 
based on direct experiments, is that the fut protection following 
the use of alcohol is very slightly different from that following 
the taking of ordinary food, and that alcohol protests the body— 
fat quite as offectively as do the fats and carbobydrates of the 
food for which it is substituted. 

(6) Protection of Body Protein.—* The power of alcohol to + 

the protein of food or body tissue, or both, from con- 
sumption is clearly demonstrated. Its action in this res} 
to be similar to that of the carbohydrates and fats ; 

t is to say, in its oxidation it yields energy needed by the 
body, and thus saves other substances from oxidation. In this 
way alcohol serves the body as food. Just how moderate 
quantities of alcohol compare with isodynamic amounts of 
sugar, starch, and fat in the power to protect protein from 
katabolism is not yet settled. Apparently it is in some eases 
equal, in others inferior, to these substances. It is by no means 
certain that fats and carbohydrates are always equal to each 
other in this power.” 

* Alcohol appears also to exert at times a special action as a 
drag. In large quantities it is positively toxic, and may retard 
or even prevent metabolism in general and protein metabolism 
in particular, In small doses it seems at times to have an 
opposite influence, tending to increase the disintegration of 
protein. The action, thongh not conclusively demonstrated, is 
very probable. It offers a satisfactory explanation for the 
occasional failure of alcohol to protect protein, the assumption 

ing that the two tendencies counteract each other. The only 
justification for calling alcohol a protein poison is found in this 
disintegrating tendency. This pharmacodynamic action of 
alcobol aj to be temporary, and most apt to occur with 
people ile accustomed to its use. The circumstances under 
which such action occurs cannot be fully defined.” 


ALCOHOL, 137 





138 BEVERAGES AND STIMULANTS. 


5. Effect of Alcohol on the Radiation of Heat 
from the Body.—Atwater finds that alcohol taken in 
moderate Grantee produces no considerable increase in the 
amount of heat radiated from the body ; in large quantities it 
causes a dilatation of the vessels of the skin, increasing the 
circulation and thus increasing the heat radiation. 

6. Rapidity of Combustion of Alcohol in the 
Body.—By Atwater’s experiments it is shown that “alcohol 
is not suddenly or rapidly oxidized ; but if there be sudden or 
rapid exidation, there is a corresponding decrease in the oxida- 
tion of the carbohydrates, fats, or protein; in other words, 
alcobol, carbohydrates, and fats replace one another as sources 
of energy, so that as one is oxidized the other is correspondingly 
6 o 


7. Alcohol as a Source of Heat in the Body.—At- 
water found that in most of the experiments “alcohol was cer- 
tainly a source of heat for the body.” 

8. Alcohol as a Source of Muscular Energy.— 
The conclusions reached by Atwater regarding this are 
extremely important: “The hypothesis that the hol con- 
tributed its share of energy for muscular work is natural and 
extremely probable, but not absolutely proved. The hypothesis 
that the energy of the alcohol was not so used is not culled for 
as an explanation of any fact observed in these experiments. 

“Tt should not be forgotten that the desirability of aloohol 
as part of a diet for muscular work is not decided by the nor 
rower question here discussed. There is a very essential differ- 
ence between the transformation of the potential energy of 
alcohol into the mechanical energy of muscular work and the 
advantage or disadvantage of alcohol in the diet of people 
engaged in muscular labor, Even with the small doses in these 
experiments there were indications that the subjects worked to 
slightly better advantage with the ordinary rations than with 
the alcohol. The results of practical tests on a large scale 
elsewhere coincide with those of general observation in imply- 
ing that the use of any considerable quantity of ‘alecholic 
beverages as part of the dict for muscular labor is generally of 
ee value and often positively injurious,” 

twater gi 





and hence are isodynamic one with the other, 
Alcohol as a Food.—Inasmuch as alcohol contains no 







ALCOHOL. 139 


u ents, it can not be looked upon as a food 
| tissue, but merely as # fuel that on oxidizing, 


digested and readily absorbed in the uli- 
food, however, it is costly, and the danger 
cess in its use is great, The habitual use 
considerable quantities does not tend to 

effects in many persons, whereas in 
| especially of a cirrhotic nature, in the tissues, 
kidneys, etc., are apt to occur, In 















Quite as important as Atwater’s experiments on “The Nu- 
tritive Value of Alcohol” is the valuable review of Abel on 
ic and Physiologic Action of Alcohol,” 
ellaied iologic of the Liquor Problem. 
summarizes the action of alcohol on the vascular system 
is a fay cial ital evider 
at ras present experimental evidence goes, we may say: 
1. That alcohol as such—that is, when it is introduced into 
circulation with the avoidance of local irritation—is not a cir 
‘stimulant.’ 
2, Alcohol in moderate quantities, say a pint of wine, has 
‘no direct action on the heart itself, either in the way of stimu- 
‘ing or depressing it. This statement is based on the results 
of experiments, extending over short periods of time 
only, and does not imply that it holds for the Lem jad use 
of alcohol weaken 
the heart. 










in this quantity. Large quantities of alco! 


“Tt has aleo no action either on the peripheral or central 

ends of the nerves which control the mte and forve of the 

heart, except probably in unusual circumstances, such as pro- 
and severe intoxication. 

“3, Aleohol in moderate quantities has also no direct action 
‘on the walls of the blood-vessels, either on their muscular por- 
tion or on the peripheral terminations of their vasomotor 
nerves. This statement also refers only to the results of single 
administrations. For the pathologic effects of the continued 
use of ‘moderate’ quantities the writings of pathologists must 


be . 
«4. In moderate quantities it has also no appreciable effect 
on the arterial blood-pressure. When a change in this becomes 


— aed 





ik . 


140 BEVERAGES AND STIMULANTS. 


apparent, it is always in the direction of a fall and not of a 
rise. An exception Me shee Wve thd seal coe Ta Boyer ES 
its upper portion. In this case a small and temporary rise of 
pressure follows the rapid injection of diluted alcohol, except 
in those instances when the blood-pressure is very low—say 
30 mm. or below. It is assumed that an anomalous condition 
of some part of the circulatory apparatus accounts for this 
unusual effect. In the early stages of its action it usually 
causes some degree of flushing of the skin and brain, and later, 
when very large quantities have been taken, vascular dilatation of 
the abdominal vessels occurs, The fall of blood-pressure due to 
very large quantities isa toxic phenomenon and is never met with 
under ordi circumstances. It is due to the depressant action 
of the alcohol on the neryous centers which control the calibers 
of the arteries and also in part to the weakened heart. 

“5. It is not to be inferred that the above statements forbid 
a reasonable and prudent use of alcohol to therapeutics, The 
day is happily past when the therapeutist plied his patient with 
a number of bottles of wine a day in the belief that he could 
stimulate the heart, lower the temperature, supply nutriment, 
and effect other good ends without detriment of any kind, by 
giving these large quantities. This broad question of the 
therapeutic use of wine can not be entered on in detail at this 
point, It may be remarked, however, that the cerebral effects 
of alcohol, its numerous indirect influences, its action in caus~ 
ing a different balance in the parts and functions of the vascu- 
lar apparatus, often justify its moderate use in therapeuties. 

«6. Alcohol, by virtue of its local action on mucous mem- 
branes, and also by virtue of its cerebral action, is capable of 
affecting the several parts of the vascular apparatus in a number 
of ways, the resulting effects often being such that the term 
‘circulatory stimulant’ is often applicable. Such indirect 
effects, which are shown by all of the pharmacologic con- 
geners of alcohol, are familiar in the use of alcohol in daily 
life and in medical practice. 

“Of these indirect effects, none is more often observed than 
a quickening or slowing in the pulse-rate, as is frequently seen 
in medical practice. These indirect influences must not 
allowed to hide the true character of alcohol, which is always 

ressant in kind, and which easily gets the upper hand of 

fects just noted. In a word, alcohol, in respect to its inherent 
action, when once in the blood and tissues, must be classed with 
the anesthetics and narcotics,” 

‘The action of alcohol on the respiration is thus summarized 


ALCOHOL. 141 
by Abel: “1. Alcohol is a respiratory stimulant of moderate 
power for human beings. During « period of an hour or more 


(3.5 per cent.). rs 
Ba atighly flavored brandy, and other alcoholic 
beverages which contain larger amounts of stimulating esters, 


«3, The stimulating action of alcoholic beverages is greater 
Ms disasor anol persons ian, Ja’ dices yino acer 
wise exhausted. 

#4. Tnereased heat-dissipation always accompanies the above- 
named effects. The compensatory increase in heat-production 
requires an increase in te oxidative processes of the tissues. 
‘The increased demand for oxygen is the direct cause of the in- 
creased activity of the respiratory center. Small or ‘purely 
exciting’ doses of alcohol have also the effect of increasing the 
movements of the digestive tract and of causing a state of *un- 
rest’ or tension in the skeletal muscles, and thus further adding 
to the demand for oxygen. According to this view, alcohol is 
an indirect stimulant of the respiratory center. 

“5. Tt should be borne in mind that these physiologic 
effects are less anced in man than in the rabbit and other 
animals, which Miter from him in respect to the ease with which 
the respiratory and heat-regulating mechanisms are influenced. 
Singer’s explanation of the action of alcohol on the respiration 
and on the heat-regulating mechanisms of the body at once sug- 
gests comparison with one or another of the antipyretics, such as 
quinin or antipyrin, and calls to mind the difficulties that ham- 
per the study of these drugs. How far the action of alcohol on 
the central nervous system, and how far its influence as a ¢ pro- 
toplasmic poison’ may modify its operation as an antipyretic; 
how far variations in the external temperature, in the humidity 
of the air, and in the temperature of the body itself influence its 
action, must all receive further study. In a word, detailed 
chemic and physiologic studies similar to those that have 
been made on other antipyretics are demanded. Such studies 
will either strengthen or disprove the above theory, and will 
tend to harmonize the conflicting views at present entertained 
in regard to the use of alcohol in fever. As the theory now 
stands, especially when taken in connection with the facts 
brought out in other sections of this paper, it affords a scientific 

ion of the more deleterious effects of alcohol in polar 
tropical as compared with temperate regions.” 





142 BEVERAGES AND STIMULANTS. 


Abel thus summarizes the work on the action of alcohol on the 
nervous system, with special reference to its psychologic action : 
“The psychologic experiments thus far made appear to 
prove that moderate quantities of alcohol (15-30-45 grams) 
shorten the simple reaction time ; the time required in a certain 
rl hetero in process and in certain more elementary men- 
effects, such as reading in a whisper and adding columns of 
simple figures ; that is, in which central motor inner- 
vation is an important r. ‘This effect, that is, greater brev- 
ity of cerebral time, is tacitly assumed by investigators to indi- 
cate that the mental operations in question are performed with 
Lica ease and with less friction; an assumption for which 
is no proof, 

“<A greater tendency to premature and erroneous reactions is 
seen when the reactor has received alcohol. The reactor often 
believes that he is reacting more quickly than usual even when 
the cerebral time is longer. 

“Tn no respect is the action of alcohol in moderate quantities 
more striking than in its influence on the association of ideas. 
The time consumed in associations involving a subsumption 
judgment is, for example, only a little shorter than normal ; 
bar the time required to find a rhyme to a given word is con- 
siderably shortened ; and this state lasts for some time after the 
alcohol has been taken. 

“In general, then, mental processes which involve the work- 
ing up of oer material are not favored by moderate 
quantities of alcohol. 

“Tt will be seen that alcohol is not found by psychologists 
to increase the quantity or vigor of mental operations ; in fact, 
it clearly tends to lesen the power of clear and consecutive 
reasoning, In many respects its action on the higher functions 
of the mind resembles that of fatigue of the brain ; though with 
this action is associated a tendency to ‘ greater motor energy and 
ease.’ There has been much discussion as to whether alcohol is 
in any sense a stimulant for the brain. We have seen that 
ena ay of high repute deny that it has this action ; 

olding that alcohol is a sedative or narcotic substance which 
belongs to the same class as paraldehyd and chloroform ; that 
its stimulating action is but fictitious ; and that even the earlier 
phenomena of its action are to be referred to a paralyzing action 
on cerebral (inhibitory) fanctions.” 

The Action of Alcohol on Muscular Activity.— 
Abel shows: “1, That alcohol has a favorable action on the 


ALCOHOL, M3 


performance of muscular work, both when the muscles are 
vigorous and when they are exhausted. 

“2, This favorable and stimulating is seen almost im- 
mediately after the administration of the aleohol, but lasts only 
; w, A wipe al succeeds th lation. In 

“3, zing action always ¢ stimulation, 
about Pat ae ds after the administration of the aleohol the 
work done reaches a minimum ; and fresh doses of alcohol show 
only a slight stimulating action. 

“4, This later paralyzing action of alcohol overbalances the 
primary stimulating effect in such a way that the sum total of the 
amountof work done with alcohol is less than that done without it. 

“5, Similar depressing effects are not seen to follow the use 
of tea, coffee, or kola.”” 

The effect of alcohol on the digestion and secretion is thus 
summarized by Chittenden :' 

“Upon the secretion of saliva the we of strong alcohol 
or an alcoholic bev in the eat has « direct stimulating 
effect, leading to a sudden increase in the flow of saliva, This 
acceleration of secretion, however, is of brief duration. The 
stimulating effect is manifested not only by an increase in the 
volume of the secretion, but also by an increase in both organic 
and inorganic constituents. The effect produced is in no sense 
peculiar to alcohol, but is common to many so-called stimulants, 
such as dilute acid (vinegar), ether vapor, ete. Indeed, the 
effect is precisely analogous to that induced by an increase in 
intensity of stimulation when the salivary glands are electrically 
excited through their nerves. 

“Hence, so far as our results go, alcohol and alcoholic fluids 
are without any specific effect upon the secretion of saliva, ex= 
cept to produce a transitory stimulation of secretion while in 
the month cavity. 

“Upon gastric secretion alcohol and alcoholic fluids have a 
marked effect, increasing very greatly both the flow of gastric 
Juice and also its content of acid and total solids. Further, 
this action is exerted not only by the presence of alcoholic 
fluids in the stomach, but also indirectly through the influence 
of alcohol absorbed from the intestine, 

“Whisky, bundy, sherry, claret, beer, and porter all agree 
gererng stimulation of gastric secretion. Further, as al- 

iy stated, the gastric juice ceereted under alcoholic stimula 
tion is more acid, contains more solid matterand more combined. 
1 Phyriologie Aspects of the Liquor Problem, p. 298, 








144 BEVERAGES AND STIMULANTS. 


hydrochloric acid than the ordinary secretion, It is likewise 
strongly proteolytic. 

“TE these results are considered in connection with our pre- 
vious observations upon the influence of alcohol and aloabolic 
drinks upon the rey, chemic processes of gastric cece, 
it is seen that side by side with igri oe pec ola 
of digestive jase ire caused by alcoholic beverages there 
occurs an increased flow of gastric juice rich in acid and of 
unquestionable digestive power, e two effects may thus 
normally counterbalance each other, though it is evident that 
modifying conditions may readily retard or stimulate the proc- 
esses in the stomach according to circumstances. Foremost 
among the latter is the rapid disappearance of alcohol from the 
alimentary 

“since. any influence exerted by alcohol or alcoholic bever- 
— upon the solvent or digestive power of the gastric juice in 

stomach must depend upon the presence of alcohol in the 
stomach contents, it follows that the tendency toward rapid 
removal of the alcohol from the alimentary tract by absorption 
must necessarily diminish correspondingly the extent of any 
retardation of gastric digestion which the presence of alcohol in 
the stomach may occasion. Since, however, the stimulation of 
gastric secretion induced by aleohol is brought about not only 
by the direct action of alcohol in the stomach, but also by the 
indirect action of alcohol absorbed from the intestine, it follows 
that possible inhibition of the digestive action of the gastric 
juice would probably be of shorter duration than the stimula- 
tion of secretion, and that consequently in the body alcoholic 
fluids would bardly lead to any retardation of gastric digestion. 

“Especially worthy of note is the rapid disappearance of 
aleohol from the stomach and alimentary tract when aleoholic 
flnids are taken. 

“Tn view of this rapid disappearance of alcohol from the 
alimentary tract it is plain that alcoholic fluids can not have 
much, if any, direct influence upon the secretion of either pan- 
creatic or intestinal juice,” 

Use of Alcohol as a Remedy in Medicine.—In con- 
ditions of heart weakness and arterial relaxation alcohol stimu- 
lates the heart, tones up the arteries, and tends to bring about 
anormal condition. In febrile conditions it lowers the temper- 
ature and checks tissue-destruction. In protracted disease it 
stimulates a weakened digestion and, by replacing a certain 
quantity of carbohydrate, often serves as a food, 

Consumption of Alcohol.—According to Thompson, 





ALCOHOL. 145, 


the total consumption of alcoholic padi a in America 
is more than 1,000,000,000 gallons, The ‘ing table, 
taken from Thompson’s Dietetics, p. 239, gives the annual per 
capita consumption of alcoholic beverages in 1890 : 





Alcoholic beverages are divided into several classes, e. g., 

spirits, liqueurs and bitters, malt liquors, wines, ete, 
‘SPIRITS, 

Spirits are ce by fermenting saccharine substances 
and obtaining the alcohol by distillation, Of these substances, 
corn, rice, barley, molasses, and potatoes are those most com- 
monly utilized for this purpose. In addition to the alcohol, 
by-products are formed, and it is to these that spirits owe their 
characteristic flavor and odor. The by-products contain the 
higher alcohols, such as propyl, butyl, and amyl alcohol, this 
mixture forming what is known as fusel oil. 

Whisky.—The United States Pha ia defines tet 
as “an alcoholic liquid obtained by distillation of the 
of fermented grain (usually of mixtures of corn, wheat, and rye) 
and at least two years old.” Whisky possesses an alcoholic 
strength of from 50 to 58 per cent. by volume. It should be 
free from disagreeable odor. The ether and aldehyds contained 
in whisky become altered in character as it ages, and the flavor 
is thus rendered more le. 

Brandy.—In the United States Pharmacopeia brandy ix 
defined as an “alcoholic liquid obtained by the distillation of 
the fermented unmodified juice of fresh grapes, and at least 
four years old.” Brandy contains from 46 to 55 per cent, by 
volume of alcohol. The quality of brandy depends upon the 
variety of grapes used and upon the length of time the brandy 
is allowed to stand: the older the brandy, the better the quality. 
With brandy, just as with whiskey, on standing ethers and alde- 
hyds are reproduced to which the special flavor of the brandy is due, 

The color of brandy is due to the tannic acid extracted from 
the oak cake in which the brandy is contained. There are 
many inferior grades of brandy on the market, some being 
merely alcohol colored and flavored with various essences. 

10 


146 BEVERAGES AND STIMULANTS. 


Rum.—Rum is the product of the distillation of fermented 
molasses, its flavor being due to certain by-products. Some of 
the so-called “rum” of the market is made by adding various 
essences to alcohol. On standing, by the development of 
special aldehyds and ethers, rum improves in quality. It con- 
tains about the same percentage of alcohol as do brandy and 


whisky, 

Gin.—Gin is produced by the distillation of rye and malt 
mash, its flavor being due to juniper berries which are added 
during fermentation. Inferior grades of gin are manufactured 
by adding juniper berries, turpentine, ete., to alcohol. Gin 
contains from 15 to 20 per cent. of alcohol ; but the strength is 
sometimes increased by the addition of alochol, eo that it may 
contain as much as 35 per cent. of alcohol. 


LIQUEURS AND SITTERS. 

Liqueurs or cordials and bitters contain a large pi ion 

of alcohol, and a high percentage of sugar and essential oils. 

The following table gives the composition of some of the more 
common liqueurs and bitters : 








Analysis of Liqueurs—(Rupp.) 
Aleohel. 
jueur. a ae 

br ay Frotama, | Wetghi. Extracts.) Sugar, | Salt. 
11 | 0.220 

30.9 | 0.310 

282 | 0.100 

432 | 0.090 

75 | 0.140 

265 | 0.075 

334 | 0.110 

34.0 | 0.091 








MALT LIQUORS. 


Under the heading of malt liquors are included beer or ale 
and stout or porter. These beverages are made by fermenting 
malt and hops. Malt is produced by ullowing moistened barley 
to germinate at a moderate temperature; in this process the 
diaztatio ferment acta upon the starch, converting it into sugar 
and dextrin. After drying and grinding, the malt is mixed 
with water and thus made into a mash, which is again heated, 
thus more completely changing the starches into sugar. 

Beer.—The quality of the beer depends largely upon the 


ALCOHOL. ui 


temperature at which the process of manufacture is carried on, 
Pale poe peo by drying the mash at low temperature, 
whereas the darker beers are the result of drying the malt at a 
hee temperature. The infusion of malt is termed “ mash.” 
diastatic action of malt is inhibited by boiling the “ mash” 
with hops ; in this way tannic acid and extrictives are with- 
drawn. The mash is now cooled and fermented with yeast, 
Tn order to secure a pure beer, great caution must be exercised 
to procure pure yeast. The yeast that rises to the surface after 
fermentation is skimmed off, the remainder settling at the 
bottom. Beer is now placed in casks, the yeast which was 
allowed to remain continuing to produce serene The 
longer this process is allowed to continue, is the 
perenne of alcohol in beer. The mild or iter ose acs 
liatinguished by the relative proportion of hops contained in 
them ; the milder forms contain considerable quantities of hops, 
whereas the bitter ones contain but small amounts, 

Volatile bodies are also produced which, in addition to the 
carbonic acid gas formed, add to the pleasant flavor of the beer, 
In order to add to the keeping qualities of beer various pre- 
servatives are added, such as calcium sulphate, salicylic acid, ete, 
These substances not only affect the flavor of the beer, but when 
taken in large quantities have a deleterious effect on the system, 

Porter and Stout.—Porter and stout are made by fer- 
menting malt, the latter, however, being roasted, during which 
process a certain amount of caramel is produced, It. is to this 
substance that the dark color is due. Beer as well as stout 
contains from 3 to 8 per cent, of alcohol, from 2 to 5 per cent. 
of dextrin, and from 0.5 to 1 per cent. of sugar. 

The following table' gives the composition of some malt 














liquors : 
ar Ja 
; | Se g re 
§ |e22| 2 g 
EVIE: a § 
Favarian winter beer | 91.81) 321 | 4.99| 0.81 | 0.44 |2.92| 0.110] 0.20 
Bavarian summer beer gost! 3.68 | 6.61 | 0.49 | 0.87 | 4.39) 0.128 | 0.22 
Munich Hofbraa . . 2.70 | 6.87 
Manich Spa 428 | 661 
eee | 91.15) 346 | 4.97 | 087)... |. . | 0.160) 0.20 
Munich Bock-beer 88.72| 4.07 | 7.23 | 0.71 | 0.00). . | 0.170) 0.27 
Bea sles porter 10| 489) 6.03 | 0.68 | ost |. . | 0.310] 081 
white beer 3.91 | 4.85 











148 BEVERAGES AND STIMULANTS. 














ila in i 
HHO 





ot $328 oat et : aoa 

















ae 





ass [fasste: ree 
ee 
si EERE Y PELE 
sonora |FSS5ES2 8 S2885 
2 | SESSSE § BEETS 
sy |§43823§ 25848 



































































enter into the production of a priest 
‘The following table, taken from Dupré? gives the main con- 
caret of grape-juice and the wine Ao is manufactured 
mape-juice or must contains— 


Water Vegetable mucus, 
Frufecoger $101 90 per cent, Ertmativea, 
Malic acid. Mineral substances. 
Albuminous substances, Tats cece} kernels, 
Wine contains— 
Water Ethers of foregoing alcohols and acids, 
a 
Prope seobl Tenetiglante 
in. 
Batylio alochol [5 % 22 per cent. Olle produced by fermentation, 
‘Amylic alcohol 
Other highor table mucus. 
poeeaee ‘Tannic acid. 
Racemio Extractives 
poem 0.8 to. 08 per cent. Mineral matters, (.15 to 0.6 per cent, 
Butyric acid 


Among the constituents of the juice of the grape are albu- 
minous substances, and fruit-sugar, and tartaric and tannic 
acids. The yeast that grows upon the albumins ferments the 
‘al with the production of ‘alonhal. ‘The character of the wine 

upon the quantity of albuminous material present: if 
a is little albumin, the yeast soon ceases in its work of con- 
verting sugar into alcohol, i in consequence of which the wine 


1 “What is Wine?" Popular Science Review, vol. vii. 


150 BEVERAGES AND STIMULANTS, 


is sweet ; on the other band, if there is much albu- 
minous material present, the yeast continues to grow until all 
the sugar is converted into alcohol, in consequence of which a 
dry or acid wine is produced. 
Ordinarily, wine does not contain more than 16 per cent. of 
inasmuch as the action of the yeast is inhibited by this 
Fae of alcohol. Frequently, however, wine is “ fortified ” 
“fortified. 


ition of alcohol ; this true of port, which is always 
” 

‘The yeast used in the fermentation of grape-juice is obtained 
in pure cultures and added to the juice to produce the required 

wor, 

The methods of wine-production vary greatly, and require 
no description here. Suffice it to say that the fermentation at 
first lasts from three to six weeks; the albuminous material is 
removed a number of times, and the wine is then placed in 
casks ; here the percen' of alcohol increases, and the color 
of the wine becomes fixed. Fermentation still goes on, how- 
ever, and may continue for many years, thus increasing the 
percentage of alcohol. 

Ethers are also produced, which continue to be formed even 
_ after the wine has been placed in bottles. The color of red 
wine is due to a coloring-matter contained in the skin of the 


grapes. 

OF the important ingredients of wine, may be mentioned 
water, acids, alcohol, sugar, ethers, glycerin, and extractives. 

Acids—The most important acids contained in wine are 
tartaric, malic, and tannic; others of less importance are acetic 
and succinic, Tartaric acid occurs in combination with potas- 
sium as potassium bitartrate. The total amount of acids in 
wine varies, but rarely exceeds 0.5 per cent. 

Alcohol.—There are several alcohols present in wine; ethyl 
alcohol occurs in largest quantity; amyl, propyl, and butyl 
alcohol are also present in varying amounts. As has been 
stated, natural wine never contains more than 16 per cent. 
of alcohol ; if it contains more than this amount, it has been 
“fortified.” This is often done, especially when the wine is to 
be shipped from warm countries to foreign districts, to prevent 
it souring. 

Sugar.—Sour wines contains about 1 per cent., and sweet 
wines about 4 per oent., of sugar; it is evident, therefore, that 
sage is present in too small a quantity to be of any food- 

ue, 


ALOOHOL, 161 


Sag pea perpetrate heer At 
are produced by the action of the alcohols and acids upon 
other, It is to the character and quantity of the ethers con- 
tained in them that the flavor of various kinds of wines is 


*"Cipern—< is presen Ja about obe ue 
i erin t in wine ut 0 
of the hung nahi 


Extractives.—A large part of the solid material of the wine 
=i gs extractives, mainly the carbohydrates, as pectins 
gams. 
Varieties of Wines.—From a dietetic standpoint the 
classification of Chambers is probably the most practical ; ac- 
cording to this author, wines ure divided into seven classes : 


a eae dry wines. 4. Acid wines, 
2. Strong sweet wines. 5. kling wines, 
3. Aromatic wines. 6. Posie wines. 


7. Rough or astringent wines. 


Strong Dry eee wines bern bees 
tage of alcohol, to which, as a ru! tie 
aleahol has been added in their production ; in other words, 
they are “fortified.” Examples of this class of wines are 
port, sherry, and Madeira. In eases of fever these wines are 
utilized in place of whisky. Port contains from 15 to 20 per 
cent, of alcohol and considerable tannic acid. Sherry is a 
fortified wine; it contains from 15 to 22 per cent. of alcohol. 

2. Strong Sweet Wines.—These wines contain fruit-sugar 
in quantities sufficient to act as a preservative and prevent 
further fermentation. Under this head may be mentioned 
Tokay, Malaga, and sweet champagne. They contain from 
18 to 22 per cent. of aleohol and from 3 to 5 per cent, of 
sugar. Owing to their sweetness they are taken in small 
quantities. 

8. Aromatic Wines.—Aromatie wines possess a superior 
flavor and contain essential oils and considerable alcohol ; ex- 
amples of this class of wines are Moselle, Capri, and some of 
the Rhine wines. 

4. Acid Wines.—The distinguishing feature of this class of 
wines is the large quantity of acid they contain. 

5, Sparkling Wines.—Sparkling wines contain considerable 
quantities of carbonic acid gas, to which their exhilarating 
effect is due. The chief variety of this class of wines is 








152 BEVERAGES AND STIMULANTS, 


champagne. The dryness or sweetness of champagne 

upon the proportion of cane-sugar and cognac added during 
the process of manufacture. In the manufacture of dry cham- 
pagne 8 per cent. of sugar is added, while the sweet brands 
contain as much as 16 per cent. Since champagne does 
not contain large tities of sugar, and since the larger part 
of the sugar it originally contains pe Caepearel during fer- 
mentation, it is considered less likely to produce flatulence, and 
is therefore preferred by invalids. Dry champagne is a pure 
wine containing from 9 to 12 per cent. of aloohol and from 1 
to 4 per cent. of sugar, 

6. Perfect Wines.—Perfect wines are defined by Chambers 
as those containing alcohol, water, sugar, ethereal flavors, fruity 
extractives, and acids, Under this head come Burgundy and 
Bordeaux, Burgundy contains a rather large percentage of 
alcohol and extractive matter; it is, therefore, said to have 
considerable “body.” Good Bordeaux wines are thoroughly 
fermented, and, together with the Burgundies, contain very 
little sugar ; they are, therefore, well borne by invalids, and are 
especially useful as tonics during convalescence from protracted 
illnesses, 


Rough Wines.—Rough wines contain considerable quantities 
of tannic acid, to which they owe their astringent effect. 
They contain little alcohol, and are of slight value for medicinal 














dh | ja 
He 
gees) g |B) * Fa 
0.390 | 0,088 | 0.206 | 0.002 | 1.990 | 0.17 | O04 
b.Soo | O67 | amy | tas | 2st | Oat | 0.08 
Ses tag faa | bas 
0.286 | O61 | 0487 | 8035 | 6.060 | 0.50 Coat 
0.873 | 0.247 | 0.680 | Lxs0 | 4440 | 9.7 | 0.098 
0.308 0.00 | 0434 520 | bau 2B) 0.058 
0.206 | 0.120 | 0.361 | 600 | 5.300] 0:28 | 0.049 





The following tables’ give the average composition of some 
American wines : 


1 Compiled from The sic American Wines, W. D. Bigelow, U. 8 
Department of Agriculture, Bulletin No. 69, 1900. . 





























ba 

















se weal Sansa 0.225 
2a 
ba foe Se BF lee oan 
ty aiaal oi 
ay AY: |Soen thet| fe | es |aisioo| S30 | Bie [tsa03) wae 211) eal iat |i sini? >: Tao) OStr 
«bewel oe | 0854 
Red Wines—Shuthern Bronk Type. 
ee obec = of 27M | 0.258 [11 108) 0.566) 0.005 | 0.425 | 2196 | 1°67). asheeele 0.0011) i) 
Walle Winer—Rhine Wine Type. 
TA: 00 





433/974] Bas | ae) 184) ase 52 | SRR) QS maa» 2]: RAL 











14 BEVERAGES AND STIMULANTS, 





































































i § i 8 i #8 # Bi e ‘Specltic gravity. 

PIPRLER Es = 

i so 

US A 

ae: : 

3 = 

fi Be 

S35 7: Sore 

ED ERE £2 

ditailil AF 18 oer 

ea ie! tat Ab fe corer | 

3 E 3 # Fa 8 8 2S 55 | ined acias. 5 

PEER PE HH Beem | 

Pitt #8: 

pt 52 | Poirization, 
Sodium chiorid, é 
: Fy 

ee aa 
ulphurous acid. 3 

ae 2 nore 1 

E "waa 











i et pled Mad (1) 


ALCOHOL. 155 


poop aipeipiaipaaia ies 


‘ life, 
ive rn On account of the 
ee aga contain they have con- 
pe food-value. The use of malt liquors is contraindi- 
cated especially in such conditions as gout, obesity, diabetes, 
and diseases of the urinary tract. 
Wines appar to exert a depressing effect on the gustric 
secretion. Taken in moderate quantities, however, by increasing 
the appetite and the motor function of the stomach, ie den 


pressing effect is not only overcome, but the digestion 
greatly im) 


proved. 
ie, gives the following conclusions as to the use of wine 
“Wines for daily use by healthy adults should not on the 
average contain more than 10 per cent. absolute aleohol (by 
weight) ; 8 or 9 per cent. is better, 
“Tf wine be used as the daily drink, it is best, as far as may 
be, to use only one kind at a time and no other form of alcoholic 


juor. 

“Sound natural wines are to be obtained at the best economic 

advan' from the Bordeaux district; the red wines are to be 
Rhine wines (white) are equally excellent, but more 
expensive. 

“ Hungarian wines are also in many instances excellent, but 
they are unequal in quality, owing to defects of manufacture. 

“Greek wines labor under the same defects, 

“The fortified wines, as a class, develop no proper vinous 
qualities till they have been for some years in bottle. Sherry, 
however, is greatly superior to the other wines of this class in 
the rapidity with which it develops the volatile ethers. 

“Fortified wines in small quantities, especially sherry, for 
the reason just named, are the appropriate stimuli of certain 
kinds of infantile and youthful debility, and of the enfecbled 
nervous system of old persons, 

“Half a bottle of a natural wine a day for a sedentary and 
a bottle a day fora vigorous and actively employed adult affords 
a reasonable and prudent allowance of alcohol, and this quanti 
of wine, either ake or with water, will be enough to par 


1 On the Uses of Wines in Health and Disease, 1877, , 39, 


BEVERAGES AND STIMULANTS. 


156 
































PO Sag) (age4p) 9p! , 20048 5, 
AS a BP (yerp) 20pm ., 70mg, 


Shen yp racte G pamnog ..capw Furppndg,, 
Sees peng ,sopro outed mug ,, 
Re bors pore ,{20pp9 ousedaamyy ,, 


Fess (a htp ax0,,) 29p—o ym 
*kaapno poyuaun fy A 


























ALCOHOL. 187 


the needs of moderate persons for a beverage at luncheon and 
dinner, the only two meals at which alcohol should, as a rule, 
be taken.” 


CIDER. 


Cider is a beverage prepared from the fermented juice of 
ripe apples. The amount of alcohol contained in this beverage 
varies between 3 and 8 per cent. by volume. It also contains 
malic acid, salts, sugar, albuminoids, and extractives. Cider is 
a diuretic drink and acts as a laxative. On exposure it under- 
goes an acetic acid fermentation, whereby it is rendered unfit 
for drinking purposes. 

The table on p. 1561 gives analyses of American ciders. 


1 Crampton, Foods and Food Adulterants, U. 8. Department of Agriculti 
Bolletin No. 18, 1877. aie 


VARIOUS FACTORS IN THEIR BEARING 
ON DIET. 


CONCENTRATION OF FOOD. 


CoxcENTRATED foods are those from which the T por 
tion of the water present has been abstracted, and thus the 
weight and the bulk of the food diminished. There are 
many ea concentrated foods on the market. They find 
their chief use in the treatment of patients who take too little 
of the usual forms of food to maintain strength, and, second, 
in cases where it is important that a large quantity of nourish- 
ment be taken. 

Food can be concentrated to various degrees, Desiccated 
meat is the most concentrated form of protein ; sugar, the most 
concentrated form of carbohydrate; and olive oil, the most 
concentrated form of fat, 

1. Concentrated Proteins.—These foods are prepared 
from milk, meat, eggs, and vegetables, Meat is concentrated 
by drying, and in this form it is generally indigestible ; which 
can, however, be overcome by predigestion or powdering; in 
this class of foods are included somatose, pemmican, and 
Mosquera’s “Beef Meal” (see p, 162). Among the con- 
centrated foods derived from the casein of milk are nutrose, 
eucasein, etc. (see p, 161), Eygs are dried in vacuo; sugar is 
usually added, and the eggs are then pulverized, Of the 
vegetable proteins utilized in concentrated form are aleuronat 
and Jegumin, 

2. Concentrated Carbohydrates.—Sugar is the most 
important of the concentrated carbohydrates. In this form, 
however, it is apt to disagree and cause fermentation. To this 
class of concentrated carbohydrates belong the malt extracts. 

3. Concentrated ‘Vegetables Many vegetables, such 
‘as potatoes, carrots, cabbage, and the like, are concentrated by 
drying. They are utilized only in those instances in which it 
is impossible to secure fresh vegetables. 

Bread is frequently dried and eaten in the form of “hard- 
tack,” when it is impossible, as during voyages, to obtain fresh 
bread. 


PRESERVATION OF FOOD, 169 


PRESERVATION OF FOOD. 


preservation of food is meant the process by which the 
foot i so changed that it can be kept for a longer or shorter 
period of time without undergcing putrefaction. The process 
of fermentation is induced by micro-organisms it in the 
atmosphere coming into contact with the food and contaminating 
it. Since patrefactive germs require a certain amount of moist- 
ure and heat for their growth, such foods as contain little water 
and that are not kept too warm are not so likely to undergo 
decomposition ; on the other ear pot containing Rae water 
undergo fermentation very rapidly. To prevent. this 

four methods of preservation are, according to Yeo," aniabley 


1. ing. 

2. Beletion of ate, air. 

3. Exposure to col 

4, Treatment with antiseptic chemic agents, 

1, Drying.—By this process a lurge proportion of the water 
is abstracted. Pemmican is a form of meat preserved by this 
method (see p. 161), Vegetables, such as carrots, peas, potatoes, 
ete, are also preserved by drying. Milk, in the form of nutrose, 

as egg powder, and fruits are often preserved in this manner, 

2. Exclusion of Air.—Air may be prevented from com- 
ing into contact with food in a number of ways: by immersing 
the food in oil or fat; by heating the food, so as to evay 
the external layers ; by coating with some impermeable sub- 
stance, as oil, salt, sawdust, varnish, or paraffin. Fish are 
frequently preserved by immersion in oil or by smoking. Ham 
and bacon are preserved by smoking, by which process the 
outer surface becomes coagulated and impermeable. Eggs are 
preserved by covering the fresh eggs with some impermeable 
substance, such as oil, fat, beeswax, or sawdust. In order 
properly to preserve food by exclusion of air it is highly im- 
portant that the food be perfectly fresh, and that any air that 
may be present be expelled. 

In canning, the food to be preserved is heated in tin cans 
until steamed, when, all the air having been expelled, the can 
is soldered and rendered air-tight. Various methods have been 
resorted to to obviate the necessity of cooking in preserving 
food. MeCall advises the partial exclusion of air and the dis- 
infection of what remains with sodium sulphite, A method of 
replacing the air by nitrogen and sulphurous acid has also been 
recommended. 

| Food in Health and Disease, p. 176. 


LANE LIBRARY. STANEQEG UMNERSITA, 


160 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


3. Exposure to Cold.—Food can be preserved indefi- 
nitely by ice. Meat and fish, which are often preserved by this 
means, should be cooked at once after thawing, Frozen meat 
loses about 10 per cent. more of its nutritive value in cooking 
than fresh meat, Frequently food is not kept directly on ice, 
but in refrigerating chambers; it can thus be shipped many 
thousands of miles on land or water without showing the 
slightest tendeney to decomposition. The use of cold storage 
for indefinite periods of time is to be condemned, and storage 
warehouses should be compelled to brand all stored food as such, 
as well as with the date of entrance. 

4, Treatment with Antiseptic Chemic Agents.— 
Under ye eirennen the only chemie agents allowable 
in preserving are salt, sugar, vinegar, and wood smoke, 

1, Salting.—The salting of food isa method that has been 
practised for many centuries. In this way meat and fish are 
easily preserved. The pale color of the meat produced by 
salting is overcome by adding a little saltpeter in addition to 
common salt, By salting, considerable proteins are extracted 
from the meat—according to Liebig, one-third of the nutritive 
value of the meat is lost in this way. After the salting has 
been accomplished it is often followed by smoking. 

2. Sugar in strong solution acts as an antiseptic, and fruits 
are thus often preserved in concentrated syrups. 

3, Vinegar acts as an antiseptic in preserving cucumbers, 
pickles, oysters, eto, 

4, Other Antiseptics for Preserving Foods.—Among 
these substances are sulphur vapor ; weak carbolic acid ; strong 
acetic acid ; injections of alum and aluminium chlorid into the 
blood-vessels ; boric acid ; borax ; salicylic acid; formaldehyd. 

Chittenden and Gies* have studied the effect of borax and 
of boric acid on the general nutrition. They conclude that, 
taken in small doses for a long time, borax does not alter 
metabolism or disturb nutrition. In larger doses borax retards 
protein and fat assimilation. In very large doses it causes 
Pavesi viele, oid Winrebad. (Gee Boot Adaltocntions Pe 
189.) Wiley *has made an extended study of food preservatives, 
and concludes that boric acid and borax used even in small 
quantities over long pore of time disturb appetite, digestion 
and the general health. The fact that certain individuals may 
take small amounts of certain food preservatives for long periods 
of time without injury is no argument in favor of their use, as 


1 Amer, Jour, Physiol, 1898, No, 1. 
‘United States Department of Agriculture, Bulletin 84. Part I. 


ARTIFICIAL FOOD PREPARATIONS. 161 


we have no method of determining who will be and who will 
not be injured in this way. Wiley states positively that there 
is no necessity for using either chemie preservatives or artificial 
coloring-matter in food-products, Food Jaws should be enacted 
and carried out prohibiting the use of coloring-matters, chemic 
preservatives, and sophistication of every ind, 


ARTIFICIAL FOOD PREPARATIONS. 


To this class of foods belong those preparations that are so 
concentrated as to furnish a large amount of food in small 
bulk ; being of small bulk, they can be added to liquid foods, 
and thus the nutritive value of the latter increased without in- 
creasing the total quantity of liquid taken, A number of these 
preparations have been mentioned under the head of beef-juices 
and meat-powders. The various casein preparations, among 
which may be mentioned nutrose, eucasein, sanose, and plasmon, 
are artificial foods. 

1, Nutrose is prepared from the casein of milk combined 
with an alkali (sodium), which converts the casein into a color- 
less, tasteless powder completely soluble in water. It contains 
from 13 to 18 per cent. of nitrogen, and is used as a food in 
digestive disturbances. It is administered in soups (one-third 
to one-half ounce of nutrose to each cupful). 

2. Eucasein is a similar preparation, in which, however, 
ammonia enters instead of sodium, 

3, Sanose is a food containing 80 per cent. of pure casein 
and 20 per cent. of egg-albumin. It is a colorless powder, It 
emulsifies in water, forming a white liquid, and can be taken in 
cocoa, mill, or broth. 

4. Plasmon is prepared from the proteins of milk, and is a 
most useful casein product. It is a white tasteless powder, 
soluble in warm water. It is administered in water, milk, or 
broths. It contains about 70 per cent. of proteins. 

Artificial Proteins made from Meat.—A number of 
these preparations have already been described. To this class 
belong: 1. Pemmican. 2. Peptone-products, 3. Mosquera 
“Beef Meal.” 4. Somatose, 

1. Pemmican is prepared by cutting meat into thin slices 
and allowing these to dry; sugar and dried fruits are added, 
the nutritive value of the meat being thereby increased. Forty 
parts of fat are added to 50 parts of meat.' 

2. Peptone-products.—Peptone-products are predigested 

‘Voit, Zeitshr. f. Biologie, 1889, vol. xxv., p, 232. 


162 VARIOUS FACTORS IN THEIR BEARING ON DIET, 


tone-products manufactured may be mentioned Kemmerich’s, 
Koch's, Benger’s, Savory & Moore’s, Carnrick’s, Armour’s 
Wine of Beef Peptone, and Panopepton. 

The following table, taken from Kénig, gives the chemic 
composition of some peptone preparations : 





rooms |g abe at en lel g 











‘Kemmerich's meat dary) 33.00 | 9:78 | 110 | 14.26 | 32.57 
area poone ey) > | gota | a0 | Laz | ine | iat 

jelly. 16)... | 20) 475 
Savory &' Moore's Suid beef = s|g7m| a7 | °: | baz! 274 








3. Mosquera Beef Meal is prepared by partially digesting meat 
by means of a ferment obtained from pineapple juice. Accord- 
ing to Chittenden, this product contains 90 per cent. of nutri- 
tive matter (13 per cent. of fat and 77 per cent. of protein). 
‘The proteins are mainly in the form of albumoses and peptones. 
‘This preparation has a yery high nutritive value and may be 
added to cocoa, milk, or broth. 

4. Somatose.—Somatose is a predigested meat consisting of 
albumoses. It is a yellowish powder, tasteless, odorless, and 
highly nutritious, and is usually well borne even in gastric 
disturbances. 

Artificial Proteins prepared from Vegetables.— 
‘The two principal forms of this class of foods are as follows : 

1, Roborat.—This is a vegetable protein manufactured from 
rice, wheat, and maize, It is a fine, odorless, and tasteless flour, 
slightly soluble in water. It is well borne by the stomach, and 
is absorbed about as well as an animal albumin (up to 95 per 
cent.). It is free from nuclein and does not increase the excre- 
tion of uric acid, It may be added to any food, but ordinarily 
30 or 40 per cent, of it is mixed with flour and baked. 

2. Legumin consists of the casein of the legumes, and isa 
highly nutritions protein food. 

3. Aleuronat is a brownish powder chiefly utilized as a food 
for diabetics. It contains 80 per cent. of protein. 

Artificial Proteins prepared from both Animal 
and Vegetable Foods.—Of this class, one product espe- 
cially must be named—i, ¢., Tropon, This is prepared mainly 


\ all 


ARTIFICIAL FOOD PREPARATIONS, 163 
from fish and ‘les, and as sold on the market i 
a brownish powder. It is eaten mixed with 


ARTIFICIAL PROPRIETARY FOODS, 


umber of proprietary foods, designed as substitutes 
for falter at infants al invalids, are on the market. Infants 
fed upon such foods alone are apt to become rachitic, Some 
of these foods have little food-value, especially the ae 
foods in which the starch has not been Many 
these preparations contain too little fat and far too grea 
of carbohydrates. According to Holt, “when scot 
are fed upon foods lacking in fat the teeth come late, the bones 
are soft, pigeany flabl 7 while Rages +" ie es 
much sugar are uently very ar at their 
is ier ah biahey wal walk et an iy erp readily about the 
se ews feta! out," 
waa ane ae ea no ge of -value, for the 
digestibility of the rt is the all-important question. Investi- 
gations into the value of food-stuffs must be conducted and con- 
trolled both in vivo and in vitro—both in the body and in the 
test-tube. The results of test-tabe experiments are of value, but 
the final test of food-stufis must be made on animals, and prefer~ 
ably on man, These experiments are both tedious and difficult, 
but there is a growing appreciation of their value and an in- 
creasing resort to their use.” 

Hutchison * divides proprietary foods into three classes : 

1. Foods prepared from cows’ milk with various 
additions or alterations, and requiring only the addition of 
water to fit them for immediate use. To this class belong 
Malted Milk, Nestlé’s Food, Lactated Food, Carnrick’s Food, 
Cereal Mill, Wyeth’s Prepared Food, and Wampole’s Milk 
Food. ‘These foods are prepared from flour and mixed 
with milk or cream and then dried. By means of the malt, 
which is added the starches are converted into dextrin and mal- 
tose. The general composition of these foods is as follows : 





“Dietetic Value of Patented Foods!" Now York Med Jour., January 28, 
1004, * Pood and Dietetics, », 445, 





164 VARIOUS FACTORS IN THEIR BEARING ON DIET, 


The chemic composition of Malted Milk and of Nestlé’s 
Food is thus given by Chittenden :* 


‘Malted Milk. Nestlé's Food. 
9240 92.76 


115 0.81 
0.60 0.36 
538 3.80 
0.29 0.13 





repared from cereals of 
which the starch has heen partly or wholly con- 
verted into dextrin or sugar, and which require the addi- 
tion of millc to fit them for use, To this class belong Mellin’s 
Food, Savory & Moore's Infant Food, and Benger’s Food. 
‘Theee foods are prepared by mixing equal parts of wheat flour 
and barley malt with bran and potassium bicarbonate. The 
mixture is made into a paste with water, and kept at a warm 
temperature until the starch is converted into dextrin and 
maltose, As these foods are r in fat, protein, and mineral 
mutters, they are added to milk in order to render them more 
nutritious, 

3. Farinaceous Foods in which the Starch has not 
been Predigested.—To this class belong Ridge’s Food, 
Neaye’s Food, Imperial Granum, and Robinson’s Patent Bar- 
ley. These foods are poor in fat, protein, and mineral matters. 

Other Proprietary Foods.—Crackers are prepared from 
flour, water or milk, and are baked into various forms. 
Baking-powder and soda, and frequently milk, butter, sugar, 
and flavoring extracts, are added. Crackers are, as a rule, 
easily digested, 

Malt Extracts.—Malt extracts are manufactured by heating 
a solution of malted barley at a moderate temperature in vacuo, 
‘The average composition of malt extracts, as given by Klem- 
perer,? is as follows : 





Malt extracts are especially useful as beverages for those 
weakened by chronic disease, as tuberculosis or anemia, and in 
the convalescence from acute diseases, as after typhoid fever 


1 New York Med. Jour, July 18, 1890, 
1 Tayden's Handbuch der Endhrungetherapie, 





COOKING OF FOODS, 165 


or pneumonia. Among the various malt Linge may be 
mentioned Maltine, Kepler’s Extract of Malt, and Hoff’s 
Extract. 

The following table gives the chemic composition of various 


foods manufactured by the Battle Creek Sani- 
tarium Co. : 








Guten: 


Gluten meal 40 percent, -| 8.70) 41.10) . - | 47,90 1.10 | 1.20 
Gluten biscuit 40 per cent. .| 8.70) 41.10) . . | 47.90 1.10 | 1.20 























COOKING OF FOODS. 


The cooking of food is an art practised by all races, savage 
as well as civilized. Food is cooked to improve its flavor, to 
soften it so that it can be masticated and more easily digested, 
and finally to destroy all parasites and disease germs that may 
be present in the raw od. By cooking, certain flavors are 
developed, which by their savoriness increase the appetite and 
the taste for the food. Cooking, moreover, destroys the tot 
fibrous enyelops that surround many foods, thus permitting 
food to be more easily acted upon by the various digestive 
fluids, Various parasitic organisms present in many foods are 
destroyed by cooking, and food thus freed from one of its 
most dangerous elements. On cooking, the protein in food 
coagulates ; under the influence of dry heat the starches are 


166 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


gradually converted into dextrin, whereas under the influence 
of moist heat the granules gradually swell until they rupture 
their envelops. by boiling are changed gradually into 

which is the source of the odor frequently given off 
in the cooking of food. When fats are heated, they undergo a 
change, with the production of free fatty acids, which are often 
reponsible for the odors that exist in the kitchen. 

Cooking of Meat.—Boiling—In cooking meats the tem- 
perature of the water should not exceed the temperature neces- 
sary for the coagulation of the proteins. In order that the meat 
may retain as much of its flavor as possible it should be immersed 
in boiling water for a few moments; in this way the protein 
on the surface immediately coagulates, thus preventing escape 
of the constituents and so retaining all the nutritive elements 
in the meat. After this has been accomplished the temperature 
of the water may be lowered and the process of cooking con- 
tinned. The broth which is so prod is thin and poor. If 
a rich, nutritious broth is desired, the meat should be cut into 
small pieces and pet in cold water, and the temperature 
gradually in to 150° F, In this way the nutritious 
elements of the meat pass out into the broth, 

Roasting.—In roasting, the meat is first exposed toa high 
temperature and afterward cooked slowly ; thus the outer layers 
ecagulate at once, preventing escape of the juices. Roasting 
not only prevents evaporation of the flavors of meats, but by 
its effect on the extractives develops savory odors and flavors. 

Baking—Baking much resembles roasting, except that by 
the latter process the heat is applied all round the meat, in- 
stead of only to one side. 

Stewing.—For this purpose meat is cut into small pieces 
and placed in a small quantity of water. The water is heated 
slowly, but not allowed to boil; a certain amount of the nutri- 
tions snbstances thus passes into the water, which then becomes 
rich, and to which flavoring substances and vegetables are 

Tnasmuch as the juice is eaten with the meat, none of 
the nutritious ingredients is lost. 

Brazing—In this process the meat is placed in a small 
vessel and covered with a strong liquor of vegetable and 
animal juices; it is then heated, but not boiled, The tough 
fibers of the meat are thus loosened and made tender; the 
meat also becomes impregnated with vegetables and spices 
present: in the juices, which enhances its flavor. 

Broiling —Broiling and roasting are similar processes, except 


al _ 


COOKING OF FOODS, 167 


that in the former smaller portions are utilized ; the is 
"che ia om a heiegy écaeeed Ra RN TRS 
action of the heat. 


Frying.—In this process the meat is put into boiling fat, 
Ses WEL ii Eecocren | snasebedl  Sutlye nce aie SBA 
duced, which have # tendency to irritate the stomach and cause 


jon. 

Cooking of Fish.—Fish may be boiled, broiled, baked, 
and fried. Boiled fish is most easily di Tnasmuch as 
the flavoring substances are more easily ilved out into the 
water and lost, less time should be consumed in boiling fish 
than in boiling meat. Sir Henry Thompson has shown that 
even with careful boiling 5 per cent. of the solid matter of fish 
is apt to be lost ; for this reason steaming is often preferable. 


EFFECT OF COOKING, 


The effect of cooking on meat is to diminish its watery 
constituents, thus concentrating and rendering it more nutritions; 
by this also the extractives, as well as some of the fats, 


are ly removed. 

following table, taken from Konig, shows the chemic 
composition of certain meats before and after cooking : 
, Nitrogenous pat, Extractives, Mineral 





its envelop, forming a ; this paste, in its turn, expands 
and eure the se pealon cooking, therefore, renders 
vegetable foods more easily digestible. 

As has been pointed out, in the cooking of meats a certain 
proportion of the ingredients is lost. Unlike meats, however, 
vegetables become more watery in cooking. In this condition 
they are more easily acted upon by the gastric secretion ; on the 
other hand, the addition of water in cooking so increases their 
bulk that the motor function of the stomach is apt to be over- 
taxed. 

When food ia cooked rapidly there is a tendency to overcook 





168 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


the outer layers and to leave the inner underdone. The better 
plan, therefore, is to cook food slowly for a longer period of 
time at a lower temperature. Various appliances are on 
market which have for their object the production of a con- 
tinuous action of a moderate heat, at the expense of as little 
fuel as possible, the “ Aladdin Oven” of Dr. Edward Atkin- 
son? is an apparatus of this kind. “Tt is a simple iron box, 
closed in front by a door, and haying an opening in the top 
that communicates with a tube to let off any superfluous steam. 
This box is surrounded by another, whose top and sides are 
made of non-conducting material, for the purpose of holding 
the heat. A standard, on which this box is set, and a lamp 
underneath complete the apparatus.” Atkinson claims that 
ordinarily two pounds of fuel are required for every pound of 
food cooked, w! with his oven two and one-half pounds 
of fuel will cook sixty pounds of food. Canon More Ede, of 
England, invented a similar apparatus for the cooking of penny 
meals.* He describes his apparatus as follows : 

“Tr consists of a box 3 feet high, 2 feet wide, 1 foot 9 inches 
deep, with an outer case of sheet iron. The sides and lid are 
lined with 2} inches of felt, and inside this, again, is a further 
lining of tin. Underneath this box, which will hold 30 gallons, 
are placed two of Fletcher's atmospherie gas-burners. The 
felt being a non-conductor, nearly all the heat from the gas is 
utilized, and a ald small expenditure of gas suffices 
to raise the temperature of the contents of the box to boiling- 
point, or to the heat required for the food which is being cooked. 

“When once the desired temperature is obtained, one of the 
burners can be turned off and the other lowered, when, owing 
to the prevention of radiation by the felt, it will be found that 
a merely nominal expenditure of gas will enable the tempera~ 
ture to be maintained for hours, and even when the gas is 
totally extinguished, many hours will elapse before food cooked 
will become cool. 

“Bat, except in the case of puddings which require rapid 
boiling, the cooking is done in an inner pan, which is placed 
inside the box, and which contains rather more than twenty 
gallons. ‘The apparatus may be best described as a huge War- 
ren’s pot, with the additional advantage that the whole of the 
inner pan is surrounded by warm water.” 

any eT Nutrition and the Art of Cooking in the 
3 Cheap Food and Cheap Choking, London, Walter Scott, 1884, 


DISEASES CAUSED BY FOOD-POISONS. 169 


DISEASES CAUSED BY ERRORS IN DIET AND 
BY VARIOUS FOOD-POISONS. 


Disease may be caused by taking too little or too much food, 
by adiet that is not well balanced,—that is, does not contain the 
combination of food-elements in correct proportions,—and by 
other factors and influences the precise nature of many of 
which is obscure. It may also be caused by certain poi 
or disease-germs or parasites taken into the body with the food 
or drink. Disease may occasionally be produced by a personal 
food idicsynerasy. It is also frequently caused by certain 
beverages. - 
‘The diseases due to the taking of insufficient food are starva- 
tion, malnutrition, marasmus, and some forms of anemia. Chlo- 
rosis is apt to occur in underfed girls, 

Overeating, or the taking of improper apes gies rise toa 
great variety of diseases, especially in those who have heredi- 
tary tendencies to certain diseases. The food, by producing 
irritation in the alimentary tract, may be the direct cause of dis- 
ease, a5 in acute indigestion, diarrhea, and the like, Disease 
may also be produced by the excessive amounts of food assimi- 
lated either being deposited as fat and causing obesity, or by 
overworking the organs of excretion, producing degenerations 
or seleroses. The kidneys, liver, and heart are the organs most 
likely to suffer, but the nervous system may also be affected. 
Tn epileptics attacks may be brought on by overfeeding. Gont, 
lithemia, and the like ave among the diseases caused by a too 
generous diet. Diseases of the skin, such as acne, eczema, and 
urticaria, may also have the same causal factor. 

Overeating is probably as prolific a source of disease as over= 
drinking, a fact that is not generally admitted. The common- 
est effects of overdrinking are the nervous conditions caused by 
excessive tea- or coffee-drinking, and the all too familiar condi- 
tion, with its well-known symptomatology, of acute or chronic 
alcoholism. 

Acute food-poisoning is due to the action of ptomains, 
and is often known as ptomain-poisoning. Ptomains, or toxins, 
are poisonous substances caused by the action of bacteria, and 
may be generated in nitrogenous foods or in the alimentary 
tract. They resemble alkaloids, and when absorbed are par- 
tially destroyed in the liver. 


170 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


Parasites in Food or Drink.—Quite a number of dis- 
eases are communicated to man through either the parasite or 
ita embryo being taken into the stomach with the food or in 
drinking-water. For a thorough knowledge of these parasites 
and their effects on the human system the student is referred to 
the text-books on bacteriology. 

The Amerba coli, which causes a form of chronic dysentery, 
is probably taken in with the drinking-water, Its life-history 
is not definitely known. 

Coccidium Oviforme.—The spores, known as iia, 
have been found in the liver, ees and other od cite ee 
They probably gain entrance into the system from water, green 
v Does, or fens handling animale auch as dogs and mbbita. 
_ The life-history of this onganism is obscure. 

Trichomonas* and cercomonas are small parasites at times 
found in the stools, 
Distoma hepaticum, or liver fluke, usually infests the gall- 
duct or the gall-bladder. The embryos are attached to aquatic 
bate and hence are believed to be taken in with them or with 
st water, Several other species are described as oceur- 
ring in China and in Egypt. 

Bilharzia hematobia, or blood fluke, is found in the urine. 
It is a native of Egypt, southern Africa, and Arabia. The 
embryos are probably taken into the body with drinking- 
water. 

Tapeworm.—Several species of tapeworm have been de- 
seribed. The neck and head of this worm, called the scolex, 
may become encysted, and the worm is then known as the 
eysticercus. 

Tenia Solium.—The pork tapeworm is a somewhat rare 
form, infection usually taking place by means of the embryos 
present in raw or underdone pork, The embryos are seen in 
the meat as small white spots, and, from its mottled appearance, 
the meat containing them is usually called measly pork. Gov- 
ernment inspection of meat has done much to prevent infection 
by this and other forms of parasites. 

Teenia medic lata or saginata is the most common tape- 
worm in the United States, Infection is produced through 
eating raw or underdone beef. There are several other rare 
varieties ; 

1 For a description of the trichomonas, see Dock, Amer, Jour, Med. Sei, 
1890, vol. oxi, py le 


<= 


DISEASES CAUSED BY FOOD-POISONS. M71 


Tenia cucumerina or dliptica, a small is 
SEATIG te dog eal sosuaalty tee Tasnkyea wea 
in the dog louse, 

Tenia flavopwnetata is a form found in Boston. 

Tania nana and madagascariensis are forms occasionally met 


Bothriocephalus latus is a tapeworm found in the north of 
, but is occasionally imported into the United States. 
‘The larve are found in fish. Two other forms, B. maritima 
and B. mystaz, have been found in man. B. cordatus, seen in 
Greenland, and 2. eristalus are other rare forms; the former 
was found in an immature state in Toeland and the latter 
usually occurs in cats or dogs. 

Tenia Echinococeus.—This is found in the intestines of dogs. 
In man it may form single or multilocular cysts. Infection 
occurs from handling dogs or from eating green vegetables. Tt 
is rare in America, but not uncommon in 

Ascaris lumbricoides, or round-worm, is a common parasite 
whose life-history is unknown, 

Oxyuris vermicularis, or pin-worm, a small parasite often 
found in children, is believed to be taken in with fruit and 
other raw 

Strongylus duodenale, also called Anchylostomum duo- 
denale, is a parasite attracting considerable attention in Amer- 
ica. Formerly but little known in the United States, numer- 
ous instances of infection by this parasite have recently been 
reported. It is a small parasite, from 6 to 10 millimeters long, 
and is present in the upper part of the intestine. It causes 
severe anemia. The embryos of the parasite are probably taken 
in with drinking-water, It is apt to occur in brick-makers, 
miners, and those following similar occupations. 

Filaria Sanguinis Hominis.—This ite is found in the 
Southern States, and is probably also eke with impure water, 
Tt causes hematochyluria and certain forms of clephantinsis. 

Filaria or Dracunculus medinensis, or guinea-worm, de- 
velops in the cyclops, a small crustacean. The larve are prob- 
ably taken into the stomach with drinking-water. It causes 
vesicles and ulcers. Cases of infection that must have occurred 
in America have been described. 

Trichocephalus dispar, or whipworm, is found in the cecum, 
and is about 4 or 5 centimeters in length. It does not, as a 
rule, cause any symptorns. 

Rhabdonema intestinale is a small parasite often spoken of 





172 VARIOUS FACTORS IN THELR BEARING ON DIET, 


as the Cochin-China diarrhea worm. It is found in the intes- 
tines, and causes a form of tropical diarrhea, It has been 
discovered in many parts of the world. 

Parasitic Diseases.—Trichiniasis.—This is a disease 
caused by eating the so-called “measly” pork, or pork in- 
fected with Urichina spiralis, This parasite measures 1,5 mil- 
limeters in length—the female, 3 to 3.5 millimeters, and the 
embryos from 0.5 to 1 millimeter, The embryos are generally 
coiled up and encapsulated, and are seen in the voluntary 
muscles, giving rise to the name mentioned above. The para- 
site is also found in the rat, and Dock believes that the disease 
is communicated to the hog by eating infected rats. 

When taken into the intestinal canal, the envelop surrounding 
the embryo is dissolved, and in from three to six days the latter 
develops into a full n trichina. The female produces the 
embryos by thousands, and these work their way through the 
intestinal wall and enter into the voluntary muscles, where they 
may be found several weeks after infection. If they are to be 
found at all, they are present in the diaphragm, which, owing to 
its proximity to the intestinal canal, is the favorite site. In the 
muscles the parasites are surrounded by a zone of irritation, 
and finally become encapsulated, lime salts being deposited in 
the capsule. Thus encapsulated, the parasite may live for 
years. Its presence gives rise to gastro-intestinal irritation, 
fever, pain, and prostration, There is frequently a picture 
simulating typhoid. A marked eosinophilia is usually present, 
and the disease proves fatal in many cases. 

Owing to the greater frequency with which raw pork is eaten 
in Germany, trichiniasis is commoner in that country than in 
the United States, A temperature of 140° F. kills the para~ 
site, and the only sure way of preventing the disease is to cook 
all pork. The presence of the parasite is easily detected, and 
in pl where meat is inspected infected meat should be rejected 
hy the Government inspector. Pickling and coring meat may, 
if the pieces are thin, kill the parasites, but they may survive 
if the pieces of meat are large. 

Diseases from Milk.—Numerous diseases are transmitted 
through the ageney of milk, the cow itself being diseased or 
subsequent contamination of the milk taking place. The cow 
may be suffering from diseased udders or from some affection 
of the mammary gland, The organism moat commonly present 
in infected milk is the etreptococous. Tubercle bacilli may find 
their way into the milk from a diseased gland or udder. Asa 


DISEASES CAUSED BY FOOD-POISONS. 173 


rule, it may be stated that if the disease, whatever it may be, 
is not in the mammary gland or in the udder, it is unlikely that 
the bacteria which gave rise to the disease will find their way 
into the milk. It should be borne in mind, however, that mil 
from a sick cow, even if it does not cause disease directly, is 
apt to be poor in quality, and is not desirable for food. 

Milk infection is most commonly the result of impure milk, 
made so by improper care and contamination with toxin- 
producing bacteria, The disease may be the result of toxins 
formed in the milk, or the bacteria themselves may be the cause 
of the disturbance. (For details as to the proper care of this 
food, see the section on Milk.) Sour milk or milk which is 
about to turn may cause gastric or intestinal disturbances in in- 
valids or children. 

Poisons Transmitted in Milk.—Poisonous substances taken 
in with the food of the animal or administered in sufficient quan- 
tities as remedies may be transmitted in the milk and cause 
symptoms in the consumer, This is not of very frequent oc~ 
curence, Among the numerous drugs which have been reported 
4s causing poisonous symptoms are ; arsenic, lead, copper, mer- 
cury, tartar emetic, iodin, atropin, yeratrum viride, etrychnia, 
eroton cil, and others. 

Tuberculosis —Milk 2s a cause of tuberculosis has of late 
ion been the subject of much discussion. This discussion was 

rgely the result of a statement made by Koch, in 1901, that 
bovine tuberculosis could not be transmitted to man, and that 
the disease as found in man and in animals was due to two 
different organisms. This statement has not been borne out 
by facts, and it may with safety be stated that the disease in 
both man and animals is due to the same organism, although 
some differences in the disease and also in the organism as 
found in man and in animals exist. If a cow has tuberculosis 
of the mammary gland or of the udder, although the disease 
may not be apparent to the naked eye, the milk will contain 
tubercle bacilli. If the disease occurs elsewhere in the et 
tubercle bacilli are not apt to find their way into the milk. 
The tubercle bacillus, moreover, does not maltiply in milk. 
Tuberculosis may be produced in man by the same bacillus that 
causes bovine tuberculosis. Where this has occurred, it has 
usually been the result of accident, the disease following being 
of a local nature and of no great intensity. With what degree 
of frequency the tubercle bacillus is found in milk, and whether 
it has ever caused tuberculosis from the use of milk containing 
it, are questions that can not be definitely answered at this time, 


174 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


Diarrheal Diseases—The question of diarrheal diseases as 
eansed by milk is of the greatest practical importance. Diarrheal 
disease is commonest in the warm months, and 97 per cent, of 
the cases that occur in children are in bottle-fed babies. Where 
the milk is pure and where proper care has been observed in 
transmission from the cow to consumer, the disease is rare. 
Where the milk is impure and is carelessly hundled, many cases 
of diarrhea and death are the result, These diseases may be pro- 
duced by toxins generated in the milk by the bacteria, or by 
the bacteria themselves being introduced into the intestinal 
tract. It is not definitely known just what bacteria give rise to 
summer diarrhea, The disease is probably due to different 
organisms. Recent investigations point to Bacillus dysentericus 
(Shiga) as the organism most commonly present. There is no 
greater lesson to be learned in the whole range of milk infections 
than that impure milk causes diarrhea, 

Diphtheria.—Diphtheria bacilli may find their way into milk 
from the milker, who may have the disease in a mild form, or 
from subsequent contamination. A number of epidemics have 
owed their origin to infected mille. 

Scarlet Fever.—Where epidemics of this disease have 
occurred as the result of milk infection, they have usually 
been traced to a case of the disease in a milker’s family. Kober 
tabulated 99 scarlet fever epidemics as follows : disease at dairy 
or milk farm, 68; persons employed at the dairy either lodged 
in or had visited infected houses, 6; from infected bottles or 
milk cans left in scarlet fever houses, 2; employees working 
while suffering or recovering from the disease, 17; employees 
aeting as nurses, 10; milk stored in or near the sick-room, 3; 
infected cloth used in wiping cans, 1. In 19 instances the in- 
fection was attributed to inflammation of the udder or to puer- 
peral fever in the cow. These outbreaks should be regarded as 
cases of streptococcus or staphylococcus infection rather than 
scarlet fever. 

Typhoid Fever.—Many epidemics of typhoid fever may be 
traced to an infected milk supply. Too much stress can not be 
laid on the importance of investigating dairy farms as a source 
of typhoid fover epidemics. Kober tabulated 195 epidemics 
caused by milk. In 67 instances the milk was probably infeot~ 
ed by using infected well-water to wash the utensils, and in 16 
of these, infected water had been intentionally added to the 
milk for purposes of dilution. In 7 instances the infection was 
atiributed to cows wading in sewage-polluted water or pastures ; 





| 


DISEASES CAUSED BY FOOD-POISONS. 175 


in 24 instances the dairy em loyees acted as nurses ;in 10 in- 
stances patients suffering with mild attacks continued at work ; 
in 1 instance the milk-cans were washed with the disheloth used 
among the fever patients ; in 2 instances dairy employees were 
connected with the ‘night soil service ; and in 2 instances the 
milk bad been kept in a closet in the sick-room, 

Asiatic Cholera.—This disease may oy be transmitted through 
the agency of milk, but the usual mode of infection is through 
drinking-water. 

Milk-poisoning (Galactotoxismus).—In 1885 tyrotoxicon 
was found in salle, end dae Hewtiniend Wallase A 
interesting series of cases of poisoning to the presence of 
this toxin in milk. The milk vad obtained from a dairy in 
which the milking was done at midnight and at noon. The 
eta Sie the one that was poisonous. While stil] warm 

it was placed in cans, and delivered to the consumers in the 
heat of the day, The est penises the growth of bacteria 
which caused ° formation of toxin, Ese have been numer- 
ous instances wl its presence in milk has caused poisoni 

Vaughan and Novy have also found it in ice-cream ART 
custard. Shearer has demonstrated its presence in vanilla and 
Jemon ee Besides tyrotoxicon, other toxins have been found 
in milk. Vaughan and Perkins have isolated a toxin, caused 
bya Sion-like illus, which produces marked symptoms. 

Cheese-poisoning (Tryrotoxismus).—As early as 
1827 theories began to be disseminated as to the reason why 
some cheese, usually apparently unaltered so far as ordinary 
observation went, should cause poisoning. Hinnefeld and 
others after him believed it to be due to the fatty acids. 
Numerous cases were reported and discussed. In 1382 and 
1884 about 300 cases of cheese-poisoning were reported to the 
Michigan State Board of Health. All who ate a the cheese 
were attacked, and the sunt varied with the quantity 
taken, -being more severe where large amounts had been in- 
gested, ‘The symptoms were vomiting and purging, with watery 
stools; the tongue, at first white, then became red and very 
dry, and there was pain in the region of the stomach. The 
pulse was feeble and irregular, and in some instances there was 
cyanosis, Vaughan studied these cases, and found that. the 
poisoning was due to twelve different varieties of cheese, most 
of which came from one factory. The cheese seemed to differ 
but little from peda cheese, but if offered to cats or 

cheese, the animals invariably chose 
the if lt to hungry cats, they would eat it and appar- 
ently with no ill effects. ‘The poison was isolated, and con- 


a 


176 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


sisted of a pees highly poisonous substance, which 
Vaughan call peoistea Pi rbot however, appears 
to be a comparatively rare poison, and other toxic substances 
have been discovered in cheese. Vaughan isolated an albu- 
mose; Vaughan and Perkins, two bacilli; and V: and 
McClymonds, a bacillus of the colon group, all of which were 
toxic. 


Typhoid Fever and Oysters.—Typhoid fever has been 
transmitted by infected oysters, the oysters having usually been 
wn very near the outlet of a sewer or on artificial beds. In 
‘ew Haven, some years ago, thirty students were infected with 
typhoid by eating raw oysters supplied by a dealer who made a 
practice of placing the fresh oysters in the river fora day or two 
after receiving them. Running from his house to the river, 
near where he had placed the oysters, was a drain-pipe. His 
daughter had typhoid at the time, and his wife had died of the 
disease shortly before. Instances have been reported in other, 
countries, but it is not a very common mode of infection. 

Poison from Mussels (Mytilotoxismus).—Accord- 
ing to Vaughan and Novy, there are three kinds of mussel- 
poisoning : 

1. Where the principal symptoms are gastro-intestinal, and 
of varying intensity. This form may at times be choleriform 
(Combé), Death may follow very rapidly—in Combé’s case it 
occurred in two days. 

2. The most frequent form is that in which symptoms are 
principally nervous, coming on shortly after the mussels are 
eaten, There isa sensation of heat and itching; a rash of an 
urticarial nature, and sometimes vesicular, appears, There may 
he dyspnea, and death may result from convulsive tremors or 
coma. Death has followed from this form in three days. 

3. In the third form the symptoms are those of an intoxica- 
tion resembling alcoholism followed by paralysis and death. 
Combé in 1827, reported death as early as three hours after 
eating the mussels, and others six or seven hours, and still others 
after longer intervals. 

Various theories have been advanced to explain the cause of 
mussel-poisoning. Brieger has isolated a toxin from mussels 
which he calls mytilotoxin, which eansed a fatal ease of poison- 
ing. Further study is needed to decide the question of the 
toxin principle in the other forms. 

Shell-fish taken from filthy water is apt to be poisonous. At 
Havre, France, cases of poisoning occurred from the eating of 
oysters taken from near the outlet of a drain from a public 





DISEASES CAUSED BY FOOD-POISONS. 17 


water-closet, uier), Various rules for recognizin, 

ba rire het ro iven, but they are Siena reli- 
Pale; xk Gt ln en sacha wilt lates en 
water, t washed with clean water, is ly 
safe. Kept at a summer temperature, whether pach gre 
it is unfit for food. 

Poisoning due to Fish (Ichthyotoxismus).—Fish 
may be poisonous under various conditions : 

fey Ses vaceralways i (2) Some are poisonous 
during the foaraig eencn: (3) Some may be infected with 
bacterial diseases w1 may cause disease in man. (4) Like 
other nitrogenous foods, fish may be infected with bacteria 
which produce toxins, 

Kobert, according to Novy and Vaughan, makes the follow- 
ing classification of poisonous fish : 

1. Where the fish are mrphed with poison glands connected 
with barbed fins, with which they their enemies, like the 

ison of snakes. These cause prostration, convulsions, and death 
in man, 

2. The genus Tetrodon, a Japanese fish which has poisonous 
ovaries, which are less poisonous in winter, when the ovaries 
are inactive, Kakké, a disease of Japan and other Eastern 
countries, is believed to be due to the eating of certain varieties 
of the Scombrida family, (See pee) 

3. Certain other fish whose flesh and glands are harmless 
may be dangerous on account of the decomposing substances 
or corals, ete., on which they feed. 

4. Poisoning due to ptomains, of which Anrep has isolated 
two. These are due to the fish being infected with saprophytic 
bacteria, The symptoms are principally due to involvement 
of the gastro-intestinal tract and nervous system—nausea, 
vomiting, diarrhea, prostration, rashes, etc. 

Tn Russia and Germany there are certain fish that, if eaten 
yaw, may produce disease, but that, when thoroughly cooked, 
are harmless. The cause is probably found in « bacterial dis- 
ease of the fish. 

Meat-poisoning (Kreotoxismus).—Many forms of 
meat-poisoning have been described, and some have been given 

ial names, Certain diseases the result of direct transmis- 
sion will be considered separately, The meat of animals that 
have died of disease of any kind is unfit for food, and the old 
Mosaic law, “Ye shall not eat anything that dieth of itself’! 
is a good hygienic rule. The Jewish laws concerning what 
1 Onn Testastent: Deuteronomy xiv: 21, 
2 


178 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


were regarded as clean and unclean meats are set forth in the 
fourteenth pheptee of the book of Deuteronomy. 

Poisoning followed the ingestion of meats of various 
kinds in which toxic eisai aie feo Some meats 
pee ee et ad e detected by ordinary means, while 
in still others putrefactive changes are not apparent. 

i vary in nature, and in some cases toxins and bacteria 

we been isolated. Among the many foods that have caused 
meat-poisoning may be mentioned canned meats—pigy’ tongues, 

< chicken, and the like; ham, sausage, brawn, veal and 
ies, ribs of beef, goose-grease—in fact, almost every kind 
Ha ‘hem of meat foods, abel 

Sausage-poisoning, known as botulismus or allantiasis, has 
been known for over a hundred years. It is becoming less 
frequent as the causes that give rise to the disease are becoming 
better known to sa ikers. In Baden, Germany, where 
very faulty methods of preparing and curing sausage were in 
vogue, the disease was formerly frequent. Blood that had 
become decomposed was often used, and in other instances the 
sausage was imperfectly cured, the outside being smoked and 
rendered harmless, the center remaining soft and highly poison- 
ous. For this reason those who ate the outside of the sausage 
exhibited no ill effects, while those who partook of the center 
were made very ill and many died. The symptoms vary with 
the kind of poison that has developed in the meat, but there 
are no characteristic lesions in those who die. 

“Von Faber, in 1821, observed sixteen persons who were 
made sick by eating fresh unsmoked sausage made from the 
flesh of a pig which had suffered from an abscess on its neck. 
Five of patients died. The symptoms were us follows: 
‘There were constriction of the throat and difficulty in swal- 
lowing, retching, vomiting, colic-like pains, vertigo, hoarseness, 
dimness of vision, and headache. Later on, in severe eases, 
there was complete exhaustion, and, finally, paralysis. The 

eballs were retracted, the pupils were sometimes dilated and 

en contracted, and they did not respond to light; there was 
paralysis of the u lids. The tonsils were swollen, but not 
as in tonsillitis. Liquids which were not irritating could be 
carried ag far as the esophagus, when they were rejected from 
the mouth and nose with coughing. Solid food could not be 
swallowed. On the back of the tongue and in the pharynx 
there was observed a puriform exudate. Obstinate constipation 
existed in all, while the sphincter ani was paralyzed. Breathing 


7 


DISEASES CAUSED BY FOOD-POISONS. 179 


was easy, but all had a croupous cough, The skin was dry 
and there was incontinence of urine. There was no delirium, 
and the mind remained clear to the last.’””* 

Schiiz cites cases of poisoning caused by cating liver sausage. 
There were loss of voice, typhoid-like stools, marked delirium, 
and mental disturbance that persisted for weeks afterward, 
‘The onset occurred in from ei; on to twenty-four honrs after 
eating the sausage, and |; from one to four weeks, There 


"Tee no (a 

poner over 60 cases where there were frequent 
Fai weal: rapid heart, and delirium. The pupils were 
usnally contracted but reacted to light, 

Ballard reported 490 deaths due to pneumonia, caused in 
most of the cases by eating infected bacon. According to this 
observer, those who had the disease could transmit it to others 
who had not eaten of the meat, a fact that has been noted in 
many other instances, After having been kept several months 
the bacon lost its toxicity. This epidemic was known as the 
Middlesborough pneumonia epidemic. 

Another interesting epidemic of meat-poisoning a at 
Middleburg, Holland. Meat from a cow sick with puei 
fever was eaten by 256 soldiers and 36 citizens, the sym) pts 
consisting of vomiting, purging, dizziness, sleeplessness, 
tion of the pupils, a pean in some cases an eczematous eruption. 
There were no fatalities. 

Gartner found Bacillus enteriditis in some instances of meat~ 
poisoning, and others have also demonstrated its presence. 
‘Vaughan and Perkins isolated two bacteria—a bacillus and a 
streptococcus—from pressed chicken that poisoned a large num- 
ber of persons at Sturgis, Michigan. Gaffky and Paak have iso- 
lated « bacillus resembling the colon-bacillus. Van Ermengem 
discovered a bacillus similar to that found in other outbreaks ; 
it was preacnt in meat that, apparently, had not undergone 
putrefactive changes ; 34 persons were affected and 3 died. 
‘The symptoms consisted of delirium, fever, pain in the abdomen 
and head, and prostration. Ellezelles, of Belgium, found an 
organism in ham that appeared, fresh, but that had produced 
poisoning in some with fatal results. The patients had marked 
nervous symptoms, consisting of diplopia, mydriasis, ptosis, 
aphasia, aphonia, and anuria, Other portions of the pig were 
eaten without causing any ill effects. The ham had been cured 
in brine, while the pies part of the pig had not. An anaégrobic 


"Vaughan and Novy, Cilluler Toxine, 


180 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


organism was searched for and found, and this was named 
Bacillus botulismus. It is as virulent as the tetanus bacillus. 


OTHER FORMS OF FOOD-POISONING. 


Mushroom-poisoning.—Poisonous fungi are often mis- 
taken for edible mushrooms, and lead to toxic symptoms, If 
there is a ring about the stalk and the mushroom peel easily 
and has pink gills, it is said to be non-poisonous. This rule is 
not a safe one, since some of the most dangerous forms of 
fangi answer to this description. The active ea iy in these 
poisonous fungi is muscarin or some allied alkaloid, The 
symptoms produced are vomiting, diarrhea, cramps, and great 
prostration. The pupils are contracted, and in children there 
may be convulsions, The treatment consists in emptying the 
stomach and bowels as promptly as possible, and in giving 
atropin and other restoratives, 

Grain-poisoning.—There are three forms of grain-poison- 
ing, generally described as ergotism, pellagra, and lathyrism, 
They are diseases seen almost exclusively among the squalid 
and destitute, the effects being due to insufficient nourishment 
combined in each case with the specific poison from the grain, 
Most cases and epidemics have occui among the poverty- 
stricken European nts, The well-to-do and properly 
nourished are much ee pees 

Ergotism (Sitotoxismus).—The history of ergotism is most 
interesting. It is very probable that many cases of “St. 
Anthony’s fire,” described in the twelfth century and later, 
were cases of grain-poisoning. It is also probable that syphilis 
and various forms of ulcers and gangrene were confounded with 
it and with one another. It is not within the province of this 
book to describe the horrible epidemics of the middle ages, with 
their wake of mutilations and misery. Within recent years 
epidemics have occurred in Russia. 

‘Thuillicr was the first to discover that the cause of the dis- 
ease existed in spurred rye. He also pointed out that the rye 
is spurred in the damp, cold seasons, and that the degree of 
virulence depends upon the amount of the poison taken. He 
proved his theories by animal experimentation. Dodart, in 
1676, ascertained that ergot was most active when fresh, and 
that it loses in virulence as it ages. It is produced by a mi- 
croscopic parasite, known as Claviceps purpurea, growing on 
the rye. The disease is caused by eating the grain on which 


DISEASES CAUSED BY FOOD-POISONS. 181 


the parasite ee to Habect, ges sintaing 
corn 
tin, bg cere dea the anesthesia and clone on The sns- 
ceptibility of different individuals varies greatly, There are 
two forms of the disease, one in which gangrene is the promi- 
nent feature, and a second in which there are convulsions and 
anesthesia, An acute and a chronic form of the disease occur. 
Tn the gangrenous form there are, at first, tingling, anesthesia, 
spasmodic movements, and later blood-stasis, followed by gan- 
grene of the extremities. In the convulsive form there are 
Fie ournya bead lasting for a week or ten days, consisting 
of headache, weakness, and tingling sensations, Following 
these there are cramps in the muscles and convulsions. The 
spasms may last for hours or days, and are apt to recur, Men- 
tal disturbances and symptoms of cord involvement may su 
yene, The disease should not be mistaken for erythromel 
Raynaud’s disease, or acrodynia, whose symptoms it simulates, 
According to Bouger, ergot may be detected in flour by mix- 
ing a sal quantity with ether and adding y few crysials of 
he mixture is then boiled anid allowed So eatinagtl 
= te ergot is present, a red tinge will be imparted to the fluid, 
Lathyrism (Lupinosis).—This is a milder form of grain~ 
poisoning, the poisonous agent being the seed of rue 
sativus and L, eicera, commonly known as the chick-pea, 
soning occurs from the meal ground from these meats which has 
been used to adulterate flour, The disease was noted as early 
as the seventeenth century, and was studied by James Iing 
India. As the result of the failure of the wheat crop at 
habad the inhabitants used the chick-pea for food, and an epi~ 
demic of lathryism followed. The caieess affects. the legs, 
producing a stiffness of the joints, and may cause a spastic 
paraplegia. 
Pellagra [Biakdeasy cea is also a disease of extreme 
Perey ne misery, and has been seen principally in Italy, 
nce, Spain, and Roumania. It has never been observed in 
America. It is caused by eating fermented maize. The exact 
nature of the changes in the grain are not fully understood. 
‘The early symptoms are indefinite weakness, pains, and digee~ 
tive disturbances. The skin is usually affected, hence the name, 
pellagra eal ae agria—i. ¢., nleer of the skin). An erythema, 
we Hols ling and ty spend tag ap] Bulle are frequent, and 
leave The skin symptoms dis~ 
om, ve a i Fgnatel skin ae After several months 
¢ symptoms subside, usually to recur the following spring. 





7 


182 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


In the severer cases there may be pronounced nervous symp- 
toms, such az convulsions, cramps, headaches, and even paralysis 
and mental disturbanee. The last do not generally come on 
until the disease has been present for several years, Many of 
the cases in the insane asylums in various parts of Italy are 
cases of Rellagrs, usually with either melancholia or a suicidal 
mania. In this stage the condition is hopeless. 

Phosphorus-poisoning.—It has been recommended that, 
after acute phosphorus-poisoning, all fat be excluded from the 
diet, on the principle that fat will dissolve any phosphorus 
remaining in the stomach and so hasten its absorption. For 
this reason the articles exeluded should be not only the butter 
and other fats, but even milk and the yolks of eggs. The diet 
should consist chiefly of cereals, gruels, and the like. After 
several days the ordinary diet may gradually be resumed. 

In chronic phosphorus-poisoning Magitot, of Paris, reeom- 
mends an exclusive milk diet, combined with the inhalation of 
oxygen, gentle exercise, and repeated small doses of turpentine. 
If suppuration has occurred, a supporting diet of the most 
nutrition character, similar to that used for other suppurative 
conditions, should be prescribed. 

Beriberi, or Kakké.—This disease is occasionally seen in 
the United States, and is probably of microbie origin. It has, 
however, been attributed to diet as well as to other causes, 
Diet probably acts only as a predisposing factor, improper food 
tending to lower the general health of the individual. The 
theory that the disease is of dietary origin is the result of 
observations made in Japan. According to Manson, up to 
1883 over one-fourth of the entire muster of Japanese sailors 
were affected with beriberi. In 1883 there were 1236 cases 
among 5349 men. In 1884 more nitrogenous food was added 
to the diet, and the following year only 41 cases were reported, 
In 1887 the disease had practically disappeared. Other hy- 
gienic reforms brought about at the same time probably had 
a decided influence in exterminating the disease. It has been 
attributed to the use of an excess of carbohydrate food or 
spoiled rice. In the Java prisons, where rice is eaten shelled, 
beriberi is said to be present in the proportion of 1 to 39, 
whilst in the institutions in which the rice is furnished the 
inmate unshelled, the disease is seen in only 1 in 10000. Miura 
and other Japanese authorities believe that the disease is due to 
eating fish of a certain variety or raw and improperly cured 
fish, (See Poisoning Due to Fish.) 


DISEASES CAUSED BY FOOD-POISONS. 183 


Manson states that with proper hygienic measures and a 
liberal and varied dietary ined sempre prevented. If rice 
is used, the amount taken should be decreased, and wheat, bar- 
ley, oats, or beans substituted. : 
Actinomycosis.—This disease is comparatively rare in 
America. There is no evidence to show that it has ever heen 
transmitted by articles of diet, but cases are erect 
infection has been traced to barley-sheaths, to 
raw, and to straw being carried in the mouth. e meer 
gland, both in cows and in women, may be infected, but so ‘fie 
no case has been traced directly to milk. 

Foot-and-mouth Disease.—This disease may be trans- 
mitted from infected cattle by means of milk or butter made 
from the milk of cows suffering from the disease, as well as by 
direct contact with the animals. The disease was studied as 
early as 1834, when three German veterinary surgeons drank 
the milk from infected cows. All developed ha tet disease, In- 
fants and children have also been infected by drinking con- 
taminated milk. The contagious Petoins is destroyed by heat, 
but the flesh, milk, and milk-products of animals with foot- 
and-mouth disease should not be used for food. During epi- 
demics especial care should be taken to avoid the products of 
such animals, and in case of donbt the milk should be boiled 
before usin, 

Hydatid Disease.—Hydatid cysts, caused by the eggs 
of Tenia echinococcus, may also be classed with the dines 
caused by diet. The parasite grows in the small intestine of 
dogs, and the ova are taken into the alimentary canal of man 
by drinking water containing them, by handling and 
carrying the infected bunds to the mouth, and by eating raw 
green les. The disease is rare in America, In the 
medical wards of the Vienna hospitals a routine question is, 
“To you keep dogs, and do you eat green salads?” 


IDIOSYNCRASIES, 

Tn considering food-poisoning, the existence of food idiosyn- 
erasies must be borne in mind, for, aside from the fatal forms, 
there are many ms in whom certain articles of diet give 
rise to curious effects. Many of these are imaginar. Cp it 
80, and it is not unusual for patients to declare is or 
that article of food does not agree with them, ‘This is especially 
true of milk. As a matter of fact, the idiosynerasy has been 
part of the mental equipment of the individual for a long time, 





.——— 


184 VARIOUS FACTORS IN THEIR BEARING ON DIBT. 


and in cases has been fostered hysicians who play 
fetal ieee taste ati thee debate kine is this so 
with regard to Tt is, however, undoubtedly true that. 
food idiosyncrasies do exist, and that in certain people partieu- 
Jar articles of diet will produce symptoms often of an = 
nature. The most usual nianifetation is the production 
rashes, generally of an urticarial ype The eating of straw- 
berries, oysters, crabs, and other shell-fish is a frequent cause. 
Tn others attacks of vomiting, gastric pain, diarrhea, faintness, 
or combinations of these, may be produced. Among other 
articles mentioned as occasionally producing this effect are the 
white or the yolk of eggs, coffee, tea, fat, honey, and, indeed, 
almost any article of diet. Amblyopia has been attributed to 
the use of chocolate. 





FOOD ADULTERATION. 


The adulteration of food is a subject of such wide scope that 
it can not be entered into here in detail.’ The subject is one of 
the greatest importance to the community at large; and where 
legal restrictions do not exist, laws should be enacted which will 
insure the proper inspection and regulation of the sale of all 
food-stuffs. The sale of injurious articles should be absolutely 

hibited, and adulterated but non-injurious commodities should 

properly branded so that the purchaser may not be compelled 
to pay an exorbitant price for an inferior article. The laws 
creat apply to both native and imported food-stuffs, 

In the United Stntes the law enacted July 1, 1903, prohibits 
the introduction of—(a) foods containing substances deleterious 
to health ; (6) those misbranded ; and (c) foods the sale of which 
is prohibited in the country from which they are shipped. 

Almost all the States have enacted food laws of more or less 
efficiency, but the laws should be sufficiently uniform and 
stringent to prevent the sale of food-stuffs deleterious to health, 
and to prevent misbranding, Although under the present law 
imported articles are pure and properly branded, there are great 
opportunities, after the articles have entered the country, for the 
perpetration of fraud ; the same is true of native food-stufls. 


+ For an extended study of thie subject the reader is referred to Blyth's 
‘book on Foods, and also w the excellent bulletins of the Division of Chemistry 
of the United States ent of Agriculture, ‘The bulletin on Food 
‘Adalteration, known as No. 13, of which some ten parts have alrendy been 
fimued, can be found i all the libraries, but, unfortunately, the earlier 
parts are out of print. It is to be hoped that this bulletin will be reprinted at 
an early date. 


FOOD ADULTERATION. 185 


Food adulteration is of two kinds; that which jurious 
and that which is non-injurious. The Iatter is practised whore 
there are no fixed standards, or, where such do exist, in debase- 
ments from these fixed standards, Adulterations may be clas- 
sified as follows : 

1. Conventional—to suit the taste and demands of the public, 
Such adulterations are usually effected by means of 
matters, many of which are harmful, and by bleaching 

jucts. 


: 2. Accidental or incidental—arising from environment, care- 
lessness, or incompetency on the of the lucer, manu- 
facturer, or his agents. This Pati consists oe admixture 
of some foreign substance, such as husks, stems, leaves, ete, 

3. Arbitrary—to comply with or take advantage of certain 
fixed arbitrary standards. 

4, Intentional—for purposes of gain and competition. 

-matters.—The use of coloring-matter in food is 
a moot point. We think we can safely assert that the use of 
any artificial coloring-matter is objectionable, and many of the 
dyes so used are harmful. Fortunately, the people are being 
edueated by Wiley and his associates, and a id for pure 
and uncolored foods is being created. 

Alcoholic beverages are frequently adulterated. Wood 
or methyl alcohol is sometimes substituted for grain or ethyl 
alcohol. This is especially true of the flavoring extracts, which 
are used in small quantities, Wood alcohol is an exceedingly 
dangerous adulterant, Blindness and even death have followed 
its use, The higher they stand in the series, the more toxic 
the alcohols become. Hunt has shown that a larger single dose 
of methyl aleohol than of ethyl alcohol is required to kill, but 
that the alcohols differ widely as regards their effects with con- 
tinued use. A quantity of ethyl alcohol somewhat below the 
lethal dose may be taken day after day without causing death, 
whereas repeated large doses of methyl alcohol may speedily 
result in death, the reason being that the end-products of grain 
alcohol are acetic acid and water, whereas the end-products of 
wood alcohol are formic acid and water. 

Adulterated alcoholic liquors contain fusel oil, tannin, log- 
wood, water, coloring-matter, and burnt sugar. Various grades 
of cheap whisky and brandy are manufactured by unserupulous 
rectifiers by mixing newly made alcohol with coloring and 
flavoring matters. An imitation of gin is frequently made 
from cheap spirits, turpentine, sugar, and water. 


ea 


The Adulteration of Beer, Wine, etc.— Wine and beer are 
sophisticated by the addition of various substances usual 

led as preservatives. Chief among these is salicylic aci * 
which is added to arrest the action of ferments. Its use is 
forbidden in France and Germany, although in the latter 
country it may be added to beers that are to be exported. 

Gerard found that, in a liter, wine contained 1.95, 1.60, 1.48. 
1.41, 1.35, 0.81, and in one case as much as 3.5 ‘grams of 
salicylic acid ; syrup contained in the same quantity, 0.50-1.50 
grams; beer, 0.25-1.25 grams; milk, 0.25-1.85 grams. In 
‘one case it will be noted thata liter of wine contained a full 
twenty-four hours’ dose of salicylic acid. 

Crampton found salicylic acid in about one-third of the sam- 

af American bottled beer which he examined. He did not 

id any indraft beer. Sulphurons acid is one of the oldest of 
preservatives. Its use is forbidden in both France and Ger- 
many, Borax is frequently used, and is also forbidden in the 
countries mentioned. Sodium bicarbonate is used in beer to 
correct the acidity caused by i sproper brewing, and also to 
cause an increase in the carbonic acid content, so that the beer 
will have a better “head.” 

Wine is adulterated by adding sugar, gummy substances, 
coloring-matters, and salicylic acid and mineral acids as pre- 
servatives. In France wine is frequently plastered by the 
addition of gypsum, or calcium sulphate. As Crampton says: 
“The sulphuric acid of the lime sills replaces the tartaric acid 
which is combined with potash, and forms an acid sulphate of 

tash, while the tartaric acid separates out as a tartrate of 
ime.” This gives the wine a brighter color, clears it, and 
makes it keep better. 

Adulterated beer may contain burnt sugar, licorice, treacle, 
quassia, coriander, caraway seed, Cayenne pepper, soda, sali- 
cylic acid, salt, carbonic acid (artificially introduced), grains 
other than barley, glycerin, glucose, water (added by retailer), 
tobacco, and Coceulus indicus, 

Cider is frequently adulterated by the addition of water and 
preservatives, and is also manufactured artificially. 

Many of the liquid malt extracts are merely beers, and most 

. of them have little or no diastasie action ; they have no special 
food-value, nor do such extracts aid digestion. Some are adul- 
terated and harmful. 

Liqueurs are eeincey adulterated and imitated, and may 
contain injurious coloring-matter, Maraschino and erme de 


186 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


FOOD ADULTERATION, 187 


menthe cherries may be colored with anilin dyes, and they 
sometimes contain an astonishing amount of coloring-muatter, 

ea.—Under the present law teas imported into the United 
States are ically froe from adulteration, Many inferior 
teas are sold, however, and their sale is not restricted. Tea 
may be adulterated by mixing exhansted or foreign leaves with 
it, and adding coloring-matter and astringents. “ Facing” is 
sometimes practised, and consists of treating the leaves with 
plumbago, indigo, or Prussian blue, the object being to make 
an inferior tea resemble a better product. The small amount 
of the adulterants used js not injurious, and the adulteration is 
easily detected. 

Coffee.—Green and roasted coffee may be imitated. An 
inferior grade of coffee is frequently branded and sold as a 
better article, and roasted coffee may be adulterated by the 
addition of too much glazing. Ground coflve is frequently 
adulterated, and may contain little or no coffee. Chicory is the 
commonest adulterant, 

Cocoa is frequently adulterated by adding starch, sugar, 
clay, brick-dust, coloring-matter, and flavoring materials. The 
cocoa-butter may be extracted and tallow or other fats and oils 
substituted, 

Flour js adulterated by adding other grains before grind- 
ing or by mixing other flours of an inferior grade or from a 
different grain. In the United States the sale of “mixed” 
flours is regulated by law. ‘The mixer must pay a special tax, 
and the product must be correctly labelled. Various mineral 
substances have been found in European flours, but such 
adulterants are seldom used in the United States. 

Bread,—This has been adulterated by the use of inferior flour, 
and by the addition of other substances. Tustanees have been 
reported of the use of sulphate of copper and of ammonium, and 
alum is also used. In foreign countries soap and gypsum have 
been used, and stannous ehlorid has been added to bread made 
from an inferior flour, for the purpose of making it resemble 
that made from a better quality. 

Butter.—This may be adulterated with oleomargarin, but~ 
terin water (“stretched butter”), lard, cotton-seed oil, beef suet, 
and olive oil, Butter and oleomargarin have about the same 
composition, and possess about equal digestibility, with the 
balance slightly in favor of butter. Oleomargarin is not 
injurious, but to prevent fraud should be correctly labelled. 

Lard.—This may be adulterated with stearin, cotton-seed 
oil, and water, The adulterants are usually harmless, 


188 VARIOUS FACYORS IN THEIR BEARING ON DIET, 


Olive oil.—This is frequently adulterated with cotton-seed 
oil, ete. Foreign oils are not so commonly adulterated as 
formerly, but foreign Inbels are frequently placed on impure 
ae the ee eteine being done in the United States. 

‘onfectionery is sometimes sophisticated with tartaric 
aa Bee sictee, starch, soapstone, and other substances, Injuri- 
ring-matters may be used, 

Spices.—These, anualany the ground spices, are fre~ 
Pose adulterated, Black pepper has been extensively adul- 
tenited with a large variety of substances, 

Honey.—After being extracted, honey is sometimes adul~ 
temated with glucose or cane-sugar syrup. This is not practiced 
to as great an extent as commonly arrest, and pure extracted 
honey may be bought in the open mar! Comb honey cannot 
pasate voter the aid Ses A thin sheet ol eae 
whic ere are hexagon: impressions correspondin; to tl 
‘bases of the cells, called comb Prundation, is used soul exten- 
sively to bring about greater uniformity in the size of the cells, 
and also to lessen the labor of the bee. In Europe it is said 
that cerasin and paraffin are used for this purpose. They can- 
not be successfully employed in America, however, and bee- 
keepers state that the use of these waxes is impossible, Honey 
may contain poison. Plugge found that the honey from 
Rhododendron ponticum is poisonous, and Xenophon, in his 
Anabasis, describes attacks of intoxication due to cating honey, 
Although death seemed near, none of his soldiers were killed by 
it, Strabo and Dioscorides both speak of honey as producing 
madness or melancholia. In ee inia honey from the cusso 
tree is used as an anthelmintic. @ honey from gelsemium is 
also poisonous. In Branchville, S. C., twenty persons were 
made ill and three died from eating honey derived from this 
source. In New Zealand honey from the “ whauriki,” a cress= 
like plant, causes severe symptoms and sometimes death, 

Glycerin.—This is adulterated with glucose and water. 

Infant Foods.—These are frequently adulterated, many 
of them being merely cereal mixtures for which an exorbitant 
price is charged. 

Baking-powder.—Starch in large quantities is often 
added to baking-powder. Alum may be added in place of 
cream of tartar; but if the powder is correctly labelled, and 
the addition is allowed by the state law, it is not to be con- 
sidered an adulterant. Mallet regards alum baking-powders as 
injurious. This is an open question. 








FOOD ADULTERATION. 189 


Canned V. les and Meat.—These frequently con- 
tain lik inane to health. Copper ait zine, apaste 
ally the former, may be used to color peas. Lead, tin, and zinc 
may be present as the result of unintentional contamination, 
Lead may gain entrance from the solder, which is frequently 
used in Jarge quantities and allowed to drop into the can. 
Lead-stoppered bottles are also sometimes used, and account 
for the presence of lead in the food. Metallic lead is objection- 
able, and the presence of lead salts is highly injurious. There ‘ 
are two kinds of tin plate used in the manufacture of cans—the 
“bright,” in which pure tin is used, and the “terne,” in which 
a mixture of lead and tin is used. This latter is employed 
for roofing purposes, although it is sometimes wrongly used 
for cans. Preservatives, such as sulphurous acid, salicylic acid, 
boric acid, and others, are frequently added to canned foods. 
Preservatives.—Various chemicals are mixed with foods 
to preserve them. In many countries the addition of such 
preservatives is forbidden by law. Sometimes only one 
servative is used, but often mixtures of two or more are 
in combination. Borax and boric acid are the most frequent 
combination. These substances, together with sulphurous acid, 
sulphites and sulphates, salicylic acid, benzoic acid, and formal- 
dehyde, are most frequently employed. A large number of 
other chemicals are used, chiefly to evade laws that forbid 
the use of the drugs just montioned. It may safely be 
stated that the addition of any chemic preservative to food 
is undesirable. ‘There are differences of opinion regarding the 
actual effects of the various preservatives upon the human body. 
Borax and boric acid as preservatives are the subject of 
numerous conflicting opinions. It is possible that some of the 
favorable opinions have been issued by those who draw their 
salaries and their opinions from the sume source. While it 
is stated by many that the use of these chemicals is not in- 
jurious, there are instances on record where they have caused 
severe symptoms and even death. Boric acid and borax 
may, however, find their proper use in preserving meats, 
such as hams, for exporting purposes. Meat sprinkled with 
borax or boric acid does not become slimy, as it does without 
it. Before the meat is used, the boric acid should be washed 
off. The German Government has expressly forbidden the use 
of such powders on meats imported into that country, This 
restriction may, however, have been inspired by the Agrarian 


party, and not by consideration for the public health. 


190 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


Beg esolates ea Bee epaaltiot bis epee its that boric 
acid and borax should not be used except where preservation is 
a necessity, and where it has been shown that other methods of 
preservation ean not be employed. Articles containing boric 
acid or borax should be properly branded for the protection of 
the young, the sick, and the debilitated. Large doses (4 or 5 
grams a day) cause loss of appetite and of ability to perform 
work ; moderate doses (3 grams a day) cause symptoms, but the 
subjects are able to continue work for some time; small doses 
(3 to 2 grams) may be taken for a limited time without result, 
but unfavorable symptoms were produced in some cases, “ It 
separ) therefore, that boric acid and borax, when continuously 

ministered in small doses for a long period, or when given in 
large doses for a short period, create disturbances of appetite, 
of digestion, and of health.’’ 

Harrington* has shown that boric acid may be the direct cause 
of subacute and chronic nephritis. Food preserved with these 
drugs is therefore especially injurious to individuals suffering 
with Bright’s disease. 

Sulphite and bisulphate of sodium are used for preserving 
all sorts of food, and especially for preserving the color of meats. 
Their use is regarded as dangerous, and has been prohibited in 
Germany. 

Sulpburous acid is frequently used, expecially for preserving 
wines. In some countries a certain amount of sulphur is allow- 
able in wine, but the amount is often exceeded. It is also 

idely used in preserving the color in dried fruits, 

Salicylic acid is widely used as 4 preservative. Itis exceed- 
ingly powerful, and is used only where the taste of the article 
is not impaired, us in beer, mult extracts, preserved fruit and 
the like. In some instances the amount of salicylic acid con- 
tained in food to be eaten by one individual in twenty-four 
hours has been found to equal the maximnm medicinal dose 
preseribed for the same length of time. It is undoubtedly 
highly objectionable, and its use should be prohibited, Tt in- 
hibits digestion and irritates the kidneys ; food preserved with 
salicylic acid is especially injurious in cases of Bright’s disease. 

Formaldehyd is frequently used for preserving milk, As 
it hardens meats, it is not usually employed as a meat preserva~ 
tive, In general, it may be stated that the use of formaldehyd 
as a preservative is undesirable and dangerous, Attempts have 

1 Remults of Boraz Experiments, Circular No. 15, Bureau of Chemistry, 


Tnited Site Department of Agricultare, 
1 American Journal of Metical Sciences, September, 1904. 


7 


FOOD ADULTERATION, 191 


recently been made to show that in milk very small 
1: 100,000 and less, would inhibit the growth of ace ae 
ms the same time not be ao ke wey ane pada of 
infants. According to Vaughn, formal in ion 
of 1: 25,000, or 1: 50,000, retards roars the growth of the Insta 
acid bacillus, ‘and thus delays the souring of milk, while it has 
but. little effect on the seal palais of the colon and typhoid 
bacilli. It removes the dan; resid Son ignal without removing the 
Such use of formaldebyd should be prokibited, as it 

it lead to the use of milk which, while sweet, might still be 

Taden with disease-producing bacteria. 

Nydrogen peroxid is used to a slight extent, and is probably 
the least injurious of all preservatives. 

Metallic Poisons and Food.—Small amounts of metals or 
their salts may find their way into food. The metallic salts 
are highly injurious, and may produce either acute or chronic 
poisoning. Many cases of lead-poisoning are traceable to con- 
taminated food. 

Lead has been considered in connection with canned goods, 

Copper may be added intentionally as a coloring-matter or it 
may gain entrance from the use of copper or brass kettles, 

Nickel is sometimes used to color green peas, and may be 
found in sel cooked i ae nickel vessels, In the latter event the 
amount found is eo small that it may ly be 

Zine is sometimes found in food, pared in ee 
Tt owes its presence to the galvanized i iron racks upon whieh 
apples are frequently dried. e amount present is, however, 
so small as to be unimportant. Zine may also enter food from 
certain kinds of solder, but these are now rarely used, 

Arsenic may be introduced into food in various ways. The 
articles most liable to contain it are beer, malt extracts, syrups, 
and foods containing glucose or vinegar. In the widespread 
occurrence of arsenic-poisoning, in Manchester, over 6,000 
Persons were affected, and over 100 died. The poisoning was 
caused by drinking beer which contained arsenic derived from 
impure sulphuric acid used in the manufacture of brewing sugar 
or glucose. In other localities the arsenic has been found to be 
contained in the malt which had been dried in kilns heated by 
burning arsenical gas-coke, 

The following table, as presented by Prof, Sharpless,’ gives 
the food articles likely to be adulterated : 

4 Prva cage No. 25, Division of Chemistry, United States Department 


192 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


icterant, 


Arttee ——idateranta 


Brena?” Sulphate uf alum. 
Copper. 

Wiesand meat “ena.°f PP 

Cheese, Saltsof mereury in 


oy al Polsonous colors, 
a artificial ow 
ences 


Son Other colons 
Cayenne popper, Red lead. 


Alum. 


Alam salt ‘ae 
of turpenti 


Quuatic tmesiam, 
‘sulphate of ihn! 

Water, 

Infested with para- 
ites, 

Anilin colors, arti: 
teial essonces. 
Salta of copper, 

Anilin colors, 


sats of tin and 


= lead, gypsum. 
Cinnamon. 
Pimento. 
Ten. 
‘Vinegar. ‘eh ant 
Wine, ae 


nilin oti 
‘crude brandy, 





Proudutent 
adulterants, 
‘Other starches which 


‘Waier, other thts, ¢x- 
, starch. 
Bxceee of waters 


Oleomargarin. 
Grape-sugar, 

Chicory, peas, rye, 
Tennis, adorns. he 
Ddus-oute, almond or 
ome aero 
inn aa saat 


Ground rie flour, 
gait, ahipbread, In 


giganto, nn 

tee aaa 
fae tages, 

Glucose, canesugar, 


Gelatin. 

Starch, btearin, salt.t 
Yellow  Inkes, flour, 
vurmeric, Cayennd 


awhritouine, anno, 


‘Turnip. 
Golatin, applejely. 


Apples, pumpkins, mo- 
ase 

Plow, ship-brond, lin- 
Polato-starch, 

Water, 





Water. 








Oxid of fron. 


Grit and sand. 
Pollen of various 
plants and ine 
Band, dirt. 
Tainted. 


Old and wormy. 


Sand, 
Burnt auger 


Sandand ditt, tn- 
nota dead and 
ive 
Porruginous 
earth. 


Bulphate of 
‘iat. 


"It was ovidently an oversight to have omitted cotton-seed oil and water, 


DIET AS A MEANS OF DIAGNOSIS. 193 


DIET AS A MEANS OF DIAGNOSIS. 


Test-meals are given to determine the functional disturbances 
of the stomach, and to ascertain whether or not pathologic con= 
ditions exist. There are many forms of test-meals and they 
serve various purposes. 

est meals Employed to Stimulate the Gastric 
Secretion for the Purpose of Determining the Se- 
eretory Function of the Stomach.—1!. The Test-break- 
fast of Ewald and Boas.—Thia consists of a roll or a slice 
of wheat bread (35 to 70 gm.) and 400 c.c. of water or tea 
without sugar or milk, taken in the morning on a fasting stomach. 
The contents of the stomach are Panta one hour afterward. 

2. The test-dinner of Riegel consists of 400 c.c. of soup, 
200 gm, of beefsteak, 70 gm. of bread, and a glass of water 
(300 c.c.), taken at noon, The stomach is emptied of its con- 
tents in from four to six hours. 

3. Test-meal of Germain Sée.—This consists of 60 to 
80 gm. of scraped beef and 100 to 150 gm. of wheat bread. 
The contents are removed after two hours. 

4. Test-meal of Kiemperer.—Klemperer gives } liter of 
milk and 70 gm. of wheat bread and empties the stomach two 
hours afterward. 

5. The Double Test-meal of Salzer.—This consists of 
40 gm. of beef scraped and boiled ; 250 c.c, of milk; 50 gm. 
of boiled rice, and 1 soft-boiled egg. This is followed. in 
four hours by an Ewald test-meal, and the contents of the 
stomach are withdrawn one hour after. 

6. The Oatmeal Test-breakfast of Boas.—This breakfast 
is composed of a plateful of oatmeal broth prepared by boiling 
down to 4 liter 1 liter of water to which a teaspoonful of 
oatmeal and a pinch of salt have previously been added. This 
test has for its object the determination of lactic acid, inasmuch 
as lactic acid is present in all ordinary breads utilized for test- 
meals, 

On account of its simplicity, the Ewald-Boas test-breakfast 
is most useful, although occasionally a Riegel dinner is found 
preferable; the only objection to the latter lies in the fact that 
in withdrawing the stomach-contents bits of meat that may not 
have been thoroughly digested are apt to obstruct the passage 
of the contents through the tube. In examining for lactic acid 
the Boas oatmeal test is preferred, (For a description of the 
various methods of examining the contents of the stomach for 

18 


194 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


acid, ferments, ete., the reader is referred to the text-books on 
diseases of the stomach and on clinical diagnosie.) 

Dietetic Tests for Determining the Motor Power 
of the Stomach.—1. Method of Leube.—This test consists 
in having the patient take 400 c.c. of soup, 200 gm. of beef 
steak, 50 gm. of bread, and 200 c.c. of water. The stomach is 
washed out at the end of six hours ; if it is found to be empty 
at this time, there can be no motor impairment of the 
stomach, 


2. Method of Boas.—If the stomach be washed out at the 
end of two hours after an ordinary Ewald-Boas test-break- 
fast, under normal conditions the stomach should be found 


empty. 

3. Test-supper of Boas.—This supper consists of cold meat 
with bread and butter and « large eup of tea. If, on washing 
‘out the stomach the following morning, food is still found to be 
present, a dilatation of the stomach exists. 

' Dietetic Test for Determining at the Same Time 
Disturbances of both the Motor and the Secretory 
Functions of the Stomach.—Method of Sahli—tIn this 
test substances not absorbed by the stomach are added to a test- 
meal. After withdrawal of the stomach-contents it is possible 
to determine how much of the test-meal has passed into the 
intestine, how much remains in the stomach, and how much 
of the withdrawn meal consists of gastric secretion. The Sabli 
test-meal consists of the following: 25 gm. of ordinary flour 
and 15 gm. of butter are placed in a suitable vessel over a 
flame and allowed to roast until brown. To this are slowly 
added 350 c.c. of water, and the whole stirred constantly ; a 
pinch of salt, sufficient for seasoning, is added, and the mixture 
is allowed to boil for one or two minutes. After the stomach 
has been thoroughly washed out the patient is given 300 e.c. 
of this soup, and the remaining 50 c.c. are retained as a control. 
After one hour the stomach contents are withdrawn and the 
quantity is noted. Three hundred cubic centimeters of water 
are now introduced through the tube, and the stomach is gently 
massaged ; within a few minutes this diluted meal is with- 
dmwn and its quantity noted.t 

Dietetic Test in the Diagnosis of Atypical Cases 
of Ulcer of the Stomach.—In cases of atypical forms of 
ulcer of the stomach Leube advises his dietetic treatment (see 


‘For the method of examining the contents see Sabli, Berlin, kin 
Wochenschr., 1902, Nos. 16 and 17; and Aronsou, Medival Record, Dec. 5, 1903. 


DIET FOR SINGERS AND SPEAKERS. 195 


p. 335) as an aid to diagnosis. If a beneficial result follows 
the treatment, the presence of an ulcer is indicated. 

Dietetic tests are often of value as a means of diagnosis and 
prognosis in diabetes. These tests are described in the section 
‘on Diabetes (p. 471). 

Schmidt and Strassburger Test-Diet-—Stranas uses the fol- 
lowing modification of this diet, as follows: Milk, 1} litres ; 
scraped meat, 80 grams; mashed potatoes, 200 grams ; eggs, 2 
grams ; butter, 40 grams ; oatmeal gruel, made with 40 grams 
oatmeal ; bouillon, } litre; and 6 zwieback of 18 grams each, 
‘The beginning of this diet is marked by giving carmine. In 
health this diet will go through the intestine in 15 to 25 hours. 
In diarrhea, where the principal trouble is in the colon, in 10 to 
16 hours; and where there is increased peristalsis of the entire 
bowel, in 3 to 5 hours. To test the digestion of certain articles 
of diet twice the nsual amount should be given, and chareoal may 
be used to mark the food so given. The amount of mucus, the 
appearance, the reaction, the amount of fermentation, may all be 
noted. This method of studying stools is simple, easily carried 
out, and of great practical value. 


DIET FOR SINGERS AND SPEAKERS. 


The diet exerts considerable influence on the voice. A full 
meal may impair the respiration to such an extent as to inter- 
fere with singing or even to make it entirely impossible. The 
congestion of the vocal cords which may follow the taking of 
food or drink or smoking often has an injurious effect on the 
voice. Irritating articles of food and drink may also impair 
the voice, und should alwaye be avoided by singers and speak- 
ers. Singers often possess curious idiosyncrasies, certain articles 
of food impairing the voice of some while improving that of 
others, W. C. Russell, in Representative Actors, gives an inter- 
mane list of articles taken by prominent actors before going 
on the stage. He states that Edmund Kean, Emery, and 
Reeve drank cold water and brandy; John Kemble took 
opium ; Lewis, mulled wine and oysters; Macready was accus- 
tomed to eat the lean of a mutton chop previous to going on 
the stage, but subsequently lived almost, exclusively on a vege 
table diet; Oxbury drank ten; Henry Russell ate a boiled 
egg; W. Smith drank coffee; Braham drank bottled porter ; 
Miss Catley took linseed tea and Madeira; G, F, Cook would 
drink anything ; Henderson used gum arabic and sherry ; 
Tucledon di Madeira ; Mrs, bt ate calves’-foot jelly 


i 


196 VARIOUS FACTORS IN THEIR BEARING ON DIRT. 


and sherry; C. Kean took beef-tea; Mrs. Wood sang on 

it porter; Harley took nothing during a performance. 
Malibran, it is said, ate a lunch in his dressing-room half an 
hour before singing. This consisted of a cutlet and half a 
bottle of white wine, after which he smoked a cigarette until it 
was time to appear. 

Asa rule, nothing should be eaten before singing or speaking. 
‘The principal meal should be taken two or three hours before, 
and it should be somewhat lighter than usual. Many singers 
eat but little on the day of their performance, but partake of a 

meal afterward. A food much used by singers is the so~ 
called “Jenny Lind soup.” This is very bland and does not 
alter the yoiee. It is made of bouillon and sage, to which are 
added, before serving, the yolks of two eggs beaten up in 4 
half-pint of cream. A half-teaspoonful of sugar is added, and 
it is flavored with spices. Others take raw eggs, egg and 
sherry, or albumin-water, while still others prefer jellies of the 
gelatin variety, or even honey. Orange-juice has its advocates, 
anc the chewing of dried plums has been recommended. Mandl 
suggests that before the performance the singer should take a 
few bites of bread or chocolate and rinse the month with cold 
water. If the song is lengthy, cold water or sugar water may 
be taken during the performance, 

Tn the interval between concerts the singer should live ona 

neral mixed diet, avoiding irritating foods, Most singers 
Gre a tendency to become stout. The general rules for dieting 
the obese may be enforced to prevent or to remedy this. 

Alcohol, in the form of the stronger beverages, is harmful to 
the voice and should always be avoided. Light wines and 
beer, except when taken to excess, are not geverally injurious. 
‘They are best avoided, however, as their use may lead to the 
formation of the liquor habit. 

Smoking is injurious to the voice. According to Mackenzie, 
however, many famous singers used tobacco freely without ap- 
parent harmful effects. 


DIET DURING ATHLETIC TRAINING. 


The course of diet and exercise which athletes, both amateur 
and professional, undergo to fit them physically for games, con- 
teste, or feata of endurance, is known as athletic training. The 
necessity for such training is fully recognized by all athletes, 
and while opinions differ as to methods, there is perfect accord 
in the ideal that is sought. 





DIET DURING ATHLETIC TRAINING. 197 


eee are required and steady nerves are a necessity. 
¢ ultimate object of all training is to reduce the hody= 
weight until it will remain constant under the regular routine 


weight for the first few weeks, varying with the previous con- 
ten of the individual. In Rbint! Oss weeks the weight 
becomes constant. The loss of weight is accomplished at the 
expense of the fat and water in the tissues, In well-trained 
men the muscles are hard and firm, the fat is reduced to a mini- 
mum, the skin is clear, the eyes are bright, the ex ion is 
indicative of perfect health, the body is active, it, and full 
of verve, and the “wind” is good. In the undertrained indi- 
vidual the tissues are not hardened and the “wind” is not 50 
good. In the overtrained there is a curious condition, due to 
overexertion ora badly chosen dietary, or both, and the indi- 
vidual loses weight and energy, and is in every way unfitted 
for the contest for which he was preparing. 

‘The length of time required to train an individual varies 
greatly, but a college youth of the average athletic type can 
usually be put in good shape in six weeks. The transition 
from ordinary life to that of training should be gradual. This 
is true both of diet and of exercise. 

‘The dict-tables of various trainers differ considerably. As a 
general rule it may be said that the diet should consist of 
wholesome food, such as good lean beef or mutton, best given 
underdone, toast or stale bread, and potatoes and green vege- 
tables of all kinds. Among the proscribed articles are all 
entrées, puddings, pastries, sauces, pickles, spices, appetizers,” 
and all fancy and complex dishes. Twice-cooked meat should 
be avoided. All spirits and strong alcoholic drinks, as well as 
tea, coffee, and nerve stimulants of any kind, should be pro= 
hibited. Some trainers allow a moderate amount of light wine 
or beer, while others forbid their use entirely. On the whole, it 
would seem best toomit them. Tobacco in all forms is forbidden, 

Water is usually allowed in considerable quantity—generally 
as much as is desired—carly in the training. If there is a 
tendency to obesity, the amount is somewhat limited. The 
quantity is reduced gradually, only sufficient being allowed to 





198 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


allay thirst ; it should be si slowly. The importance of 
i Usman of water nee pens before any 
contest is recognized Gears athletes and trainers. 

Food is best a in meals, at about equal intervals 
of time: Breakfast between 8 and 9; dinner between 1 and 2; 
and supper between 7 and 8 or 8 and 9. 

The relation of sugar to training is of especial interest, and 
opinions concerning its use differ. Men in training seem to 
crave sugar, and are often allowed a reasonable amount of 
cereals, or in tea and coffee when the latter are used, but it is 
gocally deemed advisable to forbid its use in pastries and cakes. 

er study is needed to decide this question, In this connec- 
tion it is interesting to consider the report concerning the addi- 
tion of sugar to the diet of two club crews in Holland during the 
training for a race. Atwater and Bryant! cite the following case : 

“Two young men with only two hours a day for practice, at 
the end of two months entered for the race. No change had 
been made from their usual diet except that they ate as much 
sugar as they wished, sometimes as much as a third of a pound, 
at the time of their daily exercise. One of them, however, did 
_not make this addition to his diet until the third week, when 
he n to show all the signs of overtraining—loss of weight 
an pga dull feeling, with no desire for stndy. On the 
third day after beginning the use of sugar these symptoms dis- 
appeared. At the time of the race both youths were victorious 
over their antagonists, who did not believe in the use of sugar. 
No bad effects were observed.” 

The accompanying interesting table (p. 200) is taken from 
the report” mentioned. 

‘Thompson? gives the following report of the Yale crew, on 
the authority of Dr, Hartwell, formerly a captain of the Uni- 
versity crew and of the University foot-ball team : 

“The training covered a period of ten and one-balf weeks. 
Breakfast, at 7.30 A. M., consisted of fruits (oranges, tamarinds, 
figs, and grapes) ; cereals with rich milk and sugar, ete. ; beef- 
steak, usually rare; chops, stews, hash, with once or twice a 
week some salt meat, 25 n or ham, usually accompanied by 
liver; stewed, browned, or baked potatoes ; eggs served in dif= 
ferent ways ; oatmeal-water and milk as beverage, with tea on 
special occasions for some particular individual, Dinner con— 
sisted of soups, moats, fish, vegetables, with a simple dessert, 

\ Diary Studies of Univervity Boat Crews. 

* Bulletin No. 75, United States Department of Agriculture, Experiment 

Station. * Practical Dietetics, p. 726, 


DIET DURING ATHLETIC TRAINING. 199 


sneh as rice, bread, or tapi ing, some fruit, and the 
same as at pa coe = The meats 
included roast beef, mutton, or chicken, two ki ‘ing always 
served. But little gravy was used. fits ice a 
woek, The vegetables included potatoes, mashed or boiled; 
tomatoes, peas, beans, and corn. Two bles besides 
potatoes were usually served. Supper (8 to 8.15 9. a.) con- 
sisted of cereals, as at breakfast; chops, stews, or cold meat 
from dinner ; rarely beefsteak ; potatoes, stewed or baked ; and 
eggs about three times a week, usually not on the same days 
that they were served for breakfast. Sometimes ale was per- 
mitted to some individual, After the crews were in final 
preparation for the race at New London the diet varied some- 
what. Breakfast and dinner remained about the same, but a 
light luncheon of cold meat, stewed or baked potatoes, milk 
and toast was served at 4.30 in the afternoon. After this the 
evening exercise was engaged in for about two hours, Forty- 
five minutes after this was completed cold oatmeal or other 
cereal with milk and toast was served, A light supper (9:30) 
was served just before the men retired. This diet was mm 
more liberal than that served ten years before. The men were 
allowed as much food as they desired.” 

Atwater and Bryant! give the following account of the diet 
of the Harvard boat crew at Cambridge, in 1898, in the de~ 
scription of the conditions of their dietary studies. The diet 
was simple, and consisted of roast and broiled beef and lamb, 
fricameed chicken, roast turkey, and broiled fish. raw, 
poached, or boiled in the shell, were used plentifully. 
amounts of milk and cream were also consumed. Oatmeal, 
hominy, and shredded wheat were eaten extensively, and corn 
cakes were served occasionally. Bread was almost always 
taken in the form of dry toast. Potatoes were served twice a 
day, eithor baked or boiled and mashed with the addition of 
a little milk and butter; occasionally they were “ creamed.” 
Boiled rice, prepared with a little cream and sugar, was served 
instead of potatoes at some meals. Beets, parsnips, green 
and tomatoes were used to furnish a variety of S gaatlans 
Macaroni was occasionally served. For dessert, apple, tapioca, 
custard, or other pudding containing a large proportion of milk 
and eggs, was served. The members of the crew were allowed 
beer once a day. Mill was obtaincd from one of the large 
ereameries supplying that vicinity, and was of unusually good qual- 
ity, containing 5.8 per cent, of butter-fut, A very thick, heavy 

¥ Loo, cit. 


ky 


200 vARIOUS FACTORS IN THEIR BEARING ON DIET. 
Summary of Results of Dictary Studies of University Boat Crews and 





Other Dietary Studiea, 
(Nutrients in food actually exten per man per day.) 
3 i 
Fe 
E/2|2 





DIETARY STUDIES OF UNIVERSITY NOAT CREWS | Gm Gin. 


Om, 
Harvard Res vaeny coe at Cambridge (No. 227) | 162 175 | 449 | 4130 
Harvard Freshman crew st Cambridge (No. 6) 163 223 | 468 





ty crew at Gales fon} 160| 170 | 443 | 4075 

crew at Gales Ferry (No. 231) | 185| 152 | 416 | 9675 

Xale Univesity crew at Gales Ferry (No, 232) .| 171) 171 | 434 | 4070 

Freshman crew (No. 298) || 15) 181 | 487 | 4316 

ee ae ae 
SUMMARIZED RESULTS OF OTILER DIRTAILY STUDI ER, 

Football team, college students, Connecticnt* . .| 181| 292 | 557 | 5740 


Footbal team cllegy students, California? 
Professional athlete, Sand are. 
Prizefighter, England‘... 20. 

Average of 15 college clubs? 
Average of 14 mechunics families’: 








erage ies 
Average of 14 professional men’s families . . .| 104) 125 | 423 
DIETARY STANDARDS. ® 


Man with moderate maseular work (Voit 
Man with orodeesta cisscalas work (Pays) 





Man with moderte Cee ya ‘Atwaier) ~» | «. | 8500 
Man with hard muscul Voit). . 100 | 450 | 3370 
Man with hard anne Stee {Prk 71 | 568 | 3630 
Man with hard muscular work {Prk : 4500 











‘Man with severe muscular work ‘Ras : + | 185] “71 | S08 | 3750 
‘Man with severe muscular work (Atwater). - aod 








cream was also used, diluted about one-half with milk. This 
mixture, or thin cream, contained about 16 per cent. of butter-fat. 

The beef used during the studies was entirely from the loin, 
The roasts were sometimes from the fillet, and at other times the 
ordinary loin roast with the bone was used. The meat was sliced, 


i ppanectient Hence Sta, Rpt., 1891, p. 128. 


: Ennai at (Sr) Fen oo 1896, a ont 
ie, 1 


: Uaitel oo Department of Me ‘t ue Ye Yearbook, 1898, p. 450. The 
results are summa} from Connecticut (Storrs) Sta. peel 1801 to 1897, and 
the bulletins of my United States Paerment of Agricul 


* From a in United States riment of vali Office of 
Experiment Stations, Bulletin No. 21, pp. 26-215. ee 





7 


DIET DURING ATHLETIC TRAINING. 201 


freed from practically all the clear fat, and sent to the table ina 
large platter, from which the men were served individually. The 
beef was served rare, but not too underdone ; some of the other 
club tables in the same house served much rarer meat. The 
beefsteak was freed from bone and from nearly all the visible fat 
before being served. 

Lamb chops were served with the bone. Lamb and mutton 
roasts, which were all taken from the leg, were also clear meat, 
trimmed so as to be practically free from visible fat. The 
turkey used was shi from a distance, and had been in 
cold storage. It was baked with force-meat,—i. e., “ ing”? 
or “dressing,”—although but little of this latter was served to 
the crew. Chicken was always fricasseed, and served free from 
all bones, with the seoeptien of those of the leg and wing. 

Broiled fish, usually bluefish or Spanish mackerel, was com- 
monly served for breakfast, as were also eggs, either raw or 
poached, No pastry was allowed, and the puddings were, 
as previously stated, composed largely of eggs and milk. A 
small amount of coffee jelly was served, and at one meal 
during the study ice-cream was allowed. No fresh fruit, with 
the exception of oranges for breakfast, was served. Stewed 
prunes, rhubarb, or apples were also eaten, prunes most abun- 
dantly, No beverages other than water, milk, and beer were 
allowed. Breakfast was served at 8, lunch at 1, and dinner at 
6 o'clock, although one or the other of the crews was 
late at dinner. Atwater and Bryant give the following 
statisties of the Harvard crew at Cambridge, 1898 ; the posi- 
tions shown in the table are those occupied by the different men 
at the time of the race: 




















May 26. May 26. 
Position. | Age. Before| After | Nefore| After 
-jrowing, rowing, rowing rows 











May 5 hard work fr iene, Boece Sane won Sey ai iat worn mee 


* Loe, cite 





202 VARIOUS FACTORS IN THEIR BEARING ON DIET, 


It is in in this connection, to com the diet of 
the Pali bat es as by Yeo. Mudaved gives the 
schemes of training as carried ont at Oxford and 


A DAY'S TRAINING FOR THE SUMMER RACES, 
Oxvoun, ‘Campniwor, 
7a. M.: Bis. A short walk or run. Arun of 200 yards as fast as posible, 
A. ™M,: Breakfast of underdone Underdone meat, dry toast, ten 2 cups 
meat, crust of bread or dry toast, eo one) wae oo 
22M: Dinner: mes ks gee Meat (ar 3 at breakfast}, Sept foe 
fast), bread, no ie gece toes, and. greens, 1 pint 
Sayeere): erry pieeg ees biscuit, or figs, 2 
Ring exercion. 
Cold meat, bread, lettuce or water 
ae iano or water- cress, | pint of beer. 


ey dete ee bed. 





A DAY'S TRAINING FOR THE WINTER RACE 
Oxronp, Camourpor. 
7.30 A. 4: Rise. A short walk or ran. Exercise us for summer races. 





+ Luncheon: 
Mich and } pint of beer. 


M.: Rowing exercise. Rowing exercise. 
Mei Dawes: meat asinsummer, 6 to 6 v.m.: Dinner, as in summer. 
bread, same rule as in summeras to 


gy. 
ov. 


Water a forbidden. As little 
Tiquid to be drunk as possible. 


In paepang hd the results of their observations Atwater and 

it state that, in a “general way, the difference between 

the food of the athletes and that of other people represents a 
difference in actual physical need even if neither is an accurate 
measure of that need.” One of the chief differences lies in the 
fact that the food of athletes is productive of a larger amount 
of energy than that consumed by ordinary working-people or 
college men. The daily excess over the ordinary diet was 
about 400 calories, or about 10 per cent. The amount of pro- 

* Food in Health and Disease, p, 281. 


DIET DURING ATHLETIC TRAINING. 203 


tein consumed was 45 per cent. larger. “In other words, the 
difference in protein was four and one-half times as great as the 
difference in fucl-value, and the excess in protein would account 
for a considerable part of the excess of energy of the diet of 
the athletes as compared with men in ordinary occupation.” 

Atwater and Bryant! close the account of their experiments 
with the following interesting observations : 

“Tn this connection it is epee, tad observe that many 
physiologists are coming to entertain iT 
of metabolism in the body is regulated not simply by the mus- 
cular work, but also by the nervous effort required in the per- 
formance of this work. The especially large proportion of 
protein observed in the dietary studies of the university bout 
crews, of foot-ball teams, of the professional athlete, and of 
the pugilist, as compared with the dietary studies of college 
men with ordinary exercise, and with ordinary families of 
workingmen and professional men, accord well with a view not 
uncommon of late among physiologists. According to this 
view, men who perform continued muscular labor, even if it is 
active enough to make the total amount large, do not require 
especially large amounts of protein in their food so long as 
they undergo no especial mental strain or muscular fatigue, the 
principal requirements being am abundant supply of easily di- 
gested food-material. On the contrary, when a man or animal 
must perform intense muscular work ‘fr a short period of time, 
and is, therefore, under more or leas nervous as well as museu- 
lar strain, a considerably larger supply of protein seems to be 
required than under normal conditions of slow, long-continued 
work. In other words, if a large amount of work must be done 
in a short time a considerable excess of protein is required in 
the food. This view, which has been spray advocated by 
Zuntz,? seems to be favored by the results of dietary studies 
above discussed. 

“ Recent experiments made by Dunlop, Paton, Stockman, 
and Maceadam * have to do with the amount of protein required 
when severe muscular work is performed. ‘The results are dis- 
cussed with especial reference to training, and are believed to 
“ show the importance of two points long known to athletes 
and others doing excessive muscular work. The one is the im- 
portance of proper training, for by it an abstraction of proteid 

* Loc, cit. 

* Uni \ iculture, Exporiment Station Record, 

ils pps SSESG Tn Pours Phyl 8, vol Xb, p08 





204 VARIOUS FACTORS IN THEIR BEARING ON DIET. 


matter from tissues other than muscle can be avoided ; the other 
is the importance of there being a sufficiency of protein in the 
diet to compensate for the loss which occurs. An abundance 
of protein in the diet of an athlete has other functions to fulfil 
besides this. It is required during training for building up the 
energy-liberating mechanism—the asm of musele ; and 
it is also required after work to repair that mechanism. The 
benefits of sang are well known in other ways, such as pre- 
paring the heart for suddenly increased duty and limiting the 
after fatigue effects. 

“The power of the body to perform the maximum of muscu- 
Jar work within a comparatively short time and with a minimum 
amount of fatigue is secured by means of training. Of course, 
skill in application of muscular strength is as essential as is the 
amount o wer exerted. The skill is sought by exercise and 
practice. Phe object of regulating the diet in training is not 
only to furnish the material to supply the power, but also to 
put the machine in the best condition for developing as well as 
applying the power. In other words, the man is to be sub- 
jected for a short time to intense muscular strain and consider- 
able nervous effort. This he is to bear with a maximum of 
result and the minimum of fatigue, For this he needs practical 
training, on the one hand, and proper diet, on the other. If 
the views above presented are correct, the diet for men from 
whom intense muscular effort is required for short periods 
should supply liberal amounts of energy and especially large 
amounts of protein.” 


























INFANT FEEDING. 


Tue subject of infant feeding, during both health and disease, 

is one of extreme im ee, and one on which sucess in 
jiatric practice largely depends. Before taking up the study 

of ra feeding the student should read carefully the section 
on Milk, 

Tnfancy is that period of life dating from birth to about two 
and one-half years. Childhood is the period from two and one- 
half years to puberty, The theory that infancy ends at two 
and one-half years is an arbitrary one. 

There are four methods of feeding infants: 1, Breast- or 
maternal feeding. 2. Wet-nursing, 3. Mixed fecding—i, «, 
breast-feeding supplemented by bottle-feoding. 4. Bottle- or 
artificial fi 4 

1. Breast-; g-—The milk from a healthy mother is 
by far the best nourishment for an infant during the first vear 
of its life, and can not be fully replaced by any other form of 
feeding. Infants fed on the breast-milk of a healthy woman 
are stronger and better able to resist disease. While it is true 
that babies may be reared on artificial foods and remain healthy 
and grow strong, the percentage of robust bottle-fed babies is 
much smaller than that of healthy breast-fed infants. This is 
particularly true of the poorer classes, who often lack both the 
time and the intelligenee required to rear a healthy infant by 
bottle-feeding. 

Contraindications to Maternal Nursing —The following 
rules, adapted from Holt, will be found a reliable guide in 
determining whether or not a mother is fitted to nurse her child : 

1. If the mother has tuberculosis in any form, latent or 
active, she should not nurse her child. A tuberculous mother 
not only exposes her child to infection, but hastens the progress 
of the disease in herself. If the mother has pulmonary tuber- 
culosis, nursing is almost certain to prove fatal to her. 

2. When the mother has had any serious complication, such 
as nephritis, convulsions, severe hemorrhage, or septic infection, 
during pregnancy or parturition, she should not be allowed to 
nurse her infant, 

$. If the mother is choreic or epileptic, nursing is contrain- 
dicated, 





206 INFANT FEEDING, 


4. If the mother is very feeble or has any serious chronic 
disease, the child will derive little, if any, benefit from breast- 

ling and the mother will be greatly injured. 

5. Nursing should not be attempted where experience has 
shown on two previous oceasions, under favorable conditions, 
that the mother is unable to nourish her child. 

6. When no milk is secreted, feeding is, of course, impossible. 

Good artificial feeding is to be preferred to poor breast-feed~ 
ing. If artificial feeding must be resorted to, it is well to begin 
early, for the infant's poet organs are then apt to be in 
comparatively good ition. The question has two sides, 
however, and must carefully be considered. 

Many mothers with an abundance of maternal love and 
manifold good intentions are often lacking in intelligence and 
can not be taught the proper care of an infant. 

Tf the five mother is under observation during preg- 
nancy, the breasts should be carefully examined, and if the 
nipples are found to be short or retracted, measures should be 
taken to correct this condition. his may be done by exercis- 
ing gentle traction upon the nipple daily, In extreme cases of 
retruction a breast-pump may be needed. During the entire 
nursing period the breasts should receive careful attention. 
Cleanliness is imperative, and after each nuraing the breast should 
he carefully washed, preferably with a solution of boric acid. 

During the first. forty-eight hours the child receives practi- 
cally no nourishment from the breast, the only fluid secreted 
during this time being colostrum. This has a laxative effect 
upon the infant’s bowels, emptying them of the dark brownish 
material, known as meconium, which has accumulated in the 
intestinal canal during uterine life. The child should, however, 
be put to the breast at regular intervals, so as to establish a 
free flow of milk ; this generally begins on the third day, but is 
sometimes delayed. 

During the first two days of its existence the child gets about 
six ounces of colostrum a day, which is all that is needed. It 
may, however, be given a teaspoonful or two of warm boiled 
water or of a 5 cent. solution of sugur of milk, In un- 
usually robust but fretful children, or when there is fever, a 
small amount of nourishment may be required ; this should be 

fiven according to the rules for artificial feeding. If the milk 
is delayed beyond forty-cight hours, it becomes necessary to 
feed the child by the bottle until the flow is established. The 
child should be put to the breast regularly, or the breast-pum) 
may be nsed to stimulate the secretion of the milk. Fennel, 


= 


BREAST-FEEDING. 207 


catnip tea, and the like should be excluded from the child's 
dietary. (For a careful consideration of the question of feeding 
during infaney, and for other questions concerning infant 
nutrition, the reader is referred to the exeallant wae OF OmSENE 


ee ne ae importance of 


after two or three trials, decides that the mother is incapable of 
nursing her baby; in the latter case the probabilitics are that 
nothing is wrong with the mother. Often, too, the attending phy- 
sician, especially if he is an obstetric specialist, is apt to give his 
attention wholly to the mother, leaving the child to thenurse’scare. 
‘he mental attitude of the mother has a marked effect on the 
milk secretion, and if she has been properly instructed and 
encouraged beforehand, there is usually no difficulty. If, on 
the other hand, she has graye doubts as to her capability, and 
particularly if she hears both physician and nurse discuss her 
ble incompetency, the milk secretion may be inhibited. 
he mental condition of the mother is often affected as the 
result of weighing the child. It is very desirable that the 
child be weighed regularly and the weight recorded ; but if the 
mother is at all nervous, or if the child is not doing well, the 
weighing should not be done by the mother or in her presence. 
A loss in weight, or even the fact that there is no material gain, 
may so affect the mental condition of the mother as to prove 
deleterious to the secretion of milk. With proper encourage- 
ment and by stimulating the breast by placing the child at it at 
r intervals the flow of milk is pr f 
subject of the fitness of mothers for nursing their infants 
is receiving more attention of late years, and in Germany an 
attempt has been made to show that the daughters of alcoholic 
parents or ancestry are apt to be incapable of nursing their 
infants. While this has been proved statistically, an alcoholic 
ancestry is of so common occurrence that almost any existing 
evil might be attributed to it and its relationship proved. 
Breast-nursing often proves a failure because the mother does 
not understand how to give the breast to the child, With the 
increase in civilization there seems to be 2 diminution in in- 
stinct, and careful directions should be given in every case. 
The child should lie on the right or left arm, according to 
whether the child is to nurse at the right or at the left breast. 


208 INFANT FEEDING. 


If the mother is in a sitting posture, her body should be in- 
clined slightly forward. With her free hand she should gras; 
the breast near the nipple between the first two fingers. If, 
owing to the free flow of milk, the child takes the milk too 

‘ly, this may be checked by slight pressure of the fingers. 
The child should nurse until satisfied. The contents of one 
breast are generally sufficient for one nursing, and the breasts 
should be used alternately. When satisfied, the infant will 
usually fall asleep at the breast. Under ordinary conditions 
the nursing should last for from about ten to twenty minutes, 
If the milk is taken too rapidly, vomiting may ensue immedi- 
ately after or during feeding. If too much is taken, it is re- 
gurgitated almost immediately. If the infant consumes more 
than half an hour in nursing, the breast and the milk should 
be examined. As the infant grows older it requires and takes 
more food, and consequently will require a longer time to nurse 
than it did during the early days of life. 

‘The inculcation of good nursing-habits can not be too strongly 
insisted upon. Many attacks of indigestion, colic, and diarrhea 
may be traced to improper nursing. When good habits are 
once established, there is generally very little trouble, the suo- 
cess of the training depending largely on the manner in which 
it is done. Regular hours for feeding should be fixed and 
adhered to ; and if the child is asleep at the feeding-hour, it may 
be aroused, for it will almost invariably go to sleep after nurs- 
ing. After the last feeding, which should usually take place 
at 9 or 10 o'clock, the child should be quieted and allowed 
to sleep as long as it chooses, 

During the first month or two the infant will, as a rule, 
awaken between 1 or 2 o’clock and again at about 4 or 5 
o'clock. After two or three months it will require but one 
night feeding, and after five months of age the average infant 
will sleep all night without nursing. 

When the change is being made and the child awakens for 
its accustomed nursing, it should be given a little warm water 
from a bottle and be quieted, but not taken up. Regular nursing- 
habits induce regular bowel movements and sleep, and the three 
combined insure health and comfort not only for the infant, but 
for the mother as well. A healthy child, if trained to do so, 
will sleep without rocking or coddling. Three things are, 
however, essential to secure success in this training: a satisfied 
appetite, dry napkins, and a quiet, darkened room. The infant 
must not be nursed each time it cries. If it has colic, the 
warm milk may soothe the child for a time, but later aggra- 


7 





BREAST-FEEDING. 209 
ates the trouble, which in many cases is due to overfeeding or 
sel ea boat a 

The following table, from Holt, may be used as a guide in 
breast-feeding : 

sm ltn ME" REN 

Itday 2.2... 4 6 hours 1 

~ hee eats ee 1 

8d to28th day | |. | 10 re 2 

4th to 13th week - ay 1 

8d to Bth month « a « 1 

5th to 1h 6 hi 0) 


In case of sickness and when the infant is feeble and below 
the av. especial rules are required, and directions should 
Bite idiots eciffeaph sicividial ease’ A’ good getanlitld 
is to feed the child according to the age to which the weight 
corresponds. The child’s weight is the best index of its nutri- 
tion. During the first four months it may be weighed twice a 
week ; after that time once a week is sufficient, The aver 
minimum gain for an infant is four ounces a week. If the 
weight falls below this for several weeks consecutively, it is evi- 
dent that something is wrong. During illness, of course, there 
may be no guin or loss according to the severity of the condition, 

‘When the breast milk is insufficient for, or unsuited to the 
needs of, the infant, it becomes frotful, colic occurs, and the babe 
appears to be “cross.” Disturbances of the alimentary tract, 
diarrhea with greenish stools containing a large amount of 
mucus and undigested curds, take place at times. At times the 
stools are brownish, and contain mucus and numerous curds the 
size of a grain of wheat or larger. In other cases there may 
be chronic constipation with small, hard, dry stools. 

If the infant is getting too little milk, it is fretful and gains 
slowly or not at all, but there is rarely any disturbance of the 
stomach or bowels. In these cases the nursing is continued for 
over thirty minutes without satisfying the child, or it may nurse 
& minute or two and then refuse to nurse because the supply is 
so scanty. Where the breast milk is neatly normal in quantity 
and in quality, certain measures, which will be discussed further 
on, may be taken to augment the supply and enrich the quality, 
or it may be supplemented by artificial feeding. When the 
milk is very poor in quality, as, for example, when the specific 
gravity is from 1.016 to 1.025 and when only 2 or 3 per cent. 
of cream is present, the child should be weaned at once, for the 
condition is not amenable to treatment. 

Mother's milk may easily be teated by means of Holt’s milk 

iu 


210 INFANT FEEDING. 


set, which consists of a lactometer and a cream gauge.’ With 
this the specific gravity and the amount of cream may easily be 
estimated. Estimated with this instrument the cream is to the 
fat as 5 is to 3. The following table will help in estimating 
the quality of human milk ; 








head Cream, twenty-four 
ity, Proteins. 
er ‘wouzs. 
1.081 ‘per cent. 1S per cont, 
1.028-1.029 0-12 por cont. ‘Nor (rich, 
L.002-1.085 5-4 per cent. Normal (fair 


Aelow 1.028 |High (above 10 per eont).| Normal or slightly 
below. 


« | Below 2.028 | Normal (6-10 per eent,), | Low, 
+] Balow 1-038 | Low (below 6 par cont). | Very law tvery 


Above 1,058 ‘High. Very high (ve 


| Abowe 1.088 Nonmal. 
‘Above Tat Low. 





‘Normal or nearly 
£0. 





When the mother’s milk is found to not agree with the infant, 
it may often be modified by the following means ; 

1. If the milk is too rich, the diet should be limited, espe- 
cially as to the amount of meat taken. All alcoholic and malted 
drinks should be prohibited. With plenty of fresh air and exer 
cise, such as walking, the desired effect will generally be brought 
about. ‘The exercise should be carried to the point of fatigue. 

2. When the milk is good but deficient in quantity, the 
supply may be avngmented by massage of the breasts three 
times a day for from five to ten minutes, A good malt extract 
muy be given with the meals, and fresh air and exercise pre- 
scribed. Sufficient flnid should be given, preferably mill. 

8. When the milk is deficient in quantity and poor in quality, 
improvement may be brought about by various means; Mas- 
sage, malt, and iron are to be prescribed if there is anemia, 
An aleoholic malt extract combined with peptonate of iron or 
of iron and manganese is a good combination, and may be had 
in very palatable form. The diet should be ample, and contain 
sufficient nitrogenous food. Milk should be taken with the 
meals, during the intervals between meals, and at bedtime. If 
the milk interferes with digestion, as it often does in these cases, 
the following mixture may be used with advantage : 

Fill a glass three-quarters full of milk, and add a table- 
specail of lime-water and two tablespoonfuls of cream ; then 

ll the glass with water. The lime-water may in many cases 

1 This may be had from Eimer & Amend, New York. 


— 


WET-NURSING. 211 


be omitted and the glass merely filled with plain water after the 
addition Selb yleiaa crt tinea reo 
or ing if the er is enoug! It is very im= 
hig the mother obtain eolieient seek ii night 
the child should be cared for by the nurse, and be given the 
Sheth qeuntiy tw ouflont bot i eal 
4. en the quantity is sufficient but ity is 
4 al perl 


be 
‘The foregoing measures may be tried, but Se See Foo TE 


meq 

A moot point is whether it is wise to allow the child one 
bottle a day as a routine practice. The authors always follow 
this plan after the second month, and where proper precautions 

ing cleanliness and Pasteurization have been taken, no ill 
results have been seen to follow. The advantages of this 
method are as follows : 

‘The child learns to take milk from a bottle, and if, owing to 
the illness of the mother, it becomes neceseary at any time to 
substitute the bottle, this may be done without much He 2 
On the other hand, if the child has taken nothing but 
breast, it may often refuse the bottle entirely, with disastrous 
results, severe cases of acute inanition having been known to 
follow. This method facilitates weaning. If the mother is weak, 
it allows her to obtain an undisturbed night’s rest. Among the 
upper classes the child is often weaned early so that nursing 
may not interfere with the mother’s social pleasures and duties, 
If the breast-feeding be supplemented by the bottle, many of 
these women may be induced to nurse their children daring the 
greater part of the first year, when they would otherwise give 
it up very early and abandon the child to the care of a nurse, 

2. Wet-nursing.—With the advent of a more thorough 
knowledge of infant feeding wet-nursing has, fortunately, be- 
come less frequent. Nevertheless, there are some infants that 
will thrive on nothing but breast-feeding. When this is the case, 
a wet-nurse must be chosen according to the following rules : 

The woman should be healthy and of good habits. The 
absence of syphilis, tuberculosis, alcoholism, and other diseases 
should be determined by careful examination. The nipples 
should be carefully examined for fissures and ulceration, The 
breast should be examined belore and after nursing, and the 
milk tested as previously described. The size of the breast 
alone is nota good guide as to the amount or quality of the 
milk it seeretes. The quantity may be judged by the size of 
the breast before and after nursing or by weighing the baby 


212 INFANT FEEDING. 


before and after nursing. This latter method, aiouge a good 
one, is not usually resorted to, The wet-nurse should always 
be one who has nursed her own child successfully for at least a 
month. If possible, she should be « primipara between twenty 
and thirty-five years of age. Younger or older women should 
not, a8 a rule, be employed. If the infant’s condition permits, 
the nurse should be given at least a week’s trial, for often the 
change in her mode of living may cause a scanty flow of milk 
or render it otherwise unsatisfactory. When she has become 
accustomed to her surroundings, the milk may become perfectly 
normal. Owing to idleness and a too abundant diet the milk 
may become too rich. In these cases the rules previously laid 
down may correct the condition. Suitable wet-nurses are not 
easily obtained, are expensive, and are often a source of eon- 
stant trouble and annoyance. A woman who will give up the 
eare of her own child for pay is usually a very unpleasant 
person to have about. or these reasons, except where there is 
severe acute inanition, other means should be tried before a wet~ 
nurse is resorted to. Wet-nursing is, however, very success- 
fully carried out in Germany and some other countries. 

3. Mixed Feeding.—By this method, as previously de- 
scribed, the child is fed partly on the breast and partly on the 
bottle. This method is indicated when the mother’s milk is 
poor or scanty, owing to some intervening illness, or when, 
owing to deficient quantity, the mother can not entirely nurse 
the child : it is also useful in weaning. Weaning is accom- 
plished with less discomfort to mother and child if done gradu- 
ally. If the mother is nursing the child but once or twice a 
day, her milk may become very poor, and consequently should 
be examined from time to time. In these cases the child is 
usually satisfied after a bottle, but not after the breast-feeding. 

4. Artificial or Bottle-feeding.—When it becomes neo- 
essary to feed the ohild artificially, the physician must under- 
stand the nature of the milk mixture that he prescribes, so that 
he may vary it to suit the child’s digestion and modify it to 
meet the requirements of the growing infunt, 

In the United States the only milk available for infant feeding 
is cows’ milk. ‘To insure success by artificial feeding, an accurate 
knowledge of the composition of the milk, and in how much it 
differs from mother’s milk is essential, A knowledge of the 
methods for overcoming these differences is also necessary, It 
should constantly be borne in mind that while general deduc- 
tions may be made and average figures given, the clement of 
personal equation enters largely into the problem, and each 


7 


ARTIFICIAL OR BOTTLE-PEEDING. 213 


infant must be considered a law unto itself. Children living in 
the country and in the smaller towns, where there is no over- 
crowding aud where an abundance of fresh air can be had, 
seem to thrive on cows’ mille that has been modified but little, 
ps merely by the addition of water in various proportions, 

in the larger towns, where overcrowding is frequent and fresh 
air and sunlight are not easily secured, the question is a more 
difficult one, Children with these environments require a more 
exact milk mixture and additional care. Another ea to be 
remembered is that in the country milk is generally obtained 
more or less pure and fresh, whereas in the town it is orten con= 
tuminated by dirt and bacteria, and when shipped for long dis~ 
tances is stale and often preserved by the addition of chemicals, 

‘The first changes made in milk to adapt it to the infant’s di- 
gestion were to add water, barley-water, or oatmeal-water, as 
8; by Jacobi. Liebig su; that a malted, dextrin- 
ized meal be mixed with the milk. Meigs empl a mille 
mixture that is still used in the feeding of sick infants. Bie~ 
dert, in Germany, Cheadle, in England, and many others have 
made suggestions, but the method in most common use to-day, 
that of percentage feeding, is largely of American origin, and is 
usually known as the “American method.” Although a number 
of well-known pediatricians still use the older methods, the 
American method is, in the author® opinion, the best. At one 
time it was believed that the milk should be made to corre- 
spond in the percentage of its various elements with that of 
human milk, and this is the basis of the method of percent 
feeding. There are, however, several difficulties that must 
overcome, and it was found necessary to begin with percentages 
below those ordinarily found in mother’s milk, and increase them 
as the child’s digestion became adapted to the cows’ milk. 

For our present knowledge of this subject we are indebted to 
the experiments of Dr. T. M. Rotch, of Boston, who first advo- 
cated the establishment of a milk laboratory for filling physicians” 
milk prescriptions, a plan that was worked out by him and by 
the Walker-Gordon Company. 

Tn order to adapt cows’ milk to the infant’s digestion several 
changes must be made in it. These become apparent by study- 
ing the nature and composition of the milk. 

‘The proteins differ not only in amount, but also in character. 
In human milk the proteins consist of lactalbumin and casein, 
in the proportion of two-thirds of the former to one-third of - 
the latter. In cows’ mille one-sixth of the protein is lactalbumin 
and the remainder is casein, ‘The total protein of human milk 


214 INFANT FEEDING, 


ipitates in fine flakes; that of cows’ milk, in heavy curds. 
total amount of protein material also varies, being from 1.5 
to 2 per cent. in human milk, and, on the average, 3.5 per cent. 


able, Cane-sugar has, however, many advocates, among them 
being Jacobi. Cane-sugar, owing to its excessive sweetness, is 
used in just half the quantity of milk-sugar. As it is inex~ 
pensive, it is useful in practice among the poor. 

During the first few days of life sugar may be given in the 
proportion of 5 to 5.5 per cent. ; from the second week to the 
third month, 6 percent., and from that time until the eleventh 
month 7 per cent. may be used. At the eleventh month it 
may be reduced to 5 and a few months later to 4.5 per cent. 
‘There is no advantage in giving over 7 per cent., and it may 
give rise to symptoms of excessive sugar feeding. 

Fat.—The fat of human milk averages 4 per cent. ; that of 
cows’ milk is the same. When the milk has been diluted, the 
amount must either be made up by adding cream or by using 
the upper one-third or upper half of the milk after the cream 
has risen, It is preferable to use fresh cream that has risen by 
the gravity method, or the top-milk method. 

‘There are objections, on theoretic grounds, to the use 
of centrifugal cream ; these have been mentioned in the section 
on Milk, and are of less practical interest in infant feeding than 
was formerly supposed. 

‘The amount of fat to be given varies with the age, weight, 
and digestive ability of the infant. For an average infant, 2 
per cent. the first week, 2.5 per cent. the second, and 3 per 
cent. the third week are the amounts usually prescribed. At 
four months the amount may be increased to 4 per cent. ; after 


= 


MILK MODIFICATION, 215 


Cidorlop infigetion wits tn tnge wind sects gictag ol 
to indi > wi whiti vi 
the characteristic odor of the fatty acids, sae 

Salts.—The mineral constituents of human milk make up 
about 0.2 per cent. of its entire bulk; those of cows’ milk are 
three or four times greater. These inorganic salts vary in about 
the same proportion as the proteins. When the milk is modi- 
fied for the purpose of increasing or diminishing the percentage 
of ins, it is, at the same time, modified for the salts, 

jon.—The reaction of human milk is always alka- 
line. Since cows’ milk is usually acid or neutral, this acidity 
must be corrected by adding either 5 per cent. of lime-water or 
sodium bicarbonate. The sodium salt is used in the proportion 
of 1 grain to the ounce. As the lime precipitates at the higher 
temperatures, when the milk is to be boiled it is better to add 
the bicarbonate. For young infants, when there is a hyperucid- 
ity of the stomach or acute illness, Jarger quantities than those 
just mentioned may be used. Coit recommends the use of 
potassium bicarbonate, 

Poynton, following the suggestion of A, E. Wright, recom- 
mends the use of sodium citrate. ‘Lhe soda forms a compound 
with the casein and alters the curd produced, rendering it very 
much more digestible. The citric acid forms calcium citrate by 
uniting with the calcium salts, The use of sodium citrate 
enables one to give a milk containing more protein than would 
otherwise be digested. It is useful in weaning infants, in 
tice among the poor, where milk modification is im 
done, and is of service in some cases where milk is not 
borne without the sodium citrate. From 1 to 3 or more grains 
to the ounce are used. A convenient method is to order a 
solution containing 2 grains to the dram. A drop or two of 
chloroform should be added to each 12 ounces, to prevent the 
growth of organiams which is liable to take place. From a 
rather limited experience with this method we are inclined to 
think that it is one of considerable value and worth trying. It 
seems to be especially adapted to dispensary work. 


MILK MODIFICATION. 


METHODS OF PRACTICAL VALUE IN MODIFYING MILK. 


There are a number of methods of milk modification that 
may be used with good results in the artificial feeding of infants. 





| 


216 INFANT FEEDING. 


A practical knowledge of these methods is a desideratum in the 
rearing of bottle-fed infants. ‘Those most in use are: 


b Top-milk ror 
method, 

3. Coit’s decimal method, 

4. Materna graduate. 

5. According to Maynard Ladd’s table (after Rotch). 

6. Baner’s method. 

7. According to Louis Starr’s tables. 

8, Chapin’s method. 

1. Laboratory Feeding.—In cities the best substitute 
for breast-feeding is furnished by milk laboratories, where modi- 
fications are made according to the physician’s prescription. 
The Walker-Gordon laboratories, now established in man 
cities, supply an ideally clean milk, unsterilized, pasteuri 
or sterilized ut any temperature desired, The milk is supplied 
in nursing-bottles, each bottle holding enough for one feeding 
and being ready for use. Beyond warming the bottle and 
putting on a nipple no further preparation is necessary. In 
winter the milk is delivered in baskets, and in summer in small 
refrigerators. When economy must be practised, the milk may 
be obtained in larger jars and divided into the requisite number 
of feedings by the mother or nurse. Blank forms on which to 
write prescriptions are furnished physicians. ‘The following 
is an example of such a prescription : 

















B ent. 
Fats. -+ +--+ -- 4 Number of Tyme 
Milk-sugar.- > ~~ 7 feedings. - 
Proteins. .----- 2 Amount at 
Lime-water. + - - a each feeding } =e 
Other Dilwent « . - Infant’s age... +++ +> 
Heated at 107° F. Infant's weight... ++» 

OnDERED FOR... 
Dare. SIGNATURE, 





MILK MODIFICATION, 217 


ratory records, is a le to the quan= 
tity and quality of the food mn ie infant 


Bhowing the average percentages employed, and the amount of modified mitk 




















Sed to a large number of infants. 
Percentages. 
Amount 
Works of 1ife. *eds | ——— 
heal Sugar, | Proveins, 
1 200 as 058 
ii 230 BA 10 
2 4,00 60 10 
x) 8) 8 | B 
s 125 O58 eo 
3 2.80 65 15 
60 or 135 
350 65 135 
a so os 4.98 
300 Os 15 
3.00 6a 16 
300 65 1.25 
4 30 os 135 
375 Gs 435 
4 a7 oo 15 
4 35 65 10 
PY a8 &s 120 
25 65 159 
as 6s 130 
878 65 10 
5 a5 oh 120 
5 a5 65 140 
235 ah 135 
ams GS 135 
a RIO 6s Ls 
|) 8) e] # 
4 Z i 
eo) |e 
“ si 
o 00 zo 135 
6 4.00 10 135 
400 65 475 
cr 4.00, oo 2.0 
4.00 65 20 
a 4.00 os 20 
a 400 65 20 
65 200 
6 400 65 200 
400 a5 200 
40 65 200 
7 400 65 200 
i im | eo | 39 
00 r 
T a oo 20 
7 4.00 0 pa) 
tm | 65 | 330 
7 £00 
£00 00 2m 
4.00 60 275 
£00 fo 27% 
7 4.00, os 300 














218 INFANT FEEDING, 








Premature Infanta, 
Amount fod Fat. | sugar. | Proteids, 
Mdm, «Tye ALTE ss Bae vo 0's {| ie | oi 
1 0” 











prevent coagulation of the casein. When whey is ordered, the 
ee nonce is indicated in the prescription, for example, 
a3 - 





eee O00 
ee O76 





Rotch gives the following formule, showing the proportions 
of whey and casein as a guide for feeding healthy infants where 
it is thought desirable to split the proteins : 





Proteins if | Sy | § 
Bplit. 3 
ra eal Be 
) 
z 


v 


















a a 4 - Be E 
a\f 

3 2 s = 

2/2 | 2 | e8| 88 | | 28 | 2 

1.00 | 4.00 | 0.25 | 0.25 | 025 
Promature - - {/ 150 | 450 | 025 | 080 | nas | fet | 2-14 | 2-18 
Attwerm ... i] 200) 5.00} 0.00 / 0.00| 025 1 2 10 
End of 24 week .| 250 | 5.50| 0.50| 050/095, 4 | 2 | 10 
End of 3d week «| 3.00 | 6.00| 075/075] 095| 2 | 2 | 9 
End of 4th week .| 3.50 | 6.60 | 1.00 | 0.75 | 0.50 2} : 8 
End of Oth week | 4.00 | 7.00 | 100] 0.90| 060) 3 | a | 7 
End of Bth week || 4.00 | 7.00| 1:25] 0.00] 075| 3a | 2h | 7 
End of 12th week | 4.00 | 7.00 | 1.60 | 0.00 | 1.00) 4 2 6 
End of dth month | 4.00 | 7.00| 1.50| 075| 125 43 | 3 | 6 





In most cases whey mixtures are unnecessary. In acute ill- 
ness or when there is decided lowering of the protein digestive 
power they may be of great service. According to Grulee,! the 
albumin content of whey varies with the kind of rennet used. 


4 Archives of Pediatrics, June, 1904. 





MILK MODIFICATION, 219 


‘The more perteot the cardling of the casein, the more desirable 
Tae ty va te pin 
i le, ives: ies of 
ki eiedthcation Ta the pill laboratory 


Fat. casein. facil sagar. ot. Casein, fattel sugar. 
1.00 0.25 0.25 47 250 (0.25 0.50 47 
1000 (0.25 0 47 250 (0,25 OTS 47 
100 (0.25 0.75 47 250 0.50 0.50 47 
100 0,50 0.25 4-7 0.60 0.75 47 
100 0.50 10, 47 par 0.25, 0.25 47 
1000.50 0.75 47 275 (0.25 0.50 47 
150 025 = 0.250 4-7 27 025 «O75 AT 
150 O25 0.50 47 275 (0.50 0.50 47 
160 (0.25 0.75 4-7 215 (0.50 0.75 47 
150 0.60 0250 4-7 300 0250 025 47 
150 (0.50 47 B00 0.25 0.50 47 
150 (0.50 O75 47 8.00 0.25 0.76 47 
200 0.2 6085 4-7 3.00 060 026 4 
2.00 0.25 0.50 47 3.00 0.50 0.50 47 
200 0.25 0.75, a 3.00 0.50 0.75 47 
200 0.50 0.50 47 8.50 (0.25 50 47 
200 0.50 0.76 47 850 0,25 0.75 47 
225 0.25 0.25 47 3.50 0.50 47 
225° 025 «050 AT 860 0.50 075 AT 
225 «60.256 0.75, 47 4.00 0.25 0.25 4-7 
225 (0. 0,50 47 4.00 0.25 50 47 
0.75 47 4.00 0.25 0.75 4a 
225 (0.75 0.50 47 4.00 0,50 0,25 47 
2250 «(0.75 0.75 47 4.00 0.50 0.50 a7 
250 025 025 47 4.00 0500 075 AT 


Tn order to obtain satisfactory results the subject of labora- 
tory feeding must be thoroughly studied. The authors have 
paired Holt’s scheme of haying weekly reports made on all 
artificially fed infants and on many others. These reports are 
supplied in blank form, in pads, to the mother, who fills out 
one each week and sends it to the physician. By this method 
part of the responsibility is placed on the mother, and the physi~ 
cian is kept informed as to the infant’s condition and needless 
oa are thus obviated. ‘The following! is a specimen of such 
form + 

1 From Holt, Diseasee of Infancy and Childhood, p. 184. 


INFANT FEEDING. 








$9078 P7249 ayZ saop yun mo 
2S a OE A aE ls Wiad abd ake Ge ¢ pasnqou-pooS pun 21qQv210Ju09 ppryo oy} st 
PLAT SLR ERLW Ms Fees Fees + g poof 992 Jo hun savaz ppryo 943 s20q 


> yon moe 
Sich ae usu, 
u0rwpsinFas Lo Furyq0, 
+ + + aouagsisuag 
daquinu ‘sj0079 
YF 10M 

Hig Samy und oe aa ds seouppy 
bah dees oil ako? fo quodory 


asl 


MILK MODIFICATION. 221 


The of fat, protein, and uired by an 
Bae tary ies tga ae ts borne th ed ee 
a of percentage feeding. The following schedule 
ill be found useful as an aid to the memory. The figures for 
intermediate ages are easily calculated : 











Percentage. 
Age. | ———_——— 
Premature infants! 1.0 
Im-2hday...| .- 
2d-8th 2.0 





oooeseesst 
we mum co eo coeesseoes Ty 


‘The quantity should be increased half an ounce or an ounce 
atatime. Later, as the child’s appetite grows stronger,—that 
is, when he seems dissatisfied after his bottle,—the quality is 
raised. The fat may usually be increased 0.5 per cent. at a 
time; the sugar, 0.5 to 1 per cent. at a time; the proteins, from 
0.1 to 0.25 per cent. at a time. Strong, healthy, large babies 
require more and richer milk than those of frailer constitution. 

Ssnitkin, of St. Petersburg, has estimated the amount to be 
fed to a child according to the weight. He ascertained that a 
baby’s stomach held about one-hundredth of its weight at birth, 
and that the inerease amounted to about a gram aday. By 
taking one-hundredth of the initial weight at birth and adding 
a gram for each day the average amount required for each feeding 
is ascertained. This is a fair working rule, but practically the 
amount is easily determined by the methods already described. 

What is known as nursery milk is also supplied. This is 
from a selected herd of cattle whose milk contains the fat in 
very small globules, This is said to be more easily digested, 
especially by weak infants. 

2, Top-milk Method.—Many methods have been devised 
for obtaining the desired percentage from milk as it is used in 
the home. No plan is simpler or more practical than Holt’s 
top-milk method. Similar have been devised by Chapin 








and even to make a rough analysis of, the milk used. Occa- 
sional failure may be due to the fact that a very poor milk is 


used. For this reason the authors advise that the milk 
for the infant be procured from a dairy that is known to supply 


whole milk may be used. This method works satisfactorily 
only when the milk is bottled soon after milking, before the 
cream has separated. For those who can not obtain such milk 
the necessary mixture of cream and milk may be made as indi~ 
cated by the table we 223). The top layer of cream may be 
removed from the bottled milk with a spoon; the remainder, 
by means of a small dipper ; for this purpose a Chapin milk- 
dipper, which may be obtained at any drug-store, will be found 
very useful, Another method is to use siphon. The plan of 

ing off the upper one-third is not nearly so reliable. After 
it bas been removed, and before the required portion is taken 
out, the entire upper one-third or one-half, as the case may be, 
should be thoroughly mixed. 

The following tables require no explanation, When desired, 
the percentage of lime-water may be increased, or it may be 
replaced by sodium bicarbonate, 1 gmin or more per ounce, if 
the milk is to be boiled. If the quantity required exceeds 20 
ounces, the smaller supplementary tables may be used, or the 
quantity may easily be calculated by adding an additional one~ 
fourth to each item for 25 ounces, or one-half more for 30 
ounces, ete, 

‘The sugar may be measured by means of a pill-box holding 
exactly an ounce, or very conveniently by allowing two and one- 
half level tablespoonfuls of milk-sugar to the ounce. When cane- 
sugar is used, only one-half the quantity isrequired. Dry measure 
of sugar is just twice that of weighing. Thus, one ounce of sugar 
by weight would measure two ounces in a measuring-glass, 

The following formulas have been taken from Holt :" 

1 Diseases of Infoney and Childhood, pp. 189, 191, 192. 


MILK MODIFICATION, 223 


Fiesr Sates or Forwunas—Far to Proreis, 3:1, 
SET be ork em cent. milk—fat, 10 per cent. ; 
cent. 
eer oi of Pont alt & (ay onal pared 
and esha sen 
Derived formulas, giving quantities for 20-ounce mixtures 


Fat Proteidn 
percent. per percent. 





Tincwiter © ior} with 20010 pemile .100 860 038 
» [Wiergs ada 
“Son * 2.150 550 0.60 
Fa er ae Comer mr ee mm 
SN ah cape a vie 600 0.88 
5 aes bog ta = Lt 3.00 6001. 
& 4 4 Foe 4 #17850 | 650 118 
Table Giving in 0, Condensed Form the Quantities Unually Required for 
Obtaining the Different Pat-percentages, 


AB ODE?,G H 13k LM NO 
To oblain Mt. POEL ys9 1.0 15 20 20 28 25 275 20 BO 30 B25 35 BT 40 
For total food 6.20 20.0 20.0 20.0 250 BAO 28.0 23.00 90,0 980 80.9 2600 87.0 980 40.0 


eer obames tt $010 20 20 40 89 60 7.0 800 2.0 100 14.9 1200 180 14.0 160 


Seem eS finte Pr 

+ 1 ounce in or ileepoont ounces, gives cent, 

for the lower and 6.5 for the bigher formulas lied 
Lime-water: 1 part to 20 of the i the average reqt 


Water: Sticen ot ade othe frei Tela bring the total 
tothe number of ocnces specified; {n part of this waler the milloaugar is dis: 
tolved, Barley-water or any other diluteat ae be added in the same manner, 


Srcorp Serres or Formutas—Far to Prorerps, 2:1. 


Primary Formula.—Seven per cent, milk—fat, 7 per cent. ; 
sugar, 4.4 per cent, ; proteids, 3.5 per cent. Obtained—{1) as 
upper one-half of bottled milk, or (2) by using 3 parts of milk 
and 1 part of 16 per cent. cream. 

Derived formulas, giving quantities for 20-ounce mixtures ; 








SpE 
Milksugar . os. hinchegint he hee Nye 
Limewator . Jos} with Son 7 pe milk. . 550 0.50 
Water, q.s sad. 20 02. 
=; “40 “ 575 (0.70 
i Se a ee 800 OST 
oe i ee hee 600 1.05 
Be) fe wom ow 650 135 
a) Osage ie 650 © 1.40 
we “ 4 Bon 7.00 1.68 
CaS aie Taine ponds 700 1.78 
+. (Milkesogar . i“ 
9.4 Limewater » "Woe © 7.00 2.00 
Water, qs ad. ober 


2 INFANT FEEDING. 
Table Giving in a Condensed Urually Required 
Gntatning the Diftrent Sotcperentagen +e 
a BCDEPaHiIsS ge LW 
‘To obtain percent... . 10 10 14 18 20 285 275 275 31 35 35 40 40 
For total ounces: 26.0 99,0 35.0 E40 86.00 84.00 40.00 40.0 40.0 44.0 440 48.0 
Take7 percent. milk,ounces 30 40 60 8.0 10.0 12.00 14.00 16.00 18.0 20.0 22.0 250 280 


i take one-third the number of ounces of 
topmilk ina 20-ounce mixture and add 0.15 to the result. In practice this 
rolls: Te 
+ The percentage in each case will equal onehalf of the fat. 
1 in 8 ounces, until the food 
becomts half milk; after that 1 ounce in 2, or f even tablespoonful to each 


‘Water or other diluent: Sufhcient to be added to the foregoing ingredienta 
to make the total nuinber of ounces specified ; in part of this the sugar is dix 


Tuirp Series or FormuLas—Far 10 Pores, 8:7. 


Primary Formula.—Plain milk—fat, 5 per cent. ; sugar, 4.5 
per cent. ; proteids, 3.5 per cent. 
Derived formulas, giving, quantities for 20-ounce mixtures : 


Fat Sugar Protelds 
POF cent. per cent, percent. 
Milksugar . Loz. 
|. 4 Lime-water - Lom. >with 5 oz. plain milk . . 1.00 6.00 0.87 
Water a8 ad. 20 ca. 


“6on “ “ 12 6.00 1.00 
ee os “Bo, © “ 2.160 6,50 140 
Hi aay i “Wor “ “ | .200 7.00 1.76 
Milkeugar . pox. 
ter. font “Ifo, “ “ ..240 600 210 
Water, qs ad. 20 02, 
i “Mo. “ “ ..980 5.50 
ces IR 8 BR | BED (S80 


Table Givi iea of 16 1. Milk Required for Obtain 
ne tk BAA He ond Eo Pita ee 





ABCDEFGHIJ&E 
Fo obtain fet par cent... =e = - 16 16 20 25 80 20 RO 25 8S 40 40 
For: ounces [27 152010 800 300 82.0 82.0 57.0 42.0 36.0 40.0 40.0 440 
‘Dake 16 por cont. milk, ounces: ©. ¢ 2) 80 40 60 6.0 7.0 80 80 0.0 100 110 


Proteids in all cases will be one-fifth the fat. 
Sugar: Leven tablespoonful for each 8 ounces will give 5.5 per cent. for 
the lewer forma (A, B, C, ee) and 6 per cant. for the higher formulas 
ete.) 
: acai 1 ounce to 20 ounces of the food will give 5 per cent. 


3. Coit’s Decimal Method.'—This is based on decimal 
| Archives of Pediatric, 1898, p. 34%. 


Le 


= 


MILK MODIFICATION. 225 


and volumetric methods, The inventor claims that it is easily 
memorized, and does not require any but very simple calculation 
to work out what is needed to give the required formula. Three 


sugar solution for introducing lactose not carried by the cream 
or skim-milk. Only the decimal cream and the solution 
are required during the first few months. The 10 per cent. 
cream is best obtained by allowing a bottle of milk to stand for 
fifteen hours. The upper 6 ounces of each quart, when mixed 
with half its volume of sterile water, give the required 

‘There are differences in this envi cream, teil and cen- 


trifugal cream, as shown by the following table, prepared by 
Coit: 
Percentage Composition of Decimal Cream, 
Fat. Trotein, Lactose, Water and salts, 
No. 1. Gravity. «2. . 10.0 2.33 2.06 85.01 
No, 2. Top-milk - . 10.0 3.75 4.50 S176 
No. 3. Centrifugal. « 100 1.60 2.00 36.50 


The following table shows the approximate percentages of 
protein and lactose carried by three acral creams when they 
are used to introduce definite fat-values into milk mixtures : 


Formulas. 


No, 1, Gravity cms, 190 cc. (6 fl.oz.) + water, 90 oc. (3 a 
No. 2 Top-milk, incl wvity cream, 300 oc, (10 fl.oz, 
No, 3. Centrifugal act ay peers fat + water, equal james. 


a 
Ber emt. ‘Percent Per cent. 
Ee introducing milk-fat, oo oe Protein, ae Lactose, 10 











Drelmal cream 86, 2% Ady a) aA 
“25 “09 0 

“20 eae 109 

For introducing milk-fat, 40. Protein, 0.60 Lactose, 0.8 

a) & Ee Sem 

‘Decimal cream “« “ y “ “« 045 “ 06 
No.3. “ “ 25.: 8 O40 “ O85 


u “ 90.) “ 030 “ O4 


226 INFANT FEEDING. 


‘The standard saccharated skim-milk is arly dre 
grams of milk-sugar to 1 liter of skim-milk, which is equivalent 
to adding 1 ounce to 20. The skim-milk has a formula of 4 
cent. protein and 5 per cent. sugar, or a ratio of 5 to 4. 
‘ith the addition of the sugar the introduction of the protein 
is simple. A given amount of food multiplied by 0.25 would 
indicate one-quarter of its bulk, which, if skim-milk, would add 
tothe mixture 1 per cent. of proteid. This same decimal multi- 
plier would indicate the percentage of sugar thus introduced by 
a 10 per cent. solution. The following table will show the 
lactose carried by the saccharated skim-milk corresponding to 
definite protein values : 
Saocharited wkim-anilk. 
Amount of food in cc. x 0.125 or ¢ = Protein 0.5 Lactose 1,25 
Amount of food ines. x 02500r}= “ 10 * 250 


Amount of foodinec « O3750rg= “ 16 “ 375 
Amount of foodinec. x 0.5000r}= “ 20 “500 


The standard sugar solution is easily prepared by dissolvi 
100 grams of lactoze in sufficient water Gnas measure 1 liter 
(or in proportion of 2 ounces by weight to 20 ounces of water). 
The only difficulty with the sugar is found in occasional impu- 
rities, such as free lactic acid, which should be guarded against 
because of its tendency to precipitate the casein of the mi 

For the calculation of formulas three points only are to be 
borne in mind, namely: The percentage formula desired ; the 
quantity of food required, and that the standards, except for 
protein, represent percentage values in ratio of 1 to10. Given 
these constant factors, the problem of adjusting percentage com- 
position becomes an easy one : The quantity of food required is 
reduced to cubic centimeters (ounces multiplied by 30), and this 
product is multiplied by the percentage tenth of the element to be 
introduced, The following table will serve to illustrate : 





One feeding. ‘Milk-fat, Protein. Lactose, 
2 flos = 30... . . 60,00 cc. | Required percentage 
02 formula... . 20 05 © 60 
0.5 05 
3B 
300 Working formula: 


Standard sugarsol.. . 35,00 ce. 





_ 


MILK MODIFICATION. 227 

‘One day's f000. Milk-fal, Protein, Lactose, 
B6 for x 30. . . 1060.00.00) Requiredformula, 40 LO 65 
040 “| Decimal cream. . 4.0 LO LO 
Decimal cream. . . 420,00 cc. 55 
Code ‘Standard sugar sol. . 56 
ars) Working formula : 

5250 Decimal cream, 420 cc. 

Standard sugar sol... 677.60 we ‘solution . : + B70 
‘cluding allel) 53 

‘To be divided into ae 

7 feedings of 6 


ounceseach. . 35 floz or . . 1050 cc, 
vy ‘One feeding. teed “MILK, Pan ). Lactose, 
or, X80... ee 240.00 cc. uired percent 4.0 0 7.0 
pes eee ney 





0.40 1 10 
Decimal cream . 96.00 cc. SEs 3 10 6.0 
cc! skim~ 
bay hosel Wi SUM 
“200 «| Standard sugursol. . . 8B. 
Working formula 
Seccharated skim-milk 60.00 cc. Decimalcream . . 96 cc. 
240,00c.c. ) Saccharated skim-amilk ... . . 6000 
0.35 sugar solation |. 2 Boo. 
1200 8 fonor. . s+ . oe MO oe 


Standard sugar sol. . . 84.00 cc. 


4, Materna Graduate Method.—The very simple and 
useful apparatus known as the Estraus Materna Graduate is 
of great value where one can not secure intelligent cod 
tion in the home, and also where there are no facilities for milk 
preparation. This method of infant feeding has been tried by 
the authors for several years in the Robert Garrett Free Hos- 
pital for Children, Baltimore, and too much can not be said 

ing its simplicity and efficiency. With its six formulas, 
however, it is not adaptable to all cases, some infants being 
totally incapable of taking the step from one formula to another. 

The apparatus consists of a glass jar with a lip and seven pan- 
els, and a capacity of 16 ounces. e of the panels exhibits an 

inary ounce graduation ; the other six panels present six dif- 
ferent formulas for the modification of cows’ milk, each formula 
being so arranged as to keep pace with the infant’s growth, viz. + 


Fat. hile Fates Bret cent. phan yea Percent. 


Pate « oe 1" Be eg « « 
For Formula 6 see specia! instroctions below. 


228 INFANT FEEDING. 





a) 6 |i... 
y "ag | Rarley-aracl bg 
u P Fi ber ee ee! 


Having decided which formula is to be used, the panel con- 
taining that formula is the only one to be followed. 

The cuaety desired for twenty-four hours is next to be 
considered, and the apparatus filled—onee, if 16 ounces or leas 
are required for the twenty-four hours ; twice, if from 16 to 32 
ounces are required for twenty-four hours ; three times, if 
from 32 to 48 ounces are required for the twenty-four hours. 

Directions. 

(The lines beneath the words indicate the points to which the 
yarious ingredients are to be filled in.) 

1. Milk-sugar.—Introduce milk-sugar to the line so marked. 
Where good milk-sugar can not be obtained, granulated sugar, 
in just half the quantity, should be used. A small cross on the 
apparatus indicates this point. (See directions for Formula 6.) 

2. Water.—Add boiled water {hat to the water-mark, and 
stir until the sugar is dissolved. If any particles are seen 
floating in the solution, it should be filtered either through ab- 
sorbent cotton or through two thicknesses of clean muslin, 

3. Lime-water—Ordinary lime-water, such as is obtained at 
drug-stores, should then be filled to the L-water mark. 

4. Oream.—This should be the ordinary cream (16-20 per 
cent.) as obtained in bottled milk; it should be poured in to 
the cream mark. If the cream is purchased separately, ordi- 
nary cream, and not centrifugal cream, should be used. 

5. Milk—Ordinary good cows’ milk should be used and 
the jar filled to the milk mark. 

6. The entire mixture should next be stirred. 

7. The whole should then be poured into separate bottles and 
sterilized if desired, or stoppered with cotton and immediately 
placed upon ice. 

Directions for Formula 6—1. Sugar.—In this formula 
granulated sugar should be used in place of milk-sugar, and 
the sugar introduced into the vessel to the line thus marked, 

2, Barley-gruel—Io this formula barley-gruel should be used 








: 


MILK MODIFICATION, 909 


Berley-gro! scald be prred as flows; To 1 tblenoonfa 
Barl should be eons Tol 
of barley, after 


of Robins 
barley flour ; ew uh codes cet a ei 
ing water ; cook for fifteen minutes, stir, and strain if lumpy. 

3. Cream. 4. Milk—Add the same as in other formulas. 

5, Stir, 6. Sterilize—Same as in other formulas. 

5. Maynard Ladd’s Table.'—Another method of modi- 
fying milk is according to Maynard Ladd’s table. In this the 
quantities have been estimat This method is useful in hos- 
pitals where there ie a milk laboratory. In general practice it 
is of slight value, for it necessitates memorizing a lengthy table, 
or carrying it about, both of which methods are open to objection. 














Pipapeamur| Cream in onnoee | Fatfree mk tn ocnger 
bk Sa eS i 2 
Sele] 2 3 
(la Bele] e/ 8/2/08) a1 & tle 
ali i liae/E)E) 2) 2/2) 2) 2 Uae 
a\s s Rg 2 | a 

5.00 / 2.00} 5 | 1 o 1 L 
0.75 |600|1.00) 5 15) 1 7 j Ht ? i 1 ww it 
1.00 | 5,00/0.76/5|2 | 1b) We] 1 2 3 11)16 |2 
1.60 | 4.00 | 0.00 | 6 |(*)| 2 ul) 34 | 1 | 164] 13 
2.00 | 5.00 | 0.75 | & 3 1 0 1 1 1/15 |2 
2.00 | 5,60/1.00/ 5 |4 | 3 uy y 1 | 133 
2.00/6.00/1.00/5|5 | 4 2 0 ft 3 1} 14 | 2) 
8.00 | 6.00 | 0.60 | 5 | (*)) (*) 3 NTO) 0 2) 1) 16b) 1 
8.00 | 6.00 | 0.75 | 5 \(")| & 3 1/0 | 4/2 )1/)14 
8,00 | 00 / 1,00] 6 | (1 b) : a1 Mii) 4 
3.50 1.00} 5 |? 4 4) 0 1 2 }1)t 
3.50 1.60) 5 4 1 2 3 4y}1)u 
$800| 7.00) 1.00 & | (+) eC) 1 1 | 193 
8.00 | 7.00 | 1.50 | 5 2 1/11 |2 
8.00 | 7,00 | 2.00| 5 |6 3 1 
4,00 | 7,00 | 1.00) 5 | (*)) (* 6 @ q 1 1 | 18. 
4.00 | 7.00 | 1.50 | 5 5 0 3 lj 
4.00 |7.00|2.00| 5 |8 5 2 bh 1} 83 
4.00 | 7.00 | 2.50 | 5 |S 5 5 8 oH} 1) 6/2 
4.00 | 7.00 | 3.00 | 5 |8 5 7 1 ii} 2 
4.00 | 6.00 | 3.00 | 6 | 8 65 3 7 ot 1g} 1 it 
4.00 | 5.00 | 3.00 | 5 | 8 5 3 7 103 | 11: 1 1 
4.00 | 5,00 | 3.50) 5 |8 5 3h 10 [1p 1S [4p] a] Vig 



































1 Taken from Rotch’s Pediatrics. | _ 2 rs 
Pay] indicates that the combination is impowible with the percentage of 


230 INFANT FEEDING. 


6. Baner’s Method.—Many attempts have been made 
from time to time to compute a table of equations from which 
the quantities of milk, cream, ete., may be determined for any 
given mixture; the simplest of these is that of Baner :' 


peat Gerken Lis cnncen) = 

Pestonl naedeer olor =8 
percentage of protein =P. 

To find in ounces— 

Cream (16 per cent.) -2x(F-P). 

Milk -2P_o 

Water =Q-(0+M). 

Dry milk-sugar —S=PxQ. 


100 


Example—Suppose it is desired to make 40 ounces of a 4 
per cent, fat, 7 per cent, sugur, 2 per cent, protein mixture. 
By substituting the figures in the equations above we have— 











Lovis Starr's Table of Ingredients, Hours, and Intervals of Feeding, and 
Total of Food for a Healthy Artificially Fed from Birth 
to the End of the Seventh Month? 

eB]. |S | oars tor IDrrmls) rota 
ro j He a g | a | omse |e tt 
tee 

During ietwk.| foi) | Motij) . . |grxe| . fil gomnetiaes thours| Mxij 

Bae 

Prom 24,00}! rs |. . | tase jeraxxla pinch} oy |{$4:%.' | bonours! fexvij 

Pron Giw, | fot 
to end of t| iss |, . | tox | ses la pinch) tox | {F4%"|Fonours| texe 
34 “month, 

PRE monte ¢| He | + | ray | sy ja pinen| seias| {Toor ye | pees bee) taxa) 

During th 
‘and 7th b| fans tottio| x Ja pinch} ray | {7 }snours| fsxxx0) 











1 Naw York Med. Jour, March 12, 1898. 
1 From Diseases of the Digestive Organs in Children, p. 24. 


- MILK MODIFICATION, 231 


7. Louis Starr’s Table (see 230),—This is a fre- 
quently used guide to milk-; . y 
as a basis for modification by those who object to the 
method. The latter method, however, once mastered, will 
found more satisfactory for general purposes, 


oe a the eae and ninth months five meals a day will be sufficient, 





‘This allows 40 fluidounces of food a day. 


8. Chapin’s Method.—Chapin suggests the removal of 
the top-milk or cream from bottled milk by means of a small 
milk-dij holding one ounce. He removes the cream as 
soon as the milk is delivered if the cream has separated. For 
young infants he removes 9 ounces from the top of a quart of 
milk (fat to protein, 3:1). For older infants be advises the 
removal of 16 ounces (fat to protein, 2:1). He dilutes this 
with wheat-, barley-, rice-, or oatmetl-water, using 1 or 2 
tablespoonfuls of flour and a quart of water, and boiling for 
fifteen minutes. This is dextrinized if desired, strained, and 
salted, and sugar is added. 


Procnimsrve Incerase or QuaNTITY Axp StasxoTn or Mrxrunna! 


5 . 2 of of Sox. topmilk (after 
16 ounces—oneeighth top-milk. Rid 
“5 ‘ 9} set { joved from bottle and mixed). 


F 8 on of Sox. topmilk (after being 
21 onnces—oneseventh topanitk. remored from bottle and mixed). 
Big we | ann : 
fe cl ne lop call fete belo 
24 ounces—one-sixth top-milk. ko , Yj 
Bg a no et 
ie ya ‘lk (after being 
30 ounces—onesfifth topmilk. Femoved from tote and mixed). 
Boron fox fedingy one every to) ayo of dient 
‘and one-half to three hours rae 
36 ounces—onefourth top-milk. Cig By 
Six Gos. feedings, one every three } 27 o2. of diluent. 


14 or. of sugar, 
"Chapin, Znyont Feeding. 





232 INFANT FEEDING. * 


42 ounces—onethird topmill. (eae ee 


28 oz, of diluent, 
lk, Boe of ropa fro one quart 
40 ounces—one-half i on Ty 
BR foe fra Ora hediigs, eae bottle, 
every three to three and one-half | 20 oa, of diluent. 
hours Loz. of sugar. 


48 ounces—two-thinds il 1 quart of milk. 
Bix Bon. or Bre ihn atin nef 1 pint of diluect, 


Chapin gives the composition of the mixtures in the follow- 
ing table ; 





Lowestextreme. Highest extreme, 
26-02 topanilk from milk’ | 16-02, top-milk from milk 
‘Sper cont. fat. Oper cent. fu, 


Fat Protelde Sucar | Fat Protelds Sugar 
per cont, per cent, percent. | per cout. per cent, per cent, 
2 0.38 








Diluted 8 ti 07 0.50 112 0,50 (0.50 
ADD 08 043 0.57 130 0.57 (0.57 
aS. . . 09 0.50 0.67 150 (0.67) =—(0.67 
" 65 11 0.60 080 | 180 © 0,80 0.80 
oy re 14 0.75 1,00 225 «61.00 1.00 
ms 18 1.00 133 | 800) 133) L838 
"2 270-150 «200 | 450 ©6200 © 2.00 


ey are prepared in the following manner: A tablespoonful 
of barley flour or of any other flour desired is boiled in « little 
more than a pint of water for fifteen minutes. As soon as it has 
cooled a teaspoonful of 9 good malt extract or a teaspoonful of 
dinstase is added. This mixture is stirred thoroughly, and may 
then be used in the place of ordinary barley-water. Diastase 
preparations are made by most of the leading manufacturing 
chemists, Diastoid, made by the firm of Horlick, maltine, 


MILK MODIFICATION. 233 


and diazyme are preparations of this class. The thick malt 
extricts are sometimes given to infants just before a feeding. 
Of these, several doses may be given daily for indigestion and 


Chapin suggests that a! home-made decoction of malt be 
re - caaking g mabed eae directions are as follows : 
* mal ley-grains is in a eu) = 
enough ald pte added to cover papeb leds a 
fuls, as the enacts uae Be Uae aes e 

evening and placed in a refrigerator ov 
In the morning the penne dein like thin tea, ns 
pared win 4 spoon or skimmed off, is ready for use, 
About a tublespoonful of this solution can be secured and is 
very active in diastase. It is sufficient to dextrinize a pint 
of gruel in ten to fifteen minutes. This should be prepared 
fresh every day.” 

Vegetable Broths,—Edsall and Miller have ‘imented 
with a bean flour, in which the starch is by 
of a diastasic ferment. They have found it useful in digestive 
disturbances and malnutrition. Méry recommends the use of the 
following vegetable broth as a substitute for milk after gastro- 
enteritis: 





Boil in a covered earthen pot for four hours, strain and add 
water to make 1 litre, and 6 s of salt. 

Buttermilk as an it Food.—From time to time 
buttermilk has been advocated as an infant food. It is used 
most frequently in Holland, and has recently had many expo- 
nents, among the most prominent of which is Teixeira de 
Mattos, of Rotterdam. 

The buttermilk is prepared by mixing a eet of the milk 
and a tablespoonful of rice, barley or any oth er flour desired, 
It should be heated gradually, stirring constantly until it has 
boiled up several times, Two or three tablespoonfuls of sugar 
are then added. About half an hour is required to 
this mixture. When finished, it is of a yellowish color, It 
should be poured into bottles or jars, and if it becomes Jumpy, 
it shonld be shaken thoroughly. This mixture is used 





234 INFANT FEEDING. 


eel of all ages and in about the usual quantities, It is 
cis at aren fire eerie for normal 
also for those with digestive disturbances and 

= 

Tf buttermilk feeding is commenced suddenly, vomiting and 
diarrhea may follow. If, however, its use is persisted in, the 
digestion soon returns to the normal. It is also said that an 
reversion to sweet milk will cause a similar disturbance in but- 
termilk-fed babies, and that the change should always be 
made gradually, by mixing buttermilk and sweet milk together 
before preparing the food. The authors have had no experi- 
ence with this th this fo form of feeding. 

Ramogen.—This ae modified mill conserve, manu= 
factured according to the method and under the supervision of 
Professor Biedert. It has been-highly recommended in Ger- 
many and has been introduced into the United States. It is sold 
in cans, and emulsions of it are made either with milk or 
water, according to the age and condition of the child, After 
summer diarrheas water emulsions are used as dilute, as 1:30. 
In premature or weakly infants dilutions of 1:20 are recom- 
mended to start with, using later stronger emulsions as a child’s 
condition improves. Emulsions 1:13 and 1:9 are frequently 
used. In constipation 1 :9-8-7-5 may be tried before adding 
milk to the mixture. Ramogen may also be mixed with barley 
gruel and with veal broth. In older children emulsions are 
made with Ramogen, milk and water. The composition of 
some of these emulsions is said to be as follows : 


A—RAMOGEN-WATER EMULSIONS, 
Romogen, Water, Protein, == Fat. Sugar. 


14 3 
210 4.50 


Wn 
2 
& 


Ramogen. Water. = Milk. ~— Protein. = Fat. Sugar. 


Et 13 2 = 1 lz aS 
pk 13 6 = 16 2.10 35 
x~L 1 13 w= 19 2.80 37 
XV. 1 13 %6= 26 2.90 41 


Siegert uses more concentrated emulsions, and advises the 
addition of sugar. Ramogen, as sold, is said to contain in 100 
parts ; protein, 7,1 ; fat, 15.5; sugar, 35.5; salts, 1.4. 

Girtner’s Milk.—This isa proprietary modified milk first 
prepared by Giirtner. It is made by centrifugalizing a mixture 


MILK MODIFICATION. 235 


of equal parts of cows’ milk and of sterilized water. The mixt- 
ure is put into a special machine and olstad 90 repay 8 
it is ited ically into a creamy milk a skim- 
mill. e cream thas drawn off contains about the same 
amount of fat and protein as in average mother’s milk, and 
sugar is added to it to bring the percentage up to about 7 per 
cent. When fresh, it has been used with success in feeding 
both sick and healthy infants. 

Backhaus’ —This is a centrifugalized milk that has 
been subjected to the action of a mixture of rennet, trypsin, and 
sodium carbonate, It is modified with cream and sugar of 
milk, and sterilized. It is made iv three different strengths, 
having, it is aid, the following composition : 





th, mL 
32 33 
54 48 
21 35 
On or 


‘The first mixture contains 1 per cent. of lactalbumin and 0.6 
per cent. of casein. The others consist chiefly of casein with a 
small percentage of lactalbumin, 


ARTIFICIAL FEEDING. 


In the methods of feeding just described the addition of fari- 
naceous —i. ¢., barley, oatmeal, arrow-root, rice, ete.—to 
some of the foods has been recommended by certain observers. 
That such addition to the infant’s dietary during the first 
is advisable is a question that has not been fully decided. 
When deemed necessary, it is probably best to begin the 
addition of a starchy gruel to the milk at about the eighth or 
ninth month in normal infants. In those infants who expe- 
rience difficulty in digesting the proteins, as will be explained 
ponies ste | heading of the Feeding of a pans, cen the 
purpose of preventing ition of the milk into lots, 
the addition may be on type Tt is well to begin by 

ing a half-ounce or an ounce for each feeding and, as the 
infant's starch-digesting power increases, to increase this amount 


Spee 

‘ginning Bottle-feeding.—In order to succeed it is 
necessary that this method be begun properly. The percentage 
used to begin with should always be well within the infant's 
digestive power, and raised as rapidly as possible to a milk 


_ll 





236 INFANT FEEDING. 


suited to the age of the infant. It isa good plan to start with a 
milk given in the schedule for a baby one-third the age of the 
one to be fed. Each day, or even at longer intervals if neces- 
sary, the milk may be made slightly stronger. Ifthe milk is 
made too strong at first or the percentage raised too rapidly, 
indigestion, colic, and offensive stools will be the Saeed On 
the other hand, the opposite mistake, that of feeding an infant 
ona milk too weak, should also be avoided. When this mis- 
take is made, the infant becomes pule, cries, and does not in- 
crease in weight. Severe hunger may result, and symptoms of 
inanition may follow. 

Technic of Modifying Milk at Home.—To insure 
success in home modification a very careful technic must be 
followed by the mother or the nurse. In the absence of a 
nurse specially trained for the purpose it becomes necessary for 
the physician to give careful written and verbal instructions, 
and then to see personally that these are carried out. Knowl- 
edge on the part of the mother or nurse should not be assumed, 
for, as a rule, she does not possess it. There are many nurses, 
both graduate and otherwise, whose conceptions of infant feed- 
ing and milk preparation are pructically useless, Like many 
medical students and recent graduates, they understand more 
about laparotomies than they do about milk. If this is borne 
in mind, many unpleasant experiences may be avoided. 

The vessels and instruments used should be kept bay eee 
clean, and be used solely for the purpose intended. 
or, what is decidedly better, just previous to being used, they 
should be either boiled or scalded with boiling water, preferably 
the former, 

The nursing-bottles should have rounded bottoms, so that 
there are no corners for holding dirt, and also that they can not 
be stood about the room. If only one or two bottles are used, 

should be scalded after each feeding and filled either 
with boric acid or sodium bicarbonate solution, made by adding 
a teaspoonful of either drag to a pint of water. When the 
bottle is to be used again, the solution should be poured out 
and the bottle rinsed with plain sterile water. 

The nipples should be of the ordinary short black-rubber 
variety. White nipples, which are said to contain lead, as 
well as all complicated nipples and tubes, should be avoided. 
These latter can not be kept clean, and are a source of infection 
in diarrhea. In some cities their sale is prohibited by law. 
After each feeding the nipple should be washed, turning it 


MILK MODIFICATION. 237 


oe Serpe ee ca a in a glass of 
Pee mee sisson (C7) t is a good to have several 
nipples on hand to boil them before using them for the 
first time, and then for five minutes every day. The hole or 
holes in nipple should be just large enough 
milk to drop out somewhat rapidly. It should uot flow out in 
4 stream. Ag tha hls are too mall, they cony.e eolarael te 
new ones made by using a red hot darning-needle. Some 


f 
F 


le, the milk may not drop very fast, but the food reaches 
the child mipidly enough, a et 


Preparation.—It is best to ra the entire quantity for 
twenty-four hours at one time, the weather is warm, the 
mill must be Pasteurized or sterilized immediately (eee section 
on Milk). If neither can be done, then, unless oe weather is 
cold and a clean milk can be obtained, but one feeding should 
be red at a time. 

@ top-mille method is used, the milk should be received 
in bottles, In all cities there are reliable dairies that supply 
milk in bottles, Where this is not the case, the bottles should 
be furnished the milkman, and arrangements can generally be 
made by which the milk will be poured into them as soon ms 
possible after milking. After the mill has stood for at least 
five hours, the first ounce of cream may be removed with a 

n and the remainder of the upper one-third or one-balf, ax 

ease may be, with a Chapin milk-lipper. Another method 
is to use a bent glass tube and siphon off the lower part of the 
milk from the bottom of the bottle, or the top-milk may be 
poured off with reasonable accuracy. 

The physician should always write out the quantities to be 
used for preparing the milk. The milk- or cane-sugar is dis- 
solved in hot water. Care should be taken to use a sugar that 
gives a clear solution without filtering. If the solution is not 
clear, howaver, it should bo filtered through a wad of cotton 

in the bottom of a funnel or through a piece of drug- 
gist’s filter-paper. This solution, together with the lime-water 
or sodium bicarbonate, should be poured into a pitcher. Into 
this the milk, or milk and cream, should be poured, and the re- 
mainder of the water added. The water should always be boiled. 
‘The mixture should then be stirred and poured into the nursing~ 


- 


238 INFANT FEEDING. 


bottles. The bottles should then be stoppered with moderately 
tight plugs of non-absorbent cotton, to keep out bacteria, The 
bottles are then Pasteurized or sterilized and placed in a refrig- 
erator. : 

At the feeding hour the bottle is taken out of the refrigera~ 
tor, placed in a pitcher or tall vessel of hot water to warm it, 
the cotton plug removed, and a nipple substituted. The milk 
should be heated until it is lukewarm—about 98°-99° F. The 
nipple should never be placed in the mouth to test the heat, 
but the milk may be allowed to drop on the wrist, where it 
should feel warm, but not hot. 


FEEDING DURING THE SECOND YEAR. 


During the second year of life as much care is required in 
feeding as during the first. The fear of the second summer 
would largely be overcome if the child were not allowed to eat 
food unsuited to its digestion. The fact that some children 
thrive on almost any kind of food is no excuse for permitting 
a child to have the same food as its elders, as ix so often done. 
Most of the illness and many of the deaths of childhood are 
traceable to improper diet. 

During the second year milk should form the basis of the 
dict. In cities or where the milk-supply is not above suspi- 
cion, it is best to Pasteurize the milk until the second summer 
has been passed, or even longer if circumstances warrant. As 
a rule, the milk requires but little modification, and after the 
eighteenth month, and often before, may generally be taken 
unmodified. As the child is now able to digest starchy food, 
milk-sugar may be omitted. In cases where the milk is not 
thoroughly digested, as is evidenced by curds in the stools, 
lime-water may be used, and may be added in quantities of from 
5 to 10 per cent., or even more if necessary. If the milk 
is very rich, it should be diluted either with lime-water or 
usually with plain sterile water—three parts of mill to one of 
water. If the milk is poor, or if milk that is not rich does 
not agree with the child, it may be prepared as follows: Fill a 
glass three-quarters full of milk, add one or two tablespoonfuls 
of cream, and fill to the top with plain water. If this does 
not answer, add a tablespoonful of lime-water. During ill- 
ness and often under other circumstances the alkaline carbo- 
nated waters will be found useful for diluting the milk. If 








PEEDING DURING THE SECOND YEAR. 239 
ik is poor, another plan is to use the upper two-thirds of 


iy food may be given in the form of gruel, either alone 
is better, mixed with the milk. Barley-gruel or, if 
is a tendency to constipation, oatmeal. is added, one- 
one-fourth part of gruel being added to each 

should be freshly prepared and mixed imi 
ilk. A pinch of salt and a very amall quantity of 
may be added to render it more palatable, It may 
rized like ordinary milk. 
second year five meals at about four-hour inter- 
ld be given. The bottle should be dispensed with, 
food be taken from a cup or spoon, If the bottle is 
taken from the cbild early, it may be difficult to break it 
the bottle habit, The following diet-lists for different ages 
ill be found useful : 

Twelfth to Fifteenth Month.—MGilk ; barley, oatmeal, wheat 
flour, farina, or arrow-root gruel ; barley or oatmeal jelly; 
lightly boiled yolk of given with stale bread-crumbs. 

Beef, mutton, Ek ae —— — io soa 

Orange-juice or the juice ripe fruit, as of peaches, 

First meal: On spakings ithe child should receive a cup of 
warm milk, modified as previously suggested. If the child is 
accustomed to waking very early, more milk may be given at 
pee ta ef otherwise this last may be regarded as the first 


m 
Second meal, 10.30 4. M.: Eight ounces of warm milk and 
La Sn ‘Third meal, 2 p. M.: One of following— 


ett 


Teas 
Peas 
a i 


a 


(a) Eight ounces (a cupful) of beef broth. 

by) “4 & val « 
« w 4 “ mutton « 
SW Grip a ee « chicken “ 


(¢) Yolk of a lightly boiled egg with stale bread-crambs, 
Fourth meal, 5 pr. .: Eight ounces of milk and barley- 


gruel. 

Fifth meal, 10 p. ». (if required): Eight ounces of milk. 

Orange-jnice, one or two tablespoonfuls at 2 time may be 
given one hour before the 10.30 a. . feeding. If there is a 
tendency to loose bowels, this should be omitted, 

Tf the child’s appetite is very good, a small piece of zwie- 
back may be given with either the second or the fourth meal. 
This should not be soaked in the milk, but the child should be 
allowed to nibble at it dry, 








240 INFANT FEEDING. 


to Bighteen Months.—Same as above, together with 

wider, ping (oven-dried), whole eggs very soft boiled ; 

strained oatmeal), barley, or wheat porridge; bread and milk, thin 

biscuit (crackers), junket, fontae beef or mutton in very 

small mai z 

A Sample Diet for a Child of Fifteen to Bighteen Months.— 

, 7 A. Me —Lither (a) two tableapoonfule of a cereal 

jelly (oatmeal or other grain as desired), with salt and two 

nfuls of cream, and eight ounces of milk to drink; or 

(6) a bowl of bread and milk containing eight ounces of milk 
and a slice of stale bread. 

Second Meal, 10.30 a. a.—Milk, with a cracker or thin slice 
of stale bread or a piece of zwieback. 

Third Meal, 2 1, a.—One of the following: (a) Very soft- 
boiled egg with stale bread-crambs. (4) Eight ounces of broth 

, veal, mutton, or chicken) with stale bread-crumbs or a 
ittle barley added to it. (c) A tablespoonful of mashed baked 
potato with meat broth or gravy fons to two ounces), or with 
two tablespoonfuls of cream, Milk to drink, (d) Scraped raw 
beef or mutton, two or three tablespoonfuls on a “banquet 
wafer,” with a cup of milk, A tablespoonful of junket may 
be added to any of these, 

Supper, 5.30 or 6 Pp, M—Eight ounces of milk with a piece 
of zwieback, a slice of stale bread, or a cracker or two, 

Fifth Meal, 10 v. mt, (if needed).—Cup of milk. 

Fruit-juice may be given, as previously directed. Eggs should 
not be given oftener than twice a week, as children tire of them 
easily. 

Eighteen Months to Two and One-half Years,—Milk is to be 

as the chief article of diet. Many children have no 
desire for other foods until after the second or third year, These 
children will generally be found to thrive on milk alone or with 
slight additions to the diet. As the child’s digestive power in- 
creases, the following articles may, however, be added one at a 
time. 

Fruit: Juice of ripe fresh fruit, that of oranges and peaches 
being best. Ripe fresh grapes skinned and seeded. Baked 
apple—pulp only, the skin and seeds to be carefully removed, 
Stewed prunes, the skins to be removed by passing through a 
sieve. 

Meats: Seraped raw beef or mutton ; rare roast-beef or mut- 
ton pounded to a pulp. Chicken or turkey, the lean white meat 
minced to a pulp, 


FEEDING DURING THE SECOND YEAR. AL 


Vegetables: Mashed baked potato with cream or covered 
with gravy from roust meats. If the latter is very fat, the fat 
Rei tes recsoved by ckinmtag-cr by inesnect piste ef BETS 
ting-paper. Very well-cooked spinach, celery, and cauliflower 


TGereals : Well-boiled rice and other well-cooked cereals already 


ment 

Desserts ; Boiled custard, milk and rice puddings, junket, 

Four meals will generally suffice after the eighteenth month. 
The following dietary will serve as a suggestion : 

If the child wakes early, a cup of warm milk (six ounces). 

Breakfast, 7 A. a.—(a) Four tablespoonfuls of oatmeal por- 
‘idge or other cereal with salt and two tablespoonfuls of cream ; 

ilk to drink. (b) Yolk of a lightly boiled egg with salt and 
bread broken into it; milk to drink. 

Second Meal, 10.30 a. w.—Cup of milk with two soda bis- 
cuits (crackers), slice of bread, or a piece of zwieback. 

Dinner, 2». w.—One of the following: (a) A bowl (eight 
ounces) of meat broth with rice, barley, or bread-crambs 
to it, Slice of stale bread ; junket or rice and milk pudding. 
(#) Tablespoonful of white meat of chicken or of rare beef or 
mutton, cither scraped or pounded to a pulp. Slice of stale 
bread thinly buttered, junket, rice or milk pudding, or a boiled 
custard. (0) Perfectly fresh boiled fish (the white meat) with 
a tablespoonful of mashed baked potato moistened with cream, 
Dessert as in preceding, 

Suppers 5.30-6 Pp. m.—A bowl of bread and milk or a 
cup of milk and a slice of bread or a piece of zwieback. A 
cup of milk may be given at about 10 Pp. M. if necessary. 

From two and one-half years up to the sixth year the diet 
of the child may gradually be increased. Milk’ should still, 
however, be taken in large quantities—about a quart daily— 
as well as some form of cereal for breakfast, with or without 
an egg, or fresh fruit if there is a tendency to constipation. 
Meat prepared as above should be given once a day, and 
preferably mA Sa aeatiiey 2 meal, together say to and Lee 

mn vi as spinach, s, or cauliflower tops. 
Gee cel should be Tight, and consist of bread and milk. 

Tt is well to prepare two lists, which may be given to the 
nurse or mother as a guide. One list should contain the food 
allowed, and the other list those forbidden. It is not well to 
depend on verbal instructions, as they are easily forgotten or 
misconstrued. 

16 





242 INFANT PEEDING. 


The Diet from Two and One-half to Sia Years,—Milk may 
be allowed with every meal (may be omitted from dinner if de- 
sired). The average child should take a quart a day, plain or, 
when plain milk is not thoroughly digested, modified as for 
twelve to fifteen months. 

Cream.—Two to eight ounces a day mixed with the milk, 
taken as a beverage, with cereals, etc. 

Bread and biscuit may be allowed with every meal—stale 
bread, dried bread. The so-called “pulled bread,” zwieback, 
and the various forms of biscuits or crackers, 

Cereals. —Almost any kind of cereal for breakfast ; outmeal 
and wheaten grits are the best. Rice and hominy for dinner, 
Barley is J in sou 

Vegetables may be allowed for dinner—potatoes in some form 
ora cereal with one green vegetable; spinach, cauliflower tops, 
ie ate rest te children them 

are very , but chil are apt to tire 
easily. They should be given for breakfast, as a rule, but 
never day after day. 

Meat,—Allowed once a day for dinner and in older children 
for breakfast occasionally. Boiled or broiled fish may be given 
for brealsfast or dinner, 

Brotha sand soups of simple composition may be eaten. Meat 
broths with cream and cereals are especially nutritious. 

Desserts —Once a day, with dinner. Plain custard, milk 
and rice pudding, bread and custard pudding, and junket are 
the best; ice-cream once a week, Fruit should be given once 
daily, and only ripe fresh fruit, in season, should be used. 
The best are oranges, baked apples, and stewed prunes. Rij 
peaches, pears, grapes without skins or seeds, may also 
given. Fresh juice of berries in small quantity, strawberries in 
perfect condition sparingly, Ripe cantaloupe and watermelon 
in moderate quantities may also be allawed. Great eare should 
be used in choosing and giving fruit to children. It is a very 
important article of diet, but if stale, spoiled or unripe, is capa- 
ble of doing much harm. Too much should not be given in 
hot weather. Lemonade is useful during very hot weather. 

Accorpina To Mra1s.—Breakfast—Every day, milk to 
drink. A well-cooked cereal, with salt and cream, but little or 
no sugar. Bread and butter. 

In addition to the above, one of the following every day = 
Eggs lightly boiled, poached, and for older children scrambled 
or made into a plain omelette. Boiled or broiled fish. For 


FEEDING DURING THE SECOND YEAR. 243 


beefisteak. For children meat at breakfast is not, as 
a rule, necessary. Fruit may be given before or after break- 
fast, during the latter of the oat shay 


Se iat dk on ths aac om which they rg 
od Oranges, baked , Stewed prunes, peaches, » 
grapes without seeds “a apy (hs rafter vere 
may e.picen; those known shee apples are 
jitable used raw). 
Dinner.—Bread and butter as desired every day—not to be 
eaten to the exclusion of other foods, however. 
One each day. Bouillon, beef, veal, mutton, chicken, 
ik , which may be thickened with barley or other 
cereals ioe grain or flour). Milk and cream may be added 


One meat daily—roasted or broiled. Beefsteak, beef, lamb 
or mutton chop, rare roast beef or mutton, chicken, white meat 


of gomet ae 
esate and one other 
dish sot an post in some yey should be given., Potatoes, 
baked or cauliflower tops, asparagus-tips, stewed celery, 
spinach, hominy, plain macaroni, mashed peas, young string- 
beans, and almost any green vegetable in season. 
Dessert,—Junket is the best, and may be given most fre- 
quently, but rice and milk pudding, plain custard, and plain 
tapioca pudding may also be used in small quantities. Tee- 
cream once a week. Fruit in some cases may be used. 
Supper.— light simple sy should be given ev 
day. TNT, Listed ee and tee and, for older children, 
a Hitle stewed fruit or baked apple, without too much sugar. 
Agnicies Foreippen (after Holt)—The following articles 
should not be allowed children under four years of age, and 
with few exceptions they may be withheld with advantage up 
to the seventh year. 
best frespiorn , Sausage, pork ii s all eee salted fish, corned 
goose, i, kidney, liver, bacon, meat-stews, 
and V dressing from peers 
‘egetables.—Fried vegetables of all varieties, cabbage, pota- 
toes tog se oh when boiled or reasted), rew or fried onions, raw 
shes, lettuce, cucumbers, tomatoes (raw or cooked), 
— “egg-plant, and green corn. 





244 INFANT FEEDING. 


iid and iy es Bees and rolls ; Usd and 
wt griddle-cakes ; sweet cakes, iow! jose Con~ 
taining dried fruits and those heavily Sa 
descrij Prve lid sles Fes bee £ 
iption ; is, je A eh Ce eserves. 

Drinks,—Tea, coffee, wine, beer, anc 2 

Fruits—All dried, canned, and bere frnits ; bananas ; 
all frnits ont of season and stale particularly in sum- 


mer. 

‘The meals should be given at fixed hours, which practice should 
be peel adhered to. Feeding between meals, even when con- 
sisting of the most trifling things, should be avoided. If the 
child can not go from one meal to another without discomfort, 
the intervals should be shortened. In certain cases it may be 
advisable to give a small cup of milk or broth and a cracker 
between the meals, at stated intervals, as in feeding younger 
children, 

ates eake, and the like should be kept from young chil- 

dren, In well- egies homes, if he once learns that he can 
not have them, child will soon cease to demand sweets. 
The frequent indulgence in sweets of various kinds creates a 
desire for them to the exclusion of other food. This craving is 
analogous to that for alcohol in adults, Overindalgence in 
sweets causes indigestion, headache, and the like, ailments that 
may easily be prevented. 

The child chould be taught to eat slowly and to chew the 
food well. To this end, some older individual should always 
be present at meal-times to see that sufficient time be taken for 
the meal, and that the food be finely divided, as young children 
do not, as a rule, chew very well. The quantity given to a 
healthy child should depend on his appetite. In sick children 
this is not a reliable guide, and, where possible, fixed amounts 
may be given (see Feeding of Sick Children), The child should 
not be forced to eat, nor should he be given special articles 
to tempt the appetite. If the food offored is not taken, it is 
well to wait until the next meal, when it will generally be 
found that the appetite has returned. Loss of appetite is often 
merely an indication that the digestive organs require a slight 
rest. 


During the heated portions of the year the child will require 
Tess solid and more liquid food. The same is true during sick- 
ness, Many of the gastro-intestinal disturbances attributed to 
teething are the result of improper feeding. 


DIBT OF SCHOOL CHILDREN. 25 


‘The following tables taken from Freeman’ give the diet after 
one year of age: 
Diet of the Second Yeor. 
































6am Wax orm 
AL12 mos, | $1002. milk, $-10 oF, milk. | esi jS-10ox milk.) &10 08. mili. 
462 oranigejuloe, 
mite 
‘At 15 mos, iPad ‘Son milk. Son ‘bor, 
(AL IB mos, Res grost ‘Son milk. son ‘Sox, milk, 
(At Zi mos. | 6 ox. Son milk, Son milx, 
ta 
prcerd and 
‘butter. 
Diet of the Third Year. 
Oa” WAM. an, BO rm 
Orange ui 8 ex milk. | 9.0%, soup, 10 o#. milk, 
0%, ti heat 
Gor. gruel, Brel and batter, Rood gic butter, 
Bread od Pete, ‘Dessert, 
Diet after the Third Year. 
Breakfast. Dinner, 12-1 ¥, M, Supper, 6 P. m. 
Fruit, Soup, Cereal, 
Coreal, Meat Mil 
Milk, Brea and butte, Breed and butter, 
Bread and butter, ‘Vegetables, 
Lor 2 eggn Dessert. 


DIET OF SCHOOL CHILDREN. 
The period usually spoken of as “school days” is an ex- 
tremely active one physically. The vast number of metabolic 
jing on and the growth of the body demand a plenti- 
ful and a suitable diet. Both in and out of school and in 
seminaries careful attention ehould be given to food, fresh air, 
1 Archives of Pediatrics, June, 1904, 


246 INFANT FEEDING. 


a exercise, “Tn ‘ether words, the Later Sars rae 
a reoive as much tention ox the mental growth. 
ially the diet should be the subject Fs 
corti study, the a aim being to avoid monotony and to provide 
sufficient and sal iet. In many schools the dietary 
is left to the discretion of the cook. In considering school 
dietaries several points are worthy of acd are vA 
Milk, in most cases, 18 of ‘t value, 
especial], Piadiie toe: nutrition is below Lei Tt 
should be furnished as a beverage daily for breakfast and 
su] and is advisable even with dinner. It may ee be 
heats the preparation of puddings and soups. Cream is 
valuable, and eae possible should be supplied in ati 
cient quantities. A cup of warm milk with bread or crackers 
is helpful d the middle of the morning and as a substitute 
for tea in theafternoon. Delicate children and others may with 


breakfast, acup ea or of bread and milk should be given 
on rising. 


Eggs may be used alone or in the preparation of various” 


dishes. They may be used in almost any way except fried. 
Fried eggs are apt to be very indigestible. They are often 
prepared in this way in order to disguise the stale taste of an 
egg that has been in storage for some time. 

Meat is a very important part of the diet, as it contains a 
Janger quantity of protein, from which the tissues are built 1 
and in a more available form, than in any other form of f 
Milk and eggs are also valuable sources of protein. Meat 
should be provided, therefore, in sufficient quantities, half 
pound a day being, perhaps, a good average llowance for a 
growing boy, the larger and more robust taking that quantity 
or more, the smaller and more delicate children taking some- 
what less, Steak, chops, and roasts of beef, mutton, lamb, 
fowl, and bacon are the most suituble meats, although pork, 
together with meat stews, meat puddings, sausage, ant hashes, 
may be allowed in smaller quantities. These last, while gen- 
erally relished, are not 80 tible nor such good sources of 
nutriment as those first Lie With care and proper prepara- 
tion many of their ill effects can be obviated. More meat is 
required in winter than in summer, and more in cold climates 
than in warm, Yeo states that too much meat may give rise 
to eczema. 


DIET OF SCHOOL CHILDBEY, a7 


Meat may be given twice a day, and or 
tet! gt ie horas Wien te 
not satisfy meat may be added, For this purpose 
cold sliced Roeat is 1. 

Bread and batter should be given with each meal. Bread 
made from the whole-wheat flour may be used in the langest 
quantity, but it is well to su ply various kinds of bread, toavoid 
monotony. “ Brown ” given coecticth becomes very 
tiresome. Rye bread may be Hoe ly, and tre 
made from pee of wheat and rye is very pens Rusk, 
biscuit, and crackers may also be supplied. Corn-bread, when 

ly made, may be given once a week or oftener, and 
erie cakes of buckwheat, corn, or wheat flour two or three 
times a week. These lust may be served with syrup or fruit- 
juices. 

a Sead peal pocorn of all kinds may be given for breakfast, oat- 

probably the most desirable, 

Lgl cf <loea dl weceheaay boa For dinner 
ee should be given, one green vegetable and pota- 
toes. Salads made of the green vegetables, with the very sim- 

dressings, are useful additions to the diet. 

Fruit should invariably be given once a day. 

Sugar should be provided for in the dietary. Candies and 
many of the sweets given to children are harmful and cause 
indigestion and dyspepsia. If proper sweets were provided, 
there would be slighter tendency to indulge in the less desir 
able forms whenever opportunity afforded. With the meals, 
and when the appetite ea satisfying between meals, they 
may be given with or without a glass of milk. Regularity 
should, however, be observed, and they should not be given 
immediately before or after a meal. Fruit-syrups, sugar 

syrups, honcy, preserved fruits, and jam may be eaten with 
fess Caress Carimels, chocolate, maple-sugar, and plain sugar 
taffies are the best of the other forms of swecta. 

Simple desserts, such as custards, milk puddings with rice, 
tapioca, and the like, bread pudding, plain cakes, and properly 
prepared pastry may be 

The beverages should be water and milk, Weak cocoa or 
chocolate may may given after the seventh year. Tea and coffee 
should not iven before the thirteenth year, and may be 
withheld saps still longer. Alcohol is not to be 

_ used except by a physician’s direction. 
Especial care should be taken to avoid a monotonous diet, 





248 INFANT FEEDING, 


for there are many instances where the constant ition of a 
certain form of food has created a dislike for it that has 
sisted throughout life or been overcome only with difficulty, 
A second point to be remembered is that the food should be 
well and attractively served. This has more to do 
with influencing the appetite of delicate, nervous children than 
is generally su , and can not be insisted upon too 


strongly. 

eee bond be avoided, and to this end an older 
‘person always be present when practicable ; in school, 
this should be insisted upon. On the other hand, a child 
should not, through caprice or habit, be allowed to eat too little. 
By exercising a little tact, most of the dislikes which are not 

ly rooted, but which may become so if persisted in, may 
generally be overcome. These dislikes are often the result of 
imitation. 

Sufficient time should be allowed not only for the meal, but 
for the performance of whatever small duties may be required 
of the child. A time should be set for one or two 
daily visits to the water-closet. Hurrying to school should be 
avoided, Reading and studying immediately before and after 
meals should be prohibited, as should bathing or any very 
active exercise. Some light form of recreation may, however, 
be indulged in. ‘The hours for meals should be so arranged 
that the child may have freshly prepared meals, and not cold 
luncheons or warmed-over dinners. Lastly, nibbling and eat- 
ing between meals, except under the conditions previously 
described, should be strictly prohibited. In spite of stringent 
rules, however, many infringements will occur. 

It is by neglect of the diet, fresh air, and exercise that many 
cases of tuberculosis gain headway; anemia may result from 
such neglect, and a delicate, nervous child be the outcome of 
one that should, by right, be healthy. 

Diet List for a Boys’ School.— Breakfast, 7.30 a. M.— 
Half-hour allowed. Fruit. A cereal with cream, Bread and 
butter, eggs, boiled, poached, or as omelet. Fish occasionally. 
een brea once a week; griddle cakes ance a week. Milk to 

Dinner, 1 ». M.—Three-quarters hour allowed. Soup; 
meat—roast-beef or mutton, steak, or chicken; fish once a 
week 5 toes and & green vegetable. Hominy or rice once a 
week. pee deseert ; fruit, 

Supper, 7 p. M.—Halt-hour allowed. Hash, cold meat, fish, 


OTHER FACTORS IN INFANT FEEDING. 249 


or omelet in small quantities, Bread and batter with syrup or 
preserved fruit or fruit-juice. Plain cake. Milk to 


OTHER FACTORS IN INFANT FEEDING, 

Feeding in Infant Asylums.—The ling of infants 
in overcrowded infant asylums, with their lack of air and 
paucity of attendants, is a matter of great difficulty. Any 
attempt at scientific feeding under such circumstances will ulti- 
mately lead to failure, the method in these cases being held to 
blame. The primary cause of malnutrition and marasmus in 
institutions is the lack of fresh air and individual care, and 
until these are obtainable it is useless to attempt to accomplish 
anything by special feeding methods, In smaller institutions 
the use of the Materna graduate will be found satisfactory. 

In the langer asylums it is well to have two or three general 
working formulas, such ye 3 per cent, sugar 6 per cent., 
protein 1 per cent.; and fat 4 cent, sugar 7 per cent, 
| Sea 2 per cent, These may be varied by adding more or 
less water to them to adapt them more closely to special needs, 
The younger infants may, when possible, receive special mixt- 
ures. For substitute feeding, condensed milk, barley- and egg- 
water will be found most useful. 

The allowance of a few cents a day generally made for an 
infant’s entire care is quite inadequate to accomplish any . 

The Infant’s Stools.—A very fair conception of the 
infant's digestion can be obtained from an examination of the 
stools, This should be done in all cases, and is as important 
a part of the routine as the examination of the heart or lungs. 

The size of the stool should be noted first, although this is 
not of very great importance, as it varies with the number of 
stools and the size and peculiarities of the child itself. 

The number of stools is always to be considered, but is not 
pesciyie important as the character of the stool. An infant 
may have one or two stoole a day, or as many as four, five, or 
six, but so long as the character of the stool remains good, it 
may be regarded as perfectly normal. In diarrhea the course 
of the disease is better told by the quality of the stools than 
by the number, and this may to a certain extent be said to be 
true of constipation. 

‘The consistence of the stool of nursing infants should nor- 
mally be about that of butter, although slight variations either 
way are not to be regarded as distinctly abnormal, The stool 
should be smooth, and contain no cards or solid masses, In 





250 INFANT FEEDING. 
Soe Se iN Ns ale Ee Ss 


ae are seen in the stool. These are usually 
curds a pa Ne fat. They may, however, be 
clumps of mucus, 
ucus is present normally in the stool, and its presence is 
easily demonstrated; it should, however, be so intimately 
ie with the stool that it can not be seen with the aka 
eye. Any eee of the intestinal wall causes a great 
increase in the amount of mucus in the stool. In diarrhea and 
seen intestinal in there may be large amounts, and in 
le mucus may cover the hard masses of 








The reaction of infants’ stools is usually acid or neutral, 
although sometimes it is alkaline. ither acid or alkaline 
stools may be altered in color. A return to a normal color ix 
usually brought about in these eases by the administration of 
save when the stools are acid, and vice versa. Alkaline 

oe eo in color, pee be produced by giving alkalis in 

for several days. The color of the stool often 

facets considerable information as to the condition of the 

infant. Normally the color is a light butter yellow, but the 

stools may vary somewhat in this and be lighter or 

darker. In young breast-fed infants the stools may be a dark 

yellow, like the yolk of an egg. In artificially fed babies the 

stools are apt to be very light in color or even decidedly whitish, 
Rhubarb imparts a yellow color to the stool. 

White stools are seen sometimes in artificially fed children 
that seem to be otherwise in normal condition. As a rule, 
however, white stools are either the result of the ingestion of 
excessive quantities of fat or indicate an absence of bile, In 
the former cases the stools are large, whitish, and have the 
characteristic odor of fatty acids, which resembles that of 
rancid butter. The stool may be dried and burnt with the 
same odor and the fat may be dissolved by ether. When bile 
is absent, the stools are white and have a very foul, almost eaday- 
erie, odor. 

Red stools may owe their color to the presence of fresh blood 
from the rectum or the lower part of the intestinal tract. When 
it comes from the upper rts, the blood is always black, The 
streaks of fresh blood frequextly seen where hard stools are 
passed come from slight excoriations of the anus. 

Black stools ure caused by the presence of blood. In this 








OTHER FACTORS IN INFANT FEEDING. 251 


case the stools are black and tarry. The blood may come from 
nd intestines or stomach, or from blood swallowed, especially 
it from hemorr! from the jor nares. 

Black or Dhaaki bron a aay also be caused by the 
administration of bismuth, iron, or tannic acid, Brown stools 
are frequently seen as the result of bacterial and chemic changes 
in the intestine in the course of intestinal indigestion and intes- 
tinal infection. Raw beef-jnice may give rise to foul-smelling 
brownish- or grayish-colored stools. 

Green stools are due to a large number of causes. This may 
result from intestinal indigestion and infection due to improper 
food, usually either an excess of sugar or of fit, or to the pres- 
ence of bacteria. Calomel causes green stools, and if 
continued and not neutralized in the intestine, may produce the 
same effect. 

prniobocse of Dice Eases ape stress: or} 
not be laid upon importance of investigating the souree ot 

i due to dietetic errors. There i is ample room for 
further clinical study of this subject. 

Too Low Protein.—The stools are small and constipated, if 
the other food elements are low, as they are apt to be. The 
child does not gain weight so rapidly as a normal child, or it 
may remain stationary or even lose weight. It is anemic, and 
if the low protein is continued, the child becomes marantic. 

Too High Protein.—The child is apt to have colic, vomiting 
any time, but usually half an hour or more after feeding. The 
stools contain undigested curds, and mucus, and may be yel- 
Jowish green or otherwise discolored. 

Too Low Sugar.—The gain in weight is apt to be slow, and 
the child may be constipated. These infants are usually thin. 

Too High Sugar.—Vomiting an hour or two after meals, the 
vomited matter usually being sour, Acid eructations are 
common, olic is frequent. The stools are generally grass 
green and very irritating, the buttocks often being excoriated. 

Too Low Fat.—The child gains weight slowly, and is apt to 
be constipated unless an excess of sugar ig given, as in con- 
densed-milk feeding. 

Too High Fat.—The child vomits an hour or two after feed- 
ing. Colic iscommon. The stools may be thin and or 
greenish yellow, and contain small masses of undigested fat and 
considerable mucus, ‘These small lumps are often mistaken for 
curds. They are more or less translucent, and when burnt give 
off the odor of fatty acids; they may be dissolved in be 








252 INFANT FEEDING. 


Curds are not, however, dissolved in ether, Anche UE 
more common is the large, white, rather dry stools having 
odor of rancid butter. 

At must be remembered that the condition of the stools may 
be due to one or more of the food elements, and experience in 
these cases, a8 in most others, is the best teacher. It is only by 
esate and careful observation that the feeding of infants may 

conducted properly. Another fact to be remembered is that 
the food need not be changed to meet every trifling alteration in 
the temper of the child or in the character of its stools. 


THE FEEDING OF SICK INFANTS. 


The Feeding of Difficult Cases.—The feeding of cer- 
tain infants often becomes a difficult matter, not so much on 
account of actual conditions of disease, as owing to personal 
idiosynerasy. Others again are difficult to feed because of 
actual disease of the digestive organs or on account of the 
lowering of nutrition due to the existence of other diseases, 
‘These cases will be considered in proper order. 

At the outset it must be remembered that the fault may not 
be due to the food itself, but to its preparation or the mode or 
time of administration, and to improper surroundings and care. 
‘To succeed in these difficult cases it is necessary to look dili- 
gently into the minutest details of the infant’s life. 

Loss of Weight.—Loss of weight in an infant should 
always be considered a very serious symptom. During an acute 
illness, such as pneumonia or diarrhea, this is to be 
In chronic conditions the weight may fluctuate, going up and 
down, or remaining more or less stationary. If, however, ina 
period of « month or two there is no general tendency to gain, 
in spite of the fluctuation, this indication is a serious matter. 
Where an infant is losing weight without any epecial cause, 
this may be attributed to insufficient food. If the infant is 
nursing, the breast milk may be poor or insufficient, or both. 
If the babe is bottle-fed, the milk may not have been increased 
in strength in proportion to the child’s growth. 

Tt frequently happens that difficulty is experienced in obtain- 
ing a food suited to an infant’s digestion. This end, however, 
once attained, the physician may increase the quantity, but not 
the quality, of the food, and the infant finally ceases to increase 
in weight, remains stationary, and then loses. Loas of weight 
may also be due to a food too rich in proteins or to one unsuited 


THE FEEDING OF SICK INFANTS, 253 


to the infant’s digestion. This latter cause usually, but not 
‘ives rise to other symptoms. 

Tn all cases a careful study of the food is essential. Accu- 
ate charts of the quantity of food taken, the time, whether the 
child vomits and at what time, and the number and 
of the stools, etc., are of great help. If the food is increased 


or 

child of the size and weight of the one under consideration, 
and there is then no change in the child’s condition, the food 
should be peptonized, cither partially or completely, or mixed 
with an albuminized or malted food or with barley-water. The 
addition to the dietary of albumin-water or of small quantities 
of one of the predigested beef preparations (Panopepton, 
git. v-xxx ; Liquid Beef Peptonoids, gtt. v—3j ; or one of the 
other beef preparations in similar doses mixed with water) is 
indicated. Minute doses of nux vomica or strychnin, with or 
without an alkali as bicarbonate of soda, or of creasote (Liquid 
Beef Peptonoids with creasote, gtt. v-xx, of the Arlington 
Chemical Company, is an excellent form in which to give crea- 
sote) are often of value, especially where tuberculosis is sus- 
[pea Loss of weight may be caused by persistent vomiting 
‘see Vomiting). 

Stationary Weight.—This frequently follows when an 
infant is weaned or when one is fed artificially from the outset, 
Even if the child is receiving correct percentage of food it may 
not gain for several weeks, So long as the infant is well and 
the percentage and quantity given correspond to those directed 
for an infant of the same age and weight, no alarm need be felt, 
even if a month should elapse without showing increase in 

it. However, once the regular gain in weight is estab- 
lished, it should not remain stationary, but should increase 
gradually from week to week. ‘The average weekly gain dur- 
ing the first year of life is botween four and eight ounces. The 
weight may occasionally, without any apparent assignable cause, 
be the same at one weekly weighing as it was at the preceding 
one. If this persists, a careful search for the cause must be 
made, and will often be found to be insufficient food. 

Colic.—This is more apt to occur in breast-fed than in bottle- 
fed babies on the percent usually recommended, It is eape- 
cially likely to come aes tie first three months. In 
breast-fed infants it is often a difficult matter to overcome. If 
on examination the proteins are found to be too high, an effort 
should be made to reduce them, and the intervals of nursing 





a4 INFANT FEEDING. 


well as by a host of causes that bear no relation to the food. 
Vomiting.—Immediately after Feeding —(a) From the food 
being given in too large quantities. Reduce quantity. 
(6) From food being given too dilute, al 30 necessitati 
the ukigiof too large quantities. Reduce the quantity 
crease the strength. 


in 5 

(c) From taking food too mpidly. Give more slowly—in 
breast-fed children, by regulating the flow by grasping the nij 
ple between the fingers ; in bottle-fed babies by using a eee 
with a smaller hole. 

At any Time.—Due to the abdominal binder being too tight, 
or to shaking or holding the infant with the head over the 
nurse’s shoulder, patting on the back, etc. From too high pro- 

i is is more apt to be accompanied by other symptoms, 
as colic, curds in stools, etc. 

One or Two Hours after Feeding —The vomited material is 
usually sour and curdled, or it may be watery and contain mucus, 
This is due to the percentage of fat or sugar being too high, 
The fat, or both fat and sugar, should be decreased, and the 
food be given slowly and at longer intervals. 

Vomiting also occurs in many diseased conditions. It isa 
frequent accompaniment of gastric and intestinal disorders, infee- 
tion, and all acute diseases ; it occurs in neryous diseases, such 
as meningitis, and in brain tumor, in peritonitis, and in intes- 
tinal obstruction, with coughing spells, as a habit, or reflexly 
from intestinal or pharyngeal irritation, or in toxic conditions, 
such as uremia, The treatment depends on removal of the 
cause where possible. When it occurs in ordinary acute dis- 
eases, however, much ean be done ina general way to overcome 
vomiting. The food should be given in sufficiently small quan- 
tities at two-hour intervals, or in some cases a teaspoonful of 
food may be given every hour, or even every half-hour where 
larger quantities are not retained. If the case is acute, it may 
be to secure a wet-nurse (see Inanition). Washi 
out the stomach and gavage are two very important means of 
treating persistent vomiting which should not be forgotten. 

The physiologic loss that occurs during the first forty-cight 
hours of life should not be forgotten, 


= 


GAVAGE, 255 


GAVAGE, 


Gayage, or feeding by means of a stomuch-tube, is a method 
used in various diseases and conditions of infancy and child~ 
hood. In cases where the child is not able to take nourishment, 
or only in insnfficient amount, and in cases of uncontrollable 
vomiting, this method may be resorted to. It is used in the 

ing of premature infants, whether in an incubator or not, 
and in cases of small, weak, marantic infants who, owing to 
weakness or lack of by Yaa kyr take sufficient nourishment, 

st 


Tt is also em tions about the head or 
neck where swallowing is taterfoced wit, and in acute diseases, 
such as pneumonia, in fevers, and in delirium or coma. 

The results that follow this method of fecding are surprising, 
especially in cases where there is constant vomiting or where 
the stomach has a very small capacity. In the former case the 
vomiting may cease and the food be vetiined : in the latter, the 
capacity of a stomach that previously held only an ounce or 
ricu re until an average-sized feeding is 
rel ease. 

‘The technic of the method is simple, and the procedure con- 
ducted without difficulty in children under two years of age; 
above that age it may be difficult, and a mouth-gug may be re- 
quired ; in some cases nasal feeding must be substituted. ‘The 
apparatus cenives is the same that is used for washing out 
iat stomach, and since it is frequently desirable to wash out 
the stomach before introducing the meal, the same tubing may 
serve for both purposes. It consiste of a soft-rubber catheter 
connected, by means of a piece of glass tubing, to a piece of 
rubber tubing to the other end of which a funnel is attached. 
The nurse holds the child on her lap, with the head held straight 
and not inclined in either direction. The catheter is moistened 
with warm water and held several inches from ent end, 80 23 
to allow enough of it to pass into the esophagus with the first 

at introduction. The mouth is opened, if necessary, 
and the catheter passed rapidly into the pharynx ; there is usu- 
ally a swallowing movement, and the tube is readily passed into 
the stomach, the lure is carried on too slowly, the 
tongue may interfere, or if the catheter is held too near the end, 
it may cause gagging. Before introducing the food it is well to 
wash out the si with normal salt solution. As soon as 
all the food has entered the stomach, the catheter is pinched and 
rapidly withdrawn. If it is withdrawn slowly, the food may ~ 





256 INFANT FEEDING. 


come up with the tube. If the catheter is left open as it is 
withdrawn, the dripping into the pharynx may cause vomiting. 
If the child is young, it is a good plan to keep the finger be- 
tween the jaws for a few moments to prevent gagging. If the 
food comes up, the feeding must be repeated. 


Nasal Feeding.—For this purpose a catheter in propor- 
tion to the size of the child should be used. The procedure is 
the same as that for adults. (See Forced Feeding, 


DIET IN DISEASES OF CHILDREN, 


Cyclic Vomiting.—This is o difficult condition to combat. 
The attacks come on at more or less regular intervals, and are 
due to some derangement of metabolism ; they have been said 
to be analogous to attacks of migraine. In this condition the 
tatio of the excretion of urie acid to urea is disturbed. 

During the attack it is well to give the stomach absolute rest. 
Food and drink tend to aggravate the condition. In the early 
stage of the disease normal salt solution may be given four or 
five times a day by the rectum, the quantity varying from 
3 to 8 ounces, according to circumstances. If the attack is 
prolonged, it is well to feed the child by the rectum ; even in 
eases of ordinary severity it is desirable to give the food for a 
day or two by the rectum, When the vomiting discontinues, 
the stomach should have rest for some hours before feeding is 
resumed, If there is any doubt as to the advisability of giving 
food by the stomach, it is well to continue the nutrient enemata 
fora short time. When feeding by the mouth is resumed, the 
food should be given in small quantities at intervals of three or 
four hours. Milk to which lime-water has been added, pe) 
tonized milk, albumin-water, barley-water, and the like should 
constitute the diet for three or four days. After that a return 
to the ordinary diet may be made. In the interval the diet 
may be the same as that directed for migraine. Plenty of fresh 
air and out-of-door exercise are indicated. Holt advises that 
sugars and sweets be excluded from the dietary, and that the 
starches be limited. The diet should consist of meut, green 
vegetables, milk, and stale bread. What has been said regard- 
ing any special article of diet and its relation to migraine applies 
to these cases. 

Stomatitis.—In stomatitis the feeding often becomes a 
matter of great importance. In the milder forms there is not 


DIET IN DISEASES OF CHILDREN. 257 


much difficulty in getting the child to take liquid nourishment, 
especially if it is given cold. In the severer forms, such as 
ulcerative stomatitis, the child may refuse all food. In these 
cases it should be offered food in the form of ice-cold milk, 
albumin-water, and the like. If all food is refused, or if in- 
sufficient quantities are taken, rectal feeding must be instituted. 
In some cases nasal feeding may be resorted to, but in many 
patients where this is indicated it can not be employed because 
of the inflammation extending into the nares. all cases the 
diet should be similar to that used in scurvy. Fresh fruit- 
juices and vegetables are to be given. In the ulcerative cases 
chlorate of potassium or mineral acids are useful. 

Acute Gastric Indigestion—Acute Gastritis.—As 
these diseases can not, as a rule, be distinguished from each 
other at the outset, and since the dietetic indications are along 
similar lines, they may, for convenience, be considered together. 

‘The main indications are to empty the stomach and to give 
it rest. If possible, it should be cleansed by washing with a 
tube and an abundance of warm water; where this is not pos- 
sible, warm water may be given to drink, and, if necessary, 
vomiting induced. 

Food should be discontinued entirely for six hours, and 
during this interval small quantities of hot water may be given, 
At the end of this time, if the vomiting has ceased, «mall 
amounts—1 to 3 onnces—of albumin-water or of barley-water 
may be administered. Milk in any form should be withheld 
for twenty-four hours, when, if the baby is breast-fed, it may 
be nursed for a few minutes at three-hour intervals. If this is 
found to agree with the child, the time of nursing may be 
lengthened and the intervals between feedings shortened. If 
the baby is bottle-fed, it is well to withhold cows’ milk, and to 
give albumin-water or rice-water in its stead ; when the stomach 
has become tolerant, other articles may be added. At first 
broths, free from fut, and meat-juice may be tried, followed by 
malted milk. Only small quantities should be given at first, 
and at intervals of three or four hours, As improvement 
occurs the food may be given oftener and in increasing quan- 
tities. In the severe cases, where vomiting persists, prepared 
foods, such as Panopepton or Liquid Beef Peptonoids, diluted 
with water, may be retained. For the younger infants and for 
older infants if the stomach is at all irritable, it is well to pep- 
tonize the cows’ milk when it is first given. For older infants 
asmall amount of milk may be added to a large quantity of a 

Ww 





258 INFANT FEEDING, 


cereal water, such as barley-water. It may be well to boil the 
two. for a few minutes. The amount of milk may 
gradually be increased, an equal volume of lime-water bei 
added to it at first. If the stomach is very irritable, 
doses of hot water frequently repeated may be tried, or, what is 
usually of greater service, teaspoonful doses of equal parts of 
lime-water and cinnamon-water. 

Chronic Gastric Indigestion—Chronic Gastritis. 


iy 
reason they may be considered together. In both diseases the 
aos is apt to be retained in the stomach for a long time ; it 
ly to be imperfectly digested, the large amount of 
fsa on ial is usually present in itself interfering with diges~ 
tion. The stomach should be washed out once or several times 
day with warm water or with a weak solution of sodium 
bicarbonate (1 dram to the pint), The food should be given at 
intervals of three, four, or even five hours, according to the 
age of the child, It should be suited to the infant’s digestion, 
and what has been said about infant feeding in general and the 
feeding of difficult cases applies here. Patience and judgment 
are necessary to determine what is the best food for the infant 
and just how long it should be continued without a change. 
In this, as in so many other conditions, experience is the safest 
guide. The milk may be partially peptonized or a milk low in 
proteins may be given. A milk low in fats is often attended 
by good results. Occasionally the sugar may be reduced with 
advantage, or condensed milk or one of the proprietary foods 
may be tried. Barley-water and milk in varying proportions, 
but usually with a large amount of barley-water, may be 
di |. Barley-water and a weak, fat-free veal broth may be 
mixed together in equal quantities and used to advantage. In 
some cases whey mixed with barley- or rice-water may be tried, 
and if it is possible to give fat without causing vomiting, cream 
in small amounts may be added to the mixture, 
General hygienic measures should carefully be observed. 
Dilatation of the Stomach.—The methods of diagnosis 
and treatment of this condition are similar to those when the 
disease occurs in adults. The essentials of the treatment are 
stomach-washing, small meals at sufficiently long intervals, and 
tonies, such as stryebnin and nox vomica, The character of 
the food should be about the same as that advised for chronic 


gastritis, 


DIET IN DISEASES OF CHILDREN. 


include the Shiga-Flexner dysentery bacillus, recently found in 
many cases, streptococci and other pus-forming mi 

isms, Infectious diarrhea is also known as “summer diar- 
rhea”; when it becomes choleriform, it is termed “cholera 
infantum.” It is always a serious disease. 

At the onset of any.diarrhea occurring in an infant there is 
no method, short of a bacteriologic examination, of determin- 
ing whether one has to deal with a simple or with an infectious 
diarrhea. It is well, therefore, to adopt dietetic measures suit- 
able to either condition, and to make such changes from day to 
day us the condition of the child directs. Many infants are 
sacrificed every year because this simple rule is not carried into 
offoct, 

Tn addition to these varieties there are also severe conditions 
with marked bowel lesions which some by Sela clini- 
cally ; the dietetic indications are, however, practic the same, 
and the entire subject may be considered under one head. 

Infectious diarrhea is rare in babies that are fed exclusivel: 
on the breast. These children, moreover, when afflicted wit 
the disease, are more amenable to treatment than are botile-fed 
babies, Ninety-seven per cent. of the deaths due to diarrheal 
diseases occur in bottle-fed babies. In some of the Pence toear 

a much langer percentage of cases was found in breast~ 
fed babies. The greater aay these children had been given 
unboiled water to drink. From this it would seem that the 
disease may be caused by infected water, and in warm weather, 
therefore, all water given to infants should be boiled. 

When a breast-fed baby is seized with a diarrhea in winter, 
the disease is almost sure to be of a simple nature, and a dose 
of castor oil or of calomel, followed by a little bismuth and 
chalk, is usually all that is required for relief. The dietetic 


_ 


260 INFANT PEEDING. 


management consists in shortening the length of time the child 
nurses and lengthening the interval between the feedings to 
six hours. In the meanwhile plain boiled water, or albumin- 
water, rice- or barley-water, or whey, may be given. Plain 
water is the best, perhaps, unless the child is very hungry. 
After one or two days of such treatment the ordinary regime 
may generally be resumed. 

Tn summer, however, « diarrhea, especially if severe, should 
arouse suspicion, and for twenty-four hours, or until the ebild’s 
condition warrants, milk should be withheld. The breasts 
should be pumped out caretilly at regular intervals, to prevent 
distress or a possible cessation of the secretion, The child 
should be given plain boiled water, or some one of the articles 

reviously mentioned, at frequent intervals and in small doses. 
there is great thirst, one or two teaspoonfuls should be 
given every fifteen or thirty minutes. If fluid is well re- 
ined, several ounces may be given ata time at intervals of 
two or three hours. If the child is very feeble, it should be 
stimulated with whisky and strychnin, or small doses of some 
of the liquid beef preparations may be tried, such as Pano- 
pepton, ae Beet Peptonoids, tonic beef, and similar prep- 
arations, diluted and given cold. Small doses should be given, 
and if the food is diluted sufficiently, the laxative action they 
are supposed to exert will not be obtained. If by the second day 
vomiting has ceased and the child seems better, it may be put 
to the breast fora few minutes and the effect noted. If the 
milk is well borne, the child may be given the breast every six 
hours, shortening the interval from time to time until the child 
has returned to its regular schedule. It is well to make a 
gradual return, and if the milk aggravates the diarrhea or gives 
rise to other symptoms, it should again be discontinued. When 
the breast milk is of good quality, there is rarely any difficulty 
with these cases. 

Tn bottle-fed babies every diarrhea, especially during warm 
weather, should be treated as serions, and certain precautions 
be taken. for the first twenty-four hours it isa good plan to 
withhold all food and give plain water, as previously suggested, 
Milk is absolutely contraindicated, and must not be given until 
recovery is complete. Under this plan, if the diarrhea is a 
simple one, recovery is rapid. The child’s appetite and condi- 
tion must govern the increase in diet, Albumin-water, rice- or 
barley=water, and whey are excellent foods to begin with. If 
these are well borne, malted milk may be given, followed, if 


DIET IN DISEASES OF CHILDREN. 261 


all goes well, by cows’ milk, It is a good plan, if the child is 
old enough to digest it, to mix equal of barley-water 
and milk together and boil them fora few minutes. This is 
usually well borne, and may be the first step in the return to 
the customary diet. 

Tn the infectious forms, so long as the disease is in its active 
stage, milk, since it furnishes an excellent for 
the pathogenic bacteria, acts ax a poison. In these severe cases 
no food should be given for twenty-four hours. Plain boiled 
water or very weak albumin-water may be prescribed in small 
doses at frequent intervals, Whisky in very dilute form and 
strychnin may be given as required, If the whisky is yom- 
ited and the child is very weak, ten drops of brandy may be 
administered in a teaspoonful or two of water. Sometimes 
teaspoonful doses of iced champagne will settle the stomach 
when nothing else can be retained. Washing out the stomach 
and giving it absolute rest will frequently check the vomitin, 
A common mistake is that of putting too many drugs and forks 
into an irritable, nauseated stomach, Absolute rest for several 
hours will frequently allay this irritability, In many cases 
equal parts of lime-water and cinnamon-water in 
doses is an effective method of relieving nausea, 

If the diarrhea continues while the stomach is at rest, there 
is apt to be great thirst. This may in a measure be allayed 
by small bits of ice chipped off with a needle and placed in the 

ild’s mouth, or the mouth may be sponged out with water to 
whieh a little lemon-juice has been added, 

Tf the amount of fluid abstracted from the body renders 
collapse probable, or if the child seems tly weakened, the 
subcutaneous infusion of normal salt solution is indicated. This 
should, of course, be given under aseptic precautions. One or 
more ounces may be given at a time, eight ounces being the 
ave amount for twenty-four hours. It is astonishing how 
rapidly this mixture is absorbed. 

When the vomiting ceases and the child becomes more com= 
fortable, food will usually be retained. Albumin-water, Pano- 
pepton and water, whey, rice-water, and barley-water are the 
most suitable foods. The cereal waters agree admirably with 
some children, but not with others, If the child does not take 
them plain, they may be sweetened. 

‘The return to milk should be made very gradually. In the 
severe cases cows’ milk should be withheld for a week, when, 
if the child’s condition permits, it may be tried in one small 


262 INFANT FEEDING. 


may be given, followed by partially or wholly ‘ized mill 
or the barley-water-and-milk mixture previously described. 
Plain well-ckimmed meat-broths, such as veal broth, may be 
used. Care must be taken to remove all the fat, as this isa 
frequent source of trouble. The milk should not at first con- 
tain too great a percentage of fat. This bold starvation plan, 
as it is sometimes called, succeeds better than any other. 
Later, however, care must be taken that the periods of under- 
feeding be not too protracted, for while it is desirable to “starve 
out the diarrhea,” the child must not be starved to death 

‘ing the process. A day or two of absolute abstinence from 
food no harm, as in the severe cases food is not retained, 
or, if retained, is not assimilated ; on the other hand, a reduced 
diet, continued for weeks and months, as is not infrequently 
done, is apt to prove disastrous. It is a good plan to keep an 
accurate record of all the food taken while the child is ona 
restricted dict. The amounts taken during each twenty-four 
hours may be added together, and from these it may readily be 
seen whether or not the child is getting sufficient nourishment. 

Diarrhea in Older Children.—When diarrhea occurs 
in older children, the early dietetic treatment is similar to that 
recommended for infants. As the child recovers a return to 
the ordinary diet may be made, meat, eggs, and broths of 
various kinds being given at first, followed by boiled milk and 
toast or dry bread. Vegetables and fruits should be given 
only after recovery is complete, and their effect should carefully 
be watched. Cereals may also cause a recurrence of the 
trouble, and should be most thoroughly cooked and given in 
small quantities at first. 

Meocolitis.—This term is used to include those bowel 
conditions in which there are serious lesions in the intestine. 
‘The disease usually follows a summer diarrhea. The dividing- 
line between the two is hard to draw, and it is very probable 
that ileocolitis is merely a severe form of infection with the 

iga-Flexner bacillus or other bacteria, The term dysentery 
is frequently applied to this affection. Conditions resem- 
bling this disease may come on in the course of chronic 
disorders, 

‘The feeding of these cases is a difficult problem. In general 


DIET IN DISEASES OF CHILDREN. 263 


the diet is similar to that given in diarrhea, As all nourish- 

ment is usually refused, however, when the disease is pro- 

tracted, as it is apt to be, it is extremely difficult to sustain the 

child, and the skill and tact of both nurse and physician are 

tad baahapaer hen th good plan 
‘n the acute cases, when there is vomiting, it is a 

to withhold all food for the first day ged Water may be 

‘iven in small quantities, and stimulants if necessary. Wash- 
ing out the stomach frequently allays the vomiting. This is 
best done with a tube, but in older children it is apt to cause 
excitement and does more harm than good. With younger 
children the process is easily carried out. A glass of warm 
water will sometimes accomplish the same pone! ual a 
cup of hot water sipped slowly will relieve the nausea. 
parts of lime-water and cinnamon-water form a mixtare io is 

very useful for irritable stomach. 

When the stomach continues irritable, it is best to give aoa 
one of the liquid beef preparations, such as 

Liquid Peptonoids. These combine a certain amount of ae 
* ishment with alcohol and are stimulating foods. The authors 
have fed cases of acute membtanous colitis for a week on sueh 

ions when everything else was rejected. The dose 
must be regulated according to the preparation and the age of 
the child. It is aaaaralipbeas to give Je reall doses, auficiently 
diluted with water, every two or three hours; but if fluid can 
be given only in teaspoonful doses, it may be necessary to 
give a teaspoonful of the diluted beet every fifteen minutes or 
half-hour. Completely peptonized skim-milk may be tried, 
and albumin-water and Stokes’ brandy-and. mixture are 
often given with good effect. In other cases barley- or rice 
water is retained. Malted milk is often of t senvice, and 
the malted foods, which are ordinarily mixed with milk, may 
be given mixed with water instead. Kumiss may sometimes 
be retained when other foods are rejected. Animal broths free 
from fat are also useful. If vomiting is persistent, gavage 
should be resorted to. If any one of the foods mentioned 
seems to augment the number of stools, another should be 
substituted. 

As the child improves, malted milk, one of the malted 
foods, or equal parts of milk and barley- or rice-gruel boiled 
pile may be given. Eskay’s food is valuable in the con- 

valescence from diarrheal diseases. Raw or very rare scraped 


meat may be given, but this is apt to cause yery offensive 


264 INFANT FEEDING. 


stools, Feet cooked in various ways and later plain boiled 
milk may be given, Zwieback, crackers, and toast may be 
added cautiously to the dietary, and the return to the normal 
allowance be made ually. Great care should always be 
exercised during and after convalescence, as dietary errors are 
apt to be followed by speedy and severe relapses. Fresh fruit, 
coarse vegetables, and all irritating and indigestible articles 
should be prohibited. 

Chronic Heocolitis——The dietary of a child with this disease 
is not easily constructed, The foods directed for acute cases 
are all useful, and a dietary can be formulated from them. 
The effect of any food on the stools should be watched, but 
observations should not be made in the presence of the patient, 
ag children of fonr years or more may become very morbid 
is watching frequent examinations of their stools. 

tis prion izested foods, such as the beef preparations, pepton- 

Ik, and the like, are among the most valuable articles 
hot diet in these cases, but peearos or a |, with or without 
milk, and eggs may also be milk and the malted 
foods are of service at times. ren in the form of whisky, 
brandy, port or sherry, and in whatever shape it is most palat~ 
able, may be given. 

Tnunctions with cocoanut oil or cocoa-butter are useful in 
promoting nutrition. A change of air is often followed by 
excellent results. 

Chronic Intestinal Indigestion.—Under this head 
may be included the ordinary form of chronic intestinal indi- 
cou as well as such special forms as starch indigestion and 

led mucous disease. 

Where the codperation of the mother or nurse can be secared, 
the results of treatment are very sutisfactory. If the diet can 
not be controlled absolutely, it is difficult or impossible to ac~ 
complish much in these cases, 

Chronic intestinal indigestion occurs at all ages, In young 
infants it is frequently due to improper feeding, and disappears 
when the child is put upon a proper diet. It may be seen in 
both breast-fed and bottle-fed babies. In breast-fed infants it 
is frequently caused by an over-rich milk, in which case a 
simpler diet for the mother with exercise out of doors will be 
all that is required. (See Management of Nursing Mothers.) 
In other instances, where the mother bas been taking various 
articles in order to increase the flow of milk, a return to a 
proper régimen brings relief. In still other cases the child is 


DIET IN DISEASES OF CHILDREN, 265 
the 


nursed too often or too long. ‘The disease may come on as 
result of allowing the child to sleep all night at its mother’s 
breast, with the consequent frequent and irregular night feed- 
ings. In another troublesome class of cases no cause can be 
made out. In these, if the condition persists and the child’s 
sais health is affected, weaning aad 


be relieved, nursing may be allowed to continue; frequently 
these cases recover in a short time. 

When the disease occurs in bottle-fed babies, the child has 

usually been given, for a considerable period, a food too high 
in one or more of the food elements. (This subject has been 
discussed under Infant Feeding, to which section the reader is 
referred.) Another ent cause in bottle-fed babies is the 
use of a proprietary food unsuited to the age or condition of the 
child, or the use of improper articles of diet, especially starches 
and sugars, 
Sugar and starchy food in excessive quantities is a factor in 
the causation of this disease that is often overlooked. Careful 
questioning frequently brings out the fact that sweets of various 
kinds have been given to the infant by indulgent parents or 
friends. Periodic attacks of vomiting and pain or of malaise 
and discomfort, analogous to the bilious attacks of older indi- 
viduals, may usual: relieved by reducing the carbohydrates 
to a minimum. These attacks are vecasionally so severe and 
misleading as to give rise to the diagnosis of malaria, tubereu- 
losis, typhoid fever, and many other diseases, even by compe- 
tent physicians, In almost every instance a complete cure can 
be quickly brought about by dietetic means alone. 

Between one year and eighteen months it is common for 
mothers to desire to increase the diet of their children. Milk 
should always form the basis of the diet, and if other articles 
disagree, a diet of milk and broths exclusively may bring about 
a state of perfect comfort. 

In Older Children.—The management of these cases is, as a 
rule, quite satisfactory. They require individual study, how- 
ever, for in one case the fat may be the canse of the trouble, in 
another it may be the curd in the milk, and in still another the 
carbohydrates may be the disturbing element. The diet should 
aim to give the intestine as little work to do as ible. To 
this end, the carbohydrates should be discontinued altogether at 
first ; and when they are mn again, it should be cautiously, 
and the effect should be ly watched. The fats should be 





266 INFANT FEEDING. 


greatly reduced or even omitted altogether. Protein should be 
given in as digestible a form as possible, and peptonized if it 
cause indigestion. 

In severe cases the child may be fed upon peptonized skim- 
milk. This may be completely or partially peptonized, as cir= 
cumstances demand. It should be given in moderate quantities 
every two hours. Kumiss may be used to vary the diet, and 
buttermilk, if the child will take it, forms an agreeable change. 
Albumin-water and liquid predigested beef preparations may 
also be used. Chicken or veal broth from which the fat has 
been removed may likewise be given. 

Rare or raw meat is usually well borne. It should be 
scraped fine and given immediately after preparing it. If 
desired, it may be rolled into small balls. Of this, two or 
three tablespoonfuls are an average daily allowance. | Beef is 
to be preferred, but mutton may be permitted. Dish gravy 
from which the fat has been skimmed may be given, and may 
be served in a green glass if the color of the fluid excites 
disgust. 

After a week or two, if improvement has begun, a malted 
food may be added to the milk. Eskay’s Food is of particular 
value in these intestinal cases, and is occasionally well borne 
when even peptonized milk is not. The food should be given 
at r-timed intervals; and if one meal is not well borne, 
nothing should be given until the next regular fecding-time, 
Absolutely no food should bo given botwoon meals Water 
may be allowed as desired, but should be given between meals, 
80 as not to interfere with digestion. Four meals a day, or 
even but three, should be all that is permitted. 

As improvement sets in the diet-list may be extended to in- 
clude junket and simple dishes prepared with milk or eggs or 
both together. Then a little zwieback, toast, or thin crackers 
may be allowed. Of the meats, chicken, beef, and mutton are 
the most preferable. The white meat of boiled or roast fish 
may be allowed, without any rich sauces, however, and oysters 
may be given in season. ‘The dietary must not be increased 
too rapidly, and it is well to allow a month to go by before 
making any decided changes, 

Cereals may be added in the form of a little very thoroughly 
cooked rice or barley in the broth, Later, green vegetables, of 
which the best are spinach, cauliflower tops, asparagus-tips, or 
thoroughly stewed celery, may be given. 

If improvement goes on, well-cooked cereals, such as rice 


a 


‘ 


DIET IN DISEASES OF CHILDREN. 267 


and Shae list Aart ie ‘They should be thor- 
ly cooked and strained if necessary. Oatmeal should not 
be given until the digestion has become normal, Well-cooked 
macaroni makes a it change, and fresh-frnit juices may 
be given, preferably an hour before meals. Of the latter, 
oran, is best, but in season the juice of fully ripened 
or grapes, without skins or seeds, may be given. 
As improvement , cream and butter may be added. 


im  feedin, brought on a relapse, Although every 
fan abeuld be eke to “ei relapses, when they occur they 


Directions as to quantities and preparation of food and the 
hours of feeding should be written out, and a careful record 
kept of what the child takes, and the quantity, as well as the 
number and character of the stools. By this plan it is fre- 
quently easy to detect idiosyncrasies, and to learn what agrees 
and what disagrees with the particular patient in charge. 

A point of no small importance is the avoidance of starva- 
tion. Unless a physician thoroughly understands the feeding 
of infants he may starve a child and render it weak, anemic, 
and unable to withstand the effects of the disease. Cases that 
have been set down as intractable catarrh of the intestine are 
often merely the results of starvation or due to an unsuitable 
milk mixture. In such cases, with return to a rational diet 
recovery ven ily follows, 

Constipation.—Chronic constipation is the cause of more 
worry and distress than almost any other condition. In order 
to relieve it, the diet must be regulated carefully and correct 
habits be formed. The formation of correct habits is of as 
much importance as the diet in the prevention and correction 
of this condition. Infants as young as three months of age 
may be taught to have a stool regularly by placing them upon 
a small chamber at a stated hour. In older children a fixed 
ime should be set for the daily visit to the closet. The best 
time for this is just after a meal, preferably breakfast, a3 at 





‘ 
268 INFANT FEEDING. 


this time there is a wave of peristalsis of which advantage may 
be taken. 

Constipation is quite common in breast-fed infants, and is 
usnally dee to the child’s getting a minimum amount of food 
or a milk that is low in fat and generally high in protein. The 
quality of the mother’s milk should be improved if possible, 
following the directions previously laid down, Between the 
nursings the infant should be given water, If this is not suffi- 
cient and the mother’s milk is found deficient in fat, 1 or 2 
teaspoonfuls of cream may be added to each nursing, or cod-liver 
or olive oil may be given in half to teaspoonful doses, An 
efficient change in the dict consists in giving 1 or 2 tea 
spoonfuls of soconstly cooked oatmeal. This should be of 
about the consistence of cream, well sweetened with sugar, and 
strained if necessary. This may be given once, twice, or 
oftener a day, as the case requires, and is best given with a 
nursing. Orange-juice well sweetened may be prescribed in 
doses of a teaspoonful to a tablespoonfiil, given an hour or so 
before a nursing. Stewed prane-juice may be used in the same 
manner, and in season any fruit-juice from perfectly fresh ripe 
fruit may be utilized. The very acid fruits should not be 
allowed. A teaspoonful of a malted food prepared with barley 
may be given, and emall amounts of the thick sweet malt 
extracts may be used with advantage. Mellin’s Food may he 
used to sweeten the food in place of sugar. Care should be taken 
not to disturb the infant’s digestion by the too frequent use of 
any of the articles just mentioned, or by the use of too large 
quantities ; only one article should be tried at a time. If these 
means fail, crags or suppositories must temporarily be resorted 
to. It should be borne in mind that the constant use of drags 
may defeat any efforts along dietetic lines, 

In bottle-fod babies, if the milk is modified properly, con- 
stipation will usually be overcome. If relief is not obtained 
by this means, measures similar to those directed for breast-fed 
babes must be taken. A small quantity of barley- or oatmeal- 
water may be mixed with the milk or a malted food added to 
it. Lonis Starr gives the following diet-list for constipation 
in a child from eighteen months to two and one-half years 
of : 

Pit Meat, 7 A. M.—A breakfastcupfal (f3viij) of new 
milk, with an additional tablespoonful sah of cream; 2 to4 
tablespoonfuls of thoroughly cooked ontmeal or cracked-wheat 
porridge, with eream and salt; 2 slices of whole-wheat or 


DIET IN DISEASES OF CHILDREN. 269 


bran bi buttered; the juice of a ripe orange, or half of a 
porte By ripe apple scraped with a spoon, or a small ripe 

r, scraped, or a peach, 
rand Meal, 11 A. M.—A teacuptul (f3vj) of milk, with 
an additional tablespoonful (f3ss) of cream; a slice of bran 
bread. 

Third Meal, 2 P. M—A breakfasteupful (r5vi) of mutton 
or chicken broth, or 1 or 2 tabl fils of underdone roast 
mutton, beef, or chicken minced fine and pounded to a paste; 
purée of spinach; mashed cauliflower tops; felch Set oH 
stewed celery ; whole-wheat or bran bean buttered ; junket 
and cream; rice-and-milk pudding with stewed prune-juice ; 
baked apple with cream. 

Fourth Meal, 6.30 P. M—Milk, 1 or 2 breakfusteupfuls 
(f3viij—xvj), with additional cream; whole-wheat or bran 
bread, buttered ; stewed fruit. 

For drink: pure water only. No condiment but salt. 

In older children, fed according to the rules already laid 
down, constipation is not so frequent, but when the diet is neg- 
lected and the child allowed to do as it pleases, it is a very 
common complaint. A glass of water, either hot or cold, should 
be given an hour before breakfast. Cream, as well as water, 
should be added to the milk. Barley- or oatmeal-water may at 
times be added to the milk with benefit. Meat broths are laxa- 
tive in their effects when added to this dict. Under eighteen 
months fruit-juices, or after that time perfectly ripe mead fruit, 
especially when taken an. hour before a meal, is very service- 
able. Figs and prunes stewed together are helpful, as are oat- 
meal and bread made from unbolted flour, In much older 
abies the management is similar to that recommended for 

jults, 

Holt manages an average case of chronic constipation in a 
child of four years of age as follows: “ Massage for eight min- 
utes, morning and uight; the juice of balf au orange and a 
glass of Vichy immediately upon rising; a breakfast of oat- 
meal, with one ounce of cream, dried bread with butter, an egg, 
half glass of mille with cream and water added ; a dinner of 
soup, one starchy vegetable—i, ¢., potato with cream—and one 
green vegetable, beefateak, baked apple or prunes, dried bread 
and butter, and water to drink; for supper, cream toast, ogg, 
dried bread and butter or Graham crackers, half glass of milk 
with cream and water added; a suppository containing nux 
vomica and hyoscyamus at bedtime,” 


270 INFANT FEEDING. 


Inanition.—Inanition is a term loosely applied to various 
conditions ; it should, however, be restricted to those cases of 
acute starvation coming on in very early life. It is character- 
ized by a loss of weight, and usually by fever as well, and the 
condition is not gate fone mistaken for some other disease. 
Tt follows abstinence food, such as occurs in those cases 
where infants are abandoned on door-steps, or are grossly neg- 
lected and starved. Other causes are nursing ata dry or nearly 
dry breast, in which case the child siezes the pls eagerly and 
after several vi attempts at sucking drops the nipple, cries, 
and seems to be uncomfortable. Gross errors in ing, a5 
where a child is given a food absolutely unsuited to its needs, 
zany alee bring about this condition, It may occur in infants 
with enfeebled digestion—either thore mitally debilitated 
or those rendered 80 by disease. Sudden cl in food may 
also occasionally cause it. 

In the management of these cases, which is apt to be difficult, 
the same general routine should be followed as is suggested for 
marantic babies. If possible, a wet-nurse should be secured, 
Holt advises that the breast-milk be diluted with an equal vol- 
ume of water or of lime-water. He also suggests that if there 
is diarrhea, the milk be pumped from the breasts and the cream 
removed. The proportion of fat may gradually be increased. 
When a wet-nurse can not be secured, the child should first be 
given very dilute mixtures, as suggested in the tables on pp. 218 
and 221, or a milk so modified as to be indicated for a child 
much younger than the one in band, These milk mixtares 
should be partially or completely nized. The authors 
have used weak milk mixtures to which Peptogenic Milk Powder 
has been added, with benefit. These may be given by means 
of a bottle, or if the child will not suck, by means of a medi- 
cine-d or spoon, or by gavage if necessary. In all cases 
in which a child  refueos uke food a stomach-tube should be 
passed in order to ascertain if the hagus is patent or not, 
and the fauces should also be Senay carefully both by sight 
and by touch. 

If the peptonized milk is not well irene tuaeaeted beef 
preparations, diluted condensed milk, malted or farinaceous 
foods, albumin-water, barley-water, in fact, any form of food 
that can be given, may be tried. Those just mentioned are, 
however, the most apt to prove useful. Water, if needed, may 
be given by subcutaneous injection or by the rectum, a normal 
ealt solution being best for this purpose. 


MARASMUS, 271 
Children very small at birth are best treated in the same 


anata as pees tebis eae ake infants may 
be combated by allowing food that w not be 
rare 


under ordinary conditions, id food suited for a 
the of the one under treatment sometimes succeeds when 


us, 
“wasting disease of children,” athrepsia, and simple ai 
is best described as a condition of pernicious prt 
term inanition should be used only for those cases of acute star- 
Moga with their characteristic symptoms and causes, occurring 
in infants, 


infants who have not had proper food and care, Some authors 
would place these in the list of secondary cases, and consider 
ther from another standpoint, regarding the process of nutri- 
tion as twofold—digestion as the first step, and assimilation a3 
the second. Under the head of primary atrophy these authors 
would place only those eases in which the second factor was at 
fault; or, in other words, those cases receiving care and 
a physiologically correct diet, This division 1s, for practical 
purposes, useless ; and since we lack definite information on the 
subject, the cases should be divided, from a pathologic basis, , 
into those that exhibit lesions of definite diseases, and those in 
which there are no special and constant lesions beyond rene 
of the muscles and body-fat and atrophy of the thymus gland. 
If care is taken to exclude tuberculosis as well as other dis- 
pa the diagnosis of the condition presents no especial diffi- 
ities. 


In some instances the cause of the disease can not be made 
out, whereas in other instances it is traceable to improper 
feeding, lack of care, insufficient exercise, and, most important, 
lack of fresh air and sunshine, 

When cases are seen reasonably early and if the causes ean 
be recognized and remedied, the outlook is good. In private 
practice cases among the well-to-do usually do well. If seon 
late, the prognosis is nearly hopeless, and in asylums and infant 


272 INFANT FEEDING. 


homes the outlook is most gloomy. If, when the infant is first 
seen, digestive disturbances are present and can be corrected by 
dietary measures, the outlook is more hopeful than in those 
cases where sufficient food is taken and digested but the child 
nevertheless continues to waste. In the really typical forms 
this is the ease, and the disturbance seems to be due to im= 
proper utilization of the food. Sufficient food may be taken 
Gane +h digested and absorbed, but in the burning-up of the 
food in the body some change takes place that permits it to be 

of without properly nourishing the system. 

treatment of these cases is essentially dietary and 
hygienic, and either measure alone must fail, The child must 
be kept warm, and in a well-aired room ; if ‘ible, it should 
be given sun-baths and be taken into the fresh air, In proper 
seasons of the year it should be out-of-doors most of the time, 
preferably in the country. The child’s body should be mas- 
saged gently once or twice daily, using gentle friction and a 
lubricant such as cocoa-butter or cocoanut oil. The rubbing 
movements should always be directed toward the heart, so as to 
facilitate circulation, The child should be carried about and 
coddied as much as possible, for many of these infants are 
starving for want of a mother’s love as much as for want of 
food. The child should be fed while lying on the nurse’s lap 
or arm, and not as it lies in the crib. ‘This last is, of course, 
impracticable in many infant homes and hospitals. The feed~ 
ing should be the same as has been suggested under the heading 
of Loss of Weight. Of drugs, creasote, best given in the form 
of Liquid Beef Peptonoids with creasote, carbonate of creasote, 
,or carbonate of guaiacol, is the most useful in the condition, nux 
yomica and aleohol also being of service. 

Nursing Homes for Marasmus Cases.—If homes could be 
established for the nursing and care of marantic babies, the 
infant mortality from this disease would be greatly diminished. 
‘This nursing-home plan has been carried into effect in some 
of the cities of Germany. In these institutions women who 
have recently been delivered are cared for on condition that 
they nourish one or more infants. The quantity of milk 
secreted by these women under the constant stimulation of 
several sucking children is remarkable, 

It must be remembered that a large percentage of the cases 
of marasmus occur in children who have been abandoned by 
their mothers at birth. If a child is nursed at the breast for 
two or four weeks, it is more likely to improve and live than if 


j 


RACHITIS OR RICKETS. 273 


it is taken from the breast immediately and given uncertain 
milk mixtures. 

Malnutrition.—Malnutrition is a term applied to cases of 
defective nutrition that run a more chronic course than those 
suffering from inanition or marasmus. It occurs in infants and 
in older children. In the former the management is similar to 
that of marasmus ; in the latter, the same general rules apply. 
‘The life of the child must, so far as possible, be ly 
regulated, and an abundance of fresh air and sunshine, 
with aj riate exercises and intervals of undistu rest, 
enjoin ‘he diet is, however, the most im; it element in 
a treatment. uh food gone in and wholesome, care- 

ly |, and given at i but not too juent inter- 
vals. ce aon mae it may ‘be found advisable con smaller 
meals at shorter intervals. The food should be such as is 
recommended for normal children; a list of these articles is 
ipreiion p. 243, where the details of the feeding will also be 


Feeding after Intubation.—Usually this is accom- 
plished with but little or no difficulty, but in some instances 
swallowing may at first be difficult, and in these cases semi- 
solids, such as junket, soft-boiled eggs or a very light omelet, 
wine-jelly, or milk-toast, may be substituted for the liquid. If 
the semisolids fail, it has been suggested that the child be placed 
with its head lower than its body, and that nourishment be given 
while in this position. As soon as the child learns to swallow 
with the tube in place the usual light diet may be given. 

Entiresis,— Besides the training and the medicinal treat- 
ment, a plain, nutritious diet is of great service in these cases. 
In the majority of cases of nocturnal enuresis, on question- 
ing it will be found that the children have been getting large 
quantities of coffee or tea, or that large amounts of water have 
been taken during the evening, or that the bladder has not been 
emptied before going to bed. In these cases the treatment is 
obvious, and consists in excluding coffee, tea, and stimulating 
foods (spices and the like), and in limiting the amount of fluid 
taken after four in the afternoon. Much can be done by proper 
training. When dependent upon other causes, the treatment 
must be directed toward these conditions. 

Rachitis or Rickets.—Rickets is a disease of nutrition, 
but one that is not well understood. Most of the cases occur 
in the temperate zone, and southern races transported north 
seem especially predisposed to it, It is very common among 

B 






274 INFANT FEEDING, 


the negroes of Baltimore. The authors have found that 
nearly 100 per cent. of the infants in asylums for colored 
children were affected with rickets, whereas in similar inetitu- 
tions for white children in the same city the disease was rare. 
Italians living in America seem predisposed to it, and children 
with bad hygienic surroundings are more apt to be affected than 
those reared amid better conditions. It is a disease of the city. 
The majority of the cases occur between six months and two 
years of age ; it is not often seen in breast-fed children unless 
Jactation has been continued for too long a period. Holt states 
that among the Italians in New York City it is not uncommon 
Sag children who are breast-fed. 
may be produced experimentally in animals, as has 
been proved by Bland Sutton in his famous experiments ; he 
fed lion whelps on an exclusive diet of raw meat, and in a short 
time they developed severe rickets. They were given milk, 
pounded bones, and cod-liver oil, and in three months, without 
any change in their surroundings, they were cured. Geurin 
ented on a litter of pups, and found that those who 
suckled did well, whereas those fed on raw meat developed 
rickets. Numerous experiments of this kind have been con- 
ducted, and while deductions were not always in accord, they 
tended, nevertheless, to show that the disease may be produced 
by withholding milk from young animals and substituting for 
it other articles of diet. 

In children fed artificially by improper methods rickets is 
at to develop. A food low in fats is especially liable to pro- 

luce the disease, particularly if, at the same time, the proteins 
are also deficient, In such a diet there is almost certain to be 
either an excess of the carbohydrates or of some substance 
unsuited to the child’s digestion. Among foods that causes 
rickets may be mentioned some of the proprietary foods and 
condensed milk. 

The lime salts are, under certain conditions, apparently ab- 
sorbed with difficulty, and this would seem to be the case 
when the food is deficient in fat. Hence if the child’s diet 
lacks fut or if the lime salts are deficient, the bones will be 
improperly nourished. It has been thought that this was due 
to an excess of lactic acid, and there are a number of other 
theories that need not be considered here. 

Diet —The feeding in rickets is very simple, and when it is 
possible to combine with it outdoor life and proper care and 
nursing, is very efficient. If the child must be fed artificially, 





W 


RACHITIS OR RICKETS. 275 


and if it exhibits symptoms that are # jive, such as sweat- 
ing, tenderness, pat ae eter at ni it chould be given 
cream or cod-liver oil in addition to eee In this 
way the disease may be prevented, the disease has 
developed, the child should be placed on a dict suitable to its 
age, as 8 ted in the section on the Feeding of Infants ; the 
food should consist in fresh milk, eggs, meat, vegetables, and 
fruit. The basis of the diet should be milk, which should con- 
tain 4 per cent. of fat if the child can digest that amount and 
is old enough to receive it. Fat in some form must be supplied, 
and where cream is not well borne, other forms may be tried or 
they may be given in combination, Of these, cod-liver oil is 
one of te most valuable, and may be given plain, in er 
ful doses or less, 20 as not to disturb the digestion. the 
plain oil is not well borne, it may be given in the form of an 
emulsion or with mal eeeera oe Fat bacon hone ea a 
crisp by dropping s pieces in boiling grease may ‘ied, 
and a4 often res where other fats page Butter may be 
used, but in amounts this may not be so well borne as the 
other forms. should be taken that too much be not given 
and the child’s digestion disturbed by excess of fat. 

The hypophosphites may be used for their tonic action, but 
probably exert no special effect on the disease. Iron or arsenic 
may be used if there is anemia. 

is Starr! gives the following diet-list for a child of eigh- 
teen months in which the disease is uncomplicated by diarrhea: 

First Meal, 7.30 A, M.—A breakfastcupful (8 ounces) of 
milk with a tablespoonful (one-half ounce) of cream ; on alter- 
nate days the yolk of a soft-boiled egg, with a little butter, salt, 
and bread-crumbs, and two to four tablespoonfuls of well-cooked 
and strained cracked-wheat porridge with cream and salt, 

Second Meal, 17 A, M.—A breakfasteupful (8 ounces) of 
milk with a tablespoonful (one-half ounce) of cream and a slice 
of whole-wheat bread. 

Third Meal, 2 P. M—A good tablespoonful of well-minced 
and pounded chicken or mutton, with gravy and a littlecrumbled 
stale bread ; a tablespoonful of purée of spinach, stewed celery, 
or cauliflower tops ; thin bread and butter. 

Fourth Meal, 6 P. M—Milk and cream as at first and second 
meals ; thin bread and butter. 

For drink, pure water. 

Avoid excess of farinaceous food. 


* Dineases of the Digestive Organs of Children, 





276 INFANT FEEDING. 


Should there be « complicating diarrhea with liquid offensive 
stools, a diet containing a minimum quantity of casein should 
be adopted. For example : 

First Meal, 7 A. M.—Veal broth (half pound of veal to a 
pint of water) and barley-water equal parts (3 to 4 ounces). 

Second Meal, 10 A. M.—Cream, half ounce, whey (freshly 
prepared) 6 ounces. 

Third Meal, 1 P. M—Same as first, with chicken broth in 
place of veal broth, 

Fourth Meal, 5 P, M_—Same as second, 

Fifth Meal, 10 P. M—Same as first. 

If feeble, one meal ut 4 a. M., same as second. 

In extreme cases with diarrhea Starr limits the diet to raw 
beef!juice in one to three tablespoonful doses every two hours, 
with a modified brandy-and-egg mixture twice each day. 
(See recipes for Infant Brandy-and-egg Mixture, in the sec- 
tion on ipes). 








DIET FOR SPECIAL CONDITIONS. 
DIET FOR THE AGED. 


Wuen a man has passed his fiftieth year his diet should be 
guarded, Dietary indiscretions or a too plentiful diet will 
result either in the putting on of flesh and the consequent dis- 
comforts of obesity or in the development of gout or allied 
affections. In considering the diet of the aged the old dictum 
that a man is as old as his arteries applies. Age ean not always 
be counted by years. In the aged there is a lessening of all 
physical activities. The old man takes less exercise, has 
diminished powers of digestion, and is less able to absorb the 
nutriment he has digested. His circulation Deuces 
bowels are constipated. nerative processes have 
in his organs, and he Paps apt to feel the effects of indis- 
ervtions in diet. For these reasons the diet should be lighter 
than in younger ay and the amount of food eaten should 
vary with the needs of the individual. The food should be of 
an easily digestible variety ; it should be given in smaller 
quantities at a time, and the intervals between meals should be 
shortened. If there is a tendency to obesity, food that is apt 
to be converted into fat should be given in diminished amounts. 
The proteins should be somewhat lessened from time to time. 
‘The practice of eating heavy suppers late at night and of eat- 
ing between meals should be discontinued. The person should 
learn what particular articles of food disagree with him, and 
pene from cating foods that tend to cause flatulence, Yeo 

that in the case of cooked fruits a small quantity 
(about a teaspoonful to the pound of fruit) of sodium bicar- 
bonate be stewed with them, to correct the acidity that canses 
flatulence. 

In the aged food bears a close relation to sleep. A cup of 
hot milk, hot toddy, or some hot liquid food taken at bed-time 
will often overcome troublesome sleeplessness, A few sips of 
milk ora mild stimulant taken during the early morning hours, 
when the aged ure apt to awaken, will frequently insure sleep 
again. 

om 











278 DIET FOR SPECIAL CONDITIONS. 


Food Suitable for the Aged (Yeo).—Young and tender 
chicken ran aa and other tender meats. Potted chicken, 
game, and ot 


Nutritious soups, such a4 chicken or fish purées, beef-tea, mutton 


=f 


‘Vegetable purées of all kinds may be taken in moderation— 
@. J. potatoes, carrots, spinach, and other succulent vegetables. 
Potatoes and fresh vegetables are a necessity ; if omitted, a 
scorbutic state may be engendered. Stewed celery and stewed 
Spanish or Portugal onions lend variety to the diet. Stewed 
or baked fruits, fruit-jellies, and the pulp of perfectly ripe raw 
fruits in small quantity may be taken. 

Dr. George 8. Keith, in his Fads of an Old Physician, gives 
the following account of his diet in his old age: 

“For breakfast I have a large cup of tea, with milk or 
cream ; brown bread from two to three ounces; and usually 
one and a half ounces of fish, or half that quantity, and that 
very rarely, of bacon. Sometimes for a few days I take a cup 
of coffee with half milk, but no fish or bacon. Lunch is a 
cup of cocoa or chocolate, if the weather be cold ; if it is warm, 
a small tumbler of milk, about six ounces, with the same quan- 
tity of bread as at breakfast. At both meals I use butter, not 
a quarter of an ounce, and quite as much jelly or marmalade. 
‘This is my usual lunch, but occasionally instead of cocoa I 


DIET DURING PREGNANOY AND THE PUERPERIUM, 279 


hy, Cla or some prunes with milk, or strawberries 
with cream so long as I can get them, or very rarely vegetable 
soup. When I have no milk I take usually a morsel (not half 
an ounce) of cheese. At 4 P, at, a small cup of tea, and some- 
times poets or Cc oie at 7, which is my chief 
meal, I have sou i, lentils, celery, carrots, 
Bete tha anercoanata ence ricdh anche endeseoroies 
with a little from lamb or a bone ; or fish soup, the only animal 
soup I indulge in. Fish, mostly white deep-sea fish direct 
from Montrose; of this I take no more than three ounces, with 
a potato and always another vegetable fresh from the garden. 
If there is no fish, I may take once or twice a week an ounce 
or two, certainly not more, of lamb, game, rabbit, or tripe ; 
but often I have neither fish nor flesh. The dinner ends with 
stewed fruit with cream, or pudding, or fruit tart; of these I 
take a fair helping. During the winter season, instead of fruit 
or pudding, I often have celery, with cheese, oateake and butter, 
On this diet I enjoy the best of health, and for my age Kee 
enty-eight) am up to a fair amount of exercise, walking three 
to six miles daily in good and sometimes in bad weather, and 
usually part of this is up a steep road with a rise of 260 feet. 
‘The only confession I have to make is that when at home I 
do not rise till I have had breakfast and read the newspaper. 
‘This is a habit I have recommended to many approaching my 
own age, and those who have tried it admit that they are 
stronger for the rest of the day. I enjoy brealctast just aa 
much as my other meals, though I never feel what can be 
called hunger, and have not done so for many years, I could 
omit a meal at any time without discomfort. This I have 
long looked upon as the best proof of perfect digestion. Dur- 
eA warm months I take rather less bread and butter, and 
I do not try to make this up by taking anything else.” 


DIET DURING PREGNANCY AND THE 
PUERPERIUM. 


Diet during Pregnancy.—Under ordinary circumstances 
no other diet than that to which the patient is accustomed is 
advisable. The food should be plentiful and nourishing. All 
highly seasoned food and indigestible articles are to be avoided, 
as are all articles which are known to disagree with the patient, 
When there is a morbid craving for unsuitable things the 
patient should be carefully guarded against indulging her appe- 


280 DIET FOR SPECIAL CONDITIONS, 


tite. Special diets may be ordered for patients with diabetes 
or heart disease, or where the patient is gouty, over-fat, anemic, 
or chlorotic. Prochownick' has called especial attention to 
these conditions. 

Diet in Obesity and Pregnancy.—In general, the diet 
is the same as advised in obesity. This should be combined 
with exercise, either walking or light gymnastics and 
which should not, however, be given over the abdomen. The 
diet should consist of meat, fish, green vegetables, fruit, and a 
small allowance of carbohydrates. Prochownick allows 4 or 5 
ounces (120-150 grams) daily. Fruit is permitted, but should 
not be eaten in too large quantities nor to relieve thirst. ‘The 
amount of finid should be restricted to a pint or a pint and a 
quarter (500-600 ccm). Prochownick allows a moderate 
amount of fat, as cream and butter, but not fat sauces. Soups, 
sweets, spirits, and preserves are to be avoided. The following 
is a sample dietary as advised by Prochownick : 

7.00 A. M.—Four ounces (125 com.) coffee with milk; 14 
ounces (40 ) bread and butter ; 1 or 2 eggs ; a little fruit, 
Before or after this 40 to 45 minutes walking. 

10.00 A. M.—Maseage or gymnastics. 

10.380 A, M.—Fruit ; 1 egg ; a very small slice of bread and 
butter. 

Midday.—Roast or boiled meat or fish ; vegetables, no beets 
or peas; salad; cheese; fruit; 4 ounces (125 cem,) water or 
wine and water. No afternoon naj 

4.00 P. M—A small cup of coffee or tea, not over 3 ounces 
(100 ccm.) ; a very small slice of bread and butter ; an egg, if 
necessary. Walk for an hour or an hour and a half. 

7.30 P. M.—Eggs or cold meat; 4 to 6 ounces (125-200 
ccm.) tea or milk; 1 to 2 ounces (40-60 grams) bread ; butter ; 
fruit or salad. 

Thirst is usually complained of early in the treatment. The 
diet should be varied to snit the patient, and the routine 
should be go arranged as not to be disagreeable to the patient. 
The result of the lowered amount of fluid and carbohydrate, 
together with the exercise and massage, is to reduce the amount 
of fat, tone up the system, and to produce a small child, so that 
labor is made easier. The urine chould be examined from time 
to time and the patient should be weighed. 

Prochownick's Diet in Pelvic Contraction.—<Accord- 
ing to Prochownick, Florschiitz, and others, a diet deficient in 


1 Therapeutische Monatachrifie, 1901. 





DIET DURING PREGNANCY AND THE PUERPERIUM, 281 


carbohydrates and fluids will result in a small child without 
otherwise influencing its development, a view which bas been 
confirmed by Patton in England. The diet is advised in women 
who have previously borne very large children and in women 
with contracted pelves. In the latter, Prochownick does not 
advise the diet when the conjugata vera is below 8 em., but 
there are instances where the child was born alive and well with 
the conj vera 7, 5,7, and even 6.5¢.m. By following 
his plan difficult labor may often be obviated, and even the 
induction of premature labor Cre jeas ties; diet may be 
begun ten or twelve weeks before the birth is expected, and 
after the first week or two should be rigidly followed. Fraenkel 
advises beginning four or five months before delivery. The 
average dict consists of 140 to 160 grams of protein, 80 to 130 
grams of fat, and 100 grams of carbohydrates, altogether a 
value of 1800 to 2000 calories. The fluid should be restricted 
pa 500 cem. per day. Prochownick’s original diet’ is as 
WSs 

Breakfast.—One small cup of coffee (3 02.100 cem.) ; zwie- 
back or bread (1 ounce-25 grams) ; a little butter. 

Dinner.—Any kind of meat, eggs, or fish, with little sauce ; 
green vegetables prepared with fat (as cream) ; salad ; cheese. 

-—Same as dinner, with 1 to 1} ounces (40-50 grams) 
bread, and as much butter as desi 

Absolutely forbidden.—Water, soups, potatoes, desserts, sugar, 
and beer. 

Drink per day.—Red or moselle wine, 9 to 12 ounces (300- 
400 cem.), 

All the mothers bore this diet well after getting used to it, 
Thirst was complained of during the early part of the treat- 
ment, and is especially noticeable in fat women. Some object 
to the large quantities of animal food, but this is overcome by 
the use of green vegetables and salads, All the confinementa 
reported have been easier than on previous occasions, even when 
the child was large and fat, and all the children were born alive 
even though the majority of the mothers had had previous mis- 
carriages. The children were lean at birth, with the bones of 
the head unusually mobile. The children were all apparently 
mature in every way. In the majority of instances the child 
gained normally after birth, and the diet apparently had no bad 
influence on lactation. The urine should be examined regularly 
and the amount of urea estimated. It has been suggested that 


1 Centralblutt fire Gyniihologic, 1889, 83. 





282 DIET FOR SPECIAL CONDITIONS. 


such a diet would favor eclampsia, but this has not been borne 
out clinically, 

Diet during the Puerperium.—Formerly great restric 
tions were placed on the diet of a recently delivered woman, 
thus acconnting, in part, for the loss of weight that has been 
noted, If there is no nausea and the patient desires it, a cup 
of tea or a glass of warm milk may be given soon after delivery. 

‘The appetite is generally poor for a few days after delivery, 
but should be given at regular caaeealy not too widely 
separated, The first day, milk, milk-toast, or, if desired, dry 
or buttered toast, with coffee, tea, or cocoa, according to the 
taste of the patient, may be given. Water may be allowed as 
desired. On the second and third days simply soups or any 
of the following may be added to the dietary : Meat broths, 
heef-tea, soft-hoiled or poached eggs, raw or stewed oysters, 
and some simple dessert, such as wine-jelly, boiled custard, or 
junket. During the next few days chicken, scraped beef’ or 
mutton in small quantities, baked potato, rice, and cereals may 
be given, and by the end of the week a gradual return to the 
ordinary diet may be made, 


DIET IN THE SPECIAL DISEASES OF PREGNANCY, 

Lowered Urea Output.—During pregnancy the urine 
should be watched closely, and an examination for albumin be 
made weekly, especially if there is the slightest reason to sus~ 
pect kidney disease. If albumin is found or if any untoward 
symptoms arise, the urea output for twenty-four hours should 
be estimated. If the quantity excreted is below normal, the 
patient should be put at once on a milk diet, the milk generally 
being skimmed (see Milk Cure and Diet in Nephritis), If the 
patient tires of this, lettuce salad and bread and butter may 
be allowed in addition, together with zwieback or biscuits 
(crackers). Very small quantities of herring roe may be given 
as a relish. An abundance of water, either plain water or 
what is known as Buffalo Lithia Water, should be drunk. 
Cream-of-tartar lemonade (one dram to the pint) is also useful 
as a beverage, 

Salivation.—If this occurs, the patient should be put 
upon & rigorous mill diet. 

Gingivitis.—In this condition a generous, well-mixed diet, 
including fruit and fresh vegetables, is indicated. In uddition 
tonics and astringent mouth-washes, especially those containing 
the tincture of myrrh, are to be prescribed. 


DIET DURING PREGNANCY AND THE PUERPERIUM. 283 


Pernicious Vomiting.—This is often associated with 
diseased conditions of the kidney. Whatever the cause, the 
patient should be kept in bed and placed upon a restricted 
diet, consisting of peptonized milk and similar preparations, 
given in small quantities at intervals of three or four hours, or 
even oftener. Rectal feeding may be employed for several 
days, the patient being given little or nothing by the mouth. 
High injections of salt solution help to allay thirst and to 
control the condition itself. When the vomiting has ceased, 
the return to an ordinary diet should be slowly and carefully 
made. 

Aberrant Mental Conditions during Pregnancy.— 
The patient should be placed in bed, if possible, and excretion 
prometed by means of baths and the like. An exclusive milk 

iet (or one that is nearly so) is generally to be preferred. 


SPECIAL METHODS OF FEEDING. 


RECTAL FEEDING. 


Nutrient Enemata.—The administration of food by the 
rectum is a method of feeding of ancient origin. A2tius and 
others mention it, and writers during the Middle Ages have re- 
ferred to it, though not in very glowing terms, their imperfect 
technie probably resulting in practical failure. Voit and Bauer 
found that a dog’s rectum would not absorb egg-albumin and 
water unless sodium chlorid were mixed with it, Meat-juice 
and peptone solations have been recommended, but on account 
of their cost are not in common use. Von Leube advised the 
nse of albumin to which chopped pancreas has been added. 
His formula was as follows : 150-300 grams (5-10 oz.) of 
scraped and finely chopped beef; 50-100 grams (14-3 oz.) of 
finely chopped pancreas (of the cow and hog), free from fat; 
150 cc. (5 oz.) of lukewarm water. The mixture is to be 
stirred until a lukewarm mass results. If desired, fat may be 
added—25-50 grams (about 1-1} oz). It is best to allow 
the mixture to stand for some time in a warm place before 
using. The peer pancreas extracts, either dry or liquid, 
now on the market, may be substituted for the chopped pan- 
creas, Ewald showed that this procedure was unnecessary, 
and that albumin that was not peptonized or pancreatized 
could be absorbed, especially if a small quantity of salt was 
added. This last seems to cause reverse peristalsis, and Griitzner 
has shown that snbstances introduced with the salt solution may 
be found in the stomach, a fact that has been confirmed by 
Swieznski. 

All the various classes of food may be utilized in rectal feed- 
ing. Protein may be supplied in the form of predigested meat 
or egg-albumin to which salt has been added. Nutrose and 
similar preparations have been advised. Peptones may be 
added, from 50 to 60 grams (14-2 oz.) in 250 grams ie 
44 02.) of water being the proper strength. Of the carbohy- 
drates, grape-sugar has been recommended. Not more than 300 
e.c, (6 02.) of a 10 to 20 per cent. solution should be allowed, 
If too much grape-sugar is given, it may canse pain in the 

bad 


RECTAL FEEDING, 285 


abdomen and looseness of the bowels, Starch has been used, 
and solutions containing it are readily digested and absorbed ; 
it is also said to be less likely than grape-sugar to give rise to 
symptoms of distress, Fat may be used, not more than 10 
grams (} 02.) being given in twenty-four hours. It is best 
given in the form ob yolk of Mig tat bbae fat-containing sub- 
stances, such as cream or even oils, may be used, If rectal 
feeding is to be carried out for any length of time, it is advisa- 
ble to combine various articles, and for this purpose a number 
of recipes have been given on page 288. 

Bauer believes that but one-fourth of the nutriment needed 
by the body can be absorbed by the rectum, and both he and 
other carlier writers placed the limit of time during which 
rectal feeding was practicable at from one to two weeka. The 
average time during which an individual may be sustained by 
this method of feeding may be conservatively placed at from 
four to seven weeks ; von Lait has kept a patient alive for 
es months, and Riegel for ten months, by exclusive rectal 


ing. 

‘The success of the method depends largely on proper technic. 
With poor technic the rectum soon becomes irritable, and for 
this reason rectal feeding should not be intrusted to the nurse 
or the family, but the physician himself should see that it is 
properly conducted. In hospitals or in private practice where 
the nurse has been specially trained general directions may 
suffice, but in any case explicit written directions are advisable, 
eae ne rectum becomes irritable the process is conducted with 

ifficulty. 

Procedure.—The rectum should be cleansed thoroughly by 
administering a high injection of normal salt solution one hour 
before the enema is to be given. This cleansing should be 
practised at least once a day, and if much mucus is present, it 
may be well to precede cach feoding by a cleansing enema. If 
the rectum is inflamed, a solution of boric acid may be used 
instead of the salt solution, or if there is much mucus, a solu- 
tion of sodium bicarbonate may be employed—a_teaspoonful 
of either to the pint of water being suficient. For the first 
one or two cleansing enemata the bowel should be flushed by 
the ordinary method ; later a return-flow catheter may be used ; 
with this several quarts of solution may be used ; without it 
} to 1 pint will be sufficient in most cases. 

The temperature of the cleansing enemata should be between 
95° and 99° F.; that of the enemata which are to be retained, 





286 SPECIAL METHODS OF FEEDING. 


between 90° and 95° F. Solutions that are too hot or too cold 
will promptly be rejected. 

‘The patient should lie on his side, with the hips well elevated. " 
On account of disease this position may be impracticable. A 
rectal tube or a large catheter should be used. This should 
not, however, be too large; a tube 1 cm. (about half an inch 
or less) being the proper size for an adult. For children the 
tube should be proportionately smaller. It should be lubricated 
thoroughly, but glycerin should not be used for this purpose. 

In introducing the tube, it should be twisted slightly, which 
lessens the liability of ita becoming impacted in the rectal folds. 
If it is not passed easily, a small quantity of the fluid should 
be allowed to flow in, which will serve to balloon out the 
i ami which the tube may usually be passed with ease 
for eight or ten inches or more. The tube should in all cases 
be introduced as high up as ible, as the enema is thus more 
likely to be retained and absorbed. Theoretically, too, it is 
urged that the blood from the lowest part of the rectum is 
returned through the vena cava, whereas that from the higher 
parts returns by way of the portal system and passes directly 
throngh the liver. This is of no practical moment here, as 
sugar solutions absorbed from the rectum, even when introduced 
into the lower ee do not cause glycosuria. This is ex- 
plained by the fact that the lower portion of the rectum has 
a small capacity and absorbs but little. 

The fluid should be allowed to flow in slowly from a funnel 
or a fountain-syringe. In some instances, where very small 
injections are being used, a small hard-rubber syringe may be 
attached to the tube. Care should be taken to avoid injecting 
air with the fluid. The method of administering nutrient 
enemata by means of the old-fashioned short hard-rubber nozzle 
of either a piston or a Davidson syringe can not be too strongly 
condemned. In the hands of the unskilful it may cause injury 
to the rectum, and even if used by a trained nurse, only suc- 
ceeds in placing the fluid in the lower part of the rectum, where 
it is apt to be expelled, 

After the injection the patient should lie as quietly as possible 
for at least an hour, and be instructed to try to retain the contents 
of the bowel. A pad of gauze or a towel should be pressed 
over the anus for twenty minutes or balf an hour, and the mind 
should, if possible, be diverted from the subject. After a few 
days the bowel often acquires a tolerance for the injections, and 
they may be retained without difficulty. 





RECTAL FEEDING. 237 


If the rectum is irritable and the fluid rejected, it is well to 
precede the nutrient enema by a small suppository containing 
ium, or, what is better, a small rectal injection of the tincture 
ium may be given. This may be mixed with a little 
water, but the whole should be as small as possible. 
‘The opium should not be used unless necessary, and the dose 
Peru be soe etal cceee tie bowel ; or the opium may 
be added directly to the enema, 

If there are hemorrhoids, rectal feeding will be greatly inter- 
fered with, Before each injection they may be painted with a 
2 per cent. cocain solution, and between the feeding a soothing 
ointment should be applied, 

‘The amount to be given at each injection is an important 
factor. Ax a rule, it should not exceed } of a liter, (} pint). 
If this is not well borne, the amount may be reduced to from 
80 to 100 ec. (1-3 02.). 

The number of enemata to be used will ind somewhat 
upon the patient’s constitution; as a general rule, five, or 
ae six, hours should be allowed to elapse between each 
i terralliee verano dled packing in the vagina and other 
gynecologic dressings may interfere materially with the injection 
of fluid into the bowel. 


INDICATIONS FOR THE USE OF NUTRIENT ENEMATA. 

Nutrient enemata are indicated : 

1. In extremely weakened conditions, as during the progress 
of fevers, when the quantity of food taken through the mouth 
is insufficient to sustain life or when even predigested food can 
not be retained. 

2. In diseases of the pharynx and esophagus in which ob- 
structions to the passage of food exist, as from tumors; also 
occasionally in spasmodic constrictions of the esophagus and in 
paralytic conditions of the pharynx when the patient: is unable 
to swallow food. 

3. In diseases of the stomach, as in cancer occasioning 
stricture of the cardiac orifice, with inability to swallow suffi- 
cient nourishment. In diseases of the stomach in which it is 
important to relieve the stomach of work—e. g., in carcinoma, 
in non-malignant strictures of the pylorus with consequent 
dilatation, and also in ulcer of the stomach, both when hemor= 
rhage has occurred and when liquids are badly borne. In that 
form of nervous dyspepsia known as irritable stomach, which is 





288 SPEOIAL METHODS OF FEEDING. 


accompanied by severe vomiting, nutrient enemata may be given 
to supply nourishment to the body when the stomach can not 
retain food. 

4. In delirious, comatose, or insane persons who can not be 
fed through the mouth. 


RECIPES FOR NUTRIENT ENEMATA. 


Dujardin-Beaumetz’s Nutrient Enema.— 
A cupful of milk. 
Two or three tablespoonfuls of liquid or two or three 
teaspoonfuls of Mes peptone. 
1 yolk of egg. 
5 drops of laudanum. 
7 grains of sodium bicarbonate if the peptone is acid, 


Von Leube’s Milk-peptone Enema.— 


250 ce. (80z.) milk. . . . . 170 calories. 
60 grams (2 oz.) peptone . . . 100 
270 calories. 


In place of the peptone a 30 to 50 per cent, solution 
of soluble Tata may be used. 


Egg-and-milk Enema,— 
250 ec. (8 oz.) milk. . . . . 170 calories. 
Beggs... = as BOOT 
3 grams of salt. palit 
370 calories. 


Starch-and-milk Enema.— 
60-70 grams (about 2oz.) starch 250 calories, 


250 cc, (Soz.)milk. . . Be (Ra 
420 calories, 
Sugar-and-milk Enema.— 
60 grams (2 oz.) esenie : 246 calories. 
250 cc, (Soz.) milk. . . . .170 « 
416 calories, 


Pancreas Enema.— 
50-100 grams (13-8 oz) pan- | 
cetde: Wench = th 300 calories. 
150-200 grams (5-8 oz.) meat: « 350 « 
30—45 grams (1—1} 02.) fat. \ es 
650 calories, 


RECTAL FEEDING, 289 


Singer’s Enema.— 
125 grams i oz.) milk. 
125 grams (4 oz.) wine. 
1 or 2 yolks of eggs. 
Salt. 


1 teaspoonful of Witte’s 
“(pele kad posclendiae. dala dental is 
2. 


's Enema,— 
250 Pe (8 02.) milk. 
2 or 3 eggs. 
Salt. 
1 or 2 teaspoonfuls of red wine. 
Riegel does not use peptone, as he fears that it might irritate 
the rectum and cause diarrhea, 


Ewald’s Nutrient Enema.— 
2 or 3 eggs. 
1 tablespoonful of water. 

A small amount of flour is boiled in half a cup of 20 
per cent. solution of dextrose and a weg of red wine 
added, The egg solution is stirred in, care being taken not to 
have the solution too hot lest the albumin be coagulated, Entire 
amount, 250 cc. (8 o7,). 


A aecnent Army and Hospital Formula. 


150-250 oc, (5-8 oz) 15 to 20 per cent. solution 
of dextrose. 
Add uw little starch solution or mucilage to make it more 
viseid and a few drops of tincture of opium. 


Boas’ Formula.— 
250 c.c, (8 02.) milk, 
2 yolks of eges. 
A small quantity of salt. 
1 tablespoonful of red wine. 
1 tablespoonful of “ Kraftmehl ” (Health Flour). 


Jaccoud’s Recipe.— 
250 c.c. bouillon. 
120 c.c. wine. 
2 yolks of eggs. 
4-20 grams (1-5 drams) dry peptone. 
19 


290 SPECIAL METHODS OF FEEDING. 


Rosenheim’s Enema,— 
1 or 2 teaspoonfils of peptone or a well-stirred raw egg. 
15 grams (4 drams) of dextrose if carbohydrates are 
thought desirable. 


Zuntz’s Recipe for Administration of Fat,— 
Cod-liver oil. 
Soda solution. 
200-250 c.c. (6-8 oz.) water. 


OTHER METHODS OF NOURISHING THE BODY. 


Food suppositories have been suggested, but their use is 
open to many objections, the chief one, they may not be absorbed. 

Nutrient inunctions, especially with oils, have been sug- 
gested, and in conditions of great emaciation they may prove 
useful, The body is rubbed with oil, such as olive oil, cod- 
liver oil, or cocoanut oil, or with cocoa-butter. This keeps the 
skin soft, the massage also proving helpful. It is of particular 
value in marantic infants, and has been used as a routine practice 
by the authors in all such cases, with very gratifying results. 

Intravascular feeding has been tried. According to 
Thompson, Hodder, as early as 1850, used intravascular injec- 
tions of milk for the collapse of Asiatic cholera, Others have 
used milk and peptone solutions. Normal salt solution would, 
however, seem to be a safer and a more practical method of 
petting fluid into the body, Intravascular feeding will always 

attended with too many difficulties and dangers to be of value 
to the practitioner. 

Subcutaneous feeding is a subject of considerable in- 
terest, and was used as early ac 1869 by Menzel and Perko, 
Karst, Kriig, Witthaker, and others have also employed this 
method. One of the most important contributions to the sub- 
ject has been made by von Leube. This observer could obtain 
no good results from the use of either proteins or of carbo- 
hydrates. He is of the opinion, however, that injections of oil 
are of practical value in nourishing patients under such con- 
ditions us render it necessury, us in the failure of rectal enemata 
because of the presence of hemorrhoids or irritation of the rec- 
tum. His attention was directed to the fact that large quan- 
tities of oil were used in giving camphor injections, which are 
more widely used in Germany than in America. Fat emboli 
result so rarely as to be practically no objection to the method. 
‘Von Leube uses the purest olive or sesame oil, and a 10 ac 


OTHER METHODS OF NOURISHING THE BODY. 291 
made after he onlay BT ROORS RE ea 
ic Plane aisie and stool pape died yh: 


sealed with collodion. The oil should be in} very slowly, 
ibserved. 








and, of course, the strictest asepsis must be ol 
Saline Irrigations and Infusions.—1. Saline Rectal 
Irrigations.—Rectal saline injections are jally useful in 


all conditions associated with orrhage ; in the various 

infectious diseases, as well as in intoxications and in those con- 

ditions in which it is necessury to allay thirst. 

ao aaa ered ee be a or salt solution, and should 
iven high, with tho rectal tube ; if it is necessary to 

che SEs quickly, a teaspoonful of salt may he aided to 

a pint of water, and rapidly injected by means of an ordinary 

fountain syringe. The fluid should be at about the tem 

of the body, and should be administered slowly, while the 

patient is in a reclining position, As much as } quart toa 

quart of the fluid can be utilized at one time, 

A useful method of administering salt solution is the plan 
followed in many surgical clinics. When deemed advisable, 
either on account of loss of blood, to avoid thirst, or so to fill 
np the system that further lymphatic absorption is impossible 
(as after operations about the thyroid), the solution may be ad- 
ministered continuously. To do this use either normal salt solu- 
tion or a slightly stronger solution in an ordinary douche bag. 
The bag is placed from 4 to 6 inches above the rectum of the 
patient. The nozzle is then placed in the rectum and allowed 
to stay there. ‘The fluid flows into the rectum as it is absorbed 
but not in sufficient quantity to cause it to be expelled. 

2. Saline Infusions—Saline infusions are given subcu- 
tancously, and are especially useful in cases in which rectal 
saline irrigations can not be utilized, as in certain intestinal dis- 
eases or when an immediate effect is required, as in sudden col- 
lapse from hemorrbaye or from shock. They are also useful in 
cases when large quantities of fluids have been lost by the body, as 
in the diarrheas of dysentery and of cholera, in various infectious 
conditions and intoxications, as in pneumonia, erysi and 

hoid fever; and in the uremia of chronic Bright’s disease. 
‘The most convenient location for administering the infusion is 
between the chest-wall and the mammary gland, or deeply into 
some muscle, as in the Jambar region, abdominal wall, or but- 
tock. The injection shonld be given under the most aseptic 








292 SPECIAL METHODS OF FEEDING, 


Sodium chlorid . 
Calcium chlorid . 
Potassium ehlorid 
Distilled water 





Combs has a fatal case of sodium chlorid poisoni: 
By mistake 1 paaeg set) salt solution was caged Ree 
dermically. When seen four hours later she was comatose. 
After about six hours of coma, a period of excitation followed, 
she was maniacal, and talked incoherently. This condition 
sisted for twenty-four hours, when she died—124.4 gm. (1920 
gr.) of sodium chlorid had been used. 


‘Cohen's Physiologic Therapeutics, vol. ix., p. 289. 





DIET IN DISEASE. 


General Rules for aoetiop the Sick.—The nurse and 
family should be fully imp with the importance of the 
proper feeding of the patient. Definite directions as to how 
much food, its form, its preparation, and how often it is to be 
given, should be written out. Tn all acute serious conditions, as 
in pneumonia or in typhoid fever, a record of these details 
should be kept, together with the record of the quantity of 
fluid taken, the medicines given, ete. 

‘There is usually a tendency to err in either extreme—that of 

‘iving either too much or too little food. Care should be taken 

t the patient’s wishes are, wherever practicable, carried into 
effect. The nurse and apt should be questioned carefully as 
to the patient’s likes and dislikes, and also as to his idi 
sies, A tactful, observing nurse is of inestimable value, but a 
careless or stupid one is an ever-present source of danger. 

The training of nurses in regard to feeding is often faulty, 
Every nurse should be instructed in the subjeot of peectical 
dietetics, and should know how much food is required by the 
different types of patients. The details of feeding patients 
should always be gone into. 

The food should be given at regular intervals. In uncon- 
scious or semiconscious patients this is of great importance, but 
it is just as important in the conscious, as the appetite usually 
comes on at certain times, and if the meal is not forthcoming, 
may disappear. 

The appetite of the conscious patient and of the convalescent 
should be fostered, and nothing done that may in any way dis- 
turb it. Patients vary much in this particular, but as a rule 
individuals who are not overfastidious when they are well, 
become so when weakened by disease, 

‘The sick-room should be orderly, and no dishes, utensils, or 
food be allowed to stand about the room either before or after 
using. All food and drink should be offered from scrupulously 
clean glasses or dishes. These should be as dainty as possible, 
and the food must be made attractive in appearance ; when the 
dish permits, it may be garnished with a sprig of green. The 

293 





204 DILT IN DISEASE. 


napkins and linen should be spotless. The exterior surface of 
penne a ecpe abou be wiped diy before hey, are oiera 
it. 


patien' 

Food that is stale or that has acquired an unpleasant taste 
from standing in a refrigerator together with other things should 
not be given. A strong egg in an may be the means of 
turning a patient forever against this form of nourishment. 
The food should be tasted by the nurse, but never, when possi- 
ble, in the patient’s presence or with the same spoon. If there 
is anything wrong with a dish, this should be discovered and 
remedied before it is brought to the patient. 

A nurse should always remember the eternal fitness of thi 
Utensils and dishes should be used only for the purpose 
which they are intended, and not as makeshifts for other articles. 
After caring for the patient or removing evacuations sufficient 
time shoul be allowed to elapse before feeding is begun. The 
patient should be made to feel that the utmost cleanliness and 
eare have been observed, The hands and face of the patient 
should be wiped with a moist cloth and then dried before food 
is given, and the lips cleansed after the meal is complete. 

‘The position of the patient should be as comfortable a one as 
possible, and one in which he will not tire before the meal is 
ended. If the patient is weak, the food should be given in 
such form that he may take enough of it without induei 
fatigue ; otherwise he may become tired of masticating anc 
swallowing and take an insufficient amount. Patients who can 
sit up in bed should be provided with a bed-tray on which to 
place the food. The legs should be placed high enough for the 
patient to eat comfortably from it. 

If the patient is helpless, care should be exercised in giving 
food so that it will not be drawn into the lungs during inspira~ 
tion or coughing. This may be avoided by giving the food 
slowly, and by seeing that each mouthful is swallowed before 
another is given. These patients may be fed in various ways. 
The food may be given from a spoon, or, what is usually pre- 
forred, from a drinking-eup with a spout, or by using a bent 
tube and allowing the patient to take the food from a glass. 
When the patient is taking bread and similar solids, great care 
should be exercised not to allow the crumbs to fall into the bed. 

In most severe illnesses it is necessary to awaken the patient 
during the night to administer food. This is a point that 
requires gedit judgment. Often the patient is more in need 
of sleep than of food. If the patient does not drop off to 


= 


FEEDING UNCONSCIOUS AND REFRACTORY PATIENTS. 295 


sleep very soon after taking food, it may be better to wait until 
he awakens before giving it. As a rule, however, in severer ill- 


ness the is disturbed for but a few minutes food. 
A cup Sede milk or similar light food ay ae at 


‘The patient’s mouth should always be kept clean. If 

and it should be rinsed before and after takin, 

As le mouth-wash is given under the heading of Tul 

losis & 327), but any of the alkaline mouth-washes may be 

used ; boric acid and water also make an efficient wash. If the 

mouth is dry, it should be moistened from time to time, and for 

this purpose a little glycerin, water, and lemon-juice will be 
useful. If the patient is helpless, the mouth may be 

swabbed out with cotton fastened to the end of a stout probe or 

wound about the finger. This should be moistened with some 

antiseptic solution. 

Tn all cases where the illness is likely to be protracted, 
arrangements should be made to care for and pr the food 
with as little discomfort to the household as possible, For this 
purpose a diet kitchen may be improvised, preferably in a room 
adjoining the patient’s, If the patient’s means allow, a small 
sick-room itor should be provided, and a tin receptacle 
for storing foods that do not need to be kept on ice, A gas or 
alcohol lamp will serve for heating food. A thermometer, a 
graduate, a funnel, and filter-papers are needed, and a meat- 
mineing machine will be found a useful addition. Saucepans, a 
dish-pan, and a supply of tea towels should also be provided. 
Borie acid or borax and sodium bicarbonate will help to keep 
things fresh and clean. In cases of infectious and communi- 
cable diseases a covered boiler for disinfecting all dishes and 
utensils should be added. The dishes should be boiled in water 
to which 2 or 3 per cent. of sodium bicarbonate has been added, 
and the boiling should be allowed to continue for fully twenty 
minutes after the water has begun to boil. Where instructions 
are likely to be carelessly followed out, it is best to direct that 
the dishes be boiled for an honr. 

Feeding Unconscious and Refractory Patients.— 
Unconscious patients may often easily be fed by means of a 
teaspoon. Each spoonful should be swallowed before a second 
is given. W. Gilman Thompson advises that, in the case of 
comatose children, the nourishment be poured into the nostril 
instead of into the mouth, The fluid thus given is swallowed, 
and any excess returned by the other nostril. If any difficulty 





es 


is experienced in swallowing, it is best to resort to either the 
stomach or the nasal tube. With a little practice most patients 
ean be fed with the tube more easily than in am pape 
A mouth-gag should be introduced or a roller ba: may be 
placed between the teeth and held in place by an assistant. In 


finger answers the purpose perfectly, The tube, previously 


ip 
stomach. If the tube is not passed rapidly through the pharynx, 
contraction may follow and the tube be prevented from enter- 
ing the esophagus. In order to pass the tube into the 
agus it is necessary to hold it sufficiently well back from the end. 

Tf nasal feeding is to be used, a nasal tube, or in case of 
infants a catheter, is well oiled and gently passed through the 
nose into the esophagus and then into the stomach, Care 
should be taken not to pass the tube into the larynx. This 
accident can always be avoided by waiting a moment before 
pouring in the food, Either stomach or nasal tube should be 

rovided with a funnel, and as soon as the tube has been satis- 
factorily introduced, the nourishment—milk, milk and egg, or 
whatever liquid food is desired—may be poured slowly into it. 

Tn order to prevent air from entering in advance of the food 
a small quantity of the food may be poured down the side of 
the funnel until the tube is full. In many cases it may be 
desirable to wash out the stomach before introducing the food. 
The tube should be withdrawn rapidly, so as not to excite 
vomiting. Food so introduced may be retained when it would 
otherwise be vomited. This is true both of infants and adults, 
(See the sections on Gavage, Forced Feeding in Tuberculosis, 
and Lavage.) 

In the case of refractory pationte—the insane, the hysteric, 
and others who refuse to eat—forced feeding becomes neces 
sary. In this case enough attendants should be present to con- 
trol the patient. He should be held firmly and the nasal or 
the stomach-tube be introduced. In order to prevent regungi- 
tation of the food, which some patients manage to do quite 
skilfully while it is being introduced, the ribs may be tickled. 
This prevents fixation of the diaphragm, without which the 
food can not be ejected. This should be done only when occa- 
sion demands, (Sce Dict for the Insane.) 


296 DIET IN DISEASE, 





— 


PEEDING IN FEVER. 


8 


FEEDING IN FEVER. 


Before directing attention to the diet in special forms of 
pyrexia it will be well to consider briefly the general dietetic 
pelnes involved and their application to rey class of dis- 

views con- 


There existed, in former years, many different views 
cerning the correct method of feeding fever cases. Prior to 
the ite of Graves (1848) it was the general practice to 
“starve” fevers, Graves taught that a fever patient required 
food and should be fed, and in his lectures, published in 1848, 
there appeared the Fairer, — rir you should be 
in doubt as to an opitay placed upon my grave, take 
this ‘He fod fevers.” With th the teaching of Murchison and 
others this view gradually replaced the older one, and to-day the 

fession are in accord regarding the diet indicated in febrile 
noes Minor differences in opinion exist and various theo- 
ries have been promulgated, but the practical application is the 
same in all cases, 

Tn fever the metabolic processes are increased, while at the 
sume time the power of assimilation is lowered. This results 
in the burning-up of the body proteins as well as of the fate. 
Indeed, it is stated that the proteins suffer a greater loa 
portionately than the fats. The appetite is diminished. or 
entirely lost, en a a pais lenne acsivtiy i all the 
glands concern in digestion, and, as previously noted, absorp- 
tion and the assimilation of food are a below the normal. 
Thirst also is much augmented. 

Foods appropriate for healthy individuals are not, as a 
rule, snited for fever patients, and solid foods usually cause 
vomiting or severe indigestion. In order properly to nourish 
a fever patient it is necessary that the food be easy to take, 
easy to digest, and easy to assimilate. Any food that does not 

these three qualities is not suitable for a fever patient. 
en the disease runs its course mpidly, the diet is of no great 
importance, for even if the patient take but little food, the 
of comparative fasting is a brief one eat Lay loss is 

easily made up while recovery is in a pe 
diseases, on the other hand, such as typhoid fever, rere in chrovie 
fevers, the diet is of primary importance and should be the 
physician's first care. In chronic diseases and in those fevers 
where remissions occur, the periods when digestion is compara- 


i 





298 DIET IN DISEASE. 


tively should be taken advantage of, and the patient nour- 
ished and ST wceiene as much pape 

In fevers the mouth requires especial care (sec Typhoid Fever 
and Tuberculosis) ; the bowels likewise should be regulated, and 
constipation avoided. 

Suitable beverages should be given to allay thirst, and if 
eee aa is not getting sufficient liquid with his food, he 

offered water or some other drink every three or four 
hours. ‘This should be done whether or not the patient is con- 
Pasay fora Sees seemingly conscious is often in an apathetic 
water is required not only to quench thirst, 
ire to aid in the elimination of waste-products, which, owing 
to the increased metabolism, are augmented, The most suit- 
able of all drinks is plain water. When this does not agree, 
or to meet special indications, mineral waters are often of 
use, The natural waters, since they do not contain such 
amounts of carbon dioxid, are best. If the artificial waters are 
used,—and this is generally the case,—they should be allowed 
partially to effervesce before being given to the patient, lest the 
gas in the stomach cause unpleasant symptoms. The “ Impe- 
rial Drink” (see Appendix) is very useful, and is generally taken 
with a relish. To this may be added the white of an egg, 
beaten up and strained, if the pationt is not taking much food, 
Both lemonade and orangeade are useful, and the former is 
ticularly valuable. Since the hydrochloric acid of the stomach 
is deficient during fevers, water acidulated with hydrochloric 
or peptone acid is of service, as it increases the powers of 
Barley-water, coatmeal-water, toast-water, and albu- 
sabsowater are all of service, containing, as they do, nourish- 
ment with drink. Albumin-water is made by beating up the 
white of a fresh egg, straining it through a cloth, and then 
adding six or eight ounces of water, This may be flavored 
with lemon, orange, sherry, or cognac. Wine whey is also of 
value, and under certain circumstances, as in affections of the 
bladder, flaxseed tea or gum-water may be given. Rarely, beer 
or some other beverage is permissible. Patients previously ac~ 
customed to taking large quantities of beer daily may refuse all 
forms of nourishment, un! let certain amount of this bever- 
age is allowed, 

‘The food for fever cases should always be liquid. Milk, as 
it contains various food elements in a suitable cotibination, 
is the best of this class of foods, and if properly administered 
agrees with most patients and is easily digested. It should, 
as a rule, be diluted, and a small quantity of lime-water or 


FEEDING IN FEVER. 299 


sodium bicarhonate should be added to it. Lime-water may be 


ltzer water, or cvcx Ordo OT 
= used, and may be flavored if the patient prefers. Barley~ 


agree, the ml shold be peptone. tle soni et however, 
be peptonized bad cee gectearhes rob emt 
tonization. Satie kumiss, or whey may also be used. 
termilk, however, contains but little pdesr ese kumiss = 
not be relished at first, but many ose soon Jearn to like it. 
Lastly infants’ and invalids’ food may iven. Fics aie 
may be enjoyed by the patient, and is heel Sp 

which there is oes 

Eggs may be given raw or in the form of albumin-water, and 
an excellent mode of administration, especially if the patient 
requires a stimulant at the same time, is to give the time-honored 
Stokes’ brandy-and-egg mixture. Given in this form, the 
generally agrees. It may be well to make up the mixture wii 
one-quarter or one-half the amount of brandy. 

Meat-juices and broths, for which recipes will be given further 
on, may be used. The meat-extracts are best given well diluted. 
The variety of broth should be changed day, using beef, 
veal, mutton, and chicken in turn, to avoid monotony in the 
diet, The various predigested beef preparations and beef-juices 
sold in the shops may be used at times, and are often of great 
value, especially when the patient can not retain other forms of 
food. Strained vegetable broths are useful occasionally in long- 
continued fevers, and gelatin preparations, such as calves’-foot 
jelly, wine-jelly, or fruit-jelly made with gelatin, ate oa be 
employed. Fruit-juices, especially lemon, orange, 
juices, are _generally relished. These should be aah and 
are best given cold or with cracked ice. Solutions of grape- 
sugar alone or drink sweetened with grape-sugar are to be rec- 
ommended. Granulated extract of malt dissolved in water or 
mill is relished by some patients. 

Alcohol.—The question as to the value of alcohol in fevers 
is one that has been widely discussed. The safest view, prob- 
ably, is that which takes the middle ground, for while alcohol 
may have been, and still is, greatly abused in sickness, on 

can be no doubt that it renders great service, es; 
a a food and a stimulant in fevers, Since aleohol is not nea 











300 DIET IN DISEASE. 
in all cages, the growing is to restrict its mse to those 
cases in which it is definitely in |. It should not be em- 





ployed as a routine measure in any disease, nor should it be 


heat or that equivalent of energy to the body. It should not be 
given too early in the disease lest its stimulating effect be lost 
as the system becomes accustomed to it. On the other hand, 
stimulation, either by alcohol or any other stimulant, should not 
be delayed too long. As soon as the pulse becomes compressible 
and weak the stimulant should be inistered. When one is 
sufficiently expert in auscultation, the need for alechol can be 
Jearned from the heart-beat. When the first sound becomes 
weak or loses its sharpness, it is a sign that the heart is begin~ 
ning to flag. Sir Dyce Duekworth describes this as follows : 
he cardiac indications for the use of aleohol in fever are a 
notable loss of tone in the first sound, especially if this be in- 

iable at the base (Stokes’ sign), and the associated condi- 
tion of the pulse—that of low arterial pressure and the phase 
of it known as dicrotism.”” 

Tn hyperpyrexia aleobol is of great value, for when the tem- 
perature runs very high digestion and assimilation are apt to 
come almost to a standstill. In these cases aleohol is easily ab- 
sorbed and acts as a stimulant and asa food. In continued hyper~ 
pyrexia large amounts can be given, and it seems to be entirely 
used up in the body without producing any mental symptoms, 

In the so-called asthenic fevers alcohol in small amounts and = 
at quite frequent intervals is useful. In the very feeble and in 
the aged it may generally be taken with great benefit. 

In prolonged fevers in children attended with difficulty in 
feeding alcohol is also of value. In these cases the heart indi- 
cations are usually well marked and are reliable guides to the 
dosage. In giving alcohol to children it should be well diluted, 
and small freqnent rather than large doses at longer intervals, 
should be administered. Large doses are rarely needed. 

In those habituated to the daily use of aleohol it must be 
given in some form when these persons become ill with fever or, 








FEEDING IN INFECTIOUS DISEASES. 301 


indeed, when confined to bed from any cause. When alcohol 
is withdrawn suddenly from those accustomed to large daily 
amounts nutrition rapidly fails and delirium not infrequently 
sets in, 

It should be remembered that many conditions in which 
aleohol was thought to be indispensable a few years ago are 
treated just as satisfactorily now without it. 

The form in which alcohol is to be given fever patients 
depends on individual taste. As a rule, pure whisky or brandy 
diluted with plain or with a mineral water is ble. If 
there is a decided preference for wines, a pure old wine, either 
light or red, may be prescribed. 

The quantity to be given depends upon circumstances, and 
the age, condition, habits, and tolerance of the patient all play 
an important part in deciding this question, In infants and 
young children fram } ounce to 2 ounces of whisky divided 
over twenty-four hours may be regarded as a reasonable limit, 
Tn older children from 1 to 4 ounces in twenty-four hours, and 
in adults from 4 to 8 ounces in the same of time, form 
a good average. In the case of habitués and also when other 
circumstances, too numerous to mention here, warrant, these 
amounts may be increased. 


FEEDING IN INFECTIOUS DISEASES. 


TYPHOID FEVER. 


The management of the diet is one of the most important 
factors in the treatment of typhoid fever, and the student and 
the ‘itioner should, therefore, seek to leara most thor- 
oughly how to feed a typhoid patient. Fortunately, the leading 
authorities are in accord as to the principles governing the diet 
in this disease, and the many special dict-lists that appear from 
time to time in the medical journals are best. entirely disre~ 
Pot The problem before the physician is the feeding of a 
fever patient who is likely to be ill for some weeks, who has 
a diseased condition of the bowels, and whose convalescence is 
apt to be slow and to require careful attention. It should be 
borne in mind that, owing to the presence of the fever, there is 
an actual diminution in the digestive and absorptive powers. 
The digestive juices are less active, and the amount of hydro- 
ebloric acid in the stomach is diminished. The liver is more 
or less disturbed, and the bile is less active than normally. 








302 DIET IN DISEASE, 


Poristaleis is lessened and absorption defective. In addition 
nileerations occur in the intestine and are liable to go on to per- 
Evol It should always be borne in mind a mild case 


amount of easily digested an 
disturbances of digestion should be watched for and, so far ag 
ible, corrected. 


While the starvation treatment” of former days has, owing 
to the labors of Graves and Murchison, become obsolete, care 
taust be taken not to err on the other side—the patient must 
not be overloaded with food. 

Food and drink should be given at regular intervals both by 
night and by day; the appetite of the patient should not be 
consulted, for these patients are often apathetic or have no 
desire for food. The food should be given at intervals of from 
two to four hours, according to the condition of the patient and 
the quantity taken at a time. Those who are strong and in 
comparatively good condition may take their nourishment at 
four-hour intervals during the night, even if it is given at more 
frequent intervals during the day. 

The question of drink is also of great importance in 
these cases, for in some patients severe thirst is a very dis- 
agreeable symptom to combat. Pure water, given with or 
without ice, is to be depended upon, but if there are no contra- 
indications, this may be varied in many ways. The natural 
spring waters, or, if these can not be obtained, the artificial 
ones, are often useful. The artificial waters contain large quan- 
tities of carbon dioxid, and to avoid trouble they should always 
be allowed partially to effervesce before they are given to the 

tient. there is no marked bowel disturbance, fruit-juice may 

added to the water. Lemonnde, orangeade, raspberry juice, or 
raspberry vinegar and water are often welcome changes. Weak 
tea, especially if a little red wine is added to it, is an admirable 
thirst-quencher, Cold weak coffee is relished by some. Red 











FEEDING IN INFECTIOUS DISEASES, 


303 
wine and water, white wines, or even sherry or brandy and 
water may be given to emer eee 
causes unpleasant symptoms. When there are ii ity of 

tea are to 
Eeeeere Albumin-water, since it combines food and 
oT Aap pals eee Gober lemon- or 

lice, or may n up with a lit or 

and fa (The eggs, which should always rapes Be 
should be beaten and then strained through a cloth.) The 
various mucilaginous drinks may be used, but are not generally 
relished. See Se ea EN core Fa) bapa i 
barley-water, ontmeal-water, similar beverages have thei 

place in the physician’s list of possibilities. 

Cushing and Clarke recommend the administration of large 
quantities of water in typhoid. They administer a gallon or 
more in twenty-four hours, giving it in small and definite quan- 
tities, Copious elimination of urine follows, corresponding to 
the amount of water ingested. They claim that the patient is 
made more comfortable, is less toxic, and that the nervous symp- 
toms are less than when the large amount of water is not given. 

The food par excellence in this disease is milk. There is no 
one food that meets so many indications. It possesses great 
nutritive value, is easily procured, as a rule, and is generally 
easily administered. It must be borne in mind, however, that 
there are some patients with whom milk disagrees, and many 
who do not like it. Milk, however, disagrees loss commonly 
than is generally imagined, The amount to be given daily 
varies between 1 and 3 quarts, according to the patient. 
There are not many patients who can take 3 quarts of plain 
milk, and it is generally a good plan to vary its form of ad- 
ministration, and occasionally to substitute for it other articles, 
which will be mentioned further on, so that the patient may 
continue to take milk during the entire course of the disease, 
Tf milk is given plain, it is only a question of time when it 
will disagree with any patient. Children are more apt to take 
it over long periods of time than are adults, At the Garrett 
Hospital for Children in Baltimore the authors seldom use any= 
thing besides milk for typhoid cases, and do not find it neces- 
sary to make changes in it. For older children or adults it 
should always be modified. When milk forms the diet, the 
mouth requires particular care, as the little mill that remains 
in the mouth often turns the patient against the next feeding. 

There are many ways of modifying milk and ‘ing it 
more agreeable and more digestible to the patient, The si 


304 DIET IN DISEASE. 


method is to add from 1 to 3 ounces of lime-water to each glass 
of milk, or plain water or a mineral water may be used instead. 
If milk is well borne and it is desired to increase the amount 
of nutriment, cream may be added to it. If this causes un- 
pleasant sym it should be discontinued at once. But- 
termilk may be given occasionally, but is far inferior in nutri- 
tive value to plain milk. Kumiss or kefir may be used, and 
while they may not be relished at first, most patients learn to 
enjoy them, A pinch of salt may render milk more palatable 
to some persons, and the addition of a spoonful of brandy may 
be relished by others. The milk may he given cold, be flavored 
with fruit-juices, vanilla, or nutmeg, or it may be given in the 
form of ice-cream. When milk is not well borne, it is a good 
plan to prepare barley-water and add to it an equal quantity of 
milk, boiling them together for a few minutes. Plain boiled 
milk may also be used with benefit. 

Among the disagreeable symptoms to which milk gives rise 
may be mentioned a bad taste in the mouth, which, however, is 
apt to be present in any case; a sense of fulness or pressure in 
the abdomen ; eructation, or even pyrosis. When the milk is 
not well digested, it may cause diarrhea, with colicky pains, 
and the undigested curds will be found in the stools. To 
obviate these symptoms the measures previously suggested may 
be tried (see also Milk Cures). Malted milk may be used, or 
the milk may be mixed with some of the invalid foods, or it 
may be partially or completely peptonized. For the last pur- 
pose the peptogenic milk powder will be found useful, 

When milk is found to disagree, other forms of nutriment 
must be given. If care is taken to supplement its use by other 
foods from the beginning, the milk will be less apt to cause 
disturbance, 

The carbohydrates are valuable foods in typhoid, and may be 
used in many different forms. Of these, the various gruels are 
the most easily digested, and may be given plain or mixed with 
milk or bouillon. Outmeal, thoroughly cooked (three hours’ 
boiling at least) and strained, is best, but may not agree with 
the patient, Barley-water (Robinson’s barley flour is an exeel~ 
lent preparation for making barley-water), arrow-root, ago, 
tapioca, and the prepared foods may all be used. In Germany 
alearonat flour is added to bouillon or soups. 

Of the proteins and allied substances there are a number that 
may be used. Meat is to be forbidden so long as fever occurs. 
Fat must be skimmed from soups, broths, and bouillon, as it is 
apt to disturb the patient’s digestion. Beef-juice, made acoord- 


all 


to any of the mcipes given in the Appendix, may be 
Sivegednnite expressed from very slightly broiled beef or 
skimmed dish gravy may be used. This may be served in a 
glass if the color of the juice is objectionable. Bottle 
may be employed, as may also the various ee beef 
peseeue and meat-juices now on the market. Mosquera 
eat Jelly and Valentine’s Beef-juice are useful but expensive. 
Beef-extracts are more stimulating than nutritious, 

Senator recommends gelatinous substances, such as i 
calves’-foot jelly, bottle bouillon, and the like. The gelatin 
jellies may be flavored with fruit-juices or with wine. 

Eggs should be used sparingly. Egg-water, however, when 
properly supers rarely causes distress, Raw may 
occasionally hae Nether tet Sel keno 
broth. and milk together may cause indigestion, but i 
the =a fans need of a stimulant as well as a food, Stokes’ 
brandy-and-egg mixture, already described, may be used, and 
in moderate quantities rarely disagrees. 

Somatose, eucasin, nutrose, and similar preparations may be 
mixed with bouillon or other foods. 

Alcohol holds an important place as a food as well as a 
stimulant in long-continued fevers. The tendency to-day is to 
prescribe it in smaller quantities than formerly, and many have 
abandoned its use altogether. It is, RK Os a valuable 
ally in fighting typhoid, and should not be discarded, It 
should not be given to children as a routine treatment, but 
even in young patients it is oflen of the greatest service. 
given to adults, it is well to begin with very small doses, and 
to increase these as the patient grows weaker or as the fever 
continues to progress. Too much should not, however, be 
apaae and if the d has been too large at first, it can not 

increased as n later on. In habitués, alcohol will be 
needed from the outset. 

The form of alcohol to be used is largely dependent on the 

tient’s taste. As a rule, good old whisky, ‘ly diluted, 
en Old brandy is oe but bara Fe ronal sold 
is of very inferior quality. The red wines are useful, eel 
when there is diarrhea, and the old white wines are excellent if 
the patient cares for them. The brandy-and-ogg mixture pre- 
viously mentioned is very useful. 

Each case of typhoid should be made an individual study 
and the diet arranged accordingly. A physician who prescribes 
a routine treatment in each case is not doing his duty, The 
amount of food shoyld be increased or decreased and the char- 

2 


FEEDING I¥ INFECTIOUS DISEASES. 305 


y und 
tions can be avoided. If the mouth is in condition, the 
patient can, as a rule, take his food easily ; if it is not, the 


with water may be used; diluted hydrogen peroxid is also 


should swab the mouth. The physician should assure himself 
that the nurse is carrying out his orders in this regard, for 
careless nurses are often apt to neglect this. 

Diet in Digestive Disturbances.—In cases where the 
food is rejected or badly borne it is necessary to give the 
stomach absolute rest for several hours or more, Then very 
small quantities of egg-water, barley-water and lemon-juice, or 
similar preparations, may be given. Panopepton and the liquid 
beef preparations are useful in this condition, and may be served 
with cracked ice or diluted with water. Weak tea or red wine 
and water in small doses are useful, especially if there is diarrhea. 

Diarrhea is often caused by the use of milk in which there 
are large numbers of bacteria. Where dinrrhea persists, the 
milk used should be examined and sterilized or pasteurized mill 
used, The effect of using pasteurized milk in such cases is 
often very striking, as has been shown by Edsall. 

For the diarrhea an ice-bag to the abdomen has been highly 
recommended, but is seldom well borne, Instead, cloths 
moistened with cold water may be used. 

For the painful and troublesome accumulation of gas in the 
intestine either the ice-bag or the cold applications may prove 
beneficial. The anthors have obtained excellent results from 
the use of turpentine stupes, but these have failed in the hands 
of many physicians. When the meteorism is due to the imper= 
fect digestion of starch, the carbohydrates should be reduced 
or withdrawn ; when it is due to milk, the form in which this 
is given should be changed or it should be withdrawn altogether 
for a time, 





eS ‘ 


FEEDING IN INFECTIOUS DISEASES. 307 


Hemorrhage.—When from the bowel occurs, 
the intestinal tract should he given ite rest for a number 
of hours, An ice-bag, cold applications, or a cold-water coil 
should be placed upon the abdomen. To relieve the thirst the 
patient may be allowed to suck small bits of ice, or ice-cold 
aCe aL can snay Fa given x'accsanfal doses, After some 
hours the patient may be given a teaspoonful of cold mi 
and this may be repeated every two or three hours, Beyon 
this, if the ee severe, the anteioal tract be 
given complete rest for twenty-four hours or longer. Opium 
or morphin may also be used, The return to the regular fever 
diet should be made gradually and with caution. 

Perforation.— When perforation occurs, all food should be 
discontinued and surgical treatment instituted, or where this is 
not possible, large doses of morphin or opium may be pre- 
scribed, Following operation the diet will be that of any 
bowel perforation that has been operated upon. If the patient 
rallies without surgical intervention, or when this bas been 
found impracticable, food may be given after an interval of 
twenty-four hours, but only in very small quantities at sufi- 
ciently wide intervals, It is best to begin with teaspoonful 
doses every three hours, and if the food is retained, this may 
gradually be increased. Usually food is rejected, and when 
this is the case, the stomach should be given complete rest, for 
feeding only tends to aggravate the condition. 

Convalescence,—The diet during the first weeks of con- 
valescence requires as much care and attention as it received 
throughout the febrile period ; in fact, since these patients often 
develop a ravenous appetite, born of several ’ milk diet 
and fever, even greater care is necessary. The patient's wishes 
should in nowise govern his diet, and relatives and friends 
should be cautioned against giving the patient anything not 
ordered by the physician. Many a relapse and death has been 
cansed by the misguided kindness of friends and relatives in 
this respect. 

When there has been severe bowel disturbance, the patient 
is to be kept on a liquid diet until the ninth or tenth day of 
the afebrile period. After mild cases, where there has been 
but little bowel distarbance, changes may be made in the diet 
after the fifth or sixth afebrile day. In these mild cases the 

test caution is required, as they are often quite as apt to 
lo badly as are the severe ones, and the attendants are much 
more likely to be careless in carrying out instructions. 

‘The first addition to the dietary should be made by giving a 


308 DIET IN DISEASE, 


piece of zwieback over which hot milk or cream has been 
poured. If desired, milk-toast, milk and crackers, or junket 
may be substituted for this. If this is well borne, other arti- 
cles, such as soft-boiled eggs or the soft part of oysters if they 
are in season and can be obtained fresh, may be added from 
day to day. Thickened meat broths containing well-boiled 
rice or vermicelli may be given. Finely scraped raw 4 
reduced to a pulp in the manner suggested for tuberculosis 
patients, also lends variety. 

Tender meats, vegetables, and bread-stuffs in increasing 
quantities may be allowed. Roast chicken, squab, or partri 
boiled (white) fish, such as trout; of the vegetables, spi 
cauliflower tops, asparagus-tips, purées of , carrots, or 
tender string-beans or artichokes, well-cooked rice, and haked 
potato mashed and served with cream or dish gravy; toast, 
zwieback, crackers, and the crust of bread may all be per- 
mitted, If the condition of the bowel permits, fruit-juices may 
be allowed, as well as a baked apple, apple-sauce, or junket 
flavored with fruit. Other sick-room delicacies may be ordered 
at the discretion of the physician. Chops, tender steak, and roast 
beef may generally be given in the third afebrile week (very 
finely divided meat may be allowed much carlier), and the dict 
gradually changed until the ordinary diet is resumed. For 
some time after an attack of typhoid the patient should be 
instructed to exercise care in the selection of his diet, and 
especially to avoid all food such as green fruit, green corn, 
crabs, and the like, that is likely to cause diarrhea, 

The following menu for the first week of convalescence may 
serve asa guide to the inexperienced physician, and may be 
altered to suit the individual case. It may be begun about the 
fifth or sixth afebrile day in mild cases, and about the ninth 
or tenth in severe cases, Milk should form the bulk of the 
dict. at this period. 

First Day.—Milk-toast or zwieback covered with hot milk 
or cream or crackers and milk, Beef-juice, 

Second Day.—Chicken broth thickened with rice or vermi- 
celli. (The rice should be beiled thoroughly.) Soft parts of 
several oysters, or a very lightly boiled egg. 

Third Day.—Tunket, a meat broth thickened with well~ 
cooked barley (boiled at least three hours), with barley flour, or 
with stale bread-crambs. Winc-jelly. Scraped mw beef. 

Fourth Day.—Lightly boiled or poached egg. Arrow-root, 
barley gruel, or milk-toast. Chicken-jelly. 

Fifth Day.—Tanket, a little well-boiled rice with a small 





FEEDING IN INFECTIOUS DISEASES. 309 
amount of finely divided roast chicken, squab, or partridge, 
ee ae wie mest. Apiiesaisat” howeaie 
baked custard. A piece of toast or zwi 

Seventh Day—aA small piece of finely divided broiled 


ATYPICAL TYPHOID,-COMPLICATED TYPHOID. 

There are two classes of cases in which especial attention to 
the diet is required, These are: (a) atypical typhoid, cases 
where the fever persists for weeks as practically the only symp- 
tom ; and () those cases that have run their course, but where, 
owing to some complication, most frequently the presence of 
pus, the fever remains high, 

‘The first class are often associated with extreme emaciation, 
and the fever may be regarded as a true inanition fever, In 
others the emaciation may not be extreme, but the fever may 
persist, and may not disappear until the patient is allowed to sit 
up. In these cases, after sufficient time has elapsed for healing 
oF the intestinal ulcerations to take place, and if there are no 
other symptoms forbidding it, the diet_may be increased in the 
same way a8 during an onlinary convalescence. If an exacer- 
bation of the symptoms occurs and the fever increases, it is an 
indication that too much food is being given. 

Tn the second class of cases there may be extreme emaciation, 
with the development of abscesses or furuncles. These patients 
may be benefited by an increase in the diet, for some of them 
do not seem to be able to assimilate sufficient nourishment from 
the food-supply to make up for the waste. 

In any case where there is fever the dict should be watched 
carefully and no changes be made unadvisedly, 


TYPHUS FEVER. 

The diet in this disease is the same as in all acute fevers ; 
typhus requires no especial precautions, such as are needed in 
typhoid. During the acute stage of the disease the diet should 
be liquid, milk being best, When this is not well bone ia 
substitntes, such as are used in typhoid, may be given. 
food should be administered at regular and sufficiently frequent 
intervala—cvery two, three, or four hours, according to the 
quantity the patient is able to take at one time. A quart of 
milk and « pint of animal broth may be consi a fair 
amount of food for one day. Water should be given freely, 





310 DIET IN DISEASE. 


Curschmann calls attention to the fact that are better 
borne in typhus than in typhoid, and recommends that several be 
iven every day. He also advises the use of solid food, even 
luring the period of fever, if the patient is able to masticate and 
swallow. He allows rolls, zwieback, chicken, and chopped meat, 
Asa rule, the patients require a supporting and a stimu! 
diet from the outset. Alcohol may be given when the pulse 
the general condition demand its use. Black coflee, e3} 
when there is a tendency to stupor, is also to be recom: 
Complications are treated in the same way as when they 
occur in typhoid. During convalescence the diet should be in- 
creased as rapidly as Soy the usual care being observed 
{see the section on the Dict in Fevers). Alcohol in some form 
is generally necessary at this time. ‘The form in which it is 
to be given may be governed by the patient’s taste, and the 
amount should be carefully regulated by the patient’s condition. 


SMALL-POX, 


‘The diet in small-pox is similar to that recommended in other 
acute fevers, The only point to be noted especially is that the 
supporting diet should be begun early, as in the severe cases the 
extensive eereetion makes a large drain on the patient's system. 

During the first stage of the disease there is little desire for 
food. e diet should be liquid, and consist of milk, broths, 
albumin-water, and the like. Intense thirst is generally pres 
ent, and this may be relieved by water, lemonade, or the car- 
bonated waters. 

When the initial fever subsides and the patient feels improved, 
it is well to allow any light nutritious food he may desire—milk, 
eggs, chops, ateak, or rare roast meat; bread or toast ; and the 
more easily digested vegetables, such as well-cooked potato, 
spinach, celery, asparagus-tips, cauliflower tops, and the like 
are all suitable. 

When the second period of fever comes on, a return to the 
liquid diet may again be made. The diet should be as ample 
as possible, and the food be given at regular intervals every two 
or three hours during the day and every three or four hours at 
night. Milk, plain or peptonized, milk-punch, rw egg 
and sherry, and the various combinations and dishes made of 
eggs and mille should be given. Broths, beef-jaice, and the like 
may also be added (see Recipes in Appendix). When there is 
marked dysphagia, as there 1s apt to be in all severe cases, the 





PEEDING IN INFECTIOUS DISEASES. su 


food is best given cold, at more frequent intervals, and in smaller 
quantities. feeding shige poke to in some cases. 

In cases alcohol is required, and may be given 
from time to time as the condition of the patient demands, 
‘Whisky, brandy, and port wine are,‘as a rule, borne best; the 
whisky or brandy should be given in diluted form, combined 
with a small amount of glycerin or syrup to avoid irritating 
the throat. Stimulants may be added to the milk, or they may 
be given in the form of milk-punch or egg-nog, according to 
the patient’s taste. Alcohol should not be given as a routine 
practice in all cases, as was formerly done. Mild cases and 
even those of moderate severity, in patients under twenty, usu- 
ally require little or no stimulation. 

During the convalescence the diet may be increased rapidly. 
As soon as the fever declines, meat may be added to the dietary, 
and when the appetite and digestion allow, other articles of diet 
may be given. 

SCARLET FEVER. 


Some difference of opinion exists regarding the value of 
diet in preventing nephritis in scarlet fever. A careful stud) 
of these cases, however, has led to the belief that a strict mil 
diet during the height of the disease and a mixed mill and 
farinaceous diet during convalesonce are by far the safest. 
Ziegler, reporting an experience of twenty-one years with 231 
cases kept on an exclusive milk-diet, did not have a single ease 
of nephritis, Previous to that time, on a mixed diet, half his 
cases developed nephritis, Our own experience, whilst much 
smaller, has been otherwise like that of Ziegler. The milk 
should be diluted with lime-water or with a carbonated water; 
if it disagrees, it may be peptonized, either partially or com- 
pony. Kumiss or buttermilk, particularly the former, may 

given as a change. Although they may refuse it at first, 
children often learn to like kumiss. If milk becomes distasteful 
or disagrees, it may be mixed with barley-water or arrow-root 
gruel, or these may be given plain. Oyster or clam broth, the oys- 
ters or clams havin; Pe strained out, makes a pleasant change. 

For the thirst, ‘which is generally great, plain or carbonated 
waters, barley-water, orangeade, or lemonade may be given 
freely, A level teaspoonful of cream of tartar stirred into a 
glass of lemonade is a useful diuretic drink if albuminuria is 

it. 

Plain vanilla ice-cream or a plain lemon ice may be given in 
small quantities. Finely shaved ice, also in very Hai quan- 











312 DIET IN DISEASE, 


tities, and flayored with a little lemon- or orange-juice, often 
makes a most ate! addition if angina is marked. 

Jaccoud an Dagny 5 insist that searlatinal 
generally be avi if a milk diet is adhered to for 
weeks in all cases. It is a good plan to let the diet in all cases 
be as simple as possible for three weeks, and then to make addi~ 
tions to it from day to day. If there is albuminuria or nephri- 
tis, a milk and farinaceous dict, as recommended in nephritis, 
should be adhered to. If there has been a severe albuminuria, 
without casts, or if symptoms of nephritis haye appeared, the 
dict should be liquid for a month or six weeks, the urine being 
carefully ratte in the meantime. Owing to carelessness in 
regard (o the dle, mild cases of scarlatina may be followed by 
severe nephritis, 

Tn all cases the diet should be gradually increased from day 
to day during convalescence ; the following may serve as a 
to the order in which this increase Asie made: Milk~ ro) 
junket, custard, farina puddi lie: rice-pudding, bal 
apple, bread and milk, ae oF pleas erdioge with e with- 
out paenle, corn-starch pudding, boiled custard. 

‘The return to meat is best made by allowing a small quantity of 
boiled or baked fish, the soft parts of oysters, very soft-boiled 
eggs first and then the lightest and most easily digested meats, 
chicken, raw or very rare beef’ in minute quantities, and the like. 

During the height of the disease and throughout convales- 
cence meat-extmets should be avoided, as they contain ine 
quantities of meat extractives, which are liable to irritate 
Kidneys, 

Rest in bed should be insisted upon until the fever has been 
absent at least a week. In mild cases of scarlet fever stimu- 
lants are not required ; but in the severe eases, where there is 
adenitis, marked angina, or sepsis, aleohol may be used as the 
heart and general condition indicate the need for it, (See 
Alcohol in Fevex) Strychnin and digitalis are also useful, 


MEASLES. 

In measles the diet is similar to that of any acute fever. The 
food of infants, if bottle-fed, should be more dilute than usual ; 
for older children an oxclusively liquid diet is indicated. 

Milk, soups, and broths may be allowed, and these may be 
peptonized if necessary. The food should be given at regular 
intervals, these depending on the amount given at each tine— 
generally two, three, or four hours apart. 

‘Thirst may be allayed by water, plain or carbonated, orange- 














FEEDING IN INFECTIOUS DISEASES 313 


ade, lemonade, and the like. The return to a solid diet should 
be made gradually. Alcohol may be used if necessary. When 
intestinal disturbances supervene, they should be treated 

the customary way. (See Feeding in Fever.) 


MUMPs. 


While fever or swelling exists the diet should be liquid. 
During convalescence some solid food may be tuken. me 
be observed to avoid all acids and astringents, as these 

may cause extreme discomfort and even intense pain, 


‘WHOOPING.COUGH. 


In all cases of whooping-congh the diet and the bowels 
ire the closest attention. 
the child has any tendency to the so-called “ mucous dis- 
ease” or to intestinal disturbance, this is almost sure to mani- 
fest itself during the course of the disease, as all the mucous 
membranes are apparently affected. Attacks of indigestion and 
the abdominal distention that usually follows may increase the 
number of paroxysms. There is always a tendency to vomit, 
This usually occurs with or after the paroxysms of coughing, 
but the pharynx may become so irritable that vomiting may 
be excited by the taking of food, drink, or medicine. An: 
drug that tends to produce nausea should carefully be nokia!) 

The diet for children under two years of age should be fluid. 
Milk, diluted with lime-water or a carbonated water, or pep- 
tonized, should be the mainstay. Broths, albumin-water, and 
barley-water ore also useful. In children who are weak or in 
whom vomiting is severe, some of the predigested liquid beef 
preparations, well diluted with water, may be given. These 
are stimulating and contain considerable nutriment, 

Children over two years of age, if the case ia severe, should 
be put on a liquid diet. If food is retained and vomiting is 
not troublesome, semisolid food may be given; if this causes 
no disturbance, easily digested solid food may be allowed. 
Kumiss is sometimes of value, and custards, barley, oatmeal, 
or arrow-root gruels, broths, junket, and the like are useful in 
varying the diet. 

If munch difficulty is experienced in feeding the child, the 
food should be given in small quantities every two or three 
hours. If vomiting persists, the measures recommended in the 
section on Vomiting may be tried. If a meal is vomited, it 





su DIET IN DISEASE. 


may be repeated after a short interval. Children with mucous 
disease should receive the diet recommended for that condition. 

Tn weak children and in protracted cases alcohol may be 
needel. This may be given in the form of liquid beef pepto- 
noids, panopepton, milk-punch, egg-nog, or sherry and albumin~ 
water. In many cases it is desirable to give only the stimu- 
Jants, and in these cases whisky and sweetened water or wine 
may be given, A matured whisky is usually the most 
satisfactory, as the dosage is easier to manage and the effect 
more constant, In very severe cases nutrient enemata may be 


It has been held by some that diet has a specific influence on 
the course of this disease. Hannon claims to have cured cases 
in two weeks by a “tonic diet” that consisted of roast-beef 
with toast and pure Maderia or port wine in the morning ; bis- 
cuit and wine at noon; meat broth, roast meat, toast, and wine 
in the afternoon ; wine in the evening, and cold water at night. 
He allowed no milk, vegetables, soups, or puddings. 


INFLUENZA. 


The diet in this disease should be that recommended in all 
acute febrile conditions. During the height of the disease the 
food should be liquid, and be given in small quantities and at 
regular intervals. As the condition improves a return to a 
semisolid diet and then to solid food may be made. Conva- 
Jescence is apt to be slow and tedious, and during this period 
easily digested nutritious food should be given in as large 
quantities as the patient can digest. Milk and eggs, either 
alone or combined in the form of egg or egg-nog, may be given 
between meals. Alcohol is usually indicated throughout the 
disease, and may be given in the form of whisky and water, 
wine, or malted liquors, according to the condition and taste 
of the patient. If convalescence is slow, a change of air will 
often facilitate recovery and restore the appetite and strength. 


MENINGITIS AND CEREBROSPINAL FEVER. 


Tn these diseases the diet is that of all acute fevers. The 
food may be liquid or semisolid, and should be given at regular 
intervals. If the patient is able to swallow, several ounces 
may be given at a time every two or three hours. If swallow- 
ing is difficult, small quantities of predigested food may be given 
at very short intervals—every half-hour, or if it is given only 
a teaspoonful at a time, as frequently as every fifteen minutes. 
In these cases the food may be given with a teaspoon or a med~ 


FEEDING IN INFECTIOUS DISEASES. 315 


icine-~iropper. In some cases, where it does not excite conyul- 
sions, a stomach~ or nasal tube may be used, 

If the patient is able to swallow, liquids and semisolids are 
indicated. Water may be given freely, and as the patients are 
often unconscious or only semiconseious, water should be given 
asaroutine. This is a matter that is frequently n y 

Alcohol may be used when the pulse and genersl condition 
indicate the need for stimulation. During the acute stage it is 
usually not required, and when given too early may intensify 

symptoms. As the patient’s strength fails it is 
demanded in increasing quantities, 

‘The convalescence is to be managed as after any acute fever, 
and an abundance of food should be allowed, 


DIPHTHERIA. 


The feeding of diphtheria patients is carried out along the 
same lines as those laid down for acute fevers in general. 
Owing to the location of the lesion and the frequency with 
which intubation or tracheotomy is performed, special difficul- 
ties arise, and must be met promptly and intelligently, or the 
patient may succumb rapidly. 

‘The careful management of the diet in diphtheria is of the 
greatest importance. If the patient’s nutrition is not main- 
tained, the body will not be able to withstand the effects of the 
poisons that are introduced into the circulation. 

If the disease occurs in a nursing infant, Koplik advises that 
the milk be drawn from the breast with a breast-pump and fed 
to the child from a bottle or spoon, This is done to ayoid 
infection of the breast, If the mother has been rendered immune, 
the danger of breast infection is very slight. 

Tn all cases, if there is any fever, the food should be liquid, 
and should be given in small quantities at regular intervals, 
The most useful of the liquid foods are milk, plain, with lime- 
water or a carbonated water, or nized albumin-water ; 
some form of predigested beef, as Liquid Beef Peptonoids or 
Panopepton ; soups and gruels and the various prepared foods of 
which malted milk, Eskay’s, or Mellin’s foods are examples. 

Occasionally semisolids are swallowed with greater ease than 
liquids ; in this case any of the foods just mentioned may be 
thickened with well-cooked cereals or gelatin, or custards or 
junket may be given. Ice-cream, if plain, may be allowed in 
small quantities, nog and milk-punch are sometimes use- 
ful, although, a3 a rule, stimulants are best given alone, and not 
combined with the food. 





= 


If the patient can not swallow, nutrient enemata may he 
resorted to ; or, as recommended by Gilman Thompson, a nasal 
ora stomach-tube may be employed. If the latter mode of 
feeding is adopted, care should be taken to avoid struggles with 
patients whose hearts are weak. 

Intubation.—A fier intubation has been done there may or 
fe not be some difficulty in swallowing. Asa rule, when the 

ild swallows for the first time, there may be a slight or 
some hesitation ; in the majority of cases, however, this disap~ 

rs as the apprehension of the child is allayed. There may 

a little difficulty for the first day, but this passes off gradu- 
ally as the muscles become accustomed to work under the new 
conditions. 

Some children find it difficult to close the epiglottis with the 
tube in position, and hence during deglutition some of the food is 
likely to be drawn into the larynx or even into the lungs. This 
may cause dyspnea and violent coughing, or when drawn into 
the lung may give rise to pnenmonia. This accident is not 
very likely to occur if perfectly made tubes are used, and if the 
precaution is taken to press the tube well into place before the 
mouth-gag is removed. 

O'Dwyer believed that food that enters the tube is always 
coughed up and never causes pneumonia, He recommy 
that, if the child is old enough, he be instructed to take the food 
as rapidly as possible and then to cough afterward, instead of 
after each act of deglutition, as he is apt todo. In some chil- 
dren there may be a slight regurgitation through the nose. 
Taken all in all, the difficulty experienced in feeding these cases 
is small compared to the enormous benefit the child derives 
from the operation. 

If there is difficulty in swallowing liquids, solid or semisolid 
food may be given instead. Cuastelberry, of Chicago, suggests 
thet the child be placed with his head lower than his body. In 
this position swallowing becomes eazy. The child may also lie 
across the nurse’s lap with his head thrown well back and down. 
It should always be remembered that food may be refused 
because of nausea, or because the child has no desire to take 
anything, as well as owing to any actual difficulty in swallowing. 

‘The diet should be the same as in non-operative cases, and 
if semisolids or solids are required, soft-boiled or poached 
milk-toast, custards, junket, bread and milk, oatmeal porri 
and similar foods may be given. 

Tf swallowing becomes impossible, an event that occurs very 


816 DIET IN DISEASE. 


FEEDING IN INFECTIOUS DISEASES. 317 


rarely, the child may be fed with the stomach or nasal tube or 
means of nutrient enemata. 

No especial dictetic rules are necessary for feeding trache- 
otomy cases. 

Postdiphtheritic Paralysis.—In paralysis of the mus- 
cles of deglutition which may occur after diphtheria, most of 
the food may return through the nose; or if the muscles of the 
tongue as well as the soft palate are involved, deglutition 
becomes impossible. When this occurs, the child must be fed 
with the stomach- or nasal tube or by the rectum. (See 
Gavage). 

ERYSIPELAS. 

‘The diet in erysipelas is the same as in other acute fevers. 
During the height of the disease a liquid diet, given in smull 
quantities and repeated at short and regular intervals, is recom= 
mended. As the patient improves a gradual return may be 
made to the ordinary diet. 

Aleohol is usefiul, and patients with erysipelas, like those with 
septicemia,’ may take large quantities without producing an 
intoxicating effect. In the severe forms whisky or brandy may 
be given at regular intervals in doses sufficient to maintain the 
heart action. ‘The effect of the stimulation should be watched 
carefully and the amount regulated according to rules previously 
laid down. From sixteen to twenty-four ounces a day may be 
required. 

RHEUMATISM. 

Acute Rheumatism.—The exact relation that diet bears 

to rheumatism has not been proved, and the statement that any 

ial diet may act as a predisposing factor is conjectural, 

proper and insufficient food are responsible only in so far as 
they lower the resistance of the body. 

During the acute attack the management of the diet is simi- 
lar to that of other acute fevers. me diversity of opinion 
exists as to what constitutes the best diet in these cases, 
Cheadle allows animal broths, and says that he has never seen 
any advantage result from cutting them off entirely, Senator 
prescribes a somewhat more liberal diet than is given in other 
acute fevers. 

Daring the acute stage the safest place is to put the patient 
ona milk or on a milk and farinaceons diet. If the patient 
ean not take milk, oyster or clam broth, preferably without the 
oysters or clams, raw oysters, milk-toast, barley or arrow-root 
gruel, buttermilk, kumiss, and, if these are not sufficient, soups 





Zs 


| 


318 DIET IN DISEASE. 
and broths, may be given. It is well, so far as to 
avoid animal broths, aod meatvextrcts dre con 
Thirst is usually a prominent symptom, and for this bland or 


Ces drinks may be given (Sh ate made is 

iy pines lemons have been advocated in ha 
enon Carbonated water or Vichy may be 
de and Sry de mreatbaeatel water, buttermilk, or kumiss 


mnity 

Beal one convalescence is fully established —that is, for a week 
or ten days after the fever has subsided,—the patient should be 
fed only milk and farinaceous food. The return to solid food 
should be gradual. Fish, oysters, and eggs should be added 
first, followed by chicken and later by other meats. Voruatie 
may be added of the same time, the more easily digested, such 
as well-baked potato and well-cooked spinach, cauliflower ‘ops, 
stewed celery, and the like, being chosen first. Sweets are to 
avoided, but fresh fruit may be taken. The patient’s strength 
should he fostered, and if there is anemia, the return to the more 
easily digested animal foods should not be delayed too long. 

The meals should a be of sufficient size to tax the patient’s 
digestion, and may be supplemented by two or three extra 
glasses of milk a day, with opie of toast or a biscuit, 
or by an egg-nog or a cup of vegetable broth. 

Alcohol is contraindicated in the acute stage of the disease, 
but may be prescribed for very weak patients and where cardixe 
complications indicate its use. During convalescence, if there 
is continued weakness, it may be employed. 

¢ Rhenmatism.—Where the disease is chronic, 

the diet should be as nourishing as possible. As a rule, sweets 

and meat are best avoided. Fish, eggs, oysters, and the lighter 

meats, all farinaceous foods, and the more digestible bles, 

icularly the green ones, may be allowed. When the patient 

is very weak and anemic, alcohol may be given if desired; in 

other cases, where the tonic or stimulant effect is not especially 

indicated, it is to be avoided. Care should be taken not to 

mistake this condition for gout or for arthritis deformans, as is 
so frequently done. 


ASIATIC CHOLERA. 


Infection with the cholera spirillum takes place through the 
mouth, and is usually caused by drinking contaminated water. 
Infection may also be conveyed by milk and by raw vey 
by touching a contaminated object, and by similar 


FEEDING IN INFECTIOUS DISEASES, 319 


‘The disease may be carried by flies, and thus milk and other 
ee brome intboteds 

ring a cholera the ii lactic meas 
ures are to be carried ee ree ones will 
be mentioned here; for a detailed study of this sul the 
reader is eli een ce Eee wy re Bano oa 
Fatigue, men worry, anything that lowers the me 
or tone should pacer 


All food should be cooked and all beverages boiled, with the 
exception of those bottled and known to be absolutely free from 
‘any possible contamination with the cholera spirillum. Coffee 
and other similar beverages should be made from boiled water. 
Ice should be made from distilled water, or when this is not 
pea le should not be used in any article of food or drink. 

ly boiled water should be ased for cleansing the teeth. 

All raw vegetables and all food, such as fish or shell-fish, 
that may be partly decomposed, should be avoided. Cure 
should be taken to secure milk. 

Any article of food liable to produce indigestion or diarrhea 

not be eaten. 

Since the micro-organism causing cholera will not thrive in 
an acid medium, acid drinks are a useful preventive measure 
against infection. Lemonade made with aromatic sulphuric 
acid or dilute sulphuric acid has been widely recommended. 
‘Ten or fifteen drops of the acid should be added toa glass of 
water. hoephoele acid and lime-juice, as well as vinegar and 
pak are also used. Care should be taken not to disturb the 

ligeetion by taking too much acid, and it shonld be taken 
through a tube, to protect the teeth. 

The disease is usually divided into four stages ; this division 
is, however, arbitrary. These stages are: a premonitory diar- 
rhea, a severe diarrhea, a stage of collapse, and a reactionary 
stage. The mildest cases pass through only the first and the 
second stage. The diet for each stage will be indicated further 
on. In addition to the diet, certain general indications for 
treatment may be mentioned, Kenneth MacLeod has sum- 
marized these somewhat as follows: 

The patient should be put to bed and kept absolutely quict. 
The pein diarrhea should be checked as soon as possible. 
As circulation fails stimulants should be given. If the 





320 DIET IN DISEASE. 


temperature is excessive, it should be reduced ; if the bodily 
beat is lowered, it should be raised, 

Any persistent diarrhea should be checked; any 
smite should be relieved if possible. Thirst should be fe 
layed, and = and distress alleviated so far as possible. 

During the stage of diarrhea little or no food should be Kay 
Acid drinks, and sulphurie acid especially, may be administered. 

Tf food is taken, it should be given in very small quanti 

in the form of albumin-water, beef-juice or pi dae hat 
solutions, barley- or catmeal-water, or whey. Milk is best 
avoided, for if it is not digested or absorbed, it forms a most 
excellent culture-medium for the development of the cholera 
spirillum, If it is given, it should first be peptonized. Tea 
in small quantities may be allowed if desired, or a little red 
wine (claret) may be administered. 

Tn the second stage continuous purging and Roe! 
erally occur. Morphin hypodermically is probably th i 
means of checking these symptoms, A mvetard-plastar over 
the abdomen may give some relief, or turpentine stupes may be 
applied. During this stage no food should be given, Por it will 
be rejected. Thirst should be allayed as far as possible by any 
of ie following articles, given in very small quantities and at 
ten- or fifteen-minute intervals: Cracked ice, cold water, cold 
acid water (dilute phosphoric or sulphuric acid diluted with 
water), carbonated water, iced lemonade, or lime-juice. Weak 
tea or strong black coffee may also afford relief. If vomiting 
continues, thirst may be assuaged by allowing the patient to 
hold a little iced lemonade or iced water in the mouth without 
peellvving it. 

ape does not check the vomiting, it may sometimes 
be tae by washing out the stomach with normal salt solu- 
tion or with weak boric acid solution, If the fluid in the 
patient’s body is much reduced and the patient passes into the 
third, or algid, stage, injections of normal salt solution may 
be given subcutaneously or intravenously. By this means a 
patient is often revived, but, unfortunately, the permanent 
relief hoped for by this method of treatment has not been 
attained. 

When the vomiting ceases and the severe symptoms begin to 
subside, small quantities of food may be given, At first a tea~ 
spoonful every fifteen minutes may be tried; and if this is 
retained, the quantity may be increased and the interval length- 
ened, Albumin-water, peptonized milk, and beef-juice or pre= 





PEEDING IN INFECTIOUS DISEASES. B21 


beef solutions should be given at first. The stomach 
remains irritable for days and weeks after an attack, and 
care should be ised not to excite diarrhea or yomit- 


YELLOW FEVER. 

This disease is usually described as presenting three 3 
the period of invasion and fover, followed Bee rp 
or remission, Many mild cases recover without ing into 
the third stage, which is imsely 5 arocathatiod ob the second 
stage, and is accompanied by black vomit and frequently by 
uremia and collapse, 

Almost all writers agree as to the necessity of withholding 
all food for the first seventy-two hours of the disease, At the 
outset it is well to give an enema and two or three grains of 
calomel, followed by absolute rest of the stomach so far as the 
giving of food is concerned. As most of the subjects of yellow 

are in robust health when stricken, the starvation is well 
borne. If food is given, it is almost certain to be rejected and 
to aggravate the symptoms. During this period Sternberg 
recommends the following mixture : 

Stevie: 
woe 








hour; a treatment that has been hi; peed Touatre is a 
firm believer in the efficacy of Vichy (Célestins), and admin- 
isters one or two bottles a day. Absolute rest and an abun- 
dance of fresh air are essential adjuncts to the treatment, If 
Vichy can not be obtained, soda-water, one dram to a quart of 
cold water, may be used instead. 

Tf vomiting is severe, the stomach should be given absolute 
rest and salt solution be administered by the rectum ; or if the 
rectum becomes irritable and the patient should become algid, 
the injections may be given intravenously, as recommended in 


cl \. 

During the third day, if the temperature falls below 102° 
F,, a small quantity of milk and lime-water may be given every 
four hours, This is more likely to be retained if taken cold, 

21 





LF 


322 DIET IN DISEASE. 


Gmels, and the like should be veil a ees 

milk tn Reaper or albumin-water may be allowed. 

and other beverages may excite vomiting. Anderson, Settee 

suggests one small cup of freshly prepared tea, drawn but a 

minute or two, to be taken in the morning to refresh the patient. 

Tap ea etapa 
as very it indulgences have res 

If the pat Ue eae instead of better, and if vomiti 
begins again and the diarrhea is severe, all food will be 
Teed champagne, Rhine wine, or brandy and water may be 
administered in small quantities at frequent intervals, 
coffee may also be employed. Cracked ice, soda-water, lime- 
water, Vichy, or the carbonated waters may be given a trial. 
‘Thirst may be somewhat relieved by allowing lemonade or 
dilute acid solutions to be held in the mouth rather than swal- 
lowed, Subcutaneous injections of normal salt solution, or in 
Very severe cases intravenous injections, may be tried. Mustard 
paste may be applied over the epigastrium or turpentine stupes 
may be ordered. ede hypodermically is more efficient in 
relieving the vomiting than any other drug. 

If the severe symptoms. abate, nourishment may again be 
attempted. A teaspoonful of albumin-water, with or without 
a little dilute brandy or champagne, or the same quantity of 
peptonized milk or of predigested beef-solution, may be given. 
If this is retained, it may be repeated in from twenty minutes 
to half an hour, the quantity being gradually increased and the 
interval lengthened to two hours. The stomach is apt to be 
irritable for days, and the food must be liquid and often predi- 
gested. Peptonized milk, albumin-water, chicken-broth with- 
out fat, and similar fluids may be given. The convalescence is 
to be conducted as after typhoid fever. 


DENGUE. 


thine, shy seme) fel je of mise fever. pets the 
eae and iced carbonated water may ven. 
leohol is ah usually required, except in habitués, ul E best 
vere in the early stages. Severe cases should be treated like 
yellow fever. 


MALARIA. 


During the attack of an intermittent fever the stomach is 
generally irritable, and if food is given it is likely to be vomited. 





FEEDING IN INFECTIOUS DISEASES. 323 


If the pationt has any desire for food, milk, broths, or gruels 
nay be allowed, When; the’ spoetite aabaruciie Gnas 
aoe be reeniied. The diet should be varied, and fruit 
and green vegetables administered to counteract the 

that is ly present. The anemia that follows repeated 
attacks of malaria often requires an ally uel ae 
invigorating diot, such as is prescribed in convalescence 
from fevers in general. 

Th the prolonged and more or less continuous malarial fevers 
the dict is similar to that of any acute fever. Alcohol may be 
ee na caleeoetes Slowing the veers Bae Whisky 

4 popular adjunct to treatment, and care should be exercised 
that too much be not taken and injurious habits formed. 


TETANUS. 


Tn all cases of this disease the efforts should be directed 
toward supplying the patient with the largest possible amount 
of nourishment. cases die from exhaustion, due, in part, 
to lack of food. The difficulties of feeding a lock-jaw patient 
can be appreciated only by one who has managed a severe case, 
Extreme emaciation and marked anemia, the result of insufli- 
cient nutriment, are generally present. 

When the disease is not severe, liquid nourishment can 
usually be given without difficulty by allowing the food to 

between the teeth. This is rendered easier when a tooth 
is missing. If the teeth are so regular and fit so closely 
together as to keep all food out, nasal or rectal feeding may be 
tried. In these cases food should be given every one or two 
hours, and from one to several ounces should be taken at a time, 
Milk, which should be partially peptonized, milk-panch, 
nog, albumin-water, panopepton and water or any reliable liqui 
predigested beef, meat broths, and stimulants should be admin- 
istered. Milk, if it agrees with the patient and can be given 
in sufficient quantities, is very useful. 

Tn severe cases any attempt to handle the patient or to feed 
him is likely to bring on a convulsion. This is as true of rectal 
feeding as of mouth-feeding. In some cases rectal feeding may 
be successful. In these difficult cases anesthesia may be in- 
duced by chloroform, and if the jaws relax sufficiently, a 
stomach-tube may be passed and a pint of predigested food 
and stimalant poured into the stomach, In many cases 2 nasal 
tube can be used to good advantage. 





7 


Bat DIET IN DISEASE. 


RABIES. 


The management of the diet in rabies is substantially the 
same as in tetanus. In most cases even the slightest move~ 
ments about the patient may excite violent spasms, When this 
is the case, all attempts at feeding, whether by mouth, nasal 
tube, or rectum, must be discontinued. Osler has suggested 
that the throat be cocainized so as to lessen the spasms and 

mit the patient to swallow. Whenever possible, this should 
Feraas but it can not generally be accomplished. If the 
patient is suffering from hunger, chloroform may be adminiz~ 
tered by inhalation to the point of relaxation, and food be given 
hy the stomach- or nasal tube or by the rectum, Since all 
cases of rabies are fital, the patient’s sufferings should not be 
augmented by ineffectual efforts to administer food. One who 
has never seen a case of rabies can not realize the extent of the 
suffering that attempts at feeding may induce. 


‘TUBERCULOSIS. 


‘The importance of proper dict in tuberculosis hns been 
dwelt upon since the time of Hippocrates. Areteus mentions 
the use of milk in the treatment of phthisical patients. Quo- 
tations pregnant with facts relating to the value of proper food 
might be added from almost every medical writer of promi- 
nence, Osler sums up the matter as follows: “As a healing 
of a tuberculous process is largely dependent upon the state 
of nutrition, the question of diet becomes of the very first 
importance.” 

Tn a disease with such protean manifestations there are many 
points that must be considered. As the malady usually attacks 
the lungs, this section will deal principally with pulmona: 
tuberculosis, for if the dietetic management of a case of pul- 
monary phthisis is understood thoroughly, there will be no diffi- 
eR modifying it to meet the requirements of other forms 
of the disease. 


From the outset the patient must be impressed with the fact 
that diet is of primary importance in the treatment of the 
disease, and whenever he displays a tendency to become care 
Jess in this regard, the injunctions concerning dict must be 
repeated. Directions should not be given in a general way, 
but should be specific, covering both the articles to he eaten 
and those to be avoided. The time for taking food and the 


FEEDING IN INFECTIOUS DISEASES. 825 


amount to be taken should be carefully outlined. These points 
vary with different patients, but each case must be studied in- 
dividually if success is to be attained. It is generally better to 
give written instractions concerning the diet, as the patient is 
oben peng especially if he has certain strong likes and 


Care should be taken to give only such directions as the 
condition of the patient will warrant carrying ont. A good 
diet and fresh air at home are to be preferred to starvation in 
a more suitable climate, The patient should not be permitted 
to too much of his money on railroad fare and too little 
on food. 

The nutrition of the patient is a reliable guide as to the 
progres of the aes Tf he is taking begtes nutritious 

|, is digesting it, and is gaining in weight, the prognosis is 
good. If the reverse is the case, the prognosis is bad. A per- 
sistent inability to digest food is always an unfavorable symp- 
fom. Care should be taken to avoid disturbing the stomach 

the use of nauseating dru; Patients are too tl 
wont excessively with Tanah cod-liver oil, pad at om 
and hypophosphites, while milk and eggs are not given often 
enough or only in insufficient quantities, 

Irritability of the stomach should receive early and the most 
careful consideration, It is usually due to fever, anemia, the 
swallowing of sper ‘or improper food or drags. If due te 
fever, care in selecting the diet, as will be descrtbed hereafter, 
should be exercised. When there is marked anemia, fresh air, 
sunshine, good food, massage, and iron in an easily assimilable 
form are helpful. In all cases the patient should be instructed 
not to swallow the sputum, as irritability of the stomach with 
vomiting is almost certain to follow sooner or later. He should 
be questioned closely regarding the food and drugs he is taking. 
One should be certain that he isnot taking a patent medicine in 
addition to what has been prescribed for him. “ Quick cures” 
are always attractive, and are often indulged in secretly, to the 
great detriment of the patient. A suspension of all drugs from 
time to time will do much to relieve the overdosed stomach. 
In some individuals irritability and nausea may be brought on 
by the too continuous administration of any one drug. 

‘The appetite, since it is generally poor and capricious, is not 
a good guide as to the amount of food to be taken. In most 
cases more food can be digested than ie sone demands. 
While this is so, the desires of the patient id, nevertheless, 


i 





326 DIET IN DISEASE, 


be consulted so far as and more can generally be 
accomplished by lasing fle raspae denne 
than by combating them, The of cach patient should 
be studied, and in this condition particularly tact plays an 
important réle. A nurse ora physician with natural tact and 
sympathy will often manage to get sufficient food into an in- 
tractable or capricious patient where skill and want of tact 
would fail completely. 

Other factors to be considered are the nationality and the 


thrive upon these, whereas an Englishman, a Frenchman, or 
an American would find it difficult to take some of the articles 
advised. 

In the choice and preparation of food the utmost care should 
be exercised. Detweiler’s saying, “ My kitchen is my phar- 
macy,” holds in these cases. The food should be prepared 
simply, and yet should be varied and made as tempting as 
possible, 


The stomach and intestine should be watched, and consti- 
pation promptly relieved. Patients who are taking large quan- 
tities of food and resting much of the time are apt to be 
costive. Sugars and starches are rarely well borne. This 
may be due to the presence of catarrhal conditions of the bowel, 
but may also be true even when catarrh is not present. Young, 
growing girls often crave sweets, and when this craving is 
indulged in to excess, the stomach and digestion become dis- 
ordered. 

While sufficient food should be given, an excess is injurious, 
and each patient should be watched carefully. Not more should 
be given at one time than the patient can digest with ease, 

1 and Chapman, in their studies on metabolisin in 
tuberculosis, found that some patients who were taking very 
large quantities of food and were gaining in weight were 
excreting excessive amounts of urea—over 900 grains daily. 
These patients generally maintained their normal weight, and 
the disease appeared to be quiescent. For economic reasons 
they were obliged to reduce the diet of the patients, and found 
that, instead of producing disastrous results, a gain in weight 
and general improvement followed. These patients, of course, 
were being somewhat overfed. 

Rest is important, and the patient should be instructed to 


FEEDING IN INPECTIOUS DISEASES. 327 


before and after meals; if he is not the combined 
oe pe orpimaplaryts ph sheesh ryt 6 
an hour before and after meals. 


together, age 
pecmane of a soft-rubber tube may be employed in those 
vomit everything they eat because swallowing brings on 
spasmodic cough. 

The care of the mouth is of great importance. It is well to 
rinse the mouth before and after eating. The teeth also should 
be kept scrupulously clean. Knopf advises the use of the fol- 
lowing mixture after meals ; 


K Essence of peppermint - 
Oil of wintergreen... 
Thymol ..s . 
Benzoic : 







Foods to be Used by Tuberculous Patients.— 
Milk.—This is one of the most important articles of diet for 
the tuberculous patient. Unless some special reason exists, 
milk should always form a pa He diet. It may be taken 
with the meals or be given i 
is of the utmost importance that the milk be si slowly, and 
not swallowed quickly in large quantities, e milk may be 
taken plain, or may be modified in various ways. Lime-water 
may be added, with or without the addition of cream ; car- 
bonated water may be mixed with it, or the milk may be pep- 
tonized. Buttermilk or kumiss may be taken if desired. 

Er, when they can be taken in sufficient quantities, are 

the greatest value. In certain cases, however, they may 
not be well borne. If the entire egg can not be taken, the 
whites alone may be given. Egg-albumin often renders most 
efficient service in helping to nourish these patients, ‘The 
whites of from six to twenty-four eggs beaten up lightly and 
strained through a cloth may be taken daily, A very small 
pinch of salt and a little lemon-juice or other flavoring sub- 
stance may be added, Given in this way, a large number of 
eggs can easily be taken, and are almost invariably well borne. 


328 DIET IN DISEASE, 


If the t can di: the entire, pase may be very 
Tightly ah or shang heyy be made into a light 

or poached. Hard-boiled and ar sel eggs should not be 
ea 


Meat.—Meat of all kinds, if properly 
eaten; but “hi; highl eae ishes, pare ie 
cooked meats a copes Beef and mutton are the 
mee suitable varieties. bie meats, especially raw beef, have 

ects A extolled by French writers. The experimental 
Richet and Hecionert on dogs, tending to show the 
she of raw meat, has been much criticised. Cornil and 
Chantemesse recently contributed to this subject by their ex- 
‘iments on dogs. Placed under similar conditions, some of 
Bie animals were fed on raw meat and others on cooked, and 
both series were inoculated with virulent tubercle bacilli. The 
dogs fed on cooked meat all died in a short time of tuberculosis, 
while those fed on raw meat lived. Some of the animals, at 
the time in apparent good health, were killed and showed 
tuberculous deposits. Others lived in apparent good health, and 
on being killed a year later showed tuberculous deposits i ina 
condition of healing. 

Galbraith has recently shown that the exhibition of raw meat 
is followed by mao increase of nitrogen retention, provided 
the heat value and nitrogen of the diet exceeded the actual re~ 
pte juirements of the individual per kilo. of body weight. He 

found that there was an improvement in the intestinal me~ 
tabolism, and this improvement lasts some time after the return 
to the use of cooked meat, In Galbraith’s patients there was a 
rapid increase in the hemoglobin, and the digestive leukocytes 
was remarkably increased. 

Grancher suggests that for taberculons patients the raw meat 
be given. in the form of a finely divided pulp. This is prepared 

the meat with a knife, which will result in a mass 
of ramelict meat-fiber. ‘This is placed in a mortar and pounded 
und rubbed with a pestle until quite smooth. It is then pressed 
gently through a sieve to remove any larger particles. This 
raw meut-pulp is very easily digested and ries nutritious, It 
may be given in various ways, as spread on sandwiches or given 
in milk or in warm bouillon. It may be mixed with purées of 
various kinds or with vegetables, or, in the case of children, 
with smal] quantities of preserves. It may be rolled into balls 
and 80 easily swallowed, or it may be served with an egg, with 
anchovies, or with pickled herring, 


FEEDING IN INFECTIOUS DISEASES. 829 


Ment-jwice is also of value. Thi be prepared 
eerste io -any of the ooh i inthe een 


to heat it to th or the albumin will ulate andthe 
janice le pared Ce 18 
aie, but when this can not be obtained, quid peegets ids, 


For patients who can not or will not take raw beef, very rare 
steak, roast-beef, or beef soup should be prescribed. 

Fish.—Fresh fish, boiled, broiled, or baked, may be allowed, 
Both oysters and clams from which the hard portion has been 
removed may be eaten, preferably raw, but may also be 
given stewed, roasted, or broiled. 

Cereals.— Where these can be digested, they are of value. 
Tn the early stages of the disease they serve not only as nutri- 
ment, but also aid in regulating the bowels, and are usually 
easily digested If there is constipation, they aro of especial 
value. eal, wheaten grits, cornmeal mush, and rice and 
milk are the most suitable forms, 

Vegetables.—Any of the easily digested tables may be 
allowed. They should be steamed or coke with as little 
water as possible, to avoid dissolving out the salts, which, 
together with much of the nutriment, are thrown away with 
the water. 

Bread.— Wheat or rye bread, or mixtures of both, may be 
used. Zwieback is of great value, AL hot breads, pastry, and 
cakes should be avoid 

Fruit.—All fresh and preferably ripe fruit may be allowed 
in moderation. It should be taken the first thing in the morn- 
ing or as a dessert. Baked apples and oranges are well borne 
and useful, and grapes, peaches, pears, and other fruit in season 
may be allowed. 

Pats.—In tuberculosis, when fats and oils can be taken and 
absorbed, the nosis is always much better than when these 
can not be tolerated. While they are of the greatest yalue in 


330 DIET IN DISEASE. 


Epscen by Secdeg toes ny foods ato the otary a th 
for more into is 

ean eh aia rhe ftol Soesrejene aaabe a 
dislike for fats of all kinds. They are best given in the form 
of cream and butter; the yolks of , crisp fat bacon, and 
olive oil are also useful. Cod-liver cits wally as much a food 
as a medicine, Kither the plain oil or an emulsion may be 
used, and the doses should be small to begin with and (pseents 
be increased. A common mistake is to administer the oil in 
excessive quantities. Only perfectly sweet fresh oil is to be 
used, as rancid or stale oil may disturb the digestion. Its use 
should be discontinued from time to time. dren bear oil 
better than do adults. If there is a tendency to diarrhea, fats 
and oils must be used with caution. 

Alcohol.—There is much diversity of opinion concerning the 
influence of alcohol on tuberculosis. Three views have been 
expressed, and each has its supporters: 

1. That alcoholism is antagonistic to tuberculosis, 

2. That alcoholism exerts no special influence on the indi- 
vidual as regards tuberculosis. 

3. That alcoholism definitely predisposes to tuberculosis, 

The last view bas the largest number of supporters, as aleo- 
holism probably renders the body more susceptible to all in- 
fections. Osler bas stated his opinion as follows: “It was 
formerly thought that alcohol was in some way antagonistic to 
tuberculous disease, but the observations of late years indicate 
clearly that the reverse is the case, and that chronic drinkers 
are much more liable to both acute and pulmonary tuberculosis, 
It is probably altogether a question of altered tissue-coil, the 
aleohol lowering the vitality and enabling the bacilli more readily 
to develop and grow.” 

Concerning the use of alcohol in the treatment of tubercu- 
losis, it may be said that, except in the last stages of the disease, 
it is best avoided. Nationality and habits, however, must not 
be disregarded. To those habituated to the use of a glass of 
wine or beer with their dinner, this may be allowed. The 
quantity taken must be limited to the smallest reasonable allow- 
ance. This will vary with each individual. 

Patients who are gaining in weight or who are in good con- 
dition are better off without alcohol. Those who are going 
down-hill may often take light wine, beer, or well-diluted spirits 
aes airings: Of the last, well-matured, pure whisky is 

1 it. 


FEEDING IN INFECTIOUS DISEASES, 331 


Patients with high fever who are in an exhausted condition 
ey epee freely, follo the sume rules as were 
id down in the general consideration of fevers, In these 
eases alcohol is given as a food, and is, as a rule, very well 
borne. In these advanced cases pure whisky well diluted is 


moderation. In chronic tuberculosis cocoa may 

and morning with good effect. Tea or coffee may be allowed 

in small quantities unless they luce unfavorable symptoms, 

Milk and milk-panch, buttermilk, lemonade, or ora: may 
used, and malt extracts are often of benefit. 

Number of Meals.—Food may be given from three to six 
times daily. On rising, milk may be taken, or, if desired, a 
cup of bouillon i This may be followed by breakfast, 
and about the middle of the morning a glass of milk, egg- 
albumin, beef-juice, or broth may be given with a cracker or a 
piece of toast. 

A midday dinner should be the rule, and during the middle 
of the afternoon a light lunch of scraped beef, milk, or some 
similar food may be given. 

Supper may en at a convenient evening hour, and 
before going to bed a glasa of mill may he drunk. If desired 
or if deemed necessary, a small amount of liquid nourishment 
may be taken during the night if the patient awakens, As a 
rule, however, it is well to give the stomach a full night’s rest. 
In severe cases, where only small quantities of liquid or semi- 
solid food are taken, the intervals should be shortened to every 
two or three hours. 

Feeding Advanced Cases.—In advanced cases patients 
may generally be permitted to select their diet. These patients 
can often eat hearty meals with « relish and apparently digest 
them without difficulty. As a rule, their diet must be light, 
liquid, or semisolid. The same principles may be applied here 
as in feeding fever cases, with the exception that the patient's 
desires should, as far as possible, be gratified. 

Phthisis Cures.—Various diet cures have been adyo- 
cated for the relief of phthisis, and these are referred to under 
the head of Diet Cures. The benefit which follows their use 
is due largely to the fresh air and abundance of food they 
preacribe. 





332 DIET IN DISEASE. 


Daremberg’s Dietary—In 1883 Dareml recom- 
mended the following dict for tuberculosis wen 





Detweiler’s Dietary.—The following is the schedule in 
use in Detweiler’s Sanitarium : 

7-8 a. M.: Coffee, tea, or chocolate, biseuit and butter or 
bread and butter. A glass of milk taken in small sips. 

10 a. M.: One or two glasses of milk taken in small sips, 
or bonillon with an BE bread and butter, or cold meat with 
bread, butter, and wine ; if possible, a glass of milk. 

lpm: Dinner—roast, v vegetables, dessert, wine and seltzer, 

4p. M.: Milk, kumiss, or bread and butter with wine or 


cognac. 

7-7.30 r. u.: Hot meat with potatoes, rice, noodles, cold 
meat, fine swusage, poultry with salad, preserves, and wine. 

Late in evening: A glass of milk with two or three spoonfuls 
of cognac, 

According to Munk and Ewald, the foregoing diet represents 
about 3000 calories a day. Such a diet is much better suited 
to a German than to an American stomach, 

Weber’s Dietary.—The following is taken from the 
Croonian Lectures for 1885 : 

At 7 o'clock, or earlier, while still in bed, a cup of milk, 
with a dessertspoonful or a tablespoonful of cognac, or with 
lime-water, or with a small quantity of tea or cocoa, and a small 
piece of bread and butter. 

At half past 8 or 9, after dressing, breakfast of milk, with 
some slightly stimulating addition, as tea, coffee, or cocoa, bi 
and butter, or bacon, ham, or fish. 

At 11, a tumblerful of milk or kumiss, or sometimes a cup 
of broth or beef-tea, or a sandwich and a glass of wine. 

At 1 or 1.30, a substantial meal of meat, ltry, fish, or 
game, with fresh vegetables, some light pudding or cooked 
fruit, and a glass of wine, 

At 4 o'clock a glass of milk or kumiss, or a cap of tea or 
coffee containing an abundance of milk, and some bread and 
butter or plain biscuit. 


FEEDING IN INFECTIOUS DISEASES. 333 


At7 p, m., another substantial meal, similar to that in the 
middle of the day. 

At 9.30 or 10 p. w., on going to bed, a cup of milk, bread 
and milk, or milk with some farinaceous food, as Hart’s, Lie 
big’s, Nestlé’s, or Mellin’s, At this time, if there are night~ 
sweats, the addition of a tablespoonfiul of brandy is very useful. 

Gastric Irritability.—Gastrie irritability is a troublesome 
symptom in many cases of tuberculosis. Care in avoiding nau- 
seous: and preparations will have much to do in prevent~ 
ing it, patient must also be enjoined strictly not to swallow 
the sputum. If the attack is severe, the patient should be 
blce on a liquid diet, consisting Sheds of milk in some form, 

luted or peptonized. Buttermilk and kumiss are valuable in 
this condition and are often well borne. Fresh meat-juice and 
broths may be allowed, and the various peptonized dishes men- 
tioned in the Appendix may be given to variety to the diet. 
Seraped meat mixed with milk or prepared in the form of small 
balls is often of service. The Last Bi liquid beef cia 
tions are useful, and may be given diluted with water. n0- 
pepton poured over crushed ice is sometimes retained when 
everything else is rejected. Egg-albumin is also usually re 
tained. 

Alcohol may be used in the later stage of the disease or when 
the patient is very weak. Old brandy mixed with a small 
Soa of a cold carbonated water or teaspoonful doses of iced 
champagne are advised in the very serious cases. Larger doses 
may be given in the less severe cases, 

‘ood and drink should be given in small quantities at short 
intervals—one to four ounces every two or three hours, or twice 
as much at longer intervals, "The quantity taken should be 
measured carefully and recorded, as otherwise the patient may 
receive an insufficient diet or be given a superabundance, In 
severe cases washing out the stomach gives more relief than 
any other procedure. In leas severe cases a glass of hot water 
with or without sodium bicarbonate may be taken on rising, 
ae at least half an hour before eating, or preferably an hour 

fore. 

Tf no food is retained, forced feeding by means of a stomach- 
tube may be tried. This is known as Débove’s method. 
Large quantities—8 to 16 ounces—may sometimes be retained 
when given by the tube that, if swallowed, would be rejected at 
once. If the severe form of irritability persists, rectal feeding 


may be resorted to. 


334 DIET IN DISEASE. 


Fever.—If there is fever, the question of feeding the patient 
should be carefully considered. there is much irritability of 
the stomach, the general rules for feeding fever patients may be 
followed. If digestion is not disturbed and the appetite is 
the patient may be allowed a light dict, of which milk should 
form a part; as a rule, it is best given cold. The usual 
liquid may also be allowed. Soups, white meat of chicken, 
raw or rare roast-beef, or underdone mutton are indicated, 
Boiled, broiled, or baked fish and oysters and the more easily 
digested vegetables are permissible. The patient’s surroundings 
have considerable influence on his appetite, and when possible, 
he should take his meals while reclining on a porch or in a 
sun-parlor, amid perfect quict. The excitement and fatigue of 
a meal in the dining-room are best avoided. 

If solid food does not agree, the patient should be placed on a 
liquid diet, Generally, however, a tuberculous patient with 
fever will do remarkably well on a general diet. Milk, lemonade, 
and similar preparations are useful, recipes for which will be 
found in the Appendix. 

The diet for the more advanced cases has been indicated. 

Forced Feeding (Suralimentation).—Débove discov- 
ered accidentally that food introduced by means of a stomach- 
tube was retained when, if taken by the mouth, it would be 
rejected. He therefore turned his attention to the treatment 
of tuberculous patients fear of this method, and met with 
a measurable success, jis form of treatment is especially 
a) ead in those cases where there are an irritable stomach 
und no appetite. 

Food is introduced into the stomach by the tube at regular 
intervals. Milk, peptonized or diluted, ground-meat mixtures, 
eggs and milk, dlbumin-water, beef-juice, predigested beef 
preparations, and similar liquid foods may be utilized for this 


pose. 

When, during fever, the patient’s appetite and will-power are 
equal to it, feeding may be conducted in the usual way, without 
the tube. Moderate quantities of easily digested food may be 
given at frequent intervals, Two or three rather substantial 
meals form the basis of the diet, while on rising, at bedtime, 
and during the intervals between meals liquid food is to be 
ordered. Under this method of treatment certain cases gain 
very rapidly and recover their usual weight in a short time. 
As soon as the customary weight of the patient is reached, it is 
well to diminish the quantity of food given, so as to avoid the 


DIET IN DISEASES OF THE STOMACH. 335 


sarvy bona; mepbiien aad the tiie of Sparse tee - 
a breath, torpidity, train of symptoms popularl 
Tien au BOlSnerses, “ Shonld tebe eyiite Kieran 


together 
amount of food given, will give Prange relief. Gastric catarrh 
and fever are contraindications to tation, 


DIET IN DISEASES OF THE STOMACH. 


In diseases of the stomach the selection of a proper diet is 
often of more importance than the choice of drugs. No abso- 
lute dietetic regulations can be formulated in this class of dis- 
eases, but it is important to regulate the food in conformity with 
the particular disease with which the patient is affected, and 
also to consider the individual tastes and peculiarities of the 
patient ; even in the regulation of a diet in any special discase 
of the stomach changes are often rendered necessary ; these 
moust be made gradually and according to the patient’s power to 
digest the food. 

‘ood is said to be easily digestible when it produces no gas~ 
tro-intestinal discomfort, is passed from the stomach into the 
intestine at a normal rate of speed, and is easily absorbed. 
Under normal conditions the digestibility of foods is easily 
ascertained, for the motor and secretory functions of the stom= 
ach being normal, the effect of the food upon one or both of 
these functions can readily be determined ; in the various gas- 
tric disturbances, however, this problem is more difficnlt, for 
here there may be a motor or a secretory disturbance, or both 
functions may be impaired. In determining the diet for a 
special gastric disturbance two points must be borne in mind : 
first, the power to increase the nutrition of the patient, and, 
secondly, the necessity of giving food in a digestible form, so 
as to lessen the work of the stomach. Leube has devised a 
seale of the various articles of food, given in the order of 
their digestibility. This scale forms the basis of the well-known 
Leube “ uleer diet.” 

Leube’s Diet Scale.'—Diet [.—If the digestion is very 
much reduced, the following articles of food are most easily di- 
gestible : bouillon, meat solution, milk, raw or soft-boiled eggs. 

Diet IT-—Somewhat less digestible than Diet I. are the follow- 
ing articles of food: boiled calves’-bvain, boiled thymus, boiled 
chicken and pigeon. The different forms of meat are enumer- 


 Zeitsehe: f. Min, Med., vol. vi p. 191. 





336 DIET IN DISEASE, 


ated in the order of their digestibility. Gruels, and in the even- 
ing milk mushes made with tapioca and white of egg, may also 
be placed in this list. The majority of patients can di; 
boiled calves’ feet in addition to the various meat foods already 
enumerated. 

Die I1L—If Diet I. is well borne, Diet TIT. may be 
given. This consists in adding cooked or raw beef to Diet I. 
Leube gives the following method of preparing beefsteak and 
believes that beef cooked in this way is very easily di; E 
The meat should be kept for some time, asada enced 
with a dull mn; in this way a pulp is obtained, consisting 
only of the aaiats parts of the muscle, and not containing any 
of the tough, hard, and sinewy portion, This pulp is roasted 
in fresh butter, Raw ham is also to be recommended, In 
addition to meat a small quantity of mashed potatoes may be 
given, some stale wheat bread, and small amounts of coffee or 
tea with milk (cautiously). 

Did IV.—This list is so arranged that if the patient ean 
digest the articles of food mentioned under this head for some 
time, he can then begin with his usually accustomed diet : Roast 

, Toast pigeon, venison, at roast-beef—medium 
to raw (particularly cold), veal (from the leg), pickerel, boiled 
shad, macaroni, bouillon with rice. Small quantities of wine may 
be taken one to two hours before cating ; gravies are contraindi- 
cated. Young and finely chopped spinach is allowable; other 
vegetables, such as asparagus, may be tried cautiously, although 
Leube considers this a rather risky procedure, After this fourth 
diet the patients are allowed to take a more liberal diet, but the 
increase should be gradual. They should refrain from eating 
vegetables, salads, preserves, and fruits for some time ; and when 
they are resumed, a baked apple is the first of these articles to 
be eaten, 

Beaumont’s Table.—This shows the mean time of diges- 
tion of the different articles of diet—naturally, in the stomach, 
and artificially, in vials, on a water-bath. The proportion of 

trie juice to aliment in artificial digestion was generally caleu- 
lated at one ounce of the former to one dram of the latter, the 
bath being kept as close to the natural temperature—100° F.— 
4s practicable, with frequent agitation. 


DIET IN DISEASES OF THE STOMACH. 





#9 
i 


ry 
ie 


iz 
ig 


ff 


ue 


tit 


payaaiy 
i 





eh 
Beef, with salt ont 
Beef, with musta 
Beef, fred, lean 
Beef’ 





Pork, fat and lean 


Pork, recently salted’... 















Mean Time of Chymification. 


22288, 





AA 
i) 


SSEESESEEREESEESS 

















337 






SESE & BE 


9:00 


6:30 











How prepared, 





Cake, . 
Dumpling, ny oy 
Apples, sour, # 
Apples, sour, mellow 4 
Apples, sweet, mellow... . 
Paris sts. sess 


























DIET IN DISEASES OF THE STOMACH. 339 

















tion of the stomach and with ordinary exercise,” 

The mean times of artificial chymification have been taken 
from such experimemts as were generally made with the pure 
gastric juice, or with such juice as was too slightly viti to 
impair its solvent effect in any essential degree. They exhibit 
the average, a8 near as practicable, for the digestion of one dram 
of alimentary matter in one ounce of gastric juice, or in about 
that proportion, taking the length of time the food and rie 
juice were heated. Exceptions, however, must be made for the 
bone, oil, cream, and one or two other articles, which chymify 
much slower and with more difficulty than the less concentrated 
aliments. Several experiments where the methods were the 
same and the results were similar haye been omitted. 

Penzoldt haz devised the following table giving the digesti- 
bility of food. He experimented on normal cases, achieving his 
results by means of the stomach-tube, by determining the 
progress of digestion and the exact time at which the stomach 
was entirely empty after eating a certain quantity of a special 
food. The table’ shows the period of time it takes a given 
quantity of food to leave the stomach : 

§ Deutech. Arch. f. klin. Med, 188%, p. 878, No, 57, 





g 





One to two hours: Three to four houra: 
100-200 water. Jhicken, boiled. 
290 frm. earbonated water, 330 gm. partridge, boils 
200 gm. tea, alone. 
300 fom: coffe alone. 
200 gm. cocoa, alone. 
aH A 
wines 
100-200 Sn. bated milk 160 fam: bam, raw. 
200 gm. meat broth, alone. 100 gm. veal, warm and cold, lean, 
100 gm. eggs, soft. 100 gm. beefateak, broiled, cold or 
warm, 
Two to three houra: 100 gm. beofstenk, raw, scraped. 
coffce with cream, 100 gr. tenderlois. 


i 


1 
ie 
248 
a 


150 gm, blackbread. 
150 gm. barley bread, 


it 
E 


200 
200 
200 
200 
300-000 gan. 
100 gm. nail 150 fem. wheat bread. 
Beas en ematied, 100-130 gm. Albort biscuits, 
100 gm. beelsnusage, maw. ‘em, potato, as 
250 gm. calves’ brains, boiled 150 em. Hs bole 
200 gm. calves’ thymus, 150 gen. kohlrabi, boiled. 
72 gm. oysters, raw. 150 gin, car led, 
200 im. carp, boiled. 150 gm. spinach, boiled. 
200g. pb 150 gm. cucumber sala 
200 gm, shellfish, boiled. 150 gm. radishes, raw. 
200 gm. boil ay, 150 gun. apples 
I cauliflower, 
150 frm. enulilower, an atad. Four to five horas 
160 gm. oiled. 210 gm. pigeon, broiled. 


250 gm. fillet of beef, broiled. 


water. 250 gm, beefateak, broiled, 
160 gm, mushed potatoes, 250 gm. beet tongve, sacked. 
160 gm, stewed cherries. 100 gm. smoked in slices, 
160 ga. Faye cherries, 250 gm hare, broiled, 
70 gon, white bread, old cr fresb, 240 gm. parttidge, broiled 
dry or with tea. 250 gm. ited. 
70 gm. pretcla 230 fut duck, broiled. 
70 gin. Ewieback, fresh or stale, 200 gm. herring, salted. 
dry or with tea. 150 gm. lentils, mashed. 
50 gm. Albert biscuits, 200 gm. peas as purée, 


Penzoldt has also constructed a series of four diet-lists based 
on the length of time at which various foods leave the stomach, 
depending upon their mode of preparation and on other quali- 
ties of the food. They agree in the main with Leube’s diet- 
lists, but are more complete and exact. 


DIET IN DISEASES OF THE STOMACH. 341 


PENZOLDY’S DIET-LISTS. 
Diet 1. (about Ten Days). 


‘Method of 





From beef. 
Well polled or Ent 
sterilized, 1 


“hgautd oe fw 








rea! bral] TO esi gies Ta meat — 

Thymus (calf) .| 100 gm. Botled. _Preed from all eaten fo meat 

Pigom sess | t Motted, —_jonty if you ert akon tn mak 
tho like, 


Botled. paca fat {Dest taken fn meat 
Chopped fing or Prot the tonder-|To be eaten with 
sereped, wih 4 Join, cakes, 


\. |Without aby ad-/8moked eaten 
Hitbout ay ad Uitte, Mo be eaten with 
‘Botled with milk 
| to make griel.| 


Diet HIE. (about Bight Days), 








T—JBetset- watt {Young DIN, Without gravy. —— 
1 feonea a lonty youn bird,| Without 
fresh bater, | kia, eter a 


100gm. | With fresh buster’ rom the tander-|Without gravy 








100, Raw, seruped (Smoked a tde,|With white bres, 
. |Raw, 
see fine Tushout de ¥ 
Milk bread, Zw i ‘gm. [Cris |, baked. |Btale trorcated ‘To be fea) 
reedtwle| S0gm. [Crieped iter carefully mas 
berger peetecis) om. | ed, (0) posal; 
rican] iled In’ salt tates 
iS and in and 
aahod. oa on 
Cauliflower ..| Wem |As a stile less oniy the 
Sowers 

















342 DIET IN DISEASE. 
Diet IV. (about Eight to Fourteen Day»). 


Food or drink: Betaken a preparetion. src | How wo be eaten. 





Venison ....| 200gm. |Ronsted. Leite oer 


Pariedge- ++) 1 |oestea without You 


nae te , Ws 
Ronst boot 100 gm. | Modium to rare. rol eat farm or cold 
Fillet of beef. . | 100gm. Medium to rare. [Prom 00s ‘Warm or cold. 


ch, 
Roasted. Back or leg, | Warm or cold, 
Botled in salt |All fish bones 
water without! should by care-| Fin the flah gravy. 
any abditions, fully removed, 




















Raw. slighty watt, 
ian 
caviare, 
Mashed, pushed 
shrough 
sieve. 
led. Sof, withoutany|With m lttle melted 
of the hard | “butter, 
‘With tittle 
al 
and salt. 
With about 2 [Aust have risen|To be eaten mt one, 
‘git. Of suger. 
fret |vree trom ail 
Polled frutt to! kernels and 
De strained = peel. 
through 
slove, 
Redwine... .| 100gm. 1, pure Bor Or some corre-|Hlightly warm, 
jeux, ‘kind 
f red wine. 





‘These tables of Penzoldt are valuable as a basis for the seleo~ 
tion of food in gastric disturbances. In these cases it is im= 
portant that the food be quickly dissolved in the gastric secre- 
tion, that it be readily absorbed, that it be neither fermented 
nor decomposed while being digested or absorbed, and that the 
entire process be attended with no discomfort. It must be 
borne in mind that the digestibility of food varies widely with 
the individual taste, for no matter how digestible a food may 
be, if it is unpalatable, it will not be digested proj tpi 

general it may be said: First—that in acute conditions P= 
fod should be of such a character that the stomach should be 
spared as much work as possible ; second—in chronic disturb- 
ances it is important to supply sufficient quantities of nourish- 
ment in an easily digestibl ble form, so as to maintain the body- 


DIET IN DISEASES OF THE STOMACH. 343 
weight 90 fir as possible. Eel aearmtsiie Se eee 


that is necessary during twenty-four hours the amount is esti- 
mated in calories of heat. As is well known, a human being 
ab rest requires 35 calories per kilo of weight, whereas while 
he is performing light work he requires 40 calories. In order, 

to determine the exact amount of nourishment it is 
only necessary to know the weight of the individual. Inas- 
much as the proteins can be replaced in a measure by the car- 
bohydrates and fats, an interchange of any of these three food 
elements can be made according to the patient’s condition, 
The following tables, taken from Kénig,' give the composition 
of different and the number of heat units they produce. 
When the weight of the person is known, it is an easy. matter 
to determine whether the amount of nourishment given is suffi- 
cient to maintain the body-weight. 

It is well too to weigh every patient eer with a stomach 
disorder when treatment is first inaugurated, and to repeat this 
from time to time in order to determine whether the patient is 
gaining or losing flesh. 

The diet must be considered from the standpoint of the gas- 
tric secretion ; there may exist, on the one hand, the condition 
of hyperchlorhydria and hypersecretion ; on the other, hypo- 
chlorhydria and anacidity. 

In cases of hyperchlorhydria = abundant protein diet is 
indicated, ped ts as the excess of hydrochloric acid is neu- 
tralized by this class of foods. On the other hand, as Riegel 
points out, certain cases of Biyueretl peta) at times do better 
upon milk, bread, and amylaceous foods than on protein foods. 
Ordinarily’ the proteins that are best aneried for patients 
suffering from hype yan are the meats and 
whereas the carbohydrates must be given in the most easily 
digestible form. 

In cases of hypochlorhydria there is a diminution of the 
gastric secretion ; consequently the protein foods are digested 
with difficulty, whereas the carbohydrates are more easily 
digested. In this condition, therefore, only very tender meats, 
preferably scraped, are to be given, whereas such easily digest- 
ible vegetables as spinach, asparagus, mashed potatoes, and 
farinaceous foods may be eaten in quite large quantities. In 
beth hyperchlorhydria and hypochlorhydria a reasonable 
amount of fat must be eaten, preferably in the form of good 
butter. 

+ Die menschlichen Nahrunge wnd Genussmitiel, Berlin, 1883, p. 53 


344 DIET IN DISEASE. 
COMPOSITION OF THE MOST COMMON FOOD SUBSTANCES. | 
































T. Dairy Products. 
Protein. Fut. | carbohydrates, | calories, 
Per cont. Per cont, Per cent. Jer 300, 
Cows’ milk... « 80 | 3,00-3.80 3.70 
Cream. 5 - 3.6L 26.75 3.02 276.01 
Batter . . . 0.50 90,00 887.00 
Whey ||; 0.30 8.60 
Bottermilk ~ 3.00 1.30 bs 3.07 
Kumiss (of cows’ oe 
£07 m 
ition 3.85 2.07 1 299 
0.80 
carbonic acid 
Cheese (cream) 25,00 30,00 8,00 304.00 
see 00 9.00 00 
Bgg.:-+---.! 1260 0.50 165.00 
IT, Meat and Game. 
«| 1719 20.38 ane 
. 20.78 1.50 - 
. 18,88 TAL 0.07 
| 19.84 0.82 sla 
. 14.80 36.39 0.05 
WA 6.97 < ate 
4.54 87.34 soe 
« 20,25 6.81 
97 36.48 1.50 
. 22.00 0.40 
64.50 5A 2.28 
00 1.00 4 
18.49 O24 1.20 
05 8.1L 2.38 
2214 1.00 0.76 
23.00 1.00 aa 
34 LI3 0.19 
19.77 1.92 1.42 
IIT, Fish. 
. 18.60 0.50 0.75 83,67 
20.61 1.00 ifaiie 94.64 
17.09 9.34 “ 156,93 
«| 15.01 642 2.85 132.93 
221 0.45 113.88 
4.95 0.37 ree .00 
19,60 17.00 0 
. x 16.26 7.82 
IV, Cereals and Vegetables. 
0.50 86.50 366.70 
8.50 1.35 73.00 845,78 
10,00 2.00 69.00 342.50 
6.00 0.75 52.00 245.00 














DIET IN DISEASES OF THE STOMACH. 5 
Cereale ant Vegetables (Continued). 






























Barley soup... z 1.00 11.00 60.96 
Rice pap, with milk 8.80 3.50 28.60 182.61 
Coffee. Pores [iat 2 518 
Tea 
Beor 0.50 5.25 0,30 
Porter 0.70 6.00 6.00 
VE Fruits 
Cx 
Free acid. Protein. Fat. hydrates, 
Per cent. ‘Per cent. Per cent. 
0.368 i 792 
0.36 Rod 
0.40 4.08 
0.65 Ti 
0.59 1.96 
0.54 1.01 
548 3834 
1.20 - 5.28 











346 DIET IN DISEASE, 


‘The following diet-lists, devised by von Noorden,' indicate 

how an easil diet, containing a sufficient number 
pine heat to maintain the body-weight, can be pre- 
pared = 


Milk Diet with Additic 
1. A Principally t with Additions of Carbohydrates in 





Carbo- 
Protein. | Fat. | 1/8 ritey, | Calories. 














Percent, | Per ot.| Der cent, 


70.2 66.3 69.7 1295 
10.0 on 30.0 164 
7.0 56 40.0 a 








87.2 71.8 | 139.7 1708 





Principally Milk Diet with the Addition of Carbohydrates ond Fat 
z. erie Rr had toe 





hyd ye carn Rawr, 1 ees 0 
mapa em : 












































} Berliner Klinik. 
710 sibumces ze couiatne’ in 90 a. of Denayey's peptone peaperaiie, 
in 22 gua, of Kemmerich’a, or in 20 gra. of K 


r 





DIET IN DISEASES OF THE STOMACH. 347 
IV. Milk with Tender Meat, Flour, Butter, ancl Soups. 























The diet in motor disturbances of the stomach, as in atony 
or in dilatation, depends greatly upon whether an excess or a 
deficiency of gastric juice is secreted ; if there is an increase, 
an excess in protein food gives the best results ; if, on the other 
hand, there is a diminution of this secretion, protein food must 
be given the patient in the most easily digestible form—z. 7., 
as the albumoses and peptones, The carbohydrates and ie 
lighter vegetables may be given in somewhat larger Breper. 
tion. In both conditions the ingestion of fluids should be 
reduced as far as possible. 

Normally the appetite is a fair indication of the number of 
calories of heat that may be required ; in conditions of gastric 
disorder, however, this is not the case ; these patients lose their 
appetite, and consequently often take insufficient nutrition. In 


1 Meat of various kinds, finely chopped, raw or fried in butter; cold or 
warm, taken at meals. rs shopae 





348 y DIET IN DISEASE, 


those instances in which the gastric disorder is somewhat 
tracted and accompanied by great loss of weight, and in wl 
the patient takes insufficient nourishment, it need only be 
borne in mind that such a patient, resting quietly in bed, 
requires only about one-sixth at the number of calories neces- 
sary for a patient who is not resting. This plan may, there- 
fore, be used with advantage in the treatment of many patients 
suffering from disorders of the stomach. 
Foods in Gestrie Disorders.—In those cases in which 

it is nm the stomach as much work a5 
milk is the bod iat i is usually most easily borne. pags 
to big a sufficient number of calories it must be taken in 
large quantities, Seavsaty diluted with lime-water or barley- 
water in order to add to its Aigestibility, or flavored with 
coffee, tea, or cocoa to lend variety and add to its tability. 
In those cases in which milk is not well borne buttermilk, 

whey, kumiss, and kefir may serve as substitutes. Amon, Be 
other forms of fluids that may be given are broths (chi 
beef, mutton), bouillon, beef-tea, and meat-juice. Of thes, 
meat-juice is most nutritious. 

Gelatinous Forms of Food.—Gelatinous articles of food, as 
gelatin, calves’ feet, etc., are easily digested and readily ab- 


“aia digestibility of meat can be increased by chop- 
, grinding, scraping, ete. 
etka digestibility of eggs depends upon their mode of 
preparation; raw and soft-boiled eggs are usually the most 
easily digestible forme. 

Fish.—In regard to fish, those containing but little fat are to 
be recommended for patients suffering from gastric disturbances, 
‘such as shellfish, pike, trout, carp, and halibut, 

Carbohydrates —The number of vegetables from which selec~ 
tion may be made is large. The secretions from the month and 
intestines play an important role in the digestion of these sub- 
stances, They shoul ld be masticated thoroughly. In those 
cases in which there is danger of fermentation they should be 
given with caution, The best form in which to give amylaceons 
food is in the form of zwieback, toast, stale wheat bread, tapioca 
flour, oatmeal, ete, Ebstein has highly recommended aleuronat 
flour, which contains about. 80 per cent, of protein. 

Legquminous foods contain a considerable amount of protein, 
much of which, however, is not absorbed. They are apt to Le 
rise to considerable fermentation. Potatoes are best given m: 






DIET IN DISEASES OF THE STOMACH. 349 


—— orbaked. (roopry thatainmerdier terpar racist 
from the diet of all from stomach disorders. 
Eivalia are of ‘light nattitive valog, bot give'a relish to'olise 
foods and increase intestinal peristalsis. 
Fat is to be recommended because of its tendency to increase 
the weight of the patient, and also because of its high calorie 
i value. Some observers claim, however, that it acts as an 


fat meat, greasy gravies, etc., give rise to indigestion and often 
to nausea and vomiting. Much depends, however, on the mode 
preparation, A considerable amount of fat may be given in 
form of fresh butter spread on wheat bread or toast. Cer- 
tain forms of chocolate contain quite a large percentage of fat, 
and on this account are very nutritious. Of these these, Sinnriog’s 
Vigor Chocolate is to be especially recommended. Olive oil 
has recently been recommended in the treatment of certain 
gastric disorders (sce p. 108). 

Concerning the relative digestibility and nutritive value of 
various liquid and solid foods, the reader is referred to the sec~ 
tion dealing with this subject. 

Factors bearing on the Diet in Patients 
Suffering from Gastric Disturbances.—1. Von Noorden! 
demonstrated the fact that the intestine will vicariously perform 
the work of the stomach in conditions in which the ba enit | 
function of the latter is lost. Thus, as has been shown by Ewald, 
Leube, and others, in cases of atrophy of the gastric mucous 
membrane in which there is no longer any gastric secretion the 
fades may maintain his weight, for the intestine assumes the 

igestive function normally carried on by the stomach, Ein- 
horn? hus likewise demonstrated this fact in cases of achylin 
gastrica. The point to be borne in mind is that even in cases 
in which the secretory action of the stomach is lost entirely, the 
intestine may assume this function of the stomach. 

2. In those cases in which it is necessary to spare the stom- 
ach, as when food can not be digested or is vomited, either pre- 
digested foods may be utilized or foods may be administered 
through channels other than the stomach. Among the artificial 
predigested preparations are the albumoses and peptones, Der 
ayer’s piacesrere Somatose, Nutrose, and Mi 


Beef Meal. e various methods of feeding, the 
referred to the sections on Rectal Feeding, Subcutaneous Ted, 
ing, ete. 


+ Berlin. Klinik, pt. Ww. * Medical Record, 1892. 





350 DIET IN DISEASE. 


3, The following rules for eating should be carried out : 

(@) Food should be thoroughly masticated ; this is especially im- 
portant in those cases in which there are marked gastric disturb- 
ances. Biernacki! and the authors* have shown the impor- 
tance of the effect of the salivary digestion upon the gastric 
seeretion in so far that an absence of salivary secretion not 
only results in an absence of amylolysis, but that the prote- 
olysis is much retarded. 

(b) The meals should be taken at regular intervals and in 
moderate quantities, according to the nature of the gastric dis- 
ease ; this rule must be varied under certain conditions ; ¢. 7., 
small frequent meals should be taken in atony, whereas under 
other conditions, such as hyperchlorhydria, somewhat langer 
meale should be given but three times daily. 

(e) The temperature of the food is also an important factor 
in the treatment of gastric disturbances; as Uffelmann has pointed 
out, the food should be taken at a temperature between 98° and 
100° F. The ingestion of very hot food is believed to be a 
frequent cause of ulcer of the stomach. On the other hand, 
Wegele attributes the dyspepsia of many Americans to the 
taking of ice-cold water und other drinks. 

(d) The question of rest or exercise after eating is one that 
is of considerable importance to those suffering from gastric dis- 
turbances. It is generally admitted that violent exercise should 
not be indulged in after eating. According to Schule,’ patients 
suffering from superacidity should not sleep after eating. From 
experiments not as yet published the authors have determined ; 

(1) Under normal conditions the secretory as well as the 
motor functions of the stomach are not interfered with during 
rest; during sleep after a meal, however, the secretory function 
remains normal, but the motor fanction is slightly disturbed. 

(2) In cases of hyperchlorhydria with normal motor function 
the acidity is reduced and the motor function remains normal 
while resting, wherens during sleep the acidity remains about 
the same and the motor function is impaired. 

(8) In conditions of hyperchlorhydria with motor insuffi- 
ciency the acidity is lessened and the motor function impaired 
during rest, whereas during sleep the acidity is still further de- 
creased and the motor function still further impaired. 

(4) In conditions of hypochlorhydria with normal motor 

} Zeivehr, f. Bie Mat vol xxi. b aah 
9 Berlin. Min, Wochonechr., 1805, No. x 


DIET IN DISEASES OF THE STOMACH. 351 


Sotitihy Us ekg ateenk to be reed eae ee ee 
remains normal during rest, whereas during sleep the acidity is 
increased und the motor function is disturbed. 2 
(5) In conditions of bypochlorhydria with diminished motor 
activity the acidity seems to be increased and the motor func- 
tion improved during rest, whereas during the acidity re- 
mains about the same and the motor ress Papa end with. 


gastric digestion is improved during rest, but impai sh 
Sei ciges iP ring paired by sleep, 


SPECIAL CURES IN THE TREATMENT OF THE DISEASES OF 
‘THE STOMACH. 


Among the special forms of treatment recommended in gas- 
tric disturbances may be mentioned the rest cure, the milk cure, 
ong cure, and forced feeding or gavage 

rest cure, first devised by eir Mitchell and subse~ 
quently especially developed by Burkhart, in Germany, for the 
treatment of gastric conditions, plays an important role in the 
treatment of stomach disorders, This treatment is expecially 
useful in cases of ncurasthenia with severe anorexia and emaci- 
ation. It is also useful in the treatment of ulcer, gastritis, 
atony, and gastroptosis. 

The rest treatment in gastric disorders should be carried out 
for from six to eight weeks. The results that follow this plan of 
treatment are often marvellous, For a further consideration of 
the method and plan of conducting the rest treatment systemat- 
ically the reader is referred to the section dealing with this subject. 

The Milk Cure.—The underlying principle of the milk 
cure consists in the ingestion of large quantities of milk, either 
alone or together with other foods. Under normal conditions, 
when taken alone in large quantities,—eay, three liters a day,— 
milk does not suffice as a food ; in certain digestive disturb- 
ances, however, milk given alone for a time forms a useful food 
and allows the stomach to regain its normal tone und functions, 
Milk is especially useful in the treatment of ulcer of the stom- 
ach and in certain forms of chronic gastritis; it is particularly 
useful in the secondary forms of gastritis, as those depending 
upon tuberculosis, anemia, ete, In some cases of nervous dys~ 

‘ja milk cures sometimes effect remarkable results, whereas 
in others milk disagrees and, as a consequence, the mille eure 


362 DIET IN DISEASE. 


can not be undertaken, When there is a diminution or an ab- 
sence of acid in the stomach, milk is usually not well borne. 
It is also contraindicated in severe cases of atony and of dilata- 
tion, in intestinal conditions accompanied by extreme flatulence 
and chronic diarrheas, 

When milk is given in large quantities in addition to other 
foods, it is more frequently better borne and is less apt to dis- 
agree. One of the disadvantages of the milk cure is the obsti- 
nate constipation the milk is apt to induce. Milk can often be 
rendered more digestible by the addition of barley-water, 
lime-water, milk of magnesia, and the like, or small quantities 
of coffee, tea, or whisky may be added to it. When milk dis- 
agrees, cream, buttermilk, kefir, kumiss, or matzoon may be given 
as a substitute for it, (See Milk Cure.) 

Forced Feeding or Gavage.—This method was first 

introduced by Debove, and consista in introducing milk, eggs, 
and meat-extracts into the stomach by means of the stomach- 
tube. It is especially useful in nervous anorexia, in which cases 
there is great danger of starvation from lack of nourishment. 
‘1 The Grape Cure.—In this form of bisa pet ire 
lives exclusively upon grapes; it is especially useful in plethoric 
individuals, in Aes it is important to diminish the weight; 
in chlorotic girls suffering with dyspepsia, and in certain cases 
of nervous dyspepsia. 


DIET IN DYSPHAGIA, 

Dysphagia may be due to any obstruction in the mouth, 
pharynx, or esophagus. The difficulty and pain induced by 
swallowing must be obviated by lessening the efforts at deglu- 
tition as much as possible ; for this reason food must be given 
in a concentrated form, and only in a liquid or semisolid state ; 
milk, egg-albumin, and the concentrated liquid beef prepara- 
tions are especially useful in this condition, In those cases in 
which food can not be swallowed in sufficient quantities the 

tient must be fed through the stomach-tube. In this way 
froth gruel, milk, and the like can be passed into the stomach, 
In very aggravated cases gastrotomy must be performed to 
prevent starvation. 


DIET IN ACUTE GASTRITIS, 
Oser has said that “every case of acute catarrh of the 


stomach has a natural tendency to heal of its own accord unless 
a chronic form is produced by a mistaken dietor wrong medica- 


DIET IN DISEASES OF THE STOMACH, 353 


tion.” Tt isa lly admitted fact that in the treatment of 
this condition the dict plays the role, The first step in 
tho treatment brerset lig Be lute rest for the stomach 
and a total abstinence from food for at least twenty-four hours. 
This procedure is sometimes very difficult to carry out, for 
many patients believe that food is necessary for them, and that 
they can secure relief more quickly by taking nourishment. 
‘The nausea and vomiting which are present in more or less 
degree in this condition, and which are aggravated by the taking 
of food, will soon convince the patient of the necessity of ab- 
staining from food, The thirst is, however, so severe in these 
casos that patients may be allowed to rinse the mouth with water 
frequently, to retain tiny bits of ice in the mouth, or even to 
drink very small quantities of carbonated waters. With this 
plan of treatment recovery generally follows in two or three 
days. After the first twenty-four hours feeding may be begun 
by giving cautiously small quantities of milk diluted with lime- 
water, broths, and egg-albumin; these can gradually be in= 
creased in quantity, and during the next day or two boiled 
er ories sweetbreads, scraped beef, in addition to toast, may be 

The authors are accustomed to prescribe the following diet 
about the second or third day after an attack of acute gastritis ++ 

















Calorion. 
TAs: 150 gm. milk with limewater. 6 oe ee 101 
oa 00 gm. egg-albumin flavored with orange- or lemonjuice . . 53 
11 aac: 150 gm. broth with ege 4 Ss 
lr ‘50 gm. milk with limewater., .. . . . 101 
Bs 100 gm: calm favored i oma EY 
101 160 Ge tlk wi Baier rors cee a : 101 
503 
After the third day the diet is increased as follows: 

+ 150 gm. mille (101) with 70 toast (182) 

2 fe ted ea PN 

200 gm. Bouillon with 1 2 ein 

+ 100 gm rice cooked in milk 

Hina (58) with 60 ackors : 340 

em. in (58) wi crac! 
i 50 gm. mille with 7 toast ie . 283 
7 vx: 100 gm. egg-albumin flavored with orange- or lemonjuice . . 5% 
146s 





"Tn comparing these diet liste alight mncies in the calorie values of 
the foods will be noted. ‘These differences have arisen from somo authors 
sing the calorie values of raw foo while others have compute the values 
of cooked foods. In the dietlists given by the authors calorie values of foods 
as prepared for the table are given. 

3 





3b4 DIET IN DISEASE. 


table, taken from Boas’ Magenkrankheiten, 
gives ae ieee ws te Bllored Lier Ge coool oe Oe 


lowing an attack of acute gastritis : 


Dict for Acute Gastritis, 





The dietetic treatment of chronic gastritis is of fur greater 
importance than the treatment of this disease by the use of 
drugs. The diet must be varied according to the stage of the 
disease, Inasmuch as the motor function of the stomach is 
usually unimpaired and only the secretory fanction affected, the 
most easily borne forms of food are liquids, such as broths; 
unfortunately, these foods do not furnish sufficient nutriment to 
sustain the patient. Their nutritive value may be increased by 
the addition of beef-extracts, eggs, barley and rice, peptones, 
somatose, etc. The diet should vary according to the character 
of the gastritis; in those cases in which the gastric secretion 
has entirely or almost entirely disappeared, protein food is 
digested with great difficulty; it must, therefore, be given in 
the most digestible form ; of these foods, scraped beef, stewed 
beef, stewed chicken, broiled steak, and boiled sweetbreads are 

ially to be recommended, Vegetables should also be given 
in the most. digestible form, best as a mush. Milk is useful in 
most cases ; occasionally, however, it is not well borne; when 
this is the case, it can be made more agreeable by adding small 
quantities of rice, potatoes, or cocoa to it, or kefir, kumiss, or 
matzoon may be substituted for it. In those conditions in 
which considerable acid still remains in the stomach meats in 
ene 5 forms are very acceptable; to this list may be added 
fish and eggs; vegetables, such as mashed potatoes, spinach, 
mashed carrots, especially in the form of purées, are to be 
Teoma. Tn all instances fat should be given in an easily 
digestible form—as good butter, cocoanut-butter, or Mehring’s 


DIET IN DISEASES OF THE STOMACH, 855 
as 


Vigor Chocolate. It is impossible to formulate exact rules 
ite mets of meals that should be eaten and the quantity 
that should be taken at each meal ; isinia general yay, ae 
quent meals are best borne. Mineral waters are 
the treatment of chronic gastritis, and the saline waters and 
ion, Bs wate of Kicoues Doulas, tanees (hege of 
these, the waters of Kissingen, Hombui oy (Congress 
Carlsbad, Marienbad, and Saratoga "Hlsthor aly 
noted for their usefulness in the treatment of sae 
Water should be taken in small quantities between meal iv 
coholic stimulants or at strong stimulants should, as a rule, 
be omitted ; when utilized, they should be given in small quan- 
eS and best diluted with iineral waters, Salt and spices 
be allowed occasionally in small quantities. 

id recommends the following diet in chronic gastritis : 
BA st: 150-200 gm. ten with 75-100 gm. of stale bread, toast, or 
WAM: 0 oes besa 38 . butter, 50 gm. cold meat, or occasionally 


ate i vine or one-third of a liter of milk. 
gm. water, nile boallon frome whe meet sos 


29, of: 
fdorb rm: Onefoorth 
ae . 
7 to8 vr. M.: 200 gm. ops ee. white bread ; 
‘one cup of toa. 
The authors have found the following dict-list useful in cases 
of chronic gastritis : 








Calories, 

8 a.m 900 gm. mill favored with tee aa ~ 186 

gm. stale bread (154) with 40 sem. butter (826). 480 

10 A.24 100 gm, vor wef (119) with 60 gm. stale aan toast pa 
(or chicken sandwich (260) or 50 gm. sherry (60) with egg (80)) 

Mart: Rouillon with emg, - 2 ee ee ee a 


ino oa. lamb chops (230) 
pas 





drm: 


7PM: 


356 DIET IN DISEASE. 


‘The following (Wegele) is the diet in chronic gastritis : 


Protein, ma ye, Ah 
8.00 6.0 7.60 





O18 208 = 0.15 
50. 
1260 0.8 18,00 
135 1.80 
21 04 16.30 
60 7.60 
018 20.8 0.15 
320 60 17.00 
800 50. 
00 80. 
9.00 0.8 = 76.70 
= on 6.00 16.0 
9.00 15 63.90 
17.20 (94.6 © 236.01 «19.0 
Calories .... 480 890 «= 970100 
Entire numberof calories . 0... . . . 2430 


Boas’ diet for chronic gastritis : 
8 o'clock: Stipe milk and flour soup (100 gm. ml 










Diet for chronic gastritis (Boas) : aa a 
8 o'clock: 200 gm. milk with 40 gm, cocoa +30 gm. sugar... . 4620 
50 fm. cakon or 50 go. swiebeck (1789). |). 4870 
10 o'clock: 50 gm, bread with = butter . 343.0 
00 gm. ealfbesin oF 100 gn. sweet 
broiled rockfish (71. 


5) 
12 o'clock : Gees gm., tapioca, 10 gm. butter 


tarde ih, 
100 sm. see (3), oe 100 gm. siewed ves, plavon, 
veninon, 100 gm. farina, omelet or egg, pancake 
3 o'clock: 10 gt i ad ih gigi fe ‘ : 1: 2 in 
343, 


Toldlock: 60 gm. wheat bread with 30 gm, butter’ 
63m hen! brad 8 | = 





DIET IN DISEASES OF THE STOMACH, 357 


DIET IN ATROPHIC CATARRH OF THE STOMACH, 
In conditions of atrophy of the gastric mucous membrane 
there is a complete absence of the gastric secretion. The con- 


can easily be acted upon by the intestinal juices, The food 
must be broken up into as fine particles as possible, and should 
to a large extent be given in liquid and semiliquid form. Of 
the liquids, broths, such as barley, rice, or chicken broth, are 
to be recommended, 

Vegetables are usually well borne; cereals should be eaten 
after the cellulose has been removed. Peas and beans strained 
and eaten as a purée, as in broth, are especially useful, 
as they contain quite a large percentage of protein, Potatoes 
and rice are to be eaten cooked with broth or milk, or as 4 mush. 
Eggs are to be taken soft-boiled. Meats must be given in the 
most digestible forms, as brains, scraped beef, boiled sweet; 
breads, and only in small amount ; raw oysters and boiled fish 
are also permissible. In very severe forms somatose and Mos- 
quera Beef’ Meal are to be added to the milk or broth. Milk 
is occasionally imperfectly digested in this condition, and cream, 
kefir, kumiss, or matzoon may be substituted for it. Butter 
may be eaten on crackers, stale bread, or toast. Such beverages 
‘as ten, coffce, cocoa, and small quantities of wine may be allowed, 

Small meals should be taken at intervals of two or three hours. 

The following diet-list, advised by Wegele, gives the diet in 
atrophic catarrh : 

Protetn. Fat. CGbany- Alco- 
Morning: 150 gm. cocoa 6,00 4,00 aa 





Evening: 

rin 

oh 
od 

at night: $ 10 gm. cognae 


BEEBe gE ecek 
ssssq 88 BESS 


358 DIET IN DISEASE. 


Einhorn’ advises the following diet in cases of achylia gas- 
trica : 





Scraped meat (broiled) or fish ” 
Baked or mashed . 





Gr. m.: ‘Two eggs (soft-boiled) 
wit . 


9.30 P.M: 


oe oe 


panier cai aeator ae 323 


DIET IN HYPERSECRETION. 


By hypersecretion i is meant a continuous excessive secretion 
of gastric juice; the condition may be intermittent or chronic. 
Tn intermittent it hypersecretion the excessive secretion 
occurs periodically and is accompanied by extreme distress. 
This d distress may often be lessened if a small quantity of milk 
or a hard-boiled egg is taken at the very beginning of an 
attack. Inasmuch as fluids in large quantities tend to increase 
the vomiting, their use atoald te prohibited. If thirst is 
severe, small bits of ice may be given or rectal injections 
administered. The diet during the interval GAs attacks is 
similar to that prescribed in hyperchlorhydria (q. 

Chronic Hyperseeretion.—In this con: Ce an excese- 
ive quantity of gastric juice is secreted continuously. In the 
treatment of this disorder all foods that tend to increase the 
secretion of acid in the stomach, such as spices, condiments, 
and stimulants, are to be proscribed, The diet should be made 
up largely of the proteins, since these foods are Sener well 
borne ; the carbohydrates are poorly di; hence must 
be given only in small quantities and in the most readily 
assimilable forms. Fluids should be administered sparingly. 
Food should be given at intervals of two or three hours. All 
forms of meats are allowable—chicken, roast beef, lamb chops, 

* Diseawes of Stomach, p. 870. 


al 


DIET IN DISEASES OF THE STOMACH. 359 


broiled steak; of carbohydrates, the best are oatmeal, zwie- 
and Nestlé’s food; purée of potatoes, spinach, 

lbs be cxton Milk, ls,ce cxtalne tone thee plasma 

may be taken either alone or mixed with tea, coffee, cocoa, or 


Diet-liat for Hypersceretion (after Wegele). 





‘The authors have prescribed the following diet in hypersecre- 
tion of gastric juice : 


8.4.x. 200m, milk favored with tea. « 
soft boiled exgs 








gm butter. | 
104. M.: 40 en rave seraped beet 
50 jm. tomst 5 

12 M.: 100 gm. broiled steak . 
or 100 gm, chicken or lamb chop 














100 gm, orrarngus ; 

orl ‘gm, of carrots (41) mashed and strained, 

or 100 gm. of pets (318) mashed and stmined, 

or 100 gm. ct trad ) 

100 goa, ale wheat] oun erate 8) ote 258 
4r.m,: 200gm. milk . . Se ee, 135 
Lsoft-boiled egg 80 
60 gm, toast... 154 
40.gm. butter) |: 826 
Tr. M.: 100 em, baked trout - 106 
100 em, mille ita 


DIET IN DILATATION OF THE STOMACH. a 


In the dietetic treatment of dilatation of the stomach it must 
be remembered that fluids are badly borne, and must, 
be given only in very small quantities—not over one to one 





860 DIET IN DISEASE. 


one-half liters a day. The fluids that are permissible are milk, 
‘cream, coffee, tea, and bouillon, all in small quantities, The 
thirst that accompanies this disease may be relieved by allowing 
the patient to suck bits of ice or by giving rectal injections of 
water or normal salt solution. Since nutrition is usually very 
faulty in this disease, nutrient enemata must frequently be em- 
ployed. When milk is administered, such substances as tapioca 
and rice should be added, Egg or concentrated meat-extracts 
should be added to bouillon to increase its nutritiye value, 
Meats should be given only in the most digestible forms ; of 
these, stewed chicken, boiled sweetbreads, calves’-brains, and 
beef are to be preferred. Vi bles, such as carrots, 
spinach, peas, , should be snieislertia the Sear oe 
nes, should be eaten stale; wheat bread or toast is 
bee Stewed fruits, such as stewed prunes and baked apples, 
are also permissible. Since fats are apt to cause fermentation, 
butter should be allowed only in quite small quantities, Alcohol 
is not to be recommended in this condition ; if it must be used, 
it is best given in the form of some light wine. Strong spices 
should always be avoided. 

‘The special feature of the treatment consists in giving frequent 
concentrated meals, Patients with dilatation of the stomach 
should be cautioned against visiting watering-places for the 
purpose of drinking the waters. 

The following is the diet-list used hy the authors in dilatation 
of the stomach : 





) 
100 gm, wwshed and strained (318) 
or 100 em, Srvbe, mashed ant stained (22) 










50 gm, sta] a a « 
WO gm. butter se ee Aen 


DIET IN DISEASES OF THE STOMACH. 361 
Boas’ Diet-lit in Dilatation of the Stomach. Calories. 
SAM: APA pats ate naa Se Me Se 


104.m.: 100 gm, flour, . 2. se » 437,00 
ie cat Hm > 149.00 








Morning: 100 gm, am ham 





Biederts Diet-tist for Dilatation of the Stomach. 

Protein. Fat. 
6 A.M: 500 gm, milk, 40 gm, toast... se 03 184 558 
8 4-241 Ostweal soup with 15 gm. atch mth qpbuiios: (SETA bisa 
10a.s4: Cream mixture (125 oo of mm and 


Rice four mush | 
“otal value, aboot 2524 calorien 








362 DIET IN DISEASE. " 
Biedert's Diet-tist for Dilatation of the Stomach, 
(More Nourishing than the Preceding List.) 


6 A m= 250 ce. milk, 30 gm- toast - 
Sam: 2 eggs, 20 gm. of toast . 
10 a m.: 125 ¢.c. cream, 2 zwieback | 
12a.: 140 gm. roast beef, venison, 

beef, or fish . 





‘Total value, about 2841 calories. 


DIET IN ATONY OF THE STOMACH. 


Since atony is frequently caused by injudicious and too rapid 
eating, persons with feeble digestive powers should exercise 
especial caution to eat slowly, masticate thoroughly, and avoid 
indigestible food. Persons suffering from atony of the stomach 
should eat amall quantities of food at frequent intervals. Since 
water is not absorbed in the stomach to any extent, it is advis- 
able that the quantity of fluids taken should not exceed 1} liters 
a day ; this amount should include all fluids—coffee, tea, soups, 
ete, If the thirst is very great, enemata of water or nutrient 
enemata may be admini: 

The use of milk in large quantities, as has been recom- 
mended, is not generally to be advised when the patient is 
able to go about, since the weight of large quantities of milk 
may overdistend the stomach ; when, however, a rest cure is insti- 
tuted, milk is commonly well borne, even in very lange quan- 
tities. The diet in atony of the stomach varies according to 
the nature of the gastric secretion. In cases of superacidity 
a liberal meat diet, consisting especially of chicken, beef, mut- 
ton, or ham, is to be recommended ; fish, eggs, hard and soft 
boiled, are also permissible ; the vegetables should be selected 
with care; carrots, peas, beans, and cauliflower may be given, 
but must be mashed and strained so as to rid them of cellu- 
lose; potatoes, rice, and grits may also be allowed. Butter 
is the form of fat best suited to this condition. Alecholio 
stimulants are, asa rule, not well borne, and their use should 


DIET IN DISEASES OF THE STOMACH. 363 


be prohibited ; in a limited number of cases alcohol in the 
form of a light wine acts as a stomachic, and may be pre- 
scribed. 

Tn those cases in which there is an absence or a diminution of 
acid in the gastric secretion the lighter forms of meat, such a5 
the white meat of chicken or fish, sweetbreads, stewed chicken, 
or raw scraped beef, should be allowed ; vegetables, on the other, 
hand, must be given in somewhat larger quantities. The treat- 
meat of the chronic constipation accompanying gastric atony, 
since it is one of the most constant symptoms, requires i hie 
mention. In the treatment of this condition the main reliance 
must be placed on the diet. Such forms of foods should be 
given as will, in the course of digestion, luce substances 
that excite intestinal peristalsis; among these foods may be 
mentioned Grabam bread, certain vegetables, such as carrots, 
beans, tomatoes, peas, and turnips, macaroni, stewed and raw 
frnits, buttermilk, honey, and cider, This form of diet will 
often overcome the constipation of atony without the aid of 
drugs, (For a more extensive consideration of the dietetic 
treatment of chronic constipation the reader is referred to the 
section dealing with this subject.) 

‘The following list has been used by the authors in the treat- 
ment of atony of the stomach : 








.: 40 gm. oringejuion . 
; 200 gm 
Lroftholled exe 





60gm. tout . 
40gm. butter... . =. 
10 a. m.: 100 gm. raw scraped beet | 2 | 
60 gm. stale wheat bread. . . 
12M: Mal pel rian ee 
or 


LANE LIBRARY. STANFORD UNIVERSITY 





364 DIET IN DISEASE, 


Dick ia in Atony of Stomach sith Hypochlorhydria.—(After Wegele) 














Moming: 150 gm. leguminose cocoa 6,0 
F oT Sttbeilel 
‘orenoan : 
00 gm. awichacl 0d 15,0 
Noon: 100 gm. ery 60 
200 gm. 27 436 
20 gm, malt ex: sis 218 
Afternoon: 160 gm. leguminose 40° 135 
rating 280 San tapioca pal BO 1k 
Hf tapioca pul Lf 
aaa dlsstata 
tmict - 5s “- 9.0 
i 50 gm. zwieback - 10 35.0 
10 0% 200 gma. mille 72 (06 
10 gm. cognac MS eines 
Toa ae 9 18S 69 
290 600670 BO 
DERE deere Weieslotensveys oar 
Eisai fe long aie aoa pb ecerctieky aca ond, Forel 
loidity.—( After 
ms my Protein, Pat, pydtes, Bok 
forming: gm. peptone coon .. 80 60 75 
50 gm. 133018 
Forenoon ; 30 gm. Og 0 
50 40 
1 50 
Noon: 120 50 
200 27 
Afternoon: 150 60 
50 133 
Evening: 120 80 
200 66 
10 o'clock: 100 Bi 78 
Daring the day: 50 “16 as 
TAT iu 
‘ 700 55 
Entire number of calories... . . 1800 
Diet-list for Atony of the Stomach, ax advised by Boas. 
Calories, 
8 4.2; 100 gm. mill nnd tea, 50 gm. wheat bread, 30 gm. batter 401.2 
(in constipation, 80 Ik). 
WAM: So ae eel brea bute and apt arane ara er 
‘or broiled wraee) ar or 60 gm, ham (262.2) 
12m: gr, cool gm. opens Seer ae 430.3 





DIET IN DISEASES OF THE STOMACH 365 


DIET IN ULCER OF THE STOMACH. 


Prophylactically much can be done by a carefully selected 
diet to prevent the onset of an ulcer of the stomach, As soon 
as the very first symptoms become manifest, the patient should 
be upon an absolute milk diet. The temperature of the 
food should be regulated, so that it be not given too hot or too 
cold, Anemia, which so frequently accompanies the disease, 
must be combated ; hyperchlorhydria, which is so important an 
etiologic factor in this condition, must also be overcome, 

Boas? divides the treatment of ulcer of the stomach into 
several stages : 

Stage of Hemorrhage.—In this stage Boas advises absolute 
rest im bed ; the patient not being even allowed to arise for pur- 
poses of defecation or urination. No nourishment whatever 
should be given by the mouth. In robust individuals even nutri- 
ent enemata may be omitted. If the patient is weak or in feeble 
condition, feeding by the rectum may be instituted. (See the 
section on Nutrient Enemata for the method of preparation 
and utilization of this mode of feeding.) Only two or three 
nutrient enemata are to be given daily. Boas carries out this 
plan for three or four days. After this he gradually begins 
mouth-feeding, the nourishment consisting exclusively of fluids 

iven at a temperature of 98° to 100° EF. He prefers milk 
erated swith, liveowates) wiehitea; or fll cofiee. w Teaclatilan 
he permits beef-tea, freshly expressed or artificial beef-juice, 
and egg-albumin. The carbonated waters, such as Vichy, are 
also useful. 

After the first week Boas begins the regular Leube and 
Zicmssen ulcer treatment, which he conducts as follows: The 
patient is given } liter of Carlsbad water, which he drinks in 
bed morning and evening. Hot-water applications are placed 
on the abdomen. ‘The diet during this stage consists mainly of 
milk in addition to other fluids. If the patient is very weak, 
Hiitrient enemata may occasionally be given. 

Th the treatment beginning with the third and continuing 
during the fourth week Boas permits the patient to recline on 
a couch, and continues the use of the Carlsbad water, which 
should be given for four weeks from the time it is first 
taken; he advises that the diet still consist mainly of milk, 
altho he now permits the addition of soaked zwieback, 

crackers, and soft rolls, Meats (sweetbreads, brains, 
1 Magenkrankheiten, p. 5t. 


| 


366 DIET IN DISEASE. 


meat balls), fish (perch, oysters in small quantities), in addi- 
tion to the light red wine and carbonated waters, are also 
allowed, 

After the fourth week, if the patient is doing well, Boas adds 
from 50 to 200 gm. of mashed potatoes, stewed fruits, and 
vegetables, such as spinach, carrots, and turnips, in the 
form of purées, to the diet previously given. The meats— 
broiled steak, chops, and roast beef—if well cooked, can finally 
be given more liberally. According to Boas, the patient should 
avoid raw fruit, acid and highly seasoned foods, and also very 
hot and cold drinks, for many years, Even in those 
cases in which there has been no hemorrhage Boas nevertheless 
advises the rest treatment, It is generally admitted that the 
rest cure is the only satisfactory plan for treating cases of ulcer 
of the stomach. Leuhe and Penzoldt have devised dietaries 
for these cases; these have been given elsewhere (see p. 341 
The first dietary should be followed for ten days; the secon 
for the succeeding ten days; the third, for about eight days. 
The severity of the condition in each case must, of course, 
determine the length of time during which each dietary must 
be continued. In all instances milk seems to be the most useful 
form of food during the first weeks of this rest treatment. 
This plan was carried out many years ago by Cruveilhier in 
his treatment of ulcer of the stomach. Occasionally milk does 
not agree, and substitutes must be given in its stead. Of these, 
buttermilk, kefir, matzoon, and kumiss are especially to be 
recommended. Among other preparations that have been found 
useful as foods are the well-known Leube-Rosenthal beef solu- 
tion, as recommended by Leube and Rosenthal, and chicken 
and calves’-foot jelly, as advised by Fleiner, 

In those caves in which milk is not well borne Deboye sug- 
geeia that the milk: be pamed into the stomach through the 
stomach-tube. He found that when given in this way the milk 
was not vomited. Bonveret also recommends this mode of 
feeding in intractable cases of ulcer. 

There are a number of cases of ulcer of the stomach that do 
not yield to the ordinary rest treatment as outlined by Boas, 
Lenbe, and Penzoldt. Donkin* firet directed attention to the 
fact that excellent results could be obtained in this class of 
cases by exclusive rectal alimentation. His treatment extended 
over twenty-three days; since then McCall Anderson? and 
Boas* have obtained excellent results by this plan of treat- 


1 Lancet, 1890, * Brit, Med. Jour,, 1800. * Magenkrankheiten, p. 00. 


DIET IN DISEASES OF THE STOMACH, 367 


ment in obstinate and recurrent cases of ulcer of the stomach ; 
Riegel, too, approves of this plan. Boas carries out exclusive 
rectal alimentation for at least ten days; be then allows fluids, 
such as milk, tea, bouillon, red wine, for some days, and fiually 
permits the patient to resume his usual dict. 

‘There are a certain number of light forms of ulcer of the 
stomach in which it is impossible to carry out the rest treat~ 
ment. In such cases Boas advises an ambulatory treatment 
together with the use of silver nitrate. The silver is admin- 
istered in solution on an empty stomach in from } to } grain 
doses; at the same time a carefully regulated diet is given. 
The food consists chiefly of milk and other fluids; in addition 
he allows tender meats and fish, mashed potatoes, and vegetables 
in the form of purées (cautiously), all in moderate quantities. 

Mineral waters are often utilized in the treatment of ulcer 
of the stomach ; of these, Carlsbad waters have been especially 
recommended, but Saratoga (Hathorn) can also be used with 
benefit. The mineral water treatment should be undertaken 
only at the spring, after the ulcer has healed, and after the 
patient has undergone the rest cure. The treatment at Carlsbad 
or Saratoga will often prevent the possibility of relapses. After 
the ulcer has healed, it is important to overcome the anemia 
which is usually present in most cases of gastric uleer, This 
may be accomplished by means of the diet (see Dict in Ancmia) 
as well as by sending the patient to some invigorating watering- 
place or to the mountains, Tron and arsenic should also be 
given to overcome this condition. They should not, however, 
be prescribed until the ulcer is healed. 


DIET-LISIS OF WEGELE FOR ULCER OF THE STOMACH. 
Diet I—To be followed. at least ten days. 
‘Protein. 










Morning: 9.00 120 
110 0.50 7.8 

10 ofelock: 9.00 120 
060 0.25 B7 

12 ofelock: 180 gm. pabetie - 075 045 09 
; meat solution (or eg) - 300 35 

4 delock: [80 800 120 
0.50 73 

mH r 04509 

50 gm, meat solution or lege. - 840 200 8B 

2 cakes 110 050 78 

Total. . 35.65 704 

Calories 830-390 


368 DIST IN DISEASE, 
Diet Ii —To be followed ot least seven days. 





oon ; a 
Calories... 350300 
Entire number of calories... . . - - 1100 
Diet IL—To be followed at least five days, 
Protein, Fat, 04rataa 
Morning: — 2 cups of tea or collee with 100 gm, 
of milk... : 84 


10clelock : 200 gm. bonillon - 
Legg 










N 200 up st . 2 bt 170 
Foon = soup. . Af 
150 fen. beoktenk a0 220 

300 gn. mashed pot 31 085 «83 
A'clock: fcr tea with 100 gm. 4 3.60 i 
aeakee. ss: ‘ il 

12.0 

196.7 


Calories 22) 25.) 350 | $80 520 
Entire number of calories... 2... . 1250 


Diet IV.—To be followed at least one week. 
Protein. Fat. yrdiaten, 





~ 60 
32 60 170 
76 140° (17 
1.0 02 8.1 
20 «684 45.0 
34 36 48 
- 0.5 -» 182 
45° 05 29.0 
32 28 
70 50 8.0 
85 90 _120 
20.5 63.0 199.0 
Caloris»... = 495 © 585 815 
Entiry number of calories... . . . 1900 





DIET IN DISEASES OF THE STOMACH, 369 


‘The following list, taken from Boas’ Magenkrankheiten, gives 
Ria eee en tices ot the stomach : 














3: Soup of 
Daring the dayt 1 litee mi 
Seeond. week, 
‘The same diet with the addition of 100 gm. xwieback, 
Toth seer ene enn eer awene 
Third week, cna 
8A. st: 200 gm, mille. bie ae + + 185.0 
‘50 gm. ewietack » | ‘ - 178.9 
ee ee 
Fee Spe 2135.0 





12 cfclock : Soup of 
100 gm. 


50 
Tx m: 60 gor Jean bam. < : 


Lenhartz' recently cautions against the strict abstinence diet 
in the treatment of ulcer of the stomach, even in those instances 
in which there is hemorr! He bases his conclusions on 
the fact that since ulcer of the stomach is most frequently 
accompanied by superacidity and also by an enfeebled condi- 
tion, it is best to give protein food early to overcome the ean 
as well as to build up the system, The accompanying table 
illustrates his method of feeding. 





Day after last he- 
tatemeis.-. 1 2 8 4 5 & 7 8 9 DM 2 BW 
aaa Passer ee eg sg ee 
Sunt “aon 300 4? sit oi 700 ei O68 1080 Yon 1000 role oho 108g 
Raw sofaped beet B 2xB5 2X BKB IX 2xR IXH OAR 2H 
rice 109 10) 299 200 00 900 900 300 
soo »*© © © © 100 

: » 0 #4 40 

‘20 490 657 7709 1185 HRB ITAL uN 2H on GON MOT BOT 

The and milk are given ice cold and in teaspoonful 
doses. By means of this method he has treated 60 cases with 


* Deutsch. med. Wochenschr.. 1904, No. 11, 


370 DIET IN DISEASE, 


‘ifying results. In those instances in which there has been 

orrhage the patient is kept in bed for fourteen days, and 
an ice-bag is placed on the abdomen for ten days. This same 
observer also advocates the use of large doses of bismuth. 


GASTRIC HEMORRHAGE. 


As soon as hemorrhage from the stomach occurs, the patient 
should be put to bed and not allowed to rise, even for pur- 
poses of defecating or urinating. A light ice-bag should be 
placed over the region of the stomach, and no food or drink 
whatever should be allowed; in order to quench the thirst 
small quantities of ice may be given the patient to suck. 
Nourishment must be entirely by the rectum ; but even this is 
usually unnecessary for the first few days. In order to combat 
the weakness following great loss of blood salt solutions may 
be injected into the rectum, or if the patient is very weak, 
coffee, meat-juice, or whisky may be added to the enema. In 
very grave cases salt infusions must be resorted to. 


DIET IN CARCINOMA OF THE STOMACH. 


Boas divides the treatment of cancer of the stomach into the 
treatment of cancer of the cardiac portion of the stomach and 
that of the body of the stomach, 

In the treatment of cancer of the cardiac portion of 
the stomach the diet should be such as will prevent, so far 
as pele any irritation of the diseased and stenosed esopha; 
and stomach. Solids should, therefore, be avoided. Milk is 
the food that is usually best borne in this disease. It can be 
rendered more nutritions by the addition of somatose, Nestlé’s 
food, eggs, and the like. Besides this, broths of all kinds, 
cocoa, milk with tea or coffee, or buttermilk may be given, 
Mehring’s Vigor Chocolate is useful for supplying fat. 

As soon as difficulty arises in swallowing liquids, gastrot- 
omy should be performed, in order to supply the nourishment 
which it is impossible to pass in through the esophagus. If 
this procedure is deemed inadvisable, nutrient enemata may be 
reeorted to. 

In the dietetic treatment of cancer of the body of the 
stomach milk likewise forms the most important article of 
diet. The more easily digestible forms of meat, such as sweet- 
breads, scraped beef, brains, and stewed chicken, are permis- 


DIET IN DISEASES OF THE STOMACH. 871 


sible. In this disease there is usually a distaste for meat, and 
fish may be substituted for it; of these, boiled mackerel, rock, 
haddock, or trout are to be recommended, Of the 


valuable forms of food. Milk with tea, coffee, or cocoa, or 
wine or whisky, may be given for the thirst, Fl 

veers He taken in een be ae Mehta Vigos 
Bu) necessary quan! it, butter or 8 
Chovclate is to be recommended. In these cases it is 
important to promote the general nutrition by means of rectal 
alimentation. In cases of cancer of the stomach too abundant 
a diet should not be insisted upon, a4 at best but little can be 
gained by this method of treatment, 


Diet-liat for Cancer of the Stomach, as given by Boas. 
Sam: 100 gm. milk and tea (79 50 gm. xwiebuck (174.8), 10 
¢ ne 












gm. butter 
10... 100-gm. broiled 
50 gu. toasted 2 
or 100 Sahel brain (140), sweetbrend (90), 2 
12 ook 150 gos milk advice rary = 260.00 
50 gm. » 126: 
Bex: 100 gm. 
7PM: 100 gm 
50 gm. 
9 50 gm. 
Total 
Diet-list of Wegele for Cancer of the Stomach, 
Albumin, Fut, CRM Ale 
Morning: inose cocoa 6.0 4,00 13.5 
Forenosa! E> Caner rass 66 450 88 10 
Noon : 4.0 0.1650 98 
ton 20.0 6.00 
Afternoon 60 4.00 13.5 
Evening 25.0 8.00 
70 5.00 80 
10 o'clock ‘gm, ket 66 450 38 
with the coon, 30m. honey. . O4 


with the kefir, 20 gu. cognac 
During the day: “00'gm. awlebeck”, = + 
Total... 











372 DIET IN DISEASE. 


The authors have found the following diet-list useful in many 
cases of cancer of the stomach : 





8A. Mi: 150 gm. milk with toa 
tonet . . 


Ie . 30. 
etna cerns = 
or NO] oe « 6 BE 

0mm bater S83 Lot) Bio 





DIET IN GASTROPTOSIS AND ENTEROPTOSIS, 

While the treatment of gastroptosis and enteroptosis is mainly 
mechanical,—requiring the use of well-fitting abdominal band- 
ages, massage, and electricity,—much can be accomplished by 
proper care in the diet. Remarkable results are frequently 
obtained from rest cures, the patient being compelled to remain 
in the recumbent position for a long period of time and to take 
large quantities of food. Patients afflicted with these conditions 
should lie down after eating. The diet should be very nourish- 
ing, and should contain somewhat large proportions of fatty 
foods. Milk is an excellent food in many cases, and, where 
it is well borne, may be taken in lange quantities. When mille 
is not well borne, solid foods must be administered. Of these, 
all forms of digestible meats can usually be allowed, such as 
chicken, roast-beef, broiled steak, and lamb chops; fish of 
various kinds and digestible vegetables are also permissible ; of 
the vegetables especially to be recommended are spinach, car- 
rots, asparagus, and cauliflower ; of the fats, butter, cream, and 
Mehring’s Vigor Chocolate are particularly useful. 

In order to overcome the severe constipation accompanying 
these conditions, foods that excite intestinal peristalsis are espe- 


DIET IN DISEASES OF THE STOMACH. 373 


cially to be recommended; among these may be mentioned 
cider, buttermilk, grape-juice, fruits, and honey. 


DIET IN NERVOUS GASTRIC DISORDERS. 


Nervous Anorexia.—tIn this condition it is important to 
isolate the patient from his family. Milk, in gradually inereas- 
ing quantities, and, if possible, other foods, should be given. 
Tf the patient does not take sufficient nourishment, nutrient 
enemata should be administered, or the patient may be fed by 
means of the stomach-tube. The food should be given in as 
concentrated and nutritious a form as possible ; for this purpose 
eggs are suitable. Somatose should be added to the milk, 
Frequently eases of anorexia are completely cured by a well- 
regulated rest cure of from six to ten weeks’ duration, 

Nervous Vomiting.—This is often overcome merely by 
isolation and change of scene. In severe cases patients should 
be placed in bed; they are. best fed on semisolid or liquid 
food, since the latter is more easily retained than solid food, 
It should be given in very small quantities ; scraped beef, 
rice, and toast are especially useful. Cracked ice will ohen 
afford relief, The most indigestible forms of foods are fre~ 
quently well borne when the most digestible are speedily 
vomited. In severe cases the patient should be fed for some 
days exclusively by rectal alimentation. 

Nervous Subacidity and Anacidity.—The food should 
be given in smal] quantities and frequently. The diet need not 
be limited to carbohydrate food, but should be a mixed one, 
since the intestine takes up the work of the stomach in di 
ing the protein food, A more extensive description of the diet, 
to be used will be found in the section on the Diet in Achylia 
Gastrica, 

Dict in Nervous Dyspepsia.—In this condition the diet 
should not be too restricted. Strengthening food, without any 
attempt at « too rigorons diet, should be prescribed. In those 
cases in which milk is well tolerated it should be given in large 
quantities ; when it is not well borne, buttermilk, kefir, or 
kamiss may be substituted for it. The patient’s appetite should 
be humored, and he should be allowed to eat any food he can 
digest. Alcoholic stimulants should be prohibited, or given 
only in very small quantities, In severe cases a well-con- 
ducted rest cure will produce the best resulta. 


374 DIET IN DISEASE. 
Diet ax Recommended by Burkart for Nervous Dyspepria, 
(Por the first six days of treatment.) 


plate of soup with 1 egg, 50 gm. broiled meat, and mashed 
86, it 
_ pomatons. 





Diet aa Recommended by Burkart for Nervous Dyspeptia, 


(For ninth to fifteenth day of treatment.) 
7.80 A.M: (Pt 
8.90 A.M. = and bread and butter, 
mae liter milk and 2 zwieback. 


Jiter milk. 
ip with egg, 100 gm. meat, mashed potatoes, 75 gm. prunes, 
es 





ii ml 0 at, bread and bat 
iver oni meat, tter, 
liter mill 2 swiebuok: 


Sr. 
9.30 r. M.. 


Diet as Recommended by Burkart for Nervous Dyspepsia, 
(After the fifteenth Day.) 







80 cold 
Gases Miliots « s 
20 gm. butter 
100 gm. baked potatoes 
10. xt: 900 gm. milk . 
‘oon: 300 gm. milk 10: 
200 xm. soup - 4 
200 gm. 3 5 
1 P. 9, 200 gm. potatoes I 
‘126 gm. prunes os 
200 jem. of fri r 0 
3.0 P.x.: 500 gm. milk , 0 
300 gm. milk . i 4 
5.30 9a: 80 gm. cold mont 20 
milk-toast. . 05 29.0 
20 gm. 166 OL 
Bru: 80 gm. 20 
40 gm. 52 382 
500 gu. 182 24.0 
9.30 Fr. at: 500 gm. 182 24.0 
20 gm. 26 166 
199.8 2 


DIET IN HYPERCHLORHYDRIA OR HYPERACIDITY, 


By the term hyperchlorhydria is meant an increase in the 
secretion of muriatic acid in the stomach. In the treatment of 


DIET IN DISEASES OF THE STOMACH. 375 


thoroughly par Paer pve pres neste ge =< 
too hot. The class of foods that seem to be best suited are the 
proteins, since they combine with and therefore neutralize the 
souls of see oe tbls sow gee Wie ees fet abundance 
of protein, such as eggs, meat, may iven quite 

ly ; carbohydrates should be administered in fp 
and in the most digestible forms. 


Fleischer's Table» showing the Power of Foods to Combine with HOt. 


Monts (100 grams). PureHcL Fe Opa ea id 
os 2.60 5.20 
3,20 6.40 
3.60 7.20 
4.00 
4.40 8,80 
5.20 10.40 
6.40 12.80 
7.20 14.40 
7.60 16.20 
7.60 15,20 
16,00 
8.80 17.60 
8.80 17.60 
0.40 0.80 
144 2.80 
120 
1.20 248 
2.00 4.00 
5.00 
4.00 8.00 
5.20 10,40 
5.00 14.20 
6,80 13,60 
6,80 16.80 
6.40 16.80 
10,40 20,80 
16,40 32.80 





Fleischer has investigated the subject of the combinin, 
effect of muriatic acid with various foods; he diacmical 
that beef, veal, ham, and mutton bind twice as much mu- 
riatic acid as do calves’ brains and sweetbreads; the first- 


* Krankheiten d. Speiserohr., d. Magens, us d. Darmes, 1896, p. 98% 


376 DIET IN DISEASE. 


named class of meats are therefore most suitable in conditions 
of hyperchlorhydria. In addition, Fleischer mentions the fol- 
lowing articles of foods capable of binding large quantities 
of muriatic acid : re cheese, sausage, ham, Graham bread, 
milk, and cocoa. inaceous foods are not well tolerated in 
this condition, and must be given either in a very digestible form 
or, best, combined with protein food. Only the more digestible 
vegetables are to be allowed, such as mashed potatoes, spinach, 
asparagus, peas, and carrots, strained and eaten in the form of 
purées, Fats tend to leasen the acidity of the gastric secretion, 
and are therefore to be recommended ; they are best given in the 
form of butter, cream, olive oil, and the like. Of the fluids, alka- 
line mineral waters, such as Apollinaris, Vichy, and Seltzer, are 
especially useful ; the carbon dioxid contained in these waters 
produces a sedative effect and lessens the secretion of acids, 
These waters may be used to dilute milk or wine. The table 
on p. 375, taken from Fleischer, shows the ability of various 
to combine with muriatic acid : 

Tn arranging the diet for patients with hyperchlorhydria it has 
been found best, in the authors’ experience, in dealing with pa- 
tients taking but little nourishment, to allow them to eat at 
frequent intervals; if, however, large meals are consumed, it is 
advisable to permit only three meals a day, allowing the stomach 
to rest during the intervals, 

The following dict has been used with advantage by the 
authors in cases of byperchlorhydria : 


8am: 200 
2 eoft-| 





104,x.: 50 gm, sherry (60) with 1 ogg (80 
12 set, 100 gr chickan (cx broiled sect ot 







Ana: 150¢m. milk . . 
50 gm, crckes 


Sgm. butter... “i 
Tx.m: 100 gm. milk flavored with tea 
1 soft-boiled 





DIET IN DISEASES OF THE STOMACH. 377 
Dict-list for Patiente with Gustrio Iyperacidity.—( Biedert.) 


Sone, et See 
SE ti ta: tees eae ieee 
of ‘Btn. toast» 184 BBB 488 
In the ga 10 odock: 70 gma, of broiled 
of towed without the 
it) or beefiteak 
ewieback 





















arin ws... O8 
x(a ow esta 
. 
De ee rae) Nat Ree) aE 
ete Cie Te 
One small cup of black coffee. 
In the aftemigon at 4 ofelock: 250 gm. of milk 
cocoa, 3 zwieback 135 158 448 885 
Tn the evening at 7 tel: 70 un of cold, 
meat wit em. meat, . 
Z pee Sere ee oc 
20 gm. of Swies or Dutch checee . ye »_ 54 1 0.5 _ sl 
Tol... +s. sees s+. 106B 088 1880 2508 
Diet-list for Hyperacidity —( Wegeie). 
Protein, Pat, GMS Alco 
Morning: 100 em, tea with milk... 24 96 48 
Qraftboilederm.-- 5.2 120 100 
Forenoon: 100 gm, raw ham" - 0 80 
a 20 185 | 17 
200 gn. Aleuronat’ meat broth 
(dog. Aleurona to 200breth) 
o 
20 gm, catmeal to 250 broth) . 102 17 80 
Noon: etna yee oF BO 
200 gm. mashed potatooe - | | 
100 gm. white wine with Sam- 
a6 50 
Afternoon: 36 
gm. 20 135 LT 
Evening: 50pm. cold meat wo2 40 
scrambled eggs, 100 gm. wine a5 80 
Atcosel staeel 100 pe diene toa oes BS LS 667 
To geleck at) 50 gm. milk vw ee 85 9.0 120 


Total. 





378 DIET IN DISEASE. 


DIET IN INTESTINAL DISEASES. 


The diet. quite as important a role in the treatment of 
diseases of the intestine as it does in the treatment of gastric 
disorders. In many intestinal disturbances, such as acute in- - 
testinal catarrh, diarrhea, ete., cures can often be effected by 
diet alone, when without this mode of treatment the disease 
might become intractable. ‘The diet in intestinal diseases, as 
in gastric disorders, must be such as will produce no annoying 
symptoms. The process of digestion in the intestine is ex- 
ceedingly complicated, and therefore the digestibility of foods 
in this part of the alimentary tract is most difficult to deter- 
mine. This subject was lied by Riibner,' who determined 
the of absorption of various foods in the intestine. 
‘The following table gives his results : 

















Mg ae Absorbed in percentages of— 
2/3 | a3 
viHli|, Hl. 
a 2) a B | a| 4 
376 | 95 7 9 |... 82 
247 | 95 | 97 | 95 |... | 82 
315 | 92 |94-99)95-97) 100 | 51 

94 96 97 | 100 4 
753 | 9 | a1 |... | 99 | 98 
765 | 85 68 ne 89 ot 
626 | 83 4 9 76 
641 | 93 | 85 | 8 | 97 | 70 
780 | 96 93. 91 96 81 

96 80 8 99 85 
sar | o1 | 8s |... | 06 | 68 
819 | 91 68 6 92 bd 
406 | 85 | 82 | 92 | 86 | 81 
g52 | 79 | ot | of | s2 | 76 














It is thus shown that certain forms of foods contain very large 
proportions of protein matter, but that their absorbability is so 
slight that their nutritive value is far lower than that of foods 
containing less protein, Thus, while peas contain considera- 
bly more protein (7 per cent.) than does milk (3.7 per cent.), a 
much smaller proportion of protein is absorbed in the case of 
the former than in that of the latter; on the other hand, the 
absorbability depends greatly on the mode of preparation of 
the food ; when vegetables are mashed and then strained so as 

1 Zeilechr. fs Biologie, vol. xt.) p- 116. 


DIET IN INTESTINAL DISEASES, 379 


to rid them of their cellulose envelopes, they are much more 
readily absorbed than when eaten with the cellulose. The 

ligestibility of certain foods in the intestine varies greatly with 
different individuals, For this reason exact rules cannot be 
formulated in any case, but the dict must be varied according 
to individual peculiarities, Boas! has expressed his opinion 
on this subject as follows : 

“1, Ina number of intestinal diseases a change of diet is 
‘unnecessary or may even be harmful. 

“2. In some cases special dietetic restrictions are directly 
indicated, but these should be as few as possible, 

“3, In another series of cases an abundant, heavy, not 
easily digestible or absorbable diet is indicated. 

“4, The general aim of our treatment should always be to 
50 manage the case before us that digestion of a normal dict 
will always occur in the alimentary canal without any subjoo- 
tive or objective disturbances. Under these circumstances only 
can the case be considered cured.” 

According to their effect on intestinal peristalsis, foods may 
be divided into three classes: those inducing constipation ; 
those producing a laxative effect, and those exerting no especial 
effect in either direction. In the first class are those foods 
containing an astringent, such as tannin ; among these may be 
mentioned certain red wines, cocoa, and tea. Rice, tapioca, 
barley, sago, macaroni, and potatoes have a tendency to pro- 
duce constipation in many individuals. 

Among the laxative foods may be mentioned fruits and cer- 
tain vegetables, as cucumbers, tomatoes, and cabbage; cider, 
buttermilk, beer, and the carbonated waters also exert a laxa- 
tive effect, 

In the third class, foods that have no especial effect on the 
intestinal movements, may be placed meats, fish, eggs, toasted 
bread, and zwieback. It must be remembered, however, that 
certain foods that prove laxative in one individual may be con- 
stipating in another, so that no precise rales can be formulated ; 
in each case individual tendencies must be consulted. 

Tn severe forms of intestinal disturbances rectal alimentation 
must often be resorted to. For a further consideration of the 
technic and forms of food to be utilized in this method of feeding 
the reader is referred to the section on Rectal Feeding. In those 
cases in which food cannot be given either by the mouth or by 
the rectum subcutaneous feeding becomes necessary ; for this 

+ Diseases of the Intestines, p. 141. 


380 DIET IN DISEASE. 


purpose olive oil may be used; one ounce may be injected 
twice daily under the skin, best in the region of the thigh; in 
some cases normal salt infusions are indicated. 





DIET IN INTESTINAL DYSPEPSIA, 


In intestinal dyspepsia food should be given frequently and 
in very small quantities. At first only the liquid forms should 
be used, such as weak tea, peptonized milk, malted milk, 
bouillon, and egg-albumin ; after a few days the patient may 

ually be placed on the following diet : calves’ brains, sweet- 

reads, broiled steak or lamb chops, soft-boiled boiled 

fish, such as mackerel or rock, baked potatoes, spinach, aspara~ 
gus, and stewed fruits, 

The following list Bives the general plan of a diet used by 
the authors in this condition : 


sci, | 100 gm, scraped beet (118 
10 ant: Sorapodbeet sandwich { 13) Ki wel {ira <j-sp Sae 
12a: Bouillon with 5 gm. Armour's Soluble Beef... 1... 10 
100 gm, broiled chicken.) 6 ee se ee ee ee 106 
for 100 gm, broiled steak (200), 
fF 100 gn, lamb chop (220 
50 gm. mashed potatoes or 
100 gm. applosauce . 
50 gm. w 












one ; 
100 gm, wheat bread and 50 gr. 


DIET IN ACUTE INTESTINAL CATARRH. 


As in acute gastric catarrh 0 also in acute intestinal catarrh 
the regulation of the diet is probably the most important factor 
in the treatment of the disease. The patient should be kept in 
bed ; after the bowel has been thoroughly emptied by a cathar- 
tie, liquid foods, such as clear broths,—at first without, and 

with eggs,—thin els, light tea, cocoa cooked in water, 
and egg-albumin, should be given exclusively for several days, 
In this condition milk should not, as a rule, be given, When 
there is extreme thirst, the carbonated waters may be allowed, 
but only in small quantities. The thirst is best relieved by 
placing bits of crushed ice in the patient’s mouth. After the pain 
and discomfort have disappeared, toast, crackers, stewed chicken, 


DIET IN INTESTINAL DISEASES. 381 


DIET IN CHRONIC INTESTINAL CATARRH. 


The dietetic treatment in chronic intestinal catarrh depends 
upon the condition of the fecal movements; these are, in a 
measure, an index as to the portion of the bowel involved. 
According to Nothnagel,' cases of chronic intestinal catarrh may 
be divided into four groups ; 

“1. Cases characterized by pronounced constipation. An 
evacuation appears only once in two, three, or four days ; some- 
times only with the aid of catharties, The fecal matter is 
usually hard. As a cause of the constipation, Nothnagel as- 
sumes a decreased activity of the automatic nervous apparatus 
of the intestines, this being the result of the catarrhal process. 

“2, Cases in which constipation and diarrhea constantly 
alternate. For two or three days there may be a daily evacua- 
tion of very hard dejecta, On the following day there may be 
four to six very thin or mushy movements mixed with mucus, 
accompanied by violent pains, and then again constipation for a 
day or two, ete, Or there may be quite a normal evacuation 
(once daily) for a few days in succession and then again four to 
seven diarrheal movements in one day, and after this constipa- 
tion. The principal feature of these cases is the constipation, 
but the excitability of the nervous apparatus being quite good, 
the decomposed stagnant contents often cause increased peri 
talsis and diarrhea. Sometimes these alternating periods of 
constipation and diarrhea continue for a long time. Thus the 
patient may be constipated for four or five weeks, or even for a 
few months, and then again the diarrhea may set in, lasting 
several weeks or months. 

“3, In a very limited number of cases there is a daily evac- 
uation, which is usually not formed or mushy. 

“4, Cases in which there are for months several diarrheal 
evacuations daily. The dejecta, as a rule, show the biliary re- 
action, or they may contain yellow fragments of mucus, yellow- 
tinged epithelium, and round-cells, Tn these cases the eatarrhal 
process affects not only the large bowel, but also the small in- 
testine. The absorption suffers, and there are more abnormal 


1 Speoiclle Pathologie und Therap, vol. xviiy p. 119, 


382 DIET IN DISEASE. 


products in the contents (acids), which give rise to increased 
peristalsis in the small as well as bowel.” ? 

The treatment of chronic intestinal catarrh therefore resolves 
itself into the treatment of the accompanying chronic consti 
tion, chronic diarrhea, or a condition of constipation alternating 
with diarrhea. 

Diet in Chronic herr cane this condition a 
mixed diet, containing, 80 ‘ible, those substances 

rel should be prescribed. 


The alow foods should be prescribed in cases of chronic 
consti raham and rye bread with butter, fruit, butter- 
milk, ae cide, beer, fresh vegetables, as cabbage, sauer-kraut, 
and salads. Fats are especially to be recommended, and honey 
is also useful. Salts stimulate the intestinal movements, there- 
fore foods containing salts are indicated in this condition ; among 
this class may be mentioned herring and caviare. Sugar, espe- 
cially milk-sugar, has a marked tendency to increase intestinal 
peristalsis. Water taken cold or on an empty stomach will also 
stimulate intestinal movements, 

Chronic Diarrhea.—When severe symptoms, 
such as intense diarrhea and pain, present themselves the 
patient must be put to bed and ey ‘on a very rigorous diet ; 
the period of rest may be lengthened or shortened according to 
the severity of the disease. In moderately severe cases several 
weeks will usually suffice. Nourishment should be taken in 
small quantities every few hours, sufficient must, however, be 
given to maintain the body weight. All cold drinks or carbon- 
ated waters, fruits, cabbage, and salads are to be avoided. The 
moet suitable foods in this disorder are broths containing barley, 
rice, and farina, soft-boiled eggs, eweotbreads, stewed chicken, 
broiled steak, boiled fish, toast, crackers, baked potatoes, tea, 
milk (boiled), and cocoa ; in many cases port wine is quite use- 
fal, as it contains tannin, which acts as an astringent to the 
bowels. In this condition milk even when boiled is often not 
well borne, and must then be avoided. 

The following dict-list, taken from Boas,? illustrates the method 
of prescribing nourishment in chronic catarrh of the intestine 
accompanied by diarrhen : 

+ Einhorn, Diseases of Intestines, p. 100, 
* Dimases of the Inteatines, p. 224. 


DIET IN INTESTINAL DISEASES. 383 


Sam: ey ver (O30 gu) wn rome) owt 
Wa. m: tory Cray aire eae e oan 
Bed Sal or old mentee malt or strongly pickled 
PM of oatmea}, farina, or cornstarch, etc. 
DL gel pba gelato ‘omatdee forbidden). Tn 


( 
ebony th saochadin 
i ee 


ae, 
Green ii fe 
nod disk (eae: te Ca 0 ® gm) fom ‘mot lores 
Ferrel Dade Sie a ee oh erkern, 


th little yolk of ewe and. saecharin 
steko) s : 


As ber Simaraba 
wing Derdane (Gree wines wa einlojeed SeaepanE 
AyM: Lreistee milk) with enccharin or cocoa, cakes, toust, zwieback 
red 
7 tes Bersoad goed ret (citicen} eal) Bll ca ween aE NEO EY a 


9 Ove gl of Temonad wmed or hot mulled wine 
nM: al of, hucklebery cae EY. or m 


In conditions of chronic intestinal catarrh in which 
diarrhea alternates with constipation the same plan of 
treatment may be followed as bg ts ving 
accompanied hy constipation or diarrhea ; it is expecially imy 
tant to treat by diet the more prominent symptoms, w ether. ‘t 
be diarrhea or constipation. Mineral waters are frequently 
utilized in cases of chronic intestinal catarrh, For cases 
accompanied by constipation the waters of Marienbad and of 
Saratoga (Congress ot Hathorn springs) are most beneficial. 
‘Where diarrhea is the prominent symptom, Curlsbad and Vichy 
are to be recommended. 


DIET IN DYSENTERY. 

The diet in acute dysentery is similar to that prescribed 
in acute intestinal eatarrh. The patient is put to bed and only 
liquid foods are administered. oF these the most suitable are 
bouillon, broth, egg-albumin, and tea ; gradually, as the con- 
dition improves, semisolids, such as milk-toast, rice cooked in 
milk or broth, gruels of tapioca, etc., may be prescribed. Solid 
food should be abstained from until a few days after the disorder 
has abated, 

In chronic dysentery the food should be given in small 


384 DIET IN DISEASE. 


juantities at frequent intervals. All coarse, indigestible food 
ld be avoi Tn other respects the diet is similar to that 
already given under Chronic Intestinal Catarrh, 


DIET IN ULCERS OF THE INTESTINE. 


1, Diet in Ulcer of the Duodenum.—The diet in ulcer 
of the duodenum is the same us that of gustric ulcer, and the reader 
is referred for the details to the section dealing with this subject. 
Tn cases accompanied by hemorrhage absolute rest in bed must 
be insisted upon, and rectal alimentation administered if neces- 
sary. After the first week the Leube rest cure should be insti- 
tuted, according to the methods described elsewhere. The first 
form of food to be allowed is milk ; after the first week Carls- 
bad water should be given each morning. In very severe cases 
Boas advises exclusive rectal feeding for one or two weeks. 

2, Diet in Other Forms of Intestinal Ulcers.—In 
addition to ulcers occurring in the duodenum, tuberculous ulcers, 
syphilitic ulcers, toxic ulcers, amyloid ulcers, and dysenteric 
ulcers may occur in the intestine. In any form of ulcer the 
diet should be non-irritating and easily digestible. Among 
those foods that may be given are milk, eggs, rice, farina, sago, 
all forms of broth, especially chicken and mutton broths, sweet- 
breads, stewed chicken, baked potatoes, mashed potatoes, tea, 
cocoa, crackers, and toast. 


DIET IN MALIGNANT GROWTHS OF THE INTESTINE. 


The medical treatment in malignant growths of the intestine 
is only an adjunct to the surgical treatment always indicated, 
and consists solely in treating the symptoms as they arise. The 
diet should be highly nutritious and at the same time easily 
digestible ; small quantities of food should be given at frequent 
intervals, Milk, broths, soft-boiled eggs, raw scraped beef, 
sweetbrends, baked and mashed potatoes, vegetables, such as 
carrots and peas, that have been finely divided and strained, 
stewed fruits, toast, and crackers are permissible. 


DIET IN ACUTE INTESTINAL OBSTRUCTION. 

The treatment of acute intestinal obstruction, except when 
due to the impaction of a foreign body, when it may possibly 
be passed through the bowel, is purely surgical ; as Treves has 
said: “There is one measure for acute intestinal obstruction, 


DIET IN INTESTINAL DISEASES. 385 


should be withheld. ‘Theat ey o tgoens bed bo een Pea 
ice kept in the mouth or a few drops of hot water may be given 
ed ie macbin If the disease extends over a period of 
sev days, rectal alimentation or the administration of salt 
solutions must be resorted to, 


DIET IN CHRONIC INTESTINAL OBSTRUCTION, 


In this condition the diet should chiefly be liquid or semi- 
solids, All indigestible food should be avoided, especially those 
forms that are apt to leave a large amount of residue in the 
bowel. The foods to be avoided are salads, heavy vegetables, 
and fruits. Milk broths, broiled Sees i, ne 
sweetbreads, boiled fish, rice, farina, toast, a 
are permissible, In advanced cases rectal feeding must be 
carried out. 

DIET IN APPENDICITIS. 


‘The dietetic treatment in this disease must be governed by 
the symptoms, for surgical treatment is usually indicated, The 
patient ehould be put to bed, and under no condition be allowed 
to rise until recovery is complete. During the first days Sabli 
and Penzoldt recommend that all food be withheld; liquids, 
such as egg-albumin, weak tea, thin broth, barley- or rice-water, 
or milk diluted with lime-water, may be given in small quanti- 
ties when deemed necessary. When the acute symptoms have 
subsided, this diet can be increased somewhat: the milk may 
be taken undiluted, and i may be added to the broth. When 
the pain and fever have disappeared entirely, gruels made of 
rice or barley, soft-boiled scraped beef, stewed chicken, 
toast, and erackers may be added to the list ; still later mashed 
potatoes and vegetables—finely divided and strained—may be 
allowed, and finally, when the patient is well, the usual diet 
may be resumed. 

hsner ' advises the following plan of treatment in all cases 
of appendicitis in which operation is to be performed, believing 
that it reduces the mortality and changes the class of cases in 
which the mortality is greatest into another class in which the 
mortality is very small after operation ; 

“Tn every case of acute appendicitis all food by mouth and 

4 “The Mortality in Appondicitis,” Medion! News, May 2, 1908, 
* 


386 DIET IN DISEASE, 


all cathartics are prohibited. In case the patient suffers from 
nausea or vomiting, gastric lavage is at once employed. In 
the milder cases patient is permitted to rinse the mouth 
with cold water and to drink small sips of very hot water at 
short intervals. In the severer cases the patient is permitted to 
rinse the mouth with cold water, but is not permitted to drink 
either hot or cold water for the first few days until the acute 
attack has subsided, when the use of small sips of hot water is 
begun, If the nausea persists, gastric lavage is repeated once 
or twice at intervals of two to four hours, in order to remove 
any substance which had regurgitated into the stomach from 
the small intestine,” 

“The patient is supported by nutrient enemata consisting of 
an ounce of one of the concentrated predigested liquid foods in 
the market, dissolved in three ounces of warm normal salt solu- 
tion introduced through a catheter which is inserted a distance 
of two and one-half to three inches. In case this gives rise to 
pain or irritation or nausea, it is interrupted for twelve to 
twenty-four hours at a time. In cases in which no water is 
given by mouth an enema of eight ounces of normal salt solu- 
tion is given four to six times a day in addition to the nutrient 
enemata, In cases operated during the acute attack this treat- 
ment is continued for several days after the operation.”” 

‘After the patient has been free from pain and otherwise 
practically normal for four days he is first given from one to 
four ounces of weak beef-tea, preferably prepared from com- 
mercial beef extract, every two hours. In a féw days one of 
the commercial predigested foods, dissolved in water, is substi- 
tuted ; still later, equal parts of milk and Jime-water; then 

liquids, then light diet ; and finally, after the patient has 
fully recovered, full diet is given.” 


DIET IN MUCOMEMBRANOUS CATARRH OF THE INTESTINE. 

Various diets have been recommended in this disorder by 
different writers. Fleiner advises a simple non-irritating diet ; 
others, as von Noorden, recommend a very coarse diet-—one 
that will leave a large amount of residue in the intestine. The 
authors believe, with Einhorn, that a middle course is best, and 
therefore prescribe a nutritious mixed diet that is not too coarse ; 
on such a diet the movements of the bowels become more nearly 
normal and the secretion of mucus is lessened. Von Noorden 
recommends a diet consisting “largely of Graham bread—250 
grams a day in addition to a great variety of leguminous vege- 


| 


DIET IN INTESTINAL DISEASES. 387 


tables, including the husks ; les ining much cellu- 

pale ene 

ries, t, icu= 

of batter’ and bocon, The perisanent effect of the dict Ja 

chiefly due to the amount of lulose which it contains. This 

cellulose undergoes decomposition in the intestines and thus 
softens the aiovessatar” coe 





on intestinal diseases, ) 

Ewald ' advises the following diet in certain cases of mem 
branons colitis = 

“Tt is only rational that in these cases a mild, nourishing diet 
should be instituted, which through its nourishing ties 
produces a laxative effect. This diet may be followed when- 
ever constipation does not exist—a so-called Inctovegetable or 
even constipating diet. The following diet scheme recommends 
itself for this purpose: Brealkfiust : Sweet milk, cocoa, oatmeal 
with cocoa, white or dark bread, with honey, jam, or fresh 
fruit, Dinner (preferably at midday): Vegetables or fruit, a8 
apples, plums, blueberries, raspberries, cherries, a broth of 
vegetable soup, spinach, tomato, or beet soup, a milk soup, or 
curded milk, butter, and a liberal amount of fresh vegetables 
are desirable, or pea, rice, or lentil soup, stewed vegetables 
with dumpling, macaroni, puddings, blanc-mange with fruit- 
juices, ete, ; salads, and bg ed peppered, bread with 
butter, and a light cheese, ick soup, made with 
barley, rice, bees eter, bake po potatoes, eggs, bread, butter, 
cheese, milk, ete. 

bi conte to the needs of the patient the Bes 
will be more or less carefully followed, and on certain 
small amount of meat may be allowed by way of one 

“While this diet is directed es ly against the local 
intestinal condition, still it serves to aappers and improve 
the general nutrition, because of the high percentage of carbo- 
hydrates and fats, which is very important.” 

1 American Medicine, 1904, vol. vii., p. 261. 


338 DIET IN DISEASE. 


DIETETIC TREATMENT OF NERVOUS AFFECTIONS OF THE 
INTESTINE. 


1. Atony of the Large Intestine.—The dietetic treat- 
ment of this disorder is identical to that indicated for habitual 
constipation, to be described further on. 

2. Flatulence or Meteorism.—This condition is char- 
acael by un excessive accumulation of gus in the intestine, 
Tn the dietetic treatment, therefore, foods that tend to produce 
tl quantities of hey such as beer, cider, carbonated waters, 

Shey and Graham breads, and potatoes, should be 
he disorder is often of purely nervous origin, and 

Sere this is the case, unrestricted diet is to be recommended— 
one that will tone up the patient’s system and thus cause the 


flatulence to disappear. 
8. Diet in Intestinal Neurasthenia.—This disease 
resembles nervous dyspepsia. At times the most indigestible 


food is well borne, whereas the digestible forms create discom- 
fort ; in each case it is important that the dict be regulated 
according to the patient’s digestive powers. Generally a lib- 
eral diet is indicated in these cases; in many instances a sys~ 
tematic rest cure is needed to bring about relief. 


DIETETIC TREATMENT FOR HEMORRHOIDS. 


Since constipation is often a frequent cause and aecompani- 
ment of hemorrhoids it is important that this condition be cor= 
rect. As has been pointed out elsewhere, proper diet plays 
an important réle in the prevention of chronic constipation. 
Patients afflicted with hemorrhoids should eat in moderation, 
but should ayoid all excesses of food and drink. An abund- 
ance of outdoor exercise, consisting of walking and simple 

mnastics, should be indulged in, violent gymnastics and 

jorseback-riding should be avoided. A daily evacuation of 
the bowels should be secured. Patients with hemorrhoids 
should avoid alcoholic beverages, spiced foods, strong coffee 
and tea, cheese, cabbage, and beans. The foods most suited to 
this condition are potatoes, carrots, spinach, asparagus, and 
even salads, since they stimulate intestinal peristalsis and thus 
pe de to bined the stools soft. Stewed and raw fruits, includ- 
pes, oranges, pears, and apples, are also beneficial. 
ater eit the best b bev in this condition. The waters of 
Carlsbad, Kissingen, and Saratoga are most beneficial; they 
act best when taken at the springs. 





DIET IN INTESTINAL DISEASES. 389 


Diet for Puthorie Patinte with Hemorrhoids — After Wegele) 
paming: Milk or weak Graham bread and butter with honey. 
Noon : Bou = ice aod leas 
‘oon 
Xe Bute or fruit and Graham = 

Berea wnias na perpen ey ta ela 
Diet for Nereous and Thin Patients with Hemorrhoide—(Afler Wegele.) 


Morning: Mille with tea, butter, and milk. 
Forenoom Brora a Sy 
Hy tm it 
‘Atersonn ! Scat oe te, apd breed. = 
Evening: Rice and milk, compote, and light white wine, 


DIET IN CHRONIC DIARRHEA. 
The Author? Diet-list for Moderate Cases of Chronic Diarrhea, 


8 a.m.: 200 gm. of cocoa (cooked in water) . . 
2eoft-boiled eggs... - 









50 gm. toast : 
10 AM: alee broth with 1 egg 








12 we: 
4pm: 
‘gm. toast, 
Trem: 100 en. Fice cooked in bouillon 340 
200 gm. ewoetbread . 7 
50 gm, wheat bread » xs +. 1800 
9m: 100 em. raw soraped beef - 30 +. Tike 
km, Panopepton > Or 


UP us 


‘The dietetic treatment of diarthea must vary according to 
the type of the disorder. In the neryous variety the patient 
should be instructed to restrain his bowel movements except at 
a certain hour in the mornit Under all conditions it is im- 
portant to exclude from the diet all foods that have a tendency 
to stimulate the intestines. Coarse, es foods, especially 
those containing a large percen lulose, must be avoi 
in this class are coesally to a>) mentioned cabbage, Pickles 
salads, turnips, carrots, all cold drinks, carbonated waters, and 
beverages (including champagne and beer). Among the foods to 
be recommended are broths, tea, red wines, farina, rice, and 
barley gruels, Raw milk usually has a laxative effect, but 
when’ boiled or diluted with aie par or brandy it is consti- 


DIET IN DISEASE. 


390 

pation altbongt ina certain number of cases it must be entirely 
as it inereases the number of movements. In a num- 

ber of cases of chronic diarrhea milk cures have been given with 

good results. ‘The authors have succeeded in relieving cases 

of chronic diarrhea by systematic rest cures. 


Diet-list for Chronic Diarrhea (Severe Crsei)—( After Wegele.) 

















Protein, Wat, Stee, SE 
Morning: 200 gm. scam cocon (boiled. in 
aca 28 300 120 
Leofvbolled egg - | | | 60 5.00 
Forenoon: 250 gm, decoetion of whortleberries 
from 80 gm, dried berries . 06 1.80 47 
Noon: 250 gm.soup. . . . 55 4.00 75 
1 ogg in the soup. . . 60 5.00 
100 gm. scraped meat (lean). | .207 1.50 
50 gm. rice in bouillon . 40 0.50 38.0 
Afternoon; 250 gm, whort! decoction 0.6 1,30 47 
Bening: 250 gm. maltoleguminose soup» ° 65 025 185 
SONAR rs cles : 
P 160 em. minced chicken : 150 9.00120 
During ct 75 gm. awieback - 90 150 425 
: 200 gm. whortleberry wine... . = « cs 7h 
Boer Ti; $250 gm. barley mush (20:250).. 5,0 4.00 85,0 
‘Total 872 42.00 1689 170 
Calories... . , 86080090180 
Entire number of calories... ss. es 1560 


Diet-liat for Chronic Diarrhea (Less Severe Cases)—(Ajter Wegele.) 
Yrovein, Fat, yas. alse 

12,00 

2.00 33 


2.00 32 


2.00 a3 





DIET IN INTESTINAL DISEASES, 391 


DIET TREATMENT IN HABITUAL CONSTIPATION. 


In the dietetic treatment of habitual constipation it is essen- 
tial that the food that is ingested should be such as will increase 
the intestinal movements. Those foods that leave a bulle 
of fecal matter are useful for this purpose. ‘Those that leave a 
small residue are most apt to produce chronic consti - A 
diet consisting principally of eggs and milk with only a small 
quantity of vegetables and water is one that is constipating. 

A glass of cold water taken before breakfast will often regu- 
late the bowels ; occasionally, according to Penzoldt, a pinch 
of salt added to the water will increase its efficacy; raw or 
cooked fruit, taken on an empty stomach morning or evening, 
occasionally gives good results. It is a well-known fact that 
the smoking of a cigar in the morning will often stimulate peris- 
talsis. The patient should recognize the importance of having 
an evacuation of the bowels at the same time each day. 

Chronic constipation is a frequent accompaniment of dys- 
peptic disorders, and may be relieved by appropriate treatment 
of the gastric disorder. It should not be forgotten that habitual 
constipation is frequently induced by the persistent use of 
cathartics, and the use of drags should be avoided as much 
as possible in the treatment of this disorder, Sedentary habits 
are often the cause of constipation, and for this reason proper 
exercise should always be prescribed along with the dietetic 
treatment. The vegetables that are especially useful in the 
treatment of chronic constipation are spinach, peas, cauliflower, 
cabbage, asparagus, salads, onions, celery, and tomatoes. The 
cereals that stimulate the intestinal movements are oatmeal and 
cornmeal, Graham, rye, corn, whole wheat, and bran breads 
are also wel earth Pa classed as laxatives are honey, 
cider, molasses, and acid fruits, such as apples, pears, peach 
cherries, and oranges. On account of the said and seeds ‘they 
contain, berries are effective laxatives, Prunes, dates, and figs 
are also to be recommended. 

Habitual constipation is often due to the fact that water is 
taken in insufficient quantities ; therefore, in the treatment of 
the disorder, an abundance of water must be prescribed. The 
foods to be avoided are tea, claret, cocoa, chocolate, rice, barley, 
and farina gruels, and huckleberries. In some cases milk acts 
as a laxative, whereas in others it has the opposite effect. For 
this reason its effect should be tested in every case. Boiled 
milk usually constipates, Buttermilk is preferable to sweet 


‘i 
392 DIET IN DISEASE. 


milk as a laxative. Most cases of habitual constipation can be 
relieved or cured by the dietetic treatment here laid down ; it 
is not within the province of this book to discuss the value of 
muaseage 3 suilice it to say that they are reliable 
adjuvants to the treatment of constipation. 


Diet-list for Chronic Constipation—(Afler Wegele.) 
Protein. Fat, gre, Alcohol. 
Morning: 200 gm.milkand coffee 320 440 320 
30 gm. buter= s'. O21 









47 
2.8 
53.5 
Calories. . 600 1800 1000 375 
Entire number of calories... . « 8775 


The authors frequently prescribe the following diet in cases 
of chronic constipation : 


GA.m.: 40.gm. omngejuice. - 2... 
Baim: 800 gm exllk with cafibe - 
2Qeoft-boiled eggs... 


10 A.M: 
12M: 


gm. beans. 
190 Son, Grab read ears 
200 gm. axel se ew « 


a 
SEES5 
EERE 
Pre f 
a 
Fi 


9 rat: 40 om fee (or 400 gm busier mil 








DIST IN LIVER DISEASES 303 
Diet for Habitual Constipation—(After Boas.) 


es zt th nd ee z 
=" a Ghana pampericel, tr which the’ patient 
ro 


fh 
In idday meal of ity of 
tiny ins firioaccous food, Hata bouls ef white wins (Meola) or 
er, 
Tats Meat with « lange amount of butter, Grabam breads stewed fruit, 
10 ¥..: Before retiring, fresh oF stewed fruit. 


DIET IN PERITONITIS. 

Acute Peritonitis.—The diet in acute peritonitis is 
of secondary importance, and requires peek resp 
operative pi re can be undertaken. No food whatever 
should be given by the mouth ; if necessary, rectal alimentation 
should be resorted to, If operation is not undertaken and 
vomiting has ceased, fluids may be given in a few days. Foods 
that may be prescribed are milk asf lime-water, diluted broths, 
and egg-albumin with or without brandy or sherry ; only very 
small quantities should be taken at a time but at frequent in- 
tervals; gradually plain milk, broth, and gruels may be added 
to the list ; solid food should not be allowed for several weeks. 
When stimulants are required, they should be given in the form 
of whisky, brandy, or pagne. 

Dict in Chronic Peritonitis.—The dict in chronic peri- 
tonitis should consist of boiled meats, eggs, milk, stale bread, 
toast, or crackers, and vegetables, only, however, in the form 
of purées ; carbohydrates should be eaten sparingly, on account 
of their tendency to ferment. Food should be eaten in small 
quantities at regular but frequent intervals. 


DIET IN LIVER DISEASES. 


To prevent needless repetition, certain general dietetic rules 
will here be given for the management of liver diseases in gen- 
eral. The theoretic discussions bearing on this subject have 
become so numerous as to render even brief consideration of 
them impossible. For this reason. the subject will be dealt with 
here only from a practical standpoint. 

‘The group of symptoms generally classed as “ biliousness” 
are usually the result of overeating, and the 0-called “bilious 
attack” is nothing more than a cry of the liver for relief. 


* Diseases of the Intestines, p. 247. 


394 DIET IN DISEASE, 


Many individuals when they become constipated suffer from 
these attacks. ‘These two fits furnish the indications for treat 
ment: rest and open bowels. In the acute attacks all that is 
necessary is a restricted diet for several days, together with the 
administration of calomel, followed by a saline. The object of 
treatment in all diseases of the liver should be to give the organ 
as little work to do as possible. It should not, however, be 
put at absolute rest, and it is probably not possible to accom- 

ish this oad on mg int ae apa ‘on general rrr 
n general, a sim well-mi: jieé containing protein, fat, 
and carbohydrates is indicated. In certain diseases in which 
the function of the liver is manifestly impaired, fat and carbo- 
hydrates must be restricted foe kanic. omitted entirely ies few 
days. Both, if not promptly disposed of, are apt to ergo 
oak in the intestinal canal. 

Certain articles of diet are known, while others are believed, 
to be injurious in diseased conditions of the liver. Overeating 
is injurious, first, on account of the overwork it necessitates ; 
and, secondly, because the superfluous food is apt to un 
putrefaction. The resulting bacterial products are believed to 
act on the liver in much the same manner as does alcohol. 
The excessive use of alcohol produces marked changes in the 
liver in certain individuals. This has been proved by experi- 
ments on animals. In a series of experiments performed by 
the authors in the Pathologie Laboratory of the Johns Hop- 
kins Hospital, Baltimore, actual cirrhotic changes in the liver 
were induced by the administration of aleohol.! Some persons 
may take alcohol continuously with impunity. If taken in 
excessive quantities, however, over sufficiently prolonged periods, 
it probably invariably produces chronic tissue changes. When 
a certain amount is taken, it seems to be burnt up in the body 
as food ; when this limit is passed, it becomes a poison. In 
certain fevers enormous quantities may often be consumed with 
great benefit. Just what amount may be taken with safety by 
any one individual is not known, and is dependent in large de- 
gree on idiosynerasy. It has been estimated that two ounces 
of alcohol on the average may be consumed as a food in twenty- 
four hours. The form and the amount of concentration of the 
alcohol are important factors in considering the effect of alcohol 
on the liver, Whisky, brandy, and similar spirituous liquors, 
taken in a concentrated form, undoubtedly produce more marked 
tissue changes in the liver than light wines or beer. 


* See Welch, The Physiologic Anpeets of the Liquor Question. 





DIET IN LIVER DISEASES. 395 


In alll liver diseases alcohol should be avoided unless specially 
indicated as a tonic or stimulant. In any case it should be 
given well diluted, A well-matured pure whisky well diluted 
with water is to be preferred, and this only in the smallest 
possible amount, 

Certain foods have been regarded as “ stimulating ” or “ irri- 
tating” to the liver. Among these are peppers of various 
kinds, spices, mustards, concentrated meat extracts and meat 
broths, and the substances formed in roasted and baked meats, 
To be proscribed are peppers, radishes, horseradish, onions, 
watercress, and celery, it in too large quantities is also to 
be condemned, Strong coffee and tea are harmful, but weak 
tea seems to be well borne in many cases. 

In severe diseases of the liver the diet must usually be 
restricted to mill, diluted or peptonized, gruels, albumin-water, 
kumiss, buttermilk, and bland broths, such as oyater broth. 
Orange-juice as well as lemonade may generally be allowed. 

In the milder disease and during convalescence the diet need 
not be so rigid, and Jean meat, curd, junket, bread, toast, zwic- 
back, fresh fruit, or fruit stewed with little or no sugar, may be 
allowed. In the chronic cases and lighter forms the followi 
articles may help to make up the dietary. Milk, variously dil 
and prepared, buttermilk, curd, kumiss, custard, junket, 
lean meat, if beef or mutton, preferably rare, sweetly q 
chicken, squab, liver, the soft part of oyaters, and the more di- 
gestible forms of fish, Fresh green vegetables and green salads 
without oil are permissible. Small quantities of well-baked or 
boiled mealy potato may be allowed once a day, for many 
persons do not relish a meal that does not contain potato in 
some form. The starchy foods should be partaken of some- 
what sparingly ; bread, toast, zwieback, pulled bread, and bis- 
cuits (crackers) may be permitted. Small quantities of cereal 
foods may be taken—rice, sago, and tapioca, when sufficiently 
well-cooked, may be allowed. Fresh fruit is a valuable adjunet 
to the diet, Oranges, grape-fruit, ripe peaches or pears, gray 
strawberries, ripe plums of the most tender varieties may all be 
taken. Stewed frnits only slightly sweetened and baked apples 
may be allowed with advantage. If there is constipation, stewed 
prunes are useful. Lemonade may be taken as a beverage. 

Mineral waters may be drunk freely if dropsy is not present, 
and are best taken on rising and between meals, Hot water is 
a valuable substitute for the mineral waters, It is especially 
usefial in allaying thirst when there is dropsy. . 


396 DIET IN DISEASE. 


The food should be taken slowly, well masticated, and never 
in too large quantities. If necessary, more milk may be given, 
#0 a8 to make large amounts of other food unneccessary, The 
patient should lic down directly before and after meals. In no 
case should the patient eat immediately after taking active 


In certain chronic conditions, such as hyperemia, fatty degen- 
eration, and chronic hepatitis, exercise is to be taken at proper 
times. 

In summer and in warm climates more vegetables are to be 
allowed and less meat. If putrefactive changes take place in 
the intestine, a diet consisting of white of egg and water should 
be maintained until this condition is overcome. When the 
putrefaction is caused by torpidity of the liver, it may some- 
times be prevented by increasing the amount of vegetables and 
by the use of laxatives. . 


CATARRHAL JAUNDICE. 

During the acute stage, s0 long as there is any tendency to 
yomit or while dyspepsia is marked, the patient should be 
quiet in bed. he diet should be very light and fluid. at is 
Specally to be avoided, as are, of course, all foods that are 
either chemically or mechanically irritating. 

Milk, which may either be skimmed or diluted with lime- 
water or mineral waters or peptonized, is probably the most 
useful article of diet. On account of the fat which whole milk 
contains it is, however, open to certain theoretic objections. In 
practice, nevertheless, it is rally well borne. Buttermilk 
or kumiss may also be as may beef-juice, oyster-broth, 
clam bouillon, albumin-water, and well-cooked and strained 
barley gruel. “If the stomach is irritable, food should be given 
in small quantities and at regular intervals, As the stomach 
becomes tolerant and the appetite returns, bread, zwieback, 
toast, lean meat, such as the breast of chicken, sweetbreads, 
and tender steak or chops may be administered. Soups thick- 
ened with barley or flour may be given, and the lighter forms 
of fish may also be allowed. Fruit, well cooked and without 
too much sugar, may be added as convalescence progresses, 
All coarse forms of yegetables must be avoided, but spinach, 
asparagus tips, and cauliflower tops may be given, Well- 
cooked mashed potatoes may be allowed in moderate quantities. 
The meals should be small and, if necessary, may be given 
frequemly. During convalesence, when the appetite returns in 





DIET IN LIVER DISEASES. 397 


full force, the patient should be cautioned against overeating. 
For several months the diet should be guniol onl oatig 
and coarse articles of food avoided. 
Coffee and tea should be forbidden during the acute 
but during convalescence they may be allowed, but should 
iven neither too strong nor in too great quantity. Alcohol is 
Feat avoided, Fats, such as butter and cream, ld be with- 
held longest in the return to a full diet. Tf an exeess of starch 
or of sugar is taken, disturbances are certain to follow ; if fats 
are given in too great abundance or too early, putrefactive 
changes are apt to occur. 
ineral water may be drunk freely during the course of the 
disease, and the bowels should be kept open. Carlsbad and 
Vichy are especially to be recommended, but other waters may 
be used. Plain carbonated water is useful as a beverage. 
Catarrhal Jaundice in Children.—Tho disoace is rare 
in children under two years of age. The same general princi- 
ples of diet may be adhered to as when the disease occurs in 
adults, Fat, starches, and sugar should be reduced in quan- 
tity, and rare meat, fruit, and milk more plentifully supplied. 
If vomiting occurs, milk diluted with lime-water or a 
nated water, or peptonized milk may be used. If the gastric 
symptoms are severe, the diet should be the same as that for 
acute gastric indigestion. Calomel, the sulines, and mineral 
waters should be prescribed to keep the bowels open, 


CONGESTION OF THE LIVER. 

Acute Congestion.—The treatment depends largely on 
the cause. When the congestion occurs in the course of acute 
diseases, the diet is practically the same as that of the associated 
disease. When there is pain, rest is essential. If the patient’s 
condition warrants, the diet should be largely restricted, 
Diluted milk, thin soups, albumin-water, and the like may be 
given in small quantities. In weaker patients the diet should 
be regulated according to the general condition ; if emaciation 
is extreme, a larger dict should be ordered, care’ being taken 
not to disturb the stomach. Milk, soups, lean meat, fruit, 
cooked fruit, and bread or toast should form the bulk of the 
dietary. All irritating foods, coffee, strong tea, and aleohol 
are to be avoided. ines are indicated in most cases. 

Passive Congestion of the Tiver.—The diet should 
be restricted and the same general principles observed as 
directed in liver disease in general. 


398 DIET IN DISEASE, 


ACUTE YELLOW ATROPHY. 


The diet should be restricted; usually only liquids can be 
given, such as milk, diluted as in catarrhal jaundice, albumin- 
water, etc. In general the management resembles that of an 
aneute fever. 

ABSCESS OF THE LIVER. 

In the early stages the patient should be put at rest and 
receive a very light dict of milk, grucls, albumin-water, and 
the like. After operation the dict may be as nutritious az pos 
sible, bearing in mind the general principles of diet in liver 
diseases, 

FATTY LIVER. 

The diet will depend upon the exciting cause. When the 
fatty liver is the result of general obesity, the treatment should 
be along the lines indicated for that condition. When it is due 
to tuberculosis or to other chronic infections, the diet should be 
arranged accordingly. In the severe cachexias that mark incur- 
able diseases little can be done in the way of diet. 

Tn general the food should be easily digestible ; milk, lean 
meat, and eggs are mainly to be relied on. Predij milk 
and meats may be of value, but fats and oils chould be avoided. 


AMYLOID LIVER. 
This is usually caused by long-standing suppuration. The 
food should be as easily digestible as it is possible to make it. 


At the same time the t amount of protein material con- 
sistent with the patient’s digestive powers, should be given. 


» SYPHILIS OF THE LIVER. 


The diet should be arranged according to the general prin 
ciples laid down for liver diseases in general. 


DIET IN GALLSTONE DISEASE. 


Cholelithiasis is a subject. of ever-increasing interest. It is 
estimated that about 10 per cent. of the population of Ger- 
many have gall-stones. Kehr states that only about 5 per 
cent. of these ever give rise to serious disturbances. Numerous 
theories have been advanced regarding the cause of the forma- 
tion of gall-stones. Errors in diet and the various food ele- 
ments huve been considered causative, and have led to the 
establishment of various dietaries, Most observers are, how- 
ever, inclined to consider the prophylactic measures about to 





DIET IN LIVER DISEASES, 399 


be described of value. (For an exhaustive discussion of this 

Ae ie sadait celia to the article y Dew apsesliacn 
loppe-Seyler in Nothnagel’s ac fedicine, whi 

has been ably edited by ee lace De redaniek A Packard. 

"The two frotore that in all probability exert the most influ- 
ence on the formation of gall-stones are the stasis of bile and 
the inflammation of the bile-passages and gall-bladder, To 
this end anything that will increase the flow of bile should be 
encouraged, and anything that retards it, avoided, To obviate 
the latter all food that is liable to canse indigestion, with the 
attendant dangers of putrefuctive changes setting up inflamma- 
tory processes, should be carefully avoided. 

‘The patient should lead an active, if possible an out-of-door, 
life and physical exercise should be a part of the daily routine. 
Horseback-riding for those who are in condition and who can 
afford it is excellent. Walking, fencing, golf, tennis, and 
swimming are helpful, and where these are not enjoyed, sys- 
tematic gymnastic exercises should be prescribed. ieee 
if the motions are violent ‘h, acts Sireetly by forcing the 
bile from the liver and all-blatder, and indirectly by increas- 
ing the movements of the intestines. 

‘he clothing should at all times be comfortably loose, 
Women eapecially should be cautioned in regard to this point. 
‘The corsets should fit loosely and be ded from the shoul- 
ders, so as to take the preasure from waist. After meals 
the clothing should be loosened, so as to relieve the abdominal 
organs from pressure. 

Constipation should studiously be avoided. The diet should 
be arranged with this object in mind, and the use of laxative 
salines is to be recommended where their use is necessary, 
Epsom salts and sulpbate of soda are of especial value in this 
connection. If desired, the saline mineral waters may be sub- 
stituted, or, for those who can afford it, occasional visits may 
be made to various mineral springs. 

The meals should be taken at regular intervals not too widely 
separated, Prolonged fasting should never be permitted, for 
eating increases the flow of bile while fasting causes the bile to 
be stored up in the gall-bladder. Some years ago Frerichs con- 
tended that in cholelithiasis the meals should come close together, 
Care must, however, be exercised to see that the food is being 
thoroughly digested and moved along the intestinal tract nor- 
mally. Kebradvises asupper to be taken lateat night. Other 
authors have advocated HES the patient in the middle of the 


40) DIET IN DISEASE. 


night to administer nourishment. This last would seem to be 
entirely unnecessary, Naunyn insists on the importance of a 
sufficiently large breakfast and, indeed, a large meal after any 
fast. The a American breakiast is, however, sufficiently 
large in almost all instances, Care should be taken not to err 
in the opposite direction by giving more food than can be di- 


In the choice of food there are certain things to be avoided. 
Tn the first place, all food that is not entirely above suspicion 
or that is liable to set up putrefactive changes must be inter- 
dicted. In this category are to be placed stale fruits, stale fish 
and shell-fish, overripe cheese, and the like. 

Fat should, asa rule, be reduced toa minimum, for there is con- 
siderable clinical evidence to show that an abundance of fat is 
injurious in gall-stone disease, as well as in other disorders of 
the liver. hether the fat acts in any other way than in pro- 
ducing bowel disturbances is a question that has not yet been 
decided. Herter has recently pointed out that dogs fed for 
months on a diet rich in fat and low in proteins showed conere- 
tions in their gall-bladders. Fat, should, however, not be elimi- 
nated from the dietary altogether, 

Excesses in carbohydrates, either in starches or in sugar, 
should be carefully avoided. Anything that will irritate the 
liver should be prohibited, as should all rich and complicated 
dishes. Any food that is apt to cause indigestion is to be re~ 
garded as unsuitable for the patient with gall-stones, 

Protein, carbohydrates, and fat should go to make up the 
dietary, which should consist of simple food, plainly pi , 
with care, however, to avoid a monotonous diet. Meat should 
not be eaten too freely, and only the leaner varieties should be 
used. Milk and eggs are allowable, but if the milk is extremely 
rich, a portion of the cream should be removed. Some authors 
forbid the yolk of eggs as containing too much fat. 

The n vegetables and fresh fruits are suitable articles of 
food and may be partaken of freely. Cereals and potatoes may 
be used in moderation, but not where there is “starch indiges= 
tion.” Turnips, beets, and the like may be partaken of sparingly. 
While various authors forbid the use pl artes of these, it is 
probably not the choice, but the quantity, that should be con- 
sidered in this connection. 

Bread, rolls, and the like may be eaten as desired, bearing in 
mind that in “starch indigestion” the amount should be limited. 
Pastry and any but the plainest cakes should be omitted from 





ill 


tert pe 
si ings it more in 
eager piensa yeep oe 2 ae 
avoided, but coffee and tea may be allowed in moderation. The 
drinking of hot water on rising and at bedtime has been ad- 
vised, as well as the various mineral waters menti in con- 
nection with constipation. 

Coixisting diseases are believed to exert some influence on 
the formation of gall-stones, and when gout, chronic rheumatism, 
diabetes, obesity, or dyspepsia exists, the diet should be regu- 
lated accordingly. In few diseases are there so many contra- 
dictory opinions concerning diet as in gall-stone, and for this 
reason their discussion has been omitted entirely. 


milk diet for weeks at a time where it is well borne. Where a 
more extensive dict is indicated the same lines may be followed 
as were laid down for cirrhosis in general, 

Cirrhosis.—So far as diet is concerned, all forms of cir- 
rhosis may be treated in much the same general way, Sinee no 
two cases ure exactly alike, it must never be forgotten that each 
case requires individual consideration, The heart, the kidneys, 
or the alimentary canal may be involved, and ascites may be 
present. The existence of these complications materially affects 
the management of the case, 

Certain cases of cirrhosis are due to the long-continued use 
of alcohol, highly seasoned food in excessive quantities, and, 
probably, to chronic intestinal fermentations. Certain metallic 
poisons may also cause it. 

All individuals who are predis to cirrhosis,—those who 
come from families where liver disease or other forms of cir- 
rhotic disease are frequent,—should be cautioned in nd to 
the diet and the use of alcohol, Those large eaters and drinkers 
or those who suffer from indigestion, discomfort, or even 
over the region of the liver, should be put on a simple diet, 
composed largely of milk ; the bowels should be kept open by 
the use of saline mineral waters; aleohol should be withheld 
altogether or reduced to the smallest possible amount. All rich 
f and those mentioned as irritating the liver should be 
avoided. If aleohol is given upand the patient lives correctly, 

26 


402 DIET IN DISEASE, 


much can often be done in the early stages to avert, or at least 
to -, the disastrous consequences. 
a oon pe t Ascites.—When the discase has been 
ingen ascites is not present, the patient may be put 
ona milk diet or a diet composed largely of milk and milk 
foods. Kumiss and buttermilk are very useful. Egg-albumin 
and cereal gruels may also be used. Under a simple diet of 
this kind the gastric symptoms may abate or even disappear. The 
saline mineral waters and potassium jodid are valuable adjuncts 
in the treatment. The consideration of other drags useful in 
this condition does not come within the scope of this work. 
When recovery has set in a simple dict, composed of mill, the 
lean, easily digestible meats, preferably broiled steak and chops, 
chicken, and the like, eggs, bread, green vegetables, and fruits, 
potatoes, and cereals, if desired, are allowable. The meals 
should be small and taken at regular intervals, Hot water or 
the saline waters may be taken on rising and an hour or so 
before eating. The general principles for diseased conditions 
of the liver already described must be followed, 

Cases with Ascites.—The selection of a diet for these 
cases is frequently a matter of considerable difficulty. Rest, 
salines, and a restricted, somewhat dry diet often gives great 
relief, When the kidneys are in reasonably good condition, a 
dry diet, such as is recommended for senile heart, may be tried. 
Hot water may be sipped on rising and at various intervals 
during the day, and helps to flush out the waste-produets of 
metabolism. Should kidney symptoms arise und the quantity 
of urine be greatly lessened, it is better to increase the allow= 
ance of fluid, 

If kidney disenses ure present, it is not wise to attempt to 
relieve the ascites by withholding fuids. When kidney compli- 
cations arises, French writers and others recommend a diet com- 
posed largely of milk, on the ground that it is a good diuretic, 
excreting not only the fluid itself, but a portion of the fluid 
held in the body as well, 


DIET IN DISEASES OF THE PANCREAS. 


Little has been written on this subject. Attempts at feeding 
pancreas by the mouth and by rectal encmata have not been 
productive of good results. It has been suggested that when 
the diagnosis of pancreatic disease has been made, both fats and 
carbohydrates be withdrawn from the diet, as they are apt to 





DIET IN DISEASES OF THE RESPIRATORY ORGANS. 403 


undergo fermentation in the absence of the pancreatic juice. 
‘The tile may, however, amit in the emulsifichtion of fui, and 


eee ever ntig ees Ageia the mouth, 
with S viet ding Sea peeedh extract is 
best given in salol-coated 


The diet should consist lly mil w which ich may be pep 
tonized, predigested meat solutions, re. 
Alcohol may be given as required, eae Ee 
stimulant. 

According to Dolinski, the pancreatic secretion is increased 
by the ae of acids and acid drinks. Alkaline drinks 
diminish the secretion of the pancreas, An abundant diet 
causes an increase in the amount of the secretion, 


DIET IN DISEASES OF THE RESPIRATORY 
ORGANS. 


DIET IN PLEURISY. 


The diet suitable in the treatment of pleurisy with effusion 
has been the subject of many experiments, The two principal 
methods advocated are: (1) To give the patient as drya diet as 
is possible, in the hope that, by restricting the amount of fluid 
supplied to the blood, the absorption of the fluid effusion will 
be hastened. It has also been recommended that ordinary table 
salt be taken in large quantities, on the principle that, owing to 
the increased density of the blood, a more rapid absorption will 
take place. Schroth’s “dry cure” has also been recommended. 
(2) The second plan, advocated especially by certain French 
writers, is to place the patient on an exclusive milk diet, in 
much the same manner as described in the Milk Cure. This 
is said to increase the excretion of urine, and also to cause 
the absorption of the effusion, The return toa general dict 
should be gradual. Practically either plan may. be followed, 
according to the condition of the patient, If there is fever or 
complicating kidney or heart disease, the milk diet is to be pre- 
ferred. If there are no complicating diseases and no fever, 
ordinary diet with a lessened amount of fluids should be pre- 
scribed. No soups, but little coffee, tea, or other beverages, and 
ag small an amount of water as the patient can comfortably get 
along on should be allowed. Large effusions are better removed 
by aspiration than by diet. 





404 DIET IN DISEASE. 


DIET IN EMPYEMA. 


The dietetic management of empyema is the same as that of 
any septic condition, If there is fever, the diet should be that 
advised in the treatment of fevers in general. If there is little 
or no fever, the diet should be similar to that recommended in- 
the early stages of tuberculosis. Gilman Thompson advises a 
ees much fatty food as the patient can take ag 
best meeting NEMELE RE system by the exeretion 
of such large quantities of pus. Foods that cause the genera- 
tion of gas in the intestine should be avoided. This usually 
arises from an excess of carbohydrate food, but may also be 
caused by the ingestion of lange quantities of fat. there is 
marked tympanites, the embarrassment of the respiration is 
i 


LARYNGISMUS STRIDULUS. 


Attacks may be brought on by overfeeding, by the it rt 
of indigestible articles of food, and by constipation. The diet 
should be carefully supervised, and the same general indica- 
tions met as in rachitis, 

LARYNGITIS. 

Tn chronic inflammations, especially tuberculous laryngitis, 
certain dietetic measures may be employed that will give con- 
siderable relief to the patient. Hard and dry toasts and the 
like should not be eaten, as they give rise to pain on being 
swallowed. For the same reason highly seasoned foods are to 
be avoided. Only semisolid or liquid food should be eaten. 
Milk, custards, junket, soups and gruels, raw oysters, raw 
scraped beef, and the like are the most suitable articles of di 
To allay the irritation in the larynx Loomis advises that a raw 
egg be sucked from the shell, If there is much pain om swal- 
lowing codein or cocain solutions should be applied locally 
before feeding, A tablet containing yy of a grain of cocain 
may be placed on the back of the tongue and allowed to dis- 
solve. This is generally effective, and has the advantage that 
the patient can use it himself. 

Difficulty in swallowing may sometimes be overcome by the 
following two methods ; By allowing the patient to lie flat on a 
lounge with his fice over the edge. Food is to be sucked 
through a tube from a vessel placed immediately below. ‘The 
second method consists in directing the patient to lean forward 
while eating. Sujous (quoted from Thompson) says that this 





= 


DIBYT IN DISEASES OF THE RESPIRATORY ORGANS. 405 


latter posture causes the food to pass down 

sinuses, thus avoiding the bat apnea lef 
with which causes the severe pain during degluti- 
ph a ele gteebeivdat tiv ees 


DIET IN ASTHMA. 

Asthma usually occurs in markedly neurotic individuals, who 
are apt to exhibit other neuroses, such a8 gastric and intestinal 
‘decile Various forms of food—e, g., the starches and 
sugars—have been said either to cause or to predispose the 
individual to asthma. 

As a matter of fact, many attacks of asthma are brought on 
by indigestion, this usually being directly traceable to some 
error in diet. So jaisnt is this fact that certain cases are 
classed as “ peptic” or “gastric” asthma. 

Any food that canzes indigestion should be avoided. Patients 
usually learn by experience what they can and what they can not 
digest. Some curious idiosynerasies occur: For example, in 
one patient rice may cause indigestion—even when the most 
minute quantities are introduced into his food without his 
knowledge an attack of indigestion and su ently of asthma 
may supervene. ‘These idiosyncrasies exist, of course, in others 
besides asthmatics, and many remarkable stories, some well- 
authenticated, are told in this connection. 

The asthmatic should live a quiet, well-regulated life, If 
there ie any gustrie or intestinal derangement, it should care- 
fully be treated. The diet should be light and nutritious, and 
should be taken at regular intervals. The meals should be of 
a size to be easily digested. Violent exercise of all kinds should 
be prohibited. 

e foods most suitable for the asthmatic are the lighter 
kinds of fish and meat—the white meat of chicken, roast-beef, 
beef-steak, chops, and mutton, The most easily digested vege- 
tables, such as spinach, aspamgus-tips, cauliflower tops, baked 
potatoes, and the like, may be taken. Cereale and whole-wheat 
bread may be used in moderation. In most eases, plain des- 
serts may be allowed. Pork, cheese, heavy cakes, pastry, and 
all similar indigestible articles of diet, should be avoided. Fats, 
sugars, and starches should be taken in moderation, if at all. 
Experience will generally prove the best guide os to what is 
suitable, Foods that are apt to cause flatulence are best 
avoided. 

Dinner should be taken in the middle of the day, and the 


406 DIET IN DISEASE. 


supper should be light. ating at night should be discoun- 
tenanced. Tea and coffee, if do not cause gastric dis- 
turbance, may be taken in moderation. Strong coffee has been 
credited with warding off attacks; for this purpose two or three 
saps OF strong; coffee. ero: fo be alee just befure a aaa 
a 


In the weaker pati alcohol may be allowed, best given 
in the form of matured whisky. Beer and ales be 
avoided by most patients. very case of asthma should be 
studied carefully in order to learn what food is and what is not 
harmful. All asthmatics probably give up many articles of 
diet that are in reality indicated in their condition. 


DIET IN EMPHYSEMA. 


Patients with eagles should seek to prevent flatulence 
and constipation. All indigestible foods should be avoided, 
and the diet should be along the same lines as indicated in 
asthma. Starches and sugar should be taken ouly in moderate 
juantities, as otherwise they may ferment and give rise to 
lence; the dyspnea that it is apt to bring on may be a 
source of great discomfort. In the later stages millc is found 
to agree better than any other food. Cod-liver oil, when it 
with the patient, is to be recommended. The meals 
should be small enough to be easily digested, and the heaviest 
meal should be taken in the middle of the day. 


DIET IN CHRONIC BRONCHITIS. 


‘The dietetic management of chronic bronchitis is similar to 
that advised in the early stages of tuberculosis. In the dryer 
forms demulcent drinks are useful, and hot flax-seed tea, sweet~ 
ened with sugar and flavored with lemon-juice, should be taken 
in sufficiently large quantities and is particularly effective. Hot 
drinks of various kinds may be used, and are especially useful 
in temporarily relieving troublesome cough. Hot milk or hot 
lemonade, or, if stimulants are indicated, whisky and glycerin, 
many be given. 


DIET IN HEMORRHAGE FROM THE LUNGS. 
When a patient has had a hemorrhage from the lungs he 
should immediately be put to rest and kept absolutely quiet. 
If the hemorrhage has been severe and the patient is in danger 





DIET IN DISEASES OF THE RESPIRATORY ORGANS. 407 


of collapse, in addition to the usual morphin injections, normal 
salt solution may be given by the rectum or subcutaneously, 

‘The food should be liquid in form, Peptonized or plai 
milk, liquid beef or similar preparations, fresh 
juice, bouillon, and the like may be used, and should be given 
in small quantities at regular intervals—two or three ounces 
may be given every two or three hours. If there is a tendency 
to vomit, food may be given by the rectum, 

To allay thirst only small quantities of fluid should be given 
ata time. Later, when the stomach is tolerant, larger quantities 


ar be prescribed. 

i hprbepriaadbiegrctian he waaay teehee i 
tion of the stomach its, a rapid return should be made to 
an ordinary diet, Meat should be given in abundance to coun- 
teract the anemia. 

Alcohol is, as a rule, best avoided. If it is needed as a stimu- 
lant, it should be given in small quantities. In yery severe 
cases larger quantities may be required to support the heart. 


DIET IN PNEUMONIA, 

In pneumonia, feeding is of the greatest importance. The 
patient’s strength must be fostered, for the better the nutrition 
is maintained, the more likely will the patient be to withstand 
the effects of the disease. Formerly, owing to energetic, but 
often misdirected, treatment, many patients died in the early 

of convalescence, The French writers described their 
patients as having “ died cured ”—mort guéri. 

‘The same general principles of feeding should be followed as 
are indicated in all acute fevers. During the course of the 
disease the patient should receive an abundance of water in 
addition to the liquid food supplied. Plain water or any car- 
bonated water that the patient may desire should be given, 
Milk and seltzer may be allowed freely. Lemonade, or 
ade, or water flavored with tamarinds may serve to lend variety, 
‘The “imperial drink” (the recipe for which appears at the end 
of this book) may also be given, 

During the height of the disease milk should form the basis 
of the diet. This may be peptonized or diluted with lime- 
water, Albumin-water, wine whey, malted milk, beef-juice, 
Eskay’s food, and similar preparations may be employed when 
milk is not well borne. Predigested liquid beef preparations 
may be used both for their stimulating effects and as a food. 


408 DIET IN DISEASE, 


‘They should always be diluted freely with water, unless, because 
of vomiting, a Guesebtested food is indloated. 7 

Food should be given at regular intervals of from two to 
four hours, according to the patient’s condition and the amount 
he i able to take at one time. 

Constipation, flatulence, and vomiting are to be avoided where= 
ever le. If they do occur, efforts should at once be made 
to relieve the condition. 

Tn most cases starches and sugars are best omitted from the 
diet. Fruit may be allowed at any time during the deen 
and is of special benefit during convalescence. Most grat 
during the severe stage are orange-juice, lemonade, grape-fruit, 
and grapes. During convalescence ripe peaches or pears in 
season may be added to the diet. The return to a general diet 
should be made gradually, and no solid food should be allowed 
until the fever has subsided. Then the general dietetic rules 
for convalescents may be followed. 

Pneumonia patients show a wonderful tolerance for alcohol, 
and it is apparently utilized by the body as a food as well as a 
stimulant. Large quantities may often be taken without pro- 
ducing any symptoms of intoxication, Should they occur, it 
is an evidence that the dose has been too | Alcohol 
should not be prescribed as a routine measure, but should be 
ordered as soon as the heart begins to flag. The indication for 
its use may generally be determined by auscultation before 
either the symptoms or the pulse point to the need for it. It 
should be given at once when the first sound of the heart 
becomes prolonged and weaker. In weak individuals, whatever 
their age, especially in patients over fifty, alcohol may be 
early. The dose for adults is one-half an ounce of pure whisky, 
sufficiently diluted, every four hours; this may be increased 
when necessity arises. Strychnin and other heart stimulants 
have obviated the need for the enormous doses of aleohol for- 
merly proscribed. Tn alcoholic subjects it should be given regu= 
larly. If it is withdrawn, delirium or collapse may ensue. 
The usual care should be observed in determining whether the 
stimulant is doing good or harm. It is best given in the form 
of pare matured whisky, but champagne, brandy, or rum 
may occasionally be substituted when these are better borne. 
Tn all cases they should be well diluted with plain or carbonated 
water, 

Pneumonia in Children.—The same general plan is to 
be followed as when the disease oceurs in adults, and both 





DIET IN DISEASES OF THE RESPIRATORY ORGANS. 409 


pred ately and bronchopneumonia require the same 
‘The food should te iven at nedee intervals, or if the child 
Agel ste eres, W abies store at regular intervals, If a 
child at the breast is too weak to nurse, the milk may be 
Freep nt ony eve by means ot a stomach-tube or a spoon. 
stomach-tuhe should not, however, be used in pneumonia 
as a last resort. 
infants are fed on modified cows’ milk, the milk 
should be further diluted with lime-water. Food should not 
be given oftener than every two hours, and if a sufficient 
juantity is taken, the interval may be lengthened to three or 
four hours. Milk is the most important food, and may be 
ictal vi with lime-water or with carbonated water. It may be 
ae oe rtially or completely, or be with the 
ilk Powder, with Eskay’s, Mellin’s, or similar 
eres or maalted milk may be used. Buttermilk, or _pre- 
pared after the method directed in the section on Infant Feed- 
ing, may be tried. Kumiss is often retained where plain milk 
is rejected. If milk is not well borne, barley or oatmeal gruels 
may be used by oy of variety. If these cause flatulence, 
they should be avoided. Albumin-water and fresh beef-juice 
are neeful foods, and such tions as Panoj liquid 
Raat replonclde, cod protinncnl edt areal pron tensaag a 
other foods are not. well retained or assimilated. Beef broth or 
other meat broths may occasionally be given, 
Sia problem of feeding children suffering from pneumonia is 
ently a very difficult one, for while may take a food 
ily, they may refuse it the next time it is offered or vomit it 
if taken, When milk is well borne, it should constitute the diet, 
but where it is not, the physician must have as many resources 
as possible. From one to six ounces, according to the age and 
condition of the patient, may usually be given at a time, but it 
may at times be necessary to give the food in teaspoonful or 
tablespoonful quantities. 
Tf there is much vomiting, equal parts of lime-water and 
cinnamon-water may be given to great advantage. A tea- 
Spoon of this mixture fifteen minutes before pelieg may allow 
food to be retained where it would otherwise be 
Water should in all cases be offered the child from time to 
time, and the mistake of forcing the child to take food when it 
wants only a drink of water should be avoided. If there is 
no flatulence, the carbonated waters are often very well borne. 





(oF 


oe 


410 DIET IN DISEASE. 


Alcoholic stimulants are generally needed and are well borne. 
Whisky or brandy diluted with at least eight lene of a 
Ieigtion: a ile es or glycerin being added to overcome the 

taste and re it more ble, In pneumonia, as in 
pear dissaens, aloskal 's torna tter when it is given in small 
quantities and frequently, than when larger doses at 
intervals are prescribed. ‘The average interval is two 
but it may be given hourly or even more frequently whoa 
oceasion demands. 


DIET IN DISEASES OF THE CIRCULATORY 
SYSTEM. 


DIET IN DISEASES OF THE HEART. 


General Directions for Diet.—The diet for Mee 
with heart disease usually requires more or less Le 
tion. ‘The subject may be divided into a consideration of the 
diet suitable before, and that indicated after, compensation is 
lost. 

While compensation is the diet requires comparatively 
little ouside boron te observance of Pst 
rules. When compensation is bordering on rupture, however, 
the diet must be supervised carefully, as in this way much dis- 
comfort may be spared the patient and even the time of ruptured 
com eet be postponed. 

eals should be small—more should never be given 
than Ris patient can easily digest. If the stomach is over- 
loaded, the diaphragm is pushed up and displaces the heart, and 
this may posadlon atin and dyspnea. If the meals are 
too large, the residue of any digested food in the intestine may 
undergo fermentation and cause flatulence, with its attendant 


Siegen symptoms, 
‘The meals should be simple and well cooked. Improperly 
repared food is a cause of indigestion, and may produce flatu- 
Tete ordiscomfort. The food chosen should be of a kind that 
is easy of digestion. A sufficiently long interval should be 
allowed to elapse between meals, and eating between meals 
should be strictly prohibited, as even small portions of food 
taken while digestion is in progress may give rise to flatulence 
in these patients. 
‘The meals should all be of about equal size; while the even- 





DIET IN DISEASES OF THE CIRCULATORY SYSTEM. 411 


ing meal may be a little smaller and lighter than the others, 
ba a bra bt pepsi contiaet er there should, 
as has been said, be but comparatively little difference in their 
size, and the patient should be instructed carefully in this 
regard. 

on 


The amount of fluid taken should not be too lange, 

the other hand, should it be too small, W hia. ccpenkatise 
has been lost, the question as to the amount of fluid to be taken 
becomes of much importance. At no time should it be forgotten 


small, elimination is delayed and the irritative effect of the 
retained impurities in the Blood proves harmful, Fluids should 
be taken between meals, and are best sipped slowly. Weak 
tea and coffee may be allowed in nea quantities between 
meals ; if they do not cause flatulence, however, they may be 
allowed at meal times, but always in great moderation. 
Alcohol is best avoided. If, owing to the general weakness 
of the patient, its use is indicated, it should fereccaan 
Mie and in the form of pure whisky or brandy well 
ted, Wine and beer are contraindicated. 
‘n general it may be said that a diet of plainly prepared 
foot, unencumbered by too many restrictions, is best in these 


cases. 

All highly seasoned food and the condiments in 
should be omitted from the diet, as eat tend to stim the 
appetite of the patient, and may cause him to take more food 
than it is necessary or desirable for him to have. 

Stews and fancy dishes should also be omitted, as should the 
foods usually classed as difficult of digestion, such as fried foods 
and the like. 

Starches, sugars, and fats should, as a rule, be interdicted ; 
this restriction, however, should be enforced strictly only when 
made necessary by complicating stomach disorders coming on 
3 compensation ruptures, when they are apt to cause fermenta~ 
tion and flatulence. 

Broadbent dwells on the necessity for giving a diet contain- 
ing about the usual proportion of food constituents. Starches 
and vegetables are 1 additions to the diet, they help to 
keep it from being too largely nitrogenous. If too much pro- 
tein material is taken, it is imperfectly oxidized and. the waste 
accumulating in the blood increases the work of the heart, just 
as when too much food is taken. 











2 
half an hour before eating will hel 


In the Ocrtel treatment of heart-disease the fluids are allowed 
only in a very limited d . If the patient ie on a milk diet, 
other fluids besides milk should be given in comparatively 
small quantities. 

If edema is severe, the food may be given in as concentrated 


@ form as ible. 

If tales is troublesome, fats, starches, and sugars, as 
well as beer, pastry, and stews, are to be avoided. No solid 
food should be taken between meals. Coffee or tea taken with 
the meals may give rise to flatulence. They may, however, in 
some cases be taken during the day, at a time when the stom- 
ach is empty ; should be freshly prepared and should 
never be strong. ly such quantities of food as the patient 
can digest should be allowed, and, if necessary, digestion uo 
be aided by giving essence of pepsin or other digestives. 
some cases a milk diet may become necessary. 







DIET IN DISEASES OF THE CIRCULATORY SYSTEM, 413 


Swiden dilatation of the heart or following 
any acute disease requires rest pohetin bog 

Palpitation and dyspnea are often caused by the i 
too abundant meals ; if persistent, the food should popes 
smaller quantities ‘and at shorter intervals. Four or five small, 
instead of three large, meals may be taken at regular intervals, 
or a milk diet may be ordered for a time. The general ee 
ment may be such as has been sug for flatulence, 
coffee, and tobacco should be av , and effervescin, drinks 
may also be omitted. If there is constipation, ste fruits, 
3 ly es or figs, are useful, 

yams Eisai Onda er ere met by rest and a milk diet for 

a time, with a laal return to the ordinary diet or a diet such 
seoa cava for cases of gastric catarrh. Much relief fre- 

tly follows the pecnites, of a glass of hot water or of 
Vichy half an hour before a meal. 

Be oe tion is accompanied by effusion, some~ 
must be said with special reference to the removal of 
from the body. Here, indeed, feeding is a difficult task, 

or the patient usually has a disgust for food. As Broadbent 
says, the object is to keep down the volume of the blood while 
maintaining its quality. If the patient is very ill, nourishment 
may be administered every three hours. If he is able to be 
about, it will often be well to allow him to take his meals with 
the family at the regular meal-time. He may be given chicken, 
tender meats, fish, oysters, junket, and other forms of light 
pel hes bat Leap eset at the segues oe fiat be 
may be given between the meals, at regular periods, time bei 
allowed for complete digestion to take place. Milk, albumin- 
water, egg and milk, soup, or beef-tea in small quantities are 
useful for this purpose, Broadbent recommends meat or 
chicken jelly or meat extracts, for their stimulating effect on 
the heart, Potted-meat sandwiches or meat pulp, prepared as 
directed for tuberculous patients, may be given. In Germany 
raw ham is sometimes prescribed. Constipation may often be 
avoided by adding stewed fruit, prunes, or figs, or vegetable 
purées, all in small quantities, to the dict. If necessary, pre- 
digested foods may be used. 

Fluids other than milk and soups should be taken in as 
small quantities as possible. “Imperial drink” or hot water, 
us previously suggested, may be given to quench the thirst, 

Stimulants are usually needed, but should be given only 
under the supervision of, the physician, as there is a tendency 


4h DIET IN DISEASE. 


HEART LESIONS IN CHILDREN, 


The dict is essentially the same as that for adults, Children 
who are able to be about require careful supervision, the treat- 
ment being along the same general lines as were laid down for 
adults, Less food is required than in health, and the meals 
should be smaller. Care should be exercised to see that the 
food is eaten slowly and well masticated. The diet should con- 
sist largely of milk, eggs, and meat, with or without a cereal, 
and yegvtables, the last being of the more easily digested varie~ 
ties, such ns well-cooked spinach, asparngus-tips, and cauli- 
flower tops, as these are least apt to cause flatulence. Fresh 
young peas, mashed and strained, and fresh, tender string 
beans may also be allowed. Potatoes, either well baked or 
well boiled and mashed, may be eaten in small quantities. ATI 
coarse and stalky vegetables are to be avoided, If there is 
flatulence, the carbohydrates, as well as the fats, may be very 
much lessened or omitted temporarily. 

In the more severe cases milk agrees better than any other 
form of food, and should be given in small quantities at regular 
intervals. As a rule, it should not be taken too cold. The 
various modifications of milk and other liquid foods that have 
been mentioned in connection with pneumonia may be em- 
ployed. In some cases, especially when dropsy is severe, there 
is no desire for food, and the problem of feeding then becomes 
a difficult one. In these cases predigested foods of various 
kinds, raw meat-pulp, a8 advised in tuberculosis, and beef-tea, 
beef-extract, and the like, may be tried. 


SENILE HEART. 


Balfour’s little book on The Senile Heart will prove a valu- 
able guide to the care and management of the aged. In his 
chapter relating to diet he says: “Cardiac troubles are always 
alarming, particularly in old age, but much may be done to 
relieve the patient and to prolong his life, Attention is to 
be paid to the little things of daily life—the little things of 
eating, drinking, and doing—that influence the patient’s comfort 





| 





DIET IN DISEASES OF THE CIRCULATORY SYSTEM. 415 


and gradually turn the scale of health in his favor. ee 
als Brey Fay on tall eaten 

time, difficulty may be in secu: sequiescence, All 
heart affections of the old are not ‘ily senile in character 


cardiac failure is essentially based upon imperfect 
fringe mums be conte.” ses Gt Set pote es Ua 


Smal taiaary, to be iat 2 psy A smaller number are 


than the precedin, pea These require to be specially 
dieted and cared for, s0 as to remove the obesity without dimin- 
ishing the cardiac energy or the strength of the myocardium. 

ly, there are those in whom there is more evident failure 
of the myocardium. There are more evidences of dilatation of 
the heart and of the tissues. Such cases require a specially 


diet.” 
eo etas Important Rules.—1. An interval of five hours 
should be allowed to elapse between meals. 

2. No solid food should be taken between meals. 

3. All persons with weak hearts should take their principal 
meal in the middle of the day. 

4. Persons with weak hearts should take their meals in as 
dry a form as possible. 

All indigestible food should be avoided. Especially to be 
mentioned in this class are dried, salted, or otherwise preserved 
meats, cheese, pastry, all other foods in which fatty matter has 
undergone prolonged exposure to heat, and all sweets and nuts ; 
owing to their inability to cause flatulence, vegetable food must 
be chosen with care. Vegetables of the fren family, and 
carrots, turnips, and parsnips are regarded witl disfavor by 
Balfour. Even potatoes should be eaten sparingly. Fruits 
should not be crowded into a mea) as a dessert, but may be 
allowed to form part of the meal, especially at breakfast or at 
a midday dinner. 

No good is to be gained by attem) to enforce dietetic rules 
founded on the number of grains pa or nitrogen required 
to carry on the processes of life. 

The foods to be allowed persons with weak hearts are the 
tender varieties of white fish, chicken, rabbit, game, mutton, 
or well-grown lamb, all of which Balfour gives in preference 
to tough beef. One well-boiled, ripe, mealy potato may be 


416 DIET IN DISEASE. 


allowed at dinner. Spinach, since it does not cause flatulence, 
is the safest vegetable; asparagus-tops, onions, and tomatoes 

in moderation. Peas, beans, and other legumi- 
foods, when fresh, young, and green, may be partaken of 


Not more than five ounces of fluid, and if possible less, 
should be taken with a meal. If water is desired with the 
meals, it should be taken hot and sipped slowly. If tea is 
used, it should be weak—a teaspoonful of the tea to five ounces 
of water, steeped for not more than three minutes. Coffee may 
be sweetened to taste, and tukea black or with cream. Choco- 
late and cocoa are too rich for those with weak hearts, but if 
taken alone may occasionally be useful. 

‘Alcohol should be prescribed only as it is needed. So many 
patients have been accustomed to its use all their lives that it 
cannot be cut off altogether. For those to whom alcohol is 
permitted half an ounce of whisky, brandy, or gin may be 
given in three or four ounces of water twice a day, together 
with their food; or a single glass of sherry or port or two 
glasses of any lighter wine, such as hock or claret, each glass 
to hold two fluidounces, may be ordered. The stronger wines 
are best omitted, as they are liable, if taken in larger quanti- 
ties, to give rise to dyspepsia. Champagne is, as a rule, for- 
hidden. Tdiosynerasies occur in regard to the effect of wine, 
so that the individual case must be considered before it is 
ordered, Alcohol is best given in the form of pure whisky 
and water, always in extreme moderation. As a stimulant for 
a weak heart, small quantities of alcohol are frequently pre- 
seribed, to be taken at various times during the day. This is 
most injurious treatment, for although the primary effect of 
alcohol is stimulating, secondarily it is depressant. A better 
plan is to direct such a patient to take two or three sips of 
water, as hot as can be swallowed, occasionally throughout the 
day. Apart from that taken in the food fifteen ounces of 
water a day are all that should be allowed, but if severe thirst 
is complained of, a half pint of hot water may be sipped about 
four hours after each meal or only after the principal meal, 
‘This cleanses the stomach and prepares it for rest. Hot water 

juenches the thirst better than does cold. The thirst is usually 

to a catarrhal dyspepsia, and soon disappears after the 

diet has been regulated. The following is Balfour's dietary, 
which is easily modified : 

“ Breakfast 8.30: One small slice of dry toast, weighing 





DIET IN DISEASES OF THE CIRCULATORY SYSTEM. 417 


about an ounce and a sree butter ; one soft-boiled or 
poached egg, or half « small haddock, or its equivalent in an; 
Piher fret vhite fab, with from three to Hiveloancal-al Mate 
coffee, with cream and sugar. If there be any difficulty about 
the tea, it may be rep! by a similar quantity of infusion of 
cocoa-nibs, or milk and hot water, or cream and seltzer water, 
Some prefer oatmeal porridge, with milk or cream, and in ordi- 
nary circumstances this need not be objected to, provided not 
more than four or five ounces of milk be taken, and the por- 
ridge be not more in quantity than three or four ounces of oat- 
meal, well boiled : poss also, that porridge alone be taken, 
and not porri rat, followed by tea, toast, ete., which is 
destructive of all comfort, both for stomach and heart. 

“The principal meal of the day, whatever it is called, lunch 
or dinner, should be taken about 1,30 or 2 o'clock, and may 
consist ly ap sepeenpee= more—fish and meat, or fish me 
pudding, or meat an‘ i Soups, pastry, pi 
Cision are. abeclutely”focbiddan Wkibs isk ane aes Ait 
short fibers are preferred. Half a haddock, or its equivalent 
in any other white fish, boiled in milk, steamed, or broiled, 
never fried ; wing rosa rags of the breast of a chicken, or its 
equivalent in sweetbreads, tripe, rabbit, game, or mutton; one 
single potato or a little spinach, For pudding, any form of 
simple milk pudding may be taken, or sins half a pound of 
such fruits as pears, apples, grapes, ete., either cooked or un- 
cooked, During this meal four or five ounces of hot water may 
be sipped if desired. 

“From 5 to 6 three or four ounces of tea may be taken if 
desired, infused, as in the morning, not longer than four min- 
utes, and with cream and sugar if wished ; but no solid food 
must be taken with jt—not even a morsel of cake or biscuit, 
Tf there be any difficulty about the tea, four or five ounces of 
hot water may be substituted for it, and if there seem any need 
for a stimulant at this time, a teaspoonful of Liebig’s extract 
of beef may be stirred into it. 

a Supper, or the last meal of the day, must always be a light 
meal. It should be taken about 7, and may consist of white 
fish and a potato, or toast, with butter, or some milk pudding, 
or bread and milk, or Reyalenta, made with milk or with Lie- 
big’s extract of beef. At bedtime, four or five ounces of hot 
water will soothe the stomach, promote sleep, and pave the way 
for a comfortable breakfast next morning.” 

a7 


418 DIET IN DISEASE. 
When there is anasarca, the following “dry diet” is recom- 


mended by Balfour. 

“ Breakfast—One single slice of dry toast, weighing about 
an ounce and a half, with no butter, but with a single cup of 
tea infused not longer than four minutes, with cream and sugar, 
amounting in all to not more than four ounces, and nothing 
else. 


“ Dinner—Not more than the lean of two chops, or its 
equivalent in chicken or fish; no vegetables; as much dry 
toast as may be desired; half an ounce of brandy, whisky, or 
Holland gin, in three ounces of water, and nothing else. 

“ Supper.—As much dry toast may be taken as is desired, 
along with half an ounce of brandy, whisky, or gin in three 
ounces of water; and nothing more.” 

It is not desirable that a patient in this condition drink much, 
even between meals, but if thirsty, he may be permitted to sip 
slowly three or four ounces of hot water about an hour before 
each meal, 

ARTERIOSCLEROSIS. 


In most cases of arteriosclerosis symptoms of senile heart 
occur at the same time, and the same general principles may be 
followed as were directed for that condition. The French par- 
ticularly advocate a milk dict in the treatment of arteriosclerosis, 
and where there are headaches, insomnia, and other untoward 
symptoms, an absolute milk diet may be used with advantage. 
‘As soon as the symptoms disappear a mixed diet may be sub- 
stituted. (See Milk Cure for methods of giving milk.) Min- 
eral water may be prescribed, or trips may be made annually to 
mineral springs, Whenever possible alcohol should be pro- 
hibited. 

ANEURYSM. 

Th most cases of aneurysm that are proving troublesome the 
treatment consists of rest, a restricted diet with a limited amount 
of fluid, together with potassium iodid. From ten to twenty 
grains of the iodid three times a day are sufficient. 

Certain cases of aneurysm may be relieved by rigorous diet~ 
ing. The saccular forms, and especially cases of aortic aneurysm 
with small openings, are most apt to improve under this treat~ 
ment. Dieting is also helpful, it is said, in traumaticaneurysm. 
‘Taffhell, of Dublin, advised the following diet : 

Breakfast.—Two ounces of bread with a little butter and 
ounces of milk. 7 





DIET IN DISEASES OF THE CIRCULATORY SYSTEM. 419 


Dinner.—From 2 to 3 ounces of meat without salt, and 4 
ounces of milk or claret. 


patient, and a competent nurse who will see that the diet is 
strictly adhered to is essential. Thiret may be relieved by 
small quantities of acidulated drinks or by sips of hot water. 
eran oar he eau may also morphin. Few 
patients, however, are willing to undergo the suffering that such 


healt dyes ae eat ata 
twenty-four hours s| not ex ounces, and a5 mi 
less as possible is to be taken. ‘Twenty-four ounces he places 
as the minimum. 

The object of the treatment is to produce the slow circula- 
tion of a condensed blood in the hope that fibrin may be formed 
in the sac. Burney Yeo does not favor such severe dieting. 

When the case is not a suitable one and is not givin; is 
trouble, it is probably best to recommend a quiet life and a 
simple dict, avoiding indigestible articles of food and those that 
cause flatulence. As Osler has said, the medical profession has 
furnished numerous examples of men with aortic aneurysm liv- 
ing for considerable periods and doing good work. these 
the late Hilton Fagge was a notable example. 


ANGINA PECTORIS. 

In this disease dict is of the greatest importance, The 
majority of cases oceur in ‘large eaters,” and, as Osler says, 
there is “death in the pot.” Asa rule these patients realize 
that overeating is harmful to them, 

The meals should be small and easily Gree and all rich, 
highly seasoned food, as well as anything that causes fermenta- 
tion, should be carefully avoided. Flatulence is a symptom 
that must, so far as possible, be avoided, for as soon as the 
stomach becomes distended distress follows that may produce an 


420 DIET IN DISEASE. 


attack. The evening meal should be small, and eating late at 
ais should be prohibited. 
the patient is, in addition, the subject of gout or glyoo- 
suria, his diet must be regulated accordingly. The dict suitable 
for various cases differs widely, and personal idiosynerasy must 
always be taken into account. 
wat his lectures os shred calls “A ser that Dr. Smol- 
in Humphrey Clinker, es one of his characters, Matt 
Bramble, say: “ For my own part, I have had a hospital these 
fourteen years within myself, and studied my own case with 
most painful attention, consequently may be supposed to know 
ing of the matter.” An intelligent patient should know 
what food does and what does not cause flatulence. Flatulence 
ig most apt to occur in fat abby patients and in those with 
weak hearts and arteriosclerosis. Hot water taken half an 
hour before meals may be useful. 

In those with whom the drinking of stimulants is a life-long 
habit alcohol may be allowed, best in the form of hot toddy at 
bedtime. To quote Osler again this may prevent the flatulence 
that is apt to come on during the early morning hours. c 


ANEMIA, 

Acute Posthemorrhagic Anemia.—The reader is re- 
ferred to the section on Diet after Operations for suggestions as 
to the diet in this disorder. In the case of the smaller hemor- 
rhages, which are rapidly recovered from, the usual diet. may 
be followed. In the more severe fortns, special care may be 
required, If the anemia that follows a severe hemorrhage be- 
comes chronic, the patient is to be managed the same as in 
cbronie secondary anemia, If much blood bas been lost, fluid 
should be supplied to the body in the form of normal salt solution, 
by transfusion into a vein, subcutaneously, by the rectum, or by 
the mouth, according to the condition of the patient. In most 
cases the fluid part of the blood is rapidly replaced. If the 
hemorrhage has been from the stomach or bowel, special man- 
agement, as detailed under their respective headings, is necea~ 


sary. 

Te the patient is very weak, cold milk is usually the most 
acceptable form of food. Hot milk is preferred by some, and 
is best for many cases. Fresh beef-juice and weak beef-tea are 
valuable, as is also albumin-water. As soon as the patient is 
able to eat, a diet containing considerable protein and the fresh 
green vegetables should be administered, as well as milk, eggs, 








DIET IN DISEASES OF THE CIRCULATORY SYSTEM. 421 


rare or raw meat, with spinach, tips, apples, straw- 

Indigestible articles should be avoided, and strong tea, coffee, 
and the much concentrated beef-teas should not be taken, espe- 
cially in the acute 

According to the meager experiments and observations that 
have been made on this subject, the metabolic processes of the 
body are either about normal or similar to those going on in a 
condition of hunger. Iron in some form is advisable in the 
severer cases, 

Chronic Secondary Anemia.—Efforts should be made 
to locate and remove the cause. The diet should be about the 
eame as that recommended for chlorosis. Fresh food, milk, 
eggs, meats, green vegetables, and fresh fruits are the most 
important articles of diet. Fresh air and sufficient rest are 
also essential. 

Pernicious Anemia.—In spite of the grave anemia the 
body fat and muscles often remain for a considerable time but 
little Ee cence testis aero Dowerirs is 

rogressive, an toa ing. remoyal to a 
Vifferent climate, fresh air, and attention to the diet may in some 
cases prolong life. Nevertheless the tendency of the disease is 
to become progressively worse. 

Owing to the anorexia, vomiting, and diarrhea that are apt 
to be present, the dict is a matter of importance. Coupland 
and Hunter claim that a carbohydrate diet is better borne than 
one com) largely of proteins. As the result of experiment, 
Hunter has been led to believe that intestinal putrefaction ocours 
less often on a milk and carbohydrate diet, 

Predigested foods, prepared infants’ or invalids’ foods, raw 
meat-juice, and similar articles of food may be allowed. Small 
quantities of alcohol may also be prescribed. 

During recent years the bone-marrow of long bones of ani- 
mals has been recommended highly in cases of pernicious 
anemia. ‘The marrow is eaten raw, in doses of from one to 
three tablespoonfuls twice daily. The authors have obtained 
good results in several cases from this form of treatment. 


CHLOROSIS, 
The diet for chlorotic patients is not generally understood, 
and therefore requires especial study. 
In chlorosis no changes occur in either fat or muscles, Some 
patients are fat while others are thin, this depending for the 





422, DIET IN DISEASE, 


most part on accidental circumstances, and bearing only an 
indirect relation to the anemia, The thin patients are usually 
those individuals who are of that habit ; who have co- 
existing disease of the stomach ; those who take too little food 
and who are, in consequence, suffering from malnutrition; or 
lastly, those who must undergo considerable bodily exertion, 
usually in getting their livelihood. 

‘The fat patients and those who are often edematous looking 
are individuals who are either fat by nature or who are receiving 
too much milk or other fluid with their diet. 

Under a proper diet no change in the weight may occur; or 
in the case of the fat, edematous-looking patients, there may be 
a loss in weight while the anemia is improving, or if the patient 
has been taking too little nourishment or is doing too much 
work and is thin in consequence, there may be a gain in weight. 
The metabolic processes, so far as is known, are the same as in 
health. Owing to the lowered hemoglobin value of the blood, 
the patient is not able to exert herself’ much without producing 
great fatigue. 

In the treatment of the chlorotic patient three things are 
important : iron, sufficient food at proper intervals, and rest. 

Regarding the diet, the quality and the quantity of the food 
may be the same as in healthy individuals. The meals should 
be given at regular intervals, not too widely separated—usually 
not more than three hours apart. In consequence of the shorter 
interval and because the patient’s desire for food is apt to be 
lowered, the meals should be small. The appetite is capricious, 
and while the regular meals may be left untouched, such unde- 
sirable articles as pickles and sweets may be greedily devoured 
in the intervals. This tendency should be controlled and 
nothing allowed between the meals, Von Noorden recommends 
five meals daily—at 8, 10.30, 1, 4.30, and 7 or 7.30. This 
same observer also insists on the value of taking an abundance 
of protein food at breakfast, giving as his reason that protein is 
the only food (aleohol not being considered) that is ready for 
use in the body shortly after ingestion. Carbohydrates for the 
most part go first to the liver, and fats are too slowly absorbed. 
The patient who takes the customary Continental breakfast of 
coffee and rolls has a long wait before the cells receive adequate 
nourishment. The kind of protein food is of little importance, 
and may be either meat or eggs; meat is, however, especially 
recommended, and should be jn regularly for breaket ia a 
definite quantity, 





j 


DIET IN DISEASES OF THE CIRCULATORY SYSTEM, 423 


should bow idal wee tke appetite is sh of mil 

in the cans gneally hk ay arte de food. It is 

a fo ha peciced 3n Shone foam a cep nn oee 

ut the patient iden aminetnr lie eon fat 

becomes omewhat edematous looki in 

cells retain too much water. en there is atony of the 

stomach, water is to be taken in small quantities. ‘Mille 

be used by patients who are thin and where there has been 

i seeiatig malubistion Milk and cream mixed is of great 
les, 


ae, 

Fresh fruit and vegetables, particularly the green vet 
are of especial yalue and may be partaken of freely. All kinds 
of fresh fruit in season are to be recommended, avoiding small- 
seeded berries where there is irritability of the stomach. If 
fresh fruits can not be obtained, properly prepared, evaporated 
fruit may be eaten and helps to raga the bowels, Fresh 
fruit and vegetables do not, as a rule, cause the disturbance of 
the stomach so often attributed to them. In cases of ulcer of 
the stomach and often in other gastric disorders they must, 
however, be avoided. When fruit disagrees, it usually causes 
pain or flatulence. Von Noorden recommends that it be taken 

in the afternoon or with the meals. For Americans some fruit 
at breakfast is of value, but it should not be eaten to the 
exclusion of the more important meat. 

In the ordinary case of ¢ chlorosis alcohol may be dispensed 
with. If given, it should be done guardedly, as patients be- 
come accustomed to taking it to relieve the feeling of weakness 
and faintness. A small quantity of port, sherry, or one of the 
other stronger wines may be allowed as an appetizer half 
hour before the midday meal. In the thin or overworked a 
good beer may be taken in moderation with the principal meals. 
aa wine, which is often recommended, is of no particular 
value, 

Von Noorden gives the following suggestions for the selec- 
tion of the diet in chlorosis: 

The breakfast may be'taken in bed, or the patient allowed to 
rest on a lounge for an hour after the meal. Many patients 
will go to sleep, and this should be encouraged by darkening the 


Ba 


404 DIET IN DISEASE, 


sare of eee vical exces wit ‘Two or three ounces or 


zwieback may be Fiven, togethe re soneties wits a small quantity of tea 


shonld not be taken until the end of the meal, so as not to dis~ 
turb the appetite. After eating the patient should rest from 
one-half to three-quarters of an hour, If there should be pain 
or discomfort in the stomach, hot applications may be made to 
the abdomen. 

In the afternoon, cooked or raw fruit with bread or zwieback, 
or, if fruit is forbidden, tea or cocoa and toast may be given. 
If there is no tendency to superacidity of the stomach, bread 
and honey or fruit-jelly may be allowed. A glass of milk or 
milk and cream should be taken after the meal. 

‘The evening supper should be as simple and as unirritating 
as possible, Four times a week a thick soup or gruel of oat- 
meal, barley, rice, or tapioca may be given, with meat-broth 
and butter or with milk and butter. 1f Saeed eggs or other 
light foods may be given instead. Stewed frait may also be 

allowed several times a week. If the hunger is not satistied 
cold meat may be permitted in addition, On other days eggs, 
meat, or fish may form the principal part of the evening meal. 
‘A glasa of well-brewed beer or a glass of milk may be given 
at bedtime, which should never be iiter than 10 o'clock. 

The diet in emaciated patients, since there is apt to be either 
loss of appetite or disease of the stomach, is sometimes difficult 

ate. A change of cooking may be beneficial. Von 
Noo: allows 100 grams of protein daily with butter, cream, 
or cod-liver oil, A moderate amount of carbohydrates may be 
allowed, but not to the exclusion of other food. Milk may be 
given an hour before rising in the marning, and alcohol may 
often be used with advantage. 

When the patients show a tendency to become fat and ap- 


DIB IN DISEASES OF THE CIRCULATORY SYSTEM. 425 


parently edematous, the diet must be made as dry as possible— 
Gerrvins ddr t) Sooty diet: somiecetal i etena 
diseases, Sweating may also be induced in order to reduce the 
amount of fluid in the tissues. Rapid recovery sometimes fol- 
Jows this method of treating flabby chlorotic patients. When 
there is disease of the stomach, the diet is regulated accordingly. 
Constipation is to be relieved by suitable diet, or, if necessary, 
drags may be resorted to. 


LEUKEMIA. 


‘The dict in leukemia should be a mixed one, but 
should contain as much protein as possible. The choice of foods 
will depend largely on the condition of the stomach and intes- 
tines. In leukemia the metabolic processes are heightened. 

During the early stages, however, they remain about normal. 
As the disease progresses there is said to be an increase in the 
excretion of nitrogen. ‘This calls for an extra amount of protein 
food to make up the deficien ‘This may, however, be a diffi- 
cult matter, owing to the liability to cause disturbance of the 
stomach and intestines. The diet should be arranged so as to 
contain the largest possible amount of ee assimilated protein 
material. Sugars, starches, and fats should be given sparingly, 
since their digestion requires too much time before they can be 
utilized by the tissues. 

Milk and the milk derivatives, such as buttermilk and kumiss, 
eggs, and the more easily digested meats should form the bulk 
of the dietary. When they agree, bread, toast, and well-cooked 
cereals may be taken in moderation. Of the vegetables, spinach, 
usparagus-tips, cauliflower tops, and young green vegetables are 
to be preferred, The selection of the diet will often be governed 
by complicating bowel disorders. 

Alcohol may be allowed as needed, and the desires of the 
patient should be consulted as far as possible regarding the form 
in which it is to be taken, 








PURPURA HAEMORRHAGICA. 

Litten gives the following suggestions as to the diet in this 
disease: The food must be bland and should be given cool, 
Coffee, strong tea, and spirits should be strictly forbidden. 
Alcohel may be allowed when there is collapse. Milk and 
somatose in milk are as the most valuable foods, but 
the diet may be arranged as in any acate febrile condition, A 





| 


= 


426 DIET IN DISEASE. 


diet containing a considerable amount of gelatin has been 
recommended, Other authors suggest the use of an anti- 
scorbutie diet, although no good reason exists for this, mee 
that some of the so-called cases of purpura may in reality 
seuryy or something akin to it. 


HEMOPHILIA. 


A general diet, of which milk, however, forms a considerable 
part, is suggested by Litten, who also recommends the use of 
the fresh green th et and salads. Fresh fruit and lemon- 
ade may be used freely. Coarse food, especially the coarser 
vegetables, should be avoided. 


DIET IN DISEASES OF THE GENITO-URINARY 
SYSTEM. 


Urine and Food.—The urine bears a direct relation to the 
quality and quantity of the food ingested, as well as to the 
quantity of fluid taken and the amount of work done by the 
individual. Many variations in the urine occur that are due to 
food or drink and that are nurmal. When the kidneys are dis- 
eased improper food may bring on dangerous or even fatal con- 
ditions. After a large meal of any kind the urine becomes alka~ 
line temporarily. 

Tho ingestion of large quantities of fluid and the eating of 
juicy fruits or vegetables tend to dilute the urine, and to render 
it less acid and its solid contents relatively less, With mill diet 
the urine becomes acid and indican may be found in it, A con- 
centrated dry diet decreases the amount of urine, increases the 
specific gravity, and makes the reaction more acid, Animal 

food and the more nitrogenous vegetables increase the amount 

of nitrogen compounds and the acidity of the urine. Vege- 
tables increase the carbonates and the earthy salts of the urine. 
A purely vegetable dict renders the urine alkaline. Thompson 
states that Cantani maintains that large quantities of vegetable 
acids will render the urine alkaline. 

Lipuria, according to Halliburton, may be caused by a diet 
rich in fat, even when the kidneys are normal. 

Phosphaturia is believed to be increased by the use of 
potatoes, fruit, and all fresh green vegetables, and to be de- 
creased by adbering to a diet from which these have been elimi~ 
nated. Such a diet would include meat, eggs, milk, cheese, 
cereals, and the legumes. 


rr 


DIET IN DISEASES OF GENITO-URINARY SYSTEM, 427 


Oxaluria—This is a term applied to a condition where 
calcium oxalate crystals are deposited in the urine. The normal 
limit of oxalates excreted in twenty-four hours has been placed 
by Senator at about 20 mgm, Whilst oxaluria may be regarded 
a3 an expression of a disturbance of tabblo pe 
of oxalates excreted is only one fietor to be considered. The 
“een rt of the question consists in the ver a lute 

the otdcewlas insoluble calcium oxalate in solution. 
The solubility of this salt depends upon the acid Tboeghaeg 
especially upon the quantity of magnesium salt present, 
naturally it is influenced by the amount of calcium excreted in 
the urine. A urine containing a large quantity of aes 
Phosphate and a small quantity of calcium salts will bi 
calcium oxalate in solution than urine containing the reverse. 

Oxaluria is accompanied by a number of nervous and gastric 
disturbances, generally spoken of as either neurasthenia or 
nervous dyspepsia. The exact relation of these symptoms to 
oxaluria is not always clear, and clinically the symptoms which 
arise from the of oxalate crystals irritating the urinary 
possess and the danger of formation of stone, either in the 

iney or bladder, are of much more importance. 

Previous to the experiments of G. Klemperer and Tritschler, 
it was not certain whether the oxalic acid excreted was derived 
from the food or from metabolic processes. It is beyond ques- 
tion, however, that foods containing oxalic acid when taken into 
the body increase the amount of calcium oxalate in the urine. 
Tf oxalic acid is neutralized with carbonate of soda and given to 
an individnal, buta small part of it can be recovered in the 
urine or stools, the greater part of it disappears. Of the oxalie 
acid taken in the food materials, as in spinach, about 20 per 
cent. can be recovered in the urine and stools, most of this in 
the urine, whilst 80 per cent. of it disappears. This disap- 
pearance is caused by bacterial and chemical action in the intes= 
tines, changing the oxalates into other compounds. Oxalic acid 
is also destroyed in the blood, whilst calcium oxalate is not. 
When foods containing oxalic acid enter the stomach a part of 
it is dissolved in the gastric juice and about 10 per cent. 
absorbed, In the blood and lymph circulation this is ota 
into calcium oxalate and on the llowing day it is ex 
the urine. 

Besides being taken into the body directly as oxalic acid, 
certain food substances are changed in the processes of meta~ 
bolism into oxalic acid or oxalates and go increase the quantity 





| 


DIET IN DISEASE, 


428 
excreted in the urine. Substances containing ‘alg 
Benissnd ako muscle, may be so change at By 
jrates, and pure albumin are not, but Klem a Pa 
as a frequent source of oxalates, Urio aci sot Senge 
oxalic acid in the body, but it is possible that fermentation in 
the bowel may lead to the formation of oxalic acid. 
Furthermore, oxalates ne apparently formed in the body 
apart from the food su Lathje f found calcium oxalate in 


urine of a fasting 7 anil thing te arene scent 
the amount of iszalio exereted during ae He of resolti~ 
tion of pneumonia. ene Ro: wodluced. 


Sealasie by |the: a hy the destruction of the red bl ells ty e injec~ 
tion of pyrogallic acid. Klemperer is of the opinion that part 
of the oxalic acid excreted comes from the metabolism of the 
resorbed bile, as in the bowel glycocoll is formed from glyeo- 
cholic acid. 

The arrangement of a diet to cure or to prevent oxaluria 
becomes clear upon a consideration of the foregoing statements. 
In the first place, the amount of oxalic acid and oxalic-acid- 
forming fi taken into the body must be diminished or eut 
off altogether. This means forbidding fruits and vegetables 
containing large amounts of oxalic acid, chief of which are 
spinach, sorrel, rhubarb, and cabbage. Gelatin and meats oon= 
taining many nucle, ae glands, should also be forbidden. The 
following tables give the oxalic-acid content of various foods : 

Oxalioacid Content of Various Foods Rearranged ofter Esbach's determinations, 
‘os quoted by Minkoweki, 





Contained oxalic 
id in grace 


os 
0. 
0. 
0 
0. 
0. 
0 


00, 
06 
05 





ees 
& 
2 


DIET IN DISEASES OF GENITO-URINARY SYSTEM. 429 
Oralic-acid Content of some Animal Foods (Cipoltina), 





lowering 
should not be carried to the point of affecting the urine, and is 
usually accomplished by small amounts of Vichy or similar 
mineral waters. This second indication is of minor im, 
‘The third indication is to increase the solvent power of the 


Comparison of Magnesium and Calcium Content of Various Vegetable Foods 
(dipper won Leash 
om Caletaim 
cont, fo cont 
ofthe aah, of the Aah. 
Ds 
159 28 
149 6.3 
134 08 
130 86 
109 32 
103 a6 
9.6 8.5, 
87 40 
86 36 
al BL 
79 1,02 
70 30 
63 12 
25 08 
88 33.9 
65 TS 
47 49 
63 159 
33 79 
88 125 
53 131 
29 27.9 
‘Trace 27 
37 126 
23 10.2 
35 88 
30 69 
58 132 
19 rat 
65 86 
63 78 
43 3b 
95 35.1 
83 316 
52 79 
‘Trace Me 
23, 5.8 








7 


430 DIET IN DISEASE, 


mounts of Magnesium andl Calcium Cmtained én a Cetigram of Dried: Sub 
ie | Rios oer Benge): © is 





10 


Fresh cow# milk contains 0.177 sort be catenteeid sage 
of mgnesiurs oxi in 100 com. = 


urine for calcium oxalate and so prevent its deposition. This 
is accomplished by increasing the fluid and e0 ini the 
amount of urine exereted, and by increasing the acid phosphates, 
especially the magnesium salts, in the urine and 

the amount of lime salts. In the table on page 429 i ne 
en ad Siguso ieee peoatal as is given, , sal 
table will be found it lue in arranging 

lists. The foods eeiatay more lime than magnesium are to 
be avoided, whilst the foods containing an excess of jum. 
are to be chosen. This may also be aided by the administration 
of small doses of magnesium sulphate. Klemperer recommends 
about 2 grams (30 grains) a day, to be given over a period 
of time. The acidity of the urine is also inereased by the meat 
diet usually given in oxaluria. 

The following diet-list will be found of service : 

Allowable.—Meat or fish of any kind except glands, 

Milk and eggs are excluded by Klemperer on account of 
their lime content, but Minkovwslei is of aE opinion that small 
quantities are allowable. If the symptoms are pronounced 
a should be forbidden, and in any case used sparingly if 
at al 

Fat of any kind may be given except the yelk of an egg. 

Stale bread and zwiebacl ak are te bet cartcheoee ae 
rice, barley, and hominy may be given and all the legumes. 
Potatoes may be allowed. Apples are the best fruit. 

feverages.—Water, beer, and weak coffee may be given. 
Alcohol may or may not be given, according to the individual 
and circumstances. It neither increases nor diminishes the 
excretion of oxalic acid. 

Avoid.—All glands, such as thymus, pancreas, liver, and the 
like. Gelatin calves’-foot jelly, and similar dishes, 

All frnits and vegetables containing much oxalic acid—as 
spinach, sorrel, rhubarb, cabbage, turnips, in a word all yege- 
tables except the legumes. 

Tea, chocolate, and cocoa. 

All rich and indigestible pastries and cakes. 





= 


DIET IN DISEASES OF GENITO-URINARY SYSTEM, 431 
Indicanuria.—Underhill found that when gelatin was fed 


sequent administration of ‘in does not materially increase 
the ontput of indican. is might be used in the diet of 
patients with indicanuria. If otherwise permissible the nitro- 
genous food might be diminished and gelatin added to the diet 
instead. There have been no clinical reports on this subject. 

Cystinuria.—Patients with cystinuria should live upon car- 
bohydrates, and fats with the minimum amount of nitrogenous 
food. loa eis may be reduced to 50 or 60 drams a day 
for an individual weighing 70 kilos. 

is not, as a rule, caused by the ingestion of 

certain foods by healthy individuals. Some persons, however, 
possess the remarkable idiosynerasy that egg-albumin, or even 
cheese or other articles of diet, may cause a temporary albu- 
minuria. These cases are of unusual occurrence. (The student 
is referred to text-books on clinical diagnosis or internal medi- —~ 
cine for information regarding the many causes of albumin- 
uria, 

nut articles of food—and this is particularly true of 
asparagus—may impart a special odor to the urine. Shortly 
after eating asparagus the urine will give off a peculiar odor 
that may last for over half a day. 
nes of the urine may am be altered by certain articles 


In considering the diet in diseases of the kidneys it is im- 
portant that the patient’s condition be thoroughly 
An accurate knowledge of the disease in question is indispen- 
sable for a proper understanding as to the necessary mode of 
feeding. It must be borne in mind that what is an indication 
of danger in acute nephritis, may not be so in chronic inter- 
stitial nephritis and vice versa. 

Too much stress is ordinarily placed on the presence of albu- 
min in the urine. As Emerson has shown, the percentage of 
albumin is the best index as to the p of a case of albu- 
minuria, Tt must be borne in mind, however, that this may 
or may not be so of a case of nephritis. In acute nephritis the 
urine is a fairly accurate guide, improvement in the kidney con- 
dition being usually indicated by a diminution of the albumin 
and of blood in the urine, and by an increase in the amount of 





432 DIET IN DISEASE. 


urine excreted. In subacute conditions the same may hold tr 
whereas in chronic nephritis the variations in the amount 
albumin are most untrustworthy guides as to the patient’s con- 
dition. A mere change in the diet, whether from a meat toa 
milk diet, or any other decided change, may be followed by an 
increase in the amount of albumin for some days. ‘There are 
also variations in the amount of albumin exereted that are due 
to influences not as yet un 

‘The patient’s temperature is also a good guide as to the suita- 
bility of a diet. As Emerson says, “ Variations of an acute 

in the course of a chronic one are shown by an increase 
in the percentage of albumin and a slight rise in temperm= 
ture, 

Points to be borne in mind are that the amount of albumin 
for twenty-four hours must always be estimated ; that the per- 
centage is to be compared with other observations made on the 
same patient, and that the percentage of albumin is increased 
as water is taken in pice amounts. 

As regards the actual excretory power of the kidneys, there 
are no means at present of easily or accurately estimating it. 

The general condition of the patient is one of the best 
guides as to the suitability of a method of treatment, but the 
prognosis can be made only by a skilled physician of great 


experience. 

One of the first principles in the dieting of patients with 
kidney disease is to avoid giving substances that are irritating 
to the renal epithelium. Many injurious articles of diet are 
known by the fact that they uniformly produce bad effects, A 
second group, founded on studies on metabolism, has been added 
by yon Noorden. He ascertained which end-products were 
excreted easily and which with difficulty, and advises the avoid- 
ance of substances that are broken up into end-products that are 
difficult of exeretion. 

Tn the first class are included grills and roasts, especially the 
browned outer surface of these, strong sauces, pastry, spices of 
all kinds, very acid foods, strong aleoholic drinks, tea, and 


‘Von Noorden' gives the following list of substances excreted 
with ease or with Sifticulty in acute, subacute, and in exacerba- 
tions in chronic nephritis. He states, however, that these 
observations require further study and consideration : 


+ Von Noorden, Clinical Treatixes on the Pathology and Therapy of Disorders 
of Metaboli and Nutrition, Part 11., Nephritis. 4 





DIET IN DISEASES OF GENITO-URINARY SYSTEM. 433 


Exerdied with Diffeulty. Barily Exereted. 
Urea. Uric acid. 
Creatinin, Xanthin bases 

erie wal Amdoackie 
norpante salpbaten ‘Water (exe below} 
‘Poteet salle aber tose ee 
Water (nee below). 


Early in the disease water is exereted with great difficulty— 
with more difficulty than even urea, As soon as improvement 
sets in, however, it is easily gotten rid of. The difficulty prob- 
ably lies in the mechanical interference with its excretion, 
owing to the great distention of the blood-vessels caused by 
the severe congestion. 

It is necessary next to notice briefly the articles of diet that 
give rise to the different end-products just mentioned. 

Creatinin is derived from creatin, which is it in meat~ 
extracts and in meat broths. Traces are found in the 
white and in the yolk of eggs and in meat, It is not present 
in vegetables. 

Urinary Pigments.—Little is known concerning these. They 
are all probably derived from hemoglobin, and there is no way 
of controlling hemoglobin metabolism by restricting the diet, 
Substances containing hemoglobin may, however, be omitted 
from the diet. 

Phosphoric Acid.—This is present in large quantities in meat, 
yolk of eggs, milk,and many vegetables. Milk is the principal 
food to be considered here, as it is used extensively and con- 
tains large quantities of the acid. Von Noorden suggests the 
use of calcium carbonate to overcome this acidity in the patients 
ona milk diet. 

Urea and Sulphates—These are both derived from albumin. 
The important point to remember is the fact that the amount 
of protein ingested may be reduced to a ii! small quantity if, 
at the same time, corresponding quantities of carbohydrates and 
fat are administered. Von Noorden gives about a liter and » 
half of milk daily, and usually adds a quarter of a liter of 
cream to it. He warns against the excessive use of fat in 
nephritis. Amylaceous soups or gruels are added to the dict 
where necessary. 

Hippuric Acid,—This is derived from compounds (benzoic 
esters) that are contained in green vegetables, fruits with ker- 
nels, and cranberries. These should be avoided in acute in- 

ey 








be al elimmated from the diet of patients suffering from 
renal disease, from lithiasis, and from troubles.” Citrie 
acid as contained in lemon-juice has been recommended as a 
substitute for acetic acid. Von Noorden states that there is no 
theoretic or panel objection to the use of vinegar in diseases 
of kidney, bladder, or urethra, and that he has never seen the 
slightest result from its use. . 

‘ie Acid and the Xanthin Bases.—These are relatively well 
excreted. They are, however, toxic, aud under certain condi- 
tions their elimination may be retarded. In all forms of neph- 
ritis it is, therefore, advisable to withhold all such foods as 
favor the formation of alloxuric bodies. ‘These are all animal 
tissues rich in nuclein,—especially glands,—such as sweetbreads, 
liver, spleen, kidney, and strong meat broths. 

Musele meat, of course, contains some nuclein, but not 
sufficient to justify its exclusion from the diet on these 
grounds, 

Von Noorden and others have determined, as the result of 
careful experimentation, that there is no difference in the light 
and dark meats as regards the effects of their end-products on 
the kidneys. ‘This is in direct variance with the time-honored 
view, but it is aj ntly based on uncontrovertible fects. 

Alcohol.—Little is known in regard to the excretion of aleo~ 
hl by diseased kidneys. Alcohol, whether taken in the form 
of the strong or of the weaker aleoholic beverages, is known to 
act as one of the worst of poisons to the kidneys. That it 
irritates the kidneys directly, there can be no doubt; but it is 
also true that a certain amount of alcohol will be eliminated by 
healthy kidneys without harm to them. This amount probabl; 
varies with different individuals and can not be definitely fix 
The amount that will prove injurious to diseased kidneys is 
undoubtedly smaller than for healthy kidneys. Ordinarily, 
alcohol should be strictly avoided, but there are cases in which 
it may be used with great benefit, Attacks of cardiac weak- 
ness and a small, thready pulse may be successfully combated 
by small, repeated doses. In certain cases where there is 

* Loe. ett. 








DIET IN DISEASES OF GENITO-URINARY SYSTEM. 435 


nausea, food may be retained when small quantities of wine or 
dilated brandy or whisky are given. 

Alcohol is contained in kefir and kumiss, which are used in 
Fei a preci i8) acreage eres pS 8oe 
any of the stronger forms. 

‘ater —Water may be used freely, as a rule, as soon as 
diuresis improves. It is the best dinretie that can be used 
under ordinary conditions. With increased diuresis there is 
Scrcene tities acicesth Gbsaolias exenaiats This may not, how- 
ever, be the case with certain patients. 

According to von Noorden, water should be given in limited 
amounts when the kidneys refuse to excrete it; in cases where 
diuresis is not increased by water-drinking ; and in cases where 
the water ingested serves only to augment the edema and hy- 
dremia 


ACUTE NEPHRITIS, 


‘Von Noorden’s suggestions regarding the dietetic manage- 
ment and care of acute nephritis are not entirely in accord with 
the views expressed by most authorities. Since they are the 
result of scientific observations and conclusions drawn from his 
own clinical practice, however, they are worthy of consideration. 

(a) In Severe Cases where the Secretion of the Urine is. 
Reduced.—In these cases, where the edema is increasin; 
where uremia threatens, the amount of food and drink hould 
be limited to the smallest possible quantity—eay about a half 
liter of milk a day. For the intense: thirst water, in table- 
spoonful doses, may be given, or what is usually better, i ice may 
be given to quench the thirst. The surplus water in the tissues 
should be removed by sweating. When the heart is failing and 
the pulse is small and thready, brandy or whisky may be ai 
istered in small frequent doses. Such a diet can not ordinaril 
be maintained for more than four or five days without seri+ 
ously impairing the strengh, but usually at the end of this time 
the patient has either improved or succumbed to the disease, 

(6) Cases in which the Excretion of Water is Reduced, but in 
which Anuria does not Threaten Life—In these cases, where 
there is moderate edema, von Noorden gives chiefly milk—a 
liter and a half daily, to which he adds about 350 c.c. of sweet 
cream. If the patient demands more food, or if his strength is 
much reduced so that increased feeding is desirable, he adds 
rice, groats, corn-meal porridge, crackers or zwieback, and 
sterilized grape-juice or other fruit syrups. His diet consists 





436 DIET IN DISEASE. 


of 1500 gm. of milk, 375 gm. of cream, 50 gm, of rice, 
50 gm. of zwieback, 50 gm. of butter, and 20 of sugur, 
the total heat-value of which is 2900 calories. is is equiv 
alent to 4 or 5 liters of milk. 

A strict milk diet has been recommended by some in these 
eases, but the best clinicians follow the outline just given. 
While the process is active, too much milk must not be given, 
and what is given should be properly diluted, preferably with a 
carbonated water. Ax soon as the acute process begins to sub- 
side the diet may be increased by the addition of rice and other 
cereals, bread and water, fruit, and, later on, as convalescence 
begins to be established, meat may be added. The appetite and 
digestion must regulate the increase in diet. In addition to the 
foregoing, very weak meat broths may be allowed, veal or 
chicken usually agreeing better with digestion than the others. 
Tf preferred, however, weak beef, or mutton broth may be 

‘iven. Strong meat broths and beef-teas are to be prohibited. 
ugar and cocoa may also be allowed. 

f the digestion is very good, butter and other fats may be 
permitted in moderate quantities. Calves’-foot jelly and similar 
preparations may be allowed, as well as light vegetables, the 
best being spinach, cauliflower tops, young peas, or young 
atring-beans. These vegetables are to be added as convalescence 
begins to be established and a desire for other food returns, 

As a general rule the patient’s appetite, if he has any, is the 
best guide as to the amount of food to be allowed. Too much 
will not be taken, and as the disease is generally of short dura- 
tion, the reverse is also true, During convalescence the appe- 
tite may be stimulated by dilute hydrochloric acid or bitter 
tonics, 

As to beverages, water, plain or carbonated, mineral waters, 
fruit-juice and water (lemonade, etc.), and, for weak patients, 
water and wine or water and whisky or brandy, in small quan- 
tities may be permitted. If the patient prefers mill, from four 
to seven pints may be given daily, diluted with a carbonated 
water. If it causes diarrhea, lime-water should be added to the 
milk, or if there is constipation magnesia solution or citrate of 
magnesia may be given instead. If the liver symptoms appear, 
the milk may be skimmed or buttermilk substituted. If the 
stomach becomes disordered, kumiss may be given in place of 
milk, or rice, barley, or arrow-root gruel may be substituted for 
it. If vomiting occurs, the stomach should be given complete 
rest, after which carbonated water may be allowed. A favorite 





DIET IN DISEASES OF GENITO-URINARY SYSTEM. 437 


drink under these conditions, or in fact at any time in the 
course of an acute nephritis, is the imperial drink, made by 
dissol: ise fey crant vi enats of tartar in a pint of boiling 
water and adding the juice of half a lemon and a little sugar ; 
this should be given cold. 

If the course of the disease is slow, and the condition aub- 
chronic, the dict must be increased or the patient’s strength will 
fail. In these cases small amounts of meat may be added to 
the dietary. The effect on the urine and the temperature must 
be carefully watched. If there is marked disturbance, the 
meat should be discontinued and then repeated after several 
days, The general condition of the patient is a safe guide, and 
he must not be allowed to starve to death because « small 
amount of albumin appears in his urine, 


CHRONIC PARENCHYMATOUS NEPHRITIS. 


In this disease the patient’s mode of life must be carefully 
regulated. The amount of exercise and the diet demand par- 
ticular attention. From the beginning all irritating articles of 
food are to be withheld. Secondly, the amount of protein 
should be limited, and the deficiency supplied by carbohydrates 
and fat. 

It was formerly believed necessary to replace the albumin 
lost in the urine, In chronie nephritis but nee grams are lost 
daily, and this is readily compensated for by the ingestion of 
260 ce. of milk or 40 to 50 grams of meat. The limiting of 
the protein must not be‘carried to extremes. Starvation may 
take place from giving either too little or the same form too 
constantly. No hard-and-fast rule can be laid down as to the 
restriction of protein, as every case is a law unto itself, varying 
with the occupation, the amount of rest, and the stage of the 
disease. Such conditions require the judgment born of ex- 
perience. 

Senator gives the following figures, from Voit, for a middle- 
aged, unemployed man suffering from chronic nephritis : 





‘The whole gives 1860 


The average case can probably get along with less protein 
than 85 grame daily, and Raisin suggests the following : 





438 DIET IN DISEASE. 


Protein, 50 to 70 daily, or the amount contained in 
mills or in 260 10 300 grams of milk, or in 
from $ to 10 eggs. 


Carbohydrates, 400 to 500 grams, or a cot ing amount 
of fat (100 grams of fat, 240 grams of carbohydrates—2100 
Tre tails more than Voit gives for a healthy man not 
working), 

In severe cases, where there are edema, little albumin, and 
many casts in the urine, the amount of protein must be eut 
down to from 30 to 40 grams, or what is equal to 1 liter of 
milk, or 200 grams of lean meat, or 6 . When the condi- 
tion improves, the figures may be doubl 

The average daily diet contains about 1 gram of sodium 
cblorid in the original composition of the food, and from 10 to 
20 grams are added daily as seasoning. In cases of nephritis 
it is important to limit the amount of sodium chlorid ingested. 
Observers differ in their reports concerning the influence of a 
low salt diet in nephritis, and different patients react differently, 
but many are greatly improved. The mouth becomes moist, 
the constant thirst is alleviated, the sipping of water at short 
intervals avoided, and the edema is often greatly lessened or 
disappears entirely. It is a good plan to omit the salt-cellar 
from the table or tray, and no effect is noted when the quan- 
tity of salt put into the food is either greatly reduced or omitted 
altogether. 


During acute exacerbations the patient may be put on an ab- 
solute milk diet for from one to two weeks, with most excellent 
results in many cases, At least two liters should be given daily, 
diluted, when necessary, with carbonated water or lime-water. 
Tf there is a tendency to diarrhea or to constipation, or if 
meteorism occurs, lime-water is to be preferred. Buttermilk 
may be substituted for sweet milk when constipation occu 
if the patient prefers it. Kumiss and kefir are valuable i. 
tions to the diet. The small amount of alcohol these foods 
contain is ordinarily no contraindication to their use, : 

‘The return to a general diet should be made gradually, Fat 
in the form of cream and butter may be added. Sugar, fruit 
syrups, jellies, and compotes may be given, using especially 
apples, pears, or raspberries. Carbohydrates in the form of milk, 
gruels, aud cereals, as well as toast, zwieback, and bread not too 
fresh, may be eaten, Sago and tapioca are valuable additions, 
and potatoes may also be allowed. Meat may be added in mod~ 
erate quantities, care being taken to note the effect. The white 





OO F 


DIST IN DISEASES OF GENITO-URINARY SYSTEM. 439 


meat of chicken is usually recommended at first, but recent 
investigations have failed to show any different results from the 
use of light and of dark meats. ‘The outer surfisce of roasts and 
ee 

any almond mil mulsio am: is x= 
tensively. The various phi and invalid foods my be mixed 
with the milk. Coffee and tea or cocoa may be allowed, Aleo- 
hol is prohibited, except as needed in special cases. 


CHRONIC INTERSTITIAL NEPHRITIS. 


Cases of this disease require especial study, and the nature 
of the individual and the « of the disease must be taken 
into consideration. Care should be taken to avoid acute attacks, 

Early cases, where there is no polyuria, where the heart and 
vessels are not seriously affected, and where there is little albumin 
in the urine, are frequently much improved by a course of treat- 
ment similar to that prescribed in acute nephritis. The patient 
ehould be kept in bed on a milk diet. If after two weeks there 
is no improvement, this treatment may be abandoned. 

Acute exacerbations are to be managed as when they occur in 
acute nephritis. Ordinarily, however, one has to deal with a 
chronic disease that has lasted and may continue to last for 
years. As cure is out of the question, the diet should be so 
arranged as to give the test degree of comfort and allow the 
freest activity compatible with the stage of the disease. The 
SS uires encouragement, and wherever feasible he should 

allowed to continue his ordinary avocation. If care is taken 
to avoid excesses of all kinds, many of these patients are able 
to work for years, e 

‘The kidney should be protected as much as possible, and all 
irritating food and drink, as mentioned at the Deginning of this 
section, chould be avoided. The heart must be spared and 
strengthened, and the patient’s general health maintained. The 
restriction of diet, however, need not be so rigorous as in the 
acute cases. 

When the case is hopeless, the diet may be left to the taste 
of the patient and the ingenuity of the nurse, und the last weeks 
or days made as enjoyable as possible. 

Too much stress should not be laid on the amount of albumin 
or of solid matters contained in the urine, as many variations 
occur that are not dent on the diet. 

Tn tho selection of a diet aleohol deserves special mention. 








440 DIET IN DISEASE. 


Total abstinence is the rule! Under no circumstances should 
the patient be allowed any form of alcoholic drink as a beverage, 
He should be made to understand that if he uses alcohol in any 
form he is doing so at his own risk. There are cases, however, 
in which alcohol is absolutely necessary. In old aleoholies there 
may be attacks of weak heart or complete anorexia if the stim- 
ulant is withdrawn at once; in these eases it may be allowed in 
emall amounts, Von Noorden uses it even in late cases to pre- 
vent attacks of uremic cardiac asthma, He is also firm in regard 
to his position on the use of alcohol in chronic interstitial neph- 
ritia, and states thathe is more particular about its use in chronic 
ritis sey in acute. ie =< 
ives of all kinds, celery, and ib 
ane as well, should be forbidden in peace Noorden 
allows a moderate amount of asparagus two or three times a 
week during the season, but warns against using it in excess. 
This same observer includes in his list of drugs that are 
ous in atrophic nephritis—cantharidin, copaiba, ieee sali~ 
cylic acid, carbolic acid, resorein, hydroquinon, |, 5 
boric acid, silver and mercury and prea iodoform, pa 
preparations. In this disease it is well to be cautious in the 
use of all drugs. Owing to its chronicity, and to the frequent 
occurrence of intercurrent affections, drugs are apt to be used to 
a greater extent than in any other disease. It is also trae that 
most drugs are excreted more slowly than in health, 

Tea, coffee, and tobacco are ordinarily to be forbidden, but 
may be allowed in small quantities if they do not exert an inju- 
rious effect upon the heart. Careful observations should be 
made as to the effect upon the pulse-rate and strength, upon the 
strength and character of the heart impulse, and upon the sub- 
jective sensations, 

Meat may be allowed in as great a variety as possible. The 
so-called high game and all rich meats and complicated dishes 
are to be avoided. Either light or dark meats may be allowed, 
as the appetite is, as a rule, poor, the amount of protein to be 
taken may usually be left largely to the patient, A list of 
articles of food allowed may be given, and he may be permitted 
to arrange his menu himself in most cases. Where the ite 
is normal, however, the amount of nitrogenous food should be 
limited, and diet-lists containing small amounts of protein food 
furnished the patient. In view of Chittenden’s experiments on 
healthy individuals it would seem advisable to try diets with 
the protein as low as 60 gm. of protein daily for a patient 





DIET IN DISEASES OF GENITO-URINARY SYSTEM, 441 


3 aul vi ner as : sates 

gen to 8 or 9 gm. daily. Von , averaging & 
cases covering five years’ experience, found that for 70 kilos of 
body weight, the nitrogen i in the males was from 13 to 
16 gm., and in the females 11 t 14 gm, If expressed in 
albumin, men, 81 to 100 gm. ; women, 69 to 87 gm. 
allowance for the amount in the feces, the quantity of albumin 
taken was for the men 92 to 112 gm,, and for the women 80 to 
100 gm. Based on these figures he gives an average diet as con- 
taining milk, 750 o.c.; 2 eggs; bread and vegetables ; 
men, 215 to 315 gm. weighed raw; women, 155 to 265 gm. 
weighed raw. Variations may be made to suit the condition of 
the patient. 

amount of water to be allowed should be carefully deter- 
mined. Ordinarily the patients are encouraged to take water, 
milk, and diuretic drinks. Won Noorden warns against this 
practice, arguing that the variations in the percentage of albu- 
min in the urine are valueless in estimating the course of the 
disease, and that the heart may be very much damaged by the 
extra work thrown upon it by the use of excessive amounts of 
water, The fluid absorbed from the intestinal tract must ordi- 
narily be excreted through the kidneys, and this means in- 
creased blood-pressure and increased work for the heart. Yon 
Noorden limits the amount of fluid taken to about one and one- 
quarter liters. This includes all kinds of fluid taken. The 
water taken in the solid food—usually from 500 to 700 c.c. 
daily—may be disregarded. He admits that the amount the 
patient usually takes should be determined by two or three 
days’ observation, and then that this amount be gradually cut 
down from 250 to 150 cc. a day until the desired quantity is 
reached, One day a week the patient is allowed a “drinking 
day,” on which all the water desired may be taken, It is 
found that excretion of the solid contents of the urine takes 
Place just as rapidly with this restricted amount of water as 
before, and that in case the excretion is not quite so good, the 
one-day-a-week flushing keeps the organism reasonably clean, 
In some patients every two or three months two or three liters 
a day are allowed daily for two weeks. If there is failing com- 
pensation, the flushing-out should not be resorted to, nor should 
it be allowed if there is appreciable dilatation of the left heart. 
‘The desire for water is greatly lessened by placing the patient 
on a salt-free or a comparatively eodium-chlorid-free aca 
suggested for chronic parenchymatous nephritis. 


442 7 DIET IN DISEASE. 


Care should be taken not to allow patients who have a lean- 
ing toward obesity too much carbohydrate material. This is 
frequently done in cases of contracted kidney, usually with bad 
results, On the other hand, in thin patienta, if is no 
attendant dyspepsia, a diet rich in carbohydrates may very 
greatly improve the patient's condition. 

Exercise, fresh air, freedom from care and worry, suitable 
occupation, and pleasant surroundings are all essential 
in the treatment, and should not be neglected. A change of air 
to a dry, warm, equable climate is often of great benefit. 


FLOATING KIDNEY, 

In this condition two things are to be especially recom- 
mended—viz., rest and food. The diet should be one that will 
cause the patient to take on as much flesh as possible. Many 
cases of movable kidney come on in nervous individuals who 
have lost flesh, and when the fat normally surrounding the 
kidney is replaced, the organ no longer flonts about. The 
rest cure is especially recommended in those eases that occur 
in nervous people who have lost flesh rapidly. Time and 
patience are required, and the treatment often fails because it is 
not persisted in for a sufficiently long time. In cases. of long 
standing a diet similar to that recommended in gastroptosis 
and enteroptosis should be prescribed, 


AMYLOID KIDNEY. 

‘This condition requires a supporting diet of good food, and 
measures directed toward removing the cause of the amyloid 
disease, 

PYELITIS—PYELONEPHRITIS, 

‘The diet in these conditions should be very bland and non- 
irritating. The substances and foods previously mentioned aa 
irritating should all be avoided. Milk, buttermilk, almond 
milk, and the like, should form the bulk of the diet. Milk- 
toast, gruels, and cereals may also be given. If the heart is 
strong, an abundance of fluid may be allowed in order to flush 
out the kidneys ; alkaline mineral waters and flaxseed tea are 
among the best for this purpose, Cure should be taken that 
the patient receives sufficient protein daily. Increase of dict 
may be made along the same lines as are indicated in acute 
nephritis. 





ll 


DIBT IN DISEASES OF GENITO-URINARY SYSTEM, 443 


RENAL AND VESICAL CALCULI. 


The dict as a canse of stone, especially of the uric acid variety, 
has been the subject of much controversy. In children it has 
been stated that the formation of stone usually follows a poor 
and insufficient milk supply. Ordinarily it may be said that 
too rich food, too large meals, and an inactive life are the most 
potent caumitive fictors. Certain individuals are prone to 
caleulus-formation. 

The following suggestions regarding the diet will be found 
useful : Forbid strong drinks, and all alcohol if possible; much 
meat, and especially the “nuclein-containing meats, as thymus, 
spleen, liver, brain; caviare, ete., smoked, pickled and spiced 
meats, and rich foods in general. ‘The fats and sugars, as well 
as the cereals, should be restricted. The dict should be made 
up of the plainer, well-prepared foods, and, as far as possible, a 
vegetable dict should be prescribed. Water, especially the 
alkaline mineral waters, may be allowed in abundance. A 
sojourn at Carlsbad may be recommended for certain obese 
patients. When alkaline mineral waters are given for acid 
stones, they should be used only so long as the urine remains 
acid. If it becomes alkaline, the waters should be discontinued, 
lest phosphates be deposited on existing stones, 


LITHEMIA.—THE SO-CALLED URIC-ACID DIATHESIS. 


The factors in the causation of this disease are heredity, a too 
abundant and a too rich diet, and an inactive life. It may be 
as an irregular form of gout. At present the views 
concerning its pathology are too diverse and numerous to 
deserve comment. The condition is usually manifested by 
neren neuralgia, sick headache, skin eruptions, and the 


The diet is the principal factor in the treatment, and scarcely 
of less importance are fresh air and exercise. It is more com- 
mon among the well-to-do in winter, for out-of-door life in 
summer usually means more or less nearly perfect metabolism. 

The diet should be similar to that outlined elsewhere for the 
gouty. A reduction in the quantity of food taken, especially 
of the protein supply, and an avoidance of alcohol and rich, 
complex foods are the principal indications. (See Gout.) 

the following is the dietary which Sir H. Thompson recom- 
mends in caleulous affections : 

“Fish in all its forms, except those containing much fatty 





444 DIRT IN DISRASE, 


matter—i, ¢, herrings, mackerel, eels, and the thin part of 
salmon. Game in all f rms, Onley Lean “ay yrs 
ate quantity. Preparations of gelatin, savory jelly, or jelly 
sera aor but unsweetened. Batt in moderation 

is is the only direct form of fat admitted, fat in some form 

ing necessary). An egg or two, on account of their usefial- 
ness in all cooking operations. (The objection to applies 
only to the yolks. ik in strict moderation, and only with 
tea, coffee, or cocoa. It is very undesirable and noxious in 
are quantity, as it contains a age proportion of fit and sugar, 
and its casein is di, with difficulty. It is less objection- 
able when thoroughly skimmed. Well-made whol bread. 
Oatmeal. Pearl barley, Macaroni and other Italian pastes, 
Some coarse meal is needed to act as an aperient and prevent 
constipation. Whole-meal bread is improved in flavor and 
texture by an admixture of fine (not coarse) Scotch oatmeal, in 
the pepeonsicn of about one-quarter to one-third of the wheat- 
meal employed. 

“ Dry haricots and lentils are most nutritious vegetables, and 
should be taken made into purées. They are digested with 
ease and contain much nutritious matter. Rice, sago, tapioca, 
and arrow-root are all useful if treated as savory dishes, and 
not as sweets. Fresh green vegetables are especiall; po 
Fresh green peas and broad beans, well rmaatiocial ight 
salads are permissible to persons who digest them easily, but 
oe cae ie be fee by those who digest them with Se 

ity. ery, sea-kale, as ‘us, tomatoes, toes, 
artichokes are all permit ae also are poet or 
baked, without added sugar. 

“The following are to be avoided: rhubarb, gooseberries, 
currants, strawberries, raspberries, grapes, plums, pears, and all 
sweet fruit, fresh or preserved. Saccharin may be substituted 
for sugar.” 

Lithemia in Children.—This is most often seen in the 
children of gouty parents. It is manifested usually in more 
or less periodic attacks of sick headache, nausea, vomiting, or 
neuralgic attacks, Children so afflicted are usually quick and 
bright, and of the nervous type. There is apt to be a dry 
sealy skin, and a tendeney to eevema and to what Louis Starr 
calls a roseolous eruption. The latter observer gives the follow- 
ing suggestions for dieting such children : 

“Treatment.—Little can be accomplished in the relief of 
lithemia without careful regulation of the diet. 





DIBT IN DISEASES OF GENITO-URINARY SYSTEM. 445 


“Tn breast-fed infants this is difficult to necomplish, but the 
milk must be analyzed, and any abnormal condition corrected, 
as far ag possible, by attention to the mother’s feeding, exer- 
cise, and general hygione, and by the employment, in her case, 
of an antilithic treatment. 

“ When the feeding is artificial, a home-modified cows’-milk 
mixture of proper average composition for the case in hand 
should be employed, and variations made in the of 
cream and milk as the symptoms demand, water, 0s 
it increases the activity of the kidneys, is a better diluent than 
plain water, and if the digestion will not permit of the addi- 
tion of sufficient cream to maintain a free action of the bowels, 
from one to five gmins of sodium phosphate may be added to 
each bottle of food. For children of four years a suitable 
diet is: 

“ First Meal, 8 A. M—Milk, 7 fluidounces; Viehy water, 
1 fluidounce (one or two portions); one or two yolks of soft- 
boiled eggs with salt, or a bit of fresh fish or sweetbread ; or 
one or two slices of ham or whole-wheat bread, dry. 

“ Second Meal, 1.30 P, M.—A teacupful of clear meat broth ; 
a bit of chicken, turkey, wil fowl, or fish; one well-cooked 
green vegetable—i, ¢, spinach, celery, young onions, cauli- 
flower; one or two slices of dry bran or whole-wheat bread ; 
junket or rice-and-milk pudding; cooked fruit with very little 


sugar, 
oe Third Meal, 6.30 P, M—Milk at first meal; sweetbread 
or milk-toast ; dry bran or whole-wheat bread. 

“For drink, Poland water or Vichy (domestic) ; use either 
freely, Avoid fats, starches, sweets, raw fruits, and red meats 
—i. ¢., beef or mutton. 

‘Tn still older patients—ten years and upward—a wider 
range is permissible, and the meals may be selected from the 
following list, which gives the foods allowed, as well as those 
to be avoided : 

« Breakfast.—Milk, salted, if desired ; weak cocoa with very 
little sugar. Bran bread; whole-wheat bread; dry toast; 
zwieback, Oatmeal or cracked wheat porridge, well cooked, 
with salt and milk. Eggs—yolk of soft-boiled or 5 
French omelet. Chicken broiled. Fresh fish: rockfish, perch, 
bass (no oily fish). 

« Dinner.—Oysters (in season), soup ; beef, mutton, or lamb ; 
pels or game, 1 quantity (roasted or broiled, and one 

ind only). Two green vegetables : spinach, celery, peas, string~ 





Perna carrots, t, aeetion raw or baked. Rice, 
‘iny, or macaroni (cooked aed Bread as above. 
pudding: apples baked with very little sugar; stewed z 
stewed prunes; grapes in moderation ; melons, 

“ Supper.—Milk or cocoa as at breakfast; bread as above; 
toast or zwieback ; chicken or game (roasted or broiled); oys- 
teas season) stewed or roasted; fresh fish; sweetbread, 
bi 3 one green vegetable as above ; cooked fruit, with very 


Tibia wale to ba taken fisslys, (No load. between jemele 
Supper two hours before retiring for the night. If much sugar 
is arkardlad with food, saccharin, is to be employed asa sub- 
stitute, 


* Articles to be avoided: Cream. White of ge; 
cooked with milk. Crabs, lobsters ; salmon and all rich, 
fish. Veal, pork, ham ; dried, smoked or pickled meats of 
sorts; twice-cooked meats. All fried food. Pastry, cake, 
hot bread or rolls, confectionery of all sorts, jams, jellies. 
Rhubarb, beets, cabbage, old peas, old beans, potatoes (white 
or sweet), asparagus, radishes; all raw fruits (except as men- 
tioned above), especially strawberries, raspberries, and 
Fruit cooked with much sugar, dried fruit (figs, dates), nuts. 
Mushrooms, Pickles, vinegar, spices, condiments (salt e 

“The object of both of the diets given is to allow a minimum 
of albuminons food, to diminish the formation of uric acid and 
its analogues, and a minimum of carbohydrates (sugar and 
starch) to afford the albuminoid waste an opportunity of being 
freely oxidized. From the two lists it is not difficult to formu- 
late a diet for intervening ages. 

“During the obstinate vomiting of the gastro-intestinal form 
everything taken into the stomach may be rejected ; still the 
prostration caused by the attack is diminished if the patient be 
forced to take one or two teaspoonfuls of raw-beef juice at 
regular periods, every two hours, for example, with sips of 
water, or, better, white-of-egg water in the intervals. At the 
same time rectal injections of peptonized milk or broth must be 
administered, These enemata should not exeeed two fiuid- 
ounces in quantity ut the age of three years, should be given at 
a temperature of 98° F., and at intervals of four hours; and 
onee daily the rectum must be washed clean with warm normal 
suline solution (one teaspoonful of table salt to one pint of 
water).” 








DIET IN DISEASES OF THE NERVOUS SYSTEM. 447 
GONORRHEA. 


‘The diet in this disease is of considerable importance, | Tm- 
poeeeiiood and drink not only serve to ae disease, 

it overindulgences in forbidden articles may cause a return of 
Bi echnge cvs Sti toa nemee Lexie ly been cured, 

‘The directions for diet are very enemies At eta foods 
and drinks should be avoided, as sh all inaigtinle articles, 
‘The diet should consist of plain and wholesome food. Where 
it is possible, skim-milk should form the basis of the diet. Too 
much meat should not be taken, and twice-cooked meats and 
fried and very greasy foods avoided as far as possible. Carbo- 
hydrates, as breadstuffy, cereals, and the eae vegetables, 
may be allowed. Care should be taken to avoid all complicated 

an ly seasoned foods, all pepper, spices, und salad dress 

na word, everything previously mentioned as irritat- 

ing rege the gonito-urinary tract should be avoided. Acid fruits, 
asparagus, and tomatoes are also to be forbidden. Tea and 
coffee should be prohibited or given very weak and well diluted 
with milk or cream. All alcoholic drinks should be forbidden. 
When the patient must drink, in order to avoid suspicion, claret 
hes beet recommended as least irritating, but even this is best 
avuil 

An abundance of plain or effervescing water should be taken, 
but not in sufficient quantities to disturb digestion. It is best 
to drink the water between meale and on an empty stomach. 
Flaxseed tea and similar demulcent drinks may be helpful. 

Tobacco may be allowed habitués, but not in excess. Mod- 
erate smoking in those accustomed to the habit is regarded as 
beneficial rather than as harmful. 


DIET IN DISEASES OF THE NERVOUS SYSTEM. 


The necessity for the correct management of the diet in 
nervous diseases is becoming appreciated more and more every 
year, Asa general rule it may be stated that all functional 
diseases attended with emaciation are greatly benefited, if not 
entirely relieved, merely by increasing the patient’s weight by 
such methods as are sugyested under the heading of Rest Cure. 
Patients with chronic organic lesions will, as a rule, be made 
more comfortable if the following two points are borne in mind, 
First, to overcome, so far as ble, emaciation and anemia 
where the nutrition has a tendency to be below normal; and, 


P| 





448 DIET IN DISEASE, 


secondly, and of no slighter im) to prevent undue obesity 
in ican as ae ticularly where there is disturbance 
of locomotion. A patient may be condemned to remain in bed 
or in a chair on account of the excessive weight which his inac- 
tivity has fostered. For further particulars on this subject the 
student is referred to the section on Obesity. eae 
Most patients diet as a very unimportant 
region this uy of those ea mee need 
eareflul feeding, The necessity for careful sistery should be im- 
upon these patients, and a faith in its efficacy 
seca ahem iP of a functional nature. —s 
‘The diet suitable in nervous diseases has been the subject of 
many diverse opinions, particularly in the minds of the laity. 
Fish has been vaunted as a “brain food,” and various fats or 
cereals have been suggested for nervous conditions. At the 
it time, it may be stated, there is no specific “ nerve food.” 
e nutrition of the nervous system will be good when the 
tient’s general nutrition is good, and vice versd. Both in 
feta disorders ee the aoe system and in byte = 
ndent wy exhaustion the improvement o! 
pe should be the first care. E 
‘The basis of the diet, which will be outlined later, is usually 
milk. Care should be taken to see that the patient gets 
cient fluid, and where no tendency to obesity exists, water 
should be taken with each meal and usually at bedtime and on 
rising, It may also be taken between meals if desired. When 
there is disturbance of digestion, it is a good plan to prepare 
the stomach for the meal by sipping « glass of hot water on 
rising and an hour or less before each meal. The mineral 
waters may be used when desired ; the alkaline ones are apt to 
be of most value. Carbonated waters should be used with care, 
lest the flatulence they may cause give rise to symy the 
importance of which may be greatly exaggerated by the patient. 
A_ question of great importance is whether or not alcohol 
should be used. As a general rule it should not be allowed. 
In cases with chronic lesions, where the patient has been accus~ 
tomed to the use of alcohol all his life, it may be allowed, if 
not otherwise contraindicated, as by a tendency to cerebral 
hemorrhage, arteriosclerosis, chronic interstitial nephritis, and 
the like. The use of alcohol in the functional disorders is 
usually contraindicated. Its value as a food and as a stimulant 
to nutrition should not be overlooked, and it may be used with 
t benefit in the psychoses accompanied by exhaustive eon- 
itions, 





DIEY IN DISEASES OF THE NERVOUS SYSTEM. 449 
NEURALGIA. 


Neuralgia may be due to many causes, among them the 
various teas that affect metabolism, The cause of the 
near must be determined before a suitable diet can be 

The following are among the most frequent causes : 
anemia, gout, lithemia, rheumatism, diabetes, alcoholism. 
‘The diet to be prescribed is the diet suited to the condition. 

Alcohol is a frequent cause of severe neuralgias often simu- 
lating migraine. The quantity used may be comparatively 
trifling, and the patients frequently can not be classed as aleo- 
holics. When no other cause for the disease is found all 
alcohol should be forbidden, In the cases dependent on 
anemia and on exhausted conditions alcohol is, however, useful, 
and should be used in these cases to improve the nutrition, 
and not for the temporary feeling of well-being or for the relief 
of pain, which it may in Amer a - 

Tea and coffee should be forbidden in chronic neuralgia or 
where there are frequent attacks. This does not, however, 
apply to attacks of migraine that are not affected by coffee, or 
may even be relieved by a cup of hot strong coffee taken as the 
attack is about to come on. 

According to Gowers, vegetarianism may be a cause of 
neuralgia. In these cases the addition of meat to the diet will 
give relief. The converse may be true, especially where there 
is a gouty tendency, the ingestion of too much meat frequently 
being at the root of the trouble. Care and experience alone 
will help in deciding whether the patient ix getting too much 
food, and whether his diet should be cut down and his elimina= 
tion increased, or whether the case is dependent on an insuffi- 
cient or improper diet, 

As a general rule, plain wholesome food should be ordered 
at regular intervals. The patient should not be allowed to eat 
between meals. All rich, complex, and highly seasoned foods 
should be forbidden, as should all fried K pastry, and any= 
thing known to disagree with the patient. Care should, how- 
ever, be taken that the diet be not too restricted, for the 
patient’s ability to take different articles is often purely imagi- 
nary. True idiosynerasies for different articles of food are not 
very common, ‘The excessive use of tobacco may be the cause 
of neuralgia. 

GASTRALGIA. 


A general rule may be made in these cases of ayoiding 
excesses in alcohol, tea, coffee, sweets, and tobacco, In some 
Po 





450 DIET IN DISEASE. 


cases the taking of food increases the severity of the attack. 
‘The existence of stomach disorders should be carefully deter- 
mined, and if there is no apparent basis for the trouble, a rest 
cure may give relief. 

There are other cases where the pain comes on when the 
stomach is 5, (See Diseases of the Stomach.) In these 
relief is often afforded by giving a cup of hot milk or bouillon 
with a biscuit (cracker) in the mi of the morning and 
afternoon, and at night on going to bed. If the pain begii 
in the night from the same canse, a glass of milk should be 
kept at the bedside, and when the patient is awakened by the 
pain, he may take 1 few sips of the milk. _ 


VISCERAL NEURALGIA, 

When this is not relieved by ordinary means, the patient 
should be put to bed and kept on a milk diet. Repeated ex- 
aminations should be made to determine the exact cause of the 
trouble. Many of these cases, where no cause can be assigned, 
are relieved by rest and a milk diet. 


MIGRAINE. 

Migraine, or sick headache, as it is popularly termed, should 
not be confused with ordinary neuralgia. The diagnosis may 
at times be somewhat difficult. Much can be done to lessen 
the frequency of the attacks, but any attempt entirely to over- 
come them ‘has thus far proved fruitless. Open-air life of a 
vigorous kind probably does more good than anything elge, but 
most of the sufferers from migraine find this impractical to 
carry out. The life of the patient should be regulated care- 
fully. Sufficient sleep should be obtained and late hours 
avoided. The food should be plain and wholesome, and taken 
at regular intervals, and eating between meals should be dis- 
countenaneed. Outdoor exercise should be insisted upon 
wherever possible. Excesses of all kinds must studiously be 
avoided. 

It may be mentioned that sufferers from migraine are apt to 
attribute the cause of the attack to some article of food. TDs 
is not likely to be the case, and the patient should not be 
allowed to cut aff first one and then another necessary article 
from his diet. Starch indigestion is present in some, and should 
receive careful attention, These patients occasionally get along 


™ 


DIET IN DISEASES OF THE NERVOUS SYSTEM, 451 


best on a diet that is largely vegetarian, but this is not so in 
fl case, (Coffee ‘wend “pot bs prohibited) Som iax aicubentE ts 
not the cause of the trouble, and in some instances, when 
taken at the outset of an attack, it may even afford relief. 


INSOMNIA AND DISTURBED SLEEP. 

When not dependent upon otber conditions, these are apt to 
be due either to eating at night or to a depressed state of the 
nutrition. For the first there is nothing to do bat to discon- 
tinue the habit of eating at night. There are but few 
who reach middle age and who can eat late at night with im- 
punity, and sooner or later the individual learns that he must 
give up the habit. There are some, however, with whom the 
practice seems to Sah 

When the trouble is caused by malnutrition or anemia, the 
general condition of the pationt must be treated. Good food, 
regular hours, milk, or some light food between meals, and on 
going to bed a cup of hot milk, cocoa, or, if preferred, beef-tea, 
malted milk, or similar preparation may be ordered, 

Tn many cases where the nutrition is fairly good one of the 
hot drinks just mentioned taken at bedtime may be all that is 
necessary. This is especially true of the insomnia and disturbed 
sleep that follow the doing of mental work at night. The effect 
is to dilate the abdominal vessels and to restore the equilibrium 
of the circulation. A brisk wall in the open air or five 
minutes’ exercise will often accomplish similar results. 

Tn the aged and the weak a “night-cap,” in the form of a 
stall glass of brandy or whisky, or a hot toddy, is acceptable 
and secures a good night’s rest. This should, however, be dis- 
countenanced in the young and vigorous, 


VERTIGO. 

There are so many forms of vertigo, and it arises from so 
many widely different causes, that it must not be forgotten that 
& very common cause is in a disordered digestion, Indigestion 
from whatever cause may give rise to it, and the eating of cer- 
tain irritating foods, such as shell-fish, crabs, lobsters, and the 
like, may occasionally bring on an attack, icularly in those 
unaccustomed to their use. Insufficient may also be a 
cause. All cases of vertigo require carefiil before a 
definite opinion as to their cause is given, 





452 DIET IN DISEASE, 9 


EPILEPSY. 


bears an important relation to diet. There is no 
“anti-epilepsy ” diet, and there is no form of food that 
ean be assigned as a cause of epilepsy; it is, however, a fact, 
that where the diet is carefully ted the number of attacks 
are usually leseoned. This ig particularly true of children. The 
principle involved is to give only as much food as the patient 
ean easily: digest and assimilate, and to allow sufficient time to 
elapse between feedings for him to utilize and exerete the end- 
products of what he does assimilate. When this is not done, 
attacks may be provoked by irritating substances in the bowel, 
by the absorption of toxic substances from the intestinal tract, 
or by the accumulation of the products of metabolism in the 
body. In the epileptic colonies no especial diet is used, but the 
amount and the variety of food are so regulated as to secure 
the beat results, (Seo Graig Colony Dietary.) 

Tn children a diet composed largely of milk, with the addi- 
tion of cereals and fruit, is most useful. In older persons this 
diet is not feasible except occasionally as a temporary measure, 
For these latter meat should be allowed only once a day, unless, 
on account of excessive manual labor or because of a weal 
condition of nutrition, the patient peels demands it. Milk, 
cereals, bread, vegetables, and fruit should make up the rest 
of the dietary. Each patient should be instructed to take only 
digestible food, to take his meals regularly, and not to eat too 
much. They should also be taught to eat slowly and masticate 
the food well. The avoidance of constipation is of primary 
importance, and this can usually be secured by the proper use 
of fruits, and the coarser forms of cereals. 

A diet free from sodium chlorid with sodium bromid substi- 
tuted is of considerable value in the treatment of epilepsy. The 
effect is more noticeable in the petit mal than in grand mal, but 
in both there is a decrease in the number of seizures, The 
effect of this treatment varies in different individuals. German 
and French observers report remarkable results, but these have 
not been obtained in the United States, although there seems to 
be little question of the value of the treatment. In some 
patients the withdrawal of sodium chlorid produces untoward 
effects, and these are more liable to occur when the bromid is 
not substituted. The salt-free diet is to be regarded as an 
adjunct to the bromid treatment. When the régime is badly 
borne there are dizziness, headache, weakness of the legs, loss 











DIET IN DISEASES OF THE NERVOUS SYSTEM. 453 


of memory, edema, diarrhea, and often marked mental sym; 
with a tendency to melancholia, ‘There may be a marked loss 
of appetite, which may lead to a marked aversion for food. 
Some of Voisin’s patients had to be forcibly fed. Sonsetimes _ 
the withdrawal of salt causes irritability in the young, and may 
rouse the indolent to activity. 

Quiet, ir life, pleasant occupation of a non-strenuous 
kind, an absence of worry, and agreeable forms of recreation 
are just as important as the diet in these cases, 


CHOREA. 


In chorea the diet is often of the greatest importance ; this is 
especially true when it occurs in anemic or debilitated children, 
Rest and an easily assimilable diet are the indications, The 
authors are of the opinion that absolute rest in bed, if Eowible 
isolated from the remainder of the family and under the care 
of a trained nurse, who should be a stranger, combined with a 
milk-diet or a diet composed largely of milk, will give better 
and more lasting results than any other form of treatment. If 
the patient is anemic, beef-juice made from fresh beef may be 
used to advantage, as well as mw scraped beef and similar 
foods, (See Anemia.) 


APOPLEXY. 


The Comatose Stage-—During the ear]; of the comatose 
condition—i, ¢., for the first day or peli is, as a rule, no 
necessity for giving the patient any food, As the disease is 
most likely to occur in obese, overfed individuals, the absti- 
nence from food is often beneficial. The intestinal tract should 
be flushed out as soon after the patient is seen as is practicable, 
Those about the patient should be instructed carefully as to the 
dangers of attempting to feed the patient if he is unable to 
swallow, for he may, on the one hand, choke, and, on the other, 
he may draw food or drink into his lungs during inspiration, 
and so set up a pneumonia, 

Tf the patient is in need of nourishment or of fluid, it may 
be given by the rectum. Normal salt solution may be given 
by the rectum to supply the body with fluid, but it not 
be given in too large quantities. (See Rectal Feeding.) 

Later Stages.—As soon as the patient recovers sufficiently 
to be able to swallow without danger of inspiring the food, he 
may be fed by the mouth. The food should be liquid or semi- 


454 DIET IN DISEASE, 


solid, and of a bland, ee character. The quantity 
not be too large. Milk, milk and eggs beaten together 
in the form of a milk-punch, without, however, the addition of 
a stimulant, broths, soft eggs, and milk thickened with cereals, 
or the purées of vegetables may be used. As the patient im- 
proves other food may be added, but the diet should be light, 
easily digestible, and as non-stimulating as possible, 

tient should be warned against overeating and also sees 

inking. Alcohol is allowable only in the ease of habitués 
who are threatened with collapse unless it is used, or in the 
same class where food is not assimilated without it. It should 
always be given in moderate amounts, and the dosage arranged 
wy "the physician, and never left to the nurse, the patient, or the 

ly. 

On account of the lack of exercise the diet should contain 
but little meat, but cereals, vegetables, and fruit should be given 
in small quantities at a time, and as evenly distributed through- 
out the day as possible, to avoid overfilling of the vessels, 

‘The greatest danger, from a dietary standpoint, is in those 
patients who recover sufficiently to return to their ordinary 
modes of living. They should be very carefully instructed 
neither to drink to excess nor to overeat, A full meal and 
several drinks may be the cause of a second or of a fatal 
attack. 


DIET IN VARIOUS TOXIC CONDITIONS. 


CHRONIC MORPHIN POISONING. 


Tn the treatment of the morphin habit the diet is of great im= 
portance, A good plan is to institute the rest treatment and to 
give the patient as much food as possible, ‘This method has 
the additional advantage that the patient is kept under better 
control if the nurse can be trusted; and none but one of 
the highest character, who can not be bribed, should be 
employed. 

n obese women who have formed the morphin habit—and 
many women who use the drug are apt to take on flesh—rest 
in bed, with u milk diet, massage, and electricity, may be of 
great service. 

ALCOHOLISM. 


The mild forms of alcoholism are usually easily brea 
So long as the stomach is irritable it should be given absolute 


7 


DIET IN VARIOUS TOXIC CONDITIONS. 455 


rest. If possible, alcohol should be withheld entirely. As 
soon ag the stomach will retain fluid, a saline mineral water or 
a saline purge should be given, Milk or bouillon is next to be 
preseribed, and, as the desire for food returns, a light diet of 
soft-boiled eggs, milk-toast, and the like should be allowed. 
After recovery all rich and highly seasoned food should be 
avoided, particularly the spices and peppers, which are com- 
monly used to excess, 

Tn the severe forms the diet should be that recommended for 
chronic gastritis. Some confirmed alcoholics can retain nothing 
in the stomach until they have had their morning drink, When 
nutrition is threatened, this may be allowed, but it is apt to 
lead to excesses later in the day. 

In the very severe forms, us in delirium tremens or in cases 
approaching ithe patent should take as much Aud ot possible 
to flush out the system and the intestinal tract should be thor- 
oughly purged. The food should be given in a predigested or 
in a partially predigested form, and at frequent intervals, In 
this way the craving for drink is somewhat alleviated. Bouillon 
or beef-tea to which considerable amounts of black pepper or even, 
Cayenne pepper have been added is useful in this condition, 
wehongh their use would be contraindicated for any but an 
alcohol-saturated person. Rest and suralimentation as soon as 
food can be borne constitute the best method of managing these 
cases. Strychnin may be used as a stimulant. 

Iliness or Injury in Alcoholics.—When a man who 
has been accustomed to taking several glasses of liquor 
day for years is suddenly stricken ill or injured, delirium will 
often develop if the stimulant is rapidly withdrawn, In all 
such eases the accustomed amount of alcohol should be given, 
care being taken, however, to prevent overindulgence. 

In alcoholics affected with pneumonia alcohol is necessary to 
sustain life, When delirium tremens occurs in the course of 
pneumonia, alcohol should be ordered, although in ordinary, 
uncomplicated cases of delirium tremens due to extreme over- 
indulgence it should be withheld. 


CHRONIC LEAD POISONING. 


Tn this state especial effort should be made to ascertain the 
cause, and where the condition is due to the handling of lead, 
frequent washing of the hands and cleansing of the finger-nails, 
particularly before eating, should be advi 





456 DIET IN DISEASE. 


Oliver states that abstinence from alcohol serves ap a 
ventive, and advocates that a substantial meal be taken before 
beginning work. Constipation is to be overcome by dietetic or 
medicinal means. Water should be drunk freely, and lemonade 
containing diluted sulphuric acid or aromatic sulphuric acid is 
advised as a prophylactic drink. ‘Ten or fifteen drops of the 
acid may be added to a glass of water. Milk is also drunk 
as a preventive by the workers in factories, but is probably 
of use chiefly as a diuretic and for maintaining the nutrition, 


THE WEIR-MITCHELL REST CURE. 


In his little book, Fat and Blood, destined to be one of 
the classics of medicine, Weir Mitchell has given us the technic 
of his “ rest cure,” which has been used so successfully in the 
treatment of certain cases of nervous exhaustion. Others have 
made suggestions, and Playfair, Leyden, Keating, and others 
have given directions and diet-lists, but they differ but little 
from those of Mitchell, and are not nearly 80 satisfactory, A. 
careful reading of this book is recommended, for nothing beyond 
the essentials of the treatment can be given here. 

Mitchel! defines the cure as a “certain method of revi 
the vitality of feeble people by a combination of entire rest 
excessive feeding, made possible by passive exercise obtained 
through steady use of massage and electricity.” 

‘The treatment is applicable to many forms of nervous ex- 
haustion, but particularly to nervous women who have lost. 
weight,—as Mitchell says, “those who are thin and lack 
blood.” 

Before beginning this treatment it is important to ascertain 
whether the patient ‘is losing or has lost flesh, is by habit thin 
or fat.” In those who haye become emaciated as a result of 
disease a thinning of the blood occurs at the same time, and as 
the patient recovers the former body-weight, the blood, as a 
rule, becomes richer. There are certain anemic fat persons 
who require individual consideration. (See Obesity.) In fat, 
nervous patients the treatment is of little benefit, as it tends to 
increase the accumulation of flesh; if other circumstances 
allow, these cases are better treated by a reduction cure, a8 
detailed in another section. Those who derive most benefit 
from this treatment are patients that have lost flesh. ‘The cure 
is indicated in nervous, exhausted conditions, and in certain 
other diseases in which the patient has lost flesh. In the very 





THE WEIR-MITCHELL REST OURE. 457 


earliest stages of pulmonary tuberculosis this treatment, com- 
bined with an ee cinta is of be a sae dys= 
peptics, cases of chronic i jing, an , it may 
also be recommended. In short, in ar condition in which 
there are wasting and anemia, whether or not emotional dis- 
turbance is present, the rest cure will be found useful. Women 
are better subjects for this treatment than are men, as the latter 
are less able to endure the isolation. In women who are thin 
and anemic and who complain of being tired constantly, the eure 
is of the greatest service. These women become exhausted out 
of all proportion to the amount of exercise they take, and the 
“tire” shows, as Mitchell puts it. In some cases nausea or 
diarrhea may even follow exertion, 

While the cure usually succeeds in properly selected cases, 
Mitchell states that in certain cases failure results from what he 
aptly terms “an unconquerable taste for invalidism,” from 
“sheer laziness,” or in those cases “to whom the change of 
moral atmosphere is not bracing.” 

The method is more likely to succeed and is easier to conduct 
in severe cases than in mild cases. Playfair speaks of “ the 
half-ill who constitute the difficult cases.” Organic disease is 
a contraindication, but there are certain conditions that are 
benefited by it. Heart disease with ruptured compensation 
and the irritable heart of exophthalmic goiter are both suitable 
conditions for this treatment. Many uterine and ovarian disor- 
ders are cured by it, rendering operation unnecessary, and those 
cases that have hea operated upon without bringing relief may 
often be restored to health by this method of treatment. Float- 
ing kidney, as mentioned elsewhere, is a suitable condition, if 
the case is a recent one, for the rest treatment. Certain forms 
of mental disturbance are greatly benefited by it, and the method 
of forced ctiea d the insane is but an example of this method 
of treatment. Melancholia with periods of agitation is often 
benefited by several weeks’ quiet and proper feeding when the 
agitation comes on. - 

The technic of the treatment is explained in a most interest- 
ing way by Mitchell, and the following details, largely eon- 
densed, are taken from his book. ‘The more nearly perfect the 
technic and the more closely it is adhered to, the more likely is 
cure to follow. The cases are of various grades of severity, 
and the treatment should be modified to suit the individual, 

Isolation is necessary, and the patient should be removed to 
a hospital or a sanitarium, away from familiar scenes. Home 


» i 


458 DIET IN DISEASE. 


treatment does not succeed well. If circumstances compel the 
patient to remain at home, her room should be changed. In 
severe cases with emotional manifestations visiting is forbidden, 
but it may be allowed to a “ certain extent where the patient is 
anemic owing to a distinct cause, as overwork, blood-losses, 
dyspepsia, low fevers, or nursing.” 

The nurse should be a stranger to the patient, and if for any 
reason the patient does not get along with the nurse, another 
nurse should be secured. She should be a strong, healthy, firm 
woman, with tact and sufficiently attractive qualities. The 
family should not be allowed to nurse the patient, for, as O. W. 
Holmes says, “the hysterical girl is a vampire who sucks the 
blood of the healthy about her.” 

Communication with friends and family should, as a rule, be 
cut off entirely, and not even the reading of letters should be 
allowed. After several weeks, if the patient is improving, she 
may be allowed to read the newspaper each day. 

Rest is a most important feature, and, as a rule, the patient 
should be put to bed for six weeks or two months. 

In other cases, especially where the patient is not able to un- 
dergo the regular treatment, as in dispensary cases, a modified 
rest cure may be tried. The following is Mitchell’s schedule 
for such cases; this may be modified according to cireum- 
stances : 

“7.30 a. ut. : Cocoa, coffee, hot milk, beef extract, or hot 
water. Bath (temperature stated). Rough rub with towel or 
flesh-brush. Bathing and rubbing may be done by attendant. 
Lie down a few minutes after finishing. 

“8,30 a. M.: Breakfast in bed. (Detail as to diet. Tonic, 
aperient, malt extract as ordered.) May read letters, papers, 
ete., if eyes are good. 

“10-11 A. Mi if required is usually ordered one 
hour after breakfast, or Swedish movements are given at that 
time, An hour's reat follows massage. Less rest is needed 
after the movements. (Milk or broth after .) 

“12 M.: Rise and dress slowly. If gymnastics or massage 
are not ordered, may rise earlier. May see visitors, attend to 
household affairs, or walk out. 

“1.30 a. M.: Luncheon. (Malt, tonic, etc., ordered.) In 
invalids this should be the chief meal of the day. Rest, lying 
down, not in bed, for an hour after. 

“3p. a. Drive (use street cars or walk) one to two and 
one-half hours. (Milks or soup on return.) 





THE WEIR-MITCHELL REST CURE. 459 
poy Pp. ot,: Supper. (Malt, tonic, ote. ordered, detail of 
ict.) 


“10 p, 4. : Hot milk or other food at bedtime,” 

This may be altered by omitting the out-door exercise in in= 
valids or business men who can rest only part of the time 
by conducting their business in the morning, utilizing the after- 
noon for massage and rest. If massage is not ordered, no ex= 
pense is attached to this routine. 

In extreme cases the patient is made to rest absolutely. No 
exertion of any kind is to be allowed. The bed-pan is to be 
used with the patient in the recumbent position, She should 
be removed to a conch for an hour, both morning and evening, 
while the bed is being freshened. The patient should be fed, 
and later, when allowed to feed herself, the meat should be cut 
up for her. A sponge-bath should be given daily, but if it 
causes depression, it may be given less frequently, After two 
weeks, if it is thought desirable, the patient may be read to for 
one to three hours. The monotony of the treatment is not so 
trying as would be imagined, for the routine of the day occu- 
pies most of the time, An important part of the treatment is 
the moral suasion, and when no good can be attained in this 
direction, the physician should judiciously seek to lead the 
thoughts of his patient to the selfishness of the life previously 
led. The nurse and masseuse should not be allowed to talk 
about or to listen to the patient’s ills, and sho should be tanght 
that she must speak of them only to the physician, 

and electricity are resorted to in order to. main- 
tain nutrition and circulation while at rest. Mitchell gives 
minute instructions regarding both. General massage of the 
whole body is to be given, care being taken not to excite pain 
by manipulating tender areas. The tapping movements, slap- 
ping, and the like are not to be used in nervous patients. Care 
should be exercised to avoid producing sexual excitement ; this 
may be aroused in both sane and ineane patients from friction 
near the genitals or over the back or buttocks. If it does 
occur, the operator should avoid the sensitive areas. In the 
average case massage should be given for an hour daily for 
about six weeks, and then on each alternate day. The time 
chosen for this should be about midway between meals, Care 
should be taken to keep the parts warmed by the massage well 
covered. 

The same precautions should be taken in using seal 
as when giving massage. The induced current should be used, 


= 


460 DIET IN DISEASE, 


and it is well to employ a battery in which the breaks are very 
slow—from two to seconds. The more rapid interruptions 
are useful, however, but in the hands of an unskilful operator 
may excite pain and apprehension in the patient. Tage 
may be placed four or five inches apart on the muscle, the 
whole body should be gone over. 

‘The diet is one of suralimentation, In many cases milk 
should form the basis of the diet at first. Karell’s method of 
administration is to be used. (See Milk Cure.) 

In those patients who are obese, anemic, and nervous (or 
even when they are not), in whom the other methods of reduc- 
tion are of no value, a reduction secured by means of rest and 
a milk diet often succeeds, The milk may be skimmed if nec- 
essary. The patient is put to bed and placed on a milk and 
general diet and then on an exclusive milk diet. M: and 
electricity are employed, and the patient’s weight is Lone 
it does not decrease, the amount of milk is decreased to three 
pints or even toa quart a day until the weight has fallen to 
the desired number of pounds. The diet is then gradually in- 
creased and the patient by degrees allowed to go about. Diree- 
tions for the future diet must be given; this should be along 
the lines laid down in the section on Obesity. 

Tn thin, anemic, exhausted women, who are the ones usually 
treated, the diet is as follows: The patient is put to bed and 
the diet gradnally changed from the ordinary diet to a mille 
diet. This is done by giving from three to four ounces of mille 
every two hours, after the Karell method. Then the patient 
is given two quarts of milk in each twenty-four hours, The 
amount is divided, and a portion given at eet intervals. 
At the end of the first week a pound of beef is administered 
in the form of a raw soup. This is given three times a day, 
one pound of beef being used each day, If desired, this may 
be replaced by peptonized food. (See formulas in the Appendix.) 

Mer ten 2 has three meals a day are given. These are led up 
to gradually, and the patient is kept on the milk diet until the 
stomach feels comfortable. Then, usually within from four 
days to a week, a light breakfast is allowed, and in a few days 
more a chop is given at the midday meal. After a short time 
the patient is given three full meals, together with three or 
four pints of milk instead of water, either with or after the 
meals, 

After about ten days of this treatment from two to four 
ounces of a good finid extract of malt are given before each 





THE WEIR-MITOHELL REST CURE. 461 


meal. “As to meals, I leave them to the patient’s caprice, 
unless this is too unreasonable ; but I like to give butter largely, 
and have little trouble in having this most wholesome of fats 
taken in large amounts. A cup of cocoa or of coffee and milk 
on waking in the morning is a good preparation for the fatigue 
of the toilet.” 

Tn some of the difficult cases half an ounce of cod-liver oil 
is given half an hour after each meal. If it causes nausea or 
interferes with the appetite, it is given as a rectal injection. 
‘This is of particular service where the bowels are sluggish. It 
may also be given in the form of an emulsion with 
extract. In some it acts admirably; in others it may cause 
tenesmus. 

Alcohol is not necessary to the treatment, and, asa role, is 
omitted, although a small amount helps in the accumulation of 
fat. It should always be used with great care and judgment. 
In those who have never taken it to excess or used it habit- 
ually Mitchell gives it in small daily doses. An ounce of 
whisky in milk or a glass of red wine or of champagne he 
regards as a useful adjuvant, as it increases the desire to take 
food at meals. In some even the small amount contained in 
malt extract may cause excitement, and for these cases the 
thicker malt extracts or the Japanese extract, which is made 
from barley and rice, are preseribed. 

Tron is given in large doses as soon as the patient begins to 
take solid food, and sometimes before. The form is not of as 
much importance as the dosage. The carbonate and the lactate 
are the ens prescribed by Mitchell. If the patients claim 
that they can not take iron, five grains of the pyrophosphate are 
added to each ounce of malt, and it is given without their 
Knowledge. It is generally well borne, and after a month’s 
time it may usually be given with good results in the ordinary 
forms. The Teptoncies of iron and manganese may also be 
administered either with or without malt. No other drugs 
are given except as needed to regulate the bowels—cascara, 
aloes, etc. When the patient begins to sit up, strychnin in full 
doses with iron and arsenic is given. 


SCHEDULE FOR A COMPLETE REST-CURE, 


Until otherwise ordered, absolute rest in bed. No visitors, no reading, and 

* no conversation with nuree on the subject of disease or treatment, 
First Day.—1 quart of milk in divided doses every two houra 8 A. Mt: 
Cold bath followed by a brisk rub, If patient does not react well, a warm 
tath may be used for several days and then the cold bath tried again, 11 a. 36: 





462 DIET IN DISBASE. 


20 minutes’ masage. 2-330 ¥.x,: Room darkened for a nap. 4 7.34: 20 
minutes electricity. 9 r. a.: Brisk rub over entire body. xs 
1—Same as first. Milk 1} quarte; massage and electricity in- 

ereased to 40 minutes. 

Third Day—2 quarts of milk in divided doses at 3-hour intervals; massage 
and electricity 1 hour each. 

Fourth Day.—Same with addition of white of a raw egg with each glass of 
me Dag Sane 


tonst for brealcfust. 
Tenth Day—Same with ai potato and junket for dinner—about 1.30 P, at. 
—Cocon on a ; 7.30 4.x: Bath and brisk rub, 8.30 
A, Met including ce: or bread and butter, and two 
glasses of milk with the whites of two eggs AL Ae Me: 11.30 
‘A.%.: } Pint milk, whites of one or two egges 2 ¥, at: Full dinner, in> 
ch two glasses of mil ri 


cag 9. asa of mille. 
fale as above ‘until desired eflect is obtained. This to be modified to 
suit the individual case. On twelfth day it is well to give two ounces of malt 
‘extmot with a ful of solution of papionat of ron and manganese, oF 
4 tablespoonful of Gudes Feptomangan, | Hydrochloric acid pepsi, and sx 
vomica are useful if there is discomfort after eating. Bowels to be kept open. 
Uso butter in ax large quanties ax possible. 





The following is a sample schedule' in a marked case in a 
patient of thirty-three: 

‘Patient remained in bed in entire repose. She was fed, 
and rose only for the purpose of relieving the bladder and 
rectum, 

“Oct, 10th: Took one quart of milk in divided doses every 
two hours, 

“11th: A cup of coffee on rising and two quarts of milk 
in divided portions every two hours, A pill of aloes every 
night, which answered for a few days. 

*12th-15th; Same diet. The dyspepsia by this time was 
relieved, and she slept without the habitual dose of chloral. 
The pint of raw soup was added, in three portions, on the 16th. 

“17th and 18th: Same diet. 

“19th: She took, on awaking at 7, coffee; at 7.30 half- 
pint of milk; and the same at 10 a, M., 12 M., 2, 4, 6, 8, and 
10 p,m, The soup at 11 a. w., and at 5 and 9 P.M. 

“23d: She took for breakfast an egg and bread and butter ; 
and two days later (25th) dinner was added, and also iron, 

“On the 28th this was the schedule ; On waking, coffee at 7. 
At 8, iron and malt. Breakfast, a chop and bread and butter ; 
of milk, a tumbler anda half. “At 11, soup. At 2, iron and 
malt. Dinner closing with milk, one or two tumblers, The 

1 Fut and Blood, p. 146. 


THE WEIR-MITCHELL REST CURE. 463 


dinner consisted of anything she liked, and with it she took six 
ounces of Burgundy or dry champagne. At 4, soup. At 7, 
malt, iron, bread and butter, and usually some fruit, and com~- 
monly two glasses of milk. At 9, soup; at 10, an aloe pill. 
At 12™., occupied an hour; at 4.30 P.M, electricity 
was used for an hour, 

«This diet-list, reached in a few days by a woman who had 
been unable to digest the lightest meal with comfort, seemed 
certainly remarkable. She began to gain at the end of the 
second week; the effect was noticed in her face, and during 
her two months in bed she went from 96 pounds to 136, 
and the gain in color was not less marked. At the sixth 
week the soup was dropped, wine abandoned, the iron 
lessened one-half, the massage and electricity used on alter- 
nate days, and the limbs exercised as I have described. The 
usual precautions as to rising and exercise were carefully at- 
tended to, and at the end of the ninth week of treatment my 
patient took a drive. At this time all mechanical treatment 
ceased, the milk was reduced to a quart, the iron to five grains 
three times a day, and the malt continued. At the end of six 
weeks I began to employ strychnin in doses of one-thirtieth of 
a grain thrice a day at meals, and this was kept up for several 
months, together with the iron and malt. The cure was com- 
plete and permanent.” 

‘The patient is allowed to undertake movements for herself 
very gradually, being allowed to move about in the bed by her- 
self and then sit up, and later on to sit out-doors, and then to 
walk a few steps, to take a drive, etc. If this is not done 
gradually, the moving about may be attended by dizziness, ver- 
tigo, or unpleasant exhaustion, which may be avoided entirely 
by gradually increasing the patient’s efforts for herself. 

Asthenopia is a most troublesome symptom, and patients who 
do not exhibit it generally make good recoveries. Where it 
exists, an ophthalmologist should be consulted. The eye trouble 
may persist long after all other symptoms have disappeared. 

‘The following schedule,' abridged from Mitchell, is instructive 
as showing the method of treating a man who continued at his 
business while undergoing the treatment. The patient was fifty- 
three years old, and had broken down after thirty years of 
constant application to business. He had a cough, was greatly 
emaciated, and exhibited numerous nervous symptoms, 

“6 a. m.: A tumbler of strong beef-tea made from the Au- 
stralian extract. 

+ Fat and Blood, p. Yi2 





464 DIET IN DISEASE. 


“8 a.m.; Hulf a tumbler of iron water and breakfast, con- 
sisting of fruit, steak, poe coffee, and a goblet of milk. 

“8.30 a. w.: A goblet of milk mixed with a ful 
of Loefland’s extract of malt, with six grains of citrate of iron 
and quinin, 

“10 a. M.: Electricity. 

«12 M.: Dressed Witten little personal effort as possible; 2 
second goblet of iron and malt was given him, and a carriage 
took him to his office, where he remained two hours, a carriage 
bringing him back. Walking was forbidden, He was then 

iven dinner, preceded by half’a tumbler of iron water. After 

inner, which included a goblet of milk, the third goblet of milk 
and malt was swallowed. Then a short drive might be taken. 
By 4 o'clock the patient must be undressed and in bed. 

“6p. M.: The third dose of iron water and a light supper 
of fruit, bread and butter, and cream, followed bya ear 
of milk and malt. Two quarts of milk were given in addition 
to the other food, 

“9 p, M.: Massage for one hour, followed by beef-soup, four 
ounces. 

“From 125 pounds he went up in six weeks to 133 pounds, 
and reached 140 a month and a half later, and has continued to 

in. A year later he was well and strong, and had ceased to 

what he had been for years—a delicate man.” 


DIET FOR THE INSANE. 


Feeding constitutes a very important part of the treatment of 
the insane. Al insane patients who are below the standard of 
nutrition should be built up, and an earneat effort made to increase 
the weight of the patient. One of the English alienists was wont 
to talk of the “gospel of fatness.” This is best accomplished 
by a system of feeding somewhat similar to that outlined in the 
rest treatment, the rest being prescribed or omitted as the case 
demands. It should always be remembered that an insane per- 
son may contract other diseases besides his mental disorder, and 
these should be carefully sought for and properly treated ; this 
is true especially of stomach and intestinal disorders, which may 
give rise to delusions regarding the taking of food. 

When the patient refuses food, the question as to the advisa- 
bility of feeding him by foree arises ; opinions are divided on 
this point. Everything considered, it is well to begin the forced 
feeding early, before the patient has time to suffer from his 





DIET FOR THE INSANE, 465, 


fasting. It should be accomplished by means of the stomach- 
tube or the nasal tube, and about a liter quart) of food should 
be introduced. The food may be given thus twice daily, and in 
the case of weak patients three or foar times a day, Milk, 
milk and eggs, and broths may be used for this purpose. A 
sufficient number of attendants should be at hand to control the 
patient if he becomes unruly and resists feeding. After a pa- 
tient has been fed with the tube several times he will often prefer 
to take his nourishment in the usual manner, 

Whether the esophageal or the nasal tube is to be used will 
depend on the preference of the physician, Each has its advan- 
tages. The nasal tube is generally proferred, sinoo it is easior 
to introduce, can not be bitten by the patient, and does not 
cause the patient to struggle as much as the stomach-tube ; it 
may, however, be passed into the larynx, and in this way liquid 
might be introduced into the trachea. This danger is more 
fancied real, and can be avoided if the patient is allowed 
to breathe before the fluid is poured into the tube. While he 
is breathing the tube should be pinched, and if it is in the 
larynx, this fact will be noticed at once. Ordinarily, but not 
always, coughing ensues; it does not follow when the larynx is 
anesthetic, as it occasionally is in the insane or hysteric, The 
stomach-tube does not allow the food to be regurgitated so 
easily as the nasal tabe, but for this method of feeding a mouth- 
gag is required that may injure the mouth or teeth, or it may 
slip, permitting the patient to bite the tube. If the patient has 
acquired the knack of Segnalo ee food, this may be pre- 
vented by tickling the ribs while the fluid is being introduced. 
This prevents the fixing of the diaphragm, and is successful in 
most cases. 

‘Tact and experience in handling the insane are of the greatest 
value. Some nurses or attendants have little difficulty in get- 
ting patients to eat, whereas others seem never to learn how to 
manage them. It must be remembered that an insane patient 
may not eat for reasons that are often easily overcome. 
may prefer to take his food alone, because he does not think 
himself worthy of eating at the same table or with other people. 
He may fear that his food has been poisoned, and he should be 
convinced of the fallacy of this by the nurse, who should cat a 
portion before him, or allow him see the food prepared, or he 
may be given food that can not easily be poisoned, such as eggs, 
whole vegetables, and fruit. When the patient’s confidence is 
gained, the battle is generally won. In some cases the delusion 
persists for a long time and can not be dispelled. 

30 





466 DIET IN DISEASE. 


Food should always be served daintily. An insane person 
who may be very much unbalanced may still notice the ali; 
variations in tho way of serving food. Attendants are apt to 
be negligent in this . For all patients who have a sui- 
cidal tendency the should be served on dishes that ean not 
be broken. No knives should be allowed, and the food should 
be so served as to require no cutting. An attendant should 
watch those who are apt to bolt their food, and see that it is cut 
fins Eee serving it. Cases of sudden death have followed the 

rawingof a pieceof meatintothe while eating too rapidly. 

Peale sees ares parm and css “siche Gaal 
tutions are of the nervous type require cateful dietetic super- 
vision, and the child should be trained to like the plain and 
wholesome varieties of food, and never be given the rich, highly 
seasoned dishes that so often disturb the digestion of nervous 
children, Milk should form the basis of the diet, and eggs and 
meat should be given in moderate quantities along with cereals 
and the wholesome vegetables. As a rule, infants should be 
Kept on a milk diet for a longer period than other children, and 
the change to a general diet should be made with caution. Tea 
and coffee, as well as alcohol, should always be forbidden. 
Every effort should be made to nourish the child, and to haye 
him lead a wholesome, quiet, ont-of-door life. 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 


DIABETES MELLITUS. 

Diabetes is a disease of the greatest interest to the student of 
dietetics, for it is alone by the careful regulation of the diet that 
the diabetic’s life is made comfortable and his days prolonged. 
‘The disease was known to the ancients, but its management 
was not understood. Sngar was first detected in the urine by 
Thomas Willis, one of the English physicians of the seven- 
teenth century. Properly speaking, one should say that he dis~ 
covered that the urine of the diabetic was sweet to the taste. 
Rollo was the first to diet his patients, and the literature since 
his time is so extensive that not even mention can be made of 
the most important contributions. Among those who have 
made a study of this disease may be mentioned a score of 
prominent names, among them Claude Bernard, Bouchardat, 
Dujardin-Beaumetz, Germain Sée, Frerichs, Ebstein, Seegen, 
von Noorden, Senator, Kiilz, Pavy, and Cantani. 

« By diabetes is understood a disease in which the eed 
of the organism for burning up grmpe-sugar is morbidly de- 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 467 


pressed? (von Noorden). The student should remember that 
not every person whose urine shows the of sugar is a 
diabetic. A patient is not to be Segarued as ai abecer tule 
he remeen ciiue that more or les constantly contains 
sugar. is must be t afier the ingestion of moderate 
amounts of castthydralee 18 Simultaneously with this excretion 
of grape-sugar there occur polyuria, increased thirst’ and ay 
tite, emaciation, and many other symptoms that the 
should familiarize himself with by reference to the text-books 
on the subject, 5 

The chief indications in the management of diabetes are to 
maintain the patient's strength, to increase the sugar-destroying 
power of the body, and to avoid complications. These results 
are best accomplished by supplying a sufficient amount of food 
in such a form that it may be utilized by the patient, and by 
avoiding carbohydrates. 

In order to maintain the patient’s strength it should be re- 
membered that the diabetic, like the healthy man, craves for 
each kilo of weight in each twenty-four hours— 


Hengewo 012 

If this amount is supplied according to the condition of the 
patient, the body-weight will he maintained ; if it is not, the 
patient will lose weight. (See section on Metabolism.) 
‘The patient should be weighed from time to time. Changes 
in diet will frequently cause trifling losses of weight; these are 
of no importance; constant losses of weight, however, are 
always of grave significance. 

It rica aoreea eee that the sugar exereted in the urine 
has not been utilized by the body as food, and that if this 
amount is large, it must be offset by sufficient other food, or 
loss of weight may follow. 

It has been observed that diabetic patients who take 
quantities of carbohydrates always suffer in the end, and for 
this reason they are contraindicated. If such patients take 
more carbohydrates than they can dispose of, degenerative proc- 
esses, such as impotence, arteriosclerosis, cataract, nerve-changes, 
and the like, are apt to take place. 

The following will serve as a guide to a proper understand~ 
ing of the principles underlying the dietetic management of 
diabetics, It should be borne in mind that the diabetic oo 

verts just as much potential energy into living force aa 























LE 


468 DIET IN DISEASE. 


healthy man. Working or resting, the same rules apply to the 
fone as to the healthy man. “a! rely 

Starch is the most important of the carbohydrates. Before 
it can be absorbed it must be broken down in the body, by a 

of fermentation, into soluble carbohydrates ; or, roughly 
ing, into sugars. This is accomplished “ the ferment 
iastase, which is formed principally in the saliva and me 
creatic secretion, Glycogen is a complicated molecule, and li 
wise requires decomposition before it can be utilized. 

Cane-sugar is split up into grape-sagar and levulose (fruit- 
sugar). If cane-sugar is taken in excess, it may pass into the 
urine directly, without being broken up. Fruit-sugar and 
Jactose (milk-sugar) pass unchanged directly into the blood. 

sugars pass through the portal vein to the liver. The 
amount reaching the liver in this way varies at different times. 
Tn the liver all these sugars are converted into glycogen, which 
is stored in the organ and is passed into the circulation as it is 
needed. Glycogen is also found in other parts of the body, 
especially in the muscles. The glycogen in the muscles is sup- 
plied to the blood in the same way as it is supplied by the liver. 
Before it passes into the circulation most of the glycogen is 
first converted into grape-sugar. So far as its glycogenie fune- 
tion is concerned, the liver is to be regarded as a storehouse for 
sugar, from which it is supplied ready for assimilation by the 
cells as it is needed. Glycogen may also be formed from 
teins. Carbohydrates are burnt up by the cells in the produc~ 
tion of force and heat, 

So long as the amount in the blood does not exceed the 
physiologic limit it does not pass out of the body with the 
excretions, except perhaps in the most trifling quantities in the 
urine. When the amount of carbohydrate material is insufli- 
cient in amount, grape-sugar is manufactured from the body-fat 
and from that taken as food. This probably oceurs only when 
the amount of carbohydrate ingested is too small to supply the 
needs of the organism. When the carbohydrate material sup- 
plied is too great for the needs of the body, it is stored up in 
the liver aad muscles. When the limit of eapacity is reach 
the carbohydrates are converted into fat and deposited in the 
subcutaneous tissue and elsewhere. 

When the supply is larger than can be disposed of 
these methods of storing it, the blood becomes exceedingly ri 
in grape-sugar, and the excese is excreted in the urine; asa 
result, alimentary glycosuria follows. This is a physiologic 
process, and must not be confounded with diabetes mellitus. 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 469 


Normally, minute traces of sugar are found in the urine, 

‘These amounts are 40 small as not lee detected by the ordi- 
tests ; therefore the urine may regarded as being nor- 

stally free from sugar. As sees explained, if sugar is 
in; in large quantities at short intervals, it may 
physiologically in the urine. The variety of sugar fc in 
the urine is the same as that which has been ingested. If 
grape-sugar has been taken, glycosuria results ; if cam h 
saccharosuria ; if fruit-sugar, levulosuria; if milk-sugar, 
tosuria, The amount necessary to be taken varies as to whether 
the individual is fasting or is taking large quantities of food ; 
it also varies with the individual. 

According to von Noorden, sugar appears in the urine after 
a simple ingestion of — 


Milkengar, more than 120 grams 
Canesugar’ = a We. s 
Fruiteuger “ 200 
Grapesugar “ =“ 200-250 * 


These figures are only approximate, and represent the amounts 
taken when the individual is fasting ; the limit is higher when 
the stomach contains food. 

Tf an individual is healthy, any amount of starch may be 
taken without: causing sugar to appear in the urine. The proc- 
esses of conversion take so long that sugar can not enter the 
circulation in large quantities ata time. When te is excreted 
after starch ingestion, there must be a morbidly di 
assimilation limit, and diabetes mellitus should be suspected. 
Milk-sugar may be found at times in the urine of nursing 
women, Gilycosuria may be due to various causes. Among 
these may be mentioned the ingestion of certain drugs, such as 
morphin and amyl nitrite, for example ; injury to the floor of 
the fourth ventricle, as demonstrated by Clande Bernard’s 
famous experiments, may also be a cause. Many nervous dis- 
eases and liver disorders predispose to the production of gly- 
cosuria. 

Diabetes mellitus may be produced experimentally by extir- 
pating the pancreas or by administering Nee Lesions 
consisting of hyaline degeneration of the islands of Langerhaus 
in the pancreas have been described by Opie as a] ‘ing in 
diabetes. Cohnheim has shown that the pancreas jes a sub= 
stance which, when mixed with another substance from the mus~ 
cles, eases the conversion of sugar into aleohol and earbonie acid, 
When either is withheld the sugar is not converted. When the 


ill 


470 DIET IN DISEASE. 


panereatic substance is furnished in excess, it hinders or may 
stop the process altogether. The lesions found in the pancreas 
may mean that there is deficiency of this substance, and con- 
sneey an inability to utilize glycogen. 
a age dhapler to be caused by an Se hee 
sugar; by certain poisons or nervous injuries where oa 
cogen is suddenly emptied into the circulation from its reser- 
voirs. It may be caused by a lessened consumption of sugar 
by the tissues, as has been shown in experimental pancreatic 
diabetes, and probably in diabetes mellitus in man. It may 
also be caused by a combination of the two factors, as in the 
‘imental diabetes produced by phloridzin. 
epabiiea raay be associated with other diseases ; especially to 
be mentioned as important from a dietetic standpoint are obesity, 
gout, and nervous diseases. 

Tn formulating a dietary for a diabetic one must ascertain 
definitely whether a certain diet is harmful or beneficial. Three 
things are of especial importance : the amount of sugar excreted 
daily, the gain or loss in body weight, and the general condition 
of the patient, 

In every instance the amount of sugar produced in twenty= 
four hours is to be estimated, and not merely the percent in 
the urine. The amount of sugar must always be consi 
along with the diet, lest erroneous conclusions be reached. A 
patient taking a large amount of carbohydrate food will natu- 
rally excrete more sugar than one taking a small amount. Com- 
parison must be made with previous observations made on the 
same patient, The body weight is an excellent index as to the 
progress of the patient, If he is getting sufficient nourishment 
and the disease is not progressing, he will either gain in weight 
or the weight will remain stationary, Changes in dict may 
produce trifling losses in weight; these may be disregarded 
unless they become persistent. 

To determine whether a case is mild or severe, Seegen and 
‘Traube have suggested that the urine be tested while the patient 
is taking 4 dict absolutely free from carbobydrates. If the 
urine is found to be free from sugar, it may be regarded as a 
mild case ; if the presence of sugar persists, it is a sign that the 
patient is converting proteins into sugar, and that the case is a 
severe one. Several days’ (about five) careful observation are 
necessary to determine this. The carbohydrates should not be 
withdrawn suddenly, but gradually, by lessening the quantity 
consumed each day, 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR, 471 


Lp aes uses the following carbohydrate-free dict as a 
stan 3 

Breakjast: 5 gm. of tea steeped in 200 c.c. of water; 150 
gm. of ham; 1 egg. 

Luncheon: 200 gm. cold roast beef; 60 gm. fresh eneumbers 
with 5 gm. vinegar, 10 gm. olive oil, and salt and pepper to 
taste; 20 ec. brandy with 400 cc, Apollinaris water; 60 cc. 
coffee without milk or sugar. 

Dinner : 200 ¢.¢, clear bouillon ; 250 gm. beef (weighed raw) 
basted with 10 gm. butter; 80 gm. green salad with 10 gm. 
vinegar and 20 gm. olive oil, or 3 teers of some well- 
cooked green vegetable; 3 sardines in oil; 20 c.c. cognac with 
400 c.c. Apollinaris water, 

22 (raw or cooked); 400 ¢.c. seltzer water. 

This Sandan dick is free from carbohydrates, and contains 
almost 200 gm, albumin (with 32 gm. nitrogen) and about 135 

m, fat. As soon as the urine has remained from 

for two or three days under this diet, gradually increasi 
amounts of stareh—up to 20, 50, and 100 gm.—are added, 
The authors supply this either in the form of white bread, 
containing 55 per cent. of starch, or else as Albert biscuit, 
which contains 75 per cent. of starch, When, under these 
increasing additions of starch, sugar reappears in the urine, the 
following formula is obtained : 


Tolerance = standard diet + x gm. starch. 


Tt must be borne in mind that there are wide variations in 
the glycosuria of a diabetic patient, and conclusions are not to 
be too hastily drawn. In considering the severity of a certain 
case the same standard diet may be employed. Bearing in mind 
that there may be variations due to other causes, the severity 
of a given case may be determined from the amount of sugar 
that is excreted in twenty-four hours while the patient is on the 
standard diet. 

Cases will be observed in which no glycosuria occurs while the 
patient is on the standard diet, but that will bear no addition 
of carbohydrates. Such cases occupy a place midway between 
the mild and the severe. Occasionally, er, these patients 
will tolerate additions to the proteins. In other cases, where 
glycosuria appears with the standard diet, it may be either 
reduced or checked altogether by cutting down the eupply of 
protein material. Care must, however, fs taken not to starve 
the patient. 





472 DIET IN DISEASE. 
‘Von Noorden uses the following formulas for recording the 


‘Tolerance = standard diet + 0 gm. starch. 
Tolerance = standard diet + 100 gm. meat, 
Tolerance = standard diet + gm. sugar. 


These are varied according to conditions, and afford a simple 
and accurate method of recording the progress of a case. 

Mandel and Lusk suggest a new method for pi jis in 
diabetes : i aren is placed on a meat-fat diet (ich cream, 
meat, butter eggs), and the urine is collected on the second 
day, 80 that an early morning hour (before breakfast) terminates 
the period for one day. The amount of dextrose and nitrogen 
are teceemined! If the ratio of the dextrose to the nitrogen is 
3.65: 1, it signifies a complete intolerance for rr 
and probably a rapidly fatal outcome, They call this the fatal 
ratio. If the ratio between the dextrose and nitrogen is lower, 
it oe that some carbohydrate may be burned. 

The different varieties of carbohydrates ingested may vary 
in their glycosuria-producing power. Grape-sugar causes the 
greatest percentage of sugar to appear in the urine in the short- 
est time. Starch, maltose, and dextrin very closely resemble 
grape-sugar in this respect. Fruit-sugar augments the glyco- 
suria only to one-half the extent when given in the same 
amounts, and ed stands about midway between the two. 

Fat never causes glycosuria, and alcohol in moderate amounts 
does not increase glycosuria. 

Exercise affects the glycosuria of diabetes, In early cases, 
when the nutrition is good, exercise lessens the amount of sugar 
in the urine, whereas in old cases and in emaciated patients it 
is increased. It is also increased by mental and nervous excite- 


ment, 

Glycosuria bears a very close relation to the condition of the 
digestive organs. When there is any gastric disturbance, owin; 
to the lessened absorption the amount of sugar is usually lessens 

Acute febrile diseases and chronic diseases accompanied by 
fever lessen the amount of sugar in the urine of diabetics. An 
interesting fact is that glycosuria may disappear when chronic 
interstitial nephritis supervenes. In gouty patients the urine 
may be freo from sugar during the exacerbations of the disease, 

Prophylactic Diet.—In diabetic families it is a wise pre- 
caution to limit the ingestion of carbohydrate food. Whether 
or not this has any effect in inhibiting the development of the 
disease is not known. In these families the maintenance of a 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 473 


proper hygiene should be insisted upon. Von Noorden 
gests limiting the ingestion of carbohydrates, especially in eee 
bers of diabetic families where there is a ter ‘to grow fat 
as age advances, This is particularly apt to be the case where 
the temptations of the table are great, owing to the social posi~ 
tion of the nt. 

Alcohol.—The question of alcohol for the diabetic is the 
subject of diverse opinions by the profession, _ Yon Noorden 
= ie the moderate use of alcohol for the folk Teasons : 

Tt is useful, when a fat and meat diet is red, in pre- 
vent disagreeable sensations after the taking of fut, and ae 
sequently assists the patient in taking his diet. 

a Alcohol furnishes the diabetic with a valuable fuel, as 
of alcohol gives off 7 calories of heat; or if 14.3 
gm. of alcohol are given, 10.75 gm. of fat may be omitted from 
the diet. This can be utilized only to a limited extent, as 
alcohol consumed in large quantities is productive of er 
harm, Sixty grams (2 ounces) of aleohol daily may be looked 
Upon as an average amount, and is not to be exceeded unless 
the patient, through long years of drinking, has acquired a tol- 
erance for it, 

(c) Alcohol is a [etre and a useful heart tonic, It 
is valuable in the of a man who can individualize, but 
in the hands of the routinist and yenaalitie it becomes, accord- 
ing to von Noorden, a word. 

Tf alcohol is used, the lighter fem of alcoholic drinks are 
to be preferred. 

One hundred grams of alcohol, for the most part without 
admixture of carbohydrates, are contained in : 


paresis) Pilsner beer (1 liter)—contains 35 gm. carbohydrate, dextrin, and 


7900-1500 ec. white table rine (Moselle, Rheingau, Pfals, Baden, ete.)- 
1100-1800 c.c. medium sorts of 

1000-1200 e.c. fine red Plt 

1800-2200 ¢.c. well-fermented fruit-wine (extra dry). 

280 e.c. rum. 

280 cx old. eye whiiky. 

210 ce, whisky. 

mase oe amok 


180 oo cherry brandy, 
DIETETIC TREATMENT. 
‘The diet of the diabetic must be arranged with eeveral ane 
in view: The strength of the patient must be 
if possible, increased. This means that the protein Be 


tt 








474 DIET IN DISEASE. 


be from diminishing. Von Noorden takes as a basis the 
fact that an average male adult taking moderate exercise con= 
sumes nutriment at least to the value of 35 calories to the kilo- 

of body weight. A man of average weight would, there- 
fre, require 2500 calories. The amount of sugar excreted in 
the urine is not, of course, available for body use, and must be 
made up by additions to the dietary. 

It must be remembered that while carbohydrates are either 
of little or of no nutritive value to the diabetic, in many eases 
they are positively injurious. Von Noorden likens the giving 
of carbohydrate food to a diabetic to the pouring of water into 
a sad. vessel. The tolerance for carbohydrates of cach 
individual must be borne in mind. As a matter of fact, the 
limitation of sngar and starch is easily accomplished, but it is 
difficult to cut them off entirely. Their nutritive value must 
be replaced by meats and fat; most diabetics, contrary to the 

pular belief, take fats very well. It has been urged that a 
fat and meat diet predisposes to coma, a theory that is probably 
unfounded, 

Von Noorden’s classification and methods, since they are 
perhaps the most practical, will be detailed first: 

Mild Forms of Glycosuria in which the Urine 
Remains Free from Sugar notwithstanding the 
Administration of from 50 to 150 Grams of Starch.— 
In Elderly Persons.—These are the mildest cases, in which 
from 0.5 to 2 per cent. of sugar is exereted in the urine of 
gouty or corpulent patients, generally over fifty. This disap- 
pears as soon as the carbohydrates in the diet are diminished, 
A close study of the starch tolerance in these cases is not 
necessary. Cure should be taken not to frighten the patient 
into a condition of saccharophobia, as is so often done. A 
careful supervision over the patient’s mode of living and a 
regulation of his diet are generally all that are requi 

Minute directions concerning the choice of foods are un- 
necessary in this class of cases, as they usually lead to anxiety 
and depression on the part of the patient. 

Articles of food consisting purely or largely of carbohydrate 
material should be forbidden, and certain other foods should be 
reduced in amount. 

To be forbidden are: sugar, sweetmeats, pastry, sweet wines 
(especially sweet champagnes), grucls, dishes made of flour or 
flour preparations (such ns macaroni and flour puddings), rice, 
preserves, and sweet jellies. 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR, 476 


To be permitted in reduced amounts: beer—not mor than 
one or two glasses daily—é. ¢., from one-third to one-balf a 
anol wines, which are, however, better replaced by the 
lighter ones. 

‘The patient is allowed to take his meals with the family, and 
may eat bread and potatoes according to his desire, and need 
not concern himself regarding the starch in the tables set 
before him. ‘The amount of sugar that appears in the urine on 
such a diet is trifling—usually but from 10 to 20 grams daily, 
It is better to disregard this amount than to cut off the carbo- 
hydrates completely. 

There is a Se loss of weight on this diet if the patient 
eats only a5 much as he desires, and if he is exercising. “ This 
Joss should not exceed 100 grams a week, as the patients feel 
better and are better protected from danger when their store of 
fat is above that desirable for a healthy individual. The older 
the patient and the longer the condition has existed, the more 
cautious should the physician be in this a 

‘Thin patients should be en to take more food, espe~ 
cially fats, Butter should be eaten freely on bread, and potatoes 
and fat meats, as bacon, should be taken daily. Eggs and 
cheese containing considerable amounts of fat may also be 
allowed. When this diet does not suffice, that suggested for 
mild cases of glycosuria in young persons and for the moderately 
severe forms should be prescribed. 

With the foregoing, if desired, morning coffee or tea may be 
taken, and one-half or three-quarters of a liter of light wine or 
one-third to one-half a liter of beer may be allowed. In addi- 
tion, a carbonated water may be permitted, preferably Apol- 
linaris or a weak alkaline water, One-half to one liter of this 
may be taken daily. 

All elderly patients, unless there are contraindications, such 
as organic diseases, should take sufficient exercise. ‘Those who 
can afford it may go for a few weeks each year to a snitable 
spring to take the water, 

In Young Persons.—These are usually associated with or due 
toanervous condition, The diet must be arranged carefully, and 
great care must be taken to limit the carbohydrates as much as 
possible. The younger the patient, the more marked are the evi- 
dences of excesses in carbohydrates, The tolerance should be esti- 
mated from time to time, as previously mentioned, and starch 
and sugar allowed in as large amounts as possible, but never in 
sufficient quantities to canse glycosuria or only that of the 


476 DIET IN DISEASE. 


most trifling character. Cane-sugar may be withdrawn alto- 
, and when this is done, a greater amount of starch 
read and potatoes) may be allowed. Sweet fruits are best 
avoided. Saccharin or saxin may be used for sweetening such 
foods as the patient can not accustom himself to do without. 

Milk is usually of especial value in these cases, . The standard 
diet may be increased by the addition of a liter of milk a day, 
and the amount of bread that can be added with safety may 
then be ascertained. 

When the patient takes his meals at a restaurant, von 
Noorden advises, for the sake of simplicity, that all articles 
containing carbohydrates be cut off with the exception of bread 
and potatoes. The list of forbidden articles includes sugar, 
er preserves, jellies, thick soups, macaroni, rice, and the 
ike. Fresh vegetables and fresh fruits may be allowed in 
moderation. 

This diet differs but slightly from that used in the mild 
in elderly individuals, except that the tolerance for carbohy- 
drates should be ascertained. The patient should be to 
estimate the amounts, at first by weighing the quantities allowed 
once or twice, after which he can generally judge the correct 
amount by the eye. When the patients find the diet unsatis~ 
fying and have a keen desire for sweets of various kinds, they 
may be allowed to substitute one of the conditionally allowable 
foods (see the table) for a portion of the bread or potatoes. A 
little watehfulness on the part of some one besides the patient 
ig generally required lest too much be taken. 

Von Noorden has this class of patients take one-half a liter 
(one pint) of milk on rising and on going to bed. It should 
be “ae slowly, about twenty minutes being consumed in tak- 
ing the total amount. Some patients prefer kumiss, kefir, or 
sour milk, and there is no objection to their use. The same 
observer also makes an “iron rule” regarding the taking of fat, 
from 80 to 100 grams being insisted upon as the minimum to 
be taken in twenty-four hours. A portion of the fat may be 
replaced by 30 grams G ounce) of alcohol in the form of any 
of the allowable alcoholic beverages. 

Von Noorden recommends the following quantities of fat- 
containing foods each day: 60 gm. butter, to be taken with 
bread, bread and cheese, and potatoes—480 calories. 10 gm. 
olive oil (with salad, cucumbers, etc.)—90 calories ; 30 gm, 
fatty cheese—150 calories; 1 liter milk—390 calories ; 30 gm. 
alechol—210 calories. This gives a total of 1600 calories, and 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 477 


this, with the previously mentioned carboh; and the 
remainder of his food (meat, etc.), will bring his food value to 
2500 calories or more, unless the appetite is particularly poor, 

‘This class of patients is usually the moet difficult to control, 
for they are generally not very ill and are often fond of good 
living ; extraordinary patience, tact, and firmness are required 
in dealing with them, Pleasant mental diversion and physical 
employment should be furnished. Excesses of all kinds, in- 
cluding overindulgence in alcohol, tobacco, coffee, and tea, are 
carefully to be avoided. 

Von Noorden recommends that patients of this class be sent 
to a mountain resort at an altitude of from 2500 to 5000 feet, 
and that while there a “milk cure” be tried for several weeks. 
About three liters (three quarts) of milk may be given daily, 
40 gm. of alcohol in the form of brandy or whisky being 
added to the milk or taken after it, All carbohydrates except 
well-buttered vegetables should be avoided, including bread 
and potatoes, Meat, fish, and eggs are allowable. 

In these mild cases of glycosuria sugar is absent from the 
urine or appears only in amounts up to 20 gm. daily. Even 
when this amount is exceeded for the first few days the “cure” 
should be persisted in, fora reduction generally follows after a 
few days. When it does not, kefir, which contains from one~ 
third to one-half less milk-sugar than ordinary milk, may be 
substituted for the latter. 

Moderately Severe Forms of Glycosuria.—These 
are the cases in which glycosuria occurs unless all, or nearly 
all, the carbohydrates are withdrawn, The tolerance varies 
from time to time and in different cases, Usually a decrease 
in the tolerance for carbohydrates occurs. This is especially 
common in children and in young persons, in whom the ae 
is uniformly and usually rapidly fatal. The severe forms are 
not common in old persons. 

Von Noorden recommends that these patients be subjected to 
a three weeks’ course of complete abstinence from peri beter 
at least twice, and if possible three times, in « year, while in the 
intervals a. limited amount of carbohydrates may be allowed. 

There is no food that man can eat that is completely free 
from carbohydrates. Meat, and the lightest eins of 
vegetables contain minute quantities, so that the most carefully 
ordered diet will allow from 15 to 20 grams to be taken daily, 
‘These periods of abstinence permit an estimation of the carbo- 
hydrate tolerance to be made; they strengthen the patient’s 





478 DIET IN DISEASE. 


moral tone, and remind him of the necessity of observing care 
in his diet ; and, above all, they recuperate the glycogen-burning 
faculties of the body, enabling it to cope more successfully with 
the amount of carbohydrate ingested after the period of absti- 
nence is over. 

Five meals a day must be given, or the patient will not get 
sufficient food. The following menu will serve as a guide, but 
must be varied as much as possible every day.' The aim is to 
provide nourishment to the value of 2500 calories with the least 
possible amount of carbohydrates. 


Protein, Fat, Alcohol, Calories 
Gm -Vatue. 














Om, Om, 
H.R? 
ieee: } aor 
‘ &5 
% 1) bom 
° Cone } 
e yolk of Legg and 
Lspoonfulof ol. . 8 IB 2. 
Raw cucumber, with 5 
42.80 c’dock— fal of ofl, lt. and 
pr . a ee 
he 20) 
ie a ae: 
Halt-bottle of Moselle 4 25 
cup of coffee with 1 
tablespoonful of 
oO . 5 . 
1 cup of tea ca tes 
5 o'clock—ten: {i ele ae 6 apm 
1 Gup of bouillon'with “"  *” 
16gm.marrow... .. 14 a 
is 1 
. 16 
7.90 o'clock — 
6 8. eee eda 
wh 7 ae 
. 15 
10 o'clock: Per teaese ehh ana oe mn 
relock — as 
alghteap": 4 cee rah pew 


Diet during the Period of Abstinence—This course is best 
earried out in a hospital or private sanitariam, at least at first, 
' From vou Noorden, Twentieth Century Practice of Medicine, 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 479 


The I eller should be followed so far as is possible, 
but his diet must be carefully regulated for him. A 

diet can Lol at ae only by one seme paiecs a cee 
position, ani ir tion. For this reason speci 

is necessary, and ea heater recommends that rosa ii 
himself try living on the diet restricted in carbohydrates for a 
fow days. During this time he will learn much that can with 
benefit be applied to his patients. 

During the period of abstinence from carbohydrates the 
patient ld rest as much as possible both mentally and phys- 
ically. A walk of from half an hour to an hour and a half 
may be allowed, and, in addition, the patient should be in the 
fresh air as much as possible. 

Diet in the Intervals.—When the period of abstinence is 
over, bread may be allowed and the tolerance for carbohydrates 
determined. If it is increased—and this is not generally the 
case—the patient may be allowed more carbohydrates than pre- 
viously. The average patient may be given 120 gm. (4 ounces) 
of bread daily, and occasionally larger amounts are permissible, 

Fat must be insisted upon, the various forms may be 
given from day to day, preferably as cream, butter, yolk of 
egg, bacon, olive oil, marrow, and fat-containing cheese. The 
following daily amounts will serve as a guide : 100 grams (3 
ounces) of butter ; 20 grams of olive oil ; 20 grams of baoon ; 
5 hen’s 

Aleohol, on account of its food-value and because it enables 
the patient to take the necessary amount of fat, may be allowed 
daily. Forty grams may be permitted as an average daily 
amount. 

The four tables arranged by von Noorden contain: (1) the 
foods that may be allowed unconditionally, since they contain 
little or no carbohydrates ; (2) the foods permissible in small 
quantities, all containing carbohydrates, but useful for varying 
the diet ; (3) the foods allowed conditionally on account of the 
large amounts of carbohydrates contained—when these are 
used, the amount of bread must be reduced ; (4) a list of the 
foods of especial value. 

Where necessary, the foods should be weighed by the cook 
or by’some one interested in the patient, and not by the invalid 
himself. ‘This can, as a rule, be easily done without disturbing 
the routine of the kitchen. 

If the patient desires it, a liter of milk may replace 50 
grams of ‘bread. In cases where grave complications exist, 


480 DIET IN DISEASE. 


the milk cure, as previously suggested, may be tried for several 
weeks. In all cases the patient should have an abundance of 
rest and a prolonged vacation cach year, or several times a year 
if possible; during which time he should be relieved of all 
unnecessary care and worry. 

Severe Forms of Glycosuria.—These are the cases in 
which glycosuria oceurs even when all carbohydrates are ex- 
eluded the diet. These severe forms are usually seen in 
patients under forty years of age, and run a rapid course, ter- 
minating fatally in a few months, or, in some cases, not for several 
years. Cureful dieting may prolong life and prevent the onset 
of complications. In these cases the carbohydrates are of no 
value as food, but they may be allowed now and then to satisfy 
the patient’s craving for them. In order to check the glyco- 
suria not only the carbohydrates must. be discontinued, but the 
amount of protein also must be reduced. 

Von Noorden suggests that in these cases, at least three times 
in a year, and if possible quarterly, the patient be subjected to 
a rigid course of dietary treatment. ‘This is best carried out in 
a hospital. The periods should cover a month, and during that 
time the patient’s diet must be made up from the articles men- 
tioned in Tables I. and IV., pages 491 and 494. In some 
cases, but only when necessary, one or two dishes from Table 
IL. (p. 492) may be allowed. The patient should do neither 
mental nor physical work, and should spend most of his time 
in the open air, taking short walks or drives for exercise, In 
the intervals restricted amounts of carbohydrates are to be 
allowed. Yon Noorden permits any article in Table I. (p. 494), 
always in large amounts, three or four articles in the quantities 
given in Table IT, the equivalent of from 80 to 120 grams, 
the less the better, of white bread from Table IIT. Milk 
may be allowed in the same quantities as in the eases of mod- 
erate severity. Large amounts of fat, as previously stated, 
should be insisted upon, and as much as 80 grams of aleohol, 
taken at meal-times in the form of wine, and in addition several 
drinks of brandy or whisky and water daily may be allowed. 

A course of alkaline sulphur water may be taken twice a 
year after the restricted diet, or, if there is pronounced exhaus- 
tion, alkaline muriatic waters may be prescribed, 

Diet Cures in Diabetes.—A number of so-called diet cures 
have been recently brought forward. It should be borne in 
mind that these are methods of treatment which are useful in 
certain conditions, but that they are, of course, not “cures” 


— 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR, 431 


in the accepted sense of the word. The followiug are the most 
important : 

Oatmeal Cure.—Yon Noorden first pointed out certain 
patients suffering with diabetes who, notwithstanding the fact 
of being on a strict diet, continued to eliminate ie 
could at times be quiekly and ently relieved of 
dition by being placed upon a diet of large aneatithes a Gael 
He also pointed out that in many severe forms of diabetes, oat~ 
meal is twice as well borne as an equivalent quauntity of 
bread, and frequently by gradually i sapere the Lee of 
oatmeal, the glycosuria did not inerease, while acetone and 
otic acid disappeared. The beneficial results were, fees 
only obtained when the oatmeal represented the largest propor- 
tion of food consumed, when no other carbohydrates were taken 
and no meat eaten. Von Noorden advises that the oatmeal 
enre should be undertaken for eight to fourteen days only, 
inasmuch as the patient will become satiated with this article of 
food after this length of time. In some instances, after a 
return to the usual diet, the tolerance for carbohydrates increases, 
while in others it does not, and glycosuria rapidly returns, and 
frequently diacetic acid, too, 
ata a more recent publication von Noorden reports the 
results of his observations in 100 cases of diabetes treated by 
means of the oatmeal diet. The resulta are classified into five 
classes : 

1. Those cases in which it was impossible to luce agly- 
cosuria, notwithstanding a strict diet. In phd re Te- 
markable results were frequently obtained by means of the 
oatmeal cure, which could not have been obtained in any other 
way. It was often possible in these cases to allow a certain 
Si ithoat prot of carbohydrates in addition to the usual diabetic 

jet without lucing glycosuria. 

. In Haale class of cases good results were obtained from 
fa oatmeal cure, the results were not permanent, although by 
means of this form of treatment the onset of diabetic coma was 


prevented. 

8. In another class the tolerance for carbohydrates did not 
increase after inaugurating the oatmeal cure, but aceton dimin- 
ished and remained at a minimum, even after a return to the 
usual diet. 

4. In not an inconsiderable proportion of cases the glycosuria 
increased rather than diminished on the oatmeal diet. 

5. In mild forms of diabetes without diacoturia the oatmeal 
diet, was badly borne. 

a 


7 


482 DIET IN DISEASE. 
oorpecaes Cure in sol bhstoremser per patra peo < 
‘ibed—von Noorden prefers Knorr’s 


non Haferflocken, but any eatmeal or rolled pers 
may be a Butter and simple albumins may be added, but 
no other carbohydrates and no meats. The oatmeal is cooked 
well for a long time with salt and water, and while cooking ee 
ter and a vegetable albumin are added, or the white of an 

beaten and strained, ma‘ be mixed with it as the oatmeal 
Roborat, a vegetable albumin made from rice by the Bremer 
Brodfabrik, is recommended as being’ especially le mixed 
with the oatmeal. <The quantities to be tren datly are aa follows: 


Oatmeal. - » 250 grams (74 ounces). 
Albumin -100 & 3 
Butter ....- 300 ‘9 ounces: 





The meals are given at two-hour intervals, Cognae, light 
wine, and strong black coffee are allowed. Every week or ten 
days a “vegetable day” is interposed, and occasionally a small 
amount of meat or fish is allowed, to relieve the monotony of 
the diet and render it bearable, On such a diet there is a dim- 
inution in the excretion of sugar, of acetone bodies, and of 
ammonia as well. The return to the ordinary diet must be 
made cautiously lest the acetone bodies increase at an alarming 
rate. 

In dinhetic coma von Noorden recommends the oatmeal cure 
as preferable to the milk cure, inasmuch as it usually diminishes 
the aceton bodies more quickly, He believes the beneficial 
effect of the oatmeal is due to the substances contained therein, 
especially the salts ; by analysis of the feces he showed that the 
lessened excretion of sugar in the urine was not due to a les- 
sened absorption of the oatmeal in the intestines. 

Mild cases do not bear the treatment well, Our own experi- 
ence with the catmeal diets in diabetes has been quite satisfactory.? 

Milk Cure—Numerous observers have noted that a strict 
milk diet will either diminish or even cause glycosuria to dis 
appear entirely in from twenty-four to forty-eight hours in most 
eases of this disease, A certain number of patients are entirely 
Sti by means of a milk cure and remain s0 for some time 

after again being placed upon a diet containing a considerable 

amount of carbohydrate material, In some forms of severe 

diabetes a half litre of milk is well borne without increasing the 

glycosuria. Individuals differ in the way in which thoy react 

Meee and Rubrib, American Journal of the Medical Sciences, Oc 
r, 1905, 


DISEASES IN WHICH DIRT IS A PRIMARY PACTOR. 483 


to milk-sagar, and a study must he made of each 
Naunyn has pointed out that the unfavorable effects of can 
only be detected after a lengthy and continuous use of this food. 
Milk should not be given in the mild forms of diabetes in which 
pe appears after it has been given. Won Noorden 

jonishes against the use of a etrict milk cure in all cases of 
diabetes, even when the glycosuria does not appear after taking 
as much as 4 litres of milk daily, as it may cause an intense 
anorexia which may be difficult to overcome. He advises that 
in those cases of diabetes in which glycosuria is absent on a 
milk diet to vary the diet with kefir, buttermilk, kumiss, and 
cream. Hutchinson’s sugar-free milk may also be used, 
Recipes.) We have rarely found it advisable to place any of 
our patients on an exclusive milk diet, except in those severe 
cases of diabetes in which diabetic acid is present in the urine 
and in which the patient is threatened with the onset of diabetic 
coma, or in which this condition has already set in. On the 
other hand, we have used from one-half to one litre in many 
cases in addition to other allowable foods, often with excellent 
results. The urine must be examined at regular intervals 
whenever milk is being given in such cases. 

Potato Cure.—Moasé first advised the potato cure as a means 
of treating patients suffering with diabetes. His plan is to 
replace all carbohydrates by potatoes for a period of several 
weeks. Patients are to receive 1500 grams of potatoes, replacing 
500 grams of wheat bread, inasmuch as, according to his 
iments, patients could tolerate from two and one-half to 
times as much of potatoes (weighed raw) as they could of 
wheat bread. Potatoes are relatively poor in carbohydrates, 
containing from 16 to 22 per cent. of starch, whilst wheat 
bread contains about 60 per cent. During the time of the 
potato treatment no other carbohydrates are to be consumed. 
Mossé found a marked diminution in the glycosuria and poly- 
uria while the patient was taking the potato starch, as well aa 
adiminution in thirst and an inerease in strength. He also 
observed that a certain degree of tolerance for wheat bread was 
produced after the patient bad been on the potato cure for 
several days, He attributes the beneficial effect of this diet to 
the large proportion of water and potassium salts contained in 
the potato. The large quantity of fluid diminishes the thirst, 
while the potassium salt appears to improve the general nutri- 
tion. In 23 diabetic patients to whom diets of bread and 
potato were alternately given, an advantage in favor of the 
bread was found in only 1 ease. 





484 DIET IN DISEASE. 


Offer has confirmed the observation of Mossé, and von 
Noorden, too, extols this plan of treatment, and recommends 
that the potato need not only be given as the only carbobydrate 
food in dis but also that it may be utilized to replace a 
eertain portion of the bread; for instance, in a diet in which 
75 to 125 grams of wheat bread are allowable, an amount of 
potato represented by one-third of this quantity can be substi- 
tuted for it; so that in this instance 75 to 125 grams of potato 
can be consumed daily, leaving as much as 50 to 85 grams of 
bread still to be eaten, In this way the variety of carbohydrate 
food is increased, and at the same time large quantities of fat 
can be consumed in the form of butter, which may be added to 
the potatoes. ‘The potato has an additional advantage, in that 
it lends variety in furnishing carbohydrate food, inasmuch as it 
can be prepared in various ways—baked, boiled, fried, mashed, 
ete. 

Tn our own observations with the use of the potato cure in 
the treatment of diabetes, we have followed the methods sug- 
gested by von Noorden, replacing « portion of the bread by this 
form of food. 

Yolk Cure.—Stern ' recommends the ingestion of from 10 to 
40 yolks of eggs a day, together with a small amount of protein 
and some green vegetables, in cases of diabetes in which there 
is acetonuria. He has obtained very satisfactory results, and 
states that this method of feeding is usually well borne. 

Rye Bread in Diabetes.—Lidwell recommends the use of 
rye bread, particularly in mild diabetes in middle-aged or old 
persons. He found that it checked the craving for carbohydrate 
food, and that it was not taken in as large quantities as other 
breads. Because of this and the fact that it contains less 
digestible starch, it was found to diminish the glycosuria. It 
has an additional advantage that it is cheap and can be used in 
practice among the poor. ‘The urine must be watched in all 
cases where rye bread is being used, as no rules ean be formu- 
lated as to how any food will affect any given patient. 

Mineral Waters.—In diabetes, especially in the milder 
forms, a visit to one of the watering-places where alkaline 
or alkaline sulphur waters are to be had is often of t 
benefit, Those most highly recommended are Carlsbad, 
Neuenahr, and Vichy, although many patients prefer Marien- 
bad. There is a great difference of opinion regarding the value 
of certain springs in diabetes, Physicians who live at the vari- 
ous springs are apt to extol the merits of their especial waters. 

1 American Medicine, December 3, 1904. 


7 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR, 485 


Frerichs noted that marked benefit followed often a visit to 
Carlsbad or to one of the other spas, but that sugar would tsu- 
ally peer in the urine after several months’ time. He also 
noted fact that the improvement following the first visit 
was ter than after subsequent visits, Min! iy Bee, 
and Naunyn recommend Carlsbad most highly. lya 
greater amount of benefit on a less rigid diet may be obtained 
at a spa than at home, even when the same water is taken. 
‘This may be due in large measure to the regularity of the life 
led at the resort, 

Mineral waters taken at home are of comparatively little 
value, and some authorities have seen no benefit follow their 
employment, whereas others recommend that those who are 
unable to visit Carlsbad or any of the other watering-places 
= a bottle of warmed Carlsbad water every twenty-four 

urs. 

‘The mild and the moderately severe cases are the only ones 
that receive any benefit from the use of mineral waters, The 
severe cases derive no benefit from the treatment, and a | 
journey may do positive harm to a patient in the advan 

of the disease. 

Diabetic Coma.—tIn the period of actual coma the diet is 
a minor consideration. In cases of threatened coma the treat- 
ment should be energetic, and if the patient is taken in hand 
when the first drowsy or numb feeling occurs, much ean often 
be done. The patient should be put to bed and kept absolutely 
quiet. Milk may be given to drink, and von Noorden recom- 
mends also solutions of levulose—50 grams (1% ounces) daily, 
Alcohol should be given in large quantities—a glass of cham~ 
pagne or of strong wine every hour—for the purpose of fur- 
nishing an easily utilizable food to the tissues and for maintain- 
ing the heart action. Sodium bicarbonate in large doses—30 
grams (1 ounce) at a time—has been recommended. If the 
urine is not passed very freely, salt solution should be admin- 
istered snbentaneously, and von Noorden adds from 8 to 10 
per cent. of levulose or grape-sugar to the solution, with the 
hope of establishing prompt. aoa diuresis. ‘The aliment 
tract should be emptied. Should the patient recover, he shou! 
be kept at rest for a considerable period. If, previous to the 
onset of coma, he was receiving a diet free or nearly free from 
carbohydrates, he should be allowed a mixed diet, containing 
carbohydrates, proteins, and fat. Care must, however, be taken 
that this dict be not too freely given. 





7" 


486 DIET IN DISEASE. 


little good is accomplished by restricting the diet. The carbo- 

hydrate food may be cut down in a general sort of a way, but 

rigid dietetic rules are unnecessary. In the moderately severe 

the disease an attempt may be made to restrict the 

Biab ai its Gill geeceallyba found eo be mera ve lesa iaalenns 

when this is the case, the patient may be allowed a more liberal 
the 


mild forms of the disease the diet may be along the 
lines as have been recommended for adults, great care 
being observed that the child should not be given more food 
than it can easily dispose of. It is extremely diftenlt to keep 
a child on a strict diabetic diet. As von Noorden has said, the 
strict dieting of children in carly cases has been tried so rarely 
that the results can not be accurately estimated. Children are 
not suitable subjects for cures at watering-places, 

Diabetes in Young Adults.—These are diffionlt cases 
to manage, and are usually unsatisfactory ones. The diet must, 
be carefully selected, and while the carbohydrates should always 
be kept below the limit of tolerance, there should be frequent 

riods of strict dieting. These last are best carried out in an 
institution, and the patient should be instructed carefully as to 
the life that he is to lead. Alcoholic drinks should be used 
with caution, and smoking allowed only in great moderation if 


Young diabetics should not be sent to watering-places, for 
they derive but little benefit from the visit, and are inclined 
to acquire a false impression as to the necessity for constant 
care of themselves; or in the belief that a yearly visit to the 
spring is all that is needed, they may grow careless in the 
intervals. 

Diabetes and Disease of the Kidneys.—A not in- 
frequent complication of diabetes is the contracted kidney. 
When this complicates a case of diabetes, the difficulty of 
feeding the patient is greatly increased. Von Noorden recom- 
mends that the protein be ent down to abont 100 grams (3 
ounces) a day, this amount being made up from the yarious 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 487 


kinds of meat, milk, mild cheese, eggs, and the The 

amount contained in fresh vegetables is di ‘The arti- 

Nephi es betng rar St te Oe 
itis as being irritating to i ahi be a 

Fresh vegetables, fruits, and the unirritating fats should be 

used as freely as possible. 

Milk should not be given too freely on account of the bulk of 
the fluid. The heart should be shielded against overwork, as 
in these cases a failing heart is ibly the greatest danger. 
‘The amount of fluid taken should be reduced to 1} or 1} liters 
daily. In these cases von Noorden recommends particularly 
the use of cream in as large amounts as possible. From time 
to time—say every half year—a period of water-drinking cover- 
ing threo or four weeks may be allowed. For this purpose the 
alkaline mineral waters are preferable. During this period a 
change of climate or of the place of residence may benefit the 
patient. 

In diabetics with marked symptoms of nephritis the diet 
should be such a is indicated to meet the kidney disorder, for 
the danger from nephritis and its consequences is, as a rule, 

ter than that from the diabetes. The selection of a suitable 
ict for these patients is often a difficult task. 

Diabetes and Obesity.—Diabetes and obesity are in 
many cases intimately related. In the majority of instances 
the glycosuria is mild or only moderately severe, and may gen- 
erally be controlled easily by the diet and management i- 
ously suggested for these cases, It must be borne in mind that 
the diet and life are to be so regulated as to prevent any further 
increase in weight; reduction cures, however, must not be 
undertaken unless the patient’s health is interfered with, and 
never for the sake of appearance. Diabetics bear reduction 
cures poorly, and weakness of the heart, sleeplessness, and often 
albuminuria may follow their employment. Von Noorden 
recommends an increase in physical work, rather than a starva- 
tion diet, when it becomes necessary to reduce a patient. The 
same observer also calls particular attention to the fact that 
both physicians and patients are apt to disregard the presence 
of amounts of sagas in the urine when the patient is 
obese. This he regards as a serious error, for the small amount 
is easily controlled by proper diet, and the degenerative 
esses that may be fextored by long-continued saturation of the 
tissues with eugar may thus be avoided. Moreover, if this is 
not done, the patient is apt to develop arteriosclerosis, furuncu- 





| 


488 DIET IN DISEASE. 


losis, cataract, contracted kidney, 2 tendeney to brain hemor- 
rhage, and even gangrene. 

Diabetes and Gout.—When this combination of dis 
eases occurs, both affections are usually of the milder forme, 
Lahgeont 4 the gout. The dict may easily be regulated by 
cutting off all sweets, reducing the proteins to a moderate 
amount, and allowing green vegetables, fruit, and fat. There 
is wide diversity of opinion regarding the use of alcohol. In 
diabetes without gout it may be allowed ; when gout does exist, 
it is better to withdraw alcohol, except in the case of habitués, 
when the sudden withdrawal may be followed by extreme 
weakness of the heart. 

Diabetes and Digestive Disorders.—Constipation 
should be avoided by the free nse of vegetables in the diet, 
and where the tendency to costivencss is not too great it can 
usually be overcome in this manner. Salines and similar 
cathartics should not, as a rule, be used, Won Noorden recom- 
mends the following prescription : 


RB Poly, thei mdicis. .. 2. + «+ = » giv (16.0). 
Sodii bicarbonat., 
Saif, forum... ee Ai 3ij (7.5). 


S1¢.—Onefifth to one teaspoonful given in the evening. 


Catarrh of the stomach and similar digestive disturbances 
are among the difficult conditions that the physician has to 
encounter in the management of diabetics, In the effort to 
overcome the stomach or bowel disturbance the special diet of 
the diabetic must often be neglected for a time. The diet may 
be difficult to arrange, and in these cases as near a middle 
ground as possible must be arranged. The return to the re- 
stricted diet must always be made cautiously and gradually. A 
visit to Carlsbad or to a similar watering-place may often be of 
the greatest benefit to these patients. 

Diarrhea is not, as a rule, more troublesome in the diabetic 
than in the ordinary individual, but if it displays a tendeney to 
become chronic, pains should be taken to cure the condition, for 
it will not only weaken the patient, but may also tend to bring 
‘on a comatose state. Von Noorden recommends that patients 
with a tendency to diarrhea take small doses of calcium car- 
bonate two or three times a day. Alcohol should be used 

ingly or not at all, Tea and red wine are the most suitable 
drinks for this class of patients. If these simple measures do not 
check the diarrhea, the patient should be put to bed and moist 


DISEASES IN WHICH DIRT IS A PRIMARY FACTOR, 489 


warm applications made totheabdomen. The diet should consist 
of barley gruel and the like, with tea or red wine asa 
9p Satan tha diet ta eouconctd, tho clabates taki 
until the diarrhea has been cured. Opium may also be preseribed. 
The return to the diabetic diet sl be made gradually. 

na oligo ix te es (eee acseeee ae 

iven being in the stools practically wu 

| Segece For usually disease of the pancreas or of its 
duct. This may, however, occur in severe di: when the 
pancreas is not involved. These patients lose weight itd 
rapidly. The diet in these cases must be made up of as om 
protein as the patient can take, and the amount of aleohol 
prescribed must also be increased. Meats of various kinds, 
cheese, eggs, somatose, nutrose, tropon, and similar preparations 
may be tried, and green vegetables of every variety allowed in 
as large a quantity as the patient desires. 


SUBSTITUTES FOR SUGAR. 

Various substances are used in place of sugar to sweeten the 
food and drink of the diabetic. Many of these are sold under 
trade names, as “ Crystallose” and “ Diabetin.” Preparations 
of inulin, of inosite, of mannite, and of fruit-wugar have also 
been suggested as being less injurious than cane-sugar, , 

Glycerin is sometimes used, but has many opponents, among 
them being Senator and Frerichs. It leaves a sweet taste in 
the mouth and may have a decidedly laxative effect. 

Saccharin (benzoyl-sulphonic-imid) is used largely; it has an 
exceedingly sweet taste, and may be procured in tablets that are 
equal in sweetening power to an ordinary lump of sugar. If 
taken in quantities not exceeding five ao a day, it is harm~ 
bre The following is a much-quoted formula given by James 

itewart : 






ae 
2x 
Mannite os 


Make 100 pasion’ One will avecten a up of ealfee. 
Garantose (sodium benzoyl-sulphonic-imid—Heyden) is a 


much more soluble preparation than saccharin. 

Dulein (paraphenatolcarbamid—Heyden) is in common use 
in Germany for sweetening the food and drink of diabetics, and 
is recommended by many of the highest authorities. In the 
small quantities in which it is prescribed it is harmless, but in 
the large quantities that have been given experimentally it gives 


Sodium bicarbonate 
Saccharin « 


490 DIET IN DISEASE. 


rise to such symptoms as icterus, etc. More than half a gram 
(8 grains) should not be given in any one day. It may be 
aes in tablets containing 0.025 gram each. Each of these 

the sweetening power of an ordinary lump of sugar. Some 
patients prefer the taste of dulcin to that of in, and 
vice versa, 

Sazin is a coal-tar product used to sweeten the food of the 
diabetic, and is said to be six hundred times sweeter than 
sugar; many patients prefer its taste to that of the other 
preparation. It may be obtained in tablet form. 

free marmalades, jellies, and jam are manufactured by 
Callard and Co. They also prepare preserved fruits for diabetics. 
‘These fruits are said to contain less than 2 per cent. of sugar. 


SUBSTITUTES FOR BREAD.' 


“ Torrified” Bread.—Thin slices of bread are toasted until 
yery dark brown or almost black. It is supposed that the 
starch and gluten are partially decomposed by the heat. This 
will almost peas not be eaten to excess by the patient, and 
Williamson states that this is probably its only advantage. 

Gluten bread, introduced over fifty years ago by Bouchardat, 
has always been popular in France. This bread is made from 
gluten flour from which the starch has been washed out, The 
gluten flours on the market differ very much in the amount of 
starch which they contain, a fact that can be illustrated by test- 
ing with an iodin solution, 

Directions for making gluten bread accompany the packages 
of flour. 

Bran bread, made from bran flour, is also to be recommended. 
‘The bran must be ground quite fine, or it will not be digested. 

Bera tases oe bread are! seve, drum, the, Rivas eatag 
Japanese product. Soya bread was suggested for diabetics by 
Dujardin-Beanmetz in 1890, Attfield gives the following com- 
position of Soya flour : 





Dujardin-Beaumetz gives the following as the composition 
of Soya bread ; 
* Recipes for these will be found in the Appendix, 








DISEASES IN WHICH DIET IS A PRIMARY FACTOR, 491 









Waters sc ete ee ew eee ees 

Protein 20.168 
Faw... - 9.350 
a 2.794 
Phosphoric on ee ee 0,668 


Almond cakes and cocoanut oakes are of considerable value 


as bread substitutes. Kénig gives the following analysis of 
sweet almonds : 





Alewronat is a vegetable albumin flour made ple vans He 
hausen from wheat. It is a Hae rellowie ero 
tains from 80 to 90 per cent. of albumin and mi fe a 
of carbohydrate. It was recommended in diabetes by 
who suggests that it be mixed with wheat flour. Hie formula 
contains considerable starch,—i. ¢., about one-half the amount of 
ordinary bread ; and most patients lies fer to Uae half yebell Sener 
tity of wheat bread to a double al aleuronat bread. 

Buns and cakes may also be Sane aleuronat flour, 
and they are very palatable if made with the addition of cocoa 
nut powder, as suggested by Williamson, Recipes will be 
foand in the section devoted to that subject. 

Tnulin bisowits have been su; by Kiilz and others, 
Their expense is a great objection to their use. Inulin is 
obtained from the roots of clocampane. 

Peanut flour has also been used with success in making 
various dishes for the diabetic. 

A large number of diabetic flours, breads, biscuit, and other 
sugar and starch-free foods are prepared by Callard and Co. of 
London. 

The following four tables are taken from von Noorden’s 
article in The Twentieth Century Practice of Medicine: 


TABLE 1. 


First Group—Unconditionally Allowable Foods. 

Fresh meat; All the musoular pasts of tho ox, calf, ig, horse, deor, 
aiid bod Soncade baste roantsd Sebel wot ee coke heleasn earns 
= tease barwet enloal ‘Toagus, heart, ‘brain, ewoetbronds, Ida; 

om fate 
row net vith rape ie Sil “e 


ices. 
+ Dried or smoked meat, smoked or salted ham, 
scickad Vessel at oom licaieanentoet oiiseg aeeer beef. 


a 





492 DIET IN DISEASE, 
Preah, 


+ All Kinds of fresh fish, boiled or broiled, withoat 
ima om terra sl sri with tay in of no frnneos 
sauce, melted butter. 
bert Sed Bade cline: Solan tine cin nero 

a raul es 5 

Hoped fof; puch’ na surdines incl, aasbovies, tar sal 
Fish detieatives aviary, col-liver oll 

Shellfish: Oysters, mussels, and other bivalves, lobster, crawfish, crabs, 


shrimps, turtle. 


feut-catructs: Meat of all kinds, 
}; Raw or cooked in any way, but without any admixture of flour, 
of all kinds, Rey a roe 
+ Green letwa iv spinach, “arn onion, 
Cauliflower, red and white cabbage, sorrel, French beans 
The vegetables, as far as they are suited to this mode of best 


far prepa are 
iked with meat broth or a solution of Lichig's extract and salt, covered, 


Preserved : Tinned French beans, pickled bers in 
agen pickles Se eee 
2 





cream cheeses. 
All Kinds of natural or artificial carbonated waters, either clear 
or with Temon-juice and saccharin or glycerin, or with rum, cognac, whisky, 
arrack, cherry brandy, plum Lendy, Nordhiuser, rye whisky, ete, Light 
Moselle or Hhine wines, claret, or Burgundy in amounts prescribed by 

physician, Coffee, black or with cream, without sujar, but sweetened with 
mecharin if desired, Tea, clear or with cream or ram, 


TABLE 1. 
Second Group.—Foods Permissible in Moslerate Quantities, 


These contain carbohydrates, but in so little amounts that they need not be 
considered, and demand no compensation by n reduction in the allowance of 
bread. Some of the articles contain a rather large percentage of carbohydrates, 
but the absolute quantity in which they are consumed is «mall, 

The amounts here given have been fixed by pmetical experience, and it 
will seldom be found necessary to increase them. Of the dishes here gi 
when they are allowed at all, only a few—from two to four—are to be sel 
each day. Tris possible in this way to secure m great variety in the pati 


Internal parte of animale: Calves liver, giblete—vp to 100 


a 

+ Liver preferably the fatter kinds, liver saumge with 
truley Back pudding 00" grams, Neat sausage—80 grama a0 
be, iter sausage, and the like, brawn, head-checee, eansnge-meatballs 


00 grams, 
potted beef, ham, tongue, salmon, lobster, ane 





Patties: Pitéde-foie gras, 
chovies, ete.—onehalf to one tablespoonful. 
lish sances, such as Worcestershire, Harvey, beefsteak, anchovy, lobster, 
shrimp, India soy, China soy—one teaspoonful. 
Cream, from four to six inblespoonfula a day. 
Cocoa, prepared without sugar—25 grams, 








DISEASES IN WHICH DIBT IS A PRIMARY FACTOR. 493 


fe wre gona By Chan, gmt Gerri Bal, Fee Hallas, 


Vepetables (prepared withont four or 





Fresh fruits ; 
1 spoonful of raspberries or strawberries; 4 spoonful 
gages; 12 cherries; one-half of a medium-sized pear; 
of other freah fruits, 


TABLE fl 
Third Group—Conditionally Allowable Foods, 


‘The condition under which dishes from the following table are ited is 
that an equivnlent shall he deducted from the allowance of broad. 
‘iven below are the equivalents of 50 of white bread, containing: 
grams of starch. Advantage ia taken of the fact that large 
certain carbohydrates (car ir, milk-sugar, fraitwugar, ete.) mi 
than ef starch. Some of the discs given in the blooper aia 
here because, if they are eaten in lange quantities, an account must be 
of the carbohydmtes which they contain: 
1 liter of milk (sweet, sour, or buttermilk). 
14 liters of kumi, prepared in the Russian way. 
1 to J} liters of kelir, fermented for at least two days and prepared without 
the addition of sugar. 
es es od crs breed irabams Cooma, or Fit mickel. 
grams |. Graham or Hamburg . 
45 rama of Westphalian pamspernichel bee 
100 grams of aleuronat bread, p after Ebstein's formula (containing 
27.5 per cent. of carbohydrates and 32 per cent. of vegetable albumin; the 
alesronat breads are very variably compounded). 
35 grams of zwieback and simple coffee-cukes, made without sugar. 
30 grams of English cakes of various sorts. 
30 grams of “ichel-cacao” (Stollwerck's). 
50 grams of chocolate (Stollwerck’s).. 
40 grams of chocolate (French make). 
40 grams of chestnuts shelled or 60 grams unshelled. 
85 grams of canesugar, brown sugar, or rock-candy, 
85 grams of sweet preserves. 
40 grams of frnitsugar. 
40 grame of milk-sugar. 
50 grams of frultgem. 
grams of honey. 
40 grams of ri ea rye, barley, buckwheat, millet, or oatmeal or 
cornmeal, 
45 grams of bean, pea, of lentil flour. . 
35 grams of starch preparations, potato, whext, or rice, starch, tapioca, go, 
maizene, mondamin, etc. 
85 grams of tice. ? 
ab grme of farinaceous preparations—noodle, macaroni, oatmeal, grits, 


60 gracae 6 Tendils, pons, Beass (welghed diy)- 








AMA DIET IN DISEASE, 
100 gums of green peas, 
180 grams of new potatoes. 
140 grams of winter potatoes. 
vera cat re plums, damsons, mirabelles, apri- 
200 grams of straw! gooseberrii iIberries, currants, 
§ blackberries, whortle! bluel shar 
40 of 
cca 
A bandful of walnuts, hazelnuts, almonds, or Brazil nuts. 
see deer of any'sort. 
liter of sweet wine, 
TABLE IV. 


sinlacsigenceeemi igh perc of pane is bata 
nail choise, i dus in part to the ‘Ligh pervent in pats 
that of fat "The proportion of albumin ad fat fbr fr ach 100" grams 
‘of the foodaubstance, Some contain carbohydrates also, the percentage of 
hich given for the sake of completes hati mrive value fe not 
cot 






100 Grams, Protein. Fat. Ses. Calese: 
Vegetable oil... 100 930 
Butter 8 0.6 830 

6 748 

wT 2 538 

41 1 401 

0 «. 446 

3600. | 487 

3 62 422 

: | re) 400 

82 396 

0 Lo 381 

2 0.5 i 

mal ae mutton. 6 ee eee VW 9 337 
ane 6% 1 320 

Fuses watereel . . B .. $12 
pe mackerel « om oe 882, 
Cavinre 2... 6 6 .. 276 
Cream .,..-..--+ 3 4 230 
Fat salmon (fresh or em ced) | 3 210 
Hens’ eges (weighed with the shells)” 10 05 = 142 





Seegen’s Diet-list.—Allowed in any quantity: Meat of 
every kind, smoked meat, ham, tongue, fish of every kind, 
oysters, mussels, crabs, lobsters, saat ello; aspia, eggs, caviare, 
cream, butter, cheese, and bacon. Of vegetables : Spina 
lettuce, endives, rosenkohl, pickles, green asparagus, water- 
cress, sorrel, artichokes, mushrooms, nuts. 

Allowed in moderate quantity: Cauliflower, carrots, turnips, 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 495 


Re ee en 
currant 

“Forbidden. absolutely « All foods made from flour or meal— 
bread is allowed in moderate quantities according to the phy- 


sician’s orders ; sweet ee rice, tapioca, arrow-root, 
grits, laguaes, gro sweet fruits, spay 
apna a apricots, plums, and dried 

“Drinker AUowed in any + Water, soda-water, tea, 
and coffee. Of wines: Bo y das tas Moly Ate 
trian and Hw n table wines—in a word, all wines that are 
not sweet peri ety do not contain more than the average amount 
of aleohol, 

Allowed in moderate quantity : Milk, bitter beer, unsweetened 
almond milk, lemonade without su; 


Forbidden : Doac pera one epee ees cider, fruit-wine, sweet 
ene) liqueurs, fruit-juices, water-ices, sorbets, cocoa, and 
chocolate. 


Sir William Roberts’ list* is as follows: 


Sanctioned. Porbiidden, 
opine All socharin and farinaceous foods. 
6 e. Bread, toes, 
Touly Ce Rice, ‘uploon, ‘S2g0, arrow-root, mace 
Cheer. Lager i 
age ‘Turnips, carrots, parsnips, beans, and 
Broth, sates sd ollie ide ith Lites onctalin fas Wittneaae 
soups, and jellies made We 
out Thea oF sugar. sobstances), aa for the ‘ame rea 
Cabbage, endive, spinach, fon, Si 
Rrocooli, Brassels sprouts contain enormous li 
ae ‘spring onions. 
Water-cress, mustard-ind-cress, 
Celery. 
Substitutes for Broad. The “pudding” of crabs and lob- 
Brancake, gluien bread (ond meal), Ai sveet frais, 08 
rts, a8 apples, pears, plums, 
F almond meal fneal, ros, and biscuits centri, currant, grapes, or 
Bryrnacns, 
Dry sherry, bitter ale. Port and all sweet wines, 


Bray aad whisky (in small quan- Sweet ales and porter. 


Ram and sweetened gin, 
Ten, coffee (no sugar), chocolate 
(made with Cares meal), soda- 
water, potassium bitartrate water, 


1 From Yeo, Food in Health and Disease, p. 398, 








496 DIET IN DISEASE. 


Germain See allows": 


1. All kinds of animal flesh, boiled or reasted. Ham, bacon, 
spl ai ot Fal comics, 


3. Cf a indy tity, and sauces without flour, 
4 Permits 4 ounces of bread or potatoes daily. 


}OUL Suga, 
8, Recommends Vichy water before meals, especially in gouty cus 


Dujardin-Beaumetz? adopts with little modification the 
dietary of Bouchardat : 


“Strongly recommends the substitution of potatoes cooked in the oven for 
hava, wren glaten breed: alsa the usa bread. 

“Preseribes soups made with fatty substances = with Fee a eehin! 
Vegetable soups tale with cablage, onion, Julenne soup, but bytes 

ips and carrot, and soups made with f and leek, 
“ati all kinds of animal food, fish, moll and crustices, and cautions 
yainat the use of sxuces containing flour, 
ae ele pupae an actos ser French (ang lates eee 
ws ste as spinach, sorrel c al 
celery, ely dandelion, and all salads. on 
Shores beet-root, carrots, turnips, and allows only small quantities of onions 


hal all frat bat gooseberries. 
wh oe oe tea afte, wine ie with a natural alkaline water; li 
coffee, if required, sweetened with glycerin, but 
ee ard milk. 


2 ae eo the ty bitter infusions, a8 of quassia and cinchona. 

ae Nea bo re ide sardis in il, thon in oil, Viare, and 
Spal mm tn = aca eirhc eh 
Bouchardat’s list? is as follows: 


Forbidden. 

All kinds of meat Erearee of All substanoes tich in carbohydrates, 
fat daily), ns in any way, but Milk, 
without meal or sugar. 

All kinds of fich. 


Lobster, cribs, oysters, 
Fea. 


‘Cream, 
Cablnge, lettuce, spinach, artichokes, 
re ‘beans, ete, 
a 


Peas wherries, 
Substitute for bread: gluten bread. 


rate oad Heh ond Dnecas Be 7 Ibid, p. 399, 
bid. p. 399, 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 497 


Bevensom 

Claret or Bi for 1 

ctr a 

Cantani’s is a very exclusive diet-list : 

Sanctioned, Forbidden. 

‘Meats and animal fats of all kinds (at Liver, 

all meals). Butter, as it contains traces of lactose. 
Fish of all kinds Choose. 
Lobsters. Milk. 
‘Olive oil (instead of butter). All farinaceous and mceharin foods 

(in mi absolutely. 


gan not ly dispense with 

Breve, 
Pure water, (eng 
‘Soda-water, 


rom habitanted to the use a Yio 
strong wines and ae ma 
stein ratty a5 to Tee Sd coffe coffee (in severe cases). 


Red wine. 
Tea and test in small quantity in 

milder cases. 

Ebstein? maintains that every case should he individualized. 
‘The food he prescribes depends on the age and individuality of 
the patient. For thin persons he prescribes more fat than for 
corpulent ones. 


Ea Teepe Oe f tea (black) without milk and sugar. White 
7 eevee Sos ony oe haves bees wall Wesabe 
ter, 


‘The yolk ce egg, a little fat onic oars pee een 


broth wit 
Dinner.—Broth, ee or marrow (the marrow-bone is boiled for 
“ils oto aly te marron) Some peptone may be added 


Meat { “180 pana froe from bone), roasted, boiled, or stewed—beef, mut- 
tan, pork, veal, fowl, or venison (fat ment preferred). 

Graviex, with cream or yolk of egy, not flour, 

Or fish, with melted butter. 

‘Weawabl with much fat; (storys pace! Salads 

vine and oil, and some 

‘The thea should be salted and spiced. 

r dinner, n cup of coffee or tex. 


Supper.—One “ae broth, 
cat roasted, “a 


Bread 3 to 50 gras with butter, 20 to 30 grams, 
‘Apples, pears, and “stonefruit" are allowed in small quantities, 


* From Yeo, Food im Health and Dinas, p, 400, * Tid, p. 401 
22 





—— 


498 DIET IN DISEASE. 


BavERAors, 


He forbids absolutely the use of beer, limite the use of spirits, and allows 
about half a ee ie daily. 
If the patient digests milk Well, he allows it la moderate doses, expecially 


Diiring's Diet.'\—This dietary differs from most others, and 
is founded on the theory that the most important factors in the 
causation of diabetes are a faulty diet and a disturbed digestion. 
ton , therefore, insists only on a restricted diet and the selec- 


the most digestible foods. 
—] ith iia eee 
SNE amar a it no sugar (some lime-water 
eee tees fa gegen ts 
‘Or oatmeal, barley, or rice grucl, made with water, a little salt, but no 
batter (if can not 


borne). 
fast. —White bread, stale and well-baked. 


cases). 
For Danes (aoa anes telady Bone he barley, or catmeal. 
a x, 280 ara (ge Jad 2 a icy ‘as froo from fat as 
rms), no condiments, no fitty muces, 
Cane apples, plains, eherries 
Be ea on mH eae 8 oe 
Perihepion cauliflowe cabbaget 
Genes eee eee with fat or stock). be! 
Dessert of a litle raw fruit, apples cherries and one small glass of red 
Sone iluted with water, 
about 7 P. M,)-—Gruel of barley, oatmeal, or rice, with salt (but 
ter) and strained, Tn some cases may be made with mille. 
Tee or "joed water to relieve thirst between meals, 


Diiring lays great stress on the mode in which these vegetable 
foods are prepared ; he mentions especially that the peep 
for making gruel and the legumes are, before being cooked, to 
be steeped for some time, and boiled long enough to make them 
more easily digestible. The following list of dishes that the dia- 
betie patient may ext, even when on a strict régime, shows the 
considerable variety of foods that are accessible to him. Daring 
divides them into those to be taken for breakfast, for dinner 
(carly), and for supper : 


boiled, buttered, pouched, and served in purée of green vege 
conte abo “yetaig scorers dnaertape bt 


bee je jambon. 
Omelette, suvory, 

Ham of bucoa, old or grilled. 
Brown. 

Spiced beef. 


1 From Yeo, Food in Health and Disease, p. 402 








DISEASES IN WHICH DIRT IS A PRIMARY FACTOR. 499 


Sal nerds inten 


Finnan haddock, grilled and eaten with fresh batter. 
Sole, fried in butter, or grilled and eaten with fresh butter. 
Herring, fresh, fried or grilled, and eaten with butter or with mustard 
BOR, 


Mackerel, ki 
Salmon, smoked, 
CaP mane aa lla acy aa eee 


i creo, wth of without chain and 
ta and Apollioaris water, or hock or claret and seltear water. 
Son See — 


meran cheese, snes ee 5 ertine de Volaille, ou 
BM Bee ce ‘ng of starcb, or any sugar or sweet 


at Sr (uy cote inl ee, pill ae in i fit 


pis and svory muce, or 


cules or torn oy eee ee 
dressing may he served with any of the pa allem: 

Beet, es a ae veal, turkey, wild ve 

sweetbreada. pt Siena eke ins variety 

Kare, bbl, retin rk chops with purée weg sy 
Gx Meioon; pliseaans belle, SISi ealgeet eta eae 
other meats may be served cold with asp it api and a 
ber, oF made into ritwoles with parsley other vary 

Vegsabies, in purées with ment gravy or ern Lats 

sprouts, tarniy 

Win ples meted rear sa atta Rayer aii ee on 


tomatoes, stewed with meat gravy; and Seu 
custard 


or green-curmnt padding, 

Sapper —a vi the iments or. fai, e618 oe already mentioned, sith 
Teri mee sete amma 
eran ari Hanah Coenen eee 

turl Ling ; ca 
or Finan Baddock on gluten bred toast nt 
Much igenalty my'te teflly applied vo varying the mode of eoking 
and sreving these various articles 


les af food. i, oer ae sub 
stitutes for bread may be utilized in the preparation of many dishes, 


GOUT AND GOUTINESS. 

Sydenham said : ‘ Great eaters are linble to gout, and of these 
the costive more especially. Eating as they are used to eat 
when in full exercise, their digestion is naturally im 
Even in these cases simple gluttony and the free use 
although common incentives, by no means as frequent! we 
the way for gout as reckless, inordinate drinking.” ‘This state- 
per pbs gl Ri be Now trend said since, 

The causes of gout are to sidered then as duc to the 
following : 


500 DIET IN DISEASE. 


1. Alcoholism, of which Garrod wrote: “ With an absence 
‘of alcohol in any shape, coupled with an absence of hereditary 
predisposition derived from ulcohol-drinking ancestors, gout 
would prictically be unknown.” 

2. Overeating, which some observers have placed on a level 
with overdrinking ; the one usually, however, accompanies the 
other in those who suffer from “exposure to luxury.” Food 
unearned by arbvecel exertion is the food that usually causes 
the trouble, although gout occasionally occurs in athletes who 
take an abundance of exercise. The latter class of patients 

erally suffer for the sins of their ancestors, for gout follows 

old Mosaic law. 

3. Heredity.—Gout, a5 is well known, ix a family disease, 
and nts itself cither as true gout or in the form of an 
arthritic or rheumatic tendency. 

4. Indigestion is a ee factor in the causation of gout, 
It has been said that “Gout is generally acquired with the help 
of a sound stomach,” but the stomach rarely remains sound for 
any length of time. 

5. Constipation is a factor not to be overlooked. The gouty 
not only prove to be costive, but suffer from the effects of the 
constipation, a fact to be borne in mind in arranging diet-lists 
for the gouty. 

6. Workers in lead are especially prone to gout. Mental 
work, while it does not canse gout, may lead to it indirectly. 
As Ewart says: “It does not fulfil the letter of the law that we 
shall carn our own bread by the sweat of our brow.” 

A discussion of the many theories advanced as to the causa- 
tion of gout is beyond the province of this book, and would 
lead us out of the field of dietetics. For these reasons the 
reader is referred to the text-books on the subject, and to the 
works of Garrod, Duckworth, Ewart, and others. 

The arrangement of the diet for the gouty is attended by 
many difficulties. The disease itself must be understood thor- 
oughly, and the constitution, disposition, and habits of the 
patient must all be taken into consideration. If he is afflicted 
with any of the diseases to which the gouty are prone, these 
diseases must also be taken into account, for, as will be pointed 
out, they influence largely the choice of the diet. 

In general it may be stated that a varied and simple diet of 
plainly prepared foods is the best. Sydenham wrote: “The 
more closely I have thought upon gout, the more I have 
referred it to indigestion.” This suggests the second indica- 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR, 501 


tion—the relief of dyspepsia. Anything that will improve the 
3 Sergi food tat eopecalie those of animal origin, 
nitrogenous ani 

when taken in considerable quantity, cause an increase in the 
amount of urea, and indirectly of uric acid, in the system. 
‘The non-nitrogenous foods, while they will not eause gout, can 
not be regarded as the most suituble diet, since life can not be 
sustained without the ingestion of sufficient protein, If an 
attempt is made to obtain sufficient protein material by employ~ 
ing a diet of vegetables, bread, and the like, the digestion will 
be overtaxed and more harm than be done. Regarding 
proteins, it may be stated that moderate quantities of plainly 
cooked, easily digested meats may generally be allowed, 

Starchy foods are not especially harmful to the average gouty 
patient, providing he is free from glycosuria and obesity. 
Sngar is, as a rule, contraindicated in all cases, owing to the 
acid fermentation that is apt to follow its ingestion. In some 
gouty dyspeptics both starch and sugar give rise to unfavorable 
symptoms. If there is no indigestion, they may be allowed in 
moderation, 

Fat, as a rule, is to be avoided ; this will, however, be 
governed by the amount of indigestion it causes. This last 
rule holds true of any form of food. Browned fat is the form 
digested with most difficulty, and for this reason fried 
such as fish, bacon, ete,, as well as the browned fat from roasted 
meats, should be avoided. 

Sir W. Roberts suggests that gouty patients use salt spar- 
ingly, whereas in lithuric subjects he advises that it be used in 
as large quantities as the palate will tolerate, 

Water in large quantities is usually advisable. It may be 
taken hot, with the meals, with very good results, If it inter- 
feres with digestion, it may be taken between the interval of 
eating, when the stomach is empty. 

The so-called purin bodies have received considerable atten- 
tion of late in connection with gout, lithemie conditions and in 
asthma and eczema. The purin group consists of the chemical 
compounds containing C,N,. Uric acid is the most important 
of these, but there are others, as xanthin, hypoxanthin, caffein, 
thein, theobromin, guanio, and adenin. The purin bodies found 
in the urine may be either endogenous in their origin, that is, 
those formed in the body, or exogenous, as those into the 
body in the food. The principal foods containing purin bodies 
are meats, fish, peas, beans, asparagus, onions, mushrooms, tea, 


DIET IN DISEASE, 


502 
coffee, chocolate, and perhaps oatmeal. Milk, cheese, butter, 
and eggs do not contain purin bodies. Eggs cause an increase 
in the amount of uric acid excreted, whilst alcohol affects indi- 
viduals differently in this respect. 

‘The following tables, taken from Walker Hall’s book, “The 
Parin Bodies of Food Stutls,” show the amounts of purin bodies 
in various food materials : 











‘Undried as) Purine as 
| rol 
0.582 | 4.074 
0.795 5.565, 
1.020 7.140. 
1,165 B155 
0.572 4.007 
0.965 6.755 
1,162 8.157 
1212 8.487 
0.567 3.909 
1,155 8.085, 
1137 7.959 
1,805 9.185, 
2.066 | 14.455 
2.752 19.204 
10.063 | 70.431 
1,295 9,005, 
1,260 
0,970 6.314 




















Certain meats appear richer in purins than others but with 
the exception of liver and sweetbread, when the amount of each 
sort necessary to provide the requisite amount of protein or the 
feeling of satisfaction, is calculated, there is not much difference 
between the species, 

‘The legumes—oatmeal, asparagus, and potatoes—it will be 
noted contain some purin bodies, 

Various beverages contain purin bodies, especially tea, coffee, 
and cocoa, 





Purin bodtior 
(grain por pint), 
ee ce 2 eee Bose 
Coffee se ee eee Ww Paleale - 
‘Chocolate 07 Porter , - 
Cocoa se ee 10 








DISEASES IN WHICH DIET IS A PRIMARY FACTOR, 503 


Tees bare nut been sah cals ace ae ec 
amount t, but follow 
ihces Os peak e's fe optic Tae a 











Cauliflower +: 
Aspamgus (cooked) |). 1.5050 








After two years study von Noorden has recently published 
his observations on the toleration of gouty patients for food con- 
taining purin bodies.' He first places his patients upon a diet 
free from purin bodies and then estimates the endogenous uric 
acid. Then 400 pee ee raw, are given on two 
successive days, 150 grams at and 260 grams at noon. 
Each 400 grams of beef may be estimated as containing (accord- 
ing to von Noorden) 0.24 grams of purin bodies, half of which 
disappear in the body, but the remainder should be eliminated 
in ie urine either as uric acid or purin bases. Normally the 
elimination of this amount takes place during the two days of 
the experiment or a day or two later, but in gout there may be 
aconsiderable retardation. If there is retention of purin_ni- 
trogen in the body the amount of food containing it should be 
reduced. A. patient will often tolerate smaller amounts with 
complete elimination when larger amounts cause retention. The 
tolerance and allowance of purin bodies may thus be determined, 
and the case studied much in the same way as the tolerance for 
carbohydrates is followed in diabetes. 

Preventive Treatment.—Individuals with a gouty ten- 
dency will do well to follow a dietary such aay suggested for 
echronie gout. Children of gouty parents or of gouty ancestry 
should receive a carefully regulated diet from childhood. Sugars 

1 Berliner Klinieche Wochenschrift, October 9, 1905, p, 1297. 


504 DIET IN DISEASE, 


ehould invariably be used sparingly, and all sweets must be 
avoided. Alcohol should be prohibited, and tea and coffee taken 
only moderately, if at all. Ina general way a simple varied 
dict should be advised. This caution will not, however, as a 
rule be observed unless an attack of the disease has occurred. 

Diet in Acute Gout.—The diet for the young and pleth- 
oric differs from that for the old and asthenic. 

In @ primary parorysm the food should be light and f 
erably in fluid forn. Milk, bread and milk, PEs o. 
tice, plain tapioca or sago pudding, thin mutton or chicken 
broth, and gruels may be allowed. Weak tea, if desired, may 
also be given. Aleohol, jellies, gelatin, and the like are to be 
avoided. After a day or two, if there is hunger, a small quan- 
tity of boiled (white) fish and a small amount of well-cooked, 
mealy potato may be allowed. The return to a regular diet 
should be made slowly and cautiously. In the aged, who have 
been accustomed to liberal stimulation, this light diet will not 
suffice, In these cases, in addition to the foregoing, the white 
meat of chicken or fish or other easily digested meat may be 
given. When, as often happens, stimulation with alcohol is 
necessary, two ounces of a well-matured, pure whisky, well 
diluted, may be given in twenty-four hours. If more than a 
trace of albumin appears in the urine, or if the pulse tension is 
high, Be alcohol should be given in as limited an amount as 


le. 
The return to the customary diet should be made gealoali 
and the food given be suited to the patient’s condition. Only 
Nain, well-cooked foods should be allowed, all indigestible 
ishes and pastry being forbidden. Eggs, sweetbreads, chicken, 
turkey, partridge, squab, and the like may be permitted. 

Diet in Chronic Gout and Goutiness.—The ‘gouty 
patient should be given definite directions as to what is ~ 
able, and if ws be Ca to uy eye to ne future, he 
may be permitted to man: is own diet to a very large extent. 
eeetees well said, otha after forty is either a fool or 
his own physician.” 

The diet here also is to be made up of simple, plainly cooked 
food, all rich and indigestible dishes being prohibited. There 
is often a peculiar perzonal idiosynerasy in regard to certain 
articles of diet, and this will largely influence their use. As a 
rule, however, the following outline will suffice for the guidance 
of the patient : 

Soups of the plainest sorts may be taken, especially those 
consisting largely of vegetables. Yeo has suggested the use of 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 605 


vegetable purées to which beef-extract has been added to 
them a flavor of meat. Milk is valuable in all eases, and 

it disagrees it may be skimmed, peptonized, or diluted with a 
carbonated water. Bicarbonate of soda may be added when it 
is desired to make the milk alkaline. One to five grains to the 
ounce should be need, according to requirements. 

Meat and fish may be taken daily, preferably not at the same 
meal, Fresh beef, mutton, and the like are the most suitable 
meats, and poultry may be allowed for the sake of variety. 
Eggs may be taken in moderation. 

‘Twice-cooked meats should be avoided, as should dried, 
smoked, or pickled meats, as well as pork and veal. Garrod 
allows bacon at brealcfast, but fats are, as a rule, to be avoided. 
Under special conditions, when the patient’s nutrition is poor, 
they may be given if tolerated, 

Only the lighter varieties of fish should be given, boiled 
being preferred to fried fish, Oysters and clams may be taken, 
the hard portion being discarded. Salt fish, as well as mackerel, 
salmon, eels, and all other heavy fish, should be prohibited, 
Crabs, lobster, shrimp, and the like, as well as sauces, are usu- 
ally to be avoided. 

Vegetables when they are easily digested, may be permitted. 
Peas, beans, potatoes, artichokes, salsify, onions, turnips, greens, 
cauliflower, and cabbage are all allowable, as are likewise celery, 
lettuce, and similar green vegetables. Carrots and beets, 
because of the sugar they contain, and asparagus, tomatoes, 
rhubarb, and sorrel, on account of their acids, are best avoided. 
All preserved and pickled vegetables, as well as the coarse and 
fibrous portions of all vegetables, are to be omitted from the 
dietary. 

Fruit is best taken in the morning or during the interval 
between meals, It should, as a rule, be avoided during the 
latter part of the day, after fill meals, or with wine. Among the 
most suitable fruits for the gouty are oranges and grapes. Baked 
apples or stewed fruit may be taken. The sweet juice of the latter 
is, however, best avoided, Garrod advises the avoidance of all 
stone frnits, but allows baked apples and pears, and strawberries 
sparingly, " Fothergill su that bicarbonate of soda be 
taken with stewed fruit to correct the acidity, Opinions differ 
regarding the use of fruit by the gouty. If any. particular 
fruit dimgrees with a patient, it should, of course, be avoided. 
Patients often manifost idiosyncrasies respecting fruits, and 
these furnish a guide as to their suitability. 

If there is tendency to gouty attacks, a return to a milk diet 


506 DIET IN DISEASE, 


for » few days or to a very simple milk and dict, is often 
effective. i aay sinc ba eenploged with antago it CET 
intestinal disturbances of gouty origin. Passive exercise and 
massage are beneficial in this connection, 

Duckworth gives the following dietary, devised lee: Wa 
Jackson, who remained free from gout by adhering to it 


815 a. a: 10 oun 


1ces hot water, 
850 4.x: 16 "coffee with hot milk. 
900am: 6 “ See arava 


1.00r.a.: Meat, about half a ration with little fat—no browned fat: 
potatoes with or without green vegetables; a little, it 





soustard, no 
11 ounce wer, ed from line by big. 
6.00 P. Me: 11 Jot water, 
600 ra: 16 * fea WIEN plan of sodfucn Wesrtionate. 
6 “cold milk in the tea, 
ee er nee. tae a Be ee Noe 
and butter; lonfsngar (two Iumps); 
cheese; silt, 
9,00 rat: 11“ hot water. 
‘Total of — 
fluids, 93 ounces. 


The following diet, adopted with advantage by a medical man 
who suffered from gout and gravel, was published in the Prac- 
titioner (Yeo) = 
7.30 A, M.: 10 ounces of very hot water. 


8100 a. ac: Brewkfast—Equal parts of weak tea and milk, a small quantity of 
wblis sugnt, lice of fat bacon without & strip of loan, Been 


i in frvala bates ae i tl | 
P.M: Milk jpioca, macaron 
all Besuion with Potter! ‘Ten ounoes ef Lorient 


4.00-5.00 Fr. a. : 10 ounces of hot water. 

6,00 e. ot; Dinner—White fish or fowl (usually boiled), greens, bread (no 
potatoes). Claret, 7 ounces, 

8,00-9.00 Pr. x. : 10 ounces of hot water. 


Saline Springs.— Visits to mineral springs and the taking 
of mineral waters at home often exert a happy influence 
over some cases of gout. ‘The nature of the water seems to be 
of secondary importance, for it seems to be the water, and not 
the salts contained in it, that is helpful. The relation of the 
various salts to gout is not thoroughly understood. 

The following points, regarding choice of a spring, are 
given by various anthors : 

For acute and periodic attacks of gout: Assmannshausen, 
Ens, Neuenahr, Royat, or Vichy. 

For the plethoric and robust, where there is a strong heredi- 









DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 507 


tary predisposition or where there is stomach, intestinal, liver, 
or Ihiiney ducts: Carlsbad or Marienbad. 

For chronic and debilitated cases: Kissingen, Homburg, 
Baden-Baden, Bourbonne-les-Bains, Harrogate, or Wiesbaden, 

For long-continued domestic use in mild eases; Gieshtibel, 
Salvatorquelle, or Vals. 

Among the American springs be mentioned; Hot 
Springs, Va.; Hot Springs, Ark. ; Hot Springs, N. C.; Mt. 
Clemens, Mich, ; Las Vegas, N. M.; Sweet Springs, Pa. ; 
Capon Springs, W. Va. ; Glenwood Springs, Colo. ; Coronado 
Springs, Colo.; Saratoga Springs, N. Y.; White Sulphur 
Springs, W. Va.; Bedford, Va. 

Osler recommends the following : American—Saratoga, Bed- 
ford, and White Sulphur. Jnglish—Buxton and Bath. French 
—Aix-les-bains and Contrexeville. German—Carlshad, Wild- 
bad, and Homburg. 

Alcohol and Gout.—There is probably but little doubt 
as to the injurious effect of alcohol in gouty subjects, and it 
serves not only as a predisposing factor, but as an exciti 
cause, If the patient has never used alcohol or used it but 
sparingly, and if it is not needed especially as a stimulant, it 
should be excluded entirely from the diet. On the other hand, 
if the patient has been habituated to the use or abuse of alcohol, 
its withdrawal is often followed by serious consequences. This 
is most true in those who are weak, whose cirenlation ix poor, 
or whose stomach demands an alcoholic stimulant before it be- 
gins work. Sydenham said; “The old saw is that if you drink 
wine you will have the gout, if you do not, the gout will have 
you”’—in other words, * while it may be good for the patient, 
it is bad for the disease.” 

Alcohol is contraindicated in acute gout except in the weak 
and aged. In subacute gout and in chronic gout alcohol should 
be avoided wherever possible. When its use is necessary, the 
best form of alcohol for these patients is undoubtedly well- 
matured pure whisky sufficiently diluted with water. The daily 
allowance should be placed as low as possible—two ounees or 
double that quantity in some cases should ordinarily suifice, 
Good old brandy or gin may be substituted for the sake of 
variety. Wines and malt liquors are best avoided, but curious ~ 
idiosyncracies in regard to them exist. The choice of a wine 
for the gouty is a matter of personal taste and experience. All 
very sweet or acid wines are injurious. Ewart gives the fol- 
lowing rules for choosing wines, and says that the are those 
with a “moderate percentage of alcohol and of ether ; least pos- 


508 DIET IN DISEA1E, 


sible deree of acidity ; freedom from unfermented sugar, as far 
ax that is consistent with # natural unadulterated condition 5 
freedom from tannin; genuineness as to vintage, or at least to 
derivations mixed wines do the most harm ; and lastly, matured 
age! 

Good claret or a dry Moselle is perhaps the best, while cham- 
¢ is perhaps the most injurious, wine for the gouty. This 
however, as most every variety of wine, has some enthu- 

siastic advocates, 

Tea and coffee may be allowed, but it is desirable that they 
be given unsweetened und not too strong. If, however, sweet= 
ening is thought advisuble, as it usually is, tablets of saccharin 
may be used in place of sugar. 

‘The special diseases of the gouty roquiring particular 
attention are the following : 

Gouty Glycosuria and Diabetes.— While a restricted diet is 
not desirable in these cases, large quantities of meat and heavy 
breads are generally productive of more harm than good. Very 
often, if the gouty condition receives proper attention, the gly= 
cosuria will fs lessened or may even disappear entirely, A 
moderate quantity of meat and fish, with well-tousted bread, 
brown bread, pulled bread, rice, macaroni, and the like, in mod= 
eration are to be allowed, together with milk, cream, and fatty 
foods. If symptoms are present, a mill diet for a short period 
will usnally be found beneficial. It is often well in these cases, 
even when the symptoms are not urgent, to give an occasional 
diet of milk. 

Gouty Albuminuria.—In this condition the most suitable 
diet is one containing but a moderate quantity of meat of the 
least irritating character, such as the white meat of chicken, 
steak, chops and roasts. The meat should be lean, The white 
meat of boiled fish of the lighter varieties and the more easily 
digestible vegetables may also be permitted. Whenever the 
amount of albumin in the urine is very large, or when there are 
symptoms of nephritis, a milk diet may be given for a few days 
or a week at a time. 

Acid Gouty Dyspepsia.—This is one of the most serious and 
most troublesome of the gouty affections. Many cases require a 
milk diet, and it may be necessary to peptonize the milk par- 
tially or completely. Peptogenic milk powder or one of the 
infant foods may also be used. Malted milk, albuminized 
foods, or the malted foods may be utilized. 

Tn the less severe cases, lean meat and fish may be allowed 
in small quantities. Well-prepared vegetables may be given 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 609 


ingly, while starches and fats are usually best avoided. 
ealmaregercenb of these cases is essentially the same as if 
gout were not present. 

Gouty Obesity.—The management here is similar to that in 
other conditions. Ebstein regards obesity in the gouty as an 
unfavorable symptom, and recommends meat and fat and re- 
duces the carbohydrate food to the smallest possible amount, 
His theory is that the fats protect the metabolism of the pro- 
teins to a smaller degree than do the starches and sugars. 
Sugar should be reduced, and only as little liquid as it is pos- 
sible to get along with should be allowed. Some authors recom- 
mend alcohol in small quantities. Duckworth gives a small 
amount of red Bordeaux wine mixed with a little water. 
be ait life—horseback riding or other outdoor exereise—is 
advisable. An occasional visit to Marionbad, Carlsbad, or a 
similar resort is often beneficial. 


RHEUMATOID ARTHRITIS (ARTHRITIS DEFORMANS). 


Tn this disease the diagnosis should be carefully made, as it 
is important that the patient receive a supporting diet, and not 
the restricted diet of the rheumatic and gouty. 

Diet apparently plays no part in the etiology of the disease. 
As in any chronic disease interfering with active exercise the di- 
gestion is apt to be below normal, and care must be taken that 
the food be digestible and taken in sufficiently small quantities, 
Heavy foods and ge tad articles should be avoided, as the 
patient must needs lead a sedentary life ; as a result of the latter 
constipation is apt to exist, and must be corrected. 

Garrod recommends a considerable quantity of meat to be 
taken in a well-mixed diet. Alcohol has apparently no in- 
fluence on the disease, and either spirituous or malt liquors 
may be used, if desirable, to support the patient’s strength, 
‘The chief dietetic indication is the avoidance of anything that 
will cause indigestion. 

OBESITY. 


Obesity is one of the conditions for which the physician is 
frequently asked to prescribe a diet cure. He should, therefore, 
be thoroughly informed concerning its causation, its manage- 
ment, and the reasons for and against reducing any given case. 

There is probably no condition that has been more widely 
discussed by laymen of both ancient and modern times than 
obesity, for no disease is more thoroughly associated in the lay 






Ee 


i 
de 


2a 


i ‘ated with i am 
but it is by no means confined to either old or middle age, 
exemplified in the fat children familiar to all; extreme ob 
may be a plague even of infants, Chambers is said to have 
ported a case that he saw on exhibition at Manchester—a babe 
that weighel 90 pounds at six months. Numerous cases are — 


Shakespeare 
dangers of obesity when he wrote: 


“Make lew thy body epee, and more thy grace. 
Leave gormundizing ; know th ‘pope 
For thee thrice wider than for other men." 


With Justus von Liebig’s work came a better borer 
of the formation of fat ie the body, and while there are 


very diverse opinions on the subject, the condition is, in the 
main, fairly well understood. In 1850 Chambers warned 
against fat, bread, and potatoes, In 1863 Mr. Louis Banting, 
an Englishman, published a letter giving an account of a 
method of diet that he had imines on himself with 

benefit. This method was that of Harvey, who was Bant 

physician. Haryey’s name was withheld at the time, and as a 
result the name of Banting has become associated with redue- 
tion cures and obesity. Ebstein published his work in 1882, 
and there have been numerous authors and physicians who have 
formulated methods for, or made suggestions concerning, the 
treatment of obesity. Oertel was the first to point out that 








DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 511 


there was a close relation between obesity and weak heart, and 
he made abundant contributions to the literature on the cor 
rect management of these diseases, 

ces senses OF eben yas 80 well rpbedoreeas S 
only passing mention, ut 50 per cent. owe their primary 
origin to hereditary causes, Women are more frequently 
affected than men. With the advance of years, in some there 
is a tendency to accumulate fat. Overeating and orate 
have been named us causative factors, especially when combi 
with a quiet, sedentary life, 

‘The fats and the carbohydrates are the principal elements in 
the diet that are apt to be converted into fat ; but proteins also, 
if the supply exceeds the demand and assimilation is active, 
will be converted into body-fat and stored up in the subcutane- 
ous tissues. The liver and the heart are also converted into 
storehouses for fat, and later there may be a fatty degeneration 
of both organs, as well as of the coats of the arteries, 

‘The dangers accompanying the excessive accamulation of fat 
are manifold, and include a large number of diseases that may 
be influenced by it either directly or indirectly. These will be 
discussed when the indications for reducing the weight of pa- 
tients are considered, Weak heart, anemia, gout, and diabetes 
are among the most frequent diseases associated with obesity. 

Treatment.—lIt is necessary, in attempting to treat thix 
condition to distinguish between the cases that are plethorie and 
those that are anemic. One should, moreover, consider each 
case carefully, before reduction is decided upon. The condition 
of the blood, of the heart, and of the liver, and the rte of 
increase in the patient’s weight, should all be considered, 

The general appearance of the patient—whether the sym- 
metry of the body is preserved or whether it is distorted by 
fat-deposits—is also to be studied, More important still is the 
condition of the functions of the body and the state of the 
nervous system. Of especial value is it to learn the amount 
of disturbance of respiration and of circulation. 

The age of the patient is a factor of paramount importance. 
Tn persons under twenty reduction cures should not, as a rule, 
be used, but the diet should be so arranged that there will be 
no increase in the amount of fat deposited. When the weight 
is to be reduced, it should be done very gradually, and when 
from five to fifteen pounds have been lost, a season of rest 
should follow. The period of restricted diet should not exceed 
four or five weeks. 


512 DIET IN DISEASE, 


During and even a little preceding the period of senescence 
reduction should not be permitted. ‘The physical condition of 
the patient, rather than the number of years, should be the 
guide, for some persons grow old earlier than do others, The 
condition of the arteries is a guide to senility, based on 
the dictum that a man is as old as his arteries, In persons in 
the decline of life reduction generally hastens very materially 
the breaking-down of the bodily forces. 

The following suggestions concerning the various grades of 
the disease and their fitness for reduction cures will be found 
useful : 

Advanced eases—and they may be judged from their gen- 
eral appearance and condition of health—are, as a rule, fit 
subjects for reduction. 

those who have been fit all their life or who have been 
fut for several decades, and who are approaching old age, a 
reduction cure should not be undertaken, 

Avernge cases, where the weight is from thirty to fifty 

mds above the average for their age, sex, and condition 
in life, should not bo reduced if they are aged. If tho extra 
weight is well borno, they do not need it, and tho dict should 
be so arranged as to prevent any further increase. If there is 
any reason to fear disease, they should be reduced, If the 
patient takes a great deal of exercise, uses any quantity of 
alcohol, or is given to excesses in eating, or, in fact, anything, 
he should be reduced, for the chances are that he will aceumu- 
late fat as time goes on or will become the subject of disease 
which his obesity will aggravate. Rapid reduction in these 
cases is bad as a rule, and it should be slow and systematic, 

Slight degrees of obesity, where the body weight is from ten 
to thirty pounds over the average, do not need reduction, but 
only a careful regulation of the diet and mode of living, so as 
to prevent any further deposits of fat. 

‘he question of reducing some of these patients must be 
considered, for while they unquestionably do perfectly well on 
a limitation of their increase in weight, still the question of 
personal appearance is an all-important factor with many 
women, It is more often the case with those slightly above 
the average than for those who are very obese, as the latter 
have become accustomed to their fat and are usually resigned 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 513 


to it. If these patients are not reduced the m ph 
nds, they will go to one physician after another until 

ind some one who will—generally a quack who may do fork 
harm than good by his methods and advice. When the per- 
sonal appearance can be used as an argument for the regulation 
of the diet and the manner of living, the physician has a hold 
upon the patient that he can scarcely get by any other means, 
and he may often prevent an accumulation of a troublesome 
amount of fat in after years by the careful instruction of the 
patient in the art of living as it must be practised by that par- 
ticular individual, As Ebstein puts it, “ Corpulence can only 
be permanently cured by a permanent change of life and diet, 
regulated by physiologic principles.” 

"Phere are certain objections that may be raised to reduction 
in women, The loss of the abdominal fat may lead to consti- 
pation, to hernia, to gastroptosis, to dislocation of the kidney, 
and even of the uterus, Von Noorden states that these patients 
may develop gall-stone colic, which probably results from the 
pressure of the clothing on the liver, causing interference with 
the flow of bile, and consequently favors the formation of gall- 
stones. So long as the patients are obese the pressure exerted 
by the clothing is usually trifling and does not fall directly on 
the liver. These objections to reduction cures in women are 
more marked in mild than in the more advanced eases. 

A sr diene ee is whether me is pots to reduce 
any special part of the ly more rapidly remaining 

rts. This is a method often sought by women who have 

rne several children and who have large deposits of fat in the 
abdominal walls, causing an unsightly prominence of the abdo- 
men. If the fat is reduced slowly, eee rt of the body, 
including usnally the abdomen as well, will je simul- 
taneously, If it is reduced rapidly, it seems to be removed 
principally from certain parts of the body, as the neck, breasts, 
arms, and calves of the legs. Certain advocates of massage 
claim that the massage of the parts will cause a more rapid re- 
duction. Von Noorden had one arm of an obese patient mas- 
eee for six weeks. At the end of that time the arm that had 
been massaged had increased one and one-half centimeters in 
circumference, whereas the arm that had not been massaged 
remained the same. 

Massage of the abdomen during a reduction cure may exert 
a beneficial effect by relieving the constipation, which is apt to 
be eonbiatontt Exercise is still more potent, particularly for 






render the patient more comfortable, but in many eases may be 
the direct means of prolonging the patient's life and period of 
usefulness, Th these cases reduction is not to be regarded as a 
weakening process, the reverse being true—the patients usually 
grow stronger as their weights grow less. It must be borne in 
mind, however, that each case is to be studied carefully and 
treated individually, for no general rule can be made to a) 
to every case that comes under the physician's care. This 
plies not only as to the question of reduction, but also to 
manner in which this is to be accomplished, 

Diseases Combined with Obesity.—Diseases of the 
Circulatory System.—To Oertel belongs the credit of pointi 
out the great benefits to be derived from a rational method 
treating affections of the heart when combined with obesity. 
Benefit follows not only in patients with valvular lesions, but 
in those suffering from other diseases as well. Among these 
conditions may be mentioned arteriosclerosis, myocarditis, de- 
generation of the heart muscle, the so-called fatty heart, aneu- 
rysm of the aorta, and those diseases of the chest or respiratory 
organs that interfere with the circulation. 

The reduction of the body weight in these cases, it should be 
understood, does not alter the character of the lesion itself, but 
it lessens greatly the work of the heart, and permits of more 
complete oxidation of the blood. It is of especial value* in 
those cases where the existence of the lesion itself is not incom- 
patible with the life of the patient so long as he is kept in 
reasonably good condition, If reduction is undertaken before 
there is any failure of compensation, the results are, as a rule, 
very gratifying. If compensation is on the verge of rupture, 
or if it has actually begun, it may often be checked to a remark- 
able degree and sometimes averted altogether. Reduction may 
work wonders even in what at first seem to be very severe 
cases. In the hopeless eases it is useless to attempt it, One 
should not, however, be too hasty in deciding that a case is 
hopeless, for even very serious cases may be relieved. 


















DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 515 


The ions for treatment made by Oertel are most 
useful, and will be given further on. For patients where com- 
pensation is perfect, but whose bodies are obese to a degree that 
seems to the physician to indicate danger, a rapid reduction 
eure may be instituted. Where there is beginning failure of 
compensation, Groedel, of Nauheim, von Noorden, and others 
recommend large doses of digitalis, to be followed by a some- 
what rapid reduction. This may be effected by any method, 
but, soonnling to the authors just named, those methods involy- 
ing the use of salines should be avoided. The amount of fluid, 
as well as the food, must be limited. ‘The reduction is best 
undertaken at a sunitarium, For the first few weeks four or 
five pounds a week may be removed, and after that about that 
many a month, 

The worst cases are those in which edema occurs together 
with obesity. In these cases, as a rule, not much is to be 
hoped for, and a reduction cure in the ordinary sense of the 
word should not be undertaken. These patients do not gen- 
erally have any great desire for food, and hence the amount of 
liquid consumed should be the point of especial consideration. 
The heart should be stimulated, and later, if pes exercises 
should be begun. Digitalis is, of course, of the greatest use in 
these cases. The food need not, as a rule, be limited, unless, 
az improvement sets in, fat be deposited; this is not, however, 
apt to be the case. 

Diseases of the Respiratory System.—These are to be con= 
sidered principally in their relation to the circulation, and what 
bas been said of heart diseases applies with equal truth to these. 
‘The most frequent respi disturbances are adherent pleurisy 
and emphysema. A kyphosis, by compressing the chest 
may also prove troublesome, A reduction of the body weight 
often brings about a marked improvement in these cases. 

Bronchitis in fat, and especially in elderly, patients is apt to 
be very troublesome. In many patients a very resistant bron- 
chitis, which does not yield either to drugs or to climatic treat- 
ment, occurs every winter. In these cases a reduction of the 
body weight, by allowing the patient to breathe deeply and 
with case, will often be of more assistance in effecting a cure 
than all other measures combined, f 

Chronic and interstitial nephritis is also a disease in which 
the patient must either be reduced or at least the amount of 
food and drink be so limited as to prevent any further increase 
in weight, (See the section on Diseases of the Kidney.) 


516 DIET IN DISEASE. 
In many diseases that affect the legs, such as hemiplegias, 


cord disease, and neuritis, as well as the man dis- 


orders affecting the feet or legs, a reduction in vey weg 
will often permit the patient to get about with considera! 
ease, whereas if he is allowed to accumulate fat he may ulti- 
mately become practically helpless. The same may be said of 
chronic articular rheumatism, of arthritis deformans, or of 
osteo-arthritis affecting the lower extremities. 

Obesity and gout form a combination that presents unusual 
difficulties in the selection of a proper diet. If the 
subsist on an anti-gout diet, they gain in weight, and if they 
adhere to a diet that aims to avoid gain in weight, they are apt 
to contract gout. (The reader is referred to the section on 
Gout for further information on this point.) One must choose 
between two evils and arrange the diet accordingly. Asa rule, 
a diet of lean meat with an abundance of fresh fruit and green 
vegetables is, in the average case, the best. 

There are many nervous diseases not included among those 
that render locomotion difficult that are frequently either bene- 
fited or entirely cured by a reduction in body weight if the 
patient has been much above the average. Most important of 
these are the various neuralgias, which are often the bane of fat 
persons. Sciatica and occipital, supra-orbital, and left-sided 
brachial neuralgia are among those nervous disorders that, 
according to von Noorden, may be most frequently relieved. 

This same observer has pointed out another condition in 
which gain in weight should fe limited—one that is frequently 
overlooked by the average practitioner. This is in obesity 
following the cures for pulmonary tuberculosis. These 
patients frequently take on large quantities of fat, and in some 
cases the very fatness they strive to acquire may be the means 
of their undoing, interfering, as it may, with exercise and with 
breathing. Fortunately this class of cases is not large. If 
they continue to gain in weight after the pulmonary disorder 
has been cured, or if the weight becomes a source of danger to 
them, the patient’s diet should be so arranged as to limit the 
amount of fat deposited. 

In all cases the patient must be told that it is only by 
severance that any permanent good can be effected. Little is 
to be gained by a few weeks’ dieting or by a sojourn for a few 
weeks at u watering-place if the diet is to be unrestricted there~ 
after. Many patients who will not persevere in the diet while 
at home do well at a resort, or, better still, at a sanitarium, 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR, 517 


where, in addition to being reduced in weight, learn the 
art of living as well. In others it is better Se eclame short 
courses at various intervals, These may be of four or five 
weeks’ duration, and after the patient has lost from five to fif= 
teen pounds, he may be all some freedom in the interval. 

Exercize is of the greatest importance, and should be carried 
out according to the si tions made by Oertel. Exercise 
in the open air, such as walking cither on level ind or uphill, 
as suggested by Oertel, is to be preferred to in loor exercise and 
gymnasium training. In certain towns in Germany, Austria, 
and Switzerland, as well as in this country, what are known as 
“terrain cures” have been established ; in these the paths are 
marked according to distance and as to the grade. The patient 
is carefully instructed by the Lethaia as to how far he is to 
walk and on what grades. Similar walks may be planned by 
physician anywhere if the country is of euch a nature as to 
permit it. The amount of exercise should be carefully regulated, 
and the distance to be walked, rather than the time that is to 
be ae in wires cess outlined. a pets 

in cases with wi earts prognosis is ial importance. 
According to Oertel, if there is hydremia or circulatory dis- 
turbance, the pecans will be governed by the difference in 
the quantity of fluid taken and the amount of urine exereted, 
For two days the patient should take as much fluid as be has 
been accustomed to, and the amount, as well as the quantity, of 
urine exereted, noted. For two days more the amount of fluid 
should be reduced to from 700 to 1000 «.c., and the urine 
should again be measured, If with the reduced amount of 
fluid the urine is equal in Ronee ee or larger than, the amount 
of liquid ingested, it is a sign that the heart power is not ex- 
cessively weak and that the kidneys are in fair condition, and 
a favorable oss =~ be given, providing the proper regi- 
men be followed out. the amount of urine excreted is less 
than the quantity of water ingested, the prognosis is unfavor- 
able. If the urine is only slightly less, this may be regarded 
as an actual increase, as from 18 to 20 per cent. of that taken, 
as well as the amount in the solid food, is given off with res- 
piration, perspiration, ete. If there ig arteriosclerosis, fever, 
or diabetes, the prognosis is unfavorable. 

Prophylaxis of Obesity.—In all persons with a heredi- 
tary tendency to obesity, and in all obese persons who have 
become thin, prophylactic measures should be undertaken. These 
consist in an avoidance of fat-forming foods, and, if necessiry, 





was mentioned ‘jiously, was used by Mr. Banting, who re- 
duced his weight in one year from 202 to 156 pounds—a 
loss of 46 pounds, This method was used largely in England. 
It is entirely too severe for the average patient and must be 
modified, For those with weak digestion it is usually entirely 


ing Diet for Obesity (Yeo)— Breakfast at 9 A. x 
consisted of 5 to 6 ounces of animal food-meat or boiled fish 
(except pork or = 3 a little biscuit or 1 ounce of dry roast— 
6 to 7 ounces of solids im all, A large cup of tea or coffee 
(without milk or sugar)—9 ounces of liquid, 

“ Dinner, 2 p. M.: Fish or meat (avoiding salmon, eels, her- 
ring, pork, and veal), 5 to 6 ounces; any kind of poultry or 
game. Any vegetubles except potato, parsnips, beet-root, 
turnips, or carrot. Dry roast, 1 ounce. Cooked fruit, un- 
sweotened, Good claret, sherry, or Madeira, 10 ounces. Total 
of solids, 10 to 12 ounces. 

“Tea, 6 Pp. M.: Cooked fruit, 2 to 3 ounces ; a rusk or two— 
2 to 4 ounces of solids; 9 ounces of tea, without milk or sugar. 

“Supper, 9 p, m,: Meat or fish, as at dinner, 3 to 4 ounces. 
Claret or sherry and water, 7 ounces. 

* This allowed only from 21 to 27 ounces of solids per diem, 
of which 13 to 16 ounces consisted of animal food and only 2 
ounces of bread; the rest consisted of fruit and fresh v1 
tables. There was the strictest possible exclusion of 
and sugar. 

“The total fluid was limited to 35 ounces.” 

Oertel’s Method.—Oertel makes the following suggestions 
as to the treatment of the various classes of obesity, always 
considering whether the patient is plethoric or anemic : 

(a) Where there is an abnormally inereased amount of fat 
in plethorie patients with unimpaired or only beginning changes 
in the heart uction the diet should aim at— 

(1) An increased supply of protein. 

(2) A decrease in the fat-producing substances. 








DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 519 


*(3) Little or no diminution in the supply of liquids below 
the physiologic amount (1500 ¢.c,—3 pints) 

(6) Where there is obesity in anemic patients, viz., serous 
plethora, the dict should aim at— 

“(1) An increase in the quantity of proteins. 

«(a A diminution in the amount of fat-forming substances, 
and eventually — 

(3) A decrease in the amount of fluid. 

“ & Where there is obesity in adults with hydremic sym 
toms, in whom not only the amount of epee, but also the 
abnormally increased amount of fat is slowly wasting away, 
they require— 

(1) An increase in the amount of protein taken, 

«(3} A sufficient amount of fat and carbohydrates or even 
‘an increase of same to prevent the falling off of fat. 

(3) A diminution in the amount of fluid taken.” 

Oertel lays particular stress on the fuet that dietetic rules 
should be based upon changes in the heart, and consequently of 
the circulation. Both the quality and the quantity of food and 
drink should be eerrky If the circulation is di 
small excesses, either in te or in drink, pagrus to 
distress. The most noticeable symptoms are a feeli 
pression, palpitation of the nee and difficulty in breathing. 
In pronounced cases of disturbances of the circulation, if too 
hearty a meal has been indulged in, death may follow slight 
exertion. In these cases death is due to paralysis of the heart. 
‘The effect of the meals on the circulation must be observed 
carefully, the amount of disturbance following 2 meal will 
determine the size and the number of meals that must be taken. 

The aim of the treatment is to furnish food and exercise in 
such amounts that the body fat may be burnt up and thus the 
needed reduction of weight take = free while at the same time 
the body and heart are strengthened. This can be done only 
by a careful study of each case. In a word, the physician 
must discriminate between those cases in which the respi 
and cireulatory apparatus have not been disturbed, where 
the muscular apparatus is in such condition that a considerable 
amount of bodily exercise may still be taken, and those eases 
in which the blood is poor, where advanced venous stasis 
reduces the absorption of oxygen in the lungs to s minimum, 
and where slight muscular exertion exhausts the oxygen, inter~ 
feres with respiration, and gives rise to dyspneic symptoms, 
In the first class a liberal amount of fut and carbohydrates may 


520 DIET IN DISEASE. 
be allowed—that is, as large a quantity as the patient ean dis~ 


pose of in his body by exercise without pregrwehieyi es 


of the treatment, In the second class the fats and carbo- 


Peas oeoaiptrec ans took ta wt ly the 
amount of nourishment without forming fat the following. 
are equivalent in heat and force production, or, in other words, 
they are said to have the same caloric value: 100 grams of fat, 
211 smn rein, 2 grams of starch, 234 grams of cane- 
sugar, 256 Geil grape-sugar (240 8 as a sugar 
syerere): To make this yor cet meth be seule 

a body stores up fat if more than 118 grams of protein 
and 259 grams of fat, with a caloric value of 2894, are taken ; 
but 110 grams of protein and 600 grams of starch, with a 
caloric value of 2944, may be given without producing fat. 
With a mixed diet the limit lies near 118 grams of protein, 
100 grams of fat, and 368 grams of starch, a total of 586 
gram, or of 2923 calories. The simplest way to reduce the 

forming elements is to diminish the fat and allow a certain 
amount of carbohydrates, The diet must be regulated accord- 
ing to the individual case—this is a point that can not be too 
strongly insisted upon. ecrtel gives the following figures, 


based on numerous calculations + 
Carbo 
Ginn: Grams, MEArtee Caloris, 
Minimum... «+.» + » 156 PI 70 1180 
Maximum. ... 2... 170 45 120 1608 


The amount of material burnt in the body may reach from 
2500 to 3500 calories, and the difference between that supplied 
by the food and the total amount used is taken from the fat 
stored up in the body, and the patient loses weight accordingly. 

Oertel lays particular stress on limiting the amount of fluid 
taken. He regards 1500 c.c. as the physiologic limit, and 
allows more than this—from 1800 to 2000 ¢.c.—only in very 
tall patients or when there is fever. In still other cases he 
reduces the amount to from 750 to 1200 cc. 

The solid food is to be taken in several small meals, and the 
liquids are to be taken only in the intervals between meals. 
Soups are not permitted. Five or six meals are given a day, 
their frequency obviating the necessity for eating very 
meals. 





| 


DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 621 


If ths pall ea ia doers the Ines tear NAM aE 
size, but should not include either tea or coffee. 

Oertel regards exercise as of as much importance as diet, 
Tn the average case he advises from four to five hours’ outdoor 
exercise daily, taken in the morning and afternoon. If the 
patient can not take that much—and he rarely can at first—he 
ig given exercises of increasing length and severity until the 
required amount is reached. The increase should be made 

ually, and should depend entirely on the patient’s condition. 

e should be told the distance he is to walk, and not the time 
in which he is to do it, for if the latter is done, a lazy patient 
may do much less than is necessary, whereas the energetic or 
ambitious patient may overexert himself. 

Oertel insists on the exercise being taken in the open air and 
on the careful regulation of the amount by the physician, 
Where it is ible, as it is at some of the Continental resorts, 
briceeismacin of four different grades. These are as 

lows : 





Second » the incline 5 w 10 degrees 
‘Third . « the incline from 10 to 15 degrees 
Fourth - the incline from 15 to 20 degrees 


A pedometer may be used to measure the amount of walking 
done, and furnishes a convenient means of ‘ibing walking 
exercises. Care should be taken to use fea reliable instru: 
ment, for some are very inaccurate. The amount of exercise is 
regulated according to the state of the patient’s heart, his gen- 
eral strength and condition, and also as to whether he is pleth- 
oric or anemic. Any complications that exist must be 
taken into account. 

If the patient is plethoric and the heart is in condition, 
he may be ordered to take walks of the first and second 
at the outset, the distance preseribed being about that which an 
orlinary individual would walk in from one and one-half to 
two hours. This amount should be divided up between the 
morning and afternoon, as circumstances may warrant. The 
return course is not’ taken into account. The patient should be 
allowed to consume as much time as he requires in walking this 
distance. Care should be taken to avoid overexertion. Da 
of rest may be interspersed as the need for them arises. The 
distance may be lessened or increased, according to the case. 
‘The patient should use the paths of the fourth grade only when 






622 DIET IN DISEASE, 


the heart has become strong and when he is in condition, | 
See cs cris any Si 
pat it to ly Lye 
Ordinarily, if he gets out of breath easily, he nay eae 
an inspiration and an expiration for each step. using: 
the paths of the second and third grades, the patient may from 
time to time, for short intervals, breathe in an int 
(staccato) manner, taking one inspiration for two and i 
two expirations within the next two steps. ‘This is often 
saat in securing perfect inspiration and expiration, 
the patient is anemic or hydremic, or if the heart action is 
impaired, the exercises should be begun on level ground and 
gradually increased in severity. Several weeks or more, ac~ || 
cording to the case, should be allowed to elapse before the 
patient is permitted to try the third grade paths. 

Tn patients with sclerosis and atheroma exercises must be i 
seribed with extreme caution. If the sclerosis is not ; 
the patient may derive the greatest benefit from the exercises, 
but the amount and the variety should be cautiously prescribed H 
and their effect watched. If atheroma is present, the greatest | 
eare should be taken to guard against overexertion. In all 
these cases, however, exercises should not be entirely dispensed 
with, although the amount may be limited to the minimum. | 

If there is involvement of the coronary arteries, whether or 
not stenocardic attacks have taken place, only the smallest | 
amounts of exercise should be allowed, and these should be on | 
level ground. It is only in rare eases that this amount should 
be dispensed with, for if the patient remains at rest and the 
futty condition be allowed to progress, the patient must inevi- 
tably become very weak, 

Exercise is contraindicated in myocarditis, pronounced albu- 
minuria, and general edema, When any of these are present, 
rest and proper medication are to be advised. | 

Diet After the Treatment.—The following is Ocrtel’s general 
diet, which is to be modified to suit the individual case, 

“ Morning: A cup of coffee or tea with milk (150 to 200 
¢—5 to 6 ounces) and bread, 75 grams (2} ounces), 

« Forenoon: Tn cases preceding anemia and hy ia, one 
or two soft-boiled eggs or 30 to 40 grams (one to one and one~ 
half ounces) of meat, cold or freshly broiled, 100 e.c, (3 ounces) | 
of wine, or in conditions of weakness 50 ¢.c, (13 ounces) port, 
and # small quantity of bread. 

“Noon: 100 cc. soup; 150 to 200 grams (5 to 6 ounces) 








DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 523 


meat of various kinds, be eal dig beef, veal, game, or 
fowl, not too fat ; plat pe eae Caied vegetables at disere- 
tion ; likewise fish cooked ut much grease; 25 grams 
(about 1 ounce) breed or ome farinaceous food—at most, 
100 ws (3 ounces) ; for aie pyebeiih, os 
to se) best eh or ‘after Nagel . 
method). For drink, one-sixth to poe Te rc of «te ali 
osioes} of Hight wine or beer ; water. 

150 to 200 ec. (5 to 6 ounces) of eoffee 
or tea, with about one-fourth of a liter of wat ibe See dal pint) 


ine 


and 25 to 50 grams (1 to 2 ounces) of bread if there is any 
desire for it. 
“Fivening: Meat as at noon, or eggs, 25 grams (about 1 


ounce) of bread, and possibly a small amount of che cheese, salad, 
or fruit. Beverage, wine, with or without water, or beer, best 
taken some time after the meal 2p ta O00 10.00 ea ee 
pint). Delicacies, oysters, caviure, ete., by reason of their 
nourishing qualities, may be eaten between or before meals, but 
so that they do not too much augment the total quantity of food.” 
(See Tables I. and IL, pages 524 and pe 

Ebstein’s Dietary.—Ebstein’s di consists in a diet low 
in carbohydrates, but containing ble amounts of fat. 
According to Oertel, Zuntz has te out that Ebstein’s treats 
arose from a misconception of a statement made by Voit. 
is just the opposite of the view accepted by physiologists, and 
Munk has proved experimentally (using rape oil containi 
erncie acid, which could afterward be reeognized in the tissues 
that fat may be absorbed from the intestine directly an 
deposited in the tissues without undergoing any essential 
change. The custom of giving a food is as old as Hip- 
poerates, for he says, “The food shall be fat in order to satiate 
quickly.” 

Ebstein’s diet-list forbids the use of all sugar and sweets and 

tatoes in any form, and directs that the amount of bread 

gested be reduced to six or seven ounces daily, Of the 

weotables that are allowed, the following are the most import- 
ant: asparagus, spinach, cabbage, beans, peas, and other 
legumes. Meat of every description, especially fat meat, is 
permitted. From four to six ounces of fat are daily, 

Three meals x day are allowed—a light and supper 
and a heavy midday dinner. Coffee or tea may be taken with 
the light meals, and, if desired, a glass or two af white or red 


wine with the dinner. 





¥. Volt. 


















20 | 84) 10) 008! os | Konig. 


50 | 295] 1210, O90) . . 





ml 


















12 





O62 | 1.7 | Konig. 





(Cagein 
Oat 





Table L—Oertel's Special Diet-list in Circulatory Disturbances and Obesity.” 
7 


30) 6.2) 120 | 096 


6] oa2 | 040] 11 | Konk 
| 0.70] 0.20) a9 | ™ 





+ | 120 | 113.6 








Liquids taken, 








‘Total that 
pee 


in twenty- 








DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 525 


Fr 


















Morwing: 














dole 





12 











Table I1—Oertel's Dict-list in Circulatory Disturbances and Obesity.’ 
a f i 
‘Food taken. 
Fine wheat bread 
‘Two soft-bolled: 





= 

ue: 

H/35| 
‘=| 290) a16] oat | oer) 17 | Ke 
i] 9) m2] 129 | 0.96 





Liquids taken, 








Morning, 1-8 velock = 
Goan eet 
Mite 25 
vine | 

Orel 

wi 

Port wit 
Naan 

Wi Ba 
eotco sree 
Nike 

wins 







DIET IN DISEASE. = 


Breakjast—in winter, 6.30 4. m.; in summer, 7.30 A. .: One 
cul 


pereepet black tea without milk or sugar; two ounces of white 
or 


gravy, especially fat meat, an abundance of cabbage, 
and most of the legumes (peas and Teas Dons oleae 
are almost entirely excluded, and potatoes are forbidden abso- 
lutely. After dinner a small quantity of fresh fruit and occa- 
sionally salad or stewed fruit without sugar. To this are added 
two or three glasses of light white wine. Soon after dinner 
another large cup of black tea without sugar or milk is allowed. 

Supper—between 7 and 8 Pp. M.: In winter regularly, and in 
summer occasionally, another large cup of tea without sugar or 
milk. One egg or a small portion of fat meat or both; or ham 
with fat, sausage, smoked or fresh fish, two ounces of white 
tet dbe plenty of butter; occasionally a bit of cheese and 

it. 


The feregoin dietary was followed by a man of forty-four 
who had sui ered from obesity since his twenty-fifth year. He 
lost twenty pounds in nine months, and improved in every way. 
This diet may be taken as an average diet suitable for a man 
with a sedentary occupation. 

Ebstein maintains that the diet should be such as will allow 
the patient to live comfortably without increasing his weight; 
he also calls attention to the fact that such a diet must be fol~ 
Jowed for a lifetime. 

Schweninger Method.—This is practically the same as 
Oertel’s method, with one exception—. e., that the use of fluids 
with meals is absolutely prohibited, any fluid that is allowed 
being taken fully two hours after a meal. Schweninger’s fame 
was greatly enhanced by the fact that he was Bismarck’s physi- 
cian; he used this method to keep down that famous states- 
man’s weight. 

‘The following is an outline of the diet used : 

Breakfast, 8 A.M. (to be preceded by exercise and a bath an 
hour before): Meat, eggs, or milk. After this a walk, 

Lnnch, 10.30 A. M.: Meat or fish and a glass of white wine, 
To be followed by a walk. 

Dinner, 1 ¥.M.: Meat, vegetables, and fruit compdte. 

Supper, 77. M.: Meat and fruit compdte or salad, and a 
glass of white wino. 

Bread is to be taken as sparingly as possible, 





DISEASES IN WHICH DIET IS A PRIMARY FACTOR. 527 


Schleicher Diet for Obesity. — Breakfast, 7 A. a. : A mutton 
or veal cutlet or a portion of sole as large as the palm of the 
hand ; the same quantity of bread without butter. 

8a.m.: A cup of tea with sugar. 

10,30 a. .; A sandwich of bread and meat-causage. 

Noon: Meat, eggs, green vegetables, cheese, an orange. 
Two glasses of white wine. (No soup; no potatoes.) 

4p.m.: Tea with sugar. 

7. M.: A small quantity of bread and cheese. 

9p.M.: Cold meat, eggs, salad. Two glasses of wine and 
sometimes more. 

This diet, used by Schleicher, of Antwerp, is quite similar to” 
the diet of Schweninger, except that the former does not insist 
on prohibiting fluids absolutely with the meals. 

Germain Sée Method.—Sée, one of the leading French 
authorities on diet, maintains that the amount of fluid taken 
should be increased instead of diminished. He gives as his 
reason for this the fact that many corpulent ms suffer from 
gout or the so-called uric-acid diathesis, and that the water taken 
stimulates metabolism and aids in the elimination of waste- 
products. He advises tea or coffee, taken as hot as ‘ible, in 
considerable quantities, especially at breakfast. He ibits 
alcohol, except in certain cases, where a small glass of diluted 
white wine is allowed. 

Weir-Mitchell Method.—This method, which its originator 
claims is especially suitable in those cases where there is merely 
an overabundance of fat, and also in fat anemic women, is out~ 
lined in Mitchell’s book, Fat and Blood, as follows: “The 

whose weight we decide to lessen is placed on skim-milk 
alone, with the usual precautions; or at once we give skim- 
milk with the usual food, and in a week we put aside all other 
diet save milk, and all other fluids. When we find what quan- 
tity of milk will sustain the weight, we diminish the amount 
degrees until the patient is losing half a pound of weight 
day, or less or more, as seems to be well borne. Meanwhile, 
during the first week or two, rest in bed is enjoined, and later, 
for a varying period, rest in bed or on a lounge is insisted upon, 
while at the same time massage is used once or twice a day, and 
Jater in the case Swedish movements, At the same time the 
pulse and weight are observed with care, so that if there be too 
rapid a loss or any sign of feebleness, the diet may be increased. 
Tn many such cases I allow daily a moderate amount of beef, 
or chicken, or oyster soup, more as a relief to the unpleasant- 





523 DIET IN DISEASE. 


ness of a milk diet than for any other reason. ‘When the weight: 
has been sufficiently lowered, we add to the diet beef, mutton, 


to make so speedy a change in weight while the patient eae 


with no obvious result except a gain in health and comfort,” 

This method is naturally limited to the wealthy class, those 
who can afford to give a number of weeks to nothing but the 
treatment, and is not adapted to cases where there are com- 
plications. 

The Salisbury Method.—This system, which prescribes 
meat and hot water, is said to be useful in cases of obesity that 
are complicated by digestive disturbances, especially where there 
is a tendency to fermentation. It consists in thoroughly cleans- 
ing the stomach before eating by giving a pint of hot water an 
hour and a half before each meal and at bedtime. If the 
patient experiences any difficulty in taking it, the water may 
be flavored with lemon-jnice or weak tea. The principal 
article of diet is finely minced meat, which allows the patient 
to get the maximum of nitrogenous food with the minimum of 
digestive work. It is finely minced to avoid the necessary dis- 
integration by chewing and digestion. The only food permitted 

, at first is the minced beef, with clear tea or coffee without sugar, 
Tf there is a craving for other foods, a bit of tenderloin may 
be chewed. Condiments may be taken with the meat, and a 
stalk or two of celery. If there is a craving for food between 
meals or at night, a small quantity of meat-broth or minced 
beef may be given. The amount taken should be an ounce or 
tivo at first, to be gradually increased, as the patient requires it, 
to eight ounces. Not more than a pound should be allowed at 
ameal, Mild aperients may be needed. The method is apt 
to prove tiresome at first, but this weariness will pass off after 
ashort time. When the diet is increased, the following articles 
of food may be allowed: Mutton, lamb, sweetbread, pooltet, 
white fish, soft-boiled or poached eggs, baked potato, ~ 
boiled rice or macaroni, wheat bread (stale and toasted). Two 
mouthfuls of meat should be taken to one of the other foods. 





| 


DISEASES IN WHICH DIBT IS A PRIMARY FACTOR. 529 


The ‘ing restricted diet is to be used only so as is 
necessary ; being a somewhat severe dict, it is not suitable to a 
large number of patients. Yeo suggests that the diet be in- 
creased, especially at first, by green vegetables, which will enable 
the patient to take the meat more easily. The methods of 
mincing beef and preparing it are given in the appendix. 

Yeo Method.—Yeo makes the following suggestions for the 
dieting of obese patients when no complicating disease is pres~ 
ent: The proteins are confined within the limits ye for 
healthy nutrition, All starchy and farinaceous food is reduced 
toa minimum, Sugar is prohibited entirely, Tn some cases 
he allows a small quantity of fat, for the same reasons given 
by Ebstein. Fluid at meals is to be restricted, but sufficient 
is to be allowed to aid in the digestion of food. Hot water or 
hot aromatic solutions may be allowed freely between meals, 
especially toward the end of digestion, the aim being to aid in 
elimination, especially in the gouty, No beer, porter, or sweet 
wine is to be taken, and spirituous liquors only in very small 
quantity. Yeo believes that it should be recognized generally 
that the use of alcohol is a common cause of obesity. The 
only forms in which it should be allowed are as hock, still 
Moselle, and light claret, and these only in small quantities. 
All varieties of lean meat may be taken, as well ax poultry, 
game, fish (eels, salmon, and mackerel are best avoided), and 
eggs. Meat should not be exten oftener than twice daily, and 
not more than six ounces of cooked meat should be taken at 
one time. Two lightly boiled eggs or a small portion of grilled 
fish may be taken as another meal, Bread should be toasted 
very thoroughly, and not merely browned on the surface. Soups 
should be prohibited, except a few tablespoonfuls of clear sou 
at dinner, Milk, unless skimmed or when taken as the el 
article of diet, should be avoided. All milk and farinaceous 
pnddings and pastry of all kinds are forbidden. Fresh fruits 
and vegetables, on the other band, are permitted. Yeo insists 
that individual, and not routine, treatment be carried out. He 
also recommends abundant exercise on foot, and advises that 
the bowels be emptied daily by the use of saline purgatives. 

Other Dietetic Methods.—There are so many dietetic methods 
of treating obesity that they cannot all be outlined here. The 
best-known dietaries have been described, and by a study of 
these the diversity of opinions that exist can readily be made 
out. Among those that have not been described is Chambers’ 
Method, interesting because it was one of the earliest systematic 

ou 


fruits, and the were tobe taken pencipelly ewe 
An abundance of out-door exercise was ordered, and 


was restricted to seven hours, for Chambers believed that 


ier. 
a tA secoiertd method allows a diet somewhat more 
than is prescribed by the Oertel or the Ebstein method. 

Tt does not, however, differ essentially from these two methods, 
and for this reason requires no further description here. 

Thyroid gland substance, which is usually given dry in the 
form of tablets, exerts a decided influence over metabolism. 
By its use large amounts of flesh are often lost. It is given in 
Bye eais doses several times a day. It should be given in 
small doses at first, and these should be gradually increased, 
the effect on the heart’s action being watch raratiligd When 
the use of the drug is discontinued, the weight again increases. 
Tt is a@ dangerous remedy, capable of doing much harm, and is 
not to be recommended except in one class of cases—where 
there is 4 condition of masked myxedema (myxmdeme fruate), 
so well described by Hertoghe; of Antwerp. In these cases 
the drug is of great value, and the loss of weight that follows 
its use brings about renewed health and mental vigor. Small 
doses must be given continuously lest the condition return, 
The quack cures for obesity are many, and require no com- 
ment here more than to say that there is no “royal road” to 
leanness. 













DIET FOR LEANNESS. 


It is much easier to reduce a patient who is obese than to 
fatten one who is thin. The measnre of snecess is largely de- 
pendent on the cause of the leanness. Abont one-half of all 
thin persons are so from hereditary causes, and time and energy 
















DISEASES IN WHICH DIET I8 A PRIMARY FACTOR, 531 


are dlmost wasted in an attempt to fatten these, When there 
isa definite cause for the emaciation and this can be discovered 
and removed, much can be accomplished. In these cases relief 
from worry, bustle, and excitement may be all that is r. 
More often there is starch dyspepsia, or the patient aay Be anda 
to take sugar without inducing fermentation and 

Tn a general way, the following suggestions for the relief of 
leanness may be made: The patient should lead a quiet, out-of- 
door life, free from care and excitement, and should get sufficient 
sleep. The meals should be ample, and as much carbohydrate 
and fatty food should be taken as is possible. Cream, mill 


cooked), farinaccous puddings, legumes, and sweet 
fruits should all be partaken of in abundance. All sweots— 
honey, syrups, cakes, and the like—may be taken if they agree 
with the digestion. Beer, especially of the darker varieties, 
brown stout, porter, and ale are useful, If wine is preferred, 
sweet wines or port should be chosen. If alcohol is contrain- 
dicated, malt extracts may be given. 

The patient should avoid strong alcoholic liquors, acids, 
spices, and the like, as well as many green vegetables, In a 
word, the diet should be the reverse of that recommended for 
obesity. (See Rest Cure.) 


SCORBUTUS OR SCURVY. 


It is a curious fact that as scurvy has become less and less 
common in adults, it has become more and more prevalent in 


infants. 

Scurvy in adults occurs when there is a deficiency of 
fresh food. If fresh fruits, fresh vegetables, and fresh meats 
are omitted from the dietary for any length of time, scurvy is 
almost certain to follow. It is the scourge of armies that have 
been forced away from their bases of supplies in an unpro- 
ductive country, where the commissary department is inade~ 
quate. During the late civil war 15 per cent. of the deaths 
were said to be due to scurvy, In former years, when the 
sailor was not so well cared for as he is at present, the disease 
was common on shipboard. It is apt to occur in prisons and 
where the hygienic surroundings are faulty. 

It is unnecessary to discuss here the many theories promul~ 
gated regarding the nature of the disease. Suffice it to say 
that fresh food contains a principle, be it salts or some unknown 
substance, without which man can not continue in health. This 










feopiga wicket 

given to the men in sufficient quantities. 
introduction of better methods of 

ee ey Soe 
an preventive ‘inst scurvy. 
sing och tae bles and 


fot used Soe i 
the month is so sore as to interfere with mastication, soups and 
broths, made of the articles just mentioned, and fresh frit 
juices should be given. Wright has expressed the 
the neutral citrates and tartrates are better than the fe te 
juices, since the latter, he believes, are apt to prolong the oozing of 
ood from the mouth Practically, however, there is no reason 
why the fresh fruit- should not be given, for they seem to 
act Y adtoirably. When the proper dietetic means are not at 
hand to eae the case, cabbag fort should be made to secure 
some form of green vegetables or berries. Acetic acid or the 
chlorate or bitartrate of potash may also be preseribed. v 
Infantile Scurvy (Barlow’s Disease).—Ono of the 
best contributions to this subject. is the American Pediatrie 
Society's Collective Investigation of Infantile Scurvy, 1898. In 
this, 379 cases were reported. Age is a marked > and 
four-fifths of the cases were between the sixth and the fifteenth 
month, and one-half between the seventh and the tenth month, 
‘The feeding prior to the onset of the disease was as follows : 


a Ja seen alone in 10, 


« « «4g, 
4 ww a gg 

: 3 eS «<u a 6g 
Proprietary foods 2. 6 6. 0 2 es intu © 







UNCLASSIFIED DISEASES. 533 


From the foregoing table it will be seen that the 
foods are the most frequent cause, sterilized milk being next in 
frequency. Condensed milk, likewise, is not to be overlooked 
as a cause. One should be cautious not to keep a child on 
sterilized or condensed milk for too long a time, and this should 
be explained to the mother. If circumstances necessitate the 
use of any of these foods, a tens of fresh orange-juice or 
a portion of baked apple should be given every day or 
few days, The proprietary foods that are mite mixed wi 
water alone should never be used except as a temporary expe- 
dient in illness, 

The treatment of infantile scurvy, unless complicated by 
other diseases or associated with marasmus, is, if properly con- 
ducted, most satisfuctory and simple. It is purely dietetic. 
‘The infant should be placed on a suitable mixture of pure fresh 
milk, according to the rules laid down for the feeding of infants. 
Some form of fresh fruit-juice, scraped ripe apple, or grapes 
from which skins and seeds have been removed, or any fresh 
ripe fruit, may be used, From one-half to three or four ounces 
may be given daily, Among the very poor the authors have 
used lemon-juice with benefit. Potatoes have been highly rec~ 
ommended, especially for older infants. A well-baked, mealy 
potato is beaten up with a small quantity of milk to the consist- 
ence of thick cream, and a teaspoonful or two of this is added 
to each bottle. 

The symptoms will usually become less marked in a few 
days, and in uncomplicated of average severity complete 
recovery will follow in one or two weeks, When there is 
anemia, cod-liver oil and iron are of service. 


UNCLASSIFIED DISEASES. 
EXOPHTHALMIC GOITER. 


In this disease the diet should be liqnid and nutritious, and 
indigestible food should be avoided. Milk may be given in as 
large quantities as the patient can assimilate. Any 
to constipation should be relieved promptly. Foods that are 
apt to cause flatulency (g. v.) should be avoided. 

Tea, coffee, and tobacco should be abstained from, or, if the 
patient refuses to do this, their use limited to the smallest pos- 
sible amount. Alcohol should be prohibited except in habitués, 
when sudden withdrawal may canse great cardiac weakness. 
In some cases, if necessary, alcohol may be used as a heart 
stimulant. 


=. 


534 DIET IN DISEASE, 


ADDISON'S DISEASE, 

So as the digestion is not seriously impaired a mixed 
ayo nutritious a mixture as ane should be given. 
Milk and cream, fresh meat, fish, oysters, well-cooked vege- 
tables, and farinaceous food may be used. Good wines or 
spirituous liquors may be allowed in small quantities if desired, 
or when needed as either a tonic or a stimulant. 

When gastric irritability occurs, the treatment is the same a3 
that for nervous vomiting—lig uid, even predigested, food should 
be given in small quantities (eee Nervous Vomiting and Feed- 
ing after Laparotomies). In some eases a mixture of two 

lime-water and one part of milk may be used with 
tage. If this is not retained, teaspoonful doses, given regularly 
every fifteen‘ minutes, may be tried, In the worst eases rectal 
feeding may be instituted for several days, thus giving the 
stomach a complete rest. 

When the patient becomes weakenod, even when no 
gastric symptoms exist, it is well to give food at short and 

ular intervals. Liquid and predigested food, together with 
milk, custards, egg-nog, sherry and egg, broths, and gruels are 
to be ordered, Liquid beef peptonoids, panopepton, and similar 
preparations are useful, as are also malted milk and the various 
infant foods, 
OSTEOMALACIA. 


As nutritious and as generous a diet as the patient can digest 
should be given. It has been recommended that an abundance 
of salts be taken. Phosphates and hypophosphites with eod- 
liver oil are perhaps the best means of supplying salts to the 
system. The disease requires further study. 


DIET IN DISEASES OF THE SKIN. 


Certain skin affections are caused directly or indirectly by 
dietary errors ; others are prolonged or intensified by an improper 
diet, and still others are connected in some way with diseases of 
the alimentary tract or with disturbed metabolism, 

‘The belief that skin dixeases are caused by improper food is 
very prevalent among the laity, and the effect of diet on the 
skin is often overestimated because of the common habit, which 
some physicians have, of ascribing almost all skin lesions to a 
disordered stomach. 


DIET IN DISEASES OF THE SKIN. 536 


Certain foods may cause skin lesions, usually of the urticarial 
depart ich putin Salitlipatca foi ion. 
‘his is evidently, in some cases, the result of reflex action ; in 
Som tects aren one: These lesions are 
usually, though not always, dependent on idios; ~ Broeq 
held that skin diseases may be engendered by he oa use 
of certain foods, and maintained that the disease might only 
appear years later. This has never been proved, and therefore 
uires no discussion, 

n such metabolic diseases as gout and diabetes the existence 
of some of the lesions may be explained on the ground that 
irritating abnormal by-products are excreted together with the 
sweat. 

Certain poisons taken in with the food may give rise to condi- 
tions in which skin manifestations play an pe part. In 
this connection may be mentioned ‘ism and pellagra, Aleo- 
hol and “ toper’s nose” (acne rosacea) are commonly coupled in 
the mind, although the latter may occur in individuals who have 
eth pot hich follow for the d of 

Ie si ions whi low for the dietetic management. 
eczema may be employed with advantage in the treatment of 
most curable: skin diseases, as it consists chiefly in getting the 
patient into the best possible physical condition. 


ECZEMA. 


‘The dict of both acute and chronic eczema is important. In 
general it may be stated that the prophylaxis in predisposed 
individuals consists in a simple varied diet, and the avoidance of 
such articles of food as are known to cause attacks of 
or urticaria in the patient under treatment, It should be re- 
membered that one patient will eat with impunity a food that 
will poison another. (See Urticaria.) In addition, anything 
pow to cause intestinal disturbance or indigestion should be 
avoided. 

When eczema is present, the indications are to avoid indiges~ 
tion and disturbances of the stomach and bowels. In the gouty 
the diet should be regulated according to the suggestions laid 
down for the management of gout. er coéxisting diseases 
should also be considered from a dietetic standpoint. 

The habits of the patient should carefully be considered. If 
the nutrition is below normal, efforts should be made to improve 
it by means of nourishing food, such as milk, eggs, and meat. 
If, as is more often the case, the patient overeats or is obese, 


536 DIET IN DISEASE. 


the diet should be restricted. The patient should avoid all 
indigestible articles, and partake of a diet varied ling to 
his taste, but reduced in quantity. Alcoholic drinks of all kinds 
should, as a rule, be prohibited, and coffee and tea taken in 
moderation, if at all. In obese patients careful regulation of the 
diet according to one of the methods described in the treatment 
of obesity will usually answer the purpose. 

When the disease is due to indigestion, the result of improper 
feeding, the diet should be regulated according to the form of 
disease present. All indigestible and fried foods, pickles, and 
strongly seasoned or very rich foods should be avoided. The 

igestion is often disturbed, particularly in women, by over- 
indulgence in sweets and pastry, especially at wrong hours. In 
all eases the food should be plain, well cooked, and taken at 
regular intervals, no solid food being allowed between meals. 

Schweninger recommends in some cases smaller meals than 
are ordinarily taken, at shorter intervals; in others, that the 
meal shall consist of but one or two dishes, 

In the very severe acute or persistent forms, an absolute milk 
diet or a dict composed largely of milk should be prescribed. 
(See Milk Cure.) 

Hezema in Infants.—If the child is nursing, the mill 
should be examined, and if, as is usually the case, the milk is 
found to be very rich and the baby is fat and well nourished, an 
attempt should be made to reduce the amount of fat in the 
mother’s milk according to the directions given in the section 
on Infant Feeding. Malt and alcoholic liquors of all kinds 
should be forbidden, and the amount of meat ingested should be 
reduced and exercise increased, 

In some cases, where the proteins are at fault, the child suffers 
from indigestion and colic and curds are found in the stools, 
The child usually, although not always, appears to be well 
nourished. The amount of food given the infant should be 
lessened, either by shortening the time the infant nurses or by 
lengthening the intervals. The child should be urged to take 
water between the nursings ; an alkaline water, such as Vichy, 
will be found of value, ai the child is thin and poorly nour- 
ished, fat in addition to that contained in the milk should be 
given. Cream or cod-liyer oil may be used for this purpose. 
This is not advisable in fut, well-nourished infants, for in them 
the disease may be due to an exeess of fat in the food. 

In artificially fed infants Holt advises giving firat a food 
moderately high in fat and low in protein, and then, if the de- 
sired effect is not produced, a milk low in fat and protein. 





DIET IN DISEASES OF THE SKIN. 537 


‘What has been said of the treatment of adults applies as well 
to older children. In the latter the disease is generally due to 
the excessive use of starches or sugars. Pickles and indigestil 
cold lunches may be the cause of this condition in school-chil- 
dren. The diet should be regulated according to the rules given, 
and if the disease still persists, a milk diet may be tried. The 
drinking of water between meals is often of value. 


URTICARIA. 
The first step in the treatment of urticaria is to secure free 
evacuation of bowels. For this an active saline, 


such as sulphate of magnesia, should be given. Following this, 
the diet should be very simple until the urticaria has disappeared. 
Preferably a milk diet should be given, lime-water or an effer- 
vescing water being added to the milk if necessary ; if there is 
indigestion, the milk may be peptonized. When there is a 
diminution in the quantity of urine exereted, alkaline diuretics 
may be prescribed or Vichy water may be drunk freely. 

In many individuals the attacks are brought on by certain 
articles of diet. What these are may generally be i 
by careful observation. Oysters, crabs, and other shellfish are 
a frequent cause. These and other articles of diet, if they are 
not fresh or are beginning to spoil, are also frequently respon- 
sible for this disturbance. ie produce a red rash of an 
urticarial nature in many persons. When the offending article 
has been discovered, it should be eliminated from the dietary. 


ACNE. 


In certain persons acne may be overcome by careful dieting, 
In some, special articles of diet, such as buckwheat cakes and 
other fried foods, greasy doughnuts, rich pies and cakes, and, in 
fact, almost any indigestible article of diet, have been held re- 
sponsible forthe disease, oe ; 

In giving directions regarding the diet it is well to ibit 
all indigestible foods, such as ios just mentioned, ln 
scribe a substantial varied diet of fresh food of the more easily 
digestible kinds. In the severe and resistant eases a milk diet 
may be tried, and Moser and Peiper suggest that milk be skimmed 
to remove the most of the fat. Bulkley forbids fats, butter, 
alcohol, smoked meats, and many other articles of diet. Other 
authors interdict tea, coffee, cheese, fish, and a host of other 
foods have been named as injurious. 


ee) 


638 DIET IN DISEASE. 


‘The bowels should be regula peer ee 
taken freely between meals. Cav dey a 
connection with acne might prove of considerable value. 


ACNE ROSACEA, 


As has been said elsewhere, this is rally coupled in the 
minds of the laity with alcoholism, tho ‘en is often 
a causative factor, the disease occurs also in those who never use 
alcoholic beverges, Jackson maintains that the use of large 

intities of strong tea may also argc it, on 
SaeGiicatd ba blast) ead ratesitaling ighly soa 
soned food, as well as alcohol, should one pai Tea id 
coffee, if used at all, should be taken in small quantities and 
not too strong. The diet should be similar to that prescribed 
for eczema, Many of the patients, it will be found, prefer the 
pleasures of the table toa possible betterment of the skin disease, 


PSORIASIS. 


Diet is apparently of little value in the treatment of this con- 
dition. Many authors have recommended various forms of diet, 
but in general it may be said of this, as of other skin diseases, 
that the diet should be such as the general condition of the 
patient demands. If the patient is thin and debilitated, a nour- 
ishing diet should be ordered, whereas if he is obese, his diet 
should be restricted. 

Broeq insisted on the value of regulating the diet of pa- 
tients of gouty families according to the lines laid down in 
the section on Gout, Other authors recommend that the use 
of coffee, tea, alcohol, and tobacco be prohibited in nervous 
individuals. 


PRURITUS. 


The existence of gout, diabetes, and diseases of the liver, 
kidney, or alimentary tract should be definitely determined, and 
if such disease is found to exist, the diet should be regulated 
accordingly. In severe cases a milk diet may be ordered, and 
an abundance of mineral water between meals and on rising. 

All irritating articles of diet should be avoided. All highly 
seasoned and indigestible dishes, pepper, especially paprika, 
spices, and the like, should not be used. Brocq advises that 


DIET IN DISEASES OF THE SKIN. 539 


the following articles be withheld: tobacco, alcohol, tea, coffee, 
fish, crabs. sausage, and cheese. 


FURUNCULOSIS. 


There is no special diet for furunculosis. The general nutri- 

fore should be improved by prescribing a varied diet of well- 

food. If there is disease of the alimentary tract, the 

diet should be such as is indicated in that disease. If diabetes 
or anemia coéxist, they should receive attention. 


SPECIAL CURES. 


THE MILK CURE 


Waite milk is used extensively in the treatment of many 
diseases, it has also been advocated us « special curative agent, 
Karell, of St. Petersburg, and Weir Mitchell are among the 
chief exponents of this method of treating disease. 

An exclusive milk diet has been used with good effect in 
renal, hepatic, and cardiac dropsy ; in congestion; simple hyper- 
trophy, and fatty conditions of the liver; in various gastric 
and intestinal disorders, particularly in those associated with 
defective nutrition, such as chronic indigestion, chronic oolitis, 
and chronic intestinal neuralgia ; in asthma due to emphysema 
or catarrhal conditions; in obesity ; and in functional nervous 
conditions in which the nutrition is greatly lowered, Karell 
has also advocated the milk cure in organic disease of the heart 
and blood-vessels, in advanced kidney disease, and in rheumatic 
and gouty diseases. 

Method of Administration.—Well-skimmed milk from 
the country, as fresh as can be procured, is used. 

ll uses from three to six ounces three or four times a 
day and increases the amount gradually. The milk is to be 
taken slowly at regular intervals, allowing it to mix with the 
saliva. In winter it is warmed and in summer it is given at 
the temperature of the room. After a week, if the stools re~ 
main solid, the quantity is increased, two liters a day being 
given during the second week in favorable cases. The meals 
are given at fixed intervals and the hours nigel adhered to. 
If there is diarrhea, the milk may be boiled. Karell insists on 
small quantities at the outset and that the milk be skimmed. 

Conetipation is rqgarded as a sign that the milk i agrecing, 
and may be relieved, if necessary, by enemata, or rhubarb or 
castor oil may be used. Small quantities of coffee mixed with 
the morning’s milk or stewed prunes or baked apples in the 
afternoon are also helpful in relieving constipation. 

Tf flatulence occurs, it may be attributed to the fact that too 
much milk is being given or that it has not been properly skimmed. 
If there is thirst, plain water or seltzer water may be given. 

50 








WHEY CURE. 541 


Dato ie sean Oe third week, if there is an irresistible 
craving ripen ee eae alee ete 
amount of sult may be given. Once a day milic sou 
thickened with a cereal, may be given. After five or six 

one other article of food may be allowed for dinner, and if the 
desired effect has beon produced, a gradual return may be made 
to an ordinary diet, which should, however, still contain con- 
siderable milk, 

Mitchell gives four ounces of milk every two hours, se erateally 
increasing the dose and lengthening the interval to three hours. 
He also prescribes a glass at night, if necessary, mixed with 
lime-water, or, later in the cure, mixed with one of the lactated 
infant's foods. He also insists on the necessity for prescribing 
rest with this treatment, 

Mitchell has described the effects of the milk treatment in 
general as follows: “ For the first week or two there is drowsi- 
ness, the tongue is coated, and there is a peculiar taste in the 
mouth, The patients at first lose a little weight, and later on 
generally gain considerably, The stools are light yellow and 
have a peculiar odor, like the milk stools of infancy. There is 
an increase in the quantity of urine, which may exceed the 
quantity of fluid taken into the system.” 

By this treatment many remarkable cures are effected in 
obstinate cases especially in those neuroses attended with emacia- 
tion, the improvement being due evidently to the rest and the 
easily assimilated diet. 


WHEY CURE 


In some of the foreign health resorts a enre somewhat similar 
to the milk eure has been employed, and consists in the drink- 
ing, at stated intervals, of warm whey to which alkaline 
mineral waters have been added. About one and one-half 
pints are taken daily. The amount of meat taken is limited, 
and the quantity of fruit and vegetables is increased. This 
method of treatment is said to be of value in laryngeal coughs, 
in chronic catarrhal conditions of the Iungs or intestine, in 
chronic nephritis, and in chronic phthisis. 


KUMISS CURE. 


This is a mode of cure much used in Russia. Patients who 
are to take the cure are generally sent to the country, where 
kumiss can be had. Tt is given frequently during the day—as 





542 SPECIAL CURES. 


often as every half-hour—but not for two hours before a hea 
meal, the doses being gradually increased. The diet used wit 
it consists chiefly of meat and fat, Sugar, fruits, salads, ices, 
coffee, and alcohol are abstained from, If it causes diarrhea, 
lime-water is added. During cold weather it produces an in- 
crease in the excretion of urine, and during warm, it increases 
the perspiration, Constipation is overcome and there is a gain 
in weight. Slight drowsiness, as in the milk cure, may occur, 
and stimulation of the sexual organs may take place. 

This cure is useful in pulmonary tuberculosis and when there 
is a decided lowering of the nutrition. The effects are those 
obtained from # generous diet combined with open-air life. 


THE YOLK CURE, 


Yolk of egg has been recommended in diabetes (see — 
and also as a most desireable food for the underfed and indi 
nals suffering from malnutrition, In many cases where the 
whole egg is not well borne the yolks may be used to great ad- 
vantage. From 10 to 40 yolks may be taken daily in addition 
to some other food. The fat, lecithin, and ferments found in 
the yolk render it particularly suited to individuals whose nutri- 
tion is bolow par and who do not do well on ordinary diets, 
Stern ' gives the following sample diet, outlined for a consumy 
tive weighing 50 kilos (110 Ibs,), whose normal weight 
be 63.6 kilos (140 Ibs.) : 


Number Calories 


i ae of 
sole, “calories 








200 200 
75 
100100 
Dinner: 
One plate of voup, 4 yolks 4 2000 aah 
Beet" (very Jean} 150'grams 195 
30 grams wheat toast. . - . 76 
4 o'clock; 
25 cc. skim milk, 20 e.0. whiskey, Syolke .. 8 150 870 
Bupper: 
Porridge of farina or Hce 109 grams yolk im 
WARNE ©. Tk 3 ee erate e Bale ee 50 850 
Apple siuce, 75 game 222000503 30 
At bedtime ; 
Night cap (00c. c. hot water, 10 cc, whiskey, 
1 yolk, teaspoonful grandlated mugar).~'. 2 60-110, 


15 750 «1780 
' Medical Reeord, Dec. 31, 1904. 








DIET CURES, 543 


The dict should wehpeghans ae pease tee treatment 
is to extend over any great length ban dishes devised 
ti eidekthe pulbacnayre 


DIET CURES. 


Numerous methods of curing various diseases 'by, 


means of 
special diets have been advocated by physicians men 
from time to time. For the most iy pro, ol 


associated with some religious exercise, Their populari 

as a rule, been ephemeral. are suited to rae who 
habitually overeat. Among the better known are the fol- 
lowing : 


The Grape Cure.—This is carried out chiefly in grape- 

growin countries during the vintage season. Tt is recom- 

a | for chronic constipation, for those individuals who have 
eral congested livers, for obesity, and for various lithemic 
conditions ; its use has also been suggested for many other can- 
ditions of the lungs, stomach, ete. 

The cure consists in visiting the grape district and in eating 
from four to six pounds of grapes daily. Even large quantities 
are sometimes taken. It is recommended that the fruit be 
ae when possible, on rising and between meals. When this 

, as it often does, the grapes are taken at the close of a 

ia The patient is given at the same time an easily di, 
but nutritious diet, The grapes have a decidedly laxative 
effect, which, combined with the change of scene and pleasant 
outing, often produces most beneficial results. When taken in 
too large quantities or in poorly selected cases, unpleasant symp- 
toms, such as swelling of the gums from the ald and diarrhea, 


other J Fruit Cures.—Other fruits are often used in vari- 
ous cares lasting from a month to six weeks. Apples, pears, 
oranges, lemons, in fact, almost all fruits have been vaunted at 
some time as cures, Various methods are followed, the basis 
of all being a greatly restricted diet with an abundance of fruit. 

They are used in the same diseased conditions for which the 
grape cure has been prescribed, 

Dry Cure.—This consists in taking as little water as is 
consistent with life. The water taken in addition to that con- 
tained in the food has been restricted in some cases to a pint a 
day. This treatment has been recommended for effusions in 





a | 


OM SPECIAL CURES, 


the serous cavities and joints, in obesity, and in dilata- 
tion. Many anpleasant and dangerous symptoms may follow 

this treatment. TTufnell’s treatment for aneurysm is founded 

on the same principle. 

Schroth’s Cure.—This is a form of the dry cure used in 
Europe for dilatation of the stomach, chronic peritonitis, and 
various other conditions. The amount of food is reduced for 
several days, and then nothing is given but dried bread, with 
the addition, at dinner, of boiled seedeblet A small quan- 
tity of hot wine is allowed to quench the thirst. When the 
thirst becomes intolerable, the patient is given large quantities d 
of hot wine and then the quantity is again reduced. This 
treatment is severe, and great suffering is engendered, danger- 
ons and even fatal complications often ensuing. It has been 
said to be beneficial in some cases. 

The Meat and the Hot-water Cure.—These resemble 
somewhat the Carlsbad and similar dietetic methods used in 
obesity and in dilatation of the stomach. The diet consists 
chiefly of meat-fiber, eggs, and dry toast. Hot water is taken 
before meals and at bedtime. 

The Kneipp Cure.—This consists chiefly of a diet of 
fruit, bread, and milk, with small quantities of meat and yege- 
tables, The cure directs that the patient walk barefooted in 
the grass while the dew is still on it. It became popular a few 
ye ago among the faddists and among those who habitually 
0 = 





THE DIETETIC MANAGEMENT OF SURGICAL 
CASES. 


Preparation for Operation.—Surgical operations that 
must be performed immediately, of course, admit of no 
tion. Most operations, however, may be postponed for several 
days or longer, thus enabling the patient to be put in good con- 
dition by rest, preferably in bed, and a nourishing, easily di- 
gested diet, is is of great importance in nervous women, 
and no major operation should be undertaken, except when 
urgently demanded, without giving the patient the benefit of 
us “ building-up Leer A plan that seems to be popular at 

ie present day, especially among gynecologists, is to operate 
first and then to build up the patient. Were this plan reversed, 
many operations could be avoided altogether. trath of 
this is illustrated by the following case: A nervous young 
woman of twenty was advised by a surgeon to undergo opera~ 
tion for the anchoring of a movable kidney. Later she con- 
sulted an eminent physician, who prescribed rest with 
nourishment under the care of a competent nurse. 8ix 
weeks’ time her gain in weight was such that the kidney be- 
came anchored in normal fat, whereas all nervous symptoms 
Piro rales of rot in bed tl ted by massage, 

value of rest in is greatly augment 
electricity, and baths ; by tonics ; i by laxatives to correct 
the tendency to constipation that usually exists. 

Diet and Laparotomies.—One or two days previous to 
the operation the bowels should be cleansed thoroughly by a 
saline, such as sulphate of magnesia, and in the case of abdom- 
inal or pelvic operations, an enema or two may be given in 
addition, the object being not only to secure cleanliness, but to 
obtain rest for the bowels. Licorice powder may be substituted 
asa laxative, or in delicate patients aloes, cascara sagrada, or 
citrate of magnesia may be employed. The washing-out of 
the rectum should be performed early on the morning of the 
operation—at six or seven o’clock or at least three hours before 
the operation, 

o . a5 





546 DIETETIC MANAGEMENT OF SURGICAL CASES. 


objection to adding « small piece of toast, a biscuit, or a cracker, 
This should, however, precede the operation by at least thme 
or four sale Lhe wep eariey: is Fae early in a 
morning, nothing iven before it. Operation 
gastro-intestinal tract should be proceeded by the sal diet 
given below (Dict following Operation on the Si i) 

After the operation there is usually nausea, This may be 

lessened or entirely prevented by a method which bas been 
tised for some time in Halsted’s service at the Johns Hop- 
ins Hospital and in Finney’s at the Union Protestant Infirm- 
ary of Baltimore in all cases of ether anesthesia; mee 
washing-out of the stomach after all surgical procedures 
the patient is on the table and still under the influence of the 
anesthetic, ©, 8. White,' too, extols this method in a recent 
report, in which he shows that in a series of 20 consecutive 
cases, 60 per cent. did not vomit, while in 100 consecutive cases 
of ether anesthesia without lavage only 30 per cent. did not 
vomit, 

As a rule, nothing should be given by mouth for twenty-four 
hours. Very aaah quantities of carbonated water or 
water or of very hot water may be given, or, if the patient 
is weak and in need of nourishment, milk may be given ip 

nful doses, lime-water or a carbonated water may be 
added to the milk if necessary, Hot weal tea is often accept- 
able to the patient, and if there is need of a stimulant, strong 
black coffee may be administered ; or if an alcoholic stimulant 
is desired, champagne in small doses or good brandy diluted 
with agrated water may be prescribed. If champagne or good 
brandy cannot be obtained, very old pure whisky may be used, 
For the first twenty-four or forty-eight hours the diet should be 
liquid—ailk or one of the liquids given in the diet-list below. 
Usually from 5 to 10 ounces of food will be taken the second, 
and from 10 to 15 ounces the third day, On the fourth day, 
if there are no untoward symptoms and it is deemed advisable, 
a soft diet may be given. (See list below.) After a week or 
ten days the ordinary diet may be resumed. 

Nausea and Vomiting.—This is more frejuent after 
prolonged operations and when ether has been the anesthetic 
used, but can often be prevented by washing out the stomach 


40.8 White, Annals of Surgery, August, 1904, 





THIRST. 547 


while the patient is still under the influence of the anesthetic, 
as has been mentioned, It may be rteanslioey, ce Tad continue 


for days or even a week, n the of srs 
operation and also on tebe "The orig res 
nausea and yomiting may become a matter of greatest: 
difficulty. 


While the vomiting is active no food should be given by the 
month. If it persists and the patient is weak, rectal enemata 
may prelimi unless contraindicated by some pipet 

hese may be given every six or eight 
Rectal Feeding. 

Various is for the relief of vomiting may be tried, 
A teaspoonful or two of hot water, to which has been added a 
drop of dilute hydrocyanie acid or of tincture of capsicum to 
an ounce or two of water, may be effectual. Teaspoonful doses 
of iced charm) e may be useful, as may also the following : 
Drop doses of ereasote in a teaspoonful or two of lime-water ; 
drop doses of spirits of chloroform at frequent intervals; ten 
or twenty minims of a 2 per cent. solution of cocain; mor- 
phin in very small doses, or bismuth aoe A mustard 
plaster, an ice-bag, or a hot-water bag ‘to the epigastrium 
sometimes brings relief. If the ade have not moved, the 
vomiting may be relieved by an enema. A full glass of hot 
water frequently gives relief, and even if it is rejected it serves 
to wash out the stomach. Washing out the stomach with a 
weak boric-acid solution is often effective in checking the vom- 
iting when all other methods fail. Total abstinence from food, 
drink, and medicine is the safest way to manage the majority 
of cases, 

Thirst.—This is often a troublesome symptom; in some 
cases it is almost intolerable. Kelly has reported the case of a 
patient who drank about a quart of water from a hot-water 
bag placed at her feet; many similar occurrences could be cited. 
Clark reported from Kelly’s wards the use of high enemata of 
saline solution to allay the thirst following operation, About 
a quart of solution is used. The patient must be fully under the 
anesthetic or sufficiently large quantities will not be retained. 
“A stiff rectal tube is inserted well upinto the sigmoid flexure, 
and the fluid is slowly poured intoa funnel held three feet 
above the patient’s buttocks.” While this is being done the 
patient’s buttocks should be elevated six or eight and 
the fluid allowed to flow well into the colon. It is very rarely 
expelled. If this can not be done and the thirst is intolerable, 





648 DIETETIC MANAGEMENT OF SURGICAL CASES. 


the patient may be given small quantities of plain hot water, 
carbonated water, or hot weak tea, The tea is often retained 
when water is rejected. 

Care of the Bowels.—As a rule, by the third bps 

ration, it is desirable that the bowels be evacuated, and 
this end a pill of aloes, belladonna, and strychnin or a dose 4 
cascara or licorice powder may be given. Cualomel is a favorite 
drug with some operators, one-tenth to one-fourth of a grin 
being given every half-hour or every hour until from one to 
three grains have been given. This may be followed by a half- 
glass of citrate of magnesia, a few drams of a saturated solution 
of sulphate of magnesia, or a dose of castor oil. If necessary, 
an enema may be given. Kelly gives the following formula of 
Dr. C. P. Noble: 





Not more than three enemata should be given during the 
entire third day, 

Tf the patient is doing well and there are no untoward symp- 
toms, and if ordinary efforts do not produce a movement, no 
alarm need be felt even if there be no evacuation up to the 
sixth day, At about this time they will often move naturally, 

Dietetic Management of Shock.—Much can be done, 
by proper management of the diet before the operation, to pre~ 
vent shock. hat is generally spoken of as the building-up 
process should be resorted to, especially when the patient is 
very much debilitated, before every operation that will per- 
mit it 

Following the operation, in addition to the usual means of 
stimulation, as the application of external warmth and the like, 
stimulating and nutrient enemata may be given. The first 
enema may be administered while the patient is on the table 
and still under the influence of the anesthetic, This may be 
repeated every three hours, or, if the patient’s condition allows 
it, at longer intervals. Kelly recommends an enema consisting 
of two ounces of brandy, twenty grains of carbonate of ammonia, 
with sufficient water or beef-tea at 37.8° C. (100° F.) to make 
eight ounces. Either of the following nutrient enemata may be 
used to advantage (see Rectal Feeding) : 





ANESTHESIA AND DIET. 549 


> Tit 2 to 3 ounces (80-90 
Brandy, 1 ‘ounce (a0 ca), i a te 
(2) Whiter of two 
Peptonized milk; 6 to 7 ounces (180-200 cc. 


Anesthesia and Diet.—In general the following 
may be adopted with satisfactory results in all cases wl 
an anesthetic is to be administered and circumstances per- 
mit it to be carried out, The day yrspeding the 
the patient should keep quiet ; the bowels should be th 
emptied by means of a saline, and the diet should be light and 
easily digestible. The supper should be a light one, and the 
breakfast on the morning of operation should consist of a glass 
of milk, a cup of beef-tea, or a cup of weak cocoa. If there is 
hunger, a small piece of toast or a biscuit (cracker) may also be 
given, This should be given at least two or three hours before 
the anesthetic is to be administered. If the patient is weak 
and in need of a stimulant, an ounce or two of brandy or 
whisky may be given, diluted with a small quantity of plain or 
of carbonated water, a half hour or more before the anesthetic 
is to be administered. At the time of anesthesia the stomach 
should be empty! This has a tendency to lessen the nausea that 
is apt to follow the operation, and prevents vomiting while the 
operation is in progress. If the stomach contains food and 
vomiting occurs, the vomited material may be drawn into the 
larynx and cause choking or severe coughing, or it may be 
drawn into the lungs and cause pneumonia, The vomiting and 
coughing may, besides, interfere materially with the progress of 
the operation. 

Tf it is necessary to administer an anesthetic after a full meal 
and circumstances permit, an emetic may be given to empty the 
stomach before operation is begun, or it may be better to wash 
out the stomach. 

Nausea is apt to follow after anesthesia, particularly after the 
administration of ether; this has been discussed in a previous 
Reragrapl Tf nausea does not occur, a cup of weak tea or of 

iluted milk may be given two or three hours after the oper 
tion, and if that is retained, milk may be given as often as 
every three hours if desired, For supper, bread and milk or 
cocoa or a slice of toast and a cup of tea may be allowed. Tt 
is well, however, to wait until the following day before giving 
anything more. On the following day, if there is no nausea or 








560 DIETETIC MANAGEMENT OF SURGICAL CASES. 


other untoward symptoms, a light breakfast may be given, and 
Ser Site mecdl t rot wo a peciansy a oe 
will allow may be made, 


DIET AFTER OPERATION. 

‘There are many erroneous views concerning the diet suitable 
after operations. These views are held not only by many sur- 
geons of large practice, but by physicians and hospital men as 
well, Fortunately, the day is passing when the surgeon eon~ 
siders his duty done when he removes his operating gown. 
There are still hospitals, however, where much of after- 
treatment of operations is delegated to untrained men, who, 
often fresh from the lecture-room, are uncertain as to what diet 
the patient should receive, and therefore leave this entirely to 
the fol hould be ised by the 

iet following operations sl supervi 
surgeon himself or by an assistant who has been 
trained for the purpose. In operations about the mouth, as for 
harelip, and on the alimentary tract, the management of the diet 
is often of as much importance as the operation itself. Hans 
Kehr maintains that the diet is as important a part of the 
technic after operations as the sterilizing of hands and instru- 
ments is before it- On account of the difficulty of maintaini 
a proper diet at home, owing to the interference of woll-inten= 
tioned but misguided friends, he refuses to operate at the home 
of the patient except when transportation is out of the question. 

It should be remembered that confinement to bed for weeks 
after an operation greatly impairs the nutrition, and every effort 
should therefore be made to select operations that reduce the 
period of confinement to bed as much as possible. The patients 
should be allowed to get up as soon as practicable, if only to sit 
in a wheel-chair, and so make airing more easy. Many ingen= 
ious devices have been invented for maintaining comfortable 
positions and at the same time permitting the patient to be 
moved about. In some eases massage and electricity may be 
employed, and whenever it is possible the patient should be in 
the fresh sir a part of the time. Wherever feasible the bed 
may be rolled to sun parlor or to a porch to supply the neces- 
sary light and air, When this is done marked improvement in 
the nutrition of the patient follows. 

Tn patients who are up and about no especial diet is, as a 
rule, necessary, except after operations on the mouth, larynx, or 
alimentary tract (see p. 552). The dict should be as simple and 











il 


DIET AFTER OPERATION. 551 


nutritious as pom ble eal that of the ordinary individual. 
Diabetics do best on the diet advised for diabetes, and on such 
a diet healing may be facilitated, whereas on an ordinary diet 
it may progress but slowly or not at all, Gouty and creer 
patients should receive especial attention, as has been directed 

in a previous section. Wegetarians should Lanipey decry = 
to a mixed diet—indeed, a few weeks’ stay in a hospital may 
serve to cure them from the folly of pursuing such a diet, 
Children should be fed as directed in the section on the Feeding 
of Infants and Children, and in all cases, where the condition 
permits, the child should be accustomed to the diet of the hos- 
pital before the operation, or the results of improper feeding 
may be wrongly attributed to the operation and much harm 

result. 


Tn all cases the individual should be carefully studied as 
regards his habits and nutrition. It is surprising to see how 
the condition improves and the appetite returns after pus has 
been evacuated. 

‘Those habituated to the daily use of alcohol for years should 
receive a moderate average amount, lest nutrition be interfered 
with or, delirium develop. The amount should be the minimom 
required to secure results, but should not be so low as to defeat 
the purpose for which it is given, 

Diet after Operations about the Head.—Following 
all injuries or operations about the head the dict should be 
carefully regulated. For the first few days the diet should be 
light if the brain has been affected—usually liquid—and as 
nutritious and as easy of digestion as it is possible to make it, 

The bowels should be ellie pen. No alcohol should be 
allowed except in the case of habitués, and these should receive 
the minimum amount based on their previous daily average. 
Tf the patient is unconscious or unable to swallow, he should 
be fed with the nasal or stomach~tube or rectal feeding may be 
instituted, 

After brain operations, when there are no unusual symptoms, 
the diet should be liquid for the first two or three days and 
then a semisolid or even an easily digestible solid diet may be 
allowed. Milk-toast, junket, bouillon and egg, soft-boiled or 
poached eggs, squab, chicken, and the like are allowable. The 
diet should be ight but sufficient in quantity until the patient 
is up and about, when the amount may be increased until a 
nearly normal diet is taken, 

Tn operations of a plastic nature about the face, where the 


often very bags pulled apart. 
Diet after : Hlarellp or Cleft- 
lowing these operations especial attention ne the hp 
The child should be sent to the hospital several or even 
weeks before the operation, in order to accustom to the 
attendants, to the hospital feeding, and to teach him to take 
gietiahineat from a spoon or by means of a long medicine= 
If the patient is an infant, it should receive the diet 
pair it is increasing in weight. If breast milk is to be 
‘iven, it should be taken from the breast with a 
Sod fed to the infant with a spoon. The reset, eran 
should be observed, and the technic of preparing and preserving 
the milk should be carefully carried out. The infant sl 
Led be allowed to suck too soon, for fear of breaking open the 


ad all mouth operations the diet should consist of cold 
sterilized milk or modifications of milk unti) solid food can be 
taken. Rectal feeding or feeding by means of a masal tube 
may be used as a temporary expedient, 

Diet after Esophageal Operations.—Following esoph- 
agotomy rectal feeding may be employed, or the patient may 
be fed with a nasal or a stomach-tube until he is able to swallow 
without pain. The food should be of liquid or semisolid con- 
sistence until the wound has healed, except when the patient 
may be trusted to masticate all food very thoroughly. If the 
food is regurgitated through the wound or if it passes out on 
swallowing, the feeding had better be accomplished by means 
of a tube, or rectal feeding may be instituted for several days. 

Diet after Excision of the Larynx.—The diet after 
this operation is a matter of great importance. Formerly great 
difficulties were encountered, and gastrotomy was often resorted 
to as a means of furnishing food to the patient, With im- 
provement in technic this may now usually be dispensed with. 
(The student is referred to the text-books on surgery for an 
account of the improved technic.) 

The length of time that must be allowed to elapse after the 
operation before the patient can be permitted to swallow is de- 
pendent upon the patient's condition. Graf operated upon & 
patient who was able to swallow on the day following the opera- 

















DIR AFTER OPERATIONS ON THE STOMACH. 558 


tion. The of time varies ordinarily from four days to 
eight weeks or . During this time rectal feeding may be 
employed at the outset, or the nasal or the stomach-tube may 
be used. Some operators insert a tube in the esophagus and 


dermned and is not in general use. 

Diet after Operations about the Gall-bladder or 
Liver.—Following operations upon the gall-bladder, where a 
fistula has been made, the food should consist largely of the 
pedis and carbohydrates. The fats are not well borne, and 
for this reason it is well to eliminate them so far as possible 
from the dietary, 

Diet after Operations about the Pancreas.—The 
functions of the pancreas, with the exception of furnishing a 
fat-splitting enzyme, can be assumed and carried on by the 
other glan The diet does not differ from that advised for 
other abdominal operations, but it may be well to limit the 
consumption of fats. The use of artificially pancreatized food 
has been suggested. This is a subject that requires further 
investigation. 

Diet after Operations about the Kidney.—In all 
operations about the kidney the diet should be so arranged as 
to make the work of elimination as easy as possible for the 
organ. ‘This may be accomplished by a diet such as bas been 
prescribed in chronic or even in acute nephritis. All irritating 
substances, in partienlar, should be avoided. 

Diet after Operations on the Stomach,—In pre- 
paring patients for operations on the stomach the fact that 
such individuals are often emaciated and weakened by long- 
continued illness must constantly be borne in mind; on this 
account such patients should, wherever possible, be “ built up” 
for at least a week before operation. In order to accomplish 
this result as much digestible food as the patient can consume 
should be given him. It should be offered to him in as appe- 
tizing and in as concentrated a form as possible ; asa rule, only 
small quantities at frequent intervals should be given. 

Tf necessary, rectal alimentation should be practised ; in indi- 
viduals who are anemie and very weak, the use of a salt infu- 
sion the day previous to the operation is advisable, In all 
operations on the stomach it is most important that the organ 
be as sterile as possible, and also entirely pd before the 
operation, Since the noteworthy experiments of Cushing and 





554 DIETETIC MANAGEMENT OF SURGICAL CASES. 


Livingood,' by which these investigators established the fet that 
an amierobie state can be produced in the stomach and small 
intestine, Finney, as well as other surgeons, has taken advan- 
tage of this fact in his surgical procedures on the stomach. 

‘By washing out the stomach thoroughly with sterile water 
twice daily and feeding the patient on a sterile diet the stomach 
a be kept free from micro-organisms. Finney advises the 
following procedure : 

“ For three to four days preceding the operation the patient 
is fed on sterile liquid food at intervals of two hours. The food 
is served in sterile dishes, Always before taking nourishment 
the mouth is thorougly cleansed with a 1 per cent. solution of 
earbolic acid. 

“Yor four to five days after the operation nourishment is 
administered only by means of rectal alimentation. Normal 
salt eolution enemata are alternated with the nutrient enemata 
at intervals of every four hours. 

“On the fifth day after the operation egg-albumin is given in 
teaspoonful doses, ually increased to one-half ounce every 
two hours, if well borne, and finally to one ounce every two 
hours on the sixth day, and two ounces on the seventh day, and 
four ounces every three hours on the tenth day, 

On the twelfth to the fourteenth day the patient is given a 
soft-boiled egg, and the following day soft food, and on the 
eighteenth day light solid food.” 

Surgeons differ markedly in their views regarding the time that 
should be allowed to elapse after operations on the stomach 
before mouth-feeding is begun, Some, as Ozerny, allow eight 
days to elapse, whereas others, as von Eiselsberg, give very 
light food, such as milk, the day following the operation. 
According to Kehr,' the following regulations as to diet should 
be maintained after operations on the stomach : 

1, After operation, the diet should be regulated at first 
from hour to hour, then from day to day. 

2, Strong, healthy individuals may be allowed to go with- 
out food as long as their general condition warrants it. 

“3, The more extensive the operation, the more care should 
be exercised with the diet. 

«4, Patients weakened by cancerous growths may be allowed 
liquid food as soon as the effect of the anesthetic has worn off. 

“5, An exact knowledge of the motor as well as the secre- 


‘ols Hopkins Hlompital Report ol, kx, 
) Leyden's Handbuch der Ernaihrunge Therapie, 2d edition, vol, il., p, 555. 


—s 


PEEDING THROUGH GASTRIC OR IREREEIRAD FISTULAS, 555 


tory functions of the stomach will indicate the proper method 
of feeding in these cases.” 

Diet after Operations on the Intestine.—In opem- 
tions on the Le eens the intestine the dietetic regula- 
tions are similar to those previously described under 
on the Stomach ; food may, however, be given by the mouth 
carlier than after’ operations on the stomach, The food should 
be of such a nature as will not leave too solid a residue in the 
bowels ; it must also vary according to the pathologic condition 
peel ad wal ieee to de ectenbet ithe eangali gee 

jure, 

After an ordinary appendix tion the patient may be 
given liquid sem ti ate day after operation ; on the 
third day a soft diet may be allowed, tnd on the fifth or sixth 
day solid food may be taken ; on the other hand, if the opera~ 
tion has been s serious one, with pus-formation and a gan- 
gronous appendix, he may be roquired to be fed exclusively by 
reotal enemnata for five or six days or more. 

The cause of death after gastric and intestinal ashore, 
according to F, Ehrlich,' is not so much shock as exhaustion, 
brought on by starvation before and after the operation, To 
prevent this he feeds his patients immediately after the ether 
nausea has worn off, and he feeds them well, 

He feeds his patients by a routine method in the following 
manner: So soon as the nausea from the anesthetic has worn 
off, the patient gets tea, red wine or gruel ; on the day after the 
operation he is given sweetbread in bouillon, even if it nauseates 
him; if the nausea is persistent his stomach is washed. On 
the second day, finely chopped, cooked squab, chicken or veal 
is added ; on the third day, beef, potato purée, and cakes; on 
the fourth, chopped ham (raw), soft zwieback, and soft-boiled 
eggs ; on the fifth day, white bread and spinach. After the 
seventh day the meat is not chopped and then the patient 
returns gradually to normal diet. The bowels ure regulated 
with oil enemas. The shock of the operation does not usually 
last beyond the third day. 

After operations on the rectum the patient is kept on a fluid 
diet for from four to five days; after this a soft diet is given, 
and finally, in six or seven days, solid food may be prescribed. 

Feeding Through Gastric or Intestinal Fistulas.— 
After gastric or intestinal fistulas have been made, the patient 
may, if necessary, be fed through these openings as early as 

} Minchener madicinische Wochenachrift, 1904, ii., 613, No. 14. 





556 DIETETIC MANAGEMENT OF SURGICAL CASES. 


a few hours after the operation, It is best at first. to give 
very small quantities of liquids at frequent intervals, 
Kehr advises alternately, every two hours, one-half cup of tea 
Ga a say Mane neon the second day, wine with 
adds bouillon with an egg on the third day, and 
begins wise “mushy ” food, such as potato soup, flour soups 
with egg, beef-tea with minced breast of chicken on the eighth 
day. After three weeks the patient may be allowed to masti- 
cate his food, and then, by means of a rubber tube, pass it into 
the stomach through the fistula, 


ARMY AND NAVY RATIONS, 
ARMY RATIONS. 


By the term “ration” ix meant the sum-total of the daily 
allowance of food issued by a government to its soldiers and 
sailors. Candles and soap also form part of the ration, Com- 
putation of the quantities of the various component parts of 
the ration is greatly facilitated by the use of the * Army Ration 
Issue and Conversion Tables,” which show, almost at a glance, 
the amounts required for any number of rations from 1 to 50,000, 

The subject of army rations bas reccived careful study. ‘The 
subjoined tables, taken for the most part from articles on army 
diet by Major Charles E, Woodruff, of the United States Army, 
give a summary of the rations furnished the various armies of 
the world. 

The ration in times of peace is easily arranged. Whether or 
not the soldier is well fed will depend largely on the commander 
and the cook of the company. ldier is required to do 
his own cooking, except in garrisons, when certain men are 
detailed for that duty. If the cook is energetic and skilful, he 
will be able so to arrange the diet as to give the men sufficient 
variety ; if, in addition to the regular ration, there are a kitchen- 
garden at the army post and a well managed “ savings fund,” 
the company should live very well indeed. On the other hand, 
if the cook is unskilful or lazy, and if there is neither kitchen- 
garden nor savings fund to draw upon, the company will receive 
& monotonous or even an injurious diet. The “savings fund” 
is made up of the money obtained from the sale of unused 
rations, That part of the ration which is not utilized is resold 
to the commissary, and the money so obtained is expended by 
the commander of the company for table luxuries. The fund 
is angmented by the profits of the “Post Exchange,” which is 
a sort of general store where tobacco, lunches, and the like are 
sold. The amount and variety of food supplied are set forth 
in the following tables,' compiled by Woodruff from observa- 
tions made by him at Fort Assiniboine, Montana : 

Woodruff, The Journal of the American Medical Association, December %, 
1892, p. 651, - 

sa 





3 


ARMY AND NAVY RATIONS. 





apeea pa seeeagpecaatsnsgasts 


i 








yates, | Salta | Calorie. 





Spa -Sparanse 9 guencanapgygaaas 









aSSUgg4scayessanegenngys a3 








sdeiggeseegneginegincesgna~2~ 

















Iwelsh,| Waste. |Netwelght| Water. | Protein, | Futs. 








Uncooked Food of Garrison Rations for ten Days. Weights in Pounds, Daily Average, $40.4 Men.—{ Woodruff.) 

















A cnn cach 
"herman, Percetit-of ameaten, 









‘man, ‘anee. 
4379 The flour . . - 15.91 ounces, 18 ounces. Toeludes purchases, 





on ig. a 
« Ys « 
ounce, 24 “ 
Bidite poms’ 1880 188 «80 cent, of vegetables 
wows - 18. - 
700 lie chow. | 280 a A a 50 Sen: sob: of soeetablan: 
Fees 





The United States is the only nation that furnishes the entire 
ration to the soldier, The following table, compiled from the 
« Army Ration Issue and Conversion Tables,” gives the United 
States Army ration : 





560 ARMY AND NAVY BATIONS. 
AxticLEs. Quantins, 
Meat Components. Ounces, 
0 RO es OME Co fa 2 
fr mutton whén the cst doss not exceed hit ‘of beet ] 





= 
= 


2 An 
ee 


rf 
HE 





trogps in the field when necesmry to enable 
detonate er eee 


Pa 
aS 






Or potatoes 11} and ened onan 6 
Or other fresh vegetables not canned when they ean be obtained 
in the vicinity of the pox or transported in a wholesome 
condition frmmadatesse'. sss st cn ae an 6 


ge (gills) 
el Black = 


Travel Ration,—This j is oe when nals tvel by be 
rom cooking 


or when they are separated for short peri 
facilities and do not carry cooked rations. 





ARMY RATIONS. 561 


On arriving at their destination the ordinary ration is resumed. 
When traveling beapang ba een oo man may be 
allowed a cash sum per day for the purchase of prepared coffee 
in liew of the coffee and sugar of the travel ration, 

The emergeney ration consiste of 
0 ounces 
6.0 





Woodruff states that the travel ration is insufficient for men in 
very active service. The ration is planned for healthy men and 
in order to make allowance for those who fall sick, the money 
value of the ration is given to the surgeon, who purchases what- 
ever diet is needed in addition to certain articles, such as con- 
densed milk and beef-extract, issued by the medical department. 

Concerning the selection of a ration Woodruff says: “An 
army must be fed at a great distance from the market, and it is 
therefore evident the chief objects in view in the selection of 
the soldier’s food must be facility of transportation and ease of 

reservation in all climates, Articles that are bulky or easily 

maged by rough handling, and those that are not easily pre- 
served from decay, are at once ruled out. It need searcely be 
mentioned that the articles must be produced in abundance 
throughout the country, neither imported nor the particular 

reparations of a few manufacturers. Couple with this the 
rot that the articles must be so inexpensive as to refute any 
changes of extravagance, and it will be readily understood that 
with a few exceptions the ration contains about all the articles 
that it is possible to put in at present without calling on foods 
that are preserved, canned, or otherwise specially prepared.” 

For the reasons just stated Woodruff says that the soldier's 
ration has always been simple and dry. There was but little 
change in the army ration until recent years, In arranging 
the ration for an army there are a number of matters that 
require careful consideration, An army in a cold climate 
can not thrive on the same diet that an army in the tropics 
would do well on, and vice vers4, In a cold climate any article 
that will be spoiled by freezing must be eliminated from the 
dietary. This exclides potatoes, fresh vegetables, canned goods 
that are in fluid form, and the like. 

‘The subject of diet for soldiers in the tropics is one of great 
interest. Food that excessive heat will spoil or that can not 

Ey 








562 ABMY AND NAVY RATIONS, 


zee 
& = 
i 
ris 
ree 
fa 
a 
i 


i 

E 

E 

g 

i 

I 
Lee! 


BERS 
Bae 
u 
q i 
4. 
Fo me 
Bere 
if 
rH 
fy 
Feet 
ii 
£m 
sFa 


F 
: 
Ei 
: 
i 
i 


“He premises that a tropical dietary, as com; with one 
suited to a colder climate, should et ae 
hydrates, less stimulating proteins in the form of meat, a greater 
variety of diet both of meats and of carbohydrates in the form 
of fresh vegetables and fruits, and, lastly, a fairly liberal supply 
of ice. His argument for the substitution of carbohydrates for 
fats is that the digestion is weakened in hot climates and the 
liver is inclined to torpidity, while ingested fats are to 
split up into butyric, caproic, and other irritating ack, se 

diminished secretion of the liver is unable to neutralize, 
As intestinal digestion cannot proceed in the of 
acidity, the condition known as biliousness is established, with 
putrefaction of the intestinal contents and the production of 
various harmful alkaloid substances. A catarrhal inflammation 
of the bowel results, with diarrhea, which is at first of advan- 
tage in eliminating the harmful substances, but which under 
the continued irritation of unsuitable diet is liable to continue 
and become aggravated. As to a lessened use of meat, he cites 
the dietary customs of the inhabitants of hot climates, who 
their proteins less from meat than from the leguminose. 
appetite is lessened by long and continued beat and becomes 
capricious. It craves variety, especially in vegetables and 
frnits, and these he claims cannot be had on the basis of our 
present ration. The need of ice to furnish a cool drinking 
water and to preserve the perishable constituents of the mation 
is regarded as obvious.” 

. An admirable essay on “ The Ideal Ration for an Army in 
the ics,” by Captain Edward L, Munson, appeared in the 
Boston Medical and Surgical Journal for May, 1900. Munson 
thinks that the present ration is very well chosen as to its 
nutrient properties, but that it should be rearranged for use in 


al 














‘Total carbon, 395.14 grams; nitrogen to earbon, 1; 10.6, 
The following table gives dietary suitable for the 


tropics, and po Bee the to field service ; in this the 
fatty constituents attain their maximum and the potential energy 
is high 


. Tropical Dietary IT. 

















‘Total carbon, 828.76 grams; nitrogen to carbon, 1:23, 


The nutrient value of the ordinary dictary as proposed for 
garrison duty in the tropics is as follows : 


Tropical Dielary III. 

















53.80 | 517.24 | 105,88. 
‘Total carbon, 823.76 grame; nitrogen to carbon, 1 51% 














564 ARMY AND NAVY RATIONS. 














‘Total carbon, 927.60 grama; ultrogen to carton, 1: 19.6. 


On averaging these four dietaries, as furnished by the ration 
proposed for the tropics, the mean nutrient composition is seen 
to be as follows: 











To 








‘Total carbon, 890 grams; nitrogen to carbon, 1; 2. 


Tt will be observed that while these four dietaries differ con- 
siderably from one another, yet when averaged together in equal 
proportions they do not vary greatly from the nutritive standard 
for the tropics already proposed—and this is an additional rea- 
son ape the ane els ies os should not ee selected from 
day to day. It is seen that the foregoing aver lietary, as com- 
pared with the proposed nutrient standard, fs stl slightly de- 
ficient in fats and fuel-value and a trifle in excess as regards 
protein. These discrepancies, however, if they may be eonsid- 
ered as such, are readily overcome by using Dietary IL. twice, 
whereas Dictaries I., ITI.,and IV. are each employed but once. 
The results of this change are as follows : 





‘Total carbon, 36.5 grams; nitrogen to carbon, 1; 21, 


Another point to be remembered is that if the change in diet 
is made gradually, men can be accustomed te live on almost 
any food, whereas rapid changes in the diet are not well borne 
ou ano apt @ bs dollowedl by dlisan! 

‘The army ration should not be planned with a view to 
ing a soldier on the smallest possible amount of food at 
least possible iture of money. His diet should be such 
as will maintain him in the best physical condition, regardless 
of the varied circumstances under which he may be compelled 
to live. There is no economy in underfeeding soldiers. all 
wars the number of sick and of those dead from disease due to 
improper food is larger than that due to the enemy’s bullets. 

Many theories and opinions regarding what constitutes the 
best food for a soldier have been advanced, On one point, 
however, all are agreed, and that is that the diet should be 
varied and should be so arranged as to allow of substitution of 
various articles, so that the ration may be varied to suit the 
changing conditions. This variation should be made by the 
commander, on the spot where the army is located, and not kl 
some one hae eat with the exact surroundings and 
of the men. Owing to the carelessness or ee of com= 
manders, a monotonons, disease-producing fare is often fur- 
nished, when the food might easily be varied and rendered 
suitable, A well-selected dietary presupposes a competent com- 
manding officer. 

The dryness and sameness of the food of soldiers doubtless are 
responsible for much of the drunkenness that occurs among them. 

When the troops are in permanent Sap wi reach of 
markets, and when the facilities for cooking have been properly 
arranged, practically the same ration aa is at an in the gar- 
rison may be used. When at a distance from the base of sup- 
plies and with no available market, the food must be of such a 
nature as to allow it to be easily transported in the supply 





LANE LIBRARY. STANFORD U 


ARMY AND NAVY RATIONS, 





i also palines and reps i chocolate and dried fruit have like- 
wise been recommended. Experiments have been made with 
various materials for emergene y rations, among them being 
dried meat of various kinds, and grain mixtures erihat could be 
eaten with or without coo! 

Various prepared foods are alo used, In the German Army 
“Erbwurst” is highly esteemed. This is a mixture of 
meal, fat, bacon, herbs, onions, ete., put up in the form of small 
sausages. It is mannfactured in the Government factories, the 
secret for making it having been purchased by the German 
Government from the inventor for $25, 000. If used too con- 
clea it is liable to produce flatulence and diarrhea, and a 

islike for it is engendered, Its chief value lies in the 

that it is igh and more easily transported than most 

any ar form of food, and that it is easily prepared for use. 

English soldiers object to it on account of its seasoning, but 
employ similar preparations of pea soup. 


Composition of Certain Prepared Military Foods, 































8 
3 : i 33 Authority. 
FI e* 
2 zie le 
Erbwus 1200 | 1.18 | 9.08 | 47.50 | 116 | Bl 
Efrat 20° ss | ah | Sm | Pate 
Dried pen Sou’ jis | Tos | “hi | ie va Kine 
‘Dried pea soup (: 808 | 15.81 | M41 | 36.78 | 169 | 1858) 
Ropeensou used iby bert} 4.78 21.00 | 17.25 | 46.45 | 4.40 608 | {8 Foca 





‘7 


ABMY RATIONS, 667 


In addition to the foregoing, either tea or coffee must be sup- 
plied. It must be borne in mind that the emergency rations 
are to be used only when necessary, and. that they are not to be 
relied upon for any length of time. They may contain the 
proper proportions of protein, ete, but they are dried foods, 
and their bulk is too small. 23s koma copes a 
cient food into a small compass, consequently condensed 
foods of any kind are of little value. 

At the present day, the preservation of food has reached a 
degree of perfection when almost every variety of food can be 
preserved for use. Where Tansporiaton Sallis peti 
may be used, but they are bulky and do not withstand the 
extremes of climate nor rough handling. 


Comparison of Foods of Soldiers with Various Other Dictaries, 












Grams, Grains. 

i ; 

AEE 

samara g gg eigig 
‘Mechiaiee (Conn at) 105 | 147 | M00 | 3485 | 266 | sas 
ace ceive (ea 1) ) S| ae 
EE eerian ea isa lc | | | ee 
UB eld raion (vera) 2 om on am Be 
‘Teamsters, hard work (assich ‘363 736 | 6T | aD 





‘There are so many factors to be taken into consideration that 
it will be impossible to analyze here the rations supplied the 
different armies. Americans, on account of the hi; plane 
of activity on which they live, require the stimulating effects 
of an abundance of fresh meat, In Europe fresh meat is 
expensive, and for this reason the nitrogen is langely supplied 
in the form of peas, beans, cheese, ete. In the Russian ration 
the percentage of meat is somewhat low, but the deficiency is 
made up by . 





568 ARMY AND NAVY RATIONS. 
The United Stales and Foreign Army Rations Compared.—{ Woedreff:) 












i 

=e i|P 

Gm. | Gm. 

1 Bogland. . . 1. 1) 244 | 1988 

ge) ee | ae | * 

ux | i 
vw) 45 No. e 

“al ee 
«.L Ponce... - ifm No.8. 
* Wrinthe aod | as No. de 

% Austria & ‘iis | 08 
: i |e No.5. 

4 Italy « 33 30 
143 | 600 ek 

6, Germany .. .1, Small ~ rations A ieee 

ry yrtior Moxi: 160 4) 708 
tena} Siaioas | “| 2) Be] se lps 

tt 


rations) | 

portions | Maximum | 172 

on taarch or in { Minimum | 138 
DOOUYETR, + 


z 
= 
A 
5 
3 £5 
s8euhishig 802822 £2 $2 EE eSSGEee8HS75EzY: 


Minimum | 7%| 75 | 616 

















6, United States .1. Bylaw... . NE aE 
2 Usually in field {Maximum | 106 40 No, & 
‘(by inw) inimum | 64) 240 | 460 
< 85 ‘00 
4%, Food actu 
elim 
ie) 3 | Be 
7, Franca... « War ons fiat | 186) Tet |B No.9, 
2 ounces 9t brandy ie 
‘Maxis = 14) 976 
& Romina... L Pesce ans {Mitra is | “os | 348 No. 10. 
A ounces of wine... | 9» + peel 
Maxis m4 62) 805 
RWar. cease Minimum | 149) 00 | 64 No. 1h 


Add dj ounces of wine. | su | +s 





As stated elsewhere, the United States is the only I= 
ment that furnishes the entire ration. Other nations ae part 
in food, the remainder being purchased by the soldier out of 
his pay or out of an allowance made him. These methods are 
suitable in thickly populated countries, but cannot be rae 
for soldiers on the frontier. Foreign soldiers, especially 

mane, receive boxes from home to piece out the ration, and the 


purchasing power of money for extras is greater in 
than on our frontier. The Austrian ration, which is ly 


ARMY RATIONS, 569 


increased for field duty, is said to be the most liberal in the 
world. The Italian ration, considering the climate, is liberal, 
but may be regarded as somewhat deficient in nitrogen. The 
Spanish ration is said to supply a greater variety than any other. 

In Russia and France the rations are considered liberal. 
Wine is issued in the war rations of the cipal European 
armies, and in France this may be replaced by an allowance of 
cognac. The American soldier formerly could ea reasonable 
ea ee a ea canteen, The aboli it of 

canteen has increased ess in our army, 


REMARKS, 


No. 1: This is starvation diet, and the extra food needed for 
health is purchased and charged against the soldier (about six 
cents a day), increasing, perhaps doubling, the food value. 

No. 2: be greatly changed to suit climate. 

ae 3: Sufficient for such a mild climate and very moderate 
work, 

No, 4: Varies enormously according to class of rations 
issued. Very many extra allowances of money for food, 

No. 5: This is augmented by four cents a day for vegetables, 
ete, On the march a limited emergency ration is used. The 
war ration is so insufficient that commanders of armies or 
smaller forces may change, supplement, or even double it. 

No, 6: Allowances of one-fifth of a cent a day for condi- 
ments; occasional extra money allowances for food. Excepting 
the protein, it is a very liberal dict for so mild a Gi 

No, 7: This is what the goverament may supply. Usually 
the soldier feeds himself and is given seven cents a day or more 
to reimburse him for the outlay, The food eaten is more than 
this deficient diet allows. 

No, 8: Maxima due to fats if all the bacon is used and no 
meat. The entire ration is supplicd and intended to be eaten. 

No. 9: Peace ration not stated, Tt is purchased as needed 
and charged against the soldier, War ration is subject to great 
augmentation for increased work or cold climate. com= 
manding officer may augment ration on the march. 

No, 10: Also allowed money to buy one-half to one and one~ 
half ounces extra meat, and one to one and one-half cents for 
ve ibles, salt, butter, ard, and groceries. 

Fe. 11: Extra meat and spirits may be ordered by the 
commander-in-chief. 











570 ARMY AND NAVY RATIONS. 


NAVY RATIONS. 


The following law was enacted in 1903: “ United States 
Navy ration shall consist of the following daily allowance of 
provisions to each person: One id and a quarter salt or 
smoked meat, with three ounces of dried or six ounces of canned 
fruit, and three gills of beans or peas, or twelve ounces of flour ; 
or one pound of preserved meat, with three ounces of dried or 
six ounces of canned fruit, and twelve ounces of rice or eight 
ounces of canned vegetables or four ounces of desiccated vege- 
tables ; together with one pound of biscuit, two ounces of but- 
ter, four ounces of sugur, two ounces of goffee or cocoa, or 
one-half ounce of tea and one ounce of condensed mi or 
evaporated cream ; and a weekly allowance of one-half pound 
of macaroni, four ounces of cheese, four ounces of tomatoes, 
one-half pint of vinegar, one-half pint of pickles, one-half pint 
of molasses, four ounces of salt, one-quarter ounce of pepper, 
and one-half ounce of dry mustard. Five pounds of or 
4 suitable substitute shall be allowed for every hundred pounds 
of flour issued as bread, and such quantities of yeast as may 
be necessary. 

“The following substitution for the components of the ration 
may be made when deemed necessary by the senior officer 
ent in command: For one and one-quarter pounds of salt or 
smoked meat or one pound of preserved meat, one and three- 
quarters pounds of fresh meat; in lieu of the article usually 
issued with salt, smoked, or preserved meat, fresh vegetables 
of equal value ; for one pound of biscuit, one and one-quarter 
pounds of soft bread, or eighteen ounces of flour; for three 
gills of beans or peas, twelve ounces of flour or rice, or eight 
ounces of canned vegetables, and for twelve ounces of flour or 
rice or eight ounces of canned vegetables, three gills of beans 
or peas. That an extra allowance of one ounce of coffee or 
cocoa, two ounces of sugar, four ounces of hard bread or its 
equivalent, and four ounces of preserved meat or its equivalent 
shall be allowed to enlisted men of the engineer and dynamo 
force when standing night-watches between eight o’clock post 
meridian and eight o’clock ante meridian under steam.” 

The new and old scale of the English Navy Rations is given 
for comparison with the above. The new scale was 
October 1, 1903, and from the report of Staff Surgeon J. 
Faleoner-Hall! seems to be satisfactory. 

3 British Medical Journal, Aug. 6, 1904. 





NAVY RATIONS. 671 


Scale of Dietary for Officers and Men, 


Ig... Biscuit. 





Nee, sce Spar cd Chocolate ordinary | | 





When Fresh Provisions Cannot be Procured. 


Issued every Issued In rotation, 
other day— first day— 
Dilbert att oe Salt pork. 2.2... Ib. 
BR Lbs So dina lit peas eres a. 


pressed vegetables . | | 1 oz. 
dos toevery.... + Celery seeds... . . . fo. toevery 


8 Tb. put in 8 Ib. put in 
the coppers. the coppers. 
On one alternate day— Second day— 
Tm fee eee + + Galt beef... . 02. fe ol 
Compressed vegetables. | / Los. 
Pon 2. eee eee Flour... -. . 2206 os. 
Roz. eee But... 2. res os 
poms es a vere hk Raisins 2 le Zon 
On the other alternate day— ‘Third day— 
on we ee ee meat . 9 on 
with either with either 
ee ee dos. 
4 on. preserved potatoes . Compressed vegetables lox 
or or 
4 on. rice . + Flour . . 9 on 
or 
Qo floor... .. ~~ Suet... ee os. 


fosrmuet . 2... 6: sing 2 es we ee on. 


Ra 
I} oz. raisins . |. | |. Compressed vegetables. ©: 1 on. 
or 


572 ARMY AND NAVY RATIONS, 


The in sea-going training ships and boy artificers 
receive aa ieee scale with the addition of $b. fresh meat 
SAP saad Sie, Scr, 2 ce rail andl Vcr eres Sere 

ith fresh meat. 

The following regulations, taken from the General Mess 
Manual and Cook Book for Use on Board Vessels of the United 
States Navy, 1902, gives many interesting facts concerning the 
organization and management of the mess : 


PART L—THE GENERAL MESS, 


‘must include all en] men of the navy and marine corps, chief 
‘servants, and its members are to be into. 
mosies of about twenty men each, and as nearly as possible by 
i of by ratings, as has heretofore been the custom. By this method the 
yy officers will be scattered among the messes can be no 
‘on account of discrimination—all faring alike. 


jinati 

2A mesiman is to be detailed for each mex, and he is to recxive the food 
from the cooks at the galley, serve it at the mes table, and is responsible for 
the care and the cleanliness bles. 

$. The chief commisury steward, 
with the storekeeper (when a store js established on the ship), 
form the enlisted force of the commissary ee They are the assist 
unts of the pny officer and belong to the pay division. 

4. The ity of the commiwary and his assistant ceases with the 
deli of the food to the mesamen at the galley, 

5. hs rina 2408 of Pay being et to secure tas beatae Aan 
petent and experienced men, the payment of any gratuity, either by the com- 

or by the men themselves, to pepigrones employed in the service of 

the general mess is forbidden by the regulations. 

‘The commanding officer should see Ee? facilities, including such 
boats and men as may be necessary, are afforded the commissary for getting 
mess stores on board and stowing them. 

7. It should be thoroughly understood that the gener] mess is not an 
i by its members, as was the “bei lock mess.” 


wary to investigate the Rape complaint is well founded, to take 
com- 





NAVY RATIONS. 573 


officer, an officer by the captain, is the commissary, and 
Sic pn fr heparan ap prparation of the bod for he exer 
eeplag the nocouade ot the seb ad oxtisteleterlogsall ts affairs except the 


i 
serving of the food at the mess table. 

14. His authority in the performance of these duties is commensurate with 

i ty, and all persons exxployed in the service of the goneral moss 


ject 
1 commis ary paseeey inspect a eo et 
general mow, the stores are properly stowed 
ive Yeterioration te the stores: 


Any 
direct low to the mess great care should be exercised in thelr lection and 
tre quanti Le fa tone ie then can boned with the 






ived on 
randum by which they can be checked off; and 
stor thould be carefully inspected by the commisary or the gomnmissary 





hip alls from 
17. The commisary should keep the cash accounts of the mess so that 
cao be, convenicdly ated. by the encalSompecto of the pay corps the 
r - = 
Pozieaoes mat be xlaruxtlted by qunchiosy whioWvasw’to la eettbltacinta 
the accounts are inspected. 
18, He should cause the commiswry steward to keep a stock account which 
shoal embrace all stor anal property of the ener em The ale 
Enccount should be taken into considerntion 


himself is not authorized to make, 
20. The commitstry should mark the enlisted men of his department in 


proficiency in rating and shonld immediately report any inefficiency or careless 
now in their performance of doty. 


21, He should frequently inspect the food before it is delivered to the mem 
men at the galley, and in case he finds it improperly prepared, should take 








574 ARMY AND NAVY RATIONS. 


Sateen pie hens perce eer his dation and ean ble 
ie formance 
ape rratpar at eemeenec tie ton pe Monty. Tho ail il 


2K He should report to the commieary dally, in writing, all purchases 
made and debts contracted, and. Keep that olfcer advised of the needs of the 
mes, He is todraw from the pay ent, at the appointed times, such 
Government stores ax aro due the meas, and must keep an account of these 
stores for the verification of the provision return nt the end of each quarter, 
‘When fresh provisions are issued, he should be on deck, when ‘io 
goonkye tise: fom the reprenstative of tho pay dopartiaeal 62 soca ad 
have been received on bourd and inspected. In case theoe fresh 

any other stores issued to 


in or 

the moss by the pay department are, it thin 

Fgart he matt tothe comaabmary, ht ohall abe w pamceal i vasiese 
matter to the coms who al make a 

cave he finds the objection well founded shoul take the 

steps to provide other stores, a» prese: t tions. issuing 

Book shone kep by the fay eon and ily by the commiary 

steward, in order that no question may arise at the 

the stores drawn by the general mes. The commiaary stoward may, with the 

authority of the coummisary, draw from the pay department sock Goverment 

stores a8 are required in excess of the allowance, and theve stores shall be paid 

sata the mew fund at the end of each mont! 


inspect all food before it is delivered to the messmen. It ix his duty to report 
to the es any inefficiency or neglect on the part of his asistants; 
otherwise the entire blame for poor cooking or any other delinquency at the 
galley should rest upon him. The head cook should keep the commisary 
‘steward informed as to the requirements of the alley, and should from time 
to time prepare lists of articles required by him in his cooking, which are not 
included in the navy ration. He is responsible for the gulley atenails, and 
will immediately when any are lost, worn out, or damaged. 

29, The ter, cooks should, ns far a8 pombe, be assigned specific duties se 
the gulley in order that the responsibility for ‘any neglect may readily bo 
placed. One should be detailed as “meat cook,” another as “vegetable cook,” 
and one man should, in addition to other duties, be held responsible for the 
Pp ion of the cofiee and ten. 

|. The cooks in the lower ratings should be detailed for starting 
cleaning the galley and utensils (regular cleaning stations being 
them), and for preparing the food for cooking. 

27. The organization of the force at the galley should be as complete and 
efficient aa that of a gun division. 





establiahment is 
commanding officer. The advantages of such a store are, however, #0 obvious 
tnd 40 great that provision is made in the regulations for ite administration in 
ies it exists or may be established. 

1. ‘The chtecte afm eccasianary sees eral 


and is 

being brought on board. The sale of any merchandise on board 

Pig ee 

eal sed owe welling 

special articles’ which cannot sonventantly be handled by. the 

store, may be exempt from this prohibition, bu in 
mils, pics, fruit, and such articles should not be allowed to sell 
to the men. 

82, The commissary should make agreement with reliable merchants to 
supply to the store, while the ship is in such stores ax nro miable bat 
can not be carried in stock, and theee articles should be delivered to the store- 
keeper and by him gold to the men at a very small advance. For example, if 
it be thonght advisable to have milk for anle in the stare when the ship is in 
por, the commissry should arrange with a dealer to place on boird,at « 


or itinerant merchants. ‘The it of the retail dealers profit should 
revert direct to the pated ati er he vege teal tht the 
aol fe hills el 


mary efor and the co ing oficor authorizes its aeablisant the 
tions, in charge of it, officer is to 
reorive rolaary walecriee ie the tree, giving them recelpta (stated 10 





576 ARMY AND NAVY RATIONS. 

those of retail dealers in order that the store ma} lab peerage ns 
Pésblg bal when all indettedoess kas teen lockarged a the store fs nolf 
Bereta tenes Bice sede ops erhstetema 3 Cea aoe 
in mind making money is pot one of the of the store. The in« 
justice of making profits from sles t one set of men to be divided among 
oe i 


i 
[ 
Ly 
i 

Faz 


He 
Bs 
iy 
Hl 


Fe 
pe 
ae 
pH 
e 
i 
i 
zE 
i 
| 


36, It is impracticable to operate a store unless a suitable room, used for no: 
other purpose Ant to which soly the storekeoper as noses, ia available for 


ing system : 

Books of tickets of » form prescribed by the Bureau of Supplies and Ac- 
heat! joer and storekeeper and will be 

ble at the store in lien of money. ‘The ise of these books by the Pay 
will be made at the same time ax the issue of monthly money, and by 
the storekeeper daily during the month as the men may desire to purchase 
them. For the latter iasues the pay officer will turn over from time to time a 
Limited number of books to the storekeeper, who will be held strictly account- 
able therefor, and will tur in to the pay officer daily the money received for 


‘BAe. 

shige — Newel es ney) of the ship has charge of the 
'a store. is allows ¢ services of a uty a8 

The co ion to the purchase of sock for 


aire z 
the store, should fix the prices at which the articles are sold, establish a 
i i HL its affine, 


ly inspection 
paymuster of the fleet, or i. the a ited for that purpose, 
Storekeeper.—40, The sto should be responsible to the 

commissary for the proper conduct of the store. 

He is to keep the account of the stock, and of the sales, and submit to the 
commissary from time to time lists of articles required, 

41. In order to protect the store from any los, oither through carolesmneat 
or dishonesty, the following method of keeping the accounts should be em- 


is 3 
= SiS cend ‘of cach month an account of stock should be taken by the com 
mismary steward or the paymaster’s yeoman, and the articles to be on 


hand entered in a book similar to the retam of clothing and small stores. 


columns being changed.) These quantities represent the stock on hand at the 
beginning of the new month and to them should be added all stores received 


should be entered is sak peop Bs a entree So the total receipts and 
the difference entered as “‘mlee.” By multiplying the number of each article 
fold by its selling price and taking the total of deat line in the return will bo 
found the amount which the storekeeper should have received, and this 
amount he should be required to turn in or account for, 





NAVY BATIONS, 577 


changed except at the of: and if the 
scce ti tuplored on tka Wee Palle woud ba teat estan 
can be made, this aystem will be a simple and absolute check on the 
43, The man selected for this ible di first of all, be enti 
trastworthy. "Ho must ba qulok an aocarate ef ie and see 
con 
arrange it in the storeroom, and keep the latier elean and itis 
for inspection st the applied ine Hie eto open the = 





PART 0L—THE PREPARATION OF FOOD. 


‘The Ration.—44. ‘The dietary of the enlisted men of the navy must nece* 
sarily be tased upon the mtion provided by law. In general ini where 
the circumstances are favorable, provisions which are not a part of the ration 
may at times be purchased, but articles of which there is supply already on 
board in the pay riment should not be bought unless the Government 
stores shall have deteriorated, in which case they should be surveyed and a 
new stock obtained at the first opportunity. 

4, Unless there should be ae pea reason for not doing so, the official 

to, it having been anata ete the 
necessary 


ry_ variety. 
The Galley.—46. The ship's galley for that of it used by the general 
se Teardrop eiepreipe rey coominary 
‘That officer should we that the galley nod ite utensils are iy cared 
and are ready for inspection at the appointed times. He should himself fre 
maby inspect this part of his department and advise the equipment ar 


bakers, 

and a judicious selection of the men for these rates, the navy ration should be 

- eee otto gre the enlisted men three novrishing and palatable moals 

ete , and it should be the duty of the commissary department to see that 
jone, 


Frequent inspections of the food by the commissary and the commimery 
steward and effitency on the part of the oooks, alone can insure thia, 


04 
a7 





DIETARIES IN PUBLIC INSTITUTIONS. 


Tue diet in public and in private or semiprivate institutions, 
which include armies, navies, hospitals, asylums, prisons, 
schools, colleges, and, in fact, any place where numbers of per- 
sons are fed under the direction of a steward, is a subject that 
requires close attention, During the past few years many diet- 
ery studies have been made, the greatest advantage following 

the results of such studies have been applied. In the 
line of investigation much still remains to be done, however, 
for the public bas not yet learned the importance of applying 
scientific methods to the supply aud culinary departments of 
its institutions. 

In applying modern methods to institutions a number of 

‘inciples must be considered. These may best be understood 

m a careful review of Dunlop’s Prison Dietaries, as given 
below, from which it will be seen that the amount of food nec- 
essary to nourish the body is taken as the starting-point, This 
amount is to be modified according to the condition of the indi- 
viduals to be fed. Age, sex, occupation, environment, physical 
condition, and the like must all be taken into account. The 


evaporation and waste in food kept and used must be estimated 


and allowed for. The cost of the food is an important item. 
It must be borne in mind that it is often possible to supply a 
very acceptable meal at a moderate cost where more expensive 
articles of diet, while they might seem more desirable, would 
not answer the purpose so well. The food must be suited to 
the digestive powers of the consumers, and must be served in 
as attractive and digestible a form as possible. Tt must be re~ 
membered that while the number of calories required may be 
estimated, the food representing this amount must be supplied 
in such form that it can be utilized by the individual receiving 
it. Atwater’s standards for the various classes, as given below 
under Prison Diet, are in general use in thiscountry. A vary- 
ing percentage is allowed for shrinkage and waste. This is 
usually placed at about 10 per cent, of the total energy. Mrs. 
Richards estimates 10 per cent. on the proteins and earbo~ 
hydrates, and makes no allowance on the fats (in the standards 
578 


PRISON DIETARIES. 579 


given below). Very com dietary studies have been made 
by Atwater in the hospitals for the insane in New York State, 
These studies are published in the reports of the New York 
State Commission in Laer for Se eee and 1899— 
1900. The niary adyant jis study is appar- 
ent from the fae Gah taesn toa deca $2.19 per capita 
nothwithstanding that the cost of food-products was highs 
than usual. The patients are better fed, and the diet is as 
is best suited to their condition and surroundings. 

Atwater has suggested as a new profession that of dietary 
expert. This is a field for which women are ps particu- 
larly well adapted, The dietary expert is neither a cook nor 
an ordinary steward, but should be an individual who has had 
sufficient training special lines to enable him to purchase 
food, formulate suitable and accurate diet-lists, supervise the 
keeping, cooking, and serving of food, so as to obtain the best 
results, reducing the amount of waste toa minimum, and secur~ 
ing as great a degree of perfection in the preparation of the 
food as it is possible to obtain. 


PRISON DIETARIES. 


The subject of Prison Diet has received considerable atten- 
tion, and the literature on the subject, although very large, is 
more or less inaccessible, being seattered, for the most part, 
throughout the reports of prisons and reformatories. 

Numerous views have been expressed regarding what consti- 
tutes a proper diet for a prisoner. In England the standards 
recommended by the committee appointed by the Commissioners 
of Prisons in 1878 were followed for many years, The plan 
that was pursued was to divide the prisoners into four classes : 

Crass I, ; Those confined for periods of seven days and less, 

Crass II.: Those confined for periods of more than seven 
days and not more than one month. 

Crass ITI.: Those confined for periods of more than one 
month and not more than four months. 

Cuass TV. : Those confined for periods of more than four 
months. 

‘This division was made in order to prevent those serving 
short sentences from receiving a full dietary. Since such pris- 
oners are for the most part cakes and disorderly persons, it 
was held that they might seek to be committed to prison for 
the sake of enjoying a short sentence with an abundant 





580 DIETARIES IN PUBLIC INSTITUTIONS. 


supply of food. Under the Prison Commission’s all the 
prisoners began with the first dietary after seven days, and if 
eres still in prison, they were put on the second, and so 

‘This plan is not a good one, for it would seem better to 
ely He prisoners at onee on a me 


Propoved Dietary Standards for Adults, 
(Quantities por man per day unlos otherwise stated.) 









g | 2, (8 
By whom i 2 
2 | SE) 35 
é < 
Gm. | Gm, 
‘Persons in health — eetisy conditions : 
Manat hard muscular work’... . Atwater) 150 te 
102 
. 92 
Man® with yey Titel i earns «| Atwater ® 2 
Tomates of priso tira des end 
Malo © aes at hard wor . | Danlop* 138 
Fittais ato Dunlop* 110 


male prisoners 
Bacaes aot inmates of houses of correc- 
tion, per person = Richard 
Inmates of reformatories (male) - | Richards) 








Unemployed male* prisoners . + | Danlop* 83 
Fnmator of almshoures, per person. . _ | Richards!) 76 
Punitive diet, short duration . » «| Dunlop* 59 
Punitive diet, long duration » >| Doni 


82 
The insane, per person. . . 101 
The insane, per person. . . 


(2) Assuming 92 per cent. digestible, the average in antinary mixed dict. 
(8) Those figures‘ are about 3 per Pap iral eae ven ree 
oualy, thea brence being due 12 ths edoptioa of revieed Buctoos 














)EEUEEuEs 82 ESEEE 7 





( Corresponding values fora woman are 08 as much, 
oR Figures 1 physio 
+) Figures ac  plipaclogls'demaid) hers bags | 


7 anal ellowon lowance for waste. 
ao Crore represent ration allowance, with margin for waste of about 10 


me of the most valuable studies of prison dictaries is that 
made by Dr. J. C. Dunlop for the Boottish Prison Commission, 


+ Yearbook of the Department of Agrioulture, 1901, 


PRISON DIETARIES. 581 


on careful investigation, und upon actual experiment have 





Garbo 
hydrates, 








38 | 550 | 3100 

30 | 440 | 2480 

é on 482 | 2910 

Male prison iloyed or practicall 30 | 30 | 440 | 2400 

ers UNET) or BO. + 
Female reenen Gea ed oe prataly 20 72 | 23 | 930 | 1860 
Male convicts at active 150 | 65 | 550 | 3500 
Male convicts at los active labor 320 | 50 | 550 | 8200 
Punish sent dlets abort pazishusent (wibaistanoe) Te | at | Sar | Isso 
ment 

Punishment diets, longer, with light work. .| 90 | 30 | 440 | 2400 








Nore.—Standanis for criminal Iunatice and sick prisoners, being unneces 
sary, are not included, 


Dunlop's dietaries, since they represent complete Bree 
lists raced Se a scientific basis and proved by 

here given in full. No hospital dietary is that yore 
left entirely to the discretion of the medical Sailer eas 


DUNLOP’S PRISON DIETARIES, IN USE IN SCOTTISH PRISONS. 
Rate L 
oe, prisoners under sentence of imprisonment for not longer than 
Breakfast—Daily = 
Dinner— Sunday: 
Monday: 
Tuesday = 
Wednesday: 
Thursday : 
Friday: 
Saturday : 
Suppr— Daily: 





582 DIETARIES IN PUBLIC INSTITUTIONS. 
Rare I, 
1 Septal ce eerie lnm tig ent Ba 


"Female sod juvenile : ith sentences abore 
ADs Ripe asiins Moopeding tir oiescar manana oe 


sae bas ale 

Dinner— Sunday: Brot! 
Monday + 
Tuesday: 
Wednesday : 
‘Thursday: 
Friday: 
‘Saturday: 

Supper— Duily = 





Rare UL 


Male ordinary prisoners untried, or with sentences above one calendar 
month and not exceeding four calendar months. 


from three sags to one calendar month. 
linary prisoners employed as nurses or in laundries with sentences 
from three days to six 
Female convicts in probation. 
Breakfast—Daily = 
Dinner— Sunday: 
Monday: 
Tuesday = 
Wednesday : 
Thursday : 


Friday: 











Milk 
Diwner— Sunday; — Broth 
Monday: Pea sou 
pens Broth 
“Brad. > 
Wednesday : Pea sou 


DFrLEL 


Rare Y. 





584 DIETARIES IN PUBLIC INSTITUTIONS. 


Rare VI. 
Male convicts not on probation and employed at indoor industrial labor. 








Dinner— Sunday: Pea soup pinta 
- 10. ounces. 
Cheese 14 ounces. 
Monday: Beef . 8 ounces. 
Eg Be 
to 
Bread. . 4 ounces, 
Tuesday: Beef . . 6 ounces, 
Broth, § 1 pint 
Wednesday: Boel. | Somer 
Bee 3 1 pint. 
Potato 1 pound. 
Bread. . 4 ounces, 
‘Thursday: Beef - 6 ounces, 
Romer cnet 
Breads 4 Sunes 
Friday: Beef. : 6 ounces, 
Broth . . 1 pint 
Potato - 1 pound. 
Bread 4 ounces, 
Saturday: Beef 6 ounces, 
Broth . 1 pint 
Bread ~ 6 ounces 
Suppe— Daily Coffee * pint. 
12 ounces. 
Rate VIL 
Malo convicts employed at hard labor at pablic works, 
Breakjast—Dnily: 
Dinner— Sunday: Pea soup 
Monday: Beef 
‘Tooeday = 
Wednesday: Beef 








7 An equal amount of carrot, turnip, turnip-tops, leeks, panmips, or other 
ua oegetaiie waar Ea setae 


E P 


PRISON DILTARIES. 585 





Thorday: Beef . . . 
Rice soup « 
Friday: Beef 
“> Broth 
Potato 
Bread 
Saturday: Beef 
Broth 
a Bread 
; a Bread 





Tarr IX. 


Breakfoxt—Bread . . . . . .8 ounces. 
Dinner— Bread. 1 ss 5 4 ounces. 
ounces 





* An equal t of turnij 
onan ear acca 


586 DIETARIES IN PUBLIC INSTITUTIONS. 
(B) Prisoners under punishment for prison offences for warms excesding 
three days 
Breakfeat Grol 
‘Supper— Gru 





Criminal Lunatic Department.—Where the amount 
of ration is not stated that food is allowed ad libitum, This 
does not apply to butter, of which 8 ounces weekly are to be 
allowed for each inmate, 


Breakfast— 


Thunday: 
Friday: 
Saturday: 


Supper— Daily: 








' For female convicts 6 ounces, meal ration, 
* The medical superintendent shall have power to alter the Sunday dinner, 
* Cabbage or other fresh vegetables may be substituted for potatoes, 





PRISON DIETARIES. 587 
Food-walwe of Denlop’s Dietary Average per Diem. 






ite IL. 
fate LL. with fat tree 
Rate [1 with «weet milk * 
Rate IT. with sweet milk and fabs eae 





“The following alternative and extra diets es to be allowed : 

“1, Male prisoners of more than 168 pounds weight (partly 
clothed) receiving Rates TV., VI., Vitor. or YUL, and) 
prisoners of more than 164 "pounds weight (partly clothed) re~ 
ceiving Rates III. or V., shall receive as an extra 1 ounce 
cheese and 4 ounces bread daily. 

“2, Female prisoners nursing infants at the breast shall 
receive Rate IIL., with one pint sweet milk daily additional. 

“3, Prisoners with sentences of more than one year may 
have after nine months in prison a supper consisting of } pint 
of tea or sone and 12 ounces bread daily instead of the por- 
ridge sup) This regulation does not apply to prisoners in 
Peterhead Convict Prison, nor to women with sentences of 
penal servitude in Perth Prison. 

“4, Prisoners receiving Rates III, and TV., with sentences 
of more than four months, may receive a fish dinner once 
weekly, The fish dinner shall consist of 12 ounces fresh fish, 
or 6 ounces dried fish, with 1 pound potatoes and 6 ounces 
bread with Rate ITI. diet, and 8 ounces with Rate IV. diet. 

5, When employed in the laundry, at the baths, and in 
the reception rooms, females may receive } pint tea between 
breakfast and dinner, and the same between dinner and supper. 

“6, Male prisoners employed for two hours or more in the 
open air before breakfast shall receive 6 ounces bread and } pint 
milk before beginning work, 

“7. The prison medical officers shall have power, should 
occasion arise, to increase or alter the diets of individual pris- 





588 DIETARIES IN PUBLIC INSTITUTIONS. 


oners, and to reduce the diets of individual prisoners should 
atl be satisfied that those prisoners are persistently wasting 
fi 

‘The following directions relate to the foregoing dictaries, viz. + 

“1. Each pint of soup must contain : SS Baga: marrow 
bones or oxhead or } ounce hough, neck of , or other meat, 
and (2) be seasoned with Pepper in a proportion not exceeding 
1 ounce to 100 pints and with salt 1 pound to 100 pints, The 
first of these directions does not apply to soups served with the 
meat dinners of Rates VI., VIL., and VIII. 

“2. Each pint of broth shall contain 1} ounces of barley, 
} ounce of green peas, 1} ounces of leeks, carrots, turnips, or 
other similar vegetables, as may be most easily procured, and 
¢ ounce of onion. 

“3. Each pint of pea soup shall contain 2 ounces of split 
peas, } ounce of pease meal, } ounce of onion or leeks, } ounce 
of carrots or turnips. 

“4, Each pint of rice soup shall contain 2 ounces of rice 
and } ounce chopped parsley. 

“5, Peas, barley, and rice to be well soaked before being 


used, and when served the peas ought to be ly soft. 
“6, All exelables ta be rf rand rashid ele aa 
weighed. 


“7, Potatoes should be cleaned, divided in half, and freed 
from had ones before being weighed. Especial care must be 
taken to preserve the potatoes so that they shall not vegetate or 
be inj in any way. 

“&. Gruel when made in quantities exceeding 50 pints shall 
contain 1} ounces of oatmeal per pint ; when made in smaller 
quantity 2 ounces oatmeal per pint. Gruel to be seasoned with 
salt and sweetened with $ ounce sugar per pint. 

“9, Each pint of tea to be made from } ounce of tea, L 
ounce of sugar, and } gill of sweet milk. 

“10. Each pint of coffee to be made from } ounce of 
coffee, # ounce sugar, and } gill of sweet milk. Some chicory 
may be used with the coffee and weighed as such. 

“11. Pudding (Rate IX.) to be either rice or bread crumb, 
Rice pudding to contain 14 ounce rice, } ounce sugar, and 
pint sweet milk. Bread-crumb pudding, 2 ounces of bi 
crumb, $ ounce of currants, 1} ounce flour, 1 ounce suet, and 
1 ounce sugar for each person, 

= a Meat to be weighed without bone and before being 
cooked. 


PRISON DIETARIES, 589 


“13. Fish Jobe maa after being cleaned and trimmed, 
but before being cooked. 

“14, The yessels in which the food is distributed m: ile 
collected half an hour after the prisoners have received 
except with dinner, when forty minutes must be allowed. ‘At 
unconsumed remnants of food must be removed from the cells, 

15, In the event of the following articles of diet not being 
readily obtainable or excessive in price, the undernamed substi- 
tute may be used ; 

“ Buttermilk,—Substitute skimmed or as mill in equal 
quantity, or failing these, 2 ounces of for each milk 
ration and 1 ounce sugar should that milk ration be due for a 

‘idge meal. 

“ Polato-—Substitute 2 ounces rice and 8 ounces fresh 
table for 1 pound potato, or failing fresh vegetable, 4 ounces 
rice, 

“ Cabbage or Other Vegetable (Rates VI., VIL, and VIITL.). 
—Substitute 4 ounces bread for 1° pound cabbage or other 
vegetable,” 

American Prison Dietaries.—There is no dietary that 
can specifically be called American. In the best ordered prisons 
the dietaries are based on Atwater’s standards. In many States 
the diet is left to the steward of the prison, and no particular 
method is followed. Details will be found in the reports of 
the various institutions and also in the reports of conventions 
of charities and corrections. 

English Prison Dietaries.—The Committee of 1899 
condemns the utilization of diet as a means of punisment, but 
recommends what amounts to the same, 4. ¢, that the diet of 
prisoners who are sentenced for a term of less than three weeks 
be smaller than that of those who are sentenced for three months 
or longer. For short-term prisoners they recommend that the 
diet be “adequate in amount and kind to maintain health and 
strength daring the single week,” but it is not to be made at 
tractive to the “loafer”? or mendicant, The progressive 
formerly in use is now condemned. The diet is to be uate to 
nourish the body and maintain strength, so that at the end of his 
term the prisoner may be in condition to return to his oeeupa- 
tion. For fourteen-day sentences, however, the prisoner is kept 
the first seven days on a spare diet, and for the remaining seven 
receives a somewhat fuller diet. 

The Committee recognizes that the nature of the work the 
prisoner is doing should be considered, but does not attempt to 





590 DIETARIES IN PUBLIO INSTITUTIONS. 


make any dictaries for local prisons along these lines ; since, 
therefore, the diet intended for prisoners at ordinary labor is 
barely sufticient, jd diastrat labor would, on the same 
diet, be underfed. The diet thus becomes a mode of punish- 
ment again, a practice that is to be condemned. 

‘The same wt advises a different dict for men, women, 
and children. lop gives the following résumé of the Eng- 
lish prison dietaries, 

Ordinary Prisoners’ Dietaries.—The dietaries recom- 
mended in the report for ordinary prisoners are no fewer than 
nine ; three classes, A, B, and C, each class with three dietaries 
—No. 1 for men, No. 2 for women, and No. 3 for juveniles. 

“ Class A Dietaries—For prisoners with sentences of not 
more than seven days, and for prisoners with sentences of not 
more than fourteen days during the first eeven days of their 
imprisonment. These dietaries are described in the Committee's 
report as ‘of the plainest food, unattractive, but good and 
wholesome and adequate in amount and kind to maintain health 
and strength during the single week.’ They consist of bread 
and gruel for breal and supper, and bread with either potato 
or porridge or suet pudding for dinner. An allowance of milk is 
given as an extra to juveniles. The daily food-value is esti- 
mated by the Committee as consisting of—For men, protein 
3.88 ounces (109 grams) ; carbohydrate, 17.08 ounces (484.22 
grams) ; fats, 0.89 ounces (25.23 grams) ; for women, protein, 
2.71 ounces (79.38 grams) ; carbohydrate, 13.71 ounces (391.22 
grams) ; fats, 0.74 ounces (20.97 grams) ; for juveniles, protein, 
3.93 ounces f ee grams); carbohydrate, ne ounces 

‘415.87 grams) ; fats, 1.48 ounces (41.94 ). energy 
le of such diets is found by Asha be as follows: 
For men, 2667 calories; for women, 2124 calories; and for 
juveniles, 2552 calories. A comparison with the standards of 
prisoners’ food requirements (vide p. 14 of this report) shows that 
the diet for men is insufficient except when the men are almost 
idle, that the diet for women is also insufficient except when the 
women are idle, but that the diet for juveniles is sufficient.? 
From the fact that Class A Diets are insufficient for workii 
men and women, it follows that these introduce a distinct 
element into the dietary regulation, It may be urged that 


‘The Committee compare their dictaries with Konig’s standart for mod= 
emte work. His male standard contains practically the pepe 
tein ax the standard I. gives for modernte work, but has more fat 
carbohydrate than mine. The energy value is prictically the samo.” 


i | 
| 
} 
| 





PRISON DIETARIES, 591 


slight underfeeding for a limited time does no serious harm. 
That may be so, but an insufficient diet is essentially a penal 
diet ; shortening the application cannot make an insufficient diet 
a sufficient one, and therefore an insufficient diet for even a 
short application is a penal diet. 

“ Clase B eam For prisoners with sentences of more 
than seven days and Jess than fourteen days after the expiry of 
seven days of their sentence; (2) for prisoners with sentences 
of more than fourteen days not more than three months ; 
(3) for untried prisoners, offenders of the first division who do 
not maintain themselves, offenders of the second division, and 
debtors (untried prisoners and offenders of the first division 
receive tea or cocoa instead of gracl or porridge for breakfast 
and supper). These diets consist of bread and gruel for break- 
fast, bread and potato with either tinned meat or beans and 
bacon, or soup, or suet ing, or cooked beef for dinner, and 
bread with either porridge, gruel, or cocoa for supper. Juve- 
niles are allowed a small quantity of milk for bi The 
food-value of these diets as calculated by the Committee is— 
for men, protein, 4.73 ounces (133.8 grams); carbohydrate, 
18.32 ounces (519.34 grams) ; fats, 1.38 ounces Mel ae! i 
for women, protein, 3.94 ounces (116.68 grams) ; iydrate, 
11.87 ounces (434.59 grams) ; fats, 1.06 ounces (30.05 grams) ; 
for juveniles, protein, 4.30 ounces (121.89 grams); carbo- 
hydrate, 19.15 ounces (439.13 ms) ; and fats, 1.85 ounces 
(50.74 grams). The energy wales of these diets calculated 
from these figures are—for men, 3098 calories; for women, 
2519 calories ; and for juveniles, 2772 calories. A comparison 
shows that these three dietaries closely ximate to the 
standards for men, women, and juveniles doing a moderate 
day’s work. 

“ Class C' Diets,—For all ordinary prisoners with sentences 
of more than three months. These diets closely resemble those 
of Class B. They differ by having large allowances of some 
of the dinner dishes, as potatoes, beans, and suet pudding, and 
by cocoa being substituted for porridge or gruel at supper time, 
and in the female diet by tea being given instead of gruel at 
breakfast time, The Committee estimate the daily food-value 
of these diets as follows: That for men, protein, 4.90 ounces 
Gee grams) ; carbohydrate, 19.15 ounces (542.87 grams) ; 

, 1.86 ounces (52,44 grams) ; for women, protein, 3.92 ounces 
111.11 grams); carbohydrate, 14.89 ounces (422,12 grams) ; 

, 1.61 ounces (45.63 grams); for juveniles, protein, 4. 





592 DIETARIES IN PUBLIC INSTITUTIONS. 


ounces (130,11 grams); carbohydrate, 16.40 ounces (464.94 

S and fut, 2.05 ounces (58.10 grams). pans these 

res the energy value of the diets appear to be—for men, 

3283 calories; for women, 2611 calories; and for juveniles, 

2980 ‘calories. These three dietaries may all be described as 

being in excess of the requirements of the standards for moder- 
ate work.” 

French Prison Dietaries.—The French use the canteen 
system. Prisoners having private means and working prisoners 
may purchase from the canteen certain food-supplies to augment 
the ordinary prison diet. This method has to recommend it 
the fact that it tends to make the idle prisoner work harder, 
but it has the disadvantage that it discriminates between the 
poor and the well-to-do prisoner. 

‘The French prisoner receives daily about 14 pounds of bread. 
He is given two meals a day—soup at 9 A.M. and a dish of 
vegetables at 6 P.M. Meat is served on fete days and on Sun- 
days, and to long-sentence prisoners on Thursdays. This << 
without the extras, is not sufficient for a workin, 
the purchase of the supplies allowed it may be Bay: red ae 
From the canteen the prisoner may purchase daily 14 pounds 
of bread und a portion of one of the following: pains 
cheese, butter, milk, salad, fruit, and beef. The daily value 
must not exceed 20 centimes for bread and 15 centimes for the 
other articles. The French use especial diets for the criminal 
insane, for the sick in hospitals, and for nursing mothers. 

Prussian Prison Dietaries.—These are somewhat simi- 
lar to the French. Three meals are allowed daily, Meat is 
used sparingly, and the bulk of the diet consists of cereals and 
vegetables, No classification is made, so far as is known, ex- 
cept for nursing mothers, for those serving sentences of less 
than four days, and for prison offences. 


HOSPITAL DIETARIES. 


There is a wide variation in the diet-lists of the various hos- 
pitals, dependent on the size, income, management, eto., of the 
institute. These diet-lists are designated by various names, 
according to the persons for whom they are intended and the 
articles of which they are made up, 

Tn children’s hospitals the food for each infant should be pre= 
scribed individually. For convenience those over one year and 
under two or two and one-half years may be put on a suitable 


HOSPITAL DIETARIES, 593 


dict designated as “ baby diet.” For older children the 
nations for diets are the same as in hospitals for adults. 

‘The diets in use in the average American hospitals are 
classified as follows : 

Ward Diet.—This is also known as “ full” or “ house diet.” 
It is the ordinary diet of all patients for whom special diet 
orders have not been given. (By reference to the hospital diet~ 
lists given below the composition of the various diets can be 
learned. 

Tight diet, also Inown as convalescent diet, is that used 
for convalescent patients genteally and for others for whom it 
is suitable. It cae of milk, broths, eggs, and such other 
foods as are easily digestible yet dosed] 

Special Diets.—Under this heading are included dietary 
formulas suitable for those diseases in which diet ny a page's im- 
portant part in the treatment. It includes such as have 
been recommended in certain diseases, and which bear the name 
of the inventor, as Tuffhell’s diet for anew ‘sm, ees diet 
for obesity, and such general diets as the f 

Milk Diet.—This is cote entirely of milk, two to three 
quarts usually being allowed daily. 

Meat Diet.—This consists chiefly of nitrogenous animal foods 
with a minimum of sugars and starches. It is useful in certain 
diseases of the stomach where there is acid fermentation. It 
closely resembles the diabetic diet. 

Farinaceous Diet.—This is made up of milk, butter, and 
carbohydrates. It is prescribed for convalescents and in chronic 
nephritis, ete. 

Special or extra special articles of diet, aa they are often 
termed, inelnde all articles not on the regular diet-list for the 
day, and for which special orders are generally given. 

It is a fact much to be deplored that the commissary depart- 
ment of many large hospitals is poorly managed. In some, 
special hospital stewards of experience are appointed, but in 
many the ordering and the = paration of the meals, and often, 
indeed, the distribution of the food to the patients, are ussi; 
to inexperienced persons who are frequently ignorant of the 
requirements of the patients. As a result, errors in dict, with 
their consequences, are common, and very often there is waste 
as well, Tn a large hospital a competent steward is a necessity 
and an economy as well. 

The physician should prescribe the diet for ench patient. It 
isa a that in many hospitals where the catering is not defi- 





594 DIETARIES IN PUBLIC INSTITUTIONS, 


cient, the diet for patients is selected by the nurses, with the 
exception, perhaps, in the case of a few of the more important 
diseases, such as typhoid, diabetes, and the like. The conclu- 
sion to be drawn is obvious. 


‘THE JOHNS HOPKINS HOSPITAL DIET SHEET. 
Breakfast, 8 a... : Fruit, Ei corel areal hominy, aig leer Tors 
Dinner, 1 yr, M+ “a tak fee ee eal pgs 

(roast) esa Prraemt )) oranberry sauce, sweetbreads, 
sare a ‘celery, potatoes, rice, 


Ten, 6m. 3. ¢ eset Ele sas ron 
The Johns Hopkins Hospital Daily Order for Ward. 








Mill, quarts or gallons... . Matton-broth, pints 
Eggr, domen. . . . : Chicken soup, pints 
Butter, pounds. Beofstenk . . . 
‘Number of patients on 
‘Ward diet 
Spocial diet 
Light diet. - f c 
Liquid diet 2... 2.2. pate 
Toth. se eee eee 
Par wew sched ae ot Heed Nure. 
Weekly Order. 





DIET OF THE LAKESIDE HOSPITAL, CLEVELAND, OHIO. 


Doctors. 
Breakjast: ioc wheat gem and cream, baked beans, eggs, fish-balls, brown: 
bread, toast, coffee, milk. = 
Luncheon: Scall fer, potato, cold meat, fruit mind, cake, ten, 


Dinner?” Roasbout, Yorksice pudiing, pots, moa, cel fries re 
Totte Russe, crackers and chieese, cofee, milk” 


HOSPITAL DIETARIES, 595 


Breakfast: Fru cual ga ar en Ng Gy, 
Tancheon : eo ar 


Dimer: south Ht, 
es ere eer aut eoee 


Breaifen: Frait, oatmeal’ snd cream, broiled fish, eggs, potato, rolls, toast, 
Luncheon: Soup, mutton eet, ‘brown muce, potato, frult-jelly, whipped 


Dinner: Sou ia ak, Fas pm ene omnes as 


Breakfast: Hea, gelmon! 30d oreeey, Heian Seoeh ae Bolas ee 

Lente So ca mk a a i tk 

Dinner roast mat fy potato, lettuce, 
” chsslate caine eaten saeae rt crackers: cheese, coflee, 
mill. 

‘Bscfaetz reli cateteel So Bet, Boa ae aaa eee 

Inncheon: Soup, cod & la mode, yer ieaee boatman 
cocoa and whi 


Bo mashed 
oh a ty ey poe sal sy td 


Dinner 
Breakfast: Ti AAS AE eS 


z Clam cht chowder, cold meat, doughnuts and 
Soup, >; potato, Tala ett, oliv ieee eerie 
ccaity, cuicbnow auit'okntaer veka cisele reli 


+ Ontmeal and cream, Hamburger mushroom muce, eggs on 
eee pean 
2 Soup, Hn ed meat, hot bieeuits, honey, tea, 


i 
Soup, chicken & la. Maryland, green. peas, eee, 
Oe nich feos robding. mated ometees noel ecto ota 


Laneheon: 

Dinner 

Breakfast: 

Luncheon 

Dinner 

Breajoat: Fruit, wheat gem and craw, baked beans, ogay fsb, brown 
Dread, toast, milk. 

Luncheon: Oyster er eM, lobster Pepe potato, cold meat, fruit-jelly, cake, tea, 
Dinner 
Breakfast 
Tancheon 
Dinner 


Soup, roust beef runs, olives, Jettues, Sultana ice-cream, 
- Gpamlanies age t 





596 DIETARIES IN PUBLIC INSTITUTIONS, 
Breakfast: SSE casreve net cen cE A Wail ay Sa Cela 


Breakfast: Fruit, oatmeal and cream, broiled steak, ‘oags, potato, rolls, tonst, 

Tameheon: Soup, seallops, tartar sauce, potato, cold meat, gingerbread 
cheese, tea, mil, 

Dinner: Soup, roast-beef, potato, stewed tomato, olives, lettuce, apple pie, 


‘crackers and cheese, coffee, milk. 
Nurses. 
and led ham, 
cele peteg omg gates 


mill. 
preag) PAgS epeeg Ee FE ar, 


Breafaat: Osteen! ani cream, croumed fresh fish, potats, rolls tos, cole, 
Beet tow wth dumpling 


Face’ Bee roust-beef, potato, st Li peseermctecc keri ye Bees 

Breakfast: pd inal 

Dinner: » Soubpel pen hare ete lee Laer 
sauce, coffee. 

Broafeos: Ontuneal and crear, ereumed fred Ssh, pole, lla, tony ene 

Luncheon: Creamed chipped beef, potato, fried mush and maple syrup, tes, 

Dinner: Soup, New England boiled dinner, apple pie and cheese, coffee. 


fant: Oatneal and ‘broiled stems ‘potatos olla) tcuaiy aoe aera 
Tinslen: {ad coo bed era ae ses mile 


Breakfast; Oatmeal and cream, liver and bacon, pointo, rolls, toast, coffee, 


Luncheon: Cold meat in is bors mes potato, boiled rice with cream or maple 
Dinner: Soup ret Ta ee roast lamb, mint sauce, potato, string-beans, chocolate pud- 
ing, colle. 


Bresifate Oatmeal and_cream. broiled steak, potato, rolls, tonst, 
‘Cold lamb, pickles, to, apple sauce, hot muffins, 
Dinner: Soup, me oh ieee ees tice pudding, adda ofl 


Breakfast: eae and boo sorambled eggs and bacan, potato, rolls, toast, 


Farias the ae 
Dome? Son ae pa a a 


less emecelss 








ai | 


‘HOSPITAL DIBTARIES. 597 


‘Breatft: Ontmes! and crea, Hamburger weak, potato, rolly ton, off, 


Lyneheon : ‘old moet tx Gomes an eetatoy tearm 
Dinner: — Boup, New 
? , roasted, apple wuts potato, green Doty England 


Servants’ Dining Room. 

+ Oatmeal and milk, beolled rolls, tea. 
Dinner: Brad bec, oat a bk dae pang aoe 
‘Supper: Cold meat, peach sunce, tea. 
Breakfast: Ontmeal and milk, creamed freah fish, rolls, coffee, tea. 
Dinner: Sine se dumplings, potat ae sda homer 
Supper: Cold meat, apple since, tea, 
realest: Wheat goras and milk, baked beans f-balls, brown bread, cof 
Dinner 
Supper 


fs Roast beef, potato, ees steamed molasses pudding. 

; Qold meat epple moe, tea 
Breakfast : caceeel wa ilk, creamed fresh coffee, tea. 
Dinaee: New Engladd bolted ditnen date passing.” 

: Bh ‘meat, prune siUce, ten. 


Brakts Oneal and ail, broil sea, cate, 
Diener" Baath le tds, poate mane Sioa eet ee 
‘Supper? Cold meat, peach sauce, ten: 


Sot poesia ts eevee 










Supper: er 

Breakjast: Oatmeal erpepee tte rill cpanel hype to, rolls, coffee, tea. | 
Supper: Cox bole ak endian 

Sp aascapel dl ‘up, clam dower pun, tke fanart, apie Bow bay. 

Supper: Cold meat, prone muce, ten. 7 
Breakfast; Oxtmeal and Bambu cotlee, 

‘Supper: Git oue vec teaie beni gee ice” 

Breakfast: bby eed st cortnar letersi oe 

Dinner: Regt on shamed date pig, men 

Gena . 





‘ 






T 


DIETARIES IN PUBLIO INSTITUTIONS, 

7 Oatmeal and milk, broiled potato, coffee, 
ta tsi, la, Ne Hag ing 
neal 


House Diet. 


Brenfast: Oatmeal and milly creamed fe, potato, cols ea 
lambaten, potato, creamed cabbage, buked date pudding, 
foe SA po reryite greok G-epoat rae a ae me 


Breokfnt: Qutmeal and milk, hash, calle, ten 
Dinners roast-beef, potato, tomato, caramel ice-cream. 
‘Supper eee eae aah Petal wed iy corer 


bined ‘Wheat gem and milk, baked beans, brown bread, coffee, tea. 
Soup, roast-beef, » maaah, lly, 
eens eae 





Bon Poth tai sry eel 


‘Ontmeal and creamed fresh tea. 
a ror a 
Supper: Farina, peach muce, ten, cocon. 


Broakfoat: Quumeal and milk, hash, coffe 
Perteat lanntiipoteds Dolled onlon tran iaercrtoecret aia 
bee? Coraline apple sauce, tea, cocoa, 


Breakfast: Ontmes} and milk, broiled minced beef, ito, coffee, tea. 
Dimers” Bow srt heul totais, ashi Wurtips read peclaive at 
Supper: it breakfast food, sauce, tea, cocoa, 


even: Ontmeal and milk, jecd salt fish, potato, cof 

Sup ke Gay fat, hk iakel sare eal crate ven gr 

ee! Trish mom, blanc-mange, prune waice, tea, cocoa. 
Breakfast: Ontmeal and milk, harh, coffe, tea. 

Dinner; Soup, roast-heef, potato, bei cited beets, vanilla Sercream, teu 
Supper: Hominy, peach sauce, tea, cocon. 





dae tol jee d milk, baked beans, brown bread, coffee, tea. 
Diese Soap, ceeactont, potato aqaush, prise folly, tt 

Supper: Farnie apple sauce, tea, cocoa. 

Breakjast: Ontmeal and milk, scrambled egies, 

Dinner: Soup, roast lamb, potato, boiled * Es Mer and pudding, tea. 
Bppet Catling prane Bucs tay ence vi 


FULL DIET-TABLE—NAVY HOSPITALS. 


‘The following diet will be observed for patients in hospital 
when practicable, proper restrictions being ordered, or a special 
diet: prescribed, bythe modical offer in change of ‘the ward, in 
any cage requiring it : 


‘ 





Scxpay: 





HOSPITAL DIETARIES. 599 


‘Breakfast : Cetis, 3 cuncer tend, & sence; tate, 2 oomiey milly 6 


Dinner: 


; 


{ 


Wepsrspay : 
Breakfast 


if 


‘Tacrapay: 


i 


1 ounce; catmeal, 1 + beefsteak, 6 
ounces. 


Hee Sm sae munces; bread, 4 ounces; reast-boof oF roast or 
[: fowl, 8 gunces potato 8 uses other velba 


‘ounces; 1 ounce; bread with ssnoe or 
iceneeriraeees 
Tear ota oesce Tose butter, 1 ounce ; milk, 2 
ounces ; sugar, 1 ;.cold roast mutton or cold Teast 
bean i teary owed Uslad role or taked fresh fralt er 
app! 4 ounces, 


+ Callen, 1 cumce; Dread, 4 ounces; butler, 2 ounce; mall, 2 


ounces ; » $of an ounce; cornmeal (bread or mush), 
2} ounces; ham and eggs (2) or potatoes, # ounces sausage, 


ounces. 
“ei i, my kre talrresy eed e eAcerhd 


6 ounces; aie ounces, 
‘Tea, } of an ounce; bread, 6 ounces; butter, 1 ounce; milk, 2 
‘ounces; sugar, 1 ounce; cold roastbeet or bectetew or 
ounces ; cheese, 2 ounces; baked fresh fruit or 

apple auce or stewed dried fruit, 4'ounces. 


1 ounce; ; 4 ounces ; nee dX 
ounces ; sugar, oun beans, 
{cy How or aby “i 


Vogaalie ees Gana bread, 4 ounces; boiled corned beef 
‘or roaxt-beef, 8 ounces; tows, 8 ounces; other vege 
iret fs ‘ounce ; boiled or baked dump- 


+ Coffee, 1 ounce; bread, 4 ounces; butter, 1 canes; zl, 


6 

sugar, 1 ounce; oatmeal, 1 ounce; mutton or 

Html chops 6 oaneey oF er, 4 oi bacon, § an 
3 bread, 4 ounces; roast veal or roast, 


Macaroni 8 ounces: 
pel pb me 


Tea Po an ‘ounce; bread, Sounces; butter, 1 ounce; ait, 


‘Zounoes; nagar, 1 ounce; 


+ Coffee, 1 ounce; 6 Sonces Sachets 1 etaee eet 


mee; sup tof sconces perermin Pmera = 

toes, 4 ounces, 

Vermicellf soup, 8 bees brad, 4 se ry one iH} 
ounces, potatoes, 
beans, 4 ; other vegetal pickles, 
ounce; unm e,veeable Ponies ph 


? 











600 DIETARIES IN PUBLIC INSTITUTIONS, 


Hh Bounes; kel fru or wewel deed fut o 


apple eauce, 4 ounces. 


Brraifa: Cole, 1 ounce; tread 4 ounces; tier) 1 ounce; mil, 2 
doers eno U Sooray ounia\ cramaaege tae 


6 ounces; pickles, 1 ounce; pie, 6 ounces, 
Supper: Tea, } of an ounce; bread, 6 onnces; butter, 1 ounce; milk, 2 
Toone, . nail rast eet Le ore aot 
or or cold ounces, or 
Sconce” Blawed’ doiad traktor apple mace te 





fresh fruit, 4 ounces. 
Sinai Coffee, 1 ounce; 4 ounces; butter, 1 ounce; milk, 2 
coma bes sugar an ounce; ‘or mutton stew, 
Dinner: Barley snp, 8 ounces; bread, 4 ounces; roast-mutton or roast. 
f, 8 onnoes; potatoes, ¢ come ‘ounces; other vi 6 


cine Pickles, 1 ounce; rice pudding with sauce, 6 


4 LS) sa ounce: bre 6 qunes bute, 1 ounce 8 ounoos, or 
canned mlmon, 4 ounces; apple sauce or dried 
fruit or baked fresh fruit, 4 ounces, 


The weights of meats and vegetables, including cereals, ete, 
are those of the articles as purchased, and this applies to the 
table as a whole, the exceptions, such as soups and puddings, 
being ap t. Whenever stews are indicated, 4 ounces of 
meat and an equal amount of potatoes are allowed in their 
composition, with such simple additions as palatableness may 
require. For supper the cold meats prescribed may be made 
into hashes or stews when it is considered advisable for the 
sake of variety. 

‘The item “bread” is considered to include loaf, rolls, and 
other forms, and a reasonable variety of the best quality should 
be provided. Syrup or honey, not to exceed 1 ounce, shonld | 
be allowed at breakfast as desired. It is assumed that the table 
is provided at all times with vinegar, salt, and the usual con- 
diments, 

From time to time, as the season permits, fruits and berries 
may be substituted for the desserts prescribed, and under the 
head of “other vegetables” provision for additional fresh food 
should be made as the abundance of the market permits. 

‘The foregoing table shall be observed for employees. 


g 


HOSPITAL DIETARIES. 


1. ORDINARY DIET TABLE—UNITED STATES MARINE 
HOSPITALS. 


BSuxpay: 

‘ref: Chocolate 1 pnt bend, 8 ounce: ter, of an ounce; mea 

Dinner: soa ei i to, other 
0 , 6 outcast t 

Supper: To Ff ay omens Rete peepee ery 


Braijts Collec. int; bread ounces; butler, 9 of an ounce | meat 
ounces; 
Dinner: Vs int; beef (boiled), 6 
z egable nap. Baty eae Ds owes Vpneets 
Pip EES, ; bread, 6 ounces; butter, } of a ona ercls areas 


bag ath Coe teat wre Jha le | butter, of ax ‘cones j conned 





Dinner: Beef 1 it: beef 6 fresh, 6 

inner: cs pint — tle ances: tees $ 

io tin (ated hoes 6 butter, § of ; froit 

Supper: Tea, 1 pit ‘ounces ; rere en omnes: fake 

Wepwrapay: 

Breakfast: Coffee, 1 pint; bread, 4 ounces; butter, 2 ounces; fish-hash 
Me hin, bles, 6 ounces, 

Dinner: ea iso imiee Comes ces 8 

nes; rice pudding with suuce, 4 ounces; 1, ounces. 

Supper z Tea, 1 pict; avec ik noe one ee 


fruit, 4 ounces, 
Breakfast : Coftee 1 ints nt; bread 6 omnoen; butter, 2 of an ounce; ment- 
Dinner: Boop, Abert nin 1 pint; areiray pe 6 ounces; potatoes, 8 


bread, 4 ounces: 
tab crscldl butter, $ of an ounce; fish- 
eee co uy oun ‘ounces ; 


Fupay: 
Breaifat: Coffey 1 pints 
Dinner: Verge me 





SATURDAY: 

Breakfast : Coffee, 1 pint; brend, 6 onnces : butter, a eu 
chop; 6 ounces; fried potatoes, 3 0 

Dinner: Barley a 1 i Bat ‘mutton (helled), neo ounces; bread, 4 


10 ounces, 
‘Tho ten and coffe prepared with Ik and sugar. 
i. Extra Diet. 


Dit Ue oc bane & gases ale eer 


ime Dry or dip toast, 4 ounces. 





DIETARIES L8 PUBLIC INSTITUTIONS. 


HI, Milk Diet. 


602 
Breakfast: Hominy or corn-meal mush, 14 ounces ; 16 
Dinner: ‘leo oF taplocn ee cine! cae 1h ee gene 


‘ounce ance. 
Supper: Crocked wheat of cater cooked), 14 ounces; toasted 
Icky 1a Seanerpralicas caacae ae elie 


ALLOWANCE AND COST OF OUTLAY AT CRAIG EPILEPTIC 
COLONY, NEW YORK. 














Present weekly change) weekly, | Bropored 
scree Fypoaniia” FP acioume | pereapia | cbatge i 
0.31280 
0.10422 
0.05200 
0.07643 | 0.09625 
0.07580 | 0.09000 
«| 16.50 ounces Thana 0.04550 
-} ies «| {tymanet}| osetia | 0.16002 
200 * tee 0,01375 
260 « 00800 
490 
270" 
ua" |{ 0.01620 
® 

















Part of the provisions are from the colony furm. 
Dietary of the Craig Colony of Epileptics, New York. 


Suxpar: 
Breakfast Eggs, coffee, bread, butter. 
Dinner: Soup, roast beef, wapetables, cornstarch pudding, custard sauce, 


Supper: ‘Tea, cookies, apple sauce, bread, butter. 
gay mere Rolled oats, coffee, bread, butter 
: |, butter. 
ies Beas tanttnn, yorkies ise pudding bread, 
Te Supper: Eggs or baked potatoes, tea, prunes, bread, butter. 
SDAY : 


Breabfuats Stowed potatoes, coffee, bread, butter. 
Dinner: Meatstew, potatoes, vegetables, sago jing, bread, 
: Corn bread or mush with syrup, tea, |, butter, apple sauce, 
Wroszspar: 


Breakfast: Rolled onts, coffee, bread, buttor. 
Dinner: — Soup, roast-beef, mashed potatoes, vegetables, bread, 
+ Roiled rice, oruckers, cheese, tea, butter. 
pares flee, bread, but 
reakjast: Exes, coflee, |, butter. 
Dinner: Soup, beef-hash, boiled potatoes, bread pudding, bread, 


HOSPITAL DIETARIES, 603 
Faway: 


Dinner: peel ane Jorn punto, seved 
met Sapper: seem ‘bread, butter, dried peaches. 
Breakfast: Stewed oat ogg cof, brea, bute, 


pion iat ani eae toes ben ded Sealand Ran 


The following vegetables to be used: Potatoes, beets, beans, 
peas, parsnips, celery, onions, corn, spinach, carrots, tomatoes, 
oyster plant. In case of emergency, the cook may substitute 
one article of diet for another, subject to the approval of the 
matron, physician, steward, or supervisor in of the 
division. 

DIET FOR CHORISTER BOYS IN SAINT PAUL'S SCHOOL, 

BALTIMORE. 


Breakfast: Hay corals eophe weaat eel 

Dinner—Middle of day: Sou meat give very cai made; thre or 

—s four Yoseat eepectaly ne ahs ‘and’ potatoes ; 

Bopper: Del il he melas goon 
preserves, sweats, fru! 


“ We count milk as the most important article of diet. No coffee or tea at 
any time, Gravis well made have een found very healthful Ment once 
: Sey cola atdinner. Eggs once aday, occasionally at supper. Nuts absoluesly 

forbidden.” 


DIET-LIST, TUBERCULOSIS INFIRMARY, METROPOLITAN 
HOSPITAL, BLACKWELL'S ISLAND, | 


(AU quantities are of evoked food, ready to serve.) 

Reourar Dier: 
Breakfast Corel 8 men with ill en; bread, 4 ounces; 
10a. me: 1 raw, with ft ti 8 8 orlnomm 
as: Bag rt i mm 


Dinner 12 noon: Soup, 12 ounces; meat, 5 to 7 ounces, or fish, 8 ounces ; 
"oun 8 3 ‘ounces; bread, 4 ounces; pudding, 6 


1 raw, with milk, 8 ounces 
Beg et il 


Sroms 
4.30 r. 











sa i Fruiteauce, 8 ounces; bread, 4 ounces; butter, 4 ounce; 
18 ounces, 
sew oe Drer (fo bed ele ope iy): 
£ Eel 46 8 ounces: 1 
with millones some 
Seppe: Same aa regular dist. 


Daily maximum allowance of milk, $2 ounces. 





| 


604 DIETARIES IN PUBLIC INSTITUTIONS. 


ilk. 
‘Supper: gee rt a on-jelly or boiled rice 
: as Jemon-jelly or or 
fri ing replacing cereal. 
Dall poate shite a aa 
Liqur Durr: 
Boiled milk. 


Albuminewater, ad Witum. 
Broth 


Brabfodt: Comal, 8 onncen; egg, 1 rum, with milk, 4 ounent; toast 


‘Scorched farinaceous food. 
Daily maximum of milk, 48 ounces, 
REGULAR DIET FOR TUBERCULOSIS INFIRMARY. 
Suxpar: All quantities are of cooked food, ax served. 
: Hominy, 8 ounces, with milk, 4 ounces; bread, 4 ounces; bute 
ter, } ounce; coffee, 16 ounces. 
Dinner = aries aos, 18 oundes  reass eek, R cansed) patos Mies 
bread, 4 ounces; cornstarch padding, 6 ounces. 
Supper: Stewed prunes, 8 ounces; bread, 4 ounces; butter, } ounce; 
tea, 16 onnices, 
Mopar: 


Breakjast: Oatmeal, 8 ounces; milk,4 ounces; bread, 4 ounces; batter, 
fey gk a ea 9 
¢ ‘egetable soup, 12 ounces; cor OURCES } koes, 
‘ounces; bread, 4 ounces; bread pudding, 6 pie 
Supper: Apple sauce, 8 ounces; bread, 4 ounces; buttor, 4 ounce; tea, 
‘ounces 


Toxspay: 
Breakjat: Hominy, 8 ounces; milk, 4 ounces; bread, 4 ounces; butter, } 
‘ounce ; coflee, 16 ounces 
Dinner: Fish chowder, 14 ounces; bread, 4 ounces; coffee, 18 ounces ; 
Supper: Pea Hice posting, € Te on skers, 4 16 
z or nou) ‘ounces; eracl ‘ounces; tea 
df and btias 


ounces; brea 
WEDNESDAY: 
Breakjset ; Rolled wheat, 8 ounces; milk, 4 ounces; bread, 4 ounces; but- 
ter, \ ‘ounce; coffee, 16 ounces. 
Dinner: Pot for chopped roast beef, 6. cones Ae 
8 ounces; ono vegetable, 4 ounces; bread, 4 oances; farina 
pudding, 6 ounces. 
Supper: — Stewed ies! 8 ounces; bread, 8 ounces; butter, } ounce; 
tea, 16 ounces. : 
‘THURSDAY: 
Breakfast: Indian meal, 8 ounces; milk, 4 ounces; bread, 4 ounces; but- 
ter, } ounce; coffee, 10 onnces. 
Dinner: Boiled mutton, 4 ounces ; with broth, 8 ounces; bean polenta or 
entils, 8 ounces; brand ounces; cracker pudding, Gouna, 
Supper: Boiled rice, 6 ounces; with milk, 4 ounces; bread, 4 ounces; 
butter, } ounce; tea, 16 ounces, 
Fray: 


Breakfast: Oatmeal, 8 ounces; milk, 4 ounces; bread, 4 ounces; butter, 
ounce ; coffee, 16 ounces. 
Dinner: Fresh fish, 6 ounces; potatoes, 8 ounces; bread, 4 ounces; 
hominy pudding, 6 ounces; tea, 16 ounces, 
Supper: Apple ioe, 8 canoes; bread, $ ounces; butter, } ounce; tea, 
‘ounces, 


HOSPITAL DIETARIES. 605 


Breakfast: Rolled wheat, 8 ounces: y lik, 4 ounces; bread; dunce 
Dinner:  Beetatew, it ganja a se) | ‘bread, 4 ounces; farina 


a 
Supper: Farina: ng ounce with il ounces bread, 4 ounces 5 
butter, 4 ounce; tea, 16 ounces 


1 0 3e } Daur: Egg, 1 mv, with milk, 8 ounces 


rege! 3} Dany: Cor-iver oil emulsion, as diroeted. 


82m. Dany: Milk, 8 ounces 


DIETARY OF THE SECOND HOSPITAL FOR THE INSANE OF 
MARYLAND FOR THE MONTH OF APRIL, 


Suxpar: pee 
Dasara eh gy te fg pars ipe, bread, dewert, 
Supper : Sopewe cheese, crackers, ginger cakes, bread, syrup, 
jt Bn nd 
fast = its, 
Supper: Stewed prunes, bao f ao and tea, 
‘Torspay: 
Breakfast : Oni 
Dinner : saint salem, par pari, greens epee bn and oe 
7 |, syrup, butter, and tea. 
Wroxmspay: 
Breakfast : Meat-stew, potatoes, bread, syrup, cotfee. 


Dinner: Soup, beef gre sg tip onan, ed 
: Stewed prunes, bread, syrup, tea. 


reakfad: Smoked anumge, rity bread, syrup, coffee, 
Dinner: Sal bread. 
inner ment ota, reents eens, hominy, 


Supper: syrup, butter, tea. 
Breakfast: Salt or fresh fish, 
fash: 
Brat St ot peo we 
Supper = Eien cheese, crackers, Heong oh ‘syrup, tea 
er reevialc Ontmeal, estan reel a fogs col 
: meat-stew, bread, fe. 
Dinner : Soup, eens, potatoes, onions bead. 
Supper: wush, bread, syrup, butter, tea. 


UNITED STATES GOVERNMENT HOSPITAL FOR THE INSANE, 
WASHINGTON, D. C, 


Dietary for Paticnt on the Sick List. 


Breakfast: Cereal, mackerel, creamed potatoes, coffee, toast. 
Dinner: Tomato bi lamb stew, peas, bread, pudding, 
‘Supper Tie fahren 





606 DIETARIES IN PUBLIC INSTITUTIONS, 


Mawpay: 
‘Breakfast: Cereal, hash, ccffec, 
om Corn st cherry ice-cream, 
e SS Hie pan, erry 


“Brealfast beefsteak, baked 

Dime" Vogt porpayt herrea morse be pee 
Supper: (aise teal a apelin 

Wepurpa: 


Breakfast: Wheatlet, bacor awiel 
Dinner: Span me tape framed miele, ay mod Ya parsnipe, wine 


Supper gare Sh ot milk, sliced fruit. 
2 when 
Sent : 
steal cof 
Dinners 3 Potato Wate ic, asp otage pain 
aet Egg, toast, ea. 
akfast: Cereal, mackerel, creamed Potatoes, cafes rll 
Dinner: Bean soup, veal stew, tomatoes, ice-ct 
Supper: Raw oysters, apple mnce, tea. 
+ Careal, ones potatoes, toaxt, coffee, 
Dinner: Oyster stew, fa rice, custard. 
« Supper: — Broiled shad, toast, 
Dietary for Better Class of Patients. 


7 Wheat creamed potati bread, 
"Noa ch ficamedl Ghican, fonst, tomatoes, potatoes, 


‘Cold ham, potato hag he ae ance, cake, 


: Rolled oats, steak, onior tant batter cakes. 
Potato prchaerocd Ferecigd ra pedal potatoes, balked 


Savaigo cakes, scalloped potatoes, apple sauce. 


fat: Breakfast food, lamb che affine, 
are bis 06 Fa est prea woie mene boiled onions, potatoes, 


Cold ong, ioc, ered potatoes, evaporated peaches, dough- 








calfast: Rolled oats, bacon, eggs, potatoes, corn bread. 

Vegetable soup, fist b beef (rosst), te turnips, potatoes, frarem 
ard 

Beef cruquettes, potato ealad, creampafi 


Corn-meal mush, steak, potatoes, batter cakes, 
eae soup, tam Tale, potatoes, chocolate blanc-mange, 


tres Supper, Sliced ‘beef, potatoes, hot biscuits. 
DAY: 
Breakfast: Rolled oats, fresh fish, potatoes, muffins. 
Dike Tomato bie, oyster pe, rnatbeet, corn, potatoes, Boating 


Supper: Scrambled eggs, French-friend potatoes, apple sauce. 





U, S, GOVERNMENT HOSPITAL FOR THE INSANE, 
ST. ELIZABETH, D. C. 
Sounay: For THe MoyrTH or OctoREn. 
pare Ble tenit a S PN For employees and working 
Dinner: Roaitbost, Srvad densa 
mat it reed easing, tometoes potsioen/ Aiea pete 
INDAY! 
7 Fresh fried h 
Socios Desk peat eae oe 


Seppe? i bina Ba ees toad worklog pitty dite 


Tema 
‘Breakfast: Pettijohn's food, liver and bacon, rol 
er ee een fe i a ‘ and work- 
Supper: cad afk ean employees 


WEDNEEDAY: 
Breakfad Rolled oats baked bash, elle For cmployees and working 


Patients, 
Dinner; Bean soup, corned beef, boiled rice, eabbage. 
Supper? Git appli edd Bes ae prea a eee 
logna sausage. 
‘Tuunspar: 
Breakfast : Coronal sta ‘evaporated frait, olla For employees and 
working pal pesleny, mation chap 


Poort afc hen FE ee ey ee yaitanis 


PE abe: Mackerel arr 
Dinner = Pra yc Bt iy pickles, apple or peach pie, 
‘Seeger: Brome fu {rit grker chee, For employees and work 
Sarenpa: 
Braj Boefiteak, fried hom 
ine Seal a i el sng, on 
Pee ee eteiiee = 
Suxpay: For te Moxrt or Jour. 
Breafan: Wheatle, take’ beans, roll. For employees and working 
patients, 
Di read cutee, 
3 rd Roubeef, Terre ae masons etaoes Sein 
lONDAY: 
feat: Benckod. uumge, fried hominy, rolls For employer snd 
ites, 
Dinner? Boiled shor z 
Sapper Apple jell rolls, eee raeenanl tatlen pelocls dried 





608 DIETARIES IN PUBLIC INSTITUTIONS. 


Torspay: 
Dianer: ae peesues tin an dower. For employees 


"Breakfan: Da se ay eaeiaat, For employees and working 


Dinner: Tpatineeet coeat tacts ji, browned potatoes. 
pnt Gree ee are face. noe, Bee eniplcjees Taal and working — 
‘THURSDAY: 


— Come mush, rate atone ot nas For a and 
mui 


ace sia ae Re cane Bite and porte patients, 


‘ra oe Beh, ranexvont, oiled ate ls ces, apple or poach pie. 
Supper: Evaporated fruit, crackers, cheese. For employees and work- 
patients, fried eggs. 





it ef + Boefsteak, fried hominy, 
lg ae oy ag 
pe ae ee l, cakes, For emp! 


Butter should be on the table at every meal, Gages meals 
with soup, in proportion of } ounce to. peels 
Bread supplied as desired. | 
Coffee, } ounce per capita for breakfast and dinner ; tea, yy | 
ounce per capita, for supper. | 
Syrup should be on the table for breakfast and supper every 


Geass should be on the table for dinner every soup-day, to 
be used as desired. 

All bones from meat, cut out before or after cooking, should 
be preserved and used in the soup if 

Milk and sugar are to be used in coffee an “tea as desired. 

Extra diet is served on the prescription of the physician only, 
who shall designate the special articles desired and the quantity. 


ier 2 + Rolled asa Sete 
ste Loe, 
the * Yogeabio oo, sg sheulder, kai, patos coffee, 
Supper stew, evaporated peaches, 
"Breakfast : Wheatlet, ham, potatoes, rolls. 
vent am, ) 
Dinner: Vegetable soup, roast-beef, tomatoes, potatoes, Spanish cream, 
Supper 


HOSPITAL DIETARIES. 609 


pate poles tes ke 
weet, tery back cakes, apple sauce. 
Brekfes Bollea fried hominy, rolls. 
soupy Mittin tciniypoh ical Stat recite 


2 Baked bush, rhubarb sauce, cinnamon bread, 
‘Tirvnrapay: 
oats, 


Breakfast : Rolled fried 
Dinners” Vegetable sovp, tee oat Tear Caras, ealeen eck le 


see thas pamebaaean ett 


sh, steak, potatoes, rola. 
mente » beefatew (baked), coflse. 
ae able sep fe ep etpe races 
Pe Rolled coi, trea Be binge rolls, 
Dinner: vere ae fiuh, roast-beof, corn, potatoes, floating 


‘Supper : Soraniind ‘eggs, fried potatoes. 
DIET-LIST OF BAY VIEW ASYLUM. 


‘This is the almshouse of Baltimore. The lists are given here 
not because they represent ideal diet-lists, but merely to show 
what the average well-conducted poor-house in this coun 
furnishes its inmates. In this institution the inmates are 
ees in season the diet is varied by vegetables from 


Peat Cera een Dees butter, il tea, coffee, 
milk, tea, 
Dinner: Chicken soup, gravy, 


broad, toa. 
read Barie tan Con pea etc act 
Breakjost : Ontmeal, bread, butter, milk, coflve, 


Dinner: Beef soup, roast-beef Lary, tea. 
Supper: Bread, buster, te, coffee, ll 
Turspay: 


Breakfat: Oatmeal, bread been ay milk, te, coffee 
Rapes, Bad tat tor cciae tip ee 
Teel Duenell teal todos milk, tea, coffee. 
Dinner: Chicken soup, beefiteak, apple race, bread, tea 
ee Bread, butter, tea, coflee, 
Breabjeat: Ontmeal, brea, butter, coffee, 
ps nadinaat Sat perp ieee, oe 
Seer Backer ien ak 


Fray: 
Breakfast: Bread, butter, mush and molnsswes, eggs, milk, ten, coffee, 
Dinner: Beat 
Rope! Bend biter tie cohen aie 





610 DIETARIES IN PUBLIC INSTITUTIONS, 


ea 
a regehn Toes 
Re ets a 


Tn addition to the foregoing, beef-tea, lemonade, and various 
other articles of dict are furnished from the “center-house 
kitchen” when necessary. On Fridays in spring and summer, 
when the cost is not too high, fish is given for dinner. 


General House. 
(See note at beginning of these lista.) 
Soxpay: 
Breakjast: ev tay eay, eee and coffee; on Friday, mush and molasses 


Figeen ‘Gren tacm od 
Supper: Bread, coffet, dried apples or prunes, 


Soup, beef, bread. 
i, coffee every day. 


Dinner: ‘Hash soup, bread. 
antes? Plaids scrip, breed 
Soup, beef, bread. 
Matton soup, bread. 
Hash soup, bread. 


For Working Women. 
+ Oatmeal, milk, bread, butter, coffee, tea. 
, soup, bread. 
Bread, coffee, tea, stewed fruit or pranes, 
7B butter, oatmeal, hash, tea, 
* ap, beet f, bread, oe: 
Brena, cotiec, ten every day. 


Oatmeal, Hamburg steak, bread, butter, coffee, tea 
Bacon, Rash soup, Hos nil, bread.” 


Breakfast: Bread, butter, ontmeat, coffee, tem 
ungzinner? Hash soup, bacon, apple stuce, bread, 
Breakjast; Bread, butter, oatmeal, fried bacon, coffee, tea, 
anbianer® Soup, ‘beef, bread. ‘ 
PRIDAY 


Brookfast Bread, butter, salt horring, mush, molases, coffee, tea, 
Dinner: Mutton soup, bread, rice, milk, 
Fal Ontmeal, Hambu: k, bread, butter, coffee, tea 
fast) Ontmeal, Hamburg steak, bread, butter, 
Dinner: Hash soup, bread, apple sauce, Z 

















HOSPITAL DIETARIES. 611 


eeaiiey For Farmers, 
Dimes Ran ay eee ee 
PA ca 7 Tina Comes’ nnd bese mapa oer poi 
‘Dinner: Soup, boef, bread 
‘Torpay: cbc: cold 
Deen, at eatin ee 
WHbNEDAT: 
Dinner; Hash soup, bread. 
Disses Bon bread. 
Fray: - Dime 
Dinner: Mutton soup, bread, 
Sarunpay: 
Dinner: Hash soup, bread. 
Suwpar: For Insane Department. 
fast; Breadl, in wi . 
Brskfet: ai masses winter months). 
Supper: Bread cots, 
Now eatfat: Bread, cof 
Dinners Bou read, 
Supper: Bread, 
VAY: 
Breakfast : coffee. 
Demet one ad 
Supper; Bread, stewed fruit, 
Wepxrspar: = 
Breakfast : Bread, cotlve. 
jrsch ela me Nig 
‘Tyrorspay: ae a = 
Donte pp lect taetiny 
oor: Bevel, sation cnken ten Ra ania 


Yi 
Breafon; Brel, coffe, moat snd mclamen 


Soper: Bred oot awed fal 
Sarorpar: 


‘The women are given butter on Thursdays, and those on sick 
diet receive butter, eggs, and oatmeal daily. 


DIET OP THE ROBERT GARRETT FREE HOSPITAL FOR 
CHILDREN, BAUTINORSS MD. 

Breakfast + ee oats, well ‘Sos? milk; bread, plain 

pperse cone to oes balan ae of Mala ape col 


80 12 onmoen 












Dinner: Chicken, beef, or 1 tablespoonful when © 
- - Geese animes a 
lor lcs sill 6 oun i j 


Supper : Brad 2 or is, utes, sie ‘of small grape; or 








+ Rolled oats, bread and butter, milk. 
= Stew of beef, rice cakes, or junket, and milk, 
Supper: Bread and batter, crackers, milk. 


eet old oats brad and baer, cob lh 
Bread and butter, crackern, mille 


fe 


ber Rolled oats, bread and butter, cocoa, mill 
2 oat 
Dinner: Lamb or rice, 


“HOSPITAL DIRTARIRS, 613 


IET-LIST OF THE CHILDREN'S HOSPITAL OF BOSTON. 
Mouse Diet—Children. 


Breakfast: Milk, cereals, bread and butter, 
Dinner: oe et 
boiled 
AY 5. parla poee ‘Hee, ari bree 


utter, 

Supper: Bread and milk at 10 and at 
sochexecknue ree ing en as rele 

Milk diet: sigh ney fi rye on during day, every four 


Liquid diet: Beef, iNekent och, mall frien 
Spi et Hh em eae by Han dy Greer 
fovereass, gelatin, latin, soups, rat, egenog, beetje milly 


Tee to be pnt on milk diet unless otherwise ordered by House 
Operative patients are to receive house dict until before 
pera ive pat eee regular night 


‘operation unless oth 
“Ether meal"? : Bouillon, seven ounces, four hours before operation. 


Diet for Nurses. 
Buxpar: 
Dees Ta rey eer, P be reid act uttan ester, 
ose Shrimp salad, Parker House rolls, quince jam, ca, tea. 
Teme Stock ee ats. into a pha ok ae 
Tomspar: 


Tame Ts spon gto 
? eae stew, bag peanut cool 

Roast-beef, potatoes, cream carrots, Tlouen rg cake, 
Wont 


Peeves Coe Coreal, salt-fieh ba) pring bpp 
i Ci fost, ht a oe uy peat and butter, cup cakes 
ite frosting), 
Dinner: Rod real, potatoes, oe) tomatoes, bread and butter, rhubarb 
pie. 


Taorspar: 
Breaifast: Gereal, Hambury steak, mang, tons, eos. 


f ‘Temato on bread and butter, oranges, coffee. 
Dinner : cy tats actront and Sie bead and Duty 
ri movies caramel since, 
'RIDAY 


Tonle pete Rarding: seated ra ieee op read end bate butter, gingerbread, cheese, 


Dienirs\ Saks ah, potatoes fice a ralch md, sec oe Wotio 
Washington pie, 
SATURDAY: 


Brea Cereal, cottage pie, muffins, toast, 
Potat str sali eats and phat 
Diner: ok cee med each meringue, 





am 


614 DIETARIES IN PUBLIC INSTITUTIONS. 


= Diet for Help. 
ONDA: 
Breakfast: EOI Se butter, coffee, (Men servants, 


Dinner» Roars vet) tle calor, petals, breed ea Ieaaaaaael 
2 Cold ham, hot biscuit, prunes, tea. 
Me Pat: Cera bra and bute, le. 
a 
Dinner : aah peets, oe es, breed, Ea 
Supe: Cadiment sl bee eer Beets 


bacon, bread and butter, coffee. 
mncaroni, doughnuts, coffee. 
oni, a 








Breakfast: Cereal, boiled brend and butter, coffee. 
Dinner: Roast peek, pant potatoes, bread and butter, tapioca pudding, 


Baked beans, cold hot roll ed tea. 
Supper: meat, hot rolls, canned peaches, 


"Droafat Cereal, muimges, trend and butter cbs 
Dinner: Fried ham and eggs, potatoes, bread and butter, cottage pud- 


Supper: Pickled pigy’ feet, bread and butter, prunes, tea. 


Fupar: 
Breakfast; Cereal, boiled egg, bread and butter, coffee, 
Dinners Baked’ fish, tomatoes, potatoes, bread and batter, tics pudding, 


tea. 
‘Creamed salt fish, hot rolls, apple sauce, tea. 
paid Coreal, bacon, bread and butter, coffee, 


¢ Trish sew, brond and butter, bahanas ten 
ee Cold meat, bread and butter, jam, tea. 





Out-Patient Department. 
Dinecrions vor Fxxpixe tun Bany. 


“Hava milkman leave the milk daily ; do not get it at a store. 

“The mixed milk of a number of cows is better than one cow's 

_ “Let the milk stand five hours in a cool place (if the cream has already 
risen, this is not necewary), and pour off the upper quarter from the can or 


ea 
“Mix the food in the following proportions: 





Moped feist saris tes = omnces. 
Waters vv v es > ounces, 
Limewater 2.2002! + ounces. 
Sugarofmilk 212. * tablespoonfala. 





“Give ounces ata feeding every hours.” 
(Quantities to be indicated by the physician. ) 


Durr-List. 
Milk. Boof-juice. 
Bread: Soft-boiled egg. 
Cracker. eel are 
Oatmeal. 
‘Oatmeal jelly. At the. ‘waiee the child wants. No 
Potato. other food. 


HOSPITAL DIETARIES, 615 
GREAT ORMOND STREET HOSPITAL FOR SICK CHILDREN, 
LONDON, 


Milk Diet. 


Breakfast, 8 o'clock half ; bread, two with butter, 
Fee ee Bie’ nee eiik melee, Slee Geeikhet tbe 


beeftea, onehalf pini 
Beek, Milk, one-half pint, ik twa oumoas af bread dal Reig 
or 


ight 
wikiage "ite, coebalt.plot, with two ounces of bread and Hater 


Fish Diet. 


Breakfast, 8 o'clock: Milk or cocoa, with sugar, one-half pint; bread, two and 
one-half ounces with butter. 
Dinner, 12 o'clock: Fish, one-half ounce, boiled ; bread, one ounce; mashed 
three ounoes; rice or milk 4 
Ten, $ clocks Geesds tro" nat eneiall cuncle wth ceipctoge ter or 


a 3 mill, ooehird pint. 
bret horek a 
Sere nt Bead wih Ince enrages 


Meat Dict. 
Breakjat, 8 dock: Milk or cocon with sugar, onehalf pint; bread, tno and 


‘one-half ounces, r. 
Dinner, 12 o'clock: Roast or boiled mutton or roust-beef, two and one-half 
ounces; mashed potatoes, four ounces; rice and milk 
eeock: Bread, two and onehalf ounces with dripping, butter, 
= tr troacle; milk, one-thint pint. bees 
as or 
aime nt Brad t with butter or dripping; milk, 
early vo _otunces, or j mil 
soreiag? third pin. Stay. 


Diet Ingrediente—Water or barley-water may be mixed with the mille 
srhon used aa beverage, 00 long. as the regelation quanthy.of mallk ia gtven 


in the twenty-four 
carrot, or turnips, etc, should be added twice a week to all fish 
and ment diets that include potatoes. 


seit Hoe oc tecidy nay eee nate 


Fancy Diet. 
“ Fancy diet” be ordered in cares, the child being allowed 
whatorer he ‘can tako-—tent, fish, chicken, musgo, sic; with fejomt 
variation. 
All dics ar aja for ehilren ofthe age of seven year apportionment 
is to be arranged in the wards according to the age and seeds of the child. 

















Se 





ixture—Rub the yolks 


Sad 


ig 
Hise 
} at 


inet 


j add a tea- 


of 
and a tables; 
one 

jot mill ; 

ly or old whisky, or fla 


glussful of h 


ip 


or two of sugar and a 


blespoonful of brand; 





S-—Beat uy Oe ea 


Wegele. 
egg 





Egg-no 


ae 


Brandy, 


with half an ounce of white sugar; add 4 ounces of 


C 


ful of sugar and a pinch of salt ; over this potir a glia ¢ 


on 
E 








BEVERAGES. 617 


milk and serve immediately. Hot water, broth, soup, or tea 
may be used in place of milk.—{ Drexel Institute. 

Egg Cordial.—Beat up the white of an egg until light ; add 
a tablespoonful of cream and beat up together, then add two 
teas; of sugar and a tablespoonful of brandy. 


of 
sherry wine, and sweeten with a of ; if desired, 
flavor with lemon peel. Stir peared into'a balf-pin t of 
gruel ; over this grate a little nu and serve with hot toast. 

Albumin Water.—Beat the white of an egg until 

light and strain through a clean napkin. Add six ounces 
water. sell penepinideo omen erica eed ee! 
A teaspoonful or more of sugar and a or more of 
lemon juice, orange juice, or wine may be added to 
enhance its palatableness. This d: may also conveniently 
be made by placing all the ingredients in a lemonade-shaker, 
patie! until thoroughly mixed, and then straining. Serve 
col 


Apple Water.—Pour a cupful of boiling water over two 
mashed baked apples ; cool, strain, and sweeten, Serve with 
shaved ice if desired. 

Tamarind Water.—Pour a cupful of boiling water over a 
tablespoonful of preserved tamarinds ; allow this to stand until 
cool, then strain, and serve with shaved ice. 

Currant Juice. —Take an ounce of currant juice or a table- 
spoonful of current jelly, Over this pour a cupful of boiling 
water—use cold water with the juice—and sweeten to taste. 

Lemonade No. 1.—Take the juice of one lemon or three 
tablespoonfuls of lemon juice; add from one to three table- 
spoonfuls of sugar and a cupful ic ounces) of cold water. 
Serve with cracked or shaved ice if desired. 

Lemonade No 2,—Pare the rind from one lemon, cut the 
lemon into slices, and place both in a pitcher with an ounce of 
sugar, Over this pour a pint of boiling water and let it stand 
until cool. Strain and serve with cracked ice —{Pavy.) 

Effervescing Lemonade.—This may he made by using 
a carbonated water or by adding half a teaspoonful of bicarbon- 
ate of soda or potash toa glassful of either of the foregoing 
lemonades. 

Albuminized Lemonade.—Shake together a eupful of 
water, two teaspoonfuls of lemon juice, two teaspoonfuls of 
sugar, and the white of one egg. Serve at once. 

Orangeade,—Cut the rind from one orange ; over the rind 





_ 


Ct ay fre water ; then add the juice of the oran, 
and a tabk ul of sugar; cool, strain, and serve wi 
shaved ice if desired. If this is too sweet, a teaspoonful of 
lemon juice may be added. 

Imperial Drink.—Add a teaspoonful of cream of tartar 
toa pint of boiling water ; into this squeeze the juice of half a 
lemon, or more if desired; sweeten to taste and serve cold. 
This drink is most useful in fevers and in nephritis. 

Tea.—aAdd six tablespoontuls of flaxseed to a 
quart of water ; boil for half an hour ; cool, strain, sweeten, and 
if desired flavor with a little lemon juice. 

Linseed Tea.—To a pint of water add two ables 
of linseed, the juice of a lemon ; } ounce of bruised licorice 
root (or a piece of licorice the size of a filbert), and rock-candy 
to taste. Boil for one and one-half hours and atta 

Orgeat.—Blanch two ounces of sweet almonds and four 
bitter almond seeds, Add a little orange-flower water and 
pound into a paste; rub this with a pint of milk diluted with a 
pint of water until it forms an emulsion. Strain and sweeten 
with sugar. (A demulcent and nutritive drink.)—(Pavy.) 

Mulled Wine.—One-fourth of a cupful of hot water, one- 
half inch of stick cinnamon, two cloves, a tiny bit of nutmeg, 
one-half cupful of port (heated), two tablespoonfuls of sugar. 
Boil all the ingredients except the wine and sugar for ten 
minutes; then add the wine and sugar, strain, and serve very 
hot.—( Drexel Institute.) 

Grape Juice.—Pluck Concord grapes from the stem. 
Wash and heat them, stirring constantly. When the skins 
have been broken, pour the fruit into a jelly bag and press 
slightly. Measure the juice and add one~juarter the quantity 
of sugar, Boil the juice and sugar together and then pour into 
hot bottles ; cork and seal with paraffin or equal parts of shoe~ 
maker's wax and resin melted together. Less sugar may be 
used.—(Drexel Insitute.) 

Grape Juice and Egg.—Peat the white of an egg lightly, 
strain through a napkin, and add to it two tablespoonfuls of 
grape juice. Fill a large wineglass half full of cracked ice, 
Pour the egg and grape juice over this, sprinkle sugar over it, 
and serve. 

Oatmeal, Barley, or Rice Water.—From the grain: 
Use two tablespoonfuls of grain to a quart of water. The 
gain should have been previously soaked overnight or at least 

a fow hours, When required for an emergency, the soaking 


618 RECIPES. 





CEREAL AND CEREAL GRUELS. 619 


may Poe with and the grain boiled for five minutes 
instead, water in which the grain was soaked should be 
poured off and fresh water added before cooking. The grain 
should be boiled for several hours, water being from time 
to time to keep the quantity up to a quart, Stmin, This 
makes a somewhat thin, watery gruel. 

From prepared flours: Various brinds of prepared grain 
flours wee the re such, for example, as Robinson's 
Barley Flour. These are all somewhat similar in preparation, 
From two rounded teaspoonfuls to a tablespoonfal of the pre- 

flour is added to a pint of boiling water, and this is 
iled for from fifteen to thirty minutes and then strained. 
No previous soaking is required. 


CEREAL AND CEREAL GRUELS. 


Either the grain itself or the specially prepared flour may be 
used, When the grains are used they should be spread on a 
clean table and all foreign substances removed. If the whole 
grains be used, it is well to wash them, after picking them 
over, with two or three changes of cold water. 

Cereals are best cooked in a double boiler. The lower part 
should be filled about one-third full of water, and, if more is 
added during the cooking, it should always be boiling hot. The 
cereal should be cooked over the fire for ten or fifteen minutes. 
‘The water should be boiled first and then salted. The cereal is 
added gradually and the whole stirred to prevent it from burn- 
ing. It should thon be placed in a double boiler and steamod 
until thoroughly cooked. Cereals, like other starchy foods, 
require thorough cooking. Most recipes allow too short a time. 
Oatmeal especially should be mentioned, It develops a better 
flavor if cooked for three hours or more, and it is better when 
it is prepared the day before and reheated when used. It 
should be just thin enough to pour when taken out of the 
boiler, and when cooled should form a thin jelly. 

Any cereal mush may be thinned with water, milk or cream 
and made into a gruel, or the gruel may be made directly from 
the grain or flour. Gruels should be thin, not to sweet nor too 
highly flavored, and served very hot. Milk gruels should be 
made in a double boiler. Gruels may be made more nutritious 
by the addition of whipped egg, either the white or yolk or 
both, and the various concentrated food products. 

‘When cereal flours are used, the flour should be rubbed to a 








| 


620 RECIPES, 


smooth paste with a little cold water and added slowly to boil- 
ing water, stirring constantly until it is thoroughly mixed. 


LENGTH OF TIME TO COOK CEREALS. 
Cornmeck mush: Boil 10 minutes, then steam for $ hours or more. 
7 nero 
Whestena + 


ww « «© «ype “ 
Ghuten mush: BO). 

Steamed Rice: Boil for one hour, 

Boiled Rice» Boil for twenty minotes or until soft. 


Arrowroot Gruel.—Dissolve half a teaspoonful of sugar 
and 2 quarter of a teaspoonful of salt in a cupful of water, and 
heat. Mix balf'a tablespoonful of arrowroot flour with a little 
water and add to the heated water. Boil for twenty minutes, 
stirring constantly ; then add a cupfal of milk, bring to a boil, 
strain, and serve hot. 

Barley Gruel.—Proceed as above, using a tablespoonful 
of Robinson’s Barley Flour instead of arrowroot. 

Oatmeal Gruel.—aAs above, but use oatmeal, and boil for 
half an hour or longer, before adding the milk, 

Flour Gruel.—Proceed as in making arrowroot gruel, using: 
instead a tablespoonful of wheat flour, or with Jemon juice, 
cinnamon, nutmeg or vanilla, 

Farina Gruel.—Proceed as in making arrowroot gruel, 
using instead a tablespoonful of farina, and boil but ten minutes 
before adding the milk. 

Imperial Granum Gruel.—As in the preceding, but use 
imperial granum instead of farina, 

Cracker Gruel No. 1,.—Use two tablespoonfils of cracker 
crumbs and proceed as above. Cook only two or three minutes 
and do not strain. 

Cracker Gruel No. 2.—Brown the crackers, and reduce 
to a powder by means of a rolling-pin, Add three tal = 
fals Pe the powdered crackers to Wall cupfal of Till wed hal 
a cupful of boiling water ; cook for ten minutes ; then add one 
fourth of a teaspoonful of salt and serve.—( Drexel Institute.) 

Racahout des Arabes.—This is a French preparation 
with a chocolate flavor which makes a most delicious gruel. 
Follow the directions given for farina gruel, A homemade 
racahout may be made as follows: Take one pound of cocoa, 
one pound of confectioner’s powdered sugar, one pound of rice 
flour, two ounces of arrowroot flour, and two ounces of sugar of 
milk. Mix thoroughly. 


CEREAL AND CEREAL GRUELS, 621 


Flour Ball.—Tie half a pint of flour in a square of fine 
cheese cloth, making a very tight ball. Place this in a pot of 
boiling water and cook for four or five hours. After taking out 
of the cloth, peel off the outside and grate the bard ball. Dry 
in the oven and keep in a covered jar. This is vaeful for 
making gruels for diluting milk for infants. 

Flour-ball Gruel.—Proceed as for arrowroot gruel, usii 
two teaspoonfuls of the above grated flour rubbed up in col 
water, and stir into a pint of boiling water. Cook this for ten 
minutes. 

Cornmeal Gruel No. 1.—Use two tablespoonfuls of corn- 
meal and one of flour, a teas; ful each of sugar and salt, one 
quart of hot water and a cupful of milk. Proceed as in making 
arrowroot gruel, boiling in a double boiler for three hours. 

Cornmeal Gruel No. 2.—Take a tablespoonful of corn- 
meal and moisten with a little cold water. Stir this into a pint 
of boiling water to which a pinch of salt has been added. Cook 
for three hours in a double boiler, or for thirty minutes directly 
over the fire. In the latter case it must be stirred constantly. 

Gluten Gruel.—Mix a tablespoonful of gluten flour with 
one-fourth of a cupful of cold water and stir this into one cupful 
of boiling salted water. Cook directly over the fire for fifteen 
minutes ; then add one clove and cook over boiling water for a 
half-hour.—( Drexel Institute.) 

Barley and Oatmeal Jelly_—From the grain: 
the grain as directed for barley water. Use from four to six 
tablespoonfuls of grain to the quart of water. Boil thoroughly 
for several hours until the grain is thoroughly cooked. Strain 
and cool. The jelly when hot should be just thick enough to 


ur. 

From the prepared flours: Use two tablespoonfuls of the 
flour toa pint of water. Boil from fifteen to thirty minutes 
and strain. 

Partially Digested Cereals Prepared at the Table. 
—To a sauce of well-cooked oatmeal, wheaten grits, or rice, at 
the customary temperature, add one or two teaspoonfuls of 
Fairchild’s Diastasic Essence of Pancreas, or fifteen grains of 
Fairchild’s Dry Extract of Pancreas. Stir for a few minutes 
before eating. When the ferments are added to the very hot 
foods their power becomes impaired. 

Tapioca Jelly.—Souk « cupful of tapioca of the best qual- 
ity in a pint of cold water for two hours ; when soft, place in a 
saucepan with sugar, the rind and juice of one lemon, a pinch 


- 





622 RECIPES. 


of salt, and another pint of water; stir the mixture until it 
boils ; turn into a mold and set away to cool ; if desired, a glass= 
fal of wine may be added.—{ Bartholow.) 

Tapioca Soup.—Boil a pint of meat broth or stock, and, 
while stirring constantly, sprinkle in } ounce of 
washed tapioca, Cover the saucepan, and let it stand until the 
tapioca is quite soft, Skim and serve-—( Yeo.) 

Chestnut Puree.—One pound of chestnuts are peeled, and 
boiled in water until the second (inside) skin comes off easily. 
The chestnuts are placed in a sieve until all the water drains 
off, They are then washed in a dish and afterward pressed 
through a sieve. Melt three ounces of butter in a stewpan om 
the fire, add a little salt and sugur—enough to cover the point 
of a knifo—and then the chestnuts. Stew them for half an 
hour, stirring frequently ; pour in enough bouillon so that the 
mush does not get too thick. —{ Wegele.) 


BREAD. 


Drexel Institute Bread Recipe.—For two loaves take 
two cupfuls of warm milk or water, two teaspoonfuls of salt and 
two of sugar, a tablespoonful of lard or butter, one-half cake 
of compressed yeast, and about four pounds of flour. Put the 
water or milk, salt, sugar, and fat into a bowl. Dissolve the 
yeast in warm water; add it and the flour gradually ; when 
stiff enough to handle, turn the dough on a floured board and 
knead until soft and elastic. Put it back into the bowl, and 
let it rise in a warm place until it is double its bulk. Then 
divide it into loaves or shape into biscuits. Allow these to rise 
in the pan in which they are baked. Cover the bread and 
again allow it to double its bulk. Bake loaves one hour in a 
hot oven, The large amount of yeast allows the bread to be 
made and baked in three hours, 

Brown Bread.—Take one-half cupful scalded milk, one 
half cupfal water, one teaspoonful salt, one-half tablespoonful 
butter, one-half tablespoonful lard, two tablespoonfuls of molas- 
ses, one-half eupful white flour, sufficient Graham flour to knead, 
and three-quarters of a yeast cake dissolved in one-quarter of 
a cupful of luke-warm water. Prepare the same as white bread. 
Instead of Graham flour, equal parts of Graham flour and white 
flour may be used in kneading. 

Nut-brown Bread.—The same as preceding, with one 
cupful of nuts chopped and added. 

Whole-wheat Bread.—Dissolve a quarter of a yeast cake 





VEGETABLES. 623 


in a tablespoonful of lukewarm water. Pour half a cupful of 
hot water over half a cupful of milk, and when teat 
the yeast and balf a teaspoonful of salt, To this add a ew 
whole-wheat flour and beat for five minutes. Cover and 
this to stand in a warm place for two hours and a half. Then 
add whole-wheat four gradually, mixing the mass until it can 
be kneaded. Knead until elastic ; shape and place into baking- 
3. Cover and allow to stand in a warm place until it doubles 
its bulk. Prick the top with a fork and bake for one hour. 
The oven should not be hot as for white bread. 

Pulled Bread.—Use bread made with water. Make into 
long loaves, and as soon as baked take off the crust, Pull into 
stick-shaped pieces and brown slightly in a slow oven. 

Zwie »—Cut stale bread in slices and place in the oven 
and allow to remain until the slice is col golden brown, 
Zwieback is a particularly desirable food for infants and in- 
valids, 


VEGETABLES. 
‘TIME-TABLE FOR COOKING VEGETABLES IN WATER. 





GENERAL RULES FOR COOKING VEGETABLES. 

Wash thoroughly ; pare or scrape if skins must be removed, 
Stand in cold water until cooked, to keep them crisp and pre- 
vent their being discolored. Cook in boiling water ; the water 
must be kept at the boiling-point. Use two teaspoonfuls of salt 
with two quarts of water ; put the ealt into the water when the 
vegetables are partially cooked. ‘The water in which vegetables 
are cooked is called vegetable stock. 

Fresh green vegetables require less water than others. 

Cabbage, cauliflower, onions, and turnips should be cooked an- 
covered in a lange amount of water. 

All vegetables must be drained as soon as tender. Season 
with salt and pepper and serve hot with butter or sauce. 





a 


624 RECIPES. 


‘The color may be in Saar: such ss spinach, 
by pouring cold Ata! leah ress draining. 

Gold les may be used for salads or may be in 
a portent one-half the quantity of sauce (2 cupfuls 
vegetables and 1 cupful sauce), covered with crumbs, 
and browned in a hot oven. 


cance eet 
tablespoos Perper 
leepiehioak A eebldttese 





SOUPS WITHOUT MEAT. 
(Deexen. Leerrrere) 

These soups are thickened by using butter and flour; this 
prevents a separation of the thicker and thinner parts of the 
soup. The butter should be heated until it bubbles, the flour 
and seasoning added, and enough of the hot liquid to 
smooth sauce thin enough to pour easily ; this should be poured 
into the rest of the hot liquid and cooked in a double boiler 
until the soup is of the proper consistence. 

Tn soups made of dried and beans soda is used to soften 
the casein ; it is also ied Ip tonabioer ta neutralize the acid. 
These soups must be served in hot dishes as soon as ready. 
Crisp crackers, croutons, or soup sticks may be served with them. 


Crisp Crackers: 
Split and butter thick crackers and brown in a hot oven. 


Cream-of-Tomato Soup : 


1 can tomatoes. cupful of flour, 

} teaspoonful soda. 3} teaspoonfuls of malt. 

4 cupful of butter. ial of white pepper. 
1 quart of mil 


Btew the tornatoes slowly one-half to one hour, strain, and add soda while 
hot; make a white stuce and add the tomato juice. Serve immediately. 


Cream-of-Celery Soup: 


1} cupfuls of celery. 2 table fuls of butter. 

1 pint of water, cupful of flour. 

2 cupful of mille. teaspoonful of salt. 

1. cupful of cream, teaspoonful of white pepper. 


Cook the celery in the boiling water until very soft ; stain and add the hot 
liquid; make a white suuce and cook until it is thick cream. 


Cream-of-Potato Soup: 


3 potatoes. Yolks of 2 
2 Fupfals of milk, 1 teaspoonful of malt 
4 cupful of cream, Popper, 

4 teaspoonful of onion juice. 


MILK PREPARATIONS. 625 


Cook the potatoes until soft, drain, mash, add the hot liquid, and strain 
Pe yee pare es Cook ‘in a double boiler until the ogg 
thickens, stirring constantly. Serve immediately. 


Oyster Stew: saad 

1 cupful of milk, teaspoont It. 

1 at of apeae faa ot tee 
Pepper. 


Heat the milk. Cook and strain the juice. Add the oysters, which 
have been rinsed, and cook until the curl. Sai eaeciaes aa 
hot milk, Serve at once. This soup may be thickened with a tablespoonful 
of flour cooked in the butter a4 for white sanee. 


MILK PREPARATIONS. 


Partially Peptonized Milk.—Into a clean gallows re 
or porcelain-lined saucepan place one pint of milk, four ounces 
of water, and the contents of one of Fairchild’s peptonizing 
tubes, or five grains of pancreas extract and fifteen grains of 
bicarbonate of soda, Heat gradually until it boils, stis - 
stantly, Boil gently for ten minutes, strain into a clean le, 
cork, and keep in a cool place, Before using shake the bottle 
well; serve hot or cold. Prepared in this way it will not be- 
come bitter, 

Peptonized Milk (Cold Process.)—Mix milk, water, 
and peptonizing agents as directed in the preceding recipe, and 
immediately place the bottle on ice. Use when onlinary mill 
is required. ‘This is particularly suited for dyspeptics and in- 
dividuals with whom milk does not, as a rule, agree. The 
flavor of the milk remains unchanged. 

Peptonized Milk (Warm Process.)—Put in a glass jar 
one pint of milk and four ounces of cold water ; add five grai 
of extract of pancreas and fifteen grains of bicarbonate of soda, 
After mixing thoroughly, place the jar in water as hot as can 
be borne by the hand (about 115° F.). This should be heated 
for from six to twenty minutes. At the end of this time it may 
be placed upon ice until required, ‘The contents of one of Pair- 
child’s peptonizing tubes may be used in place of the pancroas 
extract. If the milk is to be kept for any length of time, it 
should be brought to a boil, to prevent the formation of too 
much peptone, which renders the milk bitter. 

Hot Peptonized Milk.—Mix together the usual pepton- 
izing ingredients and add a pint of fresh cold milk; after 
thoroughly shaking the bottle, place it on ice. When needed 
pour out the required amount, heat it, and drink it as hot as it 
can agreeably be taken. If required for immediate use, the in- 

40 








iu 


626 RECIPES, 


gredients may be mixed together in a saucepan and slowly heated 
to the proper temperature, 

Effervescent Peptonized Milk.—Puat some finely crack- 
ed ice in a glass; fill it half-full of Apollinaris, Vichy, or 
siphon water, and immediately add the peptonized milk. Drink 

while effervescing. Brandy may be added if desired, 

Specially Pe ed Milic.—This is to be used in the 
preparation of jellies, punches, and all recipes where the milk 
is to be mixed with fruit juices or acids, Prepare according to 
the hot process ; keep the milk at a temperature of 115° F, for 
one hour ; pour into a saucepan and bring to aboil, If required 
hot, this may be used immediately, or it may be set aside on ice, 
to be used wef If not heated for an hour, the mille oe 
on being mixed with an acid. If not boiled, the pepto 
at will di ooh eres and prevent the formation rat 

Jelly.—Soak well half a box 

gente in four ounces of water, Take one pint of hot specially 
peptonized milk and add four ounces of sugar. Put in the 
gelatin and stir until it is dissolved. Pare one fresh lemon and 
one orange, and add the rinds to the mixture. Squeeze the 
lemon and the orange juice into a glass, strain, and mix with two 
or three tablespoonfuls of St. Croix ram, or brandy, if preferred. 
Add the juices to the milk, stirring constantly. Strain, and al- 
low it to cool to the consistence of syrup ; when almost ready to 
set, pour into cups and set in a cold place, Do not pour the 
milk into moulds until the mixture is nearly ready to set, other= 
wise it will separate in setting. 

Peptonized Milk Punch.—In the usual milk punch re- 
cipes the specially peptonized milk may be used in place of 
ordinary milk, Tuke a goblet one-third full of finely crushed 
ice; pour on ita tablespoonful of rum and a dash of Curacao, 
or any other liquor agreeable to the taste. Fill the glass with 
peptonized milk ; stir well, sweeten to taste, and grate a little 
nutmeg on top. 

Peptonized Milk Lemonade.—Take a glass one-third 
full of cracked ice ; squeeze into this the juice of a lemon, and 
add two or three teaspoonfuls of sugar dissolved in water. Fill 
the glass with fresh specially peptonized milk and stir well. If 
preferred, equal purts of milk and of an effervescent mineral 
water may be used. Pour the water on the lemon juice and ice, 
and immediately fill the glass with milk. 

Peptonized Milk Gruel.—Mix with a teaspoonful of 
wheat flour, arrowroot flour, or Robinson's Barley Flour with 


MILK PREPARATIONS. 627 


half a pint of cold water. Boil for five minutes, stirring con- 
stantly, Add one pint of cold milk and strain into a jar ; add 
the usual peptonizing ingredients; place in warm water (115° F.) 
for twenty minutes, then upon ice. 

Junket, or Curds and Whey.—Take a half pint of fresh 
milk ; add one teaspoonful of Fairchild’s Essence of Pepsin and 
stir just sufficiently to mix, Pour into custard cups, and let it 
stand until firmly curdled. It may be served plain or with 
sugar and grated nutmeg. It may be flavored with wine, which 
should be added before curdling takes place. 

Junket with Egg.—Beat one egg to a froth, and sweeten 
with two teaspoonfuls of white sugar; add this to a half-pint 
of warm milk; and then add one teaspoonful of essence of 
pepsin and Jet it stand until curdled. 

Cocoa Junket.—Put an even tablespoonful of any good 
cocoa and two teaspoonfuls of sugar into a sauce-pan; scald 
with two tables Is of boiling water and rub into a smooth 
paste; then stir in thoroughly one-half pint of fresh, cool 
milk ; heat this mixtare until it is Inkewarm—not over 100° F_ 
—then add one teaspoonful of Fairchild’s Essence of Pepsin 
and stir just enough to mix; pour quickly into small cu; 
glasses, and let it stand until firmly curdled, when the junket is 
ready for use. It may be placed on ice and eaten cold; as a 
dessert it may be served with whipped cream.—( Fairchild.) 

Coffee Junket.—Diseolve two teaspoonfuls of sugar in two 
tablespoonfuls of clear, strong coffee ; mix this thoroughly with. 
one-half pint of fresh, cool milk; add « teaspoonful of Fair 
child’s Essence of Pepsin as directed above, and serve in the 
same way. 

Todized Junket.—Prescribe a saturated solution of potas- 
sium jodid and also a bottle of PaCS Cr Pema Take one- 
half teacupful of milk and add the required number of drops 
of the iodid solution. Heat the milk Iuke warm and add two 
or three teaspoonfuls of the pepsin and let it stand until curdled. 
‘This will be found useful where it is difficult to administer the 
iodid by ordinary methods, 

Vannilla, Bitter Almond, or Strawberry Junket.— 
Add the flavoring extract to the cold milk and then in 
the usual way. A half a ful of vanilla or bitter al- 
mond extract ora tablespoonful of a pure concentrated straw- 
berry syrup should be allowed to a half-pint of milk. 

Lemonade.—Take two ounces of sugar, five ounces 
of boiled milk, one-half lemon, or two ounces of white wine, 





628 RECIPES. 


five ounces of boiling water, and the rind of half a lemon. 
Pour the boiling water over the peel and the sugar ; allow it to 
cool, add the milk, and then the lemon juice or wine, Strain 
after ten minutes. 

Milk Punch,—Shake together in a lemonade-shakera glass 
of milk, a tablespoonful of rum, pants or good old whey, 
and two issioodtls of sugar. After it has poured into 
eee omens Mey be grated over the top. 

‘Mix a tablespoonful of flour with one- 
aie eupful of cold milk and stir into one-fourth cupful of 
hot milk; if desired, add two raisins cut into quarters. Cook 
over boiling water for one hour, and add one-quarter teaspoonful 
of ‘salt just before serving.—{ Drexel Institute.) 

Whey.—Take a half-pint of fresh mille heated lukewarm 
(115° F,), add one tablespoonful of essence of in, and stir 
just enough to mix, When this is firmly coagulated, beat up 
with a fork until the curd is finely divided and then strain, For 
flavoring purposes lemon juice or sherry wine may be added. 

Grape Juice Whey.—Make whey as in the above recipe. 
To this add the juice of an orange and a quarter of a vintiot of 
grape juice. Strain again if necessary. This may be served 

or on cracked ice. It may be sweetened if desired. 

Cream-of-tartar Whey.—Add a heaping teaspoonful of 
cream of tartar to a pint of boiling water. Strain, sweeten to 
taste, and serve cold—(Pavy.) 

Wine Whey.—Cook together a cupful of milk and half a 
eupfal of sherry wine. As soon as the curd separates, strain 
and sweeten. This may be eaten hot or cold. 

Lemon Whey.—This is made in the same way as the fore- 
going recipe, using three tablespoonfuls of lemon juice instead 
of the wine, 


—\ Kumiss No. x.—Take a quart of skim milk, one-fifth of a 


cake of yeast, and two tablespoonfuls of sugar. Heat the milk, 
Dissolve the yeast in a little water and mix it with the 
and lukewarm milk. Pour the mixture into si 
stopper them tightly with new corks, and tie down the corks 
with stont twine. Shake the bottles well and place in a refrig- 
erator; this will allow the mixture to ferment slowly. After 
three days lay the bottles on their sides, turning them occasionally, 
Five days are required to complete the fermentation ; the kumiss 
is then at its best—(Drexel wines 

Kumiss No. 2.—Pour into wired bottles one quart of fresh 
milk, half an ounce of sugar, a piece of fresh yeast cake half 








—— 


MILK PREPARATIONS, 629 


an inch sq and keep at a temperature between 60° and 70° 
F. for one , shaking five or six times a day; then put upon 
ice —( Holt, 

Kefir With Kefilac Tablets—Pour into a well cleaned 
quart bottle one pint of pure milk, which has been boiled and 
cooled to Inkewarm temperature. 

Put one Kefilac tablet, crushed, into the bottle and shake thor- 
oughly until dissolved. Cork tight with a good, clean cork. 

Place the bottle at a temperature of' the ordinary living room 
(70°-75°), lying on its side. As fermentation advances, a curd 
will be observed forming in the bottle. Shake thoroughly four 
to five times a day until ready for use, This curd re-forms 
when the bottle is at rest, and should be shaken thoroughly each 
time the contents are used, 

After the first day a slightly sour, after the second day med- 
ium strong, sweetish sour, and after the third day, a strong, sour 
tasting, lightly foaming kefir is produced. One day old kefir 
is slightly laxative. For general use, forty-cight-hour kefir is 
recommended. 

If the kefir does not turn out right, as sometimes happens, 
when impure milk is used or whenever changeable weather pre- 
vails in the summer, it is necessary to cleanse the bottle thor- 
oughly, and boil it in a soda solution for five minutes before 
using again, 

If a larger quantity of kefir than one pint is to be made, one 
tablet should be used for each extra pint, and this proportion 
continued. It should be carefully noted that the bottle should 
be twice the size of its contents, in order to provide for fermen- 
tation, After fermentation is complete, which is about forty- 
eight hours, kefir remains good for several days, if kept on ice. 

Kefir may be used freely, and to the same extent as ordinary 
milk, From one pint_to three quarts per day, according to re~ 
quirements of the individual. 

Milk Mixture.—This is made of cream, two parts ; milk, 
one part; lime water, two parts ; sugar water, three parts (sev- 
enteen and three-fourths drams of mill sugar to a pint of water), 
—(A.V. Meigs.) 

Mitk-and cinnamon Drink,—Add a small amount of 
cinnamon to the desired quantity of milk and boil it, Sweeten 
with sugar and add brandy if desired.—( Ringer.) 

Albumized Milk,—Shuke in a covered jar or lemonade- 
shaker a cupful of milk, a tablespoonful of lime water, and the 
white of anegg. Sweeten, flavor as desired, and serve at once, 





= 


630 RECIPES. 


een cn most valuable Pye 
preparing invalids with whom it disagrees is to 
equal parts of milk and thoroughly cooked barley, rice, oat~ 
meal or arrowroot water and boil them together for ten minutes. 
This may be served plain, or flavored by cooking with it a eut- 
up raisin, a sprig of mace, or a piece af stick cinnamon, which 
should be strained out before serving. 

Trish Moss and Milk.—Soak about two 
of Irish moss for five minutes and wash thoroughly in cold 
water. Add toa cupful of milk and soak for half an bour; 
then heat slowly, stirring constantly, and then boil for ten min- 
utes, preferably in a double boiler; strain, and pour into cups 
and cool. This may be served while hot, and may be rendered 
more nutritious by the addition of the white of an egg stirred 
into it just before serving. ' 

Egg and Buttermilk Mixture.—Lightly beat the white 
of one egg and from one to four ounces of cream, Pour into 
a glass, and fill with fresh buttermilk, Stir well. 

Milk with Other Diluents.—Milk may be diluted with 
advantage in many cases by adding lime water, or Vichy, 
Apollinuris or some other sparkling table water. From one- 
half to one-eighth the total yolume may be added. 


EGGS. s 

Beggs are exceedingly valunble as food for invalids, They 
shonld always be fresh. When received they should be washed 
and then placed in a cool place. They should not be with 
any article of food having an odor, as they absorb such odors 
and the taste is thereby impaired. Stale eggs will not sink, and 
if held to a bright light they show a dark spot. The of 
an egg that has been broken may be kept fresh by placing it 
(unbroken) in a cupful of cold water. «This should be set in 
a cool place. This will keep it fresh for twenty-four hours or 
more, 

Eggs and all other albuminous food should be cooked at as 
low temperstares as possible, in order to avoid rendering them 
tough. 

Eggs are best cooked in the shell as follows : 

Soft-cooked Eggs.—Place in a pint of boiling water, remove 
from the fire, and allow to stand for eight or ten minutes. 
the egg is very cold to start with, it will take a little Jonger. 

Hard-cooked Eggs.—Place in water, bring to a boil, and 
then set on the back part of the stove for twenty minutes. 


MEATS. 631 


should be served as soon as cooked, and the dishes 
should be warmed and ready. 


EGGS AND MILK 


Rules for Custards.—The eggs should be thoroughly 
mixed but not beaten light, the sugar and salt added to these, 
and the hot milk added slowly. Custards must beeooked over 
moderate heat; if a custard curdles, pnt it in a pan of cold 
water and beat until smooth. Custards should always be 
strained.—(Drexel Institute.) 

Soft Custard.—Take a pint of milk, the yolks of two eggs, 
two tablespoonfuls of sugar, and a pinch of salt. Mix all 
except the milk in a bowl, ‘Heat the milk to the boiling-point 
and add constantly. As soon as mixed, pour into the 
in which the milk has been heated and cook from three to five 
minutes, stirring constantly until it thickens. Strain, and pour 
into a cold bowl, and flavor with from half to one teaspoonful 
of vanilla, a teaspoonful or more of sherry, or other flavoring 
material as desired, Custards may be cooked to advantage in 
a double boiler, 

Chocolate Custard.—Melt half an ounce of Baker’s choco- 
late and add to the milk, and as above. 

Steamed Custard.—Mix the above, using the whole eggs in- 
stead of the yolks, Strain, pour into cups, and steam over 
boiling water until firm. 

Baked Custard.—Proceed as above, but pour the custard into 
baking-cups. Place the cups in a deep haking-pan and fill the 
pan nearly as high as the cups with boiling water. Place in the 
oven and bake twenty minutes or longer, according to the size 
of the cup. When done a clean knife thrust into the custard 
comes out clean; if it is not done, it comes out covered with 
milk. 

MEATS. : 


General Rules for Preparing Meat—Meat must be 
weighed, trimmed, and wiped with a damp cloth. It should 
he removed immediately from the paper in which it was wrapped 
and placed in a cool place, Only tender euts of meat should 
be broiled, pan-broiled, or roasted. When meat is to be cooked 
by any of these methods, it should first be seared, and then the 
temperature slightly lowered; by searing, the albumin on the 
outer surface of the meat is hardened and the meat is thus 
cooked in its own juices. 


Tough meat should he cooked in water; boiling water hardens 











the so 


cool 







from cold broth with a cloth that has been dipped 
water and then wrung dry. Fat may be 
broth by means of tissue-paper or a slice of 
Cooking Tender Meats.— Roasting. 
into shape. Place it on a rack in a meat pan, into 
of which pieces of fat from the meat have been 
in a hot oven on the grate for ten minutes, to sear 
Tf desired it may be seasoned with salt 
remove to the floor of the oven and baste 
until it is done. Re ray Pen 
Broiling—Remove extra fat e meat grease 
broiler with a part of the fat. Broil over a clear fire; 
then turn every ten seconds, Chops one inch thick sh 
cooked for five minutes. A steak two inches thick should be 
cooked for ten minutes. Season and serve on a hot platter. ¥ 
Pan-broiling.—Remove all the fat from the meat, Heat. 
frying-pan very hot, but use no fat, Sear the meat on 










GENERAL RULES FOR SOUPS. 633 


sides, and then cook more slowly until it is done. Stand 
up on their edges to brown. Ke the pan free from fat. 

time required for pan-broiling is the same as that required for 
broiling.—(Drexel Institute.) 


GENERAL RULES FOR SOUPS. 

Both meats and vegetables should be cut into small pieces, 
The soup should be started with cold water poured over the 
meats and the heat applied gradually and the soup allowed to 
simmer, in order to dissolve as much of the nutriment as 
possible. If heated rapidly the albumin in the meat coagulates, 
and little but the extractives passes into the soup. The vege- 
tables are added when the soup is nearly done, 

Remove the fat by skimming, by using blotting-paper, by 
straining through a cloth wet in cold water, or, all, 
cooling the soup when all the fat rises to the top, when it can 
be easily removed. 

Clear soups may be rendered more nutritious by the addition 
of sago or of some cereal, as barley or rice. These may also be 
added with advantage to many thick sou 

Soups should always be served hot, Soup jellies are served 
cold, and in hot weather may be substituted for warm soups. 

Soups may also be made from soup stocks, which may be 
prepared in any quantity and kept for several days. Stocks 
may be made from any meat. ose made from chicken or 
veal aro light in color, and those from beef and mutton some- 
what darker. Stocks may also be made by using the bones 
from any kind of meats. 

Soup Stock.—To make stock, use a chicken or several 
pounds of bones with some meat attached, or a pound of lean 
meat and one quart of water. Cut-up vegetables may be added 
as desired, For flavoring add a sprig of parsley and of Ff 
a peppercorn, a small onion, and a scant teaspoonful of salt, 
Any of the flavoring vegetables may be omitted as desired or 
others added. The meat should simmer for several hours, until 
but half the quantity of water remains. Then add the other 
ingredients, simmer half an hour longer, strain and cool, 
Remove the fat, 

Soup Stock from Beef Extract.—Cook the other ingredi- 
ents, except the salt, as given above, for half an hour, using a 
quart of water, Then add a teaspoonful of beef extract a1 
quarter of a teaspoonful of salt. 

Soup from Stock.—Rice, tapioca, or whatever is desired is 
cooked and the stock added, with additional seasoning as thought 





the skin. te the meat from the bone and chop the meat 
very fine, Place with the bones—if large, they should be 
broken—in the water and soak for an hour. Cook over hot 
water for four or five hours at a temperature of 190° F. Strain 
and add salt. Water must be added from time to time to keep 
the quantity up toa pint. Remove the fat. If the broth is to 
be reheated use a double boiler, 

Sweetbread Soup,—The sweetbread is soaked in cold 
water for one hour, the water being renewed frequently di 
this time. It is then boiled for one hour in slightly sali 
water or beef both, to which one may add one teaspoonful of 
julienne to improve the taste. After it is soft the sweetbread 
is taken out of the beef broth and all blood-vessels and skin 
are removed. It may now be cut into pieces the size of a 
walnut and put on a plate, over which the beef broth is poured, 
or the sweetbread may be forced through a sieve, beef broth 
poured over this, and the whole put on the fire again until it 
boils, after which the soup may be served. This latter process 
is to be recommended in the case of dyspeptics. One hun- 
dred drams of raw sweetbread generate about 90 calories of 
heat.—(Wagele.) 

Meat Broth (Beef, Veal, Mutton, or Chicken.)— 
Cover one pound of chopped Jean meat with one pint of water 
and allow it to stand for from four to six hours. en cook over 
a slow fire for an hour until reduced to half the quantity. 
Cool, skim, pour into jar and strain. 

Veal Broth.—Pour a pint of water on a half-pound of 
finely chopped lean veal and allow it to stand for three hours. 
Boil for a few minutes, strain, and season with salt. 

Clam or Oyster Juice.—Cut the clams or oysters into 
pieces and heat for a few minutes in their juice. Strain throu, 
muslin and serve while hot. In straining great care must 
taken that sand does not pass through the muslin. The juices 
should be diluted and may be frozen.—(Drezxel Institute.) 

Clam Broth.—Wash three large clams very thoroughly, 
using a brash for the purpose, Place in a kettle with half a 
cupful of cold water. Heat over the fire; as soon as the shells 
open the broth is done. Strain through muslin, season, and 
serve.—( Drexel Institute.) 

Mutton Broth with Vegtables.—Allow one pound of 


GENERAL RULES FOR SOUPS. 635 


neck mutton to each pint of water; add carrots, turnips, onions, 
and barley ; let all simmer together for three hours. 

Mutton Broth without Meat.—Cook two “shank- 
ends” in a pint of cold water, and vegetables as directed in the 
foregoing recipe ; simmer for three hours and strain. 

Beef Tea No. x.—Cut up a pound of lean beef into 
pieces the size of dice ; put it into a covered jar with two pints 
of cold water and a pinch of salt, Let it warm gradually and 
simmer for two hours, care being taken that it does not at any 
time reach the boiling-point.—( Yeo.) 

Beef Tea No. 2.—Put a pound of finely mixed beef 

* with a pint of cold water into a suitable vessel, Let it stand 
for an hour, stirring occasionally. Put the vessel containing the 
beef into a saucepan of water, place it over the fire, and allow 
the water to heat gently for an hour (or the vessel containing the 
beef tea may be put into an ordinary oven for an hour.) 
the beef tea through a strainer. A fine sediment ay in the 
fluid, and this should be drunk with the liquid. Flavor with 
salt. At no time should the beef extract be exposed to a tem- 
perature of more than 170° F.—(Pavy.) 

Beef Tea No. 3.—Chop fine a pound of beef free fram 
fat, tendons, etc., and digest with a pint of cold water for two 
hours. Let it simmer on the stove for three hours at a tem- 
perature never above 160° F, Replace the water lost by 
evaporation by adding cold water, so that a pint of beef tea 
shall represent a pound of beef. Strain and carefully express 
all fluid from the beef.—(Bartholow.) 

Beef Tea with Oatmeal.—Mix thoroughly one table- 
spoonful of groats with two of cold water; add to this a pint 
of boiling beef tea. Boil for ten minutes, stirring constantly, 
and strain through a course sieve.—{ Yeo.) 

Beef Tea, Flavored.—bBeef tea may be flavored agreeably 
by boiling in it a pinch of mixed herbs, a bay-leaf, or a bit of 
onion, carrot, turnip, or celery and a few peppercorns. The 
roots should either be chopped small or be scraped to a pulp 
before being added to the broth.—{ Yeo.) 

Beef Juice.—Broil quickly pieces of the round or sirloin 
of asize to fit the opening in a lemon squeezer. Both sides of 
the beef should be scorched quickly to prevent the escape of 
the juices, but the interior should not be fully cooked. As soon 
as they are ready the pieces of meat should be squeezed in a 
lemon squeezer previously heated by being di in hot water. 
As it drips the juice should be received into a hot wineglass; it 





a 
636 RECIPES. 


should be seasoned to the taste with salt and a little Cayenne 
pepper, and taken while hot—{ Bartholow,) 
Beef Juice.—Cover one pound of 

lean beef with eight ounces of cold water and allow it to stand 
for eight or ten hours, Squeeze out the juice by means of 
muslin bag ; season with salt or sherry wine and drink cold or 
slightly warmed. It may be added to milk, care being taken 
that the milk be not too hot before the juice is 

Iced Meat Extract.—Cut into pieces the size of a hand 
one kilo of fresh beef; wrap in a coarse, lattice-like linen 
put under a lever press, and press slowly. The juice should be 


caught ina lain dish, This is done best by a druggist. 
By this Rathod about 500 gm. of juice are obtained. The juice 
is mixed with 250 gm. of sugar, 200 gm. of freshly expressed 
lemon juice (this last is best omitted in the ease of dyspeptics), 
and 20 gm. of cognac containing vanilla extract ; stir in well the 
yolks of three eggs; the entire mixture is then placed in a 
freezer.—(v. Ziemssen.) 

Raw-meat Juice.—aAdd to finely minced rump steak cold 
water, in the proportion of one part of water to four parts of 
meat, Stir well together, and allow it to stand for half an 
hour, Foreibly express the juico through muslin, twisting it to 
get the best results,—( Cheadle, 

Succus Carnis (Meat Jaice.)—Cut up the meat into 
smal] bits, arrange in layers separated from one another by 
coarse linen, and then place in a powerful press. From each 
kilogram of meat about 230 gm. of a blood-red juice are 
obtained. This contains about 6 per cent, of albuminates. Its 
taste is similar to that of raw meat ; its flavor may be improved 
by the addition of salt and beef tea not hot enough to coagulate 
the albumin.—(Petienkoffer and Voit.) 

Beef Essence.—Chop up very fine a pound of lean beef 
free from fat and skin ; add a little salt, and put into an earthen 
jar with a lid; fasten up the edges with a thick paste, such as is 
used for roasting venison in, and place the jar in the oven for 
three or four hours, Strain through a coarse sieve, and give the 
patient two or three tablespoonfuls at a time.—( Yeo.) 

American Bouillon (American Broth.)—Place in a 
tin vessel that can be sealed hermetically alternate layers of 
finely minced meat and vegetables. Seal it, and keep it heated 
in a water bath (bain marie) for six or seven hours, and then 

the broth.—{ Yeo.) 

Bottle Bouillon.—Cut beef, free from fat, into squares. 
Place these in a stoppered bottle, put the bottle in a basin of 


METHODS OF PREPARING RAW BEEF, 637 


warm water, heat slowly, and boil for twenty minutes. There 
will be about an ounce of yellowish or brownish fluid for each 
three-quarters of a pound of meat used, The flavor is that of 
concentrated bouillon.—{ Ujelmann.) ¥, 

Peptonized Oysters.—To hulf a dozen oysters with their 
juice add half a pint of water and boil for a few minutes. 
Pour off the broth and set it aside. Mince the oysters, and 
with the aid of a potato-masher reduce to the consistence of a 
paste, Place this with the broth in a glass jar and add fifteen 
grains each of extract of pancreas and of bicarbonate of soda 
and mix. Allow this to stand in hot water (115° F.) for one 
and one-half hours, Pour into a saucepan and add half a pint 
of milk; heat over a slow fire to boiling-point, Flavor with 
salt and pepper and serve hot. Let the heat be done 
gradually, and be careful to bring the mixture to a boil before 
taking it from the fire —( Fairchild.) 

Peptonized Beef.—Covor ono-fourth of a pound of finely 
minced lean beef (ar beef and chicken mixed) with half a pint 
of cold water. Cook over a slow fire until it has boiled for a 
few minutes, stirring constantly. Pour off the broth and rab 
or pound the meat toa paste. Put meat and broth and half a 
pint of cold water in a glass jar, and add twenty grains of ex- 
tract of pancreas and fifteen grains of bicarbonate of soda, 
Mix well und keep in a were tt about 110°-115° F. 
-—or place it in warm water allow it to stand three hours, 
stirring or shaking occasionally, Boil quickly ; strain or clarify 
with the white of an egg and season with salt and pepper. If 
desired, it need not be strained, as the small particles of meat 
are usually easily digested. Cereals may be added, boiling with 
half the amount of water previously directed, and mixing all 
together before peptonizing. At the end of three hours the 
mixture must be boiled or it will spoil—(Kairchild.) 


METHODS OF PREPARING RAW BEEF. 


Meat given raw should always be perfectly fresh and vi 
finely divided. Scrape the meat with a sharp knife, which will 
separate the coarser fibers. If the resulting mass is stringy, pass 
through a fine sieve. This may be seasoned with salt and pep- 
per, and served on toast, crackers, or bread and butter. It may 
be rolled into small balls and swallowed. These may be flay- 
ored us desired. They may also be slightly browned by rolling 
about rapidly in a hot saucepan, care being taken not to change 
any but the outside of the ball, and that but slightly. Seraped 





| 


638 RECIPES, 


PE at lea tt a Mix it with 
rah quantity of cold water until it is quite smooth, Place 

ina ante eilee nnd coven ooreeehly Bes aos 

stantly. Add a little salt and pepper am 

may be made thicker by adding less water. 

Raw Meat with Milk and Sugar.—Sempe bafaponad 
of ramp steak with a knife until all the ral eve 
sweeten with sugar, breaking the lumps of feo with the meat 
ina basin with a small wooden spoon, slowly as much 
milk peice it about the thickens of _arrowroot 5 flavor 
with brandy. Ee ratiies of the meat remains, strain through 

ner, mixture should be perfectly smooth.— 
(Ringer) 


Raw-beef Soup.—This is made by up one 
of raw beef and placing it in a bottle ae piste at aee 
and five drops of strong hydrochloric acid. ‘This mixture is 
allowed to stand on the ice overnight, and in the morning the 
bottle is placed in a pan of water at 110° F., and kept at about 
this temperature for two hours. Tt is then placed in a stout 
cloth and strained until the mass that remains is almost 
‘The filtrate is given in three portions daily. If the taste of 
raw meat is objectionable, the meat may quickly be roasted on 
one side and the process completed in the manner previously de- 
seribed.—( Weir Mitchell.) 


PANOPEPTON. 

Iced Panopepton.—To a small glass half full of clean 
crushed ice add one tablespoonful of Panopepton ; let this stand 
for a minute and then sip slowly. 

Panopepton Jelly.—This is made of one ounce of fresh 
celery cut into smal] pieces, one-half of a small box of the best 
gelatin, one-fourth of a teaspoonful of salt, two dashes of 
per, six tablespoonfuls of Panopepton, and two cupfuls of vha 
water. Soak the gelatin in half a cupful of cold water for one 
hour; put the water and cclery ina double boiler on the fre 
and simmer for one-half hour ; add the salt, pepper, and soaked 
gelatin and stir until it is dissolved; remove from the fire and 
add the Panopepton ; stir and strain through linen into a jelly 
bag and set near ice, Serve in small quantities. 

Panopepton Jelly with Orange.—The articles required 
are one half of a small box of the best gelatin, one 
fal of sugar, six tablespoonfuls of Panopepton, the juice and 
rind of one orange, and one pint of cold water, Put the gela~ 
tin, orange peel (cut in small pieces), orange juice, and cold 


serve at once. ae 


PANOPEPTON, 639 


water in a dish and let it stand for one hour, then put in 
double boiler over the fire, add the » and stir until it is 
dissolved ; now strain through linen, add the Panopepton, and 
stir well. Pour into a jelly jar and set near the'ice, Serve in 
small quantities, 

peed parr aol by seatial Spc) fall of 
boiling water add one of Po and one tea 
spoonful of rex lemon juice; a little sugar may be added if 
desired, Stir and drink immediately, sipping slowly. 

Panopepton Bouillon, Hot.—Put one tabl fal of 
Panopepton in a small teacup ; fill the cup nearly full of boiling 
water, and flavor to taste with celery salt or plain salt und pep= 
per ; stir and sip bazaiiie 

Panopepton Cordial.—Put inte a cordial glass or any 
small glass two teaspoonfuls of clean crushed ice ; add one tea~ 
spoonful of Fairchild’s Exsence of Pepsin and three teaspoonfals 
of Panopepton. Sip slowly. This 1s a good after-dinner cor 
dial for those who suffer discomfort after eating. 

Panopepton with Whey.—Put into a small teacup one 
or two teaspoonfuls of clean crushed ice ; add one fal 
of Panopepton, stir, and then fill the cup with whey. Drink 
slowly. 

Bes Gruel.—Take one cupful of hot beef broth made with 
“Soluble Beef,” one egg, and one-half mnful of salt, Beat 
the white and the yolk of the egg separately ; add the hot beef 
broth ually to the yolk, stirring continually. Whip the 
white Ces stiff, dry froth with the salt, and beat it into the hot 
broth. Return to the double boiler and reheat. Serve very 
hot, 

Barley Gruel with Beef Extract.—One-half teaspoon- 
ful of “Soluble Beef,” two cupfuls of hot water, one tablespoon~ 
ful of barley flour, one saltspoonful of salt. Dissolve the beef 
in the hot water, and mix the flour and salt together with a 
little cold water. Pour the boiling stock on the flour and cook 
for ten minutes. Strain and serve very hot. 

Beef Broth with Poached Eggs.—Prepare the broth 
in the proportion of half a teaspoonful of “Soluble Beef” to 
one eupfal of hot water and add a poached egg. 

A Nutritive Drink for Delicate Women and Chil- 
dren.—This is made by mixing one-fourth to one-half tea- 
spoonful of “Soluble Beef,” five ounces of boiling water, and 
one-half ounce of cream ; season with salt and pepper to suit 
the taste. 

Beef Broth with Grain.—Take one teaspoonful of “Sol- 








640 RECIPES, 


uble Beef,” one quart of water, one eee Spe of rice, and 
salt to taste. Dissolve the * Soluble "in the hot water, 
andiadd the well-washed rice. Simmer slowly until dissolved 
and absorbed by the rice, adding more beef broth if too much 
boils away. If not entirely dissolved, the broth should be 
strained before using. 

Beef-tea Egg-nog.—This requires one-eighth teaspoonful 
of “Soluble Beef,” one-half cupfal of hot water, one tablespoon- 
ful of brandy, and a pinch of salt, Beat the egg slightly, and 
add the salt and sugar. Dissolve the “Soluble Beef” in the 
hot water, add to the egg, and strain. Mix thoroughly, adding 
wine, and serve. 


MEAT JELLIES WITHOUT GELATIN. 


Chicken Jelly.—Half a grown chicken should be well 
pounded, and boiled in one quart of water for two hours until 
only a pint remains; season and strain, Serve hot or place on 
ice, where it will “ jel.” 

Veal-bone Jelly.—Place ten pounds of veal bones and 
ten quarts of water or weak bouillon over the fire and to 
just a boil, Skim and add two pounds of barley and a little 
salt. Simmer for five or six hours and then strain. If too 
thick, dilute, before serving, with bouillon. Stir in the yolk 
of an egg in a cup and serve. 

Meat Jelly.—This is made by cooking good boneless, lean 
beef on a water bath with a little water for sixteen hours or 
until it becomes gelatinized. Of the artificial preparations on 
the market for making bouillon, the most reliable is Liebig’s 
Extract of Meat (10 : 250 gm.) or Cibil’s Bouillon (1 teaspoon- 
ful to 250 gm.). Inaglio’s bouillon capsules are also very con= 
venient. If it is desired to make the bouillon more nutritious, 
one teaspoonful of meat peptone may be added.—(Hépp. 

Jelly for Dyspeptics.—Remove the skin and oe) from 
one calf ’s foot; wash the bones and place in cold water on the 
stove; when it begins to foam, skim off the refuse which gath- 
ers on top. After rinsing off the scum with cold water, put 
the bones into a pot with one-quarter kilo of beef or half an 
old hen, one-quarter liter of water, and 5 gm, of salt, and boil 
slowly for from four to five hours. Pour the jelly thus formed 
through a fine sieve, and lene overnight in a cellar, Next 
morning remove the fut, and clarify the cold jelly by adding one 
egg with its shell mashed, beating and stirring steadily, “Then, 
with the addition of a little cornstarch, subject the whole to a 


aii 





MEAT JELLIES WITHOUT GELATIN, 641 


gray 
roast may be utilized and is very palatable. It must be stirred 
in while the mass is still warm and liquid. ‘This jelly is usually 
relished with cold fowl, but spoils easily in summer; it must 
therefore be kept ou nme tes 

Dishes Made with .—Gelatin should be soaked 
in cold water for about hulf an hour to soften it. It may then 
be easily dissolved by adding boiling water. If it is desired to 
soften gelatin quickly, it should be placed in cold water and 
gradually heated over boiling water until it dissolves, If a 
jelly is to be strained, a wet cloth should be used for the pur- 
pose. jelly molds should be wet with cold water before’ being 
filled. When granulated gelatin is used, much smaller amounts 
are required than when the ordinary form is used. 

Wine Jelly.—Soak a teaspoonful of granulated gelatin in 
two tablespoonfuls of cold water and half a cupful of hot water. 
Add two tablespoonfuls of sugar and half a teaspoonful of 
lemon juice, and when cooling add two tablespoonfuls of 
wine—(Drexel Institute.) 

Lemon Jelly is made in the same manner as the wine jell: 
just described, using a tablespoonfal of lemon juice in place 
the quantity directed. 

Orange Jelly is made in a similar manner, using two tea 
spoonfuls of lemon juice, four tablespoonfuls of orange jui 
and three tablespoonfila of sugar, but a little less ‘of the boil 
ing water. 

Coffee Jelly is also made similarly, adding an ounce or two 
of coffee, 

Nutritious Coffee.—Dissolve a little isinglass or gelatin 
in water, put half an ounce of freshly ground into a sauce 

in with one Bie of new milk, which should be nearly boiling 

re the coffee is added ; boil together for three minutes ; clear 
it by pouring some of it into a cup and dashing it back again ; 
add the gelatin, and leave it to settle in a warm place for a few 
minutes, Beat up an Bd in a breakfast cup, and the coffee 
upon it ; if preferred drink without the egg.—( ol 

Milk Jelly.—Take two quarts of milk and half a 
pound of sugar. Boil for five or ten minutes. Cool, and add 
an ounce of gelatin dissolved in a cupful of cold water. Flavor 


ai 


Ve 


642 RECIPES, 


with the juice of two or three lemons and three glasses of good. 
Bordeaux wine.—(Schlesinger.) 

Trish-moss Blanc-mange.—Wash « tablespoonful of 
Trish moss in several changes of water and pick it over eare~ 
fully. Place it in a double boiler together with half a cw 
of milk. Cook until it thickens when dropped on a cold 
Add salt, strain, and flavor. Pour into a custard cup that has 
first been rinsed in cold water—{ Drexel Institute, Nes 

Meat Jellies with Gelatin.—Use any kind of meat 
broth desired, but always one with appetizing flavor. Adda 
teaspoonful of granulated tin to enough broth to cover it, 
and allow the gelatin to for a few minutes, Then add the 
remainder of a cupful of the broth very hot and stir until the 


- gelatin is dissolved. Strain, and pour into molds to cool. 


Meat Jellies with Tapioca.—Mix a cupful of broth as 
above with four level tablespoonfuls of powdered tapioca, Heat 
until quite clear, stirring constantly, Add salt and season as 
desired. Pour into molds and cool. 

Meat Jellies with Irish Moss.—Wash two tablespoon- 
fuls of sis mows thoroughly. Add this 10 x eupful of hot 
broth and allow it to stand for half an hour; then slowly, 
stirring constantly, and boil for ten minutes, preferably in a 
double boiler. Strain, and pour into molds and eool. 

Albuminized Jelly.—Any of the above meat jellies may 
be rendered more nutritious by the addition of the white of an 
egg. The egg should be well beaten and stirred into the jelly 
just after it has been taken off the fire. 


RECIPES FOR FOODS FOR DIABETICS. 


Gluten Bread.—Mix one pound of gluten flour with three- 
fourths of a pint or one pint of water at 85°F. (With some 
of the prepared flours—Bishop’s, for example—no yeast is ne- 
quired.) As soon as the dough is mixed put it into tins and 
place them immediately in the oven, which should be at a tem- 
perature of about 430° F, Or the dough may be made into 
small dinner rolls and baked on flat tins, The loayes take 
about one and one-half hours t bake, and the rolls three-fourths 
of an hour, Either are easily made, The addition of a little 
salt improves the bread, 

When any special brand of flour is used, the directions that 
accompany it should be followed closely, 

Gluten Pudding.—A batter of egg, cream, and glaten 


= 








RECIPES FOR FOODS FOR DIABETICS. 643 


Soar As peepared. ‘This is flavored with lemon or other essences 
Gluten Pancakes.—Add gluten flour to one or two 

and beat into a batter, ‘The pancakes may be sweetened wil 

little saccharin or eaten with glyecrin.—{ Williamson.) 
Jeffries’ Gluten Biscuit.—Mix thoroughly fen flour, 

one cupfal; best bran, prevent scalded, one cuy 

powder, one teaspoonful ; salt to taste ; two eggs 5 Se 


one cupful, 

Diabetes Bread.—Take one quart of set milk or milk and 
water, one hi teaspoonful of good butter, one-fifth of a 
cake of com yeast beaten up with a little water, and two 


well-beaten eggs. Stir in gluten flour until a soft dough is 
formed ; knead as in making ordinary bread ; place in pans to 
raise, and when light bake in a hot oven.—(James Stewart.) 

Camplin’s Bran Cakes.—Tuke a sufficient quantity—say 
& quart—of wheat bran, boil it in two successive waters for a 
quarter of an hour, each time straining it through a sieve ; then 
wash it well with cold water (on the sieve) until the water runs 
off perfectly clear ; squeeze the bran through a cloth as dry as 
possible, and then spread it thinly on a dish ; place it in a slow 
oven; if put in at night, let it remain until the morning, ee 
if perfectly dry and crisp, it will be ready for grinding. ‘The 
bran thus prepared must be ground in a mill, and sifted through 
a wire sieve that has so fine a mesh that a brash must be used 
to pass it through ; that which remains in the sieve must be re- 
ground until it becomes quite soft and fine. Take of this bran 
powder three ounces (some patients use four ounces); the other 
ingredients are as follows: three new-lai id eggs; ona and. one- 
half or, if desired, two ounces of butter; about half a pint of 
milk, Mix the eggs with a little of the milk, and warm the 
butter with the remainder; then stir the whole well together, 
adding a little nutmeg or ginger or any other agreeable 
Bake in small tins (patty pans), eich must be well buttered, 
in a somewhat quiel se oven for about half an hour, When 
baked, the cakes should be a little thicker than a captain’s bis- 
cuit; they may be eaten with meat or cheese for breakfast, din- 
ner, or supper. At tea they require a somewhat liberal allow- 
ance of butter, or they may be eaten with curd or with any 
soft cheese. It is important that the four be prepared as 
directed above. If the cakes do not keep well or if they have 
not been well prepared, place them before the fire for ten minutes 
every day. 

Almond Pudding.—Take two eggs, one-quarter of a pound 


644 RECIPES. 


of almond flour, one-quarter of a pound of butter, and three tab- 
loids of saccharin dissolved in a tablespoonful of brandy. Warm 
the butter, beat in the almond flour and the yolks of the 
and add the dissolved saccharin. Whip the whites into a stiff 
froth, and beat all together. Put into dariole molds and bake 
in a quick oven; serve with a little hot sauce made with dry 
ary snocharin.—( Mrs. Hart.) 
ond Biscuit.—To each ounce of almond flour add the 

whites of two pgs and salt to taste. Whip the whites to a 
stiff froth, add the almond flour, and beat well together. Put 
in buttered patty pans and bake in a moderately quick oven for 
from fifteen to twenty minutes. The whole must be done 
quickly, and baked as soon as the ingredients are mixed. This 
biscuit is a useful substitute for bread.—(Mrs. Hart.) 

Almond Cakes. No. x.—Take one pound of ground 
almonds, four eggs, two tablespoonfuls of milk, a pinch of salt. 
Beat up the eggs and stir in the almond flour ; place in twelve 
flat tins and bake in a moderate oven for about fifteen minutes. 


‘Saundby. 
renee ‘sais No. 2,—Break up about one-quarter of a 
und of sweet almonds in a stone mortar (or almond flour may 
be used), Put the flour into a linen bag, which should then be 
immersed for one-quarter of an hour in boiling water, acidulated 
with a little vinegar to remove the small amount of sugar from 
the almonds. Mix well with three ounces of butter and two 
. Then the yolks of three eggs and a little salt are added, 
and the whole stirred briskly for some time, Beat the whites 
of three eggs to a fine froth and add to the mixture, The paste 
is then made into biscuits, smeared with butter, and baked with 
a gentle fire——(Scegen.) 

Aleuronat Bread.—Tuake about six or seven ounces of ordi~ 
nary wheat flour and the same quantity of aleuronat powder; 
five ounces of the best butter; one teaspoonful of salt ; three 
quarters of an ounce of baking powder. The flour and the aleur- 
onat are mixed in a warm dish, and the melted butter and milk 
(made lukewarm) are added gradually, followed by the salt, and 
finally by the baking-powder (one part of sodium carbonate 
and two parts of cream of tartar). The dough is well mixed, 
then molded into two loaves, and baked at a good heat,— 
(Bbstein,) 

Aleuronat and Almond Cakes.—Three ounces of aleur- 
onat ; three ounces of almond flour; beat up one egg, and add 
about two teaspoonfuls of cream and a little water, Moisten 
the aleuronat with a little water containing saccharin and let it 


ill 


RECIPES FOR FOODS FOR DIABETICS, 645 


stand for a few minutes ; then add the almond flour, theegg, the 
cream, and the water just as required to make a light paste. 
Spread ona tin. Cut into squares, and bake ina moderate oven 
for twenty minutes.—( Williamson.) 

Alcuronat Pancakes.—Take one egg and beat it up in a 
little water and cream ; take two teaspoonfuls of aleuronat pow= 
der and half a teaspoonful of baking-powder and a little salt, 
Mix well, and then add gradually to the egg and cream and 
heat into a batter ; allow it to stand for five minutes. If it is 
too thick, add a little more cream and water, Fry in an ordi- 
nary frying-pan with a little lard. At the end of about 
eight minutes, when the under surface is browned, turn it over 
and continue to bake for five minutes longer—{ Williamson, 

Aleuronat and Suet Pudding.—This is a palatable 
cheap dish. To make it take two ey oS ae flour and 
two ounces of suet, one a pinch of salt, a teaspoon= 
ful of baking~powder. “Sprinkle a little aleuronat flour on a 
chopping-board and chop the suet on this part of the board, 
Then mix the remaining aleuronat with the suet in a dishy 
Add the salt and the baking powder, Beat up the egg in t 
three tablespoonfuls of water to which a little saccharin has been 
added. Add the egg gradually to this mixture, rubbing the 
whole mass well intoa paste, It may be necessary to add a 
little more water. Drop into a tin pudding mold smeared with 
butter or lard, float it in a pan of water, and boil for two hours, 
taking care that the boiling water does not get into the mold ; 
or, better still, the pudding may be baked in the oven. Its 
taste is improved by the addition of half an ounce of almonds, A 
small quantity of red wine may serve as a sauce—( Williamson.) 

Cocoanut Pancakes.—Beat up one egg in two tablespoon- 
fuls of milk, or, better, in a little cream ra water, and add a 
pinch of salt. Then add two tablespoonfuls of cocoanut powder 
(freed from sen). Allow this to stand for from five to ten 
minutes. Add a little more cream and water. Mix well until 
it is a little thicker than ordinary pancake batter. Put a little 
lard in the frying-pan and heat until the lard is just melted ; 
then drop in half of the mixture. Allow this to remain over a 
moderate fire for a few minutes—about five—until the under 
surface is brown; then turn the cake over and heat for another 
five minutes. The other half of the mixture may be used for 
the second pancake,—{ Williamson.) 

Cocoanut Cakes.—Mix three tablespoonfuls of cocoanut 
powder into a paste with a little German yeast and water. The 
mixture aboald' ba allowed to remain by the fire or in a warm 





646 RECIPES. 


place for about twenty minutes, or until fermentation occurs and 
it becomes “puffy.” Then add a small quantity of a watery 
solution of saccharin. Beat up one egg, and add this with two 
teaspoonfuls of cream and a little water to the cocoanut paste. 
‘The whole should be well mixed, dropped into small tins, and 
baked in an oven for about thirty minutes—( Williamson. 
weet Almond Cates —To make these, fat 
ing i fients are required : uarters of a 
the finest cocoanut powder, caus of a pound Bg ground 
almonds, six eggs, and half a cupful of milk, Beat up the 
and stir in the cocoanut and almond flour, Divide into 
sixteen flat tins, and bake for twenty-five minutes in a moderate 
oven.—(Saundby.) 
Cocoanut Pudding —Tuke three tablespoonfuls of cocoa- 
nut powder, mix with a little water and German yeast, and 
for twenty minutes in a warm place, so as to allow the 
quantity of sugar present to decompose ; add four tablespoonfuls 
of cream, one egg, a little salt, and half a pint of water sweet 
ened with saccharin. Mix intoa paste. Place in a dish 
with butter. Cook like rice pudding, in a slow oven for thirty 
a ea Williamson.) 

Light Custard.—Beat up well one egg; make a mixture 
of cream and water and boil ; gradually add the boiled cream 
and water, while hot, to the egg, stirring with » spoon. Then 
place the mixture in a pan over the fire, and stir constantly until 
it becomes thick; then pour into a glass. It is im) t that 
the mixture should not be heated too much—i. e., that it be not 
boiled—as the albumin would be coagulated. Flavor with cin- 
namon and sweeten with saxin or saccharin if desired. 

Cheese Cakes.—Take one pint of milk, half a tablespoon 
ful of rennet, one ounce of butter, two eggs, one tabl 
of brandy, one-quarter of an ounce of almonds, and a little 
saccharin. Curdle the milk, and let it stand in a warm 
until thoroughly set; tie » piece of muslin over a bowl and 

rx the milk over the muslin ; let it stand until all the whey 
i been strained off. Beat the curd smooth, and add the but- 
ter and egg, well beaten, with the brandy, almonds, and saccharin. 
When well mixed pour into patty pans and bake for fifteen or 
twenty minutes—(Mrs. Hart.) 

Stewed Lettuce.—A well-grown head of lettuce should be 
selected. Boil this in plenty of water, taking care not to let it 
fall to pieces. When nearly done take it out of the water, drain, 
and place in a stewpan with a litde rich brown gravy and allow 
it to simmer for twenty minutes. 




















RECIPES FOR FOODS FOR DIABETICS, 647 


Inulin Biscuit.—Put 50 gm. (1} oz.) of inulin in a large 
porcelain basin, place this over a hot-water bath, and with 30 c.c. 
(1 02.) of milk and as much hot prea may be necessary, rub up 
into a smooth dough, into which the yolks of four and a lit- 
tle salt have been mixed. To thiead the whites of the four: 
having first beaten them toa foam, and working them in 
Bake in tin molds smeared with butter. The taste of the Biscuit 
may be improved by adding vanilla or other flavoring extract, 
Inulin is too expensive to be used by the average patient. 

Peanut Flour.—This contains about 26 per cent. of carbo- 
hydrates. ‘The peanut kernels should "be boiled in water for 
half an hour to extract a portion of the oil which contain, 
They should then be dried, and rolled into fine les with a 
rolling-pin. Place the kernels in boiling water eidulated with 
tartaric acid or vinegar, in order (1) to extract saccharin ele- 
ments ; (2) overcome the taste and odor of the peanut; (3) to 
prevent emulsification of the remaining oil, When they have 
been thoroughly boiled in acidulated water, the ground kernels 
should be subjected to dry heat and then rolled into a fine flour. 
This flour may be made into a form of porridge with milk ; 
bread and biscuits may also be baked from it; and it may be 
made into the form of a German pancake—(Stern. ) 

Home-made Substitute for Bread.—Beat up thorough- 
ly six eggs ; add a teaspoonful of baking-powder or ita chemical 
equivalent, and one-quarter of a teaspoonful of salt, and beat 
again. Pour this mixture into hot waffle-irons ameared with 
butter, and bake ina very hot oven. By way of variety almonds 
(powdered) may be added. These biscuits may be eaten hot with 
butter and cheese, 

Sugar-free Milk for Diabetic Feeding.—Take 1 liter 
of skim milk, heat to a temperature of 30° C., and add 10 c.c. 
of glacial acetic acid, diluted with 100 c.c. of water. Mix, ant 
allow the mixture to stand for about fifteen minutes, 
the separated casein, and let it drain on very fine muslin, usi 
no pressure. Remove the casein toa mortar, rab into a sm 
paste, add 4 liter of distilled water, and strain as before. 
peat this washing of the casein twice. Transfer to a mortar, 
rub until quite smooth, and add 24 gm, of potassium hydrate 
dissolved in 100 ¢.c, of water (or as much of the potassium hy~ 
drate as is necessary to make the product just alkaline to phe- 
nolphthalein), Add 100 gm. of ordinary Devonshire clotted 
cream, 5 gm, of gelatin, previously dissolved, 0.06 gm. (a ie) 

of saccharin, and water, at about 38° C., up to 1 liter. ly, 
strain through fine muslin, —(Hutehinaon.) 








THE CHEMICAL COMPOSITION OF AMERICAN 
FOOD MATERIALS. 


THe material in this section has been taken from the re~ 
vised edition of Bulletin No. 28 of the Experiment Stations 
of the Department of Agriculture of the United States. This 
very valuable bulletin was prepared by W. O. Atwater and A. 
P. Bryant, and represents the best compilation of analyses of 
American food materials down to 1899, Only the averages 
have been abstracted from the tables; for ordinary purposes 
these will be found to be sufficient ; for the complete tables the 
reader should refer to the original bulletin, 

The earliest quantitative food anulyses were made in 1795 
by Pearson, in England, who analyzed potatoes. In 1805 
Einhoff analyzed potatoes and rye. Later other workers gave 
various accounts of their work, but the great impetus to the 
study of food materials was given by Liebig and his. 
whose work was done chiefly in the period between 1840 
1865. About 1864 Henneberg and his associates elaborated 
the so-called Weende method for proximate analysis. This 
method, with slight alterations, is used to-day wherever food 
analyses are made. ‘The methods followed in different coun- 
tries agree so closely that for the Inst twenty years it has been 
possible to accept analyses by chemists in different parts of the 
world and compare them with one another without hesitation” 
(Atwater and Bryant). Since the establishment of the 
ment stations an enormous amount of work has been 
The results given in the tables (on pp. 657-683) show the 
averages of thousands of analyses; these, together with the 
accompanying list, have been taken directly from Atwater and 
Bryant's publication. 


EXPLANATION OF TERMS.' 
The terms used in reporting analyses of foods and 


stufls need some explanation. Some of these terms have a 
technical meaning which is well recognized and understood by 


1 hese definitions are quoted from Atwater and Bryant. 


648 





EXPLANATION OF TERMS. 649 


scientists, although the dictionaries and similar books of refer- 
ence have not yet included these uses in their definitions, In 
other cases the same word has been used by scientists in differ- 
ent ways. secheg Byler oeppiatrecey Wie epee 
below in the sense in which they are employed in the 

table and the publications of the Experiment Stations of the 
United States Department of Agriculture. 


COMPOSITION OF FOOD MATERIALS, 


Ordinary food materials, such as meat, fish, eggs, potatoes, 
wheat, ete., consist of : 

Refuse.—As the bones of meat and fish, shells of shellfish, 
skin of potatoes, bran of wheat, ete. 

Edible Portion —As the flesh of meat and fish, the white and 
yolk of eggs, wheat flour, etc. This edible portion consists of 
water (usually incorporated in the tissue and not visible as 
such), and nutritive ingredients or nutrients, 

The principal kinds of nutritive ingredients are protein, fats, 
carbohydrates, and ash or mineral matters. 

‘The water and refuse of various foods and the salt of sulted 
meat and fish are called non-nntrients. In comparing the values 
of different food materials for nourishment they are left out of 
account. 

Protein.—This term is used to include nominally the total 
nitrogenous substance of animal and vegetable food materials, 
exclusive of the so-called nitrogenous fats. Actually it is 
employed, in common usage, to designate the product of the 
total nitrogen by an empirical factor, generally 6.25. 

This total nitrogenous substance consists of a great variety 
of chemical compounds, which are conveniently divided into 
two principal classes, proteids and non-proteida, 

The term proteid, as here employed, includes: (1 
simple proteids, ¢, ¢., albuminoids, globulins, and their 
tives, such as acid and alkali alb bumins, coagulated proteids, 
proteoses, and peptones ; (2) the so-called combined or eom= 
pound proteids; and (3) the so-called gelatinoids (sometimes 
called “ glutinoids”) which are characteristic of animal connec- 
tive tisaue, 

‘The term albuminoids has long been used by European and 
American chemists and physiologists as a collective designation 


for the substances of the first two groups, ay 
it to all three of these groups. Of late Pree, ee: P taveath = 





650 CHEMICAL COMPOSITION OF AMERICAN FOODS, 


gators and writers have employed it as a special designation for 
compounds of the third class.’ 

‘The term non-proteid is here used synonymonsly with non- 
albuminoid, and includes nitrogenous animal and vegetable 
compounds of simpler constitution than the i The 
most important animal compounds of this class are the so-called 
“nitrogenous extractives” of muscular and connective i 
“such as creatin, creatinin, xanthin, hypoxanthin, and alli 
cleavage products of the proteids. To some of these the term 
“meat bases” hus been applied. The latter, with certain 
mineral salts (potassium phosphates, cte.), are the most import= 
ant constituents of beef-tea and many commercial ‘meat 
extracts,” : 

‘The non-proteid nitrogenous compounds in vegetable foods 
consist of amids and amido acids, of which asparagin and 
aspartic acid are familiar examples, 

‘The ideal method of analysis of food materials would involve 
quantitative determinations of the amounts of each of the 
several kinds or groups of nitrogenous compounds. This, how- 
ever, isseldom attempted. The common practice is to beens d 
the percentage of nitrogen by the factor 6.25 and take the prod- 
uct as representing the total nitrogenous substance. For many 
materials, animal and vegetable, this factor would be nearly 
correct for the proteids, which contain, on the average, not far 
from 16 per cent, of nitrogen, although the nitrogen content of 
the individual proteids is quite varied. ‘The variations in the 
nitrogen of the non-proteids are wider, and they contain, on 
the average, more than 16 per cent. of nitrogen. It is evident, 
therefore, that the computation of the total Braet sub- 
stanee in this way is by no means correct. In flesh of 
meats and fish, which contain very little of carbohydrates, the 
nitrogenous substance is frequently ostimatod by difference—i. ¢., 
by subtracting the ether extract and ash from the total water- 
free substance. While this method is not always correct, it is 
oftentimes more nearly so than the determination by use of the 
usual factor. 

The distinction between protein and proteids is thus 
sharp. The latter are definite chemical compounds, while the 
former is an entirely arbitrary term used to designate a group 
which is commonly assumed to include all of the nitrogenous 
matter of the food except the nitrogenous fats. 


‘United States Department of Agriculture, Office of Experiment Stations, 
Bulletin 685, p. 118. 


EXPLANATION OF TERMS. 651 


In the tables herewith the common usage is followed, by 
which the protein is given as estimated by factor—i. ¢., total 
ei multiplied by 6.25. In the analyses of meats and 
fish, however, the figures for “by difference” are also 

iven. Where the proteid non-proteid nitrogenous matter 
ave been estimated in a food material the proportions are indi- 
cated in a footnote. 

Fats.—Under fats is included the total ether extract. 
Familiar examples of fat are fat of meat, fat of milk sass 
oil of corn, aes al cee The i ts of the 
extract” of animal and vegetable foods and 
which it is customary to group roughly as fats, include with the 
true fats various other substances, as fatty acids, lecithins (nitrog- 
enous fats), and chlorophylls, 

Carbohydrates: —Caroohydrates are usually determined by 
difference. They include sugars, starches, ae, gums, 
woody fiber, etc. In many instances separate determinations 
of one or more of these groups have been made. The deter- 
minations of fiber” in le foods—i. ¢., substances allied 
to carbohydrates but insoluble in dilute acid and alkali, and some- 
what similar to woody fiber—are given in a separate column. 

‘The figures in parentheses in the erude-fiber column show 
the number of analyses in which the fiber was determined. 
‘The figures for “total carbohydrates” inclade the fiber, ds well 
a8 8 , starches, ete. Where the sugars or starches have 
been determined separately, footnotes are added giving the aver- 
age results. 

Ash or Mineral Matters—Under this head are included 
phosphates, sulphates, ehlorids, and other salts of potassium, 
sodium, magnesium, and other metallic elements, Where 
analyses of the mineral matters have been found they are added 
in the form of footnotes. These results usually give the per- 
centage composition of the ash as uced by incineration 
rather than the proportions in which the different mineral 
ingredients occur in the food material. 

Frel-value-—By fuel-value is meant the number of calories 
of heat equivalent to the energy which it is assumed the body 
would be able to obtain from one pound of a given food material, 
provided the nutrients of the latter were completely digested. 
‘The fuel values of the different food materials are calculated by 
use of the factors of Rubner, which allow 4.1 calories for a 
grim of protein, the sume for a gram of carbohydrates, and 9.3 
calories per gram of fats. These amounts correspond to 18.6 





652 CHEMICAL COMPOSITION OF AMERICAN FOODS. 


calories of energy for each hundredth of a pound of ‘in and | 
of carbohydrates, and 42.2 calories for each hw ofa 
pound of iat in the given food material. In the following tables 
the fael-value per pound has been calculated by use of these 
factors. In these calculations the values of protein by factor 
have been used in all cases with the exception of salt cod and 
hen’s eggs, in which the value of protein by difference was used. 





CUTS OF MEAT. 

‘The methods of cutting sides of beef, veal, mutton, and 
pork into parts, and the terms used for the different “ cuts,” 
as these parts are commonly called, vary in different localities. 
The analyses bere reported apply to cuts as indicated eee 
following diagrams. These show the positions of the di 
ent cuts, both in the live animal and in the dressed carcass as 
found in the markets. The lines of division between the dif- 
ferent cuts will vary slightly, according to the usage of the 
local market, even where the general method of cutting is as 
here indicated. ‘The names of the same cuts likewise vary in 
different parts of the country. 

The Cute of Becf—The general method of cutting up a side 
of beef is illustrated in Fig. 1, which shows the relative posi- 
tion of the cuts in the animal and in a dressed side. The neck 
piece is frequently cut so as to include more of the chuck than 
is represented by the diagrams, The shoulder clod is usual, 
cut withoat bone, while the shoulder (not indicated in diageaeiy 
would include more or less of the shoulder-blade and of the 
upper end of the fore shank, Shoulder steak is cut from the 
chuck, In many localities the plate is made to include all the 
parts of the fore-quarter designated on the diagrams as briaket, 
cross-ribs, plate and navel, and different portions of the plate, 
as thus cut, are spoken of as the “brisket end of plate” and 
“navel end of plate,” This part of the animal is largely used 
for corning. The ribs are frequently divided into first, second, 
and third cuts, the latter lying nearest the chuck and being 
slightly less desirable than the former. The chuck is some 
times subdivided in a similar manner, the third cut of the 
chuck being nearest the neck, The names applied to different 
portions of the loin vary considerably in different localities, 
The nearest the ribs is frequently called “small end of 
loin” or “short steak.” The other end of the loin is called 
“hip sirloin” or “sirloin.” Between the short and the sirloin 





ai 





is a portion quite generally called the “tenderloin,” for the 
reason that the real tenderloin, the very tender strip of meat 


lying inside the loin, is found most 
fully developed in this cut. Por- 
terhouse steak is a term most fre- 
quently applied to cither the short 
steak or the tenderloin, It is not 
uncommon to find the flank cut so 
as to include more of the loin than 
is indicated in the figures, in which 
case the upper portion is called “flank 
steak.” The larger part of the flank 
is, however, very frequently corned, 
as is also the case with the rump. 
In some markets the rump is cut so 
as to include a portion of the loin, 
which is then sold as “rump steak.” 
The portion of the round on the in- 
side of the leg is regarded as more 
tender than that on the outside, and 
is frequently preferred to the latter. 
As the leg lies upon the butcher's 





sy 
ee 
a 
A 





654 CHEMICAL COMPOSITION OF AMERICAN FOODS. 


table this inside of the round is usually on the upper or top 
side, and is therefore called “top round.” Occasionally the 
plate is called the “ rattle.” 

The Cuts of Veal—The method of cutting up a side of veal 
differs considerably from that employed with beef. This is 
illustrated by Fig. 2, which shows the relative position of the 
cuts in the animal and in a dressed side. The chuck is much 
smaller in proportion, and frequently no distinction is made 
between the chuck and the neck. ‘The chuck is often cut so 
as to include considerable of the portion here designated as 
shoulder, slowing more nearly the 
method adopted for subdividing beef. 

The shoulder of veal as here indicated 
includes, besides the portion corresponding 
to the shoulder in beef, the larger part of 
what is here classed as chuck in the adult (o| 





FXG, 2—Dingrams of cots of veal: 1, Neck: 2, chuck: 3, shoulder; 4, foreshank; 
i) 16, ribe:7, lon: §, lank: 9, leg: 10, hind shank —(Atwater and Bryant, Bulletin 
AMG api el Ee el pad ale) 


animal. The under part of fore-quarter, corresponding to the 
plate in the beef, is often designated as breast in the veal. The 
part of the veal corresponding to the rump of beef is here in- 
cluded with the loin, but is often cut to form part of the leg. 
In many localities the fore- and hind-shanks of veal are called 
the “ knuckles.” 

The Cuts of Lamb and Mutton.—Fig, 3 shows the relative 
position of the cuts in a dressed side of mutton or lamb and in 
alive animal. The cuts in a side of lamb and mutton number 
but six, three in each quarter. The chuck includes the ribs as 
far as the end of the shoulder-blades, beyond which comes the 


CUTS OF MEAT, 655 


loin. The flank is made to include all the under side of the 
animal, Some butchers, however, make a larger number of 
cuts in the fore-quarter, including a portion of the cuts marked 
“Join” and “chuck” in Fig. 3, to make a cut designated as 
“rib,” and a portion of the “flank” and “shoulder” to make 
a cut designated as “ brisket.” The termi “ chops” is ordinarily 
used to designate portions of either the loin, ribs, chuck or 
shoulder, which are either out or “chopped” by the butcher 


p 


| 





gS Tn tae ian tn: os peas 
into pieces suitable for frying or boiling. The chuck and ribs 
are sometimes called the “ rack,” 

The Cuts of Pork,—The method of cutting up a side of pork 
differs considerably from that employed with other meats, A 
large portion of the carcass of a dressed pig consists of almost 
clear ie This furnishes the cuts which are used for “salt 
pork” and bacon. Fig. 4 illustrates a common method of cut- 
ting up pork, showing the relative position of the cuts in the 
animal and in the dressed side, The eut designated as “back 








7 


656 CHEMICAL COMPOSITION OF AMERICAN FOODS. 


cut” is almost clear fat, and is used for salting and pickling. 
The “ middle cut” is the portion quite generally used for bacon 








wey 


Fee, 4—Diagrams of outs of pork: 1, Mead) 2, shoulder: 5, back; 4, middle out) 
eB Jed Bs § loin, ter-and Bryant, Bulletin No, 
5, belly: 6 hams 7, ribs; lol vrais and pa "28, Oiice of Expert 


and for “lean ends” salt pork. ‘The belly is salted or pickled 
or may be made into sausages. 

r Beneath the “back cut” are the ribs 
and loin, f from A ae obtained 
“spareribs,” “chops,” and roasting 
sae here designated by dotted lines. 
The hams and shoulders are more fre- 
quently cured, but are also sold as fresh 

rk “steak.” The tenderloin proper 
1s a comparatively lean and very small 
strip of meat lying under the bones of 
the loin and usually weighing a frac- 
tion of a pound, fe fat is usually 
trimmed off from the hams and shoulders, 
which is called “ham and shoulder fat,” 
and is often used for sausages, ete. What 
is called “ leaf lard,” at least in some lo- 
calities, comes from the inside of the back. 
Tt is the kidney fat. 

As stated above, cuts as shown in the 
diagrams herewith correspond to those 
of which analyses are reported in the 
tables beyond, but do not attempt to 
show the different methods of cutting 
followed in markets in different parts of the United States. | 














itl 





CHEMICAL COMPOSITION OF AMERICAN FOOD 
MATERIALS. 


(The figures given are the averages in each inatance.) 






















































Perc Perce |Fer tile 
m5) .. 

5] 2: | 03 [15 

32 LO 
ta a3 | ie 

Edibl taben oe u Lo oo 
As ard eee yt 3 we | tap | lat 08 %S 

chuck, including ‘shoulder, 

= | 628 oo 

eee: S| ina | ORS] US| | 88 a7 | ee 
onuck, igeluding ‘shoulder, 
ery bis 
2 |. . | 582| 172) 169 09 | 1585 
2 | 3) 8) ma/ 130 Rn 07 | 1208 
it oo, tS) 19s | 14 aa 10 us 
it | gar | St] tht | ton | Ba 3 | 0 
7}. | m7| as) asa] sno 10 | nos 
7 | a) 626) 5 A) mo os | 
2 |... | 20] 16. ¥ Lt 08 | 1620 
2 | 102 | “8 ig ith #3 a7 | 1s 
B |... | 7) a9 | 2s] as 12 | 620 
3 85 | 82) m9 | M9) 43 M 605 
| aS 195 | M65 
Elsa) me] Bs | 8] he io | 4a 
LJ ~. | 2) 19] 179) oD os | 09 | RO 
6 | 102) 540) 170) 16 Me | OF | aS 
tJ - | S42] rt) 166 | me Os | 1515 
. B3| 4) 65) 162) 7a Os | 1600 
2 a. | MT) 140) 125) OLS cosas 
2 60 | 33.0) 182 120) a oF ms 
5 . | 8) 46) a2) a7 1 | 65 
B | 30 | O46 an 0.9 470 
12 | .. | 670) 197 | 20.0) 127) ., 
| tat) 82) 1D) 167) Ma) ao ie 
2 |. | me! 1s 19 | 1190 
wt | 18s | ms) a 0.9 | 1040 
ost 









=> 





P 


658 CHEMICAL COMPOSITION OF AMERICAN FOODS. 





H 
| 
ene 

Refuse. 



































Per et.) Per et.) Ber ct. 
Oe. | oT 6 id 
6 | 102) a2 we 08 
4 -. css boa 09 
a aT) a mt oe 
6 ae | OS MOT Os 
6 os wnt 0 
Oo}. m2 wd os 
a|..| m2 we Lt 
ao | 8) 407 a 06 
2 ae | TOL mM | 
2 | 295] 05 6a or 
10 au wh oo 
4 Mol) @ 
2 4 
i G 
a or 
a OF 
7 Os 
7 oe 
a 08 
3 Lo 
4 12 
4 oo 
6 w 
6 a7 
6 oo 
bb OF 
9 Or 
6 06 
2 w 
a 1 
4 + 
2 “8 
it O8 
it tH 
0 oe | TRG 4a 
6 | 106) 69 Aa 
a . | 0 MW 
Bla] B 
8 «| 665 at 
u“ 72 | 607 10 
$ | ia | ot Mm BH 














9 All Join parts are included under analyses of “loin!” 












HE a8 2g 98 G2 $8 08 G2 GE a2 a¢ 32 92 28 ez 35 au ne 8 GB EEE [Nope] 


; 


CHEMICAL COMPOSITION OF AMERICAN FOODS, 































659 
ot Petal Cala, 

bed . 
fa | tet | a | oat a} | itt 

os | 204 os 
Se | Hea | Geo] aS] os | | dhe 

2 | 220 or} .. | aa 
wos | 93] a | ae] >| aa | Ss 
os | ima) 83/9] ¢ 2 | OS | Se 
| dar! ara] aap] aon) .. | ag 

ing | 450 | ks | tee | doa | 22 | OF | ie 

<- | ata | 1 
fan | $03) 180) 183) 2) 2 | ot |e 
.. | ma] sor] a7] oe]... | a2 | oro 
4a | ans | 3) at) ae} S| ae | 205 

ae | TD 4 - 
fas | UA] 122) GR) 83] 2 | ae | Se 
«| 670) soa] 196] 116] .. | 09 | #70 
aag | aao | 128) 128) Fa) 2. | on | oe 
«| 724| 219| 212) sa] .. | uo | oo 
fas | 901] ax) ms] 23] 5 | 04 | ono 
zo, | 674 | 909 | 198 | 335 os | es 
bab] 15) 96) a1) oa 04 | 405 
4 |. | ma} ma] as) aa]. | ar | 450 
4 | m3| 083 | 103 | 165| 10 og | 345 
5 |. | a1] oa oa at | 605 
4 | iss | Sea] 164) 165! 44 oy | 490 
uw | .. | oas| ao) soa) 113 a1 | 0 
a2 | ioe | 50a] 14) 162) 98 oy | 70 
5 |. . | wos] 195 | 183 | 198 0 | 1200 
3 | ino) ous] any | ser | 377 09 | 1075 
2|.. | mr} oar] 213) 36 10 | 565 
2 | dos | 15] 164/48) 27 03 | 400 
«|. | e668] 189] 184] 122 og | 05 
4 883) 107 | 14d | 8S O68 | os 
10 | | ooa| aro | ana | 214 09 | i200 
10 | i87 | at} 345 | 140 | 15.5 07 | 110 
2/]..| 70 ges | a8 a2 | S05 
2 | ano | ona | ino tae) 28 09 | 470 
4 |. | 068] 200) ms] 194 ip | yas 
4 | 168 | 593) 367) s61) 2 as | 785 
«| 9.8] 168) 173 | 216 op | 1250 
int | 90a | 194 183, 07 | 1000 

















‘The “ clod”* usually contains no refuse, 











660 CHEMICAL COMPOSITION OF AMERICAN FOODS. 






ae viene 





Bee anes 





robased 
Loth weak, nd ghteriota. 
Le portion 


Sandwich thea} as purchased 
‘BEEF, CANNED, 
Boiled beef, a par 








= we Se ee Ore 


awe SS we we ws 























SEES 





te ete 





Brecks 


BS 


ae 






SSE Sh 


els 








cE BE 26 SE BE 


2 

















Bee ER fs Ssussise 


B06 66 t6 Fe Ee 
sie 59 32 53 58 


Scchanteeesce 










ateatdesicezt af ¢ 68 cz Enkeaaia 





CHEMICAL COMPOSITION OF AMERICAN FOODS. 661 











oa 


shank, fore 
‘Edishe portion ee 
Shank hind, median ini ° 
Eaible portion Ze 
thawed 


‘Ax pure! 
Shoulder, lean— 
Falble 








hased 
siionlderand faa, inedieim 
Ealible portion . cae 
Aspurchued : 2222 

Pipa por 
portion 


utes purchased 
Baile portion 











Aa purel ree 
Side, with kidney, {ut ‘ahd 
tlow— 


Ftc eee 











oan ao ee 


We ae ao ee Ce as HB os oo ae eS ow 














@ fe £2 £2 & be SE EE 


8 2 
SE st EL GG EE ES ER ES Ef EE EB SE & Ee EE EE 


g2 
iS 


& 





BE-EE & 


gE 








ec se EE ct ce ce 























S 


BG So 5 &e && Sb &f GF Gb Sh Sk EE S SS & 


&o 5 58 Gc 








662 CHEMICAL COMPOSITION OF AMERICAN FOODS, 























421 


a9 
79 


129 | 
M6 


bt 


Protein, 

é 

a 
Per. 


i 





wz 
1A | 155 


198 
165 | 15.9 
185 | 182 
11 

160 | 15,9 
is | 130 
ay | 142 
ano | 1205 
109 | 19.0 
12a) 19 


(in| ia 
197 | 188 


a5) ana 
125 | 120 








WS) 167 | 163 








se a6 





So fs ce é 
s 


& & 








f= §5 Sf S85 S& ss 





‘5 
ion 
1685 
i 
it 
1900 
ms 

mo 
‘0 
bd 
Ton 
se 
ty 
ihe 
108 


& Se 85 Se ss 















as SABE 


MUTTON, COOKED. 
Mutton, leg roast, edible por. 






MUTTON. ORGANS. 





TORK, FISH. 
‘Chuck ribs and shoulder— 
ible portion... « 








As purchased.) 2S 
Rant and it fai in’ 


wipes: 
ible portion 
pure! Seri 
ide, not including lard 
Raible portion 













eee oe 


Bee SE sow om SS we wee ww _ 


SS oe 


ae 





















ta 
Per ob) Per 
4) 
2) 169 
Wa | 180 
| 102 
wa) 10 
09 | 93.0 
os | 109 
a4) 18 
63 | 28 
9) Ws 
wa | 235 
ATH) MA 
gal a 
Ma 
990 | 185 
485 | 181 
ma! mo 
48 
cua | ana 
40 | 18 
war | ane 
ms) 07 
4a) 1M 
WAS) at 
aa) 
520 | 166 
48) ia 
us| 15 
a8 | IL 
65 | 189 
ag2| a7 
36) 17 
18) 18 
0 | 120 
oa! v4 
ao) 
Ma 
wd 
25 
7 








RxE GR EE ES Ee BE 
SE €8 Bf EE EEE £2 BE RE BE BE 


$s8 


BE EE S82 





HE sce £ G8 BE ET 


ey 





BR.SE E 

















&8 S65 


s 
6G EBREG & 


S& S& S66 £5 SES Sh SE LE Se SE 





SE Ge fe 


Houle § HEEGE [ome 








SE G2 #9 G8 sic 52 de¥ 32 $2 Hi 38 EE 








el era 











a 














z 
& 
sep [rw 


Ft 
ie 


te cE eeeeee 


a cE BE 


ce 82 Bf 





&& && && Geese 


Bee 
Ses HS EE ub EREEE8P 


Pir 


Es 
2, 
is! 











SE 6s £ Sh Ge ce 





SE RE 35 SE EE BE EE cB 














BES UE ES as GG UE HE G2 G2 2 GEESE HE 





B25 Sf Sk st £6 Ge ES 





CHEMICAL COMPOSITION OF AMERICAN FOODS, 665 


















































Li 
‘Perot | Perch, Pert Pert Fret Meret) Cala 
ais | i556) 145) 426! .. | 110 | goes 
265 | 130| 328] 353) 22 | er | a740 
As pura eo) | aH] Sa) MS ae] oc] at a 
1] .. | 336 | a¢8| 256) a76| 22) 22 | 2080 
a] ci | oaa| ee) amg] aoa) oo | a | eas 
2 |.» | 4p] asa] m4} aan] .. | 4m | s440 
2 | 2! | 58] 207) 2] zea] 2 | aa | saa 
@ | 52] 44a | t00) 85 | aaa] 2. | aa | x00 
a 7a | goss 
1 69 | 2005 
ails 7 | 1005 
1 0 | 66 
® 7 | 1008 
‘ i | it 
1 Ts | 2310 
1 73 | coms 
a}. a 0 
aul 4s | 2220 
1 254 42 | a185 
re ees 23| @3 = | 80 | 3700 
1 | ioo | 292 | 291 | 291 | 265 | 2 | 72 | 1575 
au | .. | 308 | 120] 127 | 442] 2 | 22 | aras 
chased afl az} ita} arg | gas) .. | aa | x60 
Pork and beef chopped to- 

ssanhtiteti as purchased «| 1 | .. / pa] 94] a0 | 261). . | 10 | 1380 
2 gos | a41| 26 | a9! .. | 70 | 2190 
2 we) us| a9 | a2) 22 | om | 195 
a az | 200 | 246 | 445 27 | 200 
2 209 | 245 | zo | 424 7 | 2am 
1 44 | 201| ira | aay a3 | 1770 
1 430 | 280/ .. | az 46 | 1485 
soo | ara | aa | 208 20 | 3200 
426 | 2469 | 232 | 278 G4 | 1035 
wer | 149 | 140 | 99 ae 
289} 09) po | oR 2665 
66 | 166) 16) 248] .. | 20 | 12n5 
aos | x45 | 165 | a6] >>| ne | anno 
we] ag] ae] else) ae | Be 

4a7 | 128/26] a4] 27 

oar | 192 oF 
ST | 3] MO |] | Re 





| 


666 CHEMICAL COMPOSITION OF AMERICAN FOODS, 





















































[Per ct Per et) Per ct) Oa. 
1 |. | aar| 10x q 
1 | ive] 3] ae 3 ids 
a bed Bey he 1380, 
i #5] 4 14 | ‘si 
mo 1 720) 207 14 | is 
ard i ris| 1a va | to 
er, as parchasod | || 5 6 
a 1 a7 | 205 tt | ioe 
RE as 1 HG | 168 Ya | 870 
iver, a8 aes 9.6 | 229 “7 | 385 
OULTRY AND GAME, COOKED, 
a] 59.9 | 270 us 
1 oa | 242 | 
a]. | oan] aus 14 | wo 
a | 7a] sa] aon 1a | 875 
Moreen] L 1. | 65) 178 10 
hey, roast, cditie a} is] seo 1 | se 
Ruby nas gianni 
mont, an ie 
portion... 5 1]... | oo} .. 16 | $70 
POULTRY AND GAME, CANNED. 
Chicken sandwich, as pur 
chased . as i 1 w59| 208 26 | 15 
Farkey sandwich se puredyd | 1 ata) 207 ar 
Plover, roast, as purchased .| 1 a1 | gas 
Quail, ox parohased . a 1s | 7 
isi, PILESHE. 
2 to2| 49}... | ax | go 
2 ar) 24) 22) oa | a8 
2 M4) 17] oe | a2 
H os| Oh) 22) on | Se 
1 War 12 | a6 
1 ai | 88 oa | 125 
1 aes} 03) =* | 14 | poo 
1 83/02]... | 08 | 120 
6 asa} 2A] oe 
t |: |e] 
1 st] 22)... | 05 | as 
4 |. | wal ane] age] as ut 
As mate 2 | Gz) ma} ta] 7a) oF 
ninciiad, entrasis ‘removed, Pal Pr eh _ s 
Biuetan, entrails rexadved— 4 ve 7” 
Ralble'portion . . 1 |... | ts! 4] 190] 22] 2. |e | ato 
Aa pus ay 1 | és} as] 100) 9s) o6| 55 | om | a0 
alg inh, eteatis res’ d— 
Eiible portion... - + Ling B31 49131 22] aaa 
As purdhased': >>: 1! oes! srg! es! gel aa! oy 





: 


CHEMICAL COMPOSITION OF AMERICAN FOODS, 667 























































3 
i a 
j 
Per et| Per e| Por ot| Per ct) Per et| Per ot Bor ct) Oxts, 
| 700] 180) 174] 20). | 12 | goo 
as | 401] 1a w2| os! 22 | 06 | do 
ina | S63] tet] tee] moa] == | ge | as 
iva | sia) no) 16 | ta6) SS as 
+ | eo] aga) ama] es] ot | at | ou 
soa | ose | 108) 199) 75) .. | 09 | 020 
«| sae} m5 | aaa} oa! .. | x2 | gan 
Ga | sar | sa) 80) og] 22 | 06 | 165 
ms | oss] 1) sos | ag] 22 | om 
-+ | 828] 167) wha} oa) 2. | 09 | aus 
--, | m1] 187) 186] os). 2 | a70 
v2 | 724] 170| 169] os) °° | 10 | 335 
- | seo] 170) 169] ox) -. og | mas 
403 | avo] ion) a0) oa! 22) 09 | 190 
jon | BE | 483] ME] td]. | ae | 
do | bra] 48) 146] 72) >.) om | feo 
-. | | 142] a9] 06] .. | 1a | 290 
ois | sa6| 54) 51) o3| 22 | os | a9 
so | ws] 64] 63] oa] .. | of | 190 
7 | 172) 108 
ia 2) 08] 2: | dd | oS 
a} me] aaz] o7] .. | a9 
H mos | 73) 23] 03] 2: | 08 | im 
3]. | m4] ey ata! 5a] .. | 10 | sos 
3 | in7| ora] aoa) sor} aa] 2. | oo | ao 
2 ras | wol| ama] za] .. | 1a | 600 
2 | 426) 417) 12) 109) 39) 6. | OM | a5 
1 |... | m2] tse] a7] 09] .. | 42 | a0 
1 | dos} aaa] aa] et) oa] 22 | om | ato 
1 |. . | ata] 10] 9} ana] .. | 07 | ooo 
1 at] an) ra] i | oa | 465. 
paket ‘ a] a] ae 
te te sie] ne] aa] 2. | 2 | se 
Muile’whole "~~ 7") : 
ieeeets 2222] | a) ai]c [a 
aiacietionen whoig— k | a 
Kable 1 woz} 126] on]. | 14 | a0 
1 wot) wo} ra] i.) oe | as 
a wa} aa} ao]. | 12 | 0 
2 78| 72] a3] ..) 04 | 200 
2 tar] 187] 04]. | 12 | 80 
Fy 187] 196] os]. | aa | amo 
2 gol a9! os! .,) a6 | 10 








668 CHEMICAL COMPOSITION OF AMERICAN FOODS. 


































B Ef Se BE 














so pee betaine tbe] = 
80.8) 179) 178) OA) . aa Ld 
wa| ts) oa] os| 2: | ou | ts 
yeo| aug| 217] os! [1 | aap 
48 | 14) S| OG) mu 
728) 18) a7) TH) .. | 10 
Hs | WR] 102) GR) cs | as | 
mo| 16 | 195] 51 14 | 360 
wo) ta] ta] a1] 5) | oe | a5 
| RE] Ok] cs | Ob | te 
785) 197) 192) 10) . 1a 4 
42.0) 10.8) 105) OG) .. | OF 
cas | 20] 2] 128] .. | a | o50 
wy) 5) 144) BY). | Oe aD 
rebased a = 2 asa} | 135 

Salthon, lanalockd, so ce hag bo fe 
ry 

as $ | ios] 23) 38] 8) 38] <2 [a8 | 
ra os 

salmon 
sectlonai— 

Edible portion , wa) os 1080 
purchased | > 148] 5 735 
mas ~ 
ie Pa 

As purchased. | aa] 2 i 

Shad roe, as pu Be} 26 00 

Palote porto ay 520 
je : 

ahead | ie = 
abe of 

Baible portion... . « Th} Sond 400 

‘Anpurchased >; : oF} tt 108 

small whale— 

Ealible portion... . - 1a}. 48 

As purdhnsed z uo] oy 0 
ible portions’ ss: 796 

tased - SS ~y 0s 
stm ae 
7) 

35 

135 

5, 

20 

705 

865, 

485, 

10 

20 

m5 

















PA ape ere et oe el ee Pe wer 


Si Sh && Sb SS EE Sh Sa Sr Se FRE SE 





Fable portion ay 

7 aed iS: | aa] se s 
if, walmon or Wiko— 

Palbleportion. ss... | ma]. 

Ax pa Ben : Ext 
Tarbot— 

Fable portion... « 144 

As purchased >. 7) an 
Wenketsh, whole— 

Raible portion... 6. +. 24]. 

‘As purchared 252 a is 








m0" 
‘Kalble los se 
Mackerel, salt, cin 


‘Mackerel, salt, canned 
Keaible: Me ww 


0 a 
‘ramuey, an purchasca 


























15) 0s 
Wo] 04 
37) 08 
26) 08 
wz) of 
WA) OL 
ne} 28 


























2 BE te sE EE a re EE ER 


te 5B rs 


See 6 ae Ge Ses 












BE ue ves eesse se az 3 


@ 58 38 e: si GG uk z 








670 CHEMICAL COMPOSITION OF AMERICAN FOODS. 





















































= 
‘Food materials. ie 6 
lds 
z Ea 
Per ct Per e4| Per eter ct Per ct Per et| Per t| Cali. 
2|.. | saz] 195/151) of] .. | 15] gos 
2 | azo wa} 308) oa| >>| oF | goo 
4 18 20 | 26 | a0 
4 | 419 | 99 at | 16) WO 
1]. | soa 42 | 27) a 
1 | OD) HO | oo 7 
a]. | sos oz | 2a | 940 
1 m1 az | aa} as 
1 | oa | a0iz 06 | 15 | 195 
ee ESS 19 | 13 | 40 
+ | Bo6 | 10.9 Or) OF hos 
6 |.. | we o4 | 22 | m0 
5 | 617 | 907 02 | 08 | 190 
ra 42 | 19 | a55 
1 | 47 | 4X0 a2 | a0 | 160 
“ a | BOD az | 20 | oes 
| 14 | r01 a7 | oa | 45 
o oe | BOS a3) 11 | a0 
a 803 aa | 14 | Bas 
ral ea e 45, 
1 | 64 iss . 3 1 
2 < | 78 12 | 890 
1 | 70d | 19.2 ti | 08 | 90 
‘SARLLFINM, RTC, CANNED. 
Clams, tong, ns parcbased .| 1 | .. | 845] n0|.. | aa] 20] a | a5 
Clams, LF 1 B29 | 105 0 
cmepemeecty | $) 2: | BEE): | 8) at) 
a pare i Z r 
creas purchased 2/52) Ba) ) ss] ae) | | we 
rim, ws Jee ri} a [22 | toa] one o| 02 | 26) 520 
mon, 
Hone’. uncooked—1 
Bible portion, « « « o) va7| 14 | 148] 105 10 | 120 
nan ua + | ira} 05] 19] 131] 9a] >. | oo | tm 
Batbloportion. ......{ 19 ma| ixa| 140| 120) -. | 08 | Tos 
aaepeciaed ‘ ‘edits . Ha) OO it WA Fx] a7 | 0 
Bet oe edtne n.. | aaa} aa} ame] oz] 2. | a6 | a 
emortion eee ee] ty. | aes! apr | sea] ass}. . | at | aT0e: 
+ Kew are diMcult of analysis and the disc the, Ne 
ao Hemost hatter gen 
This also probable that the Mictor 6.25 Sa Sone oe ee 
aiflorened ie perhaps the more nearly correct, and coned fo the 


of the flel-ralue per por 


CHEMICAL COMPOSITION OF AMERICAN FOODS. 


671 





Food materials, 


Number of 
‘analyses. 


Prowin. 


ily 





Fuel-value 
per pound, 





Aximat. Foon (Continued). 
parmy rnopvers, ETC, 
Butter, as purchased... . 





Cheese, Boudon, ne p y 
Cheese, California datas par 
Chetntteh in an parehd 
Cheese, remap ‘as pureh”s 5 
Cheese, cottage, hase 
Chete; Crown trand ream, 





eaeee ts ure pared 





chased 
Chetge, “Neuchatel, as pur 
cups raza mii, 


eapple, és parch'd 
oquel fort, as purch'’d 
Ke ae milk, as 


halos Brice aa puritinted | 
Cheese, whole milk. (See 
Full cream cheese.) 
Cream, as purchased... . 
Komiss, ag purchased” <. * 
Milk, eondensed, sweetened, 
as purchased’ 
‘Milk, ‘condensed, “unsweet- 
ned, “evaporated 
"as purchased . 
Milk, skimmed, as purchased 
Milk, whole, as’ purchased 
‘Whey, ax purchased... . ° 
(MISCELLANEOUS, 
Gelatin, ax purchased... 
ars Toot jeliy,us parchased 
Tsinglass, sturgeon, as pur- 














Spinal column column, Seine ‘as 


ark rene as purchnied 


‘Lard, unrefined, as purch’d 
Delon pet 


Gleomargarine, as purchased 
Beef juice, aut purchased 





























B2ee & 

















as|.. | 185 
gs}. | oa 
as}. . | 88 
93 
03, 
40 
os 



































672 CHEMICAL COMPOSITION OF AMERICAN FOODS, 






























































S| 3 
Wife visiesial ; a | 
i z z 2|4 
Veorrasne Foon. Pateel 
TLOURS, MEAL, KTC. Per cf.| Per et. Per ct, Per ct, Per et,| Otte, 
eranuinted od 73 | 09 7 
Rarley weal ant tou H sa] 23] BR] Oh) So | ie 
. 3 a5) Li) 78) os | tt rf 
Bockwpest tour ‘tae -| ea| 12| 79| oa | oo 
groate: . woo) 41) G4) Mr as 
Eolemisng a Ha) Sh) 3) me oa | a8 e 
een meal rn » #5| da] ta] Ba) 1 | 1B 
t | aga) BS) St] 43) ee | & 
4) 8] S| i] 88 a uw) a 
5 wa! as] 21] m3) a4 | oF 
(:jB HE es 
MPa RAB AR ES 
1 wo | “S| 03 | 13 ae 
2 ai8| 12) 04) es 05 
2 mo) OF) Ol) 2a os 
mw |..| 77] m7] za] one] oo] on | 
* 2) a3) 24) on) 08 | 23 | aa 
“ 76) 165 | 73) OS) 10 | 19 
a 123 | 30| oa| m™o| o2 | 04 | s6n0 
3 T25) 28) OF] Ma). 02 | oa5 
2 95| 79| oa! 89) 02 | om | y 
aie 55) 36) 61) O80) ior | oe 
S| ii] 129] os! oo! m7) 04 | oF | asso 
1} it} a| iso) 20) 3] x8 | 2B | a0 
a) 22] ame) ao] ta) me) | os | seas 
> va| sa) i] ne! oo 3073 
5 142 | 1a] 71a| 06 | 8 | 166s 
8 wa) ia) 23] re | 29 | os | a0 
wm |..| 108) 2] 22) m0| on | 8 | 1000 
119 | 123] 28] maz | a7 | 08 | 1085 
1.9) 109) bt) TRH os 
8) eee 
128 | 108) 13) 745) OF | 05 iso 
us| 14) 10) 6) OF | OS | tee 
ng wheat yal 7] 4a) 18) on rT 
er wheat ° oe wal no! o8 | ie4| pa 
Un om 125° 108) 10 ut i 
ee ne 124) U3] 19| 749) OF 
get 
mail grade not indica 120/114) 10) 384] 03 | 08 | 2090 
‘Wheat flour, patent roller | 
i acs aa ~ | ase} 0} 19 | me} os | om | a005 
Whent flour, unclass, proces, 
gtade not Indicated— 
Spring wheat —. aed |} 124) 108) nol mal os | a | tee 















‘Veoxranux Foon (Continued), 
YLOURS, MEALS, ETC. (Cont'd). 


Mirteerenees (Cmuend 








fi 
Bread, rye, whole, as purch'd 
‘Brend, rye and wheat, as pur- 





en 4 
ate 7 asia: 

& purch'd . 
White: bread; biscuits aa 


os 









RE of 


eee PaoteSaet 








Bien | wo B weouen wo Basen & wette ow 


























§ SRERSES & EERE EE 


SEBEE 


SERER ELE 















R erstsee & Sesh So 


sieves 


£ 


ae 


ns 


ges 





gee? 










sa3i344 


Se 


BEGE 


00 
03 
ma 
459 
wo 
a5 
ora 
wl 
oo 
OT 
m2 
08 
er 
ct) 
0.4 
226 
a 
m9 
55 
Cty 
aT 
mA 
2 
8 
oT 
6 
55.0 
as 


z 
R 








ENSScesin 8st 


(3 


= 


as 
Os 
a4 


RS 


Ash, 


fecce chenectes ee? 
S8ic8 SSES2R5GE 5207 


ay 
ia 
22 
Lo 
40 
09 
10 
oo 
OT 
08 
oy 
12 
13 
1s 
os 
13 
mB 
12 
10 


at 








BEG EG GE & EESERE | SSEGESE 2 ZdGE 38 











674 CHEMICAL COMPOSITION OF AMERICAN FOODS. 





‘(Oontinued), 
Pats ti ae 


White bread, ‘misediane- 


pe nea al 
a4 | Sat 






Cisierele 
BiBie 
aC a 





ecse 





Sf eckte se c 


& 8 sehecse 
£e eeceees eb 


Baker's cake, ms purchased 
Chooolate cake, as 





ERE 








Peer Cb SEReCEG EE Etts EC EE SS e 
8058 5 53 HSESEES 32 HWE 52 2 9098 FSF 





88: 








flour 
te bend fom grade 01 


Patent four. « 
ite broad from baker's flour . 
ite bread from low-grade flour! ><; 































Per 
4]..] 8 109] 642 | .- 
a) lc) ass ao | ox | Oo 
4)e, | me 106 | eo1 |. 
8 198 17 | ong | oo 
ml.. | mo ao | 03a | 04 
O)..| ar or 
ve | 108 28 
3D Fe 102 
ms. 


6 Rees & 


é 


12 
a 
os 
aa 
ar 
a3 
uw 
on 
08 
os 
on 
nH 














&B SBESSSECES EE SESE EEE OG BREE 


g sigc83088 2 EE $88 2 982 8 3688 


= ees 




















Caramels . . . 


Chocolate creams 





7 


676 CHEMICAL COMPOSITION OF AMERICAN FOODS. 





Ss. 


Protein 
Fat. 
ES 
Fiber. 
Ash. 











ai| 2 
2° |@ 
‘Vewieranite Foon (Continved), 
BREAD, CHACKRIG, PASTRY, 
2 













































feet} one 
06 | a 
me on | 120 
m3 o2 | ss 
160 se 
as & 
oh 03 
ar 
ast 
$80 oa 
50 168 
:: |e = 
Try 10 
‘VEO RTA Bia! A a ae 
hasod..| 2 
tei) as pureh'd a 18) Od 1% 08 100, 
peek 1 ary ad) ga]. Ro 
1 a4] O68) saa]. mo 
eee 1 47] O53) 146) .. 370 
aed .| it 25) 14) we) 44 1009 
Has te wen, ‘ aio} 1a] oa] 1075 
4 ee | 104) tat 16] WH) + 10 
1 ws| za] o| a0) 17 70 
i mos] G2| 04| “op ox 38 
1 43| 322) 24) ma]. 1705 
1 953) 08) It Woe oS 
moe] S| sl gg] Bt) al 
hs 3 : 
Beets ook, Gainte porto] i || se) 23] ot| fa]. iss 
u .. | 87h} 16] Ot 3 oo 
Sacer: "| iio 8] 18] St] 38 8 
Eaibl et . voy 1 15 16] 08) BA) 44 td 
Ax purchased ; 72| t4| O2| 43| . 8 
Sie ay purohasod 1 ma) 4d os) 62) .. 
Ratbleqorion +. - s+. 2 ma) a7 43 
purchased; ct baal ae) i) oat % 





1 Soch vegetables as potatoes, squash, beets, etc., have a certain of 
material. skin, aceds,st. The ainaunt Vario with the method of 
tables, and can not be accurately estimated. ‘The figui 


{ablos, fruits, ote. are ‘med iS copresent epproxiisutely 

























































Perch Per et Cale, 
.. | 2 10 | 210 
mo) 706 ov | 160 
- | ao| a7] a0] sos ay 
+» | 8) 18) OB) 47 OF 7” 
| m5} 11) os] 38 10 
woo] 6) ov) on) oo a| 8 
= Gal 45) of) as 4 i} 
5) 16) 02) 29 oe 
| m4) a1) 11/97) of | o7 | ato 
0) M4) 12) OF] TT). | O8 | OO 
wea) 08] O92) &1/ OF | OF 
a| o7| ag] 26| | o« 
mo) 18) os) fa oe 
ms) 29) 4) 22) - AT) ou 
aia} 24) 10/6! >. | 40 | om 
m7) 42 os). 22 
ma) 20) Of] $3 | aa | oS) i 
a | OB) 12 sa). | OF 
150 | 780) 10 tH 50 | 06 | 06 ino 
+e | St) 7] 10] sal. | ma | amo 
.. | OAT) E2] OR) 29) OF % 
ino | m5) 10] 02) 25]. 
.. | a | BS) O4] O8) OF 10 
-.| 2) 16] o2| ta] Ba 
As purchased ios | a/ 4 | 02] tS) MY] as | oe 
OUaiBicportion. . .. w|..|@6| 1] o3| 99| os | on | os 
OAL Barna cana) * | 100) 78) M4] 08| a9) .. | 08 | a0 
re Recess a} ..} ma} a2] ra] a9] .. | 09} 290 
2]. | mt! 10) 01] a2 
2 | oxo] Gb) as] OF] 88]: : | 88] HB 
3]. | mo] | os] a5] 26 | 24 
_ | doo} a4] 13) o4| 108 1 
a | >| 95 | 266 | 10! oxo] 4s | ae 
5) inn | M8] 2] o3] ag] | ae] 
: | dso} | a8) o2| 98 06 
««| ms] or] aa] se]. | a5 | oo 
+ | | 34] oa] sz] ae | or | gas 
tao | 24] xa| ous | 4a | aa 
i |g) 94) 08) mr] 2 | a4] ao 
ino | 2| 22] Q2| wa] 04] 20) Be 
20.0) 2G) 18) O14) 7). . | OF 
«+ | ra] 85] 4) soe as | 1000 
«+ | mo! a5! oa} 209 10) 40 











678 CHEMICAL COMPOSITION OF AMERICAN FOODS. 












































Per ct.| Por et| Per ct.| Per et. (Por ot, | Ohits. 
22| as| 98 | 47 45 | 2075 
wa} 26} 20) 18 15 | 905 
wo! 18] o7| ma) 18 | 11] 70 
2] 14] 06) 99). | o9 | doo 
oo] ao] or) amr) .. | oo | a 
a1! 40] o1| 52] 12 | 06 | 120 
5! 05) or] 26). | 08) to 
ma) 1a] or] 5a) or] 10] ams 
a} 09! or) do] ., | on] os 
mal os] o7| a6| 11 | oF | 105 
wo) 04! 04] 22 o4| 65 
2 11 | 190 
#) al allel ale 
ws) 17] 05] 33 62) 25 
wa} gi| os| a2 ga] io 
ws) 21] 44] 26). | 14] a0 
3 14] 05] 90| 08 | 08 | am 
8) 8) Bla ES 
ta) 139] sa] eas] .. | va | a} 
mG) 18] Of] Bt on 
a@z| 03] oa] at] 22 | Oe | ie 
25) O8}.. wo} 6] a7) no 
M4!) 15) 01) 28] OS | 12] as 
mo) 69) 25) 1% as | a1 | op 
m7) 11] o1| x8] os | 18] os 
co) 12] O11] 84] O8 | 25 5 
m6] 10] or] xa| a6} 12 
2] a1} o1| 25} 05 | 14] 
a6} 45] o1| 125] 10 | 42) am 
HL) aT 92) 10] 10 
WS) 40 us) 12) 16 
27) 70) O2) 85] 12] 16 
OAT) Ih) On ka) OS | 18 
Wl) 28) 1.2) 192.0) 08 | 09 | 485 
6/16] 04] 96) 05 | 08 | oes 
5 wa! i]. .| as] o6 | 10} to 
4 WA) OF) OL) 86] OF) 12 o 
3 ma| 11| os! sa} os | 18 
q w2| 19| oa] ata] an | tt 
HE /B) 8) eg eg 
Bu , fs PUTER u 79 | 36} Lo] is6| 08 | O9 3 
Tomatoes‘as purchased. << 19 oo) 12! 02! 40! os! 06 





; 



























































i ala 
Liile 
HeLa al Mot SL bd 
pe Por Der Ons. 
2 a) 15) og ar id 
2 4) 14) O28 ww 
1 43) 10) os 2 | 1085 
1 60) 11) a6] Me). 47 | wo 
Ae i w23| ox) $03) (AS {22/12 | tas 
paithe . ae ar a 
Avra: 2 fg ma) 14) ita) 33 | 
ria, af fared 1 60) 165) 85) oO bf vane 
Beppe, jas poreli'd | § 63) "da| $3) Soo] 22 | Fa) tao 
Pickles, encumber, a pur 
torsinlxed ax pinched | sa) St) eal bls: | OF] ae 
Piektes; speed; as purchased | in| oa] oa] az] i. | a7 | mo 
FRUITS, BERRIES, ETC. FRESH 
. 6 
. eis] os) o3| in| 2 | 3) Ss 
nu mo) ona] .. |omal .. 5 | oo 
z wos) to} io] ie] 22 | Oa | oe 
«lal a] i] el lg] 
‘ wos) 13! 10] 9| 25 | 05 Zo 
Cherries — 
7 “ = 10} Os eri a oa 65 
ri 3 wo) aa) tel Fe) aa | on | die 
pate i so) iS). | as] | or | ase 
‘ernie a ma us|. .| ass]. .| 08} am 
Orpen 
ie portion aah: mal 13| 16] w2 03 | go 
a purchased.” Hs | | 40) 12] tal St 3 
Picelloberries odsttéportion| 1 sa| 06| oe) wel >: | 03 | au 
Yaitle portion . . 4 ms! in| o7| as] 11] os | an 
ased: : : : @5| o7| 05] so]. | oa] 1s 
wane 2 ee fee poe) MBL ee Pee] m0 
za 1 fos| os)... | 9a} 21] on | 1 
ween 1 ee es A. | Os wo 
out +}..[ 9! o6|..] wo] ..| on] as 
1 | ee} m4) a6): | is) 55) a6 | os 
a|..| 9 os us|. | os | a0 
. 70) OA OG Mies o4 | 170 
= -+] t]s. | me ot] os) ga] a0] 04] 90 
Aspurdhased’ 2212222! 2 | iso] 3! os} eal ta] Of | ost te 
“Praits contain a, certain proportion of tnedbie tatetal, ag skip, goed eg, 





a | 


680 CHEMICAL COMPOSITION OF AMERICAN FOODS. 


= 












ses cece? 
e 
‘3 





5as 












Si 88 6 5 
ee fe: 


Ene 














BER EC SERGE CESS £28 2 8 & Gee BER EeES 
358 53 G2582 E805 ss se 2s ues sae ueue 


hi) 16) 22 
wal 47) 10 . 
19.0| OB] 15 oe 
wa} me] a7 : 
wal a1] 25 oo 
wa} 19) 25 ae 
is8| 45) O39 RN - 
Wa) 28! 08 a 
05} 28) o4 o> 
.. | ma] a oe 
iso | 190) 18 
26 
as 
7a 


ESERGSE BRE BE URGES RHEE 





BH 





Tat quiiy haved 
28 quailty, as burehaged, 
es. sewed, as purchased + 


Grape butter, ax purchased” 
ee (orange pecl), as 


























BRece bree erecete 
gguul Fede aabtedd 


BEEEE ESS 


ineapples, as 
‘Prone sauce, as purchased - 


CHEMICAL COMPOSITION OF AMERICAN FOODS. 681 
















































\Per et) jFer et} Cate. 
748 05 | 460 
409 07 | 1090 

48| 210 | Sig 20 
= 27) 115 | 2 Hf | ie 
1 40! a9 | 74 as | sors 
1 23) 130 an | 1300 
1 4. ar] ara 24 | 2020 
1 | ioe] 26) m2) gar a6 | 1690 
1]. | a3) 10] eos} rol .. | a9 | some 
1 | doe) 26) “me | x7) as) >: | ao | 605 
1] .-| 44] o79] ora] a5] .. | 20 | sias. 
1 Os) ay} 88) 05] >: | 04 | ao 
Mh hee 62) s4| aa] 1s | 9) aia 
>| iao| He) $3] G3] Sa] Maa | Ose 
o|,.| s9| sor] zo] ma] 27} oe | sere 
8 | deo] a5) si G3) oa]. | at | ra 
1 | yy | 4! 87] gag] me]. | ay | eee 

"based 8) 7, — x 
east ot ae : aa ry = a = “ne 
genet mi 9 jive 1]... | sar) oa] 15) 46] 22) oO | 396 
‘Cocoanut, prvpared, as 

2]..| a5} as] ora] os]. .| 10 | 916 
1|.. | a7 186} oa] 120 24 | sm0 
1 | 02a) 28) 75) BL) Oe 4a | 1970 
1 - Wa) 4) ht aa | anes 
1 | aa 68 | 255 | 48 Ox | 1288 
Mac 29| 6. 15 | 1808 
1 | ive i] 0t) @3 0 | "eo 
@]e. 28) MO) he 20 | e800 

; | 5] 69 | aos | oa] 2 1s 
aie. a moa | a0 ma 33 | io 
1]... | 20] 120] 712] a3 1s | 2435 
1 | G2] 14 | s2| ma] 62 07 | 1020 
1|../ 27| 98| 7os| wa}. . | 19 | a5 
1 | 4s] 15] sa| so) ao). | 10 | tHe 
r]..] ca] sso] wa) ao]. | Ra | onan 
1) ../ a8) os| wor a8 | 1170 
4 | ao] 2] Sh] 0) i 6 | 1880 
1]. 2] aa] tae] ae 28 | 205 
1 | aoe) 23 | "RF ] sek | 30a 17 | 1909 














‘Food materials 








‘Veorr ante Foon (Continuedt), 


ute (Continued). 
Pine nuts 
Table ine erat (Mirus aoe 






























[Per ct Per | Per et| Per ct.| Per et. Per‘ 
Rabie. ae +]. .| ot aa] oor] aa] .. | a7 | apes 
ihe rare aie 1 | io) 12] es] 12a] 19 a | 65 
Dis oreo eee) aa a3] 40] 103 a2 | ae 
er | | valle bal esi | 
windiest | ae 
“Eras 2]. | oe] see] cea] a0 43 | a0 
. 1 | 71] 07) 49) 173] as] -. | 05 | a5 
a]... | 26) 276] ons) atz 19 | aos 
+ | Ma] 06) “ra} 148] x0) | om | os: 
4]. | 25) 166] ona} asa 14 | mss 
. a 10| 69 | MH) 68) 3 py 
i]s. | a6) 2a7| a6) a9] ¢ 
2]. ao 7 s 
Bf ss] Se) ate] 8b] Se] 5 | 93 | eo 
5|..| saa] on] ..] 4]..] os] mo 
a}..] oa) 7] o«} ao] .. | 18] 
sy 
z i i i 
2 alg 3 
EH F 
x 
# B/E / 2 lee] 2 12714 & 
Per ot Per et.| Pev ot.| Per ot| Per ct.| Per et,| Pew ct} Cate. 
tis: [as] lsc] a] 
{ci} sta] aes] ct | as] ge] go | ae 
2 oT ea Os | 67) 20 ey 
5 aus) 46]: . | 4a] oo] da 
1 aa) 25 aa] 55 | 14) oe 
a oan | 2a 1} oa] ov 
1 sea | Bt 28| a0 | 6 
a soa} mA ap} a7] 14 
2 os) oe OL) 15 | 10 
1 0) 25 oe Ot) LE 
1 Hos | 25 Wo) Ts # 
t 0) 27) .. | we Pr 
2[--| ms) 53) ..) O9 ie 
ai. maloarl.. orl a7 






































CHEMICAL COMPOSITION OF AMERICAN FOODS. 683 





















































Protein. 3 3 
af Tg eg 33 
Food materials. g es E e 
#i| | stl g/l 4 (ik 
z & |e |e 
Usctassivimp Foon Marte- 
RIALS (Conlinuerd). 
ANIMAL AND VEGETABLE 
(Continued). 
[Per ct.| Per et| Perch Pert Peret.| Per ct. Peret.| Per ct 
a 40 ia | 43.) 16 | 210 
1 38 os | 42°} 19 | 170 
‘ 36 o7| 76 | 12 | 235 
1 28 27| 57 | 13 | 270 
a 1s 1] 66 | 13 | 135 
1 61 19} 39 | 15 | 265 
1 ay va | 09 | “65 
Miscelloncous. 
Hash, as purchased . 1]... | aa] 60 19 | a4 | 24 | 365 
“Infants and invalids! 
foods," as purchased?. .| 22 | .. | 00 | 127 33 | 762 1795 
Mincemeat, commercial, a 
pure Sue cet {5 ai 1ST) OF 14 | 602 | 40 | 1905 
Mincemeat, home'mad 
‘purehi RS 3 saa] 48 87 |s21 | 20 | 970 
Salad, ham, as purchased 1 eon | 154 75 | 58 | 20 | 710 
Sandwich, ogg, as purchased | 1 414) 96] << | 127] aes | 18 | 1305 
Sandwich: chicken, as pur- > 
Obed. eee eres 1 435] 123] .. | 54] sat | 17 | 1055 





' This includes malted milk, infants’ foods, and similar preparations which 
are sold under various trade names, but are similar in composition. 


RAPID REFERENCE DIET-LISTS. 


‘These lists have been inserted to enable the practitioner to 
make rapid reference when so desired. Additional lists will be 


found under the headings 


of the various diseases. Additions 


and changes may be made to suit the individual patient. It is 
convenient to have a printed form containing list of the fhods 
usually allowable and those usually forbidden. With such a 


form a diet may be easily prescribed by 


marking off all articles 


wel are not thought desirable, The following is a useful 
ist : 


All foods are allowable unless marked off the list. 


Poodle 


Purecs and Qreams, 
Barley, 


RAPID REFERENCE DIE£T-LISTS. 685 


Poached, J artichoke, Puddings, 
i ferunal 
Omelet, Boots, Bread, 
Scrambled. ‘Carrots, Cornstarch, 
Milk, Parsips, Blane mange, 
Whole, ‘Tomine Re 
Skimsoidy ean ites Veptae Jonker’ 
Detiermill, G : Cap costars; 
3 ‘Sour krant, Orcam, 
Kel Vegetable marrow, Chocal 
Matzboo, Sea kale, . Fruit flavors. 
Tomatoes, 
Rolled mill, Laon Woatten 
5 
‘Milk and barley-water, Lemon, 
aalie. Watercress, Sherbet, 
Crea ae. Sponge cake, 
or re 
Americ peo Lemon jelly, 
ens Sia, Ye jl, 
cheddar, x 
Pineapple, Green corn. ry: 
eltzer, Fruit. 
Roquefort, Raw, Beverages, 
Stewed, Ferre 
Cereals, ee. Prange, Albumin water, 
Oatmeal, ‘Apples, Lemonadi 
Cracked wheat, Imperial drink, 
ce, a 
Barley, ieeeed Grape juice, 
Paring, Grapes, ape {a 
Com meal, Plume, Barley water, 
Hominy, Prunes, Bico water, 
sears, = ty ae 
‘gra Olives, 
Sa Choco! 
a Pairing 
Spat Pate, 
Figs, Mineral Waters. 
lane Berries 7 
Eee, Nuts. vee water, 
pe Toasted, 
ae ste 
Roots and Tobers, White & flour, 
Poet, ye : Alcoholic 


Ry 
Boiled, Gaackers, According to diroc- 
Mashed, 


686 si RAPID REFERENCE DIET-LISTS. 


It is frequently found advisable to have a list of the articles 
cea most pecker forbidden, The following will be 


Rich Goorne, ‘Cauliflower, Pies, 
Fried foods, Savage, ae at 
Pork, Radi Preserves, 
SS Ste ee 

she ed fish, Boots, 
Corned meat, Smoked fish, Salads, . tants, 
Potted meats’ Salted’ sh,” Hot bread, ‘Teed water, 
Liver, Salmon, Hot cakes, Tee cream, 
Kidney, Salt mackerel, Nuts, 
Dock, Sardines, ios, 

FEVER. 


General Directions.—As a rule, the food should be fluid 
and given at regular intervals in small quantities. 
May take: 
Milk.—Milk and barley water, malted milk, perrcatee! yee 
Sue battermilk, ege-nog (nal 9 sian Anes mille rat beet 
ice, beet eS eee iu oa so bt a as 
“i Tiga be peptone tone bea and tie ks, Thee care 
diluted with water. 
«—Albumin water with flavoring of orange or lemon juice, with 
e a8 sherry or jean stimilants, 


Drinks. — Water barley water, ries 
waters Vicky ee ‘Poland, Wi range sulk, barley wate, 
DYSPEPSIA AND CHRONIC GASTRITIS. 
May take: 
Soupe-—Mation, chicken, beet, cyst, toullon, ee tapioca, tarley, 
Meats.—Boiled brains, boiled or broiled sweetbreads, 
Gr broiled. beef, broiled steak, roast beef oF mutton, kes 
Jat, lamb chops, boiled, broiled, or roasted chicken, syuab, 
Fish.—Raw, broiled, or stewed oysters, boiled or broiled 
BE go i at 
ft boiled, zo 





string beans, lima oa Paras (best 
tr rod play ep Sa 
Loatised and Trained. Tettnce (without vinegar,) creases, (without 


‘inegar. ) 
Farinaceous Food.—Rico, cornstarch, sago, tapioca, arrowroot, 
ta, rermictili, cream of whext, als whest Uread, toast, grated 
oan Hh et pe nds, ri ae. pad- 
eFtS.—Blanemange, homing, custards, rice 1g, tapioca 
ding, bread pudding. ® ae 
Fruits.—Lemons, oranges, raw, baked, or stewed spries gmpes, stewed 
ry sind maw, or stewed, peaches, stewed penrs, stewed prunes, stowed 
ee. 








ATONY OF THE STOMACH. 687 


Foods.— Hutte, cream, te ar 
mile ie rn Mimestes milk sith Vichy talk Savor 
tea, milk flavored with cofice, ketir, kumiss, junket, whey, cocoa, 
wih Waterson Vichy Apollineis, Poland, Lithia water, Congress, 
Hathome, Carlsbad. * 


ee a 


k, hashes, comed 
ash ee te ey it, a, ae bs reared tab, 





radish, cabbage, ‘tomatoes, cucuml sweet potatoes, 
bread a1 candi , cheese, strong tea, strong. 
Sates slcobolig wirxants locates, lover 3 


DILATATION OF THE STOMACH. 
May take: 

Meats.—Boiled brains, boiled or broiled eweethreads, ry 
broiled steak roast bee, rot tb chops oil, Tectat ensued 
chicken, broiled or roasted squab, birds or tarkey, 

Fish.—Raw, broiled or stewed oysters, broiled or boiled mackerel, rock, 
bass, trout, or be fal. 

Eggs.—Raw, iled, poached. 

Vegeatin"Reare pch spinach fated! lima beans, (best 
mashed and ied mashed,) turnips, carrots, 
(mashed and sti seek) atten wit vinegar,) creses (without 


vinegar.) 2 
= tuploca, arrowroot, horn 
ii, vermicelll, cream "of wheat, gees rend fous, toate 
oad cd ay pln 
Fruits eked or nee pple sen 
‘90d8.—Butter (; an aa 


Di “ie mainly between meala pe ty sera 
milk, milk flavored a ‘tea, milk ee with coffee, all 
water (not with meals, 


Must not take: 
‘Soups, fried foods, Sealer cores ‘meat, potted rae 
Hive, Kidney, a anes 
= fieh, all mon, salt ee ines, parr ieee 


mae ors al ‘cucumber, ee sweet potatoes, 

tone! alade, bot bred ii Scoot bie pastry, cheese, 

strong tea, strong coffee, aleoholic , icecream. 
ATONY OF THE STOMACH. 


May take: 
ee are me pallet ge beolied eronnnenet = screed Heli ar 
See or ease chicken, broiled or routed squib, roast turkey, 


—Raw, Tie ea stewed oysters, broiled or boiled mackerel, rock, 


al 


688 RAPID REFERENCE DIET-LISTS. 


eee eee "ae, rushed, tof, cre kt 
train bread, 


cone 
arene 
vite, ous bo hast, etal wheat braba, tously 
‘bread, pulled bread, 2wiekack, 
Dessorts.~-Wlancsnange, honey, custarda rice padding, taploce peddling 


Fruits.—Lomons, oranges, raw (seray baked or 
auerejapcm a oF ere Weck corel pare Repent 
Drinl 


rovTaken mainly between meals, Milk, buttermilk, mal 

poptonized milk, may with Trae ais with Vichy, mille a ey 

int tea, milk flavored with coff abe >, Kurniss, Juke, whey, cocoa, 
ji 


‘ater, water (not with hot water, grape juice, 
me not take: 
hi corned ted 
Sa it tones pe, voll Ses 1a eae oe eu 


Deitel wets icy auidowe, Rievemesat 

Suess Emon pstos, bot 5 ot brea or kes, eee 
pies, pastry, cheme, strong tea, strong coffee, all pI ae Naosg=) 
water, icecream. 





RIA OR HYPERACIDITY. 


May take: 
Meats.—Boiled or broiled brains, raw scraped beef, bolled or 
beef, broiled steak, roaxt mutton, broiled chi ra fab, boiled, 
broiled or roasted chicken, broiled or ‘squab, ronst’ turkey, 
broiled or roasted binds, 
Farinaceous Food.—Rice, cornstarch, mes tapioca, arrowroot, hom! 
grits, vermicelli, cream of wheat, stale wheat bread, toast, corn 


pulled bred, zwiebuck, 
Fruilts.—Baked or stewed apples, stewed apricots, stewed peaches, stewed 


ray Foods. "Date, cream, pure olive of 
—Taken mainly between meals, Mil, ba ittermilk, malted 
ae ptonized milk, milk with lime-water, milk with Vichy, milk fa 
with tea, milk fayored with coffee, kefir, kumi, jankeet, whey, cocoa, 
aoe eae eee Congress, 
»—Vicl ’ol water, 
Eiabiares, Crista. 9 A 3 





Must not take: 
Soups, fried food i, stews, hashes, corned meat 
liver, kidney, diac Eons uc ah pb es 


figh, salmon, salt mackerel, sardines, cwuliflower, lead fog 
cucumbers, arene potatoes, beets, tomatoes, acid fruits, salads, 

or cakes, nuts, candies, pies, pastry, cheese, strong tea, strong coffee, 
sleoholle iauisots, ice-water, ice-cream. 


ULCER OF THE STOMACH. 


Finsr Wxxx.—Broth, mutton, chicken, beef, oysters, bouillon, four 
.—Raw or in bouillon. 
Drinks.—Milk with Vichy, milk with lime-water. 
ae War —Broths.—Mutton, chicken, beef, oyster, bouillon, floar, 
rice, barl 


CHRONIC DIARRHEA, 689 


nak pare ‘hicken, beef, oyster, bouillon, tapioca, 
tie le, oh La, vere 


Se ifoken, le brele, aqua broad 

a oy 

Fish.—Rav, brolled, o stewed oysters, boiled rock or buss 
Ha, sf ated 


inaceous -—Rice, comstarch, tapioca, arrowroot, 
cream of wheat Lye wei Li 


tor. 

Drinks.—Milk, rualted milk, peptonized milk with Vi 
with lime-water, milk with’ tea, milk in pe os 
has; ooeiera ieieiaeeaie Rite d 

Forrmt Wark. 


May take: 

Soups.—Muiion, chisken, be oyster, bouillon, ree tpioes, barley, 
‘vermicelli, clam. 

‘Meats. —Boiled brains, boiled or broiled sweetbreads, boiled, 
tr broiled beef, broiled steak, roast beef rout mbvton, brolled' mutton 
chops, rast. oiled,’ broiled, or foasied chicken, 

Fishery, brolled ne eyed opnies: rela’ or Dotad aolenal cds 

Ray, Or or 
bass, trout or blueish 
— Raw; eolh besked 


Eggs. ity poached, 
Vegetables.—Asparagus, mashed and strained), 
afeaked or mashed), ta Strips, ox gees) urine Lari 


ice, cornstarch, 

grit tg eet cream ot" wheat, page ies ‘bread, toast, Saige ae 
Salled bread, zwieback. 

Desserts.. 


ae —Rilone-mangs, custards, rice pudding, tapioca pudding, bread 
rf 
Fatt: Bake Sas gram, pure alive 


fee, kefir, ki og waiieg ae water (not ot 
meal) oe walora =ViEKy, ae 
rind es 


May take: 
Motion, chicken, oyster, bouillon, rice, phate barley, vermi- 


Meats.—Boiled brains, boiled or broiled ped tee 
broiled steak, roast, broiled mutton te he a ee Folled o ‘or broil 
chicken, ed squinb, roast 

Fish.—Raw, broil ce noraareen! broiled or boiled mackerel, rock, 
bass, trout or blue-fish, 

Eggs.—Raw, rofthoiled, ponched. 

Vegetables — Asparagus spinach, pens res and strained), potatoes 


ey vermcel, i co sale weoat tread tonto allel tase 


Desserts.—Blanc-mange, custards, rice pudding, tapioca pudding, bread 
pudding. 
“ 





690 RAPID REFERENCE DIET-LISTS, 


(small quantity). 
Drinks. (bated atl mi mille peptonized milk, milk with lime 
fea tea, junket, whey, cocoa (. ), albumin- 
eat eae 
coh ana 
Must not take: 
Rah coups ted fod pork vay stom, hos, comed meat, 
rer, kidne! sons sage, crab 
wk "iy aa aaa Se : 
=o age, co 
beets salads, hot bread ee 
out 


strong lea, strong co! alcoholic stimulants, ice-water, 
Sa Ripe : 


‘CHRONIC CONSTIPATION, 
May take: 
Sara Se chicken, beef, oyster, bouillon, rice, tapioca, barley, 
Meats.—Boiled brains, Lees or benlles pees 


or broiled beef, broiled roast mutton, eres ereca 
chops, roast ee oe te trot roasted’ chicken, broiled 


¥ I, Seid bsg ene fi Re 
les. —. iiled onic ees 
Tima beans tomal oe joe ripe etc 
hy, eure beng rete on 


Jette 
Farinaceous Foods.—Ontmeal, tay homii 
peciaty wom oa vias tt paket aan 





brown bretd, ire bi 
ream, blane-mange, honey, syrup, custards, rice a 
apis boa fing, bread 
1 _ reshaat ked or stowed 
re or stewed ‘hes, nana Eae or 


Foods,—Butter, cream, pare ol 
eben wainly. between misala. itn, i Soteleall eon ea 
Tnilk favored with tes, milk Gavored with enflee, ker, Kemtay junket 
whey, albumnin-water, water (not with meals), hot, water, erape | Jel 


Must not Bis. 


if chogola: bath farina. 
To, dl Sean nope ate, rice, ley or a_gruels, bckleberries, 


DEBILITY AND ANEMIA, 
May take: 


Thickened crema mel — beef, oyster, bouillon, rice, tapi- 
Masten te coneet bot open del ed, rare baled srr 
—Raw soray 10) il or Tana, mre 
roast beef, roast mutton, ‘eho 
tron re roar Gackan. Dealal ortearet agen 
Fish.—Raw, broiled, or stewed oyster, broiled or boiled ee rock, 
bass, trout oF blaefiah, 


— 


OBESITY. 691 


en ayaa with her oft ods erable 
waked eit vagal emer 


f S aetna 


Fatt) 1.— Butter, cream, pure olive oil, cod liver oil. 
Drinks.—Milk, buttermilk, salle with lime- 
water, milk one ale finvored with tea, milk flavored with cof 


oemnb meals), gs i  ioalt extract, “Meseol Walera-—Viehy, 


ite Rock. 
Must not take: 


Cot pare Pee eh eee ee ed meat, turkey, mukage, cabbage, 
t bers, 
ite coe wpe pred ace potato ee aad can 


OBESITY. 

General Directions.—Avoid sugars and starchy food and 
take little or no fatty food, Eat sparingly and take but little 
fluid, and that, apart from meals, 

May take: 

Soups (anal (eoal sensi) eset Seelgeyins Saree 


beef, ae teonet s hops, ronst at oe as chops, 
or roast roa Fed i al or 
boiled or brofled 


led, 
Vegetables (host mashed and strained) —. spiel, pa liad 
Pe in hans ease Seetoe reaps 
Farinaccous Foads.—iale wheat brad (mall quantity, sista, 
toast: juantit graham juten bread (#mall quant 
Fruits ec) tem cig Tew epplea: grasek OE Ee ek 
pars Heda Wei meals), } Bot ft wate tee oe Ee 
Hina, Cara. 


wiatact tae 


Rich soups, fried foods, pork, veal, 
a nero 





692 RAPID REFERENCE DIE£T-LISTS. 


DIABETES. 


General Directions.—EKat meats, , green 
and fatty foods, and avoid sugars, starchy “he 


May take: 
ne see veal, mutton, oyster, turtle, terrapin, clam broth, 
Meats.—All kinda except ver. Gelatin 


Cheese.—All kinds of cheese, especially cream cheese. » 
Fish —All kinds of fish and in any fom, oysters clam terrapin, lobster, 
shrimp, ult fish, unlos they cause too great 
Farinaceous Foods.—Gluten 
Spore man dneetea bles, spinach, lett chicory, sorrel, 
inach, lettuce, romaine, 
Bee artichokes, mire pickles, ‘cucumbers, cranberries, trufiles, mash~ 


Vegetables sometimes allowable.—Green string beans, cauliflower, 
cabinge, sourkraat, slaw, egg-plant, vegetable murrow, asparagus, 


Faults Acid fruits of any kind, sour apples, sour cherries, sour oranges, 
red currants. 


Temons, ray 

Nuts.—Ail repeats ‘mit a eoeonn, walnuts, filberts, almonds, but- 
ternuts, pecans, 

Fatty Foods.—Cream, bates, olive oil, cod liver oil, ar marrow. 

a tiny or coffee without magne, alkaline mineral waters, Rhino 


Bormundy, b bp a whiskey 
Allowable sie'at Tinos jal Directions. — 
toes, and oatm taal og Agee eo Mth Nee rete 
Must not take: 
All sweet foods, sugnrs, confections, and the like. All starchy food, a8 rice, 
hominy, and foods Pres with flour, oto. 
Meats.—Liver, pilté de 
Vegetables.—Potatocs, turtle, beets, carrots, peas, beans (not always 
string beans), cauliflower, swect fruits, dates, gmpos, prunes, 
bananas, preserves, and oa 
Nats. Paints and chestn 
Beverages.—Sweet wines, ‘er, cordials, beers, porter. 


GOUT AND GOUTINESS, 


General Directions.—Take eee wantities of plain 
nutritious foods. Avoid excesses of meat, all nae foods, and 
eat only moderate quantities of starches and sugars, 


May take : 
6. —Meat soups in small quantities. Mutton (weak), chicken (wealk), 
beef (weak;) oyster, bouillon, rice, tapioe, barley, vermicelli, clim, reg 


a chore, amt fam chop bailed broiled, or ronsted 
(asap or roasted squab, bacon, broiled or roasted binds 
once a 

Fish ftw broiled, or stewed oyrters, boiled or broiled rock, bass, trout 


Bege ts anal quantity, raw. 


TUBERCULOSIS. 693 


Vegetables.—Spinach, young peas, string beans, (baked, small 
quantity), turni cauliflower, cabbage, Tettee (niihout vinegar), 
celery, cressea (without vinegar), onions. 

Fai rinaceous F Foods.—Rice in small quantity, oatmeal, cornstarch, saj 
tapioca, arrowroot, hominy, grits, vermicelli, cream of wheat, stale ‘wheat 
bread, toast, grabam bread, rye bread, corn bread, pulled bread, zwie- 


Desserts.—Bla: ), custards , iddit 
(gue) pio dng (oe roar rend odd (oo mage) ml 


Fruits.“Lemons, oran azples (tart) ra, baked or emsdy stewed 
apricots, raw or stewed peaches, stewed prunes, stewed cherries, Fruit 
to be stewed without sugar. 

Drinke. “Teken only with meals. Milk, bttenmitk, peptonized 

}-—Taken mainly with m il uttermil milk, 
milk with Vichy, milk flavored with tea, milk flavored with coffee, kefir, 
rumiss, junket, whey, ime juice or Jemnade without sugar, water hot 
ater,” Mineral —Vichy, Apollinaris, Poland, Lithia water, 


Must not take: 


Rich soups, fried foods, hard-boiled pork, veal, stews, hashes, turkey, 
corned meat, potted meat, biti Oo Finey, duck, goose, sausage, crabs, 
lobsters, preserved fish, smoked fish, salted fish, salmon, salt mackerel, 
sardines, radishes, ruslroo asparagus, tomatoes, dried beans, old peas, 
pickles, sweet ee eddinee ta, hot bread or cakes, nuts candies, preserves, 
Pies pesry rich puddings cheese trong tt, trong cole, ‘alcoholic 
stimulants, sweet sy ice-cream, ‘stew berries, cider. 


ALBUMINURIA. 


WEIGHTS AND MEASURES. 
Balative Value of “Apstheonrlad and Meiria ‘Mears: 


‘Minis. 
cubic 








| Cudte centimeters 


wueoae 
ee 
e 


£E28 





juidounces, 
Cubic centimeters, 


18 = 68200 
19 = 691,60 

















g E E 
z 3 z 4 Bs 
g 8 é cae | 
3 4 2 § $ 4 
BOE A er Bb 8 
1000 = 33.81 400 = 18.53 26 = 6.76 
900 = 30.43 800 = 10.14 10 = 271 
800 = 27.05. 200 = 676 9 = 243 
700 = 23.67 100 = 338 8 = 216 
600 = 20,29 Thm 258 7 189 
500 = 16.90 50 1,09 6 = 162 
= 101 5 = 135 





5 
a 
gi! 
3 








WEIGHTS AND MEASURES. 


Relative Value of Avoirdupois and Metric Weight. 


697 





Grams. 








voreoene 





and Avoirdupois Weight, 





Gm. Ounces. Gr. 


Gm. Ounces. Gr. 





























28.35 = 1 88 = 1+ 149| 125 - 44179] 600 = 21+ 72 
. 29.00 = 1+ 10 | 39 = 1 + 164] 150 — 5 +127) 650 = 22 + 405 
30.00 = 1+ 25 | 40 = 1 + 180) 200= 7+ 2! 700 = 24 + 303 
3200 - 1+ 56 | 50 = 1 + 334 | 250 = 8 + 358| 750 = 26 + 198 
33.00 = 1+ 72 | 60 = 2+ 50 | 300 = 10 + 265| 800 = 28+ 96 
34.00 = 1+ 87 | 70 = 2 + 205 | 350 = 12 + 152| 850 = 29 + 429 
35.00 = 1 + 103 | 80 = 2 + 300) 400 = 14+ 48/ 900 = 31 + 326 
36.00 = 1 + 118 | 85 = 3 500 = 17 + 279| 950 = 33 + 222 
37.00 = 1 + 133 |100 = 3 + 230 | 550 = 19 + 175/ 1000 = 35 + 120 
Relative Value of Apothecaries’ and Metric Weight. 
Grains, Grams. | Grains. Grams. | Drama. Grams. 
1 = 0.0625 m4 - 1.55 1 - 3.90 
2 - 0.1300 Pa - 1.62 2 = 7.80 
3 ~ 0.1950 26 - 1.70 3 - 11.65, 
* = 0.2600 27 - 1.75 4 - 15.50 
5 Ss 0.3240 28 - 1.82 5 - 19.40 
6 = 0.4000 30 - 1.95 6 = 23.30 
7 - 0.4600 32 - 2.10 7 = 27.20 
8 = 0.5200 33 - 2.16 ‘Ounces. 
9 = 0.6000 “4 - 2.20 1 - 31.10 
10 al 0.6500 35 - 2.25 2 = 62.20 
11 = 0.7150 36 - 2.30 3 - 
12 - 0.7800 38 - 2.47 4 = 124.40 
4 = 0.9070 39 - 2.55 5 = 155.50 
15 = 0.9720 40 = 273 6 = 186.60 
5 = 1.0000 4 = 2.86 7 = 217.70 
16 = 1.0400 48 = 3.00 8 - 248.80 
18 - 1.1600 50 - 3.25 9 = 280.00 
20 = 1.3000 52 - 3.40 10 - 311.00 
21 = 1.3600 56 = 3.65 48 =- 1492.80 
22 - 1.4250 58 - 3.75 100 - 3110.40 





698 A SHORT LIST OF BOOKS ON FOOD AND DIET. 
Relative Value of Metric and Apothecaries' Weight. 


Gres Grains, Grama. Grains. 
1 = 9 = 138.90 
2 = 30,88 mw = 15482 
3 = 46,30 100 - 1543.23 
4 = 61.73 125 1929.04 
5 = TAG 150 = 2374.85 
6 - 02.60 176 - 2700.05 
Ri ren 98,02 1000 = «15482.85 
8 = 12346 


A SHORT LIST OF BOOKS ON FOOD AND DIET. 
Quite a pee list of books on the subject of dicteties will 
be found in Index Catalogue of the Si General's 
Library. i shiition ss tees tat cine here given 
the reader is referred to the numerous valuable contributions 
published by the United States Department of Agriculture. 


Atwater, i in report of New York ee 1897-1900, 
Bauer, “Dietary of the Sick,” in von Ziemasen’s Handbook of General 


Kindererniheung im . 
Bi ae eae rt 
Ballataavaria, Piyeol 


ae the best is “AE te 1884, 
e Hee, gin ). 





aoe 
Haig, A. diet and 
Hart; Mrw, Ernest, Diet in Sickness and Health, 1895, 

Hutchison, Food ond Dietetics. 

Von Leyden, Handbuch der 

Maffott, Thomas, Health Jn 1655, 

Munk sod Uialinano, Die Brndhrang den gemnden nd krenken Aone 


189) 

Mion Roomtany “ Diabetes," in Twentieth Century Practi 

Von Noorden, Dire Meche and pare Pet 2—“Nephri- 
ts and Obese.” 

Von Norden, dey St 

Ovetel, “Obesity,” in wry Practice. 

Taree iene he iton, 

aud 

Penzoldt and Sing Handbuch der Therapie. 

Roberta Sir W., Lectures on Dictetica and Dympepsia. 

Sats tock es Tica of he Digestive Organs in Childhood. 

rr, Louil 
‘Thompson, Sir Henry, Diet in Relation to Age and Activity. 
Thompron, Sir Henry, Food and Feeding. 





Weirtgtell rat and Blook 
Yeo, Food in Health and Disease, 


INDEX. 


Axscess of liver, di 
Abvorbability of! ict in, ‘abe showing, 


Absorption, 27 
in infant digestion, 32 
testine, 28 
an 
rat 
of cereal 43.” 
of eggs, 


of foods, 41 
of fruits, 46 
of vegetables, 46 
of legumes, 
of meat, 4° 
of milk, 44 
of proteins, 42 
of roots, 46 
of tubers, 46 
of vegetable foods, 45. 
Acetic acid, excretion of, in nephritis, 


434 
Achy gastrica, diet in, 357 
acetic, excretion of, in nephritis, 
434 


boric, as preservative, 189 
‘on metabolis 
on nutrition, 160 
citric, excretion of, in ne 
uty dyspepsia, diet in, 
ippuric, excretion of, in nephritis, 


brits, 434 


phosphoric, excretion of, in nephri- 
tis, 433 
salicylic, a8 preservative, 190 
sphacelinic, 181 
sulphurous, as preservative, 190 
uric, excretion of, in nephritis, 434 
wines, 151, 
Acid-albumin, 24 
Acide, bile, function of, 29 
of win 
‘Acidulous watery, alkaline, 128 
muriated, 123 
saline, 124 








Acne, diet in, 537 
rosacea, diet in, 538 
Acratothermal waters 130 
Actinomycosis, 
‘Addison's “isa Piet i in, 594 
Adulteration, 184 
accidental, 185 
arbitrary, 185 
conventional, 185 
incidental, 185 
intentional, 185 
of alcoholic beverages, 185 
of baking-powders, 188 
deer, 186 
of bread, 187 
of butter, 187 
of canned meat, 189 
bles, 189 
of cider, 186 
‘of cocoa, 187 
of coffee, 187 
of confectionery, 188 
oo flour, 187 
f glycerin, 188 
ney, 188 
t infant fos gd 188 
of lard, 187 
of liqueurs, 186 
of malt extracts, 186 
of milk, 65 
of olive oil, 188 
of 188 





ices, 
of tea, 187 
of wine, 186 
Age, relation of food to, 58 
, diet for, 277 
food suitable for, 278 
Aladdin oven, 168 





Albuminized jelly, 642 
lemonade, 617 
Albuminoids, 18, 649 
‘Albuminuria, diet-list for, 698 
effect of diet on, 481 
uty, diet in, 508 
mized milk, 629 





699 


700 INDEX. 
Alcohol, 138 Alcohol, proportions oxidized and un- 
ie ‘secretion, on 148 protection a balay 137 
obcichy nativity 42 of terial by, 137 
‘on nervous system, 142 of in by 187 
Smee Ret 
of alira, 148 oy Ce ee 
eee sts es sien 
as food, 1 diet in, 
tas source of beat, 188 Menronat, 162 
of moscular energy, 198 almond cakes, 
combustion of, rapidity of, 188 and suet pudding, 645 
consumption of, 14 bread, 644 
on digeation of food, 106 fu dite, 491 
om oo eee of ae oe 103 
a 
ererion oe pep a ee Gr! 4 
in acute gout, 504, 507 feo rettcon waters, 123 
rheumatian, 317, 318 muriated, 123 
i senor ae ioe es 122 | 
in athenie fovorg 200, 406 Albalis allmentaiy, 4) 
it 
oe ae area 
In “chronis Interstitial nephrtiy | Binoy G44 
cakes in 
pteeiotanem nephritis, 489 No ou” 
in dinbetes mellitus, 473 No. 2 644 


in erysipelas, 317 
in Eo 


in 
Pitibetes mellitus, 488 
in hemorsiage from lung 407 
in hemorehagie pu lc purpare, 42 
in hyperpyrexia, 
in influenza, 
in lenkemin, 425 
in malaria, 313 
In meningltis, 315 
in nervous disoases, 
In pncumonin, 408 
ry children, 410 
in porpnre 1hemorshagiea, 425 
let fever, 312 
ia senile heart, 410 


in typhoid fever, 405 
in sepins fever, 
Vir Mitchell restoure, 461 
in whooping-congh, 
i chor and energy of, 186 


of wine, 150 





Afraonds, 102 
Almshonse of Feldiesoes, cia of, 609 


Atperinn bouillon, 638 


eer venile heart, diet in, 
Anchylotmum duodenal, 171 
posth 


diet 


Anemis, acute 





Anil wees artificial | Atkinson’ 


made from, 162 
ee 


i cn shasta AO 
Ass inp of  0 
Apel cuntes Bren eat tay 2 


later stages, diet in, 453 
Apotticcartes? ane measure, 


weit ne ao of, O07 
ive bw 
Appendlcls di 
Appetite, pty zh ston, 
Apple water, 617 
Apples, 100 
‘Armies, foreign, rations of, 587 
‘Army and hospital enema, 
rations, 657, 
during travel, 560 
emergency, a 
in tropics, 
Aroma sine BBE 
rowrvot gruel, 620 


Anerowler, aleohol in, 418 
in, 418 


antitie defe dict in, 509 
seonatenl diet in, 509 

Artichol tates 95 

Artificial 
infant Seating 


Ascaris lambetotten i 
Ascites if iver with dic i, 


Re: diet in, 402 
‘Asiatio cholera, diet in, 313 


ale aoe! 
dict i 


Asylum, 
infant 
Athletic Ua perce protein 


diet da 
ait dt to, 198 


Se nd diet of, 609 





ria and nor 
with ypoctlctii dst in, 64 
Atrophic catarrh of atomic, diet in, 
‘Atcophy, age ello, Met lt 
in eile, dit in, 271 
Avwater's illustrating uses of 
Alvi pho ever, fever, diet in, 309 
pois and metric hy rl 
tive value of, 697 
Bactuxas botulismus, 180 
in meat-poisoning, 17 
<r 


infected, i 179 
int is poeraners ay “ 


Banting’s diet in obesity, 518 
Barley bread, 92 ‘ 


with beef-szernck 639 
jelly, 621, 


Barlow's Slacase, dot 
y 
Bat ns eflect en oubellan AL 
St ale of 80) 
Beaumont’ table of chymification, 





702 INDEX, 
Borie acid as 
rods gy cocapomnon Preservative 
percent spe of, table on nutrition, 160 = 
as condatas, 
Beehtea 640 See he 
thay 635, Tatus, 1) 
nee mgs 
Oy 
a A 635 Bottle-feeding of ee 
ea 
Beer, 146 Bouchari’s diet in diabetes, 
adulteration of, 186 in A 
95 Bouillon, 80 
Benzoyl-sulphonicimid as substitute 636 
for in a 489 bottle, < 
Beverages 12,61 Boy's school, diet for, Sr 
Bied in ila ‘of stomach, | Bran ar 
ue cakes, Comps 
ic hyperacidit; 
gic o 3, 877 : rr 
Bieedias function of, 29 for infants, 616 
function of, Tre 66 
huematobla, 170 r 
Biscuit, ai 644 adulteration of, 187 
7 
luten, O43 barley, 23 
eres iabetes, 490 bran, fn diabetes, 490 
pate ‘of sodium a8 preservative,| brown, 622 
concentration of, 158 
Bitter sine junket, 627 643 
waters, 1 Recipe for, 622, 
Black pit in infant feeding, 250,261 | gluten, 92, 642 
Fie apa = aoa! in infant aiclaee in dlabetes, 490 
ing, 25) home-made snbstitute for, 647 
Teh mom, 642 in tubsrenlosis, 329 
Sea taekeoaearst Riis aa nut 
in cancer of ‘871 pulled, 
in chronie a 
intestinal ae with disrrhea, in diabetes, 490 
B83 substitutes for, in diabetes, 490 
in dilstation of stomach, 381 torritied, in diabetes, 
in habitual constipation, 393 wheat, 91 
oma nover| ee 
method of determining motor La vel 
of stomach, 194 Ting of infants, 


nae test. Stee cnat xe 


Boas-Ew: sar ald ten Test reakfut, 193 

Boat crows of univeniities, diet of, 200 
Body-fat, protection by alcohol, 187 
Body-material, protection by alcohol, 


Bedy-orctas protection by alcohol, 


Bolling meat, 166 

Booe-marrow, 111 

Borax as preservative, 189 
effect on nutrition, 160 








INDEX. 703 


Broth, clam, 684 of stomach in diabetes mel- | 
mutton, 634 Cotarral Rami det i, 996 
an 634 re ee 

without meat, Caudle, 617 
veal 634 Cauliflower, 96 
vegetable, 233 Celery, 7 

Brown bread, 622 soup, cream of, 624 
‘tools in infant feeding, 251 Cellulose, 28 

Pate dated dyspepsia, | Cereal a9 
eskar?s dot for servous t. 

But a. ma of, 45 

itter, al 
adulteration oof, 187 aes | compattlon of, table howe 

B 1 in tuberculosis, 329 

Buttermilk, 67 length of time to cook, 

Fa he 630 Partly cipestnd pepated see 
ms Cerebrospinal fever, alcohol in, 315 

CABBAGE, 96 diet in, 314 

Calcium and ae suo of yo method of treating obexity, 

Calculi, renal, diet in, 443 Chapin’ eto of mile mositcatin, 

liet is 

CalFs-foot ely 40 Cheme, 67 

ies, ( Rs cakes, 646 i 

orl ‘Cheese paleoning, 17 
Gamplin’s bran cakes O28 Chemical ccmptaliion of American 
ing, 77 rial, 648, G49, 657 
, 105 Chestnut puree, 622 
composition of, table showing, | Chestnuts, 102 
675 + Chicken broth, 

eet cauleration af, 199 | cole weata Indigestion fn, 
i getrie 
vegetables, adulteration of, 189 vidiee iy 

Canning of food, 150 gmstritin in, diet in, 267 

Cantani's diet in diabetes, 497 mince in, 271 

Caramel, 105 cat uundice ip, diet Sis 

Carbohydrates, 19, 651 chronic sf 
‘absorption of, 44 i 





intestinal, acute, diet in, 380 diseases of, diet in, 256 
chronic, chronic constipation in, of heart in, diet in, 414 
fet in, 382 ocema in, diet in, 696 
diarrhea in, diet in, 382 enuredis in, dlot In, 273 i 
Alarrhea alternating with const | fever in, dit in, 
jpation in, diet in, 388 Great Ormond’ Steet Hospital of 
diet In, 381 London for, diet of, 6L 


mucomembminous, diet in, 386 hospital of Boston, diet in, 613 





704 INDEX. 
“trae i Cocoanut cakes, 645 


ution in, dit in, 270 ‘in diabetes, 481 
Ig afer, 273 = parton 
saan gant. 
nul 
pneumonia in, tn cho hy, 410 fe a 
Dae eg ot cealterstion of, 187 
timore for, diet of, O11 jelly, O41 
school, diot for, 245, ket, 627 
scurey in, diet in, 682 nutritious, 641 
Stomatitis in, diet'in, 256 propnmation of, 134 
Chittenen's om protnin| Colts dat snthod of mille miodk 
req) 
Chlorasis, alcool in, 423 stone, olive oll in, 110 
dein on ing cl ae 
Chocolate, 135 Coloring er 385 
custard, 63 Coma, 
Cheletithins, det jn, 998 Combbtion of nloohalraplaty of, 188 
olive oil in; 108 issary, 57%, 576 
‘Asiatic, dict in, 918 
mille as cause of, 175 
Chorea, diet i 
Chorister a bore in suing Paul's school, Composition, chemfeal, of 


German table of, 
“a of, table showing, 337, 
Cider, 15° 
cerlbeeten 06 186 | 
‘effect on motabol- 
ism, 4 
Cincom sulphate, effect on metab- 


Cireulnory system, dict i, 410 
asa of in obesity, treatment 


Girthoss a oes, diet in, 401 
hhypertroph ic, diet in, 401 
with ascites, viet in, nay 
without pho es diet in, ae 
Citrie acid, excretion of in ‘Rhitis, diet-lint for, 690 








434 in chronic fntestinal swtarrb, diet 
Clam broth O84 
juice, oligo in, 110 
Clayiceps purpuren, 180 in children, diet in, 267 
ate ae openition for, diet after,| _ in diabetes mellitus, diet in, 488 
Conmmption, food of perons in dit 
elit, eon fo 5 ferent clroumatances tablo 
showing, 02 
of aleohol, 144 
Contamination of milk, 69 
Gonvalescencs Jn. fever, diet 
in, 207 
Cooking of fish, 167 





65 
and almond cakes, 646 effect of, 167 








INDEX. 105 
Cooking of meat, 168 Dates, 100 
og of, 10 Debithy, dict-list for, 600 
of naval rations, 577 Delirium tx diet in, 455 
soups without meat, 624 Dengue, diet in, 
‘meat, 632 Dotweiler’s diet for tuberculosis, 332 
tough meat, 631 Devonshire cream, 66 
‘elect of, 167 Diabetes mellitus, aleohol in, 473 
aera rules for, 623 wlouronat in, 4% 
in water, timetable for, 623 almond cakes 
Cooks, naval, 574 benzoyl i-imid as substi- 
Copper in 191 tute fon mga in, 
Cornmeal grog No. 1, 621 Bouchan’s diet in, 490 
0. , 
Cornatin, 1 Cantani’s diet in, 497 
Cows? milk, proprietary foods prepared of diet in, 
No, 1, 620 cocoanut cakes in, 491 
No. 2, 6 coma of, diet in, 485 
Crackers, 104 tion in, diet in, 488 
ot ghd, epileptics, dietary of, 4 baer hd 
ij lon, iileptis lic liet cures: 
eh vi diet in, 466 
65 lti 472 
Crea eee 624 Sic ‘dborders in, diot in, 48% 
n- cou ive 
Cream-of-potato soup, 624 disease of Kidneys in, et in, 486 
Cream-of-tartar whey, Ee ase jet in, 
Creamoftomato soup, B24 Guloin as substitute for sugar in, 
Greatinin, excretion of, in nephritis ae re 
i 5 
Criminal lunatic department of prison, | Ebstein's diet in, 498 
jet in, 080 Fat not digested in, dt, 499 
Crisp crackers, 824 guruntose as 0 
itbn of, table showing, 88 Garfoain Sées det in 496 
componition of, tal * 
Cryataflene, 489 gluten bread in, 
Gacumbers, 97 in as anbetitute for sugar 
j 
Currant juice, 617 gout in, aleohol in, 488 
ints, 100 fn, 488 
rd, baked, 681 gouty, dit Sn, 508 
chocolate, 831 children, diet in, 488 
light, 646 in elderly persons diet in, $74 
sof, 631 in young adults, diet in, 486 
nteamed, 631 dict in, 475 
Custards, rules for, 681 inulin bisenits in, 491 
‘Cats of beef, 652. milk eure in, 
of lamb, 654 era] waters in, 
of meat, 652 moderately severe forms, 477 
of mutton, 64 obesity in dit in, 
of pork, 655 paraphenatolcarbamid as gubsti- 
of veal, tute for 489 
Cyclic vornjting of children, diet in,| peanut flour in, 491 
256 potato cure in, 483 
Cystinuria, diet in, 481 necipes for food in, AB 
Cysts hydatid, 189 diet in, 
i rye bread in, 484 
Disneys diet for tuberculosis, ct us substitute for sugar 


46 


706 


Dinbetes sali oe, maxes as substitute 
ser ta 


bread in, 
von Scones etn, in, 491-494 
yolle mee 


children, diet in, 259, 282 
in diabetes mellitus, diet in, 488 
Diarrheal diseases Jiainaa "| 
Dial after excision of 
intubation in children, he 


in obesity, 518 
Tefore nomics, 46 
Bouchard in di betes, 496 
vachard's, in din! 
in obesity, 590 
Cantani’s, in diabetes, 497 
Gane 3 in obesity, 529 


ra Mths, 480 

Darembergs for tuberculosis, 392 

Team for tuberculosis, 332 

diseayes catwed by errors in, 169 
in which itisa primary factor, 466 





INDEX, 


np emt dy 


an ae aa 
awe to pie “89 


aE 


tie cleeioce te it in. Sait Pau 
for sehool children, 
= sll n ois 86, 


ae et J emacs 


Ger Sée's, in diabetes, 496 
nS in 





romcen, 538 
in ‘acta scene of liver, 397 
Soro tages 


in children, 257 
ati 
in children, 267 
pout, 504 
intestinal eatarrh, 880 
obstruction, 384 
nephritis, 486 
peritonil 
posthe dic anemia, 420 
thenmat 7 
yellow of liver, 308 
in“Addinon’ 


in sdvadind eases at tata 





INDEX. 107 
Diet inset, 44 Diet in constipation in dibs eli 
liver, 308 4 po incoalecenen fever a7 
in anerala, 420 : in cymlnurla, lt 
er) s  aaaiaed 
i 
pipe tools i dit ning 08 
in appendicitis, $85 Bon 
‘ip arteriosloroxis, 418 Gantan?s, 
in arthrltls deforma Beaumots, 498 
in Asiatic cholera, 18 ing’s, 408 
Re aa st Wee, 498 
in atony iat 
of stomach, 462 in “18 
with Bypercborhydeia and] Sn elderly etwng 474 
Doral acy, fn yore olay 
In aurephur aareh of smash, 857 reprint sr ‘ 
au catarrl 7: 
in atrophy in children, 271 Raber, 
in ate typhoid fever, 309 ‘94 
h bromehie in obey, 515 inditedscnma dio 
irousinoam of mac, #70 In dare alterating with, po 
in caiarch of slommch ia labeice| —- spailontarcheea = 
in atu fate, 396 in chikven, 250, 262 
in catarthal 
in children, 307" in diabetes iellitus, 488 
in cerebrospinal fever, 814 in digestivo disorders in disbetes 
in chlorosis, 421 488 
in cholelithiasis, 398 int id fever, 306 
in chorea, 453 in dil of stomach, 359 
in chronie bronchitis, 406 in children, 268 
constipation, 891 in diphtheria, 5 
inchronic intestinal eatarrb, 882] in disaae, 20 
diarrhea, 389 general rales for, 295 
in chrooie intestinal catarrh, 882] in diseases of children, 266 
dysentery, 383 of elreulat ore 410 
gastrie indigestion in children, 258 e in best O14 < 
itia, a) system, 
in children, 958 of heart 410 
good In children, 414 
yypersecretion of gastric juice, 358] of kidneys, 441 
Meboalitis in children in diabots mellitus, 486 
interstitial nephritis, 439 of legs in obealty, 516 
joigenion ia children, 204 He mG 
ous 
Peed pf 
ephritis in ot a of ral 
Poreochppstorsneynctieg SAT teu, Sa 
Peritoaitia, 208 of shin, BEA 
Fhcumatism, $18 of stomach, 985 
secondary anemia, 421 factors bearing on, 
in cirrhosis of liver, 401 legals 
with ascites, 402 Leube! 
Yithout ascites, 402 Penzoldt’s, 341, 842 
in complicit tphold fever, 209 | in diatrid sep, 41 
congestion of liver, in 
in coutiparion’ in children, 267 in \| 


708 INDEX. 
Diet in in diseases of heart, 26 ee ee 
in eczema, 535, in insane, 
in infants, 536 in Soscmnsla, 451 
in edema in diseases of heart, 312 in intermittent: es open of 
in obesity, 515 sustric j 
in emphysema, 406 in interstitial ritis in obesity, 
jp eosroptati 378 in jotetinal dienes, 378 
in cumete in Shildrea, 273 sete 380 
in epilepsy, 452 288 
in erysipelas, 317 ‘neurusthenia, 388 
in lnc goiter, 583 in intutation in 16 
See in diabetes mol- i eee lus, 
in 
in fauy liver, 398 in lead-poisoning, 455 
in fever, 207 In leannenr, 630 
in children, 300 leukemia, 425 
in tuberenons, $94 in lithemia, 443 
in flatulence in diseases of heart, 412 in children, 444 
in floating soy 8 in los urea output in pregnancy, 
Jn paltetone dense, 398 {n malaria, 322 
in in 
it rs in mali hs of ii 
aneeie se “ in igant growtl intestine, 


in hemophilia, 426 
in hemorrhage from lungs, 406 
from stomach, 370 


in hyperncidit 
in hyperchlorhydris, 343, 
in hypersecretion of gustele Juice, 


in dorsi cirrhosis of livor, 


in hypochlorhydria, 343 
in ileocolitis in children, 262 
fn inanition in children, 270 
in indicanuria, 431 

in infantile scurvy, 582 





in malnutrition in children, 273 
in marasmus, 271 
in Marine howpitals, extra, 001 


in rotor diturbanes of stomach, 
Sn mucomenbranous catarrh of in- 
testine, 386 


= Pe 313 508 

in sent bay at 
let fever, 

nerrDus anacidity of stomach, 378 

‘anorexia, 373 

diswases, 447 


INDEX. 709 
Diet in obesity, Cham! 529 Diet in tul 824 
Eni, 0 
Germain Sée's, 627 infirmary, 604 
in diabetes mellitus, 487 seers Wenge Black- 
in 280 'é Island, 
Ocrtel's 613. Weburs 332 
Salisbury’, 628 in typhoid fever, 301 
Schleicher's 527 in typhus fever, 309 
Schweninge?'s 626 in ulcer of duodenum, 384 
WeirMitchell's, 527 of intestine, 384 
Yeo's, 629 of 365 
in osteomalacia, 654 in urioacid as 
in oxaluria, 404 BD ome jn urticaria, 59 
in itation dinenses heart, om 
baer inv calenli, 433 
in pascive congestion of liver, 307. | in visceral 450 
oo ear . 
in perforation in typhoid fever, 307 leguanianin in diseases of stomach, 
in peritonitis, 39% 38 
in pernicious anemia, 421 Leube'y fn diseases of stomach, 335 
Vomiting ofp , 283 quid, vic disorders, 343 
in phospbaturia, milk, ‘on metabolism, 39 
in pleuriny, 408 ls it , 618 
in poeamonia, 407 ‘of Baltimore, 609 
in children, of Bay View Asylum, 609 
in postdiphtheritic paralysis, 317 boat crews of universities, 200 
in ney, 279 of Children’s Hospital of Boston, 618 
i obesity, 380 tal for Inne 
in praritus, 538 at St. Elizabeth, D, C., 007 
in pworiasis, 588 at Washington, D. C., 605 
in public institutions, 578 of Great ital for 
in pacrperium, 282 Children, London, 615 
in parpura hemorrhagics, 42% ‘of Johns Hopkins Hospi 
in pyelitis, 442 si ‘land, 
in pyelonephritis, 442 504 
in rublen $24 of Robert Garrett Free Hopital for 
in rachitia, 273 Baltimore, 61 


in renal ealenli, 443 
in rheumatiam, 317 
in rheumatoid ‘arthritis, 509 
in slfaton Jn prognaney 282 
in salivation in A 
in scarlatinal nephritis, 312 
in scarlet fever, 311 
in scurvy, 631 
in adalts, 531 
in infants, 582 
in skin diseases, 535 
in anall-por, 310 ma 
in special diseases of pregnancy, 
in omutitis in childtene 306 
in sudden dilatation in ‘diverse of 


413 
in syphilis of liver, 398 

in tetanus, 298 

in thirst after operation, 547 
in toxic conditions, 454 


Children, 
of Second Hospital for Insane of 


eicahae tok Gia pata seeernaresy 
preptyiectiey in diabetes mellitus, 
relation of urine to, 426 
Robert's, in diabetes, 495 


motor power of stomach, 104 
for diagnos of ulcer of stomach, 


INDEX. 


Dilatation of stomach, diet in, 259 
inehildee, dt fn, 258 
olive oil in, 108 

nudes ieee oo heart, dict in, 


4 
Diphtheria, diet 
tainbetion ae 


530 

Ducin ones for sugar in dia- 
TDunlogt sieiany sensiarian for prison- 
Dusdensth, sent of live ol, 109 





chemi 
fiet of tleobol upon, 156, 
Emotion effecting, 5? 


lamin at See also Infant digestion. 
infant, 31. 

influence of various factors on, 54 
intestinal, 24 

of milk, 65, 

onder a of meals affect- 


is 
ysioljgy and chemistry, 17 
Nya comains bantes asd ada 
meals affecting, 67 
solivary, 22 re 
temperature of food affeoting, 57 
tobacco affecting, 62 
variety in ‘diet afectin 36 
Digestive disorders in diabetes melli- 
tas, diet in, 488 
In typhoid fever, diet in, 306 


Eaxray mineral waters, 129 ~ 
Ebstein’s dict in dinbetes, 497 
‘in obesity, 523 

vin inet, fot 

‘tiseases" 


ini 
aa 


osreb bay 


in obesity, treatment of, 515 
Ede’s pret ries it cooking 
meals, 


Egeattumin, 78 
Fggand-brandy Aiea 66 





| 


mnopencrate ik, 284 
-water-1 
Enema, Jaccoud's, 
nutrient, 26 — 
army and hospital, 
Daje fn-Beaumets, 238 
umets, 
nd-milk, 258 
wwald's, 280) 
indications for use of, 287 
method of giving, 285 


gu k, 288 
‘Von Leube's milk-peptone, 288 
Zunte's fat, 200 

Energy, muscular, alcohol as source 


of, 
of alcohol, metabolism of, 136- 

English navy rations, seale of,670, 671 
prison dietaries, 589 

Rnterokinase, 26 

ea tren diet in, 372 

Eure in children, dit in, 273 


20 
oxidizing, 21 








Wt 


Farinaceous foods in which starch has 
not predi 164 


bination, quantity required, 48 
oantity required, 48 
Aunte’s recipe for administration of, 


Futaplith 20 
Fatty foods, Indieations for uve of, 107 
iver, diet in, 808 

Feces, miners! matter in, 113° 


205. See also Infant 





woking So is 


mae es thro 
Aged diet 


intel sn 888 








teration, 
alcohol ns, 138 
arsenic in, 191 
canning of, 159 
chemical | eampoxtion, 648, 649, 657 
classes of, 63 
eoloring-mattem i in, 185 
concentration of, 168 


‘copper in, 191 
Pease of, Penzoldt’s table of, | F 


339, 
‘ion of, effect of alcohol on, 136 
aie portion, 64 
ieee as which starch has not 


ae from cereals of which 
ae has been converted into 
dextrin or sugar, 164 








INDEX, 


fatty, indications for 107 
Re ahaa eitcentd i ut, 


fase of, 
relation of urine to, 426 
fo age, 58 


acute, 169 by, 160 
‘vod-poitons, caused by; 

Foods alu ot oer 136 

per pound of nutrients in Mia 

oa le showing, 42 

Footand-mouth disease, 
Forced feeding im diseases of stomach 
567 


Foreign armies, rations 
ign 190” 


Formildehyd a presorvat 


7 


ail 


INDEX. 713 
‘ormaldehyd in milk, 100 Germain Sée's test-meal, 193 
Fired wl 180, 161 a i eee 
Fee non dietarie, 502 ag fb met 
Fut cures, 543 Gluten bse, Jeff, 61 
in tuberculosis, 829 bread; 92, 62 
Froits, 99 in dinbetes, 490 
temptation aft table showing, 101 | fenorkey 643 
ia the temaachy of ie 6az 
it-sugmr, 106 g ke, 60 
Frying meat, 167 
Evel rae, dot Givecrit, aduleration of, 188 
Fungi, 1 as tytn for sugar in diabetes, 
Funtichlaxs det tn, 889 
G 100 
Galactotosionnus, 175 
Gall-bladder, operntions about, diet 


in, 398 
cate, flesh er get of, 83 
Garantove ax ys for ugar in 


Garlic, 97 


Garrett Free ital for Children, 
batnory tt 8 eas 
Gartner's milk, 394 


Gastralgia, diet in, 449 
Gastric juice, 23 
jon on food elements, 24 
hypersecretion of, chronic, diet 
in, 
diet in, 358 
ee diet in, 358 
earl alive ofl in, 108 
cn et of meal ‘on, 143 
Gatrtin abot, dit ip, 358 
se ldren, diet in, 257 
chrom det 
in eblidten, diet to, 258 
diet-ist for, 686, 


of stomach, 352 


am Infants, 255 
latin, ‘shes made with, 641 


ii 18, ee 
in diseases of stomach, 


Gelatosen, 24 
Geneml mers, 572 

organization and administration, 
Geaitoarinary sete ems of iat 


Germain’ pan dict in diabetes, 496 
in obesity, 627 





ginclat oeede, = 


Gmopon lid 





Grape-sugar, 105 





74 INDEX, 
Great Ormond Street Heredity, relation of food to, 58 
London, diet of, 615 | Hippuric uci, exeretion Php 
CA aga (img th 
bie, 6” ‘duiteration of, 188 
ion of, Horse meat, 83. 
composition of, table showing, 98 | Horseradish, 107 
Gruel, arrowroot, ‘Hospital and army enema, 289 
barley, 620 at Lakeside, Cleveland, det of, 14 
ath bee dey on % 
w 
commeal No. 1, 62 light, 693 
No. 652 moat, 593 
cnscer fo 1, 020 a 
0. Ly 
630 eee 
farina, 620 for Childrea of Great Or 
flour, 620 mond Street, 615, 
floartall, 621 Robert Garrett, diet of, 611 
for bri St. Eliza- 
ial um, D. C,, dietary of, 6OT 
nai 3 Son feng, At at Waihi D.C, dietary 
oatmeal, 620 of Maryland, dietary of, 605 
for taberculaxiy Island, 
Hager, 116 Jou of dietary of, 594 
lopkins, 
Ham, 83 in, extra, OOL 
Taatieperation for et after, 52 Salary, COL 
jareli ration for, after, it 
Head, operations about, dit after, 61 Navy, diet fn 608 
Headache, diet in, 450 Bay View Anylum, diet of, 609 
Heart, dincasen of, alochol in, 411 | Ht 
dict in, 410 Hluckleberries, 100 
trance in, diet in, 413 Humanized milk, 74 
in, diet in, 412 Hydatid di 183 
Aatulence in, diet In 412 Br 1, See alo Fat. 
uu oes in, a 
wa Hore Pel 
2 ats Hype acidity, 
tic iet in, 
Fiudien dilutation in, tiet in, 413 pope re 
senile, alcohol in, 416 diet in, $48, 874 
anaiaren jn, diet in 418 pyle ton 88 oan 
jet in, Hyperpyrexia, 
Heat, alcohol as source of, 138 persecretion gastric juice, 
‘uiliation of, effect of alcohol on, 188 | "chronic, det fn, 858 ; 
Heat-value of food, 34 diet in, 
Hemipeptone, 25 intermittent Leathe 358 
Hemophilia, diet in, 428 Hypertrophic 
Heenorstage from lungs, alcohol in, - ee a ee. 
01 al stomach 
diet in, 407 Poe thy diet fa, 364 
from storach, diet in, 370. diet in, $43 
in typhold fever, diet in, 307 
pititeer of woman dit So a6, |Toun meat extract 698 
Wt 10 parpura, « NO} 
Hemorrholds, diet in, ‘a8 tobinnd mows," 10S 
Heredity ns cause of yout, 600 Tehthyotoxismus, 177 


josyncrasies, food, 188 
Mea eye a chihdcen, det 


in children, diet in, 262 
Imperial drink, 618 


vom rue, 620 
Tnaoition in chil re, dt in, 270 
Indicanuria, effects of diet om, 431 
nitrate 130 
acute gastric, 1 children, 
dict in, 257 
as canse of gout, 500 
chron gsi in ehilden, det 


intestinal, in children, diet in, 264 
Individual tendencies, relation of food 


61 
Infant, randy andegs mixture for, 


aes peep in, 32 


25 

contra-indications to, 205 
buttermilk in, 233 
Chapin's method, 231 
Coit's decimal method, 224 

ic in, 253 * 
Aietete' errors in, symptoms of, 
‘ighteen months to two and one- 

If dered 40 

= to eighteenth month, 
Giirtner’s milk, 234 


malted gruels in, 232 
Materna Graduate Method, 227 
Maynard Ladd’'s method, 229 
mixed, 212 
nasal, 256 
second. yer, 238 

ES 


setae cases, 252 


Starr's table, 231 
stationary weight in, 258 


saline, 291 


Infusions, 
Jone department of Bay View Aar~ 


Jum, diet of 
for, se 


of ty 
valent art Sat 


fnstitul cy diet In, 578 
fiat perlie saetete glad 


in, 8 
constipation in, diet in, 382 
Siar atreating with on- 
stipation in, diet in, 383 
diet in, 381 
mucorembranous, dit in, 386 
3 s 
infants, 82 
fa in, 32 


note 
Seman 
diet in, 880 


716 


Intestinal fistula, 
flatulence, diet in, 


INDEX. 
throogh, 855 | Johns Hopkins Heltah dietary of 


Cs eg canine, in children, Tunket 027 


sercatieah diet i oa 
jon, ents det i, 


ing, 200 
He in children, feeding after, 


ste in, 916 


Dlane-mange, O42 
and arvenic waters, 129 
a 127, rm 
sul 

nin, 168 


Jaceoun’s ener 
Jaundice, fori diet in, 896 


ilren diet in, at 
Jefiier gluten lsc. 643 ni 
Telly, tose 6 

barloy, 621 





batter alinond, 627 


ati os 


rea feeding of infants, 216 


tea ible milk modifation, 28 
healde Hospital, Cleveland, diet of, 


Lamb, 83 
cuts of, O54 


arotamiie and diet, 546 
Manca at = 


Lard, adulicration of, 187 
cee serial diet in, 404 


fg det 
= i dict after, 662 


Lecithin, 
Legs, disiases of, in. obesity, treatment 
of, of ts 


lll 


INDEX. 717 
Lemon jelly, 641 Maowestom and calcium contents of 
whey, 628 vegetable foods, 429, 430 
Lemonade, albuminized, 617 Maidismus, 181 
effervescing, 617 Malaria hobo in, 323 
milk, 62 
toned, 626 aligns growths of intestine, diet 
‘0. 1, 
No. 2 617 Malnutrition in children, diet in, 273 
‘Lemons, 99 Malt extracts, 164 
Lenhartz’s diet in ulcer of stomach, adulteration of, 186 
369 liquors, 146 
Lentil, 94 action and therapeutic use of, 155 
Lettuce, 97 Maltase, 20 


stewed, 646 
Leubele “diet soale, in disearon of 


stoma 
method for determining motor power 
of stomach, 194 
Leukemia, aloohol in, 425 
i ik 3 

vu 
resi 
Licheng, 108 
‘Lit 99 


Lime-water, 616 
Linseed tes, 618 


ipase, 25 
Friars uria, effect of diet on, 426 
Papors of 146 sie 
adulteration of, 186 
Lithemia, diet in, $43 
in children, diet in, 444 
Lithium carbonate, effect on metab- 
olism, 40 
Liver, abscess of, lit i in, 398 
absorption in, 
soe yellow suapky of, diet in, 


amyloid, diet in, 398 
faiaen of, diet in, 401 on 
tro iet in, 
writ ascitey diet in, 402 
without poe fons diet in, 402 
congeston of, acute, diet in, 397 
diet in, 397 
ive, diet in, 397 
diseases of, alcohol in, 394, 395 
diet in, 393 
fatty, diet in, 398 
elcogenic function of, 30 
», poisoning from, 179 
eyphili is of, diet in, 398 


urea and, 81 
Lunatic department, criminal, of 
prison, diet in, 
Lungs, shemerrbage ees alcohol in, 
dict, 
aphoak | ‘ar 





Malted gruels i in infant feeding, 232 
Manganese, 11 
Marasmus, diet in, 271 
nursing homes for, 272 
Marine hospitals, diet in, extra, 601 
milk, 602 
ordinary, 601 
Manor Cree a bolism, 41 
effect on metal 
Maer Sing me method of infant 


Maternal nord og of infant, 205 
contra-indications to, 205 

Matzoon, 68 

Maynard Ladd’s table of milk modi- 
fication, 229 


Meals, number of, in tuberculosis, $31 
order and and, frequency of, effect on 


rest ae exercise petome and after, 
effect on digestion, 57 
test-, for determining secretory funo- 
tion of stomach, 193 
Measles, diet in, 312 
Measures and weights, 696 
Meat, 78, 631 
absorption of, 44 
artificial proteins made from, 161 
baking of 166 


bases, 
brazing of, 166 
peng of 166, 632 


canned, adulteration of, 189 _ 
composition of, table showi a 
concentration of, 158 
cooking of, 166 
effect of, 167 
cure, 544 
cuts of, 652 
digestibility of, 79 
fora of 7 
frying of, 16: 
Freel rules for preparing, 631 


in diseases of stomach, 348 


paney, diet to, 
workes chawe of goat, 500 
ee effect ees 41 
om general, 572 
‘nganition tnd administmtion, 


Metabolism, 32 
‘eflect of antipyrin on, 40 
of baths on, 41 
of borfe acid on, 40 
of bromid of potassium on, 40 
of cigarettoamoking on, 40 
of cinchonidin sulphate on, 40 
of drugs on, 40 
of fasting on, 39 
of lithium carbonate on, 40 
of mawage on, 4 
of mental work on, 41 
of milk diet on, 39 
of muscular work on, 40 


liscase, 41 
ray of alecho}, 196 
amount required, 30 


86, 

Metallic poisons in food, 191 

Meteorism, diet in, 388 

Moitic and apothecaries’ measure, rel- 
ative value of, 696 

weight, relative value of, 698 
and avoirdupois weight, relative 

value of, 697 

Metropolitan Hospital, Blackwell's Te 
land, tuberculosis infirssary of, 
diet for, 603 





INDEX. 


Er panel 


absorption of, 44 
ition: 


Chapin's method, 231 
Caits decimal method, 294 
Tis 216 ar 
laterna bbe 

aalreds of pcteal vine io, 216 
m 
Starr's table, 231 
top-milk, 221 

modified, 71 

mother’s, modification of, 210 
testing of, 208 

nuriery, 291 

Pasteurization of, TL 

peptonized, cold 035 
eflervescent, 





INDEX. 719 
Milk, hot, 625 Motor and fanctions of 
ually, raped of, dist 
iy, 698 etio test for determining at 
warm process, (125 wes he 194 
poisons transmitted in, 173 stomach, diet in, 347 
porte, ie ene stomach, i 
Prevemelcan ‘Boas’ method, 194 
preservation of, 69 ‘Rony? test-supper, 194 
ey ete eure tet Taubes method! 194 
bane) Mouth, care of, in tuberculosis, $27 
wees 213 in typhoid fever, 396. 
punch, Mo dinearo, 183 
peptonized, Mucomembranous catarrh of intestine, 
reaction of, 215 tet 
salts in, 216, Malberties, 1 
66 Malled wine, 618, 
sterilization of, 71, 72 Mumps, diet in, 313 
‘sugar of, 106, $14 Muscular activity, action of alcohol 
for diabetic feeding, 647 on, 142 
variations in, 64 oars alebol wx te of, 138 
variogs Kinds of ‘comporition, table eee effect on Reetabolleny 40 
owing, 
acti other dnenty 690, 630 Huskrooms, 108 — 
‘lle-and-cereal wat poisoning from, 
Mil-ndsinminon i 629 Mme "106 
‘enema, 288 Mutton, a” 
Maken enema, 288 broth, 634 
Milk-and-ugar enema, 288 wit 64 
Milk enenus, Vou ‘Tenbetg|' _ wishou: mest, 
cuts of, 
Milk-poisoning, 175 ‘Mytilotoxismus, 176 
Mill bate 2 Mose unto, thyrokd gland ub- 
Mineral matter, 651 in, 
i oy ns Nasax feeding of infants, 256 
in princi ASA 
inewetlis Nausos after operation, diet in, 648 
a N a 508 
waters, a et 
alkaline, 122 rong e ca 
classification of, 125 
earthy, 129 ot sr 
ii ibetes melli Be ret in, 435 
Mixed infant feedis ic Sas alcohol in, 439 
Modifoation, milk, 89, 215, See also ee 
Modified milk, 71 Peet ern ie 
Molasses, 105 


Mollusles, composition of, table show 
ing, 88 


Morel, 1 
oe chronic, diet in, 
Mosquera beef meal, 162 
‘Moss, Iceland, 108 
Irish, 108 
Mother's ey modification of, 201 
teating of, 201 





of citric ncid in, 484 
af creatinin in, 433 


or ea iy 4 


ph igggents So 


720 


iy estat of BIS 
mae as anacidity of storie, det in, 


soorecia att hi 373. 
diseaset; alcohol i 


ie a peep! 


Sets 
Rout to, dict in, 388 


ti Fa olive ail in, 108 
Nice Bed 191 sf 


<t ina a 1 
Huvsrows 
Nutrient enema, 384.” See also Enema, 


‘aunt 

nt) 

Nation etl of borax on, 160 
of boric acid 


on, 
Natritions cof 


Gal 
Nutritive drink for delicate women and | OI 


children, 
Nutrose, 161 
Nuts, 101 

composition af, table showing, 102 


erated aa aaU 
cure in severe 
uel, 620 


fy, 


tot rata of Boas, 193 


Oats, a0 
Obesity after cures for _pulm 
tuberculosis, diet in, 615 
terrain cures in, 517 
Banting’s diet in, 518 
Bouchard's diet in, 630 
Pee HT treatment of, 515 
causes of, 
Ghuberd method of treating, 529 


aia in, 500, BIS 
ice oe md 





INDEX. 


nervous 





ee atone ane 
in 
iin gustric a 108 


in stricture of 


INDEX. 721 
Mor clefiealse,dietafer, 652 | Pusteurifadon of milk, 71 i 
Pas i 
resins opr Peaches, 100 
nausea after, diet in, B49 Peanut, 4 
on esstepn dic ater 558 ner nets, 492 
cu intainn, dist ‘after, 655 Peary, 100 
preparation ae et oe Peltgs, 181 
; 
shook after, dietetic management of, | Pellis agria, 181 
As Pelvic Prochownicl’s diet 
thirst after, treatment of, 047 in, 280 
vomiting after, treatment of, 46 Pemmican, 161 
gees poet Seat ees 
ge 9 table of digestibility of food, 339, 
Ongeat, 618 340 
‘Osteomalacia, diet In, 534 Popper, 106 
Grenatioras tates ot pea) 100 "agin ns into peptones, 24 
Pratonct reece 428 in it Te 
‘diet ny 428, 490 Beptones, Pepain changing, prtena 
Seek leat 17h ad pice, 625 
vermicul 
Opstor Juloos 634 bar aed | 
stew, 


Pancreas, diseases of, alcohol in, 403 
diet in, 402 


Operations about, diet after, 663 
operations aboot, 
Pancreatic julca, 24 a 


Pare oat \theritic, diet in, 317 
i 
Pimbhenolearbe 7s 


\id as substitute for 








nephritis, 
Phosphoross, 117 





Poisons, food, diseases caused by, 160 
Poisons, eesti in food, 191 
‘tmnsmitted in milk, 178 
Pork, 83 
cuts of, 655 
Porridge mall, 628 
Posidiphtberitic paralysis, diet in, 317 
oatieacettineic amet tanta Giak 


in, 420 
Potassium, pd of, effect on metab- 


Profligestion of milk, 74 
Premaney, aberrant mental conditions 


280 
gingivitis in, dict in, 232 





280 

pernicious vomiting in, dict in, 283 
solivation in, diet in, 982" 
special diseases of, diet in, 282 

Preservation of food, 159 


exclusion of air, 150 
be exposure to cold, 100 








ord 
oa feon 

Prochownlok’s diet in _petvio. com 
rietary foods, 163 

eer bent e 
Frepared from cows milk, 168 


and , distinction between, 650 
‘ficial, made from 


changing i 
= 
enzymes, 20 


Prunes, 100 

Pruvitis, diet in, 588 

Prussian prison dietaries, 692 
diet in, 638 

loge action of aleohol, 142 


Pe 
Public institutions, diet th, 568 
Pudding, ne and suet, 645 








gluten, 642 
suet and alenronat, 645 


Pulled bread, 623 
Pumpernickel, 91 
Pumpkins, 07 





INDEX. 723 
a ood oatrials, 602 etait a 
Hee eetaoe eatarts SeSood |” “ele tac B17 
chronic, diet in, 318 
h diet in, 425 | diet in, 817 
tig, diet in, Rheumatoid arthritis, diet in, 509 
ephritis, diet in, 442 Rhubarb, 97 
lorospasm, clive oil in, 100 Rico, 92 
lorus, stenoais of, olive oil in, 108 | water, 618 
tuloer of, olive oil in, 109 Rickets, diet in, 273 
Riege!’s enema, 289 
Bae ‘ae in, 324 : ae 092 
et in, 
Racahbat des arabes, 620 Rotert Garret Free ital 
relation of food to, 68 dren, Baltimore, diet of, 611 
Rachitis, diet in, 273 Roberts diet in diubetes, 496 
Radiation of heat eft of aleobol on, | Robora, 163 482 
Rainn 100, | Sompbaltion 3 table showing, 8. 
i jan of 
amos ah, oe Reseniielm's ena, 20 
te: Rough wines 
Ramogenrwatermilc emulsions, 284 | Rum, 146 
Raspberries, 100 Rye bread, 91 
Ratlons, army, 857 in diabetes, 484 
during travel, 600 i. 
in rap ‘sabe an substitute for myar in diabetes, 
navy, 510 
cooking of, 577 Sabli’s method of determining at 
preparation of, 577 time motor and 
of foreign armies, 667 secretory functions 


Raw beef, methods of preparing, 697 


sa 0 i Pil nd sugar, 638 
w meat with milk 2 , 
Reaction of milk, 215 
Recipes, 616 

for food for diabetics, 042 

for nutrient enema, 
Rectal feeding, 244. See also Enema, 

nutrient, 


irrignt ine, 291 
Rel ool infant feding, 280 


of WeirMitchell, 456 
alcohol in, 461 





724 INDEX. 
Saxin as for in dia- eflect on metab 
epheiae So is shan sub 
bed | a 
eset in, 31; Bee sugar in 439 
diet in, 11 Haulphate of ux prsereating 
as cause of, 174 chlorid poisoning, 
Schlsieher’s die i obesity, 927 watery 125, 
Schinidt and Strassburger’s testadiet, ie. 
My det for, 248, 603 Soldiers ae for, O61, 662 
", diet in et for, 
hy diet for, 245 Somatose, 162 Ye 
Schroth’s cure, 544 Sorghum, 92 
Schw sat in obetty, 688 | Horr, 97, 
Sourvy, diet in, 531 ‘Soup, beef, row, 633 
in adults, dit in, 531 celery, cream of, 624 
Season, relation of food to, 60 from stock, 683. 
Secondary aneinis, chronic, diet in, Jenny Lind, 196 
4 potato, cream of, 624 
Secretin, 27 stock, 633 
Secretion, action of alcohol on, 143 from beef extract, 633 
gastric, action of alcohol on, 143 sweotbread, 634 
‘of saliva, action of alcohol on, 143 tapioca, 622 
ty and motor functions of | tomato, cream of, 624 
iomach, disturbances of dlet-/ Soups, Reneral rules for, 38 
etic test for determining at | withont meat, cooking af, 624 
same time, 194 in 490 


function ok maench determining of, 
comel test-breakfast of Boas, 
test-breakfast of Ewald and 
Boos, 193 
teat-dinner of Riegel, 193 
test-meal of Germain Ste, 193 


‘Of Klemperer, 198 
om 18 





text-meal, 

Senile heart, alcohol in, 416 

anasares in, digt in, 418 

diet in, 414 
Sex, relation of food to, 58 
Shaddocks, 99 
Shellfish, 87 
Shock after operation, dietetic man- 

agement of, 548 

Silica, 118 
Singers, diet for, 198 
Singer’s enema, 28) 
Bitotoxismus, 180 
Size and relat of body, relation of 


Sleep, disturbed, diet in, 451 
Small-pox, alcohol in, 311 
diet in, 310 





Bpirity, 145, 
5 
Springs, walla) in gout, 506 


enema, 288 
Starr’ table of milk modification, 231 


‘Stoapein, 
Stenosis Apis olive oil in, 109, 
in, 108 


35 
in diabetes mellitus diet in, 488 
dilatation of, dict fn, 
Attn diet i, 258 
a 
olive oll iny 108 


INDEX. 725 


Seta ee of, carbohydrates in, 


diet in, 395 
factors bearing on, 349 


in, 348 
cman of sweet-almond oil in, 


Joguminous foods in, 343 
Leube's diet reale in, 335 
Tiquid foods in, 348 
meat in, 348 
milk cure in, $5) 
olive oil in, rt 
Penzoldt's diet-lists in, 341, 342 
rest care in, 351, 
4] eure 
didlarbexiaet 98. Slelor andl Meee 
functions of, dietetic test rae 
determining at same time, 194 
fala of feeding through 
hemorrhage from, diet in,'370 
hypomeldity of, diet in, $74 
in infant digeation, 31 
pele of, in tubereulosis, dietin, | Sugarfree 


mole testa of, dint ins, 847 


power of, dterniting, 194, 
Let pec 


norvoun anaeidliy of dt i, $73 
disorders of, tock In, 373 
subacidity of, diet in, 373 

neurosis of, olive oll in, 109 


le diet i, 3 
telist for, 688 


Sees ta in diagnosis of, 104 
hemorrhage in, diet in, 865 
‘Stomach-tube, feeding infants by, 255 
Stomatitis in children, diet in, 256 
Sols black, in infint fooding, 250, 


blackish -brown, in infant feeding, 
21 


own in intt feeding, 201 
green, in infant feeding, 

in infant feeding, 249 

red, in infant feeding, 250 





ies Lg es 
abla ted adalatstetton 


of wine, 
pthc to athletic training, 108 
sins for, in diabetes mellitus, 


oe it 
ses mk Tor dase feeding, 


Sulphite as preservative, 190 


Sulphur, 117 
Saphrous ci preserrutive, 190 
mes 127 


Spe “recor ais 
“7 - irl oot 
ee ‘otic management of, 


Sreat, mineral matter in, 118 

Fabeed ier eroulion of in pe 
trie disorders, 

Sreethread soupy Wt 


Syntonin, 24 
8 ers + diot in, 398. 
‘yp iver, diet in, 





726 INDEX, 
mediocanellata, 170 ‘Trichiniasis, 172 
ane Titostas te 
7 
170 army ritions in, 562—564 
water, 617 ‘diet for soldiers in, B64, 562 
Pecan ‘Truflle, 105 
ca, {32 ‘ Tibcenlcis enced eum a5 
Tate alos ot 26 301 be 
faxed. G8 cohol in, 280 
618 bread fo, 82 
‘of food, effect on di-| care of mouth in, 327 
cereals in, 329 
cares in obwity after cure for| Darembeny’s det fr, 819 
pulmonary tuberoulesis, ‘s a 
for teame| diet in, 324 
GaN sing tener pare re yey 
Speed) eee 
in diagnosis of ulcer of stomach,| fever in, diet in, 294 
Sw nicaoee ih | eee ea 
motor er w 
Tot Boas, 198 forced feeding in, 
of Ewald and Boas, 193 fruit jn, 320 
Teavdiet of Schmidt and Surasebunger, | gustric irritability in, diet in, 888 
Mestadinner of Riegel, 198 vs Sfecepolign, Hloepital, Back: 
n a 
Testing mother’s milk, Ns Het tor, 803 
‘est-meal of Germain Bée, 193 meat in, 328 
of Klemperer, 193 nice in, 329 
Detcaair ie datvrmliing wereiory | “oallcey Betas 
function of stomach, 183 ‘umber of meal fn, $81 
‘Test-supper of Bons, 194 obesity after cures’ for, dict in, 516 
‘Tetanus, diet in, terrain cures in, 517 
Thea, 182 suralimentation in, 
‘Theobroma cacao, 136 Topetables in, 990 
‘Theobromin, 135 eber's diet for, 382 
‘Thirst after operation, treatment of, 647 % 
Thyroid gland substance in myx.| abvorption of, 48 
fruste, composition of, table showing, 96 
in obesity, 580 Turnips 99 
‘Timetable for cooking vegetables in| ‘Typhoid fever, wleohal in, 905 
water, 623 atypical, diet in, 309 
‘Tobacco, effect on digestion, 62 care of mouth in, 906 
‘Tomato soup, cream of, complicated, diet in, 309 
o convalescence in, diet in, 307 
‘Topmilk infant feeding, 221 diet in, 301 
Torrified bread in dinbetes, 490 digative disturkances in, diet in, 
TPasistog ates sevact ot. pec hemorrhage in, diet in, 307 
jing, athletie, amoun emer is 
‘required in, 203 Fre || ask sneha pe urea 
diet daring, 190 milk in, 808 ane 
tion of sugar oysters an catune 
Travel ration, BO perforaiion in, diet in, 307 
Treacle, 105 Typhus fever, alcohol in, 
Trichina spiralin, 172 diet in, 309 


INDEX. 


Uxeen of duodenum, diet i, 384 
of intetin, diet in, 384 
in, 109 


of pylorus, olive 
A here? diet in, ne 1, 104 
ietetic test in diagnosis of 
diet-list for, 688 
hemorrhage in, dit in, 385 
Unclassified di 
Unconscious patients i eting of 295 
Untreny boat crews, diet studies of, 


‘Urea and liver, 31 
excretion of, in nephritis, 433 
low rea output, in pregnancy, diet 
282 


Uric a id, excretion of, in nephritis, 


Uricacid diathesis, diet in, 443 
Urinary pigments, excretion of, in 
nephritis, 433 
Urine, mineral matter in, 113 
relation to food, 426 
Urticaria, diet in, '537 





Varia junket, 627 
Variola, alcohol in, 311 
diet in, 310 
‘Vascular system, action of aleohol on, 


Veal, 83 
broth, 634 
cuts of, 654 
Veal-bone jelly, 640 
Vegetable and animal foods, artificial 
* prsgee made from, 163 
rot 


diet, dimnd vanta of, 98. 
effect on metabolism, 38 
‘ote i f, 45 
al ion of 
Vegetneise 623 
artificial proteins made from, 162 
canned, adulteration of, 189 
carbohydrates of, 89 
concentrated, 158 
cooking in water, timetable for, 623 
effect * id ed 
general rules for, 623 
digestibility of, 90 
extractives in, 89 
fats fui, 90 


P deorption of, 46 
composition of, oe showing, 98 
in tuberculosis, 329 


727 


Vegetarian diet, effet on metabolism, 


Vegetarianiam, 98 
Ve ea 

el et i 
Vea te it in, 443 
Vinegar, 1 

in Cation of food, 160 
Viscera, animal, 85 

‘composition of, table showing, 85 
Visceral neuralgia, diet in, 450 
Vomiting after operation, treatment 


eyelic, of children, diet in, 256 
in infant feeding, 254 
at any time, 254 
immediate, 254 
one or two hours after, 254 
nervous, diet in, 373 
pernicious, in pregnancy, diet in, 283 
von Leube’s milk-peptone enema, 288 
von Noorden’s diet in chlorosis, 422, 


423 
in diabetes, 491-194 


Watrors, 102 
Water, 17, 120 
albumin, 617 
apple, 617 
barley, 618 
cures, diet at, 130 
excretion ot ‘in nephritis, 483, 485, 
in vegetables, 90 
lime, 616 
oatmeal-, 618 
rice, 618 
tamarind, 617 
Waters, acratothermal, 130 
alkaline acidulous, 123 


arsenic and iron, 129 
bitter, 126 
bromin and iodin, 125 
indifferent, 130 
iodin and bromin, 125 
iron, 127 
and arsenic, 129 
sulphated, 128 
milk-and-cereal, 630 
mineral, 122 
alkaline, 122 
clanifcation of, 122 
earthy, 1! 
sodium Thor, 125 
simple, 125 
sulphurous, 127 
| Weber's diet for tuberculosis, 332 








728 INDEX, 
‘it herria Wield of, 150, 151 
; tition Ge ABD 
with h \raria, 364 | adulteration of, 186 
for, atrophic eatarh of womch,| alcohol of 100 
for cancer of stomach, 871 thors of, 151 
for chronie constipation, 802 extractives of, 151 
390 forte 1204 181 
8 
forint of stra, 361 Sol on 
slaty. 377 mulled, 618 
re perfect, 162 
for ion La gastric Juice, pistes je 
Betthew 16 
Wi eer be nptesselstia eh eeaee ary, 191 
set i Bay | ig 
ati 
at gr lig Monge 
, S87 | Women, delicate, nutritive drink for, 
reat ou 
Ween rah Fd an Xaver Ima excretion of Sn neph 
ot 
Whaurils 88 a , 
Wheat, 91 
Whey, 67, 7 ee Yelle i ae acute, of liver, diet 
cure, 541 feo 
‘pe juice, 628 eos diet no 520 
femon; 628 
ee a 
White stool in infant feeding, 250 | Ze jn food, 101 


Whole-wheat br 


Wh g-cough, in, 314 
Metin ais - 





coats for administration of 
Umietack, 623 








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personal supervision from actual apparatus, living models, and dissections on the 
cadaver, Among the many additions to this edition may be mentioned: Colonic 
lavage and flushing, Hirst's operation for vaginismus, Dudley's treatment for cysto~ 
cele, Montgomery's round ligament operation, Chorio-epithelioma of the Uterus, 
Passive Incontinence of Urine, and Moynihan’s methods for Intestinal Anastomosis, 
The illustrations also have been carefully studied and many changes made, and 
a large number of new ones have been introduced, 
Moward A. Kelly, M.D. 

Professor of Gynecology, Johas Hopkins University 

" [tis different from anything that has as yet appeared. ‘The illustrations are particularly 


clear and satisfactory. One specially good feature ix the pains with which you describe so 
many details so often left 10 the imagination."* 
Charles B. Penrose, M. D. 

Formerly Professor of Gynecology 69 the University of Pennsyloania 

“1 know of 80 book that goes so thoroughly and satisfactorily into all the detaifr of every 
thing connected with the subject, In this rexpoct your book diffars from the ethers.” 
George M. Edebohls, M. D. 

Professor of Diseases of Women, New York Post-Graduate Medical Scheot 

“Atext-book most admimbly adapted to fexch gynecology to those who must get thele 
Jnowledge, even to the minutest and most elementary details, from books,” 











DISEASES OF WOMEN. 3 





Hirst’s 
Diseases of Women 





A Text-Book of Diseases of Women. By Bakron Cooke Hikes, 
M. D., Professor of Obstetrics, University of Pennsylvania; Gynecolo- 
gist to the Howard, the Orthopedic, and the Philadelphia Hospitals. 
Octavo of 745 pages, with 701 original illustrations, many in colors. 


Cloth, $5.00 net. 
RECENTLY ISSUED—NEW (24) EDITION 
WITH 701 ORIGINAL ILLUSTRATIONS 


‘The new edition of this work has just been issued after a careful revision. 
As diagnosis and treatment are of the greatest importance in considering diseases 
of women, particular attention has been devoted to these divisions. ‘To this end, 
also, the work has been magnificently illuminated with 7or illustrations, for the 
most part original photographs and water-colors of actual clinical cases accumu- 
lated during the past fifteen years. The palliative treatment, as well as the 
radical operative, is fully described. enabling the general practitioner to treat 
many of his own patients without referring them to a specialist. An entire sec- 
tion is devoted to = full description of all modern gynecologic operations, illumi- 
nated and elucidated by numerous photographs, The author's extensive exe 
perience renders this work of unusual value. 


OPINIONS OF THE MEDICAL PRESS 





Medical Record, New York 

Tis merits cau be appreciated only by a careful perusal... Nearly one hundred pages 
are devoted (o technic, this chapter being in some respects superior lo the descriptions in 
many other text- boks.” 


Boston Medical and Surgical Journal 

“The author haa given special attention to diagnosis and treatment throughout the book, 
and has produced a prictical treatise which should be of the greatest value to the student, the 
general practitioner, and the specialist.”* 


Medical News, New York 
"Office treatment is given a due amount of consideration, so that the work will be as 
useful to the non-operator as to the specialist." 


Hirst’s 
Text-Book of Obstetrics 


New(Sth)Edition, Revised 











A Text-Book of Obstetrics. By Barron Cooxe Hirst, M.D., 
Professor of Obstetrics in the University of Pennsylvania. Handsome 
octavo, 915 pages, with 767 illustrations, 40 of them in colors. Cloth, 
$5.00 net; Sheep or Half Morocco, $6.00 net. 


JUST ISSUED 


Immediately on its publication this work took its place as the leading text-boole 
on the subject. Both in this country and in England it is recognized as the mast 
satisfactorily written and clearly illustrated work on obstetrics in the language, 
‘The illustrations form one of the features of the book. They are numerous and 
the most of themareoriginal. In this edition the book has been thoroughly revised, 
More attention has been given to the diseases of the genital organs associated with 
or following childbirth. Many of the old illustrations have been replaced by better 
ones, and there have been added a number entirely new, The work treats the 
subject from a clinical standpoint 


OPINIONS OF THE MEDICAL PRESS 





British Medical Journal 

“The popularity of American test-books in this country is one of the features of recent 
years. The popularity is probably chiefly due to the great superionty of their itlustrations 
‘over those of the [english text-books. ‘The illustrations in Dr, Hirst's volume are far more 
numerous and far better executed, and therefore more instructive, than those commonly 
found in the works of writers on obstetrics in our own country." 


Bulletin of Johns Hopkins Mospital 
The work is an admirable one in every sense of the word, concisely but comprehensively 
written 





‘The Medical Record, New York 

“Phe illustrations are numerous and are works of art, many of them appearing for the first 
time. ‘The author's style, though condensed, is singularly clear, so that it is Hever necessary 
to re-read a sentence in order to grasp the meaning. Asa true model of what a modern text= 
book on obstetrics should be, we feel Justified in affirming that Dr, Hlzst’s book is without » 
rival," 


OBSTETRICS. 





Webster’s 
Text-Book of Gynecology 


With Beautiful Mlustrations 


A Text-Book of Gynecology. By J. Crarence Wensrer, M. D, 
(Ep1y.), F. RR. C.P.E., Professor of Gynecology and Obstetrics in Rush 
Medical College, in Affiliation with the University of Chicago ; Obstetri- 
cian and Gynecologist to the Presbyterian Hospital, Chicago. Large 
octavo volume of 712 pages, with 372 magnificent text-illustrations and 
10 colored plates. Cloth, $7.00 net; Half Morocco, $8.00 net. 


JUST READY—FOR THE PRACTITIONER 


‘This entirely new work on diseases of women is based on Dr. Webster's 
extended clinical experience, and unusual prominence is given to the scienti> 
fic basis of each subject under consideration. Special endeavor has been made 
to include all the important original investigations of recent years, so that the work 
represents the present-day knowledge upon a subject of the greatest importance to 
every practitioner, Indeed, Dr. Webster has written this work expecially for the 
ceneral practitioner, discussing whe clinical features of the subject in their widest 
relations to general practice rather than from the standpoint of specialism, The 
magnificent illustrations, three hundred and seventy-two in number, are nearly all 
original. Drawn by expert anatomic artists under Dr. Webster's direct super- 
vision, they portray the anatomy of the parts and the steps in the operations with 
rare clearness and exactness. These illustrations, selected because of their 
practical and technical value, form a rich collection, supplementing a text of 
unusual conciseness. 

Reuben Peterson, M.D., 


Professor of Obstetrics and Gynecology, University of Michigan. 


Ishall recommend It and shall bave it placed among the list of text-books in the next 
catalogue of the school, It is a very ereditable work." 





6 SAUNDERS’ BOOKS ON 


Webster’s 
Text-Book of Obstetrics 








A Text-Book of Obstetrics. By J.CLarence Wesster, M{D.(Eptn,), 
F. R-C.P.E, Professor of Obstetrics and Gynecology in Rush Medical 
College, in Affiliation with the University of Chicago; Obstetrician and 
Gynecologist to the Presbyterian Hospital, Chicago, Handsome octayo 
volume of 767 pages, beautifully illustrated, including many in colors. 
Cloth, $5.00 net; Sheep or Half Morocco, $6.00 net. 


RECENTLY ISSUED—BEAUTIFULLY ILLUSTRATED 


‘This entirely new work is written for the student of obstetrics as well as for 
the active practitioner. The anatomic changes accompanying pregnancy, labor, 
and the puerperium are described more fully and lucidly than in any other text- 
book on the subject. The exposition of these sections is based mainly upon 
studies of froven specimens, in which department the author has had a larger 
experience than any other worker. Unusual consideration is given to embryo- 
logic and physiologic data of importance in their relation to obstetrics. Great 
care was taken in the selection of the illustrations, aiming to meet the varied re~ 
quirements of both the undergraduate and the practising physician, The book 
expresses the most advanced thought of the day. 





OPINIONS OF THE MEDICAL PRESS 





Medical Record, New York 
“The author's remarks on asepsis and antisepsis are admirable, the chapter on eclampsia. 
4s fall of good material, and. . . the book can be cordially reoommended as a safe guide,” 


Buffalo Medical Journal 
Asa practical text-book on obstetrics for both student and practitioner, there fs Toft very 
litle to be desired, it being as near perfection as any compact work that has been published.” 


Dublin Journal of Medical Science 
* Both to the studeat .. . and to the practitioner who requires the latest opinion on any 
point of practice, Dr. Webster's book will be of the greatest value.” 


GYNECOLOGY AND OBSTETRICS 7 


Kelly and Noble’s 


Gynecology 
and Abdominal Surgery 





Gynecology and Abdominal Surgery. Kdited by Howarp A. 
Key, M. D., Professor of Gynecology in Johns Hopkins University ; 
and Cuartes P. Nosie, M. D., Clinical Professor of Gynecology in the 
Woman's Medical College, Philadelphia. Two imperial octavo volumes 
of 900 pages each, containing 600 illustrations, some in colors. 


READY VERY SOON—IN TWO VOLUMES 


WITH 600 ILLUSTRATIONS BY MAX BRODEL AND HERMANN BECKER 


In view of the intimate association of gynecology with abdominal surgery the 
editors have combined these two important subjects in one work, For this reason 
the work will be doubly valuable, for not only the gynecologist and general prac- 
titioner will find it an exhaustive treatise, but the surgeon also will find here the 
latest technic of the various abdominal operations. It possesses a number of 
valuable features not to be found in any other publication covering the same fields. 
1t contains a chapter upon the bacteriology and one upon the pathology of gyne- 
cology, dealing fully with the scientific basis of gynecology. Inno other work 
can this information, prepared by specialists, be found as separate chapters. 
‘There is a large chapter devoted entirely to medical seymecology written especially 
for the physician engaged in general practice. Heretofore the general practitioner 
was compelled to search through an entire work in order to obtain the information 
desired, Abdominal surgery proper, as distinct from gynecology, is fully treated, 
embracing operations upon the stomach, upon the intestines, upon the liver and 
bile-ducts, upon the pancreas and spleen, upon the kidneys, ureter, bladder, and 
the peritoneum. Special attention has been given to modern fect and illustra~ 
tions of the very highest order have been used to make clear the various steps of 
the operations. Indeed, the illustrations are truly magnificent, being the work of 
Mr, Max Bridel and Mr. Hermann Becker, of the Johns Hopkins Hospital. 


& SAUNDERS’ BOOKS ON 





Penrose’s 
Diseases of Women 


Fifth Revised Edition 





A Text-Book of Diseases of Women. By Cuaries B. Penrose, 
M. D,, Pu. D., formerly Professor of Gynecology in the University of 
Pennsylvania; Surgeon to the Gynecean Hospital, Philadelphia, Oc- 
tavo volume of $50 pages, with 225 fine original illustrations. Cloth, 
$3.75 net. 





RECENTLY ISSUED 


Regularly every year a new edition of this excellent text-book is called for, 
and it appears to be in as great favor with physicians as with students. Indeed, 
this book has taken its place as the ideal work for the general practitioner. The 
author presents the best teaching of modern gynecology, untrammeled by anti- 
quated ideas and methods. In every case the most modern and progressive 
technique is adopted, and the main points are made clear by excellent {Hustra- 
tions. The new edition has been carefully revised, much new matter has been 
added, and a number of new original illustrations have been introduced. In its 
revised form this volume continues to be an adiirable exposition of the present 
status of gynecologic practice, 





PERSONAL AND PRESS OPINIONS 


Howard A. Kelly, M. D., 
Professor of Gynecology and Obstetrics, Johus Hepkies University, Baltimere. 
ses of Women’ received, have 





“1 shall value very highly the copy of Penrose’s * Di 
already recommended it to my class as THE NeST book. 


E. E, Montgomery, M. D., 
Profesor of Gywe Jefferson Medical College, Philadelptia. 
“The copy of A Text-Hook of Diseases of Women‘ by Penrose, received to-day. Thave 
looked over it and admire it very much. I have no doubt it will havea lange sale, as it jussly 
merits,” 


Bristol Medico-Chirurgical Journal 
"This is an excellent work which goes stmight to the mark. . .. The book may be tiken 
asa trustworthy exposition of modern gynecology.” 





GYNECOLOGY AND OBSTETRICS. 9 


The American 
Text-Book of Obstetricy 


Second Edition, Thoroughly Revised and Enlarged 








The American Text-Book of Obstetrics. In two volumes, Edited 
by Ricuagp C. Norris, M.D., Assistant Professor of Obstetrics in the 
University of Pennsylvania; Art Editor, Robert L. Dickinson, M.D., 
Assistant Obstetrician, Long Island College Hospital, N. Y. Two 
handsome octavo volumes of about Goo pages cach; nearly goo illus- 
trations, including 49 colored and halftone plates. Per volume: 
Cloth, $3.50 net; Sheep or Half Morocco, $4.00 net. 


RECENTLY ISSUED—IN TWO VOLUMES 


Since the appearance of the first edition of this work many important advances 
have been made in the science and art of obstetrics. The results of bacteriologic 
and of chemicobiologic research as applied to the pathology of midwifery ; the wider 
range of the surgery of pregnancy, labor, and of the puerperal period, embrace 
new problems in obstetrics. In this new edition, therefore, x thorough and critical 
revision was required, some of the chapters being entirely rewritten, and others 
brought up to date by careful scrutiny. A number of new illustrations have been 
added, and some that appeared in the first edition have been replaced by others 
of greater excellence, By reason of these extensive additions the new edition 
has been presented in two volumes, in order to facilitate ease in handling, The 
price, however, remains unchanged. 





PERSONAL AND PRESS OPINIONS 





Alex. J. C. Skene, M.D.. 
Late Profersor of Gynecology, Long Inland College Hospital, Brooklyn. 


” Permit me to say that * The American Test-Book of Obstetrics’ is the most magnificest 
medical work that I have ever seen, T congratulate you and thank you for this superb work, 
which alone i¢ sufficient to place you first in the ranks of medical publishers,” 
Matthew D. Mann, M. D., 

Professor of Obstetrics and Gynecology in the University of Buffalo. 

“TI like it exceedingly and have recommended the first volume as a text-book for our 
sophomore cliss, It is certainly a most excellent work. I know of none better.” 


American Journal of the Medical Sciences 


“As an authority, asa book of reference, as a ‘working book” for the student or prec 
tioner, we commend it because we believe there is no better." 


2A SAUNDERS BOOKS ON 





GET THE NEW 


ie ten American STANDARD 


Illustrated Dictionary 
Just Issued—New(4th) Edition 





The American Illustrated Medical Dictionary. A new and com- 
plete dictionary of the terms used in Medicine, Surgery, Dentistry, 
Pharmacy, Chemistry, and kindred branches; with over 100 new and 
elaborate tables and many handsome illustrations. By W. A. Newman 
Dortanp, M. D., Editor of “The American Pocket Medical Diction- 
ary.” Large octavo, nearly 850 pages, bound in full flexible leather. 
Price, $4.50 net; with thumb index, $5.00 net. 





Gives a Maximum Amount of Matter in » Minimum Space, and at the Lowest 
Possible Cost 


WITH 2000 NEW TERMS. 


‘The immediate success of this work is due to the special features that distin- 
guish it from other books of its kind. It gives a maximum of matter in a mini- 
mum space and at the lowest possible cost. ‘Though it is practically unabridged, 
yet by the use of thin bible paper and flexible morocco binding it is only 13g 
inches thick. ‘The result is a truly luxurious specimen of book-making. In this 
new edition the book has been thoroughly revised, and upward of fifteen hundred 
new terms that have appeared in recent medical literature have been added, thus 
bringing the book absolutely up to date, ‘The book contains hundreds of terms 
not to be found in any other dictionary, over 100 original tables, and many hand- 
some illustrations, a number in colors. 











PERSONAL OPINIONS 


Howard A. Kelly, M. D., 
Profasor of Gynecology, Johns Hopkins University, Baltimore, 
"Dr, Dorland’s dictionary is admirable. It is so well gotten up and of stich convenient 
sis. No errors have been found in my use of it.” 
J. Collins Warren, M.D., LL.D., F.R.C.S. (Hon.) 
Professor of Surgery, Harvard Medical Scho. 


“T regard it asa valuable aid to my medical literary work. It is very complete and of 
convenient size ty handle comfortably. I use it in preference to any ether.’* 


GYNECOLOGY AND OBSTETRICS, at 





Garrigues’ 


Diseases of Women 
Third Edition, Thoroughly Revised 





A Text-Book of Diseases of Women. By Hewry J, Gannicurs, 
A.M., M. D., Gynecologist to St. Mark's Hospital and to the German 
Dispensary, New York City, Handsome octavo, 756 pages, with 367 
engravings and colored plates. Cloth, $4.50 net; Sheep or Half 
Morocco, $5.50 net. 


‘The first two editions of this work met with a most appreciative reception by 
the medical profession both in this country and abroad, In this edition the entire 
work has been carefully and thoroughly revised, and considerable new matter 
added, bringing the work precisely down to date. Many new illustrations have been 
Introduced, thus greatly increasing the value of the book both as a text-book and 
book of reference. 


Thad. A. Reamy, M.D., Professor of Ctinical Gynecology, Medical College of Ohio, 

“One of the best text-books for students and practitioners which has been published in the 
English Jangusge it is condensed, clear, and comprehensive. The fins ears and 
great chnical experience of the distinguished author find expression in this book.” 





American 
Text-Book of Gynecology 


American Text-Book of Gynecology: MepicaL AND SuRGICAL. 
Edited by J. M. Batpy, M, D,, Professor of Gynecology, Philadelphia 
Polyclinic. Imperial octavo of 718 pages, with 341 text-illustrations 
and 38 plates, Cloth, $6.00 net; Half Morocco, $7,00 net. 


SECOND REVISED EDITION 


This volume is thoroughly practical in its teachings, and is intended to be a 
working text-book for physicians and students, Many of the most important 
subjects are considered from an entirely new standpoint, and are grouped together 
in a manner somewhat foreign to the accepted custom. 

Boston Medical and Surgical Journal 


“The most complete exponent of gynecology which we have, No subject seems 10 have 
been neglected.” 


2 SAUNDERS’ BOOKS ON 


Dorland’s 
Modern Obstetricy 


Modern Obstetrics: General and Operative. By W. A. NewMan 
Dortanp, A.M, M.D., Assistant Instructor in Obstetrics, Univer- 
sity of Pennsylvania; Associate in Gynecology in the Philadelphia 
Polyclinic. Handsome octavo volume of 797 pages, with 201 illustra- 
tions. Cloth, $4.00 net, 


Second Edition, Revised and Greatly Enlarged 


In this edition the book has been entirely rewritten and very greatly enlarged. 
Among the new subjects introduced are the surgical treatment of puerperal sepsis, 
infant mortality, placental transmission of diseases, serum-therapy of puerperal 
sepsis, ete, By new illustrations the text has been elucidated, and the subject pre- 
sented in a most instructive and acceptable form. 

Journal of the American Medical Association 

“This work deserves commendation, and that it has received what it deserves at the hands 
of the profession Is attested by the fact that # second edition Is called for within such # short 
time, Especially deserving of praise is the chapter on puerperal sepsis.” 


Davis’ Obstetric and 
Gynecologic Nursing 














Obstetricand Gynecologic Nursing. By Epwarp P. Davis, A. M., 
M.D., Professor of Obstetrics in the Jefferson Medical College and 
Philadelphia Polyclinic; Obstetrician and Gynecologist, Philadelphia 
Hospital. 12mo of 400 pages, illustrated. Buckram, $1.75 net. 

RECENTLY ISSUED—SECOND REVISED EDITION 


Obstetric nursir 








demands some knowledge of natural pregnancy, and gyne- 
nursing, really a branch of surgical nursing, requires special instruction 
and training. ‘This volume presents this information in the most convenient 
form. This second edition has been very carefully revised throughout, bringing 
the subject down to date, 





colog 


‘The Lancet, London 
Not only nurses, but even newly qualified medical men, would learn a great deal by a 
perusal of this book. It is written in a clear and pleasant style, and is a work we ean recom- 


mend. 


GYNECOLOGY AND OBSTETRICS. 13 


Schaffer and Edgar’s 
Labor and Operative Obstetrics 


Atlas and Epitome of Labor and Operative Obstetrics. By Dr. 
O, Scuirrer, of Heidelberg. From the Fifth Revised and Enlarged 
German Edition, F-dited, with additions, by J. Cuurron Epcar, M.D., 
Professor of Obstetrics and Clinical Midwifery, Cornell University Medi- 
cal School, New York, With 14 lithographic plates in colors, 139 other 
illustrations, and 111 pages of text. Cloth, $2.00 net. /n Saunders’ 
Hand-Atlas Series. 

This book presents the act of parturition and the various obstetric operations 
in a series of easily understood illustrations, accompanied by a text treating the 
subject from a practical standpoint, ‘The author has added many accurate repre- 
sentations of manipulations and conditions never before clearly illustrated. 
American Medicine 

“The method of presenting obstetric operations is admirable, ‘The drawings, representing 
original work, have the commendable merit of itlusteating instead of confusing. It would be 


difficult to find one hundred pages in better form or containing more practical points for 
students or practitioner. 


Schaffer and Edgar’s 
Obstetric Diagnosis and Treatment 














Atlas and Epitome of Obstetric Diagnosis and Treatment. By 
Dr. O. Scuarrer, of Heidelberg. From the Second Revised German 
Edition, Edited, with additions, by J. C.irrox Enea, M. D., Professor 
etrics and Clinical Midwifery, Cornell University Medical School, 
N.Y. With 122 colored figures on 56 plates, 38 text-cuts, and 315 
pages of text, Cloth, $3.00 net. /n Saunders’ Hand-Atlas Series, 








This book treats particularly of obstetric operations, and, besides the wealth 
of beautiful lithographic illustrations, contains an extensive text of great value, 
‘This text deals with the practical, clinical side of the subject, The symptoma- 
tology and diagnosis are discussed with all necessary fullness, and the indications 
for treatment are definite and complete. 

New York Medical Journal 
The illustrations are admirably executed, as they are in all of these atlases, and the text 


can safely be commended, not only as elucidatory of the plates, but as expounding the scien 
tific midwifery of to-day.’ 









“uM SAUNDERS’ BOOKS ON 


Schaffer and Norris’ 
Gynecology 


Atlas and Epitome of Gynecology. By Dr. O. Scharrer, of 
Heidelberg. From the Second Revised and Enlarged German Faition, 
Edited, with additions, by Rictarp C. Norris, A. M., M, D., Gynecolo- 
gist to Methodist Episcopal and Philadelphia Hospitals. With 207 
colored figures on go plates, 65 text-cuts, and 308 pages of text, 
Cloth, $3.50 net. /w Saunders’ Hand-Adas Series, 

The value of this atlas to the medical student and to the general practitioner 
will be found not only in the concise explanatory text, but especially in the illes- 
trations. The large number of colored plates, reproducing the appearance of 
fresh specimens, give an accurate mental picture and a knowledge of the changes. 
induced by disease of the pelvic organs that cannot be obtained from mere 
description. 


American Journal of the Medical Sciences 

© OF the illustrations it ix difficult to speak in too bigh terms of approval. ‘They are so 
clear and true to nature that the accompanying explanations are almost superiinous, We 
commend it most exnestly,”” 


Galbraith’s 
Four Epochs «. Woman’s Life 


Second Revised Edition—Recently Issued 

















The Four Epochs of Woman's Life: A Srupy in HyGirne. By 
Anxa M. Garerarra, M.D., Fellow of the New York Academy of 
Medicine, etc. With an Introductory Note by Joun H. Musser, 
M.D., Professor of Clinical Medicine, University of Pennsylvania. 
12mo of 247 pages. Cloth, $1.50 net. 


MAIDENHOOD, MARRIAGE, MATERNITY, MENOPAUSE 


In this instructive work are stated, in a modest, pleasing, and conclusive manner, 
those truths of which every woman should have a thorough knowledge. Written, 
as it is, for the laity, the subject is discussed in language readily grasped even by 
those most unfamiliar with medical subjects. 

Birmingham Medical Review, England 


“We do not as « rule care for medical books written for the instraction of the pablic, But 
we must admit that the advice in Dr, Galbraith's work is in the main wite and wholesome,” 


GYNECOLOGY AND OBSTETRICS. 5 


Schaffer and Webster’s 
Operative Gynecology 


Atlas and Epitome of Operative Gynecology, By Dx. O. Scuar- 
ren, of Heidelberg. Edited, with additions, by J, CLARENCE WEBSTER, 
M.D. (Edin.), F.R.C.P.E., Professor of Obstetrics and Gynecology in 
Rush Medical College, in affiliation with the University of Chicago, 
42 colored lithographic plates, many text-cuts, a number in colors, and 
138 pages of text. / Saunders’ Hand-Atlas Series. Cloth, $3.00 net. 








RECENTLY ISSUED 


Much patient endeavor has been expended by the author, the artist. and the 
fithographer in the preparation of the plates of this atlas. They are based on 
hundreds of photographs taken from nature, and illustrate most faithfully the 
various surgical situations. Dr, Schaffer has made a specialty of demonstrating 
by illustrations. 

Medical Record, New York 

“The volume should prove most helpful to students and others in. grascings details usually 

to be acquired only in the amphitheater itself” 


De Lee’s 
Obstetrics for Nurses 


Obstetrics for Nurses. By Josrrm B. De Lex, M.D. Professor of 
Obstetrics in the Northwestern University Medical School; Leeturer 
in the Nurses’ Training Schools of Merey, Wesley, Provident, Cook 
County, and Chicago Lying-In Hospita 12mo volume of 460 pages, 


fully illustrated. Cloth, $2.50 net. 
JUST ISSUED—NEW (2nd) EDITION 








While Dr. De Lee has written his work especially for nurses, yet the prac- 
titioner will find it useful and instructive, since the duties of a nurse often devolve 
upon him in the early years of his practice, The illustrations are nearly all 
original, and represent photographs taken from actual scenes, ‘The text is the 
result of the author's eight years’ experience in lecturing to the nurses of five 
different training schools 
J. Clifton Edgar, M.D. 

Professor of Obstetrics and Clinical Midwifery, Cornell University, New York. 

© IC is far and away the best that has come to my notice, and I shall take great pleasure in 
recommending it to my ourses, and students as well, 


16 SHUNDERS BOOKS ON GYNECOLOGY AND OBSTETRICS. 


American Pocket Dictionary Ld pd ate 
Tue Amenican Pocker Mepicat Dictionary. Edited by W, 
A. Newman Dortanp, A.M., M.D,, Assistant Obstetrician to the 
Hospital of the University of Pennsylvania; Fellow of the American 
Academy of Medicine. Over 550 pages, Full leather, limp, with 
gold edges. $1.00 net ; with patent thumb index, $1.25 net. 
James W. Holland, M. D., 
Pafoar of Medical Chemittry and Toxicolugy at the Jeferwon Medical College, 


"Tam struck at once with admiration at the compact size and attractive exterior, 1 
can recominend it to our students without reserve. 


Cragin’s Gynecology. New 6th) Edition 
Essenriars or Gyxrcorocy, By Epwix B. Cracix, M.D. 
Professor of Obstetrics, College of Physicians and Surgeons, New 
York. Crown octavo, 215 pages, 62 illustrations. Cloth, $1.00 
net. /x Saunders’ Question-Compend Series. 
‘The Medical Record, New York 
“A handy volume and «distinct improvement of atudents) compands in. penera 


No author who was not himself a practical gynecologist could have consulted the 
student's needs so thoroughly as Dr, Cragin has done.” 


Boisliniere’s Obstetric Accidents, Emergencies, and 
Operations 
Opsrerkic Accipenrs, EMERGRNCIES, AND OPERATIONS. By 
the late L. Cu. Borstiniere, M.D., Emeritus Professor of Ob- 
stetrics, St. Louis Medical College ; Consulting Physician, St, Louis 
Female Hospital. 381 pages, isle Cloth, $2.00 net. 
Betish Medical Journal 


" Itis clearly and concisely written, and Is evidently the work of a teacher and practt= 
tioner of lange experience. {ts ment lies inthe Judgment which comes from experience:"* 


Ashton’s Obstetrics. Recently Issued—New (6th) Edition 
Essextiats or Ousrereics. By W. Easterty Asuton, M.D, 
Professor of Gynecology in the Medico-Chirurgical College, Phila- 
delphia. Crown octavo, 256 pages, 75 illustrations. Cloth, $1.00 

net. /x Saunders’ Question-Compend Series, 


Sesthers Practitioner 


* An excellent little volume ecataining correct and practical knowledge. An admir~ 
able compend and th densation we have seen. 


Barton and Wells’ Medical Thesaurus Recently Inued 

A Tuesaurus or Mepicat Worps AND Prrases. By WILFRED 

M. Barton, M. D,, Assistant to Professor of Materia Medica and 

Therapeutics, Georgetown University, Washington, D. C,; and 

Watrer A. Wetts, M. D., Demonstrator of Laryngology, George- 

town University, hington, D.C. 12mo of $34 pages. Flex- 
ible leather, $2.50 net; with thumb index, $3.00 net.